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Geneva, Switzerland, WHO, 2006. 15 p. (WHO/HIV/2006.05)In August 2006, the World Health Organization (WHO) launched a coordinated global effort to address a major and often overlooked barrier to preventing and treating HIV: the severe shortage of health workers, particularly in low- and middle-income countries. Called 'Treat, Train, Retain' (TTR), the plan is an important component of WHO's overall efforts to strengthen human resources for health and to promote comprehensive national strategies for human resource development across different disease programmes. It is also part of WHO's effort to promote universal access to HIV/AIDS services. TTR will strengthen and expand the health workforce by addressing both the causes and the effects of HIV and AIDS for health workers (Box). Meeting this global commitment will depend on strong and effective health-care systems that are capable of delivering services on a scale much larger than today's. (excerpt)
Arlington, Virginia, Family Health International [FHI], HIV / AIDS Prevention and Care Department, 2001.  p. (UNAID Best Practice Key Materials; USAID Cooperative Agreement No. HRN-A-00-97-00017-00)Countries with low HIV prevalence share a set of concerns and challenges regarding their responses to a potential HIV epidemic. Many of these countries also present an opportunity to avert large numbers of future HIV infections if appropriate prevention strategies are chosen and implemented early, greatly reducing future HIV/AIDS-related costs to the country. The purpose of this publication is to identify those challenges and propose a prevention strategy that can maintain low HIV prevalence in the general population, while reducing existing or preventing potential HIV sub-epidemics in population subgroups with substantial levels of risk behavior. Decisions on the strategic placement and targeting of prevention interventions are important to both international agencies and countries planning their prevention response. Both need to make difficult choices regarding geographic and population subgroups to ensure that resources are allocated efficiently. (excerpt)
Estimation of the incidence and prevalence of sexually transmitted infections. Report of a WHO consultation, Treviso, Italy, 27 February - 1 March 2002.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2002. 26 p. (WHO/HIV/2002.14; WHO/CDS/CSR/NCS/2002.7)WHO in collaboration with the Office of International and Social Health at the Department of Health, Veneto Region, Italy organized a consultation on the estimation of STI prevalence and incidence on 27 February– 1 March 2002 in Treviso, Italy with the following objectives : to determine the strengths, weaknesses and appropriateness of the current WHO approach to estimating the prevalence and incidence of STIs; to identify the STIs or syndromes that are most appropriate for surveillance and the most appropriate methods for deriving estimates of their incidence and prevalence; to identify structural surveillance needs within countries; to determine the utility and feasibility of using specific STI data as indicators of HIV risk behaviour within the concept of second-generation HIV surveillance; and to make recommendations for how the data collected can best be used to prevent STIs and to improve the care of individuals with STIs or their outcomes. (excerpt)
Perspectives in Health. 2003; 8(2):26-29.More and more, nurses in the Caribbean have been packing their bags and heading for countries with less-than-perfect climates to get better pay and more respect. Now the region is looking for ways to keep them from leaving – and even to lure those abroad back home. (author's)
2003 world population data sheet of the Population Reference Bureau. Demographic data and estimates for the countries and regions of the world.
Washington, D.C., PRB, 2003. 13 p.With every passing year, prospects for population growth in the more developed and less developed countries grow more dissimilar. On this year’s Data Sheet, the total fertility rate (TFR) for the more developed countries is a mere 1.5, compared with 3.1 in the less developed countries—3.5 if outlier China’s large statistical effect is removed. But the passage of time, as well as the difference in fertility rates, is ensuring that the two types of countries can expect to continue to have different population sizes in the future. The decline in Europe’s fertility rates is not a recent phenomenon; those rates have been low for quite some time. As a result, there have been long-term changes to age distributions in Europe, and this “youth dearth” is now taking on a more significant role in the near certainty of population decline. (excerpt)
In: Population policies and programmes. Proceedings of the United Nations Expert Group Meeting on Population Policies and Programmes, Cairo, Egypt, 12-16 April 1992. New York, New York, United Nations, 1993. 27-41. (ST/ESA/SER.R/128)The world population reached 5.4 billion in mid-1991, and it is growing by 1.7% per annum. The medium-variant United Nations population projection for the year 2025 is now 8.5 billion, 260 million more than the United Nations projection in 1982. This implies reducing the total fertility rate in the developing countries from 3.8 to 3.3 by the year 2000 and increasing contraceptive prevalence from 51 to 59%. This will involve extending family planning services to 2 billion people. For the first time, fertility is declining worldwide, as governments have adopted fertility reduction measures through primary health care education, employment, housing, and the enhanced status of women. Since the 1960s, contraceptive prevalence in developing countries has grown from less than 10% to slightly over 50%. However, 300 million men and women worldwide who desire to plan their families lack contraceptives. Life expectancy has been increasing: for the world, it is 65.5 years for 1990-1995. Infant mortality rates have been halved. Child mortality has plummeted, but in more than one-third of the developing countries it still exceeds 100 deaths/1000 live births. Globally, child immunization coverage increased from only 5% in 1974 to 80% in 1990. At the beginning of the 1980s, only about 100,000 persons worldwide were infected with HIV. During the 1980s, 5-10 million people became infected. WHO projects that the cumulative global total of HIV infections will be between 30 and 40 million by 2000. The European governments are concerned with growing international migration. Currently, 34.5% of governments have adopted policies to lower immigration. In the early 1970s, the number of refugees worldwide was about 3.5 million; by the late 1980s, they had increased to nearly 17 million. A Program of Action for the Least Developed Countries for the 1990s was adopted in September 1990 to strengthen the partnership with the international donor community.
[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.
BMJ (CLINICAL RESEARCH ED.). 1998 Jul 4; 317(7150):11.While most industrialized nations and a handful of developing countries are seeing the spread of HIV infection level off or even decline, infection rates are reaching alarming new highs in much of the developing world, according to the first country by country analysis by the joint United Nations Programme on HIV/AIDS (UNAIDS). Along with the widening gap in infection rates, the report also reveals a looming divide between countries where rates of new AIDS cases and deaths from AIDS are falling and countries where they are rising as people infected with the disease succumb in greater numbers than before. The major reason is uneven access to newer antiretroviral drugs, which forestall the development of AIDS. Among the report's most striking findings was new information concerning 13 countries in sub-Saharan Africa, where at least 10% of all adults are infected with HIV, with the prevalence in many capital cities 35% or more. Botswana and Zimbabwe have each reached a prevalence of 25%, a new world high. (full text)
AIDS ANALYSIS AFRICA. 1998 Feb; 8(1):3, 6.In recent years, HIV/AIDS funding has gone largely to prevention measures, drug therapy for people who are already infected with HIV, and basic related science. HIV/AIDS vaccine development has been of only low priority, and almost no effort is targeted toward vaccines appropriate for use in developing countries. A vaccine, however, is theoretically the only way to end the epidemic. An attempt was made at the Abidjan AIDS Conference to reinvigorate the AIDS vaccine research program, but because the potential market for such a vaccine is in the poorer developing countries, it will be difficult to convince the pharmaceutical industry to renew investment in vaccine research. Pharmaceutical companies see no profit potential in vaccine development and marketing. The World Bank's suggestion on how to encourage the pharmaceutical industry to invest again in vaccine research is discussed. The gp120(E) vaccine is undergoing an early-stage trial in Thailand, and another trial is scheduled for later in 1998 in Uganda. However, none of the 25 possible vaccine types which have been developed in the laboratory and tested for safety on humans has gone into efficacy trials. Experts calculate that even if more intensive work were to begin now, a vaccine could not become generally available before 2005, due to the 8-year product evaluation cycle. Whether a vaccine based upon one HIV subtype will be effective against other subtypes, and the need for governments and donors to invest in the development of a vaccine are discussed.
AIDS ANALYSIS ASIA. 1995 Jul-Aug; 1(4):2.The United Nations Children's Fund (UNICEF) has launched a study, "Progress of Nations," of standards of health, education, nutrition, and progress for women. It reveals that many rich nations have records on health, nutrition, and women's rights that are much worse than those of poorer countries. Economic growth does not necessarily result in a better standard of living for the majority of people. "Progress of Nations" uses specific indicators to gauge achievements, then ranks each country accordingly; it also states how much individual nations are contributing to the global aid budget, and where funds are being spent. A table lists countries chronologically in order of introduction of education about sexually transmitted diseases (STDs), including acquired immunodeficiency syndrome (AIDS). Singapore (1986), Sri Lanka (1986), Japan (1987), China (1989), Thailand (1989), Hong Kong (1990), Malaysia (1991), and Viet Nam (1991) have done so. As of early 1993, Bhutan, Cambodia, Indonesia, India, Lao Republic, Nepal, Pakistan, and the Philippines had not incorporated sex education into school curriculums. One section examines the fertility decline since 1963 in all countries and the unmet need for family planning. In Thailand and Indonesia, where population growth has been reduced dramatically over the last 30 years, 12% and 14% of married women aged 15-49 years want to stop having children or to postpone the next pregnancy for at least 2 years, but are not using contraception.
Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study.
ARCHIVES OF CLINICAL NEUROPSYCHOLOGY. 1993 Mar-Apr; 8(2):123-35.In preparation for a World Health Organizations (WHO) study of human immunodeficiency virus-1-associated neurological and psychiatric disorders in a variety of geographic and sociocultural settings, 2 new tests of neuropsychological performance were evaluated. The goal was to identify instruments that are not only able to tap the primary functional domains affected in symptomatic HIV-1 cases but also suitable for cross-cultural use. The WHO/UCLA Auditory Verbal Learning Test (AVLT) presents subjects with a list of words with universal familiarity drawn from 5 categories (body parts, animals, tools, household objects, and vehicles), while Color Trails 1 and 2 is based on the use of numbered colored circles and universal sign language symbols. These instruments represent modifications of the previously utilized Rey AVLT and Trail Making A and B tests. Both the new instruments and the reference tests were administered to healthy or HIV-infected volunteers in 2 developed country settings (Germany and Italy) and 2 developing country sites (Thailand and Zaire). There was a significant correlation between scores on each new test and those on the reference tests, indicating that the new instruments tap the same functional domains. The variance of the z-transformed scores from test site to site was reduced for the WHO/UCLA AVLT compared to the Rey AVLT and for the Color Trails 2 compared to the Trail Making B, suggesting that the new tests are more culture-fair than their predecessors. Finally, the percentage of impaired subjects identified through the new tests was significantly higher among seropositive than seronegative subjects, indicating that these instruments are indeed sensitive to HIV-21 associated cognitive damage across different cultures.
Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting] Estrategias de control e investigacion de la tuberculosis en el decenio de 1990: memorandum de una reunion de la OMS.
BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. 1993 May; 114(5):429-36.Mycobacterium tuberculosis, the pathogenic agent causing tuberculosis, is carried by one third of the world's population. Some 8 million new clinical cases of tuberculosis are diagnosed annually. Pulmonary tuberculosis is the most infectious clinical manifestation, tubercular meningitis is the principal form causing infant death, and tuberculosis may affect various other organs. Untreated tuberculosis has a fatality rate of over 50%. Chemotherapy greatly reduces the rate, but some 2.9 million persons die of tuberculosis each year because of the inadequacy of many national treatment programs. Tuberculosis is the most important cause of death from a single infectious agent in the world. An estimated one fourth of avoidable deaths to adults aged 15-59 in the developing world are attributed to tuberculosis. Tuberculosis is especially prevalent in Africa south of the Sahara and in Southern Asia. Two new obstacles threaten to aggravate the problem: the HIV epidemic and drug resistance. HIV infection is the most serious risk factor yet identified because it converts latent tuberculosis infection into active disease. In Africa almost half of all persons seropositive for HIV are also infected with tuberculosis. Ineffective treatment programs favor the formation of pharmacoresistent strains, and drug resistance has become a major problem in various parts of the world. Effective measures exist to control tuberculosis. Although it does little to protect adults against infectious forms of tuberculosis, the BCG vaccine prevents the most lethal forms. Coverage of infants the BCG is over 80% in the developing world as a whole, but under 60% in sub-Saharan Africa. Chemotherapy can cure almost all cases and convert cases with positive sputum into noninfectious cases, reducing transmission. Normal treatment must be administered over at least 12 months, straining the resources of health services in developing areas. The introduction of a shorter therapy has revolutionized treatment in some national programs, which have achieved cure rates of 80% in new patients. Evaluation of some national programs has demonstrated that well managed short duration chemotherapy is cost effective even under difficult conditions. Progress in controlling tuberculosis has been slower than expected in developing countries because of excessive optimism about the prospects for quick declines as occurred in the industrialized countries, and because of lack of resources. A well organized and vigorous international effort under World Health Organization leadership is required to bring the tuberculosis problem to the world's attention, mobilize assistance on a wide scale, and provide information and direct support to national programs. Research will be needed to adapt proven control techniques to local cultures, develop new drugs, shorten treatment regimens, and encourage greater patient compliance.
WORLD HEALTH FORUM. 1991; 12(4):496-7.WHO estimates that the number of AIDS cases worldwide will grow from about 1.5 million to 12-18 million by 2000--a 10 fold increase. Further it expects the cumulative number of HIV infected individuals to increase from 9-11 million to 30-40 million by 2000--a 3-4 fold increase. Dr. Hiroshi Nakajima, the Director-General of WHO, points out that despite the rise in AIDS, there is something for which to be thankful--neither air, nor water, nor insects disseminate HIV and causal social contact does not transmit it. Further since AIDS is basically a sexually transmitted disease, health education can inform people of the need to make life style changes which in turn prevents its spread. In addition, Dr. Nakajima illustrates how frank health education and information campaigns in the homosexual community in developed countries have resulted in reduced infection rates. In fact, many of the people disseminating the safer sex message in the homosexual community were people living with HIV and AIDS. HIV has infected >7 million adults and children in Sub-Saharan Africa since the AIDS pandemic began. It is now spreading quickly in south and southeast Asia where at least 1 million people carry HIV. In fact, WHO believes that by the mid to late 1990s HIV will infect more Asians than Africans. Further Latin America is not HIV free and it can be easily spread there too. Heterosexual intercourse has replaced homosexual intercourse and needle sharing by intravenous drug users as the leading route of HIV transmission.
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.
JOHNS HOPKINS MAGAZINE. 1989 Feb; 41(1):10-1.The reuse of unsterilized syringes is spreading AIDS, hepatitis B and the African Ebola-Marburg virus. In the US 25% of the AIDS cases are related to intravenous drug abuse. In developing countries syringe reuse is related to poor health care delivery systems. In these countries syringes are used over 5 times before sterilization; in some countries the syringes are distributed by people who sell injections of vitamins and antibiotics. In 1986 Halsey challenged the medical community to design a syringe that would not transmit these diseases, and shortly thereafter a separate challenge was issued by the World Health Organization. The requirements of this syringe are its self destruction after use, little requiring retraining of medical personal, and no more than 1 cent to the cost, and be simple to make. These challenges brought 70 various syringe entries and all but 3 were eliminated. The Hopkins syringe is similar to a regular syringe except it has a polymer insert that seals up after one use. When water flows around the polymer insert it swells and closes off the passageway preventing any liquid from flowing in or out of the syringe. Another syringe seals up in 2.5 minutes which allows the health worker time to draw and inject a patient before the syringe destructs. By using hydrogels that are already approved for use in contact lenses and food substances, the safety has been tested. Companies looking at production costs estimate that the polymer insert will add only 1/4 of a cent to the cost of a syringe.