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