Get Excited: AIDS2012 Arrives in Washington, DC July 2012


From July 22 to 27, 2012, Washington, DC will host the nineteenth international AIDS conference, known as AIDS 2012. The AIDS 2012 conference theme, “Turning the Tide Together,” reflects organizers’ recognition that in 2012 the global AIDS community finds itself at a unique juncture: research advances have made it possible to envision an end to the epidemic at the precise moment when funding challenges threaten to slow progress on scientific discovery and program implementation.

The CSIS Global Health Policy Center is pleased to present a video featuring the perspectives of many of the participants in the Friends of AIDS 2012 group, as well as the insights of government officials, private sector representatives, advocates, and program implementers who have been long-time conference participants.

Global HIV Prevention—Check!

by Kate McQuestion E-mail
In 2006, an article in the New England Journal of Medicine cited the substantial success of the implementation of a routine checklist on reducing catheter-related infections in the Intensive Care Unit of a Michigan Hospital. This story was shortly followed by media uptake the WHO Patient Safety Checklist, which, when utilized, reduced surgery-related mortality by almost 50%. The clinical use of checklists has become a hot topic for clinical quality improvement advocates, and as such, they been generally embraced in some areas of clinical practice.

Could this kind of tool be effective in public health?

The concept of a checklist is, intentionally, simple. The checklist serves as a mechanism to combat human failures of attention or memory—particularly in high stress or repetitive environments. The overall goal of a checklist is not only to ensure that each item is checked-off as prescribed, but to ensure an environment that promotes teamwork and professional discipline. Due to the ability of checklists to make complex systems approachable, they have already been widely used in industries such as aviation and construction, and now are advancing in medicine as well.

HIV prevention efforts, too, involve complex systems consisting of dynamic target populations, multiple programmatic efforts, and a lack of measurable quality indicators—all in all, making sustainable quality improvement challenging.

Checklists might provide a standardized method to ensure basic quality improvement and program management practices in an environment where pressing need may often lead to deficits in consistent and quality programming. Furthermore, they can be used as a tool to increase quality by improving communication, both internally within an organization, but also with the members of the target population being served.

It is a common complaint that too little emphasis falls of clinical delivery sciences, but it is fair to say that even less falls of preventative services delivery. NGOs working in HIV prevention need to keep better track of both the outcomes and impact of their programs. With out measuring results, it is hard to identify best practices and improve quality standards. HIV Quality Improvement Checklist tools could serve as a constant reminder for NGOs to monitor and evaluate results, thus improving health of communities world-wide.

Sources:

  • Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Eng J Med 2006; 355: 2725–32.
  • Gawande A. The Checklist Manifesto: How to Get Things Right. Henry Holt and Co: New York, 2009.
  • Haynes AB, Weiser TG, Berry WR, et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population [published online ahead of print January 14, 2009]. N Engl J Med. 2009; 360(5):491-499.

Kate McQueston is a Master of Public Health Student at The Dartmouth Institute for Health Policy and Clinical Practice and Intern at the WHO Regional Office for Europe Division for Communicable Diseases.

I will not be blogging about AIDS today: World AIDS Day Round-Up

Flickr, Sully Pixel

Today is World AIDS Day, which means that every blog out there that deals with international health, development, and/or humanitarian work has commented on it in some form or fashion. (I have seen great material on Humanosphere in particular.) Since most of these people are well-established professionals that know way more than I do, I will let them all speak for me and just try to collect the highlights of all that I have read today.

The Global Health Delivery Project put together a great round-up of media stories and major research reports.

End the Neglect posted a reading list as well as a great “status report” by blogger Alanna Shaikh.

The Center for Global Development has posted several blog entries on HIV/AIDS leading up to today, including a response to President George W. Bush’s piece on Pepfar in the Washington Post.

And finally, my personal favorite: Sarah Boseley of the Guardian wrote a piece on the importance of keeping AIDS on the agenda all year long.

One Step Forward, Two Steps Back: Court Decision in China Upholds HIV Employment Discrimination

China always seems to find its way into human rights headlines these days. Now that the sound and fury of Liu Xiaobo’s Nobel Peace Prize has died down, the People’s Republic is in the news again: this time for a landmark court decision in which a man lost a discrimination case for being denied a teaching job based on his HIV status. Wu Xiao (an alias that means “Little Wu”), a 22-year-old college grad, passed a series of written tests and an interview for the position, so he should have been perfectly qualified for the post. However, when his mandatory blood test revealed his HIV status, the local education bureau in Anqing rejected his application. The court ruled that the criteria for hiring civil servants (which disqualifies HIV-positive individuals from being hired) overrules a 2006 law that prohibits discrimination against persons with HIV and their families. The verdict is highly discouraging to Chinese AIDS advocates.

Discrimination against persons with HIV is nothing new. The history of the disease is littered with horror stories of stigma, persecution, and invasion of privacy, and discrimination continues all over the world in various forms, including cultural norms and, in some cases, even laws. In Chile, HIV-positive women are frequently pressured to get sterilized, and some are even sterilized without consent. Twenty-two countries, including Russia, Egypt, and South Korea, will deport foreign nationals based solely on HIV status, and other countries (such as Malaysia and Syria) will not allow students with HIV to apply for study. Gugu Dlamini, a SouthAfrican woman, was beaten to death after speaking openly about her HIV status at an AIDS awareness gathering on World AIDS Day in 1998.

China is certainly no stranger to HIV/AIDS discrimination. From the government’s frantic cover-up of the “Bloodhead Scandal” (in which 30,000-50,000 people were infected through blood transfusion programs in the 90s) to present-day violations of patient privacy laws, Chinese HIV patients face harsh stigma from healthcare providers, government officials, and their friends and neighbors. On the surface, the country has been somewhat proactive in mitigating this: it passed its first laws regarding HIV patient privacy in 1988, and it is illegal to disclose personal information of HIV-positive individuals. Chinese President Hu Jintao and Prime Minister Wen Jiabao make visible appearances with people with AIDS every year on World AIDS Day, and ARVs are available to AIDS patients for free. However, privacy laws are routinely violated, and people with HIV are ostracized from their families and communities. The government routinely harasses and often imprisons AIDS activists (Hu Jia, for example, was held under house in 2006 and has been in jail since 2008). Fear, ignorance and the threat of discrimination discourage individuals from getting tested and deter many who already know their status from seeking treatment. Chinese AIDS patients are encouraged by their providers to use fake names and IDs when seeking treatment and picking up medicines.

Wu’s lawyers plan to appeal the decision, but advocates are frustrated. “The entire H.I.V. community had high hopes, but now the door appears to be shutting for people who want to use the courts to fight against discrimination,” said Yu Fangqiang, whose organization represented Wu in his case. Others, however, urge patience, and point out that the fact that the case was even heard demonstrates progress. Either way, it is crucial to end the institutionalization of discrimination against HIV. Cultural norms will not change until the official government position changes, and, along with it, its laws. People will not seek treatment until they are no longer afraid to come out of hiding.