Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000There is also evidence that continued vigilance is critical even when behaviourchange appears to have become established. The use of condoms among a newlysexually active generation of men who have sex with men for example cannot beassumed, just because an older generation changed its behaviour.Gradually, without losing focus, action must expand steadily until complete countrycoverage is achieved.8. Learning from experienceThe last 15 years of HIV prevention and care have led to the development of a richbody of experience and expertise. While it is essential that individual countries“own” their response there is a great deal of evidence that some policies, strategiesand technologies are particularly effective: that which UNAIDS calls “best practice”.Drawing on best practice and adapting it to local circumstances is valuable both atthe outset, and as the response matures. Learning within a national context is alsoimportant.District bureaucracies provide the critical link between local and national activities.The district level is well placed in many countries to analyse, document and disseminatewhat they learn from the local responses. They can then press for, andnegotiate with, the national authorities the changes and reforms needed in key sectorsto sustain local responses. There are multiple examples of good HIV “projects”– successful interventions that have identified the recipe for success in a given environment.They can provide valuable insights to national programmes.Similarly, national programmes are in a strong position to scale up local responsesto the national level by incorporating local lessons into their strategic planning andreform processes. For example, governments can effectively adopt policy changesand programme approaches that have “passed the test” at the local level.Box 21. International support for national responsesDonor assistance to HIV/AIDS has increased substantially over time. In 1998, 14 ofthe largest donors in the OECD Development Assistance Committee providedUS$ 300 million for HIV/AIDS activities. In 1987 – soon after it was first recognizedthat HIV had spread massively in many developing countries – levels of official developmentassistance (ODA) funding to AIDS were only at 20% of the levels seen adecade later. This increase has occurred at the same time that overall ODA contributionsto developing countries have steadily declined.Unfortunately, as spectacular as this increase appears, it has not kept pace with thespread of the epidemic – or even the most basic requirements for HIV programmesof the most-affected countries. During the same period, the number of infections hasrisen from 4 million to over 34 million, a figure that continues to grow given the more–––>112