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HIV/AIDS among Inmates of and Releasees from US Correctional Facilities, 2006: Declining Share of Epidemic but Persistent Public Health Opportunity  [PDF]
Anne C. Spaulding,Ryan M. Seals,Matthew J. Page,Amanda K. Brzozowski,William Rhodes,Theodore M. Hammett
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0007558
Abstract: Because certain groups at high risk for HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) come together in correctional facilities, seroprevalence was high early in the epidemic. The share of the HIV/AIDS epidemic borne by inmates of and persons released from jails and prisons in the United States (US) in 1997 was estimated in a previous paper. While the number of inmates and releasees has risen, their HIV seroprevalence rates have fallen. We sought to determine if the share of HIV/AIDS borne by inmates and releasees in the US decreased between 1997 and 2006. We created a new model of population flow in and out of correctional facilities to estimate the number of persons released in 1997 and 2006. In 1997, approximately one in five of all HIV-infected Americans was among the 7.3 million who left a correctional facility that year. Nine years later, only one in seven (14%) of infected Americans was among the 9.1 million leaving, a 29.3% decline in the share. For black and Hispanic males, two demographic groups with heightened incarceration rates, recently released inmates comprise roughly one in five of those groups' total HIV-infected persons, a figure similar to the proportion borne by the correctional population as a whole in 1997. Decreasing HIV seroprevalence among those admitted to jails and prisons, prolonged survival and aging of the US population with HIV/AIDS beyond the crime-prone years, and success with discharge planning programs targeting HIV-infected prisoners could explain the declining concentration of the epidemic among correctional populations. Meanwhile, the number of persons with HIV/AIDS leaving correctional facilities remains virtually identical. Jails and prisons continue to be potent targets for public health interventions. The fluid nature of incarcerated populations ensures that effective interventions will be felt not only in correctional facilities but also in communities to which releasees return.
The cost and impact of male circumcision on HIV/AIDS in Botswana
Bollinger Lori A,Stover John,Musuka Godfrey,Fidzani Boga
Journal of the International AIDS Society , 2009, DOI: 10.1186/1758-2652-12-7
Abstract: The HIV/AIDS epidemic continues to be a major issue facing Botswana, with overall adult HIV prevalence estimated to be 25.7 percent in 2007. This paper estimates the cost and impact of the draft Ministry of Health male circumcision strategy using the UNAIDS/WHO Decision-Makers' Programme Planning Tool (DMPPT). Demographic data and HIV prevalence estimates from the recent National AIDS Coordinating Agency estimations are used as input to the DMPPT to estimate the impact of scaling-up male circumcision on the HIV/AIDS epidemic. These data are supplemented by programmatic information from the draft Botswana National Strategy for Safe Male Circumcision, including information on unit cost and program goals. Alternative scenarios were developed in consultation with stakeholders. Results suggest that scaling-up adult and neonatal circumcision to reach 80% coverage by 2012 would result in averting almost 70,000 new HIV infections through 2025, at a total net cost of US$47 million across that same period. This results in an average cost per HIV infection averted of US$689. Changing the target year to 2015 and the scale-up pattern to a linear pattern results in a more evenly-distributed number of MCs required, and averts approximately 60,000 new HIV infections through 2025. Other scenarios explored include the effect of risk compensation and the impact of increasing coverage of general prevention interventions. Scaling-up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly; program design elements such as feasible patterns of scale-up and inclusion of counselling are important in evaluating the overall success of the program.
The securitization of the HIV/AIDS epidemic as a norm: a contribution to constructivist scholarship on the emergence and diffusion of international norms
Vieira,Marco Antonio;
Brazilian Political Science Review (Online) , 2007,
Abstract: this article discusses the emergence in the late 1990s of an innovative conceptualization of security that proclaims the global hiv/aids epidemic a threat to international peace and stability. the study provides a framework for understanding the securitization of the hiv/aids epidemic as an international norm defined and promoted mainly by multilateral bodies, powerful states in the north and transnational hiv/aids advocacy networks. the hiv/aids securitization norm (hasn) is an attempt of the present analysis to synthesize under a single analytical concept the myriad of ideas and international prescriptions about hiv/aids interventions. the article identifies the actors who developed the main strategic prescriptions of the hasn and the transnational mechanisms that promoted the diffusion of its concepts throughout the state system.
Fighting HIV/AIDS: is success possible?
Okware,Sam; Opio,Alex; Musinguzi,Joshua; Waibale,Paul;
Bulletin of the World Health Organization , 2001, DOI: 10.1590/S0042-96862001001200007
Abstract: the fight against hiv/aids poses enormous challenges worldwide, generating fears that success may be too difficult or even impossible to attain. uganda has demonstrated that an early, consistent and multisectoral control strategy can reduce both the prevalence and the incidence of hiv infection. from only two aids cases in 1982, the epidemic in uganda grew to a cumulative 2 million hiv infections by the end of 2000. the aids control programme established in 1987 in the ministry of health mounted a national response that expanded over time to reach other relevant sectors under the coordinating role of the uganda aids commission. the national response was to bring in new policies, expanded partnerships, increased institutional capacity for care and research, public health education for behaviour change, strengthened sexually transmitted disease (std) management, improved blood transfusion services, care and support services for persons with hiv/aids, and a surveillance system to monitor the epidemic. after a decade of fighting on these fronts, uganda became, in october 1996, the first african nation to report declining trends in hiv infection. further decline in prevalence has since been noted. the medical research council (uk) and the uganda virus research institute have demonstrated declining hiv incidence rates in the general population in the kyamulibwa in masaka districts. repeat knowledge, attitudes, behaviour and practice studies have shown positive changes in the priority prevention indicators. the data suggest that a comprehensive national response supported by strong political commitment may be responsible for the observed decline. other countries in sub-saharan africa can achieve similar results by these means. since success is possible, anything less is unacceptable.
Fighting HIV/AIDS: is success possible?  [cached]
Okware Sam,Opio Alex,Musinguzi Joshua,Waibale Paul
Bulletin of the World Health Organization , 2001,
Abstract: The fight against HIV/AIDS poses enormous challenges worldwide, generating fears that success may be too difficult or even impossible to attain. Uganda has demonstrated that an early, consistent and multisectoral control strategy can reduce both the prevalence and the incidence of HIV infection. From only two AIDS cases in 1982, the epidemic in Uganda grew to a cumulative 2 million HIV infections by the end of 2000. The AIDS Control Programme established in 1987 in the Ministry of Health mounted a national response that expanded over time to reach other relevant sectors under the coordinating role of the Uganda AIDS Commission. The national response was to bring in new policies, expanded partnerships, increased institutional capacity for care and research, public health education for behaviour change, strengthened sexually transmitted disease (STD) management, improved blood transfusion services, care and support services for persons with HIV/AIDS, and a surveillance system to monitor the epidemic. After a decade of fighting on these fronts, Uganda became, in October 1996, the first African nation to report declining trends in HIV infection. Further decline in prevalence has since been noted. The Medical Research Council (UK) and the Uganda Virus Research Institute have demonstrated declining HIV incidence rates in the general population in the Kyamulibwa in Masaka Districts. Repeat knowledge, attitudes, behaviour and practice studies have shown positive changes in the priority prevention indicators. The data suggest that a comprehensive national response supported by strong political commitment may be responsible for the observed decline. Other countries in sub-Saharan Africa can achieve similar results by these means. Since success is possible, anything less is unacceptable.
Responding to the AIDS epidemic in Angola  [PDF]
Brian G. Williams
Quantitative Biology , 2014,
Abstract: The epidemic of HIV in Angola started later and stabilized at lower levels than elsewhere in southern Africa. With a relatively small population and a high GDP, Angola is in a good position to intervene decisively to control HIV. The effectiveness, availability and affordability of anti-retroviral therapy (ART) make it possible to contemplate ending the epidemic of HIV/AIDS in Angola. We consider what would have happened without ART, the No ART counterfactual, the impact on the epidemic if the current roll-out of ART is maintained, the Current Programme, the impact if coverage is rapidly increased to reach 90% of people with CD4+ cell counts below 350/micro-litre by 2015 and HIV-positive pregnant women are all offered ART for life (Option B+), the Accelerated Programme, and what might be possible under the 2013 guidelines from the World Health Organization, starting in 2015 and reaching full coverage of ART by 2018, the Expanded Programme.If Angola is to reach the 2015 targets in the Presidents Acceleration Plan testing services will need to be expanded. A regular, uninterrupted supply of drugs will have to be assured. Existing health staff will need to be strengthened. Community health workers will need to be mobilized and trained to encourage people to be tested and accept treatment, to monitor progress and to support people on treatment; this in turn will help to reduce stigma and discrimination, loss to follow up of people diagnosed with HIV, and improve adherence for those on treatment. Effective monitoring and evaluation systems will have to be in place and data collection will have to be extended and improved to support the development of reliable estimates of the current and future state of the epidemic, the success of the programme, levels of viral load suppression for those on ART and the incidence of infection.
Multi-Sector Participation In The National Response To Prevent And Address The Hiv/Aids Epidemic In The Republic Of Cuba, 2007-2008  [cached]
Isora Ramos Valle,Isabel Louro Bernal,Ana Teresa Farinas Reinoso,Susana Llanusa
Social Medicine , 2010,
Abstract: The development of a strong national response involving multiple sectors—including civil society—is an essential aspect of the social management of the HIV/AIDS epidemic. The goals of this response are to control the epidemic and improve the quality of life for people living with HIV/AIDS; this includes combating stigma and discrimination, as well as ensuring due compliance with the law. Cuba has a national program to prevent and control HIV/AIDS. Since 2003 Cuba’s national program has received material and financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Program evaluation is carried out by an independent team at ENSAP (National School of Public Health). This paper reports on results of one part of that evaluation: an assessment of the agencies and sectors who made up the organized social and national response to the HIV/AIDS epidemic. The evaluation primarily used qualitative analyses of the activities and tasks proposed by sectors in their 2006-2008 work plans. Visits were made to the provinces of Ciudad de la Habana, Matanzas, and Holguín. Qualitative techniques included in-depth interviews, semi-structured interviews, observation, and review of documentary evidence of all kinds (videos, reports, minutes, protocols, results of social research, and radio broadcast messages) and varied depending on the particular features of each sector. We noted improvements in multi-sector participation in the prevention and response to the national HIV/AIDS epidemic. Conscious of their role, sectors generally carried out their programmed activities and had improved their organization, planning, and systematization; integration among the sectors was also better. These local initiatives provided evidence of a multi-sector response characterized by autonomy, emotional involvement, and an identification with the goals of the project; this went beyond simply meeting targets. Cross-sector work showed a marked increase and a qualitative leap in management compared with the previous evaluation. Interviewees from different sectors all considered discrimination and stigmatization of people living with HIV to have decreased, both within their organizations and in the general population.
Private pharmacies in an integrated approach to HIV/AIDS services
JL Carapinha
SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) , 2008,
Abstract: The South African National AIDS Council emphasises that success in tackling HIV/AIDS depends on leadership at every level of society, as well as mobilisation and co-operation in all sectors including government, health care workers and civil society (SANAC, 2006). This may be an acknowledgement that South Africa's response to HIV/AIDS has been inadequate to effectively control the epidemic. It points to insufficient dialogue between the government and the private sector, and among health care workers in general. In particular, there has been inadequate attention given to the importance of private pharmacies in an integrated approach to HIV/AIDS services. SAHARA-J Vol. 5 (4) 2008: pp. 206-209
Prevention of Parent to Child Transmission (PPTCT) Program Data in India: An Emerging Data Set for Appraising the HIV Epidemic  [PDF]
Sema K. Sgaier, Radhay S. Gupta, Raghuram Rao, Ajay Gaikwad, Sonali Harangule, Suvidha Dhamne, Sateesh Gowda, Sylvia Jayakumar, Banadakoppa M. Ramesh
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0048827
Abstract: Background Evidence based resource allocation and decentralized planning of an effective HIV/AIDS response requires reliable information on levels and trends of HIV at national and sub-national geographic levels. HIV sentinel surveillance data from antenatal clinics (HSS-ANC) has been an important data source to assess the HIV/AIDS epidemic in India, but has a number of limitations. We assess the value of Prevention of Parent to Child Transmission (PPTCT) programme data to appraise the HIV epidemic in India. Methods/Findings HIV data from PPTCT sites were compared to HSS-ANC and general population level surveys at various geographic levels in the states of Karnataka, Maharashtra and Andhra Pradesh. Chi-square tests were used to ascertain statistical significance. PPTCT HIV prevalence was significantly lower than HSS-ANC HIV prevalence (0.92% vs. 1.22% in Andhra Pradesh, 0.65% vs. 0.89% in Karnataka, 0.52% vs. 0.60% in Maharashtra, p<0.001 for all three states). In all three states, HIV prevalence from PPTCT centres that were part of the sentinel surveillance was comparable to HSS-ANC prevalence but significantly higher than PPTCT centres that were not part of the sentinel surveillance. HIV prevalence from PPTCT data was comparable to that from general population surveys. In all three states, significant declines in HIV prevalence between 2007 and 2010 were observed with the PPTCT data set. District level analyses of HIV trends and sub-district level analysis of HIV prevalence were possible using the PPTCT and not the HSS-ANC data sets. Conclusion HIV prevalence from PPTCT may be a better proxy for general population prevalence than HSS-ANC. PPTCT data allow for analysis of HIV prevalence and trends at smaller geographic units, which is important for decentralized planning of HIV/AIDS programming. With further improvements to the system, India could replace its HSS-ANC with PPTCT programme data for surveillance.
IS THERE A “HIDDEN HIV/AIDS EPIDEMIC” IN TURKEY?: THE GAP BETWEEN THE NUMBERS AND THE FACTS
P?nar Ay,Selma Karabey
Marmara Medical Journal , 2006,
Abstract: Since the number of persons living with HIV/AIDS was relatively low compared to the hard-hit countries, HIV/AIDS was not considered as an emerging health problem in Turkey. However Turkey carries a number of factors which enable the spread of HIV/AIDS and the reported rates are accepted to be an underestimation due to the drawbacks of the present surveillance system. This paper discusses the epidemiology of HIV/AIDS in Turkey, factors influencing risk and prevention and the need concerning prevention and control activities in order to address future challenges to combat the epidemic.
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