The global HIV/AIDS pandemic requires a vigorous response that focuses on enhancing the capacity of countries and communities to treat the disease and to support and sustain those affected by it.

Bristol-Myers Squibb has been involved in the fight against HIV/AIDS for more than a decade. Today Bristol-Myers Squibb is the only company with once-daily oral drugs in each major treatment class for HIV. Even as the company has continued to develop better therapies, it has been keenly aware of the need to expand access to HIV therapies by working with the Accelerating Access Initiative, which includes United Nations agencies and several other pharmaceutical companies, and through other actions. In 1999, it launched the groundbreaking $150 million SECURE THE FUTURE® program, the largest corporate effort of its kind, to aid women and children in sub-Saharan Africa infected and affected by HIV/AIDS. As that work continues in Africa, the company and the Foundation have been supporting programs in other hard-hit communities in Asia, the former Soviet Union, Latin America and the United States to expand capacity and explore and validate creative sustainable solutions to this terrible pandemic.

Bristol-Myers Squibb recognizes that medicines alone will not be sufficient to treat this disease. Health care infrastructures must be developed and enhanced, stigmatization must be overcome and capacity must be built so that local people generate and sustain local solutions to this global problem. By working at the community level, while also involving countries and governments, Bristol-Myers Squibb has developed model programs that can be used around the world—from curricula for health professionals first developed by the Baylor College of Medicine in the SECURE THE FUTURE program for Africa that have now been distributed in 47 countries, including being adapted and used in Ukraine, to awareness programs that are applicable across many cultures and countries to the first ever Pediatric AIDS Corps for Africa. Benefits accrue to the communities by controlling disease transmission and ultimately, by building safety nets so that treatments can be delivered effectively.

Some of the world’s fastest-growing rates of HIV infection can be found in Russia, Ukraine and other former states of the Soviet Union. Among the most critical needs in these areas is proper training for health professionals. Since 2001, the Bristol-Myers Squibb Foundation has been actively working with the Ministry of Health and other partners in Ukraine to provide such training. In 2003-2004, it supported work with a $60,000 grant to adapt a special curriculum created by the Baylor AIDS Institute for health care professionals who work with HIV patients for the special needs in Ukraine, an area where up to a half million people -- or 1 percent of the population -- are believed to be HIV-positive. In 2005, the responsibility and a second grant of $60,000 for the training was transferred from Baylor to a local NGO, the International HIV/AIDS Institute based in Kiev, which conducted 8 training sessions for over 300 physicians and nurses.

Russia and Ukraine have emerged as new epicenters in the global HIV/AIDS pandemic, registering two of the world’s fastest growing rates of new infection. Independent experts from the region and the West estimate that up to 1.5 million Russians may be infected, representing over 2 percent of its adult population. Ukraine faces a similar crisis, with an estimated 500,000 cases of infection. If current trends persist, epidemiologists warn that up to 8 million Russians and 5 million Ukrainians could be infected within a decade, reflecting adult prevalence rates of 10 percent and 8 percent, respectively. In both countries, the epidemic is growing fastest among the general (non-drug using, heterosexual) population, ages 15-30.

The Foundation and Company have provided $475,000 in funding to support two key areas of activity: the implementation of HIV/AIDS-related workplace education and non-discrimination programs and activities to mobilize corporate executives and labor leaders to advocate with governments for a strong national response to the growing HIV/AIDS epidemic. The workplace project incorporates the Baylor Curriculum for Healthcare Professionals Training into TPAA’s HIV@Work Employee Education Program currently operating in businesses in Russia and Ukraine. A Policy & Leadership Initiative helps to ensure active involvement and strong preparation of business and labor leadership to advocate for a vigorous national response to HIV/AIDS when interacting with policymakers. Support for the Policy & Leadership Initiative also allowed TPAA to prepare for the G8 summit held in St. Petersburg in 2006. TPAA helped organize the Parliamentarians for Global Action "Pre G8 International Policy Conference on HIV/AIDS in Eurasia," which brought together 110 participants, including parliamentarians and business leaders to further strengthen public-private partnerships in the fight against HIV in Russia and Ukraine, as well as in G8, China, India and Eurasian countries.

Despite the rising rates of HIV infections among young people in Russia, education and prevention program are not taught in the public schools. To address this issue, Miramed, an NGO focused on women's rights and health, has undertaken an initiative to pilot curricula it has developed for life skills, sex education and HIV/AIDS education for use in orphanages in two school districts in Russia. For this work, the Foundation is providing a three year grant of $265,000. In the summer of 2006, the MiraMed/Women Children First "Navigator" program, funded by the Foundation, was chosen as the winning program from among 29 finalists and selected for distribution as the HIV/AIDS prevention curriculum in Moscow public schools by the Moscow Department of Education. The program will be used in the Department’s strategy to work toward preventing drug and alcohol use, and in the prevention of the transmission of HIV in the city. Key to the success of the program will be training teachers and gaining support from NGOs involved in AIDS education.

The Guangxi Zhuang Autonomous Region has witnessed an alarming and growing number of HIV cases among local injecting drug users (IDUs) in an area where about 90 percent of all drug users inject themselves to sustain their habit. In parts of the region, HIV infection rates among IDUs range from 20 to 70 percent. In addition, nearly two-thirds of prostitutes in this region reported never using a condom. Today, infections are growing rapidly among the general population as well.

To address this issue, a capacity building effort for AIDS prevention and control in Guangxi has begun among professional medical personnel, along with an effort to create an environment of community support, care and acceptance for people living with HIV/AIDS. The goals of the project funded by the Foundation with a grant of approximately $700,000 to the China Center for Disease Control are to establish a formal training center for medical personnel in Nanning and Liuzhou on HIV/AIDS treatment and nursing and to develop community health education, public education and community support for people living with HIV/AIDS in Guangxi and Lizhou.

Although national HIV prevalence remains below 1 percent in Vietnam, there are already some 2,500 HIV-infected children in the country. Many of these children have been abandoned and are currently in orphanages. Because the AIDS pandemic is relatively confined in Vietnam, the country’s health care workers have minimal experience with the disease and how to treat it. With grants to date to the Worldwide Orphan Foundation totaling $215,000, the Bristol-Myers Squibb Foundation is supporting an effort to train Vietnamese health care professionals in pediatric HIV/AIDS treatment using the HIV Curriculum for Health Professionals originally designed by the Baylor College of Medicine for SECURE THE FUTURE. This partnership was expanded this year to include a Medical Mentoring Program, which has two components: recruiting local physicians in Vietnam and developing a corps of experienced pediatric HIV specialists to serve as mentors to local physicians. The mentors will travel throughout Vietnam in order to train, assist and support local pediatricians in treating children with HIV.

African immigrants to France often have difficulty navigating many social services, particularly health care services. For HIV-positive immigrants, the stigma of the disease as well as cultural and language barriers compound the difficulty considerably. MIGAS—a nonprofit organization made up of health care professionals, social workers and people from the African community—is committed to enhancing the ability of immigrants to access HIV/AIDS care. With the support of a $112,000 training grant from the Bristol-Myers Squibb Foundation, MIGAS has trained peer educators to reach out to the African community and to partner with health care providers and social workers at Bichat-Claude Bernard Hospital in Paris to better address the needs of this severely underserved and vulnerable population. As of March 2006, MIGAS has provided navigation services to 144 patients from the immigrant African community in Paris.

With the evolution of AIDS in the United States from a terminal diagnosis to a chronic disease, Leeway is now serving individuals who are living longer, whose medical conditions are stabilized, but who are not fully capable of living outside a structured environment. Among the challenges of these vulnerable patients are poverty, substance abuse, mental illness, homelessness, co-morbid disabilities and aging with HIV. Many of these patients, with clinical oversight, transitional housing and social supports could be moved back into the community. But because such components of care for those with AIDS do not exist, Leeway's patients continue to occupy hospital beds, thus limiting access for those with greater medical needs and costing the system more in Medicaid expenditures.

To address this care and resource allocation issue, Leeway is undertaking a project to implement an extension of the continuum of care for people living with HIV/AIDS -- in particular, for the most vulnerable of Connecticut's HIV positive population -- focusing on intensive case management and new models of supportive housing. The foundation of this new array of services (home care, outpatient mental health, adult day health and substance abuse services, home delivered meals, nutritional counseling, disease self management education, etc.) and residential settings would be a Medicaid-funded community intensive, case management system for HIV/AIDS patients, supported by a Home and Community Based Services 1951c Medicaid HIV/AIDS waiver. Following the model of such services used for patients with serious mental illness, a nurse practitioner with expertise in HIV/AIDS care and related co-morbidities would direct the care plan of each participant, determine which community services are needed for each individual resident, organize the appropriate providers and direct the community care services for clients. For this project, the Foundation has provided a grant of $459,000. In the spring of 2006, the state of Connecticut also joined the partnership by appropriating $200,000 for the pilot and drafting the Medicaid waiver.

$1.5 million in unrestricted grants under the company’s pioneering Freedom to Discover no-strings-attached biomedical research grants program were awarded to researchers at three leading biomedical institutions to support basic research efforts in HIV/AIDS. At the Dana-Farber Cancer Institute in Boston, Dr. Joseph Sodroski is working on HIV envelope glycoproteins and their role in the viral entry process. Dr. John Moore, at Weill Medical College of Cornell University in New York, focuses on viral entry as well but also has a major emphasis on prophylactic strategies and vaccines. Dr. Richard D’Aquila of Vanderbilt University School of Medicine in Nashville is conducting both basic and clinical research on mechanisms of drug resistance.