Care and support for people living with HIV/AIDS

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Report on the global HIV/AIDS epidemic – June 2000Table of contents6 Global estimates of the HIV/AIDS epidemic as of end 19997 Preface8 AIDS in a new millennium: a grim picture with glimmers of hope8 Africa: the enormous challenges of a long-lasting epidemic12 Asia holds HIV at bay – but for how long?15 Latin America: an epidemic with many faces17 HIV in the Caribbean: small islands, large epidemic18 Eastern Europe and Central Asia: drug injecting is still the main risk19 High-income countries: long survival but more risk behaviour21 Waking up to devastation21 The demographic impact of AIDS21 The population chimney23 Increases in adult and child mortality rates are already being recorded25 In some countries, over a third of 15-year-olds may die of AIDS26 Social and economic impacts27 Household impacts29 The toll on teaching…29 … the toll on learning31 Health sector under stress32 Impact on agriculture33 The bottom line: HIV is hurting business37 What makes people vulnerable?38 Fear, stigma and denial: a vicious circle40 Uninformed and hence vulnerable42 Lack of education: a growing liability45 Men and women on the margins46 Young girls: vulnerable for many reasons49 Violence against women49 Violence in the home51 Sexual abuse of women and children55 Prevention: daunting challenges ahead55 Avoiding heterosexual transmission: how well are existing prevention strategies working?56 How many young people manage to delay first sex?56 How many stay abstinent before marriage?57 Sex before marriage: the HIV risks58 What about fidelity between regular partners?59 Condom use: rising, but still not enough65 Men who have sex with men65 Prevention is faltering in high-income countries67 The high cost of neglect and denial68 Men who have sex with men and women71 HIV and other sexually transmitted infections: an opportunity to strengthen prevention72 Turning past failure into future success74 Injecting drug use: the other HIV epidemic76 Reducing HIV transmission among drug users: interventions are effective but not politically popular3
Report on the global HIV/AIDS epidemic – June 200078 Opening new doors with counselling and testing79 The challenge of prevention for couples81 Preventing mother-to-child transmission of HIV85 Care and support for people living with HIV/AIDS85 Meeting the needs: challenges and achievements87 The interlocking benefits of care and prevention87 The community is key88 Greater involvement of people living with HIV/AIDS – the GIPA principle88 Community standards for care and support89 Health care: where are the gaps?91 Comprehensive care and support strategy needed93 Psychological and social support and other measures to alleviate the impact of HIV/AIDS94 Alleviating economic impact96 Improve health service delivery97 Care and support packages99 Improve access to drugs100 Strategies for cost and price reduction105 Better prospects for preventing infections in those with HIV106 A new incentive for testing?107 National responses to the epidemic: factors that make a difference108 Common features of effective national responses115 Conclusion116 Annex 1. How reliable are estimates of HIV infection and AIDS deaths?119 Annex 2. HIV/AIDS estimates and data, end 1999119 Notes on specific indicators listed in the table123 Table of country-specific HIV/AIDS estimates and data, end 1999Boxes10 Box 1. A measure of success: reduced HIV rates in young Zambian women13 Box 2. A measure of success: changing behaviour in Tamil Nadu16 Box 3. A measure of success: young Brazilians increasingly reject unprotected sex27 Box 4. The orphans left behind34 Box 5. HIV in the workplace: the business response38 Box 6. Breaking the silence in Africa41 Box 7. AIDS hotline: reducing vulnerability in Egypt49 Box 8. Working with vulnerable girls in Nepal50 Box 9. Rape in war53 Box 10. Child-friendly courts in Zimbabwe59 Box 11. How well do condoms work?63 Box 12. The female condom64 Box 13. Making the safe choice easier68 Box 14. Needed: an AIDS vaccine70 Box 15. Male circumcision and HIV infection91 Box 16. Strengthening “horizontal” collaboration on HIV and sexuallytransmitted infections in Latin America and the Caribbean92 Box 17. Health reforms and HIV: experience from Phayao Province, northern Thailand101 Box 18. Experience in Brazil with generic alternatives to proprietary antiretrovirals103 Box 19. Lessons from the UNAIDS Drug Access Initiative106 Box 20. Use of cotrimoxazole prophylaxis in people with HIV/AIDS in Africa112 Box 21. International support for national responses114 Box 22. Debt relief4
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Care and support for people living with HIV/AIDS

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