Q&A With Project HOPE's Dr. Renslow Sherer

Dr. Sherer is a William B. Walsh Fellow and Senior Technical Adviser at Project HOPE and Clinical Associate in the Section of Infectious Diseases at the University of Chicago Hospitals in Chicago. As a physician, he has been a primary caregiver for persons with HIV disease in Chicago since 1982. He is a leader in Chicago and around the world in HIV prevention, care, research, training, and health policy. In recognition of World AIDS Day, Dr. Sherer  answers questions about the successes and challenges of Project HOPE's HIV/AIDS programs.

A: At a recent summary status of HIV/AIDS prevention and treatment programs at the 11th European AIDS Conference in Madrid, Spain in October, Helen Rees from South Africa noted that one important recent innovation in HIV prevention was micro-credit. Simple economics are one of the drivers of the spread of HIV. Poverty has a uniquely harmful impact on the vulnerability of women to HIV infection, and on young women in particular. It’s extremely important to provide women with viable alternatives to support themselves, other than prostitution or economic dependence on an older, wealthier man. The poverty relief provided by micro-credit programs provides an incentive for an alternative means of support for women to buy food for their families, to support a business, to improve their family’s health and nutrition, and to allow young women to stay in school.

Project HOPE is actively engaged in micro-credit HIV/AIDS programs in support of orphans, vulnerable children, and their caregivers and families in Mozambique and Namibia. Our micro-credit programs provide small loans to women in the program to start up or expand small businesses. Our micro-credit programs are unique because of the explicit operational link between health education and poverty relief.  The loans are combined with health education sessions that teach about HIV prevention and treatment, family nutrition, parenting skills, critical issues for orphans such as safety and security, civil and legal rights, and the importance of education. Project HOPE’s micro-credit programs are unique in providing a linkage to economic relief and health education of other proven HIV strategies such as the full ABCs of HIV prevention. Our micro-credit programs are part of a full package of HIV prevention strategies. 

Project HOPE has also been a leader in the integration of HIV prevention and HIV treatment and care. HIV prevention education needs to be an integral part of HIV/AIDS patient care and treatment programs, including health educator training. Similarly, HIV care and treatment, including HIV testing, needs to be incorporated into community-based HIV prevention programs to increase the immediate enrollment of people with HIV into care and treatment programs.  At Project HOPE, we understand that each is interdependent of the other. Project HOPE programs in China, Honduras and Malawi all feature comprehensive integration of prevention, care and treatment programs.

Q: What are the major accomplishments of Project HOPE’s HIV/AIDS programs over the past year?

A: The single most dramatic success in the previous year is the success of our antiretroviral therapy scale up and capacity building program in Hubei Province, China. China has 650,000 HIV infected people, and Hubei is in the list of the top 10 provinces with HIV infection rates. From 2002-2007, Project HOPE conducted a program to train health care professionals and community workers on the prevention, care and treatment of HIV/AIDS. From 2002 to 2006, over 3,000 people living with HIV were enrolled in care and treatment, and the mortality rate due to AIDS declined from 49 percent to 8.8 percent. These results were presented at the International AIDS Society meeting in Sydney in July 2007.

Also, we are very proud of the fact that our micro-credit and Orphans and Vulnerable Children (OVC) programs in Mozambique and Namibia have served 25,071 orphans and trained 4,441 caregivers of orphans.  Project HOPE was recognized on three occasions in 2007 for its high quality OVC services. The USAID Namibia Mission recently awarded two additional awards to Project HOPE to expand the OVC program in new districts with a specific emphasis on elder caregivers and on HIV prevention in young women. Project HOPE Mozambique’s OVC program was recognized by the USAID Mission in Mozambique for the accuracy and transparency of its monitoring and evaluation process, and all OVC grantees in Mozambique are now using this methodology.  And finally, the OVC Program was presented at the President’s Emergency Plan for AIDS Relief (PEPFAR) Implementers Meeting in Kigali, Rwanda in May 2007, specifically describing the success of the program in securing birth certificates for more than 1,700 orphans and vulnerable children in Mozambique in the fall quarter of 2006.

Q: What advances will Project HOPE be making in HIV/AIDS programs in the coming year?

A: Project HOPE prides itself on developing quality and sustainable HIV/AIDS prevention, care and treatment, and education programs, as well as being a leader in innovative programs  to address cutting-edge problems in HIV and related infectious diseases. One example is our recent work in Malawi with TB and TB/HIV co-infection.

The TB epidemic in Malawi has experienced severe increases in case incidence and deaths during the era of AIDS. In Malawi, 75 % of people with TB also have HIV infection. Other critical issues faced by the Malawi National TB Program are severe human resource deficits and infrastructure limitations, as documented by community and health facility surveys conducted in the first year of the Project HOPE TB Program in Malawi.  By working with community health workers in Malawi, coordinating closely with national and regional TB officials, and providing technical assistance for laboratory upgrades and expansion of the lab technology workforce, our program objectives are to improve the detection of TB and to improve treatment outcomes by improving the cure rate, the treatment completion rate, and reducing the death rate for people with TB and TB/HIV co-infection. An important component of this work is linking with other key providers of TB and HIV services in Malawi, such as the TB-CAP and several PEPFAR providers, and linking the TB and HIV system to the greatest extent possible.