HIV Policy and Advocacy Monitor

"Saving lives has to be the state's top priority; it is a crime for a government to withhold life-saving treatment from its citizens."--Dmytro Sherembey

Dmytro Sherembey is the chairman of the Board of Directors for Patients of Ukraine, a charitable foundation that advocates for the health needs of Ukraine's vulnerable populations. He is also a dedicated activist on behalf of numerous health and human rights causes. Sherembey spoke with the HIV Policy and Advocacy Monitor about his organization's work in Ukraine and challenges faced by people living with HIV (PLHIV) during the current geopolitical crisis.

Click here for the interview.

Policy Analysis

Measures of HIV Treatment Progress Highlight Lagging Investments

Science Speaks

http://sciencespeaksblog.org/2015/01/21/measures-of-hiv-treatment-progress-highlight-lagging-investments/

Antigone Barton's blog post for Science Speaks discusses two articles that analyze the impact of lagging investments in HIV treatment from PEPFAR and other global donors. For PEPFAR, the lack of a "presidentially set" target for aid planners, coupled with decreased funding and exhausted reserves, led to a 35 percent decrease in the number of people receiving ART. Globally, World Health Organization guidelines cannot be followed because of limited investments to ensure early HIV diagnoses and faster access to care.

A Decade of Investments in Monitoring the HIV Epidemic: How Far Have We Come? A Descriptive Analysis

Health Research Policy and Systems

http://www.health-policy-systems.com/content/pdf/1478-4505-12-62.pdf

This study used country progress reports from the UN General Assembly Special Session on HIV/AIDS (UNGASS) to assess national and global successes in HIV monitoring and evaluation (M&E), as well as remaining challenges. Since UNGASS issued a Declaration of Commitment in 2001, engagement on and funding for HIV M&E have increased, with M&E system performance in high-burden countries improving dramatically from 2006-2010. However, resource constraints highlight the need for both strategic investments and the integration of M&E data into broader health information systems.

Funding AIDS Programmes in the Era of Shared Responsibility: An Analysis of Domestic Spending in 12 Low-Income and Middle-Income Countries

The Lancet

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2814%2970342-0/fulltext

This study analyzes the capacity of 12 sub-Saharan African countries with high HIV prevalence to finance their national HIV responses from domestic sources, and the effects of domestic resource mobilization on the level of external donor support. The authors compared their estimates of domestic AIDS financing to total financing requirements to calculate total funding gaps and future need for donor funding.

National HIV Prevention Funding - An Essential Investment

National AIDS Trust

http://www.nat.org.uk/media/Files/Policy/2014/NAT_prevention_funding_briefing.pdf

In this brief, the UK's National AIDS Trust addresses UK government funding for domestic HIV prevention, which faces a 50 percent reduction in 2015. It also highlights concerns about sustained levels of HIV transmission and limited public understanding of prevention. Finally, it reviews the financial benefits of prevention programs and argues that the government should commit to at least maintaining previous levels of funding for HIV prevention in 2015-2016 and thereafter.

Avoiding 40% of Premature Deaths in Each Country, 2010-30: Review of National Mortality Trends to Help Quantify the UN Sustainable Development Goal for Health

The Lancet

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961591-9/fulltext

The authors discuss the prominent role of HIV and other communicable diseases (among several factors) in the high levels of premature deaths in many developing countries. A two-thirds reduction in HIV, tuberculosis, and malaria deaths is one of the four critical sub-targets suggested to help reach an overall target of reducing each country's premature deaths by 40 percent and broadly improving healthcare for all age groups.

Beyond 2015: How Health Policy Can Help Countries Prepare for the Future

Health Policy Project

http://www.healthpolicyproject.com/index.cfm?id=publications&get=pubID&pubId=781

Suneeta Sharma and Rebecca Mbuya-Brown of the USAID- and PEPFAR-funded Health Policy Project discuss global health gains over the two previous decades, including significant reductions in child and maternal mortality and increased access to antiretroviral therapy. However, developing countries face an array of persistent and emerging health challenges in advance of Millennium Development Goals deadlines. The authors present five ways to prepare for the future of health policy, given the changing global health landscape.

White House Releases FY16 Budget Request

Kaiser Family Foundation

http://kff.org/news-summary/white-house-releases-fy16-budget-request/

The White House's FY2016 budget request includes the majority of funding for U.S. global health programs. The administration has flat-lined PEPFAR funding and cut tuberculosis funding for USAID Global Health Programs by 19.1 percent. Furthermore, while the pledge to provide $1 to the Global Fund for every $2 pledged by other donors has been met, the overall U.S. contribution to the Global Fund was reduced by 18 percent.

New Resources: Models, Tools, and Research

US Guidelines on Prevention with People Living with HIV Now Emphasise Engagement with Care, HIV Treatment and Social Factors

aidsmap

http://www.aidsmap.com/page/2931199/

A recent article for aidsmap summarizes new recommendations from the Centers for Disease Control and Prevention on HIV prevention interventions. Since 2003, when guidelines were last issued, there has been greater focus on antiretrovirals and the social and structural factors behind transmission. The new guidelines also stress the importance of rigorous data collection to identify and more effectively treat underserved individuals and groups.

The Effectiveness and Efficiency of the HIV Response in Africa: Views and Recommendations of Grassroots Caregivers and Other Stakeholders

International AIDS Society

http://www.healthpolicyproject.com/index.cfm?id=publications&get=pubID&pubId=414

This brief, produced with support from the USAID- and PEPFAR-funded Health Policy Project, describes efforts by the International AIDS Society to survey its members and consult with a variety of HIV and AIDS community stakeholders to improve the effectiveness and efficiency of HIV service planning and delivery. Responses highlight the importance of inclusiveness, health systems strengthening, and cooperation between government agencies and other donors.

How Can People Living with HIV and Key Populations Access Justice in Ghana?

Health Policy Project

http://www.healthpolicyproject.com/index.cfm?ID=CHRAJupdate

This blog post, written by members of the Ghana Commission for Human Rights and Justice (CHRAJ) and the Health Policy Project, discusses CHRAJ's new online reporting system for cases of discrimination against people living with HIV and key populations. Although some cases have been resolved under the system, there is a need for continuous civil society engagement to ensure that all known cases of discrimination are reported to the proper authorities and investigated.

Advocacy

15 HIV Advocates to Watch in 2015

Mark S. King

http://marksking.com/my-fabulous-disease/15-hiv-advocates-watch-2015/

Mark S. King, an award-winning blogger, author, and HIV and AIDS advocate, profiles 15 HIV advocates from around the world who significantly (and positively) impact the delivery of HIV programs to ensure that the highest-need populations are reached and treated effectively.

Interview with Dmytro Sherembey

HIV Policy and Advocacy Monitor: What drove you to become involved in advocacy?

I have advocated on behalf of a variety of health- and governance-related causes for more than 20 years and view myself as a product of others' advocacy work, especially that of the ACT UP movement in the United States during the early years of the global HIV epidemic. When I contracted HIV 15 years ago, there was no treatment available in Ukraine. To be treated, you had to either travel abroad or do what I did, along with several other activists: stay and fight for the right to treatment. ACT UP fought for access to combination therapy treatment and demanded that it be made available to everyone around the world. Between their advocacy and our own, Ukrainians like me are on therapy, alive, and thriving.

HIV Policy and Advocacy Monitor: Can you provide examples of successful Patients of Ukraine advocacy campaigns?

In 2011, it was unclear whether the government would continue to provide antiretroviral therapy (ART) to those already receiving the treatment. In collaboration with the Ukrainian Network of People Living with HIV, Patients of Ukraine collected 500 postcards signed by children living with or affected by HIV and delivered them to the president at a press conference. Each card included the campaign's request to the president's administration: "Let us live." After the conference, the prime minister signed an order to finance treatment for PLHIV and, in January 2012, the minister of health announced that the state would pay for treatment for an additional 42,000 Ukrainians living with HIV.

Now, with the currency devaluation and the war, there are once again concerns about whether the government will be able to continue financing treatment. Patients of Ukraine has proposed a tax on alcohol and tobacco to help fund the health sector. Advocacy helps us find solutions to health problems and promote change in the broader health system. It is the key to our success because, from an investment perspective, it provides a significant return by impacting many people's lives.

HIV Policy and Advocacy Monitor: How have the ongoing conflict with Russia and Ukraine's internal strife compromised health services in Crimea and in the east and southeast of Ukraine?

Services have been most compromised in areas not controlled by Ukraine. Volunteer organizations have tried to deliver ART to conflict zones but it is not possible to systematically control the delivery process. This leaves people exposed to possible treatment discontinuation, worsening health, and increased risk of transmission. After the war, rebuilding the most conflict-affected regions and ensuring access to HIV care and treatment for residents of these places will be very difficult.

HIV Policy and Advocacy Monitor: How has your organization's work changed or refocused since the 2014 change in government?

Patients of Ukraine is currently engaged in a healthcare sector reform initiative. We have presented ideas and proposals to the government and will continue advocating for healthcare reform in 2015. We will begin by targeting the pharmaceutical sector to make medicines on the market less expensive by allowing, for example, direct procurement of medical supplies. We are also working to liberalize domestic markets by breaking down barriers to creating and developing high-quality medicines in Ukraine. Reducing the money spent on medicines will free resources for Ukrainian hospitals to more effectively meet the needs of their patients. As a result of direct procurement and a more liberal marketplace, the country would recoup over a billion dollars from black market sales.

These efforts will be followed by a service availability assessment to monitor the health sector and produce valuable data for use in a range of advocacy efforts. Saving lives has to be the state's top priority; it is a crime for a government to withhold life-saving treatment from its citizens. Patients of Ukraine works to remind the state of this priority, particularly in the context of its 2015 budget.

HIV Policy and Advocacy Monitor: How does Patients of Ukraine keep up-to-date and knowledgeable about relevant issues to present decisionmakers with appropriate solutions?

We never expect someone to solve anything for us; change is something you have to achieve on your own. Our organization tries to build its expertise around advocacy topics by seeking knowledge from various stakeholders and experts, and collaborating with people who share our views and beliefs. By collecting this knowledge and experience, we use it to affect positive change.

The USAID- and PEPFAR-funded Health Policy Project's HIV Policy and Advocacy Monitor is a monthly newsletter focusing on the advancement, development, and analysis of policies, advocacy campaigns and organizations, and policy-related data to inform the response to HIV and AIDS at the global, national, and local levels. It includes news items, resources, advocacy reports, and innovative policy analyses on a wide range of topics such as treatment, key populations issues, gender, and financing for HIV policies and programs.

If you would like to suggest an item for inclusion in the next issue, please send it to: [email protected].

About the Health Policy Project

The Health Policy Project is a five-year cooperative agreement funded by the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (formerly Futures Institute), Partners in Population and Development Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA).