Making the health care system 'safe' for persons with HIV infection or AIDS.

If health care reform is implemented in states and nationally, the safety of this process needs to be examined for persons with human immunodeficiency virus (HIV) infection or the acquired immunodeficiency syndrome (AIDS). Reform should assure ongoing prevention and transmission control of HIV and continuous coverage of medical costs for persons ill with HIV or AIDS. These persons currently benefit from various state and federal categoric programs designed to assure access to preventive and personal care services. Washington State has passed health care reform legislation that envisions integrating these programs to provide a system of population-based and personal health care. This legislation was analyzed using existing epidemiologic and entitlement information about persons with HIV infection or AIDS in the state to assess its effect. The relationship between public health and personal care services will be a central concern for those with HIV infection or AIDS, and complete coverage of this group may be achieved relatively late in the process of implementing health care reform. Health personnel planning under health care reform will affect the delivery of HIV- and AIDS-related services. Including treatment of AIDS in the basic benefit package merits particular attention. These issues parallel those being faced by the nation as a whole as it seeks to ensure epidemic disease control and compassionate care for long-term disabling illness if health care reform is implemented.     

HIV/AIDS programmes should focus on improved access

This paper discusses the need for HIV/AIDS programs in sub-Saharan countries to focus more on improved access to information to empower poor people living in remote areas. It is noted that despite Glaxo Wellcome's move to reduce the cost of antiretroviral therapy, it is unlikely to have an impact on most of those infected with or affected by HIV/AIDS, since concerns regarding lack of sustainability, bureaucratic administration, and communication difficulties predominate in the country. In this regard, it is therefore recommended that national HIV/AIDS programs be balanced with the needs of both the community and the individual and in prevention and care. Health workers should be explicit in confronting traditional beliefs, such as those about gender roles and traditional medicine, in prevention campaigns. Moreover, there is also an urgent need to improve access to condoms; strengthen health programs such as directly observed treatment short-term (DOTS) courses for tuberculosis and the syndromic approach to sexually transmitted disease treatment; and improve practical support to communities caring for those who are sick and the orphans. Lastly, all partners working with prevention programs should use the more positive community attitudes towards HIV/AIDS issues seen in many sub-Saharan countries to develop evidence-based programs that focus more on improved access and less on sustainability.     

From PMTCT to a more comprehensive AIDS response for women: a much-needed shift

Half of the 33.2 million people living with HIV today are women. Yet, responses to the epidemic are not adequately meeting the needs of women. This article critically evaluates how prevention of mother-to-child transmission (PMTCT) programs, the principal framework under which women's health is currently addressed in the global response to AIDS, have tended to focus on the prevention of HIV transmission from HIV-positive women to their infants. This paper concludes that more than ten years after their inception, PMTCT programs still do not successfully ensure the adequate treatment, care and support of HIV-infected women. Of particular concern is the continued widespread use of single-dose nevirapine despite World Health Organization recommendations to employ more effective combination therapies that do not potentially jeopardize women's future treatment outcomes. In response, the article calls for a more comprehensive approach that places women's health needs at the centre of AIDS responses. This is critical in settings where the pandemic is generalized and there is a push to greatly expand PMTCT programs, as a more effective and equitable way of meeting the needs of women in the context of HIV. Without such a comprehensive approach, women will continue to be impacted disproportionately by the pandemic, and current strategies for prevention, including PMTCT, and treatment will not be as effective and responsive as they need to be.     

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

Summary Points

• HIV prevention programs for sex workers, especially female sex workers, are cost-effective.
• There are opportunities to further increase the impact of HIV prevention programs for sex workers and to adapt interventions to a changing context.
• Many sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; receive limited domestic financing in many countries; are inadequately codified to ensure consistency and quality; and have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile and internet-based sex workers.
• We recommend increasing our understanding of HIV epidemic transmission dynamics, improving situation analyses and programmatic mapping, increasing domestic financing for sex worker HIV prevention programs where feasible, delivering well-codified, comprehensive programs using “Science of Delivery” principles and developing more effective models to reach informal sex workers, male and transgender sex workers, and mobile and internet-based sex workers.
• Given their marginalization, concerted efforts must be made to ensure sex workers have equitable access to HIV prevention, care, and treatment services, as well as wider health services, particularly for STIs, mental health, and addictions.

     

The XI International Conference on AIDS: at the crossroads of hope and urgency.

This month Canada will host the largest conference ever held on the worldwide epidemic of AIDS. More than 12,000 participants from over 130 countries are expected to convene in Vancouver from July 7 to 12 for the XI International Conference on AIDS. As at previous conferences, the program will be organized along four tracks: basic science, clinical science, epidemiology and public health, and social and behavioural science. The author notes that although in each of these areas there is reason to take heart, we must not become complacent in the fight against HIV infection and AIDS. The pandemic is still growing at an alarming rate, and governments need to be reminded that a failure to commit funding and resources to the extension of programs for AIDS research, prevention and care is both cynical and unwise. Now is the time to redouble our efforts, not to abandon them.     

UN says up to half the teenagers in Africa will die of AIDS

According to the Joint UN Programme on HIV/AIDS report, AIDS will cause early death in as many as half of the teenagers living in southern Africa. In Botswana, demographers have predicted that two-thirds of the 15-year-olds will die of AIDS before the age of 50. In terms of global estimates, the report indicated that there are 34.3 million people infected with HIV, of whom 1.3 million are children under the age of 15. The impact of the AIDS epidemic is accounted for in the erosion of all key measures of a nation's health, especially in much of sub-Saharan Africa. These key measures include economic development, educational attainment, and child survival. Although there are a few success stories in the countries of Uganda and Thailand, which show that strong prevention campaigns and increased condom use help in curbing the epidemic, the report revealed the need for a massive increase in political will.     

Use and commercialization of Podocnemis expansa (Schweiger 1812) (Testudines: Podocnemididae) for medicinal purposes in two communities in North of Brazil

The emergence of alternative medicines for AIDS in Asia and Africa was discussed at a satellite symposium and the parallel session on alternative and traditional treatments of the AIDSImpact meeting, held in Marseille, in July 2007. These medicines are heterogeneous, both in their presentation and in their geographic and cultural origin. The sessions focused on the role of these medications in selected resource poor settings in Africa and Asia now that access to anti-retroviral therapy is increasing. The aims of the sessions were to (1) identify the actors involved in the diffusion of these alternative medicines for HIV/AIDS, (2) explore uses and forms, and the way these medicines are given legitimacy, (3) reflect on underlying processes of globalisation and cultural differentiation, and (4) define priority questions for future research in this area. This article presents the insights generated at the meeting, illustrated with some findings from the case studies (Uganda, Senegal, Benin, Burkina Faso, China and Indonesia) that were presented. These case studies reveal the wide range of actors who are involved in the marketing and supply of alternative medicines. Regulatory mechanisms are weak. The efficacy claims of alternative medicines often reinforce a biomedical paradigm for HIV/AIDS, and fit with a healthy living ideology promoted by AIDS care programs and support groups. The AIDSImpact session concluded that more interdisciplinary research is needed on the experience of people living with HIV/AIDS with these alternative medicines, and on the ways in which these products interact (or not) with anti-retroviral therapy at pharmacological as well as psychosocial levels.     

United Nations system efforts to support the response to AIDS in China

In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations in supporting and strengthening those responses.Achievements of the United Nations (UN) highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups;providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS.     

Doctors' rights and patients' obligations

Marshall examines arguments for and against physicians breaching their duty of confidentiality to persons diagnosed with HIV or AIDS by notifying third parties such as sexual partners or general practitioners who give care unrelated to HIV or AIDS. The arguments presuppose that the confidentiality right is not absolute, but may give way under certain circumstances. A physician's obligations to the larger community, for instance, may outweigh the obligation to keep a diagnosis of AIDS or HIV confidential. Marshall also argues that physicians who incur risks by treating patients with AIDS or HIV have a right to knowledge that will help them protect themselves. A patient with AIDS or HIV may be obliged to reveal this fact to physicians when seeking care for other health problems, or to allow the diagnosing physican to do so. These arguments may have implications for the debate over testing patients for AIDS or HIV without consent.     

Keeping the faith: African American faith leaders' perspectives and recommendations for reducing racial disparities in HIV/AIDS infection

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders' recommendations for tailoring HIV prevention for a faith-based audience.     

Bone marrow suppression and severe anaemia associated with persistent Plasmodium falciparum infection in African children with microscopically undetectable parasitaemia

In sub-Saharan Africa the highest overlap between malaria and HIV infections occurs in female adolescents. Yet control activities for these infections are directed to different target groups, using disparate channels. This reflects the lack of priority given to adolescents and the absence of an accepted framework for delivering health and health-related interventions to this high-risk group. In this paper it is argued that female adolescents require a continuum of care for malaria and HIV – prior to conception, during and after pregnancy and that this should be provided through adolescent services. The evidence for this conclusion is presented. A number of African countries are commencing to formulate and implement adolescent-friendly policies and services and disease control programs for malaria and HIV will need to locate their interventions within such programs to ensure widespread coverage of this important target group. Failure to prioritize adolescent health in this way will seriously limit the success of disease control programs for malaria and HIV prevention.     

United Nations system efforts to support the response to AIDS in China

In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations (UN) in supporting and strengthening those responses. Achievements of the United Nations highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of the United Nations system in the near future include strengthening national leadership by supporting the 'three ones', i.e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups; providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS.     

UN warns that AIDS deaths are set to reach record level

The Joint United Nations Programme on HIV/AIDS (UNAIDS) warns that AIDS deaths are set to reach a record level during the year 1999. Estimates from UNAIDS reveal that 2.6 million people will die from diseases related to HIV and AIDS during 1999--a higher global total than any year since the beginning of the epidemic. In addition, 32.4 million adults and 1.2 million children are estimated to be living with HIV infection by the end of 1999. About 95% of those infected live in the developing world, and this proportion was predicted to rise even further as infection rates continued to rise in countries where poverty, poor health systems, and limited resources for prevention and care fueled the spread of the virus. The highest prevalence of the infection is seen in sub-Saharan Africa; close to 70% of the global total of HIV-positive people come from this region. However, the challenge also remains in industrialized countries, where unsafe sexual behavior and drug injection are practiced.     

Funding policies for HIV and AIDS: time for change.

Funding for HIV and AIDS in England has been allocated to regions by a formula based on the number of cases of AIDS and HIV infection and on population size. Regions have distributed the resources directly to hospitals and community services. A survey of staff and managers in North East Thames region showed that funding arrangements have led to unsatisfactory development of services for HIV and AIDS. Firstly, because hospitals are funded according to current numbers of patients services are highly developed at the central London hospitals and underdeveloped in outer districts. Secondly, specialised community care teams have been established rather than integrating care for HIV and AIDS into generic primary care. Thirdly, the information on district of residence of infected patients is inaccurate, limiting allocation of funds according to population needs. Fourthly, prevention of infection has been given far less attention than treatment and care despite the lack of effective treatment. In future allocations for HIV and AIDS should be made to purchasers rather than directly to providers.     

Resilience and Risk: Childhood and Uncertainty in the AIDS Epidemic

In a study of depression and risk amongHIV-affected young people (children whose parents areinfected with or have died from HIV/AIDS), subjectsdid not report high risk sexual or substance usebehavior. Findings are attributed to parentalparticipation in a community-based HIV service programthat provides parents with HIV prevention educationand long term social and emotional support. Multi-generational community based models ofprevention that include parents as critical elementsof instruction may also be effective in substanceabuse treatment programs and in programs for childrenwho experience difficulty in school.     

AIDS Prevention and Control in Japan

Surveillance for the acquired immunodeficiency syndrome (AIDS) in Japan started in September 1984 and in February 1987 was extended to seropositive carriers of human immunodeficiency virus (HIV) antibodies. A total of 2,000 hospitals and clinics throughout the country have actively participated in the surveillance. An educational program for health care workers, including physicians, was initiated in July 1985 by issuing a series of government memoranda and distributing pamphlets and posters. Counseling programs for people concerned about AIDS and laboratory support to provide screening services have been developed. Laboratories that can also perform confirmatory tests will be established shortly. The screening of all donated blood was established in November 1986.Education programs for the public have been conducted mainly through the production and distribution of various materials and pamphlets. Research has been focused primarily on diagnosis and treatment, with international cooperation emphasized. A new act of legislation has been proposed in the Parliament that will require mandatory reporting of cases of AIDS and HIV infection with confidentiality preserved. Further debate may be needed to reach national consensus on this issue. The proposed law will not include provisions that would affect international travelers, foreign students or immigrants.     

Urban Low-Income African American Men, HIV/AIDS, and Gender Identity

In a 1993 Human Organization article, Jerome Wright called for more research on African American male sexual behavior and the risk for HIV infection. The present article is a response to that call. Wright pointed out a well-known fact of HIV/AIDS prevention programs: such programs have not been very successful in reaching low-income African American males. The present article suggests that perhaps the key to better understanding sex-related health-risk behavior is to conduct more systematic research on gender identity, and the historical and sociocultural origins of such identities. I argue that if we are truly interested in developing effective HIV/AIDS programs targeting low-income African American males, then the sociocultural "meanings" that this population attaches to AIDS-related phenomena must be understood in the broader contexts of American constructs of masculinity, and in the real and perceived experiences of black men in America. Data from several ethnographic and qualitative research projects carried out among low-income African American male and female residents of Baltimore, other parts of Maryland, and Washington, D.C. are used in support of my primary arguments. [HIV/AIDS, African American Males, Gender Constructs, Sociocultural Meaning, Plantation America]     

亚洲各国艾滋病疫苗简介

获得性免疫缺陷综合征(acquired immunodeficiencysy ndrome,AIDS),即"艾滋病",是一种致死率极高的全球传染性疾病,尚无有效的治愈方法。目前,亚洲已成为世界第二大艾滋病高发区。对经济并不发达的亚洲地区来说,研发艾滋病疫苗,对于预防人类免疫缺陷病毒(human immunodeficiency virus,HIV),即"艾滋病病毒"的传播具有重要的战略意义。本文对中国、泰国、印度、日本和澳大利亚的艾滋病疫苗研发和临床试验进行了分析和总结,并分析了亚洲开发艾滋病疫苗的前景及应对策略。