Project HEART was launched in 2004 in partnership with the CDC and PEPFAR to scale up access to HIV prevention, care and treatment services in Côte d’Ivoire, Mozambique, South Africa, Tanzania and Zambia. As of September 2011, Project HEART has enrolled more than 1 million people in HIV care programs (including 80,000 children), provided antiretroviral treatment for more than 560,000 patients, and tested and counseled more than 2.5 million pregnant women.

The success of Project HEART is especially remarkable given that the final stage of the project merely marks the beginning of a new one, in which local partners and organizations are responsible for HIV program management in their own countries. In just three years, EGPAF was able to build up the capacity of local governments and civil society organizations and transition the management of HIV prevention, care and treatment programs over to local partners. This was accomplished by following a three-pronged strategy:

As we turn our focus toward ending the AIDS epidemic, it becomes increasingly important to strengthen local health systems and capacitate them to handle the HIV/AIDS epidemic in a comprehensive and sustainable manner. The World Health Organization (WHO) defines six building blocks for health systems strengthening to help clarify the essential functions of a health system. Project HEART is a great example of putting these principles into practice and making a commitment to, and investing in, health systems strengthening. The result is something we can all celebrate: the successful transition of a large-scale HIV program to local partners and governments. Job well done!

First to speak was Katherine Fritz of the International Center for Research on Women. Her statements were hopeful, alluding to the encouraging fact that the AIDS death rate has decreased by 17% since 2001. “The tide has turned and we are swimming with the current,” she said in reference to incorporating women’s issues into the greater conversation on AIDS treatment and prevention. While progress has been made, she reminded the audience that many factors, including biological susceptibility, social vulnerability, economic dependency, and a lack of female controlled prevention continue to put women at a disproportionate risk for contracting the virus.

Dr. Lulu Oguda, Senior Medical Officer at the Elizabeth Glaser Pediatric AIDS Foundation, and Heather Boonstra from the Guttmacher Institute contributed to the discussion on HIV and gender by stressing the importance of integration in the medical field, saying that it is imperative that HIV positive, expectant mothers get the treatment they need to prevent transmission of the disease to their children. Unfortunately, many clinics in rural Africa are specialized to deal with only certain aspects of HIV prevention and care. With some clinics providing ART treatments for women and others providing natal and post-natal medication to prevent mother to child infection, it is nearly impossible for an HIV positive, pregnant woman to move from clinic to clinic simply to get the range of treatments she needs, for herself and for her baby.

While providing care for HIV positive women and preventing mother to child transmission continues to present many challenges, it is clear that much that can be done in the future. Treating AIDS as a chronic illness much like diabetes, instead of an emergency issue, will allow patients to take responsibility for their own care. Including comprehensive treatments and integrated services into existing health structures will also make it easier for women to help prevent the transmission of HIV and help the world make strides in eradicating the disease.

I work in the communications department at the Elizabeth Glaser Pediatric AIDS Foundation, and World AIDS Day is one of the busiest days of the year for us. But this World AIDS Day – my fifth since joining the Foundation – was the first that I’ve spent in Africa, visiting Foundation-supported health clinics and patients in Swaziland.

This morning, after a misty drive up a steep, muddy dirt road, two colleagues and I visited the rural Mkhulamini Clinic. The waiting room was packed with patients; we had only a few minutes to visit with the nurses and give them some supplies donated by Foundation supporters in the U.S.

We also visited the more urban Luyengo Clinic, where we talked with the staff about the challenges they face in their prevention of mother-to-child transmission (PMTCT) of HIV program. They told us how hard it is for pregnant women to disclose their HIV status to their husbands, and how some HIV-positive women stop coming for treatment after childbirth, because once their babies have been treated they no longer think it’s important to treat themselves.

Despite all the obstacles, the hardworking staff at both the Luyengo and Mkhulamini clinics help to prevent countless pediatric HIV infections each year.

But the most moving part of my day was our visit to the home of Mfanzile and Zanele Dlamini and their 13-month-old daughter, Phiwayinkhosi (“Phiwa” for short). The Dlaminis are patients at Mkhulamini Clinic – both Mfanzile and Zanele are living with HIV. Zanele received PMTCT services while pregnant with Phiwa, and so far the baby has tested HIV-negative – she’ll take her final test at 18 months.

Mfanzile and Zanele have almost nothing. They live in a tiny, one-room house with no running water and just one small bed. They survive through subsistence farming and Mfanzile’s small salary as a night watchman. They struggle to get enough food. But thanks to the antiretroviral medication and PMTCT services they receive, the Dlaminis are alive and they have hope for a healthy future.

When I looked into baby Phiwa’s eyes, I saw that hope. I envisioned her 20 years from now, as a healthy young woman. We can make it happen if we all work together – it’s time to create a generation free of HIV.

View more photos of the Dlamini family here.

-Heather Mason Kiefer, Senior Writer/Editor, Elizabeth Glaser Pediatric AIDS Foundation

Lisa Bohmer (Elizabeth Glaser Pediatric AIDS Foundation), Maurice Middleberg (Global Health Council), Jeff Richardson (Abbott Fund) and Jane Kambalame (Embassy of the Republic of Malawi) held a hearing illustrating the necessity of PEPFAR as vital to the effectiveness of each organization.

Many of these groups are funded and supported by PEPFAR and are examples of what the bill has done and can do in the future – increased support will allow them to reach more men, women and children with HIV/AIDS. The reauthorize PEPFAR bill will double the number of people on retroviral treatment to 3 million, including over 450,000 children.

All the information you need to make your call is here.

The Elizabeth Glaser Pediatric AIDS Foundation began its international programs in 1999 with funding from the Bill and Melinda Gates Foundation and have since been aided by PEPFAR and other private-public funds. Their programs have helped over 4.8 million women prevent transmission of HIV to their children in over 2,800 sites around the world. Bohmer states than an essential component of effective Public-Private partnerships is strong leadership and governance on the national level.

The Abbott Fund partnered with the PEPFAR Partnership for Pediatric AIDS Treatment and the Government of Tanzania, and has trained over 7,600 health care workers in Tanzania and provided over 50 million rapid HIV tests throughout Africa. Richardson reminded the audience that “no one can do it alone,” hence the need for effective partnerships. He concluded by listing the 3 C’s essential to fighting the HIV epidemic. “If we can collaborate, coordinate and cooperate with good partners then we will be able to turn the epidemic around”

The Global Health Council has been providing NGOs and local communities with the funding and resources they need to combat preventable diseases for over 35 years. Middleberg stated that there must be clear consensus on goals, articulated strategies, defined roles and responsibilities, and transparency for any partnership to work.

Jane Kambalame from the Republic of Malawi, where 900,000 men, women and children live with HIV/AIDS, noted how global advocacy partnerships have improved medical care via investment in technology, infrastructure and direct treatment. The shortage of facilities and doctors delay the treatment and care of HIV/AIDS. However, Kambalame believes the Public- Private Partnerships in Malawi have helped fill the resource gap and have led to visible improvements. She stressed the importance of the reauthorization of the PEPFAR bill and the expansion of PEPFAR to new countries is essential to combat HIV/AIDS in Africa.

Learn more about PEPFAR here.

-Betsy Avila, with Olutosin Akinyode