Death of a Disease in the 21 st Century:

Transcription

1 Death of a Disease in the 21 st Century: Engaging the Critical Link Patricia L. Riley, CNM, MPH, FACNM Division of Global HIV/AIDS Centers for Disease Control and Prevention Center for Global Health Division of Global HIV/AIDS ARC Summative Congress June 20, 2012

2 Story of Smallpox Described as worst infectious disease in history Attributed have killed at least 1/2 billion Believed to have emerged in human population about 10,000 BC Easily recognized by pustular rash

3 Global Trends of HIV

4 Global HIV/AIDS Reported by UNAIDS, WHO and UNICEF 11/2011 People living with HIV/AIDS in million million Proportion of adults living with HIV/AIDS in 2010 who were women 50 % Children living with HIV/AIDS in 2010 People newly infected with HIV in 2010 Children newly infected with HIV in million million 2.7 million million 390, , ,000 AIDS deaths in million million

5 Smallpox Through the Ages First documented: Pharaoh Ramses V of Egypt 4 Year Reign: 1145 BC 1141 BC Year of Death: 1141 BC Cause of death: Smallpox

6 Smallpox Through the Ages 1600 s - well established in European population centers 10% of all deaths including royals: Mary II of England (last of the Tudors), Emperor Joseph of Austria, Tsar Peter II of Russia, King Louis XV of France Introduction to the Americas/Africa in 16 th century Spanish, French, British, and Portuguese expeditions Devastating impact on non-immunized indigenous popuations Smallpox and US Presidents: George Washington Abraham Lincoln

7 The first smallpox vaccine Dr. Edward Jenner s 1796 discovery Observations of milkmaids in England Experiment with cowpox inoculation of James Philip - followed by variolation of smallpox material No ill effects; Resulted in smallpox immunity Jenner s work on vaccine discovery now seen as one of the greatest public health advances in modern history Limited impact in halting smallpox spread due to fear and vaccine transport challenges WHO s realization 185 years post-jenner s findings

8 Public Health Heroes in Smallpox Eradication Dr. DA Henderson Dr. William F. Foege

9 Personal accounts of WHO s Smallpox Eradication Campaign

10 Smallpox and HIV/AIDS Similarities Stigma A lethal disease for which there is no cure Disproportion burden on low-income countries Global efforts and resources 20 th century global health target was Smallpox Eradication 21 st century global health target is an AIDS-Free Generation

11 President Obama s HIV/AIDS Goal: Provide ART to more than 1.5 million HIV+ pregnant women over the next two years Provide ART to 6 million people by million more clients than PEPFAR s previous goal of 4 million.

12 Increase of AIDS-related care: Expanded services for Preventing-Mother-to-Child- Transmission of HIV (PMTCT) Expanded availability of Voluntary Medical Male Circumcision a low cost procedure that reduces the risk of female-to-male transmission by more than 60%, Treatment as Prevention 052 clinical trials (May 2011) documented effective treatment of a person living with HIV reduced the risk of viral transmission to partners by 96%

13 Secretary Clinton s Global Policy Address: Science-guided global policy and US investment Emphasizes country ownership of HIV/AIDS programs Supports MOH and local organizations in acquiring the skills to strengthen their health systems Urges global donor nations to support and strengthen the Global Fund.

14 Nurses and Midwives role in advancing global health PEPFAR s initial focus Gains but also missed opportunities Realization of workforce in 2008 Emphasis on the importance of nurses, midwives, and doctors PEPFAR platform enables support of health care systems and workforce like ARC Nursing and midwifery have the opportunity to play a key role in realizing the AIDS Free Generation goal

15 Opportunity to Demonstrate the Critical Link Nurse-Initiated and Managed antiretroviral therapy (NIMART) NIMART outcomes comparable to physician-initiated and prescribed HIV treatment in certain settings Preventing Mother To Child Transmission of HIV (PMTCT) Option B+ - nursing/midwifery input critical in shaping and designing services

16 21 st century heroes and heroines Reaching the goal requires quality at all levels Pre-service training compliant with global standards of education Maintaining knowledge and skills throughout our career involvement in continuing education Service delivery patient-friendly services commitment to fulfill our role regardless of where we work in the health delivery system Opportunity to make a difference Opportunity to shape your role and contribution in global health

17 These are times in which there is great opportunity - times of significant professional and scientific breakthrough. And yet, there are also major challenges that face nurses and midwives as they work to enhance the health of the people they serve. - Marla E. Salmon, ScD, RN, FAAN