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The newspaper of The Johns Hopkins University November 26, 2007 | Vol. 37 No. 12
World AIDS Struggle Still Staggers

JHPIEGO/Mozambique staff member Judite Cardoso conducts an HIV rapid test during a supervision visit to a Mozambican NGO that is doing home-based HIV counseling and testing.
Photo by Ana Maraquene, JGPIEGO/Mozambique

JHPIEGO workers fight battle on world's front lines

By Greg Rienzi
The Gazette

Every Dec. 1, people around the globe fasten red ribbons to shirts, jackets, hats and all manner of visible attire. The symbolic gesture serves to commemorate World AIDS Day, the now 19-year-old occasion that was created to focus attention on the devastating impact of the HIV/AIDS epidemic.

The numbers continue to stagger.

According to the World Health Organization, 39.5 million people were living with HIV in 2006-- 2.6 million more than in 2004. Every minute, roughly eight people are newly infected with HIV.

Nearly 3 million people died of AIDS in 2006, a rate of 8,000 per day, and more than 25 million people have died of the disease since 1981, when it was first recognized.

Despite considerable advances in the medical community's understanding of this disease, the fight against HIV/AIDS remains uphill, especially in low-resource countries, where many people lack accurate information about prevention and treatment options.

For the past six years, a major soldier in this struggle has been JHPIEGO, the Johns Hopkins- affiliated international health organization.

The organization, which reports to the Office of the Provost, focuses on training and support for health care providers working in limited-resource settings throughout Africa, Asia, the Middle East, Latin America and the Caribbean.

JHPIEGO's unique contributions to global HIV/AIDS efforts have been to strengthen country and regional capacities to provide high-quality HIV-related health services and bring the latest research to practice.

The organization's staff and colleagues travel the world partnering with countries to translate knowledge into action and "scale up" research findings, according to Kelly Curran, JHPIEGO's technical director for HIV/AIDS and infectious diseases.

Since 2002, JHPIEGO has worked with the Centers for Disease Control and Prevention, through its University Technical Assistance Program, in support of the Global AIDS Program. Under this program, JHPIEGO partners with the Johns Hopkins schools of Medicine, Nursing and Public Health to design, implement and monitor country-specific, comprehensive HIV/AIDS programs. It also serves as a technical resource for state-of-the-art training materials and for HIV/AIDS care and treatment guidelines, protocols and standards.

Currently, the organization has staff in 25 countries throughout Africa and the Caribbean who work on innovative approaches to treatment, counseling, testing and prevention.

Curran, who has been with JHPIEGO since 1998, said that being HIV positive is not the death sentence it was a few decades ago, but in many low-resource countries there are few health clinics, long waiting lists for treatment and insufficient practice of prevention methods. Of the 4.3 million new infections in 2006, 65 percent occurred in sub-Saharan Africa.

Curran said that while new, more accurate reporting techniques will likely reveal a decrease in new HIV infections, the reduction will not be significant enough.

"The number of [new infection] cases is still terrible and far outpacing the effectiveness of new antiretroviral therapies," she said. "With 4.3 million new cases and limited resources, efforts to treat those infected is sort of like filling up a bucket with holes in it."

The key, she said, is testing and prevention.

"Many people simply don't know they are positive. That is the first barrier," she said. "We need to scale up testing programs to identify those who are infected."

Recently, research has confirmed the effectiveness of a major HIV risk–reduction option--male circumcision. Certain cells on the underside of the penis foreskin act as "targets" for HIV. Through removal of the foreskin, circumcision reduces a man's risk of acquiring and transmitting the disease. In a South African study, circumcised men were found to be 61 percent less likely to acquire HIV than their uncircumcised counterparts.

Curran said that male circumcision is a relatively simple, low-cost intervention that can save millions of lives. JHPIEGO has worked with WHO to develop a global reference manual on the procedure under local anesthesia, and accompanying training materials.

"We are helping scale up these services by setting up clinical training sites and advocating for nonphysician clinicians to perform the procedure, such as clinical officers and nurses," she said. "We want to make sure the procedure is offered to the population in a safe way and also let the patients understand that it's only partially protective; they need to continue to take other steps to reduce the likelihood of transmission such as partner reduction, delaying sexual debut and the use of a condom."

Another area of particular concern to JHPIEGO staff is mother-to-child transmission of HIV. While this type of transmission is now rare in the United States, where most women are tested for HIV during prenatal care and have access to antiretroviral treatment options, mother-to-child transmission rates are still high in most African countries.

Last year alone, 500,000 children were newly infected with HIV, 90 percent of them living in sub-Saharan Africa. Unless preventive measures are taken, between 25 percent and 45 percent of HIV-infected pregnant women will pass the virus on to their newborns during pregnancy or childbirth, or through breastfeeding.

There is hope, however. In Botswana, the first African country to make HIV testing routine and antiretroviral therapy available free of charge, mother-to-child transmission rates are now below 4 percent.

JHPIEGO tries to apply such lessons learned. Currently, the organization works in several sub- Saharan African countries and in Haiti to reduce mother-to-child transmission by promoting practices such as HIV counseling and testing, the use of antiretroviral drugs to reduce the viral load of the mother, the promotion of safe childbirth practices and counseling on safe infant feeding.

Specifically, JHPIEGO set up a program in the Zambia Defense Force health system, a network of hospitals and health centers that serve members of the military, their families and the communities that live in the immediate area. The organization's field staff conducted training and other technical assistance to help them implement new services, including antiretroviral therapy and prevention of mother-to-child transmission.

JHPIEGO staff also instruct health care professionals in proper hand washing and gloving techniques and instrument processing to reduce the likelihood of HIV transmission in a medical setting.

"We are out there in the field because we can make a difference by helping improve prevention methods and treatment," Curran said. "The various ministries of health in these countries are doing good work, but we want to help them do their job better and function as well as possible."

For more about JHPIEGO's HIV/AIDS efforts, go to


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