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  1. 1
    Peer Reviewed

    HIV, infant feeding and more perils for poor people: New WHO guidelines encourage review of formula milk policies.

    Coutsoudis A; Coovadia HM; Wilfert CM

    Bulletin of the World Health Organization. 2008 Mar; 86(3):210-214.

    The release of the new WHO guidelines on HIV and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. This widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. This paper explores these issues by addressing feeding choices made by HIV-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty. Accumulating evidence on the increase in malnutrition, morbidity and mortality associated with the avoidance or early cessation of breastfeeding by HIV-infected mothers, and the unanticipated hazards of formula feeding, demand a deeper assessment of the measures necessary for optimum policies on infant and child nutrition and for the amelioration of poverty. Piecemeal interventions that increase resources directed at only a fraction of a family's impoverishment, such as basic materials for preparation of hygienic formula feeds and making flawed decisions on choice of infant feeding, are bound to fail. These are not alternatives to taking fundamental steps to alleviate poverty. The economic opportunity costs of such programmes, the equity costs of providing resources to some and not others, and the leakages due to temptation to sell capital goods require careful evaluation. Providing formula to poor populations with high HIV prevalence cannot be justified by the evidence, by humanitarian considerations, by respect for local traditions or by economic outcomes. Exclusive breastfeeding, which is threatened by the HIV epidemic, remains an unfailing anchor of child survival (author's)
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  2. 2

    The Positive Partnerships Program in Thailand: empowering people living with HIV. Highlights.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 2007 Sep. 15 p. (UNAIDS Best Practice Collection; UNAIDS/07.25E; JC1362E)

    A project rolling out in rural Thailand, the Positive Partnerships Program (PPP), has shown that targeted economic assistance can boost self-esteem, ambition and hope-all of which help reinvigorate community bonds and have a beneficial impact in promoting enabling environments for HIV prevention and treatment efforts. This best practice document examines how and why PPP may serve as a flexible and adaptive model in other countries. The project has two distinct yet complementary goals. to enable people living with HIV to lift themselves out of poverty, through the provision of microcredit loans that allow people to set up small businesses in their communities; to reduce HIV-related stigma and discrimination against people living with HIV through business partnerships between one HIV-positive person and one HIV-negative person. The enthusiastic response to PPP from people living with HIV and funders alike serves as a useful reminder of the need to develop comprehensive strategies in response to the AIDS epidemic that reflect a full range of economic, social, legal and political considerations-not just those narrowly based on health. (excerpt)
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  3. 3

    The Positive Partnerships Program in Thailand: empowering people living with HIV.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 2007 Jul. 48 p. (UNAIDS Best Practice Collection; UNAIDS/07.22E; JC1260E)

    Nearly 600 000 people are living with HIV in Thailand. As in every other country, most are poor and many are isolated from their communities. Breaking down the mutually reinforcing barriers of poverty and stigma they face has proved immensely difficult. These barriers are not insurmountable, however. A new project rolling out in rural Thailand, the Positive Partnership Program (PPP), has shown that targeted economic assistance can boost self-esteem, ambition and hope-all of which help reinvigorate community bonds and have a major, positive impact on HIV prevention and treatment efforts. The core of PPP is the provision of microcredit loans to resource-constrained HIV-positive individuals who otherwise have no access to credit in conventional, affordable ways. These loans are intended to support the efforts of people living with HIV to lift themselves out of poverty by setting up small businesses in their communities. Closely linked to this poverty-reduction goal is another vital objective: the reduction of HIV-related stigma and discrimination. As conceptualized by PPP's implementing entity-the Population and Community Development Association (PDA), a Bangkok-based nongovernmental organization-a unique aspect of the PPP project greatly facilitates progress towards achieving these two goals simultaneously: loans are given out not to people living with HIV alone but to partnerships between an HIV-positive and an HIV-negative person. By the end of 2005, a total of 375 partnerships had been formed since the project began in January 2004. (excerpt)
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  4. 4

    Population, development and HIV / AIDS with particular emphasis on poverty: the concise report.

    United Nations. Department of Economic and Social Affairs. Population Division

    New York, New York, United Nations, Department of Economic and Social Affairs, Population Division, 2005. [69] p. (ST/ESA/SER.A/247)

    The HIV/AIDS epidemic has been a gathering force for nearly a quarter-century, and it continues to be a major global challenge. AIDS finds its victims in both rich and poor countries. There is no region of the world where HIV/AIDS is not a potentially serious threat to the population. Sub-Saharan Africa has so far borne the brunt of the AIDS devastation, and the region continues to experience high rates of infection. About 3 million people in the region were newly infected with the virus in 2004. Countries in Eastern Europe and Asia now have the fastest-growing rates of HIV infection in the world, and the populous countries of China, India and Indonesia are of particular concern. In some more developed countries, there are signs of a resurgence of risky sex between men. (excerpt)
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  5. 5

    Aid can work.

    Bourguignon F; Sundberg M

    Finance and Development. 2007 Mar; 44(1):[5] 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)
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  6. 6

    Mark Malloch Brown: addressing HIV / AIDS challenges head-on.

    Choices. 2004; 4-5.

    This approach is underpinned by promoting leadership in government, in civil society, in the private sector and in communities. We promote leadership of people living with HIV/AIDS and women's leadership to ensure that they participate in planning and implementing HIV/AIDS responses. We also work with a broad range of partners, including from the media and in the arts, to generate society-wide responses that are gender-sensitive and respect the rights of people living with HIV/AIDS. We also work to strengthen community capacity for action and social change by helping communities to address the underlying causes of the epidemic. (excerpt)
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  7. 7

    HIV / AIDS does not recognize borders.

    Choices. 2001 Dec; 1.

    As UNDP's Goodwill Ambassador to combat poverty, I am deeply aware of the link between poverty and AIDS. Poor people suffer more from disease, and HIV/ AIDS creates more poverty. Being poor is hard enough, but poverty added to a deadly disease is nothing short of a disaster for families and whole communities. Since HIV/ AIDS is found especially among the youngest and most active, the more it spreads, the more people in the prime of life must stop working and support those who depend on them. The results are devastating for low-income families. HIV/AIDS is becoming a major development problem affecting all sectors of society and, even worse, it is wiping out the progress made thus far. While it has been possible to contain the spread of HIV/AIDS in rich countries through prevention campaigns and investment in research and treatment, things have been very different in many poor countries. In the poorest countries, many have no access to information that could prevent infection, and those who are infected do not have the drugs that could give them a few more precious years to live. (excerpt)
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  8. 8

    The challenge of HIV / AIDS.

    Brown MM

    Choices. 2001 Dec; 4.

    We are facing the most devastating global epidemic in modern history. Over 60 million people have been infected. In the worst affected countries one in four adults are now living with HIV/AIDS, a disproportionate number of younger women and girls. More than 80 percent are in their twenties. The result is a devastating hollowing out of communities, leaving only the very young and the very old and thrusting millions of families deeper into poverty. Meeting this challenge means progress on three fronts: first, preventing new infections and reversing the spread of the epidemic; second, expanding equitable access to new HIV treatments; third, alleviating the disastrous impact of AIDS on human development. Effectively responding to HIV/AIDS requires a wide range of initiatives under strong national political leadership, including sex education in schools, public awareness campaigns, programmes in the workplace, mobilization of religious and community leaders, action to mitigate the impact on poverty and essential social services, support for orphans and tough policy decisions in ministries of finance to ensure optimal allocation of resources to cope with the crisis. (excerpt)
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  9. 9

    The hard-hit Caribbean.

    Daly O

    Choices. 2001 Dec; 16-17.

    The Caribbean is regarded as one of the territories hardest hit by the HIV/AIDS pandemic, which has become a major cause of death among men and women in the 15 to 44 age group in several countries. There are an estimated 500,000 people living with HIV/AIDS in the region. The World Health Organization (WHO) reports that more than half the Caribbean's HIV/AIDS victims are under 25 and that as many as 60 percent of the newly infected are in the 15 to 24 age range. This infection rate is estimated to be second only to that of sub-Saharan Africa. Barbados and the Organization for Eastern Caribbean States (OECS) member states--former British Territories that gained independence between 1966 and 1984--are part of this Caribbean grouping. Together these islands have a population of approximately one million people. And based on the experience of sub-Saharan Africa, it is expected that the epidemic will deepen already high levels of poverty existing here. (excerpt)
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  10. 10

    Haiti battles both poverty and HIV / AIDS.

    Chantal R

    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)
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  11. 11

    HIV / AIDS and poverty reduction strategies. Policy note.

    Bjorkman H

    New York, New York, UNDP, 2002 Aug. 20 p. (Policy Note)

    UNDP Policy Notes are intended to inform and strengthen the delivery of policy and programme support to countries. This note provides policy guidance on the important challenge of integrating HIV/AIDS priorities into poverty reduction strategies, including Poverty Reduction Strategy Papers (PRSPs). Poverty reduction strategies are becoming the main development planning instrument in many countries, determining national priorities and domestic as well as external resource allocation. In the case of HIPC countries, poverty reduction strategies shape the speed of debt relief, and the allocation of debt relief savings. Integrating HIV/AIDS into poverty reduction strategies therefore helps to create the necessary policy and planning environment for a comprehensive, multi-sectoral and adequately funded response to the epidemic. The Policy Note provides a synthesis of cutting-edge thinking on the interface between poverty reduction strategies and efforts to reverse the spread of HIV/AIDS. It proposes nine policy areas that UNDP and its partners must focus on as a matter of priority. At the core of the Policy Note is a checklist with specific guidance on how to integrate HIV/AIDS into poverty reduction strategies, relevant for all countries regardless of their current HIV prevalence rates. The Note concludes by bringing the discussion to the global level. It recommends that UNDP--in the context of the Millennium Development Goals Campaign--step up its advocacy for placing HIV/AIDS at the centre of the international development agenda, capitalizing and building on its work at country level. (excerpt)
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  12. 12

    Ukraine human development report. Special edition 2003. Ukraine and HIV / AIDS: time to act.

    United Nations Development Programme [UNDP]

    Kyiv, Ukraine, UNDP, 2003. 36 p.

    Ukraine is a young nation on the move. The national response to HIV/AIDS is also gathering pace. It is bringing together fresh coalitions of people, leaders and institutions who want to stop the further spread of this virus and to ensure care for those who are in need. The good news for all is that there are now known ways of preventing the spread of the virus and treatment is increasingly available. The challenge remains immense -- to some overwhelming. The insidious nature of the virus is that it attacks men and women in the prime of their life -- between the ages of 15 and 40. It robs children of their parents, and society of its productive citizens. Limited budgets and ungrounded stigma have severely hampered a scaled-up nationwide response. Positive rhetoric is helpful, but it needs to be matched by personal commitment and concrete actions. With the infusion of new resources, now is the time to remove the log jams and unleash a broad-based national effort to change the current course of the epidemic. As the Secretary General of the United Nations Kofi Annan recently said, "We have come a long way, but not far enough. Clearly, we will have to work harder to ensure that our commitment is matched by the necessary resources and action." (excerpt)
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  13. 13

    Debt, adjustment and the politics of effective response to HIV / AIDS in Africa.

    Cheru F

    In: Global health and governance. HIV / AIDS, edited by Nana K. Poku and Alan Whiteside. Basingstoke, England, Palgrave Macmillan, 2003 Dec. 109-122.

    Today in much of Africa economic growth has slowed and living standards for the majority have suffered in the face of rising unemployment and mass poverty, resulting in incomes that are presently below the 1970 level. One problem that has been the focus of much attention and contention over the past 20 years is the huge foreign debt owed by African countries to bilateral donors and multilateral institutions. Debt servicing is consuming a disproportionate amount of scarce resources at the expense of the provision of basic services to the poor. In order to receive help in servicing their debts, countries must agree to implement structural economic reforms. This often entails drastic cuts in social expenditures, the privatisation of basic services, and the liberalisation of domestic trade consistent with WTO rules. These policy decisions have had a direct impact on the capacity of African countries to promote, fulfill and protect the right to health of their citizens. This is further compounded by ill-conceived privatisation of basic services such as water and health services, without any regard for the ability of the poor to access these essential services at a cost they can afford. Finally, adherence to WTO trade rules, which often comes as an extension of liberalisation policy, hampers the capacity of African governments to produce or purchase less expensive generic drugs for their citizen without fear of retaliation from the developed countries. (author's)
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  14. 14

    Access to HIV treatment and care. Fact sheet.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 2004 Jul 6. [2] p.

    The global community is at a crossroads in expanding access to HIV treatment and care. Never before have the opportunities been so great: unprecedented political will in countries; unprecedented financial resources to fund treatment, care and support; and unprecedented affordability of medicines and diagnostics. Despite these extraordinarily positive conditions, access to antiretroviral treatment and other HIV-related disease care remains abysmally low. As part of addressing this emergency, UNAIDS, WHO and their partners are fully committed to getting 3 million people on antiretrovirals by the end of 2005. (excerpt)
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  15. 15

    Economic analysis of HIV / AIDS. Background paper.

    Bonnel R

    Washington, D.C., World Bank, AIDS Campaign Team for Africa, 2000 Sep. 16 p.

    HIV/AIDS is a major development crisis. Not since the Black Death devastated medieval Europe has humankind observed infectious disease deaths on such a scale. Life expectancies, which rose steadily before the onset of the HIV epidemic, are decreasing in nearly all the 25 countries where the adult prevalence rate exceeds 5 percent. In the countries most heavily affected by HIV/AIDS, life expectancy is projected to fall to about 30 years by 2010– a level not seen since the beginning of the 20th century. Various factors related to poverty, inequality, gender inequality, sexually transmitted infections, social norms, political and social changes, including labor migration, conflicts and ethnic factions have facilitated the rapid spread of HIV. But what has enabled HIV/AIDS to undermine economic and social development is its unprecedented erosion of some of the main determinants of economic growth such as social capital, domestic savings and human capital. For these reasons, the HIV epidemic has been transformed from a health issue into a much wider issue impairing economic and social development. Because it prevents an increasing share of the population from participating in economic growth, the HIV/AIDS epidemic increases poverty. The result is a vicious circle whereby HIV/AIDS reduces economic growth and increases poverty, which in turn accelerates the spread of HIV. Preventing further spread of HIV/AIDS, in addition to providing care and support programs to those both affected and infected by this epidemic, requires early intervention and the mobilization of external resources. The purpose of this paper is to discuss and quantify the economic rationale that underlies such an effort. (excerpt)
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  16. 16

    Public report. First meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, January 23-24, 2003, Geneva, Switzerland.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]. Global Reference Group on HIV / AIDS and Human Rights

    Geneva, Switzerland, UNAIDS, 2003. 13 p.

    There is more than 20 years of experience showing that the promotion and protection of human rights is critical to mitigating the impact of HIV/AIDS epidemic on peoples lives. However, the integration of human rights into HIV/AIDS work is increasingly under attack by governments and public health officials. The field is therefore now at an important juncture of it's history. There is a growing and crucial need for efforts that would highlight the effectiveness of the diverse ways in which the connections between HIV/AIDS and human rights are being understood and worked on. It is most critical to continue to keep abreast of and address current human rights issues in relation to HIV/AIDS. It is also essential to consider what is needed to collect the evidence of what has been effective; and to develop better ways to ensure that rights are genuinely integrated into the HIV/AIDS work happening within countries. To help meet these goals, the Joint United Nations Programme on HIV/AIDS (UNAIDS) established a Global Reference Group on HIV/AIDS and Human Rights (Reference Group). This technical group has been put together to serve as an independent advisory body to UNAIDS, including Secretariat and Cosponsors and other organizations involved in policy, advocacy, programme development, implementation, monitoring, evaluation, research and training related to a rights-based approach to HIV/AIDS. In fulfilling its mandate, the Reference Group will liaise closely with other UNAIDS Reference Groups, namely, HIV/AIDS Estimates, Modeling and Projections; the International AIDS Economic Network; the Reference Group on Injection Drug Use; and the Reference Group on Epidemiology. The Reference Group will cover a wide range of topics including, but not limited to the following: 1. Stocktaking of standards and approaches to integrating human rights in the response to HIV/AIDS leading to a common methodology for analysis and terminology. 2. The development of rights-based indicators, including those to monitor HIV/AIDS risk, vulnerability and impact reduction. 3. The development of human rights and legal guidelines and methods to support countries in the design of national AIDS strategies, policies, and legislation. 4. The development of a strategic approach for integration of HIV/AIDS-related issues in UN human rights treaty bodies, charter-based bodies and other human rights mechanisms. (excerpt)
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