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In: State of the art: AIDS and economics, edited by Steven Forsythe. Washington, D.C., Futures Group International, POLICY Project, 2002 Jul. 2-8.Policymakers need a reasonably complete picture of resource flows from sources to uses that finance HIV/AIDS prevention, care, support, and treatment. Without that picture, they risk misallocation, waste, and faulty strategic planning. For now, in most parts of the developing world, the picture remains largely unpainted. Filling in the details on financing is among the key challenges to HIV/AIDS policymakers today. Limited data for Latin American and Caribbean (LAC) region countries offer virtually the only cases of adequate resource flow data outside the United States. Those countries spent a thousand dollars per person living with HIV/AIDS (PLWHA) in 2000. The U.S. federal government’s Medicaid program for indigents spent 35 times as much for each AIDS patient under its care in that same year. Low-income countries, largely dependent on donor assistance, spent far less per person and per PLWHA—as little as 31 cents per person, and eight dollars per PLWHA in sub-Saharan Africa. These enormous disparities underline a dual challenge: First, use what little money is available in poor countries very effectively; and second, demonstrate to all concerned that more resources must be forthcoming to confront the HIV/AIDS pandemic in poor countries, lest the negative effects swamp any effort to develop. (author's)
Africa Recovery. 2003 May; 17(1): p..Africa today suffers from a "deadly triad" of interrelated burdens -- food insecurity, HIV/AIDS and a reduced capacity to govern and provide basic services -- says UN Secretary-General Kofi Annan. Therefore, a "new, integrated response from both the governments of Africa and the international community" is needed, he told the Group of 8 (G-8) industrialized countries in early March. That means taking long-term development measures at the same time as giving immediate relief to people suffering from famine, he said. At the beginning of the year, some 25 million Africans required emergency food aid, but quick relief shipments have since eased the threat of starvation in most countries of Southern Africa. (excerpt)
Africa Recovery. 1999 Dec; 13(4): p..Within a generation, the world could -- and should -- become a place where every infant is properly nurtured and cared for, where every child receives a quality basic education, and where every adolescent is given the support and guidance he or she needs in the difficult transition to adulthood, says the State of the World's Children 2000, published in December by the UN Children's Fund (UNICEF). Acknowledging the progress made in protecting children over the course of this century and in the decade since the 1989 adoption of the Convention on the Rights of the Child, UNICEF says much more remains to be done. It draws particular attention to three tragedies of which children and women are currently the main victims, largely in the developing world: armed conflict, HIV/AIDS and poverty. And the report adds that women are victims of these ills in disproportionate numbers due to gender discrimination. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 2-4. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The 2003 Expert Working Group made several changes to the MEC to indicate that women often can safely use IUDs in conditions related to HIV and other sexually transmitted infections (STIs). Taken together, these changes should help reduce some providers’ concerns about offering IUDs in areas where HIV infection and other STIs are common. At the meeting the WHO Expert Working Group concluded that a woman generally can start using an IUD, if she wishes, even if she has AIDS—provided she is receiving ARV therapy and is clinically well—or if she has HIV infection or she is at high risk of HIV infection. The Expert Working Group changed these conditions from category 3 to category 2 for starting IUD use. According to the bulk of research considered at the WHO meeting, IUD use does not increase a woman’s chances of acquiring HIV infection. Women generally can keep their IUDs if they become infected with HIV or develop AIDS while using IUDs (category 2), although IUD users with AIDS should be carefully monitored for pelvic infection. Limited evidence shows that complications of IUD use are no more common among IUD users infected with HIV than among IUD users who are not infected with HIV. Also, IUD use does not increase HIV transmission to sexual partners. (excerpt)
Global HealthLink. 2003 Sep-Oct; (123): p..On July 21, 2003, Dr. Jong-Wook Lee took office as director-general of the World Health Organization (WHO). In a world where emerging threats to global health are becoming increasingly encompassing, the individual at the helm of the pre-eminant health organization must be recognized as a major player on the world stage. In his inaugural address to WHO staff, Dr. Lee outlined his vision for the coming years of his tenure. Simply stated, he believes that WHO's work must be guided by three principles: doing the right things, in the right places, in the right way. Foremost among the 'right things' is a scaled up effort to fight HIV/AIDS to be led by a new HIV/AIDS leadership team with a mandate to develop a strategy for ensuring achievement of the "three by five" goal, i.e., providing 3 million people in the developing world with antiretroviral therapy by the close of 2005. WHO departments working on the three major infectious diseases - HIV/AIDS, tuberculosis and malaria - will be unified into one cluster that will be able to work effectively with the Global Fund. Additional 'right things' articulated by Lee include expanded attention to child and maternal health, noncommunicable diseases, tobacco control, nutrition, violence, and mental health as well as the eradication of polio. (excerpt)
New York, New York, Population Council, 2004 Apr. 40 p.Preventing unintended pregnancy among HIV-positive women through family planning services is one of the four cornerstones of a comprehensive program for prevention of mother-to-child HIV transmission (PMTCT). Reducing unintended pregnancies among HIV-positive women through family planning reduces the number of children potentially orphaned when parents die of AIDS-related illnesses. It also reduces HIV-positive women's vulnerability to morbidity and mortality related to pregnancy and lactation. In addition, family planning for both HIV-positive and -negative women safeguards their health by enabling them to space births. The global public health community––NGOs, governments, and international donors–– has mobilized to design and provide essential PMTCT services: voluntary counseling and testing (VCT), infant feeding counseling, outreach to communities and families, and a short course of antiretroviral therapy. In most cases, the implementation approach has been to incorporate PMTCT into services that already reach pregnant women and women of childbearing age: antenatal care, obstetrical care, and maternal/child health. Yet the complexity of introducing PMTCT into the real world—that is, existing health services in resource-poor settings—soon became clear. Population Council and its research partners have been addressing several key questions about PMTCT services and how well they function in field settings. This report reviews field experiences with the integration of family planning and PMTCT services. It is hoped that this review will provide evidence and information for developing effective strategies for appropriately promoting family planning within PMTCT programs. (excerpt)
New York, New York, UNICEF, 2003 Sep.  p.Armed conflict fuels the spread of HIV in many ways: by the disintegration of communities, displacement from the home, separation of children from their families, and the destruction of schools and health services. Another contributing factor is rape and other human rights abuses that proliferate during wartime. Moreover, the impoverishment that results from conflict situations often leaves women and girls destitute. For many, trading sex for survival becomes the only option. Crowded and unsafe camps for internally displaced persons and refugees expose women and children to the risk of sexual violence. That, combined with inadequate health services and opportunities for learning and recreation, creates a situation that is conducive to the spread of HIV. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 2003. 36 p.The rapid needs assessment tool has been developed through collaborative work with an expert group, and pre-tested in four countries— Bangladesh, Brazil, Ghana, and Kenya. The current report presents the results of these assessments along with issues for consideration in the possible improvement of the needs assessment tool and the recommended process for using the tool. The four reports conclude that while condoms are widely available, and condom use is generally increasing, there is much that could be done to improve their distribution, their promotion, and their utilization, especially among key target groups that are at a high risk for HIV. In all four countries, a significant bifurcation of condom programming was found between the distribution of condoms through family planning services and the promotion and distribution of condoms by HIV/AIDS prevention programs. Little coordination or joint planning of condom programming was found. Overall, the rapid needs assessment tool was found to be valuable and easily adjusted to local circumstances. However, the current forms and process of the assessment tool have incorporated suggestions from field implementers as well as UNFPA collaborators that will strengthen its future implementation. The process of consulting key condom programming managers and policy makers led to the identification of problems and the next steps for solving them (which was an important objective of the tool). In fact, the rapid needs assessment’s bringing together all of the stake holders involved in condom issues for mutual discussion of problems and potential solutions proved effective in all four countries. This process of engagement, discussion, argument, and ultimately, consensus, was probably the most valuable aspect of the exercise. Despite strong efforts to create a rapid needs assessment exercise, in none of the countries could it be implemented within the time frame of the 7-10 days that was desired. While data gathering activities did not necessarily take a long time, the process of scheduling meetings and interviews with high level government officials required a far greater time frame than anticipated – approximately two months — due to travel schedules, local administrative crises, and holidays. (excerpt)
New York, New York, UNFPA, 2001. 32 p. (Preventing HIV / Promoting Reproductive Health)UNFPA has worked in the field of population and development for more than three decades and has addressed the issue of HIV/AIDS for the last decade. However, no organization by itself has the capacity or the resources needed to address and halt the pandemic. An effective response requires careful collaboration and coordination among organizations, with each bringing to the partnership a distinct set of capabilities, strengths and comparative advantages. As one of the eight cosponsors of UNAIDS (the other cosponsors being UNICEF, UNDP, UNDCP, UNESCO, ILO, WHO and World Bank), UNFPA chairs Theme Groups in many countries and supports HIV-prevention interventions in almost all of its country programmes. To maximize its response and to strengthen coordinated activities with other partners, it is critical for staff at every level to have a common understanding of the Fund’s policies and strategic priorities. The aim of this document is to provide such guidance to staff, delineating the niche in which UNFPA as an organization has a definite comparative advantage in addressing the HIV/AIDS epidemic, especially at the country level. (excerpt)
Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: guidelines on care, treatment and support for women living with HIV / AIDS and their children in resource-constrained settings.
Geneva, Switzerland, WHO, 2004. v, 49 p.Mother-to-child transmission (MTCT) is the most important source of HIV infection in children. In 2001, the United Nations General Assembly Special Session on HIV/AIDS committed countries to reduce the proportion of infants infected with HIV by 20% by 2005 and by 50% by 2010. Achieving this urgently requires an increase in access to integrated and comprehensive programmes to prevent HIV infection in infants and young children. Such programmes consist of interventions focusing on primary prevention of HIV infection among women and their partners; prevention of unintended pregnancies among HIV-infected women; prevention of HIV transmission from HIV-infected women to their children; and the provision of treatment, care and support for women living with HIV/AIDS, their children and families. WHO convened a Technical Consultation on Antiretroviral Drugs and the Prevention of Mother-to-child Transmission of HIV Infection in Resource-limited Settings in Geneva, Switzerland on 5–6 February 2004. Scientists, policymakers, programme managers and community representatives reviewed the most recent experience with programmes and evidence on the safety and efficacy of various antiretroviral (ARV) regimens for preventing HIV infection in infants. This information was reviewed in the context of the rapid expansion of ARV treatment in resource-constrained settings using standardized and simplified drug regimens. Prior to the Technical Consultation, a draft set of recommendations had been issued for public comment. (excerpt)
Geneva, Switzerland, UNAIDS, 2004. vii, 64 p.This report grows out of our shared belief that the world must respond to the HIV crisis confronting women. It highlights the work of the Global Coalition on Women and AIDS—a UNAIDS initiative that supports and energizes programmes that mitigate the impact of AIDS on girls and women worldwide. Through its advocacy and networking, the Coalition is drawing greater attention to the effects of HIV on women and stimulating concrete, effective action by an ever-increasing range of partners. We believe this report, with its straightforward analysis and practical responses, can be a valuable advocacy and policy tool for addressing this complex challenge. The call to empower women has never been more urgent. We must act now to strengthen their capacity, resilience and leadership. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], HIV / AIDS Branch, UNAIDS Inter-Agency Task Team on Young People, 2004. 8 p.Young people remain at the centre of the epidemic in terms of transmission, vulnerability, impact, and potential for change. Today’s young generation, the largest in history, has not known a world without AIDS. Of the over 1 billion young people worldwide, 10 million are currently living with HIV. If we are to reach the global targets set forth in international agreements, urgent action and increased investment must be made in HIV prevention, treatment and care programmes specifically for young people. (excerpt)
New York, New York, UNFPA, 2004. iv, 17 p. (E/500/2004)This report is intended for use in planning contraceptive supply, and for advocacy and resource mobilization. It contains country-specific information provided by donors on the type, quantity and total cost of contraceptives they supplied to reproductive health programmes in developing countries during 2002. The United Nations Population Fund (UNFPA) collected information for this report in 2003; as in earlier years, the UNFPA database is especially useful to illustrate commodity shortfalls and changes in funding by donor and country. The report highlights trends since 1990 and the gap between estimated needs and actual donor support, comparing UNFPA estimates of condom requirements for STI/HIV prevention, and contraceptive requirements for family planning programmes, with actual donor support. It also indicates donor support by region and product, the top ten countries supported by donors and the quantity of male and female condoms supplied. UNFPA tried to collect information on donor support for antibiotics for prevention of STIs/RTIs. In many cases, however, either donors did not record this information or the countries receiving support did not disaggregate information by commodity. UNFPA’s Commodity Management Unit will continue to discuss how to collect this information. (excerpt)
Investing in people: national progress in implementing the ICPD Programme of Action, 1994-2004. International Conference on Population and Development.
New York, New York, UNFPA, 2004.  p.The 1994 International Conference on Population and Development (ICPD) articulated a bold new vision about the relationships between population, development and individual well-being. At the ICPD, 179 countries adopted a 20-year forward-looking Programme of Action (ICPD PoA), which built on the success of population, maternal health and family planning programmes of the previous decades while addressing, with a new perspective, the needs of the early years of the twenty-first century. As the ICPD is reaching its mid-point in 2004, it is fitting that countries take stock of progress that has been made so far in achieving the Cairo goals. UNFPA is mandated to assist countries in their review of operational experiences in implementing the ICPD PoA, and to that end, conducted a Global Survey in 2003 to appraise national experiences ten years after Cairo. An overall response rate of 92 per cent was achieved for developing and countries in transition. For donor countries, the response rate was 82 per cent. The objectives of this report are to: (a) describe, from an operational perspective, the progress that has been made, and the constraints that have been encountered, by countries in their efforts to implement specific actions of the ICPD PoA and the MDGs; (b) present measures taken with some regional highlights; and (c) summarize the major conclusions arising from the 2003 Global Survey and assess the way forward. The various chapters of the report present the findings and conclusions emanating from the analysis of the Survey. (excerpt)
Bulletin of the World Health Organization. 2004 Jun; 82(6):400-400A.The global epidemic of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is the greatest threat to human health and development since the bubonic plague and the advent of tobacco consumption. It threatens not only to continue the decimation of millions (over 20 million deaths so far, with 34—46 million people currently living with HIV/AIDS) but also to reverse many of the gains made in developing countries over the past 50 years. Consequently, as the world health report 2004 states, history will judge the current generation by its response to this global threat. The ambitious "3 by 5" initiative of WHO and UNAIDS to reach three million people with antiretroviral therapy by the end of 2005 intends to halve the treatment gap, in which only 400 000 of the six million people who need treatment currently receive it. "By tackling [HIV/AIDS] decisively," says Lee Jong-Wook, Director-General of WHO, "we will also be building health systems that can meet the health needs of today and tomorrow, and continue the advance to Health for All". (excerpt)
BMJ. British Medical Journal. 2004; 328: p..Multidrug resistant tuberculosis in parts of eastern Europe and the former Soviet Union is 10 times as common as in most parts of the world, a new report from the World Health Organization said this week. The report, which is WHO's third on drug resistant tuberculosis, contains new data obtained from the WHO/IUATLD (International Union Against Tuberculosis and Lung Disease) Global Project on Anti- Tuberculosis Drug Resistance Surveillance. Speaking at the report's launch in London this week, Dr Paul Nunn, coordinator of tuberculosis, HIV, and drug resistance at the Stop TB department of WHO, said: "We see about nine million cases worldwide every year and about two million deaths." He said: "This report . . . covers 77 geographic settings, most of which are countries—except in certain instances like China, where several settings are in one country. Thirty nine of the settings are new, and 67 657 cases were tested. (excerpt)
In: AIDS in Africa: Help the victims or ignore them?, edited by V. Lovell. New York, New York, Novinka Books, 2002. 1-21.Sub-Saharan Africa has been far more severely affected by AIDS than any other part of the world. According to a December 1, 2001 report issued by the Joint United Nations Program on HIV/AIDS (UNAIDS), some 28.1 million adults and children are infected with the HIV virus in the region, which has about 10% of the world's population but 70% of the worldwide total of infected people. The overall rate of infection among adults is about 8.4%, compared with 1.2% worldwide. UNAIDS projects that half or more of all 15 year-olds will eventually die of AIDS in some of the worst-affected countries, such as Zambia, South Africa, and Botswana, unless the risk of contracting the disease is sharply reduced. An estimated 19.3 million Africans have lost their lives to AIDS, including an estimated 2.3 million who died in 2001. UNAIDS estimates that 3.4 million new HIV infections occurred in 2001, down from the estimated 3.8 million new infections in 2000. Experts are cautious in suggesting that this decline might represent some success in prevention efforts, particularly since the adult infection rates continue to increase in a number of countries, including Nigeria, Africa's most populous nation. Moreover, they point out that 3.4 million new infections still represents a very fast and highly destructive rate of spread. AIDS has surpassed malaria as the leading cause of death in sub-Saharan Africa, and it kills many times more people than Africa's armed conflicts. (excerpt)
Sport for development and peace: towards achieving the Millennium Development Goals. Report from the United Nations Inter-Agency Task Force on Sport for Development and Peace.
New York, New York, United Nations, 2003. vi, 36 p.This report analyses in detail the potential contribution that sport can make towards achieving the United Nations Millennium Development Goals (MDGs). It provides an overview of the growing role that sports activities are playing in many United Nations programmes and crystallizes the lessons learned. It also includes recommendations aimed at maximizing and mainstreaming the use of sport. (excerpt)
Bangkok, Thailand, UNESCO, Asia and Pacific Regional Bureau for Education, 2002. 101 p.The inventory has been grouped by types of materials which include the following: Guideline materials; Curriculum; Teaching materials; Learning materials; Resource/reading materials; Training materials; Support audio-visual materials. Under each of these types of materials are sub-groups by themes or topics such as those dealing with care and counselling; information, education and communication, programme development, AIDS curriculum, life skills, adolescent reproductive health, prevention and care, training, peer education, and the like. However, in addition to accessing the various teaching/learning materials by types, the documents can also be retrieved by target audience, educational level, introduction methods, methodologies, objectives or specific uses, and geographical coverage through the help of the indexes found at the end of the inventory. (excerpt)
Washington, D.C., Academy for Educational Development [AED], Food and Nutrition Technical Assistance Project, 2003 Feb. 32 p. (Occasional Paper No. 1)This paper, commissioned to support the development of the Office of Food for Peace's new Strategic Plan, analyzes the implications of these trends in poverty and malnutrition for USAID food security programming. The paper argues for a conceptual shift that explicitly acknowledges the risks that constrain progress towards enhanced food security, and addresses directly the vulnerability of food insecure households and communities. Enhancing peoples' resiliency to overcome shocks, building people's capacity to transcend food insecurity with a more durable and diverse livelihood base, and increasing human capital will result in long-term sustainable improvements in food security. (excerpt)
AIDS on the agenda: adapting development and humanitarian programmes to meet the challenge of HIV / AIDS.
AIDS Analysis Africa. 2003 Jun-Jul; 14(1):9-10.The opportunity which mainstreaming presents to development agencies is to build on the ways in which their ordinary work contributes, indirectly, to the overall response to HIV and AIDS. They can do this by ensuring that their core work -- such as promoting food security, improving water supplies and sanitation, or extending credit -- reduces susceptibility to HIV infection and vulnerability to the impacts of AIDS. For example, development work which empowers people, particularly women and girls, and addresses gender inequality and poverty, makes them less susceptible to HIV infection. And work which strengthens communities, and enables poor households to improve their livelihood security, also makes people and societies less vulnerable to the impacts of AIDS. (excerpt)
AIDS Analysis Africa. 2003 Jun-Jul; 14(1):6-8.Given that Budget 2003/4 significantly steps up the amount of funds going to the provinces for HIV/AIDS, there are now two critical questions facing us. 1. Extra money for HIV/AIDS was put into the Equitable Share in Budget 2003/4. Will provinces use the additional funds in their equitable share grant to increase their provincial health budgets and boost funding to HIV/AIDS interventions? Or will those funds be diverted to other priorities as identified by individual provinces? 2. Will provinces be able to spend the added funds? Absorption is a real problem-provincial departments are already struggling with capacity in terms of lack of financial management and programme management skills, insufficient staff, or unfilled posts. This issue is not unique to HIV/AIDS but symptomatic of other social sector programmes. In essence, analysis of Budget 2003/4 suggests that--from a public finance perspective--the main challenge for government's response to HIV/AIDS in the foreseeable future is not going to be lack of financial resources, but the capacity to spend. (excerpt)
Global AIDSLink. 2003 Jun-Jul; 12.A bill was drafted and finally endorsed in early 1998 stating that the vaccine candidate had a favorable safety profile from pre-clinical and clinical testing in the country of origin; that there was evidence of clear benefit to the population; that there was a Memorandum of Understanding affirming interaction between UNAIDS/WHO manufacturers/sponsoring agencies and Ugandan representatives; and that the final decision about the vaccine candidate would be made by the government of Uganda, and endorsed by the parliament. The media closely followed these processes and, in February 1998, 40 army men -- a cohort that had undergone intensive preparation for 18 months since 1994 -- became the first volunteers recruited for the study. Despite the protracted nature of the process, it paved the way for other vaccine candidates to enter Uganda with minimal resistance, in an environment with the necessary infrastructure and level of community preparedness. Uganda now has an HIV Vaccine Preparedness Plan and, while the ALVAC trial ended successfully in 2001, three other vaccine candidates have already found their way into the country. (excerpt)
Journal of the Association of Nurses in AIDS Care. 1999; 10(1):17-20.There is a need for increasing international collaboration in the search for a safe and effective HIV vaccine. In addition to the ethical issues that must be considered in conducting any clinical research, unique issues arise in vaccine research and in international research. Careful deliberation and guideline development regarding the ethics of international vaccine research was the focus of a series of recent consultations sponsored by Joint United Nations Programme on HIV/AIDS (UNAIDS) around the world. (author's)
Boston Globe. 2003 Jun 22;  p..A draft report for the UN's AIDS agency has found that even when people use condoms consistently, the failure rate for protection against HIV is an estimated 10 percent, making them a larger risk than portrayed by many advocate groups. The report, which looked at two decades of scientific literature on condoms, is likely to add fuel to a heated political battle on US policy in fighting AIDS in the developing world. (excerpt)