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Journal of the Association of Nurses in AIDS Care. 2008 Sep-Oct; 19(5):335-7.The U.S.-Mexico Border region, which includes some of the poorest counties in the country, has large rural populations with health care service shortages leading to poorer health outcomes than in the rest of the country (United States-Mexico Border Health Commission, 2008). In combination with these factors, an increase in the number of HIV cases along the border led to a request from the Health Resources and Services Administration for a collaborative effort to systematically assess the education and capacity building needs of health care providers in this region. The three AETCs geographically located along the border (Pacific AETC [California, Arizona], Mountain- Plains AETC [New Mexico], and Texas/Oklahoma AETC [Texas]) interviewed more than 75 border clinicians to determine their unique HIV-related education needs. Four broad training-related needs emerged: (a) to increase integration and coordination of HIV training activities, (b) to expand HIV training beyond AETC-targeted providers, (c) to offer site-based trainings that include cultural sensitivity themes and incentives for participation, and (d) to maintain a binational perspective by including Mexican clinicians in training activities. (excerpt)
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.
London, United Kingdom, ACF International Network, . 80 p. (Hunger Watch Publication)This report documents the findings of Local Voices, a six month qualitative research project that provided HIV orphans, vulnerable children and their carers with the opportunity to discuss and document the difficulties they face providing food, water and healthcare for their families. Through meetings, detailed interviews and discussions the project initiated and developed an ongoing dialogue with 20 families in four areas of the Kitwe district in the Copperbelt province of Zambia: Chimwemwe, Kwacha, Chipata and Zamtan. The discourse that developed over the course of the project has given Action Against Hunger (ACF-UK) and CINDI insight in two key areas. Firstly, the research has added a household perspective to existing ideas and analysis of food security in an HIV/AIDS context. Secondly, the project highlights the knowledge and learning that can be gained when people living with a positive HIV diagnosis are seen as 'experts' and their experiences are used to help identify and address the problems they face. Through the voices of the project's participants, the testimonies and images that are the core of this document explore the social and economic impact HIV/AIDS has on families affected by the disease. ACF-UK and CINDI pioneered this work because we believe HIV/AIDS can no longer be seen as just a medical issue. Within this report we demonstrate that HIV/AIDS has a direct impact on the economic and social well-being of both households and communities; and as such it must be tackled using an integrated approach where food, livelihoods and social protection are highlighted as solutions alongside access to medical care. This report opens with statistics that outline current rates of HIV/AIDS and poverty in Zambia, focusing specifically on the Copperbelt province and the Kitwe district. The testimonies that form the centrepiece of this report are introduced by a summary of the key social and economic issues that HIV orphans, vulnerable children and their carers face, together with a synopsis of government and community based organisation (CBO) responses. These topics have been selected as they cover the core issues that were raised during the Local Voices project. The document ends with a brief conclusion and the report recommendations.
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, UNAIDS, 2007 Jan. 57 p. (UNAIDS/07.04E; JC1301E)In 2005 and early 2006, the landscape of the AIDS response shifted dramatically. Global pessimism over the unchecked spread of the disease in the developing world receded in the face of impressive efforts to expand access to treatment. Signs that prevention efforts were bearing fruit were seen in a growing number of countries from the hardest-hit regions, which started to report drops in HIV rates, particularly among the young. The global community had responded to urgent appeals by enormously increasing the financial resources available to fight the disease. While millions continued to die annually, these developments gave rise to hope that there was a light at the end of the tunnel. Unimaginable even a year or two earlier, it was now possible to start talking about the prospects of providing access to HIV prevention, treatment, care and support services to all who needed them. (excerpt)
Setting national targets for moving towards universal access. Further guidance to complement “Scaling Up Towards Universal Access: Considerations for Countries to Set their own National Targets for AIDS Prevention, Treatment, and Care and Support”. Operational guidance. A working document.
[Geneva, Switzerland], UNAIDS, 2006 Oct. 23 p.This document provides operational guidance to country-level partners and UN staff to facilitate the next phase of the country-level consultative process on scaling up towards universal access to prevention, treatment, care and support services. It concerns the setting of ambitious targets for the national HIV response to achieve by 2008 and 2010, and builds on previous guidelines. Targets need to be ambitious in order to achieve the universal access goals. Analysis by UNAIDS of existing national targets and rates of scaling up indicates that current efforts are inadequate to achieve universal access in the near future. The process of countries setting their own targets will promote partner alignment to national priorities, strengthen accountability and facilitate efforts by countries and international partners to mobilize international support and resources. Targets should have political and social legitimacy. The consultative process should be multi-sectoral, include full civil society participation, lead to consensus on the targets, and formal approval of these targets before the end of 2006. (excerpt)
AIDS is not a business: A study in global corporate responsibility -- securing access to low-cost HIV medications.
Journal of Business Ethics. 2007 Jun; 73(1):65-75.At the end of the 1990s, Brazil was faced with a potentially explosive HIV/AIDS epidemic. Through an innovative and multifaceted campaign, and despite initial resistance from multinational pharmaceutical companies, the government of Brazil was able to negotiate price reductions for HIV medications and develop local production capacity, thereby averting a public health disaster. Using interview data and document analysis, the authors show that the exercise of corporate social responsibility can be viewed in practice as a dynamic negotiation and an interaction between multiple actors. Action undertaken in terms of voluntary CSR alone may be insufficient. This finding highlights the importance of a strong role for national governments and international organizations to pressure companies to perform better. (author's)
Health Policy and Development. 2004 Aug; 2(2):131-135.International agencies are beginning a rapid scaling up of antiretroviral distribution programs in Africa. Some are particularly looking for "faith-based organizations" (FBOs) as partners. The new initiatives may offer both unprecedented opportunities and some dangers for FBOs who wish to join in. The opportunities include increasing our capacity to provide not only HIV/AIDS care but other aspects of health care, and a potential for increased communication and cooperation between Christian organizations. The dangers include the likely widespread appearance of antiretroviral resistance; long term sustainability; negative impact on other aspects of HIV care and prevention; indirect costs to FBOs; corruption; encouragement of a culture of money and power, drawing FBOs away from their perceived missions; overextension; and harmful competition among FBOs. Organizations should be aware of the opportunities and dangers, and review their own calling and mission, before embarking on large-scale, externally-funded programs of ARV distribution. (author's)
Washington, D.C., World Bank, Global HIV / AIDS Program, 2006 Aug. 11 p.AIDS has wide consequences for development, and presents enormous challenges to businesses in the worst hit countries. The epidemic affects workers, managers and markets by increasing costs and reducing productivity. The International Finance Corporation (IFC), the private sector arm of the World Bank Group, works with client companies to mitigate the effects of the epidemic on their operations through its IFC Against AIDS program. The program works with companies in Africa and India, and efforts are underway to raise awareness among clients in China and assess program conditions in Russia. (author's)
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)
Washington, D.C., World Bank, Global HIV / AIDS Program, 2005 Dec. 5 p.Many countries are working to expand access to antiretroviral (ARV) drugs for millions of people with HIV/AIDS. Uninterrupted and timely supplies of safe, effective and affordable ARV drugs are needed. They must be dispensed correctly by health workers, and consistently taken by patients. A partnership between the World Bank and World Health Organization (WHO), in collaboration with the Global Fund for AIDS, TB and Malaria (GFATM), UNICEF, UNAIDS, and the American and French Governments is helping countries build capacity to procure and manage HIV/AIDS drugs and related supplies. This effort has helped support an increase in the number of people on ARV treatment in low- and middle income countries, from 400,000 at the end of 2003, to about one million in June 2005. (author's)
Ottawa, Canada, Youth Coalition, 2006. 30 p.The current global generation of young people is the first in history to have lived their entire lives in the prevalence of HIV/AIDS, and are disproportionately affected. Millions of children and youth have been orphaned by HIV/AIDS; thousands of others are HIV positive themselves; and many others are affected by it in a variety of ways. None of us are immune to it. In response to the pandemic, governments and international organizations have adopted a variety of responses, but the numbers show that what has been done thus far clearly is not adequate. The reality is that none of these responses, initiatives or programs will be truly successful and effective until they integrate a sexual and reproductive rights and a gender perspective. Furthermore, every initiative must include youth from the beginning to ensure that we young people, have the youth-friendly information, education, services and products that we are entitled to as our human right, in order to make informed and healthy decisions about our sexual and reproductive lives. This guide is intended to: Provide an overview of the linkages between sexual and reproductive rights and HIV/AIDS; Explain the importance of HIV/AIDS initiatives having a sexual and reproductive rights perspective, as well as a youth perspective; and Discuss ways that young people can advocate for their sexual and reproductive rights within HIV/AIDS frameworks, in their countries, regions, and globally. (excerpt)
Integration between sexual and reproductive health and HIV and AIDS and malaria: opportunities and strategic options for the Global Fund to Fight AIDS, Tuberculosis and Malaria. Discussion piece.
[London, England], HLSP, 2006 Nov.  p.There is a growing body of knowledge which emphasises integration of sexual and reproductive health (SRH) as critical to the effectiveness of responses to HIV and AIDS, and the success of HIV and AIDS programmes. Further, accelerated headway in malaria prevention and/or treatment can be achieved through integration with SRH efforts. This paper briefly explores the evidence base for integration, identifies the enabling environment at global and national levels and discusses the opportunities and challenges for supporting integration by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). The paper concludes with strategic options for the Global Fund. (excerpt)
Finance and Development. 2007 Mar; 44(1): p.This approach is a bit like setting up a straw man only to knock it down. The aid industry unquestionably provides ample fodder for critics: many cases exist of aid funding poorly conceived, badly executed, unsustainable projects (for example, cement factories built far from sources of gypsum and sand). And some badly managed countries have, indeed, received millions, especially during the Cold War, when aid was extended for geopolitical objectives. At times, aid agencies followed fads that later proved misguided (recall the popular integrated rural development projects of the 1970s). This does not prove that all aid has been, or is, ineffective. It is entirely unsurprising that many economists have found the relationship between aggregate aid and growth to be weak. Evidence suggests a high level of heterogeneity in the effects of aid, which comes on top of the typical statistical problems that arise in cross-country analysis. Multiple markers for development success--income growth, poverty reduction, literacy, access to sanitation, and inoculations--further complicate empirical analysis. Case studies do not solve this problem because of the difficulty of establishing a counterfactual: some argue that aid has not prevented growing numbers of poor in Africa; others argue that the situation would be far worse without aid. Although these findings may make aid seem indefensible, much of the criticism is misguided. This isn't to say the impact of aid is easily known or that we can fine-tune aid to improve results. Even though it will be difficult for some time to come up with adequate evidence, there are strong grounds for believing that aid fosters development. (excerpt)
Exploring disparities between global HIV / AIDS funding and recent tsunami relief efforts: an ethical analysis.
Developing World Bioethics. 2007; 7(1):1-7.The objective was to contrast relief efforts for the 26 December 2004 tsunami with current global HIV/AIDS relief efforts and analyse possible reasons for the disparity. Methods: Literature review and ethical analysis. Just over 273,000 people died in the tsunami, resulting in relief efforts of more than US$10 bn, which is sufficient to achieve the United Nation's long-term recovery plan for South East Asia. In contrast, 14 times more people died from HIV/AIDS in 2004, with UNAIDS predicting a US$8 bn funding gap for HIV/AIDS in developing nations between now and 2007. This disparity raises two important ethical questions. First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response? The principle of justice requires that two cases similarly situated be treated similarly. For the difference in the international response to the tsunami and HIV/AIDS to be justified, the tragedies have to be shown to be dissimilar in some relevant respect. Are the tragedies of the tsunami disaster and the HIV/AIDS pandemic sufficiently different, in relevant respects, to justify the difference in scope of the response by the international community? We detected no morally relevant distinction between the tsunami and the HIV/AIDS pandemic that justifies the disparity. Therefore, we must conclude that the international response to HIV/ AIDS violates the fundamental principles of justice and fairness. (author's)
Journal of the Association of Nurses in AIDS Care. 2007 Jan-Feb; 18(1):60-62.The XVI International AIDS Conference had its own essence that differentiated it from previous meetings. This meeting was characterized by the presence of well-known individuals from foundations, international organizations, the media, pharmaceutical companies, nongovernmental organizations, activists, HIV-positive persons, health care professionals, researchers, and others concerned with HIV/ AIDS. Absent as notable exceptions were politicians currently in office. Melinda Gates and the two Bills (Gates and Clinton) and United Nations envoy Stephen Lewis gave stirring speeches. The impact of HIV/AIDS on women was recognized, with more than 100 sessions devoted to women. And although the conference organizers are to be congratulated for so much that was right about the conference, there are some areas requiring further attention. In the conference summaries, one never saw addressed issues of primary concern to nurses. For example, symptom management is given short shrift. Truth in advertising requires that I mention that this is an area of my research. I am not saying that my research should have been mentioned. I am stating that none of the studies in this area seemed on the radar screen of those completing the summaries. This contributes to the invisibility of nursing. (excerpt)
Breaking barriers. Effective communication for universal access to HIV prevention, treatment, care and support by 2010.
Lusaka, Zambia, Panos Southern Africa, Panos Global AIDS Programme, 2006. 25 p.Effective HIV and AIDS communication is central to the achievement of universal access. This paper reviews lessons learned from the response so far and suggests that there is an urgent need to strengthen communication approaches that look beyond narrow, short-term interventions focused on individual behaviours. Development actors must realistically and effectively engage the social, political and economic drivers of the epidemic, in a way that is informed by the experiences and priorities of those most affected. There is also a need to better understand and engage with the distinct communication dynamics of social movements and the neglected area of interpersonal communication - both of which are key to an effective response. The intransigent problems of stigma and discrimination must also be addressed. The challenge is at once social, political and technical, but without this paradigm shift in development and communication practice, universal access will remain elusive. As country-level plans for universal access are being developed in late 2006, it is vital that they explicitly include fully resourced communication strategies, activities and targets that are integrated into programming at all levels. Communication challenges include: the effective coordination of the response; sustained advocacy to tackle the underlying drivers of the epidemic; and the specific communication needs of prevention, treatment and care initiatives that require grassroots ownership and social mobilisation. (excerpt)
JAMA. 2007 Feb 21; 29(7):744-746.HIV disease is essentially the black death of the 21st century, killing on a massive scale and threatening to cripple economies and topple governments. However, the continued spread of the HIV epidemic and the new availability of lifesaving antiretroviral drugs have triggered an extraordinary response by governments, international organizations, philanthropies, pharmaceutical companies, religious organizations, and individuals. Campaigning against HIV/AIDS has no precedent in the history of medicine. Smallpox was eliminated by a globally coordinated strategy that required a single patient encounter to deliver the vaccine. In contrast, the directly observed therapy strategy at the core of modern tuberculosis treatment necessitates daily patient contact over much of the treatment course and, therefore, a much larger health workforce. Treating AIDS requires the daily delivery of medications as well as the clinical management of patients-- for the rest of their lives. Antiretroviral medications can help control disease, but do not cure it. More problematic yet, stopping treatment once started promotes the emergence of resistant strains of the virus, making halfway programs hazardous to public health. The sheer volume of health workers needed to tackle HIV disease--and the health systems to support their work--is off the scale of any previous public health campaign. (excerpt)
New York, New York, IAVI, 2006.  p.Twenty-five years after the first five cases of a novel immunodeficiency disease were described, the AIDS pandemic has become the greatest global public health crisis since the Black Death in the Middle Ages. Although the ideal global response to HIV/AIDS must be a comprehensive approach that includes education, prevention, treatment, and care, the only way to end this epidemic is to develop a safe, accessible, and preventive vaccine. The ultimate goal is an AIDS vaccine that prevents infection from the wide spectrum of globally diverse HIV isolates and is applicable for use in the developing world, where the need is the greatest. However, a vaccine that suppresses viral load and slows progression to AIDS or suppresses and blunts transmission of HIV would have significant public health impact. To achieve that, a host of scientific, public policy, and political actions must be taken in a coordinated, interlinked fashion to make all of the necessary resources available (Figure 4). While scientific challenges continue to be the main obstacle in the search for an AIDS vaccine, countless examples of successful technology breakthroughs show that judicious policy changes and political will matters enormously. It is vital to enlist political leadership, non-governmental organizations, community groups, and a range of strategic coalitions that can amplify and reinforce support for AIDS vaccines. (excerpt)
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)
Menlo Park, California, Henry J. Kaiser Family Foundation, 2005 Oct.  p. (HIV / AIDS Policy Fact Sheet)Mozambique has over one million people estimated to be living with HIV/AIDS (1.3 million as of the end of 2003). Although Mozambique's prevalence rate (the percent of people living with the disease) is lower than some of the hardest hit countries in the region, it is higher than the sub-Saharan African region overall and recent estimates suggest that the prevalence rate may be on the rise. The epidemic poses significant development challenges to this low-income country. The Government of Mozambique formed a National AIDS Council (NAC) in 2000, and is currently operating its National Strategic Plan to Combat HIV/AIDS for 2005-2009. (excerpt)
Menlo Park, California, Henry J. Kaiser Family Foundation, 2005 Oct.  p. (HIV / AIDS Policy Fact Sheet)Zimbabwe has almost two million people estimated to be living with HIV/AIDS (1.8 million as of the end of 2003), representing the third largest HIV/AIDS burden in sub-Saharan Africa. The HIV/AIDS prevalence rate (the percent of people living with the disease) in Zimbabwe is among the highest in the world, although recent evidence suggests that prevalence may be starting to decline. The epidemic continues to pose significant development challenges to this low-income country, which faces additional complications including drought conditions, substantial internal migration and displacement, and other factors that exacerbate the epidemic's impact. The Government of Zimbabwe established a National AIDS Coordination Programme (NACP) in 1987. In 2000, the Government formed the National AIDS Council (NAC), and is currently developing its National AIDS Strategic Framework for 2005-2009. (excerpt)
Menlo Park, California, Henry J. Kaiser Family Foundation, 2005 Oct.  p. (HIV / AIDS Policy Fact Sheet)Zambia has almost one million people estimated to be living with HIV/AIDS (920,000 as of the end of 2003). Zambia's HIV prevalence rate (the percent of people living with the disease) is twice the rate in sub-Saharan Africa overall and the epidemic continues to pose one of the most significant development challenges to this low-income country. The Government of Zambia established a National AIDS Prevention and Control Programme in 1986. In 2000, the Government formed a National AIDS Council (NAC) and is currently implementing its National HIV/AIDS/STI/TB Implementation Plan for 2002-2005. (excerpt)
24309709Uganda has more than a half million people estimated to be living with HIV/AIDS (530,000 as of the end of 2003). The country of Uganda is widely considered to be an HIV/AIDS success story, having reduced its HIV prevalence rate (the percent of people living with the disease) significantly over time, from one of the most severe epidemics in the 1980s, with a peak in the early-1990s, to a rate lower than that of the sub-Saharan African region overall. However, the epidemic has already had a significant impact in Uganda, and continues to pose development challenges to this low-income country. The Government of Uganda established a National AIDS Control Program (NACP) in 1986, the first HIV/AIDS control program in the region. In 1992, the Government formed the Uganda AIDS Commission (UAC), and is currently operating its National Strategic Framework for 2000/2001-2005/2006. (excerpt)
25309708The United Republic of Tanzania (mainland Tanzania and the island of Zanzibar), the largest country in East Africa, had an estimated 1.6 million people living with HIV/AIDS as of the end of 2003. Although Tanzania's prevalence rate (the percent of people living with the disease) is lower than some of the hardest hit countries in the sub-Saharan African region, it is higher than the prevalence rate of the region overall (8.8% compared to 7.5%). The epidemic poses significant development challenges to this low-income country. In 1985, the National AIDS Control Programme was established to respond to the epidemic. The Tanzania Commission for AIDS (TACAIDS) and the Zanzibar AIDS Commission (ZAC) were created in 2001 and 2002, respectively. Tanzania is currently operating its National Multi-Sectoral Strategic Framework on HIV/AIDS for 2003-2007. (excerpt)