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Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach.
International Journal of Adolescent Medicine and Health. 2016 Nov 10; 30(2)The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-a-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.
Geneva, Switzerland, UNAIDS, 2017. 12 p.People who use and inject drugs are among the groups at highest risk of exposure to HIV, but remain marginalized and out of reach of health and social services.
Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.
Permanente Journal. 2016 spring; 20(2):59-70.The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.
Characterizing the HIV/AIDS epidemic in the Middle East and North Africa: time for strategic action.
Washington, D.C., World Bank, 2010.  p. (World Bank Report No. 54889)This study is a continuation of the previous sector review, conducted in 2004. The 2008 review had two main objectives. This review is primarily an update on the situation. In its development strategy, Benin gave considerable importance to the health of its population. This effort is part of the long-term vision of the country. Improving health status, especially for the poor, is one of eight strategic directions for that vision. Similarly, on a more operational level, this objective is reflected in the current Growth Strategy for Poverty Reduction (GPRS 2007-2009). Benin is particularly committed towards the Millennium Development Goals, including 3 on the health sector. This review was also an opportunity to further analyze the constraints in the health system, consistent with the new strategy Health Nutrition and Population World Bank, Strategy adopted in 2007. But this exercise was not intended merely to be analytical. It also aimed to enrich the political dialogue between, on one hand, the actors in health and, secondly, the World Bank and other development partners. This effort relates more specifically to some themes such as governance, private sector involvement and alignment of partners' efforts (called technical and financial partners in Benin or PTFs). From this perspective, the journal is also a contribution to Benin's efforts to advance the IHP (International Health Partnership Plus). This initiative is now the main tool for implementing the Paris Declaration. In practice, the journal has sought to contribute to the consensus between the Ministry of Health and the donor group on the diagnosis of the health system and the changes needed to strengthen it. Several guidelines have emerged stronger from this discussion, particularly in the area of governance of the health system. Beyond the reinforcement of the various components of the health system, two fundamental principles should guide the transformation of this system: 1) A principle of corporate governance: through decentralization of the health system, health facilities must have their basic needs better taken into account (hence the need for bottom-up planning) and especially as more independent financially administrative; and 2) A principle of individual governance: health workers should be strongly encouraged to improve their performance (competence, productivity and compliance of patients). Given the limited success of measures to strengthen inspections and other controls "top-down, this incentive can only come from clients, either directly (i.e., bonuses based on cost recovery), or preferably indirectly with a mechanism for payment by results funded by the state and possibly partners.
Journal of the European Economic Association. 2012 Oct; 10(5):1025-1058.This paper estimates whether exports affect the incidence of HIV in Africa. This relationship has implications for HIV prevention policy as well as for the consequences of trade increases in Africa. I estimate this impact using two sources of data on HIV incidence, one generated based on UNAIDS estimates and the other based on observed HIV mortality. These data are combined with data on export value and volume. I find a fairly consistent positive relationship between exports and new HIV infections: doubling exports leads to a 10%-70% increase in new HIV infections. Consistent with theory, this relationship is larger in areas with higher baseline HIV prevalence. I interpret the result as suggesting that increased exports increase the movement of people (trucking), which increases sexual contacts. Consistent with this interpretation, the effect is larger for export growth than for income growth per se and is larger in areas with more extensive road networks.
New York, New York, United Nations Population Fund, HIV/AIDS Branch, . 8 p. (Guidance Brief)This Brief has been developed by the Inter-Agency Task Team (IATT) on HIV and Young People1 to assist United Nations Country Teams (UNCT) and UN Theme Groups on HIV/AIDS in providing guidance to their staffs, governments, development partners, civil society and other implementing partners on HIV interventions for most-at-risk young people. It is part of a series of seven global Guidance Briefs that focus on HIV prevention, treatment, care and support interventions for young people that can be delivered through different settings and for a range of target groups.
New York, New York, United Nations Population Fund, HIV/AIDS Branch, . 8 p. (Guidance Brief)A series of seven Guidance Briefs has been developed by the Inter- Agency Task Team (IATT) on HIV and Young People1 to assist United Nations Country Teams (UNCT) and UN Theme Groups on HIV/AIDS in providing guidance to their staffs, governments, donors and civil society on the specific actions that need to be in place to respond effectively to HIV among young people. This Brief provides a global overview and is complemented by a separate Brief for most-at-risk young people and five others on HIV interventions among young people provided through different settings /sectors: community, education, health, humanitarian emergencies and the workplace.
The past, present, and future of reproductive health surveillance in the US-Mexico border region [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A110.This editorial discusses reproductive health surveillance in the US- Mexico border region. It touches on past, present and future projects for that area including the United States- Mexico Border Health Commission (USMBHC) and the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP).
MEASURE Evaluation Bulletin. 2001; (2):1-27.This issue of the MEASURE Evaluation Bulletin includes articles in a number of areas of monitoring and evaluation of AIDS programs. The first four articles are based on a field test of indicators on knowledge, sexual behavior and stigma that was carried out as part of a large international effort to improve monitoring and evaluation of national programs. The field test resulted in revisions of standard indicators for AIDS programs, which were eventually published by UNAIDS, and revisions of the survey tools that are now used to collect AIDS information in many countries. Three subsequent articles deal with different aspects of monitoring and evaluation. The first of these explores estimation of the size of core groups, such as commercial sex workers or bar workers, which is essential but difficult. Capture-recapture techniques can be used to make such estimates, although there are multiple pitfalls. The next article focuses on monitoring trends in HIV prevalence among young antenatal women, which is the most feasible method of monitoring HIV incidence. Modelling shows that using prevalence trends to extrapolate incidence trends has to be done very carefully, but can be done if one takes measures to minimize the various biases. The last article of the Bulletin discusses the use of newspaper clippings as a source of indicators on political will and commitment and stigma. Although newspaper clippings have been cited as an easily accessible source for these indicators, the analysis suggests that an analysis of newspaper clippings may be more suitable for a cross-sectional situation analysis or in-depth qualitative research than for monitoring purposes. (excerpt)
The sexual and reproductive health of young people in Latin America: Evidence from WHO case studies.
Salud Publica de Mexico. 2008 Jan-Feb; 50(1):10-16.This original article addresses the sexual and reproductive health needs of young people aged 15 to 24 in Latin America. It introduces five articles from original research projects in three countries: Argentina, Brazil, and Peru. These projects were funded by the World Health Organization. This article explains the importance of studies that address the sexual and reproductive health of young people in developing countries. It provides an overview of sexual and reproductive health issues in Latin America and a discussion these issues in the three study countries. The five articles deal with difficult and challenging issues, including: knowledge of STIs and HIV/ AIDS; pregnancy related practices; quality of care; the role of young men in couple formation, pregnancy and adoption of contraceptive practice; and, the role of obstetricians and gynecologists in public policy debate about family planning and abortion. The four articles in this special section help to improve our understanding of the factors that contribute to risky sexual behavior and negative reproductive health outcomes among youth in Latin America. The findings are useful to help inform and improve health care interventions in various contexts. (author's)
Washington, D.C., World Bank, Latin America and the Caribbean Region, Human Development Department, 2007 Oct. 55 p. (Policy Research Working Paper No. 4377)A new literature on the nature of and policies for youth in Latin America is emerging, but there is still very little known about who are the most vulnerable young people. This paper aims to characterize the heterogeneity in the youth population and identify ex ante the youth that are at-risk and should be targeted with prevention programs. Using non-parametric methodologies and specialized youth surveys from Mexico and Chile, the authors quantify and characterize the different subgroups of youth, according to the amount of risk in their lives, and find that approximately 20 percent of 18 to 24 year old Chileans and 40 percent of the same age cohort in Mexico are suffering the consequences of a range of negative behaviors. Another 8 to 20 percent demonstrate factors in their lives that pre-dispose them to becoming at-risk youth - they are the candidates for prevention programs. The analysis finds two observable variables that can be used to identify which children have a higher probability of becoming troubled youth: poverty and residing in rural areas. The analysis also finds that risky behaviors increase with age and differ by gender, thereby highlighting the need for program and policy differentiation along these two demographic dimensions. (author's)
Geneva, Switzerland, UNAIDS, 2007.  p. (UNAIDS/07.07E; JC1274E)These Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access are designed to provide policy makers and planners with practical guidance to tailor their national HIV prevention response so that they respond to the epidemic dynamics and social context of the country and populations who remain most vulnerable to and at risk of HIV infection. They have been developed in consultation with the UNAIDS cosponsors, international collaborating partners, government, civil society leaders and other experts. They build on Intensifying HIV Prevention: UNAIDS Policy Position Paper and the UNAIDS Action Plan on Intensifying HIV Prevention. In 2006, governments committed themselves to scaling up HIV prevention and treatment responses to ensure universal access by 2010. While in the past five years treatment access has expanded rapidly, the number of new HIV infections has not decreased - estimated at 4.3 (3.6-6.6) million in 2006 - with many people unable to access prevention services to prevent HIV infection. These Guidelines recognize that to sustain the advances in antiretroviral treatment and to ensure true universal access requires that prevention services be scaled up simultaneously with treatment. (excerpt)
In: The HIV challenge to education: a collection of essays, edited by Carol Coombe. Paris, France, UNESCO, International Institute for Educational Planning, 2004. 253-263. (Education in the Context of HIV / AIDS)Twenty years after the identification of AIDS, some 60 million people have been infected by HIV, a number corresponding to the entire population of France, the United Kingdom or Thailand. Those who have died equal the population of Norway, Sweden, Finland and Denmark combined. Those currently infected - more than 40 million - number more than the entire population of Canada. The number of children thought to be orphaned by HIV/AIDS - some 14 million - is already more than the total population of Ecuador. Over the coming decade their numbers may rise to a staggering 50 million worldwide. In other words, the extent of this pandemic is unprecedented in human history. And the worst is yet to come, for many millions more will be infected, many millions more will die, many millions more will be orphaned. On September 11 2001, more than 3,000 people died in the New York bombings. Every day, around the world, HIV infects at least five times that number. But it is not only individuals who are at risk. The social fabric of whole communities, societies and cultures is threatened. The disease is certain to be a scourge throughout our lifetime. (excerpt)
Youth Development Notes. 2006 Nov; 2(1):1-4.Young people are at the heart of the HIV/AIDS pandemic. Not only are they disproportionately represented in terms of new infections, but they are also key to overcoming the disease. Effective HIV prevention efforts that focus on youth are crucial to reversing the pandemic. The World Bank is one of the largest official financiers of HIV/AIDS programs in the world, with over $2.7 billion committed for HIV/AIDS prevention, care, support and treatment since 1988. A recent review of Bank projects related to HIV/AIDS (1999-2004) reveals that over 40% include specific youth components, and virtually all include youth as a target group. This note summarizes the growing body of evidence of what works to prevent HIV/AIDS among youth in developing countries. (excerpt)
Geneva, Switzerland, WHO, 2006. 35 p.Marriage is widely regarded as a place of safety to shelter from the risks of adolescence. In many parts of the developing world, parents and policy makers see marriage as a walled garden where cultural and family values protect young girls from defilement and stigma. Particularly in poorer and rural areas, there is pressure on parents to marry off their daughters while they are very young before they become an economic liability. Millions of girls reluctantly enter into marriage while they are still children, just sexually mature but unready in every other way for this profound change in their lives. Typically, an adolescent bride knows little of her new husband or new life, has little control over her destiny and is unaware of the health risks that she faces. When an adolescent girl starts a sexual relationship with a man 10 years older than she is, he may be sexually experienced. If he is infected with a sexually transmitted infection (STI) or with HIV, a marriage certificate offers no protection. In the context of the AIDS pandemic, it is a chilling fact that the majority of unprotected sex between an un-infected adolescent girl and an infected older man takes place within marriage with the blessing of parents and community. Neither AIDS nor STIs respect marriage as a place of safety. (excerpt)
Recent experiences in infectious diseases: strengthening public health infrastructure in disease surveillance.
Contact. 2005 Jan; (179):29-31.In the past century there have been remarkable achievements in the prevention and treatment of infectious diseases. Bacteria and viruses have been identified; laboratory techniques have greatly advanced; the pathogenesis and epidemiology have been defined for most diseases; and antibiotics and vaccines have been developed to treat and prevent a host of discusses. Examples are everywhere. We have eradicated smallpox and come close to doing the same for polio. Inexpensive treatments such as Oral Rehydration Therapy (ORT) for diarrhoea have greatly reduced mortality and morbidity among children. Improvements in water and sanitation helped to reduce expose to certain pathogens. Yet, despite these great successes in controlling and treating infectious diseases, they remain a serious medical burden in both developing and industrialized in countries. It is estimated that about 15 million of the 57 million annual deaths (about 26%) are directly related to infectious diseases. This estimate does not include deaths due to the consequences of past infections (for example, rheumatic heart disease) or from complications of chronic infections (for example, hepatocellular carcinoma from hepatitis B infection). (excerpt)
Geneva, Switzerland, UNAIDS, 1997 Oct. 7 p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)Young people are especially vulnerable to HIV and other sexually transmitted diseases (STDs). They are also vulnerable as regards drug use (and not just injected drugs). Even if they are not engaging in risk behaviours today, they may soon be exposed to situations that put them at risk. Very often they cannot talk easily or at all about AIDS, or about the risk behaviours that can lead to HIV infection, at home or in their community. However, most of them do attend at some point, and school is an entry point where these topics - often difficult to discuss elsewhere - can be addressed. (author's)
Geneva, Switzerland, UNAIDS, 1999 May. 145 p. (UNAIDS Best Practice Collection. Key material; UNAIDS/99.26E)Since early in the epidemic, enquiry into the factors influencing HIV-related vulnerability has been recognized as essential for prevention efforts. While much early work focused on the individual determinants of sexual and drug-related risk-taking, increasingly the contextual factors which render some groups more vulnerable than others has come to be recognized. Factors as diverse as age, gender, social position, economic status, cultural norms, beliefs and expectations determine the risks faced, and enable and constrain individuals in their actions. It is now widely recognized that both individual persuasion and social enablement are essential for programme success, and increasing numbers of prevention programmes and activities are designed on this assumption. The recent UNAIDS report Expanding the Global Response to HIV/AIDS Through Focused Action recognizes the importance of such an approach and seeks to encourage its application in countries across the world. Yet knowing how to develop and fine-tune programmes requires insight into the often complex determinants of behaviour in specific cultural settings and contexts. Good quality social enquiry has a key role to play in providing this information and in supporting the development of work that is attuned to the needs of particular groups. (excerpt)
Geneva, Switzerland, International Organization for MIgration, 2005. 47 p. (IOM-UNAIDS Reports on Mobile Populations and HIV / AIDS No. 2)This report addresses HIV risk and programmes for one particular category of mobile worker: truck drivers. Truck drivers are not migrants: the word “migrant” designates a person who, voluntarily and for personal reasons, moves from his or her place of origin to a particular destination with the intention of establishing residence. Nor are truck drivers forced to move, as are refugees or internally displaced persons. They do not change their place of permanent residence. But truck drivers do undertake regular travel for professional reasons, in common with other mobile workers such as seafarers, members of armed forces, airline personnel and traders or business people. (excerpt)
Towards an AIDS-free generation. The Global Initiative on HIV / AIDS and Education. Briefs for decision-makers.
Paris, France, UNESCO, International Institute for Educational Planning, IIEP Publications, 2005 May.  p. (IIEP/May 2005/HIV-GI/02.R2)What is the global initiative on HIV/AIDS and Education? The Cosponsoring Organizations of UNAIDS launched the Global Initiative on HIV/AIDS and Education in March 2004. This initiative aims to radically enhance national responses against the epidemic by helping governments to implement comprehensive, nation-wide education programmes for young people. The partners in the Global Initiative are united by a commitment to implement a jointly developed framework on HIV/AIDS and Education. The Global Initiative is designed: To complement and link with the "3 by 5" Initiative to scale up treatment against AIDS; To be part of the broader prevention effort spearheaded by UNAIDS; To facilitate the implementation of the so-called "Three ones" at the country level: One agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all partners; One National AIDS Coordinating Authority, with a broad-based multisectoral mandate; One agreed country-level Monitoring and Evaluation System. (excerpt)
Bulletin of the World Health Organization. 2004 Dec; 82(12):923-927.Using religion to improve health is an age-old practice. However, using religion and enlisting religious authorities in public health campaigns, as exemplified by tobacco control interventions and other activities undertaken by WHO's Eastern Mediterranean Regional Office, is a relatively recent phenomenon. Although all possible opportunities within society should be exploited to control tobacco use and promote health, religion-based interventions should not be exempted from the evidence-based scrutiny to which other interventions are subjected before being adopted. In the absence of data and debate on whether this approach works, how it should be applied, and what the potential downsides and alternatives are, international organizations such as WHO should think carefully about using religion-based public health interventions in their regional programmes. (author's)
New York, New York, International Women's Health Coalition [IWHC], . 2 p.Today, about 1 billion people are between 10 and 19 years of age, 85% of them in developing countries. The Programme of Action of the International Conference on Population and Development recognized that adolescents have a special need for sexual and reproductive health information, education and services, and that these services must respect the right of adolescents to privacy. Many women around the world marry as adolescents. Across Sub-Saharan Africa, at least half of young women enter their first marriage or union by age 18 (e.g. Mali, Niger - more than 75% of young women; Cameroon, Malawi, Uganda, Nigeria - more than 50%). In Egypt and the Sudan, the proportion is 27%, but in Yemen, it is 49%. In Latin America and the Caribbean, between 20 and 40% of adolescent women in countries such as Brazil, the Dominican Republic, Mexico, El Salvador, Guatemala, and Trinidad and Tobago are married before age 18. Across Asia, the likelihood of early marriage is quite variable: 73% of women in Bangladesh enter a union by age 18, compared with 14% in the Philippines and Sri Lanka, and 5% in China. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 1999.  p.It is estimated that more than 700 000 people were living with HIV infection in the Western Pacific Region in 1998, with more than 18 000 new AIDS cases occurring in the same year. In contrast, the cumulative number of HIV diagnoses reported in all countries of the Region was about 100 000 and reported AIDS incidence in 1998 was 3300. This reflects a very high level of under-diagnosis and under-reporting of HIV and AIDS cases in the Region. The number of people living with HIV infection is projected to reach 1 million in 2000, and the yearly number of new cases of AIDS to doubled. Analysis of the trend of the relative proportion in HIV risk exposure based on reported cases in the Region suggests that there have been three waves. First, sexual contact among men was the driving force in the early epidemic in Australia and New Zealand, with rapid decrease in prevalence by the late 1980's. Second, the widespread sharing of equipment among injecting drug users (IDUs), primarily in Malaysia, China and Viet Nam was most important during the late 1980s and early 1990s, eventually leveling off around 40% of reported cases (it should be noted that this mode of transmission is probably over-represented due to the mandatory HIV testing of injecting drug users in rehabilitation centres or prison). Finally, the more recent trend has been a steady increase in the proportion of reported cases associated with heterosexual contact. Transmission of the virus through this mode has been gradually increasing since the beginning of the epidemic and is expected to continue to increase in the future. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, STI, HIV and AIDS Focus, 2004. 41 p.This document is intended to support the 100% condom use programme (CUP) technical staff to: anticipate the kinds of questions that may be asked about the programme; and, begin to plan the approach and to identify points of information that may help to respond in their settings. Contained in this document are a sample of 25 questions that have, at one point or another, been posed to programme staff about the 100% CUP. Points that might be addressed in a response to these questions are also suggested. (excerpt)
Promoting condoms in clinics for sexually transmitted infections: a practical guide for programme planners and managers.
Manila, Philippines, WHO, Regional Office for the Western Pacific, STI, HIV and AIDS Focus, 2001.  p.The promotion of condom use among patients with sexually transmitted infections (STI) is important in the prevention and control of STI, including HIV. This guide aims to help STI programme planners and managers to improve condom promotion among STI patients. It reviews the major areas in condom promotion for STI services, including: creating a favourable environment; training service providers; counselling clients on condom use; managing condom supplies; and monitoring condom use. Some additional resources and sample exercises are also outlined. Further information and technical support in promoting condoms for STI prevention may be obtained from the World Health Organization, Regional Office for the Western Pacific. (excerpt)