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Health Policy and Planning. 2015 Feb; 30(1):8-18.Kyrgyzstan has adopted a number of policy initiatives to deal with an accelerating HIV/AIDS epidemic. This article explores the main actors in HIV/AIDS policy-making, their interests, support and involvement and their current ability to set the agenda and influence the policy-making process. Fifty-four semi-structured interviews were conducted in the autumn of 2011, complemented by a review of policy documents and secondary sources on HIV/AIDS in Kyrgyzstan. We found that most stakeholders were supportive of progressive HIV/AIDS policies, but that their influence levels varied considerably. Worryingly, several major state agencies exhibited some resistance or lack of initiative towards HIV/AIDS policies, often prompting international agencies and local NGOs to conceptualize and drive appropriate policies. We conclude that, without clear vision and leadership by the state, the sustainability of the national response will be in question.
Global Call to Action: Maximize the public health impact of intermittent preventive treatment of malaria in pregnancy in sub-Saharan Africa.
Malaria Journal. 2015; 14:207.Intermittent preventive treatment of malaria in pregnancy is a highly cost-effective intervention which significantly improves maternal and birth outcomes among mothers and their newborns who live in areas of moderate to high malaria transmission. However, coverage in sub-Saharan Africa remains unacceptably low, calling for urgent action to increase uptake dramatically and maximize its public health impact. The ‘Global Call to Action’ outlines priority actions that will pave the way to success in achieving national and international coverage targets. Immediate action is needed from national health institutions in malaria-endemic countries, the donor community, the research community, members of the pharmaceutical industry and private sector, along with technical partners at the global and local levels, to protect pregnant women and their babies from the preventable, adverse effects of malaria in pregnancy © 2015 Chico et al. Open Access.
Global Public Health. 2014; 9(8):865-879.Lauded for getting specific health issues onto national and international agendas and for their potential to improve value for money and outcomes, public-private global health initiatives (GHIs) have come to dominate global health governance. Yet, they have also been criticised for their negative impact on country health systems. In response, disease-specific GHIs have, somewhat paradoxically, appropriated the aim of health system strengthening (HSS). This article critically analyses this development through an ethnographic case study of the GAVI Alliance, which funds vaccines in poor countries. Despite GAVI’s self-proclaimed ‘single-minded’ focus on vaccines, HSS support is fronted as a key principle of GAVI’s mission. Yet, its meaning remains unclear and contested understandings of the health systems agenda abound, reflecting competing public health ideologies and professional pressures within the global health field. Contrary to broader conceptualisations of HSS that emphasise social and political dimensions, GAVI’s HSS support has become emblematic of the so-called ‘Gates approach’ to global health, focused on targeted technical solutions with clear, measurable outcomes. In spite of adopting rhetoric supportive of ‘holistic’ health systems, GHIs like GAVI have come to capture the global debate about HSS in favour of their disease-specific approach and ethos.
Community health care: Bringing health care at your door. Report of side event at 67th World Health Assembly.
[Geneva, Switzerland], World Health Organization [WHO], Global Health Workforce Alliance, 2014.  p.The side event held at the 67th World Health Assembly provided an opportunity to deliberate on integrated community health care (CHC) in attaining the Millennium Development Goals (MDGs) and Universal Health Coverage (UHC). The session also explored effective policies and strategies that could be used to remove the obstacles to deliver quality health care and positioning community health workers (CHWs) as an integral part of local health teams.
Journal of the International AIDS Society. 2013; 16(1):18452.Introduction: The female condom is the only evidence-based AIDS prevention technology that has been designed for the female body; yet, most women do not have access to it. This is remarkable since women constitute the majority of all HIV-positive people living in sub-Saharan Africa, and gender inequality is seen as a driving force of the AIDS epidemic. In this study, we analyze how major actors in the AIDS prevention field frame the AIDS problem, in particular the female condom in comparison to other prevention technologies, in their discourse and policy formulations. Our aim is to gain insight into the discursive power mechanisms that underlie the thinking about AIDS prevention and women's sexual agency. Methods: We analyze the AIDS policies of 16 agencies that constitute the most influential actors in the global response to AIDS. Our study unravels the discursive power of these global AIDS policy actors, when promoting and making choices between AIDS prevention technologies. We conducted both a quantitative and qualitative analysis of how the global AIDS epidemic is being addressed by them, in framing the AIDS problem, labelling of different categories of people for targeting AIDS prevention programmes and in gender marking of AIDS prevention technologies. Results: We found that global AIDS policy actors frame the AIDS problem predominantly in the context of gender and reproductive health, rather than that of sexuality and sexual rights. Men's sexual agency is treated differently from women's sexual agency. An example of such differentiation and of gender marking is shown by contrasting the framing and labelling of male circumcision as an intervention aimed at the prevention of HIV with that of the female condom. Conclusions: The gender-stereotyped global AIDS policy discourse negates women's agency in sexuality and their sexual rights. This could be an important factor in limiting the scale-up of female condom programmes and hampering universal access to female condoms.
American Journal of Public Health. 2013 Apr; 103(4):623-31.The low priority that most low-income countries give to neonatal mortality, which now constitutes more than 40% of deaths to children younger than 5 years, is a stumbling block to the world achieving the child survival Millennium Development Goal. Bangladesh is an exception to this inattention. Between 2000 and 2011, newborn survival emerged from obscurity to relative prominence on the government's health policy agenda. Drawing on a public policy framework, we analyzed how this attention emerged. Critical factors included national advocacy, government commitment to the Millennium Development Goals, and donor resources. The emergence of policy attention involved interactions between global and national factors rather than either alone. The case offers guidance on generating priority for neglected health problems in low-income countries.
Contemporary Politics. 2012 Jun; 18(2):186-199.Capacity-building has become a mainstay of many AIDS and public health programmes. This article examines its impact on civil society organisations and claims-making around citizenship, as these have been articulated through heterogeneous policy networks doing HIV prevention work. Drawing on a growing literature on the Foucauldian notions of biopower and governmentality, the genealogy of capacity-building as a globalised technology of governmentality is traced, examining its uses both at the international level and in Brazil. Brazilian civil society organisations have undoubtedly been transformed by their participation in networks carrying out capacity-building projects. While recognising these effects, the conflicts and productive tensions inherent to such networks are highlighted.
Guidance for evidence-informed policies about health systems: Linking guidance development to policy development.
PLoS Medicine. 2012 Mar; 9(3):e1001186.Contextual factors are extremely important in shaping decisions about health systems, and policy makers need to work through all the pros and cons of different options before adopting specific health systems guidance. A division of labour between global guidance developers, global policy developers, national guidance developers, and national policy developers is needed to support evidence-informed policy-making about health systems. A panel charged with developing health systems guidance at the global level could best add value by ensuring that its output can be used for policy development at the global and national level, and for guidance development at the national level. Rigorous health systems analyses and political systems analyses are needed at the global and national level to support guideline and policy development. Further research is needed into the division of labour in guideline development and policy development and on frameworks for supporting system and political analyses. This is the second paper in a three-part series in PLoS Medicine on health systems guidance.
International Journal of Gynaecology and Obstetrics. 2010 Jul; 110 Suppl:S17-9.Unsafe abortion is a recognized public health problem that contributes significantly to maternal mortality. At least 13% of maternal mortality is caused by unsafe abortion, mostly in poor and marginalized women. The International Federation of Gynecology and Obstetrics (FIGO) launched an initiative in 2007 to prevent unsafe abortion and its consequences, building on its work on other major causes of maternal mortality. A Working Group was identified with collaborators from many international organizations and terms of reference provided direction from the FIGO Executive Board as to possible evidence-based interventions. A total of 54 member associations of FIGO, representing almost half its member societies, requested participation in the initiative, with 43 subsequently producing action plans that are country specific and involve the national government and multiple collaborators. Obstetrician/gynecologists have demonstrated the importance of the initiative by an unprecedented level of engagement in efforts to reduce maternal mortality and morbidity in country and by sharing experiences regionally. (c) 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Trends in development assistance and domestic financing for health in implementing countries. Global Fund to Fight AIDS, Tuberculosis and Malaria third replenishment (2011-2013).
Geneva, Switzerland, Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 Mar.  p.Donors at the Mid-Term Review of the Global Fund's Second Voluntary Replenishment 2008- 2010 held in Caceres in March 2009 requested a report on the progress made by African countries with regard to the Abuja Declaration. This declaration, adopted at a 2001 summit of the Organisation of African Unity, was a commitment of African states to allocate at least 15 percent of their annual budgets to the health sector. Donors at the Mid-Term Review meeting also requested information concerning counterpart funding from middle-income countries. 2. This update begins with an explanation of current trends in development assistance for health (DAH) and the role that these external resources play in the total expenditure on health in low- and middle-income countries. It examines progress in 52 African countries and a sample of 20 non-African middle-income countries. It utilizes data from the Organisation for Economic Co-operation and Development (OECD) / Development Assistance Committee's (DAC) aggregated aid statistics and the Creditor Reporting System (CRS), the Institute for Health Metrics and Evaluation (IHME) Development Assistance for Health database, the World Bank Development Indicators and the World Health Organization (WHO) National Health Accounts database. 3. Since the Abuja Summit in 2001, many African countries have increased the proportion of their national budget allocated to health. Over half of African countries recorded increases in health budget allocations between 2001 and 2007. By 2007, three African countries had achieved the Abuja target of 15 percent, and three others had exceeded this amount. For all 52 countries, the average general government expenditure on health as a percentage of total government expenditure rose marginally from 8.8 percent in 2001 to 9.0 percent in 2007. 4. The proportion of gross domestic product (GDP) devoted to health also increased marginally in the period 2001-2007, from 5.0 percent in 2001 to 5.3 percent in 2007. Substantial flows of DAH to these countries (amounting to US$ 4.7 billion in 2007) have contributed to these increased total expenditures on health. 5. Funding of the health sector in the lower-income countries examined contains a substantial proportion of DAH. In the middle-income countries examined, this funding is predominantly from domestic sources and external resources only contribute a negligible proportion of the total expenditure on health. In nearly two-thirds of the middle-income countries assessed for this paper, external resources contributed less than 1 percent of the total expenditure on health in 2007. 6. In the current economic climate, the likelihood of African governments significantly increasing the proportional allocation to the health sector is not encouraging. With the current low per-capita expenditure on health in these countries, inflows of external resources remain critical if African countries are to run national programs at a scale necessary to achieve national and global targets in the fight against the three diseases. 7. Global Fund policy requires lower-middle income countries and upper-middle income countries to contribute substantially to their national program costs, for a number of reasons: to ensure national ownership of programs and their longer-term sustainability of programs, as well as to ensure sufficient funds are available to lower-income countries. In line with the Paris Declaration on aid effectiveness and in an attempt to avoid imposing specific further reporting requirements, it has not been the practice to request middle income countries to identify specific program components that they will fund. It is recognized that data in this domain needs to be strengthened and systematically collected and the Secretariat will explore ways in which to do that with technical partners in a manner that is consistent with aid effectiveness principles. The reform of the Global Fund business model, known as the architecture review, presents an opportunity for progress in this work.
Coordination, management and utilization of foreign assistance for HIV / AIDS prevention in Vietnam. Assessment report.
Ha Noi, Vietnam, CCRD, 2006 Oct. 82 p. (CCRD Assesssment Report)International assistance for HIV / AIDS prevention and control in Vietnam has significantly contributed to combating this epidemic. However, while current resources have not yet fully met the needs, the management and utilization of resources still had many limitations which affect the effectiveness of foreign assistance and investments. The independent assessment was prepared for the Conference on “the Coordination of Foreign Assistance for HIV / AIDS Prevention and Control”. Analytical assessment and comments on the management and coordination of foreign aid were made on the basis of Government’s official procedures and regulations on those issues. This research was carried out in October, 2006.
A practical guide to integrating reproductive health and HIV / AIDS into grant proposals to the Global Fund.
[Washington, D.C.], Population Action International, 2009 Sep. 61 p.Starting in recent proposal rounds, The Global Fund for AIDS, Tuberculosis and Malaria (GFATM) has stated more explicitly that countries can include reproductive health as part of their proposals on AIDS, tuberculosis and malaria, as long as a justification is provided on the impact of reproductive health (RH) on reducing one of the three diseases. This document is for countries and organizations, including CCMs, government and nongovernmental organizations and civil society organizations, to help in integrating reproductive health, including family planning (RH) and HIV / AIDS in proposals submitted to the Global Fund. The document takes a country approach to integration since the Global Fund seeks to support proposals that build on and strengthen national programs. (Excerpt)
Reproductive Health Matters. 2009 May; 17(33):91-104.This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public–private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.
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.
Trips and public health: solutions for ensuring global access to essential AIDS medication in the wake of the Paragraph 6 Waiver.
Journal of Contemporary Health Law and Policy. 2008 Fall; 25(1):142-65.In 2003, the World Trade Organization (WTO) proposed a waiver to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), known as the "Paragraph 6 Waiver," in order to create flexibility for developing countries and to allow easier importation of cheap generic medication. ... To the companies who own pharmaceutical patents, the notion that a government can use their product without the permission of the patent holder seems unfair and counterproductive. ... Canada was one of the first countries to enact legislation for the sole purpose of exporting generic drugs to developing countries and its experience is indicative of the problems presented by compulsory licensing and the Paragraph 6 Waiver. ... Exact amounts and methods for determining remuneration vary but presumably a fair system would compensate patent holders for the loss of their patent rights while maintaining the system's cost effectiveness for countries issuing the compulsory licenses. (excerpt)
American Journal of Public Health. 2008 Sep; 98(9):1594-7.In 1948, after its first World Health Assembly, the WHO took action to form a Secretariat in Geneva. It was given space for its initial years in the Palais des Nations, which had been the last home of the League of Nations. As stated in Chapter I of its Constitution, WHO was "to act as the directing and coordinating authority on international health work." This was a much broader scope than any other international agency in the orbit of the UN. (excerpt)
Geneva, Switzerland, UNAIDS, . 13 p.For over 25 years, our world has been living with HIV. And in just this short time, AIDS has become one of the make-or-break global crises of our age, undermining not just the health prospects of entire societies but also their ability to reduce poverty, promote development, and maintain national security. And in too many regions AIDS continues to expand - every single day 11 000 people are newly infected with HIV, and nearly 8 000 people die from AIDS-related illnesses. Yet, despite the magnitude of the AIDS crisis, today we are at a time of great hope and great opportunity to get ahead of the epidemic. Our crisis-response tactics have led to real progress against AIDS. Funding for efforts against AIDS has risen from 'millions' to 'billions' in just a decade. Political commitment and leadership on AIDS is higher than ever before. In more and more countries - including some of the world's poorest - we are seeing real results in terms of lives saved because effective HIV prevention and treatment programmes are being made widely available. Leaders of both developing and rich countries have now committed themselves to working together so as to get close to universal access to HIV prevention, treatment, care and support by 2010 - a critical stepping stone to halting the epidemic by 2015, as set out in the Millennium Development Goals. (excerpt)
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)
Lancet. 2007 Jul 7; 370(9581):15-16.A new spirit of cooperation and coordination between the key global players in the fight against HIV/AIDS was cemented at a meeting for programme implementers in Kigali, Rwanda, in mid-June. The partnership comes amidst concerns about rising infection rates in some countries where infections had slowed, as well as worries about the unpredictability of funding for HIV/AIDS activities. The collaboration is expected to curb duplication of efforts and wastage of resources, and to ultimately scale-up AIDS prevention and treatment. The meeting-usually an annual gathering for the US President's Emergency Plan for AIDS Relief (PEPFAR) and its grantees-opened up for the first time to include the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, the World Bank, UNICEF, WHO, and the Global Network of People Living with HIV/AIDS (GNP+), who were all co-sponsors of the conference. (excerpt)
Non-communicable diseases and global health governance: Enhancing global processes to improve health development.
Globalization and Health. 2007 May 22; 3(1):2.This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health). The paper assesses the merits of the Millennium Development Goals (MDGs) and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy. (author's)
Bulletin of the World Health Organization. 2007 Mar; 85(3):192-199.International health policy-makers now have a variety of institutional instruments with which to pursue their global and national health goals. These instruments range from the established formal multilateral organizations of the United Nations to the newer restricted-membership institutions of the Group of Eight (G8). To decide where best to deploy scarce resources, we must systematically examine the G8's contributions to global health governance. This assessment explores the contributions made by multilateral institutions such as the World Health Organization, and whether Member States comply with their commitments. We assessed whether G8 health governance assists its member governments in managing domestic politics and policy, in defining dominant normative directions, in developing and complying with collective commitments and in developing new G8-centred institutions. We found that the G8's performance improved substantially during the past decade. The G8 Member States function equally well, and each is able to combat diseases. Compliance varied among G8 Member States with respect to their health commitments, and there is scope for improvement. G8 leaders should better define their health commitments and set a one-year deadline for their delivery. In addition, Member States must seek WHO's support and set up an institution for G8 health ministers. (author's)
Washington, D.C., AED, LINKAGES, 2006 Sep. 6 p. (Experience LINKAGES; USAID Cooperative Agreement No. HRN-A-00-97-00007-00; USAID Development Experience Clearinghouse Doc ID / Order No. PN-ADH-497)One of LINKAGES' goals is to assist global and local organizations in integrating results-oriented behavior change interventions, technical information, supportive policies, and other project innovations into their own programs to improve breastfeeding and related complementary feeding and maternal dietary practices. LINKAGES developed a mainstreaming framework to better define, observe, track, and guide the process. This issue of Experience LINKAGES describes what mainstreaming means and how mainstreaming lends itself to the replication, scale up, and sustainability of project innovations. LINKAGES defines mainstreaming as making routine an innovation that successfully addresses an opportunity or problem. Mainstreaming is done by--not for--organizations. Replication, scale up, and sustainability are mainstreaming goals within an organization's "geography" of headquarters, regional centers, national offices, and field projects. (excerpt)
Food and Nutrition Bulletin. 2003; 24 Suppl 4:S69-S77.The importance of micronutrient deficiencies or "hidden hunger" was clearly emphasized by the inclusion of specific goals on iron, vitamin A, and iodine deficiency at the 1990 World Summit for Children and other major international nutrition conferences. Significant progress has since been made toward eliminating vitamin A and iodine deficiencies, with less progress made toward reducing the burden of iron-deficiency anemia. The role of international agencies, such as the World Health Organization, United Nations Children's Fund, Food and Agricultural Organization, and World Bank in assisting countries to make progress toward the World Summit for Children goals has been very important. International agencies have played a critical role in advocating for and raising awareness of these issues at the international, regional, and national levels among policymakers and the general population. Using a rights-based approach, UNICEF and other agencies have been instrumental in elevating to the highest political level the discussion of every child's right to adequate nutrition. International agencies have also been very supportive at the national level in providing technical guidance for programs, including monitoring and evaluation. These agencies have played a critical role in engaging the cooperation of other partners, including bilateral donors, non-governmental organizations, and the private sector for micronutrient programs. Furthermore, international agencies provide financial and material support for micronutrient programs. In the future, such agencies must continue to be heavily involved in programs to achieve the newly confirmed goals for 2010. The present paper focuses on the role of international agencies in combating micronutrient deficiencies, drawing on the lessons learned over the last decade. The first section of the paper summarizes the progress achieved since 1990, and the second section describes the specific role of international agencies in contributing to that progress. (author's)
International Workshop on Multi-Micronutrient Deficiency Control in the Life Cycle, Lima, Peru, May 30-June 1, 2001.
Food and Nutrition Bulletin. 2002; 23(3):309-316.Thirty-one representatives from international organizations, nongovernmental organizations, government agencies, universities, and the private sector participated in a three-day workshop in Lima, Peru, organized by the Universidad Nacional Agraria La Molina and supported by the Ministry of Health Peru, UNICEF, and the World Health Organization. The objective of the workshop was to develop a protocol for a comprehensive micronutrient supplementation program for populations in developing countries that suffer from deficiencies of several micronutrients. The workshop consisted of two components: presentation of preliminary results of the multicenter study on infant supplementation and recommendations on the policy and community, monitoring and impact evaluation, and research aspects of supplementation programs. This paper provides the summary reports of the second component. (author's)
New York, New York, IAVI, 2006.  p.Twenty-five years after the first five cases of a novel immunodeficiency disease were described, the AIDS pandemic has become the greatest global public health crisis since the Black Death in the Middle Ages. Although the ideal global response to HIV/AIDS must be a comprehensive approach that includes education, prevention, treatment, and care, the only way to end this epidemic is to develop a safe, accessible, and preventive vaccine. The ultimate goal is an AIDS vaccine that prevents infection from the wide spectrum of globally diverse HIV isolates and is applicable for use in the developing world, where the need is the greatest. However, a vaccine that suppresses viral load and slows progression to AIDS or suppresses and blunts transmission of HIV would have significant public health impact. To achieve that, a host of scientific, public policy, and political actions must be taken in a coordinated, interlinked fashion to make all of the necessary resources available (Figure 4). While scientific challenges continue to be the main obstacle in the search for an AIDS vaccine, countless examples of successful technology breakthroughs show that judicious policy changes and political will matters enormously. It is vital to enlist political leadership, non-governmental organizations, community groups, and a range of strategic coalitions that can amplify and reinforce support for AIDS vaccines. (excerpt)