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Supporting and sustaining national responses to children orphaned and made vulnerable by HIV and AIDS: Experience from the RAAAP exercise in sub-Saharan Africa.
Vulnerable Children and Youth Studies. 2006 Aug; 1(2):170-179.The growing number of children orphaned and made vulnerable by HIV and AIDS in sub-Saharan Africa presents an enormous socioeconomic and public policy challenge. Despite international commitments to increase resource allocation and scale up services and support for AIDS-affected children, families and communities, the national- and sub-national-level state responses have been inadequate. The rapid assessment, analysis and action planning (RAAAP) process for orphans and vulnerable children, conceived in late 2003, was intended as a multicountry incentive to identify and resource immediate actions that can be taken to scale in 16 heavily affected countries. This review of experiences to date with the RAAAP process highlights some key areas of learning, including: (a) fund mobilization has been slow and has reached approximately only one-third of what is required; (b) ownership and integration into development planning of the issue of orphans and vulnerable children at country level has been undermined by the perception that the response is an 'emergency' and externally (donor) driven exercise; (c) centralized planning has failed to appreciate the complexity of context and responses at the meso- and micro-levels within countries, entailing the need to support a comprehensive decentralization process of planning and implementation; (d) comprehensive multisectoral and interagency collaboration, involving civil society, is an important but overlooked element of the planning process; and (e) definitional variation between countries has led to large variations in budgets and coverage targets. While the RAAAP process has undoubtedly raised awareness at state level of the nature and extent of the 'orphan crisis' and raised vital resources, only full integration of the new planning process for orphans and vulnerable children within the range of macro and national development tools will allow the response to be sustainable in the longer term. (author's)
Journal of Acquired Immune Deficiency Syndromes. 2006 Dec; 43(5):618-623.The number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from < 2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa's performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government's own Operational Plan. The public-sector HAART ''rollout'' has been uneven across South Africa's nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources-- especially nurses--is likely to constrain the growth of HAART coverage. (author's)
Geneva, Switzerland, UNAIDS, . 10 p. (Facts about UNAIDS)National governments have the primary responsibility for dealing with HIV/AIDS within their own borders, even though many individuals and groups -- from government as well as the wider society -- must be part of the national response. The role of UNAIDS is to strengthen the ability of countries to respond to the epidemic, and to coordinate the UN system's support to that end. To be effective, the national response must be broad-based and multisectoral. AIDS remains an important health issue, but many of the causes and consequences of the epidemic lie outside the health sector. With its unique, collaborative approach, UNAIDS can support countries in the following ways as they mount an expanded response to the epidemic: By advocating more effectively for the introduction of AIDS issues into the country's health, economic and social development agendas. Each UN organization can work with its major counterparts to promote cross-sectoral collaboration; By involving a greater number of partners in AIDS activities. Each UN organization can help involve partners not yet participating in the response to the epidemic, including government departments, nongovernmental organizations (NGOs) and the private sector; By allocating resources more efficiently and effectively in support of national efforts. Working together, the UN organizations can identify overlaps, gaps and opportunities for integrating AIDS into related programmes; By making better use of local and regional technical expertise available in the UN system. (excerpt)
Strategies to support the HIV-related needs of refugees and host populations. A joint publication of the Joint United Nations Programme on HIV / AIDS (UNAIDS) and the United Nations High Commissioner for Refugees (UNHCR).
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS UNAIDS], 2005 Oct. 38 p. (UNAIDS Best Practice Collection; UNAIDS/05.21E)Many countries are already overburdened by the impact of AIDS, and are often unable or unwilling to provide these populations with the HIV-related services they require. This places many refugees in a unique situation. They are no longer guaranteed the protection of their country of origin, they often do not have the assistance of the country of asylum, and they go without the HIV-related services which they need and to which they are entitled under international human rights instruments. This failure to provide HIV prevention and care to refugees not only undermines effective HIV prevention and care efforts, it also hinders effective HIV prevention and care for host country populations. Since refugee populations now remain on average in their host country for 17 years,2 the implications for both refugee and host populations are very serious. Addressing HIV-related needs in the context of refugee situations requires a change in the thinking of the authorities in many countries of asylum. It is impossible to determine the actual length of time that refugees will remain in the host country. However, it is critical that during this time both refugees and surrounding host populations receive all necessary HIV related services, including those that require long-term funding and planning. Failure to provide these interventions could be very harmful to both refugees and the surrounding host populations. In order to meet the HIV-related needs in the context of refugee situations, UNHCR and UNAIDS advocate for the implementation of the best practices described below. Both organizations believe that these practices will generate more effective, equitable and sustainable frameworks to help countries better address both the needs of refugees and their own citizens, whether they are displaced themselves or hosting refugees in their communities. (excerpt)
Tools to determine quality of antiretrovirals. [Herramientas para determinar la calidad de los medicamentos antirretrovirales]
Washington, D.C., PAHO, .  p.The quality of pharmaceutical products in the Americas is normally ensured through the application of a regulatory and normative framework at the country level that assesses medicines used by the population in terms of quality, safety and efficacy. The application of Good Manufacturing Practices by the producers of pharmaceutical products, combined with the regulatory systems put in place by public health authorities establishes an effective framework in which product quality can be guaranteed. HIV/AIDS Antiretroviral medicines exist within the Latin American and Caribbean markets however as multisource (originator and generic) pharmaceutical products for which there are limited publicly available quality assurance standards, analytical methods and reference standards. Before countries move to procure ARV, a process must be initiated at the country to determine the acceptable quality reference and criteria. (excerpt)
[Unpublished] . Presented at the 32nd Annual Meeting of the African Studies Association, Atlanta, Georgia.  p.HIV infection with clinical progression to AIDS appears to be among the most severe human infectious diseases documented to date. As of 1st September 1989, the cumulative total of cases of AIDS reported from 152 countries was 177,965 cases of which 30,978 (17.4%) have been reported from Africa. However, it is known that the reporting of AIDS cases from Africa is incomplete and the proportion may be higher. The AIDS situation has been recognized as a global emergency and the World Health Organization has been given the mandate to coordinate global efforts to prevent the infection and control the disease. The World Health Assembly and the United Nations General Assembly have called upon all countries to establish national AIDS prevention and control programmes in line with the Global Strategy. The WHO has developed several guidelines and strategies to assist the development of national AIDS prevention and control programmes. The Global AIDS Strategy has three objectives: (1) to prevent transmission of the human immunodeficiency virus (HIV); (2) to reduce the morbidity and mortality associated with HIV infection; and (3) to unify national and international efforts against AIDS. (excerpt)
Bulletin of the World Health Organization. 2003 Oct; 81(10):776.At a special session of the United Nations General Assembly in New York on 22 September, WHO declared the failure to expand access to antiretrovirals in the developing world a global health emergency. The announcement was made together with UNAIDS and the Global Fund to Fight AIDS, Tuberculosis & Malaria. (excerpt)
Positively Aware. 2003 Mar-Apr; 14(2):20-24.Developing and implementing a model HIV prevention program at the grass-roots level in the People's Republic of China is a very difficult undertaking, but this is the task we have agreed to with the Health Bureau of Zhejiang Province in China. The U.S. Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and various universities in the U.S. are actively involved with HIV/AIDS in China; but all of these undertakings are between professionals, usually physicians, or high level administrators on all sides. What has not been done, and what is unique to the relationship that Howard Brown Health Center (HBHC) is developing, is to work directly with the people in China who will implement the treatment and prevention programs among the Chinese population. Getting out in the field among the Chinese populations most at risk-men who have sex with men (MSM), intravenous drug users (IDUs), and female sex workers-is a major milestone. (author's)