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It has now been 25 years since the apocryphal report in the CDC Morbidity and Mortality Weekly Report dated June 5, 1981 entitled, “Pneumocystis Pneumonia - Los Angeles”, which announced what was to become HIV/AIDS. HIV has now affected virtually all countries that have looked for it and has had a devastating impact on the public health and medical care infrastructure around the world. HIV/AIDS has also disproportionately affected nations with the least capacity to confront it, especially the developing world nations in Sub-Saharan Africa, South and Southeast Asia, and the emerging republics of Eastern and Central Asia. The pandemic, unlike any other disease of our time, has had profound impacts on the practice of public health itself: bringing affected communities into decision making; demanding North-South partnerships and collaborations; and changing the basic conduct of clinical and prevention trials research. While much has been written in scholarly publications for medical, epidemiologic and disease control specialists, there is no comprehensive review of the public health impact and response to HIV/AIDS in the developing world. This edited volume seeks to systematically describe the emergence and form of the epidemics (epidemiology), the social, community and political response, and the various measures to confront and control the epidemic, with varying levels of success. Of particular importance are strategies that appear to have been useful in ameliorating the epidemic, while contrasting the situation in a neighboring country or region where contrasting prevention or care initiatives have had a deleterious outcome. Common to all responses has been the international multi-sectoral response represented by the Global Fund for HIV/AIDS, Malaria and Tuberculosis, the President's Emergency Plan for AIDS Relief, and the Gates Foundation, among others, to promote HIV pharmacologic therapy in resource-poor settings. The chapter authors will explore the political challenges in meeting HIV/AIDS prevention and care in concert with the public health realities in specific country and regional context.
Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.
Providing an introduction to HIV/AIDS, this book explains the science, the international and local politics, the demographics and the devastating consequences of the disease. This book is aimed at general readers interested in the science, the epidemiology and the social effects of the disease which has killed 20 million.
HIV is the leading cause of premature death in Thailand. Since the first case of AIDS was reported in 1984 more than one million Thais have been infected. The social, human and economic costs of this burden are enormous. The Thai government has shown a strong commitment to providing care and support to persons living with HIV/AIDS by launching the National Access to Care Program (NAPHA) in 2003, which provides for publicly financed antiretroviral therapy (ART) to all HIV-infected people. This book documents through interviews how ART has radically changed the lives of those living with HIV. In the words of an HIV positive 29-year old man, ART is a "miracle." The book then develops an innovative analytical framework and uses it to show how the future sustainability and cost-effectiveness of this ambitious program depend critically on Thai government choices of AIDS treatment policy, HIV prevention policy and AIDS drug pricing. For the most likely assumptions, the book estimates that ART will save years of healthy life at a cost of between $700 and $2,400 per year. Successful AIDS treatment accumulates ever-increasing numbers of patients who need subsidized ART. Despite the magnitude of the resulting fiscal burden, the authors judge this expenditure to be a worthwhile public health investment for Thailand, However, they show that the future sustainability of the program will hinge critically on how well the government manages the quality of ART service delivery, on whether it is able to sustain its past successes in HIV prevention and on its negotiations with multinational pharmaceutical manufacturers on the prices of new AIDS drugs.
A global economic analysis of HIV infection amongst sex workers, finding that evidence based and rights affirming interventions are not implemented to the level that their efficacy warrants, and that doing so at scale would be cost effective and deliver significant returns on investment.
When working with countries to measure and compare health systems functioning, it is important to strike a good balance between avoiding blueprints that do not allow for country contexts and specificities while also encouraging a degree of standardization that enables comparisons within and between countries as well as over time. Standardized indicators allow comparisons between countries and can help mutual learning, including the identification of bottlenecks and the sharing of lessons learned. This handbook does not attempt to cover all components of the health system or deal with the various monitoring and evaluation frameworks. Instead, it is structured around the WHO framework that describes health systems in terms of six core components or "building blocks": service delivery, health workforce, health information systems, medical products, vaccines and technologies, financing and leadership/governance. The selection of indicators was guided by the need to detect change and show progress in health systems strengthening. Indicators relate to both the level and distribution of inputs and outputs. While the focus is on low- and middle-income countries, experiences from high-income countries are also used to guide the development of measurement systems. Each section has proposed core indicators that all countries are encouraged to collect, plus a wider set of indicators that users can choose or modify as needed. It is anticipated that the core indicators will enable the production of country "dashboards" that contain the instruments by which health systems trends can be regularly monitored and compared. Countries should integrate new indicators with existing indicators of their health sector and statistical strategies and plans. Health systems monitoring should also be seen in the context of the indicators' impact on access to priority health services and their contribution to reaching the Millennium Development Goals (MDGs). The handbook is divided into six sections, each of which covers one health system component or building block and is set out along the following lines: -introduction to the component and related indicators; -description of possible sources of information and available measurement strategies; -proposed "core indicators", supplemented, where necessary, by additional indicators that may be used depending on the country health system attributes and needs.
Based on careful analysis of burden of disease and the costs ofinterventions, this second edition of 'Disease Control Priorities in Developing Countries, 2nd edition' highlights achievable priorities; measures progresstoward providing efficient, equitable care; promotes cost-effectiveinterventions to targeted populations; and encourages integrated effortsto optimize health. Nearly 500 experts - scientists, epidemiologists, health economists,academicians, and public health practitioners - from around the worldcontributed to the data sources and methodologies, and identifiedchallenges and priorities, resulting in this integrated, comprehensivereference volume on the state of health in developing countries.