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Interim patient monitoring guidelines for HIV care and ART. Based on the WHO HIV Patient ART Monitoring Meeting, held at WHO / HQ, Geneva, Switzerland, from 29-31 March 2004. (March 2005 update of 6th August 2004 draft).
Geneva, Switzerland, WHO, 2005 Mar. 191 p.These guidelines have been provided by the World Health Organization (WHO) and other international partners in order to: 1. Facilitate national stakeholder consensus on a minimum, standardized set of data elements to be included in patient monitoring tools; 2. Aid in the development of an effective national HIV care/ART patient monitoring system; 3. Enable the rapid scale-up of effective chronic HIV care, ART and prevention; and 4. Contribute to effective programme monitoring and global reporting and planning through the measurement of district-, national- and international-level indicators. (excerpt)
Sex work and HIV / AIDS. UNAIDS technical update. [Prostitución y VIH/SIDA. Actualización técnica de ONUSIDA]
Geneva, Switzerland, UNAIDS, 2002 Jun. 19 p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)This Technical Update focuses on the challenges involved in the protection of sex workers (and, subsequently, the general population) from HIV infection, and discusses the key elements of various effective interventions. Significantly higher rates of HIV infection have been documented among sex workers and their clients, compared with most other population groups. Though sex work is often a significant means of HIV infection entering the general population, studies indicate that sex workers are among those most likely to respond positively to HIV/STI prevention programmes—for example, by increasing their use of condoms with clients. This document explores the many issues involved in providing care and support for sex workers, preventing entry into sex work, and reducing risk and vulnerability through programmes at the individual, community and government levels. (author's)
Unintended consequences: drug policies fuel the HIV epidemic in Russia and Ukraine. A policy report prepared for the UN Commission on Narcotic Drugs and national governments.
New York, New York, Open Society Institute, International Harm Reduction Development program, 2003. 16 p.Taking action now to reduce HIV transmission rates and treat those already infected is critical. With the goal of avoiding adverse effects on social welfare and public health, the Russian and Ukrainian governments should reconsider how they interpret international treaties. Policy changes should be made in the following areas: Harm reduction. The governments should play an active role in establishing and supporting a large, strategically located network of harm reduction programs that provide services for IDUs, including needle exchange, HIV transmission education, condom distribution, and access to viable treatment programs such as methadone substitution. Similar services should be available in all prisons. Education. Simple, direct, and dear information about HIV transmission should be made available to all citizens-especially those most at risk. Similarly, society at large should be educated about the realities of drug use and addiction as part of an effort to reduce stigma. Discrimination and law enforcement abuse. Public health and law enforcement authorities should take the lead in eliminating discrimination, official and de facto, toward people with HIV and marginalized risk groups such as drug users. Authorities must no longer condone or ignore harassing and abusive behavior, including physical attacks, arrest quotas, arbitrary searches, detainment without charges, and other violations of due process. HIV-positive people, including IDUs, should be included in all policy discussions related to them in the public health and legal spheres. Legislation. Laws that violate the human rights of people with HIV and at-risk groups should be repealed or restructured to better reflect public health concerns. Moving forward with the above strategies may make it appear that the governments are backing away from the goals and guidelines of the UN drug conventions. They may be criti- cized severely by those who are unable or unwilling to understand that meeting the goals of the conventions, some of which were promulgated more than 40 years ago, is far too great a price to bear for countries in the midst of drug use and HIV epidemics. Governments ultimately have no choice, though, if they hope to maintain any semblance of moral legitimacy among their own people. (excerpt)
[Berne], Switzerland, Aide Suisse contre le SIDA, 1988 Apr.  p. (Documentation 1)This document contains 12 brief and nontechnical articles by experts on different aspects of AIDS diagnosis and control. The 1st 3 articles, on AIDS information and communications, include a discussion of the international exchange of information on AIDS, an outline of worldwide activities of the World Health Organization Special Program Against AIDS, and a discussion of information policy on AIDS. The next several articles, on AIDS transmission, include articles explaining why mosquitoes do not transmit AIDS and why AIDS is not spread by kissing. An article calls for fighting AIDS instead of using it as a vehicle for social control or discrimination against marginal groups. 3 others call for greater understanding and compassion rather than fear in dealing with AIDS patients. A more detailed article on means of contamination and the unlikelihood of infection through casual contact is followed by a work suggesting that screening for HIV be limited primarily to blood donors and individuals with symptoms suggesting HIV infection. The final article analyzes why Switzerland has the highest per capita prevalence of AIDS in Europe and explores the epidemiology of AIDS in Switzerland.
Update. 2001 Jun; 6-7.This paper presents an interview with Dr. Peter Piot, executive director of the Joint UN Programme on HIV and AIDS (UNAIDS), regarding the link between HIV/AIDS and drug abuse. Piot notes that sharing or using contaminated needles carries a very high risk of HIV infection. Anyone who shares a contaminated needle or who engages in high-risk sexual behavior under the influence of drugs can become infected with HIV. More and more countries are reporting cases of injecting drug use, with 114 of them reporting HIV cases as a direct result. Asia is undoubtedly the region with the largest number of HIV/AIDS cases associated with injecting drug use, due to the sheer size of both its population and its drug injecting population. Prevention of this mode of transmission requires preventing people from engaging in drug abuse, ensuring access to drug treatment, and reaching out to injecting drug users and engaging them in a comprehensive package of prevention interventions. The recently approved UN system position paper entitled “Preventing the transmission of HIV among drug abusers” demonstrates a clear and strong commitment to HIV prevention. Moreover, Piot indicated that although much has been achieved regarding this critical issue, there is still a need to overcome a range of barriers to prevention.
[The year of the World AIDS Day: children in a world of AIDS] Arets varldsaidsdag: barn v en varld med aids.
LAKARTIDNINGEN. 1997 Nov 26; 94(48):4501-2.Children living in a world with AIDS was the theme of a UNAIDS campaign launched because 1 million children are infected with HIV and 9 million children have become orphans due to AIDS (90% in sub-Saharan Africa). During 1996 alone, 400,000 children were infected: 90% were infected during pregnancy, delivery, or while breast feeding; the remaining 10% were infected sexually or via blood or blood products. In Africa, only one-third of HIV-infected children survive their 3rd birthday, and 8% of all children in Zimbabwe have lost their mothers to AIDS. A similar situation is rapidly evolving in Asia and South America. In Spain and Italy, more than 600 children have AIDS; most of them were infected through drug-abusing mothers. In France the figure is comparable, but here a large segment is represented by children of mothers from African countries. The total number of children with AIDS in the European Community is 2800: 86% were infected through their mothers. Romania has 4000 children with AIDS, who were predominantly infected via nonsterile syringes and blood transfusion. The European Commission has a specific AIDS prevention program, which addresses the measurement of disease spread, counteracting the disease, information and education, support for persons with HIV/AIDS, and countering discrimination. The risk of mother-to-child HIV transmission can be reduced from 25% to 8% by zidovudine (AZT) treatment during pregnancy and delivery.
Estimating the rate of mother-to-child transmission of HIV. Report of a workshop on methodological issues, Ghent (Belgium), 17-20 February 1992.
AIDS. 1993 Aug; 7(8):1139-48.A meeting was held in 1992 in Ghent, Belgium, under the auspices of the European Economic Community AIDS Task Force in collaboration with the WHO Global program on AIDS and UNICEF. THe objective were: 1) to address methodological issues in the estimation of the rate of mother-to-child (MTCT) transmission of HIV-1, with special reference to developing countries, and 2) to present a critical evaluation of selected perinatal studies using a standardized methodological approach. The discussions and recommendations made during the workshop are summarized. In the previous 8 years, numerous studies had been conducted to estimate the rate of MTCT of HIV. Many of these had encountered problems in data collection and analysis, making it difficult to compare transmission rates between studies. 14 teams of investigators participated, representing studies from central (5) and eastern Africa (3), Europe (2), Haiti (1), and the US (3). A critical evaluation of the projects was carried out under 4 headings: 1) enrollment and follow-up procedures, 2) diagnostic criteria and case definitions, 3) measurement and comparison of MTCT rats, and 4) determinants of transmission. The different estimations of the rate of HIV MTCT reported ranged from 13-32% in industrialized countries and from 26-48% in developing countries. For the purpose of calculating the rate of HIV MTCT, it is important to establish whether a child who dies before 15 months is HIV-infected. 3 definitions were proposed for children who died before their infection status could be determined by serology. Factors identified as possible risk factors for HIV MTCT included impaired maternal clinical and immunological status, HIV-seroconversion during pregnancy, shortened duration of pregnancy, choriamnionitis, vaginal delivery, prolonged and/or complicated labor, and breast-feeding. Maternal age and parity did not appear to be associated with MTCT in most studies.
AIDS. 1992 Dec; 6(12):1505-13.HIV/AIDS specialists have developed and applied 3 different scenarios to a comprehensive decision analysis model to estimate mortality rates for children of mothers infected with HIV during pregnancy and for children of mothers who were not infected with HIV during delivery. Scenario I represents Central Africa where HIV prevalence and incidence are high. Some scenario I assumptions are HIV prevalence in pregnant women of 30% and proportion of initially uninfected women who become infected after delivery during lactation (d) of 6%. Scenario II is a population where HIV epidemic is rather recent (e.g., some parts of Asia). Its assumptions are HIV prevalence of 5%, and s is 2%. Scenario III symbolizes high-risk populations in North America and Western Europe (HIV prevalence and s = 1%). The scenarios also consider child mortality rates and relative risks (RRs) of mortality of breast fed children and those who were not breast fed. Universal breast feeding would effect equal or higher mortality than non-breast feeding, when the RR of mortality is no more than 1.5 and HIV prevalence/incidence is high (high prevalence = > 10% and high incidence = > 5%). In developing countries, where the RR of mortality is high if children are not breast fed (RR > 3), breast fed children have almost always lower child mortality than those who are not breast fed, regardless of HIV infection status. The decision to breast feed when the HIV status is known depends greatly on the degree of an additional mortality risk if an infant is not breast fed. The model substantiates WHO and CDC recommendations: HIV-positive women in the UK and the US should not breast feed, while those in developing countries with high RR of child mortality should breast feed. Additional research would define the range of HIV transmission rates from breast feeding and increase specific assessments of RRs for various parts of the world.
[The second session of the Global Commission on AIDS in Brazzaville, the Congo, 8-10 November 1989] Vtoroe zasedanie Globalnoi komissii po SPID v Brazzavile, Kongo, 8-10.11.89.
ZHURNAL MIKROBIOLOGII, EPIDEMIOLOGII I IMMUNOBIOLOGII. 1990 Nov; (11):119-20.The Global Commission on AIDS is a duly constituted organ of the World Health Organization established in 1989. Its functions are the examination and elucidation of the global progression of epidemics, especially that of the HIV, and fighting the spread of HIV infections. It has 23 members. There was evidence of the spread of AIDS in connection with narcotic use (contaminated needles), thus combating drug use was a major factor in halting its spread. At the end of the 1980s the AIDS epidemic was graver than expected. Despite the global strategy and the change of the behavior of high risk groups, AIDS continues to spread. The number of the infected increased in eastern Europe, western Africa, and southeastern Asia mainly as a result of drug use and prostitution. The strategy includes fighting against prejudice and discrimination, promotion of sexual education, and the use of condoms. The strategy for the 1990s includes strengthening clinical research and therapy; the development of a vaccine; ethics and human rights; and the study of prostitution, the behavior of clients and prostitutes, and very sexually active groups. The widespread practice of blood transfusion during delivery in Africa, insufficient nutrition, and anemia was detailed by the Congolese member. The danger of spreading AIDS further by the contaminated blood of donors who obtain false AIDS tests was mentioned. A special session of the General Assembly of the UN could address the issues of narcotic demand, combat the danger of cocaine use, and suggest appropriate legislative measures. The 3rd meeting was scheduled for March 1990 in Geneva with an agenda on safe blood transfusion; quarantine and isolation; and developing a vaccine within 5 years whose testing on humans poses ethical problems, as observing the law without violation of human rights is required.
Geneva, Switzerland, WHO, 1992 Jun 22. 4 p.After reviewing 15 HIV prevention projects in 13 countries, the WHO Global Programme on AIDS has concluded that several approaches are effective in changing sexual behavior. The various projects centered around condom marketing programs, mass media campaigns, and friends and co-workers. Mass media campaigns and commercial marketing techniques in Zaire (attractively packaged condoms with appealing names) have resulted in a dramatic increase in condom sales, from <100,000->18 million between 1987-91. The government in Thailand has been able to gain the support of brothel owners and the prostitutes in 66 of 73 provinces to work toward achieving 100% condom use. For example, it penalizes brothel owners who do not comply. In Samut Sakhon, client condom use has reached almost 100%. Mass media campaigns in Switzerland have encouraged people to increase condom use from 8% to 52% between 1987-90, and condom sales have increased almost 2-fold (7.6-13.8 million between 1986-91. The community-based program in Zimbabwe uses prostitutes, actors, and musicians to tell their peers about HIV transmission and infection and encourage them to use condoms. In Tanzania, truck drivers, their assistants, and prostitutes along the trans-African Tanduma highway inform others about AIDS and condoms. In <1 year, condom use among prostitutes along the highway increased from 50% to 91%. Other successful projects include a community-based project in Ciudad Juarez, Mexico where prostitutes serve as peer educators (>85% condom use) and a mass media campaign in the Philippines (96% of youth remembered the campaign). Political will and adequate resources in these efforts will save millions of lives.
[Unpublished] 1989.  p. (WHO/GPA/INF/89.21)In October 1989, WHO and the International Labour Office (ILO) organized a consultation on AIDS and seafarers. Participants included shipowners, public health professionals, physicians, seafarer organizations, and government representatives. They concluded that seafarers were not at particular risk since they work and live basically on ships for extended periods of time. Nevertheless conditions do exist that warrant special attention. For example, they are a geographically mobile young population living and working in a mixed cultural environment. This environment restricts their accessibility to health facilities and timely information and HIV and AIDS. Further, the nature of their profession limits social interaction on board ship and on shore. Therefore the consultation stated aims and objectives to help prevent HIV transmission and to promote the health of HIV positive seafarers on the job. Shipping owners and seafarer organizations should develop strategies together, and where appropriate, with governmental and other agencies to achieve these goals. The consultation recommended that WHO and ILO provide guidance AIDS health promotion, encourage its integration into overall health promotion, and support any regional pilot projects on AIDS health promotion. They should also establish a resource center and a network to disseminate resource packages with culturally sensitive material, such as video tapes and posters. In addition, these international organizations should reexamine current occupational health and safety regulations and medical guides for ships and the manner in which they are applied. Accordingly they should develop a seafarer's manual for physician use. WHO and ILO should widely distribute the consultation statement to relevant organizations. Finally, they should encourage national AIDS committees to tie in with individuals working on HIV/AIDS issues for seafarers.
[Unpublished] 1989. Presented at the 5th International Conference on AIDS, Montreal, Canada, June 4-10, 1989. 7 p. (WHO/GPA/DIR/89.2)Based on AIDS statistics reported to WHO, as of June 1, 1989, 149 nations reported 157,191 AIDS cases. 69% of these cases lived in 43 countries in the Americas, 16% in 47 countries in Africa, 14% in 28 European countries, and 1% in 31 countries of Asia and Oceania. Yet WHO estimated that the actual number was probably 480,000. Further, a Delphi study showed that >3 times the number of new HIV infections will occur during the 1990s than did in the 1980s. The global AIDS epidemic followed 3 courses in the 1980s. The 1st consisted of markedly rising HIV infection cases in areas already affected by HIV. In 1987, HIV seroprevalence among intravenous drug users stood at almost 1% in Bangkok; in 1988, 20%, and in June 1989, >40%. The 2nd involved the appearance of AIDS in areas that either had not been affected or only slightly so. In Abidjan, Cote d'Ivoire, HIV-1 seroprevalence rose to 4% form <1% within 2 years. Finally, complex and diverse social, economic, and cultural situations at national, provincial, and community levels served to further the extent of AIDS. The proportion of AIDS cases related to intravenous drug use jumped from 3%-13% in 1 year in Brazil and from 6%-34% in 4 years in Europe. To prevent the spread of AIDS, WHO founded the Global Programme on AIDS in 1987. As of June 1, 1989, it gave >US$60 million to 127 nations and arranged technical support for >1000 assignments to assist nations in developing national AIDS programs. WHO expected such programs to be developed in all the world's 187 countries by the end of 1989. To prevent the spread of AIDS, these programs must form linkages with other health and social programs. They also need to concentrate their efforts on health and social problems unique to their nation. They must take the lead in finding new approaches to prevent the spread of AIDS, caring for AIDS patients, and to guarantee equity in the provision of services.
IN POINT OF FACT 1990 Jun; (68):1-3.The global AIDS and HIV situation, in terms of prevalence, by region and sex, means of transmission, progress in treatment, and the tasks undertaken by the WHO Global Programme on AIDS are summarized as of June 1990. Over 250,000 cases of AIDS had been reported to WHO from over 150 countries by mid-1990. Because of under-reporting WHO estimates that actually 700,000 cases of AIDS exist. WHO predicts 1 million cases by 2000. 6-8 million persons with HIV are estimated, and 15-20 million are predicted for 2000, depending on the rate of increase in Asia and Latin America. Heterosexual transmission accounts for about 60% cases, increasing rapidly, especially in urban areas. 75-80% of cases in 2000 will have been heterosexually transmitted. Developing countries have 2/3 of current HIV infections, expected to be 75-80% in 2000. It is thought that 1 out of 20 adults in sub-Saharan Africa is HIV+. Among men, the ratio is 1 out of 75 in North America, 1 in 125 in South America, 1 in 200 in Western Europe. Among women, the ratio is 1 in 700 in North America, 1 in 500 in South America, 1 in 700 in Western Europe and 1 in 20,000 women in Eastern Europe. Progress has been made in treating HIV with antiviral drugs such as Zidovudine, and in managing complications of HIV such as Pneumocystis carinii pneumonia, Kaposi's sarcoma, and cytomegalovirus retinitis. A potential lead for a vaccine has been reported from animal research. The objectives, activities, collaborative functions and priorities of the WHO Global Programme on AIDS are summarized.
NETWORK. 1990 Apr; 11(2):5-7,20.Safe and adequate blood supplies are needed, especially in high Human Immunodeficiency Virus (HIV) prevalence rate areas. Tests for HIV are available in most developing countries today. Much virus screening is taking place. The best way to control HIV's transmission is to establish a blood transfusion system (BTS). Proper storage, distribution, collection, and testing of blood must be done. Trained technicians and appropriate criteria for using transfusions should be included in any BTS. Establishing a central BTS requires much money and the national government must be committed to it. In 1988, WHO started the Global Blood Safety Initiative (GBSI) in conjunction with others. It's objective is to support integrated BTSs in all countries. 8 countries have been chosen for priorities, to develop BTSs. GBSI is also working in other countries to train technicians, get blood donors, and prevent HIV infections. A major problem in most developing countries is adequate blood supplies. In rural areas, many transfusions come from family members. Blood can be screened, and results given in 10-15 minutes. Large city hospitals can use ELISH HIV testing. It requires a 1-day wait for results but costs < the faster tests. Paid donors do not like blood screening, because it may lead to loss of income. Large countries need to use testing facilities in different regions. But smaller ones can use a centralized system, if they have good transportation. In November, 1989 a workshop was held in Yaounde, the capital of Cameroon, to set up appropriate blood transfusion guidelines. 45 physicians and blood bank managers took part. 9 of the 10 provinces were represented. The conference concluded that the number of transfusions should be reduced, and volunteer donors should be sought. In February, 1990 more than 700 Romanian children had been infected with HIV. This may have been caused by injecting adult blood into young babies who appear anemic. This is known as microtransfusion and health officials have banned it.