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Sexually Transmitted Infections. 2008; 84(Suppl 1):i1-i4.This introductory article refers to the journal supplement that assembles important new data relating to several assumptions used for the new HIV and AIDS estimates. The collection of methodological papers in the supplement, aim to provide easy access to the scientific basis underlying the latest HIV and AIDS estimates for 2007.
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)
Reaching regional consensus on improved behavioural and serosurveillance for HIV: report from a regional conference in East Africa.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 1998. 12 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/98.9)This report documents a regional workshop on surveillance systems for HIV held in Nairobi, Kenya, on 10.13 February 1997. The UNAIDS-funded workshop gathered government epidemiologists, AIDS programme managers, and social scientists from Kenya, Malawi, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe as well as specialists from UNAIDS and other partner institutions. The group aimed to present current data and to work together to suggest practical guidelines for improving HIV surveillance systems in a maturing epidemic. (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)
Geneva, Switzerland, UNAIDS, 2005 Dec.  p. (UNAIDS/05.19E)Acquired Immunodeficiency Syndrome (AIDS) has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed 3.1 million [2.8--3.6 million] lives in 2005; more than half a million (570 000) were children. The total number of people living with the human immunodeficiency virus (HIV) reached its highest level: an estimated 40.3 million [36.7--45.3 million] people are now living with HIV. Close to 5 million people were newly infected with the virus in 2005. There is ample evidence that HIV does yield to determined and concerted interventions. Sustained efforts in diverse settings have helped bring about decreases in HIV incidence among men who have sex with men in many Western countries, among young people in Uganda, among sex workers and their clients in Thailand and Cambodia, and among injecting drug users in Spain and Brazil. Now there is new evidence that prevention programmes initiated some time ago are finally helping to bring down HIV prevalence in Kenya and Zimbabwe, as well as in urban Haiti. The number of people living with HIV has increased in all but one region in the past two years. In the Caribbean, the second-most affected region in the world, HIV prevalence overall showed no change in 2005, compared with 2003. (excerpt)
Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings.
Journal of Acquired Immune Deficiency Syndromes. 2006 Apr 15; 41(5):632-641.The objective was to estimate the potential impact of antiretroviral therapy on the heterosexual spread of HIV-1 infection and AIDS mortality in resource-limited settings. A mathematic model of HIV-1 disease progression and transmission was used to assess epidemiologic outcomes under different scenarios of antiretroviral therapy, including implementation of World Health Organization guidelines. Implementing antiretroviral therapy at 5% HIV-1 prevalence and administering it to 100% of AIDS cases are predicted to decrease new HIV-1 infections and cumulative deaths from AIDS after 10 years by 11.2% (inter-quartile range [IQR]: 1.8%-21.4%) and 33.4% (IQR: 26%-42.8%), respectively. Later implementation of therapy at endemic equilibrium (40% prevalence) is predicted to be less effective, decreasing new HIV-1 infections and cumulative deaths from AIDS by 10.5% (IQR: 2.6%-19.3%) and 27.6% (IQR: 20.8%-36.8%), respectively. Therapy is predicted to benefit the infected individual and the uninfected community by decreasing transmission and AIDS deaths. The community benefit is greater than the individual benefit after 25 years of treatment and increases with the proportion of AIDS cases treated. Antiretroviral therapy is predicted to have individual and public health benefits that increase with time and the proportion of infected persons treated. The impact of therapy is greater when introduced earlier in an epidemic, but the benefit can be lost by residual infectivity or disease progression on treatment and by sexual disinhibition of the general population. (author's)
Washington, D.C., World Bank, AIDS Campaign Team for Africa, 2000 Sep. 16 p.HIV/AIDS is a major development crisis. Not since the Black Death devastated medieval Europe has humankind observed infectious disease deaths on such a scale. Life expectancies, which rose steadily before the onset of the HIV epidemic, are decreasing in nearly all the 25 countries where the adult prevalence rate exceeds 5 percent. In the countries most heavily affected by HIV/AIDS, life expectancy is projected to fall to about 30 years by 2010– a level not seen since the beginning of the 20th century. Various factors related to poverty, inequality, gender inequality, sexually transmitted infections, social norms, political and social changes, including labor migration, conflicts and ethnic factions have facilitated the rapid spread of HIV. But what has enabled HIV/AIDS to undermine economic and social development is its unprecedented erosion of some of the main determinants of economic growth such as social capital, domestic savings and human capital. For these reasons, the HIV epidemic has been transformed from a health issue into a much wider issue impairing economic and social development. Because it prevents an increasing share of the population from participating in economic growth, the HIV/AIDS epidemic increases poverty. The result is a vicious circle whereby HIV/AIDS reduces economic growth and increases poverty, which in turn accelerates the spread of HIV. Preventing further spread of HIV/AIDS, in addition to providing care and support programs to those both affected and infected by this epidemic, requires early intervention and the mobilization of external resources. The purpose of this paper is to discuss and quantify the economic rationale that underlies such an effort. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2003.  p. (WHO/CDS/TB/2003.319; WHO/HIV/2003.01)The main aim of the guidelines is to enable the central units of national TB and HIV/AIDS programmes to support districts to plan, coordinate and implement collaborative TB/HIV activities. The guidelines are intended for countries with either an overlapping TB and HIV epidemic or where there is an increasing HIV rate which may fuel the TB epidemic. The WHO “Strategic Framework to Reduce the Burden of TB/HIV" provides the evidence base for these guidelines. The guidelines are designed to implement the interventions as described in this framework. The guidelines reflect lessons learned from TB/HIV field sites including ProTEST with experience from comprehensive TB/HIV health services and interventions. The guidelines are structured in line with the main theme of putting these interventions into action: what to implement, how to implement it and by whom. The health situation is urgent and requires a move away from small scale, often costly and time-limited pilot projects to phased implementation of collaborative TB/HIV activities. Phased implementation will build on experience learned form ProTEST pilot sites. Human and financial constraints make phased implementation necessary. (excerpt)
Washington, D.C., World Bank, South Central Europe Country Department, 2003 Feb 11.  p.The purpose of this paper is to review the current status of the AIDS epidemics in ECC05 countries (Bulgaria, Croatia, and Romania), to evaluate the approaches and strategies currently being used in each country, and to make recommendations both for government strategies and for the Bank’s current and potential future involvement in relation to these strategies. The paper is divided into three sections: 1) an overview of recent regional perspectives; 2) a situation analysis and evaluation for each country including current strategies and implementation arrangements, and 3) a discussion of potential actions by the Bank. (excerpt)
VIDAS. 1999 Jan; 2(12):5-8.According to the most recent estimates of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), at the end of 1998 the number of people living with HIV (the virus that causes AIDS) will have grown to 33.4 million, 10% more than just a year earlier. The epidemic has not been controlled anywhere. In practically all countries of the world, new infections occurred in 1998. (excerpt)
[90 percent cases of HIV transmission are due to perinatal contagion or breastfeeding. One million children were HIV positive in 1977] El 90 por ciento de casos por contagio perinatal o lactancia. Un millon de niños/as portan VIH en 1977.
RedAda. 1997 Dec; (26):22-24.A million children under 15 years of age will have contracted HIV worldwide by 1997, while in 1996, of the one and a half million people who died of this disease, 350,000 were under 15, according to UNAID numbers released on the occasion of the world AIDS campaign (December 1), whose theme this year is "Children in a World with AIDS." Approximately 90 percent of children with HIV were infected by their mothers, during pregnancy or childbirth or through mother's milk, according to the UN organization. (excerpt)
Perspectives in Health. 2004; 9(2):30-32.Think about a vacation in the Caribbean and what comes to your mind? Clean air, superb scenery, relaxation, reinvigoration, and renewal? Unfortunately, this is not the reality for many residents of the poorer Caribbean islands. In several Caribbean countries, from 15 percent to 30 percent of the population live below the poverty line. The region’s infant mortality rates vary from 10–12 per 1,000 live births in Barbados and St. Lucia to 24 in Jamaica and 52 in Guyana. Meanwhile, HIV/AIDS has taken a particularly heavy toll on the Caribbean, with prevalence rates that are second only to those of sub-Saharan Africa. In the wake of the United Nations Millennium Summit, prime ministers of the Caribbean Community (CARICOM) met in Nassau in 2001 to review the region’s health priorities and declared their conviction that “The health of the Nation is the wealth of the Nation.” Inspired by this—and by the spirit of the Millennium Development Goals—Caribbean governments have developed new strategic plans for health. How realistic are their goals in the current economic and political climate? How likely are these strategies to succeed in improving quality of life for the Caribbean poor? (excerpt)
Emerging Infectious Diseases. 2004 Nov; 10(11):1979-1983.The mechanisms, techniques, and data sources used to monitor and evaluate global AIDS prevention and treatment services may vary according to gender. The Joint United Nations Programme on HIV/AIDS has been charged with tracking the response to the pandemic by using a set of indicators developed as part of the Declaration of Commitment endorsed at the U.N. General Assembly Special Session on AIDS in 2001. Statistics on prevalence and incidence indicate that the pandemic has increasingly affected women during the past decade. Women’s biologic, cultural, economic, and social status can increase their likelihood of becoming infected with HIV. Since 2000, global financial resources have increased to allow expansion of both prevention and treatment services through a number of new initiatives, such as the Global Fund to Fight AIDS, TB and Malaria; the U.S. President’s Emergency Plan for AIDS Relief; and the World Bank MAP program. Programs should be monitored and evaluated to ensure these investments are used to maximum effect. Different types of data should be included when assessing the status of the HIV/AIDS epidemic and effectiveness of the response. Each of these “data streams” provides information to enhance program planning and implementation. (excerpt)
AIDS. 2004; 18 Suppl 3:S49-S53.The widespread use of any antimicrobial agent, including antiretroviral agents, has the potential to select drug-resistant populations of microorganisms. HIV drug-resistant strains have been recognized as a serious threat to the efficacy of current antiretroviral treatments and could jeopardize efforts to increase access to treatment in countries most affected by the HIV epidemic. The WHO Global HIV Drug Resistance Surveillance Programme aims at enhancing and enabling the response to the threat of antiretroviral drug resistance by assessing the geographical and temporal trends in HIV drug resistance, increasing our understanding of the determinants of HIV drug resistance, and identifying ways to minimize its appearance, evolution and spread. Based on a global network of experts and collaborating institutions, the programme is developing and field-testing tools and guidelines for the regular monitoring of the level and spread of HIV resistance, particularly in treatment-naive patients. Although relevant progress has been made, several important challenges still exist to the implementation of this essential and innovative programme. (author's)
Geneva, Switzerland, WHO, 2004. 60 p.By tracking the past course of the HIV/AIDS epidemic, warning of possible future spread and measuring changes in infection and behaviour over time, second- generation surveillance is designed to produce information that is useful in planning and evaluating HIV/AIDS prevention and care activities over time. This objective has been met in many countries, where useful, high-quality data are now available. Nevertheless, a gap remains between the collection of useful data and the actual use of these data to reduce people's exposure to HIV infection and to improve the lives of those infected. More effort has been put into improving the quality of data collection than into ensuring the appropriate use of data. Collecting high-quality data is an important prerequisite to using them well, but why are available data not used better? One reason is that surveillance systems are often fragmented. This means that many departments or groups are responsible for various aspects of data collection. Each considers its job done after it has held its own "dissemination workshop". No single entity is responsible for compiling all the data, analysing them and presenting them as a cohesive whole. Further, very few countries budget adequately for analysing, presenting and using data, either the financial or human resources. When financial resources are allocated, people often underestimate the skills and time required to use data well. Many surveillance officials responding to an informal WHO/UNAIDS survey gave one final reason: they simply do not know how to use the data. This is hardly surprising: most people responsible for surveillance systems are physicians and public health professionals who are good at interpreting trends in disease but who have limited training in the different ways HIV surveillance data can be used to improve programming, measure the success of prevention, lobby for policy change and engage affected communities in the response. This publication aims to provide guidance in these areas. It discusses the three major areas of data use: programme planning, programme monitoring and evaluation and advocacy, giving examples of how data can be used effectively in these contexts. The publication concentrates on the mechanics of using data: not just what can be done with data but how it can be done. How can data be packaged for different audiences? Who should be involved in dissemination? What makes a good press release? What steps are required to produce a national report? Practical guidance is given on how to develop interesting and persuasive presentations and how to present data effectively. Suggestions are made for bringing together programme planning and advocacy. Different countries have different epidemics, different surveillance systems and different data use needs. It is hoped, however, that all countries can find some general principles that will provide pointers on how to improve performance in areas of data use relevant to them. (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):917.I find reassuring the fact that the Child survival series could constitute a renaissance in child-health matters, as suggested by Boniface Kalanda in the accompanying Debate section online. To remain quiet while 10 million children die every year, mostly in developing countries, is certainly unacceptable. (excerpt)
AIDS Reader. 2003 Jan; 13(1):5-6.In a special session of the United Nations, held from June 25 to 27, 2001, access to medications was recognized as one of the fundamental elements ensuring the innate right of all persons to enjoy the highest attainable standard of health. The prevention and treatment of HIV/AIDS were emphasized as "mutually reinforcing elements" of an effective health response. Yet, of the 43 million people currently living with HIV/AIDS, fewer than 1 million have access to and are treated with antiretrovirals. That fact has become part of a new public service campaign to increase awareness of this issue in the United States. (author's)
[Unpublished] 2003. Strategy paper for the Global Compact Policy Dialogue on HIV / AIDS, Geneva, Switzerland, May 12-13, 2003. 4 p.Successful businesses are those that adapt to the changing environment in which they operate: this could include changes in technology, legislation, markets or labour supply. HIV/AIDS is now a factor that companies must take into account in their planning and operations. It has been clear for some time that many companies are affected in two main ways: production is disrupted and productivity reduced at the same time as direct labour costs are rising. Productivity is affected by the loss of skilled and experienced workers, by absenteeism, and by falling workplace morale, including the loss of confidence in companies who take no action in high-prevalence situations. Rising costs include medical treatment, funeral costs, insurance, and the costs of replacing, training and retraining staff. (excerpt)
[Bangkok, Thailand], United Nations Development Programme [UNDP], South East Asia HIV and Development Project, 2000 Jul. , 19 p.One of the greatest challenges for workers in HIV prevention is the establishment of programmes that result in primary prevention of the spread of HIV. Such programmes must target the temporal and spatial factors that create environments that are fertile for transmission, rather than simply reacting post facto to local trends in HIV prevalence and incidence. Recently, the role of development in affecting the vulnerability leading to possible HIV infection in communities has become increasingly clear. Development efforts can sometimes de-stabilize a community by moving people in or out of it, or by affecting people’s economic or cultural environment. For example, the construction of a dam can at once force people to leave their homes near the construction and find work elsewhere, and recruit new people into the area to work on the dam. Such social and cultural flux changes the way people behave and the populations with whom they are in contact. To be effective, HIV preventive efforts must be closely synchronized with exactly those development factors that acutely increase a population’s vulnerability. The proposed Early Warning Rapid Response System (EWRRS) has been conceived to establish this synchronization. By linking information about development activities with information about effective prevention for the populations affected, an EWRRS would have a critical role in HIV prevention. Knowing which development activities can trigger population movements, which populations are moving, where they will be, and what languages they speak can foster public- and private-sectoral coordination of immediate actions to educate and support these populations to reduce their vulnerability. Such knowledge can also lead to retooling development activities in order to achieve both the development objectives and HIV prevention. In May of 2000, representatives from the Greater Mekong Sub-region and international HIV specialists met in Bangkok for a Think Tank Consultation on the EWRRS. The work of that meeting is summarized here. While the EWRRS is an unconventional idea, the efficacy of which may be difficult to show at this point in its conception, its potential to promote well-informed and coordinated actions to significantly reduce HIV spread is compelling. (excerpt)