The HIV Modes of Transmission model: a systematic review of its findings and adherence to guidelines

Introduction: The HIV Modes of Transmission (MOT) model estimates the annual fraction of new HIV infections (FNI) acquired by different risk groups. It was designed to guide country-specific HIV prevention policies. To determine if the MOT produced context-specific recommendations, we analyzed MOT results by region and epidemic type, and explored the factors (e.g. data used to estimate parameter inputs, adherence to guidelines) influencing the differences. Methods: We systematically searched MEDLINE, EMBASE and UNAIDS reports, and contacted UNAIDS country directors for published MOT results from MOT inception (2003) to 25 September 2012. Results: We retrieved four journal articles and 20 UNAIDS reports covering 29 countries. In 13 countries, the largest FNI (range 26 to 63%) was acquired by the low-risk group and increased with low-risk population size. The FNI among female sex workers (FSWs) remained low (median 1.3%, range 0.04 to 14.4%), with little variability by region and epidemic type despite variability in sexual behaviour. In India and Thailand, where FSWs play an important role in transmission, the FNI among FSWs was 2 and 4%, respectively. In contrast, the FNI among men who have sex with men (MSM) varied across regions (range 0.1 to 89%) and increased with MSM population size. The FNI among people who inject drugs (PWID, range 0 to 82%) was largest in early-phase epidemics with low overall HIV prevalence. Most MOT studies were conducted and reported as per guidelines but data quality remains an issue. Conclusions: Although countries are generally performing the MOT as per guidelines, there is little variation in the FNI (except among MSM and PWID) by region and epidemic type. Homogeneity in MOT FNI for FSWs, clients and low-risk groups may limit the utility of MOT for guiding country-specific interventions in heterosexual HIV epidemics

Embracing different approaches to estimating HIV incidence, prevalence and mortality

Background: Joint United Nations Programme on HIV/AIDS (UNAIDS) and Murray et al. have both produced sets of estimates for worldwide HIV incidence, prevalence and mortality. Understanding differences in these estimates can strengthen the interpretation of each

Guidelines for using HIV testing technologies in surveillance: selection, evaluation, and implementation

[UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance]."WHO/CDS/CSR/EDC/2001.16.""UNAIDS/01.22E.""Global surveillance of HIV/AIDS and sexually transmitted infections (STIs) is a joint effort of the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, initiated in November 1996, is the main coordination and implementation mechanism for UNAIDS and WHO to compile the best information available and to improve the quality of data needed for informed decision-making and planning at national, regional and global levels. ... The Centers for Disease Control and Prevention (CDC), Atlanta, USA, deserves special credit for having prepared these Guidelines. The key professional staff, Dr. Christopher Murrill and Dr. Rebecca Martin, should be congratulated for their efforts in producing this document, with editorial assistance from Ms. Sadhna Patel and Ms. Beatrice Divine." - p. iiAlso available via the World Wide Web.Includes bibliographical references (p. 37-38)

On the front line: a review of programmes that address HIV among international peacekeepers and uniformed services 2005–2010

The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Department of Peacekeeping Operations (DPKO) have published On the front line: A review of programmes that address HIV among international peacekeepers and uniformed services 2005–2010. This report outlines the progress made and the obstacles encountered in implementing Resolution 1308 and will serve as background when the Security Council meet on 7 June to deliberate progress towards the resolution. In 2000 when the United Nations Security Council adopted Resolution 1308 it was a watershed moment in the global AIDS response. It was the first time in its history that the Security Council unanimously adopted a resolution addressing a public health concern and its implications for international peace and security. There are clearly new opportunities for consolidating the progress and addressing new challenges. The imperative to further explore the relationship between AIDS and insecurity is also clear Michel Sidibé, UNAIDS Executive Director and Alain Le Roy, Under-Secretary-General for United Nations Peacekeeping Operations The resolution recognized that societal violence and instability exacerbate the spread of HIV and, left unchecked, could pose a threat to international peace and security. It called on UNAIDS and DPKO to develop HIV-specific strategies and programmes within the context of United Nations peacekeeping operations. The report notes that significant progress has been made in providing access to HIV prevention, treatment, care and support services for all sections of society—including peacekeepers and other uniformed services personnel. Nevertheless, during the past 10 years, the evolving landscape of crises and conflicts throughout the world has reshaped these challenges and underscored the need for a new response to AIDS in the context of United Nations actions to help prevent conflict, ensure security and build peace

The adequacy of policy responses to the treatment needs of South Africans living with HIV (1999-2008): a case study

South Africa has the largest HIV/AIDS epidemic of any country in the world. Case description: National antiretroviral therapy (ART) policy is examined over the period of 1999 to 2008, which coincided with the government of President Thabo Mbeki and his Minister of Health, Dr Manto Tshabalala-Msimang. The movement towards a national ART programme in South Africa was an ambitious undertaking, the likes of which had not been contemplated before in public health in Africa. Discussion and evaluation: One million AIDS-ill individuals were targeted to be enrolled in the ART programme by 2007/08. Fewer than 50% of eligible individuals were enrolled. This failure resulted from lack of political commitment and inadequate public health system capacity. The human and economic costs of this failure are large and sobering. Conclusions: The total lost benefits of ART not reaching the people who need it are estimated at 3.8 million life years for the period, 2000 to 2005. The economic cost of those lost life years over this period has been estimated at more than US$15 billion

Engaging Local Non-Governmental Organizations (NGOs) in the Response to HIV/AIDS.

During the past few years, a number of key donor programs have scaled up their global response to the crisis of HIV and AIDS. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the President’s Emergency Plan for AIDS Relief (PEPFAR), the United Nations’ Millennium Development Goals (MDGs), the World Bank’s Multi-country HIV/AIDS Program (MAP), and other bilateral donors and charitable foundations have raised significant resources to fight HIV/AIDS. Spending on HIV/AIDS in low- and middle-income countries increased from $1 billion in 2000 to$6.1 billion in 2004. By 2007, global resources for HIV/AIDS are expected to expand to $10 billion. Local non-governmental organizations (NGOs), faith-based organizations (FBOs), and community-based organizations (CBOs) have been at the center of the response to the HIV/AIDS pandemic. In many countries, they have been responsible for the majority of the resources reaching individuals and have played a leading role in developing and implementing sustainable strategies to mitigate and prevent HIV/AIDS. One of PEPFAR’s strategic principles is to encourage and strengthen faithbased and community-based non-governmental organizations. The identification of sustainable and efficient local NGOs and the capacity building of these partners is the cornerstone on which the effective engagement of local NGOs is built. The goal of this paper is to begin a discussion among donors, international and local NGOs, and multilateral and U.S. government representatives on how to effectively engage indigenous partners and transfer much-needed resources

Gênero, direitos humanos e impacto socioeconômico da Aids no Brasil

Foi realizada análise crítica, levando-se em consideração as questões de gênero, dos resultados oficiais do relatório do governo brasileiro para o Programa Conjunto das Nações Unidas para o HIV/Aids - UNAIDS. Mais especificamente, foi abordado o cumprimento das metas resultantes da Declaração de Compromisso sobre HIV/Aids, nos itens Direitos humanos e Redução do Impacto Social e Econômico da Aids até o ano de 2003. Foram apontados os conceitos chave incluindo reflexões sobre os indicadores e estratégias que auxiliam a sociedade civil organizada a efetivar seu monitoramento até 2010.The paper critically analyzes, from the gender standpoint, official results presented in the Brazilian government report to the Joint United Nations Programme on HIV/AIDS (UNAIDS). Specifically, the fulfillment of 2003 targets set forth in the United Nations Declaration of Commitment on HIV/AIDS, under the category of Human Rights and Reduction of the Economic and Social Impact of AIDS, are evaluated. Key concepts are highlighted, including indicators and strategies that may help civilian society better monitor these targets until 2010