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Eastern Mediterranean Health Journal. 2008; 14 Suppl:S90-6.Now, 28 years after acquired immune deficiency syndrome (AIDS) was first recognised, it has become a global pandemic affecting almost all countries. WHO/UNAIDS (Joint United Nations Programme on HIV/AIDS) estimate the number of people living with human immunodeficiency virus (HIV) worldwide in 2007 at 33.2 million. Every day 68 000 become infected and over 5700 die from AIDS; 95% of these infections and deaths have occurred in developing countries. The HIV pandemic remains the most serious of infectious disease challenges to public health. Sub-Saharan Africa remains the most seriously affected region, with AIDS the leading cause of death there. Although percentage prevalence has stabilized, continuing new infections (even at a reduced Estimated number of people living with HIV globally, 1990-2007, data from UNAIDS rate) contribute to the estimated number of persons living with HIV, 33.2 million (30.6-36.1 million). A defining feature of the pandemic in the current decade is the increasing burden of HIV infection in women, which has additional implications for mother-to-child transmission. In sub-Saharan Africa, almost 61% of adults living with HIV in 2007 were women. The impact of HIV mortality is greatest on people in their 20s and 30s; this severely distorts the shape of the population pyramid in affected societies. Globally, the number of children living with HIV increased from 1.5 million in 2001 to 2.5 million in 2007, 90% of them in sub-Saharan Africa. HIV/AIDS also poses a threat to economic growth in many countries already in distress. According to the World Bank analysis of 80 developing countries, as the prevalence of HIV infection increases from 15% to 30%, the per capita gross domestic product decreases 1.0%-1.5% per year. The powerful negative impact of AIDS on households, productive enterprises and countries stems partly from the high cost of treatment, which diverts resources from productive investments, but mostly from the fact that AIDS affects people during their economically productive adult years, when they are responsible for the support and care of others. This crisis has necessitated a unique and truly global response to meld the resources, political power, and technical capacity of all UN organizations, developing countries and others in a concerted manner to curb the pandemic. AIDS often engenders stigma, discrimination, and denial, because of its association with marginalized groups, sexual transmission and lethality, hence it requires a more comprehensive and holistic approach. During the past 10 years, many developments have occurred in response to this pandemic. WHO has played an important role in this response. This article reviews the major developments in treatment and prevention and the role of WHO in response to these developments.
Lancet. 2008 Jul 26; 372(9635):333-6.Funds available for HIV/AIDS programmes in low-income and middle-income countries rose from US$300 million in 1996 to $10 billion in 2007. However, a combination of worldwide economic uncertainty, a global food crisis, and publications that indicate discontent with progress in fighting the HIV/AIDS pandemic will not only threaten to restrict increases in the overall availability of both donor and national funds, but will also increase the competition for resources during the move towards universal access to treatment and prevention services. Thus, UNAIDS will be under increasing pressure in its presentation and justification of resources needed for HIV/AIDS programming. Here I discuss UNAIDS' 2007 estimates of resource requirements for fighting HIV/AIDS in terms of their usefulness to both donor and recipient governments for budget planning and for setting priorities for HIV/AIDS programmes. I identify weaknesses in the UNAIDS estimates in terms of financial transparency and priority setting, and recommend changes to improve budgeting and priority setting.
Stakeholders' opinions and expectations of the Global Fund and their potential economic implications.
AIDS. 2008 Jul; 22 Suppl 1:S7-S15.OBJECTIVES: To analyse stakeholder opinions and expectations of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and to discuss their potential economic and financial implications. DESIGN: The Global Fund commissioned an independent study, the '360 degrees Stakeholder Survey', to canvas feedback on the organization's reputation and performance with an on-line survey of 909 respondents representing major stakeholders worldwide. We created a proxy for expectations based on categorical responses for specific Global Fund attributes' importance to the stakeholders and current perceived performance. METHODS: Using multivariate regression, we analysed 23 unfulfilled expectations related to: resource mobilization; impact measurement; harmonization and inclusion; effectiveness of the Global Fund partner environment; and portfolio characteristics. The independent variables are personal and regional-level characteristics that affect expectations. RESULTS: The largest unfulfilled expectations relate to: mobilization of private sector resources; efficiency in disbursing funds; and assurance that people affected by the three diseases are reached. Stakeholders involved with the fund through the country coordinating mechanisms, those working in multilateral organizations and persons living with HIV are more likely to have unfulfilled expectations. In contrast, higher levels of involvement with the fund correlate with fulfilled expectations. Stakeholders living in sub-Saharan Africa were less likely to have their expectations met. CONCLUSIONS: Stakeholders' unfulfilled expectations result largely from factors external to them, but also from factors over which they have influence. In particular, attributes related to partnership score poorly even though stakeholders have influence in that area. Joint efforts to address perceived performance gaps may improve future performance and positively influence investment levels and economic viability.
The evolving cost of HIV in South Africa: Changes in health care cost with duration on antiretroviral therapy for public sector patients.
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul; 45(3):348-354.A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. t-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs. (author's)
Choices. 2001 Dec; 17.Each passing day, one is more and more aware of the devastating scope of the HIV/AIDS epidemic and of the toll it will take on future generations in Haiti. This island nation has a population of eight million people, 70 percent of whom are poor, 50 percent illiterate and 70 percent unemployed. The combination of high rates of poverty, illiteracy and unemployment increases people's vulnerability to the AIDS virus. Haiti, the poorest country in the Americas, has the highest rate of infection of that region, and 67 percent of all the cases reported in the Caribbean. Since the advent of the epidemic in the 1980s, some 300,000 Haitians have died from it; more than 160,000 children have been orphaned, and about 260,000 currently live with the virus. (excerpt)
Access to treatment in the private-sector workplace: the provision of antiretroviral therapy by three companies in South Africa.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2005 Jul. 47 p. (UNAIDS Best Practice Collection; UNAIDS/05.11E)The availability of antiretroviral therapy from 1996 onwards has made a huge impact on the lives of those people living with HIV who can afford the drugs. But most of the beneficiaries of the new drugs live in the world's high-income countries. For many of them, AIDS has become a manageable chronic condition rather than a death sentence. Affluent countries have seen a 70% decline in AIDS-related deaths since the introduction of antiretroviral therapy. In countries in which antiretroviral drugs are provided on a large scale (in Brazil, for example), the impact is remarkable. The number of hospital patients with AIDS is greatly reduced, people living with AIDS return to their families and jobs, and AIDS-related morbidity and mortality fall dramatically. However, for the huge majority of people living with HIV in low- and middle-income countries, it is a different story. Neither they nor their countries' health-care services can afford to annually pay the huge amounts of money that the drugs cost, even taking into account recent reductions in drug prices. Cost has not been the only barrier to wide-scale provision of antiretroviral therapy in low- and middle-income countries. Health experts have expressed concerns about providing drugs to large numbers of people in settings where health-care services do not even offer adequate basic care, let alone the support and monitoring needed for antiretroviral therapy. The slow progress in antiretroviral provision has meant that although five to six million people need antiretroviral therapy in low- and middle-income countries, only about 700 000 had access to it by the end of 2004. In sub-Saharan Africa, more than four million people need treatment, but only 310 000 had access by the end of 2004. (excerpt)
Towards the creation of strategic partnerships: improving access to drugs for HIV / AIDS. Report of a consultative meeting, 30 June - 2 July 1997, Salle C, WHO, Geneva.
Geneva, Switzerland, UNAIDS, 1998. 20 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/98.40)From January 1996, the UNAIDS Secretariat has been in consultation with key players in the pharmaceutical industry, NGOs, people living with HIV, UN, major bilateral donors, country representatives and National AIDS Programme Managers on issues relating to access to drugs for HIV/AIDS. This meeting, held on 30 June to 2 July 1997, was the climax of this consultative process. The meeting brought together people living with HIV/AIDS, NGO representatives, National AIDS Programme Managers and UN representatives. With a modified version of the Search Conference approach, the following questions were raised: What are the current and future issues on access to drugs for HIV/AIDS at country and global levels? What partnerships should be created at country level to address these issues? What should be the content of these partnerships at country level? What should the UN do at global and country level to support these partnerships? To foster regional exchange of experience as well as enhance regional specificity, participants were assigned groups on a regional basis. (excerpt)
Canadian HIV / AIDS Policy and Law Review. 2002 Dec; 7(2-3):57-58.In mid-2002, the World Health Organization (WHO) estimated that some six million people with HIV/AIDS in developing countries are currently in need of life-sustaining antiretroviral (ARV) therapy, but that only 230,000 have access to these medicines, half of whom live in one country, Brazil. The WHO believes that, with a concerted international effort to expand access to HIV treatment and care, three million people could have access to ARVs by the end of 2005. A number of recent initiatives provide some useful tools toward reaching this goal. (author's)
Estimated cost to reach the target of 3 million with access to antiretroviral therapy by 2005 ("3 by 5").
Geneva, Switzerland, WHO, . 2 p.This document explains the assumptions used to estimate the cost of providing life saving antiretroviral drugs to 3 million people in developing countries by the end of 2005 (3 by 5). These estimates reflect the 3 by 5 strategy and model of care as outlined at the WHO/UNAIDS International Consensus Meeting on Interim Recommendations for Technical and Operational Procedures for Emergency Scaling up Antiretroviral Treatment in Resource-Limited Settings, November 18-21, 2003, Lusaka, Zambia. (excerpt)
Science in Africa. 2004 Jan;  p..Short-term relief followed by long-term disaster is not sound policy. Nonetheless, that could be a result of the Aids strategy being contemplated by the World Health Organisation, which on December 1 - World Aids Day - announced a plan to treat 3-million people with HIV/Aids by 2005. The WHO is proposing that billions of dollars be spent on increasing access to anti-retroviral drugs. That is a noble intention. However, it may not be the most cost-effective way to stem the tide of HIV/Aids: it may even be counterproductive. Let's be clear. Reducing the cost and increasing the supply of medicines to the poor is a good thing. But on its own it is not enough. Nor should it be today's priority. The roots of Africa's health care crisis run far deeper and broader than a mere shortage of drugs. Spending billions on drugs is likely to prove a disappointing waste. (excerpt)
Bulletin of the World Health Organization. 2003 Oct; 81(10):699.WHO’s new Director-General has just declared AIDS to be a global health emergency. This move is not unprecedented but does signal a welcome departure from business as usual. Can declarations change the world? They can if they lead to action commensurate with the problem. (excerpt)