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Lancet Infectious Diseases. 2008 Jan; 8(1):14.A report from the International Treatment Preparedness Coalition (ITPC) warns that meeting the "near universal access target" to AIDS drugs access by the 2010 deadline will require an enormous effort by governments, global agencies, and drug companies. According to the report, which looked at AIDS treatment access in 14 countries, "scale-up is working but high prices, patent and registration barriers, and ongoing stock-outs are core issues impeding AIDS drug delivery". "The issues highlighted in this report are real and widespread", said Nathan Ford of Médecins Sans Frontières (MSF; Johannesburg, South Africa). The HIV programmes run by MSF across the developing world are struggling against user fees, high drug costs, lack of human resources, and poor health infrastructure, he told TLID. The ITPC, a group of 1000 treatment activists from more than 125 countries, highlights that the high cost of antiretroviral drugs is a particular barrier in Argentina, China, and Belize. (excerpt)
Geneva, Switzerland, WHO, 2005. 64 p.In an effort to keep abreast of rapid changes in the landscape of the HIV pandemic, WHO and UNAIDS report semiannually on progress toward "3 by 5". The first update was presented at the XV International AIDS Conference in Bangkok, Thailand, in July 2004. This second report measures progress made by countries and describes how international partners are supporting their efforts. In addition, it summarizes how the building blocks of antiretroviral (ARV) therapy programmes are being put into place and how issues beyond treatment are being addressed. It provides examples of country progress and a global estimate of the number of people receiving ARV therapy, and it assesses how well the therapy is working. It also identifies some of the challenges faced in resource-constrained settings and how these are being met by improving health care systems, links between prevention and treatment and providing equal access to quality care. This report is based on reports and updates provided by dozens of international, national and community organizations involved in scaling up ARV therapy. We thank everyone who has contributed to this progress report. WHO departments at the headquarters, regional and country levels worked with national governments and nongovernmental organizations to gather the latest information on the scaling up of ARV therapy. The UNAIDS Secretariat and the UNAIDS Cosponsors gathered information on how United Nations agencies and international nongovernmental organizations are translating the rapidly expanding commitment to "3 by 5" into action. (excerpt)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:80-87.The paper critically analyzes, from the gender standpoint, official results presented in the Brazilian government report to the Joint United Nations Programme on HIV/ AIDS (UNAIDS). Specifically, the fulfillment of 2003 targets set forth in the United Nations Declaration of Commitment on HIV/AIDS, under the category of Human Rights and Reduction of the Economic and Social Impact of AIDS, are evaluated. Key concepts are highlighted, including indicators and strategies that may help civilian society better monitor these targets until 2010. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:94-100.The objective of this study was to analyze, on the national level, the process of monitoring the proposed UNGASS indicators through the use of the Brazilian National Program for STD/AIDS's indicators. Two groups of proposed indicators were analyzed in 2002 and 2005 respectively, as part of the monitoring of the progress of the UNGASS Declaration of Commitment. The availability of information and limitations in calculating the proposed indicators in Brazil were analyzed and the appropriateness of the indicators for monitoring the epidemic in Brazil was discussed. Of the 13 quantitative indicators originally proposed by UNGASS, five were not included in the National Program. One was not included due to its qualitative nature. Two of the indicators were considered to be of little use and two were not included due to the lack of available data needed for their calculation. As the epidemic in Brazil is characterized as being concentrated, within the second group of proposed UNGASS indicators those that refer to the accompaniment of epidemic among high-risk population groups were prioritized. The study highlights that the National Program concentrates its efforts in the development, adaptation, and sharing of sampling methodologies for hard to reach populations. Such activities are geared towards estimating the size of vulnerable population groups, as well as obtaining more information regarding their knowledge, attitudes, and practices. The study concludes that by creating the possibility of international comparisons between advances achieved, the proposal of supranational indicators stimulates countries to discuss and make their construction viable. In a complementary way, the national monitoring systems should focus on program improvement by covering areas that permit the evaluation of specific control and intervention actions. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:42-51.Items from the UNGASS Draft Declaration of Commitment on HIV/AIDS (2001) are analyzed. The Brazilian experience of new methods for testing and counseling among vulnerable populations, preventive methods controlled by women, prevention, psychosocial support for people living with HIV/AIDS, and mother-child transmission, is discussed. These items were put into operation in the form of keywords, in systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The Brazilian experience relating to testing and counseling strategies has been consolidated through the utilization of algorithms aimed at estimating incidence rates and identifying recently infected individuals, testing and counseling for pregnant women, and application of quick tests. The introduction of alternative methods and new technologies for collecting data from vulnerable populations has been allowing speedy monitoring of the epidemic. Psychosocial support assessments for people living with HIV/AIDS have gained impetus in Brazil, probably as a result of increased survival and quality of life among these individuals. Substantial advances in controlling mother-child transmission have been observed. This is one of the most important victories within the field of HIV/ AIDS in Brazil, but deficiencies in prenatal care still constitute a challenge. With regard to prevention methods for women, Brazil has only shown a shy response. Widespread implementation of new technologies for data gathering and management depends on investments in infrastructure and professional skills acquisition. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:31-41.The focus of the present study is the Brazilian response within science, technology and innovation to the targets formulated in the UNGASS document. An analysis was made of items 70-73 of the UNGASS Draft Declaration of Commitment on HIV/ AIDS (2001), which defined science, technology and innovation targets relating to HIV/AIDS. The main topics listed in these items were put into operation in the form of keywords, in order to guide systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The success of Brazilian research within the field of characterization and isolation of HIV-1 is undeniable. Phase II/III vaccine studies have been developed in Rio de Janeiro, Belo Horizonte and São Paulo. Empirical studies on the monitoring of primary resistance have been developed in specific populations, through the Brazilian HIV Resistance Monitoring Network. Within the field of monitoring secondary resistance, initiatives such as the National Genotyping Network have been highlighted. Two national systems - the Mortality Information System and the Notifiable Diseases Information System-AIDS - and some studies with wider coverage have given rise to work on trends within the epidemic. The production of high-quality generic medications and their free distribution to patients have been highlighted. Brazil has implemented a consistent and diversified response within the field of HIV/AIDS, with studies relating to the development of vaccines, new medications and monitoring of the epidemic. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:5-8.Recognizing the HIV/AIDS pandemic as an unprecedented worldwide emergency and one of the greatest challenges to life and the enjoyment of human rights, the United nations called on member states to reflect on this matter. In June 2001, around 20 years after the first AIDS cases were recorded, the United Nations General Assembly Special Session on HIV and AIDS (UNGASS HIV/AIDS) was held in New York. The Session culminated in the drafting of the Declaration of Commitment on HIV and AIDS: a document that reflected the consensus between 189 countries, including Brazil, and stated some essential principles for an effective response to the epidemic. The Declaration recognized that economic, racial, ethnic, generational and gender inequalities, among others, were factors that boosted vulnerability and, whether acting separately or in synergy, favored HIV infection and the onset and evolution of AIDS. The Declaration of Commitment on HIV and AIDS has become transformed into a tool for reaffirming the urgency and necessity of promoting the solidarity that the epidemic demands. It aims towards better management of the actions and resources destined for controlling HIV and AIDS and towards social control over public HIV/AIDS policies. (excerpt)
Fulfilling reproductive rights for women affected by HIV / AIDS. A tool for monitoring progress toward three Millennium Development Goals. Updated version.
Chapel Hill, North Carolina, Ipas, 2006 Aug. 20 p.In 2004, more than 25 national and international organizations presented a statement to the secretariat of the United Nations (UN) Commission on the Status of Women that highlighted relatively neglected areas in the reproductive health of women affected by HIV/AIDS. In collaboration with the International Community of Women Living with HIV/AIDS (ICW), the Center for Health and Gender Equity (CHANGE) and the Pacific Institute for Women's Health, Ipas used that statement and a literature review to develop this practical tool to help nongovernmental organizations (NGOs) address those neglected areas of reproductive health. Since the Millennium Development Goals (MDGs) have become a common framework for assessing progress in development, the tool links those areas of reproductive health to three of the MDGs related to empowering women, improving maternal health and combating HIV/AIDS. This document is an updated version of the original resource published in 2004. Changes were made after the eight partner NGOs listed below piloted the benchmarks in 11 developing countries. (excerpt)
Antiretroviral treatment for injecting drug users in developing and transitional countries 1 year before the end of the "Treating 3 million by 2005. Making it happen. The WHO strategy" (‘3 by 5').
Addiction. 2006 Sep; 101(9):1246-1253.The objective was to describe and estimate the availability of antiretroviral treatment (ART) to injecting drug users (IDUs) in developing and transitional countries. Literature review of grey and published literature and key informants' communications on the estimated number of current/former injecting drug users (IDUs) receiving ART and the proportion of human immunodeficiency virus (HIV) attributed to injecting drug use (IDU), the number of people in ART and in need of ART, the number of people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) and the main source of ART. Data on former/current IDUs on ART were available from 50 countries (in 19 countries: nil IDUs in treatment) suggesting that ~34 000 IDUs were receiving ART by the end of 2004, of whom 30 000 were in Brazil. In these 50 countries IDUs represent ~15% of the people in ART. In Eastern European and Central Asia IDU are associated with > 80% of HIV cases but only ~2000 (14%) of the people in ART. In South and South-East Asia there were ~1700 former/current IDUs receiving ART (~1.8% of the people in ART), whereas the proportion of HIV cases associated to IDU is > 20% in five countries (and regionally ranges from 4% to 75%). There is evidence that the coverage of ART among current/former IDUs is proportionally substantially less than other exposure categories. Ongoing monitoring of ART by exposure and population subgroups is critical to ensuring that scale-up is equitable, and that the distribution of ART is, at the very least, transparent. (author's)
Geneva, Switzerland, WHO, 2005.  p. (WHO/HTM/TB/2005.349)The goal of this series of annual reports is to chart progress in global TB control and, in particular, to evaluate progress in implementing the DOTS strategy. The first targets set for global TB control were ratified in 1991 by WHO’s World Health Assembly. They are to detect 70% of new smearpositive TB cases, and to successfully treat 85% of these cases. Since these targets were not reached by the end of year 2000 as originally planned, the target year was deferred to 2005.4 In 2000, the United Nations created a new framework for monitoring progress in human development, the MDGs. Among 18 MDG targets, the eighth is to “have halted by 2015 and begun to reverse the incidence of malaria and other major diseases”. Although the objective is expressed in terms of incidence, the MDGs also specify that progress should be measured in terms of the reduction in TB prevalence and deaths. The target for these two indicators, based on a resolution passed at the 2000 Okinawa (Japan) summit of G8 industrialized nations, and now adopted by the Stop TB Partnership, is to halve TB prevalence and death rates (all forms of TB) between 1990 and 2015. All three measures of impact (incidence, prevalence and death rates) have been added to the two traditional measures of DOTS implementation (case detection and treatment success), so that the MDG framework includes five principal indicators of progress in TB control. All five MDG indicators will, from now on, be evaluated by WHO’s Global TB Surveillance, Planning and Financing Project. The focus is on the performance of NTPs in 22 HBCs, and in priority countries in WHO’s six regions. (excerpt)
AIDS. 2006 Mar 21; 20(5):653-656.On 1 December 2003, when pilot projects had shown the feasibility of antiretroviral therapy (ART) in the poorest regions of the world, and the prices of antiretroviral drugs had steeply decreased, the World Health Organization (WHO) launched its '3 by 5' initiative, aiming to provide ART to 3 million people by the end of 2005. WHO described the large-scale provision of ART as 'a global health emergency [for which] urgent action is needed'. In June 2005, '3 by 5' released an interim report documenting the impressive progress made, but acknowledging its pace is slower than originally anticipated. However, although the AIDS epidemic in sub-Saharan Africa certainly requires an emergency response with short-term plans and objectives, we argue that the short time horizon risks constricting our insights and that a much longer-term view is now necessary in view of the ultimate goal of universal access to ART. (excerpt)
Bulletin of the World Health Organization. 2006 Feb; 84(2):145-150.This paper reviews the data sources and methods used to estimate the number of people on, and coverage of, antiretroviral therapy (ART) programmes in low- and middle-income countries and to monitor the progress towards the "3 by 5" target set by WHO and UNAIDS. We include a review of the data sources used to estimate the coverage of ART programmes as well as the efforts made to avoid double counting and over-reporting. The methods used to estimate the number of people in need of ART are described and expanded with estimates of treatment needs for children, both for ART and for cotrimoxazole prophylaxis. An estimated 6.5 million people were in need of treatment in low- and middle-income countries by the end of 2004, including 660,000 children under age 15 years. The mid-2005 estimate of 970,000 people receiving ART in low- and middle-income countries (with an uncertainty range 840,000-1,100,000) corresponds to a coverage of 15% of people in need of treatment. (author's)
New York, New York, UNICEF, 2005. 25 p.The world must take urgent account of the specific impact of AIDS on children, or there will be no chance of meeting Millennium Development Goals (MDG) 6 - to halt and begin to reverse the spread of the disease by 2015. Failure to meet the goal on HIV/AIDS will adversely affect the world's chances of progress on the other MDGs. The disease continues to frustrate efforts to reduce extreme poverty and hunger, to provide universal primary education, and to reduce child mortality and improve maternal health. World leaders, from both industrialized and developing countries, have repeatedly made commitments to step up their efforts to fight the spread of HIV/AIDS. They are beginning to increase the political leadership and the resources needed to fight the disease. Significant progress is being made in charting the past and future course of the pandemic, in providing free antiretroviral treatment to those who need it, and in expanding the coverage of prevention services. But children are still missing out. (excerpt)
[Children. HIV / AIDS. It's everyone's responsibility] Niños. VIH / SIDA. La responsabilidad es de todos.
VIDAS. 1997 Nov; 1(4):12-13.The most recent perspective of UNAIDS and its associates involves a world in which HIV transmission has been greatly reduced, where the treatment, care, and assistance provided are adequate, and where the vulnerability of children, their families, and their communities to the effects of HIV/AIDS has decreased appreciably. (excerpt)
WHO, UNAIDS set HIV treatment goal for developing countries. Plan is to treat 3 million with HIV infection by 2005.
American Journal of Health-System Pharmacy. 2004 Jan 15; 61(2):128, 130.The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in December unveiled the Treat 3 Million by 2005 Initiative--better known as 3 by 5--an ambitious plan to bring effective antiretroviral therapy to 3 million HIV-infected people in developing countries by 2005. "Whether we get there by 2005, that will depend on what we do today," emphasized UNAIDS Executive Director Peter Piot, during a December 1 webcast sponsored by the Kaiser Family Foundation. A WHO strategy document describes 3 by 5 as a "comprehensive strategy linking treatment, prevention, care and full social support for people affected by HIV/AIDS." The success of the initiative will require cooperation among national and local governments, employers, private foundations, faith-based organizations, and communities, according to WHO. "I think that this is achievable" said Chiedza Maponga, chair of the Department of Pharmacy at the University of Zimbabwe, in an e-mail interview. "However, there needs to be a strong global commitment, particularly from the rich countries." (excerpt)
Perspectives in Health. 2004; 9(2):30-32.Think about a vacation in the Caribbean and what comes to your mind? Clean air, superb scenery, relaxation, reinvigoration, and renewal? Unfortunately, this is not the reality for many residents of the poorer Caribbean islands. In several Caribbean countries, from 15 percent to 30 percent of the population live below the poverty line. The region’s infant mortality rates vary from 10–12 per 1,000 live births in Barbados and St. Lucia to 24 in Jamaica and 52 in Guyana. Meanwhile, HIV/AIDS has taken a particularly heavy toll on the Caribbean, with prevalence rates that are second only to those of sub-Saharan Africa. In the wake of the United Nations Millennium Summit, prime ministers of the Caribbean Community (CARICOM) met in Nassau in 2001 to review the region’s health priorities and declared their conviction that “The health of the Nation is the wealth of the Nation.” Inspired by this—and by the spirit of the Millennium Development Goals—Caribbean governments have developed new strategic plans for health. How realistic are their goals in the current economic and political climate? How likely are these strategies to succeed in improving quality of life for the Caribbean poor? (excerpt)
Global AIDSLink. 2001 Aug-Sep; (69):14.The United Nations General Assembly concluded a historic, three-day special session on June 27 and promised to speak openly about the disease, to work to reduce infection rates and provide treatment to those infected, and to provide the money to accomplish those goals. The 16-page declaration was approved by the member nations after settling disagreements concerning the wording of the document. In the final declaration, the 189-member body acknowledged that discrimination against those with AIDS and those whose behavior makes them susceptible to the disease, lack of women’s rights and failure to provide adequate sex education for the young contribute to its spread. The meeting was scheduled only six months prior, when nations recognized that AIDS threatens to eliminate an entire generation in some countries, particularly sub-Saharan African nations, and that economies around the globe would be devastated. The meeting, the first UN special session devoted exclusively to a health issue, brought a new level of attention to HIV/AIDS. It also recorded the world’s governments’ pledges to deal with the pandemic. The declaration requires member states to report their progress on specific targets and methods for reducing the spread of HIV, the virus that causes AIDS. (excerpt)
Johannesburg, South Africa, ActionAid International, 2004 Jun. 11 p. (3 by 5 Discussion Paper)This paper addresses these concerns. Prevention, care and support: in the push to provide antiretrovirals, prevention, care and support programmes must not slip down the priority list of the world’s governments. ActionAid International calls on developing countries to demonstrate clearly in their 3 by 5 plans how ARV treatment delivery will interface with, and be balanced by, other prevention, care and support initiatives, including the promotion of good nutrition. Equity: initially, the limited supply of ARVs under 3 by 5 will be the focus of a struggle between different interest groups trying to ensure access for their client populations. ActionAid International’s past experience would suggest that men, and those that are better off or living in urban areas, will win out over women, children, marginalised groups and those living in rural areas. We call on all involved in developing 3 x 5 plans to ensure equity in access by focusing on the special needs of women, marginalised groups, poor and rural communities. Ideally, such groups should be involved in the design and implementation of care services that will be appropriate to their needs and be located close to where they live. Health systems: ActionAid International welcomes the recent emphasis given by the WHO World Health Assembly to health system strengthening as an essential component in delivery of 3 by 5. In many of the countries most affected by HIV/AIDS health systems are not working, having been undermined by World Bank/IMF structural adjustment programmes as well as attrition caused by HIV/AIDS. The rapid rebuilding of health systems is a basic requirement if 3 by 5 is to succeed. ActionAid International calls on donors to provide increased funding and support and to ensure that large-scale capacity building programmes for health service personnel are instituted without delay. (excerpt)
Lancet. 2004 Jul 3; 364(9428):63-64.The “3 by 5” goal to have 3 million people in low and middle income countries on antiretroviral therapy (ART) by the end of 2005 is ambitious. Estimates of the necessary resources are needed to facilitate resource mobilisation and rapid channelling of funds to where they are required. We estimated the financial costs needed to implement treatment protocols, by use of country-specific estimates for 34 countries that account for 90% of the need for ART in resource-poor settings. We first estimated the number of people needing ART and supporting programmes for each country. We then estimated the cost per patient for each programme by country to derive total costs. We estimate that between US$5·1 billion and US$5·9 billion will be needed by the end of 2005 to provide ART, support programmes, and cover country-level administrative and logistic costs for 3 by 5. (author's)
Progress towards implementation of the Declaration of Commitment on HIV/AIDS. Report of the Secretary-General.
New York, New York, United Nations, General Assembly, 2003 Jul 25. 21 p. (A/58/184)The present report is submitted pursuant to paragraph 100 of the Declaration of Commitment on HIV/AIDS (General Assembly resolution S-26/2, annex), adopted by the Assembly at its special session on the human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) on 27 June 2001. The year 2003 is especially significant since it is the year in which the first of the time-bound targets set out in the Declaration of Commitment fall due. The majority targets in 2003 pertain to the establishment of an enabling policy environment, which set the stage for the programme and impact targets of 2005 and 2010. The report is based primarily on responses provided by 100 Member States on 18 global and national indicators developed by the Joint United Nations Programme on AIDS to measure progress towards implementation of the Declaration. The regional breakdown of States that responded is as follows: sub-Saharan Africa — 29; Asia and the Pacific — 15; Latin America and the Caribbean — 21; Eastern Europe and Central Asia — 13; North Africa and the Middle East — 8; high-income countries — 14. Virtually all heavily affected countries provided information relating to policy issues addressed by the indicators. The activities cited in the report are intended to be illustrative and not a comprehensive listing of all activities that have been undertaken in order to implement the Declaration. (excerpt)
Lancet. 2003 Sep 13; 362(9387):918.The table shows our rough calculations for the inputs that will be needed to reach the 3 million target. We have used statistics relevant to the most heavily affected region, sub-Saharan Africa, although other lower-prevalence regions may have better health infrastructure to implement interventions more rapidly. Our estimates only refer to interventions that lead to start of therapy, not to those needed for maintenance. We have done this rough calculation because there is a dearth of published experience about the large-scale effectiveness of interventions that move people through a process from awareness to action—i.e., for services to be in demand (WHO aims to ensure rates of 60% and 90% for accessibility of voluntary counselling and HIV testing and for AIDS education and services for youths by 2005). (excerpt)