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The practice of charging user fees at the point of service delivery for HIV / AIDS treatment and care.
Geneva, Switzerland, WHO, 2005 Dec.  p. (WHO Discussion Paper; WHO/HIV/2005.11)The global movement to expand access to antiretroviral treatment for people living with HIV/AIDS as part of a comprehensive response to the HIV pandemic is grounded in both the human right to health and in evidence on public-health outcomes. However, for many individuals in poor communities, the cost of treatment remains an insurmountable obstacle. Even with sliding fee scales, cost recovery at the point of service delivery is likely to depress uptake of antiretroviral treatment and decrease adherence by those already receiving it. Therefore, countries are being advised to adopt a policy of free access at the point of service delivery to HIV care and treatment, including antiretroviral therapy. This recommendation is based on the best available evidence and experience in countries. It is warranted as an element of the exceptional response needed to turn back the AIDS epidemic. With the endorsement by G8 leaders in July 2005 and UN Member States in September 2005 of efforts to move towards universal access to HIV treatment and care by 2010, health sector financing strategies must now move to the top of the international agenda. Rapid scale-up of programmes within the framework of the "3 by 5" target has underscored the challenge of equity, particularly for marginalized and rural populations. It is apparent that user charges at the point of service delivery "institutionalize exclusion" and undermine efforts towards universal access to health services. Abolishing them, however, requires prompt, sustained attention to long-term health system financing strategies, at both national and international levels. (excerpt)
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)
SAfAIDS News. 2005 Sep; 11(3):2.Most people living with HIV and AIDS (PLWHA) are found in severely resource-constrained settings, where the pandemic continues to grow at an alarming rate, throwing into disarray the already enormous treatment challenge. High AIDS mortality rates are mainly experienced in sub-Saharan Africa, particularly in the southern Africa region. Yet recent events paint a gloomy picture regarding financial support for international remedial efforts against HIV and AIDS. There is uncertainty over continued funding of AIDS programmes in the future, forcing us to ask tough questions such as whether the aim of providing antiretroviral therapy (ART) to individuals clinically qualified to receive these medicines will be feasible and whether it will be possible to retain those already on treatment in the future. (excerpt)
Cambridge, Massachusetts, Management Sciences for Health [MSH], Guinea PRISM II Project, 2005 Oct. 59 p. (Development Experience Clearinghouse DocID / Order No: PD-ACH-471; USAID Cooperative Agreement No. 675-A-00-03-00037-00)The PRISM project (Pour Renforcer les Interventions en Santé Reproductive et MST/SIDA) is an initiative of the Republic of Guinea as part of its bilateral cooperation with the United States of America designed to increase the utilization of quality reproductive health services. The project is funded by the United States Agency for International Development (USAID) and is implemented by Management Sciences for Health (MSH) in collaboration with the John Hopkins University/Center for Communication Programs (JHU/CCP) and Engenderhealth. The project's intervention zones correspond to the natural region of Upper Guinea as well as Kissidougou prefecture, thus covering all of the 9 prefectures of Kankan and Faranah administrative regions. This annual report covers the activities and results of PRISM over the fiscal year 2005, October 1, 2004 to September 30, 2005. Like all of PRISM's activity reports, the present report is structured according to the 4 intermediate result areas: (1) increased access to reproductive health services and products, (2) improved quality of services at health facilities, (3) increased demand of reproductive health services and products (4) improved coordination of health interventions. The report consists of three parts. The first part presents the introduction, an executive summary, and the summary of the principal results attained over the course of the year in each of the four intermediate results (IR). The second part presents in detail for each IR the project's strategies and approaches, the implemented activities and the results attained over the course of the year. The third part presents the operational aspects having had an impact on the project over the course of the year. (excerpt)
Geneva, Switzerland, UNAIDS, 2005 Dec.  p. (UNAIDS/05.19E)Acquired Immunodeficiency Syndrome (AIDS) has killed more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed 3.1 million [2.8--3.6 million] lives in 2005; more than half a million (570 000) were children. The total number of people living with the human immunodeficiency virus (HIV) reached its highest level: an estimated 40.3 million [36.7--45.3 million] people are now living with HIV. Close to 5 million people were newly infected with the virus in 2005. There is ample evidence that HIV does yield to determined and concerted interventions. Sustained efforts in diverse settings have helped bring about decreases in HIV incidence among men who have sex with men in many Western countries, among young people in Uganda, among sex workers and their clients in Thailand and Cambodia, and among injecting drug users in Spain and Brazil. Now there is new evidence that prevention programmes initiated some time ago are finally helping to bring down HIV prevalence in Kenya and Zimbabwe, as well as in urban Haiti. The number of people living with HIV has increased in all but one region in the past two years. In the Caribbean, the second-most affected region in the world, HIV prevalence overall showed no change in 2005, compared with 2003. (excerpt)
Ensuring women's access to safe abortion: essential strategies for achieving the Millennium Development Goals.
Chapel Hill, North Carolina, Ipas, 2005.  pApproved by world leaders in September 2000, the Millennium Development Goals (MDGs) articulate a series of time-bound, quantitative targets for ending poverty, improving health and promoting gender equality. The MDGs lack, however, any mention of human rights or reproductive and sexual health. In particular, the MDG framework does not include the critical issue of abortion, despite the fact that unsafe abortion leads to the unnecessary and completely preventable deaths of women and is a persistent problem rooted in poverty, gender inequity and the failure to implement human rights. Over the past decade, the international community has committed itself in a series of political and legal agreements to promoting and fulfilling women’s and men’s sexual and reproductive rights. Governments at the International Conference on Population and Development (ICPD) in 1994 agreed to a definition of reproductive health that includes abortion in circumstances where it is legal under national legislation. The MDGs echo elements of the ICPD consensus, but none specifically address its core commitment to ensure universal reproductive-health services. At the Fourth World Conference on Women, held in Beijing in 1995, sexual rights were acknowledged as integral to human rights and women’s empowerment, and countries were encouraged to review restrictive abortion laws. (excerpt)
Studies in Family Planning. 2005 Dec; 36(4):311-315.Women in many countries are often denied vital family planning services if they are not menstruating when they present at clinics, for fear that they might be pregnant. A simple checklist based on criteria approved by the World Health Organization has been developed to help providers rule out pregnancy among such clients, but its use is not yet widespread. Researchers in Guatemala, Mali, and Senegal conducted operations research to determine whether a simple, replicable introduction of this checklist improved access to contraceptive services by reducing the proportion of clients denied services. From 2001 to 2003, sociodemographic and service data were collected from 4,823 women from 16 clinics in three countries. In each clinic, data were collected prior to introduction of the checklist and again three to six weeks after the intervention. Among new family planning clients, denial of the desired method due to menstrual status decreased significantly from 16 percent to 2 percent in Guatemala and from 11 percent to 6 percent in Senegal. Multivariate analyses and bivariate analyses of changes within subgroups of nonmenstruating clients confirmed and reinforced these statistically significant findings. In Mali, denial rates were essentially unchanged, but they were low from the start. Where denial of services to nonmenstruating family planning clients was a problem, introduction of the pregnancy checklist significantly reduced denial rates. This simple, inexpensive job aid improves women's access to essential family planning services. (author's)
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)
Geneva, Switzerland, WHO, 2005.  p.AIDS Medicines and Diagnostics Service is a network that aims to increase access to good quality and effective treatments for HIV/AIDS by improving supply of antiretroviral medicines and diagnostics in developing countries. Goals: To ensure that the supply of quality commodities is never an obstacle to expanding treatment, care and support; To use improved commodity supply to catalyze rapid expansion of treatment, to promote equity, and to support prevention. (excerpt)
Habitat Debate. 2005 Mar; 11(1): p..In all societies, men have better access to superior transport, be it more regular use of the family car or disposable income to take public transport instead of walking. The lack of mobility generally, let alone poorer job and educational opportunities, plays an important and under-appreciated role in perpetuating the economic disadvantages of women. Gender inequality in transport is a consequence of social organization and the outcome of differential access to economic, time and other resources. The greater domestic responsibilities of women, coupled with weaker access to household resources, have significant consequences for their transport an travel status. In many parts of the world, women also face customary or legal restraints, their rights to travel or a particular mode of transport with violations often resulting in physical harassment. Personal safety and avoiding harassment are major preoccupations whether women drive, use public transport, cycle or walk. They are especially vulnerable to violent attacks or sexual abuse when transporting heavy goods or with accompanying children. (excerpt)
Habitat Debate. 2005 Mar; 11(1): p..Access to adequate sanitation in urban areas remains one of the most under-funded and undervalued development objectives among the international community. Although Millennium Development Goal 7, Target 11 broadly refers to improving the lives of slum dwellers by 2020, and Target 10 talks of improving access to safe drinking water, not one of the other targets specifically talk of improving sanitation. It was only at the World Summit on Sustainable Development in 2002 that access to sanitation was finally recognized as an internationally agreed target. The Summit agreed to “halve, by 2015, the proportion of people who do not have access to basic sanitation”. UN-HABITAT, in recognition of this important target, has also incorporated it in its slum definition, and will be monitoring this target as part of its global monitoring of slum conditions. National statistics on access to sanitation also under-rate and understate the problem. Hundreds of millions of urban dwellers, “with sanitation facilities” only have access to a poorly-maintained latrine shared with dozens of other people often outside their homes. (excerpt)
WHO clinical staging of HIV infection and disease, tuberculosis and eligibility for antiretroviral treatment: relationship to CD4 lymphocyte counts.
International Journal of Tuberculosis and Lung Disease. 2005 Mar; 9(3):258-262.Setting: Thyolo district, Malawi. Objectives: To determine in HIV- positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). Design: Cross-sectional study. Methods: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. Results: A CD4 lymphocyte count of =350 cells/µl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. Conclusions: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of =350 cells/µl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy. (author's)
Lancet. 2005 Jul 9; 366(9480):169-171.How can we assure fair treatment in selecting HIV/AIDS patients for antiretroviral treatment? Who should be selected and how? I set aside older ethical and policy controversies about prevention versus treatment and address instead the urgent issue created by the WHO goal of treating 3 million by 2005. By WHO criteria, the goal means selection of only 3 of the 6 million people who would benefit. How should we pick the lucky 3 million, assuming countries develop or scale up their capacity to deliver antiretroviral treatments and patient demand for them is great? Unfortunately, we lack agreement on ethical principles that can resolve key policy decisions involved in scaling up treatments, including those relating to cost recovery, patient eligibility, siting of treatment centres, and giving priority to special groups. As a result, equality in outcomes can only be established through a fair, deliberative process that is transparent, encourages relevant stakeholders to deliberate on relevant reasons, provides room for revising decisions, and enforces adherence to the process. Of course, basic human rights considerations, such as universal access and prohibition on discrimination, act as necessary constraints on these processes and outcomes. (excerpt)
Journal of the Association of Nurses in AIDS Care. 2005 May-Jun; 16(3):41-51.Children in Southern Africa are living under extreme, difficult circumstances because of the spread of HIV/AIDS. Protecting and enhancing the rights of children can be regarded as an investment in the future. The principles identified in the World Fit for Children document from the United Nations International Children’s Emergency Fund, within the context of HIV/AIDS, were used as a theoretical framework for a study conducted in one of the provinces of South Africa. A survey was conducted as a collaborative research project to map out critical trends regarding the fulfillment of children’s rights, patterns, and structures of services available and the identification of capacity gaps. Right holders and duty bearers were interviewed, area surveys were conducted, and field observations were performed to determine data. Recommendations were made to raise the awareness of children’s rights and to mobilize the community into action. To realize children’s rights, emphasis must be placed on physical survival, development, and protection. Duty bearers should recognize and accept their responsibilities to establish, facilitate, manage, and/or control plans of action to address the devastating consequences of HIV/AIDS. Children should be empowered with knowledge, skills, and awareness to engage in and claim their rights. (author's)
As Niger's emergency eases, another crisis looms. [Niger : la situation d'urgence ne s'apaise que pour faire place à une autre crise]
Lancet. 2005 Sep 24; 366(9491):1065-1066.The influx of international aid into Niger and the pending harvest has eased the plight of 3 million people at risk of starvation. But as the crisis recedes in the Sahel region, the UN has sounded the alarm about the deadly combination of drought, poverty, and HIV/AIDS in southern Africa. The UN estimates that up to 10 million people in Lesotho, Malawi, Mozambique, Swaziland, Zimbabwe, and Zambia will need assistance during the next 6 months. Aid groups such as CARE International warn that the scale and complexity of the southern African crisis will dwarf that of the Sahel. Zimbabwe is particularly at risk because of the accelerating economic and agricultural collapse, compounded by President Robert Mugabe’s recent clampdown on shack dwellers and street traders, which left some 700 000 people without a home or a job. The UN forecasts that up to 4 million people may need aid but has been unable to launch an appeal for funds because the government refuses to acknowledge the emergency. (excerpt)
Reproductive Health Matters. 2005; 13(25):106-108.The year 2005 is a pivotal year for ensuring that sexual and reproductive health are fully addressed in the implementation and monitoring of the Millennium Development Goals (MDGs). When the MDGs were developed following the Millennium Summit in 2000, no goal was included on sexual and reproductive health, for reasons that are now history. Matters that have an impact on, or are components of, sexual and reproductive health were included – maternal and child health, HIV/AIDS, gender equality and education – but sexual and reproductive health were left out. This year, however, there are real opportunities to redress the imbalance and to ensure that sexual and reproductive health are there for the rest of the time earmarked for the implementation of the MDGs, i.e. in the ten years to 2015. Targets and indicators were set shortly after the MDGs were agreed. As far as maternal health was concerned the target set was the reduction of maternal mortality by two-thirds and for HIV/AIDS of halting and beginning to reverse the spread of HIV/AIDS, both by 2015. Whole other areas are not included, however, especially access to contraceptive services. There is an increasing trend among donor governments to tie development aid to the MDGs, and to use monitoring of implementation of the MDGs for this purpose. Hence, implementation of the Programme of Action of the International Conference on Population and Development 1994 would be more easily achieved if targets for achieving sexual and reproductive health were fully integrated into the MDG process. (excerpt)
Population 2005. 2002 Sep-Oct; 4(3):8.The HIV/AIDS epidemic shows no sign of leveling off in the hardest hit countries and as much as $10 billion is needed annually to fight it effectively, according to UNAIDS Executive Director Peter Piot. Addressing the 14th international AIDS conference in Barcelona in July, Mr. Piot said that unless the global community provided more assistance to countries with high rates of HIV/AIDS, like debt relief, there could be catastrophic results. “The epidemic hit the world 20 years ago but we failed to contain the increase in HIV cases. The answers point towards politics, power and priorities. $10 billion is needed annually to combat the menace,” he said. Mr. Piot told his audience they must mobilize political support, scale up AIDS prevention and treatment, eliminate stigma, develop a vaccine and arrange funds to fight the disease. (excerpt)