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AFRICA HEALTH NEWSA WHITAKER GROUP PUBLICATION JULY/AUGUST 2008

PEPFAR

US SENATE VOTES TOTRIPLE HIV/AIDS FUNDINGe US Senate voted overwhelmingly in July to commit $48 billionver the next ve years to the global ght against HIV/AIDS, tuber-ulosis and malaria. e legislation, which builds on the Presidents

Emergency Plan for AIDS Relief (PEPFAR), is the most ambitiousoreign public health program ever launched by the United States.

Senate approval is the last major obstacle to the bills becoming law.t is targeted to prevent 12 million HIV infections and treat three mil-on people over ve years. It also seeks to address Africas severe health

worker shortage by supporting countries in developing long-termealth workforce plans and by funding the training of 140,000 newealth workers.

Since passage in 2003, PEPFAR has helped bring lifesaving antiret-oviral drugs to about 1.7 million people and has supported care forearly 7 million, including about 2.7 million AIDS orphans and vulner-ble children. It has also provided HIV testing and counseling to about3 million people. Before the program began, only 50,000 people in allf sub-Saharan Africa were receiving anti-retroviral therapy.

e Senate bill differs from the version passed by the US House of Representatives in April in several respects. In an amendment agreed toust hours before the nal vote, the Senate agreed to set aside $2 billionf the $50 billion designated in the original bill to fund American In-

ian water, health and law enforcement programs. e bill also reverses21-year-old law that bans most foreign visitors who are HIV-positive

rom entering or gaining permanent residence in the US.In a concession to conservatives who feared that money earmarked

or prevention programs would be used by abortion providers, the Sen-te bill requires that more than half of the programs bilateral aid goo AIDS treatment and care and avoids the requirement contained inhe House version that 20% of the money go to HIV prevention activi-es. e Senate version also does not include the clause included in the

House bill authorizing family planning groups to provide education,esting and condoms.

e Senate bill provides $10 billion - $2 billion a year - to the Globalund to Fight HIV/AIDS, Tuberculosis and Malaria. About $4 billion

will be spent on ghting TB, the leading cause of death among thoseuffering from AIDs, and $5 billion on combating malaria.

Eager to send the bill to President Bush for his signature, the Houseoreign Affairs Committee has said it would accept the Senate versionnd the full House will take up approval of the legislation before Con-ress goes into summer recess at the end of July.

Sen Richard Lugar (R-Ind), the top Republican on the Senate ForeignRelations Committee, credited PEPFAR with helping to prevent insta-ility and societal collapse in several at-risk countries. In addition, heaid, the program had facilitated deep partnerships with a new genera-on of African leaders, and it has improved attitudes toward the Unitedtates in Africa and other regions.

A red ribbon adorns the White House in recognition of World AIDS Day and the US commitment to ghting AIDS globally.

R EPORT

3 MILLION NOW HAVE ACCESSTO AIDS TREATMENTNearly 3 million people in low- and middle-income countries werreceiving antiretroviral therapy (ART) by the end of 2007, accordinto a report released in June by World Health Organization (WHO)UNAIDS and UNICEF.

e report, Towards Universal Access: Scaling up Priority HIV/Interventions in the Health Sector, also documented improved acto interventions aimed at preventing mother-to-child transmission HIV, expanded testing and counseling, and greater country commment to male circumcision in heavily-affected regions of sub-SahaAfrica.

is represents a remarkable achievement for public health, WHDirector-General Dr. Margaret Chan said. is proves that, with commitment and determination, all obstacles can be overcome. People ing in resource-constrained settings can indeed be brought back to enomically and socially productive lives by these drugs.

Reaching the 3 million gure represented a milestone for gloagencies ghting HIV/AIDS because that was the target sought byend of 2005. Although that target was not met until two years latewas credited with jump-starting the effort towards sc aling up ART

Meeting the target, the report stated, can be attributed to increasavailability of drugs due to price reductions, improved ART delivsystems that are now better adapted to country contexts, and increasdemand for ART as the number of people testing positive for Hclimbs.

e report estimated that about 31% of the estimated 9.7 millionpeople in need of ART received it by the end of 2007. Nearly 500women were able to access ART to prevent transmission to their

born children - up from 350,000 in 2006. Some 200,000 childrenceived ART in 2007, compared to 127,000 at the end of 2006.

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P AGE TWO

PROGRAM IMPLEMENTERS TARGETPREVENTION AT KAMPALA MEETING

HIV/AIDS

While acknowledging the enormous advanc-s made in the care and treatment of thosenfected by HIV/AIDS, delegates gathered in

Kampala in June for the 2008 HIV/AIDS Im-lementers Meeting called for much stron-er programs to prevent transmission of theirus.We need to acknowledge that HIV preven-

on is chronic disease management just asreatment is, US Global AIDS Coordinator

Ambassador Mark Dybul told the gathering of ,700 HIV/AIDS program implementers fromround the world.

We must walk with people from the timehey are very young to the time they are beyondisk, keeping messages and methods fresh andlive, to tackle sexual behavior like we tackledmoking, to make it cool and a part of societalxpectations for individuals to practice socially esponsible behavior, to make gender violencend gender inequality not only uncool but un-cceptable, Ambassador Dybul said.

We need to develop combination preven-on to parallel the intensity, focus, and suc-ess of combination antiretroviral treatmentntegrating social and behavioral change withroven scientific and medical methods, hedded.

While 3 million people in low and middlencome countries are now receiving antiret-oviral treatment, the World Health Organi-ation (WHO) estimates that for every twoeople who are newly put on treatment, fiveecome infected. And, Dr. Peter Piot, Execu-ve Director of UNAIDS told delegates, while7% of countries in the world have establishedlear and ambitious goals for HIV treatment,nly about 50% have targets for key HIV pre-ention strategies.

In addressing the theme of the meeting,Scaling Up Through Partnerships: Overcom-

ng Obstacles to Implementation, speakersointed to the need to forge more concretenks across the board to improve health sys-

ems generally and to place more responsibil-ty in the hands of government and local au-horities.

Moving out of a failed and flawed era of onors and recipients, we are entering a newra in development based on partnership be-ween equals, Ambassador Dybul s aid. Onen which we, the international partners, mustcknowledge our role as the junior partner tohe countries we are privileged to support.

One area highlighted by those attending

the meeting was the need to understand thedynamics of local AIDS epidemics and tailorresponses to specific situations. Dr. Piot de-scribed this as making the money work forpeople on the ground.

There are still many areas where we canstrengthen local ownership, reduce unit costsof delivery, improve coordination and increaseaccountability, he said.

Dr. Tom Kenyon, Principal Deputy andChief Medical Officer in the Office of theGlobal AIDS Coordinators, pointed to the bestresults occurring when there is good coordina-tion at the country level between developmentpartners around a national plan.

This is where our resources achieve the

greatest results, when we are led by the hostcountry with a shared vision and shared goals,leadership and country ownership, transpar-ency on both sides, and trust and mutual re-spect, he said.

During the five-day conference, which be-gan on June 4, more than 200 papers werepresented by delegates from governments,NGOs, including faith- and community-basedgroups, multilateral organizations, the privatesector and groups representing people livingwith HIV/AIDS.

Despite the challenges posed by the chang-

ing face of the epidemic , it was agreed thatthere were many past successes upon whichto build. Addressing the opening session, Am-bassador Dybul told the delegates, You haveirrevocably shattered the pernicious and par-ternalistic myth that people in resource-poorcountries could not manage complex chronicprevention, care, and treatment programs ona national and, in fact, continental scale. Andin so doing, you have created new models andlessons learned for development overall.

For transcripts from the 2008 Implement-ers Meeting go to: www.kaisernetwork.org/hivimplementers2008.

Ugandan President Yoweri Museveniand Mrs. Janet Museveni at the meeting

TUBERCULOSIS

PARTNERSHIP TAKESAIM AT TB THREAT INSOUTH AFRICAe Global Health Initiative of the WorldEconomic Forum and the Lilly MDR-

(multidrug-resistant tuberculosis) Partneship launched a new toolkit in June to bothe involvement of South African companin tackling the countrys tuberculosis (Tcrisis.

Developed with inputs from national international partners including the privsector, the toolkit provides concrete guidelto help South African companies rapidlycrease their TB control programs by adopa joint approach to diagnosing and treatinggrowing number of TB patients who are HIV positive.

With 70% of TB patients also infected HIV, South Africa now accounts for 28%HIV-TB positive cases worldwide. Tawith the emerging threat of fatal drug-retant strains of the disease, the GovernmenSouth Africa has recognized the importancengaging the private sector in achieving itcase detection and treatment targets.

Businesses have a fundamental respobility towards both their employees andwider community, and for preservationtheir long-term interests by ensuring the

tional development of human capital to dreconomic growth, said Mr. Alex AzarLilly and Companys Senior Vice-PresidenCorporate Affairs and Communications. berculosis has the capacity to undermine athis.

e TB toolkit aims at intercepting the progression of the disease by giving businguidelines that help them leverage their eing health infrastructures and managemtools and resources to greater effect. Italso help companies increase opportuniand activities in the prevention, diagn

and treatment of TB/HIV co-infections in workplace.Eli Lilly and Company launched the

MDR-TB Partnership, an alliance of 14 puand private organizations, in 2003. It provcomprehensive services for individuals families afflicted with MDR-TB - diagntreatment and surveillance of patients; traing of doctors and nurses; community sport, patient advocacy and anti-stigma effin the workplace; and transfer of Lilly dmanufacturing technology to pharmaceutcompanies in high-burden MDR-TB countto increase local drug supplies.

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P AGE T

M AJOR N EW INITIATIVE

BUSINESS OPENS NEW FRONTON GLOBAL FIGHT AGAINSTAIDS, TB AND MALARIAe Global Business Coalition (GBC), an alliance of more than 225

nternational companies, announced in June an unprecedented pack-ge of private sector initiatives aimed at turning the corner in theght against HIV/AIDS, tuberculosis and malaria.

e pac kage includes a GBC-United Nations health-action roadmapor optimal cross-sector coordination, a plan led by New York Stock

Exchange (NYSE) Euronext to tighten integration of business into themalaria ght, and the deployment in Africa of a series of critical actioneams to identify ways that corporations can coordinate their skills andesources to maximize their impact on Africas health challenges.

Speaking on June 9 at GBCs 2008 Gala and Awards for Business Ex-ellence in New York, Mr. John Tedstrom, Executive Director of GBC,he private sector arm of the Global Fund to Fight AIDS, Tuberculosisnd Malaria, said , e evolution of business role as an active par tner

n the ght has reached a point at which a major, world-changing break-hrough is possible.

e aim of the new package, Mr. Tedstrom said, was to move away rom isolated partnering to globally- and nationally- coordinated part-ering by more effectively matching specic business infrastructurend skills to gaps in the ght, and by engaging business more actively n the ground.

My message: Seize the moment. e way to do this is coordinationsmart, strong partnerships at all levels. And make those partnerships

work, he added.e roadmap, to be delivered to the UN Secretary-General Ban Ki-

Moon on World AIDS Day 2009, will chart the way to a cost-effec-ve, results-intensive strategy. It will identify the gaps in technology,esources, infrastructure, and know-how that business can, in concert

with key partners, ll and, in so doing, make the right difference in theight places at the right time, Mr. Tedstrom said.

NYSE Euronext, the worlds largest exchange group and a world lead-r for listings, cash equity trading, derivatives and the distribution of nternational ma rket data, joined GBC in April and co-hosted a World

Malaria Day event with GBC and the UN Foundation that focused onhe importance of cross-sector collaboration to achieve the goal of elim-nating malaria mortality by 2010.

Working with GBC, the UN Foundation and the NGO, Malaria Nomore, NYSE Euronext has commited to ensure that more than 10 mil-

on insecticide-treated bed nets will be dispensed as quickly as possibleo all those living in areas most affected by malaria.

GBCs rst critical action team will be deployed to Kenya within theext three months. In June, the coalition signed a strategic partnership

with the government of Kenya that will allow GBC, in partnership withmember companies and AMPATH (the Academic Model for the Pre-vention and Treatment of HIV/AIDS) , to dramatically increase HIVesting by going to the homes of more than 2 million Kenyans who willlso be screened for TB and provided with anti-malaria bed nets and

medications for intestinal worms.GBCs 2008 Gala and Awards for Business Excellence brought to-

ether private sector leaders with major partners in the ght includ-ng UN Secretary-General Ban and other top UN officials, Global Fund

Chairman of t he Board Mr. Rajat Gupta and Executive Director Michel

Kazatchkine, Ministers of Health from a host of countries including

Angola, Benin, Cote dIvoire, Kenya, Lesotho, Liberia, Namibia, SAfrica, Swaziland, Sudan and Tanzania , and the First Ladies of RwaSudan and the Republic of Georgia.

Awardse GBC Awards for Business Excellence were earned by compa

that, in GBCs view, had demonstrated extraordinary commitments, tions and results.

HIV/AIDS: Leadership - Viacom for leveraging its media platfoto communicate critical health messages globally.

HIV/AIDS: Community Philanthropy - Intesa Sanpaolo forcreating Project Malawi in partnership with local government andNGOs.

HIV/AIDS: Women & Girls - Johnson & Johnson for providingcomprehensive services in South Africa to prevent mother-to-childHIV transmission.

HIV/AIDS: Comprehensive Workplace Programs - StandardBank Group for its workplace policy to encourage employees andtheir families to know their HIV status and to reduce the stigmaassociated with HIV/AIDS.

HIV/AIDS: Workplace Testing & Counseling - Telekom S.A.Ltd. for its Thuso HIV/AIDS Workplace program in South Africawhich provides education, awareness, testing and treatment.

HIV/AIDS: Expanded Community Initiatives - Xstrata Coal

South Africa for its comprehensive community program inMpumalanga province to combat HIV/AIDs, tuberculosis and otheropportunistic infections.

HIV/AIDS: Core Competence - BBC World Service Trust for iHIV/AIDS media campaign in India which has reached more than250 million people.

Excellence on Tuberculosis - BD (Becton, Dickinson Company)for its initiative to improve diagnostics for tuberculosis in thedeveloping world.

Excellence on Malaria - Exxon Mobil Corporation for its AfricHealth Initiative which focuses on malaria research, community

disease control and community advocacy.

ExxonMobil won the GBC Award for Business Excellence on Ma

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AGE F OUR

P REPARED AND D ISTRIBUTED BY THE W HITAKER G ROUP

G LOBAL H EALTH

WORLD HEALTH ASSEMBLY CHARTS NEWCOURSE FOR WHOAfrican health care received a major boostin May when the World Health Assembly passed a key resolution at its annual ses-sion in Geneva to remove intellectualproperty (IP) barriers that impede essen-tial research and to use innovative meth-ods to encourage research, developmentand access to medicines for common dis-eases of the developing world.

e 61st session of the Assembly, the de-cision-making body of the World HealthOrganization (WHO), was attended by over 2,700 participants from 190 nations.e resolution regarding IP was the resultof two years of deliberations by the WHOsIntergovernmental Working Group on

Public Health, Innovation and IntellectualProperty (IGWG) which brought togetherstakeholders from government, the phar-maceutical industry and NGOs.

is is a major breakthrough for publichealth that will benet many millions of people for many years to come, said WHODirector-General Dr. Margaret Chan. isis a contribution to fairness in health andthis is pro-active public health at its very best.

e Whitaker Group (TWG) participatedin both the Assembly and the IGWG where

it emphasized the role of public-privatepartnerships (PPPs) in addressing Africashealth care needs.

At Mays Assem-bly, TWG hosted aluncheon on the roleof PPPs, attended by 80 African Minis-ters of Health andmembers of delega-tions, at which Dr.Rajiv Venkayya of the Bill & MelindaGates Foundationspoke about thehealth partnershipsthe foundation has

forged in Africa, and Dr. Paul Antony of the Pharmaceutical Researchers and Manu-facturers of America (PhRMA) presentedan important new health tool, the websitewww.globalhealthprogress.org, which al-lows health officials to identify health pro-grams and resources by region and issue.

TWG also distributed the rst volume

of its new direc-tory, e Whitaker Group Guide to USPublic and Pri-vate Resources for Advancing HealthCare in Africa,which providesbackground andcontact informationon health programsand resources available for health care ini-tiatives in Africa.

e directory includes information onpublic and private funds for a variety of health concerns including HIV/AIDS, ma-

laria, neglected tropical diseases, water andsanitation, health education and training,immunization, reproductive health, capac-ity building, health infrastructure, commu-nity-based health solutions, research andtechnology, supply chain management, eyecare and disaster management.

e Assembly endorsed a six-year ac-tion plan to tackle what are now the lead-ing threats to human health globally: car-diovascular diseases, diabetes, cancers andchronic respiratory diseases which dispro-protionately effect low- and middle-income

countries.Delegates also requested that WHO in-

tensify its work to curb the harmful use of alcohol and that members commit theirown Ministries of Health to take action toprotect the health of its citizens from theimpacts of climate change.

In addition, participants reaffirmed theircommitment to eradicating polio and pre-paring for an inuenza pandemic, scalingup immunization programs, assessing thehealth aspects in migrant environmentsand ending female genital mutilation.

At this World Health Assembly, wewitnessed the interplay between the po-litical, trade and health interests, com-mented the President of the Assembly, Dr.Leslie Ramsammy, Minister of Health forGuyana. Child and maternal health, andthe prevention and management of non-communicable diseases rely on the supply chain and commodities. We are now muchcloser to having an increased ow of qual-ity health commodities that will lead tobetter health.

R IVER B LINDNESS

AfDB FUNDS FINALPHASES OF APOCPROGRAMe African Development Fund (ADF), theso loan window of the African Developme

Bank (AfDB), approved a grant of $24.5 mlion in July to fund Phase II and the phasiout stage of the Onchocerciasis (river blinness) Control Program (APOC) in 19 Afcan countries.

e grant anticipates the successful conclsion of the 34-year battle to eradicate the psitic disease which at one time claimed thesion of 40,000 people each year - 99% of wwere Africans. e APOC, the regional sucessor to the Onchocerciasis Control Prog(OCP), aims at eliminating river blindnesspublic health problem in Africa by 2015.

According to the World Bank, more t600,000 cases of blindness have so far prevented by the program, 25 million hectof formerly evacuated arable lands have made safe for settlement and agriculture, 18 million children, born in now-protectedeas, have been spared the risk of the disea

In West Africa, where the program wasinstituted beginning in 1974, the Bank mated there had been a 20% economic ratreturn. Elsewhere in Africa, operations bein 1996 have resulted in a 17% economicof return. Overall, over one million yearproductive labor have been added to the ecomies of participating countries.

e World Bank attributed the success the control program to global partnersbetween multilateral institutions, bilateral nors, participating governments, NGOs the private sector, particularly Merck and which, since 1987, has been donating Mzan to any government making the reques

The program has also been hailed as a blu print for new initiatives to eradicate ottropical diseases such as lymphatic lariasand schistosomiasis.

The ACOP program operates in Angola, Brundi, Cameroon, Central African RepublChad, Congo, Democratic Republic of CongEthiopia, Gabon, Liber ia, Malawi, NigeTanzania, Uganda, Equatorial Guinea , SuMozambique, Rwanda and Kenya.

The total cost of Phase II and the phaing-out program is estimated at $122 millioexcluding Mercks drug donations. The ADgrant will meet 20% of the total cost, wiother donors contributing $75.5 million aregional governments giving $18.8 million.

Dr. Margaret Chan,WHO Director-

General

e Assembly called for scaling up vaccine

programs