WHO GLOBAL TUBERCULOSIS REPORT 2013

Tuberculosis (TB) treatment has saved the lives of more than 22 million people, according to the WHO "Global tuberculosis report 2013". The report also reveals that the number of people ill with TB fell in 2012 to 8.6 million, with global TB deaths also decreasing to 1.3 million.

The new data confirm that the world is on track to meet the 2015 UN Millennium Development Goals (MDGs) target of reversing TB incidence, along with the target of a 50% reduction in the mortality rate by 2015 (compared to 1990). A special "Countdown to 2015" supplement to this year’s report provides full information on the progress to the international TB targets. It details if the world and countries with a high burden of TB are “on-track” or “off-track” and what can be done rapidly to accelerate impact as the 2015 deadline approaches.

Key challenges

The report underlines the need for a quantum leap in TB care and control which can only be achieved if two major challenges are addressed.

• Missing 3 million – around three million people (equal to one in three people falling ill with TB) are currently being ‘missed’ by health systems. • Drug-resistant TB crisis – the response to test and treat all those affected by multidrug-resistant TB (MDR-TB) is inadequate. • Insufficient resources for TB are at the heart of both challenges. TB programmes do not have the capacity to find and care for people who are “hard-to-reach”, often outside the formal or state health system. Weak links in the TB chain (a chain that includes detection, treatment and care) lead to such people being missed.

“Quality TB care for millions worldwide has driven down TB deaths,” says Dr Mario Raviglione, WHO Director of the Global TB Programme. “But far too many people are still missing out on such care and are suffering as a result. They are not diagnosed, or not treated, or information on the quality of care they receive is unknown.” WHO estimates that 75% of the three million missed cases are in 12 countries.

On the second challenge, the problem is not only that the links in the MDR-TB chain are weak, but that the links are simply not there yet, the report suggests.

WHO estimates that 450 000 people fell ill with MDR-TB in 2012 alone. China, India and the Russian Federation have the highest burden of MDR-TB followed by 24 other countries.

While the number of people detected worldwide with rapid diagnostic tests increased by more than 40% to 94 000 in 2012, three out of four MDR-TB cases still remain without a diagnosis. Even more worrying, around 16 000 MDR-TB cases reported to WHO in 2012 were not put on treatment, with long waiting lists increasingly becoming a problem. Furthermore, many countries are not achieving high cure rates due to a lack of service capacity and human resource shortages.

A further challenge identified relates to the TB and HIV co-epidemic. While there has been significant progress in the last decade in scaling-up antiretroviral treatment for TB patients living with HIV, less than 60% were receiving antiretroviral drugs in 2012. This, the report urges, must improve.

Five priority actions The WHO report recommends five priority actions that could make a rapid difference between now and 2015.

• Reach the 3 million TB cases missed in national notification systems by expanding access to quality testing and care services across all relevant public, private or community based providers, including hospitals and NGOs which serve large proportions of populations at risk. • Address with urgency the MDR-TB crisis. Failure to test and treat all those ill with MDR-TB carries public health risks and grave consequences for those affected. High-level political commitment, ownership by all stakeholders, adequate financing and increased cooperation are needed to solve bottlenecks in drug supply and build capacity to deliver quality care. • Intensify and build on TB-HIV successes to get as close as possible to full antiretroviral therapy (ART) coverage for people co-infected with TB and HIV. • Increase domestic and international financing to close the resource gaps – now estimated at about US$ 2 billion per year – for an effective response to TB in low- and middle-income countries. Full replenishment of the Global Fund is essential, given that most low-income countries rely heavily on international donor funding, with the Global Fund providing around 75% of financial resources in these countries. • Accelerate rapid uptake of new tools – through technology transfer and operational research to ensure that countries and communities most at risk benefit from these innovations.

“The WHO Global TB report highlights the very big gains the global community has made in the fight against tuberculosis,” says Osamu Kunii, Head of the Strategy, Investment and Impact Division of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “We are now at a crucial moment where we cannot afford to let these gains go into reverse. We need the commitment of the international community to address the significant funding gap to fight this disease.” (2013)

http://www.who.int

Good practice guide: Community-based TB/HIV integration TB afflicts almost nine million people a year and kills more than one million, sparing noone – young, old, rich, poor, male or female. The burden of this age-old killer falls disproportionately on the people who have the fewest resources to cope with it. The poor, the very young, the elderly, people living with HIV, drug users, prisoners, and other groups who are marginalised by society represent the populations most affected. TB kills more women of reproductive age each year than all pregnancy-related conditions combined, and it is the fourth leading cause of death in girls and young women between the ages of 10 and 19 in low income countries. Despite the need to combat TB, most governments and their national TB programmes often lack the political will and the human and financial resources to do so effectively.

The global community has set an ambitious vision for itself: a TB-free world.

Getting there will require a massive, coordinated, and urgent mobilisation of all available resources – human, financial, and technical. There is a need for new drugs that can treat TB more quickly and effectively. We need to speed up the uptake of new, rapid diagnostic tests. We must redouble our efforts to find an effective vaccine to prevent TB. And health systems need to be strengthened to be able to deliver these new products efficiently to the people who need them most.

In this context, there is an urgent need to engage actively with the community-based organisations that are already so important in strengthening and supporting our formal health systems.

This guide by the HIV/AIDS alliance will provide practical information and tools needed to get started working on TB. It provides information on TB/HIV, highlights the kinds of TB/HIV activities community organisations can support, discusses how to engage effectively with the national TB programme and shows how to fund and monitor the TB activities.

It also includes an accompanying workbook to guide you through a step-by-step process to plan and implement effective activities. This guide is intended for use by CBOs, other civil society organisations (CSOs), and additional groups that work in HIV or other areas of health and want to incorporate TB activities into their programming. It is useful for organisations that are just starting to work in TB as well as those with more experience.

http://www.aidsalliance.org

TB afflicts almost nine million people a year and kills more than one million, sparing noone – young, old, rich, poor, male or female. The burden of this age-old killer falls disproportionately on the people who have the fewest resources to cope with it. The poor, the very young, the elderly, people living with HIV, drug users, prisoners, and other groups who are marginalised by society represent the populations most affected. TB kills more women of reproductive age each year than all pregnancy-related conditions combined, and it is the fourth leading cause of death in girls and young women between the ages of 10 and 19 in low income countries. Despite the need to combat TB, most governments and their national TB programmes often lack the political will and the human and financial resources to do so effectively.

The global community has set an ambitious vision for itself: a TB-free world.

Getting there will require a massive, coordinated, and urgent mobilisation of all available resources – human, financial, and technical. There is a need for new drugs that can treat TB more quickly and effectively. We need to speed up the uptake of new, rapid diagnostic tests. We must redouble our efforts to find an effective vaccine to prevent TB. And health systems need to be strengthened to be able to deliver these new products efficiently to the people who need them most.

In this context, there is an urgent need to engage actively with the community-based organisations that are already so important in strengthening and supporting our formal health systems.

This guide by the HIV/AIDS alliance will provide practical information and tools needed to get started working on TB. It provides information on TB/HIV, highlights the kinds of TB/HIV activities community organisations can support, discusses how to engage effectively with the national TB programme and shows how to fund and monitor the TB activities.

It also includes an accompanying workbook to guide you through a step-by-step process to plan and implement effective activities. This guide is intended for use by CBOs, other civil society organisations (CSOs), and additional groups that work in HIV or other areas of health and want to incorporate TB activities into their programming. It is useful for organisations that are just starting to work in TB as well as those with more experience. (2013)

http://www.aidsalliance.org

1. Oktober 2013 - Das Neue Vergabeverfahren des Globalen Fonds (New Funding Model/ NFM) wird ab Januar 2014 voll umgesetzt. Dazu wird der Verwaltungsrat des Fonds bei seiner anstehenden Sitzung im November 2013 einige letzte Feinjustierungen vornehmen. Das ist gut so. Denn: Genf, wir haben in Problem!

   Das neue Vergabeverfahren: Eine bittere Pille für Einige

Die wohl größte Veränderungen durch das NFM sind die neu entwickelten Kriterien nach denen Länder ihre Finanzierung beantragen können. Damit will der Globale Fonds einer gewissen historischen und als falsch wahrgenommenen Unwucht im Fluss seiner Ressourcen entgegenwirken. Kern des NFM ist daher eine Berechnung, die festlegt, in welcher Höhe den Ländern Finanzmittel zustehen. Diese Rechnung umfasst epidemiologische Daten zu HIV/AIDS, Tuberkulose (TB) und Malaria sowie eine Schätzung, wie viel ein Land selbst zur Bekämpfung der Krankheiten beitragen könnte. Diese basiert auf den durch die Weltbank vergebenen Klassifizierungen nach dem Durchschnittseinkommen der Bevölkerung. In der Tat kann diese Arithmetik den ärmsten Ländern Afrikas und Asiens helfen, mehr Ressourcen zur Bekämpfung ihrer teilweise massiven Probleme zu bekommen. Allerdings gibt es Kritik am Modell: So sei eine Entscheidung, die vor allem auf nationalen Krankheitsdaten und Einkommen basiert wenig geeignet, abzubilden wo genau die größten Probleme wirklich lägen.

Ein großes Problem entsteht dadurch beispielsweise für Menschen in Russland oder anderen so genannten Ländern Mittleren und Höheren Einkommens in der Region, die in Expertenkreisen als EECA bezeichnet wird: Osteuropa und Zentralasien. [1] Die Region ist bekannt für ihre massiven Probleme mit resistenten Tuberkulosestämmen und darüber hinaus der einzige Ort der Erde, wo die Ansteckungsrate von HIV weiterhin ansteigt. Viele Länder stehen so genannten „konzentrierten Epidemien“ gegenüber: HIV und TB verbreiten sich vor allem – noch – in so genannten Hochrisikogruppen. Im Zentrum der Epidemien stehen oftmals Drogengebraucher/innen, Sexarbeite/innen oder andere – aus sozialen, geografischen oder anderen Gründen marginalisierte – Gruppen. Trotz eventuell vorhandener Finanzmittel im Land gibt es zumeist wenig bis gar keine Gesundheitsdienstleistungen für diese Menschen. Der politische Wille fehlt. So kommt es, dass nur 23% der bereits an HIV/AIDS-Erkrankten Zugang zu Therapie haben. Im südlichen Afrika liegt der Anteil der Behandelten doppelt so hoch. Ein Grund: die Regierungen der Staaten ignorieren bei manchen Randgruppen das Menschenrecht auf Zugang zur Gesundheitsfürsorge. Dies – und nicht der Mangel an staatlichen Ressourcen – hindert die Menschen am Zugang zu Prävention, Behandlung und Pflege.

Der Globale Fonds: Hoffnung für marginalisierte Gruppen

Von Beginn an hat der Globale Fonds eine zentrale Rolle bei der Bekämpfung der HIV- Epidemie unter Drogengebrauchern gespielt. Sogenannte Harm Reduction Programme gehören zu den erfolgreichsten Methoden, die Gesundheit der Betroffenen zu schützen und Ansteckungen zu vermeiden. Zentrales Element ist das Angebot von sterilen Einspritzbestecken an Drogengebraucher. Alleine zwischen 2002 und 2009 hat der Globale Fonds fast eine Viertelmilliarde Euro für solche Programme in 22 Ländern der EECA-Region zur Verfügung gestellt. [2] Damit war er der wichtigste Geldgeber und hat den Ausbau von Harm Reduction Programmen ermöglicht. In einer Region in der Drogengebraucher bisher kriminalisiert und ausgeschlossen waren, förderte der Fonds die Menschenrechte und volle Beteiligung der Betroffenen.

Nach der Logik des Neuen Vergabeverfahrens wird sich das jedoch bald ändern: Da Länder Mittleren und Höheren Einkommens zumeist eine im Vergleich zu anderen Regionen relativ geringe Gesamtkrankheitslast, aber eine gemäß Weltbankkriterien hohes nationales Einkommen haben, wird ihre Finanzierung durch den GFATM drastisch gekürzt werden. Experten aus der Region EECA befürchten Einschnitte von bis zu 50%. Auch die existierende Regelung, dass sich in Ausnahmefällen auch Nichtregierungsorganisationen direkt mit Finanzierungsanfragen an den Globalen Fonds wenden können, steht bei der anstehenden Sitzung des Verwaltungsrats zur Disposition.

Somit könnten überall dort, wo der politische Wille zum Schutz der eigenen Bevölkerung fehlt, die Nebenwirkungen des Neuen Vergabeverfahrens tödlich sein.

Deutschland kann helfen

Deutschland verfügt über Erfahrungen im Bereich Harm Reduction zu Hause und gute Kontakte in einigen der betroffenen Länder. Außerdem ist die Bundesregierung einer der größten Geber des Globalen Fonds. Es ist wichtig die negativen Konsequenzen des NFM für Hochrisikogruppen in scheinbar wohlhabenden Ländern intensiv zu analysieren. Die Betroffenen – egal ob in EECA, oder sonst wo – müssen unterstützt werden. Diese Verpflichtung ergibt sich aus den Menschenrechten, aus Abwägungen zum Schutz der öffentlichen Gesundheit und ist schlussendlich auch eine strategische Frage für Deutschland: Osteuropa und Zentralasien sind gar nicht so weit weg von Berlin.

Tobias Luppe arbeitet bei Oxfam und vertritt Nichtregierungsorganisationen in der deutschen Regierungsdelegation zum Verwaltungsrat des Globalen Fonds.

Ivan Varentsov ist Regionalkoordinator des Civil Society Action Team beim Eurasian Harm Reduction Network (EHRN)

http://blog.oxfam.de

he authors conducted a systematic literature review to identify gender-transformative interventions with impacts on prevention of HIV or sexually transmitted infections (STIs); reduction of violence against women; decreased risky sexual behavior; and/or changes to inequitable gender norms and attitudes.

The evidence suggested that gender-transformative programs may increase protective sexual behaviors, improve attitudes, prevent gender-based violence, and reduce STI incidence, and should be scaled up; however, more rigorous research is needed. The authors examined 2,560 articles and found 15 studies that met the inclusion criteria, which included interventions that were mainly small group discussions, and only three randomized control or cluster trials. Most interventions were implemented in Africa and the United States, followed by Asia and Latin America. Only one study, assessing HIV/STI outcomes in South Africa, had no effect on HIV incidence, but reduced herpes simplex virus-2 among men. The overall findings gave partial evidence of positive effects on risk reduction, e.g., condom use, with some showing significant improvement. Interventions were associated with reductions, some significant, in violence against women; and some interventions influenced attitude changes about gender roles and masculinity. The authors concluded that gender-transformative interventions should be scaled up to complement programs to prevent HIV and violence, in addition to other types of interventions, e.g., structural or community-level programs, yet additional trials and long-term studies are needed for rigorous evaluation. (2013)

http://download.springer.com

The authors investigated associations among individual-, household-, and community-level factors and HIV testing uptake among men in eight African countries, using Demographic and Health Surveys (DHS) (from 2001-2006).

Despite efforts to increase HIV testing in the African region, the proportion of men who report ever having been tested for HIV remains low. Research has focused on individual level determinants of women’s testing however little is known about factors associated with men’s testing behavior. This analysis investigates community influences on HIV testing among men ages 15–54, using Demographic and Health Survey (DHS) data from Chad, Ghana, Malawi, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe. Multilevel models were fitted in each country for the outcome of ever receiving an HIV test.

The findings showed that a variety of site-specific community-level factors help to explain factors affecting men’s testing behavior. The proportion of men who reported having ever testing for HIV ranged from 7 percent to 29 percent, in Chad and Uganda, respectively. At the individual level, more education and media exposure were positively associated with HIV testing. Factors associated with increased testing included higher levels of education among both men and women; larger proportions of men employed; greater knowledge of HIV prevention measures among both men and women; and larger proportions of men reporting condom use at last sex. Associations between testing and other factors were mixed. For instance, the link between average number of sexual partners and testing behavior varied; in Zambia, Zimbabwe, and Nigeria, those with more sexual partners were more likely to report HIV testing. For Nigerian men, there was positive association between HIV testing and living in a community with higher tolerance for violence against women; however, this association was negative in Uganda. Further research on the determinants of testing uptake is critical, particularly in sub-Saharan Africa where heterosexual adults are at high HIV risk. (2012)

http://download.springer.com

1. October 2013 - The Global Fund adopted a Gender Equality Strategy (GES) in 2008. At the time, the mere existence of the strategy was seen as symbolically important. However, since then, evaluation after evaluation has shown that little progress has been made on implementing the strategy.

Participants at a workshop in Geneva in July 2013 said that the strategy was “commendably progressive on paper, especially in the world of international development,” but that the GES has not been adequately costed or budgeted, that its implementation has been limited, and that no adequate communications strategy has been rolled out to explain or promote it.

As we reported in a separate article, workshop participants said that “far too few grant agreements specify or fund gender-sensitive or gender-transformative activities, and where they do, progress is not tracked.”

According to a report on the workshop, the Global Fund is preparing a GES implementation plan. This would be the second such plan. A four-year GES Plan of Action was developed in 2009, but few people knew much about its contents. The entire plan was never released publicly; a summary of the plan was included in a report prepared for the Third Replenishment.

For inspiration, the drafters of the new implementation plan need look no further than the 2008 GES Strategy which said that “the Global Fund will champion and fund proposals that scale up services and interventions that reduce gender-related risks and vulnerabilities to infection … and address structural inequalities and discrimination.” The GES Strategy listed nine examples of interventions it said it would champion:

1. Take into account the different needs and vulnerabilities of women and men, girls and boys, and of men who have sex with men, transgender, bisexual and lesbian populations. 2. Provide for the specific health needs of women and girls, men and boys, and reduce barriers that inhibit equitable access to prevention, treatment and care (including lack of specialised, targeted and integrated health services, user fees, discriminatory practices and attitudes by healthcare workers, etc.). 3. Address factors that impose disproportionate burdens of care and support on women and the elderly and put in place programs to mitigate these burdens. 4. Reduce the risks and vulnerabilities that increase women’s and girls’ susceptibility to infection by the three diseases, and mitigate the impact for those already infected (Including, gender-based violence, female genital mutilation, early or forced marriage, lack of access to education, wife inheritance, increased risk due to pregnancy, discrimination in employment, etc.). 5. Focus on women who face challenges in being able to access health services, many of whom are at-risk of HIV infection or are particularly marginalised such as sex workers, people who inject drugs, lesbian, bisexual or transgendered women, partners of bi-sexual men. 6. Include programs that empower women and girls so they can protect themselves, by having access to sexual and reproductive health care (SRH), access to female-controlled prevention measures (female condom, negotiating condom-use, etc.), and access to education. In this context the Global Fund will champion activities that strengthen SRH-HIV/AIDS service integration. 7. Target the structural issues that increase the vulnerability of women, girls, men who have sex with men, transgender, bisexual and lesbian populations, including sociocultural, legal, political and economic inequalities and discrimination. 8. Ensure that men and boys are targeted with appropriate interventions in prevention, treatment and care activities. 9. Use transformative approaches than involve and or engage men and young boys in the gender inequalities fight.

It seems to me that we already have the recipe. If we could implement these kinds of interventions through Global Fund grants, we’d be well on our way to making a difference. (by David Garmaise, aidspan)

http://www.aidspan.org

1. October 2013 - This recent study shows that, alarmingly, young people are more likely to drop out of HIV care, compared to other age-groups, and that youth-oriented services improve retention rates.

In the programme Access, Services and Knowledge (ASK): What young people want, what young people need, STOP AIDS NOW!, as part of a coalition of youth empowerment organisations, aims to address the specific needs and challenges of young people living with HIV. STOP AIDS NOW! not only advocates for youth friendly services to improve retention rates of young people. We also want to see inclusion of treatment literacy in sexuality education and HIV prevention programmes, now often omitted. It can be challenging for young people to take treatment every day at the right time. A good support system by friends, peers, family and health services is essential to create an enabling environment for youngsters to adhere to their treatment.

Patients aged between 15 and 24 years are significantly more likely to drop out of HIV care compared to individuals in other age groups, research published in the online edition of AIDS shows. The research was conducted in four sub-Saharan African countries and involved patients newly entered HIV care or initiating antiretroviral therapy (ART) between 2005 and 2010. Patients in the 15- to 24-years age group were significantly more likely to be lost to follow-up compared to both younger and older age groups.

"This study provides important insights on program outcomes previously not sufficiently described," comment the authors. "In addition to confirming attrition 1 year after starting ART...we found that youth were substantially more likely than young adolescents and older adults to die or be lost to follow-up before initiating ART."

Approximately 20% of all HIV-positive people in sub-Saharan Africa are aged between 15 and 24 years (youth), and 40% of incident infections are in this age group. Previous research has shown that there is a high attrition rate among young people in sub-Saharan Africa in the first year after starting HIV therapy.

An international team of investigators wanted to see if this was also the case for young people newly entering HIV care.

They therefore collected data from 160 HIV clinics in Kenya, Mozambique, Tanzania and Rwanda. Between 2005 and 2010, these clinics provided care to 312,335 patients who newly entered care or who started treatment.

The investigators compared attrition rates (death or loss to follow-up) between youth and other age groups (10 to 14 years; 25 to 54 years; 55 years and over) in the first year after entry into HIV care pre-ART and in the first year after the initiation of HIV therapy. The factors associated with loss to follow-up were also explored.

Young people account for 17% of patients entering care and 10% of patients starting HIV therapy. Young people had higher median CD4 cell counts when entering care compared to other age groups (383 cells/mm3 vs 348 cells/mm3 [10 to 14 years]; 251 cells/mm3 [25 to54 years); 232 cells/mm3 [55 years and over]).

Analysis of patients startingHIV therapy showed that patients aged between 15 and 24 years had a median CD4 cell count of 184 cells/mm3, which was lower than patients aged between 10 and 14 years (204 cells/mm3) but higher than individuals in the older age groups (161 cells/mm3 and 169 cells/mm3, respectively).

Overall, approximately a third (32%) of pre-ART patients had died or were lost to follow-up in the first year after entering HIV care. The rate of attrition among young patients was 48%.

The rate of attrition in the first year after starting HIV therapy was 17% overall and 27% among young people. The vast majority of cases of attrition, both before (98%) and after (87%) the initiation of ART, among patients aged between 15 and 24 were due to loss to follow-up rather than death.

"Youth may be becoming LTF [lost to follow-up] for reasons other than illness," comment the authors. "High levels of migration for work, and lack of belief in the benefits of attending clinic and initiating ART among youth, particularly if healthy and not yet eligible to initiate ART, are two possible explanations."

Young people were between 50 and 100% more likely to die or drop out of HIV care before and after treatment, compared to other age groups.

Attrition rates among young people pre-ART were significantly lower among pregnant women than in men. Among young people starting therapy, both pregnant and non-pregnant women had a lower risk of attrition compared to men. The provision of youth-friendly services reduced the risk of loss to follow-up after starting HIV treatment.

Young people attending clinics providing sexual and reproductive health services, including condom provision, had a significantly lower risk of attrition (AHR = 0.47; 95% CI, 0.32-0.70), as did 15- to 24-year-olds attending clinics that offered adolescent support (AHR= 0.73; 95% CI, 0.52-1.0).

"We suggest that youth-friendly interventions be implemented and evaluated for their effectiveness in improving retention," conclude the investigators.

http://www.stopaidsnow.org

Geneva, 11 October 2013 - The Global Fund to Fight AIDS, Tuberculosis and Malaria has appointed Kate Thomson, a leader in global health and development with nearly 30 years of AIDS activism, as Head of the Critical Enablers and Civil Society hub, a new position that underlines the Global Fund’s strengthened efforts to promote human rights and deeper partnership with civil society.

Thomson, who joins the Global Fund from UNAIDS, brings extensive experience in policy and advocacy, having worked within civil society organizations and multilateral institutions with a particular emphasis on people living with HIV and communities at higher risk.

“Kate is a passionate leader with unrivalled expertise and commitment,” said Marijke Wijnroks, Chief of Staff of the Global Fund. “No one is better suited than Kate to help lead the Global Fund’s drive for effective responses that are grounded in human rights and centered on communities.”

Osamu Kunii, Head of the Strategy, Investment and Impact division, said that the agreement by UNAIDS to release Thomson for an extended period reflects the close partnership, collaboration and commitment between the two organizations.

“Kate brings tremendous experience to our team,” said Osamu Kunii, Head of the Strategy, Investment and Impact Division. “We’re very grateful that she was able to join us.”

Thomson joined UNAIDS in 2005 and as Chief of Community Mobilization she guided their work with civil society, brokering partnerships to promote and enhance the role of communities and strengthen the AIDS response in countries and globally. Her work entailed close collaboration with the Global Fund, as well as multilateral and bilateral partners, and a broad and diverse range of civil society organizations, from grass-roots groups to large international non-governmental organizations. Thomson previously worked for the Global Fund from 2002-2004 as Manager of Civil Society Relations, and was one of its first employees.

Her work in community mobilization began in the 1980s when Thomson helped establish Positively Women, the first organization of women living with HIV in the UK and one of the first globally. She subsequently played a role in the creation of a number of other global, regional and country-level networks of people living with and highly impacted by HIV. She has a master’s degree in English from Goldsmith College, London.

http://www.theglobalfund.org

Von 2000 bis 2010 wurden in Nicaragua in 11 Jahren 1.3 Mio. Geburten registriert. 367‘095 der Mütter waren adoleszent, davon 172‘535 jünger als 14 Jahre. Mit anderen Worten, 13% der Babys haben eine Mutter, die weniger als 14 Jahre zählt. Die schwangeren Mädchen wiederholen den Zyklus der Armut, denn sie werden Mutter, bevor sie biologisch reif sind.

Oft sind sie Opfer von Vergewaltigung, ja von sexueller Gewalt in der Familie. Obwohl die Antikonzeptiva in den Gesundheitszentren gratis sind, wagen die wenig gebildeten Mädchen nicht, danach zu fragen, da sie die Kritik der Familie, aber auch anderer DorfbewohnerInnen fürchten. Diverse konservative evangelische Sekten sind in Nicaragua aktiv und verbieten jegliche Verhütungsmassnahmen.

Unsere Projektpartnerinnen setzen sich ein für die Verbesserung der Basisgesundheitsversorgung und für die Stärkung des Selbstwertgefühls und der Rechte der Frauen und Jugendlichen und kämpfen gegen die häusliche und sexuelle Gewalt.

Frauenkollektiv 8 de Marzo Managua

Das in Managua, Esquipulas und Matagalpa aktive Colectivo de Mujeres 8 de Marzo setzte sich 2012 noch verstärkt mit öffentlichen Kampagnen für den Schutz der Rechte der Frau, insbesondere gegen die Gewalt an Frauen und für die Legalisierung der therapeutisch indizierten Abtreibung ein. »No estoy sola… de tu violencia me voy a defender«, lautete der Slogan, mit dem die Kampagne in die Strassen getragen wurde: »Ich bin nicht allein… ich werde mich gegen deine Gewalt wehren«. Vorträge, Aufführungen der Theatergruppe, Diskussionen in den zwölf Frauengruppen, Demonstrationen, Flugblätter und beschriftete Hemden werden eingesetzt, um über die Rechte der Frauen zu informieren.

Die von medico finanzierte Pflegefachfrau Martha Arauz organisiert regelmässige Jugendtreffen. Aufklärungsarbeit, Information über Verhütungsmethoden, über die Gefahren der Drogen und sexuell übertragbare Krankheiten sowie Anleitung von Rollenspielen gehören zu ihrem Aufgabenbereich. Zudem untersucht und begleitet Martha Arauz Frauen, die im Refugium Schutz vor sexueller und häuslicher Gewalt suchen, bei medizinischen Problemen.

Frauenkollektiv Masaya

Die Zusammenarbeit mit dem Erziehungs- und dem Gesundheitsministerium konnte im Verlaufe des Berichtsjahres verbessert werden. Es wurde ein Zusammenarbeits-Vertrag erarbeitet und unterzeichnet.

Die Sozialarbeiterinnen des Frauenkollektivs sind in den Schulen willkommen mit dem Thema Vorbeugung der sexuellen Gewalt gegen Frauen und Jugendliche. Auch die Arbeit der 13 Alphabetisatorinnen wird geschätzt. Während acht Stunden pro Woche erlernen Frauen in Gruppen Lesen und Schreiben, aber auch Rechnen. Frauenspezifische Themen, Kenntnisse über die Rechte der Frau und über den Körper nehmen einen grossen Stellenwert ein. Eine Ausbildungsbestätigung wurde den insgesamt 147 erwachsenen Schülerinnen versprochen.

Unter dem Motto Verhütung von Schwangerschaft in der Adoleszenz hielten die Verantwortlichen des Frauenkollektivs öffentliche Vorträge in verschiedenen Dörfern. Die Kampagne zur Verhütung des Gebärmutterhalstumors, der HIV-Übertragung und des Brusttumors wurde gemeinsam mit dem Gesundheitsministerium weitergeführt. Die individuelle psychologische Betreuung von Opfern häuslicher und sexueller Gewalt, die Arbeit mit den Frauenselbsthilfegruppen, die Jugendarbeit mit regelmässigen Treffen in Kleingruppen und der Organisation von grossen Tagungen für alle Jugendlichen sind weitere Aufgaben des Frauenkollektivs. (Auszug aus dem Jahresbericht Nicaragua 2012)

http://www.medicointernational.ch

An estimated 33 million people are living with HIV globally. About 22 million people, or 67 percent of the worldwide total live in Sub-Saharan Africa, where the pandemic is most severe. Almost one third of all new HIV infections and AIDS related deaths occur in this region. Meanwhile, more than 15 million children are orphans due to AIDS.

In 2001, World Vision launched the Hope Initiative to respond to the HIV pandemic focusing on a community led response. In Africa, these communities have women, men, girls and boys who are making remarkable contributions in response to HIV and AIDS.

This book honours those people.

Brochure published in 2010.

http://wvi.org

http://www.aidsfocus.ch

Tansania | World Vision Schweiz

Obwohl sich die Ausbreitung von HIV/ AIDS in den letzten Jahren reduzierte und Unwissenheit und Vorurteile der Bevölkerung im Projektgebiet Kagera in Tansania weitgehend abgebaut wurden, werden die Folgen der Pandemie noch jahrzehntelang zu spüren sein.

Besonders schwierig ist die Situation der Kinder. Erkranken und sterben deren Eltern, bleiben die Kinder der Schule fern, um zu Hause die Familie am Leben zu halten. Weder Kräfte noch Wissen reichen aus, um den Haushalt erfolgreich weiter zu führen. Sind weder Verwandte noch Nachbarn in der Lage einzugreifen, müssen die Kinder bereits in jungem Alter die Verantwortung für die ganze Familie übernehmen.

World Vision wirkt dieser Not entgegen und engagiert sich besonders in den drei Bereichen:

• Ausbildung: 330 Waisenkindern wird der Schulbesuch ermöglicht. Sie erhalten Schulmaterial wie Bücher, Hefte, Schreibzeug und Schuluniformen. World Vision übernimmt die Schulgebühren für den Besuch der Sekundar- oder Berufsschule (die Primarschule wird vom Staat finanziert). Eine handwerkliche Berufsausbildung stellt die Weichen für eine eigenständige Zukunft.

• Aufklärung: World Vision informiert die Bevölkerung in Seminaren über die Gefahren von HIV/AIDS und den richtigen Umgang mit der Krankheit. Betroffene werden psychosozial betreut.

• Materielle Hilfe: Härtefälle werden mit Haushaltutensilien und Nahrungsmitteln versorgt.

• Nachhaltigkeit: Unterstützt Waisenkinder, ihre Pflegeeltern, und HIV betroffenen Menschen durch Ausbildung in Betriebswirtschaft und Kredite für Kleinbetrieb die zur zukünftige selbst-Unterstützung führen.

World Vision ist seit 1993 im Gebiet Kagera tätig. Das Rückgrat der Arbeit gegen HIV/AIDS bilden nebst den Fachleuten die freiwilligen Helfer und Berater. In jedem Dorf werden mehrere Personen ausgebildet, die verschiedene Aufgaben in ihrem engeren Umfeld übernehmen. So kümmern sie sich um die Aufklärung der Bevölkerung, machen Hausbesuche, pflegen die Kranken und bieten den Waisenkindern praktische, psychosoziale und materielle Unterstützung an.

Die enge Zusammenarbeit mit schulischen Institutionen, der Bevölkerung und örtlichen Behörden lässt einen anhaltenden Erfolg erwarten.

Oktober 2013

http://www.worldvision.ch

Bangladesch | World Vision Schweiz

World Vision Bangladesh’s Mymensingh HIV and AIDS prevention Project works in 4 areas including the municipality of Mymensingh and three other sub districts in the Mymensingh and Tangail district, which are both border areas to India.

The project is located in a densely populated area where many migrant workers are moving between the countries. Most of the target people are living in slum areas with people have high risk behaviors, are illiterate, economically insolvent and struggling for survival in addition to the high prevalence of HIV and AIDS transmission. These target populations include groups with high risk behaviour, such as brothel-based and floating sex workers, rickshaw pullers, transport workers, drug addicts, adolescent girls, day labourers, youth, college students and community women.

The project has a goal to prevent further spread of HIV & AIDS among the high-risk behavior population of Mymensingh area. Emphasis is given to STI treatment & control, condom promotion, safe blood donation campaign, reproductive health issues and stigma & discrimination. Each of the four projects utilize a variety of awareness activities to achieve this. They include mass awareness campaigns, rallies, orientations and seminars on reproductive health issues especially for adolescents, quiz competition amongst the youth, video show orientations for target groups, workshops for support groups, and campaigns on safe and voluntary blood donation in addition to the promotion and running of STI (sexually transmitted infections) service center. The distribution of communication and education materials on HIV, AIDS and STI prevention is also a big component. Emphasis is as well given to referral of clients to voluntary testing centers of two like-minded organizations. These two organizations are providing counseling, testing and free condom distribution. Strong linkages and networking with local partners and stakeholders such as, the Civil Surgeons and Mymensingh Medical College amongst others who cooperate in positively influencing the prevention program. (November 2011)

http://www.worldvision.ch

Mauritanien | World Vision Schweiz

Die Gesundheitsversorgung in Mauretanien ist ungenügend und der Grossteil der Bevölkerung hat keinen Zugang zu moderner Diensten. Gleichzeitig ändern sich im Zug der stets wachsenden Verstädterung die kulturellen Normen und Verhaltensweisen. Es fehlt an Aufklärung und Orientierung. Themen wie Drogen, Familienplanung, HIV und AIDS und andere Krankheiten werden kaum angesprochen. Dies sind jedoch bedeutende Probleme des Landes. World Vision thematisiert diese mit Hilfe des Gesundheitsmobil „Caravane de l’Espoir“ und Medien-Kampagnen (Radio und TV). Diese Art von Aufklärung ist äusserst effizient und effektiv, da zwei Drittel der Bevölkerung weder lesen noch schreiben können.

Präventionsarbeit mit dem Gesundheitsmobil

Mitarbeiter und Volontäre der NGO „Nedwa“ fahren in einem grossen Lastwagen, der zu einer Bühne umgebaut werden kann, durch das Land und sensibilisieren die Bevölkerung durch Theater (Theatergruppe mit 25 Personen), Musik, Filme und Diskussionen über Themen wie HIV- und AIDS-Prävention, das Zusammenleben mit AIDS-Kranken, Familienplanung, Mädchenbeschneidung und andere Gesundheitsfragen. In Zusammenarbeit mit der NGO „santé sans frontière“ werden nach einem Auftritt freiwillige HIV-Tests angeboten und durchgeführt, die Kenntnis des eigenen Status stellt einen entscheidenden Schritt im Kampf gegen AIDS dar. Die „Caravane de l’Espoir“ erreicht unter anderem Tausende von Menschen in abgelegenen Gegenden. Durch die Kampagnen werden vor allem viele der 60 Prozent Jugendlichen des Landes angesprochen.

World Vision Mauretanien ist seit 1984 mit Nothilfe- und Entwicklungsprojekten tätig. Das Gesundheitsprojekt spezialisierte sich ab 1987 auf Medien-Kampagnen und Gesundheitsaufklärung. Später entstand sogar ein Studio zur Herstellung von audio-visuellem Material, dessen Leiter über vielschichtige Entwicklungserfahrung verfügt. Inzwischen ist aus dem Gesundheitsprojekt die NGO „Nedwa“ entstanden, welche weiterhin sehr eng mit World Vision kooperiert. (November 2011)

http://www.worldvision.ch

Südafrika | Fastenopfer

Südafrika ist auch 19 Jahre nach Ende der Apartheid geprägt durch grosse wirtschaftliche und soziale Ungleichheit. Die Ärmsten stammen vorwiegend aus der schwarzen und farbigen Bevölkerung. Die Einkommensmöglichkeiten für die Armen sind wegen hoher Arbeitslosigkeit und nicht gesichertem Zugang zu Land gering.

Viele leben als saisonale Tagelöhner und Tagelöhnerinnen oder von der Fürsorge. Dementsprechend sind die sozialen Probleme und der finanzielle Druck auf Familien gross: Hohe Kriminalität und sexuelle Gewalt gegen Frauen und Kinder durch überforderte Männer, Prostitution und eine extrem hohe HIV/Aids Rate von 18 Prozent.

Die eigene Lebenssituation aktiv verändern

Pacsa ist eine ökumenische Organisation, die Quartiervereine, Frauen- und Jugendgruppen sowie Glaubensgemeinschaften bei ihrer Selbstorganisation begleitet, damit diese ihre Lebenssituation aktiv verändern können.

Chancengleichheit von Frauen und Männern fördern

Dazu gehört die Vermittlung von Kenntnissen zum Umgang mit sexueller Gewalt und HIV/Aids. Informationsveranstaltungen werden in Kirchen und bei öffentlichen Anlässen gehalten. Zusätzlich werden theologische Texte zu HIV/Aids sowie sexueller Gewalt publiziert und verbreitet. Die von Pacsa begleiteten Gruppen lernen, eigene Projekte zu entwickeln, die Geschlechtergerechtigkeit fördern und HIV/Aids zur Sprache zu bringen. Pacsa bietet auch Weiterbildungen für lokale Kirchen an, wie geschlechtergerechte Strukturen und Aufgabenteilungen thematisiert und eingerichtet werden können.

Von Mann zu Mann

Die Partnerorganisation unterstützt Männergruppen bei der Vernetzung und deren Öffentlichkeitsarbeit. Pacsa ermöglicht Männern, sich mit Männlichkeit im afrikanischen Kontext auseinanderzusetzen und entwickelt mit ihnen gemeinsam eine männliche Spiritualität.

http://www.fastenopfer.com

Inputs of the aidsfocus.ch Conference 2013 and contributions by the speakers are published in the reader of the conference, the Bulletin 129 of Medicus Mundi Switzerland: Farai P. Mahaso, BHASO, “Support Groups belong to the Community and not to BHASO “, Sanghamitra Iyengar, Samraksha, “Communities make it possible“, Jochen Ehmer, SolidarMed, „Warum wir HIV anders und stärker bekämpfen sollten“, and a report from the conference by Helena Zweifel, aidsfocus.ch/ Netzwerk MMS.

Additional contributions are targeting the “critical enablers”. Thabisani Ncube, terre des hommes Schweiz, “Children today, adults tomorrow: Making a difference now!" (Tanzania), Bruno Gremion and Sybille N’Zebo, “Towards an HIV-free new generation” (Swaziland), Marianne Widmer, mediCuba-Suisse, “ Prävention HIV/Aids und fokussierte MSM-Arbeit (Kuba) und Muriel Mac-Seing. Handicap International, „Investing in one billion people with disabilities around the world”, as well as crontributions on creating a supporting environment.

Luciano Ruggia, Raphaël Bize and Françoise Dubois-Arber present “ANSWER – African Net Survey – We Respond!”, a Swiss behavioral surveillance survey among Sub-Saharan Africa migrants living in Switzerland, with and for the African community by the Federal Office of Public Health.

The reader of the Conference is available in print (info@medicusmundi.ch) and accessible online.

http://www.medicusmundi.ch

1. September 2013 - This week's news that the UK government would contribute £1billion to the Global Fund to fight AIDS, Tuberculosis and Malaria for the next three years surprised many Global Fund lobbyists who didn't expect to get what they asked for. It is a truly remarkable outcome - and could prove to be a turning point in the history of global health. Since the announcement the Department for International Development (DFID) has been tweeting: "Every 3 minutes, for the next 3 years UK aid will save a life by backing the Global Fund to beat 3 of the world's biggest killers: AIDS, TB and malaria."

DFID - known to be an exacting donor - is clearly convinced that there is a strong business case for substantial investment. By more than doubling its previous contributions, the UK is sending a very strong message to other donors that the Global Fund has taken on board significant changes under the leadership of its new Executive Director Mark Dybul.

The Global Fund can already boast a remarkable track record: saving nine million lives since its creation in 2002.

Its most recent reports show that countries have used Global Fund money to double the numbers of people on HIV treatment to over 10 million over the past five years. The number of TB cases detected and treated has also doubled, reaching 11 million people. Malaria programmes have treated more than 260 million cases of malaria, and distributed over 340 million insecticide treated bed nets - resulting in one third fewer malaria deaths in Africa over the past decade.

The new UK £1billion won't just expand those numbers, it will also be part of a far more profound effort - the big push to finally defeat the three diseases on the back of the huge scientific advances in recent years.

The Global Fund's target for this replenishment - US$15billion - could reach 85 per cent of people in need of HIV, TB and malaria interventions (when combined with other global resources). And that could mean finally turning the curve of the epidemics so that a real decline is possible within our lifetimes.

The UK is the world's largest economy committed to spending 0.7 per cent of GDP on aid - and that means it needs to find good organizations to spend the money for it. It has high standards as well as a high target.

The confidence in the Global Fund - and the acknowledgement that defeating the three diseases should be a priority - happened because of an intelligent, savvy coalition of advocates with smart tactics. DFID met the ask because of the diversity of askers: politicians from all parties backed the Global Fund's ask - and pushed it forward in public and behind the scenes. So too did celebrities - with Sir Elton John and Bono being the most visible - as well as NGOs, people living with HIV and TB (many from Africa) and other donors, including Bill Gates, making the case over and over again.

The UK met this smart advocacy with a smart solution. £1billion is a remarkable commitment but it comes with heavy strings attached: the UK promise will only be realized on the condition that the Global Fund reaches its full target of US$15billion. Australia, Germany, Japan, Canada still haven't confirmed their pledges - now they know that the more they give, the more the pounds will flow.

So, the pressure is on in the build up to the final pledging conference that John Kerry just announced the U.S. will host in December. The UK-US special relationship now extends to being the top two Global Fund donors - with the UK leapfrogging the French, who were happily in 2nd position. Within minutes of the UK announcement French activists were demanding that their government give more and reclaim second place.

For the remainder of the year we can expect lots of back and forth as each government seeks to prove they care about global health more than the other.

The UK's £1billion is not only very generous; it's also very clever. (Robin Gorna, Huffington Post)

http://www.huffingtonpost.co.uk

Geneva, 23 September 2013 — As world leaders prepare to meet at the United Nations General Assembly to review progress towards the Millennium Development Goals—a new report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) shows dramatic acceleration towards reaching 2015 global targets on HIV.

New HIV infections among adults and children were estimated at 2.3 million in 2012, a 33% reduction since 2001. New HIV infections among children have been reduced to 260 000 in 2012, a reduction of 52% since 2001. AIDS-related deaths have also dropped by 30% since the peak in 2005 as access to antiretroviral treatment expands.

By the end of 2012, some 9.7 million people in low- and middle-income countries were accessing antiretroviral therapy, an increase of nearly 20% in just one year. In 2011, UN Member States agreed to a 2015 target of reaching 15 million people with HIV treatment. However, as countries scaled up their treatment coverage and as new evidence emerged showing the HIV prevention benefits of antiretroviral therapy, the World Health Organization set new HIV treatment guidelines, expanding the total number of people estimated to be in need of treatment by more than 10 million.

“Not only can we meet the 2015 target of 15 million people on HIV treatment—we must also go beyond and have the vision and commitment to ensure no one is left behind,” said Michel Sidibé, Executive Director of UNAIDS.

Significant results have also been achieved towards meeting the needs of tuberculosis (TB) patients living with HIV, as TB-related deaths among people living with HIV have declined by 36% since 2004.

Despite a flattening in donor funding for HIV, which has remained around the same as 2008 levels, domestic spending on HIV has increased, accounting for 53% of global HIV resources in 2012. The total global resources available for HIV in 2012 was estimated at US$ 18.9 billion, US$ 3-5 billion short of the US$ 22-24 billion estimated to be needed annually by 2015.

As well as outlining new global HIV estimates, the 2013 UNAIDS Report on the global AIDS epidemic reviews progress on ten specific targets which were set by United Nations Member States in the 2011 UN Political Declaration on HIV and AIDS.

The report finds that progress has been slow in ensuring the respect of human rights, securing access to HIV services for people most at risk of HIV infection, particularly people who use drugs, and in preventing violence against women and girls––a key factor in vulnerability to HIV. Gender inequality, punitive laws and discriminatory actions are continuing to hamper national responses to HIV and concerted efforts are needed to address these persistent obstacles to the scale up of HIV services for people most in need.

http://www.unaids.org

Gemeinsam gegen HIV/Aids: Der Fotokalender 2014 zeigt Menschen mit HIV/Aids, die erlebt haben: Über die Krankheit zu sprechen, ist befreiend.

„Als mein Mann an Aids starb, ahnte ich, dass ich auch das Virus in mir trug. Würde ich sterben? Wie sieht mein Leben mit HIV/Aids aus?“ Melania Mrema-Kyando, Pfarrerin und Leiterin der Frauenarbeit der Südprovinz der Moravian Church in Tansania, spricht heute offen über ihre Erkrankung, obwohl HIV/Aids in vielen Ländern Afrikas immer noch ein Stigma ist. Männer lassen sich schon bei Verdacht von ihren Frauen scheiden. Manchmal zwingt sogar die eigene Familie die Infizierten, ihr Zuhause zu verlassen. Viele verheimlichen daher ihre Erkrankung - und gehen aus Angst vor Entdeckung nicht zum Arzt.

Selbsthilfegruppen als Befreiung

Der Schritt zum offenen Bekenntnis war für die Pfarrerin befreiend. Und er ist es bis heute für viele Betroffene. Denn als Melania Mrema-Kyando Leiterin der Frauenarbeit wurde, gründete sie zahlreiche Selbsthilfegruppen. In der Gruppe in Rungwe wuchs der Wunsch, andere Betroffene zu ermutigen und in der Öffentlichkeit das Stigma der Erkrankung zu bekämpfen. Daraus entstand die Idee eines Fotokalenders.

So sind mit Unterstützung der ökumenischen Mitarbeiterin Claudia Zeising (Tansania) und der Fotografin Regina-Mariola Sagan professionelle Porträtbilder und kurze Texte entstanden, in denen Frauen, Männer und Kinder ihre Lebensgeschichten erzählen.

Der Fotokalender, der ab Mitte Oktober lieferbar ist und 12 Franken kostet, ist durch seine hohe Qualität und das grosszügige Format (32,5 x 46 cm) ein schönes Weihnachtsgeschenk. Pro Kalender unterstützen Sie die HIV/Aids-Arbeit unserer afrikanischen Partnerkirchen mit fünf Franken

http://www.mission-21.org

Filmfest Ärzte in Afrika

http://www.aidsfocus.ch

Basel | Wie soll die Gesundheitspolitik global gestaltet werden, um Gesundheit auch für die ärmsten Bevölkerungen in Entwicklungsländern zu sichern? Darum geht es unter anderem bei der gegenwärtigen internationalen Debatte über die neuen Entwicklungsziele für die Zeit nach 2015. Die Weltgesundheitsorganisation propagiert Universal Health Coverage (UHC) als Mittel, um Gesundheit für alle finanzierbar und zugänglich zu machen. Am diesjährigen MMS Symposium werden die TeilnehmerInnen in die Debatte um Definition und Ausgestaltung von UHC eingeführt und Hinblick auf die neue entwicklungspolitische Agenda kritisch diskutieren.

Universal Health Coverage (UHC), auf Deutsch am besten mit „allgemeine Gesundheitsversorgung“ übersetzt, wurde von der WHO als Vorschlag für ein Oberziel für den Gesundheitsbereich in die Debatte rund um Nachfolgeziele für die MDGs eingeführt. Die WHO versteht UHC zunächst als ein System, das die Bereitstellung des Zugangs zu den benötigten Gesundheitsdienstleistungen sichert, ohne dass dabei für die NutzerInnen finanzielle Härten entstehen.

Im Weltgesundheitsbericht 2010 („Health systems financing: the path to universal coverage“) stand bei der Definition von UHC noch eindeutig die Gesundheitsfinanzierung im Zentrum, heute wird der Begriff von der WHO umfassender – und schwammiger – genutzt, auch im Sinne einer allgemeine Stärkung der Gesundheitssysteme oder gar als Nachfolgebegriff für „Gesundheit für alle“. Die Verabschiedung der Resolution „Transition of National Health Care Systems towards Universal Coverage“ durch die UNO-Generalversammlung im Dezember 2012 zeigt aber auch, dass das Konzept eine grosse Ausstrahlung erhalten hat.

UHC ist interessant, weil das Konzept den Zugang zur Gesundheitsversorgung mit der Finanzierungsthematik verknüpft und einen umfassenden Versorgungsanspruch benennt. Der erneuerte Fokus auf das Gesundheitsversorgungssystem ist auch gegenüber den vertikalen, krankheitsbezogenen Zielen der MDGs ein klarer Fortschritt.

Anderseits wird die geläufige unkritische und überschwängliche Verwendung von UHC als Nachfolgeslogan von „Health for all“ oder „Primary Health Care“ zu Recht kritisiert. Das Konzept verleitet dazu, Gesundheit und ihre Grundlegung (im holistischen Sinn) auf Zugang zur Gesundheitsversorgung zu reduzieren und klammert die wichtigen politischen, wirtschaftlichen und sozialen Determinanten von Gesundheit zunächst einmal aus. Auch ist genau hinzuschauen, wie denn eine allgemeine Gesundheitsversorgung auszugestalten ist, das sie wirklich alle Menschen erreicht und über ein Minimalpaket hinausgeht, und wo in der Umsetzung von UHC in ressourcenarmen Ländern die Verantwortung der einzelnen Staaten durch eine Verantwortung der internationalen Gemeinschaft ergänzt werden sollte. „Nicht alles geht auf dem Weg zu UHC“, lautete der Titel eines kürzlichen Beitrags im WHO-Bulletin.

http://www.medicusmundi.ch

Bern / Wabern | 10 years ago, aidsfocus.ch was initiated by members of the Network Medicus Mundi Switzerland who felt the need to share knowledge and experiences and to join forces in the AIDS response. We have come a long way, but AIDS is not over yet. We are convinced that getting to zero new infections, zero AIDS related deaths and zero stigma is feasible, if the world community keeps up and renews its commitment. We take the occasion of the 10th jubilee of aidsfocus.ch as an opportunity for looking back and for energizing ourselves for the way forward towards an ADIS-free future.

aidsfocus.ch will celebrate the 10th jubilee with a get together with partners and friends. The South African Ambassador Georges Johannes, the National Councillor Yvonne Gilli and Gerhard Siegfried, SDC, will address the participants, and the South African rapper Evaron Orange and friends will set a musical note to the 10th jubilee.

"In diesen zehn Jahren hat aidsfocus.ch enorm viel Verständnis für das Thema Aids in der Dritten Welt geweckt, wofür ich Ihnen und Ihrem Team meinen besten Dank aussprechen möchte." (Ruedy Lüthy, Harare)

1. years – aidsfocus.ch renews its commitment to an AIDS-free future

Time and place: 17.30 – 20.30, Bernau - Kultur im Quartier, Dachstock, Seftingenstrasse 245, Wabern/ Bern http://www.bernau.ch