SECURE THE FUTURE® is working to decentralize HIV treatment into primary health care facilities to bring medical care to people in their communities.

Bristol-Myers Squibb has learned much in the struggle to address the pandemic through its medicines and its philanthropic efforts. SECURE THE FUTURE® has provided $150 million in funding to more than 200 community education, support, medical research and care programs in 11 countries in the region. With all that has been accomplished, there is still important work ahead to address the health disparities and health outcomes -- particularly in women and children and their families, says Sebastian Wanless, M.D., senior medical director, SECURE THE FUTURE.

"SECURE THE FUTURE has led the way in many respects in demonstrating that community-based efforts can help deliver effective treatments. Data from our community treatment and support sites clearly demonstrate the value of providing a wide range of community support programs to those receiving treatment," explains Wanless. "Nutritional programs, psychosocial counseling, income generating projects and home-based care all help patients achieve good clinical outcomes."

What's more, these services are practical and can be developed even in the most resource-limited regions of the world. The SECURE THE FUTURE funded and developed community support programs were designed as models for use in other regions of the world.

The challenge now for SECURE THE FUTURE is to expand and decentralize the efforts, moving from larger health centers into local health clinics in the community and in the countryside, to train more health care workers at all levels to deliver treatment and support, and to enhance efforts to reach the most vulnerable populations, especially children.

New programs are being developed and funded by the Foundation, in partnership with non-governmental organizations, local governments and institutions like the Baylor College of Medicine. In the district around Ladysmith in South Africa, for example, clinical services for HIV treatment previously only available at Ladysmith Provincial Hospital are now being decentralized to primary health centers. By moving to health centers where primary health care is delivered, treatment and support will be closer to the people in their own communities. An added benefit to decentralized health care delivery is the impact in reducing the stigma of AIDS by treating it alongside other diseases.

After eight years in Africa, the Foundation is now seeking to replicate successful community-based treatment and support approaches that have been modeled in six countries in the region. In Namibia, for example, the government has recognized the value of the community component established by SECURE THE FUTURE in the Caprivi region and has requested that the Foundation replicate it in another region while the government provides the clinical support. SECURE THE FUTURE is committed to provide others with the expertise and assistance needed to replicate these programs throughout Africa.

The Pediatric AIDS Corps (PAC), created by Bristol-Myers Squibb and the Baylor College of Medicine, sends 50 U.S. and Canadian physicians a year to Africa to treat HIV-positive children and their families as well as to train local health care professionals. The PAC doctors are expected to treat some 80,000 children over the next five years. They will be based at the Children's Clinical Centers of Excellence, established by the company and Baylor in cooperation with local governments, and will work in rural hospitals and health centers to extend the reach of care and training to remote areas of the countries. Three Children's Clinical Centers of Excellence are in full operation, two are under construction and more will be sited.

SECURE THE FUTURE is also working, with the assistance of the PAC doctors and the Children's Clinical Centers of Excellence, to develop successful programs to stop the transmission of HIV from mother to child. Novel programs that extend the continuum of care from antenatal screening and counseling of the mother, through birth to evaluation of the child at 12-18 months to determine HIV status, are additional examples of how SECURE THE FUTURE is working in the community to address HIV/AIDS in Africa's most vulnerable populations.