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Multilateral, regional, and national determinants of policy adoption: the case of HIV/AIDS legislative action.
International Journal of Public Health. 2013 Apr; 58(2):285-93.OBJECTIVES: This article examines the global legislative response to the HIV/AIDS epidemic with a particular focus on how policies were diffused internationally or regionally, or facilitated internally. METHODS: This article uses event history analysis combined with multinomial logit regression to model the legislative response of 133 countries. RESULTS: First, the results demonstrate that the WHO positively influenced the likelihood of a legislative response. Second, the article demonstrates that development bank aid helped to spur earlier legislative action. Third, the results demonstrate that developed countries acted earlier than developing countries. And finally, the onset and severity of the HIV/AIDS epidemic was a significant influence on the legislative response. CONCLUSION: Multilateral organizations have a positive influence in global policy diffusion through informational advocacy, technical assistance, and financial aid. It is also clear that internal stressors play key roles in legislative action seen clearly through earlier action being taken in countries where the shock of the onset of HIV/AIDS occurred earlier and earlier responses taken where the epidemic was more severe.
Reproductive Health Matters. 2011 Nov; 19(38):197-207.In March 2009, UN member states met at the 53rd Commission on the Status of Women (CSW) to discuss the priority theme of "the equal sharing of responsibilities between women and men, including caregiving in the context of HIV/AIDS". This meeting focused the international community's attention on care issues and generated Agreed Conclusions that aimed to lay out a roadmap for care policy. I examine how the frame of "care" - a contested concept that has long divided feminist researchers and activists - operated in this site. Research involved a review of documentation related to the meeting and interviews with 18 participants. Using this research I argue that the frame of care united a range of groups, including conservative faith-based actors who have mobilized within the UN to roll back sexual and reproductive rights. This policy alliance led to important advances in the Agreed Conclusions, including strong arguments about the global significance of care, especially in relation to HIV; the need for a strong state role; and the value of caregivers' participation in policy debates. However, the care frame also constrained debate at the CSW, particularly about disability rights and variations in family formation. Those seeking to reassert sexual and reproductive rights are grappling with such limitations in a range of ways, and attention to their efforts and concerns can help us better understand the potentials and dangers for feminist intervention within global policy spaces. Copyright (c) 2010 UNRISD. Published by Elsevier Ltd. All rights reserved.
Southern Med Review. 2011 Dec; 4(2):15-21.Objectives: Although poor reproductive health constitutes a significant proportion of the disease burden in developing countries, essential medicines for reproductive health are often not available to the population. The objective was to analyze the guiding principles for developing national Essential Medicines Lists (EML). The second objective was to compare the reproductive health medicines included on these EMLs to the 2002 WHO/UNFPA list of essential drugs and commodities for reproductive health. Another objective was to compare the medicines included in existing international lists of medicines for reproductive health. Methods: The authors calculated the average number of medicines per clinical groups included in 112 national EMLs and compared these average numbers with the number of medicines per clinical group included on the WHO/UNFPA List. Additionally, they compared the content of the lists of medicines for reproductive health developed by various international agencies. Results: In 2003, the review of the 112 EMLs highlighted that medicines for reproductive health were not consistently included. The review of the international lists identified inconsistencies in their recommendations. The reviews' outcomes became the catalyst for collaboration among international agencies in the development of the first harmonized Interagency List of Essential Medicines for Reproductive Health. Additionally, WHO, UNFPA and PATH published guidelines to support the inclusion of essential medicines for reproductive health in national medicine policies and EMLs. The Interagency List became a key advocacy tool for countries to review their EMLs. In 2009, a UNFPA/WHO assessment on access to reproductive health medicines in six countries demonstrated that the major challenge was that the Interagency List had not been updated recently and was inconsistently used. Conclusion: The addition of cost-effective medicines for reproductive health to EMLs can result in enhanced equity in access to and cost containment of these medicines, and improve quality of care. Action is required to ensure their inclusion in national budget lines, supply chains, policies and programmatic guidance.
Integrating poverty and gender into health programmes: a sourcebook for health professionals. Module on HIV / AIDS.
[Manila, Philippines], World Health Organization [WHO], Regional Office for the Western Pacific, 2008.  p.This module is designed to improve the awareness, knowledge and skills of health professionals on poverty and gender concerns in the field of HIV / AIDS. Experience increasingly shows that the socioeconomic factors contributing to the rapid spread of HIV in the Region include low education, limited access to health care services and increased mobility within and between countries -- factors that are largely determined by poverty and gender inequality. The growing commitment to curbing the HIV / AIDS epidemic requires that health professionals at community, provincial, national and international levels have the knowledge, skills and tools to more effectively respond to the health needs of poor and marginalized people and address the gender inequalities fuelling the epidemic. However, many health professionals in the Region are not adequately prepared to address these issues. This module is designed to help fill this gap.
Journal of Health Care Finance. 2010; 36(4):75-79.When the United Nations declared "health care for all" (at the conferences at Alma-Ata in 1978 and the Ottawa Charter in 1986),(1) the declarations were largely premature to impact the upcoming HIV/AIDS epidemic. These UN declarations still apply today, as multitudes of humanity continue to die from what amounts now to be a treatable chronic disease. Can the wealthier, industrialized countries stand by and watch the decimation of the populations of the developing world by HIV / AIDS? The global "health 9/10 gap," relates that only 10 percent of global heath resources go to developing countries - i.e., those having 90 percent of the poorest world populations. (2) The World Bank/World Health Organization has been at the forefront of providing resources for the global HIV/AIDS epidemic, (3) but for many countries of the developing world (especially Sub-Saharan Africa) it may be too little, too late. This work explores the application of an ecological model to global policy against HIV/AIDS, highlighting access to antiretroviral drugs (ARV). ARV distribution is constrained by patents and laws protecting the intellectual property rights of the international pharmaceutical corporations. In response to this situation, more questions arise. Will governments in the developing world invoke compulsory licensing (patent-breaking) in their negotiations with the international pharmaceutical corporations to provide medications against HIV/AIDS in their countries? Can international political and financial negotiations with these pharmaceutical corporations speed the growing push for a solution to this solvable crisis? The answers may lie in the "Brazilian model," that is a developing world government using all means available to provide ARV drugs for all its citizens with HIV/AIDS. The basis of this model includes negotiating with the pharmaceutical corporations over patent rights and importation of copied drugs from the Far East.
Current Opinion In HIV and AIDS. 2009 May; 4(3):222-31.PURPOSE OF REVIEW: We review the current literature supporting adoption of higher CD4 thresholds for initiation of antiretroviral treatment and survey progress in adoption of early treatment policies in resource-limited settings. We highlight some of the challenges and opportunities implementation of early treatment will bring. RECENT FINDINGS: The initial success of combination antiretroviral treatment resulted in the recommendation to treat early all individuals with HIV. However, the gradual realization that antiretroviral treatment was associated with toxicity led to a more tempered approach. Recent cohort studies and some clinical trials have shown that delaying treatment is associated with increased morbidity and mortality. SUMMARY: Early treatment is routinely practiced in developed countries. Now, early treatment is being adopted as a strategy in many resource-limited settings. The implications of this policy shift are not known, but we predict early treatment will have important consequences for the health system, the individual, and the community. Whereas these consequences will bring significant challenges, the increased numbers of HIV-infected individuals on treatment will result in many new opportunities - antiretroviral treatment will become less expensive, systems to deliver chronic care will be strengthened, and the policy shift will focus greater attention on pregnant women and children. Finally, some authors postulate that early treatment may impact HIV transmission.
Global Public Health. 2009; 4(2):131-49.Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.
Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, .  p. (USAID Contract No. HRN-C-00-00-00019-00)The Global Fund to Fight AIDS, TB and Malaria aims to attract, manage, and disburse resources that will make a significant and sustainable impact on the three focal diseases. The Global Fund has also stated its commitment to support programs that address the three diseases "in ways that contribute to the strengthening of health systems." The Global Fund is likely to have a variety of direct and indirect effects upon health care systems that could be positive or negative in nature. To be effective and sustainable in the long run, interventions will depend upon well-functioning health systems. This is true not only for the Global Fund, but also for other initiatives, such as the World Bank Multisectoral AIDS Program (MAP), the President's Emergency Plan for AIDS Relief, and others that aim to substantially increase the scale of response to specific diseases, particularly HIV/ AIDS. (excerpt)
Support to mainstreaming AIDS in development. UNAIDS Secretariat strategy note and action framework, 2004-2005.
Geneva, Switzerland, UNAIDS, . 10 p.Twenty years into the pandemic, there is now ample evidence for the complex linkages between AIDS and development: development gaps increase people's susceptibility to HIV transmission and their vulnerability to the impact of AIDS; inversely, the epidemic itself hampers or even reverses development progress so as to pose a major obstacle to the achievement of the Millennium Development Goals. The growing understanding of this two-way relationship between AIDS and development has led to the insight that, in addition to developing programmes that specifically address AIDS, there is a need to strengthen the way in which existing development programmes address both the causes and effects of the epidemic in each country-specific setting. The process through which to achieve this is called 'Mainstreaming AIDS'. In recognition of this, the 2001 United Nations General Assembly Special Session Declaration of Commitment on HIV/AIDS requires countries to integrate their AIDS response into the national development process, including poverty reduction strategies, budgeting instruments and sectoral programmes. (excerpt)
Bulletin of the World Health Organization. 2007 Mar; 85(3):200-206.International interest in the relationship between globalization and health is growing, and this relationship is increasingly figuring in foreign policy discussions. Although many globalizing processes are known to affect health, migration stands out as an integral part of globalization, and links between migration and health are well documented. Numerous historical interconnections exist between population mobility and global public health, but since the 1990s new attention to emerging and re-emerging infectious diseases has promoted discussion of this topic. The containment of global disease threats is a major concern, and significant international efforts have received funding to fight infectious diseases such as malaria, tuberculosis and HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome). Migration and population mobility play a role in each of these public health challenges. The growing interest in population mobility's health-related influences is giving rise to new foreign policy initiatives to address the international determinants of health within the context of migration. As a result, meeting health challenges through international cooperation and collaboration has now become an important foreign policy component in many countries. However, although some national and regional projects address health and migration, an integrated and globally focused approach is lacking. As migration and population mobility are increasingly important determinants of health, these issues will require greater policy attention at the multilateral level. (author's)
Orphans and vulnerable children affected by HIV / AIDS in Brazil: where do we stand and where are we heading?
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:23-30.This study aimed at identifying human rights' status and situation, as expressed in the United Nations General Assembly Special Session on HIV/AIDS, of children and adolescents living with HIV/AIDS, non-orphans and orphans affected by AIDS, based on local and international literature review. The main study findings did not allow to accurately estimating those children and adolescents living with HIV and non-orphans affected by HIV/AIDS but data was available on those living with AIDS and orphans. The limitations and possibilities of these estimates obtained from surveillance systems, mathematical models and surveys are discussed. Though studies in literature are still quite scarce, there is indication of compromise of several rights such as health, education, housing, nutrition, nondiscrimination, and physical and mental integrity. Brazil still needs to advance to meet further needs of those orphaned and vulnerable children. Its response so far has been limited to providing health care to those children and adolescents living with HIV/AIDS, preventing mother-to-child HIV transmission and financing the implementation and maintenance of support homes (shelters according to Child and Adolescent Bill of Rights) for those infected and affected by HIV/AIDS, either orphans or not. These actions are not enough to ensure a supportive environment for children and adolescents orphaned, infected or affected by HIV/AIDS. It is proposed ways for Brazil to develop and improve databases to respond to these challenges. (author's)
New York, New York, UNDP, Bureau for Development Policy, HIV / AIDS Group, 2004. 32 p.HIV/AIDS multi-sectoral strategic planning has been promoted and successfully undertaken in a number of countries. In most cases, the planning process results in the design and completion of national strategic frameworks (NSF) or plans. While such frameworks continue to provide valuable strategic orientation, they have often not served the intended purpose of guiding successful and well-coordinated implementation at national, provincial, regional, district, constituency and community levels. To date, the transformation of strategic frameworks into effective and coordinated action remains a major concern for most governments and their partners. The broad diversity of actors, the numerous sectors involved and the variety of components of the response illustrate the complexity of implementation and coordination. To achieve a strategic multi-sectoral response, it is important to develop a strategic framework and management approach consistent with national policies, priorities and local experiences. (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)
Female circumcision, AIDS discrimination to be monitored - Committee on the Elimination of Discrimination Against Women.
UN Chronicle. 1990 Jun; 27(2): p..The eradication of female circumcision and avoidance of discrimination against women victims of acquired immunodeficiency syndrome (AIDS) were the subjects of two general recommendations adopted at the ninth annual session of States Parties to the 1979 Convention on the Elimination of All Forms of Discrimination Against Women. The 100 States Parties were asked to report to the Committee on the Elimination of Discrimination Against Women-the 23-member body which monitors compliance with the instrument-on measures taken to eliminate female circumcision which, it stated, has "serious health and other consequences for women and children". (excerpt)
UN Chronicle. 1986 Apr; 23: p..The first global evaluation of the World Health Organization's "Strategy for Health for All by the Year 2000' was reviewed by the 31-member Executive Board of the World Health Organization (WHO)(Geneva, 8-22 January). The Board also demanded action to protect the rights of non-smokers and to prevent and control the spread of the Acquired Immune Deficiency Syndrome (AIDS). The Board also asked for a special report on health and development in Africa, for review by the special session of the United Nations General Assembly on the critical economic situation in Africa in May. Noting that 86 per cent of Member States had reported on evaluation of their national health strategies, the Board urged all Member States to work towards reducing "socioeconomic and related health disparities among people'. (excerpt)
AIDS Bulletin. 2005 Jun; 14(2):3-4.What we do now and how we choose to do it will affect Africa’s future and future generations. It seems a clear and obvious truism – yet not always one easy to live by in a world of instant need and gratification. UNAIDS has recently released a new report entitled AIDS in Africa: Three scenarios to 2025 which sketches three very different scenarios for AIDS in Africa and points out that our actions today determine our future tomorrow in terms of this epidemic and our continent. UNAIDS is quick to point out that the scenarios are not predictions rather they are stories about our possible futures and how the epidemic may develop. The aim is to highlight the various choices that will face African governments and societies in the coming decades, and to unpack the many broader factors that fuel the epidemic and examine how these interact. What is very stark is that depending on our actions today up to 43 million infections could be averted over the next 20 years – roughly equal to the population of South Africa. The report faces up the reality that the death toll will rise no matter what, but it is still possible to influence how much it rises. The scenarios, presented as stories, were developed by a team of people over a two-year period and involved collaboration with the African Union, the African Development Bank, the UN Economic Commission for Africa, the United Nations Development Programme, the World Bank and Royal Dutch Shell. They look at the possible course of the epidemic by 2025 when “no one under the age of 50 will remember a time without AIDS”. The stories are intended to be provocative and to stimulate debate and thus more informed decision making. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Department of HIV / AIDS, 2005.  p.The epidemic of HIV infection and AIDS among injecting drug users (IDUs) and its spread from IDU populations to their sexual partners and the wider community is an important but often neglected aspect of the global AIDS pandemic. This neglect has resulted from: ignorance of the existence or extent of the epidemic; cultural, social and political constraints on the development of responses; and prejudice against people engaged in illegal behaviour such as drug use. Nevertheless, the major reasons these epidemics are so often neglected are the lack of understanding of the importance of controlling the epidemic, ignorance of effective methods for controlling the epidemic and a lack of knowledge about how to develop effective responses. (excerpt)
In: State of the art: AIDS and economics, edited by Steven Forsythe. Washington, D.C., Futures Group International, POLICY Project, 2002 Jul. 58-63.The Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) calls for spending on HIV/AIDS programs to increase to US$7-10 billion annually by 2005. The Declaration specifies a number of goals at the global and national level and calls for specific actions to reach those goals, but it does not specify how the funding should be allocated. The Report of the Commission on Macroeconomics and Health estimates that spending on HIV/AIDS in low- and middle-income countries should increase by US$14 billion by 2007 and suggests that US$6 billion is needed for prevention, US$3 billion for care, and US$5 billion for antiretroviral (ARV) treatment. A detailed estimate of spending requirements prepared for UNGASS calls for minimum spending of US$9.2 billion annually by 2005 in low- and middle-income countries to provide coverage of essential prevention, care, and mitigation services in an effort to reach the UNGASS goals. Details of spending needs by category of intervention are shown in Figure 1. A recent analysis shows that these coverage levels are sufficient to achieve the UNGASS goals. However no analysis has been done to show whether this is the most cost-effective approach to achieving these goals or whether the same goals could be reached with less funding and a more strategic allocation of resources. (excerpt)
In: State of the art: AIDS and economics, edited by Steven Forsythe. Washington, D.C., Futures Group International, POLICY Project, 2002 Jul. 2-8.Policymakers need a reasonably complete picture of resource flows from sources to uses that finance HIV/AIDS prevention, care, support, and treatment. Without that picture, they risk misallocation, waste, and faulty strategic planning. For now, in most parts of the developing world, the picture remains largely unpainted. Filling in the details on financing is among the key challenges to HIV/AIDS policymakers today. Limited data for Latin American and Caribbean (LAC) region countries offer virtually the only cases of adequate resource flow data outside the United States. Those countries spent a thousand dollars per person living with HIV/AIDS (PLWHA) in 2000. The U.S. federal government’s Medicaid program for indigents spent 35 times as much for each AIDS patient under its care in that same year. Low-income countries, largely dependent on donor assistance, spent far less per person and per PLWHA—as little as 31 cents per person, and eight dollars per PLWHA in sub-Saharan Africa. These enormous disparities underline a dual challenge: First, use what little money is available in poor countries very effectively; and second, demonstrate to all concerned that more resources must be forthcoming to confront the HIV/AIDS pandemic in poor countries, lest the negative effects swamp any effort to develop. (author's)
IAEN: Current Issues in the Economics of HIV / AIDS. AIDS and education, April 25, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 43 p.Each country with a slightly different focus on the piece of research and in Malawi, the piece I'm going to talk about today is really embedded in a much larger study, a larger longitudinal study. But because of some of the data that we're finding in our pupils and teachers in the conditions of AIDS in Malawi, we decided that we should look a little bit further into what the impact is on the classroom and specifically on learning, so that's going to be the focus of my remarks and I hope really it stimulates some discussion. We're at the beginning of looking at this issue more systematically in the classroom, so I hope I don't fall into the category that Steve referred to earlier as maybe I should have come next year instead of this year. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. India: Approaches to containing and treating the HIV / AIDS epidemic, April 25, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 50 p.Now I want to give you just the flavor of the conclusions before we launch into the explanation of what we actually did. We arrived at estimates at the costs per healthy life years saved from an anti-retro viral strategy in India and we have three different strategies which I will define in detail in a minute. The most cost effective of those treatment strategies would buy healthy life years at government expenditure of $146 dollars per healthy life year. The most expensive of the three would cost $280 dollars per healthy life year we estimate and those estimates are pretty large in comparison to the price of healthy life years that we're familiar with from making if you will (unintelligible) report and from other estimates that have been produced of gains that could be saved from (unintelligible) vaccination or even road traffic accidents per nation. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. Contrasts and comparisons of simulation modeling exercises and their use in analysis of policy options and interventions, Thursday, April 24, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 61 p.The problem that we were addressing with this model was the fact that most countries now have strategic plans for organizing the national HIV/AIDS effort. But, that there’s very little strategic analysis of the funding that goes into that plan. In fact, the costing (unintelligible) after the goals are already set. This creates a variety of problems, but the major one is that the funding and the goals are not linked in any way that allows you to see how changes in the funding, either in the total amount or in the allocation, effects the goals you can achieve. It means, it makes it difficult to set reasonable goals. It also makes it difficult to do strategic allocation funding. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. TRIPS and HAART: Recent developments, sound policies, Thursday, April 24, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 50 p.What I'm going to talk about is the pricing of antiretrovirals and other AIDS drugs. Now this is to be within the framework of the intellectual property provisions of the Oriqui round treaty, the so called TRIPS Provisions once you recognize from the beginning that not all antiretroviral came under patents for many of the key source nations, TRIPS didn't take affect until after, well until a lot of AIDS drugs were already on the market. I'm going to assume that a drug has patent protection and then the question would be how should that drug be priced? And can we have slide one please, which… when a provider of a drug has essentially patent protection or some other reason for having a monopoly of the source, the ideal kind of pricing for it assuming that it's going to be trying to maximize it's profits is sometimes called tiered pricing, sometimes called differential pricing economist, and we've been talking about these kinds of problems for about 150 years now. Economists call it discriminatory pricing or even more technically Ramsey Brummel Bradford (Misspelled?) pricing, the basic idea is this. (excerpt)
IAEN: Current Issues in the Economics of HIV / AIDS. Effective strategies for resource mobilization and resource allocation -- global and regional perspectives, Thursday, April 24, 2003. Transcript.
[Palo Alto, California], Henry J. Kaiser Family Foundation, 2003. 49 p.I want to talk about now a kind of evaluation for a couple of minutes that is perhaps a little bit different than what we think about when we say monitoring and evaluation and I want to start out by whispering something that you are not allowed to repeat outside of this room and that's that, well I think we have very convincing evidence of the effectiveness of specific interventions intervention of HIV/AIDS. I don't think we know what works at the level of communities or countries. We have very little information about what works at that level. We have three very important randomize community trials that you are probably all familiar with. (excerpt)
Paris, France, UNESCO, International Institute for Educational Planning, 2004. 40 p. (IIEPApr. 2004/UHIVSD/R4)The HIV/AIDS epidemic is unprecedented in human history. It has been with us for 20 years — and the worst is yet to come: many millions more will be infected, many millions more will die, many millions more will be orphaned. Not only individuals are at risk — the social fabric of whole societies is threatened. The disease is likely to be a scourge throughout our lifetime. Its spread has not been curbed — on the contrary, the epidemic is expanding to new regions and spreading in some areas even more rapidly than it did in the earlier years. Unlike other epidemics, it primarily affects young adults, particularly women. It thrives on and amplifies poverty and exclusion. It strikes hardest where lack of education, illness, malnutrition, violence, armed conflicts and discrimination are already well entrenched. Yet, although it strikes the poor and disadvantaged, it also heavily affects the skilled, the trained and the educated — i.e. the groups most vital for development. Children are at risk on an unparalleled scale. Millions are already infected — in some countries more than a third of 15-year-olds will die of AIDS-related illnesses in coming years. Millions more are becoming orphans of one or both parents — more than 30 million in less than 10 years. Many youth will grow up deprived, desocialized and disconnected. Children are losing teachers at school and parents who can support them at home. In some areas classes and even whole schools are closing, resulting in a poorer education, while at the same time the economically developed world moves into the knowledge society. (excerpt)