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AIDScience. 2003; 3(10): p..The belief that sex is the primary mode of human immunodeficiency virus (HIV) transmission in sub-Saharan Africa is an assertion so widely accepted and has remained unquestioned for so long that it has taken on the status of a received truth. The World Health Organization (WHO) and the Joint U.N. Programme on HIV/AIDS (UNAIDS) recently convened an expert consultation to review issues raised in a series of papers published in the International Journal of STD & AIDS (1-4) that questioned the validity of that assertion. After examining the papers, WHO and UNAIDS issued a press release announcing that "the vast majority of evidence [supports the view] that unsafe sexual practices continue to be responsible for the overwhelming majority of infections". As co-authors of the controversial articles, and as participants in the Geneva meeting (three of us), we state that WHO's conclusion is premature. It is neither based on those discussions, nor on a more considered review of the relevant literature. (excerpt)
Unintended consequences: drug policies fuel the HIV epidemic in Russia and Ukraine. A policy report prepared for the UN Commission on Narcotic Drugs and national governments.
New York, New York, Open Society Institute, International Harm Reduction Development program, 2003. 16 p.Taking action now to reduce HIV transmission rates and treat those already infected is critical. With the goal of avoiding adverse effects on social welfare and public health, the Russian and Ukrainian governments should reconsider how they interpret international treaties. Policy changes should be made in the following areas: Harm reduction. The governments should play an active role in establishing and supporting a large, strategically located network of harm reduction programs that provide services for IDUs, including needle exchange, HIV transmission education, condom distribution, and access to viable treatment programs such as methadone substitution. Similar services should be available in all prisons. Education. Simple, direct, and dear information about HIV transmission should be made available to all citizens-especially those most at risk. Similarly, society at large should be educated about the realities of drug use and addiction as part of an effort to reduce stigma. Discrimination and law enforcement abuse. Public health and law enforcement authorities should take the lead in eliminating discrimination, official and de facto, toward people with HIV and marginalized risk groups such as drug users. Authorities must no longer condone or ignore harassing and abusive behavior, including physical attacks, arrest quotas, arbitrary searches, detainment without charges, and other violations of due process. HIV-positive people, including IDUs, should be included in all policy discussions related to them in the public health and legal spheres. Legislation. Laws that violate the human rights of people with HIV and at-risk groups should be repealed or restructured to better reflect public health concerns. Moving forward with the above strategies may make it appear that the governments are backing away from the goals and guidelines of the UN drug conventions. They may be criti- cized severely by those who are unable or unwilling to understand that meeting the goals of the conventions, some of which were promulgated more than 40 years ago, is far too great a price to bear for countries in the midst of drug use and HIV epidemics. Governments ultimately have no choice, though, if they hope to maintain any semblance of moral legitimacy among their own people. (excerpt)
BMJ. British Medical Journal. 1992 May 2; 304(6835):1135.India will receive $85m from the World Bank to supplement a $100m national AIDS control program which started this month. The money will be spent over 5 years on HIV screening, improving the safety of blood products, and putting into operation the WHO's strategies for controlling HIV infection. The assistance follows the release of results from India's nationwide surveillance program in 1991, which looked at the prevalence of HIV in over 1.2 million high risk people. About 7000 people were found to be infected with HIV and over 100 had AIDS. India has had a system of a nationwide surveillance for people infected with HIV since 1985, when a study by the Indian Council of Medical Research identified the 1st cases, found among prostitutes. Further studies showed that HIV was being spread predominantly through heterosexual activity and by intravenous drug users. In Bombay the proportion of prostitutes infected with the virus rose dramatically from less than 1% in 1986 to 1 in 5 in 1990. In some parts of the city 70% of prostitutes were found to be infected. Bombay has the highest number of recorded cases, followed by Madras and Manipur. Under Prime Minister Narasimha Rao the government set up regional AIDS management centers, which offer blood tests, educate the public about transmission of HIV, and try to alleviate the economic effects of HIV infection. Its 1989 AIDS Prevention bill, however, has been criticized for going too far. Critics complained that people were harassed to have blood tests, doctors were forced to disclose the names of patients infected with HIV, and people who were found to be positive for the antibody were put in isolation. After complaints from human rights organizations the government has withdrawn the bill for amendments. (full text)
Lancet. 1989 Feb 18; 1(8634):396.The World Health Organization (WHO) issued a consensus statement about AIDS and sexually transmitted diseases (STD) and partner notification for patients with HIV infection. Evidence that genital ulcer disease (GUD) is a risk factor and facilitator for HIV-1 infection in heterosexual people is strong, especially in developing countries. A few studies have shown an association of antibodies to herpes simplex virus type 2 (HSV-2) and Treponema pallidum (the chief cause of genital and anorectal ulcers in developing countries). A consistent relation between HIV-1 and HSV-2 and T. pallidum has been demonstrated in seroepidemiological studies. Data assessing the link between other STD pathogens and HIV-1 transmission are insufficient, but it is plausible that all STD pathogens that cause genital ulcers or inflammation are risk factors for increased susceptibility to HIV-1 infection. Investigating this possibility should be a research priority, as genital ulcer diseases intervention may help to prevent sexual transmission of HIV-1 infection. Partner notification programs, as part of a comprehensive AIDS prevention and control program, should be carefully designed. Because the notification procedure can cause individual and social harm and detract from other AIDS prevention and control activities, a careful assessment of medical, legal, logistic, social, and ethical issues needs to be made. Other variables, such as cost, local environment, and epidemiology need to be taken into account. Issues of patient referral, target populations, training of notification personnel, patient consent, diagnostic accuracy, and the logistics of notification need to be addressed. WHO suggests that the following criteria be monitored when assessing efficiency of partner notification activities: number of index persons; number of partners identified; number of partners notified and their seroprevalence; cost; satisfaction; compliance and acceptability; counseling and support; staff training; confidentiality; and adequacy of follow-up.