Introducing PSI’s New Director of HIV and TB: Q & A with Nina Hasen

Nina Hasen recently joined PSI as the Director of HIV and Tuberculosis. Coming to us from the Office of the Global AIDS Coordinator (OGAC), which oversees the President’s Emergency Response for AIDS Relief (PEPFAR), Nina brings not only expertise in HIV and AIDS programming and policy, but also a strong scientific and academic background through her PhD from the University of Wisconsin, keen management skills from nonprofit work in the U.S. and the U.K. and a discriminating palate from her time as the owner of Freddi’s Falafal Cart.

PSI’s Regina Moore caught up with Nina recently to learn a bit more about her and her work.

What motivated you to work in global health and development?

I’ve wanted to change the world for as long as I can remember. Between my childhood ballerina and Broadway star aspirations, I wanted to find a cure for cancer. I spent a lot of years looking for exactly the right way to change the world – through helping women get safe abortions, preventing sexual assault, and implementing health information systems – but it wasn’t until I decided to pursue a nursing career that I really found my way. I didn’t become a nurse, but I did discover my inner scientist. This led me in turn to graduate school, where I studied how experience changes our brains and our brains shape our behaviors. While I loved learning science, I found doing it much too isolating and frustrating. Research across many disciplines shows clearly that being poor and disenfranchised makes people sick. “Shouldn’t we be doing something about poverty besides studying how it hurts people?” I kept thinking. So I applied for a policy fellowship through AAAS – the folks who publish Science Magazine. Through them, I landed a position at the Office of the Global AIDS Coordinator. It was a huge learning curve at first, but I loved working in global health right off the bat. Working on HIV prevention at OGAC gave me the chance to influence how our government addresses a massive injustice: the disproportionate impact of HIV on the world’s most disenfranchised and impoverished populations. It was gratifying and exciting and I felt like I’d finally found my home.

What has been the most inspiring moment of your career?

That is a tough one. There have been so many!

Just recently I had the privilege of attending a regional meeting for members of the PSI network in Latin America and the Caribbean. One of my new colleagues, Sussy Lungo, presented the work that PSI’s Central American network member, PASMO, has done to promote the rights of transgender men and women in the region. This work was done through the PEPFAR Gender Challenge Fund – a fund I helped to set up in my first year at OGAC. Sussy talked about how the program had brought transgender activists together with government staff and transformed attitudes. It was incredibly inspiring and hopeful to see those dollars put to work so powerfully.

Another moment that I will never forget was in a slum in Addis Ababa, Ethiopia. I was visiting a USAID-funded program for sex workers that distributes condoms and provides information, education and communication on their use. I sat in a tiny room, surrounded by 18 young women and talking with them about their lives.

“Where did you get condoms before this program started?” I asked. Their answer made me cry.

“Before this program,” they said, “we didn’t know condoms existed.”

With your background at the Office of the Global AIDS Coordinator, what do you see as the biggest challenges and opportunities facing PEPFAR and other actors in the global HIV and AIDS response today?

We have made tremendous progress in HIV and AIDS globally. We’ve substantially reduced the number of new infections, both through traditional prevention interventions like condoms and education, as well as through newer interventions such as voluntary medical male circumcision (VMMC). The antiretroviral drugs (ARVs) available for treatment now are much better – the regimens are simpler, cheaper and have many fewer side effects. This means treatment is available to many more people living with the virus, and these people are living longer, healthier lives. But the epidemic is still growing in many parts of the world and the funds we have will not be sufficient to ensure prevention, care and treatment for everyone if we are not smarter and more strategic than we have been.

The greatest opportunity is in using the tools we have more effectively. How do we more rapidly deploy VMMC, both to protect the men we circumcise and to avert the maximum number of new infections in their female partners? We know that ARVs have tremendous potential to prevent new HIV infections. People living with the virus who are taking ARVs as prescribed are 96% less likely to pass on the virus to their sexual partners. People who don’t have HIV who take these drugs as prescribed have similar levels of protection. How will we make these drugs available to the people who need them – both HIV positive and HIV negative? I think the answer lies in thinking much more creatively about how we make these products and services available to the populations who need them.

New data from the Strategic Timing of Antiretroviral Treatment (START) trial shows people benefit by being put on treatment as soon as they are diagnosed with HIV. What does this mean for the global HIV response and what are the implications for future HIV programming?

The START findings are great news. One of the greatest challenges in the HIV response is getting people who are diagnosed with the virus to stay engaged in care when they are not yet eligible for treatment. Current guidelines in many countries don’t recommend treatment until people reach a specific CD4 count. Many people leave care during this period between diagnosis and initiating treatment and don’t come back until they are very sick. This is bad for them and bad for the epidemic because it means they are more likely to infect others during this time. Many studies show that people living with HIV are much more motivated to seek care when they can get ARVs. The START results will provide more incentive to governments and donors to change treatment guidelines, allowing ARVs to be offered to patients as soon as they are diagnosed rather than waiting until their CD4 counts reach a certain level. In this way, START means longer healthier lives for patients, and fewer new infections. So START is a good thing.

Nevertheless, some HIV prevention advocates view these results with anxiety. They fear that more data supporting the value of HIV treatment may lead to more cuts in funding for HIV prevention. Many programs have already been eliminated, and many of us understandably fear for our clients and beneficiaries.

However, I think it is time for everyone to embrace the opportunities that ARVs present. We know that these drugs have a powerful role to play in prevention, and they won’t be enough to end the epidemic on their own. Even as funding shrinks – especially as funding shrinks – donors will be looking to fund those programs that bring the best of new technologies to the worst affected populations in effective ways. Let’s shift our focus to the substantial opportunities in front of us to do just that.

For PSI, START and all the developments around ARVS are an opportunity to rethink our position in the global HIV and AIDS response. We have seen ourselves primarily as condom social marketers and providers of prevention services such as behavior change communication and VMMC. I want to see our conception of ourselves grow. I want us to become the “fixers” of the HIV response in the countries where we work, understanding the market failures that underlie gaps in prevention, care and treatment and working to address them. In some cases this will mean directly providing commodities and services – sometimes commodities and services we’ve never provided before. In other cases it will mean working with other market actors to eliminate barriers they face to providing those goods and services. No matter what happens with donor funding, our clients will be facing HIV – either as people living with the virus, or as people at high risk of getting the virus – for decades to come. Let’s take the lead in using the power of markets to ensure they have access to the very best products and services in HIV prevention, care and treatment for themselves and their families.

PSI has HIV and AIDS programs in more than 60 countries, so you have a big job ahead of you. What are you most looking forward to in leading PSI’s HIV and tuberculosis portfolio?

I came to PSI because I think harnessing the power of markets is essential for addressing the HIV epidemic. I wanted to work for an organization that is at the cutting- edge of this approach. So I’m most excited to learn, to spend time with PSI’s amazing programs across these 60 countries and gather knowledge from and with our network.

On a more personal note the PSI network spans the globe, so this job promises to have you traveling a lot. What’s your number one necessity while traveling?

I have a little obsession about traveling light. I usually travel with just a backpack and a small suitcase I don’t have to check.

But I always bring my electric toothbrush.

Even though it’s big and means I have to bring a charger, that toothbrush makes me so happy it’s worth the weight.

Finally, is there anything I haven’t asked that you think is important for people to know about you?

I spent the early years of my career working on women’s health and preventing gender-based violence. These experiences working at the community level are the foundation of how I think about global health. I love the big picture I get working at headquarters, but I never forget that actual change happens in communities.

Also, if you ever want to know what I’m thinking, the answer is probably “what is the next delicious thing I get to eat?”

Photo credit: Wilson Center – Environmental Change and Security Program

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