XVII International AIDS Conference: From Evidence to Action - Epidemiology

As the epidemic matures, accurate information about where new infections are occurring, and in which populations, is becoming increasingly critical in designing effective, targeted interventions relevant to current epidemiological trends. Although the quality and accuracy of HIV surveillance data and methodology have improved, in many cases the second generation WHO/UNAIDS surveillance system has not been fully implemented at the national level. National surveillance systems in many low and middle-income countries often do not collect disaggregated data on some most at risk populations, which is critical to developing targeted prevention interventions

Male circumcision for HIV prevention in high HIV prevalence settings: what can mathematical modelling contribute to informed decision making?

Experts from UNAIDS, WHO, and the South African Centre for Epidemiological Modelling report their review of mathematical models estimating the impact of male circumcision on HIV incidence in high HIV prevalence settings

High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting.

SETTING: Thyolo District Hospital, rural Malawi. OBJECTIVES: In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district. DESIGN: Cohort study. METHODS: Review of routine antenatal, VCT and PMTCT registers. RESULTS: Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95-97] were pre-test counselled, 2965 (95%, CI: 94-96) underwent HIV-testing, all of whom were post-test counselled. Thirty-one (1%) mothers refused HIV-testing. A total of 646 (22%) individuals were HIV-positive, and were included in the PMTCT programme. Two hundred and eighty-eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n=646) was 358 (55%, CI: 51-59) by the 36-week antenatal visit, 440 (68%, CI: 64-71) by delivery, 450 (70%, CI: 66-73) by the first postnatal visit and 524 (81%, CI: 78-84) by the 6-month postnatal visit. This left just 122 (19%, CI: 16-22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available. CONCLUSIONS: In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one-quarter were HIV-positive and included in the PMTCT programme. The progressive loss to follow up of more than three-quarters of this cohort by the 6-month postnatal visit demands a 'different way of acting' if PMTCT is to be scaled up in our setting

Understanding the gender disparity in HIV infection across countries in sub-Saharan Africa: Evidence from the Demographic and Health Surveys

Women in sub-SaharanAfrica bear a disproportionate burden of human immunodeficiency virus (HIV) infections, which is exacerbated by their role in society and biological vulnerability. The specific objectives of this article are to (i) determine the extent of gender disparity in HIV infection; (ii) examine the role of HIV behaviour factors on the gender disparity and (iii) establish how the gender disparity varies between individuals of different characteristics and across countries. The analysis involves multilevel logistic regression analysis applied to pooledDemographic andHealth Surveys data from 20 countries in sub-Saharan Africa conducted during 2003–2008. The findings suggest that women in sub- Saharan Africa have on average a 60%higher risk of HIV infection than their male counterparts. The risk for women is 70%higher than their male counterparts of similar sexual behaviour, suggesting that the observed gender disparity cannot be attributed to sexual behaviour. The results suggest that the risk ofHIV infection among women (compared to men) across countries in sub-Saharan Africa is further aggravated among those who are younger, in female-headed households, not in stable unions or marital partnerships or had an earlier sexual debut.⁄ acquired immune deficiency syndrome (AIDS) awareness and sexua

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)

Male Circumcision as an HIV Prevention Strategy in Sub-Saharan Africa: Socio-Legal Barriers

UNAIDS and WHO recommend safe, voluntary male circumcision as an additional, important strategy for the prevention of heterosexually-acquired HIV in men in areas with high HIV prevalence and low levels of male circumcision. Comprehensive male circumcision services should include HIV testing and counseling, partner reduction, and male and female condom use. Yet, male circumcision can have deep symbolic meaning that could pose barriers to implementation. In some parts of the world, it is a traditional practice with religious or cultural significance, in others it is a common hygiene intervention, and in yet others it is unfamiliar or foreign. Consequently, the proportion of men who are circumcised varies from \u3c5% to \u3e80%, with an estimated 30-40% of adult men circumcised worldwide. Confirming a number of observational studies, three randomized controlled trials in Africa have shown that circumcision reduces the likelihood of female-to-male HIV transmission by 50-60%, leading WHO/UNAIDS to conclude that the evidence is compelling . Male circumcision is a relatively simple, inexpensive one-time surgical procedure that is cost-effective, but raises a host of ethical, legal, and human rights challenges

Achieving the WHO/UNAIDS antiretroviral treatment 3 by 5 goal: what will it cost?

The "3 by 5" goal to have 3 million people in low and middle income countries on antiretroviral therapy (ART) by the end of 2005 is ambitious. Estimates of the necessary resources are needed to facilitate resource mobilisation and rapid channelling of funds to where they are required. We estimated the financial costs needed to implement treatment protocols, by use of country-specific estimates for 34 countries that account for 90% of the need for ART in resource-poor settings. We first estimated the number of people needing ART and supporting programmes for each country. We then estimated the cost per patient for each programme by country to derive total costs. We estimate that between US5.1 billion dollars and US5.9 billion dollars will be needed by the end of 2005 to provide ART, support programmes, and cover country-level administrative and logistic costs for 3 by 5

An exploratory study of Hungarian university students’ sexual attitudes and behaviours

Sexual health is the integration of the somatic, emotional, intellectual and social aspects of sexual being that may positively enrich personality (WHO, 1975). It includes not only the prevention of sexually transmitted infections (STIs), unwanted and unplanned pregnancy, coercion, violence and discrimination, but also a positive approach to sexuality (Edwards & Coleman, 2004). Given the apparent inadequacies of the global approach to sexual health education (SHE) for young people (UNESCO, 2009), it is unsurprising that the prevalence of STIs have increased worldwide (WHO, 2018). Although Hungary is still among the countries with low HIV/STISs infection rate, sexually active young people are at higher risk of infection (Goodwin et al., 2003; Gyarmathy, McNutt, et al., 2002; UnAIDS, 2018).peer-reviewe

An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa

HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted as an essential tool in scaling up and improving access to treatment, care and support especially in community settings. Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-todoor offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa, including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%) observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%) clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor quality of HCT after training