Has donor prioritization of HIV/AIDS displaced aid for other health issues?

Advocates for many developing-world health and population issues have expressed concern that the high level of donor attention to HIV/AIDS is displacing funding for their own concerns. Even organizations dedicated to HIV/AIDS prevention and treatment have raised this issue. However, the issue of donor displacement has not been evaluated empirically. This paper attempts to do so by considering donor funding for four historically prominent health agendas--HIV/AIDS, population, health sector development and infectious disease control--over the years 1992 to 2005. The paper employs funding data from the Organization for Economic Cooperation and Development's (OECD) Development Assistance Committee, supplemented by data from other sources. Several trends indicate possible displacement effects, including HIV/AIDS' rapidly growing share of total health aid, a concurrent global stagnation in population aid, the priority HIV/AIDS control receives in US funding, and HIV/AIDS aid levels in several sub-Saharan African states that approximate or exceed the entirety of their national health budgets. On the other hand, aggregate donor funding for health and population quadrupled between 1992 and 2005, allowing for funding growth for some health issues even as HIV/AIDS acquired an increasingly prominent place in donor health agendas. Overall, the evidence indicates that displacement is likely occurring, but that aggregate increases in global health aid may have mitigated some of the crowding-out effects.     

Has HIV/AIDS displaced other health funding priorities? Evidence from a new dataset of development aid for health

In recent times there has been a sense that HIV/AIDS control has been attracting a significantly larger portion of donor health funding to the extent that it crowds out funding for other health concerns. Although there is no doubt that HIV/AIDS has absorbed a large share of development assistance for health (DAH), whether HIV/AIDS is actually diverting funding away from other health concerns has yet to be analyzed fully. To fill this vacuum, this study aims to test if a higher level of HIV/AIDS funding is related to a displacement in funding for other health concerns, and if yes, to quantify the magnitude of the displacement effect. Specifically, we consider whether HIV/AIDS DAH has displaced i) TB, ii) malaria iii) health sector and 'other' DAH in terms of the dollar amount received for aid. We consider this question within a regression framework controlling for time and recipient heterogeneity. We find displacement effects for malaria and health sector funding but not TB. In particular, the displacement effect for malaria is large and worrying.     

云南艾滋病防治专项经费分配影响因素分析

目的深入了解中央专项经费分配过程中的影响因素,为完善分配决策提供科学依据。方法采用定性调查的方法,对云南省德宏州芒市、红河州建水县、蒙自县及保山市龙陵县各级从事艾滋病防治中央专项经费管理的相关人员进行深入访谈,并对结果进行分析。结果资金拨付时间过长,统一物资招标采购过程漫长等因素影响中央专项经费的拨付;二次分配使得基层对经费信息掌握不全面,计划工作量与实际工作量的差异导致经费不足,预算制定缺少后勤保障经费将直接影响防治活动的实施,工作中临时增添的活动缺乏相应的经费支持等因素影响中央专项经费的使用。结论解决艾滋病防治中央专项经费分配存在的问题,需要合理制定计划工作量和经费预算,激励地方财政投入配套经费,紧密结合基本公共卫生服务等。     

Reorienting health and social services

The global HIV/AIDS epidemic poses the particular challenge of how to concentrate resources and bring about results without provoking stigmatization against those groups who are highly vulnerable. AIDS-based discrimination is increasing around the world and is manifested in the unwillingness to fund programs claiming that the victims are at fault. This means that sexually transmitted diseases (STDs) and AIDS programs are responsible for promoting nondiscriminatory approaches. STD treatment programs generally provide pre- and post-test counseling, but broader antistigmatization efforts have been carried out by AIDS service organizations and nongovernmental organizations. A well-developed response to HIV/AIDS and STDs involves service and program providers, community health workers, traditional health practitioners, general and private practitioners, pharmacists, traditional birth attendants, and social workers. Outreach staff need to link with community workers and volunteers close to the client groups. HIV/STD diagnosis and treatment programs need to be coupled also with intensive community-led prevention and support activities in order to influence sexual behaviors. Programs conducted in this spirit share information more easily, provide authoritative roles for nonbiomedical workers, and have clear goals that are supported by the clients. These programs forge alliances between clients, service providers, and community leaders. The underlying concept of human rights embraces a broader perspective looking for the determinants and remedies for vulnerability to HIV/STD. HIV/AIDS/STDs must be fought to defeat both the virus and social backlash. This two-pronged struggle requires the reorientation of health and social services centering on partnerships and a conducive management style. Health and social services can be constrained by a trend toward reduced funding, but HIV-affected communities induce them to change whereby new partnerships could be forged.     

Estimating resource needs for HIV/AIDS health care services in low-income and middle-income countries

As funding mechanisms like the Global Fund for HIV/AIDS, Tuberculosis and Malaria increasingly make funding decisions on the basis of burden of disease estimates and financial need calculations, the importance of reliable and comparable estimating methods is growing. This paper presents a model for estimating HIV/AIDS health care resource needs in low- and middle-income countries. The model presented was the basis for the United Nations' call for US dollars 9.2 billion to address HIV/AIDS in developing countries by 2005 with US dollars 4.4 billion to address HIV/AIDS health care and the rest to deal with HIV/AIDS prevention. The model has since been updated and extended to produce estimates for 2007. This paper details the methods and assumptions used to estimate HIV/AIDS health care financial needs and it discusses the limitations and data needs for this model.     

Developing country health systems and the governance of international HIV/AIDS funding

Donor country initiatives for the prevention and mitigation of HIV/AIDS are not a matter of simple burden sharing. Instead, they have brought in their wake many of the complexities and unforeseen effects that have long been associated with more general overseas development assistance. In the case of funding directed toward HIV/AIDS, these effects are by no means either secondary or easily calculable. It is widely acknowledged that there is no consensus framework on how these impacts may be defined, no framework/toolkit for the evaluation of impacts and no longitudinally significant data that could provide the substance for those evaluations. The subject of this study focuses not on the health outcomes of funding but on how donor-recipient relations could be better deliberated, negotiated and coordinated. We argue that effective leadership and governance of developing country health systems for HIV/AIDS work requires a reconfiguration of how donor-recipient relations are conceived and contracted, and for this purpose, we propose an adaptation of the Organisation for Economic Co-operation and Development Paris Declaration principles of aid effectiveness.     

International law,human rights and HIV/AIDS

This article explores the relevance of international human rights law in the response to the HIV/AIDS epidemic at national and international levels. Public health advocates can use arguments based on this body of law to promote responses to HIV/AIDS that reflect sound public health principles and documented best practice. Development assistance is increasingly linked to rights-based approaches, such as participatory processes, and strategic alliances between health professionals, organizations of people living with HIV/AIDS, and affected communities. Legal and human rights advocacy strategies are increasingly productive and necessary.     

HIV/AIDS and community conflict in Nigeria: implications and challenges

This paper discusses how HIV/AIDS prevention, treatment and mitigation activities and funding for such work can lead to community conflict. The central role of communities in combating HIV/AIDS is widely agreed, with the contributions of social capital networks and civil society seen as pivotal; a rights-based approach to HIV/AIDS activities is considered essential. Yet experiences from a UK Department for International Development funded project in Nigeria suggest that greater critical attention must be given to the impacts and effects of HIV/AIDS on communities, and the ways in which conflict can develop, emerge and be sustained, resulting in severe breakdown of social cohesion and reduction or cessation of HIV/AIDS activities. It is argued here that conflict can be fuelled by the different priorities and perceptions of community members and groups vis-à-vis those of development organisations, and by the impact of funds on often desperately poor communities. Case studies analyse the development of the conflict, failed attempts at resolution, and two post-conflict project interventions whose design and implementation were informed by its experiences and outcome. The paper concludes by considering the potential input of participatory approaches, community psychology and change management in the development and implementation of HIV/AIDS interventions specifically so as to reduce potential for conflict. Its intention is to contribute to the debate on how best to implement genuinely community-based and managed HIV/AIDS interventions.     

AIDS advisors say administration has grown complacent

President Clinton's AIDS advisors charge that the current administration's interest in and support of HIV and AIDS programs is diminishing. While AIDS advisors and advocates within the Presidential Advisory Council on HIV/AIDS acknowledge that President Clinton is the first U.S. president to take significant actions to address the epidemic, the nation is still without a consistent strategy for prevention, research, and eradication. Advisors cite lack of funding, outdated restrictions, and a continued refusal on the part of the President to authorize Federal funding of needle exchange programs as evidence that AIDS issues are a low priority for this administration. The absence of an initiative to provide current HIV and AIDS drug therapies to low income people and those without health insurance is also cited as evidence. AIDS advocates express strong reservations over proposals to create a national name-based HIV surveillance system.     

Increasing access to oral health care for people living with HIV/AIDS in rural Oregon

Access to oral health care for people living with HIV/AIDS is a severe problem. This article describes the design and impact of an Innovations in Oral Health Care Initiative program, funded through the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance (SPNS) program, that expanded oral health-care services for these individuals in rural Oregon. From April 2007 to August 2010, 473 patients received dental care (exceeding the target goal of 410 patients) and 153 dental hygiene students were trained to deliver oral health care to HIV-positive patients. The proportion of patients receiving oral health care increased from 10% to 65%, while the no-show rate declined from 40% to 10%. Key implementation components were leveraging SPNS funding and services to create an integrated delivery system, collaborations that resulted in improved service delivery systems, using dental hygiene students to deliver oral health care, enhanced care coordination through the services of a dental case manager, and program capacity to adjust to unanticipated needs.     

From brothel to boardroom: prospects for community leadership of HIV interventions in the context of global funding practices

The empowerment of marginalised communities to lead local responses to HIV/AIDS is a key strategy of funding agencies' globalised HIV/AIDS policies, given evidence that disempowerment is a root source of vulnerability to HIV. We report on two multi-level ethnographies at the interface between HIV prevention projects for sex workers in India and their funding environment, examining the extent to which the funding environment itself promotes or undermines sex worker empowerment. We show how the 'new managerialism' characteristic of the funding system undermines sex worker leadership of HIV interventions. By requiring local projects to conform to global management standards, funding agencies risk undermining the very localism and empowerment that their intervention policies espouse.     

Position of The Canadian Dietetic Association and The American Dietetic Association: nutrition intervention in the care of persons with human immunodeficiency virus infection

The goals of nutrition intervention in HIV disease include early assessment and treatment of nutrient deficiencies, the maintenance and restoration of lean body mass, and support for activities of daily living and quality of life. The maintenance and restoration of nutritional stores is closely interrelated and interdependent with each of the other recommended medical therapies. Therefore, it is vital to the health of persons with HIV/AIDS to have access to the services of a registered dietitian, who is the essential member of the health care team for providing nutrition care (48). The registered dietitian should take an active role in developing nutrition care protocols for HIV/AIDS in their practice setting. The dietetic professional must take responsibility for obtaining and maintaining current knowledge in this area and take the lead in translating current nutrition knowledge and research into practical and realistic nutrition guidelines for the individual with HIV/AIDS. Further research is needed in the area of HIV/AIDS and nutrition. Registered dietitians and other members of the health care team are encouraged to conduct nutrition research in the area of nutrition interventions and outcomes of nutrition therapy. Additionally, government health related agencies, national AIDS-related organizations, and private industry should be encouraged to provide funding sources and support to the issue of research in nutrition related problems and interventions in HIV/AIDS.     

Are Health Educators Being Prepared to Provide HIV/AIDS Education?: A Survey of Selected Health Education Professional Preparation Programs

Health education professional preparation programs were surveyed to determine the extent of HIV/AIDS education health educators are receiving. The survey also addressed content areas, skills being developed or enhanced, areas of deficiency in preparation programs, and areas in which national professional associations may assist in the preparation of AIDS educators. One hundred eight-three surveys were mailed; 114 (68%) were completed and returned. Twenty-one institutions reported planning a separate course on HIV/AIDS. Most were designing general service courses to reach a broad cross-section of students. Twenty-five institutions (23.8%) reported previously offering or currently offering a specific course on AIDS. One hundred two (89.5%) respondents reported HIV/AIDS warranted the attention and funding it had received. Thirty-seven (35.2%) respondents reported AIDS education was of sufficient importance to influence hiring of faculty members in their departments. Survey findings demonstrate that current AIDS education courses targeted to the general student population may not be adequate in meeting the professional preparation needs of health educators charged to provide AIDS education.     

Urban women educate their community on HIV / STDs,family planning and reproductive health

To broaden the context of HIV/AIDS prevention interventions in an urban slum in Rio de Janeiro, Brazil, a model program was developed that involved training 12 low-income women to serve as paid community health agents. The 4-month training course covered the health education topics of reproduction, HIV/AIDS, family planning (FP), and reproductive health and was guided by the belief that women's vulnerability to HIV/AIDS is embedded in gender relations and that health education should be bolstered with promotion of individual autonomy among trainees. Trainees also conducted simple research to analyze the needs of their community and assessed and produced the health education materials they would use in the community. The HIV/AIDS intervention model developed by the women takes the form of three community meetings on 1) gender relations, 2) sexuality and HIV/AIDS prevention, and 3) AIDS. Women who attend the meetings are given cards that simplify their acceptance as FP clients at local health centers. The training empowered the 12 women and led to positive improvements in their lives. Because their community is controlled by drug dealers, the women had to overcome restrictions on their interactions with their neighbors. The training gave the women the courage to do this and to be recognized and accepted in their communities. While the paid project is completed, the women have continued offering educational sessions. Currently, the project staff is seeking funding to find ways to replicate this intervention model at a lower cost.     

The end of AIDS?: AIDS reporting in the Australian press in the mid-1990s

In news reports of HIV/AIDS, the discourses giving meaning to the pandemic have constantly shifted and changed since its emergence in the early 1980s. This article presents an analysis of HIV/AIDS reporting in the Australian press in the three-year period between 1994 and 1996. It focuses on two dominant topical themes appearing in this period: politics and policy debates around HIV/AIDS and medico-scientific research and treatment issues. It is argued that in the mid-1990s HIV/AIDS has increasingly become portrayed as a biomedical rather than a public health problem, and again as affecting gay men rather than the general population. It is suggested that these changes in representation may eventually lead to ‘the end of AIDS’ as a highly prominent phenomenon in the news media, with implications for general attitudes towards the syndrome and future policy and funding decisions.     

New plan seeks to reinvigorate HIV prevention efforts

AIDS Action has proposed a plan for increased Federal funding and greater public awareness for the prevention of HIV infections. The "virtual vaccine" plan requests a 25 percent increase in the Centers for Disease Control and Prevention's $634 million budget for HIV prevention programs. Other portions of the plan include funding for counseling, testing, drug treatment, education, health promotion campaigns, and vaccine development.     

健康教育在艾滋病领域中的应用

目前国际上尚无针对艾滋病有效的疫苗和治愈方法,健康教育是公认的防治艾滋病的有效手段之一。近年来,国外和国内都开展了许多艾滋病的健康教育活动,积累了丰富的经验和行之有效的策略。此文就国内外艾滋病健康教育研究进行综述。     

Current approaches to prevention of HIV infections.

The HIV education and prevention strategy of the Centers for Disease Control has three principal components: (a) public information and education, (b) education for school-aged populations, and (c) risk reduction education and individual counseling and testing services for people at increased risk of HIV infection. The most visible components of the public information and education programs are the National Public Information Campaign ("America Responds to AIDS"), the National AIDS Hotline system, and the National AIDS Information Clearinghouse. Components of the youth education program consist of funding for national health and education organizations, funding for State and local education departments, training, surveillance of education efforts, and evaluation. Counseling and testing has entailed performance of approximately 2,500,000 HIV antibody tests with pre- and post-test counseling, notification and counseling of sexual and needle-sharing partners of those infected with HIV, and targeted risk reduction education through community-based organizations. Over time, these activities will continue to evolve and become more effective.