Tag Archives: Disability Aid Abroad

Heightened HIV risk for people with disabilities

Inaccessible health services for people with disabilities (PWD), combined with social stigma and violence, contribute to high HIV risk – a gap that must be filled if the disabled are not to remain disproportionately vulnerable to HIV/AIDS, say health experts and activists.
“People with disabilities are at increased risk for exposure to HIV infection. HIV, in some cases in itself, can cause disability,” said Jill Hanass-Hancock, a senior researcher at the Health Economics & HIV/AIDS Research Division (HEARD), a South African research institute.

Globally there are an estimated one billion people living with a mental or physical disability, according to the UN World Health Organization. Many live in low- or middle-income countries and have poorer health and little formal education compared to the general population.

“We cannot talk about reducing HIV and its co-morbidities if you exclude this 15 percent of the world’s population,” added Hanass-Hancock, speaking at the AIDS 2014 Conference, hosted by the International AIDS Society in Melbourne on 20-25 July.

Data are scarce; most national HIV monitoring or surveillance programmes do not specifically track incidence among people with disabilities.

An 2014 meta-analysis of data and data from STD testing by STDAware.com from Sub-Saharan African countries showed that PWD are 1.3 times (1.48 for women) more at risk of contracting HIV than people without disabilities.

The 2014 “Gap Report” published by the Joint UN Programme on HIV/AIDS (UNAIDS) listed PWD as one of the key populations “left behind” in the global HIV response.

The no sex myth

Central to the struggle of PWD to gain inclusion in HIV response is breaking down the assumption that they are not sexually active and therefore do not need HIV services.

A 2014 Human Rights Watch (HRW) report on Zambia documented PWD describing how healthcare workers thought of them as “asexual”.

“People with disabilities are people first. They have the same needs and desires when it comes to relationships and being sexually active,” said Rosangela Berman Bheler, senior adviser at the UN Children’s Fund (UNICEF).

Others caution that PWD are at greater HIV risk due to other factors.

“PWD are four times more vulnerable to sexual abuse and violence. This increases their risk for HIV infection,” said Muriel Mac-Seing, HIV/AIDS protection technical adviser of Handicap International.

According to UNAIDS, “vulnerability, combined with a poor understanding and appreciation of their sexual and reproductive health needs, places people with disabilities at higher risk of HIV infection.” A 2012 article in The Lancet showed that people with mental and intellectual disabilities were at particularly high risk of abuse and violence.

Access barriers

Betty Babirye Kwagala, a medical counsellor for The AIDS Support Organization in Uganda, said the root of the heightened risk for people with disabilities can be seen in basic infrastructure.

“Services are not accessible – literally. Many health facilities do not have ramps or doors wide enough to accommodate people in wheelchairs,” said Kwagala who has had a physical disability since a car accident when she was 19. Five years ago she was diagnosed with HIV.

In her work as a medical counsellor, Kwagala has seen first-hand the lack of information and education materials suited for the needs of PWD, and a parallel lack of knowledge among health workers about how to communicate.

“How can a health worker who does not know how to use sign language communicate with someone who is deaf? They usually use gestures. But you cannot use gestures when prescribing medication,” said Kwagala.

Hanass-Hancock acknowledges bridging communication and understanding between health workers and PWD is critical to increasing the uptake of HIV services. But, she warns, such interventions need to take social conditions into consideration.

“People with disabilities often depend on a care-giver. This has a great impact on getting information privately and confidentially,” said Hanass-Hancock, adding that strategies such as SMS outreach and counselling for hearing impaired people, or easy-to-understand picture books for people with intellectual disabilities need to be developed.

Data gap

HRW’s research in Zambia, where one in 10 people has a disability, recommends a “twin-track approach starting with existing healthcare services more accommodating to PWD by simple things like widening doors”. PWD-specific interventions should be developed as well, they argue, and needs for either approach should be supported by improved data.

“We need to disaggregate the data to break it down by disability because all disabilities are different and will require different interventions. Then we can talk about creating tailor-fit services for them,” said Rashmi Chopra, a researcher on disability rights at HRW.

Lack of information – including about health and HIV – can leave PWD especially vulnerable inhumanitarian emergencies.

The Sphere Standards, which set out best practice in the delivery of humanitarian aid, encourage humanitarian actors to disaggregate data in their assessments, programming, and monitoring and evaluation tools by, among other things, noting if there is a disability involved.

However, Handicap International has critiqued the Sphere recommendation as insufficient to “mainstream a highly heterogeneous group such as [people with disabilities]”, and says recording the type of disability is crucial.

Despite the data gap, campaigners remain hopeful, saying the discussion has advanced from the days when the intersection between HIV and PWD was not even recognized.

“We must not forget that this is a dignity and human rights issue: most countries in the world – including donor countries – have ratified the UN convention on the rights of persons with disabilities (CRPD). It’s time for them to be responsible for their disabled citizens,” said Muriel Mac-Seing, HIV and AIDS protection and technical adviser for Handicap International.

CRPD, which has been ratified by 147 countries, mandates that governments “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.”
[Courtesy IRIN]

Maps of Malaria Hotspots to Save Lives

30 September 2014

Major Progress in Malaria Fight

Malaria is one of the world’s biggest killers. In 2010, an estimated 660,000 people lost their lives to the disease – most of them children in Africa, where a child dies from malaria every minute.

Until recently, however, it was difficult to access information about the locations of Africa’s malarial hotspots or how they are influenced by the weather there. Information about the continent’s malaria distribution was scattered across published and unpublished documents, often gathering dust in libraries.

But now, thanks to a digitised malaria mapping database that brings together all available malaria data, the disease no longer has the ‘blind killer’ status of past decades. MARA – Mapping Malaria Risk in Africa – was launched in 1996, with initial support of US$10,000 from the WHO’s Special Programme for Research and Training in Tropical Diseases to map information on malaria prevalence across Africa. The project’s first phase (1997-1998) aimed to produce an accurate atlas of malaria risk for Sub-Saharan Africa.

The project was set up as a pan-African enterprise, not owned by any specific organisation but coordinated by South Africa’s Medical Research Council, in the spirit of open collaboration.

A group of scientists, based at institutions across Africa and Europe, worked together on the project. Further funding came from donors including Canada’s International Development Research Centre, the Wellcome Trust, TDR and the Multilateral Initiative on Malaria (MIM), and the Roll Back Malaria Partnership. African institutions contributed through expertise, staff time and facilities.

Five regional centres – each using a standardised data collection system, were established across Africa. French-speaking West had an office in Bamako, Mali, while English-speaking West had a base in Navrongo, Ghana. Yaoundé, Cameroon hosted the Central Africa office; Nairobi, Kenya hosted the East Africa post and Durban in South Africa became home to the Southern Africa centre.

The project built expertise among local malaria control staff to enable them to reference the collected data, and it trained epidemiologists, medical doctors and researchers. In total it trained: 33 people to use GIS (geographic information systems) and databases, 23 to study climate change effects on the spread of the disease and 45 to interpret the results for people who might want to use them. Eight people got master’s degrees and PhDs on malaria.

The mapping project tracked down information on malaria prevalence from both published and unpublished sources to identify malarial mosquito hotspots, disease prevalence and the weather conditions that fuel transmission.

The MARA database contains more than 13,000 malaria prevalence surveys collected over 12,000 locations: with 37 per cent in Southern Africa, 33 per cent in West Africa, 25 per cent in East Africa and five per cent in Central Africa. The data remains live but no new material is being added.

The project then disseminated this information to national and international policymakers, distributing 3,000 poster-sized malaria distribution maps to malaria control programmes, health departments and research institutions in malaria endemic countries.

Whereas previously the absence of centralised records had made choosing appropriate solutions very difficult, the new data systems help countries identify transmission periods, implement control programmes and tailor control measures according to individual contexts – which also saves valuable resources. Rajendra Maharaj, director of the Malaria Research Unit at South Africa’s Medical Research Council, says the project has a strong legacy in the support it provides for the planning of malaria control programmes.

Konstantina Boutsika, an epidemiology and public health researcher from the Swiss Tropical and Public Health Institute (Swiss TPH), in Basel, Switzerland, where the database is now hosted, says the original maps are still available as downloads from the MARA website, as is a CD-rom developed by South Africa’s Medical Research Council to enable easy access to MARA project data.

Boutsika, who has been at MARA’s helm from 2006, says a project highlight is the first accurate assessment of the malaria burden in Africa, which has been made possible by advances in geographical modelling. “We can now give useful answers with regards to malaria,” she says.

MARA has made its results available through the technical reports published regularly on its website in both English and French.

The programme’s main beneficiaries have been identified as scientists, malaria control programme staff and local communities.

Maharaj says the scheme helps alleviate disease and death, especially in children and pregnant women, and has contributed to the efforts to reach the sixth Millennium Development Goal on combating HIV/AIDS, malaria and other diseases.

MARA was also one of 700 projects – selected for their exemplification of practical solutions to challenges – presented at the EXPO2000 world fair in Hanover, Germany. The programme owes its success to its strong team of investigators from participating organisations, Maharaj says: “The big lesson was inter-country collaboration, which is essential for malaria control”.

It has not all been smooth sailing, however. The main challenge was the collection of non-digitised data, explains Maharaj.

“But this was overcome by teamwork, whereby malariologists from all walks of life worked within ministries, academic and scientific institutions to source data that was stored in archive boxes, university libraries and government storerooms,” he says. And Boutsika adds that obtaining funding to sustain the programme was difficult because harmonising various databases required a heavy investment.

When funding for research ran dry in 2006, the project was given a new lease of life by the Bill & Melinda Gates Foundation and Swiss TPH, and moved from Durban to Basel, where phase II was launched. In 2009, the software team at Swiss TPH merged the MARA databases from phases I and II and developed a new web interface.

Since then, the MARA database has been in the public domain accessible to registered users and can be downloaded in different formats. Boutsika says researchers individually continue to collect data in Africa and use the MARA database as a sounding board.

[Courtesy AllAfrica News]

YAOUNDÉ, 26 March 2014 (IRIN) – Three new polio cases have been confirmed in Cameroon over the past two weeks, making it the country’s first outbreak since 2011 and causing alarm among health officials who link the virus’s spread to weak vaccine campaign coverage and displacement following violence in neighbouring northeastern Nigeria and the Central African Republic (CAR).
Cameroon has confirmed seven polio cases since 2013. Just one case is enough to instigate emergency country-wide vaccination measures under the national health policy. It last experienced a polio outbreak in 2009, the strain also identified in Nigeria and Chad.

The World Health Organization (WHO) has said the virus is at a “very high risk” of crossing borders, and one polio case of the same strain as in Cameroon has just been confirmed in Equatorial Guinea, which saw its last case in 1999.

Cameroon has put in place emergency measures to try to contain the virus, but weak or non-existent monitoring in the cross-border areas with Nigeria and CAR is seriously hampering any national efforts, said Paul Onambelle, a doctor at the Cité Vert district hospital in Yaoundé.

The estimated 100,000 refugees in Cameroon who have fled violence in Nigeriaand CAR make control efforts even harder, said Elisse Clarisse Onambany of the National Expanded Program on Immunization (EPI), who insists refugee children must be included in any immunization campaign, “which means the supply and resources needed must increase”, she said. Half of the refugee population is made up of children aged 11 or under, according to the health authorities.

Immunization in the Far North Region has been extended to include some of the children in the Nigerian refugee population, but thousands of children are still not being accessed because of insecurity in the border area with Nigeria, families being continually on the move, and difficult terrain, said Maria Enjema, a nurse at Far North district hospital of Maroua. “Despite continuous effort by the government to reduce the risk of polio in the north, it is very difficult for health workers to reach all the children, particularly those living along the borders with Nigeria because of the high risk [of Boko Haram-related violence] involved,” she told IRIN.

Meanwhile, ongoing polio campaigns have not always successfully reached the 90 percent of children (aged 0-5 years) needed to eliminate the disease. Some 43 percent of children in Cameroon have not received the three doses required for immunity, and 30 percent have never been vaccinated, said health officials.

The government and partners issue regular polio campaigns for children aged 0-5 in the three northern regions: Far North, North and Adamawa, where the risk of infection is high, but cultural resistance in these areas has limited campaign efforts, said Onambany. “People have different beliefs when it comes to maternal care. Some communities with various religious standpoints on the vaccine say the body is sacred and does not need any chemical to feel better, while some Cameroonians see it as some sort of a public plot.”

Onambany said lack of resources also limited ongoing polio campaign coverage.

Many parents do not understand or believe that three oral vaccinations are required and so they drop out after the first or second round.

Loveline Penda, a mother of five in Yaoundé, told IRIN: “The numbers of vaccines keep increasing and I doubt sometimes what the difference will be if my child does not take a vaccine. Sometimes I miss out but I don’t have to worry because I just believe that my child will be fine.”

The government must take cultural resistance and lack of understanding more seriously and “work to change people’s opinions and knowledge [on polio],” said Idris Haman, a researcher at the University of Yaoundé.


Cameroon health officials are expanding the region-specific immunization campaign nationwide in April, May and June 2014, with the help of partners, said Onambany.

The National EPI will also soon launch an intensive awareness-raising campaign about the vaccination.

“The upcoming campaigns will ensure that the quality of campaign is improved by reaching children three times. We will also intensify communication and sensitization effort so that no family is left untold of the dangers of missing out vaccinations,” Onambany told IRIN.

Over recent years the government has stepped up its surveillance and response to polio, working through networks of trained staff in district hospitals, as well as with community-based monitoring networks and NGO partners. Without support from development partners like WHO and the UN Children’s Fund (UNICEF), containment issues would be lagging far behind, said the EPI.

But unless surveillance steps up across borders, the risk that the polio virus could continue to spread remains a top concern, said Onambelle.

[Courtesy of IRIN Africa]

Mental Health in Africa

As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.

Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries’ agendas than other health issues.

“Everyone is putting their money in HIV, reproductive health, malaria,” says Sheila Ndyanabangi, director of mental health at Uganda’s Ministry of Health. “They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest.”

Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond,” Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. “Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets.”

According to a May report from the UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history. Yet it also acknowledges that they have done little to reach the world’s most vulnerable. The report says the MDGs were “silent on the devastating effects of conflict and violence on development” and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world’s most vulnerable will only be trapped in that cycle.

“The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention,” said Minas. “We’ve gone beyond that, and now understand we’re dealing with complex systems, where all of the important issues are very closely interrelated.”

Poverty and Mental Illness

In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

“The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term,” say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda – which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords’ Resistance Army – monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

“We need to be mentally healthy to get out of poverty,” Ethel Mpungu, the study’s lead researcher, told IRIN.

The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

“It really is around issues of development and economics – those things can no longer be ignored,” says Minas. “They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes.”

Putting mental health on the agenda 

As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME – the programme for improving mental health care – was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

“Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria,” said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. “But if people don’t care whether they live or die, they’re not going to be able to take advantage of these things that are offered.”

[Courtesy of IRIN]

Africa:Major Progress in Fight Against Malaria

24 December 2013
Geneva/ Washington DC — Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the World Malaria Report 2013 published by the World Health Organization (WHO).

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the ten countries with the highest malaria burden, and among children aged less than five years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria, which caused approximately 627 000 malaria deaths. An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under five and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. “Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths,” said Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “This is our historic opportunity to defeat malaria.”

[Courtesy AllAfrica News]

Africa: Mental Health Update

September 2013:
As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.

Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries’ agendas than other health issues.

“Everyone is putting their money in HIV, reproductive health, malaria,” says Sheila Ndyanabangi, director of mental health at Uganda’s Ministry of Health. “They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest.”

Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond,” Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. “Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets.”

According to a May report from the UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history.

Yet it also acknowledges that they have done little to reach the world’s most vulnerable. The report says the MDGs were “silent on the devastating effects of conflict and violence on development” and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world’s most vulnerable will only be trapped in that cycle.

“The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention,” said Minas. “We’ve gone beyond that, and now understand we’re dealing with complex systems, where all of the important issues are very closely interrelated.”

In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

“The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term,” say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda – which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords’ Resistance Army – monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

“We need to be mentally healthy to get out of poverty,” Ethel Mpungu, the study’s lead researcher, told IRIN.

The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

“It really is around issues of development and economics – those things can no longer be ignored,” says Minas. “They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes.”

As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME – the programme for improving mental health care – was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

“Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria,” said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. “But if people don’t care whether they live or die, they’re not going to be able to take advantage of these things that are offered.”

[Courtesy pf IRIN]

South Africa: HIV/Aids Vaccine Research Hope

13 November 2013

South Africa is the only country in the world where a large AIDS vaccine trial is being planned, as the global scientific community struggles to find a way to eradicate HIV.

Announced at this week’s international AIDS Vaccine Conference in Barcelona, the South African trial will involve the only vaccine shown to have some effect on the virus when it was tested among 16,000 people in Thailand. Released in 2009, the Thai trial’s results showed that HIV infection rates were 31 percent lower in participants who had received the vaccine than those who had not.

“On the eve of some of the most important vaccine trials, I am proud of the critical role that the people of South Africa will play,” said Ntando Yalo from the Networking AIDS Community Of South Africa, speaking at conference opening.

But the trial’s researchers are cautious.

Glenda Gray is the South African trial’s lead researcher and executive director of the Perinatal HIV Research at the University of the Witwatersrand. She told conference delegates that trial would begin by testing the Thai vaccine on a small group of people to confirm the vaccine worked as well in South African populations as it did in Thai participants.

“It might not show the same efficacy as in Thailand,” Gray said. “For example, South African women are bigger, and have different (levels of) exposure to the virus.”

With a national HIV prevalence rate of about 17 percent, South Africans are likely to have had much more exposure to the HIV than people in Thailand, where just one percent of the population is HIV-positive. The modest protection offered by the Thai vaccine might be too weak for South Africa, Gray added.

If the vaccine is effective within this smaller group, researchers will modify it for use against the predominant strain of HIV found in South Africa. This modified vaccine would be tested on about 240 people and, if successful, move to a larger trial involving about 5,400 people.

Chasing a “Machiavellian” virus

But the virus, described as “Machiavellian” by scientist Dr Scott Hammer at the start of the conference, continues to evade almost all attempts to eradicate it.

Johnson & Johnson Head of Research Dr Jerry Sadoff said he had been involved in creating 11 vaccines, none of which had taken more than seven years to develop. HIV was the exception, he said.

“You can make a career out of the AIDS vaccine – I have been researching it for almost 30 years,” he joked.

Most vaccines train the body to recognise and kill viruses by injecting people with small, non-toxic “deactivated” parts of the virus.

The body learns to make antibodies to fight the deactivated virus, so that when it is faced with infection from the live, dangerous virus, it is able to recognise and fight it.

But HIV’s constant mutation once it is the body makes it a moving target that is hard to pin down.

About two percent of people infected with HIV are able to contain the virus so that they don’t get sick. Scientists have been studying these “elite controllers,” including sex workers in South Africa, for years but still don’t yet know how their immune systems manage to do this.

Unlocking how our immune systems can produce “broadly neutralising antibodies” to fight HIV is “one of the holy grails of vaccine design,” according to Hammer.

But as scientists struggle to unlock the secrets of our immune systems and HIV, AIDS Vaccine Conference organisers have decided to move away from narrow focus on vaccines.

About 13 years after the first AIDS Vaccine Conference was held, the Global HIV Vaccine Enterprise will open next year’s conference to a wider range of scientists working on HIV prevention methods, including antiretroviral (ARV)-based vaginal or rectal gels – or microbicides – as well as other forms of ARV-based prevention and medical male circumcision.

This much larger gathering of HIV prevention experts will convene in Cape Town next year.

Organisers also raised the issue of a therapeutic HIV vaccine for the first time. Unlike the vaccine being tested in South Africa, a therapeutic HIV vaccine would aim to treat HV infections, not prevent them. A small therapeutic HIV vaccine trial is currently underway in the United States.

[Courtesy AllArica News]