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MMWR. Morbidity and Mortality Weekly Report. 2016 Feb 12; 65(5):115-9.Blood transfusion is a life-saving medical intervention; however, challenges to the recruitment of voluntary, unpaid or otherwise nonremunerated whole blood donors and insufficient funding of national blood services and programs have created obstacles to collecting adequate supplies of safe blood in developing countries (1). Since 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has provided approximately $437 million in bilateral financial support to strengthen national blood transfusion services in 14 countries in sub-Saharan Africa and the Caribbean* that have high prevalence rates of human immunodeficiency virus (HIV) infections. CDC analyzed routinely collected surveillance data on annual blood collections and HIV prevalence among donated blood units for 2011-2014. This report updates previous CDC reports (2,3) on progress made by these 14 PEPFAR-supported countries in blood safety, summarizes challenges facing countries as they strive to meet World Health Organization (WHO) targets, and documents progress toward achieving the WHO target of 100% voluntary, nonremunerated blood donors by 2020 (4). During 2011-2014, overall blood collections among the 14 countries increased by 19%; countries with 100% voluntary, nonremunerated blood donations remained stable at eight, and, despite high national HIV prevalence rates, 12 of 14 countries reported an overall decrease in donated blood units that tested positive for HIV. Achieving safe and adequate national blood supplies remains a public health priority for WHO and countries worldwide. Continued success in improving blood safety and achieving WHO targets for blood quality and adequacy will depend on national government commitments to national blood transfusion services or blood programs through increased public financing and diversified funding mechanisms for transfusion-related activities.
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.
Antiretroviral resistance patterns and HIV-1 subtype in mother-infant pairs after the administration of combination short-course zidovudine plus single-dose nevirapine for the prevention of mother-to-child transmission of HIV.
Clinical Infectious Diseases. 2009 Jul 15; 49(2):299-305.BACKGROUND: World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B. METHODS: Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare). RESULTS: Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, [Formula: see text] for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038). CONCLUSIONS: The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.
New York, New York, UNICEF, 2008 Apr. 48 p.This report will focus on three major themes. First, strengthening communities and families is crucial to every aspect of a child-centred approach to AIDS. Support by governments, NGOs and other actors should therefore be complementary to and supportive of these family and community efforts, through, for example, ensuring access to basic services. Second, interventions to support children affected by HIV and AIDS are most effective when they form part of strong health, education and social welfare systems. Unfortunately, because maternal and child health programmes are weak in many countries, millions of children, HIV-positive and -negative alike, go without immunization, mosquito nets and other interventions that contribute to the overall goal of HIV-free child survival. A final theme of this report is the challenge of measurement. Documenting advances and shortfalls strengthens commitment and guides progress. A number of countries have data available on the 'Four Ps', and targeted studies are being developed to assess the situation of the marginalized young people who are most at risk but often missed in routine surveys. (excerpt)
Flash-heat inactivation of HIV-1 in human milk: A potential method to reduce postnatal transmission in developing countries.
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul; 45(3):318-323.Up to 40% of all mother-to-child transmission of HIV occurs by means of breast-feeding; yet, in developing countries, infant formula may not be a safe option. The World Health Organization recommends heat-treated breast milk as an infant-feeding alternative. We investigated the ability of a simple method, flash-heat, to inactivate HIV in breast milk from HIV-positive mothers. Ninety-eight breast milk samples, collected from 84 HIV-positive mothers in a periurban settlement in South Africa, were aliquoted to unheated control and flash-heating. Reverse transcriptase (RT) assays (lower detection limit of 400 HIV copies/mL) were performed to differentiate active versus inactivated cell-free HIV in unheated and flash-heated samples. We found detectable HIV in breast milk samples from 31% (26 of 84) of mothers. After adjusting for covariates, multivariate logistic regression showed a statistically significant negative association between detectable virus in breast milk and maternal CD4+ T-lymphocyte count (P = 0.045) and volume of breast milk expressed (P = 0.01) and a positive association with use of multivitamins (P = 0.03). All flash-heated samples showed undetectable levels of cell-free HIV-1 as detected by the RT assay (P less than 0.00001). Flash-heat can inactivate HIV in naturally infected breast milk from HIV-positive women. Field studies are urgently needed to determine the feasibility of in-home flash-heating breast milk to improve infant health while reducing postnatal transmission of HIV in developing countries. (author's)
WHO approach to track HIV drug resistance emergence and transmission in countries scaling up HIV treatment [letter]
AIDS. 2005; 19(12):1329-1330.Treatment access programmes are currently expanding in resource-limited settings. The potential barriers to long-term success (such as intermittent drug supply, drug stock-outs, poor patient monitoring, incorrect prescribing practices and low adherence) as well as the need to begin programmes quickly to treat millions of individuals, have raised fears that the aggressive plan to roll out antiretroviral therapy (ART), particularly in Africa, may generate an epidemic of drug-resistant strains of HIV. (excerpt)
Toronto, Canada, International Council of AIDS Service Organizations [ICASO], 1998 Jun. 16 p.Over the past few years, the International Council of AIDS Service Organizations (ICASO) and its component networks and organizations have undertaken a process to determine how best to highlight human rights activities within the work it does on HIV/AIDS. This process included the ICASO Inter-Regional Consultation on Human Rights, Social Equity and HIV/AIDS, which was held in Toronto, Canada, in March 1998. This consultation constituted the first ever international meeting specifically focussing on HIV/AIDS and human rights, social equity and community networking issues. The plan described in this document is an important milestone in this process. It is part of ICASO’s ongoing efforts to provide a framework that will be useful in the work of community-based HIV/AIDS organizations. The consultation also formally endorsed the International Guidelines on HIV/AIDS and Human Rights issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Office of the United Nations High Commissioner on Human Rights. Participants to the Consultation believe that the Guidelines provide a platform for the development of activities and initiatives, including advocacy education. Community-based organizations (CBOs) would need to prioritize and select specific issues they feel are critical to their efforts in prevention of HIV/AIDS, and in the care and support of those living and affected by HIV/AIDS. Section 2.0 of the document describes the links between human rights and HIV/AIDS. Section 3.0 outlines a framework for the work ICASO will be doing over the next several years in the area of human rights, social equity and HIV/AIDS. The framework consists of guiding principles, role statements, goals, objectives, activities and structures. The framework has been prepared primarily from a global perspective. Finally, Section 4.0 contains work-plans from three of the five regions of ICASO (Asia/Pacific, Africa, and Latin America and the Caribbean) showing how human rights issues will be incorporated into their work. (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)
New York, New York, Population Council, 2004 Apr. 40 p.Preventing unintended pregnancy among HIV-positive women through family planning services is one of the four cornerstones of a comprehensive program for prevention of mother-to-child HIV transmission (PMTCT). Reducing unintended pregnancies among HIV-positive women through family planning reduces the number of children potentially orphaned when parents die of AIDS-related illnesses. It also reduces HIV-positive women's vulnerability to morbidity and mortality related to pregnancy and lactation. In addition, family planning for both HIV-positive and -negative women safeguards their health by enabling them to space births. The global public health community––NGOs, governments, and international donors–– has mobilized to design and provide essential PMTCT services: voluntary counseling and testing (VCT), infant feeding counseling, outreach to communities and families, and a short course of antiretroviral therapy. In most cases, the implementation approach has been to incorporate PMTCT into services that already reach pregnant women and women of childbearing age: antenatal care, obstetrical care, and maternal/child health. Yet the complexity of introducing PMTCT into the real world—that is, existing health services in resource-poor settings—soon became clear. Population Council and its research partners have been addressing several key questions about PMTCT services and how well they function in field settings. This report reviews field experiences with the integration of family planning and PMTCT services. It is hoped that this review will provide evidence and information for developing effective strategies for appropriately promoting family planning within PMTCT programs. (excerpt)
New York, New York, UNICEF, 2003 Sep.  p.Armed conflict fuels the spread of HIV in many ways: by the disintegration of communities, displacement from the home, separation of children from their families, and the destruction of schools and health services. Another contributing factor is rape and other human rights abuses that proliferate during wartime. Moreover, the impoverishment that results from conflict situations often leaves women and girls destitute. For many, trading sex for survival becomes the only option. Crowded and unsafe camps for internally displaced persons and refugees expose women and children to the risk of sexual violence. That, combined with inadequate health services and opportunities for learning and recreation, creates a situation that is conducive to the spread of HIV. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 2003. 36 p.The rapid needs assessment tool has been developed through collaborative work with an expert group, and pre-tested in four countries— Bangladesh, Brazil, Ghana, and Kenya. The current report presents the results of these assessments along with issues for consideration in the possible improvement of the needs assessment tool and the recommended process for using the tool. The four reports conclude that while condoms are widely available, and condom use is generally increasing, there is much that could be done to improve their distribution, their promotion, and their utilization, especially among key target groups that are at a high risk for HIV. In all four countries, a significant bifurcation of condom programming was found between the distribution of condoms through family planning services and the promotion and distribution of condoms by HIV/AIDS prevention programs. Little coordination or joint planning of condom programming was found. Overall, the rapid needs assessment tool was found to be valuable and easily adjusted to local circumstances. However, the current forms and process of the assessment tool have incorporated suggestions from field implementers as well as UNFPA collaborators that will strengthen its future implementation. The process of consulting key condom programming managers and policy makers led to the identification of problems and the next steps for solving them (which was an important objective of the tool). In fact, the rapid needs assessment’s bringing together all of the stake holders involved in condom issues for mutual discussion of problems and potential solutions proved effective in all four countries. This process of engagement, discussion, argument, and ultimately, consensus, was probably the most valuable aspect of the exercise. Despite strong efforts to create a rapid needs assessment exercise, in none of the countries could it be implemented within the time frame of the 7-10 days that was desired. While data gathering activities did not necessarily take a long time, the process of scheduling meetings and interviews with high level government officials required a far greater time frame than anticipated – approximately two months — due to travel schedules, local administrative crises, and holidays. (excerpt)
Geneva, Switzerland, UNAIDS, 2004. vii, 64 p.This report grows out of our shared belief that the world must respond to the HIV crisis confronting women. It highlights the work of the Global Coalition on Women and AIDS—a UNAIDS initiative that supports and energizes programmes that mitigate the impact of AIDS on girls and women worldwide. Through its advocacy and networking, the Coalition is drawing greater attention to the effects of HIV on women and stimulating concrete, effective action by an ever-increasing range of partners. We believe this report, with its straightforward analysis and practical responses, can be a valuable advocacy and policy tool for addressing this complex challenge. The call to empower women has never been more urgent. We must act now to strengthen their capacity, resilience and leadership. (excerpt)
New York, New York, UNFPA, 2004. iv, 17 p. (E/500/2004)This report is intended for use in planning contraceptive supply, and for advocacy and resource mobilization. It contains country-specific information provided by donors on the type, quantity and total cost of contraceptives they supplied to reproductive health programmes in developing countries during 2002. The United Nations Population Fund (UNFPA) collected information for this report in 2003; as in earlier years, the UNFPA database is especially useful to illustrate commodity shortfalls and changes in funding by donor and country. The report highlights trends since 1990 and the gap between estimated needs and actual donor support, comparing UNFPA estimates of condom requirements for STI/HIV prevention, and contraceptive requirements for family planning programmes, with actual donor support. It also indicates donor support by region and product, the top ten countries supported by donors and the quantity of male and female condoms supplied. UNFPA tried to collect information on donor support for antibiotics for prevention of STIs/RTIs. In many cases, however, either donors did not record this information or the countries receiving support did not disaggregate information by commodity. UNFPA’s Commodity Management Unit will continue to discuss how to collect this information. (excerpt)
Investing in people: national progress in implementing the ICPD Programme of Action, 1994-2004. International Conference on Population and Development.
New York, New York, UNFPA, 2004.  p.The 1994 International Conference on Population and Development (ICPD) articulated a bold new vision about the relationships between population, development and individual well-being. At the ICPD, 179 countries adopted a 20-year forward-looking Programme of Action (ICPD PoA), which built on the success of population, maternal health and family planning programmes of the previous decades while addressing, with a new perspective, the needs of the early years of the twenty-first century. As the ICPD is reaching its mid-point in 2004, it is fitting that countries take stock of progress that has been made so far in achieving the Cairo goals. UNFPA is mandated to assist countries in their review of operational experiences in implementing the ICPD PoA, and to that end, conducted a Global Survey in 2003 to appraise national experiences ten years after Cairo. An overall response rate of 92 per cent was achieved for developing and countries in transition. For donor countries, the response rate was 82 per cent. The objectives of this report are to: (a) describe, from an operational perspective, the progress that has been made, and the constraints that have been encountered, by countries in their efforts to implement specific actions of the ICPD PoA and the MDGs; (b) present measures taken with some regional highlights; and (c) summarize the major conclusions arising from the 2003 Global Survey and assess the way forward. The various chapters of the report present the findings and conclusions emanating from the analysis of the Survey. (excerpt)
Bulletin of the World Health Organization. 2004 Jun; 82(6):400-400A.The global epidemic of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is the greatest threat to human health and development since the bubonic plague and the advent of tobacco consumption. It threatens not only to continue the decimation of millions (over 20 million deaths so far, with 34—46 million people currently living with HIV/AIDS) but also to reverse many of the gains made in developing countries over the past 50 years. Consequently, as the world health report 2004 states, history will judge the current generation by its response to this global threat. The ambitious "3 by 5" initiative of WHO and UNAIDS to reach three million people with antiretroviral therapy by the end of 2005 intends to halve the treatment gap, in which only 400 000 of the six million people who need treatment currently receive it. "By tackling [HIV/AIDS] decisively," says Lee Jong-Wook, Director-General of WHO, "we will also be building health systems that can meet the health needs of today and tomorrow, and continue the advance to Health for All". (excerpt)
Bangkok, Thailand, UNESCO, Asia and Pacific Regional Bureau for Education, 2002. 101 p.The inventory has been grouped by types of materials which include the following: Guideline materials; Curriculum; Teaching materials; Learning materials; Resource/reading materials; Training materials; Support audio-visual materials. Under each of these types of materials are sub-groups by themes or topics such as those dealing with care and counselling; information, education and communication, programme development, AIDS curriculum, life skills, adolescent reproductive health, prevention and care, training, peer education, and the like. However, in addition to accessing the various teaching/learning materials by types, the documents can also be retrieved by target audience, educational level, introduction methods, methodologies, objectives or specific uses, and geographical coverage through the help of the indexes found at the end of the inventory. (excerpt)
Washington, D.C., Academy for Educational Development [AED], Food and Nutrition Technical Assistance Project, 2003 Feb. 32 p. (Occasional Paper No. 1)This paper, commissioned to support the development of the Office of Food for Peace's new Strategic Plan, analyzes the implications of these trends in poverty and malnutrition for USAID food security programming. The paper argues for a conceptual shift that explicitly acknowledges the risks that constrain progress towards enhanced food security, and addresses directly the vulnerability of food insecure households and communities. Enhancing peoples' resiliency to overcome shocks, building people's capacity to transcend food insecurity with a more durable and diverse livelihood base, and increasing human capital will result in long-term sustainable improvements in food security. (excerpt)
[Unpublished] .  p.This paper presents the findings and recommendations of the World Bank AIDS Vaccine Task Force, formed in April 1998 to identify how institutions can accelerate the development of an AIDS vaccine for developing countries, as part of its broader program to combat AIDS, and in collaboration with its international and development partners. The World Bank has already taken important steps to reduce the impact of the AIDS epidemic through lending for AIDS prevention and care, analytic publications, participation in international partnerships, and launching of an anti-AIDS initiative in Africa. Nevertheless, progress on potentially one of the most important interventions--a preventive AIDS vaccine--is slow. This is caused by several barriers, such as the cost of the technology for an HIV vaccine, lack of financial investments from international agencies, and policy constraints. Based on existing studies of the economics of AIDS vaccine development and demand, review of a broad range of existing and potential mechanisms to promote an AIDS vaccine, and consultations with industry, international donors, and developing countries, the recommendations of the AIDS Vaccine Task Force for the promotion of international efforts in HIV vaccine development are highlighted.
India, World Bank health chiefs meet. Lenders confer with developing - world leaders on vaccine program.
GLOBAL HEALTH COUNCIL'S GLOBAL AIDS PROGRAM NEWSLETTER. 1999 Oct-Nov; (58):17.Policymakers, donors, and nongovernmental organizations met in New Delhi, India in August to discuss how the World Bank (WB) can hasten the development of an affordable and effective AIDS vaccine. The meeting sought the advice and views of development partners on effective, feasible, and affordable mechanisms that can be supported by the WB. Participants requested the continued financial assistance of the WB in the development of an AIDS vaccine for low-income countries. This request was made in view of the minimal global spending on AIDS research and development, which is spent primarily on vaccines designed for, industrialized countries. Prior to the meeting, consultative meetings were held in Paris, Thailand and South Africa concerning how the WB could encourage greater private investments in AIDS vaccine and how to collaborate efforts with other international partners. The WB has a vital interest in preventing the spread of HIV/AIDS, and has lent nearly US$1 billion for 81 HIV/AIDS projects in 51 countries since 1986.
NATURE. 1994 Oct 20; 371(6499):644.A World Health Organization (WHO) advisory committee has recommended that large-scale Phase III clinical trials of HIV vaccines be allowed in developing countries despite the fact that the vaccines have not passed safety tests in the country of origin (the US). This unusual step was taken in recognition of the difference in conditions which prevail in many developing countries from those which exist in the US. However, no ethical shortcuts are to be made in the trials. Despite the unanimous decision, many committee members are concerned that the trials could unfairly raise expectations of success or that the vaccine may cause a more severe case of AIDS in people who may become infected. However, because the vaccine may save lives, it was decided to allow testing to proceed. The US Department of Defense is thought to be planning trials of a recombinant gp 120 vaccine in Thailand in collaboration with the US company Biocine. Another US company, Genetech, is planning trials in an as-yet-unspecified country.