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BMJ. British Medical Journal. 2006 Aug 19; 333(7564):367.The world's richest nations are failing to ensure that people living with HIV/AIDS in the developing world have universal access to antiretroviral drugs, delegates at the 16th international AIDS conference in Toronto were told this week. In an opening address, Microsoft founder Bill Gates said that he was making AIDS the top priority of his foundation, at which resources doubled last month to $62bn (£33bn; €49bn), after a donation by US investor Warren Buffett. Bill Gates, who with his wife Melinda pledged $500m to the Global Fund to Fight AIDS, Tuberculosis, and Malaria last week, emphasised the importance of seeking more funds, creating cheaper drugs with fewer side effects, and achieving more widespread treatment for the world's most vulnerable people with HIV/AIDS. (excerpt)
New York, New York, SIECUS, .  p. (SIECUS PEPFAR Country Profiles: Focusing in on Prevention and Youth)The Republic of Rwanda is home to approximately 8,441,000 people. More than 90% of the population lives in rural areas, in part because lack of economic opportunities and violence are driving people from urban areas. Rwanda's population is comprised of two main ethnic groups -- the Hutus (84%) and the Tutsis (15%). Rwandans are largely Christian (56.5% Roman Catholic, 26% Protestant, 11.1% Adventist), with a small minority holding Islamic beliefs (4.6%). Rwanda gained independence from the Britain in 1962 and has recently experienced dramatic governmental upheaval and civil war, beginning in 1990 and culminating in the 1994 genocide of approximately 800,000 people. During the conflict, roughly two million refugees fled to neighboring countries. While most refugees have returned to Rwanda, many continue to live in the Democratic Republic of Congo (DROC), Uganda, and Zambia. Conversely, Rwanda shelters nearly 38,000 refugees from the DROC, as well as over 4,000 internally displaced persons. With much of the population uprooted and in light of the real and perceived political dominance of Rwanda's ruling party, attempts at ethnic reconciliation have been complicated. In the aftermath of the 1994 genocide, however, Rwanda has been able to hold local, legislative, and presidential elections. In 2003, Rwandans, in addition to adopting a new constitution, overwhelmingly supported the election of President Paul Kagame, who was originally appointed to the office in 2000 by members of Parliament. The next presidential election is scheduled for 2008. (excerpt)
New York, New York, SIECUS, .  p. (SIECUS PEPFAR Country Profiles: Focusing in on Prevention and Youth)South Africa is home to over 44 million people. South Africa's population is diverse-- the country officially recognizes 11 different languages and is home to a variety of ethnic groups and religions. Until 1991, South African law divided the population into four major racial categories: African (black), white, coloured, and Asian. Although this law has been abolished, many South Africans still view themselves and each other according to these categories. Black Africans from various ethnic groups comprise about 79% of the population. White people of European descent comprise about 10% of the population. Coloured people, who are mixed-race people primarily descending from the earliest settlers and the indigenous peoples, comprise about 9% of the total population. Asians, who descend from Indian workers brought to South Africa in the mid-19th century to work on the sugar estates in Natal, constitute about 2.5% of the population and still live primarily in the KwaZulu-Natal Province. Over half of South Africans identify as Christian, and 28.5% hold traditional, indigenous and/or animist beliefs. South Africans who identify as Muslim and Hindu (60% of whom are Indian) represent 2% and 1.5% of the population, respectively. (excerpt)
New York, New York, SIECUS, .  p. (SIECUS PEPFAR Country Profiles: Focusing in on Prevention and Youth)The United Republic of Tanzania, which consists of the mainland and the island of Zanzibar, is home to 36.8 million people. The vast majority (99%) are native Africans, of which 95% are Bantu (an ethnic group consisting of more than 130 tribes). While mainland Tanzanians hold a variety of beliefs (35% Muslim, 35% indigenous, and 30% Christian), more than 99% of the inhabitants of Zanzibar practice Islam. Tanzania was formed through the merger of Tanganyika and Zanzibar in 1964, after the two nations gained independence from U.N. trusteeship administered by Britain. In 1995, one-party rule came to an end with the first democratic elections held in the country in nearly 30 years. Since that time, two contentious elections have been conducted, with the ruling party declaring victory despite claims of voting irregularities by international observers. (excerpt)
New York, New York, SIECUS, .  p. (SIECUS PEPFAR Country Profiles: Focusing in on Prevention and Youth)Uganda is home to over 26 million people, comprising at least 18 different ethnic groups. The largest group, the Baganda people, make up 17% of the population. Today, an increasing number of people practice some form of Christianity, roughly 66% of the population, with an equal number subscribing to Roman Catholic and Protestant teachings. Of the remaining 34%, half practice Islam and half practice traditional, indigenous religions. Uganda is struggling to emerge from a turbulent and violent political history. President Yoweri Museveni seized power through a military rebellion in 1986. In 1996, he became the country's first directly elected president and was re-elected in 2001. He is also the chair of the National Resistance Movement (NRM), the only fully and freely functioning political organization in the country. Although there are seven organizations that could be characterized as political parties, Museveni has declared that the NRM is not a political party but a movement that "claims the loyalty of all Ugandans."2 Presidential elections are scheduled for February 2006, and although the constitution limits presidents to two terms in office, Musevini is campaigning to alter the constitution to permit him to run for a third term. (excerpt)
New York, New York, SIECUS, .  p. (SIECUS PEPFAR Country Profiles: Focusing in on Prevention and Youth)Zambia is home to 11 million people, who represent more than 70 different ethnic groups, many sharing a common language, Bantu. Today roughly 35% of people live in urban areas. Although at one point the country was becoming increasingly urbanized, intense poverty on the rise since the 1970s has seen many people returning to rural areas. Religious beliefs in the country are varied. It is estimated that between half and three-quarters of Zambians practice Christianity, and that between a quarter and one-half practice Islam or Hinduism. A small minority practice indigenous faiths. Zambia gained its independence from Britain in 1964, and then was under one-party rule until the early 1990s. President Levy Mwanawasa was elected in 2001, although opposition parties claim the elections were marred by irregularities. Mwanawasa, however, has actively worked to rectify the perception of corruption in the government. For example, he lifted his predecessor Frederick Chiluba's immunity from investigation and prosecution regarding allegations of corruption. The next elections are scheduled for 2006. (excerpt)
The 10-year struggle to provide antiretroviral treatment to people with HIV in the developing world.
Lancet. 2006 Aug 5; 368(9534):541-546.In March, 2006, the WHO took stock of the 3 by 5 initiative, which had been formally launched with UNAIDS 2 years earlier. With 1.3 million people on antiretroviral treatment in developing countries by the end of 2005, the world had not reached the target of treating 3 million people living with HIV/AIDS. In terms of numbers, at least, some said that the campaign failed. But the initiative did show that with the right vision and a determined effort by all relevant parties, development achievements that seem unthinkable are indeed possible. The apparent failure to achieve what was always an aspirational goal should not overshadow the fact that the progress on access to antiretroviral treatment might have no precedent in global public health. For no other life-threatening disease has the world moved from the first scientific breakthroughs to a commitment to achieve universal access to treatment in less than a decade. But we should not forget that the number of new HIV infections still outpaces the expansion of access to treatment, and that progress remains slow in view of the millions still dying from AIDS every year. (excerpt)
Oxford, England, Oxfam International, 2006. 122 p.This report shows that developing countries will only achieve healthy and educated populations if their governments take responsibility for providing essential services. Civil society organisations and private companies can make important contributions, but they must be properly regulated and integrated into strong public systems, and not seen as substitutes for them. Only governments can reach the scale necessary to provide universal access to services that are free or heavily subsidised for poor people and geared to the needs of all citizens -- including women and girls, minorities, and the very poorest. But while some governments have made great strides, too many lack the cash, the capacity, or the commitment to act. Rich country governments and international agencies such as the World Bank should be crucial partners in supporting public systems, but too often they block progress by failing to deliver debt relief and predictable aid that supports public systems. They also hinder development by pushing private sector solutions that do not benefit poor people. The world can certainly afford to act. World leaders have agreed an international set of targets known as the Millennium Development Goals. Oxfam calculates that meeting the MDG targets on health, education, and water and sanitation would require an extra $47 billion a year. Compare this with annual global military spending of $1 trillion, or the $40 billion that the world spends every year on pet food. (excerpt)
Journal of Acquired Immune Deficiency Syndromes. 2006 Dec; 43(5):618-623.The number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from < 2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa's performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government's own Operational Plan. The public-sector HAART ''rollout'' has been uneven across South Africa's nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources-- especially nurses--is likely to constrain the growth of HAART coverage. (author's)
Social Science and Medicine. 2007 Jan; 64(2):287-291.This article builds on a previous study which found low numbers of patent applications for HIV antiretroviral drugs in African countries. A high level of variation was noted across individual countries, and consequently, the present study has sought to account for sources of the variation through statistical analyses. First, a correlation between the number of patents and HIV infection rate was observed (r = 0.448, p < 0.001). T-tests identified significantly higher numbers of patents in national members of two intellectual property organizations (IPOs)--African Regional Intellectual Property Orginisation (ARIPO) and the Organisation Africaine de la Proprie´ te´ Intellectualle (OAPI)--than in countries who did not belong to an intellectual property organization. The relationship between IPO membership and number of patents was also statistically significant in a multivariate Poisson regression. These findings demonstrate that higher numbers of patents are found in countries where they are more easily filed. This has important policy implications given the worldwide trend toward increased recognition of pharmaceutical patents. (author's)
Right to education during displacement: a resource for organizations working with refugees and internally displaced persons.
New York, New York, Women' s Commission for Refugee Women and Children, 2006.  p.This resource is the first in a series of tools that identifies everyone's right to education, with a focus on refugees, returnees and internally displaced persons (IDP). This version is designed for use by local, regional and international organizations, United Nations (UN) agencies, government agencies and education personnel working with displaced communities. Is it mean to serve as: an awareness raising tool to encourage humanitarian assistance agencies to implement education programs - and donors to found them; training and capacity-building resource for practitioners and others working with displaced populations on international rights around education; and a call to action for organizations and individuals to promote access and completion of quality education for all persons affected by emergencies. (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)
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)
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)
[Bangkok, Thailand], ITPC, 2007 Dec.  p.In the first section of the report, nine country teams provide first-hand reports on central issues related to AIDS service scale-up in their countries. Each demonstrates that increasing access to AIDS treatment brings not only better life and new hope, but also shines light on challenges and effective approaches to a spectrum of health, poverty, and human rights issues. In part two of this report, 14 national teams review drug access issues, and find that global and national processes for AIDS drug registration are burdened by inefficiencies, duplications, delay, and, in some instances, corruption. In many cases key ARVs, particularly newer and second-line therapies, are not yet registered in high impact countries - an administrative roadblock that puts lifesaving care out of reach for hundreds of thousands of people. The report makes a number of concrete recommendations to the key players who are responsible for making near universal access to AIDS treatment a reality by 2010. (excerpt)
Global Public Health. 2009; 4(2):131-49.Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.
[Wellington, New Zealand], Family Planning International, 2006 Dec. 27 p.This report focuses on the relationship between policies implemented by the World Trade Organisation, World Bank, and the International Monetary Fund, and access to health, particularly sexual and reproductive health. .
[Geneva, Switzerland], Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 Jan 12. 17 p.The AMFm is an innovative financing mechanism to expand access to affordable artemisinin-based combination therapies (ACTs) for malaria, thereby saving lives and reducing the use of inappropriate treatments. The AMFm aims to enable countries to increase the provision of affordable ACTs through the public, private not-for-profit (e.g. NGO) and private for-profit sectors. By increasing access to ACTs and displacing artemisinin monotherapies from the market, the AMFm also seeks to delay resistance to the active pharmaceutical ingredient, artemisinin.
In: While the world sleeps: writing from the first twenty years of the global AIDS plague, edited by Chris Bull. New York, New York, Thunder's Mouth Press, 2003. 401-412.Public concern over the global AIDS epidemic, particularly in Africa, has grown enormously in recent years, but there is considerable debate about what the international community can and should do about it. Especially controversial has been the high cost of antiretroviral drugs used to extend the lives of people with AIDS. The pharmaceutical companies that make these drugs price them beyond reach of the world's poor, but in November 2001 at the WTO meeting in Doha, Qatar, these companies were forced to accede to pressure from developing-country governments, nongovernmental organizations, and activists, and allow poor governments to adjust certain rigid patent rules applying to vaccines and drugs in order to protect public health. Despite this apparent triumph of international pressure, far more needs to be done. A coalition of governments and nongovernmental organizations, led by the UN, recently launched the Global Fund Against AIDS, Tuberculosis, and Malaria (referred to here as the Global Fund), and its performance will test how well such a global institution can confront the most serious health crises of our time, and perhaps in all of human history. (excerpt)
Global AIDSLink. 2001 Apr-May; (67):9.For many years, I have worked for access to treatment for people living with AIDS in the developing world. In a well-circulated 1997 article I wrote, “While thousands die of AIDS in the developing world, their brothers and sisters in Europe and North America are taking medication and getting back to the business of focusing on life instead of death.... I think in fifty more years, people will be asking the same questions about the AIDS epidemic as they did about the Holocaust. How was it possible that so many people with resources and intelligence, who knew so much about AIDS, sat passively by and watched their brothers and sisters die for lack of the same medications that everyone knows can prevent the deaths of people with AIDS?” Nearly four years later, I continue to work in Central America promoting treatment access for people with AIDS. The panorama has changed somewhat since 1997. But the realities of every day life for people with AIDS have changed very little in my part of the world, and, I would venture to say, in most of the developing world. (excerpt)
Micro-finance in rural communities in Southern Africa. Country and pilot site case studies, policy issues and recommendations.
Pretoria, South Africa, Human Sciences Research Council, 2002. , 170 p.While micro-finance in its various forms has helped to make loan capital more accessible to low-income rural communities, much remains to be done to increase its outreach, impact and sustainability. The essential objective of this study is to make well-researched recommendations for IRDP policy and strategy to enable the micro-finance agents that it will shortly be appointing to maximize improvements in these key indicators in the three pilot sites. Chapter 1 outlines the institutional context and terms of reference of the report and briefly discusses its timeframe, methodology, value and limitations. Chapters 2 and 3 depict, on the one hand, the demand for financial services in the three pilot sites and, on the other, access to micro-finance in the respective communities. In Chapter 4 an account is given of the essential nature and capabilities of microfinance, of recent developments in this regard, of fundamental lessons from international experience and of best practices in a rural context. Chapter 5 identifies the key sets of policy issues facing, in the first instance, public policy makers seeking to promote micro-finance development and, in the second, donors/investors/wholesalers seeking to support individual micro-finance retailers. It then applies the findings of Chapter 4 to the three on-the-ground pictures sketched out in Chapters 2 and 3 to arrive at some initial and very tentative recommendations for policy for the IRDP in the respective pilot sites. (excerpt)
Chapel Hill, North Carolina, INTRAH, PRIME, 2002 Apr 4.  p. (PRIME Voices No. 10; USAID Grant No. HRN-A-00-99-00022-00)Over the four days of the conference, speaker after speaker rose to emphasize the urgency of the risk to the lives of women who are endangered by the lack of access to quality PAC services. They also highlighted the importance of linking PAC with family planning to prevent repeat unwanted pregnancies, and with other reproductive health services. The key roles of primary providers and communities were also singled out in proposed interventions. (excerpt)
Geneva, Switzerland, WHO, 2004 Jun.  p. (WHO/EDM/PAR/2004.4; Development Experience Clearinghouse DocID / Order No. PN-ADB-693)Antiretroviral therapy, prevention and treatment of opportunistic infections and cancers, as well as palliative care are important elements of HIV/AIDS care and support. HIV/AIDS care hence requires a wide range of essential medicines. If available, these effective and often relatively inexpensive medicines can prevent, treat, or help manage HIV/AIDS and most of the common HIV-related diseases. Less than 8% of people who require antiretroviral (ARV) treatment can access these medicines in developing countries. The high price of many of the HIV-related medicines and diagnostics offered by common suppliers – especially antiretroviral and anti-cancer medicines – is one of the main barriers to their availability in developing countries. There are several other important barriers, including a lack of the basic components required for care, treatment, and support of people living with HIV/AIDS (PLWA) such as: trained staff in health facilities, constant availability of laboratory equipment and supplies, sufficient funding, efficient pharmaceutical services, strong political will and government commitment. Wider availability of information on prices and reliable sources of medicines can help those responsible for procurement make better decisions. Since 2000, prices of important first-line ARVs have fallen considerably. This trend is attributable to a cumulation of factors including advocacy, corporate responsiveness, competition from generic manufacturers, sustained public pressure, and the growing political attention paid to the AIDS epidemic. In addition, originator companies began announcing discount offers for the benefit of the poorest countries or those where HIV/AIDS prevalence is highest. (excerpt)
Choices. 2004; 7.I left the 1998 International AIDS Conference in Geneva frustrated and angry. The slogan of the conference--'Bridging the Gap'--was right on target, but none of the major players in the conference (the international agencies, governments, the big pharmaceutical companies) offered a vision, let alone a strategy, for making life-saving treatments available to the millions of HIV-positive people in poor and developing countries. As has been true since the beginning of the AIDS epidemic, it was left to HIV-positive people themselves and to advocacy groups to formulate demands, mobilize the political support to challenge the status quo and lead in the development of new policies. Dramatic changes have occurred between 1998's 'Bridging the Gap' and 2004's 'Access for All' conferences. In the intervening six years, an alliance of NGOs from around the world with a bloc of progressive poor and developing countries has won significant victories: It is no longer morally acceptable to do nothing about the death and suffering of millions; The broader global AIDS community has accepted that any effective approach to stopping the epidemic must include treatment as well as prevention and mitigation. (excerpt)
Cambridge, Massachusetts, Management Sciences for Health [MSH], Guinea PRISM II Project, 2005 Oct. 59 p. (Development Experience Clearinghouse DocID / Order No: PD-ACH-471; USAID Cooperative Agreement No. 675-A-00-03-00037-00)The PRISM project (Pour Renforcer les Interventions en Santé Reproductive et MST/SIDA) is an initiative of the Republic of Guinea as part of its bilateral cooperation with the United States of America designed to increase the utilization of quality reproductive health services. The project is funded by the United States Agency for International Development (USAID) and is implemented by Management Sciences for Health (MSH) in collaboration with the John Hopkins University/Center for Communication Programs (JHU/CCP) and Engenderhealth. The project's intervention zones correspond to the natural region of Upper Guinea as well as Kissidougou prefecture, thus covering all of the 9 prefectures of Kankan and Faranah administrative regions. This annual report covers the activities and results of PRISM over the fiscal year 2005, October 1, 2004 to September 30, 2005. Like all of PRISM's activity reports, the present report is structured according to the 4 intermediate result areas: (1) increased access to reproductive health services and products, (2) improved quality of services at health facilities, (3) increased demand of reproductive health services and products (4) improved coordination of health interventions. The report consists of three parts. The first part presents the introduction, an executive summary, and the summary of the principal results attained over the course of the year in each of the four intermediate results (IR). The second part presents in detail for each IR the project's strategies and approaches, the implemented activities and the results attained over the course of the year. The third part presents the operational aspects having had an impact on the project over the course of the year. (excerpt)