The Global Pulse Journal Blog

Figure 1.

For the first time in the 15 year-long search for an HIV prevention method that women can control, a vaginal microbicide gel called Viread has been shown to decrease the risk of HIV infection by as much as 54%.  Even though the microbicide does not prevent transmission in every woman who uses it, this is the first promising tool that women are able to use without the cooperation of the male partner.  This is an important consideration most of the new HIV infections in women living in Africa were acquired through forced sex with infected men who refuse to wear condoms. Women and girls represent 60 percent of the 22 million people infected with HIV living in Africa.

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The Bill & Melinda Gates Foundation, the Health Institute of Carlos Slim Foundation and the government of Spain have each contributed $50 million to fund the Salud Mesoamerica 2015 Initiative.  The Inter-American Development Bank will coordinate and commission independent evaluations as well as manage the combined contributions of the donors. The project’s primary aim is to reduce health inequities by fighting dengue fever and malaria and improving nutrition and maternal health in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. The funding amount received by each country will be based on their poverty and health inequity status.  While each government will determine what programs to finance with the Initiative,  incentives will be placed for more equitable allocation of domestic funding and for policy that improves the health of the poor.   This project is expected to generate globally-relevant knowledge of how to scale up cost-effective health interventions in poor communities.

This is not the first time that Slim and Gates have partnered up.  They have been working together at Prodigy MSN, which has just celebrated its 10^th anniversary.

For a look at the US government’s role in improving global maternal, newborn, and child health check out the Kaiser Family Foundation’s recently released report entitled “The U.S. Government’s Efforts to Address Global Maternal, Newborn, and Child Health: The Global Health Initiative and Beyond.” The report discusses US efforts towards improving child and maternal health including the recently heightened focus placed on these issues by the Administration’s Global Health Initiative. It provides a detailed overview of the U.S. government’s response thus far, looks at U.S. funding trends for maternal and child health, examines international and domestic agencies’ activities related to maternal and child health, explores U.S. participation in international multilateral efforts and identifies key policy issues surrounding the future of the U.S. involvement in such health issues.

A related webcast and fact sheets on maternal and child health and family planning are also available.

This Friday January 29, 2010, PBS will air a documentary focusing on maternal health in Haiti on its newsmagazine show NOW. The episode explores the context of the global maternal health crisis with a focus on the work of the Haitian Health Foundation, winner of the 2008 Global Health Council Best Practices Award. The earthquake has further stressed a resource-challenged system, with many centers for maternal health damaged or destroyed. Filming for this episode overlapped with the earthquake and the show touches on the additional challenges facing expecting and new mothers and their children living within this crisis.

Visit http://www.pbs.org/now/sched.html for more information on air times or the documentary will be available online starting Friday night January 29th at http://www.pbs.org/now/.

This is a guest post by Vanessa Coleman, coordinator of the International Women’s Health Leadership Institute and the International Women’s Health Working Group.

This New Year as you set down and make resolutions, we at AMSA urge you to make another one. Ghandi once said “Be the change you want to see in the world.” Imagine how much of a difference we could make in our practices, medical schools and in our communities if each of us 30,000 AMSA members made this resolution? Apply for AMSA’s inaugural International Women’s Leadership Institute and BE THE CHANGE.

Read on for details. Read the rest of this entry →

Britain’s Medical Research Council (MRC) announced that the Pro 2000, a vaginal microbicide gel, was ineffective in preventing the spread of HIV infection in a trial conducted in four African counties. PRO 2000 works by inhibiting the entry of HIV into cells .The trial was sponsored by the Microbicides Development Program (MDP), a not-for-profit partnership of 16 African and European research institutions took place between September 2005 and September 2009, involved 9,385 women .

Sheena McCormack, who led the trial, was disappointed in the results because a smaller trial held earlier, indicated that that the results for the current larger trial would be different from what they were. The smaller trial included more than 3,099 women and was funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH. The sites include 6 countries in sub-Saharan Africa and one site in the United States. The results of the smaller trial were presented at the Conference on Retroviruses and Opportunistic Infections in Montreal, Canada in February. These results indicted that the Pro 2000 gel would reduce transmission rated by 30 %. Earliers this year, ENDO Pharmaceuticals purchased the PRO 2000 from Indevus Pharmaceuticals.

Currently, women make up half of all people worldwide living with HIV and in sub-Saharan Africa, women represent nearly 60 percent of adults living with HIV.

In most cases, women become infected with HIV through sexual intercourse with an infected male partner. Manufacturers were hoping that this microbicide would be a potential solution for hose whose partners refuse to use condoms and could have empowered women with a prevention method they could initiate. Even though this microbicide failed to prevent the spread of HIV, scientists have not given up hope, as here are currently dozens of microbicides being tested. A previous post on the Global Pulse Blog discusses the debates that have taken place about the role of microbicides on HIV prevention.

As part of World AIDS Day efforts to educate the public about the HIV/AIDS pandemic, Global Fund Ambassador for the protection of mothers and children against AIDS and first lady of France, Carla Bruni-Sarkozy released a series of interviews “talking about and letting the world know that a woman who is expecting a child can make sure that this child can have a healthy life,” Ms Bruni-Sarkozy told the BBC. She recalled her experience meeting mothers in Burkina Faso and cited this experience as showing her that progress can and must occur in the fight against mother-to-child transmission of HIV. She renewed a call to eliminate mother-to-child transmission of HIV by 2015 through a focus on educating women and increasing their access to means to fight and prevent the disease. This has been a focus area of the Global Fund, UNAIDS, UNICEF, WHO and UNFPA.

This is an important effort given the impact of mother-to-child transmission of the virus.

• Currently, over 45% of HIV-infected pregnant women receive ARV prophylaxis (up from 10% in 2004)
• Only 15% of children born to mothers infected with HIV in reporting low- and middle-income countries were tested for the virus within the first two months of life
• Only 38% of the over 730,000 children in low- and middle-income countries in need of ARV treatment in 2008 received these medications

For more on these efforts, see press coverage of the Global Fund’s World AIDS Day activities.

From the University of Pennsylvania Press, comes a new book titled Reproductive Health and Human Rights: The Way Forward.  Edited by Laura Reichenbach of the Population Council and Mindy Jane Roseman of Harvard Law School, the book reflects on the past fifteen years of international efforts surrounding health, poverty, and gender inequality, with special focus on the consequences of the 1994 United Nations International Conference on Population and Development (ICPD) and its resulting Programme of Action.

From the publisher’s website:

The book grapples with fundamental questions about the relationships among population, fertility decline, reproductive health, human rights, poverty alleviation, and development and assesses the various arguments — demographic, public health, human rights-based, and economic — for an against ICPD today.

A number of the chapters address institutional challenges to ICPD and consider how the challenging political, religious, academic, and disciplinary contexts matter.  Other chapters engage operational and conceptual issues and whether ICPD has been able to move the reproductive health agenda forward on topics such as maternal mortality, abortion, HIV/AIDS, adolescents, reproductive technologies, and demography.  Finally, several chapters examine how ICPD has been sidelined by emerging health and development agendas and what could be done in response.  Unlike any book yet published, Reproductive Health and Human Rights: The Way Forward examines the state of the arguments for reproductive health and rights from a multidisciplinary perspective that provides policymakers, scholars, and activists with a better understanding of how reproductive health and rights have developed, their place in the global policy agenda, and how they might evolve most effectively in the future.

To read an excerpt from the book, click here.

While I was a Peace Corps volunteer in Mozambique I had the chance to interview three women from my community who were living with HIV, but receiving treatment thanks to PEPFAR (the United State’s multi-billion dollar initiative to combat HIV).  I filmed these women as part of a larger video project about preventing HIV/AIDS in Mozambique.

You can see them and hear what they have to say here: http://www.overstream.net/view.php?oid=spr5lzmgn8l6

In somewhat belated honor of Mother’s Day in the US, I would like to share the following post by Vanessa Coleman at AMPLIFY:

According to the World Health Organization (WHO) , 99% of deaths during childbirth occur in low-income countries. For example, the chance of maternal death in high income countries is 1 in 7300, where as in low income countries it is 1 in 73. As young people, this is especially important and relevant because most of the young women who are dying could very well be our friends, schoolmates and classmates had they lived in a different country (particularly if they had been fortunate enough to live in a high income country as we do). The leading cause of death in young women aged 15-19 in low-income countries is from childbirth complications.

Leading causes of maternal mortality worldwide:

Within the US, maternal mortality rates are hardly cause for complacency.  The world’s foremost economic power (pending post-recession change in paradigm), we rank 28th in infant mortality, and 41st in maternal mortality:

Based on 2005 estimates, the U.N. analysis suggests that one in 4,800 women in the United States carry a lifetime risk of death from pregnancy. By contrast, among the 10 top-ranked industrialised countries, fewer than one in 16,400 are facing a similar situation.  The reason? According to experts, in many European countries and Japan in the industrialised world, women are guaranteed good-quality health and family planning services that minimise their lifetime risk.  Many independent experts and sympathetic legislators hold the current U.S. public health policy responsible for its dismal record because some 47 million U.S. citizens have no access to health insurance, most of them African Americans and other minorities. [IPS News]

Steep disparities in maternal health are linked to ethnicity and socioeconomic status, with African-American women being 4 times more likely to die in childbirth than white women, a point that is alternately called our “national shame”, and goes ignored.

More reading: How do socioeconomic factors affect disparities in mortality? by Deborah Maine, in the Journal of the American Medical Women’s Association, provides some nice historical context on maternal mortality in the US.