Photo Credit: Catholic Guardian Society and Home Bureau

Pandemic:My Country Is On Its Knees

Ellen ChanRebecca FinchCourtney KappesGretchen Landgraf

April 20, 2011

Key Concepts

The HIV & AIDS epidemic is devastating Africa – Brain Drain –

The emigration of skilled professionals from one country to another

Change in Family Structure – Grandmothers taking care of grandchildren “child-headed households”

Lack of ACCESS and an excess of STIGMA Death and “passing” –

During 2009 – 1.3 million people died in Africa from AIDS Hunger and Malnutrition –

The HIV & AIDS epidemic is compounded by Africa’s severe lack of food and malnutrition

Epidemiology Triangle

Most African countries lack all components of a model for wellness: Appraisal of health risk by clinicians Funding for widespread behavior and therapeutic interventions Adequate public health and social services

Current AIDS Related Statistics

Region

Adults & children living with HIV/AIDS

Adults & children newly infected

Adult prevalence

AIDS-related deaths in

Sub-Saharan Africa 22.5 million 1.8 million 5.00% 1.3 million

North Africa & Middle East 460,000 75,000 0.20% 24,000

Global Total 33.3 million 2.6 million 0.80% 1.8 million

About 16.6 million children were orphaned from AIDS in 2009

http://www.avert.org/aids-orphans.htmhttp://www.avert.org/africa-hiv-aids-statistics.htm

Health Care Systems Org & Delivery

Nominal Public Policy When CD4 count drops below 200, a person requires

treatment of antiretroviral drugs Health Care Delivery

Overcrowded University Teaching Hospitals, Hospitals, Clinics, Hospices

Many primarily supported by international NGOs “Home Based Care”

Promising practices Prevention of Mother-to-Child Transmission (PMTCT) &

PMTCT-PLUS program

International Coordination

Consortium of American foundations led by Rockefeller Foundation directed by Columbia School of Public Health Initiated PMTCT-Plus at number of facilities across Africa

Doctors without Borders (Medecins Sans Frontieres) 1100 in treatment 2500 on list for future treatment

programs UN World Food Programme

Held workshop about HIV prevention to truck drivers Mercy Corp

Peer Education and Youth Empowerment Programs

http://www.mercycorps.org/topics/hivaids/15550

Community Support

Catholic AIDS Action People Living With AIDS Community based organization for commercial

sex workers Encourages safe sex and provides condoms

Residential School for Orphan Girls Recovery, acclimatization, academe

Results: No stigma! Universal availability of free treatment and HIV counseling, Empowerment, & Self-confidence

FinancingInternational Funding

Private International NGOs Rockefeller Group, Mercy Corp,

Columbia University Advocated by International

Celebrities

Local Income Generating Projects Miniature Papier-Mache Coffin

Fabrication Community Grown Cabbage

Patches Profits go towards purchasing

coffins

$$$

Challenges or Erected Barriers?

Africa’s circumstances result in treating care as market justice, but the poverty of the population forms a permanent barrier to access under this approach

Results in maldistribution of access to this resource, as with nutrition/food

Cultural inhibitors: widespread socio-economic disparity between leaders and populations

Ostracism and banishment by those not infected Children and grandmothers raising families – a

missing generation

Recommendations and Solutions

Education HIV prevention by condom adoption Empowerment and rebuilding of self-esteem

Treatment Simple medication with big differences Universal availability of treatment and counseling

Eradicating Stigma Elimination of prejudice and intolerance

Other Recommendations

Set country-specific, reasonable targets by achievable percentage of GDP to health Supply-side approach instead of one-size-fits-all

Focus on resources available and build infrastructure Medical delivery capability

“Cheap” solutions can make huge differences Education on higher HIV infection rates among older

men Mechanisms to drive discussions on condom adoption “Cabbages and Condoms” restaurants in Thailand

Bossert, T. J., and Ono, T. (2010). Finding affordable health workforce targets in low-income nations. Health Affairs, 29:7, 1376-1382.http://hbswk.hbs.edu/item/3395.htmlhttp://www.nytimes.com/2006/08/06/world/africa/06aids.html

Discussion

How can governments and NGOs sustainably support community based solutions to social and economic disparities with respect to the AIDS epidemic?

How can small scale successes be expanded regionally? Who should be responsible for the necessary infrastructure and implementation of larger scale ventures?