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HIV, infant feeding and more perils for poor people: New WHO guidelines encourage review of formula milk policies.
Bulletin of the World Health Organization. 2008 Mar; 86(3):210-214.The release of the new WHO guidelines on HIV and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. This widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. This paper explores these issues by addressing feeding choices made by HIV-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty. Accumulating evidence on the increase in malnutrition, morbidity and mortality associated with the avoidance or early cessation of breastfeeding by HIV-infected mothers, and the unanticipated hazards of formula feeding, demand a deeper assessment of the measures necessary for optimum policies on infant and child nutrition and for the amelioration of poverty. Piecemeal interventions that increase resources directed at only a fraction of a family's impoverishment, such as basic materials for preparation of hygienic formula feeds and making flawed decisions on choice of infant feeding, are bound to fail. These are not alternatives to taking fundamental steps to alleviate poverty. The economic opportunity costs of such programmes, the equity costs of providing resources to some and not others, and the leakages due to temptation to sell capital goods require careful evaluation. Providing formula to poor populations with high HIV prevalence cannot be justified by the evidence, by humanitarian considerations, by respect for local traditions or by economic outcomes. Exclusive breastfeeding, which is threatened by the HIV epidemic, remains an unfailing anchor of child survival (author's)
Use of WHO clinical stage for assessing patient eligibility to antiretroviral therapy in a routine health service setting in Jinja, Uganda.
AIDS Research and Therapy. 2008 Feb 28; 5(4): p.In a routine service delivery setting in Uganda, we assessed the ability of the WHO clinical stage to accurately identify HIV-infected patients in whom antiretroviral therapy should be started. Among 4302 subjects screened for ART, the sensitivity and specificity (95% CI) of WHO stage III, IV against a CD4 count less than 200 x 10/6/l were 52% (50, 54%) and 68% (66, 70%) respectively. Plasma viral load was tested in a subset of 1453 subjects in whom ART was initiated. Among 938 subjects with plasma viral load of 100,000 copies or more, 391 (42%, 95% CI 39, 45%) were at WHO stage I or II. In this setting, a large number of individuals could have been denied access to antiretroviral therapy if eligibility to ART was assessed on the basis of WHO clinical stage. There is an urgent need for greater CD4 count testing and evaluation of the utility of plasma viral load prior to initiation of ART to accompany the roll-out of ART. (author's)
Supporting and sustaining national responses to children orphaned and made vulnerable by HIV and AIDS: Experience from the RAAAP exercise in sub-Saharan Africa.
Vulnerable Children and Youth Studies. 2006 Aug; 1(2):170-179.The growing number of children orphaned and made vulnerable by HIV and AIDS in sub-Saharan Africa presents an enormous socioeconomic and public policy challenge. Despite international commitments to increase resource allocation and scale up services and support for AIDS-affected children, families and communities, the national- and sub-national-level state responses have been inadequate. The rapid assessment, analysis and action planning (RAAAP) process for orphans and vulnerable children, conceived in late 2003, was intended as a multicountry incentive to identify and resource immediate actions that can be taken to scale in 16 heavily affected countries. This review of experiences to date with the RAAAP process highlights some key areas of learning, including: (a) fund mobilization has been slow and has reached approximately only one-third of what is required; (b) ownership and integration into development planning of the issue of orphans and vulnerable children at country level has been undermined by the perception that the response is an 'emergency' and externally (donor) driven exercise; (c) centralized planning has failed to appreciate the complexity of context and responses at the meso- and micro-levels within countries, entailing the need to support a comprehensive decentralization process of planning and implementation; (d) comprehensive multisectoral and interagency collaboration, involving civil society, is an important but overlooked element of the planning process; and (e) definitional variation between countries has led to large variations in budgets and coverage targets. While the RAAAP process has undoubtedly raised awareness at state level of the nature and extent of the 'orphan crisis' and raised vital resources, only full integration of the new planning process for orphans and vulnerable children within the range of macro and national development tools will allow the response to be sustainable in the longer term. (author's)
Supporting civil society organisations to reach key populations in the Latin American and Caribbean region. A look at HIV / AIDS projects financed by the World Bank.
[Brighton, United Kingdom], International HIV / AIDS Alliance, 2006. 52 p.The purpose of this study is to assess the extent to which World Bank financed projects are supporting civil society organisations (CSOs) to reach four key populations (men who have sex with men (MSM), sex workers (SW), intravenous drug users (IDUs) and persons living with HIV/AIDS (PLWHA) in the Latin American and Caribbean (LAC) region. The study refers to the first three key populations (KPs) as 'at-risk KPs' when discussing KPs who may or may not be HIV infected. The study has two main outputs: an initial mapping of World Bank financed AIDS prevention and control projects in LAC and the role of CSOs and KPs in those projects; identification of factors that impede or facilitate CSO access to World Bank resources that target KPs. The International HIV/AIDS Alliance has commissioned this study to improve understanding of the dynamics at the country level with World Bank financed projects concerning CSOs and KPs. (excerpt)
[New York, New York], Population Council, Frontiers in Reproductive Health, 2007 Jul.  p.Progress in the initial stages of the documentation process can be slow, though it gathers momentum over time. Successful communication channels such as email are important for maintaining the momentum. Familiarity with applying the GRIPP framework and process and having existing networks in the field adds value to the product. An initial lack of knowledge about stakeholders can slow down the documentation process. However, the documentation process can help discover who these stakeholders are and the usefulness of the study to them. Case study information is much easier to recall and richer when the research is still current or only recently concluded. A snowballing effect, which results in getting more stakeholder perspectives than originally thought, can occur during the process. A study may have clinical and social and other dimensions, which have very different processes and outcomes with relation to a given research study. Each needs to be followed up in order to fully understand the utilisation and effectiveness of the research. A well-positioned facilitator may be the best placed to assume a neutral position and document the research process. Many of the obstacles in relation to the documentation process that were encountered could be overcome if researchers built the documentation process into their research schedule. (excerpt)
Sexual and reproductive health of women living with HIV / AIDS. Guidelines on care, treatment and support for women living with HIV / AIDS and their children in resource-constrained settings.
Geneva, Switzerland, WHO, 2006.  p.The sexual and reproductive health of women living with HIV/AIDS is fundamental to their well-being and that of their partners and children. This publication addresses the specific sexual and reproductive health needs of women living with HIV/AIDS and contains recommendations for counselling, antiretroviral therapy, care and other interventions. Improving women's sexual and reproductive health, treating HIV infections and preventing new ones are important factors in reducing poverty and promoting the social and economic development of communities and countries. Sexual and reproductive health services are uniquely positioned to address each of these factors. (excerpt)
Geneva, Switzerland, UNAIDS, 2003 Dec.  p. (Fact Sheet)All over the world, the AIDS epidemic is having a profound impact, bringing out both the best and the worst in people. It triggers the best when individuals group together in solidarity to combat government, community and individual denial, and to offer support and care to people living with HIV and AIDS. It brings out the worst when individuals are stigmatized and ostracized by their loved ones, their family and their communities, and discriminated against individually as well as institutionally. (author's)
Lancet Infectious Diseases. 2008 Jan; 8(1):14.A report from the International Treatment Preparedness Coalition (ITPC) warns that meeting the "near universal access target" to AIDS drugs access by the 2010 deadline will require an enormous effort by governments, global agencies, and drug companies. According to the report, which looked at AIDS treatment access in 14 countries, "scale-up is working but high prices, patent and registration barriers, and ongoing stock-outs are core issues impeding AIDS drug delivery". "The issues highlighted in this report are real and widespread", said Nathan Ford of Médecins Sans Frontières (MSF; Johannesburg, South Africa). The HIV programmes run by MSF across the developing world are struggling against user fees, high drug costs, lack of human resources, and poor health infrastructure, he told TLID. The ITPC, a group of 1000 treatment activists from more than 125 countries, highlights that the high cost of antiretroviral drugs is a particular barrier in Argentina, China, and Belize. (excerpt)
International guidelines on HIV / AIDS and human rights. 2006 consolidated version. Second International Consultation on HIV / AIDS and Human Rights, Geneva, 23-25 September 1996. Third International Consultation on HIV / AIDS and Human Rights, Geneva, 25-26 July 2002. Organized jointly by the Office of the United Nations High Commissioner for Human Rights and the Joint United Nations Programme on HIV / AIDS.
Geneva, Switzerland, Office of the United Nations High Commissioner for Human Rights, 2006. 115 p. (HR/PUB/06/9)The International Guidelines on HIV/AIDS and Human Rights arose because of various calls for their development in light of the need for guidance for Governments and others on how to best promote, protect and fulfill human rights in the context of the HIV epidemic. During the first International Consultation on AIDS and Human Rights, organized by the United Nations Centre for Human Rights, in cooperation with the World Health Organization, in Geneva, from 26 to 28 July 1989, participants discussed the possible elaboration of guidelines to assist policymakers and others in complying with international human rights standards regarding law, administrative practice and policy. Several years later, in his report to the Commission at its fifty-first session (E/CN.4/1995/45, para.135), the United Nations Secretary-General stated that "the development of such guidelines or principles could provide an international framework for discussion of human rights considerations at the national, regional and international levels in order to arrive at a more comprehensive understanding of the complex relationship between the public health rationale and the human rights rationale of HIV/AIDS. In particular, Governments could benefit from guidelines that outline clearly how human rights standards apply in the area of HIV/AIDS and indicate concrete and specific measures, both in terms of legislation and practice, that should be undertaken". (excerpt)
Africa Renewal. 2007 Oct; 21(3):5.Out of nearly 25 million Africans today living with HIV/AIDS, almost 60 per cent are women, reports the Joint UN Programme on HIV/AIDS (UNAIDS). In some African countries, more than two-thirds of people with the virus are women. It was therefore appropriate that UN Secretary-General Ban Ki-moon appointed an African woman, Ms. Elizabeth Mataka, as his new special envoy for AIDS in Africa. A citizen of Botswana, Ms. Mataka has lived and worked in neighbouring Zambia for many years, and since 1990 has been on the frontline of Africa's struggle against the disease, as a community activist, programme director and international advocate. At the time of her UN appointment on 21 May, she was serving as executive director of the Zambia National AIDS Network and as vice-chairperson of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The struggle against HIV/AIDS requires a far greater focus on women, says Ms. Mataka. "Unless we empower women not just economically, but with technology that they can initiate and control to protect themselves against infection, we will remain with very limited success," she told Africa Renewal from her office in Lusaka. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Jan. 57 p. (UNAIDS/07.04E; JC1301E)In 2005 and early 2006, the landscape of the AIDS response shifted dramatically. Global pessimism over the unchecked spread of the disease in the developing world receded in the face of impressive efforts to expand access to treatment. Signs that prevention efforts were bearing fruit were seen in a growing number of countries from the hardest-hit regions, which started to report drops in HIV rates, particularly among the young. The global community had responded to urgent appeals by enormously increasing the financial resources available to fight the disease. While millions continued to die annually, these developments gave rise to hope that there was a light at the end of the tunnel. Unimaginable even a year or two earlier, it was now possible to start talking about the prospects of providing access to HIV prevention, treatment, care and support services to all who needed them. (excerpt)
Setting national targets for moving towards universal access. Further guidance to complement “Scaling Up Towards Universal Access: Considerations for Countries to Set their own National Targets for AIDS Prevention, Treatment, and Care and Support”. Operational guidance. A working document.
[Geneva, Switzerland], UNAIDS, 2006 Oct. 23 p.This document provides operational guidance to country-level partners and UN staff to facilitate the next phase of the country-level consultative process on scaling up towards universal access to prevention, treatment, care and support services. It concerns the setting of ambitious targets for the national HIV response to achieve by 2008 and 2010, and builds on previous guidelines. Targets need to be ambitious in order to achieve the universal access goals. Analysis by UNAIDS of existing national targets and rates of scaling up indicates that current efforts are inadequate to achieve universal access in the near future. The process of countries setting their own targets will promote partner alignment to national priorities, strengthen accountability and facilitate efforts by countries and international partners to mobilize international support and resources. Targets should have political and social legitimacy. The consultative process should be multi-sectoral, include full civil society participation, lead to consensus on the targets, and formal approval of these targets before the end of 2006. (excerpt)
Lancet. 2007 Dec 1; 3703(9602):1811-1813.The recent UNAIDS/WHO AIDS epidemic update revises downwards the global estimate of people living with HIV/AIDS to 33.2 million (range 30.6-36.1 million). This is a reduction of 16% compared with the estimate in 2006 (39.5 million, 34.7-47.1 million). The biggest reason for this decrease is the major revision for India, to 2.5 million people (2-3.1 million) or about 0.4% of adults. That estimate is less than half the earlier one of 5.7 million people (range 3.4-9.4 million). What is the basis for this drop and what are the implications for further planning of HIV/AIDS control in India? The new HIV estimate for India is based on population data from the third National Family Health Survey of more than 102 000 adults (82% of eligible people), and includes upward adjustments for under-represented groups at high risk of HIV. The survey data provide the most reliable HIV estimate for India so far. These data corroborate the findings from our study last year in Guntur district in south India, in which we showed that the official method used so far to estimate the HIV burden in India led to a 2.5 times higher estimate than population data adjusted for under-represented groups at high risk of HIV. (excerpt)
Lancet. 2007 Dec 1; 370(9602):1817-1818.Progress towards making male circumcision for HIV prevention a reality in Africa has been slow because of cultural hurdles in a few countries, financial constraints in most, and a serious shortage of skilled practitioners throughout the continent. Joint Programme on HIV and AIDS made one of the most important policy statements in recent times on the fight against HIV in developing countries. After a 2-day consultation in Montreaux, Switzerland, the UN agencies released a document that urged countries with high rates of heterosexually transmitted HIV to consider adding male circumcision to their armamentarium against AIDS. The recommendation had a sound scientific basis. The results of three randomised controlled trials undertaken in Kisumu, Kenya, Rakai District, Uganda, and Orange Farm, South Africa had shown that male circumcision reduces the risk of heterosexually acquired HIV infection in men by around 60%. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Sep. 15 p. (UNAIDS Best Practice Collection; UNAIDS/07.25E; JC1362E)A project rolling out in rural Thailand, the Positive Partnerships Program (PPP), has shown that targeted economic assistance can boost self-esteem, ambition and hope-all of which help reinvigorate community bonds and have a beneficial impact in promoting enabling environments for HIV prevention and treatment efforts. This best practice document examines how and why PPP may serve as a flexible and adaptive model in other countries. The project has two distinct yet complementary goals. to enable people living with HIV to lift themselves out of poverty, through the provision of microcredit loans that allow people to set up small businesses in their communities; to reduce HIV-related stigma and discrimination against people living with HIV through business partnerships between one HIV-positive person and one HIV-negative person. The enthusiastic response to PPP from people living with HIV and funders alike serves as a useful reminder of the need to develop comprehensive strategies in response to the AIDS epidemic that reflect a full range of economic, social, legal and political considerations-not just those narrowly based on health. (excerpt)
Lancet. 2007 Dec 1; 370(9602):1821.One Sunday morning last year, an elderly Zambian woman, four grandchildren in tow, showed up at Elizabeth Mataka's door. "I'm looking for Mrs Mataka-people said she will help me. She's the one who helps grandmothers", the woman said. She had found exactly the right person. Mataka, herself a grandmother of three, heads the Zambia National AIDS Network (ZNAN) and helps coordinate funds fl owing in from donors. And earlier this year she was elevated to the highest levels of the global response to the pandemic. In April, 61-year-old Mataka was elected Vice Chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The next month, she got a surprise midnight call from New York with the news that she had been chosen to replace the outgoing United Nations Special Envoy for HIV/AIDS in Africa, Canadian diplomat Stephen Lewis. (excerpt)
Lancet. 2007 Dec 1; 370(9602):1802.Ahead of World AIDS Day on Dec 1, UNAIDS released their annual global HIV/AIDS estimates for 2007. The new revised data show that the global HIV prevalence has leveled off and that the number of new infections has fallen from 40 million estimated last year to 33.2 million, in 2007. However, with 6800 new infections and 2500 deaths every day, AIDS is still a leading killer globally and remains one of the primary causes of death in Africa, especially in sub-Saharan Africa. The downward revision is largely due to improved methodology, an increase in sentinel surveillance sites and population-based household surveys, and changes in key epidemiological assumptions used to calculate the estimates. Revised figures for India account for much of the decrease, followed by several sub-Saharan African countries, including Nigeria, Mozambique, Zimbabwe, Kenya, and Angola. For the first time the report also documents the progress being made by prevention and treatment programmes as seen by a decline in new infections in some countries and a reduction of mortality and improvement of life expectancy in others. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Jul. 48 p. (UNAIDS Best Practice Collection; UNAIDS/07.22E; JC1260E)Nearly 600 000 people are living with HIV in Thailand. As in every other country, most are poor and many are isolated from their communities. Breaking down the mutually reinforcing barriers of poverty and stigma they face has proved immensely difficult. These barriers are not insurmountable, however. A new project rolling out in rural Thailand, the Positive Partnership Program (PPP), has shown that targeted economic assistance can boost self-esteem, ambition and hope-all of which help reinvigorate community bonds and have a major, positive impact on HIV prevention and treatment efforts. The core of PPP is the provision of microcredit loans to resource-constrained HIV-positive individuals who otherwise have no access to credit in conventional, affordable ways. These loans are intended to support the efforts of people living with HIV to lift themselves out of poverty by setting up small businesses in their communities. Closely linked to this poverty-reduction goal is another vital objective: the reduction of HIV-related stigma and discrimination. As conceptualized by PPP's implementing entity-the Population and Community Development Association (PDA), a Bangkok-based nongovernmental organization-a unique aspect of the PPP project greatly facilitates progress towards achieving these two goals simultaneously: loans are given out not to people living with HIV alone but to partnerships between an HIV-positive and an HIV-negative person. By the end of 2005, a total of 375 partnerships had been formed since the project began in January 2004. (excerpt)
Lancet. 2007 Dec 1; 370(9602):1808-1809.Important questions about implementation of the new guidance by WHO and UNAIDS on provider-initiated HIV testing and counselling were raised by Daniel Tarantola and Sofia Gruskin. Their comments and those by other critics centre on individuals' rights to confidentiality, to refuse testing, and to not disclose their status if they fear negative consequences. We are concerned that a singular focus on the individual's rights of refusal overlooks the rights of the individual's sexual partners to protect themselves from HIV. Human rights and public health will be best served by an ethical framework which recognises that both persons in a sexual relationship or exchange have equal rights and responsibilities for their mutual pleasure and protection. Further, these individual rights are meaningless unless each partner respects the rights of the other. Protection of the human rights of both partners needs more commitment from health systems, and from societies, than simply ensuring informed consent and confidentiality. (excerpt)
A nongovernmental organization's national response to HIV: the work of the All-Ukrainian Network of People Living with HIV.
Geneva, Switzerland, UNAIDS, 2007 Jul. 47 p. (UNAIDS Best Practice Collection; UNAIDS/07.23E; JC1305E)The All-Ukrainian Network of People Living with HIV/AIDS (the 'Network') was formed in the late 1990s by HIV-positive individuals alarmed at the surging HIV epidemic in their country and the lack of resources and support for themselves and others living with the virus. It has grown rapidly and steadily since then, providing services and support to more than 14 000 people living with HIV. Its roots are in the self-help ethos, based on the belief that people living with HIV must be directly involved in leading national and local responses to HIV. The Network's four key strategy components are: increasing access to non-medical care, treatment and support; lobbying and advocating to protect the rights of people living with HIV; seeking to increase acceptance towards people living with HIV throughout society; and enhancing the organizational capacity of the Network. (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Mar. 4 p. (UNAIDS Policy Brief)Nearly 40 million people in the world are living with HIV. In countries such as Botswana, Swaziland, and Lesotho people living with HIV make up a quarter or more of the population. People living with HIV are entitled to the same human rights as everyone else, including the right to access appropriate services, gender equality, self-determination and participation in decisions affecting their quality of life, and freedom from discrimination. All national governments and leading development institutions have committed to meeting the eight Millennium Development Goals, which include halving extreme poverty, halting and beginning to reverse HIV and providing universal primary education by 2015. GIPA or the Greater Involvement of People Living with HIV is critical to halting and reversing the epidemic; in many countries reversing the epidemic is also critical to reducing poverty. (excerpt)
Towards universal access to prevention, treatment and care: experiences and challenges from the Mbeya region in Tanzania -- a case study.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2007 Mar. 49 p. (UNAIDS Best Practice Collection; UNAIDS/07.11E; JC1291E)This study takes stock of the situation in Mbeya in 2005, documenting the region's continuing efforts to build on the Regional Programme's strong comprehensive prevention approaches to further increase their coverage while strengthening the new district focus, expanding multisectoral work and making available antiretroviral treatment. In doing so, this study describes Mbeya's progress towards universal access and identifies ongoing challenges. Through its comprehensive, decentralized and multisectoral approaches and the continuing efforts of a variety of actors, the region appears to be in a better position to reach universal access than other parts of Tanzania and Africa in general. The experiences of the Mbeya region to date can serve as lessons learnt to other parts of the country and, more broadly, the continent. This publication is neither a scientific study nor an evaluation of the Regional Programme. It is an analytical description of HIV control activities in the region to date and their status to date. Its focus is mainly on access. The programmes presented here follow national and international recommendations. The quality of the individual programmes, however, has not been assessed for the purpose of this publication. (excerpt)
Inferiority of single-dose sulfadoxine-pyrimethamine intermittent preventive therapy for malaria during pregnancy among HIV-positive Zambian women.
Journal of Infectious Diseases. 2007 Dec 1; 196(11):1577-1584.The World Health Organization advocates 2-3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (SP IPTp). The optimal number of doses and the consequences of singledose therapy remain unclear. Data were from a randomized, controlled study of human immunodeficiency virus-positive Zambian women comparing monthly versus 2-dose SP IPTp. We compared maternal and neonatal birth outcomes as a function of how many doses the mothers received (1 to >/= 4 doses). Of 387 deliveries, 34 received 1 dose of SP. Single-dose SP was significantly associated with higher proportions of maternal anemia, peripheral and cord blood parasitemia, infant prematurity, and low birth weight. SP conferred dose-dependent benefits, particularly in the transition from 1 to 2 doses of SP. Women randomized to the standard 2-dose regimen were much more likely to receive only 1 dose than were women randomized to monthly IPT (relative risk, 16.4 [95% confidence interval, 4.0-68.3]). Single-dose SP was a common result of trying to implement the standard 2-dose regimen and was inferior to all other dosing regimens. At a programmatic level, this implies that monthly SP IPTp may ultimately be more effective than the standard regimen by reducing the risk of inadvertently underdosing mothers. (author's)
Towards universal access by 2010. How WHO is working with countries to scale-up HIV prevention, treatment, care and support.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2006. 32 p.In 2005, leaders of the G8 countries agreed to «work with WHO, UNAIDS and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010». This goal was endorsed by United Nations Member States at the High-Level Plenary Meeting of the 60th Session of the United Nations General Assembly in September 2005. At the June 2006 General Assembly High Level Meeting on AIDS, United Nations Member States agreed to work towards the broad goal of "universal access to comprehensive prevention programmes, treatment, care and support" by 2010. Working towards universal access is a very ambitious challenge for the international community, and will require the commitment and involvement of all stakeholders, including governments, donors, international agencies, researchers and affected communities. Among the most important priorities is the strengthening of health services so that they are able to provide a comprehensive range of HIV/AIDS services to all those who need them. This document describes the contribution that the World Health Organization (WHO) will make, as the United Nations agency responsible for health, in working towards universal access to HIV prevention, treatment, care and support in the period 2006-2010. It proposes an evidence-based Model Essential Package of integrated health sector interventions for HIV/AIDS that WHO recommends be scaled up in countries, using a public health approach, and provides an overview of the strategic directions and priority intervention areas that will guide WHO's technical work and support to its Member States as they work towards universal access over the next four years. (excerpt)
The practice of charging user fees at the point of service delivery for HIV / AIDS treatment and care.
Geneva, Switzerland, WHO, 2005 Dec.  p. (WHO Discussion Paper; WHO/HIV/2005.11)The global movement to expand access to antiretroviral treatment for people living with HIV/AIDS as part of a comprehensive response to the HIV pandemic is grounded in both the human right to health and in evidence on public-health outcomes. However, for many individuals in poor communities, the cost of treatment remains an insurmountable obstacle. Even with sliding fee scales, cost recovery at the point of service delivery is likely to depress uptake of antiretroviral treatment and decrease adherence by those already receiving it. Therefore, countries are being advised to adopt a policy of free access at the point of service delivery to HIV care and treatment, including antiretroviral therapy. This recommendation is based on the best available evidence and experience in countries. It is warranted as an element of the exceptional response needed to turn back the AIDS epidemic. With the endorsement by G8 leaders in July 2005 and UN Member States in September 2005 of efforts to move towards universal access to HIV treatment and care by 2010, health sector financing strategies must now move to the top of the international agenda. Rapid scale-up of programmes within the framework of the "3 by 5" target has underscored the challenge of equity, particularly for marginalized and rural populations. It is apparent that user charges at the point of service delivery "institutionalize exclusion" and undermine efforts towards universal access to health services. Abolishing them, however, requires prompt, sustained attention to long-term health system financing strategies, at both national and international levels. (excerpt)