Global Fund - 10 Years of Impact

<
 Good video to illustrate what the Global Fund has achieved in one decade - and the enormous amount still to be done!

Eurozone Crisis setting back global health advances

Today is the 10^th anniversary of the founding of the Global Fund for HIV, TB and Malaria.  This was an initiative promoted by then UN General Secretary Kofi Annan in 2002 to put significant funding into fighting the three biggest communicable diseases afflicting the developing world.

Sadly, it is a tenth anniversary with quite a shadow cast over it. After nearly a decade funding a steady increase in provision of treatment, care and prevention initiatives in all three diseases, the Global Fund had received pledges and projected contributions of $11.7 billion in 2010 for the time period 2011-13, but subsequently several donors (mainly form the EU, and in particular the Eurozone) have reneged on their pledges or delayed in coughing up the promised cash as the wrestle with their own economic crises. The Fund is still disbursing some $10 billion of previously approved grants between 2011 and 2013, but no new grants will be made until 2014 unless some or all the previously promised funding arrives.  This means that in the Democratic Republic of the Congo for instance, 28,000 people with HIV who were meant to start life-saving treatment by 2014 may now be unable to. 

The irony of this is that the British Government had found the Global Fund to be one of the most effective, transparent and accountable mechanisms for funding effective treatment and prevention that was saving lives on a major scale. So much so it had agreed to double its funding last year (although the UK has also drastically cut back its bilateral funding for HIV & AIDS at the same time) In fact, the Global Fund is being widely recognised as one of the most effective mechanisms for delivering the Millennium Development Goals (certainly with respect to the fourth goal, which was to reduce the spread of these three diseases, and to see number of infected and dying decrease significantly by 2015).

Now, the MDGs and the Global Fund are not without their critics, and others have seen corruption and inefficiency or skewed priorities where some have seen transparency and effective resource allocation. TB HIV and malaria are not the only major health problems facing developing countries. Other illnesses, particularly non-communicable disease such as diabetes and cancer, as well as less fatal but no less debilitating parasitical diseases are major but still largely neglected issues.  And by focussing so much money and energy into a few illnesses, wider health issues were in danger of being neglected.  We have not been above agreeing with these reservations in this blog. However, there can be no major doubt that the funding crisis facing the Global Fund will mean millions will not get on to treatment programmes, and that this will inevitably cost lives.

Other recent research has shown that in all areas, funding for health related development is in decline, despite clear evidence that it works.  The problem is that so many donor nations are in severe economic decline, and that other issues such as climate change, food and water security and sustainable economic development have become more fashionable.  In this instance at least it is the fickleness of donors and the public of wealthy nations that looks set to wreck progress on the health of the poor rather than feckless developing countries frittering away aid.  The Coalition Government here in the UK, much to its credit, has been one of the few to buck this trend, but even it is facing an increasingly hostile climate of public and press opinion against its policy on overseas aid, and increasing political opposition from within the governing Tory party itself.

But the evidence is there to see. Maternal and infant mortality are reducing, the rates of HIV infection and AIDS related deaths are going down dramatically, and similar stories can be told around so many global health issues.  And in many of these it is national initiatives resourced by the Global Fund that have plaid a significant role.

We may need to rethink how we fund and support the development of health systems in the developing world in the long term, but we cannot just sit back now and watch a decade of progress collapse.  It is a mark of our humanity what we do with our resources when time gets tough. If we forget our neighbour in need when times get tough, what does that say of us?

The Winner of the 2011 Dignity and Right to Health Award

It is the great privilege and pleasure of the ICMDA HIV Initiative to announce that Dr. Olive Frost is the most worthy winner of the International Christian Medical and Dental Association (ICMDA) HIV Initiative Dignity and Right to Health Award for 2011.

The Award is given to individuals for excellence, outstanding leadership and compassion in responding to the HIV/AIDS epidemic.

We acknowledge the excellent and faithful work of the other 2011 nominees - Dr. Saira Paulouse in Delhi, and also the comprehensive and continual growth of the ministry of Andi and Sheeba Eicher from Thane - Mumbai and their organization which is called Jeevan Sahara Kendra. Both ministries and their programs are exemplary.To read more of their work click on 2011 DRH Nominees

The story of Dr Olive Frost is quite unique. Olive, a retired obstetrician and gynaecologist from North Wales is now well into her seventies and has for many years been working quietly as "a humble plodder" in her own words, in several countries in Central Asia where humanitarian work is important, and where there is an emerging just and compassionate response to those who struggle with the disease caused by HIV. She has sown many seeds and though small, there is an emerging growth of many new programs. These programs are often led by women in situations where there have been many difficulties. Yet through a powerful commitment to stand with the stigmatized and discriminated, the power of humanitarian responses are being demonstrated in an important way in several countries including Kyrgyzstan, Tajikistan and Ukraine.

Olive has worked for nearly twelve years across several Central Asian republics. In that time she has worked on the challenges and issues of women and teenagers' health, sexual health and HIV prevention training in various community groups.  In all of these countries there are now autonomous non-government organisations (NGOs) working with the wider community, and two of the first leaders have gone on to form NGOs of their own. Olive has always take a supportive role, and has contributed to the development of independent movements and organizations that are carrying on the work.

The community groups in all  settings have been at the heart of Olive's work since she began, and continue to be the main route through which wider prevention and care and support is offered to the wider national communities.

In the context of Central Asia Olive has focused on inspiring and encouraging a response from community organisations. This has included involvement and leadership of a task group aimed at equipping and informing community leaders on HIV AIDS since 2006. In particular this has led to seminars and conferences held within Central Asia for leaders and workers to be informed regarding HIV and  AIDS and envisioned as to involvement and a response. Olive has taken a lead in arranging and teaching at these.

In her work in Central Asia and beyond through the impact of her wide travel and teaching connected to maternal and child health Olive has been seen to empower PLWHA. As an older female doctor Olive has been well respected within Central Asia and has been able to advocate gender equality in response to the epidemic.           

  

Olive has sought to involve other key players in Central Asia including ACET as well as other local NGOs. We can be greatly encouraged by this important and inspirational work!

We are most grateful to Dr James Tomlinson for this nomination.

We congratulate Dr. Olive Frost and salute her for the commitment and devotion she demonstrates in and through all that which she has done and continues to do for the plight of those living with HIV & AIDS. The worldwide family of the ICMDA joins in congratulating her, giving praise and thanks to God for such models as this which bring transforming HOPE and LIGHT into otherwise desperate situations.

Each year the ICMDA HIV Initiative Committee calls for nominations for this Award. Nominees are sought who live a life which 'does justice, loves kindness and walks humbly with God' (Micah 6:8).

Previous winners are: Dr Biangtung Langkham (2006 - India) , Prof Ruth Nduati ( 2007 - Kenya) and Dr Geoff Foster (2008 - Zimbabwe), Dr Stephen Watiti (2009, Uganda) and the joint winners of 2010 Dr Gisella Schneider (Germany) and Dr Joseph Kwong Leung Yu (Taiwan).

Faith Healing and it's impact on AIDS

At the start of 2012, it is worth stopping to reflect where we got to in 2011.

 

First the good news – new HIV infections are down, deaths are down, and the number of people on antiretroviral treatment is up.  The UN High Level Meeting on AIDS in New York last June committed the world to getting 15 million onto antiretrovirals by 2015, and to zero new infections, zero deaths and zero AIDS related stigma by 2020.  Hilary Clinton at a recent speech committed the US to work towards an AIDS free generation, with the recent research findings that antiretrovirals are a key element in reducing new infections forming one of the planks in that commitment. 

In October a UK Consortium meeting at Lambeth Palace reiterated the important role of faith based responses to HIV.  In short, it has been a year where the science, the statistics and even the political will seem to have been blowing the right way for once.

However, that is not the complete story.  For on the downside, funding is rapidly disappearing, making the likelihood that these high level targets will be met less and less likely (especially around access to treatment). There are also worrying signs that faith is not always good news in the fight against AIDS.

These two stories should come as no surprise – the economic downturn has hit the whole aid industry hard, and is going to make sustaining major drives to increase accedes to treatment, care and prevention politically more and more difficult.

And that faith is not always good news is not news for many who feel that religious people and institutions have been discriminating against people with HIV for years, perpetuating stigma.  This situation has changed a lot, and continues to change, but we know that many people of faith still find it hard to deal positively with HIV.  But it is a more specific issue that is of current concern.

Recent news stories have highlighted the role of religious healers (particularly from African Pentecostal and Charismatic Christian traditions) who have been encouraging people with HIV to stop treatment because they claim that God had healed them of HIV.  Many of these people had subsequently grown very ill, and some have died.  That this happens in many developing countries has been documented for some time. But there is now growing evidence that it is a problem here in the UK as well, where the fastest growing churches are African led and Pentecostal in flavour.

Whether because they are charlatans out for  money or (as I suspect in the majority of cases) well meaning but misguided, pastors and religious leaders in many traditions are claiming that God has healed a person, and then getting them to ritually dispose of their medication as a sign of their belief in their healing.  The consequences are a serious threat to the well being and even the life of the individual, and a potential threat to public health.

Stopping ARVs can lead to a rapid rebound in viral load, threatening a collapse in the immune system, but also rendering the individual much more infectious to sexual partners as well as to their unborn and newborn children. Furthermore sudden cessation of treatment can lead to viral drug resistance, limiting future treatment options for the individual and anyone they may subsequently infect.

There is plenty of evidence that faith has a part in the healing process.  We know that a sugar pill can have similar efficacy in stopping pain as an analgesic, if the patient believes it is a real pain killer.  The trust and faith that a patient places in a doctor, nurse or care team can have a big impact on their subsequent recovery. And it is true that people often cope better with debilitating conditions when they have been prayed for, or had other interventions that appear to have no basis in science, but in which the individual has faith. 

If, like me, your world view accepts a God who intervenes in the physical world to effect cures, the fact that prayer can affect health comes as no surprise.  But even if you only accept this as a pscyho-neuroimmunological response, it is still not to be discounted.  There is a mounting body of research on the impact that religious belief and practice (especially within a wider faith community) can have in have in preventing illness and promoting recovery, whether or not you accept the existence of miracles.

But to take the leap of taking someone off of medication with no medical verification is highly suspect.  Such an approach works on an assumption that God does not work through medical interventions and that only miraculous healings are valid.  This is, needless to say a position that is not taken by Christians, Muslims, Jews or other major faith groups, who have for centuries held that medicine is not only valid in treating illness, but that the skills and learning that facilitate it are a gift from God.

In short, this practice is based on a misunderstanding of both science and orthodox theology.  Not all Pentecostal and African lead churches follow this practice – the majority would always encourage people to take prescribed medication and only come off it on the advice of their doctor.  However, there are undoubtedly some churches that do encourage people to stop treatment in an unplanned and inappropriate manner. This is not unique to this particular Christian tradition either - there are anecdotal reports of Muslim faith leaders and traditional religious healers who are also encouraging treatment cessation, although the evidence of the scale of this in any religious community in the UK or elsewhere is still very sketchy. 

These practices are not something that can be challenged by just presenting the science behind ARVs and the evidence of their efficacy. The world view of these faith leaders does not give primacy to scientific evidence per se. Instead we need to start with challenging these religious leaders to rethink their theology from within their own faith and using their own scriptures, and this can only be done by other leaders from within their tradition.  If they can be encouraged by their peers to see that science and medicine are also God given, only then can we hope to persuade them that the science is worth looking at and to be trusted. 

At the same time, we need to help the health professions to understand the world view, belief systems and values of patients coming from a variety of faith backgrounds. Assuming that your patient shares with you the same understanding and values about health, illness, aetiology, medicine, drugs, compliance, etc. is dangerous. We need to help train health professionals to bridge this gap in understanding, and to get allies within the faith traditions to work alongside them to communicate with patients.

But above all, we must challenge these healers.  Some of them could be allies in our response to HIV, but at the moment are working against us.  But just condemning them will drive them further underground – instead we (faith leaders, faith based organisations, secular NGOs, governments) all  need to work together to tackle this head on.