Using Simulation for AIDS Policy Modeling: Benefits for HIV/AIDS Prevention Policy Makers in Vienna, Austria

In spite of advanced therapies and the success of additional prevention programs, the HIV/AIDS epidemic still remains a challenge. Our paper refers academics, health care managers, and policy makers to the relevance of AIDS policy simulators in better decision-making. By highlighting the types of decisions AIDS policy models can support, we demonstrate the strategic role of AIDS policy simulators for the efficient and effective planning of scarce resources to fight the epidemic. For each type of decision, we then review exemplary AIDS policy simulators that have helped policy makers make better decisions. Finally, we present the benefits of an AIDS policy simulator for HIV/AIDS prevention policy makers in Vienna, Austria.     

AIDS policy modeling for the 21st century: an overview of key issues

Decisions about HIV prevention and treatment programs are based on factors such as program costs and health benefits, social and ethical issues, and political considerations. AIDS policy models – that is, models that evaluate the monetary and non-monetary consequences of decisions about HIV/AIDS interventions – can play a role in helping policy makers make better decisions. This paper provides an overview of the key issues related to developing useful AIDS policy models. We highlight issues of importance for researchers in the field of AIDS policy modeling as well as for policy makers. These include geographic area, setting, target groups, interventions, affordability and effectiveness of interventions, type and time horizon of policy model, and type of economic analysis. This paper is not intended to be an exhaustive review of the AIDS policy modeling literature, although many papers from the literature are discussed as examples; rather, we aim to convey the composition, achievements, and challenges of AIDS policy modeling.     

血液安全政策执行情况与AIDS控制效果的综合评判

目的为深入探讨血液安全政策与AIDS流行及控制的关系,综合评判襄樊市血液安全政策执行情况及AIDS流行与控制效果,寻求最经济有效的预防控制措施。方法应用层次分析法(AHP法)综合评判襄樊市血液安全政策执行情况及AIDS流行与控制效果。结果襄樊市无偿献血安全政策执行情况与AIDS控制效果呈逐年上升趋势,1996年前综合指数较低,1997~1999年综合指数中等,2000~2002年综合指数较高。结论实施无偿献血、加强血液安全管理和AIDS控制工作,效果十分明显。     

An investigation into support for restrictions on HIV carriers in the Chicago metropolitan area

An investigation into support for restrictions on people testing seropositive for HIV is reported on. Data were collected during telephone interviews with two-hundred adults aged eighteen to sixty-five in the Chicago metropolitan area. Using the analytic technique of LISREL, six models which attempt to explain support for restrictions were tested. It was found that the model best supported by the data indicates that two groups contribute to support for restrictions on HIV carriers--one due to intolerance of homosexuality and one to mistrust of public health officials regarding their control and management of the AIDS epidemic. The relevance of these findings for public health policy makers is discussed.     

沈阳市1991—2009年艾滋病疫情分析

目的分析沈阳市艾滋病流行特征并预测其流行趋势,为制定防治对策提供科学依据。方法利用艾滋病疫情报告数据,分析沈阳市1991—2009年的艾滋病疫情。结果至2009年底,共发现HIV/AIDS 1 052例,男933例,女119例;20～49岁年龄组报告的例数最多,占82.7%。人群分布：1997年前HIV传播是从外来输入到高危人群,近几年则扩展到各人群,并从以血液传播为主转变成以性传播为主,到2009年经性传播占59.9%,同性传播是异性传播的2倍,血液传播占15.9%。结论沈阳市近年来艾滋病疫情发展迅速,经性传播引起的HIV/AIDS将越来越多,需采取有效措施,遏制艾滋病的蔓延。     

成都市HIV/AIDS疫情监测分析

目的 了解流行现状,明确防制工作重点,为防控提供依据.方法 收集成都市1992-2006年HIV/AIDS病例报告、流行病学个案调查表,以及哨点监测、专题调查等资料进行统计分析.结果 成都市1992-2006年累计报告HIV/AIDS 1 319例,年平均报告增长速度为46.92%.近2年共监测各类人群399 318人次,检出率为0.23%.以静脉注射吸毒传播为主(43.97%),性接触感染逐年上升.流动人口是潜在的危险因素.结论 成都市艾滋病流行快速增长,存在多种潜在危险因素.应采取强有力的防制措施,不断完善监测系统,加大开展高危行为干预,加强流动人口防治,控制进一步流行.     

Editorial

Worldwide, more than 8500 people are newly infected with HIV each day and there are 21 million cumulative HIV/AIDS cases worldwide, 90% in developing countries. HIV infection and AIDS are firmly entrenched and spreading in India. World Health Organization projections suggest that India may have the highest number of HIV-positive cases by 2000. The double challenge is therefore presented of preventing personal infection and caring for others who are infected. While AIDS research is making some progress, it is clear that the war against HIV/AIDS will be long. Global efforts to prevent the spread of HIV infection are beginning to show positive results, with evidence of the slowing down of the HIV infection rate and the stabilization of the spread reported from some areas. Coordination, commitment, and social policy together with alternative people-oriented and socioculturally appropriate strategies must be brought to bear against the epidemic in India. The country's HIV/AIDS surveillance and blood banking systems also must be improved. Finally, efforts must be taken to ensure that all people have access to care.     

Cultural Approach to HIV/AIDS Harm Reduction in Muslim Countries

Muslim countries, previously considered protected from HIV/AIDS due to religious and cultural norms, are facing a rapidly rising threat. Despite the evidence of an advancing epidemic, the usual response from the policy makers in Muslim countries, for protection against HIV infection, is a major focus on propagating abstention from illicit drug and sexual practices. Sexuality, considered a private matter, is a taboo topic for discussion. Harm reduction, a pragmatic approach for HIV prevention, is underutilized. The social stigma attached to HIV/AIDS, that exists in all societies is much more pronounced in Muslim cultures. This stigma prevents those at risk from coming forward for appropriate counseling, testing, and treatment, as it involves disclosure of risky practices. The purpose of this paper is to define the extent of the HIV/AIDS problem in Muslim countries, outline the major challenges to HIV/AIDS prevention and treatment, and discuss the concept of harm reduction, with a cultural approach, as a strategy to prevent further spread of the disease. Recommendations include integrating HIV prevention and treatment strategies within existing social, cultural and religious frameworks, working with religious leaders as key collaborators, and provision of appropriate healthcare resources and infrastructure for successful HIV prevention and treatment programs in Muslim countries.     

The impacts of AIDS movements on the policy responses to HIV/AIDS in Brazil and South Africa: A comparative analysis

Abstract

Brazil and South Africa were among the first countries profoundly impacted by the HIV/AIDS epidemic and had similar rates of HIV infection in the early 1990s. Today, Brazil has less than 1% adult HIV prevalence, implemented treatment and prevention programmes early in the epidemic, and now has exemplary HIV/AIDS programmes. South Africa, by contrast, has HIV prevalence of 18% and was, until recently, infamous for its delayed and inappropriate response to the HIV/AIDS epidemic. This article explores how differing relationships between AIDS movements and governments have impacted the evolving policy responses to the AIDS epidemic in both countries, including through AIDS programme finance, leadership and industrial policy related to production of generic medicines.     

EPP模型在江苏省艾滋病疫情估计、预测与分析中的应用

目的评估江苏省艾滋病疫情流行情况,用EPP模型估计及预测艾滋病疫情,为相关政策的制定提供依据。方法依据江苏省艾滋病病例报告、哨点监测、专题调查等获得的数据,参考有关资料,运用EPP模型对江苏省疫情进行估计和预测。结果经模型估计江苏省首例HIV感染者出现在1987年,至2009年现存活的HIV/AIDS为12099例,总人群的感染率为0.02%。结论这是EPP模型初次运用于我国单个省份,结果显示目前江苏省处于艾滋病低流行阶段,但流行形式不容乐观,性接触传播所占的比例逐年升高。     

Replicating PEPFAR's success: how interventions shown to be effective abroad can be applied to the AIDS epidemic in the US

The President's Emergency Plan for AIDS Relief (PEPFAR), which began in 2003, initially responded to the global AIDS epidemic by applying lessons learned in treating the disease in the United States to addressing the emergency abroad. As the program expanded, it evolved to support interventions increasingly tailored to local needs in countries receiving PEPFAR assistance. This global experience has created a knowledge base of how to provide HIV/AIDS prevention, care, and treatment services in low-resource settings. It underscored the importance of treatment adherence, family-centered care, and integration of HIV into broader health care delivery systems. Applying these lessons can help US policy makers address existing gaps in HIV care in the United States, where the availability of HIV treatment has at times masked the continued need for testing, early diagnosis, targeted prevention for key populations, and a solid array of social services for people living with HIV/AIDS and their families. This article identifies PEPFAR practices that merit further exploration for adoption in the United States, including strategies to increase adherence to drug treatment regimens and to ensure that HIV services are broadly integrated with other aspects of health care.     

温州市1985-2000年艾滋病流行病学分析

目的：分析温州市艾滋病流行状态,为艾滋病防治策略提供科学依据。方法：对1985－2000年温州市艾滋病监测资料进行分析。结果：1985－2000年底温州市共检出艾滋病毒感染者74例,其中病人19例,15例死亡。74例中50．0％经性接触传播,47．3％经血液传播。75．7％的感染者为流动人口。结论：温州市艾滋病感染呈上升趋势,应采取综合性措施预防和控制。     

艾滋病流行地区艾滋病感染者/艾滋病病人随访模式探讨

目的通过艾滋病感染者/艾滋病病人(以下简称HIV/AIDS)随访服务提供方和接受方的视角,初步了解随访干预的影响因素,探讨在吸毒严重的艾滋病流行地区的随访模式。方法采用半结构化访谈的方法对4名主管艾滋病工作人员,14名随访责任人、40名HIV/AIDS进行个人深入访谈,每人约1~1.5小时。结果政府重视、政策支持、"四免一关怀"政策、社区维持治疗、随访工作人员数量、HIV/AIDS的流动、歧视、家庭支持、违法犯罪被公安抓获、交通不便等是影响HIV/AIDS随访的主要因素。结论社区为基础的随访模式不仅可以充分发挥人力资源优势,降低社会歧视,方便提供心理支持,减少HIV/AIDS暴露的机会,还可以及时地随访到外出流动而失访的HIV/AIDS。社区药物维持治疗门诊(MMT)在HIV/AIDS随访当中也发挥了重要作用。建议在艾滋病流行地区迅速采用以社区为基础的随访模式,发挥MMT的随访管理作用,加强与公安部门的合作,在监管场所随访HIV/AIDS。     

山东省HIV/AIDS流行状况分析及预测

目的分析山东省艾滋病流行状况,为政府制定艾滋病控制策略提供依据.方法依据全省的艾滋病病例报告、各类监测报表、专项流行病学调查等资料;用SPSS软件进行分析;用工作簿（WORKBOOK）对全省高危人群基数和艾滋病疫情进行预测;采集HIV感染阳性者外周静脉防凝血,提取核酸,进行基因序列测定和亚型分析.结果截止2004年底,山东省累计报告艾滋病病毒感染者436例,艾滋病病人152例,死亡65例;预测全省现有感染者7000余人.17个省辖市有16个市的68个县（市区）有疫情报告;感染方式仍以血液途径传播为主,但性传播呈明显上升趋势,HIV感染人数呈快速增长趋势,近2年检出数占13年总数的68.2%.全省存在多种HIV病毒株亚型,已检出B、B′C等3种亚型以及CRF07-BC、CRF08-BC、CRF01-AG和CRFD1-AE等4种重组毒株.结论山东省HIV感染已进入快速增长阶段,艾滋病在我省人群、地域分布广泛,同时具有明显的地区和人群聚集性;艾滋病发病和死亡人数将持续增加;艾滋病流行由吸毒、献血员、卖淫嫖娼等高危人群向一般人群传播;女性感染者所占比例有较大幅度增加,母婴传播危险性增大.     

1992～2005年山东省艾滋病流行特征分析

[目的]分析山东省艾滋病流行特征，为艾滋病防治工作提供依据。[方法]采用Execl数据库和SPSS11．5统计软件分析山东省艾滋病疫情流行特征。[结果]按时间、人群特征和传播途径分布，山东省艾滋病流行分为3阶段，1992-1995年，以出入境劳务人员、性传播途径为主；1996～2003年，以既往有偿献血员、血液传播为主；2004-2005年．以流动人口和外来妇女为主，性传播、血液传播、母婴传播3种途径同时并存。[结论]山东省的艾滋病疫情仍呈上升趋势，女性比例增加，应采取措施控制艾滋病的进一步蔓延。     

HIV与输血传播病毒的母婴传播的调查

目的 了解艾滋病高发区HIV与输血传播病毒(TTV)母婴传播情况。方法 对华中地区某艾滋病高发农村228名母亲及其年龄小于15岁的子女180名进行入户流行病学调查，采集静脉血检测抗HIV、抗TTV，回顾性分析2种病毒的母婴传播特点。结果 82例HIV阳性母亲1993年后生的103名儿童中，39例HIV阳性，母婴传播率为37.9％；59例抗TTV阳性母亲所生的76名儿童中，5例抗TTV阳性，母婴传播率为6.6％。结论 HIV与TTV在当地均存在母婴传播；母婴传播是儿童感染HIV的主要途径。未对HIV流行地区高危生育期妇女进行有效的HIV监测与咨询，未及时采取有效干预措施是造成该地区儿童感染HIV的主要原因，亟需制定实施相应的对策，控制HIV进一步蔓延，保护HIV感染高发区妇女及儿童的健康。     

湖北省艾滋病防治现状与对策分析

目的通过分析湖北省艾滋病疫情和防治现状,提出湖北省艾滋病防治对策。方法采用文献回顾、资料查阅和访谈方法对湖北艾滋病疫情和防治情况进行分析。结果湖北省艾滋病经采供血途径感染已基本得到控制,经注射吸毒和经性途径传播比例在上升,母婴传播的问题不容忽视。湖北省基本建立了政策保障机制;多种途径开展健康教育;加强了艾滋病疫情监测;实施各项阻断措施,切断传播途径;落实“四免一关怀”政策,强化救治措施。结论湖北省仍需要明确目标,强化管理,把住疫情筛查关,落实“四免一关怀”政策,强化救治措施,普及防治知识,扩大各种干预措施的高危人群覆盖面。     

湖北省艾滋病防治现状与对策分析

目的 通过分析湖北省艾滋病疫情和防治现状,提出湖北省艾滋病防治对策.方法 采用文献回顾、资料查阅和访谈方法对湖北艾滋病疫情和防治情况进行分析. 结果湖北省艾滋病经采供血途径感染已基本得到控制,经注射吸毒和经性途径传播比例在上升,母婴传播的问题不容忽视.湖北省基本建立了政策保障机制;多种途径开展健康教育;加强了艾滋病疫情监测;实施各项阻断措施,切断传播途径;落实"四免一关怀"政策,强化救治措施.结论 湖北省仍需要明确目标,强化管理,把住疫情筛查关,落实"四免一关怀"政策,强化救治措施,普及防治知识,扩大各种干预措施的高危人群覆盖面.     

Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings--insights from South Africa

Sub-Saharan Africa is experiencing a multiple disease burden. Noncommunicable diseases (NCDs) are emerging, and their risk factors are becoming more common as lifestyles change and rates of urbanization increase. Simultaneously, epidemics of infectious diseases persist, and HIV/AIDS has taken hold in the region, although recent data indicate a decrease in new HIV infection rates. With the use of diabetes as a marker for NCDs, it was estimated that the number of people with diabetes would rise between 2000 and 2010 despite the HIV/AIDS epidemic, largely because of the aging of the population and the increase in risk factors for diabetes in South Africa. These numbers are likely to increase further, given the declining HIV/AIDS mortality rates and longer life expectancy due to the up-scaling of antiretroviral therapy (ART), with its concomitant metabolic complications. Given that treated HIV/AIDS has become a chronic disease, and the health care needs of people on ART resemble those of people with NCDs, and given that vertical programs are difficult to sustain when health systems are underresourced and strained, there is a powerful argument to integrate the primary level care for people with chronic diseases, whether they be NCDs or infectious diseases. Pilot studies are required to test the feasibility of an integrated service that extends from health facilities into the community in a reciprocal manner based on the WHO Innovative Care for Chronic Conditions model of care. These will begin to provide the evidence that policy makers need to change the mode of health care delivery.