NIH Statement on World AIDS Day December 1, 2018

Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases
Maureen M. Goodenow, Ph.D., Director, Office of AIDS Research

​Each year on World AIDS Day, we reflect on the remarkable progress that has been made against HIV. Indeed, we have come a long way since the disease now known as AIDS was first reported in 1981.

An AIDS ribbon depicted with broadly neutralizing antibodiesNIAID

We now have life-saving antiretroviral drugs to treat and greatly extend the lives of men and women living with HIV. Daily antiretroviral therapy that suppresses HIV to undetectable levels benefits people living with HIV and prevents sexual transmission of the virus to others. We also have a range of options available for people to prevent acquisition of HIV. These options include pre-exposure prophylaxis, or PrEP, a single pill that can reduce the risk of acquiring HIV by more than 95 percent when taken daily. Emergency post-exposure prophylaxis, or PEP, also can prevent HIV infection if it is begun within three days of exposure and taken for an additional 28 days. 

If these methods of treatment and prevention could be widely implemented, an end to the HIV pandemic would be feasible. However, lack of access to health care, high costs, and stigma create barriers to successfully preventing HIV and managing it across the lifespan. To bring about a durable end to the HIV/AIDS pandemic, we must develop longer lasting, more easily implementable tools, including a vaccine that can treat and prevent HIV at a lower cost. 

The development of a safe and effective HIV vaccine is the highest priority for HIV prevention. Currently, scientists at the National Institutes of Health and around the world are following two major paths to develop a preventive HIV vaccine.

One path relies on a trial and error approach, referred to as an “empiric” approach to quickly move vaccine candidates into human clinical trials. The ongoing National Institute of Allergy and Infectious Diseases (NIAID)-sponsored HVTN 702 study aims to build on the modestly successful results from RV144, an HIV vaccine trial conducted by the government of Thailand, sponsored by the U.S. Army and supported by NIH, that was the first to demonstrate that an HIV vaccine candidate can protect people from infection. The Phase 2b/3 HVTN 702 trial began on World AIDS Day 2016 and is enrolling 5,400 men and women in South Africa. Another large vaccine efficacy trial, called HVTN 705/HPX2008 or Imbokodo, launched last year. This Phase 2b proof-of-concept trial is evaluating an investigational vaccine regimen designed to induce immune responses against a variety of global HIV strains. It aims to enroll 2,600 HIV-negative women in sub-Saharan Africa.

The second path to developing an HIV vaccine involves the assumption that a particular type of an immune response would be protective against HIV infection and designing a vaccine to specifically induce such a response, in this case using broadly neutralizing antibodies(link is external) (bNAbs). Some people living with HIV naturally produce bNAbs, albeit too late after infection to clear the virus. Scientists have isolated several varieties of bNAbs from people living with HIV that have been shown in the laboratory to inhibit most HIV strains from infecting human cells.

Two NIAID-funded clinical trials directly testing the hypothesis that bNAbs can prevent HIV infection recently completed enrollment. This pair of large, multinational trials are assessing whether giving infusions of bNAbs to healthy men and women at high risk for HIV protects them from acquiring the virus. The results of these AMP (antibody-mediated prevention) studies are expected in 2022.

Recently a team of scientists at the Vaccine Research Center of NIAID used their detailed knowledge of the structure of HIV to find an unusual site of vulnerability on the virus and design a novel and potentially powerful vaccine. An experimental vaccine regimen they designed based on this vulnerable site elicited antibodies in animals that neutralize dozens of HIV strains collected from throughout the world. The scientists are optimizing the vaccine regimen, and a first-in-human trial is anticipated to begin in the second half of 2019.

Beyond vaccines, recent animal and human studies have shown that bNAbs against HIV also hold promise as new, longer lasting forms of prevention and treatment, including sustained viral remission.

In 2017, scientists found that giving monkeys two powerful anti-HIV antibodies immediately after infection with an HIV-like virus enabled the immune systems of some of the animals to control the virus long after the antibodies were gone. This year, a small group of people living with HIV sensitive to these two potent anti-HIV bNAbs—3BNC117 and 10-1074—tolerated multiple infusions of the antibodies and suppressed HIV levels for more than 15 weeks after stopping antiretroviral therapy. Additionally, scientists at NIH announced in April 2018 that they had used two genetically modified versions of these bNAbs to protect monkeys from an HIV-like virus for up to 37 weeks.

NIH-funded scientists are working on an experimental bNAb treatment together with an immune stimulatory compound that may target the viral reservoir—populations of long-lived, latently infected cells that harbor the virus and that lead to resurgent viral replication when suppressive therapy is discontinued. Early, promising results in animals, published in Nature in October(link is external), may inform strategies to achieve sustained, treatment-free viral remission in people living with HIV.

For those already living with HIV, the virus can present numerous complications and conditions, even when HIV is well-managed. Globally, tuberculosis (TB) is the leading cause of death for people living with HIV. In March 2018, scientists announced that a large, international clinical trial found that a 1-month antibiotic regimen to prevent active TB was at least as safe and effective as the standard 9-month regimen for people living with HIV. Adults and adolescents in the trial were more likely to complete the short-course regimen, making it easier to prevent this potentially fatal co-infection.

Individuals living with HIV have a higher risk of end-stage kidney disease because of damage caused by HIV and its complications. Unfortunately, transplant organs are in short supply and high demand. In May 2018, the first large-scale clinical trial to study kidney transplantations from deceased donors with HIV to recipients living with HIV began across the United States. The HOPE in Action Multicenter Kidney Study will determine the safety of these transplants. It offers a chance to improve the health of those living with HIV while increasing the overall supply of transplantable organs.

We are optimistic that an end to the HIV pandemic is feasible. However, to reach this goal, we must apply the tools and advances already at hand as we continue to follow the science in laboratories and clinics around the world. Today we honor the achievements of dedicated researchers, health care professionals, clinical trial participants and members of the global community, and we reaffirm our commitment to work together to fill the remaining gaps.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

IOM Tells UN General Assembly to Act Now on Migrant Health

At the first of three IOM side-events on health at the 73rd United Nations General Assembly in New York Thursday (27 September), IOM Regional Director Argentina Szabados noted that diseases like TB, HIV/AIDS and Hepatitis “don’t carry passports but can move from country to country.”

Argentina Szabados, IOM Regional Director for South-Eastern Europe, Eastern Europe and Central Asia addresses the UN high level side event on HIV, TB and Viral Hepatitis in New York yesterday (27/09). Photo: IOM Participants hold copies of the UN Common Position paper. Photo: IOM

Szabados – whose office covers South-Eastern Europe, Eastern Europe and Central Asia – spoke at a high-level panel to discuss the UN’s Common Position on combatting the three diseases, which affect millions across the region.

“Four in ten people living with HIV in the European Economic Area are migrants,” she told the expert panel at UN Headquarters. “This region is the only one where new infections of HIV are on the increase, where multi-drug resistant TB is eroding health gains, and where people are more prone to viral hepatitis. This is particularly true of the east of the region, and of all the vulnerable groups, migrants are at highest risk.”

The theme of the discussion centred on leaving no-one behind in access to healthcare. Szabados stated that not only are migrants being left behind, they also leave everything behind when they set out on often-perilous journeys: “They leave their homes, their families, their possessions, their culture, their language. Sometimes they leave their identity, or even their very lives.”

The panel discussion was chaired by WHO’s Dr. Masoud Dara; co-panellists included Dr. Nedret Emiroglu, Director of the Division of Health Emergencies and Communicable Diseases at the WHO, and Prof. Stanislav Špánik, State Secretary of the Ministry of Health, Slovak Republic.

Dr. Emiroglu noted that despite a decline in TB rates, Multi-Drug Resistant TB in on the increase.

“One thousand Europeans fall ill with TB every day,” she said. “This is an unacceptable number. When it comes to HIV, it is of even more concern: two million people are living with HIV, 80 per cent of them in the East of the region and Central Asia. Only one third of them are getting the treatment they need.”

Szabados said the Global Compact for Migration, which will be ratified by Member States at a special session of the UN in Morocco in December, gave the world a migrant-centred approach to the challenges posed by migration, including health challenges, “for the first time in human history.”

Noting that migration was as old as humanity, she stressed that it was neither practical nor desirable to reduce human mobility and Member States must thus work towards eradicating diseases.

“We must not demonize the disease: we must cure, inform and prevent, and we must give migrants, especially the young, tools to protect themselves. Apart from the rights issue, which is the most salient, keeping migrants healthy makes simple economic sense,” she concluded.

The UN Common Position on HIV, TB and Viral Hepatitis: Links to Migration
By Dr Jaime Calderon

Ending tuberculosis (TB), HIV and viral hepatitis by 2030 is part of the Sustainable Development Goal (SDG) on health and well-being but cannot be achieved by the health sector alone. A number of socioeconomic and environmental determinants affect these ongoing epidemics in European and central Asian countries, which can only be addressed through action across sectors.

Within the UN Issue-based Coalition on Health and Well-being in Europe and Central Asia, WHO/Europe, together with sister UN agencies, has developed a UN common position paper on ending TB, HIV and viral hepatitis in Europe and central Asia through intersectoral collaboration.

It recognises that despite the  substantial health improvements that have been reached in the WHO European Region, with life expectancy has been steadily growing, not all are benefiting from this trend, in particular the marginalized and vulnerable parts of society including prisoners, homeless people, injectable drug users, victims of human trafficking and of gender based violence, children, youth, migrants and refugees, sex workers and men who have sex with men.

Despite the fastest decline in TB incidence in the world, by an average of 5.3 per cent a year since 2006, this region bears the highest proportion of multi drug-resistant TB globally, with only about half of these patients successfully treated. Antimicrobial resistance (AMR) is a growing concern also for HIV and viral hepatitis, threatening the effective prevention and treatment of the conditions and increasing healthcare costs. The WHO European Region is the only region with increasing number of new HIV infection with a staggering 75 per cent since 2006, also increasing the number of deaths due to AIDS-related causes.

The Common Position supports links between services for the three diseases and other sectors, including alcohol and substance dependence, mental health, gender-based violence, sexual and reproductive health, food insecurity and nutrition, taking also into consideration migration patterns and urbanization dynamics.

The migration process can expose migrants, particularly those in situations of vulnerability, to health risks associated with perilous journeys, including exposure to infectious and communicable diseases, severe psycho-social stressors, violence and abuses.

Migrants may also suffer from limited access to continuity and quality of health care, and from structural exclusion and marginalization, discrimination and many other forms of inequities.

IOM advocates for, and implements, comprehensive programmes with its partners that look at preventive and curative initiatives to benefit mobile populations as well as their host communities. Migrant-sensitive and migrant-inclusive healthcare systems are high on IOM’s agenda, and “Healthy migrants in healthy communities” marks IOM’s activities as contribution towards the physical, mental and social well-being of migrants.

The UN Issue-based Coalition is a regional partnership initiative led by WHO/Europe to support the achievement of SDG 3 on health and well-being for all at all ages as well as the health-related targets present in other SDGs. It reports to the United Nations Regional Coordination Mechanism for Europe and Central Asia. One of the Issue-based Coalition’s 4 workstreams focuses on TB and HIV.

Dr Jaime Calderon is Senior Migration Health Advisor at IOM’s Regional Office for South-Eastern Europe, Eastern Europe and Central Asia

You are the key to your good health

By Alpha Bedoh Kamara

Except in situations beyond your control, such as being poor, mentally challenged, physically challenged, and living in a community where public health policies are poor or not implemented, and access to healthcare is poor, you have the key to your good health.

What you eat, drink, and breathe, affect your health

There is a prevalent of poor healthcare infrastructures and poor public health policies in most developing countries such as in Africa, where access to sustainable clean pipe-borne water, electricity, and standard education are poor and unavailable.

Healthcare disparities are also a concern in some developed countries with minority communities suffering the brunt due to high rate of unemployment, illiteracy, poverty, and the lack of better insurance coverage.

However, inspite of the challenges people could protect themselves from most of the major causes of diseases by taking positive measures to stay away from the ravages of ill-health.

According to the World Health Organization (WHO), “more than half of all deaths in low-income countries in 2016 were caused by the so-called “Group I” conditions, which include communicable diseases, maternal causes, conditions arising during pregnancy and childbirth, and nutritional deficiencies. By contrast, less than 7% of deaths in high-income countries were due to such causes. Lower respiratory infections were among the leading causes of death across all income groups.

“Noncommunicable diseases (NCDs) caused 71% of deaths globally, ranging from 37% in low-income countries to 88% in high-income countries. All but one of the 10 leading causes of death in high-income countries were NCDs. In terms of absolute number of deaths, however, 78% of global NCD deaths occurred in low- and middle-income countries.

“Injuries claimed 4.9 million lives in 2016. More than a quarter (29%) of these deaths were due to road traffic injuries. Low-income countries had the highest mortality rate due to road traffic injuries with 29.4 deaths per 100 000 population – the global rate was 18.8. Road traffic injuries were also among the leading 10 causes of death in low, lower-middle- and upper-middle-income countries.”

Cigarette smoking increases the risk of coronary heart disease by itself. When it acts with other factors, it greatly increases risk. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot – American Heart Association

The WHO indicator points to the top ten causes of death worldwide and it is not surprising that Respiratory Infections, Diarrhoeria, Heart Disease, HIV/AIDS, Stroke, Malaria, Tuberculosis (TB), Road Accidents,  Alzheimer’s Disease, Diabetes, Lung Cancer, Trachea and Bronchus, Chronic Obstructive Pulmonary Disease (COPD), Lower Respiratory Infections, Stroke, and Ischaemic Heart Disease (coronary artery disease), stand out as the culprits.

These diseases could be prevented and millions of lives saved, and you are the key to your good health!

An estimated 4.2 million premature deaths globally are linked to ambient air pollution – WHO

One of the keys to addressing the challenges of some of these diseases is practicing positive lifestyles and advocating and lobbying for health policies to protect the community from environmental hazards.

Do you know that what you eat, drink, and breathe, affect your health?

You may not have the money or insurance cover for hospital check-up, especially for the millions of poor people in developing countries, but you have the ability to practice positive lifestyles, to choose what to eat and drink, and to engage and lobby your electorates to pass laws to protect the environment from pollution.

Also, remember to drive responsibly, SPEED KILLS!

 

During HIV infection, antibody can block B cells from fighting pathogens

NIH scientists suspect process aims to curb immune-system hyperactivity.

Colorized scanning electron micrograph of a B cell from a human donor.NIAID

For the first time, scientists have shown that in certain people living with HIV, a type of antibody called immunoglobulin G3 (IgG3) stops the immune system’s B cells(link is external) from doing their normal job of fighting pathogens. This phenomenon appears to be one way the body tries to reduce the potentially damaging effects of immune-system hyperactivity caused by the presence of HIV, according to the investigators, but in so doing, it also impairs normal immune function.

The research was led by scientists in the Laboratory of Immunoregulation and the Laboratory of Immunogenetics at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The investigators made their discovery by analyzing blood samples from 83 HIV-uninfected, anonymous donors and 108 people who were living with HIV at various stages of infection. The people living with HIV came from a variety of racial and ethnic backgrounds. Some of these people were being treated for their infection, while others had not yet begun therapy.

The scientists observed that IgG3 appeared on the surface of B cells only under certain conditions. It appeared in people living with HIV, but not in HIV-uninfected people. Also, IgG3 predominantly appeared on B cells of people of African American or black African decent during the chronic phase of untreated HIV infection when the virus was not adequately controlled.

A site on B cells called the B-cell receptor normally binds to foreign entities such as pathogens. This binding stimulates the B cell to produce many copies of the antibody form of the receptor, which can trap a pathogen and mark it for destruction. The scientists found that IgG3 short-circuits this process in certain people living with HIV by docking on the B-cell receptor, blocking it from adequately responding to the pathogen or other intended target. The researchers also demonstrated how other components of the immune system contribute to IgG3 interference with normal B-cell function during HIV infection. Finally, they showed that IgG3 stops binding to B-cell receptors when a chronically infected person starts treatment that controls the virus, illustrating that the IgG3 activity is directly linked to the presence of HIV during chronic infection.

Women are more affected by HIV/AIDS than men in many Sub-Saharan African countries

The World Bank new dashboards in the Health, Nutrition and Population Portal  has provided a window into the healthcare challenges affecting countries through which efforts could be made with more effective approaches to address the health needs of a particular country.

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Women are more vulnerable to HIV than men, especially in Sub-Saharan Africa. In 20 Sub-Saharan African countries, more than 60 percent of the HIV affected population are women. In other regions, less than half of the HIV affected population are women (South Asia: 33%, Latin America and Middle East: 38%). According to the UNAIDS, structural, behavioral and biological factors are compounding the risk of HIV infection among women.

Source: Health Dashboard > Topic > HIV/AIDS http://datatopics.worldbank.org/health/health

Changes are seen in Cause of Death in low-income countries

Cause of Death is mainly classified into three categories:

1. Communicable diseases and maternal, prenatal and nutrition conditions,
2. Non-communicable diseases, and
3. Injury.

In high-income countries, the majority of deaths are caused by non-communicable diseases such as ischaemic heart disease and stroke, while the majority of deaths are caused by communicable diseases in low-income countries. However, we can see changes in the cause of death in low-income countries for the past 16 years. In Zambia, Kenya, Malawi, Niger and Botswana, with the highest proportion of cause of death by communicable diseases, more than 78 percent of the deaths were caused by communicable diseases in 2000. However, the proportion of cause of death by non-communicable diseases has increased in these countries in 2016. In Botswana, the number of deaths caused by communicable disease has rapidly declined, but the deaths by non-communicable diseases has increased between 2000 and 2016.

The risk of impoverishing expenditure for surgical care is very low in North America and Europe, but high in Sub-Saharan Africa and South Asia

The risk of impoverishing expenditure for surgical care is high in many countries in Sub-Saharan Africa and South Asia. The majority of people in these regions cannot afford to pay for surgical care. People in these regions are at risk of being pulled into poverty when they pay for surgical and anesthesia care, due to direct out-of-pocket payments for the care. In North America and Europe the risk is very low because of their risk-sharing system.

Many people still live in households without basic hand washing facilities

Safe hygiene practices are crucial for human health. Hand washing with soap and water is used to monitor Sustainable Development Goal 6 (Clean water and sanitation), and is considered one of the most cost-effective interventions to prevent diarrhea and respiratory infections, especially among children. In 38 of the 70 countries with data, less than half of the people live in households without basic hand washing facilities in 2015.

Source: Health Dashboard > Topic > Water and Sanitation http://datatopics.worldbank.org/health/health

 

Culled from http://blogs.worldbank.org

BY HARUNA KASHIWASE . CO-AUTHORS: YATAO LU, EMI SUZUKI, YING CHI

The top 10 causes of death

 

The WHO list of ‘the top 10 causes of death’ provides a window for people to be better prepared in taking preventive measures to protect themselves from causative factors that may expose them to the top ten diseases.

While efforts are being made in the medical and technology industry in furthering research in clinical medicine as well as breakthroughs in new medical innovations, public health interventions through various strategies in promoting awareness about diseases and their causes are very vital in saving lives.

It is my hope that readers take advantage of the information and make it beneficial to the family, community and the country- Editor’s note

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4.2 million deaths every year as a result of exposure to ambient (outdoor) air pollution – WHO

Of the 56.9 million deaths worldwide in 2016, more than half (54%) were due to the top 10 causes. Ischaemic heart disease and stroke are the world’s biggest killers, accounting for a combined 15.2 million deaths in 2016. These diseases have remained the leading causes of death globally in the last 15 years.

Chronic obstructive pulmonary disease claimed 3.0 million lives in 2016, while lung cancer (along with trachea and bronchus cancers) caused 1.7 million deaths. Diabetes killed 1.6 million people in 2016, up from less than 1 million in 2000. Deaths due to dementias more than doubled between 2000 and 2016, making it the 5th leading cause of global deaths in 2016 compared to 14th in 2000.

Lower respiratory infections remained the most deadly communicable disease, causing 3.0 million deaths worldwide in 2016. The death rate from diarrhoeal diseases decreased by almost 1 million between 2000 and 2016, but still caused 1.4 million deaths in 2016. Similarly, the number of tuberculosis deaths decreased during the same period, but is still among the top 10 causes with a death toll of 1.3 million. HIV/AIDS is no longer among the world’s top 10 causes of death, having killed 1.0 million people in 2016 compared with 1.5 million in 2000.

Road injuries killed 1.4 million people in 2016, about three-quarters (74%) of whom were men and boys.

Leading causes of death by economy income group

More than half of all deaths in low-income countries in 2016 were caused by the so-called “Group I” conditions, which include communicable diseases, maternal causes, conditions arising during pregnancy and childbirth, and nutritional deficiencies. By contrast, less than 7% of deaths in high-income countries were due to such causes. Lower respiratory infections were among the leading causes of death across all income groups.

Noncommunicable diseases (NCDs) caused 71% of deaths globally, ranging from 37% in low-income countries to 88% in high-income countries. All but one of the 10 leading causes of death in high-income countries were NCDs. In terms of absolute number of deaths, however, 78% of global NCD deaths occurred in low- and middle-income countries.

Injuries claimed 4.9 million lives in 2016. More than a quarter (29%) of these deaths were due to road traffic injuries. Low-income countries had the highest mortality rate due to road traffic injuries with 29.4 deaths per 100 000 population – the global rate was 18.8. Road traffic injuries were also among the leading 10 causes of death in low, lower-middle- and upper-middle-income countries.

Source: Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2016. Geneva, World Health Organization; 2018.

Why do we need to know the reasons people die?

Measuring how many people die each year and why they died is one of the most important means – along with gauging how diseases and injuries are affecting people – for assessing the effectiveness of a country’s health system.

Cause-of-death statistics help health authorities determine the focus of their public health actions. A country in which deaths from heart disease and diabetes rise rapidly over a period of a few years, for example, has a strong interest in starting a vigorous programme to encourage lifestyles to help prevent these illnesses. Similarly, if a country recognizes that many children are dying of pneumonia, but only a small portion of the budget is dedicated to providing effective treatment, it can increase spending in this area.

High-income countries have systems in place for collecting information on causes of death. Many low- and middle-income countries do not have such systems, and the numbers of deaths from specific causes have to be estimated from incomplete data. Improvements in producing high quality cause-of-death data are crucial for improving health and reducing preventable deaths in these countries.

Society reaps the benefits when women enjoy better health care

Weak political commitment, inadequate resources and persistent discrimination against women and girls: these are just some reasons that many countries still don’t openly and comprehensively address sexual and reproductive health and rights.

This is borne out by figures. Each year in developing countries, including those in Africa, more than 30 million women don’t give birth at a health facility. More than 45 million have inadequate or no antenatal care. And over 200 million women want to avoid pregnancy but don’t have accessto modern contraceptive methods.

Author: Marleen Temmerman Director of the Centre of Excellence in Women and Child Health and Chair of the Department of Obstetrics and Gynaecology (OB/GYN), The Aga Khan University

Disclosure statement: Marleen Temmerman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

The United Nations’ Sustainable Development Goals -– introduced in 2015 –- were created to address many of these problems. The goals recognise that sexual and reproductive health and rights are fundamental to people’s health and survival, to gender equality and to the well-being of humanity.

But many countries on the continent still have a long way to go before they make any headway with these goals .

In a bid to boost these fundamental rights, the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights was convened in 2016.

I was one of the experts from across the world who served on the commission to try and find new ways to achieve universal sexual and reproductive health. Our main finding – released this year – is that sexual and reproductive health services are fragmented, often duplicated and inefficient.

As part of the findings we’ve developed a set of evidence based interventions that’s rooted in human rights. These are a direct response to the gaps identified by the commission. It’s hoped that by plugging these gaps, we can contribute to achieving the Sustainable Development Goals by 2030. After all, advancing sexual and reproductive health rights -– particularly among women – will help address the gender based disparities in health and other sectors.

Our findings

The commission’s findings address commonly recognised components of sexual and reproductive health like contraceptive services, maternal and newborn care, and the prevention and treatment of HIV/AIDS.

But it also addresses components that are often neglected or are addressed in isolation. These areas are critical if people are to make autonomous decisions about their health and lives, and include:

• comprehensive sexuality education;
• safe abortions;
• the prevention and treatment of sexually transmitted infections other than HIV;
• counselling and care for sexual health and well-being; and
• preventing, detecting and managing gender-based violence, infertility and reproductive cancers.

The interventions come in different forms. One example involves incorporating information on how to prevent sexually transmitted infections, contraception and sexual well-being into adolescent health programming. This upholds young people’s right to self-determination about their sexuality and results in improved health outcomes.

Another intervention is offering contraceptive counselling as part of postpartum and post-abortion care. Each year in developing regions, more than 200 million women want to avoid pregnancy but don’t use modern contraception methods. Giving them this access allows them to access contraceptives easily and reduces the risk of unintended pregnancy.

This intervention could reduce unintended pregnancies by 75% from 89 million in 2017 to 22 million. And it would only come at a cost of USD$ 9 per person per year. This is a modest cost, considering that half of this is already being spent to cover the costs of current levels of care.

Other interventions may have to involve amending a country’s laws or policies. For instance, in 2010 the Kenyan government passed laws that allow abortions to happen under certain circumstances. But eight years later health professionals are still reluctant to perform the procedure as they fear legal consequences. Why? Because the penal code hasn’t yet been revised and so they might still be held guilty of a crime.

The result of this gap between law and paperwork is that there were close to half a million unsafe abortions in Kenya in 2012. At least 100 000 of those women needed to be treated in hospital and roughly a quarter died due to complications.

All of this shows that while achieving universal access to sexual and reproductive health and rights is ambitious it’s also achievable and affordable.

A way forward

There are several steps that governments need to take to tackle these issues. The first is that governments, multilateral organisations and advocates should embrace the commission’s recommended package of essential sexual and reproductive health interventions and push for its inclusion in national and international planning.

It’s also crucial for health ministries and service providers to consider how and where to introduce these interventions into the health care system. They must also work out how best to integrate sexual and reproductive health interventions into other health care services.

Many developing countries are not currently equipped to provide the full spectrum of interventions. But that does not preclude them from committing to achieving universal access to sexual and reproductive health and rights and to making continual and steady progress, regardless of their starting point.

* Dr Zeba Sathar, who is the Population Council’s Country Director in Islamabad, Pakistan, also contributed to writing this article.

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The article first published by The Conversation