Over the last 35 years, the global AIDS pandemic has claimed more than 34 million lives.
According to the UNAIDS report, AIDS by the Numbers 2016, there are currently 36.7 million people living with HIV (PLHIV) worldwide. In 2015, 1.1 million AIDS-related deaths were reported, as were 2.1 million new infections. That translates into about 5,700 new infections a day, with 66 percent of these occurring in sub-Saharan Africa.
Some 1.8 million children under the age of 15 are living with HIV worldwide, most having contracted the virus from their mothers during pregnancy, birth, or breastfeeding. UNAIDS reports that more than half of these children do not have access to life-saving antiretroviral medicines and that an estimated 17 million children − the vast majority of them in sub-Saharan Africa − have lost one or both parents to AIDS.
In advance of the 21st International AIDS Conference (AIDS 2016) in Durban, South Africa, data on the progress that has been made since the last time the city hosted this event 16 years ago demonstrated much progress:
- In 2000, fewer than 1 million PLHIV were on antiretroviral therapy. In 2015, that number was 17 million.
- In 2000, there were 3.2 million new HIV infections reported. In 2015, there were 2.1 million.
- In 2000, 490,000 children contracted HIV. In 2015, that number decreased to 150,000.
- In 2000, the annual cost of antiretroviral therapy per person was $10,000. In 2015, annual cost of first-line medications is just $100 per person.
- In 2000, $5 billion was invested in the global AIDS response. In 2015, it was $19 billion.
Yet against this positive backdrop, UNAIDS released another study, The Prevention Gap Report, which indicates that decreases in new HIV infections among adults have stalled over the past five years. In fact, the number of new infections is on the rise in some parts of the world, including Eastern Europe and Central Asia where a 57 percent increase in new HIV infections was reported every year between 2010 and 2015. During that same time frame, the Caribbean saw a 9 percent rise in annual infections among adults, while rates in the Middle East and North Africa increased by 4 percent.
“We are sounding the alarm. The power of prevention is not being realized. If there is a resurgence in new HIV infections now, the epidemic will become impossible to control. The world needs to take urgent and immediate action to close the prevention gap.”
AIHA first began implementing HIV-related prevention programs, awareness campaigns, and treatment services in Eastern Europe where, at the time, some communities were experiencing infection rates that jumped by 200 percent or more over the course of a few years. Late in 2004, with funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR), AIHA launched a new HIV/AIDS project to bring its unique partnership model and programmatic expertise to countries targeted for technical assistance and support under the groundbreaking initiative.
AIHA’s HIV/AIDS Program
A key objective of AIHA’s HIV/AIDS projects is creating the sustainable human resource capacity necessary to provide ongoing treatment, care, and support to PLHIV and those affected by the virus. We accomplish this by developing expertise among health and social service professionals and other care providers, cultivating training capacity so knowledge and skills can be passed on to others, and amassing a body of evidence-based resources and informational materials that will serve as a clearinghouse for those involved in HIV/AIDS care.
AIHA’s current efforts to address the global AIDS pandemic are implemented through specific projects, including:
HIV/AIDS Twinning Center
AIHA’s flagship HIV project since 2004 has been the HIV/AIDS Twinning Center Program. Through a series of cooperative agreements with the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), AIHA has utilized its highly effective − and cost-effective − partnership model to mobilize and coordinate technical assistance in low- and middle-income countries whose health systems have long been overburdened by HIV and other public health challenges. In support of PEPFAR priorities and global 90-90-90 targets, AIHA has established more than 55 capacity-building partnerships and other initiatives in 14 countries under the Twinning Center. Most of these are in sub-Saharan Africa. To date, these interventions have provided in-service training for more than 50,000 health and allied care providers and graduated more than 10,000 individuals from pre-service programs at partner institutions worldwide. AIHA has also placed 105 highly skilled professionals in long-term assignments in five African countries through the Twinning Center’s Volunteer Healthcare Corps; these highly skilled professionals have collectively contributed more than 23,545 professional days to strengthen health system capacity in host countries.
AIHA has been implementing a PEPFAR project to improve access to a safe supply of blood in selected countries in Asia and Eurasia (Cambodia, Kazakhstan, Kyrgyzstan, Tajikistan, and Ukraine) since December 2012 with funding from the US Centers for Disease Control and Prevention (CDC). Through this project, AIHA has provided targeted technical assistance designed to strengthen blood and transfusion services based on local needs and priorities.
Social Welfare Workforce Capacity Building in Support of USAID OVC Projects in Nigeria and Zambia
Through a Social Welfare Workforce Strengthening Initiative implemented through the HIV/AIDS Twinning Center, AIHA is providing technical assistance under three USAID-supported projects in sub-Saharan Africa: STEER and SMILE in Nigeria and Zambia Rising in Zambia. While each project differs, AIHA’s role is focused on developing in-country capacity to train and provide ongoing for community-based para social workers to improve access to care and support services for orphans and vulnerable children and families.
Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia
From 2004-2012, AIHA was the prime implementing partner of the Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia, a unique network of individual experts and stakeholder organizations in HIV medicine. Established by AIHA with the support of WHO/Europe and funding from the German Society for Technical Cooperation (GIZ) and other donors, the Knowledge Hub’s goal was to build the human and organizational capacity necessary to provide high-quality care to people living with HIV/AIDS in the nations of Central and Eastern Europe and the former Soviet Union. The Baltic AIDS Training and Education Center, based in St. Petersburg, Russia, served as an affiliate of the Knowledge Hub from 2008-2012. From inception through September 30, 2012, AIHA’s Knowledge Hub developed more than 40 distinct training courses on HIV-related topics and trained 6,437 health and allied care providers from 12 countries spanning the region.
EurasiaHealth AIDS Knowledge Network
AIHA’s EurasiaHealth AIDS Knowledge Network (EAKN) served as a central clearinghouse of evidence-based Russian language guidelines and other resources for health professionals working in HIV/AIDS care in Eastern Europe and Central Asia from 2004 through 2012. During this time, EAKN’s expansive online catalog represented a preeminent resource in the region. It included hundreds of documents that were translated into Russian and other regional languages, including many HIV/AIDS treatment guidelines from WHO and US agencies, such as the Department of Health and Human Services, CDC, and the National Institutes of Health, as well as other leading international organizations.
Strategic Health Partnership Initiative
In partnership with the Russian Ministry of Health and Social Development, AIHA worked to harness the expertise of the US and Russian medical communities to bolster HIV/AIDS capacity in Russia, as well as strengthen Russia’s capacity to provide professional assistance to developing and transitioning nations around the globe, particularly as relates to laboratory services for HIV, tuberculosis, and other infectious diseases, through the USAID-supported Strategic Health Partnership Initiative. Click here to read the closeout report for Phase I of the project (2007-2010); click here to read the report for Phase II (2010-2012)
Ukraine National PMTCT Scale-up Project
In late 2000, AIHA launched a USAID-funded pilot PMTCT project to improve quality of care in Odessa Oblast by expanding collaboration between healthcare facilities and nongovernmental organizations providing services to people living with HIV/AIDS. This pilot project adopted a comprehensive medical-social model. Based on its success, AIHA implemented the Ukraine National PMTCT Scale-up Project starting in June 2005 in Cherkassy, Dnipropetrovsk, Kyiv, and Mykolayiv oblasts. In November 2005, the project was launched in the second-phase oblasts of Chernigiv, Crimea, Kherson, and Odessa, and continued through 2007. Final data concerning the HIV status of infants whose mothers participated in the PMTCT project was collected and analyzed in 2008, revealing that the rate of vertical transmission at the 32 target sites decreased from an average of 21 percent to 6 percent. Other notable outcomes include an expanded pool of 303 trained healthcare providers, managers, and allied staff capable of providing quality, evidence-based PMTCT-related services at project sites and the creation of methodological centers of PMTCT excellence in each oblast, which greatly strengthened local capacity-building infrastructure.
HIV/AIDS Treatment, Care, and Support Project in Russia
AIHA’s HIV/AIDS Treatment, Care, and Support Project in Russia built on the success of four partnerships established by AIHA in 2004 with USAID support. These partnerships linked US institutions with significant experience providing high quality medical and support services to people living with HIV with their counterparts in Russia. Working together, partners developed replicable HIV treatment and care models in the target regions focusing on four main areas:
1. Care coordination and case management;
2. Patient management and adherence;
3. Patient access and retention; and
4. HIV and TB detection and treatment
AIHA provided direct technical assistance and support to these partnerships, conducting clinical trainings, replicating our model PMTCT Program, establishing HIV/AIDS Information Resource Centers to enhance use of information and communication technology at partner institutions, and developing or adapting Russian-language publications on HIV?AIDS. In addition, AIHA and our partners collaborated closely with local health administrations to ensure sustainability of model programs developed through the partnerships.
With support from Russia’s national HIV/AIDS program and international donor organizations such as the Global Fund, availability of antiretroviral medications increased dramatically during this time. Consequently, in 2006 AIHA began rolling out successful HIV treatment, care, and support models in the PEPFAR priority regions of St. Petersburg and Orenburg Oblast through its HIV/AIDS Twinning Center program with support from PEPFAR through USAID/Russia. AIHA’s scale-up activities in these regions largely replicated and expanded on partnership accomplishments.
Clinical trainings on ART and opportunistic infections — coupled with onsite mentoring and other support activities provided by US partners — successfully built district and regional networks of well qualified healthcare providers. Other key focus areas included palliative care and treatment of patients co-infected with tuberculosis or hepatitis, as well as ART adherence support with focus on patients who are injecting drug users and quality assurance through chart audits and patient satisfaction surveys.
HIV case management was also a major focus of the project. AIHA developed a standard training course on case management, training more than 230 specialists.
Some key project accomplishments included:
- Supporting more than 4,427 patients receiving ART in St. Petersburg and Orenburg
- Training and mentoring 2,898 healthcare providers and allied professionals on provision of HIV care, including ART and management of opportunistic infections
- Training 100 percent of primary level infectious disease specialists in St. Petersburg on management of ART
- Establishing AIDS Training and Educational Centers (ATECs) in St. Petersburg and Orenburg, and training 120 Russian professionals as master trainers
- Implementing a three-level educational program to strengthen the role of nurses in HIV/AIDS care, training 65 nurses in the basics of HIV infection
- Expanding and improving counseling and testing services at project sites
- Developing “Case Management Guidelines for Professionals,” a booklet on best practices in HIV case management
Volga River AIDS Alliance
AIHA and AIDS Healthcare Foundation (AHF) implemented the Volga River AIDS Alliance from December 2006 through December 2008. This public-private partnership was designed to scale up primary level care and treatment for PLHIV in Russia’s Samara and Saratov oblasts. It was supported by USAID through its Global Development Alliance Initiative. The project built on the many accomplishments of AIHA’s USAID-funded partnerships linking institutions in Saratov with a community-based health consortium in Bemidji, Minnesota, and health facilities in the Russian city of Togliatti with counterparts in Providence, Rhode Island. Both these partnerships were established in 2004 to create model HIV/AIDS care, treatment, and support programs that could be replicated throughout Russia. As the implementing partner, AIHA led the training and monitoring and evaluation components, while AHF provided expertise in clinic operations and management, as well as professional mentors and faculty.