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Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach.
International Journal of Adolescent Medicine and Health. 2016 Nov 10; 30(2)The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-a-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.
Lancet. HIV. 2016 Jul; 3(7):e286-8.Add to my documents.
Retrovirology. 2018 Apr 2; 15(1):29.Pre-exposure prophylaxis (PrEP) for HIV prevention has evolved significantly over the years where clinical trials have now demonstrated the efficacy of oral PrEP, and the field is scaling-up implementation. The WHO and UNAIDS have made PrEP implementation a priority for populations at highest risk, and several countries have developed guidelines and national plans accordingly, largely based on evidence generated by demonstration projects. PrEP presents the opportunity to change the face of HIV prevention by offering a new option for protection against HIV and disrupting current HIV prevention systems. Nevertheless, as with all new technologies, both practical and social requirements for implementation must be taken into account if there is to be sustained and widespread adoption, which will also apply to forthcoming prevention technologies. Defining and building success for PrEP within the scope of scale-up requires careful consideration. This review summarises where the PrEP field is today, lessons learned from the past, the philosophy and practicalities of how successful programming may be defined, and provides perspectives of costs and affordability. We argue that a successful PrEP programme is about effective intervention integration and ultimately keeping people HIV negative.
National responses to global health targets: exploring policy transfer in the context of the UNAIDS '90-90-90' treatment targets in Ghana and Uganda.
Health Policy and Planning. 2018 Jan 1; 33(1):17-33.Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, program and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Program on HIV/AIDS set ‘ambitious’ treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by program, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to ‘90-90-90’. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in program-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90-90-90. Interviews were transcribed and analyzed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh’s policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90-90-90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of program activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation, facilitating a shift in the HIV program from ‘business as usual’ to approaches targeting geographies and populations.
The importance of sexual and reproductive health and rights to prevent HIV in adolescent girls and young women in eastern and southern Africa.
Geneva Switzerland, World Health Organization [WHO], 2017. 24 p. (Evidence Brief; WHO/RHR/17.05)Over the last several years, countries in the eastern and southern Africa (ESA) region have made significant and commendable progress in preventing mother-to-child transmission (PMTCT) of HIV and in scaling up HIV treatment efforts. However, despite these gains, there have been no significant reductions in new HIV infections and the region continues to be the hardest hit by the epidemic, highlighting the need to place stronger emphasis on HIV prevention. The risk of HIV infection among adolescent girls and young women (AGYW) in the ESA region is of particular concern. The 2016 UNAIDS World AIDS Day report, Get on the Fast-Track – The life-cycle approach to HIV, stated that efforts to reduce new HIV infections among young people and adults have stalled, threatening to undermine progress towards ending AIDS as a global public health threat by 2030.
Contraceptives and condoms for family planning and STI & HIV prevention external procurement support report.
New York, New York, United Nations Population Fund [UNFPA], 2014 Dec. 86 p.Access to reproductive health, including family planning, is recognized as a human right. Support from donors is critical to improving and ensuring the security of essential contraceptives and other life-saving reproductive health commodities. Contraceptives procured through external support constitute a significant contribution to reproductive health, including family planning and, through the dual protection provided by condoms, the prevention of sexually transmitted infections (STIs) including HIV. This report, updated annually, is a rich source of data for development that can drive good planning for contraceptive supply, advocacy and resource mobilization. The report contains dozens of figures, tables, and graphs, along with information and analysis that can influence policy dialogue, advocacy and interagency work. It aims to enhance coordination among donors, improve partnerships between donors and national governments, and mobilize the resources needed to accelerate progress towards universal access to sexual and reproductive health, and in particular to reduce the unmet need for family planning. The report also analyses data received from individual donors and partner organizations about the support they have provided directly to developing countries for the procurement of contraceptives and condoms.
Geneva, Switzerland, WHO, 2015 Nov. 2 p. (Pre-Exposure Prophylaxis (PrEP); Policy Brief)This policy brief defines PrEP, presents the World Health Organization's current recommendations for PrEP use and the evidence for it, discusses PrEP's expected cost-effectiveness, and lists considerations for PrEP implementation.
Washington, D.C., PAI, 2015 Aug. 2 p.There are more people displaced in the world today than at any other point in history, and more than 75 percent of those needing humanitarian assistance are women and children. In humanitarian emergencies, many women want to avoid pregnancy; however they lack access to the services and supplies that would allow them to delay pregnancy. To meet the reproductive health needs of people in humanitarian emergencies, organizations and policymakers should know the answers to these 10 critical questions.
Bonn, Germany, GTZ, 2016 Apr. 7 p.This factsheet summarises the results of the past collaboration between BACKUP and the International Planned Parenthood Federation (IPPF) on the ‘Shadows and Light’ project. BACKUP Health and the International Planned Parenthood Fed-eration (IPPF) have collaborated over many years to foster greater and more rapid action on SRH and HIV linkages within the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund). Recent collaborative work has highlighted gaps in addressing the specific needs of key populations within Global Fund pro-grammes. ‘Shadows and Light’, a three-year project funded by BACKUP Health, aims to address the linked SRH and HIV needs of key populations within four IPPF member associations. The project involved the Family Planning Association of India and transgender people, Reproductive Health Uganda and sex work-ers, Family Health Options Kenya and people who inject drugs, and the Cameroon National Association for Family Welfare and MSM. The project recognised that a comprehensive response to HIV must include initiatives that meet the needs of those who are marginalised, vulnerable, socially excluded and under-served. Based on these linkages, addressing SRH within HIV programmes and services funded by the Global Fund is a key opportunity to ensure sustainability in service provision to key populations.
Geneva, Switzerland, UNAIDS, 2016. 12 p.Gender inequalities and harmful gender norms are important drivers of the HIV epidemic, and they are major hindrances to an effective HIV response. While access to HIV services for women and girls remain a concern, a growing body of evidence also shows that men and adolescent boys have limited access to HIV services. Current effort to advance both gender equality and sexual and reproductive health and rights as key elements of the HIV response do not adequately reflect the ways that harmful gender norms and practices negatively affect men, women and adolescent body and girls in all their diversity. This in turn increases HIV-related vulnerability and risk among all of these groups.
[London, United Kingdom, IPPF, 2015]. 2 p.The Zimbabwe National Family Planning Council (ZNFPC, the IPPF Collaborating Partner in Zimbabwe) and other civil society organizations (CSOs) have identified a number of ‘high priority’ pledges: progress towards these pledges is critical for increasing access to modern family planning (FP) methods. Civil society calls on the government to: Facilitate the active participation of girls and young women, including those who are marginalized and those living with HIV, in all aspects of national programming and decision-making relating to HIV and AIDS; Strengthen commitment to women’s health by responding to the health impact of unsafe abortion, a major public health concern, by scaling up post-abortion care and reducing unintended pregnancies through expanded and improved family planning services; Implement evidence-based HIV prevention programmes that address the needs of girls and young women, especially those living in prison or detention centres, those involved in transactional sex or child marriages, survivors of gender-based violence and orphans.
Geneva, Switzerland, UNAIDS, 2017. 198 p. (UNAIDS/JC2900E)Since they were launched at the 20th International AIDS Conference in Melbourne, Australia, in 2014, the 90-90-90 targets have become a central pillar of the global quest to end the AIDS epidemic. The targets reflect a fundamental shift in the world’s approach to HIV treatment, moving it away from a focus on the number of people accessing antiretroviral therapy and towards the importance of maximising viral suppression among people living with HIV. This shift was driven by greater understanding of the benefits of viral suppression -- not only does treatment protect people living with HIV from AIDS-related illness, but it also greatly lowers the risk of transmitting the virus to others.
Population-level impact of an accelerated HIV response plan to reach the UNAIDS 90-90-90 target in Cote d'Ivoire: Insights from mathematical modeling.
PLoS Medicine. 2017 Jun; 14(6):e1002321.BACKGROUND: National responses will need to be markedly accelerated to achieve the ambitious target of the Joint United Nations Programme on HIV/AIDS (UNAIDS). This target aims for 90% of HIV-positive individuals to be aware of their status, for 90% of those aware to receive antiretroviral therapy (ART), and for 90% of those on treatment to have a suppressed viral load by 2020, with each individual target reaching 95% by 2030. We aimed to estimate the impact of various treatment-as-prevention scenarios in Cote d'Ivoire, one of the countries with the highest HIV incidence in West Africa, with unmet HIV prevention and treatment needs, and where key populations are important to the broader HIV epidemic. METHODS AND FINDINGS: An age-stratified dynamic model was developed and calibrated to epidemiological and programmatic data using a Bayesian framework. The model represents sexual and vertical HIV transmission in the general population, female sex workers (FSW), and men who have sex with men (MSM). We estimated the impact of scaling up interventions to reach the UNAIDS targets, as well as the impact of 8 other scenarios, on HIV transmission in adults and children, compared to our baseline scenario that maintains 2015 rates of testing, ART initiation, ART discontinuation, treatment failure, and levels of condom use. In 2015, we estimated that 52% (95% credible intervals: 46%-58%) of HIV-positive individuals were aware of their status, 72% (57%-82%) of those aware were on ART, and 77% (74%-79%) of those on ART were virologically suppressed. Reaching the UNAIDS targets on time would avert 50% (42%-60%) of new HIV infections over 2015-2030 compared to 30% (25%-36%) if the 90-90-90 target is reached in 2025. Attaining the UNAIDS targets in FSW, their clients, and MSM (but not in the rest of the population) would avert a similar fraction of new infections (30%; 21%-39%). A 25-percentage-point drop in condom use from the 2015 levels among FSW and MSM would reduce the impact of reaching the UNAIDS targets, with 38% (26%-51%) of infections averted. The study's main limitation is that homogenous spatial coverage of interventions was assumed, and future lines of inquiry should examine how geographical prioritization could affect HIV transmission. CONCLUSIONS: Maximizing the impact of the UNAIDS targets will require rapid scale-up of interventions, particularly testing, ART initiation, and limiting ART discontinuation. Reaching clients of FSW, as well as key populations, can efficiently reduce transmission. Sustaining the high condom-use levels among key populations should remain an important prevention pillar.
New York, New York, UNICEF, 2017 Jun. 84 p.This report details the results achieved by UNICEF for and with children worldwide in 2016. It covers the organization’s programme work, humanitarian action, partnerships and advocacy efforts in all strategic sectors, with an emphasis on reaching every child and accelerating progress for the most vulnerable and disadvantaged girls and boys. The report also highlights UNICEF’s innovations, its efforts to improve efficiency and effectiveness, and the stories of individual children and families directly affected by UNICEF’s work in the course of its 70th anniversary year.
Reinvigorating the AIDS response to catalyse sustainable development and United Nations reform. Report of the Secretary-General.
[New York, New York], United Nations, General Assembly, 2017 Apr 7. 25 p. (A/71/864)Bold global commitments, shared financial responsibility and a people-centred approach based on the principles of equity have yielded shared success in the AIDS response. The 90-90-90 initiative has guided a dramatic expansion of antiretroviral treatment and greatly reduced AIDS-related deaths, while also contributing to a reduction in new HIV infections. A global plan to eliminate mother-to-child transmission of HIV has more than halved the number of new HIV infections among children. The AIDS response has made an important contribution to the demographic dividend of Africa, its recent economic growth and the emerging vision of Africa as a continent of hope, promise and vast potential. Global optimism has fuelled the highest ambition within the 2030 Agenda for Sustainable Development: ending the AIDS epidemic by 2030. A fast-track response to reach this target has been agreed by the United Nations General Assembly within the 2016 Political Declaration on HIV and AIDS: On the Fast Track to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 2030. Achieving our aims on AIDS is interlinked with and embedded within the broader 2030 Agenda: both are grounded in equity, human rights and a promise to leave no one behind. Hard-fought gains must not be lost. An international architecture that has stimulated leadership, provided direction, mobilized unprecedented levels of financial resources and saved millions of lives must not be taken for granted. Closing the investment gap of $7 billion per year and ensuring that financial resources are wisely used will avert tens of millions of new HIV infections and AIDS-related deaths, a return on investment that is nothing short of priceless. (Excerpts)
Lancet. 2016 Nov 26; 388(10060):2579.Add to my documents.
Lancet. 2016 Aug 20; 388(10046):743-4.Add to my documents.
Washington, D.C., World Bank, 2005.  p. (World Bank Working Paper No. 68)In recent years, Europe and Central Asia has experienced the world’s fastest growing HIV/AIDS epidemic. Yet, in the Western Balkan countries the HIV prevalence rate is under 0.1 percent, which ranks among the lowest. This may be due to a low level of infection among the population—or partly due to inadequate surveillance systems. All major contributing factors for the breakout of an HIV/AIDS epidemic are present in the Western Balkans. HIV/AIDS disproportionably affects youth (80 percent of HIV-infected people are 30 years old or younger). Most of the Western Balkan countries have very young populations, which have been affected by the process of social transition, wars, unemployment and other factors. Among youth, there is generalized use of drugs and sexual risk behavior. Therefore, the number of cases of HIV has been increasing, especially in Serbia, and the incidence of Hepatitis C has clearly increased, which suggests that sharing of infected needles is practiced by injecting drug users. Apart from human suffering, an HIV/AIDS epidemic can have a significant impact on costs of care for individuals, households, health services and society as a whole. This study has found weak public health systems and gaps in financing and institutional capacity necessary to implement evidence-based and cost-effective HIV/AIDS Strategies. Political commitment must increase for action to occur promptly. Prevention interventions are cost effective and, in the short term, affordable with own-country resources. Medium- and long-term interventions would require donor assistance. Longer-term interventions would aim at preventing poverty, exclusion and unemployment, for example, by empowering young people to participate in the regional and global labor market.
Evolution of couples voluntary counseling and testing for HIV in Rwanda: From research to public health practice.
Journal of Acquired Immune Deficiency Syndromes. 2016;  p..Background: Couples’ Voluntary HIV Counseling and Testing (CVCT) is a WHO-recommended intervention for prevention of heterosexual HIV transmission which very few African couples have received. We report the successful nationwide implementation of CVCT in Rwanda. Methods: From 1988-1994, pregnant and post-partum women were tested for HIV and requested testing for their husbands. Partner testing was associated with more condom use and lower HIV and STI rates, particularly among HIV discordant couples. After the 1994 genocide, the research team continued to refine CVCT procedures in Zambia. These were re-introduced to Rwanda in 2001 and continually tested and improved. In 2003, the Government of Rwanda (GoR) established targets for partner testing among pregnant women, with the proportion rising from 16% in 2003 to 84% in 2008 as the PMTCT program expanded to >400 clinics. In 2009 the GoR adopted joint post-test counseling procedures, and in 2010 a quarterly follow-up program was established in government clinics with training and technical assistance. An estimated 80 - 90% of Rwandan couples have now been jointly counseled and tested resulting in prevention of >70% of new HIV infections. Conclusion: Rwanda is the first African country to have established CVCT as standard of care in ANC. More than 20 countries have sent providers to Rwanda for CVCT training. To duplicate Rwanda’s success, training and technical assistance must be part of a coordinated effort to set national targets, timelines, indicators and budgets. Governments, bilateral and multilateral funding agencies must jointly prioritize CVCT for prevention of new HIV infections. Copyright: 2016 Wolters Kluwer Health, Inc.
New York, Evaluation Office, United Nations Population Fund [UNFPA], 2014 Nov. 145 p.Purpose: The purpose of the evaluation is to assess the performance of UNFPA in the field of family planning during the period covered by the Strategic Plan 2008-2013 and to provide learning to inform the implementation of the current UNFPA Family Planning Strategy Choices not Chance (2012-2020). The evaluation will also inform other relevant programmes such as the Global Programme for Reproductive Health Commodity Security (GPRHCS) (2013-2020) and the Preventing HIV and Unintended Pregnancies Strategic Framework (2011-2015). Finally, the evaluation results will feed into the mid-term review of UNFPA current Strategic Plan 2014-2017. Objectives: The primary objectives of the evaluation are to: 1. Assess how the framework as set out in UNFPA Strategic Plan (and revised development results framework (DRF)) 2008-2013 and further specified in the Reproductive Rights and Sexual and Reproductive Health Framework (2008-2011)as well as in the GPRHCS (2007-2012) and the Preventing HIV and Unintended Pregnancies Strategic Framework (2011-2015), has guided the programming and implementation of UNFPA interventions in the field of family planning; 2. Facilitate learning and capture good practices from UNFPA experience across a range of key programmatic interventions in the field of family planning during the 2008-2013 period to inform the implementation of both outcome 1 of UNFPA current Strategic Plan and the Choices not Chance 2012-2020 Strategy; inform the GPRHCS (2013-2020) and the Preventing HIV and Unintended Pregnancies Strategic Framework (2011-2015) as well as future programming of interventions in the field of family planning. (excerpt)
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed.
Geneva, Switzerland, WHO, 2016.  p.These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.
Geneva, Switzerland, UNAIDS, 2016.  p.Efforts to reach fewer than 500 000 new HIV infections by 2020 are off track. This simple conclusion sits atop a complex and diverse global tapestry. Data from 146 countries show that some have achieved declines in new HIV infections among adults of 50% or more over the last 10 years, while many others have not made measurable progress, and yet others have experienced worrying increases in new HIV infections.
Geneva, Switzerland, UNAIDS, Joint United Nations Programme on HIV/AIDS, 2014 Oct. 40 p.In December 2013, the UNAIDS Programme Coordinating Board called on UNAIDS to support country- and region-led efforts to establish new targets for HIV treatment scale-up beyond 2015. In response, stakeholder consultations on new targets have been held in all regions of the world. At the global level, stakeholders assembled in a variety of thematic consultations focused on civil society, laboratory medicine, paediatric HIV treatment, adolescents and other key issues. The 90-90-90 UNAIDS target seeks to: 1) By 2020, 90% of all people living with HIV will know their HIV status; 2) By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 3) By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression. Key points: 1) Governments, health experts and civil society must take advantage of the next five-year window to meet the 90-90-90 target to tackle AIDS; 2) Early treatment can reduce infection rates by 90 %; 3) A paradigm shift in HIV/AIDS treatment has seen average drug prices fall from an average of US$15 000 to US$ 80; and 4) Health systems will improve as a result of investment in HIV/AIDS treatment; financing from the international community is indispensable.
Global Public Health. 2016 Aug 6; 1-15.The drive for universal health coverage (UHC) now has a great deal of normative impetus, and in combination with the inauguration of the sustainable development goals, has come to be regarded as a means of ensuring the financial basis for the struggle against HIV and AIDS. The argument of this paper is that such thinking is a case of ‘the right thing at the wrong time’: it seriously underestimates the scale of the work against HIV and AIDS, and the speed with which we need to undertake it, if we are to consolidate the gains we have made to date, let alone reduce it to manageable proportions. The looming ‘fiscal crunch’ makes the challenges all the more daunting; even in the best circumstances, the time required to establish UHCs capable of providing both essential health services and a very rapid scale-up of the fight against HIV and AIDS is insufficient when set against the urgency of ensuring that AIDS does not eventuate as a global health catastrophe.
Guideline: Updates on HIV and infant feeding. The duration of breastfeeding and support from health services to improve feeding practices among mothers living with HIV.
Geneva, Switzerland, WHO, 2016.  p.The objective of this guideline is to improve the HIV-free survival of HIV-exposed infants by providing guidance on appropriate infant feeding practices and use of ARV drugs for mothers living with HIV and by updating WHO-related tools and training materials. The guideline is intended mainly for countries with high HIV prevalence and settings in which diarrhoea, pneumonia and undernutrition are common causes of infant and child mortality. However, it may also be relevant to settings with a low prevalence of HIV depending on the background rates and causes of infant and child mortality. This guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to achieve the Sustainable Development Goals, the global targets set in the comprehensive implementation plan on maternal, infant and young child nutrition, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) and the Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021. The target audience for this guideline includes: (1) national policy-makers in health ministries; (2) programme managers working in child health, essential drugs and health worker training; (3) health-care providers, researchers and clinicians providing services to pregnant women and mothers living with HIV at various levels of health care; and (4) development partners providing financial and/or technical support for child health programmes, including those in conflict and emergency settings. (Excerpt)