Latest news with #DesmondTutuHealthFoundation
Yahoo
03-06-2025
- Business
- Yahoo
A precarious success story: In South Africa, the hard-won progress of a youth-led HIV education program is threatened by international funding cuts
In Philippi village in the Western Cape of South Africa, 24-year-old Simamkele Matinise works at an HIV-prevention mobile clinic alongside over a dozen young people in the community. 'It's more friendly for the youth,' Matinise tells Fortune on-site in Philippi. 'It provides a safe environment for us.' A row of brightly painted trucks with a slogan written across them—'Don't delay. Get protected today!'—comprises the clinic. The trucks are stationed in the main entrance of the village, adjacent to the side of a building covered in a mural of a woman peacefully holding her young boy in a colorful garden. Above the trucks, the mural is illuminated by the hot South African sun. The youth-led mobile clinics are part of a project with the Desmond Tutu Health Foundation to fight HIV/AIDS in the community. The Foundation received funding from the Gates Foundation, starting with an initial planning grant to brainstorm how best to provide HIV education and prevention in hard-to-reach communities plagued by high disease rates. Over 7.5 million children and adults are living with HIV in South Africa, the largest concentration of people living with the disease globally. Many youth on the ground say the high transmission rates have made access to treatment and prevention even more urgent, particularly for the young girls most susceptible to infection. And it became clear that 'access shouldn't lie with the individual in seeking the care, but with how close you can bring the services to the person,' said Elzette Rousseau, a social and behavioral scientist and co-investigator of the Desmond Tutu Health Foundation's FastPrEP project, which uses the youth-led mobile clinics. The mobile clinic's four trucks offer HIV testing, education on the infection, and an opportunity to receive a prevention method. Pre-exposure prophylaxis (PrEP) is a highly effective medicine that reduces the risk of getting HIV. It is now offered in more than one way. Matinise had not heard of the three now available HIV prevention methods—oral PrEP, injectable PrEP, and the dapivirine vaginal ring for longer-acting protection—before volunteering with the clinic. She has since tried two of them. 'From the information that I get here, I'm always telling the next person, whether in my community or at work, 'Look, there's fastPrEP. There are the trucks!'' she says, who works as a shop clerk in the community when she's not volunteering at the clinic. 'I was excited because you have to protect yourself. You can never know. Tomorrow you might be raped. It's not safe now because we get raped even from families.' In a report released last year by South Africa's Human Sciences Research Council, about one in three women in the region reported experiencing gender-based violence, including sexual violence. Culturally sensitive delivery of health care services is a matter of life and death, youth and community leaders told Fortune, particularly because of the highly prevalent stigma around HIV in communities most deeply affected by the virus. Nomathemba Chandiwana, chief scientific officer at the Desmond Tutu Health Foundation, says successful delivery of health care services counters the age-old notion from the 1989 film Field of Dreams that insinuates if you build something, people will come. Many young men and women fear going to the traditional government clinic, where they have to stand in long lines behind massive 'HIV' signs to get tested or ask questions about prevention. Often, they worry they will be seen and assumed to have the virus. Other times, women in particular fear their families or spouses will assume they've been unfaithful. 'You've got to go to them,' Linda-Gail Bekker, the CEO of the Desmond Tutu Foundation and a physician-scientist who has been fighting the HIV/AIDS epidemic on the African continent for decades, tells Fortune. 'They don't come to you.' Over 60 youth meet with leaders of the project monthly to inform the approach and brainstorm ways to reach more people, including co-designing the exterior of the trucks. 'These young people are the best people to help us find solutions,' Bekker says. Bekker says the youth-led community initiatives taught her an important lesson about the complexities of global health delivery. 'Don't take a single step without going back to the community and asking them: Can we do this better? Can we do this more effectively? Can we do it in a more cost-effective way? Where did we screw up?' Melinda French Gates, who visited the Desmond Tutu Health Foundation in 2012 as then co-chair of the Gates Foundation, saw the power of community-driven solutions first-hand. 'This is the importance of listening,' she told Fortune in a February interview, reflecting on over two decades in global health. 'We can't devise things from Seattle or New York and expect that they're just going to sail out into the community.' For 22-year-old Solatho Manjati, working at the clinic has provided a newfound sense of purpose. He loves seeing people have 'an element of choice.' 'If it didn't exist, it would mean that there would be a barrier for people accessing healthcare services,' Manjati tells Fortune. 'It would mean that instead of reducing the spread of the virus, [you're] throwing petrol into the fire.' The same week Fortune traveled to Philippi, President Trump signed an executive order to begin dismantling USAID, cutting funding for programs that help curb HIV infections and deaths. While the Desmond Tutu Health Foundation's funding from the Gates Foundation may not be threatened for this particular project, they depend on other modes of funding, too. Rousseau recently shared that a handful of the foundation's grants were funded through the National Institutes of Health (NIH) in the U.S., and some projects have begun termination discussions. More broadly, HIV aid budgets have been slashed or reduced from the world's wealthiest donor countries, which puts pressure on the entire global health ecosystem and threatens a reversal of progress. HIV infections have been reduced by 60% since the mid-90s, but 40 million people still have HIV as of 2023, and 600,000 are dying each year. Despite the Gates' Foundation's recent announcement that it will spend $200 billion by the end of 2045 to significantly reduce the world's deadliest diseases, nothing can get done without government buy-in and collaborative partnerships across the public and private sectors. It's unclear what will become of the bipartisan-supported President's Emergency Plan for AIDS Relief (PEPFAR), established under President George W. Bush in 2003, for example, which has invested over $110 billion in the fight against HIV/AIDS globally. Over 6 million people could die in the next four years if President Trump cuts U.S. aid for HIV/AIDS. Bekker hopes that funding is restored, because she has seen the power of community-led interventions throughout Africa. 'This money has been put to such good use around the world and on such a scale. I just see a small part of it because of my focus,' she said. 'I have great hope for my continent … we'll prevail. We've got to keep pressing forward, believing that eventually good things happen to people who stay the course and do the right thing.' Back in Philippi, steps away from the parked trucks, you can see the word 'Ubuntu' a Zulu word meaning I am because we are—etched next to another mural covering an abandoned basketball court. It feels strikingly relevant to the youth's work below, many of whom have become friends, as they join forces to bring other people alongside their mission to destigmatize HIV and save their neighbors and friends from illness. As for Manjati, he dreams of becoming a minister of health one day, so that this youth-led HIV prevention program and others like it live on. He recites the well-known expression that you can take the horse to the river, but you can't force it to drink. 'But the horse, knowing where the river is, in its own time, can go and drink the water,' he says of working on health programs that educate people on ways to protect themselves. 'It's a privilege,' Manjati says of his work. This story was originally featured on
Daily Maverick
15-05-2025
- Health
- Daily Maverick
New strategies required to protect mothers and infants who are still getting HIV
Over the past two decades, South Africa made massive progress in reducing transmission of HIV from mothers to their babies. Even so, about 7,000 babies still contract the virus every year. Experts put this down to having the right puzzle pieces for prevention but failing to integrate them optimally. About 7,000 infants in South Africa still contract HIV from their mothers every year — a stark reminder that, while significant progress has been made in preventing mother-to-child transmission (MTCT), that progress has somewhat plateaued. Twenty years ago, there were 10 times as many — about 70,000 — new infections per year in babies. Today, the MTCT rate has dropped from a peak of over 30% at the turn of the century to about 2.7%. The story is mainly one of antiretroviral medicines helping suppress the virus in the bodies of mothers living with HIV, thus protecting tens of thousands of babies over the years. But the story is also one of progress that has slowed in recent years — while South Africa's MTCT rate lingers well above 2%, it is at or below 1% in several developed countries. About a decade ago, South Africa was making great progress towards reducing new HIV infections among children and keeping their mothers alive, but that has been followed by some complacency, says Professor Linda-Gail Bekker, CEO of the Desmond Tutu Health Foundation and Director of the Desmond Tutu HIV Centre. As pointed out by Professor Adrian Puren, Executive Director of the National Institute for Communicable Diseases and the the head of its Centre for HIV and Sexually Transmitted Infections, 'although the vertical transmission (another term for MTCT) rate is low, because of the high burden of maternal HIV, the absolute number of vertical transmissions remains high'. As pointed out by Dr Glenda Gray, a Distinguished Professor at the University of the Witwatersrand: 'We have very high rates of HIV in pregnant women in South Africa. About a third of all women in our country who are pregnant are HIV infected, and it's even higher in some parts of KwaZulu-Natal and particularly in young women.' An evolving problem The progress of the past two decades is largely due to increased access to antiretroviral therapy and how well the medicines suppress the virus in a person's body. If a mother living with HIV is stable on treatment, the chances are very close to zero that the virus will be transmitted to her baby. In the public sector, pregnant women are routinely tested for HIV and offered antiretroviral therapy if positive. A complication, however, emerges when a woman contracts HIV late in pregnancy or in the months after birth and the virus is then transmitted to her baby via breastfeeding before she is diagnosed and can start the treatment that will suppress the virus. The latest estimates from Thembisa, the leading mathematical model of HIV in South Africa, suggest that this dynamic is indeed driving much of the MTCT in the country. Of the approximately 7,200 babies who contracted HIV in South Africa from mid-2023 to mid-2024, only 2,500 became positive before or at birth. The rest of the transmissions occurred during breastfeeding in the months after birth. While a portion of these mothers were on antiretroviral therapy, the majority had not been diagnosed with HIV yet. HIV-exposed infants are at particularly high risk if the mother was recently infected. As Bekker explains, this is because a person who has just acquired HIV has a very high amount of the virus in their body, since their immune system hasn't had time to fight it yet, making it easier to pass the virus on. 'So, you get very high viral loads, and this is therefore a very dangerous time for vertical transmission,' she says. Dvora Joseph Davey, an associate professor of epidemiology at the University of California, Los Angeles, and the University of Cape Town, concurs. 'We know that in South Africa, over a third of HIV in infants is due to getting HIV from their mothers who were HIV-negative at their first antenatal visit, and they acquired HIV at some point during pregnancy or lactation,' she says. She explains that MTCT is in part due to inequity in healthcare. Mother-to-child transmissions often occur in certain pockets, such as in rural areas, because of limited access to prevention methods, late diagnosis, not starting treatment on time, and coming into antenatal care late. 'This points to missed opportunities in sustaining maternal antiretroviral therapy adherence and viral suppression throughout the breastfeeding window — an area where we urgently need more targeted and consistent support,' says Olwethu Mlanzeli, who leads Communications and Advocacy for the youth HIV-focused initiative Africa Reach. What to do? South Africa's 2023 guidelines for preventing vertical transmission (of several infectious diseases) does cover several of the issues experts raised in interviews with Spotlight. Among others, the guidelines recommend that pregnant women or new mothers who are newly diagnosed with HIV should be started on a dolutegravir-based antiretroviral regimen, since dolutegravir is particularly effective at rapidly suppressing the virus. The guidelines prescribe testing babies for HIV at birth, 10 weeks, and at six and 18 months. But in South Africa, good guidelines are not always followed by universal implementation. In line with this, several experts firstly suggest simply strengthening existing HIV treatment and prevention services, particularly those aimed at women before, during and in the months after pregnancy. It is suggested that women should continually be offered HIV testing during all stages of pregnancy and after birth. Joseph Davey says this needs to be integrated better, so that the same nurse offers contraceptives, HIV testing and HIV prevention medicines, proactively. Her research has shown that, at least on a small scale, training clinics to integrate the services can work well. Puren notes that the integration of MTCT care could also be done by joining HIV testing with infant immunisation programmes. 'There doesn't need to be a major overhaul,' adds Joseph Davey. 'These are simple steps related to data collection and targets around HIV testing that can be implemented within existing standards of care.' Experts also suggest that it is crucial to put women and babies on HIV treatment and HIV-prevention treatment as widely as possible during the postnatal phase. Joseph Davey cautions that these interventions are not the same across the country. The Western Cape, for instance, has explicit guidelines around HIV prevention medicines and pregnancy that have been updated every few years, while this does not seem to be the case for other provinces. Joseph Davey says that expanding this could be helpful. But even with good guidelines, there are barriers to adherence. Bekker notes that a daily HIV prevention regimen may be difficult to take for a pregnant woman experiencing morning sickness, or while she is a new parent. 'So here comes the perfect opportunity for long-acting injectable pre-exposure prophylaxis, such as cabotegravir or hopefully, in the future, lenacapavir,' she says. Not widely available Cabotegravir injections provide two months of protection against HIV infection per shot and lenacapavir six months per shot. Neither is yet widely available in South Africa. Cabotegravir is registered here, and lenacapavir's registration is expected in the next six months or so. There are other potential advances, according to Gray, that could make a significant difference. 'Antiretrovirals can mop up and control a lot, but to eradicate breast milk transmission we need other monoclonal antibodies or an HIV vaccine. And so, if we really are committed to eradicating paediatric HIV, then we need more tools besides antiretroviral therapies in the toolbox.' For now, these alternatives to antiretrovirals remain experimental and none have been proven to work or been approved for use by regulatory authorities. Lastly, Mlanzeli notes that patient awareness is a key part of the challenge, especially during the postnatal period. 'There's a need for greater investment and visibility around prevention of MTCT programmes, particularly in the postnatal period,' she says. 'While many governments allocate substantial resources to HIV programmes overall, these resources don't always translate into strengthened support for mothers and infants.' Brodie Daniels, Specialist Scientist at the HIV and other Infectious Diseases Research Unit at the South African Medical Research Council, agrees. 'What we need to focus on now is educating women on the increased risks during pregnancy and breastfeeding if they are HIV-uninfected during their antenatal visits,' she says. 'Women need to be encouraged to test more often during these periods, so that if they do seroconvert, both they and their infant can be placed on prophylaxis.' Impact of aid cuts In recent months, large and abrupt cuts to HIV funding from the United States government have severely disrupted HIV services in South Africa and neighbouring countries. While some limited funds are still flowing, it is a small fraction of what there was previously and there is little hope that funding will be restored. Several researchers Spotlight spoke to are very worried that the cuts will negatively impact MTCT rates. The cutting of some services, specifically those aimed at marginal groups, will probably lead to many not being able to access HIV counselling, prevention and testing services in a timely manner. Thus, the number of women contracting HIV while pregnant or breastfeeding and not being virally controlled may increase. But the silver lining is that change is within reach, if the resources are available and implementation is done right. As Bekker puts it: 'We know exactly what we need to do, and it's not like we don't have the tools. We need to just do it!' DM
The Guardian
06-03-2025
- Health
- The Guardian
Nearly half of women in Africa will be obese or overweight by 2030
An alarming rise in obesity in Africa has been compared with the HIV epidemic, with stigma and lack of treatment having a disproportionate impact on women. Almost half of women in Africa will be obese or overweight by the end of the decade, according to a recent study by the World Obesity Federation. While people in richer countries embrace the use of weight loss jabs to slim, few have any confidence that the groundbreaking medicines will be available in sub-Saharan Africa in the near future. And treatment for the host of diseases that accompany obesity, including diabetes, heart disease and high blood pressure, can be equally hard to access. Dr Nomathemba Chandiwana, who specialises in obesity and non-communicable diseases (NCDs), is chief scientific officer at the Desmond Tutu Health Foundation in South Africa. 'Obesity feels like HIV but more compressed,' she said. 'We've got a disease we don't quite understand, it's there, we're not doing much about it. The drugs are kind of there, but not available. Stigma is also an issue. So you can make a lot of parallels.' In another similarity between the conditions on the African continent, women are more likely than men to be infected with HIV. And while 25% of men in Africa are overweight or obese, for women the figure is 40%. In most other world regions the gap is much smaller, or reversed. And the trend is accelerating. While 45% of women in Africa will be overweight or obese by 2030, for men the figure is 26%, according to the World Obesity Atlas. Chandiwana said the question of why obesity was rising faster among women in Africa was complex, and involved multiple intersecting factors. 'Urbanisation and lifestyle shifts play a major role – many African cities lack safe spaces for physical activity, and long working hours, caregiving responsibilities, and safety concerns, etc, make movement harder for women. Unlike men, who may engage in occupational or leisure physical activity, women's daily routines are becoming more sedentary,' she said. 'HIV and antiretroviral therapy (ART) add another layer. In high HIV-burden settings like South Africa, ART-related weight gain, especially with drugs such as dolutegravir, is becoming more noticeable, disproportionately affecting women.' Biological factors such as reproductive health, menopause, and differences in cravings, metabolism, genetics and hormones are additional factors, she said. 'It is definitely going to get worse as ultra-processed foods become more ubiquitous, climate change increases and [because of] gender inequity,' said Chandiwana, with women facing more barriers to activities such as exercise because of their other commitments. 'We need prevention and treatment targeted specifically at women in South Africa.' Already, two-thirds of women in South Africa are overweight or obese, the second highest rate on the continent, after Eswatini. The rates in women could be a warning sign. Research suggests that countries' experiences of rising obesity typically begin with higher levels in women and higher-income groups before spreading through the population. Chandiwana said she was excited by the possibilities of the new generation of anti-obesity drugs called GLP-1 receptor agonists, such as Wegovy or Mounjaro, which have been popularised in the west by celebrities and politicians such as Oprah Winfrey and Boris Johnson. She said she had been about to get US funding for the first trial of semaglutide in women with HIV, shortly before the Trump administration froze most research spending. 'I think these drugs are a gamechanger and also they legitimise obesity as a chronic disease,' she said. 'Without treatment, people always look at it as a personal failure. It's you, you haven't done enough. But when you have treatment, we've got more in our toolbox.' Sign up to Global Dispatch Get a different world view with a roundup of the best news, features and pictures, curated by our global development team after newsletter promotion There is 'an equity issue' she said, where patients' access to the new, 'best-in-class drugs' depend on where they live in the world. She said diabetes patients in South Africa are having to return to using insulin in glass vials, rather than the more modern alternative of pens with measured doses. 'It doesn't matter where you are, there's a drug that's available that can help you with your disease. We do have to try the best we can to give people access,' Chandiwana said. Johanna Ralston, CEO at the World Obesity Federation, said cultural norms and expectations around obesity in some African countries might play a role in making women more vulnerable to obesity. 'As is the case in many Caribbean and Middle Eastern countries, it is more culturally acceptable for women to have excess weight, and in some cases is desirable.' Ralston said: 'Gender-responsive action is needed to address these disparities and more research is needed to understand the nuances.' Brenda Chitindi of the Zambia NCD Alliance agreed that cultural attitudes to obesity were an obstacle to tackling the condition in her country. 'Obesity is a very big challenge in Zambia because we have not taken it seriously. Most of the time we think when you are obese, you eat well – without knowing that it is a disease,' she said. Speaking at the NCD Alliance Global Forum, a conference for NCD advocates last month, Chitindi said: 'The other big challenge is where the [food] industry right now have brought into the country these fast foods. Where a lot of people have been attracted and, ignoring the regional food we have … they rush to these fast foods to show people 'we are well off, we eat well', without knowing they contribute to obesity. 'The government is looking at the revenue that they get from this industry, which is a very big challenge as well.' The latest edition of the World Obesity Atlas assessed countries' 'readiness' to address obesity by looking at factors such as their ability to provide treatment for NCDs, and policies for prevention such as taxes on sugary drinks, and restrictions on marketing unhealthy food to children. These were lacking in many countries, the report's authors found. But they warned that a reduction in the number of adults who are overweight or obese will require 'dramatic policy interventions'.
Yahoo
27-02-2025
- Health
- Yahoo
Trump Ends Thousands of USAID-Funded Programs in South Africa
(Bloomberg) -- The US has permanently stopped funding thousands of health-care programs in South Africa, with notifications sent to affected organizations. The Trump Administration Takes Aim at Transportation Research Shelters Await Billions in Federal Money for Homelessness Providers NYC's Congestion Pricing Pulls In $48.6 Million in First Month New York's Congestion Pricing Plan Faces Another Legal Showdown NYC to Shut Migrant Center in Former Hotel as Crisis Eases The move comes almost a month after Trump halted most aid to South Africa after accusing the government of confiscating privately owned land. The nation's authorities haven't appropriated any personal land since apartheid ended in 1994. 'The termination orders are coming through in droves,' Desmond Tutu Health Foundation Chief Executive Officer Linda-Gail Bekker said in an interview. The United States Agency for International Development letters, earlier published by local news service Bhekisisa, were also sent to groups funded by the President's Emergency Plan for AIDS Relief, or PEPFAR. While PEPFAR funding accounts for about 17% of South Africa's HIV/AIDS budget, 'the entire program is at risk, because so many critical projects, such as monitoring and testing, will be weakened,' Bekker and others said in a statement. A US-funded HIV vaccine trial, where South African Medical Research Council had teamed up with scientists from eight countries on the continent, has been halted because of the terminated financing. The US earlier this month issued a waiver to allow some PEPFAR activities to resume in South Africa, focusing on 'life-saving' tasks such as HIV care, testing, counseling, and medicine procurement. The waiver also covers salaries for critical health workers and staff, and was set for 90 days. Even so, the chaos from how the stop-work orders were implemented resulted in many clinics remaining closed. 'Crucial support staff will be lost as well, putting further pressure on the country's already stressed public health service,' the group known as Change said. 'The South African government has an obligation and duty to act with urgency to respond to both these drastic cuts, and the attack on South Africa's HIV and TB programming.' --With assistance from Ashleigh Furlong and Ana Monteiro. Trump's SALT Tax Promise Hinges on an Obscure Loophole Warner Bros. Movie Heads Are Burning Cash, and Their Boss Is Losing Patience Walmart Wants to Be Something for Everyone in a Divided America China Learned to Embrace What the US Forgot: The Virtues of Creative Destruction Meet Seven of America's Top Personal Finance Influencers ©2025 Bloomberg L.P.
Bloomberg
31-01-2025
- Health
- Bloomberg
Bekker: PEPFAR Was Put In Place to Save Lives in Africa
Humanitarian groups are warning that the Trump administration's halt on foreign aid risks both lives and American influence in Africa. The order is likely to affect HIV programs, malaria prevention, maternal-health support and clean-water access across the continent. Linda-Gail Bekker, Desmond Tutu Health Foundation's CEO spoke to Bloomberg's Chief Africa correspondent Jennifer Zabasajja on Horizons Middle East and Africa on the potential changes to the President's Emergency Plan for Aids Relief or PEPFAR - implemented under George W. Bush's administration. (Source: Bloomberg)
