X HIV/AIDS Prevention and Care in Resource-Constrained Settings

PREFACEIn 20 years of responses to the AIDS pandemic theworld has learned many hard lessons. We havelearned that half-measures do not work: progress ismade only when communities and nations wholeheartedlyembrace the fight against AIDS. We havelearned that there is no “one-size-fits-all” solution indesigning and delivering the most effective preventionand care initiatives. We have learned that HIV feedson social inequality, especially the inequality betweenmen and women. This is why we must confront theneed for long-term, structural change to effectivelyaddress the pandemic.Above all, we have learned that we are not powerlessto change the course of the pandemic.Communities and whole nations have demonstratedthat it is possible to reduce the spread of HIV.Many have taken action before the epidemic has takenhold, but others have managed to pull back the epidemiceven in their countries after its growth to devastatingscale. And while scientists continue working tofind a cure or an effective vaccine, great advances havebeen made in care and treatment. Where these havebeen within financial reach they have immenselyimproved the quality of life of people living withHIV/AIDS (PLHA).This Handbook is a valuable tool for extendingthe reach of effective responses to HIV/AIDS wherethey are needed most. There are 40 million PLHAin the world today, and 95 percent live in resourceconstrainedcountries. Until and unless the impact ofAIDS is reduced, these countries face little prospect ofbuilding a more secure and prosperous future.While every community needs to devise the preventionand care solutions that are most effective in itsown local context, there are some universal principleson which success has been built:■ Leadership is required at every level of society toensure a comprehensive and coordinated effortagainst HIV/AIDS. Leadership is the key to liftingthe veils of denial and discrimination as well as tomobilizing resources and creating synergy betweendifferent elements of the response.■ We must know what drives the pandemic torespond effectively to it. This means understandingpatterns of sexual practice and drug use, as wellas the distribution of HIV infection.■ Prevention and care are not competing priorities;they are mutually reinforcing strategies.Extending access to comprehensive care, includingantiretroviral therapy, is a priority even in the mostresource-constrained settings, because it bringsrenewed hope and greater energy to the response.■ Social exclusion must be tackled as one of thedrivers of the pandemic. People are more vulnerableto HIV when they are deprived of respect andcommunity support. The most successful responsestrategies are those that have given a leading role toPLHA and others seen to be most at risk.■ At this stage in the global pandemic the overwhelmingneed is for an increase in the scale ofresponses. An AIDS response must take rootacross every region, throughout every nation, fromtown to town and village to village.Reversing the AIDS pandemic is about changingthe world we live in—our behaviors and relationships,where money flows and who makes decisions. Itrequires every one of us to play our part.PETER PIOT, MDExecutive DirectorJoint United Nations Programme on HIV/AIDS(UNAIDS)HIV/AIDS Prevention and Care in Resource-Constrained Settings V