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  1. 1

    UNAIDS in individual countries.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, [1996]. 10 p. (Facts about UNAIDS)

    National governments have the primary responsibility for dealing with HIV/AIDS within their own borders, even though many individuals and groups -- from government as well as the wider society -- must be part of the national response. The role of UNAIDS is to strengthen the ability of countries to respond to the epidemic, and to coordinate the UN system's support to that end. To be effective, the national response must be broad-based and multisectoral. AIDS remains an important health issue, but many of the causes and consequences of the epidemic lie outside the health sector. With its unique, collaborative approach, UNAIDS can support countries in the following ways as they mount an expanded response to the epidemic: By advocating more effectively for the introduction of AIDS issues into the country's health, economic and social development agendas. Each UN organization can work with its major counterparts to promote cross-sectoral collaboration; By involving a greater number of partners in AIDS activities. Each UN organization can help involve partners not yet participating in the response to the epidemic, including government departments, nongovernmental organizations (NGOs) and the private sector; By allocating resources more efficiently and effectively in support of national efforts. Working together, the UN organizations can identify overlaps, gaps and opportunities for integrating AIDS into related programmes; By making better use of local and regional technical expertise available in the UN system. (excerpt)
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  2. 2

    UNAIDS: an overview.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 1996. 9 p. (Facts about UNAIDS)

    Around 6 million people worldwide have died of AIDS since the start of the epidemic. Well over 20 million are living with HIV, the virus that causes AIDS. Already, there are communities and even whole cities where one out of every three adults is infected, and the repercussions of these dense clusters of illness and death will linger for decades. The epidemic and its impact are becoming a permanent challenge to human ingenuity and solidarity. Since the first of January 1996, UNAIDS -- the Joint United Nations Programme on HIV/AIDS -- has carried the main responsibility within the UN system for helping countries strengthen their long-term capacity to cope with this challenge. Based in Geneva, Switzerland, the new programme is cosponsored by six organizations of the UN family -- United Nations Children's Fund (UNICEF), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Nations Educational, Scientific and Cultural Organization (UNESCO), World Health Organization (WHO), and the World Bank. Together with its cosponsors and other partners around the world, UNAIDS is hard at work on its mission -- leading and catalysing an expanded response to the epidemic to improve prevention and care, reduce people's vulnerability to HIV/AIDS, and alleviate the epidemic's devastating social and economic impact. (excerpt)
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  3. 3

    Epidemic of sexually transmitted diseases in Eastern Europe. Report of a WHO meeting, Copenhagen, Denmark, 13-15 May 1996.

    World Health Organization [WHO]. Regional Office for Europe; Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Copenhagen, Denmark, WHO, Regional Office for Europe, 1996. [3], 14 p. (EUR/ICP/CMDS 08 01 01)

    In response to the alarming rise in sexually transmitted diseases (STDs) in the newly independent states, the WHO Regional Office for Europe, WHO headquarters and the Joint United Nations Programme on AIDS organized a meeting of experts from the most affected countries to exchange information and to identify priority actions for the control of the epidemic. The participants included 15 experts from Belarus, Kazakhstan, Latvia, the Republic of Moldova, the Russian Federation and Ukraine. The participants called for urgent action, including a careful assessment of the existing systems for STD control, reallocation of resources among the various activity areas and strong advocacy to generate awareness at the top level of government and strengthen its support for the recommended initiatives. They also urged that national coordination of programmes to promote sexual health and prevent STDs and HIV be strengthened, that statutory services be made more accessible and acceptable to patients and that efforts be made to ensure that all health workers managing patients with STDs, including those in the private sector, provide high-quality care. (author's)
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  4. 4

    Malawi: regional policy workshop on AIDS prevention in a civil-military environment.

    Civil-Military Alliance Newsletter. 1996 Aug; 2(3):3-4.

    This article presents excerpts from a speech by Malawi’s First Vice President and Minister of Defence, the Right Honourable Justin C. Malewezi at the opening address to the policy workshop.
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  5. 5

    AIDS prevention in military populations -- learning the lessons of history.

    Kingma SJ

    [Hanover, New Hampshire], Civil-Military Alliance to Combat HIV and AIDS, 1996. [4] p. (Occasional Paper Series No. 2)

    CONCLUSION: The armed forces that do not deal with HIV prevention will be condemned to deal with AIDS. One can paraphrase the military leader quoted at the outset of this paper by saying that the armed forces that ignore the mission of HIV prevention will be "destined to repeat the errors of history by failing to perceive the impact of [this] disease." The armed forces of all countries must face the increasing risk of HIV infection in their ranks, and address the prevention of AIDS as a priority mission. (excerpt)
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  6. 6

    HIV vaccines advocacy: the role of UNAIDS. Research and accessibility.

    Piot P

    TB AND HIV QUARTERLY. 1996 Jun-Aug; (11):7-9.

    This article presents an interview with Dr. Peter Piot, executive director of the Joint UN Program on HIV/AIDS (UNAIDS) on the role of UNAIDS in the advocacy of HIV vaccines. Piot stressed that an efficient HIV vaccine, truly protective against HIV infection, could make all the difference in the campaign against AIDS. To this effect, the role of the UNAIDS is to carry out advocacy in favor of research as well as to collaborate with the diverse private initiatives that already exist. Commenting on the issue of guaranteed accessibility of HIV vaccine for developing countries, Piot states that it is possible to sell the product through seeking the support of donor organizations. When vaccine trials in a country are supported, it will also be made sure that the basic guarantees exist for making that product accessible to the population. Moreover, considering the impact of the pandemic on the business and economic community, Piot emphasized that alliance between the public and private sector is necessary in the struggle against AIDS. In general, the role of UNAIDS in the evaluation of a preventive vaccine for HIV is centered around communication, impact on community, and impact on prevention programs.
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  7. 7

    New U.N. program promotes multisectoral approach to AIDS prevention. Q and A [with Peter Piot].

    AIDSCAPTIONS. 1996 May; 3(1):34-6.

    The new joint United Nations (UN) Program on HIV/AIDS (UNAIDS) coordinates the HIV/AIDS activities of its six co-sponsors: the UN Children's Fund (UNICEF), the UN Development Program (UNDP), the UN Population Fund (UNFPA), the UN Educational, Scientific, and Cultural Organization (UNESCO), the World Health Organization (WHO), and the World Bank. In this interview, UNAIDS Executive Director Peter Piot discusses the program's goals and challenges. The UNAIDS program will be more multisectoral in scope than other efforts, involving all sectors of society that can affect the course of the epidemic or are affected by it. This includes the health and education sectors; ministries of trade, finance, planning, and development; nongovernmental and community organizations; people living with HIV and AIDS; research institutions; and the business sector. In each country, the UN agencies will form a "Theme Group on HIV/AIDS" to formulate intersectoral strategies.
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  8. 8

    UNAIDS: toward an expanded response to the HIV / AIDS pandemic.

    Cowal SG

    GACETA MEDICA DE MEXICO. 1996; 132 Suppl 1:21-4.

    The joint UN Program on HIV/AIDS (UNAIDS) is a program cosponsored by UNDP, UNESCO, UNFPA, UNICEF, WHO, and the World Bank. UNAIDS works at the global as well as the country level with the following mutually reinforcing roles: policy development and research, technical support, and advocacy. The program became operational on January 1, 1996. HIV/AIDS is spreading epidemically and becoming epidemic. In such a context, staying uninfected until old age is a major challenge in communities with a high prevalence of HIV. However, prevention measures have had limited success, mainly because the broader context or environment in which people live has not been conducive to prevention. A need exists to integrate HIV prevention and care for affected individuals, families, and communities with more and better-quality interventions along the prevention-care continuum. At the same time, vulnerability must be reduced through societal action, ranging from community mobilization to international initiatives.
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  9. 9

    Family Health International 25th Anniversary Symposium: Improving Reproductive Health Worldwide, November 23, 1996, Research Triangle Park, NC.

    Family Health International [FHI]

    Research Triangle Park, North Carolina, FHI, 1996. [2], 22 p.

    This report of the 25th Anniversary Symposium of Family Health International (FHI) opens with an overview that summarizes three presentations: 1) a description of FHI's organization presented by its President; 2) a commentary on FHI's first 25 years and future challenges using Thailand as a model of a developing country that achieved strong economic development, slower population growth, and lower mortality during this period; and 3) a sketch of the US Agency for International Development's involvement in population programs. The second part of the report reproduces three more detailed reports on the operation of FHI. The first detailed essay relates the history of FHI's efforts in the area of contraceptive research and defines four distinct time periods: the early 1970s when FHI collected data, the later 1970s to early 1980s when FHI initiated strategies to improve research, the mid-1980s when FHI began to focus on achieving regulatory approval of new products, and the 1990s when research has expanded into new areas. The second essay covers FHI's research into ways to prevent transmission of sexually transmitted diseases and HIV/AIDS, including the evaluation of barrier methods and vaccine trials. The third essay describes how women's perspectives are incorporated into research following the principles that women's rights are human rights and that women's welfare is an end in itself. The report ends with a summary of the closing comments of the FHI's Chief Executive Officer who noted that FHI has grown tremendously in 25 years but that the agency continues its mandate to collect first-class data for use by policy-makers while pursuing new activities.
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  10. 10

    Country watch: Comoros and Morocco.

    Brunger W


    The European Commission (EC) supports programs using radio to inform and educate about HIV and AIDS in developing countries, particularly with regard to illiterate or rural populations. In 1992, in Comoros (where 80% of adults and 65% of persons aged 15-25 listen to radio and there is no national television and only one printed medium--a French magazine), as part of a National AIDS Programme initiative aimed at mobilizing youth and women leaders, two journalists of the national radio channel produced an EC-supported series of 20 radio programs that were broadcast twice weekly every other week as part of the popular program "Sante" (Health). A series of 11 programs were broadcast in 1994-95 by Radio Comoros and by two private stations that were popular with youth. Surveys showed the following: 1) the popular shows were the main source of information on HIV/AIDS and were particularly successful in rural communities when broadcast in the local language; 2) the majority of villagers wanted this and other health information to continue; and 3) public information regarding sexuality was accepted by a large majority. The radio series caused Islamic religious leaders to discuss HIV prevention and condoms. An EC-supported project in Morocco occurred in 1993. The 3-month national information campaign about HIV/AIDS covered myths and rumors, infection risks, prevention measures, the disease and women and youth, the epidemic's socioeconomic impact, the role of nongovernmental organizations (NGOs), and the role of the media. A 1-hour program in Arabic was broadcast twice a week for 24 weeks, 12 30-minute programs were broadcast in three Berber dialects, and several short spots were aired daily. The program format included presentations and discussions by health staff, psychologists, sociologists, and NGO staff; listener participation was allowed. 1000 men and 700 women were surveyed using a questionnaire. Roadside interviews were conducted in some cities. These showed that the information was understood. Many listeners criticized the lack of information on television and wanted more information broadcast.
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  11. 11

    Guidelines for HIV interventions in emergency settings.

    World Health Organization [WHO]; United Nations High Commissioner for Refugees [UNHCR]; Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 1996. [3], 59 p. (UNAIDS/96.1)

    In emergencies, the priority concern is the people who are at risk of imminent death from injury, starvation, exposure, or disease. With an estimated 30-40 million people expected to be infected with HIV by the year 2000, HIV/AIDS control must be regarded as a critical component of emergency responses. The purpose of this manual is to provide guidelines to enable governments, nongovernmental organizations, and United Nations agencies to adopt the measures necessary to prevent the rapid epidemic spread of HIV in emergency situations such as natural disasters and civil strife and to care for those already affected. HIV spreads fastest in conditions of poverty, powerlessness, and social instability--situations at their most extreme during emergencies. For planning purposes, emergencies can be divided into five stages: the destabilizing event, loss of essential services, restoration of essential services, relative stability, and return to normality. Although the nature of the emergency dictates HIV/AIDS interventions, basic elements of a response to any emergency include prevention of HIV transmission through safe blood transfusion, availability of materials and equipment needed for universal precautions, condom provision, and the dissemination of basic HIV/AIDS information. This manual both outlines salient goals during each stage of an emergency and provides standards for relief workers for delivery of the minimum package of HIV interventions in emergency settings.
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  12. 12

    Establishment of WHO-sponsored field sites for HIV vaccine evaluation in developing countries.

    Heyward WL; Osmanov S; Esparza J


    Probably 90% of the estimated 14-15 million people living with HIV infection worldwide reside in developing countries. With the global HIV pandemic disproportionately affecting people in the developing world, developing countries need to be involved in all stages of vaccine development, from initial research to the approval and licensing of a product to the public. During 1991, World Health Organization (WHO) teams visited 14 developing countries in Africa, Asia, and Latin America to assess their capacity and interest in conducting HIV vaccine trials. The assessments considered the epidemiological aspects of the epidemic in the country, the clinical and laboratory infrastructures available, the logistical and operational aspects of conducting vaccine-related research, and the community and political support for HIV vaccine trials. In 1992, the WHO Steering Committee on Vaccine Development announced that it would work with the national authorities and scientists of Brazil, Rwanda, Thailand, and Uganda to develop and implement comprehensive plans for HIV vaccine research, development, and evaluation. The activities in Rwanda, however, were suspended due to recent genocide and related civil unrest. National plans have been developed with WHO assistance in the other three countries. HIV isolation and characterization and epidemiologic, clinical, and social and behavioral studies are discussed as essential for the preparation of the field sites for vaccine trials.
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  13. 13

    HIV vaccine trials in developing countries. The UNAIDS perspective.

    Heyward WL; Osmanov S; Esparza J

    [Unpublished] 1996. Presented at the 11th International Conference on AIDS, Vancouver, Canada, July 7-12, 1996. 12 p.

    Even though most people agree that a safe, effective, and available HIV preventive vaccine is needed, few agree on the characteristics of such a vaccine and how to proceed. The debate revolves around the uncertainties of the immunological correlates of protection, the antigenic significance of HIV genetic variability on vaccine-induced protection, and the biological variability of HIV and the meaning of animal protection experiments with experimental vaccines. The decision to move towards efficacy trials depends on feasibility, the science, and the vaccine. One important feasibility factor is availability of a well-characterized population with a high incidence of HIV infection, despite available interventions. A scientific factor to consider is HIV characterization (genetic variability, HIV subtypes). Current safety and immunogenicity data from phase I and II trials and ability of the vaccine to induce neutralizing antibodies and CTLs comprise some vaccine factors. Researchers have found high-risk populations willing to participate in phase III trials in Thailand. UNAIDS proposes a balanced approach strategy of conducting efficacy trials with vaccine candidates which have met minimal requirements while also conducting basic research to acquire more information on what is needed for a protective immune response. The efficacy trials may reveal some information related to such a response. Final decisions and responsibilities lie with national governments and institutions. UNAIDS is prepared to help countries in their decision making efforts. Extensive preparation and international collaboration and coordination are needed for phase III efficacy trials. Developing countries (e.g., Thailand) themselves must participate in HIV vaccine development, since most HIV infections are in these countries and these countries have the most to gain. Genetic variability of HIV and different co-factors and routes of HIV transmission indicate the need to conduct multiple efficacy trials in different areas worldwide.
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  14. 14

    Human rights and HIV / AIDS: UNAIDS at the UN Commission on Human Rights.

    Timberlake S

    WORLD HEALTH. 1996 Sep-Oct; 49(5):24-5.

    The executive director of the Joint UN Programme on HIV/AIDS (UNAIDS) and its human rights advisor addressed the annual meeting of the UN Commission on Human Rights in April 1996. The address summed up the extent of the HIV/AIDS epidemic: more than 21 million people, 1.5 million of whom are children and 9 million of whom are women, are infected with HIV; more than 5 million have died of AIDS; and 5 people are infected every minute. The protection of human rights is crucial to prevent the spread of HIV/AIDS. Key rights include the rights to information, education, health, and non-discrimination. Coerced sex and sexual violence against females must be stopped, since these actions put women and girls at risk of HIV infection. A conspiracy of silence keeps people and communities from knowing that AIDS is in their communities. It keeps governments from taking urgent action. An act of the Commission keeping HIV-related human rights a top priority will lead to breaking through this conspiracy of silence. More than 50% of new HIV cases are 15-24 years old. Among new HIV cases 15-19 years old, in some regions the girl to boy ratio is 2:1. The increase in the HIV infection rate in females leads to an increase in HIV-infected infants. By the year 2000, about 5 million children will have lost parents to AIDS. HIV/AIDS also adds the misery of stigmatization and discrimination to children infected with or affected by HIV/AIDS. Governments need to implement efforts to reduce children's vulnerability to HIV, to protect children against HIV discrimination, and to provide children and their families with the support and services they need. Children have the right to HIV-related education and information. The prevalence and spread of HIV in prisons is increasing worldwide. Prison officials deal with the activities that spread HIV (sex and drug use) by using discipline rather than by providing education and condoms. Prisoners have the right to health, security of person, equality before the law, and freedom from inhuman treatment.
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  15. 15

    Female condom importance acknowledged in HIV prevention.

    AIDS WEEKLY PLUS. 1996 Dec 9; 7-8.

    The Female Health Co. (FHC), London, United Kingdom, has signed a three-year agreement with the Joint United Nations Program on HIV/AIDS (UNAIDS) to provide a global public sector price for the female condom to 193 affiliated countries. An adjunct education and social marketing program, supported by UNAIDS, will be launched. High rates of acceptance have been shown previously when the female condom has been introduced with an effective educational approach. Negotiations between FHC and UNAIDS began in September 1996; 80 of 193 countries, upon inquiry, have already identified a requirement for over 7 million female condoms in 1997. UNAIDS estimates that nearly 50% of new human immunodeficiency virus (HIV) infections are in women; the female condom is the only woman-controlled product providing protection against sexually transmitted diseases (STDs), including HIV and acquired immunodeficiency syndrome (AIDS). Studies have indicated that the number of unprotected sex acts decreases when the female condom is available. Dr. Peter Piot (UNAIDS) states that the female condom is important in those cultures and situations where women have limited control over sexual decisions. Dr. Mary Ann Leeper (FHC) states that the company is committed to making the female condom available in developing countries.
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  16. 16

    UNDP in India: a retrospective. Special report: India.

    Godwin P

    AIDS ANALYSIS ASIA. 1996 Nov; 2(6):9, 15.

    This article reviews the purpose and achievements of India's UNDP Regional HIV Project, which ended in June 1996. To reduce vulnerability to HIV, the project concentrated on: 1) identifying the reciprocal role of socioeconomic factors in HIV transmission, 2) strengthening the role of nongovernmental organizations as mediators between communities and the government, 3) fostering the creation of multisectoral policies and procedures developed to elicit increased private sector response to HIV, and 4) promoting development of an enabling environment characterized by appropriate legal and ethical responses to the epidemic. Thus, the project published a series of pertinent publications and supported studies and workshops. The principles guiding decisions about which activities to fund included: 1) minimalizing management costs, 2) mobilization of technical assistance, 3) capacity building by encouraging innovation, and 4) flexibility. The project was successful in validating the likely scope and scale of the socioeconomic impact of HIV, in complementing and supplementing the work of other agencies, and in legitimizing UNDP's role as the agency that understands and can support socioeconomic and multisectoral responses to HIV (which, in turn, defines UNDP's role within UNAIDS).
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  17. 17

    International funding of the global AIDS strategy: official development assistance.

    Laws M

    In: AIDS in the world II: global dimensions, social roots, and responses. The Global AIDS Policy Coalition, edited by Jonathan M. Mann and Daniel J.M. Tarantola. New York, New York, Oxford University Press, 1996. 375-89.

    This book chapter reports on the current state of international funding for AIDS programs in developing countries. The chapter opens by discussing the development assistance provided by the developed countries which are members of the Organization for Economic Cooperation and Development and notes that development assistance is declining and that no published summaries on development assistance provide detailed information on the allocation of funds to HIV/AIDS programs. The data for this chapter, therefore, were drawn from an international financing survey conducted for this publication. The nature of the survey and complications involved in this type of data collection are then reviewed. Adequate survey responses were received from Australia, Canada, Denmark, France, Germany, Japan, Luxembourg, the Netherlands, Norway, Sweden, the UK, and the US. The data are tabulated to display bilateral, multilateral, combined multi- and bilateral, and total funding. To reveal the trends exhibited by the major donors and to track funds donated to developing countries, tables present 1) total contributions to the Global AIDS Strategy for 1986-93 according to these funding channels, 2) multilateral contributions by country for 1987-93, 3) multi- and bilateral contributions by country for 1987-93, and 4) bilateral contributions for 1986-93. Pie charts show donor contributions by country and recipient countries. The increase in World Bank loans for HIV/AIDS prevention and care is covered as is the reduced supply of donors, increasing demand for development assistance, and evidence of donor fatigue. It is concluded that it will be critical for the UN AIDS Program to improve the financial accountability of both donor and recipient countries so that HIV/AIDS resources can be evaluated. Unless this occurs, such resources will likely continue to decline in proportion to needs.
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  18. 18

    Why UNAIDS?

    Piot P

    In: AIDS in the world II: global dimensions, social roots, and responses. The Global AIDS Policy Coalition, edited by Jonathan M. Mann and Daniel J.M. Tarantola. New York, New York, Oxford University Press, 1996. 370-1.

    More than a decade of struggle to control acquired immunodeficiency syndrome (AIDS) has demonstrated the importance of multisectoral actions to address the societal causes and consequences of the epidemic as well as the individual aspects of prevention and care. Toward this end, six United Nations agencies have consolidated their efforts in a Joint United Nations program: UNAIDS. The main focus of UNAIDS is to strengthen national capacity for a broad-based response that encompasses government departments and ministries, people infected with human immunodeficiency virus (HIV), communities threatened by the epidemic, nongovernmental organizations, academic institutions and the private sector, and bilateral agencies. UNAIDS' staffing and operations are guided by the principles of technical soundness, inclusion, participation, gender sensitivity, ethics, and respect for human rights. Its roles include policy development and research, technical support, advocacy, and coordination. UNAID has prepared a draft of a strategic plan to cover the period 1996-2000.
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  19. 19

    Human rights and responses to HIV / AIDS.

    Gruskin S; Hendriks A; Tomasevski K

    In: AIDS in the world II: global dimensions, social roots, and responses. The Global AIDS Policy Coalition, edited by Jonathan M. Mann and Daniel J.M. Tarantola. New York, New York, Oxford University Press, 1996. 326-40.

    This book chapter examines the human rights aspects of responses to HIV/AIDS. The chapter opens by tracing the three phases which have characterized the relationship between human rights and HIV/AIDS prevention and control efforts (the proposed application of stringent public health measures, a recognition that discrimination against those with HIV/AIDS is counterproductive to prevention efforts, and the perspective that a lack of human rights increases vulnerability to infection). The discussion continues with an examination of the responses of nongovernmental organizations and the intergovernmental system to violations of human rights related to AIDS. A review of current controversies which have a human rights component includes HIV testing; the rights of migrants with HIV/AIDS; and human rights aspects of national laws, policies, and practices relating to AIDS. Finally, the results of a survey of national laws and practices are reported as showing that involuntary testing of "high-risk" individuals is still part of many AIDS prevention and control programs and that other policies which infringe on human rights are being enacted without legal justification. It is concluded that discrimination against people with HIV, people with AIDS, and people considered at high risk of acquiring the infection remains an important problem and that vigilance and enormous effort will be required to bring organizations at every level into compliance with international consensus on nondiscriminatory approaches to HIV/AIDS prevention and control.
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  20. 20
    Peer Reviewed

    Population and women's reproductive health: an international perspective.

    Miller K; Rosenfield A

    ANNUAL REVIEW OF PUBLIC HEALTH. 1996; 17:359-82.

    This overview describes current growth in the population of the world as well as the momentum which keeps populations expanding even after fertility rates decline. This background information precedes a discussion of the 1994 International Conference on Population and Development (ICPD) which includes the preparatory activities, the position of the ICPD in the context of previous decennial population conferences, major innovations included in the Program of Action, and the process used to reach consensus. The following six major reproductive health concerns which arose from the ICPD are then considered: gender inequality; access to contraceptive services; sexually transmitted disease (including HIV/AIDS) prevalence, health effects, and programmatic effects; maternal mortality; unsafe abortion; and adolescent pregnancy. It is concluded that the ICPD was of enormous significance because it managed to gain consensus on some of the most controversial topics in the area of reproductive health and to mirror some of the most pressing population problems of the decade. The major drawback of the Program of Action is seen as the fact that its success will depend upon the political and financial will of governments.
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  21. 21

    AIDS: a global response [editorial]

    Piot P

    SCIENCE. 1996 Jun 28; 272:1855.

    There are an estimated 21 million people infected with at least one of the 10 known subtypes of HIV worldwide, with more than 8500 people newly infected daily. The US Centers for Disease Control and Prevention estimate that 40,000 US citizens became infected last year with HIV. In heavily affected countries in Africa and Asia, where 33% of urban adults may be infected, AIDS deaths among young and middle-aged adults are threatening health systems, economies, and national stability. Global travel facilitates the spread of HIV worldwide. For the first time, however, a number of developing countries are registering a drop in new HIV infections, suggesting that prevention efforts focused upon safer sexual and drug-related behavior are working. Recent scientific breakthroughs are encouraging. Combination therapy with antiretroviral drugs may be able to not only defer the progression of disease and improve the quality of life, but turn HIV infection into a chronic nonprogressive condition. Furthermore, it has been determined that zidovudine can interrupt mother-to-child transmission of HIV. Research, however, remains central to preventing future HIV transmission. The development of accessible vaccines and vaginal microbicides are especially needed. The author notes that although 90% of HIV infections worldwide are in developing countries, AIDS intelligence and research and development are overwhelmingly concentrated in the industrialized world. In this context, efforts must be made to ensure the development of vaccines and therapies which are accessible and effective against AIDS in the developing world. The new Joint United Nations Program on HIV/AIDS (UNAIDS) has an important role to play in establishing a much needed partnership between developing and developed countries.
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  22. 22

    Sexual reality. The gap between family planning services and clients' needs.

    Gordon G

    In: Learning about sexuality: a practical beginning, edited by Sondra Zeidenstein and Kirsten Moore. New York, New York, Population Council, 1996. 363-79.

    IPPF's AIDS Prevention Unit (APU) conducted HIV prevention training workshops for key staff of family planning associations (FPAs) in West Africa. The experience of these workshops and the findings of a 1992 needs assessment among selected FPAs have articulated the nature of the gap between clients' needs and social norms and providers' values in relation to sexual behavior. This chapter of the book entitled Learning about Sexuality: A Practical Beginning examines how sexual options to minimize the risk of HIV infection (condom use, abstinence, fidelity within marriage, and nonpenetrative sex) correspond with the realities of the attitudes and sexual lives of different client groups. It also addresses how effective these options are in preventing HIV/AIDS. Another discussion revolves around the extent providers help clients determine the best HIV prevention strategy for themselves. The book also covers whether providers help clients overcome gender inequalities that place them at risk of HIV infection or reinforce gender stereotypes. Significant obstacles among the work of the APU include providers' long-standing attitudes, biases, and perception; consideration of counseling and education as if the clients can freely decide what to do about sex; providers' concern for social and moral well-being of clients; and conflict between contraceptive targets and the mandate to provide clients with the information needed to make informed choices about reproductive and sexual health. The book provides four steps to address these obstacles and to change the behavior of both FPA staff and clients in order to close the gap between their goals and perception: structured sessions on gender issues in FPA staff training and actively challenge gender discrimination and attitudes that result in sexual ill health; structured activities on religion, traditional sexual culture, and sexual health in FPA staff training; pilot projects that test the feasibility of FPAs using a participatory community development approach in sexual health; and network with groups that have resources to address some underlying determinants of sexual health.
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  23. 23

    HIV / AIDS in Latin America and the Caribbean.

    World Bank

    PHNFLASH. 1996 Feb 2; (103):1-2.

    An estimated 1.2-2.0 million people had been infected by 1995 in Latin America and the Caribbean, and more than 300,000 new HIV infections occur annually. The lack of seroprevalence studies, however, makes reliable estimates difficult. To date, there are 126,000 cumulative AIDS cases and 59,162 deaths recorded in Latin America, and 8065 AIDS cases and 4778 deaths recorded in the Caribbean. New infections are particularly evident among the most socially and economically marginalized populations in the region, as well as among people aged 15-25 years. Relative to other population age groups, these latter individuals are more likely to be highly mobile and involved in tourism and commercial sex, factors which may increase one's vulnerability to infection. The World Bank has sponsored a regional initiative on HIV/AIDS in Latin America and the Caribbean for the period 1996-98 designed to mobilize and unify national and international efforts against HIV and STDs by raising the awareness of regional government administrators, helping to develop a new generation of STD/AIDS control programs to follow the first generation of programs implemented in Brazil and Honduras, and helping the development of regional approaches to STD/AIDS control. The project will cost an estimated US$6.6 million, of which the World Bank will provide approximately US$1.0 million. The initiative will enable countries in the region to share the results of studies in different countries, to build upon the best practices of each others' programs, and to develop strategies for controlling AIDS and STDs across borders. The Bank has also financed projects or project components in Brazil, Haiti, and Honduras. These initiatives are briefly discussed.
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