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

Values of sexual behaviour in Central and Eastern Europe

Despite the profusion of social cognitive models for the prediction of sexual behaviour, we have only limited knowledge as to the role of individual values in predicting risky sexual activity. This study assessed the relationship between a recently developed value structure and sexual behaviour in the context of rising HIV infection in central and eastern Europe. Five hundred and three respondents (business people, doctors and nurses) from Estonia, Georgia, Hungary, Poland and Russia completed Schwartz’s Portrait Values Questionnaire and reported their condom use, partnership history and record of sexual disease. Results indicated that values had a moderate but consistent relationship with sexual behaviour, with riskier sexual activity reported by those high on Openness to Change, Hedonism and Self-Enhancement. These findings are discussed in the context of the need for culturally sensitive interventions in order to tackle the growing HIV epidemic in this region.This project was supported by a research grant from the Research Support Scheme operated by the Soros Foundation, Prague

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

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 road to eliminate mother‐to‐child HIV transmission

Viaplana, AlbertPrimer pla de la plaça Lesseps en obres. En el procés de deconstrucció, una grua alça la biga 1, llosa 6 del costat Besòs de la plaça

Prevalence and barriers to HIV testing among mothers at a tertiary care hospital in Phnom Penh, Cambodia. Barriers to HIV testing in Phnom Penh, Cambodia

<p>Abstract</p> <p>Background</p> <p>One-third of all new HIV infections in Cambodia are estimated to be due to mother-to-child transmission. Although the Ministry of Health adopted a policy of provider-initiated HIV testing and counseling (PITC), nearly a quarter of pregnant mothers were not tested in 2007. Greater acceptance of HIV testing is a challenge despite Cambodia's adoption of the PITC policy.</p> <p>Methods</p> <p>A hospital-based quantitative and cross-sectional survey was conducted to assess the prevalence of and barriers to HIV testing among mothers after delivery at the National Maternal and Child Health Center in Phnom Penh. The Center is one of the largest maternal and child care hospitals in the country to offer PITC services. All 600 eligible mothers who were admitted to the hospital after delivery from October to December 2007 were approached and recruited. Data were collected via a semi-structured questionnaire.</p> <p>Results</p> <p>The prevalence of HIV testing among women who delivered at the hospital was 76%. In multivariate logistic regression, factors such as the perceived need to obtain a partner's permission to be tested (OR=0.27, 95% CI=0.14-0.51, p<0.01), the lack of knowledge about HIV prevention and treatment (OR=0.38, CI=0.22-0.66, p<0.01), and the lack of access to ANC services (OR=0.35, 95% CI=0.21-0.58, p<0.01) were found to be the main barriers to HIV testing.</p> <p>Conclusion</p> <p>To achieve greater acceptance of HIV testing, counseling on HIV prevention and treatment must be provided not only to mothers but also to their partners. In addition, utilization of non-laboratory staff such as midwives to provide HIV testing services in rural health facilities could lead to the greater acceptance of HIV testing.</p