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Lancet. 2002 Oct 12; 360(9340):1108-1110.This paper reports on the organization and administration of WHO under the management of Director-General Gro Harlem Brundtland. It describes the three broad categories of the work of WHO and the several areas that are considered to be organization-wide priorities for WHO.
AIDS ANALYSIS AFRICA. 1996 Feb; 6(1):1.Considerable data on AIDS in Malawi are available at the local level, but much of the information long languished instead of being formally collected and put together to provide an overall picture of the epidemic in the country. A World Health Organization (WHO) epidemiologist, however, has completed the first comprehensive, nationwide survey of HIV prevalence rates in Malawi. 1.6 million of Malawi's 11 million population are infected with HIV, making it one of countries in Africa worst affected by the epidemic. In 1995 alone, there were an estimated 265,000 new HIV cases and 74,900 deaths from AIDS. There are also fears about the safety of the blood supply. The WHO survey suggests that three of the country's 62 hospitals are not testing blood for HIV. Moreover, the effectiveness of the system is undermined by the widespread carelessness and dishonesty of overworked technicians who conduct the tests. While the reasons are many and complex for the spread of HIV, it seems that the policies of former President Hastings Kamuzu Banda were a contributory factor. President Banda's neglect of grassroots health care, especially in rural areas, and his refusal to allow public debate on the disease no doubt fueled the spread of HIV in Malawi. Traditional sex practices also probably play a role. For example, in some ethnic groups, young teenage girls are sexually initiated by men specially chosen for their physical prowess. Any one of these men who happens to be HIV-seropositive and has sex with many of these young girls may pass the virus on to many other people.
The AIDS epidemic in Tanzania: rate of spread of HIV in blood donors and pregnant women in Dar es Salaam.
SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES. 1992; 24(6):701-6.Based on test results from blood samples of blood donors, pregnant women, and children (ages 5 to 15 years), data on reported acquired immunodeficiency syndrome (AIDS) cases, and the calculated influence of the "transient effect" (an effect caused by the variability of individual incubation periods), the prevalence of human immunodeficiency virus (HIV) in the total population of Tanzania is approximately 2.8% (650-700,000 cases in 24 million people). For pregnant women, the prevalence of HIV rose evenly from 1.3% in 1984-85 to 14% in 1991, a tenfold increase with an average doubling time of about 24 months. The prevalence in blood donors rose from 2.0% in 1984-85 to 10.0% in 1988, with an average doubling time of about 21-32 months. No children tested positive. The cumulative number of AIDS cases in Tanzania reported to the World Health Organization (WHO) rose from 462 in July 1986 to 27,396 in September 1991, resulting in an average doubling time of 10 months. However, based on information from the Epidemiology Unit of the Tanzanian National AIDS Control Programme, the doubling time for reported AIDS cases, calculated annually, rose from less than half a year to 2 years. In view of this, estimates of rates of spread and future projections should not be based on the number of reported AIDS cases in the first 5 years of the epidemic when the "transient effect" is greatest (a large number of cases will have a short incubation period). Since the doubling times calculated from seroprevalence studies agree with those calculated from AIDS case data in 6-8 year old epidemics, projections should be made based on the former. Epidemiological studies involving sexual behavior would identify target populations for intervention.
NEW YORK TIMES. 1992 Jun 4; A1, B10.The international AIDS Center at the Harvard School of Public Health led a coalition of AIDS research from around the world in an analysis of more than 100 AIDS programs and discovered that the HIV/AIDS pandemic is more serious than WHO claims. Its findings are in the book called AIDS in the World 1992. AIDS programs do not implement efforts that are known to prevent the spread of HIV. For example, clinicians in developing countries continue to transfuse unscreened blood to many patients, even though HIV serodiagnostic test have existed since 1985. Further, programs do not evaluate what works in other programs. As long as people debate whether or not to distribute condoms, exchange needles, or offer sex education and whether people with AIDS deserve care, the fight against HIV/AIDS is hindered. The report recommends that leader come up with a new strategy to address the AIDS pandemic. WHO claims to have done just that at its May 1992 meeting. An obstacle for WHO is political pressure from member nations. On the other hand, the private Swiss foundation, Association Francois-Xavier Bagnoud, finances the Harvard-based AIDS program, allowing members more freedom to speak out. The head of the Harvard program believes the major impact of AIDS has not yet arrived. Contributing to the continual spread of HIV is the considerable difference of funding for AIDS prevention and control activities between developed and developing countries (e.g., $2.70 per person in the US and $1.18 in Europe vs. $.07 in sub-Saharan Africa and $.03 in Latin America). Even though developed countries provide about $780 million for AIDS prevention and care in developing countries, they do not enter in bilateral agreements with developing countries. 57 countries limit travel and immigration of people with HIV/AIDS. Further, efforts to drop these laws have stopped. Densely populated nations impose travel constraints to prevent an explosive spread of HIV.
NURSING RSA. 1992 Aug; 7(8):11.South Africa needs to implement effective interventions immediately to prevent the AIDS pattern which exists in other African countries; e.g., Uganda, where 25% of the youth have AIDS. An official from the Department of National Health and Population Development's AIDS Unit said at a national conference on home based care for persons with AIDS in June 1992 that 1 in 50 young adults in South Africa is HIV positive. HIV prevalence is greatest in Natal and lowest in the Cape. HIV infection is greatest in people with sexually transmitted diseases and in those with newly diagnosed tuberculosis. By August 1994, 750,000 people will be infected with HIV. Interventions espoused and implemented by the AIDS Unit include condom distribution and a communication and education campaign encouraging condom use and partner reduction. Another speaker at the conference highlighted the disadvantages women face which make them vulnerable to acquiring HIV. These disadvantages include the traditional subordinate role of women (particularly Black women) in the family, economic dependency on men, and inadequate access to education. Based on these disadvantages, WHO's Global Program on AIDS is developing a woman-based strategy which includes health and social services for women, home-based care, HIV surveillance of women attending certain clinics, distribution of information and education for women, and supportive social environment. The Program for Appropriate Technology in Health has developed a dipstick test for HIV antibodies (HIV Immuno-Dot), designed to reduce HIV transmission through blood transfusions. It does not need a skilled technician, a refrigerator, or a laboratory. It is inexpensive and produces results in 3 hours. 8 tabs, making up a strip, have dots of a synthetic peptide from the GP41 molecule, and HIV-1 envelope protein. HIV-1 antibodies bind to the strip. Placing the strip in a solution turns the dots red if the blood is HIV-1 infected. This red dot warns health workers not to use the donated blood.
WESTERN JOURNAL OF MEDICINE. 1987 Dec; 147(6):694-701.This article describes AIDS case definitions and reporting and the problems with serologic studies of HIV antibody detection. These problems include technical limitations of HIV antibody testing, false positive results due to the presence of malaria antibodies, and cross reactions between HIV 1 and HIV 2. There is a summary of the three basic modes of transmission: sexual, perenteral, and perinatal. Geographic patterns of transmission differ with the frequency of the three modes of transmission and the ways in which HIV infection occurs in different cultures. Three patterns are identified. Pattern I involves homosexual and bisexual transmission with some heterosexual transmission and significant perenteral transmission through intravenous (IV) drug use. Population seroprevalence is 1%. Countries with this pattern are North America, Europe, some areas of South America, Australia, and New Zealand. Pattern II involves larger risk groups and heterosexual transmission. There is high seroprevalence among women, and, as a result, perinatal transmission is evident. Seroprevalence is >1%. Examples of this pattern are central, eastern and southern Africa and Haiti. In Pattern III, the phenomena is recent and transmission is homosexual and heterosexual, particularly among prostitutes or persons from known HIV endemic areas. Imported blood and blood products have contributed to parenteral transmission. Middle Eastern and Asian countries exemplify this pattern. The global epidemiology is discussed by region: the Americas, Europe, Africa, and Oceania. Case reports from 127 countries to WHO have totaled 62,811 in 1987. 70% of the cases reported are from the United States. The estimated number of AIDS cases worldwide is 100,000-150,000, and HIV infected people are thought by WHO to number 5-10 million. In the United States, reported AIDS cases continue to double every year. There is some evidence for stabilization in at least one homosexual population. Between 1985-86, there was a 130% increase in heterosexual the number of heterosexuals (mostly women) who acquired AIDS from contact with IV drug users or bisexual men. Brazil has the second largest number of cases and follows Pattern I. Europe reported 5687 cases by 1987 compared to 44,000 for the US. The highest rate of AIDS cases in Europe is from Switzerland at 34.9/million (which compares to 140.2/million in the US). 50% of the reported cases in Europe are in people from Africa or the Caribbean. African AIDS is distinguished by 50% of cases being in women. AIDS cases from transfusion are still a problem. Perinatal transmission occurs. Nonmedical parenteral transmission (ritual scarification, circumcision, and so on) and medical injections play a role in transmission of HIV infection among children. Surveillance has improved. Oceania reported 569 cases by 1987. Australia has the highest rate in Oceania at 23.8/million and a male to female sex ratio of 26:1; pattern I predominates. Other countries which have reported cases are Thailand, Japan, the Philippines, Israel, and 2 cases from China.
[Unpublished] 1992. , 15 p. (WHO/GPA/RES/SFI/92.1)A summary of current state and future trends to HIV infections and AIDS cases in world regions prepared from the most recent information on file at the WHO Global Programme on AIDS as of January 1992. HIV infection and AIDS began in the 1980s or earlier in homosexual or bisexual men and intravenous drug users in urban Americas, Australia, and Western Europe, and in heterosexuals in East and Central Africa. There is another virus called HIV-2 with a lower virulence, but similar mode of transmission and clinical syndrome prevalent in West Africa. By 1992 450,000 AIDS cases were reported to WHO, but about 1.5 million AIDS cases are thought to have occurred, including 500,000 in children. About 9-11 million HIV infections, including 1 million in children, are estimated to exist. In Australia, North America, and Western Europe, spread of HIV to homosexuals has decreased, but growth in the intravenous drug-using population and heterosexuals may still occur. In Latin America prevalence is high in homosexual or bisexual men, injecting drug users, and prostitutes, and is increasing dramatically in women. In Africa heterosexual transmission is still the rule; infections from blood products account for about 10% of cases. In East and Central Africa 2/3 of the HIV cases are in 9 countries, where urban HIV prevalence reaches 25-33% in adults. In Africa there is also a growing problem of 750,000 pediatric AIDS so far, and possible 10 million orphans in the 1990s. Spread of HIV in high risk populations in South East Asia is rapid, notably in Bangkok, Thailand, in Yangon, Myanmar, and in Bombay and in northeastern India. The potential for spread in this region is a great concern. Areas of East Asia contiguous with South East Asia are also at risk. In Eastern Europe there are clusters of outbreaks related to improper use of blood products. WHO predicts that 4 million people have HIV and TB. WHO projects that global HIV infection will amount to 15-20 million by 2000. A major research topic and concern is estimation of when and at what level HIV prevalence will peak in world regions.
AIDS ANALYSIS AFRICA. 1992 Nov-Dec; 2(6):4, 6.Developing countries face considerable obstacles to ensuring a safe blood supply and safe blood transfusions. There is a tendency for developing countries to not have enough available blood so they depend on family blood donors. Blood donors receive money for their donation. Testing is unreliable as is recording of results. Many clinicians do not have the experience to adequately determine when a transfusion is needed, e.g., physicians ordered a blood transfusion for a 5-year old African girl with pneumonia who had anemia (hemoglobin level of 52 m) after the 1st HIV test was negative. Yet this anemia case did not require a blood transfusion. A repeat of the test revealed the donated blood was indeed HIV positive. 2 other children also received that blood. The basic principles of blood safety are enough safe blood donors, a responsible blood transfusion service which can ensure appropriate and safe processing and testing of blood, and appropriate use of blood. A safe blood donor is healthy and has no risk factors for HIV and other infections. 40-60% of donated blood in developing countries goes to pregnant women often during delivery and children. The leading source of blood in the least developed and developing countries is replacement donors (88% and 81% respectively) who tend to be family members or friends. Yet often relatives of the patient pay someone they do not know to donate their blood. Blood banks also pay for donations and more than 56% of them are uncoordinated banks in hospitals. So organized blood donation services which can safely test and process blood would reduce the risk of transmitting HIV and other infections. WHO has set up a blood safety policy that encourages member countries to establish their own national blood transfusion policy. It supports countries along these lines via its global Programme on AIDS an the Global Blood Safety Initiative. Any blood safety activities can only succeeded with political commitment.
BMJ. British Medical Journal. 1992 Aug 8; 305(6849):325-6.The press widely publicized investigative findings at the international AIDS conference in Amsterdam, the Netherlands about patients with signs or symptoms consistent with AIDS or AIDS-related complex but who did not have HIV-1 or HIV-2 antibodies or the viruses themselves. Yet the formal scientific sessions ignored this topic and the conference summaries only casually mentioned it. Tests used to try to detect HIV were antibody testing, virus isolation, or molecular detection techniques. The press suggested several emotive questions not based on clinical data such as the safety of national blood supplies. 4 of the 5 patients in New York City had HIV risk factors. The only clinical indications of immunodeficiency in 1 patient was Mycobacterium tuberculosis infection and 2 somewhat low CD4 counts which may have actually been due to tuberculosis. Laboratory personnel have not yet reconfirmed reverse transcriptase activity of lymphocytes from 2 patients. So far these cases do not exhibit epidemiological criteria for a new transmissible agent. There has been no case clustering or a pattern of sexual or vertical association of cases. These cases may only be more detections of cases of rare spontaneous primary or secondary immunodeficiency disease. If epidemiological support does suggest a transmissible agent, laboratory personnel may find it difficult to isolate and identify agent. The US Centers for Disease Control and WHO wants to coordinate reporting and classification of cases so epidemiologists can quickly verify or reject laboratory findings based on a larger series of cases. Only with full evaluation of ongoing research and development of sensitive and specific detection systems for new pathogens can the scientific community address questions concerning the safety of blood supplies. This reaction of the press indicates a need for the peer review system to continue to establish the soundness of research before its release to the press to avoid undue concern.