Rajesh Gupta, MD, MS, MPH is currently a researcher at Stanford Medical School and has  worked with Google.org, the World Health Organization and the Division of Social Medicine at  Harvard.

Tell us about yourself. What do you do at Stanford, and what is your experience in the field of advocating for access to essential medicines, and HIV medications in particular?

At Stanford, I finished my MD and will finish my MS this quarter.  Currently, I am also the Medical Director at a San Francisco-area therapeutics company.  I was fortunate enough to have designed (with Jim Kim, PIH founder and, now, Dean of Dartmouth University) the Green Light Committee for drug resistant tuberculosis.  We brought down the cost of second-line drugs needed to treat drug-resistant tuberculosis by about 95% of their original price.  The strategies we designed were used to help increase access to antiretrovirals as well.

Where does the international community stand in providing comprehensive access to antiretroviral therapy for those who need it?

Thankfully, the international community is now in a mode of recognizing the importance of treatment and providing treatment for all who need it.  It may seem slightly obvious but that was not the case a few years ago.  For a long time people were debating whether or not treatment was possible.  Then they debated which was the better value, treatment with antiretroviral therapy or prevention using the ABC’s (Abstinence, Be Faithful, Condoms).

What are some of the challenges that you see in reaching this goal?  In your opinion, what do you think needs to happen in order to ensure that those who need ARV treatment get the medications they need?

The challenges are quite difficult but can be overcome.  This includes getting proper financing to purchase and deliver the drugs to patients, designing large scale patient-centered treatment programs and designing appropriate treatment protocols.  Much work has been done so far.  Often, the hardest part is not reaching the first 50% of people but getting to the remaining 50%.  We are certainly much better off now than 10 or even 5 years ago.

What is your opinion on recent initiatives by pharmaceutical companies like GlaxoSmithKline and Merck who have pledged increased donations? Do you think this is a sustainable solution?

There has and always will be a role for big research-based pharmaceutical companies and for donations.  I will always support donation programs, but only as part of a more comprehensive solution.  This comprehensive solution includes the involvement of generic-based pharmaceutical companies to ensure that prices remain low and supplies remain continuous in the long-term.

What do you view as the role of young people in combating the HIV/AIDS epidemic?

Social awareness is something young people are really great at.  Facebook and Twitter are amazing because of what young people are doing with it.  Think about the power youth could have in using social media networking to advance the rights of individuals with HIV/AIDS.

The other area is innovation.  Honestly, some of the best solutions in HIV/AIDS are going to come from young people who simply challenge traditional obstacles.  The world of HIV/AIDS needs fresh people with a new lens on life who approach problems with the determination that a solution exists.

What would you say to FACE AIDS’ chapter members who are interested in this field?

Here are three concrete things you can do.

1) I would encourage everyone to get some concrete experience in the large world of health, whether in the US or abroad.  This can range from technology development to volunteering at a local public health clinic to serving food at a soup kitchen.  Everything we do in our daily lives can impact the health of others in a positive way.  Health is a marker of many social problems.  The closer you can connect yourself to understanding the underlying problems, the better understanding you can get of health.  This is a good foundation to build upon your interest.

2) I would also say that whatever you do, do it well.  At most FACE AIDS chapters, this translates to “study hard.”  The world is full of people who want to do good for the world but think good intentions are all that is necessary.  The poor and sick deserve much better than that.  They deserve people at the top of their game helping them.

3) Diversify your experience.  Some of the people who have the most innovative solutions in global health have a good understanding of multiple disciplines.

From Stanford Magazine May / June 2010

Riding for Rwanda

Stanford rowers pedal for FACE AIDS.

STANFORD HELPED PROVE another axiom of life last summer, and the individual who gets the credit more than went the extra mile. One moment, Austin Keeley was bicycling smoothly out of the Colorado Rockies. The next, he was out of control, hurtling over the road’s guardrail. As he flew, a spike-like piece of metal—a mile marker, Keeley thinks— snagged his jersey and carved a bloody line across his chest.

Keeley and bike partner Dave Evans, both ‘11, flagged down a car for the 30-minute trip to a hospital in Cañon City, Colo. An inquisitive physician wanted to know quite a bit about who they were, so Keeley explained that they were members of the Stanford rowing team on a cross-country fund-raising ride for the FACE AIDS organization. Obviously intrigued, the doctor picked up a large syringe of pain medication, looked for the right spot to plunge it into Keeley’s chest and then announced he was a former Cal athlete. Theorem proved: Ouch, it really is a small world.

A year later, Keeley’s tumble is a jokingly ghoulish source of entertainment for the three freshman teammates who will take over the Ride Against AIDS this summer. Already inspired by the physical challenge—almost 4,500 miles in 67 days—they banter about the marketing potential they see in Keeley’s scar, thanks to its resemblance to the Nike Swoosh. Underneath those laughs, however, is a much deeper connection. They all share an intense “rowing brothers” camaraderie that defines them as athletes and is driving their effort for FACE AIDS.

Headquartered at Stanford, the organization was started in 2005 by three students—Katie Bollbach, Jonny Dorsey and Lauren Young, all ‘07—out of concern for shunned and orphaned HIV/AIDS victims in Africa. FACE AIDS mobilizes students across the United States to take part in fund-raising campaigns, with the proceeds going toward healthcare in Rwanda. Executive director Julie Veroff, ‘07, says $125 pays a year’s antiretroviral treatment for one patient.

The crew team’s involvement began in 2007, when a former rower, Jeremy Barton, ‘06, initiated the ride with friend Robby Sumpf, ‘06. They pioneered a trip that includes scheduled meetings with interested groups but also seizes on happenstance encounters that generate publicity and contributions. That ride raised almost $8,000 for FACE AIDS and resulted in an ongoing partnership with the rowers.

Evans and Keeley raised more than $19,000. Improving on that is up to the cyclists who start pedaling June 14: Shane Hegde, Sanford Roberts and Zane Silver, all ‘13, women’s crew member Claire Fisher, ‘13, and four students from other universitites. They’re hoping alums around the country will help bring attention to their trek.

The Cardinal riders are conspicuously aware of their good fortune at being Stanford students and say they want to do something substantial to help people in distress. They especially want to do it together. “I expect,” says Silver, “to end up being in contact with these guys for the rest of my life.”

May: HIV/AIDS and Access to Treatment

On Thursday May 6th at 3:30pm PST / 6:30pm EST, please join

us as we hear from Richard Zule-Mbewe, a Global Health Corps Fellow from Malawi currently working on Health Literacy at the University of Medicine and Dentistry of Newark, New Jersey.

Richard holds a B.S. in Technical Education from University of Malawi’s Polytechnic. During his studies he completed a two semester teaching practicum in local secondary and technical training schools. Shortly after graduating in January 2006, he joined a consulting firm as a Data Management Consulting in HIV/AIDS, and then worked at the Baylor College of Medicine Children Foundation in Malawi as a Monitoring and Evaluation Officer. In the future, Richard hopes to pursue a dual masters degree in public health and business administration, with a focus on health policy and biostatistics.

To join the call:

1. Dial the U.S. number: 1 (201) 793-9022
2. Enter the conference room number: 2390580 #
3. You will enter the room immediately if the moderator is present or you will be placed on hold for up to 10 minutes.

From Jeffrey S. Crowley, Director of the Office of National AIDS Policy and Senior Advisor on Disability Policy

On Friday, May 14, 2010, the White House Office of National AIDS Policy (ONAP) will hold a community meeting to provide an update and gain additional recommendations for the National HIV/AIDS Strategy (NHAS).  For those who cannot attend the meeting in person, ONAP will hold a conference call shortly after the meeting to discuss the strategy.

We know the strategy’s success will rely on the participation of our community partners across the country.  That’s why we hosted 14 community discussions across the country, and conducted an online call to action to solicit recommendations via our website. In February, we co-hosted with the Department of Health and Human Services, a community meeting to update the public on our progress and introduce the Federal HIV Interagency Working Group.  Earlier this month, we released a report summarizing community recommendations we received for the National HIV/AIDS Strategy.

During the May 14 meeting and the conference call, ONAP will provide a brief overview of key priorities and identify issues where additional feedback would be helpful.  Participants will be able to offer suggestions for the strategy, and we encourage public input on the following topics:

•    Involving non-traditional stakeholders in fighting HIV/AIDS
•    Expanding the engagement of key partners including businesses and philanthropy, faith communities, and HIV service providers
•    Ensuring that implementation of the National HIV/AIDS Strategy is successful

Below are details for both the community meeting and conference call:

ONAP COMMUNITY MEETING

When:  Friday, May 14th at 11:00 am (Eastern Time).  Guests should arrive by 10:15am to ensure smooth security processing.)  The meeting will end by 12:30 pm.
Where:   South Court Auditorium in the Eisenhower Executive Office Building of the White House
To RSVP for this event, please submit the following information to aidspolicy@who.eop.gov by Close of Business Monday, May, 10th: Full Name, Date of Birth, Social Security Number, Country of Origin, Citizenship.  Members of the public will be accommodated on a first come first served basis as meeting room space is limited. We will respond to RSVPs to confirm all reservations to attend the event.

ONAP COMMUNITY CONFERENCE CALL

When: Friday, May 14th at 1:00pm (Eastern Time).  The call will end at 2:00 pm (Eastern Time).
Conference Call Phone Number: (800) 288-8961

Media wishing to attend must send the following information to media_affairs@who.eop.gov by close of business on Monday, May 10: News Outlet, Full Name, Date of Birth, Social Security Number, Country of Origin, Citizenship.

While microfinance programs have long targeted female clients because of the associated positive impacts seen in their children’s health and education (as well as other benefits), should microsavings programs also make targeting female clients an express part of their missions?  David Roodman of the Center for Global Development writes an interesting summary of a study measuring the impacts of microsavings that was conducted in Kenya and Uganda.  I found the gender differences in use of savings and subsequent impact on business growth particularly fascinating.  

“First Randomized Trial of Microsavings” (David Roodman)

What do you think?

Hey again!  For anyone interested in or curious about our focus on savings programs, in which members of our partner associations learn about and encourage each other to save very small amounts each month (usually approximately $1-2 per person), check out these articles about the importance of “microsavings.”  Once seen as merely a side-effect of microfinance, experts now consider community-based microsaving to be one of the simplest and most effective ways to help increase financial stability among the poor.   

Putting the Microsavings in Microfinance (Nicholas Kristof)

A Better Mattress: Microfinance focuses on lending. Now the industry is turning to deposits. (The Economist) 

Thanks to John Thomas for sending these articles along to me!

In this blog, I have made many references to FACE AIDS’ “structured savings” program.  I would like to dedicate a whole post to explaining what exactly structured savings is and how it is impacting our partner associations. 

Structured Savings vs. Microfinance

Structured savings looks a lot like microfinance.  In fact, our structured savings program, which we began piloting with 2 community-based cooperatives in 2009, has borrowed a lot from successful microfinance institutions and programs from around the world.  The main difference is that, rather than giving our money out to cooperative members (and collecting the repayment and interest ourselves), we give cooperatives the tools to start their own lending programs.  Read on for an overview of how the cooperative-run structured savings program works. 

How our “Structured Savings” model works:

We give cooperatives the funding to start their own small loan projects when we pay them salaries for the pin-making project. 

We then start the structured savings project by providing training to cooperative members on the basics: what is a loan?  What is an interest rate?  How do I reimburse?  After providing cooperatives with these basic tools, we help the cooperative leaders distribute loans to their members (these first loans are financed by their salaries from the pin-making project).  When the members repay their loans, the cooperative deposits that money into the cooperative’s bank account.

At the end of the reimbursements, the cooperative has been repaid all of their original money from the salaries.  Plus, they have earned the interest from each member’s loan.  In this way, the project is income-generating.  The cooperative can then decide whether to use the profits to give larger loans or to distribute the profits between the members.

Our results:

We began testing this project with 2 cooperatives in Kirehe in 2009.  We gave 30,000RWF/member to each cooperative as the final part of their salary from the pin-making project.  This money was used to finance the first loans to the members.  At the end of the first loan cycle, both cooperatives had 100% repayment rates.  

Girimpuhwe, our partner cooperative of AIDS orphans, chose a 10% interest rate over 6 months.  By the end of their first loan cycle, in January 2010, they had already saved an additional $207.  Using this profit, Girimpuhwe was able to pay the registration fees to become a fully-registered Savings and Credit Cooperative while also giving out a second round of loans to its members. 

Dukundane, our second association with a structured savings program, also paid back with 10% interest rates with a 100% repayment rate, saving $185.  They are also using these profits to register officially with the local government. 

In addition to the group savings earned, members from both associations report that the project gives them a safe and easy way to save their earnings, and helps them access larger amounts of capital at critical times (such as during planting season).  Several women in Dukundane also reported that having access to credit and running their own businesses has made a huge impact on the health of their families, because the women have their own money to spend, rather than having to ask their husbands’ permission.  In this next round of loans, we will be evaluating the impacts of the project on the health, education and overall socioeconomic status of our beneficiaries and their families.  We expect to see that having continued access to loans and a safe place to save improves the basic health and access to education of our beneficiaries.

Looking Forward

After less than a year, both Girimpuhwe and Dukundane are nearly ready to run their lending programs independently.  We are estimating that we will provide active support to each cooperative for a year while setting up the project, but that the project can continue without active follow-up (or any additional financial support) after the first year. 

Given the success of the first loan cycle of the structured saving program, we are excited to expand the program’s reach, and are currently training 2 more associations to run their own cooperative-led lending programs.  We are also creating a training curriculum for cooperatives to develop such programs on their own, financed by their own savings.  Promoting safe and structured ways to save is one of the largest benefits of our program, and we hope to create trainings on structured savings for cooperatives that can be more widely used throughout Rwanda.

Hi everyone!  It’s Claire, and I’m excited to introduce you to the newest addition to our Rwanda team.

Jean Bosco, FACE AIDS Program Assistant in Rwanda

Jean Bosco Bamuririmbe, FACE AIDS’ new Program Assistant, can certainly hold an audience. A recent graduate of the PIH School Fee’s program, Jean Bosco graduated from secondary school as one of the highest ranked students in his class in December 2009. Head boy of his dormitory, president of both his school Boy Scout club and the anti-AIDS club, he is a natural leader. After the 2009 Forum, in which he participated, he was elected the president of a cooperative of all of the students graduating from the School Fees program in 2009. This association, called Youth Community, is already actively recruiting and organizing more youth to found new FACE AIDS chapters.

Jean Bosco’s natural leadership abilities were made apparent to me on his first day working with FACE AIDS: we went together to meet ABEDO, one of FACE AIDS’ partner associations. ABEDO is in the process of beginning its own structured savings program, and on that day we were meeting with its members to answer any questions they had about loans and reimbursements. As it was his first day, I expected Jean Bosco to sit back and listen, which he did — for the first half of the meeting. But after appraising the situation, he began to speak. I watched as ABEDO’s members laughed, nodded their heads and smiled at his suggestions for how to get their program up and running. At the end of the meeting, their president came up to me and said, “Where did you find him? He is going to help us a lot!”  

As you can tell, I am very excited to have Jean Bosco on our FACE AIDS Rwanda team. Read on for a more complete interview with Jean Bosco!

Interview with Jean Bosco (March 17, 2010)

What would you like to tell the FACE AIDS team about your life?

I was born in 1984 into a very poor family. But today, things are much better! I am the oldest child in my family. My father was a hunter and also a farmer. I started school in 1991. At that point, I had one little brother and one little sister. I went to primary school at Kabare. At the end of my first trimester, I found out that I was ranked the 16^th best student. I went back home and I was very happy with myself, but my father punished me. He told me I should always try to be the best.

It was up to me to buy my own uniform, so I started farming before and after school to make enough money. In the second trimester, I did even better and was the 4^th best student in my place. And then, in the 3^rd trimester of my 2^nd year, I was ranked the top student. Happily, I was able to continue to 3^rd year, in which I was again ranked the top student. In the last semester of that year, the war started. The 6^th of April, 1994. I remember – it was a Friday. We were getting ready to start our studies for the next week, but then, the war began. And my studies stopped. We left Rwanda and fled to Tanzania. We were in a refugee camp called Cyabarisa (in Karagwe Province). We left Rwanda on the 1^st of July in 1994, and we stayed in Tanzania until 1996. We returned to Rwanda in September of 1996. When we were in Tanzania, I studied for 2 trimesters in Tanzania in the refugee camp schools. When we returned, I should have continued in my 4^th year, but I had to stop because my family was too poor. It was very hard to find food to eat, much less pens and paper. I returned home to help my parents. From 1997 until 2002, I was out of school. I sold fish, farmed, and then I started a small photography business. I bought the camera on May 10, 2000. I also bought a bike so that I could ride around the countryside and find customers. In this way, I made enough money to return to school by September, 2002.

I then started secondary school with the help of Partners In Health, who paid for my school fees. It was difficult, but in my 2^nd and 3^rd years I did very well. I love science (math, chemistry, physics). Unfortunately, I wasn’t able to continue in the science track, but instead focused in language and literature. I was also the leader of the school’s Boy Scouts troop and leader of my dormitory. I was also the president of the anti-AIDS club.

What are your dreams for the future?

I think that my future will be good, especially when I think about how my life was before. My family was very poor. So now I am very happy, because I have found work, and this will let me help my two little brothers and my little sister. I will help them go to school. I am very happy because I finished my secondary school career with good marks. If there is an opportunity, I would love to go to university. Of course! If I have the means, I will go back to school. But now, I must first support my little brothers and sisters.

What do you do to have fun?

I am happy when I am with many people, especially at shows and events. Also, when I can teach other people, I am very happy. I like starting clubs to help orphans and poor young people. I like helping other people. If I had money, I would help even more people. My goal is to start cooperatives. In secondary school, I started an associated for PLWHA. Now, it is a cooperative that works with Partners In Health, helping its members find opportunities to go to school. And I think that FACE AIDS gives a voice to my objectives!

Anything else you would like to tell us?

First, I would like to thank the FACE AIDS team in America for being involved in FACE AIDS, and for caring enough to do something to help orphans and other living with HIV/AIDS and for creating opportunities for PLWHA. I would love to see how chapters in the US work, and maybe I can come visit. You are also very welcome to come to Rwanda, so that we can continue this conversation and we can learn from your ideas!