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

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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
I N T R O D U C T I O NPAUL R. DE LAYGUNILA ERNBERGKAREN STANECKI
Page 1 and 2: Edited byPeter R. Lamptey, MD, DrPH
Page 3 and 4: © 2001 Family Health International
Page 5 and 6: SECTION II:Chapter 6PAGE 137Chapter
Page 7: Chapter 21PAGE 501Chapter 22PAGE 51
Page 11 and 12: F igure 1Factors That InfluenceThe
Page 13 and 14: F igure 3HIV Seroprevalence for Pre
Page 15 and 16: F igure 5HIV Seroprevalence for Com
Page 17 and 18: F igure 7HIV Seroprevalence for Pre
Page 19 and 20: F igure 9Life Expectancy With and W
Page 21 and 22: F igure 11Population of Zimbabwe,Wi
Page 23 and 24: invest; and feedback further amplif
Page 25 and 26: R EDUCING MOTHER-TO-CHILDTRANSMISSI
Page 27 and 28: F igure 13HIV Seroprevalence in Adu
Page 29 and 30: ACKNOWLEDGEMENTSWe wish to express
Page 32 and 33: SOFIA GRUSKIN, JD, MIAAssistant Pro
Page 34 and 35: THOMAS M. PAINTER, PHDBehavioral Sc
Page 36 and 37: glossary of A C R O N Y M SACTG AID

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