General Objectives and Methods in HIV/AIDS Surveillance

Preventing transmission of virus is still the single intervention known as effective in limiting the spread of HIV infection. So, the epidemiological surveillance of HIV/AIDS is an important tool used by public health specialists in controlling epidemics. Epidemiological surveillance is a continuous process of collecting, analysing, interpreting and disseminating data in order to plan, implement and assess public health interventions. The objectives of HIV/AIDS surveillance should be specific, measurable, transformed into actions, realistic, planned to be done in due time. The main methods used by HIV/AIDS surveillance in collecting the data are biological surveillance, behavioural surveillance, other sources of information. The main indicators recommended for any HIV/AIDS programme components include the fields of politics, condoms availability and quality, social stigmatus & discrimination, knowledge, vertical transmission, sex negotiation and attitude, sexual behaviour, especially in youngsters, injection with drugs, safe blood and derivatives, STI treatment and prevention, care and social support, social & health impact. Data collected by public health surveillance systems guide the responses to the events, measure and monitor the burden of the disease, assess public health politics, etc.. Integrated approach in epidemiological surveillance takes into account, generally, the integration of all activities that have to do with epidemiological surveillance into a single service with multiple functions using the same structures, procedures and personnel. Second generation HIV/AIDS surveillance is a WHO concept developped on modular systems. The metodology in risk behaviour surveillance studies includes: justifying, behavioural risk, methods for collecting data, behavioural data value, steps in organizing behavioural surveillance studies

Recognizing the influence of social determinants on HIV risk behaviors and the need for structural interventions to prevent HIV in women

The design and implementation of structural interventions may provide for simultaneous and longitudinal responses to prevention needs in multiple contexts as defined by social determinants, thus varied opportunities exist to respond to the HIV prevention needs of women. According to the CDC, in 2010, the rate of new HIV infections among black women was 20 times that of white women, and the rate among Hispanic/Latino women was 4 times the rate of white women. Additionally, 86% of HIV infections in women were attributed to heterosexual contact and 14% to injection drug use (CDC, 2012). These numbers are reflected outside the US with 49% of those infected by HIV being women with a predominant source of infection being related to heterosexual transmission (WHO, 2008). In sub-Saharan Africa, of those living with HIV, 60% are women. Attention to the influential context of social determinants of health provides unique opportunities for innovative prevention practice in HIV/AIDS prevention for women. In this paper, social determinants of health as an influential, behavioral concept is defined both in terms of women’s health and their sexual behavior decision making, along with examples of potential structural interventions that not only address the social determinants of their HIV risks but also reflect the contextual complexity of their life experiences. An earlier study (Abdul-Qader and Collins, 2011) solicited statements from a sample of experts in HIV prevention and areas of public health to identify potential structural interventions that would be feasible and impactful regarding HIV prevention - the DHAP Structural Interventions Mapping project. Data was elicited from these stakeholders most likely to be designing and guiding interventions to determine their perspectives on feasible and impactful structural intervention to address sexual behavior in women. The current paper is based on secondary analysis of 20 of these potential structural interventions generally and specifically applicable to women and their HIV prevention needs. Qualitative analysis resulted in three overall themes of economic interventions, response to violence against women and integrated health service delivery strategies that address key health-belief and socio-cultural issues. The themes are reflected and substantiated in current research literature, and provide a foundation for the next steps regarding research, policy planning and program implementation for developing evidence-based structural interventions focused on preventing HIV in women

Issues and Challenges of HIV/AIDS Prevention and Treatment Programme in Nepal

This paper explores some of the key issues and challenges of government HIV/AIDS prevention and treatment programme in Nepal. Providing HIV/AIDS prevention and treatment services in Nepal is associated with a number of issues and challenges which are shaped mostly on cultural and managerial issues from grass root to policy level. Numerous efforts have been done and going on by Nepal government and non-government organization but still HIV prevention and treatment service is not able to reach all the most at risk populations because cultural issues and managerial issues are obstructing the services. The existing socio-cultural frameworks of Nepal do not provide an environment for any safe disclosure for person who is HIV infected. Thus, there is an urgent need to address those issues and challenges and strengthen the whole spectrums of health systems through collaborative approach to achieve the millennium development goals. It will be the purpose of this paper to contribute to the policy makers by exploring the pertinent issues and challenges in the HIV/AIDS programme

Global HIV Prevention Progress Report Card 2010

Assesses progress in terms of data quality and outcome on the working group's recommendations including on prevention strategies, information systems, funding, policy, transparency, evidence-based approaches, technical support, research, and advocacy

Behavior Change and HIV Prevention: (Re)Considerations for the 21st Century

Outlines the evidence base for the effectiveness of HIV-prevention programs aimed at reducing high-risk behaviors. Discusses elements of successful programs, challenges and limitations, and recommendations for expanding behavioral prevention programs

Grand Challenges: Improving HIV Treatment Outcomes by Integrating Interventions for Co-Morbid Mental Illness.

In the fourth article of a five-part series providing a global perspective on integrating mental health, Sylvia Kaaya and colleagues discuss the importance of integrating mental health interventions into HIV prevention and treatment platforms. Please see later in the article for the Editors' Summary

Ethical Challenges of Randomized Violence Intervention Trials: Examining the SHARE intervention in Rakai, Uganda.

ObjectiveWe identify complexities encountered, including unanticipated crossover between trial arms and inadequate 'standard of care' violence services, during a cluster randomized trial (CRT) of a community-level intimate partner violence (IPV) and HIV prevention intervention in Uganda.MethodsConcepts in public health ethics - beneficence, social value of research, fairness, standard of care, and researcher responsibilities for post-trial benefits - are used to critically reflect on lessons learned and guide discussion on practical and ethical challenges of violence intervention CRTs.ResultsExisting ethical guidelines provide incomplete guidance for responding to unexpected crossover in CRTs providing IPV services. We struggled to balance duty of care with upholding trial integrity, and identifying and providing appropriate standard of care. While we ultimately offered short-term IPV services to controls, we faced additional challenges related to sustaining services beyond the 'short-term' and post-trial.ConclusionStudies evaluating community-level violence interventions, including those combined with HIV reduction strategies, are limited yet critical for developing evidence-based approaches for effectively preventing IPV. Although CRTs are a promising design, further guidance is needed to implement trials that avoid introducing tensions between validity of findings, researchers' responsibilities to protect participants, and equitable distribution of CRT benefits

A Geospatial Analysis of CDC-funded HIV Prevention Programs for African Americans in the United States

Given the increase in HIV/AIDS infection rates among racial and ethnic minorities, particularly African Americans, this study was undertaken as part of a larger research effort to examine the distribution of HIV prevention services focusing on African American populations within the United States. Data were gathered via a national survey of community-based organizations (CBOs) funded by the Centers for Disease Control and Prevention (CDC). A geocoded national database was constructed to identify, locate, and map these HIV prevention programs. A total of 1,020 CBOs responded to the survey, yielding a response rate of 70.3%. These CBOs administered a total of 3,028 HIV prevention programs. Data describing intervention types and persons served, combined with the address and service area of responding CBOs, were integrated with census data (2000) and analyzed by using a geographic information system (GIS). The results of our national level analysis show that HIV prevention services for African Americans have fair coverage where African Americans comprise a substantial proportion of the population in urban areas in northeastern states, but that HIV prevention services for African Americans are inadequately distributed in the southeastern states. A local-level analysis was conducted for Alabama, where 68% of HIV/AIDS cases are among African Americans. Specific interventions such as street and community outreach, health communications, and public information are fairly well provided to African Americans in more urban cities in Alabama, however, individual- and group-level interventions have poor coverage in rural areas where a large percentage of African-Americans live. Overall, our study illustrates that the use of GIS adds value when used with other data sources to provide prevention services that are accessible to the populations most in need

Identifying Opportunities for Collaboration Across the Social Sciences to Reach the 10-10-10: A Multilevel Approach.

BACKGROUND:The national and global strategy to combat HIV, often referred to as the "90-90-90," aims to diagnose 90% of people living with HIV, get 90% of those diagnosed onto antiretroviral treatment (ART), and achieve viral suppression in 90% of those on ART. The remaining 10-10-10 who will be undiagnosed, not on ART, or not virally suppressed, include vulnerable persons and populations most affected by social determinants of health. Given their foci on the social determinants of health at the individual, social, and structural levels, social scientists are in a prime position to help reach the 10-10-10. A potentially effective way for social scientists to achieve this goal is to examine the issues that affect the 10-10-10 using a multilevel framework, to understand at what levels their own approaches fit within such a multilevel framework, and to seek intentional collaborations with other social scientists who may work at different levels but whose approaches may complement their own within multilevel collaborations. APPROACH:The present article describes how a multilevel framework can guide collaboration across disciplines within the social sciences toward the common goal of reaching the 10-10-10. CONCLUSIONS:Within a multilevel framework, social scientists can work collaboratively to address the needs of individuals among the 10-10-10 within the social and structural contexts (eg, social norms, stigma, poverty, and barriers to care) that affect their health. Such an approach draws on the unique strengths and approaches of different social-science disciplines while also building capacity for individuals most affected by social determinants of health