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Geneva, Switzerland, UNAIDS, 2010 Dec.  p. (UNAIDS/10.12E/JC2034E)This Strategy has been developed through wide consultation, informed by the best evidence and driven by a moral imperative to achieve universal access to HIV prevention, treatment, care and support and the Millennium Development Goals.
Geneva, Switzerland, UNAIDS, 2011.  p.30 years into the AIDS epidemic, 30 milestones, thoughts, images, words, artworks, breakthroughs, inspirations, and ideas in response.
Millennium Development Goal 8, The Global Partnership for Development: Time to deliver. MDG Gap Task Force Report 2011.
New York, New York, United Nations, 2011.  p.The objective of MDG 8 is to assist all developing countries in achieving the goals through a strengthened global partnership for international development cooperation. The present report describes how that partnership is producing significant results on many fronts, but notes that many important gaps between expectations and delivery remain. (Excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2010.  p. (Discussion Paper Series on Social Determinants of Health No. 2)Complexity defines health. Now, more than ever, in the age of globalization, is this so. The Commission on Social Determinants of Health (CSDH) was set up by the World Health Organization (WHO) to get to the heart of this complexity. They were tasked with summarizing the evidence on how the structure of societies, through myriad social interactions, norms and institutions, are affecting population health, and what governments and public health can do about it. To guide the Commission in its mammoth task, the WHO Secretariat conducted a review and summary of different frameworks for understanding the social determinants of health. This review was summarized and synthesized into a single conceptual framework for action on the social determinants of health which was proposed to and, largely, accepted by, the CSDH for orienting their work. A key aim of the framework is to highlight the difference between levels of causation, distinguishing between the mechanisms by which social hierarchies are created, and the conditions of daily life which then result. This paper describes the review, how the proposed conceptual framework was developed, and identifies elements of policy directions for action implied by the proposed conceptual framework and analysis of policy approaches. (Excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2010.  p. (Discussion Paper Series on Social Determinants of Health No. 1)Today an unprecedented opportunity exists to improve health in some of the world's poorest and most vulnerable communities by tackling the root causes of disease and health inequalities. The most powerful of these causes are the social conditions in which people live and work, referred to as the social determinants of health (SDH). The Millennium Development Goals (MDGs) shape the current global development agenda. The MDGs recognize the interdependence of health and social conditions and present an opportunity to promote health policies that tackle the social roots of unfair and avoidable human suffering. The Commission on Social Determinants of Health (CSDH) is poised for leadership in this process. To reach its objectives, however, the CSDH must learn from the history of previous attempts to spur action on SDH. This paper pursues three questions: (1) Why didn't previous efforts to promote health policies on social determinants succeed? (2) Why do we think the CSDH can do better? (3) What can the Commission learn from previous experiences -- negative and positive -- that can increase its chances for success? (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)
Oxford, England, Oxfam International, 2006. 122 p.This report shows that developing countries will only achieve healthy and educated populations if their governments take responsibility for providing essential services. Civil society organisations and private companies can make important contributions, but they must be properly regulated and integrated into strong public systems, and not seen as substitutes for them. Only governments can reach the scale necessary to provide universal access to services that are free or heavily subsidised for poor people and geared to the needs of all citizens -- including women and girls, minorities, and the very poorest. But while some governments have made great strides, too many lack the cash, the capacity, or the commitment to act. Rich country governments and international agencies such as the World Bank should be crucial partners in supporting public systems, but too often they block progress by failing to deliver debt relief and predictable aid that supports public systems. They also hinder development by pushing private sector solutions that do not benefit poor people. The world can certainly afford to act. World leaders have agreed an international set of targets known as the Millennium Development Goals. Oxfam calculates that meeting the MDG targets on health, education, and water and sanitation would require an extra $47 billion a year. Compare this with annual global military spending of $1 trillion, or the $40 billion that the world spends every year on pet food. (excerpt)
Lancet. 2006 Nov 4; 368(9547):1552-1554.In September, 1994, thousands of policymakers, activists, health specialists, and members of the donor community gathered in Cairo, Egypt, for what turned out to be a unique UN International Conference of Population and Development (ICPD), a true turning point. The Cairo conference put the ideas of comprehensive sexual and reproductive health and rights, choice, women's empowerment, a life-cycle approach, and gender equity at the centre of the international agenda, and signalled the end of the so-called population era. Instead of pursuing demographic targets via family-planning programmes, the goals of the ICPD Programme of Action (signed by 179 countries) were to achieve universal access to safe, affordable, and effective reproductive health care and services, including those for young people, and promoted a gender perspective. The package of services incorporated family planning information and contraceptives, skilled care at pregnancy and childbirth, safe abortion services where and when abortion is legal, and treatment and management of sexually transmitted infections and HIV/AIDS. Governments set a realistic timeframe of 20 years, to accomplish the goals established in the Programme of Action. (excerpt)
The 10-year struggle to provide antiretroviral treatment to people with HIV in the developing world.
Lancet. 2006 Aug 5; 368(9534):541-546.In March, 2006, the WHO took stock of the 3 by 5 initiative, which had been formally launched with UNAIDS 2 years earlier. With 1.3 million people on antiretroviral treatment in developing countries by the end of 2005, the world had not reached the target of treating 3 million people living with HIV/AIDS. In terms of numbers, at least, some said that the campaign failed. But the initiative did show that with the right vision and a determined effort by all relevant parties, development achievements that seem unthinkable are indeed possible. The apparent failure to achieve what was always an aspirational goal should not overshadow the fact that the progress on access to antiretroviral treatment might have no precedent in global public health. For no other life-threatening disease has the world moved from the first scientific breakthroughs to a commitment to achieve universal access to treatment in less than a decade. But we should not forget that the number of new HIV infections still outpaces the expansion of access to treatment, and that progress remains slow in view of the millions still dying from AIDS every year. (excerpt)
Choices. 2004; 7.I left the 1998 International AIDS Conference in Geneva frustrated and angry. The slogan of the conference--'Bridging the Gap'--was right on target, but none of the major players in the conference (the international agencies, governments, the big pharmaceutical companies) offered a vision, let alone a strategy, for making life-saving treatments available to the millions of HIV-positive people in poor and developing countries. As has been true since the beginning of the AIDS epidemic, it was left to HIV-positive people themselves and to advocacy groups to formulate demands, mobilize the political support to challenge the status quo and lead in the development of new policies. Dramatic changes have occurred between 1998's 'Bridging the Gap' and 2004's 'Access for All' conferences. In the intervening six years, an alliance of NGOs from around the world with a bloc of progressive poor and developing countries has won significant victories: It is no longer morally acceptable to do nothing about the death and suffering of millions; The broader global AIDS community has accepted that any effective approach to stopping the epidemic must include treatment as well as prevention and mitigation. (excerpt)
Bulletin of the World Health Organization. 2006 May; 84(5):337-424.Developing countries are failing to make full use of flexibilities built into the World Trade Organization's (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to overcome patent barriers and, in turn, allow them to acquire the medicines they need for high priority diseases, in particular, HIV/AIDS. First-line antiretroviral (ARV) drugs for HIV/AIDS have become more affordable and available in recent years, but for patients facing drug resistance and side-effects, second-line ARV drugs and other newer formulations are likely to remain prohibitively expensive and inaccessible in many countries. The problem is that many of these countries are not using all the tools at their disposal to overcome these barriers. Medicines protected by patents tend to be expensive, as pharmaceutical companies try to recoup their research and development (R&D) costs. When there is generic competition prices can be driven down dramatically. The TRIPS Agreement came into effect on 1 January 1995 setting out minimum standards for the protection of intellectual property, including patents on pharmaceuticals. Under that agreement, since 2005 new drugs may be subject to at least 20 years of patent protection in all, apart from in the least-developed countries and a few non-WTO Members, such as Somalia. Successful AIDS programmes, such as those in Brazil and Thailand, have only been possible because key pharmaceuticals were not patent protected and could be produced locally at much lower cost. For example, when the Brazilian Government began producing generic AIDS drugs in 2000, prices dropped. AIDS triple-combination therapy, which costs US$ 10 000 per patient per year in industrialized countries, can now be obtained from Indian generic drugs company, Cipla, for less than US$ 200 per year. This puts ARV treatment within reach of many more people. (excerpt)
Bulletin of the World Health Organization. 2005; 83:948-953.Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. Our recommendations regarding research priorities for health equity are based on an assessment of what information is required to gain an understanding of how to make substantial reductions in health inequities. We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people’s chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas. (author's)
In: Thematic compilation of General Assembly and Economic and Social Council resolutions, [compiled by] United Nations High Commissioner for Refugees [UNHCR]. Geneva, Switzerland, UNHCR, 2003 Feb 1. 515-538.The provisions reproduced below call upon States to ensure access for refugee and displaced women to emergency relief, health programmes, counselling services, and material assistance. GENERAL ASSEMBLY RESOLUTIONS: Calls upon all States and donors providing immediate relief to refugees and displaced persons to endeavour to lessen the special vulnerability of women in these circumstances, by ensuring their access to emergency relief and to health programmes, and. their active participation in decision making in centres or camps for refugees or displaced persons; Further calls upon all States and donors assisting in the rehabilitation, resettlement or repatriation of refugees and displaced persons to recognize the pivotal role of the mother in the family, and thus in the provision of family welfare, to ensure women's rights to physical safety and to facilitate their access to counselling services and material assistance. (excerpt)
How was the UNAIDS drug access initiative implemented in Chile? [¿En qué consistió la iniciativa de acceso a las drogas ONUSIDA implementada en Chile?]
Evaluation and Program Planning. 2004 Aug; 27(3):295-308.In 1997, UNAIDS decided to implement Drug Access Initiatives (DAI) in four different pilot-countries. We studied the implementation of the DAI in Chile as part of the evaluation program conducted by the ‘Agence Nationale de Recherche sur le SIDA’ (ANRS/France). The objective was to understand how the politico-organizational dynamic influenced the implementation process of the DAI. Approximately 50 semi-directed interviews and observation activities were conducted with the actors who participated in the implementation of the DAI or who played a role in the HIV/AIDS context. The program theory models were established and their evolution analyzed. This article offers an original analysis of an international HIV/AIDS drug access program that was put in place at a time when such programs were seen as a priority by international and governmental institutions. It also offers some insights for the creation of international projects that will be locally implemented. (author's)
Sex work and HIV / AIDS. UNAIDS technical update. [Prostitución y VIH/SIDA. Actualización técnica de ONUSIDA]
Geneva, Switzerland, UNAIDS, 2002 Jun. 19 p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)This Technical Update focuses on the challenges involved in the protection of sex workers (and, subsequently, the general population) from HIV infection, and discusses the key elements of various effective interventions. Significantly higher rates of HIV infection have been documented among sex workers and their clients, compared with most other population groups. Though sex work is often a significant means of HIV infection entering the general population, studies indicate that sex workers are among those most likely to respond positively to HIV/STI prevention programmes—for example, by increasing their use of condoms with clients. This document explores the many issues involved in providing care and support for sex workers, preventing entry into sex work, and reducing risk and vulnerability through programmes at the individual, community and government levels. (author's)
JOURNAL OF TROPICAL PEDIATRICS. 1989 Aug; 35(4):197-8.The 'Child Survival Revolution' (CSR) which emphasizes the technological approaches of Primary Health Care (PHC) as defined in Alma Ata, disregards the structural conditions and processes that lead to seldom diminishing morbidity and mortality rates among the poor in the Third World. The CSR may save some lives, but will not attack the underlying and basic causes of child mortality in developing countries. We must not rely on GOBI as a technical solution to what is essentially a socioeconomic and political problem. Choices to seek or not to seek better health for family members are all intimately linked to the state of poverty of most potential beneficiaries of GOBI-FF. Some additional empowerment of the people is needed for meaningful choices to become realistic options. GOBI-FF and the CSR are a combination of new technologies communicated by social marketing with mostly a top-down implementation, taking for granted the existing social and political institutions. Although the messages of the program call for political will, for social mobilization, for involvement of the population, and for changes in the health infrastructure, these concepts are used in a very inconsistent, demagogic, fuzzy and empty way. GOBI is too strongly supply oriented and ignores the social constraints behind a weak demand for the effective utilization of existing or new health services. Third World countries often end up following rules dictated from or set-up outside the country. Social marketing too, makes people mostly consumers, not protagonists and promoters. People need access to significant remedial interventions; knowledge is not enough. Evidence shows that people are 'patterning' their behavior to what the provider wants from them just to receive the program's benefits. Health professionals must help create the necessary support systems to empower the poor. (author's modified)
Washington, D.C., PAHO, Pan American Sanitary Bureau/Regional Office of the World Health Organization, 1985. xix, 265 p. (Official Document No. 201)Efforts to meet the goal of health for all by the year 2000 have been hampered by the internal and external problems faced by many countries of the Americas. The pressures of external debt have been accompanied by a reduction in the resources allocated to social sector programs, including health programs. In addition, the conflict in Central America has constrained solutions to subregional problems. The health sector suffers from uncoordinated services, lack of trained personnel, and waste. Thus 30-40% of the population do not have access to basic health services. In 1984, the governments in the region, together with the Pan American Health Organization (PAHO), undertook projects in 5 action areas: new approaches and technology, development, intra- and intersectoral linkages, joint activities by groups of countries, mobilization of national resources and external financing, and preparation of PAHO to meet the needs of these processes. New approaches include the expansion of epidemiological capabilities and practices, the use of low-cost infant survival strategies, the improvement of rural water supplies, and the development of domestic technology. Interorganizational linkages are aimed at eliminating duplication and filling in gaps. Ministers of health and directors of social security programs are working together to rationalize the health sector and extend coverage of services. Similarly, countries have grouped to deal with common problems and offer coordinated solutions. The mobilization of national resources involves shifting resources into the health field and increasing their efficiency and effectiveness by setting priorities. External resources are recommended if they supplement national efforts and are short-term in nature. In order to enhance these strategies, PAHO has increased the managerial and operating capacity of its central and field offices. This has required consolidating programs, retraining staff, and instituting information systems to monitor activities and budgets. The report summarizes health indicators and activities by country, for all nations under PAHO.
Journal of Family Law. 1981-1982; 20(2):241-61.Abortion, a topic which challenges the religious and moral values of many individuals, has an impact on population control relied upon by some nation-states in achieving economic and social development. This is seen in India, and previously in the Eastern European states of Czechoslovakia, Bulgaria, East Germany, Hungary, Poland and Romania after WW II. In these states abortion is accepted largely for economic reasons. Abortion has strongly emerged as an issue in the development of international law, particularly in the area of human rights. This article studies that emergence by looking at the right to privacy, its expression in various human rights documents, and both the restrictive and liberal view of its application to woman's right to terminate a pregnancy, without external interference. The fetus' right to life is discussed and finally the interests of women, the fetus, and the public are analyzed to determine the importance of each of these interests to world peace and public order. International human rights agreements, e.g., the Universal Declaration on Human Rights, express the right to privacy in general terms, making it difficult to determine the scope of the right. In a case brought before the European Commission on Human Rights, 2 West German nationals' claimed the scope of the right to privacy includes the right of the woman to decide whether to terminate her pregnancy the commission held that such interference was not a breach of the woman's right to respect for her private life. The primary goal of human rights is to establish maximum respect for the individual and it is in this context that the right of a woman to choose to terminate a pregnancy is analyzed. Autonomy is an element of respect for the individual. Denying women the legal right or information to control fertility limits their ability to control their health, educational, political, social and cultural status. The fact that fertility control substantially affects the status of women is recognized in international human rights agreements. Sex equality is achieved by giving women the right to abortion. Legal proscriptions against abortion are inconsistent with the goals and objectives of human rights, especially the individual woman's right to respect and autonomy.
Washington, D.C., World Bank, 1984. 36 p. (International Conference on Population, 1984; Statements)In his address to national leaders in Nairobi, Kenya, Clausen expresses his views on population growth and development. Rapid population growth slows development in the developing countries. There is a strong link between population growth rates and the rate of economic and social development. The World Bank is determined to support the struggle against poverty in developing countries. Population growth will mean lower living standards for hundreds of millions of people. Proposals for reducing population growth raise difficult questions about the proper domain of public policy. Clausen presents a historical overview of population growth in the past 2 decades, and discusses the problem of imbalance between natural resources and people, and the effect on the labor force. Rapid population growth creates urban economic and social problems that may be unmanageable. National policy is a means to combat overwhelmingly high fertility, since governments have a duty to society as a whole, both today's generation and future ones. Peoples may be having more children than they actually want because of lack of information or access to fertility control methods. Family planning is a health measure that can significantly reduce infant mortality. A combination of social development and family planning is needed to teduce fertility. Clausen briefly reviews the effect of economic and technological changes on population growth, focusing on how the Bank can support an effective combination of economic and social development with extending and improving family planning and health services. The World Bank offers its support to combat rapid population growth by helping improve understanding through its economic and sector work and through policy dialogue with member countries; by supporting developing strategies that naturally buiild demand for smaller families, especially by improving opportunities in education and income generation; and by helping supply safe, effective and affordable family planning and other basic health services focused on the poor in both urban and rural areas. In the next few years, the Bank intends at least to double its population and related health lending as part of a major effort involving donors and developing countries with a primay focus on Africa and Asia. An effective policy requires the participation of many ministeries and clear direction and support from the highest government levels.
Planned Parenthood Review. 1984 Spring-Summer; 4(1):18.Since the beginning in 1971 of the Planned Parenthood Federation of America's international program, Family Planning International Assistance (FPIA), US$54 million has been contributed in direct financial support for the operation of over 300 family planning programs in 51 countries; over 3000 institutions in 115 countries have been supplied with family planning commodities, including over 600 million condoms, 120 cycles of oral contraceptives, and 4 million IUD; and about 1 million contraceptive clients were served by FPIA funded projects in 1982 aone. Since 1971, however, the world's population has increased from 3.7 billion to around 4.7 billion people. About 85 million people are added to the world each year. There is consensus that without organized family planning programs, today's world population would be even higher. FPIA measures its progress in terms of expanding the availability of contraceptive services in devloping countries. FPIA supported projects have helped make services available in areas previously lacking them, and has helped involve a wide variety of organizations, such as women's groups, youth organizations, and Red Cross Societies, in family planning services. A prime concern of FPIA, which has limited resources, is what happens to projects once FPIA support is terminated. FPIA has been paying attention to local income generation to help projects become more self-supporting and to increas staff members' management skills. The more successful income-generating schemes appear to be directly related to family planning, selling contraceptives and locally produced educational materials, and charging fees for family planning and related medical services and tuition for training courses. FPIA funded to projects use management by objectives (MBO) to help improve management skills. MBO helps grantees improve their ability to set objectives, plan, monitor, report, and do day-to-day project management.
The human right to family planning. Report of the Working Group on the Promotion of Family Planning as a Basic Human Right to the Members' Assembly and the Central Council of the International Planned Parenthood Federation, November 1983.
London, International Planned Parenthood Federation, 1984. 52 p.This report examines the problems involved in the exercise of the right to family planning; reviews the approaches taken towards overcoming these problems and promoting the right to family planning at local, national, and international levels, including the experience of the International Planned Parenthood Federation (IPPF); and makes recommendations to the 1983 meetings of the Central Council and the Members' Assembly on the action that should be taken by the IPPF and its members to enhance the commitment to family planning as a basic human right during 1982-84 Plan and beyond. The report's 5 sections discuss the following: the concept of the right to family planning (historical background and a conceptual elaboration); links between the right to family planning and other human rights (basic human rights and needs, advocacy for social development, and women's rights); access to fertility regulation information and services (full and voluntary choice of methods, rights of young people, financial accessibility of fertility regulation services, and the right to have children); incentives and disincentives to individuals and couples, incentives to providers of fertility regulation information and services, and research needs; and strategies for promoting family planning as a basic human right (ensuring that the individual has the knowledge of the right to fertility regulation and understands the options, generating societal support for family planning, ensuring ready access to the means ror fertility regulation, legal support for the right to family planning, and increasing political commitment to the right to family planning). The application of the term "the right to family planning" to many different elements of personal and social behavior as well as to policy making and program development has led to some confusion and potential conflict between rights and responsibilities. It is recommended that a clear distinction be made in the definition of the right to family planning to reflect 2 important components, namely, the right of everyone to have ready access to information, education, and services for fertility regulation; and the right of everyone to make decisions about reproductive behavior. Family planning organizations canachieve institutional credibility as caring organizations and assure program effectiveness by encouraging the recognition of the links between the right to family planning and the right to other social and economic improvements that are the essence of development.
Population and the role of the family, statement made at the Scientific Conference on Family and Population, sponsored by the International Union of Family Organizations, Hanasaari, Espoo, Finland, 26 May, 1984.
New York, N.Y., UNFPA, . 5 p. (Speech Series No. 112)The family is the fundamental guarantor of the past, present and future of society. The social norms and values of a culture are transmitted from generation to generation through the family. Through the family, fresh influences are modulated and filtered and eventually harmonized with accepted norms. It is a highly influential instrument of social change. The family is also the guardian of social stability. In many developing countries the major social change affecting the family has been the fall in fertility which has been going on since the mid-1960s and has become a definite trend. The implication of lower fertility is that the nuclear family will become more socially significant than the extended family. This raises questions such as the role and care of the elderly, and women's role as workers outside the home. 2 main considerations are imbedded in the recommendations to the International Conference on Population in 1984: 1) that free choice in the size and spacing of the family is a basic human righ and that access to informatin and the means of family planning is a part of that right; 2) that it is the right and responsibility of governments to develop and implement population policies in the context of national development goals. These twin principles of respect for the rights of individuals and respect for national sovereignty are fundamental to all international agreements and action in population.