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Adoption of the 2015 World Health Organization guidelines on antiretroviral therapy: Programmatic implications for India.
WHO South - East Asia Journal of Public Health. 2017 Apr; 6(1):90-93.The therapeutic and preventive benefits of early initiation of antiretroviral therapy (ART) for HIV are now well established. Reflecting new research evidence, in 2015 the World Health Organization (WHO) recommended initiation of ART for all people living with HIV (PLHIV), irrespective of their clinical staging and CD4 cell count. The National AIDS Control Programme (NACP) in India is currently following the 2010 WHO ART guidelines for adults and the 2013 guidelines for pregnant women and children. This desk study assessed the number of people living with HIV who will additionally be eligible for ART on adoption of the 2015 WHO recommendations on ART. Data routinely recorded for all PLHIV registered under the NACP up to 31 December 2015 were analysed. Of the 250 865 individuals recorded in pre-ART care, an estimated 135 593 would be eligible under the WHO 2013 guidelines. A further 100 221 would be eligible under the WHO 2015 guidelines. Initiating treatment for all PLHIV in pre-ART care would raise the number on ART from 0.92 million to 1.17 million. In addition, nearly 0.07 million newly registered PLHIV will become eligible every year if the WHO 2015 guidelines are adopted, of which 0.028 million would be attributable to implementation of the WHO 2013 guidelines alone. In addition to drugs, there will be a need for additional CD4 tests and tests of viral load, as the numbers on ART will increase significantly. The outlay should be seen in the context of potential health-care savings due to early initiation of ART, in terms of the effect on disease progression, complications, deaths and new infections. While desirable, adoption of the new guidance will have significant programmatic and resource implications for India. The programme needs to plan and strengthen the service-delivery mechanism, with emphasis on newer and innovative approaches before implementation of these guidelines.
The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis.
PloS One. 2018; 13(2):e0192910.BACKGROUND: Nearly a quarter of a million children have acquired HIV, prompting the implementation of new protocols-Option B and B+-for treating HIV+ pregnant women. While efficacy has been demonstrated in randomized trials, there is limited real-world evidence on the impact of these changes. Using longitudinal, routinely collected data we assessed the impact of the adoption of WHO Option B in Rwanda on mother to infant transmission. METHODS: We used interrupted time series analysis to evaluate the impact of Option B on mother-to-child HIV transmission in Rwanda. Our primary outcome was the proportion of HIV tests in infants with positive results at six weeks of age. We included data for 20 months before and 22 months after the 2010 policy change. RESULTS: Of the 15,830 HIV tests conducted during our study period, 392 tested positive. We found a significant decrease in both the level (-2.08 positive tests per 100 tests conducted, 95% CI: -2.71 to -1.45, p < 0.001) and trend (-0.11 positive tests per 100 tests conducted per month, 95% CI: -0.16 to -0.07, p < 0.001) of test positivity. This represents an estimated 297 fewer children born without HIV in the post-policy period or a 46% reduction in HIV transmission from mother to child. CONCLUSIONS: The adoption of Option B in Rwanda contributed to an immediate decrease in the rate of HIV transmission from mother to child. This suggests other countries may benefit from adopting these WHO guidelines.
Southern African Journal of HIV Medicine. 2016; 17(1): p.Background: The World Health Organization (WHO) HIV treatment guidelines have been used by various countries to revise their national guidelines. Our study discusses the national policy response to the HIV epidemic in sub-Saharan Africa and quantifies delays in adopting the WHO guidelines published in 2009, 2013 and 2015. Methods: From the Internet, health authorities and experts, and community members, we collected 59 published HIV guidelines from 33 countries in the sub-Saharan African region, and abstracted dates of publication and antiretroviral therapy (ART) eligibility criteria. For these 33 countries, representing 97% regional HIV burden in 2015, the number of months taken to adopt the WHO 2009, 2013 and/or 2015 guidelines were calculated to determine the average delay in months needed to publish revised national guidelines. Findings: Of the 33 countries, 3 (6% regional burden) are recommending ART according to the WHO 2015 guidelines (irrespective of CD4 count); 19 (65% regional burden) are recommending ART according to the WHO 2013 guidelines (CD4 count = 500 cells/mm3); and 11 (26% regional burden) according to the WHO 2009 guidelines (CD4 count = 350 cells/mm3). The average time lag to WHO 2009 guidelines adoption in 33 countries was 24 (range 3–56) months. The 22 that have adopted the WHO 2013 guidelines took an average of 10 (range 0–36) months, whilst the three countries that adopted the WHO 2015 guidelines took an average of 8 (range 7–9) months. Conclusion: There is an urgent need to shorten the time lag in adopting and implementing the new WHO guidelines recommending ‘treatment for all’ to achieve the 90-90-90 targets.
Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.
International Journal of Health Planning and Management. 2013 Jul-Sep; 28(3):257-68.The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright (c) 2012 John Wiley & Sons, Ltd.
Geneva, Switzerland, UNAIDS, 2007 Mar. 4 p. (UNAIDS Policy Brief)Nearly 40 million people in the world are living with HIV. In countries such as Botswana, Swaziland, and Lesotho people living with HIV make up a quarter or more of the population. People living with HIV are entitled to the same human rights as everyone else, including the right to access appropriate services, gender equality, self-determination and participation in decisions affecting their quality of life, and freedom from discrimination. All national governments and leading development institutions have committed to meeting the eight Millennium Development Goals, which include halving extreme poverty, halting and beginning to reverse HIV and providing universal primary education by 2015. GIPA or the Greater Involvement of People Living with HIV is critical to halting and reversing the epidemic; in many countries reversing the epidemic is also critical to reducing poverty. (excerpt)
Ensuring the sexual and reproductive health of people living with HIV: Policies, programmes and health services.
Reproductive Health Matters. 2007 May; 15(29 Suppl 1):1-3.IN 2006, there were some 39.7 million people living with HIV, half of them under the age of 25.* People living with HIV have sexual and reproductive health needs and concerns, some of which are related to having HIV and others which they have in common with their noninfected peers. Yet sexual and reproductive health policies, programmes and services often fail to take into consideration the needs and wishes of people living with HIV. Most programmes currently revolve around voluntary testing and counselling for HIV, access to antiretroviral and other AIDS-related treatment, and hospital and home-based care for those with HIV- and AIDS-related illnesses. In relation to sexual and reproductive health care, HIV prevention predominates. There are condom social marketing and other safer sex promotion programmes and recent initiatives to promote family planning for people with HIV. Prevention of mother-to-child transmission of HIV in antenatal and delivery care has also begun to get greater programmaticattention and support. (excerpt)
Joint ILO / UNESCO Southern African Subregional Workshop, 30 November - 2 December 2005, Maputo, Mozambique. Improving responses to HIV / AIDS in education sector workplaces. Report.
Geneva, Switzerland, ILO, 2006. 63 p.The workshop was organized under the auspices of an ILO programme initiated in 2004, developing a sectoral approach to HIV/AIDS education sector workplaces, as a complement to the ILO's code of practice HIV/AIDS and the world of work, adopted in 2001. A number of research papers and assessments prepared by international organizations in recent years have highlighted the impact of HIV and AIDS on the education sector workforce in developing countries, especially in sub-Saharan Africa. High prevalence results in morbidity and mortality rates which deprive affected countries of some of their most educated and skilled human resources. In addition, teachers are often not trained or supported to deal with HIV in schools, and the disease has also affected the management capacity of education systems. In 2005, UNESCO joined the ILO in a collaborative project, aimed at the development of an HIV and AIDS workplace policy and related resource materials for use by education staff and stakeholders at national and institutional levels in southern African countries. The workshop in Maputo brought together representatives of government (ministries of labour and education), employer organizations and teacher/educator unions from seven countries to participate in this process, along with representatives of regional and international organizations (see Appendix 1 for list of participants). (excerpt)
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)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:5-8.Recognizing the HIV/AIDS pandemic as an unprecedented worldwide emergency and one of the greatest challenges to life and the enjoyment of human rights, the United nations called on member states to reflect on this matter. In June 2001, around 20 years after the first AIDS cases were recorded, the United Nations General Assembly Special Session on HIV and AIDS (UNGASS HIV/AIDS) was held in New York. The Session culminated in the drafting of the Declaration of Commitment on HIV and AIDS: a document that reflected the consensus between 189 countries, including Brazil, and stated some essential principles for an effective response to the epidemic. The Declaration recognized that economic, racial, ethnic, generational and gender inequalities, among others, were factors that boosted vulnerability and, whether acting separately or in synergy, favored HIV infection and the onset and evolution of AIDS. The Declaration of Commitment on HIV and AIDS has become transformed into a tool for reaffirming the urgency and necessity of promoting the solidarity that the epidemic demands. It aims towards better management of the actions and resources destined for controlling HIV and AIDS and towards social control over public HIV/AIDS policies. (excerpt)
CommonHealth. 2005 Spring; 36-43.As defined by the World Health Organization (WHO):2 Palliative medicine is the study and management of patients with active, progressive, far advanced disease for whom the prognosis is limited and the focus of care is the quality of life. [It is] the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social, and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are applicable earlier in the course of the illness, in conjunction with treatment. Palliative care: Affirms life and regards dying as a normal process; Neither hastens, nor postpones, death; Provides relief from pain and other distressing symptoms; Integrates the psychological and spiritual aspects of patient care; Offers a support system to help patients live as actively as possible until death; and Offers a support system to help families cope during a patient's illness and with their own bereavement. In short, palliative care comprehensively addresses the physical, emotional, and spiritual impact a life-threatening illness has on a person, no matter the stage of the illness. It places the sick person and his/her family, however defined, at the center of care and aggressively addresses all of the symptoms and problems experienced by them. Many healthcare providers apply certain elements of the palliative care treatment approach-- such as comprehensive care and aggressive symptom management-- to the care of all of their patients, not only those who are terminally ill, offering the type of care we would all like to receive when we are sick. (excerpt)
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)
Paris, France, UNESCO, 2006 May. 42 p. (ED-2006/WS/27- CLD 27702)The UNAIDS Inter-Agency Task Team (IATT) on Education promotes quality education as a human right and supports a rights-based approach to the implementation of all educational activities. If education is based on a commitment to rights, then it must embody rights in its conduct. This has implications when one considers the obligation of countries to provide a quality education for all -- including those infected and affected by HIV and AIDS. Because of the nature of the pandemic, those who are uninfected are also viewed as being affected. The topic is even more salient due to national governments', civil society groups', and development agencies' commitments to Education for All (EFA), as goal number six refers to addressing all aspects of the quality of education so that recognised and measurable learning outcomes are achieved by all, especially in literacy, numeracy and essential life skills. A quality education focuses on learning. (excerpt)
Choices. 2001 Dec; 5.The HIV/AIDS epidemic is the world's most serious development crisis. Nearly 58 million people have been infected, and 22 million are already dead. The epidemic continues to spread, with over 15,000 new infections every day. The devastating scale and impact of this catastrophe is a call of the utmost urgency for each of us to act. On 27 June 2001, the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), adopted the "Declaration of Commitment on HIV/ AIDS." The Declaration recognized in clear and forthright terms the driving forces of the epidemic, including social, economic, and cultural aspects; and set specific measurable goals in four key areas: prevention of new infections; provision of improved care, support and treatment; reduction of vulnerability; and mitigation of the socio-economic impact of HIV/AIDS. The global community is challenged to respond to the epidemic in a new way, with strategic attention to its human rights and gender dimensions, greater accountability for results, and courageous and visionary leadership. (excerpt)
Geneva, Switzerland, UNAIDS, 1996. 9 p. (Facts about UNAIDS)Around 6 million people worldwide have died of AIDS since the start of the epidemic. Well over 20 million are living with HIV, the virus that causes AIDS. Already, there are communities and even whole cities where one out of every three adults is infected, and the repercussions of these dense clusters of illness and death will linger for decades. The epidemic and its impact are becoming a permanent challenge to human ingenuity and solidarity. Since the first of January 1996, UNAIDS -- the Joint United Nations Programme on HIV/AIDS -- has carried the main responsibility within the UN system for helping countries strengthen their long-term capacity to cope with this challenge. Based in Geneva, Switzerland, the new programme is cosponsored by six organizations of the UN family -- United Nations Children's Fund (UNICEF), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Nations Educational, Scientific and Cultural Organization (UNESCO), World Health Organization (WHO), and the World Bank. Together with its cosponsors and other partners around the world, UNAIDS is hard at work on its mission -- leading and catalysing an expanded response to the epidemic to improve prevention and care, reduce people's vulnerability to HIV/AIDS, and alleviate the epidemic's devastating social and economic impact. (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)
Windhoek, Namibia, Family Health International [FHI], 2002. 15 p.This workshop followed the November 25-29 Eastern and Southern Africa Workshop on Children Affected by HIV/AIDS. Approximately 50 people, representing 17 countries, attended the one-day workshop, which was convened by the UNICEF Eastern and Southern Africa Regional Office in Nairobi with the support and co-operation of USAID and Family Health International. The objectives of this workshop were to: Share knowledge, information and experience relating to alternative forms of care for children without family care (orphans and other vulnerable children in each country who are living in institutional care, on the street, child headed households etc.) with a major focus on how to strengthen and greatly increase better care for such children in Africa; Identify issues of common concern relating to alternative care, and discuss possible solutions; Enable delegates to incorporate this information into country-level action; and Consider possible next steps. (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)
Kyiv, Ukraine, UNDP, 2003. 36 p.Ukraine is a young nation on the move. The national response to HIV/AIDS is also gathering pace. It is bringing together fresh coalitions of people, leaders and institutions who want to stop the further spread of this virus and to ensure care for those who are in need. The good news for all is that there are now known ways of preventing the spread of the virus and treatment is increasingly available. The challenge remains immense -- to some overwhelming. The insidious nature of the virus is that it attacks men and women in the prime of their life -- between the ages of 15 and 40. It robs children of their parents, and society of its productive citizens. Limited budgets and ungrounded stigma have severely hampered a scaled-up nationwide response. Positive rhetoric is helpful, but it needs to be matched by personal commitment and concrete actions. With the infusion of new resources, now is the time to remove the log jams and unleash a broad-based national effort to change the current course of the epidemic. As the Secretary General of the United Nations Kofi Annan recently said, "We have come a long way, but not far enough. Clearly, we will have to work harder to ensure that our commitment is matched by the necessary resources and action." (excerpt)
Moscow, Russia, Transatlantic Partners Against AIDS, 2005. 52 p.The purpose of this Handbook is to assist members of the Federation Council and deputies of the State Duma of the Russian Federation, and other Russian officials on the federal and regional levels, in enacting appropriate legislation and legislative reform to address AIDS, whether they be initiatives prohibiting discrimination against PLWHA or members of highly vulnerable groups, laws guaranteeing reliable HIV prevention information for all Russian citizens, or other policy priorities — and ensuring adequate fiscal and other resources to support them. This Handbook provides examples of the best legislative and regulatory practices gathered from around the world. Best practices are given for each of the 12 guidelines contained in the International Guidelines on HIV/AIDS and Human Rights, published in 1998 by the Office of the United Nations High Commissioner for Human Rights (UNHCHR) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). The Handbook also presents detailed information on the Russian AIDS epidemic with regard to the establishment and implementation of these Guidelines. Most importantly, the Handbook outlines concrete recommendations on measures that legislators can take to protect human rights and promote public health in responding to the epidemic. (author's)
AIDS. 2006 Mar 21; 20(5):653-656.On 1 December 2003, when pilot projects had shown the feasibility of antiretroviral therapy (ART) in the poorest regions of the world, and the prices of antiretroviral drugs had steeply decreased, the World Health Organization (WHO) launched its '3 by 5' initiative, aiming to provide ART to 3 million people by the end of 2005. WHO described the large-scale provision of ART as 'a global health emergency [for which] urgent action is needed'. In June 2005, '3 by 5' released an interim report documenting the impressive progress made, but acknowledging its pace is slower than originally anticipated. However, although the AIDS epidemic in sub-Saharan Africa certainly requires an emergency response with short-term plans and objectives, we argue that the short time horizon risks constricting our insights and that a much longer-term view is now necessary in view of the ultimate goal of universal access to ART. (excerpt)
New York, New York, UNICEF, 2005. 25 p.The world must take urgent account of the specific impact of AIDS on children, or there will be no chance of meeting Millennium Development Goals (MDG) 6 - to halt and begin to reverse the spread of the disease by 2015. Failure to meet the goal on HIV/AIDS will adversely affect the world's chances of progress on the other MDGs. The disease continues to frustrate efforts to reduce extreme poverty and hunger, to provide universal primary education, and to reduce child mortality and improve maternal health. World leaders, from both industrialized and developing countries, have repeatedly made commitments to step up their efforts to fight the spread of HIV/AIDS. They are beginning to increase the political leadership and the resources needed to fight the disease. Significant progress is being made in charting the past and future course of the pandemic, in providing free antiretroviral treatment to those who need it, and in expanding the coverage of prevention services. But children are still missing out. (excerpt)
Joint ILO / WHO guidelines on health services and HIV / AIDS. Tripartite Meeting of Experts to Develop Joint ILO / WHO Guidelines on Health Services and HIV / AIDS.
Geneva, Switzerland, ILO, 2005.  p. (TMEHS/2005/8)These guidelines are the product of collaboration between the International Labour Organization and the World Health Organization. In view of their complementary mandates, their long-standing and close cooperation in the area of occupational health, and their more recent partnership as co-sponsors of UNAIDS, the ILO and the WHO decided to join forces in order to assist health services in building their capacities to provide their workers with a safe, healthy and decent working environment, as the most effective way both to reduce transmission of HIV and other blood-borne pathogens and to improve the delivery of care to patients. This is essential when health service workers have not only to deliver normal health-care services but also to provide HIV/AIDS services and manage the long-term administration and monitoring of anti-retroviral treatments (ART) at a time when, in many countries, they are themselves decimated by the epidemic. (excerpt)
New York, New York, Human Rights Watch, 2005 Feb-Mar. (1) 2 p.The Commission on Narcotic Drugs (CND) is the central agency in the United Nations system responsible for setting international drug policy. At its 48th session from March 7-14, 2005 in Vienna, the Commission will focus on HIV/AIDS. This year the U.N. Office on Drugs and Crime (UNODC) chairs the consortium of U.N. agencies that makes up the Joint U.N. Programme on HIV/AIDS (UNAIDS), making the Commission’s focus on HIV/AIDS particularly timely. Of the approximately five million new HIV infections in 2004, an estimated 10 percent stemmed from injection drug use. In some countries, such as Russia, injection drug use accounts for up to 75 percent of reported HIV cases. HIV/AIDS among injection drug users is spread chiefly through the sharing of blood-contaminated syringes. This makes it critically important for drug users to have access to noninjected drug opiate substitutes (such as methadone and buprenorphine), as well as sterile injection equipment, until such time as they can stop using drugs. This is especially true given the chronic and relapsing nature of drug addiction and the worldwide scarcity of effective drug treatment. (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)
[Unpublished] 2000 Sep 8.  p.A lot of publications have been produced on care for people living with HIV/AIDS. This document attempts to bring key issues on HIV/AIDS care in one practical and concise publication. It is intended to provide guidance to all partners in the provision of HIV care and support in resource-constrained settings. The purpose of this document is to identify the key elements and interventions in provision of care and support for PLHA and affected communities. Each element of care is discussed and references for more information on how this element should be implemented are provided as much as possible. These references will be interactive for those documents having an electronic file available in WHO or in UNAIDS Secretariat websites. These references are practical publications useful for the implementation of the key elements of HIV/AIDS care. This document also covers structural elements for service delivery. Finally, it discusses prioritization of the various elements of HIV/AIDS care: these two sections are helpful in the process of prioritization and implementation of HIV/AIDS care interventions listed in this document. (excerpt)