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Lancet. 2005 Jul 2; 366(9479):1.Last week, WHO distributed to all European ministries of health one of the most important documents on prison health ever published. The report, Status Paper on Prisons, Drugs and Harm Reduction, brings together the wealth of evidence that shows that infectious disease transmission in prisons can be prevented and even reversed by simple, safe, and cheap harm-reduction strategies. Perhaps most importantly, the paper affirms WHO’s commitment to harm reduction, despite opposition from many governments who view such approaches as a tacit endorsement of illegal behaviour. The public-health case for action is strong, but political commitment to this method of combating health problems in prisons remains elusive. Indeed, health problems in prisons are numerous. Prisoners are often from the poorest sectors of society and consequently already suffer from health inequalities. Being in prison commonly exacerbates existing health problems—incarcerating anyone, especially vulnerable groups such as drug users and those with mental illness, has serious health and social consequences. (excerpt)
[Unpublished] 1990. , 18 p. (GPA/GCA(3)/90.11)The member of the Global Commission on AIDS (GCA) convened on March 22-23, 1990 to explore the issue of drug use and HIV infection, review prevention activities, and identify critical issues for AIDS prevention and control in the early 1990s. This document provides a full account of each session including the names of the presenters, the information shared, and the discussions that followed. In the session about drug use and HIV infection, the problem was identified as being "truly global" because the sharing of injection equipment occurs everywhere. Some of the reasons cited for sharing equipment are initiation into intravenous drug use, social bonding, and practicality. Rapid spread of HIV has been seen in New York City, several Italian cities, Edinburgh, and Bangkok. Characteristically, it has taken only 3-5 years after the introduction of HIV for about 50% of injecting drug users (IDU) to be infected. Several studies have demonstrated that behavior change can lower the risk of transmission and infection rates. Amsterdam, Innsbruck, Seattle, and Stockholm had all achieved stabilization of their prevalence of HIV among IDUs at levels between 10-30%. It was emphasized that the means for behavior change must be provided for education to have an impact. The discussion of prevention activities featured the use of education, information, and communication (IEC) programs to execute mass campaigns, focus interventions, and provide monitoring and evaluation. Specific prevention activities discussed were condom usage, outreach to persons with sexually transmitted diseases, and blood safety. There were separate presentations on the status of blood transfusion programs and vaccine development. 10 issues were identified by the GCA that warrant priority attention in the early 1990s. These critical issues are research, complacency and abatement of a sense of urgency, preservation and protection of human rights and legal issues, equity of access, human sexuality, women and AIDS, AIDS as a disease affecting families, HIV/AIDS and drug use, economic and social implications of HIV/AIDS, and the collation and improvement of data.
INTER-AMERICAN PARLIAMENTARY GROUP ON POPULATION AND DEVELOPMENT. BULLETIN. 1991 Dec; 8(11):1-3.The author indicts World Bank, International Monetary Fund, and overall developed country policy as responsible for Latin America's large impoverished and disenfranchised child and adolescent population. As an example of the magnitude of the problem, he notes that 1/3 of Brazil's 150 million population is comprised of youth and children. 8 million live on the streets, of which only 1 million receive official aid. Forced to fend for themselves, these youths fall into drug addiction, prostitution, and crime, suffering poor health, malnutrition, and widespread illiteracy. Many are sold, imprisoned, kidnapped, and exploited. Street children in Rio de Janeiro even suffer the added threat of being killed by the Squadrons of Death who consider the murder of juveniles a solution to delinquency. The state of affairs has deteriorated to such an extent in Peru that abandoned children are considered the most significant social problem. Argentina, Bolivia, Haiti, Honduras, Guatemala, and Nicaragua all suffer similar problems of impoverished youths, and claim some of the highest infant mortality rates (IMR) in the world. Cuba is the only country in Latin America with an IMR comparable to and often lower than many developed countries. Chile and Costa Rica follow closely behind in their achievements. Where Latin America already holds the largest gap between wealthy and poor, meeting adjustment demands of Northern economies and countries has only made conditions and inequities worse. Recession and poverty have worsened at the expense of youths. Attempting to pay down debt over the 1980s, improvements in Latin America's trade balance have gone unnoticed as the South has grown to be a net exporter of capital. Latin American nations need more than token charitable donations in times of emergency and particular duress. Development programs sensitive to the more vulnerable segments of society, and backed by the political will of developed nations, are called for. Unless constructive, supportive policy is enacted by Northern nations to help those impoverished in the South, social rebellion and continued, enhanced resistance should be expected from Latin American youths in the years ahead.
ANTIBIOTICS AND CHEMOTHERAPY. 1991; 43:1-13.Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.