Over the last 40 years, the global AIDS pandemic has claimed close to 33 million lives.
According to the UNAIDS report issued in November 2021, Unequal, Unprepared, Under threat, there were 37.7 million people living with HIV (PLHIV) worldwide by the end of 2020. In 2020, 680,000 people died with AIDS-related illnesses and 1.5 million people became newly infected with HIV. More than 10 million people are not on treatment, either because they are unaware of their HIV-positive status (4.1 million) or they know their HIV status but are not able to access treatment (6.1 million). While there are more than four times the number of HIV positive people on treatment compared to a decade ago, more than one-quarter of those with HIV today are still not accessing treatment.
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 an estimated 17 million children − the vast majority of them in sub-Saharan Africa − have lost one or both parents to AIDS. HIV is spreading most rapidly among the most vulnerable populations and marginalized groups including adolescents, particularly girls, men who have sex with men, and people who use drugs.
“Stigma and denial, structural racism, discrimination against adolescent girls and young women, as well as bias and barriers to access for other vulnerable and key populations, social determinants of health like poverty, housing, and education – these are all persistent sources of inequalities that have an impact on efforts to fight HIV/AIDS.”
AIHA first began implementing HIV-related prevention programs, awareness campaigns, and treatment services in Eastern Europe in the early 2000s 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. That project lasted for more than 15 years.
AIHA’s HIV/AIDS Programs
AIHA’s HIV/AIDS interventions are broad-based and needs-driven. They provide technical assistance, clinical training and mentoring, and other forms of support needed to strengthen underlying health systems and develop sustainable capacity to train human resources for health − all with the goal of providing comprehensive, client-centered treatment, care, and support to attain the ambitious global 95-95-95 treatment targets by 2030 (95% of people living with HIV know their HIV status, 95% of people living with HIV who know their HIV positive status are accessing treatment and 95% of people on treatment have suppressed viral loads).
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 efforts to address the global AIDS pandemic have been implemented through specific projects, past and present, including:
Targeted Programmatic Support Across Countries (CDC1950)
In September 2019, the U.S. Centers for Disease Control and Prevention (CDC) awarded AIHA a five-year grant to implement a wide range of activities to combat the HIV/AIDS pandemic. This multi-year, multi-country project is broad in nature, and provides a vehicle by which AIHA can assist the CDC at the global and country level, in support of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The goal of the project – entitled Targeted Programmatic Support Across Countries (CDC1950) – is to provide comprehensive and cost-effective technical support for the acceleration of evidence-based HIV prevention and treatment program implementation, as well as aligned health systems strengthening activities. So far, AIHA has implemented activities in the Philippines, Thailand and Laos in Southeast Asia; Zambia, Tanzania, Nigeria, and Kenya in sub-Saharan Africa; and Guatemala, Haiti, and the Dominican Republic in Latin America. In 2022/3, the Philippines has been the focus of AIHA’s activities under CDC1950.
Orphans and Vulnerable Children (OVC) in Nigeria
According to UNICEF, there were an estimated 13.8 million children and adolescents (0-18 years) worldwide who have lost one or both parents to AIDS as of 2019, 80% of whom live in sub-Saharan Africa. In Nigeria, there are an estimated 2.5 million orphans and vulnerable children due to HIV/AIDS. The Society for Family Health (SFH), a Nigerian-based NGO, in partnership with AIHA, Save the Children Federation (SCF), and the AIHA established Nigerian organization Twinning for Health Support Initiative (THSI-N) received a five year award from USAID entitled the Integrated Child Health and Social Services Award (ICHSSA 3) Program with the goal to integrate evidence-informed strategies to enhance OVC services, strengthen social services to OVC, and strengthen the OVC systems’ services and support in Kano, Nigeria. Specifically, the objective of the ICHSSA 3 Program is “to ensure that OVC are cared for and protected by their households, communities, local and state government” through civil society and partnerships. Nigeria was selected because there remains a significant risk among adult populations not on HIV/AIDS treatment (40%) and low use of ART among HIV-positive pregnant women (30%) – indicating a significant at-risk population that could benefit from pre-OVC and OVC services as part of HIV prevention and treatment programs. AIHA and our partner organization THSI-N have been working to deliver a full package of technical assistance activities to ensure that local and state governments have sufficient, high performing human resources to protect and care for OVC.
Pre-exposure Prophylaxis (PrEP) Training for Clinical Associates in South Africa
With support from Gilead Sciences pharmaceutical company, AIHA collaborated with the South Africa-based Foundation for Professional Development (FPD) and Professional Association of Clinical Associates of South Africa (PACASA) to roll out PrEP to target populations via AIHA-trained Clinical Associates.
PrEP is a prevention intervention for individuals at very high risk of contracting HIV that includes daily doses of medications that can stop HIV from taking hold and spreading throughout the body if used consistently and as prescribed. According to the U.S. Centers for Disease Control and Prevention (CDC), daily PrEP reduces the risk of sexual transmission of HIV by more than 90 percent – a success rate that increases further when combined with the use of condoms and other prevention methods. Among people who inject drugs, PrEP reduces the risk by more than 70 percent.
South Africa was the first country after the United States to approve PrEP as part of an overall combination HIV prevention strategy, but it has only been introduced in a limited number of sites, including pilot sites that provide services for key populations, such as female sex workers (FSWs) and men who have sex with men (MSM).
This project built on AIHA’s 13 years of experience implementing HIV interventions in South Africa, including eight years of broad-based experience supporting the training, deployment, and ongoing professional development of Clinical Associates.
With a strong focus on developing a locally-driven and sustainable approach to the roll-out of PrEP – including increasing public awareness of the availability and benefits of PrEP – AIHA empowered Clinical Associates to train additional health workers on how to more effectively implement PrEP across many facility and community-based settings throughout South Africa. AIHA helped develop the new professional cadre of Clinical Associates during its PEPFAR supported Twinning Center Project.
HIV/AIDS Twinning Center
AIHA’s flagship HIV project from 2004-2019 was 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 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 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. These interventions 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 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 collectively contributed more than 23,545 professional days to strengthen health system capacity in host countries.
AIHA implemented 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) from 2012 until 2018 with funding from the US Centers for Disease Control and Prevention (CDC). Through this project, AIHA 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, AIHA provided 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 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.