27 November 2013

Five Questions with Karen Allen, UNICEF Pacific Representative

The Kiribati Family Health Association youth group with Karen Allen 
UNICEF Pacific Representative and UNICEF Colleague 
© UNICEF Pacific/2013/Teannaki
Can you tell me about your personal experience on HIV and AIDS? 
When did you first hear about it and how did you feel about it?

I first heard about HIV AIDS when I was doing my PhD studies in the USA in the late 1980s. The disease was initially stigmatised and it took a huge social movement to make it a public health priority. For seven years in Bangladesh I hardly heard anything about it. But when I moved to East Africa in 1994, I quickly learned a lot about it as a major public health catastrophe for many African countries. My husband eventually moved from the field of family planning to HIV AIDS, and worked relentlessly on expanding prevention and treatment in Kenya and Uganda – so I learned a lot from him. I also learned a lot within UNICEF, across the eastern and southern African region, I saw entire villages, towns, to some extent, cultures, being decimated – more than decimated as prevalence reached almost 50% in some locations. So many children became orphaned and despite extended family care, the quality of their lives was severely compromised. It was and is heart breaking, considering that HIV AIDS is preventable and, now, treatable though not curable.

With renewed global goals of zero new HIV infections, zero stigma and discrimination and zero AIDS related deaths, how would you define the role of the UNICEF Pacific HIV & AIDS Programme in ensuring that women, children and adolescents vulnerability to HIV & AIDS is reduced in the Pacific region?

The fact that we have an HIV& AIDS programme, resourced by core funding, shows our commitment to the global and Pacific goals of zero new infections. We have a special commitment to prevention of mother to child transmission; we are really in the lead on this and have to carry through – with the knowledge, testing and technology available today, it is totally do-able to reach zero cases of mother to child transmission. We have to focus, concentrate our resources and make it happen.

Globally, new HIV infections have declined in recent years and this can be attributed to significant investments that sustained HIV response over the years. Lately though, investments have declined substantially. What are the implications to the women, children and adolescents of the Pacific in relation to these latest developments?

It is not surprising that investments in HIV response have declined, since the very high levels of resourcing in the late 1990s and first decade of this century were not sustainable, given so many competing public health priorities. Also, we have seen HIV AIDS response mainstreamed successfully in most public health programmes, so there is less need for an expensive vertical approach.

That said, we must continue to wave the red ribbon and remind all stakeholders that it is not yet time to be complacent. Integration and mainstreaming should not mean becoming invisible.

In the region, the rate of HIV testing in pregnant women is still relatively low. In your opinion, what are the potential barriers and how can these be addressed ?

Despite relatively high antenatal care (ANC) services coverage across the Pacific, in a number of countries HIV testing coverage  in pregnant women remains to be very low. The main barriers for HIV testing are availability and accessibility of services especially in outer islands. Therefore, while working towards higher ANC attendance and higher percentage of assisted, safe deliveries, we also need to find ways to get HIV and other STI testing done through mobile outreach using new point of care testing technologies. Mobile outreach for testing, counselling and referrals on STIs may be an easier goal than increasing ANC visits – though both should be pursued.

We need to get more influential people in every country in every community talking to men and women about STIs, testing and treatment. In Kiribati and Fiji, for instance, our office is working hard on persuading religious leaders to help with this movement.

In my opinion, we should advocate with Health Ministers for opt-out rather than opt-in testing for every pregnant woman who comes to health facility, private and public, for ante-natal care. This means, that when she is informed about the mandatory tests for good pregnancy care, she will also be told there will be an HIV test, unless she signs that she does not want it. Counselling should always be available along with the test.

What are your thoughts on HIV & AIDS education in the region and what advice would you give to the adolescents and young people in this region?

The implication of the relatively low prevalence (compared to high prevalence countries) in the Pacific, is that people, including young people, do not pay enough attention to understanding how HIV is transmitted, and how to prevent it. It is not only large investments in response that led to a decline in prevalence globally. It is also because so many people were dying – that woke people up and got them to abandon or reduce risky behaviour.

I think we have to package HIV AIDS awareness and knowledge building with awareness and knowledge building about all sexually transmitted infections. Taking preventive measures against any of these, will help prevent all of them. And STIs in general are very prevalent in the Pacific.

I think we also need to link our goal prevention of adolescent pregnancy to our goal of prevention of HIV and AIDS.  Using condoms properly and consistently is well known for its dual results: reduce STIs and reduce pregnancies.

By tying these things together and having a more integrated approach, we can somewhat compensate for reduced funding for HIV AIDS prevention.

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