United Nations Programme On HIV/AIDS Research Articles

Modeling the implementation of universal coverage for HIV treatment as prevention and its impact on the HIV epidemic.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently updated its global targets for antiretroviral therapy (ART) coverage for HIV-positive persons under which 90 % of HIV-positive people are tested, 90 % of those are on ART, and 90 % of those achieve viral suppression. Treatment policy is moving toward treating all HIV-infected persons regardless of CD4 cell count-otherwise known as treatment as prevention-in order to realize the full therapeutic and preventive benefits of ART. Mathematical models have played an important role in guiding the development of these policies by projecting long-term health impacts and cost-effectiveness. To guide future policy, new mathematical models must consider the barriers patients face in receiving and taking ART. Here, we describe the HIV care cascade and ART delivery supply chain to examine how mathematical modeling can provide insight into cost-effective strategies for scaling-up ART coverage in sub-Saharan Africa and help achieve universal ART coverage.

Realization of an AIDS-free generation: ensuring sustainable treatment for children.

According to a 2011 statement from the Joint United Nations Program on HIV/AIDS (UNAIDS), “by 2015 children everywhere can be born free of HIV and their mothers remain alive.” These ambitious goals were defined to provide renewed energy and to reinvigorate programs to realize the vision of an AIDS-free generation.1 Since the launch of the Global Plan Toward the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (focused on 22 countries with the highest estimated numbers of pregnant women, with a goal to reduce new HIV infection by 90% and HIV-related maternal deaths by 5%), there has been a substantive expansion of investments resulting in improved access to antiretroviral therapy (ART) in pregnant women as a means to eliminate vertical HIV transmission. As a result, at the end of 2012, 62% of pregnant women with HIV in low- and middle-income countries were receiving ART for prevention of vertical transmission, a significant increase from 14% in 2005.2 This progress has led to a reduction of new infections among children; between 2009 and 2012, it is estimated that 670 000 children in these countries were prevented from acquiring HIV infection.2

Developing and implementing global gender policy to reduce HIV and AIDS in low- and middle -income countries: Policy makers’ perspectives

Gender inequalities have been recognised as central to the HIV epidemic for many years. In response, a range of gender policies have been developed in attempts to mitigate the impact and transform gender relations. However, the effects of these policies have been less than successful. In March 2010 the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the Agenda for accelerated country level action on women, girls, gender equality and HIV (the Agenda), an operational plan on how to integrate women, girls and gender equality into the HIV response. This paper explores the perspectives of those involved in developing and implementing the Agenda to understand its strengths and limitations. In-depth one-on-one interviews were conducted with 16 individuals involved in the development and implementation of the Agenda. The data were analysed using thematic network analysis. Facilitators of the Agenda centred on the Agenda's ability to create political space for women and girls within the global HIV/AIDS response and the collaborative process of developing the Agenda. Barriers to the implementation and development of the Agenda include the limited financial and non-financial resources, the top-down nature of the Agenda's development and implementation and a lack of political will from within UNAIDS to implement it. We suggest that the Agenda achieved many goals, but its effect was constrained by a wide range of factors.

Global Policy Review of Recommendations on Cotrimoxazole Prophylaxis among People Living with HIV.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) Treatment 2015 calls for expanded access to HIV care and treatment, including cotrimoxazole preventive therapy (CPT), for prevention of HIV-related morbidity and mortality. We review 115 national guidelines from 92 countries for recommendations on CPT for adults and adolescents and determine the level of consistency with the World Health Organization (WHO) guidelines. Of the 66 countries with recommendations, 5 (8%) countries recommend lifelong CPT for people living with HIV; 19 (29%) countries recommend a CD4 count threshold of ≤350 cells/mm(3) or WHO clinical stages III and IV or II, III, and IV; and 19 (29%) countries recommend a CD4 count threshold of ≤200 cells/mm(3). Of the 48 countries with recommendations on discontinuing CPT, 25 (52%) countries recommend discontinuation of cotrimoxazole when the CD4 count is >200 cells/mm(3). World Health Organization guidelines offer countries flexibility on the use of CPT, and countries are recommending a wide range of CD4 counts and WHO clinical stage criteria for prophylaxis initiation and discontinuation.

Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.

Adoption of national recommendations related to use of antiretroviral therapy before and shortly following the launch of the 2013 WHO consolidated guidelines.

To determine the status of key national policies on the use of antiretroviral therapy (ART) at the time of the launch of the 2013 WHO consolidated guidelines as well as to track early progress towards adoption of these recommendations following dissemination. Descriptive analysis of global data on baseline ART policies as of June 2013 and early intentions to adopt the 2013 WHO for use of antiretroviral drugs guidelines as of November 2013. Compilation of existing global reports on key HIV policies, review of national guidelines, data collection through annual drug procurement surveys and through guidelines dissemination meetings in each of the six WHO regions. Data were available from 124 low- and middle-income countries, including 97% of the 57 high-priority countries that have been identified by WHO and the Joint United Nations Program on HIV/AIDS (UNAIDS). At baseline, only one country reported recommending antiretroviral therapy (ART) at a CD4 T-cell count 250 cells/μl or less for adults and adolescents in 2013, whereas nine countries already recommended using CD4 T-cell count 500 cells/μl or less. Recommendations for ART initiation regardless of CD4 T-cell count for HIV-infected patients with tuberculosis (86%), hepatitis B (75%), all HIV-infected women who were pregnant or breastfeeding (option B+: 40%) or HIV-infected persons in a serodiscordant relationship (26%) had been nationally adopted as of June 2013. Eight of 67 countries (12%) already recommended treating all children less than 5 years of age. The triple antiretroviral combination of tenofovir + lamivudine (or emtricitabine) + efavirenz was recommended as the preferred first-line option for adults and adolescents more frequently (51%) than for pregnant women (38%), or for both adults/adolescents and pregnant women (28%; P < 0.05). Fewer than half (37%) of all countries reported recommending lopinavir/ritonavir for all HIV-infected children less than 3 years of age; 54% of countries reported recommending routine viral load monitoring, whereas only 41% recommended nurse-initiated ART. A number of key WHO policy recommendations on antiretroviral drug use were adopted rapidly by countries in advance of or shortly following the launch of the 2013 guidelines. Efforts are needed to support and track ongoing policy adoption and ensure that it is accompanied by the scale-up of evidence-based interventions.

M&amp;E Competencies in Support of the AIDS Response: A Sector-Specific Example

Abstract: The Joint United Nations Programme on HIV/AIDS (UNAIDS) led a consultative process to develop a self-assessment tool for HIV monitoring and evaluation (M&amp;E) leadership competencies. The tool seemed fit-for-purpose in M&amp;E staff recruitment and professional development. The willingness to use the self-assessment was related to the pragmatic and reality-based nature of the tool. A competency-based approach to M&amp;E training was well accepted by professionals working at national and service-delivery levels. However, there is a need to update the HIV M&amp;E competencies to adapt to specific M&amp;E challenges in the broader context of aid effectiveness and to reflect a maturing evaluation profession.

Estimates of the number of people living with HIV in Italy.

Objective. To estimate the HIV prevalence and the number of people living with HIV (PLHIV) in Italy with a projection for 2020. Methods. Two methods elaborated by Joint United Nations Programme on HIV/AIDS (UNAIDS) were used: Estimate and Projection Package and Spectrum. Results. A total of 123,000 (115,000–145,000) individuals aged 15 or more were estimated to be living with HIV in Italy at the end of 2012 and the estimated HIV prevalence was 0.28 (0.24–0.32) per 100 residents aged 15 or more. In 2012, the estimated number of new HIV infections among adults was 3,000 (2,700–4,000), and the number of adults in need for ART was 93,000 (80,000–110,000). The projection estimates that 130,000 (110,000–150,000) adults will live with HIV/AIDS in 2020 in Italy. Conclusion. Estimates of PLHIV in Italy stress the high number of PLHIV in need of care and treatment, as well as the need for more information and prevention campaigns.

Global Action to reduce HIV stigma and discrimination

Global Action to reduce HIV stigma and discrimination

HIV infections and AIDS-related deaths falling globally

HIV infections and AIDS-related deaths have fallen around the world, thanks to more affordable antiretroviral drugs and increased HIV testing, according to a report from the Joint United Nations Programme on HIV/AIDS (UNAIDS). New HIV infections among adults and children fell to 2.3 million in 2012

Listening to diverse community voices: the tensions of responding to community expectations in developing a male circumcision program for HIV prevention in Papua New Guinea.

BackgroundThe success of health programs is influenced not only by their acceptability but also their ability to meet and respond to community expectations of service delivery. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended medical male circumcision (MC) as an essential component of comprehensive HIV prevention programs in high burden settings. This study investigated community-level perceptions of MC for HIV prevention in Papua New Guinea (PNG), a setting where diverse traditional and contemporary forms of penile foreskin cutting practices have been described.MethodsA multi-method qualitative study was undertaken in four provinces in two stages from 2009 to 2011. A total of 82 in-depth interviews, and 45 focus group discussions were completed during Stage 1. Stage 2 incorporated eight participatory workshops that were an integral part of the research dissemination process to communities. The workshops also provided opportunity to review key themes and consolidate earlier findings as part of the research process. Qualitative data analysis used a grounded theory approach and was facilitated using qualitative data management software.ResultsA number of diverse considerations for the delivery of MC for HIV prevention in PNG were described, with conflicting views both between and within communities. Key issues included: location of the service, service provider, age eligibility, type of cut, community awareness and potential shame amongst youth. Key to developing appropriate health service delivery models was an appreciation of the differences in expectations and traditions of unique cultural groups in PNG. Establishing strong community coalitions, raising awareness and building trust were seen as integral to success.ConclusionsDifficulties exist in the implementation of new programs in a pluralistic society such as PNG, particularly if tensions arise between biomedical knowledge and medico-legal requirements, compared to existing socio-cultural interests. Community participatory approaches offer important opportunities to explore and design culturally safe, specific and accessible programs.

Penile Measurements in Tanzanian Males: Guiding Circumcision Device Design and Supply Forecasting

Voluntary medical male circumcision decreases the risk in males of HIV infection through heterosexual intercourse by about 60% in clinical trials and 73% at post-trial followup. In 2007 WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended that countries with a low circumcision rate and high HIV prevalence expand voluntary medical male circumcision programs as part of a national HIV prevention strategy. Devices for adult/adolescent male circumcision could accelerate the pace of scaling up voluntary medical male circumcision. Detailed penile measurements of African males are required for device development and supply size forecasting. Consenting males undergoing voluntary medical male circumcision at 3 health facilities in the Iringa region, Tanzania, underwent measurement of the penile glans, shaft and foreskin. Age, Tanner stage, height and weight were recorded. Measurements were analyzed by age categories. Correlations of penile parameters with height, weight and body mass index were calculated. In 253 Tanzanian males 10 to 47 years old mean ± SD penile length in adults was 11.5 ± 1.6 cm, mean shaft circumference was 8.7 ± 0.9 cm and mean glans circumference was 8.8 ± 0.9 cm. As expected, given the variability of puberty, measurements in younger males varied significantly. Glans circumference highly correlated with height (r = 0.80) and weight (r = 0.81, each p <0.001). Stretched foreskin diameter moderately correlated with height (r = 0.68) and weight (r = 0.71, each p <0.001). Our descriptive study provides penile measurements of males who sought voluntary medical male circumcision services in Iringa, Tanzania. To our knowledge this is the first study in a sub-Saharan African population that provides sufficiently detailed glans and foreskin dimensions to inform voluntary medical male circumcision device development and size forecasting.

Publications from International Organizations on public health

The Publications from International Organizations on Public Health section includes a wider selection of the most recent publications edited by the main international organizations active in the field of public health, such as: the European Food Safety Authority (EFSA), the Food and Agriculture Organization of the United Nations (FAO), the International Council for Science (ICSU), the International Labour Organization (ILO), the Organisation for Economic Co-operation and Development (OECD), the United Nations Educational, Scientific and Cultural Organization (UNESCO), the United Nations Environment Programme (UNEP), the United Nations Programme on HIV/AIDS (UNAIDS), and the World Health Organization (WHO).

AIDS and HIV Infection after Thirty Years.

AIDS and HIV Infection after Thirty Years.

Aportaciones y límites del uso de la Abordaje Centrada en la Persona (ACP) para la fundamentación teórica de la consejería en VIH / SIDA

Although it fi gures as an important prevention technology, national and international studies point out that counseling in the STD/AIDS fi eld present frailties and problems, among them the lack of theoretical grounds or inconsistencies among theoretical bases and technical developments. This study aimed to examine the conceptual contribution of one of the theoretical frames that infl uenced the construction of counseling strategies and techniques in STD in Brazil, the Person-centered therapy (PCT), developed by Carl Rogers, as well as the limits of its employment in the STD/AIDS context, from the analysis of documents produced by the World Health Organization, the Joint United Nations Program on HIV/ AIDS (UNAIDS), and Ministry of Health – Brazil, regarded as the main normative references for counseling. The documentary material was approached interpretively, the rogerian conceptual constructions compared with the work process recommended in the documents, examining its consistence and internal coherence. Incompatibilities were evidenced regarding their objectives, focus, expected results and professional attitude. Such disagreements seem to stem from differences among the original aims of PCT-based counseling and those demanded in STD/AIDS prevention strategies. The confl uence of many goals added to counseling in the fi eld of STD/AIDS presented complications to a consistent use of the PCT. The study agrees with the pertinence and interest of the rogerian approach in counseling as a support technique for the decision making and management of everyday situations in the fi eld of prevention, but the need to revise objectives and standardized procedures focused on behavioral change and epidemiological vigilance is also stressed.

The HIV epidemic and human rights violations in Brazil

Efforts to mitigate stigma and discrimination have been central to the national response to HIV in Brazil, a country historically recognized as a leader in human rights-based HIV prevention, treatment and care. Brazil is credited with avoiding a potentially generalized HIV epidemic by providing universal access to antiretroviral therapy (ART) and associated HIV care since 1996. The Brazilian AIDS policy, although hailed as a model worldwide, has been more difficult to implement among more vulnerable groups of people living with HIV/AIDS, such as drug users, homeless persons, people who use drugs and sex workers, who are often stigmatized as noncompliant or difficult to retain in care. (Published: 12 November 2013) Citation: Malta M and Beyrer C. Journal of the International AIDS Society 2013, 16 :18817 http://www.jiasociety.org/index.php/jias/article/view/18817 | http://dx.doi.org/10.7448/IAS.16.1.18817

Sexual Violence and Genital Injury: The Physiology of HIV Transmission Risk

The American Journal of Reproductive Immunology (AJRI) has kindly agreed to publish the proceedings of a recent Scientific Research Planning meeting entitled ‘Sexual Violence and HIV Transmission’. This conference was the first of its kind to focus on the physiology of sexual violence as a factor in HIV transmission. All review articles from this meeting will be available Online as a special issue of AJRI early in 2013. We are delighted to present a unique collection of perspectives representing the basic sciences, public health, the behavioral and social sciences, clinical research, and epidemic modeling. The review articles in this issue were developed as a contribution to the consultations and Scientific Research Planning Meeting on Sexual Violence and HIV transmission convened by the Social Science Research Council on March 19–20, 2012 at the Greentree Foundation in New York (hereafter referred to as the Greentree Meeting). In addition to the individual articles, this Special Issue also includes a Summary of the Greentree Meeting Proceedings. Financial support for the Meeting was provided by the National Institutes for Health, Office of AIDS Research; the Joint United Nations Programme on HIV/AIDS (UNAIDS) and UN Action Against Sexual Violence in Armed Conflict (UN Action). The principal motivation for convening the Greentree Meeting was to generate new insights about the physiology of sexual trauma and its role in HIV transmission, acquisition, and pathogenesis. Although many scholars, practitioners, and policy-makers have begun to associate sexual violence with heightened HIV risk, genital trauma has yet to be identified as a cofactor in epidemiological models of HIV transmission or as a plausible explanation for the vastly disproportionate rates of infection among young girls as compared to young boys in some settings. This is more than just an anomaly in sub-Saharan Africa, where 76% of all HIV-positive women reside and young women between 15 and 24 years are between two and eight times more likely than their male peers to be HIV positive. For the survivors of sexual violence in conflict-affected and HIV endemic areas, the relationship between the behavioral, structural, and physiological drivers of HIV transmission is far more complex than being simply a function of ‘heterosexual transmission.’ We believe that the Greentree Meeting broke through a crucial impasse in HIV research that has resulted from a tradition of siloed and disciplinary-specific approaches to an inherently bio-social problem. The Greentree Meeting, a potentially replicable model of collaboration, offered a two way process of discovery: with greater understanding about the physiology of HIV transmission risk, behavioral, public health, and social science researchers are better able to assess the relevance of biomedical factors across different geographic and social settings. Similarly, greater understanding on the part of biomedical researchers about the social dynamics that influence transmission can help generate new insights about the physiology of risk among specific populations. ‘The contribution of sexual violence and genital injury to HIV transmission and acquisition has not yet been fully understood or integrated into the global AIDS response, even as it plays a potentially significant role in the development of HIV epidemics, particularly among young women. Causal pathways between sexual violence and genital injury and HIV infection are complex and involve a range of biological, behavioral, and social factors that must be explored simultaneously. Participants at the Greentree Scientific Research Planning Meeting identified a robust agenda for inter-disciplinary research, cognizant of its applications to program and policy that should be pursued imminently.’ We hope that all the outputs of the Greentree meeting will, collectively, catalyze additional interdisciplinary research, policy, and practice that further establishes the links between sexual violence and HIV and, ultimately, helps reduce infections among those most at risk.

Burden of Communicable Disease among the Native and Repatriating Afghans

Burden of Communicable Disease among the Native and Repatriating Afghans

Engaging to End the Epidemic

Engaging to End the Epidemic

Common Skin Conditions in Children with HIV/AIDS

The most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) data inform us that approximately 2.3 million children were infected with HIV at the end of 2009. The greatest burden of this infection is thrust squarely on the most impoverished healthcare systems in the world. Sub-Saharan Africa is home to at least 68% of the global total of HIV infection of 22.5 million. Although a scale up of antiretrovirals has been one of the UNAIDS priorities, and access to services to prevent mother-to-child transmission has increased, an estimated 370,000 children were newly infected in 2009. Hence, infected mothers continue giving birth to HIV-infected children who require appropriate healthcare to diagnose and treat their underlying immunodeficiency and related disorders. Skin lesions are common in these children as they present with infections common in the general population, albeit more severe. Those lesions that are markers of HIV or AIDS are important signs heralding an improving or declining immune system and the success of antiretrovirals. Cutaneous manifestations of HIV/AIDS can be classified broadly as infections and infestations, inflammatory conditions, tumors, and antiretroviral related. This manuscript discusses the more common skin conditions seen in children infected with HIV so as to improve the diagnosis and therapy administered by healthcare professionals especially in sub-Saharan Africa.