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2008 UN Report on Global AIDS epidemic

The UNAIDS report clearly shows that stronger measures are needed to turn the epidemic around and that ‘knowing your local epidemic’ remains critical to an effective response.(1)
The 2008 Report on global AIDS epidemic is a report from the Joint UN Programme on HIV/AIDS (UNAIDS) and includes contributions from 10 UN system organizations brought together in the AIDS response effort of UNAIDS.(2) The Report: -confirms that the world is making some real in its response to AIDS, but 27 years into the efforts AIDS continues to challenge all efforts. Today for every 2 people who start taking the antiretroviral drugs, another 5 become newly infected. This 2008 Report: -is the most comprehensive ever, reflecting input from countries about what works and why. -asks whether the right actions are being taken, are the right actions being undertaken in the right manner, and have these actions been sufficiently scaled to make a difference. To answer these q’s, the Report relies heavily on data reported to UNAIDS by 147 UN Member States in early 2008-- on 25 core UNGASS indicators, using evidence to assess progress.
P19 shows a useful table of national indicators for the implementation of the Declaration of Commitment on HIV/AIDs referring to programmes, knowledge and behavior and impact of the indicators. Civil society monitors progress. Since HIV was first recognized, approaches and methodologies to monitor the epidemic and the response have continuously improved and as a result the world is better equipped than ever to estimate HIV prevalence, rate of new infections, to determine the extent of programme coverage, to characterize and evaluate national responses and to gauge the level of funding available for HIV programmes in low/middle income countries.Key weaknesses include countries that monitor/evaluate but have no HIV database and 1 in 4 countries with monitoring/evaluating have not calculated budgetary req’ts. The number of monitoring/evaluating countries continues to grow but they must ensure that they actually use the info generated to improve decionmaking.
P67-68 HIV is a biological entity that is responsive to medical interventions, but the epidemic has continued to expand largely due to failures to tackle societal conditions that increase HIV risk and vulnerability. 2 sets of societal factors that have not been effectively addressed in most countries: -gender equality and empowerment of women and girls, and -discrimination, stigma and social marginalizations. A human rights approach to HIV ensures that matters that are often considered discretionary are recognized as legitimate entitlements of all individuals, it empowers people to know and claim their rights and it helps stakeholders to address power imbalances that exist at household, community and national levels.
P132 The impact of retroviral drugs on the management of HIV infection has been startling, with improvements in health proving to be far more marked and enduring than anticipated when the combination antiretroviral therapy first emerged in the 1990’s. Recent studies in Denmark suggest that a young man diagnosed with HIV is likely to live an additional 35 years with available medications, a tripling of life expectancy of people with HIV. (Lohse 2007). The best time to initiate antiretroviral therapy remains a subject of debate.
P155 Focused efforts are required to ensure that all people needing treatment have equal access civil society-- surveys confirm that many people living with HIV face considerable obstacles to accessing HIV treatment (Human Rights Watch). For example several countries stipulate the young people living with HIV must obtain parental consent before receiving antiretroviral drugs. One report indicates that names of people who appear on the Russian Federation’s national registry of drug users often results in discrimination in service access for HIV positive people.
See also an ‘Evidence for action’ table on p160. (1)http://www.un-ngls.org/site/article.php3?id_article=548 (2) http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp 7 chapters, 212 pp plus annex,supplementry errata sheet. Contributors: UN Office of High Commissioner for Refugees, UN Children’s Fund, World Food Programme, UN Development Programme, UN’s Population Fund, UN Office on Drugs and Crime, International Labor Organization, UN Educational, Scientific and Cultural Organization, WHO,World Bank, Global Fund to Fight TB+Malaria, UNGASS Civil Society Steering Committee
P26 Universal access does not imply there will/should be 100% coverage of HIV prevention, treatment, care and support services --some patients who are medically eligible to receive antiretroviral drugs do not receive them for various reasons (a deliberate decision by the patient not to, or to do so at a later time), different settings often have different distinct needs; universal access cannot fit a standardized time frame or approach.
WHO advises clinicians working in settings where CD4 count is available to consider initiating treatment when CD4 count falls below 350 cells per mm and to initiate in all patients with counts of CD4 below 200 cells per mm when testing is unavailable. WHO recommends treatment where patients exhibit clinical signs of advanced or severe immune suppression (WHO 2006). The US HHS recommends initiation of antiretroviral therapy in patients who have experienced an AIDS-defining opportunistic illness or have a CD4 count of less than 350 cells per mm (Panel on Antiretroviral Guidelines 2006) .
p141- TB remains the most common opportunistic infection for people living with HIV. As a life threatening and highly stigmatized illness HIV infection has effects on mental health.Also, as HIV disease progresses, nutritional status often declines
P 149 Although there has been major progress, treatment scale up has not kept pace with actual needs.P 153 An issue of emerging importance is the role of palliative care , existing palliative care programmes are under enormous pressure to meet growing demands. Economic obstacles to using antiretroviral drugs exist in the form of user fees, copayments or other out of pocket costs, most countries have policies for providing free antiretroviral drugs however in 17 countries patients who receive free drugs must cover considerable costs of diagnostic tests or treatment for opportunistic infections.

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