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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.
Washington, D.C., World Bank, Global HIV / AIDS Program, 2006 Jul. 7 p.A Grant from the World Bank provided a strong impetus to Djibouti's national HIV response in 2003. Clear objectives and priorities, effective government action and commitment, and close cooperation among the key donors and government organizations have contributed to strong results in the national response to HIV. The Global Fund cites Djibouti as a "best practice" example of donor coordination and harmonization and UNICEF recognizes the outreach to young people and community interventions as best practices. (author's)
Lancet. 2006 Feb 4; 367(9508):396.Zimbabwe is a small country in southern Africa that is in the midst of an economic, political, social, and HIV/AIDS crisis. Over the past few years at least a quarter of the population, including most of its doctors and nurses, has emigrated, leaving behind them a crumbling health-care system, which was once the envy of most of Africa, and one of the highest HIV/AIDS rates in the world. Zimbabwe does not see any of the US government's PEPFAR funds, and has been excluded from many bilateral programmes designed to improve access to HIV care and treatment. (excerpt)
As Niger's emergency eases, another crisis looms. [Niger : la situation d'urgence ne s'apaise que pour faire place à une autre crise]
Lancet. 2005 Sep 24; 366(9491):1065-1066.The influx of international aid into Niger and the pending harvest has eased the plight of 3 million people at risk of starvation. But as the crisis recedes in the Sahel region, the UN has sounded the alarm about the deadly combination of drought, poverty, and HIV/AIDS in southern Africa. The UN estimates that up to 10 million people in Lesotho, Malawi, Mozambique, Swaziland, Zimbabwe, and Zambia will need assistance during the next 6 months. Aid groups such as CARE International warn that the scale and complexity of the southern African crisis will dwarf that of the Sahel. Zimbabwe is particularly at risk because of the accelerating economic and agricultural collapse, compounded by President Robert Mugabe’s recent clampdown on shack dwellers and street traders, which left some 700 000 people without a home or a job. The UN forecasts that up to 4 million people may need aid but has been unable to launch an appeal for funds because the government refuses to acknowledge the emergency. (excerpt)
Report of the expert meeting: “3 by 5”, What Are the Implications? Organized by the Royal Tropical Institute, Aids Fonds and Share-Net, 16 September 2004, Amsterdam.
Amsterdam, Netherlands, KIT, 2004. 27 p.In 2003, the WHO started an initiative to expand access to HIV treatment. “3 by 5” is the name of the global target of providing anti-retroviral therapy (ART) to three million people living with HIV/AIDS in resource-limited countries by the end of 2005. It is a step towards the goal of providing universal access to treatment for all who need it. The WHO’s framework for emergency scaling up of anti-retroviral therapy contains 14 key strategic elements. These elements fall into five categories – the pillars of the “3 by 5” campaign: i) global leadership, strong partnership and advocacy; ii) urgent, sustained country support; iii) simplified, standardized tools for delivering antiretroviral therapy; iv) effective, reliable supply of medicines and diagnostics; and v) rapid identification and application of new knowledge and successes. The strategy also aims to develop guidelines for ensuring the quality of anti-retroviral drugs and to build country-level capacity for delivery and utilization of simple diagnostics for monitoring patient adherence to treatment as well as drug resistance. In the first six months of this strategy, progress was made towards the goal of increasing access to treatment. But much remains to be done, and urgently, if the world is to meet its target of providing treatment to three million people by the end of 2005. (excerpt)
Global AIDSLink. 2003 Aug-Sep; (81):10-11.Rampant, unchecked HIV/AIDS, a famine that threatens 7 million of the country's 12 million people with starvation, a tradition of male dominance, a dictatorial president whose land "reforms" have decimated the formerly bountiful farms, and an 80 percent unemployment rate have pushed the once prosperous nation of Zimbabwe to the brink of collapse. As a social activist deeply concerned about AIDS, I've traveled to Zimbabwe three times in the past two years and witnessed the ever-deepening humanitarian crisis there. Since the beginning of the AIDS plague in sub-Saharan Africa more than 20 years ago, our nation has consistently failed to adequately respond. The term "criminal negligence" is not too harsh to describe the way we have averted our eyes from the exploding AIDS pandemic that now imperils the entire region. Finally, President Bush has taken the extraordinary step of promoting a landmark global HIV/AIDS bill (HR 1298) to provide US $15 billion ($3 billion annually for five years) to fight AIDS in parts of southern Africa and the Caribbean; Zimbabwe, however, is not included. Despite the fact that Zimbabwe is the second hardest hit nation in the world, it appears the Zimbabwean people are to be punished for President Mugabe's reign of terror. While it may be understandable that our government chooses not to offer assistance to a country controlled by a dictatorial leader, it is terribly troubling that those among us who generally champion the rights of the oppressed and disenfranchised have also looked away. (excerpt)
Washington, D.C., Africa Action, .  p.Debt is the greatest economic obstacle to African efforts to combat the HIV/AIDS crisis. Debt repayments rob $15 billion from the continent every year. This money could be used to provide health care to millions of people and to fund the war on HIV/AIDS. But it is instead being taken away by foreign governments and institutions. Africa's debts must be canceled to allow Africa's people to control their own resources and direct them towards their real priorities--combating poverty and the HIV/AIDS crisis. (excerpt)