2013-05-25T15:08:32-04:00 Dr Alvaro Bermejo http://www.huffingtonpost.co.uk/author/index.php?author=dr-alvaro-bermejo Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Dr Alvaro Bermejo Good old fashioned elbow grease. tag:www.huffingtonpost.com,2013:/theblog//3.3193996 2013-05-01T12:36:13-04:00 2013-05-02T07:15:03-04:00

Dr Alvaro Bermejo http://www.huffingtonpost.com/dr-alvaro-bermejo/
"There is nothing sadder than sitting there, waiting for someone to die," Maurine quietly told a group of parliamentarians in London earlier this week. After her father's death, Maurine was also diagnosed with HIV, along with her baby son.

"It was a very sad time," said Maurine, whose organisation Lean On Me supports young women living with HIV in Kenya. "So many of my friends died, and some committed suicide because they didn't want to end up bedridden. I remember sitting with my son on the balcony, wondering which of us would go first. Then the Global Fund came, and here I am."

By rolling out medicines for HIV and TB and bed nets which help to prevent malaria, the Global Fund to fight AIDS, TB and Malaria has saved the lives of nearly nine million people over the last decade - people like Maurine and her little boy.

"Now I am strong!" her son says, in a film produced by Here I Am, a campaign led by people who have survived HIV, TB and malaria thanks to Global Fund supported programmes. Maurine is a Here I Am ambassador and has travelled from Kenya to ask the UK government to make an early funding announcement ahead of the Global Fund Replenishment Conference in the autumn.

The Global Fund was created by G8 countries in 2002, and currently provides over half of all HIV treatment globally, four fifths of all international assistance to fight TB and 60 per cent of international malaria funding. With over a decade of impact behind it and bolstered by recent scientific and research advances, the Fund can now go even further and could actually bend the curve of the HIV, TB and malaria epidemics, but it needs the continued support of G8 countries like the UK and the US.

While the UK government scored the Global Fund highly in its 2011 review of multilateral aid organisations, it also identified changes that needed to be made to further increase the Fund's impact. As Chair of the Global Fund Board, the UK then led a major transformation of the Fund's funding and accountability mechanisms. I have represented developed country NGOs on the board of the Global Fund for the last two years and seen firsthand how it has evolved to become an organisation of the 21st century.

Two weeks ago President Obama included $1.65 billion for the Global Fund in his 2014 budget request - a tremendous vote of confidence. However under federal law the US is limited to providing no more than one third of total Global Fund financing, so other donors will have to commit $3.3 billion for the same period in order for the Fund to access the full US pledge. It is therefore critical that the UK announces an increase in its contribution and does it well in advance of the autumn replenishment. By doing so, the UK will help to leverage larger pledges from other countries and to maximise potential funding from the US. My organisation, the International HIV/AIDS Alliance, and our partners are calling for a doubling from the current level of £500 million over the period 2011-2013 up to £1 billion over the next three years.

Some donors may be tempted to delay investing in fighting HIV, TB and malaria until the economic situation improves. In reality, this is a false economy. The three diseases already carry a high cost both in human and financial terms, and if we don't grab the opportunity to defeat them, the costs will only increase. In countries like Uganda new HIV infections are already increasing, while multidrug-resistant TB is becoming more widespread around the world, especially in Eastern Europe. If we reduce investments in malaria, a whole generation of children who have never developed resistance could die. If the tools we had for preventing HIV, TB and malaria were fool-proof we could afford to wait, but they are not. All of the science we have - HIV treatment as prevention, pre-exposure prophylaxis, male circumcision, existing TB medicines, insecticide room spraying and use of bed nets - is only partially effective, and to take advantage of it we need to act now, using the resources and systems that have already been put in place. This is a once-in-a-lifetime chance.

The G8 summit at Lough Erne is approaching. In 2005, when Tony Blair hosted this meeting, G8 leaders made an historic promise to work towards universal access to HIV treatment and help African countries to scale up action against malaria. These pledges, which enjoyed cross-party and widespread public support, have helped to fundamentally change the global HIV and malaria response. Today some eight million people are benefiting from antiretroviral drugs and malaria deaths in Africa have been cut by 30 percent between 2005 and 2010.

David Cameron has identified other priorities for this summit - trade, tax and transparency - and will host a pre-meeting focused on world hunger. These are all vital issues, but the Prime Minister also needs to protect what has already been achieved and should encourage the G8 to deliver on past promises. As Maurine Murenga put it to Parliamentary Under Secretary of State for International Development Lynne Featherstone: "If we stop now, we may lose the gains we have made. A luta continua. The struggle must continue in the spirit of saving lives."]]> tag:www.huffingtonpost.com,2013:/theblog//3.2787931 2013-03-01T05:38:29-05:00 2013-05-01T05:12:01-04:00

Dr Alvaro Bermejo http://www.huffingtonpost.com/dr-alvaro-bermejo/
And that's just in the UK. Imagine if you're a transgender woman in some Latin American countries where being able to access your right to identity, health and equality is all but impossible and where you face abuse, violence or even death on an almost daily basis.

As International Women's Day approaches, the International HIV/AIDS Alliance - who I represent - together with the Latin American and Caribbean Network of Transgender People (REDLACTRANS), has published a report that reveals how a shocking trend of systematic targeting of a population on the basis of their identity is going uninvestigated in Latin American countries including Guatemala and Honduras.

Entitled 'The Night Is Another Country: Impunity and violence against transgender women human rights defenders in Latin America' the report indicates that transphobia in the region is leading to a terrible climate of impunity with executions, torture and arbitrary detentions of transgender women, many of whom are human rights defenders, going unpunished. Between 2005 and 2012 in Colombia, 60 transgender women were murdered without a single person having been brought to justice. In the same period 35 transgender people were killed in Guatemala with only one person undergoing legal proceedings.

You might be wondering why an organisation working on HIV issues would concern itself with the transgender community. Quite simply because transgender women in Latin America face an extremely high HIV prevalence rate of around 35 per cent compared with the general population which stands at less than one per cent. More often than not they are thrown out of their homes at a young age and excluded from education meaning that the vast majority are pushed into sex work, even as teenagers. This in turn leads to a much greater risk of contracting HIV and other sexually transmitted diseases.

Transgender women who are sex workers in the region, often also activists, are subject to regular police brutality and face further humiliation when they are taken to prisons and detention centres intended for men where they suffer disproportionately from sexual violence inflicted on them by other inmates and security officials.

Marginalising trans women dissuades them from seeking health services and leads to a derailing of HIV prevention efforts. In most countries in Latin America, with the exception of Argentina, there is no legislation explicitly recognizing or mentioning transgender identity, thereby rendering them invisible and denying them legal and civic status. Additionally, public health care institutions are not usually accessible to such women and do not cater for their needs.

Because of the social exclusion that transgender women face and the context of violence and discrimination that surrounds them, it is virtually impossible to provide an effective HIV response focused on this at risk group. Key recommendations made by the report include calling for the arrests and trials of those responsible for murders, hate crimes and other human rights violations; providing legal recognition of gender identity; extending comprehensive health services to the transgender community; and ensuring that prisons and healthcare systems accommodate transgender women in facilities intended for women and protect them from abuse and degrading treatment, including rape.

Governments must respect, protect and fulfil their obligations towards their transgender citizens and, in doing so, put an end to senseless killings and dehumanising brutality. Then, and only then, might transgender women like Rosario (not her real name) from Honduras who has been shot at four times in the past 12 years feel safe to exercise her right to the identity she chooses.]]> tag:www.huffingtonpost.com,2012:/theblog//3.2177639 2012-11-25T19:00:00-05:00 2013-01-25T05:12:01-05:00

Dr Alvaro Bermejo http://www.huffingtonpost.com/dr-alvaro-bermejo/
Other clauses within the bill mean that the reputation of anyone working with the gay or lesbian population such as medical doctors working on HIV and AIDS and civil society leaders active in the field of sexual and reproductive health could be severely compromised.

If the bill is passed it's likely to lead to even more HIV infections in politically isolated populations, especially among men who have sex with men. They will be prevented from having access to essential public health information, such as how to protect themselves from HIV and how to access life saving treatment and support services that are stigma-free.

With an HIV prevalence rate of 6.5%, Uganda is a country where a large number of people living with HIV do not know their status and where access to treatment is still below 60%. Recent national data indicates a decline in condom use and public health programming generally is impeded due to the criminalisation of homosexual behaviour and the related widespread stigma. Denying men who have sex with men and transgender people access to HIV-related services puts all of the country's citizens at risk.

Last September, Commonwealth ministers of foreign affairs - including the Ugandan minister - agreed that, "Heads of government should take steps to encourage the repeal of discriminatory laws that impede the effective response of Commonwealth countries to the HIV/AIDS epidemic, and commit to programmes of education that would help a process of repeal of such laws." Shame on the Ugandan parliament in that case for agreeing to even debate the bill in the light of such a commitment.

We have been here before with this dreadful bill. After a huge global outcry last year, Ugandan president Museveni blocked its progress but the speaker of parliament Rebecca Kadaga recently said that it would be passed as a "Christmas gift" to its advocates. It defies belief that somebody who has been entrusted to represent a nation's people could actively promote such a state-endorsed violation of basic human rights to self expression, autonomy, and to health.

The Global Commission on HIV and the Law recently presented incontrovertible evidence that discriminatory legislation such as criminalisation of homosexuality has a devastating impact and enhances HIV-related risks among men who have sex with men and other vulnerable groups most at risk of the epidemic. As the latest UNAIDS report on the Global Epidemic published this week indicates, it is such politically and socially isolated groups who bear the brunt of the HIV epidemic.

The Commission also stressed the need to have "laws that protect human rights to save lives, save money and end the epidemic."

An adverse legal environment where most at risk groups face being criminalised for their behaviour and made a target for harassment and violence is not the answer if we want to see the HIV epidemic brought under control.

To see a truly effective HIV response, civil society and health care providers have to be in a position to be able to work with all marginalised groups and be able to provide stigma-free services. If the bill is passed, it will change the course of the epidemic in the country in completely the wrong direction and put the lives of thousands at risk.]]> tag:www.huffingtonpost.com,2012:/theblog//3.1974046 2012-10-17T12:33:41-04:00 2012-12-17T05:12:02-05:00

Dr Alvaro Bermejo http://www.huffingtonpost.com/dr-alvaro-bermejo/ 'The danger of a single story' is my favourite TED talk but, on a visit last week to Haiti, I found that I - along with many many others - had fallen into the trap.

It's almost three years since the earthquake that left the lives of 3.5 million individuals and their families in tatters and killed some 220,000 people but say the word Haiti aloud among friends and who doesn't immediately still conjure up a visual image of devastation, helplessness, vast tented cities, fragmented aid, foreigners driving white land cruisers and the rubble of a National Palace that has become shorthand for a ruined country, a symbol of collapse. We've heard so many versions of this single story of Haiti, sadly partly true.

But only partly. Look at the country's HIV situation and Haiti has succeeded in halving the prevalence rates in under two decades, from around 4% in 1994 to 2% now. The best, most cost-effective model of integrated HIV care, training and research I've ever seen is Haitian - the GHESKIO centre in Port-au-Prince. Haiti's antiretroviral (ARV) coverage is well over 50%, and they are switching their approach to preventing transmission from mother to child to the improved B+ option which not only provides the same triple ARV drugs to all HIV-infected pregnant women beginning in the antenatal clinic setting but continues the therapy for these women for life.

A forum of local NGOs is coalescing to claim leadership in the AIDS response and to reclaim prevention. Take for example the Alliance's member organisation in Haiti, POZ, which is providing prevention, care and support at community level and, despite the challenges, is determined to scale up its work with men who have sex with men and sex workers if, as seems likely, the epidemic is increasingly affecting these at risk groups and their sexual partners.

In Cap-Haïtien in the north, I was stunned by the Caracol Industrial Park currently being built with multimillion dollar investment from the US government and the Inter-American Development Bank and which will create up to 65,000 jobs in the region in the coming year. Indeed POZ are hoping to run HIV awareness sessions with the construction workers and future employees in the months to come as well as work with people living with HIV on income generating opportunities. This is also Haiti, but such stories are rarely heard.

I've seen plenty of countries with no leadership, where donors do all the heavy lifting. That's not at all what I found last week in Haiti. While Pepfar, the Global Fund and other donors have played an important role in the HIV response, the real accomplishments are down to national organisations working tirelessly to mobilise communities and provide prevention, care and treatment services. I have little doubt that we'll soon count Haiti and its organisations among the great successes of the HIV response. And success in turn will lead to sustainability.

The danger of the single story, as the Nigerian author Chimamanda Ngozi Adichie puts it so compellingly in her TED talk, is that it creates stereotypes, and the problem with stereotypes is not that they are untrue but that they are incomplete and we risk a critical misunderstanding. So if you read the recent Audit: USAID Haiti work 'not on track' article, you may have assumed, as I did, that it's about the problems of working in Haiti. Instead it's about how the largest US contractor working to stabilize Haiti after the earthquake "has a weak monitoring system and is not adequately involving community members". Just another reminder that the single story can be so, so damaging.

We need to put an end to Haiti's single story and let its people find the ways forward. Meanwhile in Myanmar, a single story of a different kind - one where the hope and optimism we all share is dictating the simplified narrative - is in danger of being constructed. But that's a whole other tale, maybe for next time!]]> tag:www.huffingtonpost.com,2012:/theblog//3.1704844 2012-07-26T19:00:00-04:00 2012-09-25T05:12:06-04:00

Dr Alvaro Bermejo http://www.huffingtonpost.com/dr-alvaro-bermejo/ Daily Mail), also referred to by one US outlet as a classy knee-length cherry red dress. Wyclef Jean performed at the Keep The Promise march and Alicia Keys mingled with the great and the good.

The conference is the world's largest gathering of experts, activists, people living with HIV and policy makers. Some 20,000 people who, just like me, have a point to get across in the tumult of symposiums, receptions, satellite sessions, plenary talks, round table debates and meetings.

It can be hard to shout loud enough when you're up against ground-breaking scientific achievements that will always - and rightfully - capture the headlines. Keeping up with them all during the course of the week can be overwhelming to say the least. There was news of a study taking place in Africa on a vaginal ring that will act as an HIV blocker. A new TB combination cocktail, PA-824, which is expected to be able to work in tandem with HIV therapy. New treatment options for HIV-positive children and adolescents. Not to mention all the chattering that goes on around finding a cure, a vaccine to end the AIDS epidemic once and for all.

All of which goes to show that our thirst for knowledge in the long struggle to beat the disease is neither diminished nor vanquished. The sheer scale of the optimism, humanity and solidarity on display in Washington this week is enough to re-energise and refocus even a hardened old veteran like myself.

Of course, not everything in the garden is rosy. Bill Gates warned that far too many people are still dying of AIDS. "We don't have the tools to end the epidemic", he stressed. Meanwhile, a Lancet report published this week highlighted that drug-resistant HIV has been increasing in parts of sub-Saharan Africa over the last decade. Additionally, the World Health Organisation announced that new HIV infections are spiralling in Eastern Europe and Central Asia, largely due to most at risk groups such as people who inject drugs not having access to prevention and treatment services.

Working in this field has certainly been one long rollercoaster ride, more often than not a case of two steps forward one step back. It was heartening though to hear of the US government's commitment to developing a blueprint for an AIDS-free generation by World Aids Day this December. The detail remains to be seen but for me this week there's one area that wasn't talked about quite enough in all the excitement over biomedical advances and that's the importance of investing in communities themselves - those carrying the greatest HIV burden - if we are really to break the back of the epidemic.

Delivering accessible and affordable quality health services for all those who need them is impossible without community mobilisation. If we strengthen community-based structures, integrate them into health systems and support links with other development sectors, we can make significant inroads into reducing HIV infections and create sustainable health and social care systems for the HIV and AIDS response.

Without communities and human rights, there is no such thing as an effective HIV response. In order to attain universal access to treatment, prevention and care, their frontline position must universally be acknowledged.

There, that was the point that I wanted to get across this week. And now I've done it. Not such a jamboree after all!]]> tag:www.huffingtonpost.com,2012:/theblog//3.1326673 2012-03-07T19:00:00-05:00 2012-05-07T05:12:02-04:00

Dr Alvaro Bermejo http://www.huffingtonpost.com/dr-alvaro-bermejo/
In sub-Saharan Africa alone, HIV is responsible for 46% of all deaths among women of child-bearing age, many of which could be prevented with simple effective contraception and condoms to prevent both unintended pregnancy and sexually transmitted infections, such as HIV - technically known as 'dual protection'.

In 2012, three years before the 2015 deadline the world set for itself to reduce preventable maternal deaths and new HIV infections, we must act more boldly than we have up until now. Women who are at risk of unplanned pregnancy are also at risk of HIV, and vice versa so separation of these services no longer makes sense. The global health community must work to bring family planning and HIV services together - and quickly - to save women's lives.

The challenge to achieving this exists at the very highest levels. So the question is how do we ensure women receive the support they need to protect themselves against unplanned pregnancy and HIV infection?

In the past many HIV and family planning services have operated in complete isolation of one another, and only through integration of sexual and reproductive health and HIV can we hope to address this challenge.

Here in the West, where women have access to quality healthcare, free contraception, advice and condoms often in one place, it can be an issue we don't give much thought to. But today, on International Women's Day, we should remember the 215 million women around the world, most at risk of both unplanned pregnancy and HIV, who want contraception and HIV prevention services, but have no access to integrated services.

Marie Stopes International and the International HIV/AIDS Alliance are working together to make it possible for women to access HIV prevention, care and treatment services during any visit to their family planning provider - and for those accessing HIV services to access family planning. We know that this increases effectiveness, efficiency of health service delivery, and provides value for money through less duplication of effort. We believe our approach will save women's lives.

We call on the public to urge leaders to support the bringing together of services in the developing world. We encourage organisations working with us to support the integration of family planning and HIV services.]]>