The Changing Hiv Aids Landscape

HIV/AIDS reverses life expectancy gains, erodes productivity, consumes savings and dilutes growth efforts, threatening the realization of the Millennium Development Goals (MDGs) in Africa.The report is the result of an extensive analytical and consultative process begun in 2006, that engaged more than 1,000 people from over 30 countries and many institutions mostly in Africa, as well as UN agencies, multilateral and bilateral donors, and foundations. The report reaffirms the Bank's commitment to combating HIV/AIDS in Africa, moving from its initial emergency response to the next phase, including the goal to provide at least US $250 million annually and to create an Africa HIV/AIDS Incentive Fund to enhance the evidence base, promote the multisectoral response and provide technical support, analysis and policy advice to countries.

Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

Europe's "Black Death" contributed to the rise of nation states, mercantile economies, and even the Reformation. Will the AIDS epidemic have similar dramatic effects on the social and political landscape of the twenty-first century? This readable volume looks at the impact of AIDS since its emergence and suggests its effects in the next decade, when a million or more Americans will likely die of the disease. The Social Impact of AIDS in the United States addresses some of the most sensitive and controversial issues in the public debate over AIDS. This landmark book explores how AIDS has affected fundamental policies and practices in our major institutions, examining: How America's major religious organizations have dealt with sometimes conflicting values: the imperative of care for the sick versus traditional views of homosexuality and drug use. Hotly debated public health measures, such as HIV antibody testing and screening, tracing of sexual contacts, and quarantine. The potential risk of HIV infection to and from health care workers. How AIDS activists have brought about major change in the way new drugs are brought to the marketplace. The impact of AIDS on community-based organizations, from volunteers caring for individuals to the highly political ACT-UP organization. Coping with HIV infection in prisons. Two case studies shed light on HIV and the family relationship. One reports on some efforts to gain legal recognition for nonmarital relationships, and the other examines foster care programs for newborns with the HIV virus. A case study of New York City details how selected institutions interact to give what may be a picture of AIDS in the future. This clear and comprehensive presentation will be of interest to anyone concerned about AIDS and its impact on the country: health professionals, sociologists, psychologists, advocates for at-risk populations, and interested individuals.

Men who have sex with men (MSM), injecting drug users (IDUs), sex workers, and transgender individuals are among thARps at elevated risk for HIV/AIDS in both concentrated and generalized AIDS epidemics throughout the world. Addressing the health needs of vulnerable populations is critical to an effective and equitable response to the global AIDS epidemic. Vulnerable populations are very often not well served by health services designed to meet the needs of the general population. The behavior of MSM, IDUs, and sex workers is criminalized in many countries, and many governments ignore or are actively hostile towards these individuals. There are numerous examples of targeted services that can reach marginalized populations with effective HIV prevention and treatment services. Health worker training and other measures can make general health systems more responsive to the needs of vulnerable populations. Donors and policy makers should assess what types of services can best meet the needs of vulnerable, marginalized groups in each specific setting. Donors, policy makers, and advocates should press for policy reforms that reduce stigma and make it easier to meet the health needs of vulnerable populations.

We began to research for this book in 2000, with the idea that we might contribute to the search for solutions to the global HIV/AIDS pandemic by c- bining perspectives from different disciplines. Much has happened in the interv- ing years. First, the severity of the HIV/AIDS pandemic in sub-Saharan Africa – and the threat it posed for many others regions of the world – led to a movement among several countries to correct the imbalance between producers and users of ph- maceutical products. This effort produced a clarification of the right of gove- ments to produce generic medicine under compulsory licenses and an amendment of the World Trade Organization’s TRIPS Agreement to allow exports of generic medicines from one WTO Member to another. In 2007, the amended rules were put into practice, with Canada authorizing the export of generic antiretroviral drugs to Rwanda. However, at the same time, global patent laws have been undermined due to regulatory capture, most notably in free trade agreements and through political pressure on countries like Thailand to not to exercise their right to issue compulsory licenses for pharmaceutical products. Second, the amount of money available for the treatment and prevention of HIV/AIDS has increased dramatically, with the establishment of the World Bank Multi-Country HIV/AIDS Program for Africa (MAP), the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR), among other funding initiatives.

​HIV Treatment as Prevention: Primer for Behavior-Based Implementation provides the first practical guide to integrating behavioral prevention with antiretroviral therapies for people living with HIV infection. This brief book discusses the historical and social context embedding the shifting landscape in HIV prevention, where the use of effective treatments have become the focus of HIV prevention. While using treatments for prevention is promising, the history of HIV prevention offers several important pitfalls that must be avoided if HIV treatments are to ultimately succeed in preventing new HIV infections. Lessons learned from the successes and failures of other biomedical technologies used in HIV prevention, specifically syringes, condoms, and HIV testing are critical to the success of using HIV treatments for prevention. HIV Treatment as Prevention: Primer for Behavior-Based Implementation summarizes the scientific evidence for advancing the use of antiretroviral therapies for HIV prevention. The evidence makes clear that HIV treatments can prevent HIV transmission, but will fail if behavioral aspects of treatment and HIV transmission are ignored. Of greatest concern are medication adherence and risks for contracting other sexually transmitted infections. Placing HIV treatment within the context of behavioral interventions for maintaining medication adherence and reducing sexual risk behaviors is therefore essential to the future of HIV prevention. HIV Treatment as Prevention: Primer for Behavior-Based Implementation highlights two pioneering behavioral interventions aimed at maximizing the effects of antiretroviral therapies for preventing HIV transmission. One of the interventions, developed by the Author’s research team, is discussed in detail and the intervention manual is included as an Appendix.

Home-based care has been one of the most effective community care strategies in developing countries for people living with HIV/AIDS in their AIDS stage. This is because the poorly equipped and highly understaffed public health systems are failing to cope with the extra demand of caring for the AIDS patients (in and out of hospital). The HBC programs traditionally have been providing physical, emotional, spiritual and palliative care to the chronically and terminally ill patients. Up to 90% of care for patients in developing countries is done in homes. However, the increased and widespread accessibility of people living with HIV/AIDS to antiretroviral therapy in Zambia through the public health system is changing the type of demands by the PLWHAs on the HBC services. Many formerly bedridden patients are now well and what they need most is support to restart their livelihoods. They also need support and monitoring of their adherence to ART. Some HBC programs have started changing to meet these new and evolving needs, albeit at a slow pace. The consequences of delayed responses to these changing needs is the increased likelihood of PLWHA loosing the gains made.

With more than 33 million people living with HIV/AIDS, and an infection rate that is increasing rather than falling among high-risk groups, the 30-year history of the AIDS epidemic has been characterised as 'islands of success in a sea of failure'. Given the lack of a medical cure for the disease, the world has looked to social marketing campaigns to promote behaviour change that would decrease infection rates. Under the best of circumstances, change is difficult, and health behaviour change, especially when it relates to sex and politics, is even more challenging, so social marketers have a difficult task that calls on every technique at their disposal. There is an increasing expectation that HIV/AIDS social marketing interventions will yield measurable results, and that involves fully understanding the AIDS landscape, marketing theory and practice, and the evolving medical picture relating to the pandemic. This research explores links between social marketing and HIV/AIDS while mapping their marketing connections to both the conventional and alternative medical communities. To better understand the HIV/AIDS landscape, early research focused on three diverse countries - Mexico, Uganda, and the United States - selected for their significant cultural, economic, and political differences. Given the multiple social perspectives and fields of knowledge involved in this project, a transdisciplinary approach using mixed research methods was selected. Mixed methods for collecting and presenting data included case studies, content analysis, semi-structured interviews, a quantitative survey, and in-depth reaction interviews. Through analysis of 18 social marketing campaigns in the three countries selected for study, the content, focus, purpose, and implications of the controlled public dissemination of HIV/AIDS information were examined. Key informants with professional and academic credentials in the areas of marketing, advocacy, and HIV/AIDS medicine were interviewed to learn rationales behind the campaigns and to explore political and economic factors that affect HIV/AIDS health activism. The last major phase of information gathering surveyed more than 340 patients at a clinic in Houston, Texas, to ascertain their knowledge and perceptions about HIV/AIDS treatment and prevention information. After the survey data was compiled, reaction interviews from key informants provided additional input. Informed by this wealth of secondary and primary research, an Integrated Social Marketing Conversation (Marcon) Model was created to demonstrate that social marketing campaigns should be localised and customer centred, with participants engaging in an ongoing conversation at every stage. The communication model offers valuable guidelines for more effective dissemination of HIV/AIDS prevention and treatment information to high-risk, high-interest target audiences such as HIV-positive people and the organisations that work with that subculture. Because this research crosses so many boundaries and addresses an actual need, it should be of interest to a wide variety of individuals and organisations in both academic and professional fields. From marketers to medical practitioners to activists associated with HIV/AIDS issues, this project's findings will apply to their concerns. Also, HIV/AIDS organisations - both government agencies as well as private groups - should find information in this work that addresses their ongoing efforts. While investigating existing models for HIV/AIDS communication, it became evident that most research and communication models have focused on how HIV/AIDS prevention programmes are working and what is effective, but little has been done in regards to treatment options and information. For that reason, the integrated social marcon model presented in this thesis is an important addition to the body of practical literature on this topic. Finally, the volatility of the issues examined here and the contacts made during five years of work offer multiple possibilities for follow-up research and fieldwork with opportunities to make a positive contribution in the battle against the HIV/AIDS pandemic.

The science of the virus and its effects and the clinical approaches to its treatment and transmission prevention are placed in the context of the history and epidemiology of the HIV-AIDS pandemic. Each organ system of the body is explored as to manifestations of the disease, treatment now and in the future, as well as what the disease has taught us about the immune response. The science of epidemiology, which is so important in allowing for tracking of the disease and potential limitation of transmission, is another aspect of AIDS explored in detail. The pandemic manifests differently in different parts of the world, and the relevance of the volume is enhanced by its international group of contributors. No other text provides the historical and epidemiological context of this disease along with an update of diagnosis and treatment. The underlying science and epidemiology of AIDS are not neglected, so the student or clinician who is treating patients with AIDS can gain a full understanding of HIV/AIDS in individual patients and in their communities.