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PLoS Medicine. 2007 Jan; 4(1):e44.The HIV/AIDS area has always been highly politically and emotionally charged, and we wrote a controversial and provocative piece. Most of the responses to it were unreasoned. The most cogent response came from UNAIDS (the Joint United Nations Programme on HIV/AIDS), and it generally restated an already well articulated position. We disagree with a number of the points for the reasons discussed in our original essay, and applaud one point. First, a brief restatement of our argument is warranted. There is good evidence that HIV-related stigma adversely affects the lives of people living with HIV/AIDS. There is little or no evidence, however, to support the notion that HIV-related stigma is one of the determinants of the global HIV epidemic. Furthermore, an argument could be made for why stigma might slow or contain the spread of infection in the general population. Given the very different effect the two positions would have on policy and the significance of the HIV epidemic, they deserve investigation. Among epidemiologists, two competing hypotheses, for which there is no strong evidence either way, would constitute a position of equipoise. (excerpt)
PLoS Medicine. 2007 Jan; 4(1):e51.In their essay "HIV, Stigma, and Rates of Infection: A Rumour without Evidence", Daniel Reidpath and Kit Yee Chan rightly underscore the insufficient body of research on the relationship between stigma and discrimination and HIV transmission . Increased scientific attention and effective programming against stigma and discrimination are both sorely needed. But the Joint United Nations Programme on HIV/AIDS (UNAIDS) does not accept a number of points made in the essay. Discrimination based on health status, including HIV, is a human rights violation, and stigma is the social form of this violation. HIV stigma and discrimination are wrong in and of themselves, and should be stopped for that reason alone. Reidpath and Chan suggest, as "an alternative hypothesis to the UNAIDS position", that stigma against certain groups, including people living with HIV, may have a public health value because it "could reduce opportunities for contact between high- and low-risk groups". UNAIDS cannot endorse a hypothesis that bases a public health goal on a human rights violation; nor do we believe it is either right, or necessary, to pit the public health against human rights. (excerpt)
Geneva, Switzerland, UNAIDS, 2000 Jul. 47 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/00.28E)Surveillance is the radar of public health. Nevertheless, its precise contours and justifications remain a matter of contention. Although the World Health Organization (WHO) Epidemiological Surveillance Unit in the Division of Communicable Diseases has defined disease surveillance quite broadly, most public health authorities, such as the United States Centers for Disease Prevention and Control (CDC) and the World Health Assembly, typically identify three key elements of surveillance. Surveillance involves the ongoing, systematic collection of health data, the evaluation and interpretation of these data for the purpose of shaping public health practice and outcomes, and the prompt dissemination of the results to those responsible for disease prevention and control. Surveillance, then, encompasses more than just disease reporting. "The critical challenge in public health surveillance today," conclude two prominent figures who have helped to define surveillance in the United States, "remains the ensurance of its usefulness." Two issues emerge from this understanding of surveillance. The first entails a question of efficacy. The second involves matters of privacy. Although conceptually distinct, the two are nevertheless intimately related. While the necessities of surveillance may justifiably limit some elements of privacy, such limitations are only justifiable to the extent that they in fact benefit the public's health. (excerpt)
Progress towards implementation of the Declaration of Commitment on HIV/AIDS. Report of the Secretary-General.
New York, New York, United Nations, General Assembly, 2003 Jul 25. 21 p. (A/58/184)The present report is submitted pursuant to paragraph 100 of the Declaration of Commitment on HIV/AIDS (General Assembly resolution S-26/2, annex), adopted by the Assembly at its special session on the human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) on 27 June 2001. The year 2003 is especially significant since it is the year in which the first of the time-bound targets set out in the Declaration of Commitment fall due. The majority targets in 2003 pertain to the establishment of an enabling policy environment, which set the stage for the programme and impact targets of 2005 and 2010. The report is based primarily on responses provided by 100 Member States on 18 global and national indicators developed by the Joint United Nations Programme on AIDS to measure progress towards implementation of the Declaration. The regional breakdown of States that responded is as follows: sub-Saharan Africa — 29; Asia and the Pacific — 15; Latin America and the Caribbean — 21; Eastern Europe and Central Asia — 13; North Africa and the Middle East — 8; high-income countries — 14. Virtually all heavily affected countries provided information relating to policy issues addressed by the indicators. The activities cited in the report are intended to be illustrative and not a comprehensive listing of all activities that have been undertaken in order to implement the Declaration. (excerpt)
Lancet. 2003 Sep 13; 362(9387):879.In a damning indictment of China’s efforts to control the spread of HIV/AIDS, an international human rights organisation has accused the country’s central and local authorities of a cover-up that fosters discrimination, prevents adequate treatment, and threatens to worsen what is already one of the world’s largest outbreaks of the disease. (excerpt)