Regulating compassion: an overview of Canada's federal medical cannabis policy and practice

The epidemic of HIV/AIDS linked to injecting drug usage is one of the most explosive in recent years. After a historical epicentre in Europe, South and North America, at present it is clearly the main cause of dissemination of the epidemic in Eastern Europe and some key Asian countries. Recently, 10 African countries reported the spread of HIV through people who inject drugs (PWID), breaking one of the final geographical barriers to the globalization of the epidemic of HIV among and from PWID. Several countries of the Asia and Pacific Region have HIV epidemics that are driven by injecting drug usage. Harm reduction interventions have been implemented in many countries and potential barriers to implementation are being overcome. Harm reduction is no longer a marginal approach in the Region; instead, it is the core tool for responding to the HIV/AIDS epidemic among PWID. The development of a comprehensive response in the Region has been remarkable, including scaling up of needle and syringe programmes (NSPs), methadone maintenance treatment (MMT), and care, support and treatment for PWID. This development is being followed up by strong ongoing changes in policies and legislations. The main issue now is to enhance interventions to a level that can impact the epidemic. The World Health Organization (WHO) is one of the leading UN agencies promoting harm reduction. Since the establishment of the Global Programme on AIDS, WHO has been working towards an effective response to the HIV epidemic among PWID. WHO's work is organized into a number of components: establishing an evidence base; advocacy; development of normative standards, tools and guidelines; providing technical support to countries; ensuring access to essential medicines, diagnostics and commodities; and mobilizing resources. In this paper, we trace the course of development of the HIV/AIDS epidemic among and from PWID in the Western Pacific and Asia Region (WPRO) as well as WHO's role in supporting the response in some of the key countries: Cambodia, China, Lao PDR, Malaysia, the Philippines and Viet Nam.     

中美艾滋病疫情信息和估计方法的比较

美国是世界上最早发现艾滋病的国家,在过去的30年艾滋病疫情得到了有效的控制。自1985发现第一例艾滋病病人以来,中国的艾滋病疫情呈快速增长,疫情日趋严重。通过比较我们发现中美两国艾滋病疫情特点不同,在艾滋病预防控制体系上存在差异,艾滋病疫情报告系统和疫情数据收集方法也明显不同。基于上述原因,两国分别采用了适合本国的艾滋病疫情估计方法。准确地估计疫情为国家从宏观上制定策略和措施提供科学依据,同时又是政策开发、项目设计和评价、资源配置以及进一步开展的基础。深入地比较中美两国艾滋病疫情信息特点,希望对中国艾滋病疫情估计有一定借鉴意义。     

Worse than we thought? The AIDS epidemic at the end of the year 2001

HIV/AIDS is a global emergency with far-reaching effects. There is no country that has been left unscathed by the epidemic. It affects all countries socially, economically and culturally. It three-tens development and human security. In spite of our hopes and calculations the situation regarding the world's AIDS epidemic further worsened. Momentarily about 40 million persons live with HIV/AIDS. Their number steadily grows. Globally the worst situation still exists in Sub-Saharan Africa but the fastest growing epidemic is in Eastern-Europe (Russian Federation, Ukraine) which threatens with a possibility of a new and fast wave of epidemic. Although there are new drugs in the clinical practice, the most important task is further on, a vigorous health education, to prevent further catastrophe.     

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.     

Brazil and access to HIV/AIDS drugs: a question of human rights and public health

I explore the relationship between public health and human rights by examining the Brazilian government's policy of free and universal access to anti-retroviral medicines for people with HIV/AIDS. The Brazilian government's management of the HIV/AIDS epidemic arose from initiatives in both civil society and the governmental sector following the democratization of the country. The dismantling of authoritarian rule in Brazil was accompanied by a strong orientation toward human rights, which formed the sociopolitical framework of Brazil's response to the HIV/AIDS epidemic. Even if the Brazilian experience cannot be easily transferred to other countries, the model of the Brazilian government's response may nonetheless serve as inspiration for finding appropriate and lifesaving solutions in other national contexts.     

济南市艾滋病流行特征与趋势分析

[目的]全面了解济南市艾滋病流行特征,探讨切实有效的防治模式.[方法]对济南市近年来有关艾滋病疫情资料进行分析.[结果]1998年以来,累计发现抗-HIV阳性者95例,其中HIV感染者65例,艾滋病病人30例.HIV感染者和艾滋病病人逐年增加.95例中,流动人口80例;男性71例,女性24例;20～39岁青壮年71例;经性接触感染者29例,静脉注射吸毒感染者28例.[结论]济南市HIV感染者和艾滋病病人逐年上升,以性接触、静脉吸毒途径感染为主,外来流动人员占多数.     

HIV/AIDS: global trends,global funds and delivery bottlenecks

Globalisation affects all facets of human life, including health and well being. The HIV/AIDS epidemic has highlighted the global nature of human health and welfare and globalisation has given rise to a trend toward finding common solutions to global health challenges. Numerous international funds have been set up in recent times to address global health challenges such as HIV.     

An age-period-cohort analysis of 50,875 AIDS cases among injecting drug users in Europe

BACKGROUND: The long average incubation time from HIV infection to AIDS makes it difficult to estimate recent HIV transmission from AIDS incidence data. Age-period-cohort (APC) analysis can separate out the effects of age, calendar time and birth cohort to provide a clearer picture of transmission trends. METHODS: AIDS incidence data from 1981 to 1994 among intravenous drug users (IDU) for 12 Western European countries were used. Yearly incidences per 100,000 population or 100,000 person-years were calculated by age at diagnosis and 5-year birth cohort (1950-1954, 1955-1959, 1960-1964, 1965-1969 and 1970-1974), and corrected for reporting delay. Incidence patterns were compared between birth cohorts and countries. RESULTS: For most countries the impact was greatest on the cohort born 1960-1964. Comparing incidence patterns in the 1965-1969 to 1960-1964 cohorts suggest the epidemic has plateaued at low to intermediate levels in Austria, Greece and the North-Western European countries, and at high levels in France, Italy and Switzerland. For most countries transmission amongst the 1970-1974 as compared to the 1965-1969 cohorts could not be assessed due to small numbers and short follow-up time. In Spain the epidemic was uncontrolled with a high incidence among recent birth cohorts. In Portugal the epidemic was still at an early and expanding phase. CONCLUSIONS: The APC analysis revealed large country differences in the dynamics of the HIV/AIDS epidemic among IDU. Full interpretation of these differences is dependent on information from other sources about the local public health response and trends in drug injecting behaviours. Earlier introduction of the virus and higher prevalence of injecting drug use may explain some of the generally higher incidence in Southern European countries, but the larger part of it is most likely explained by local characteristics of drug users, such as younger age and more frequent sharing of needles and syringes, and a less effective public health response.     

温岭市艾滋病疫情流行现状与应对策略

目的分析温岭市艾滋病病毒(HIV)感染和艾滋病(AIDS)流行情况及影响因素,为制定艾滋病防治策略和高危因素干预提供科学依据。方法对温岭市2000—2010年艾滋病网络疫情报告和流行病学调查资料进行分析。结果自2000年温岭市发现首例HIV感染者,截止2010年底,全市共报告HIV抗体阳性者185例,其中AIDS患者63例,20例已死亡。自2006年以来,疫情呈现迅速上升趋势,该地人口感染者所占比例逐年增加(53.51%),感染者以男性(74.60%)和20～49岁的青壮年组(76.76%)为主,但呈现高龄化趋势,50岁以上占21.62%;3种传插途径均存在,以性接触传播为主(74.05%)。结论温岭市AIDS进入快速增长期,呈现多元化流行模式,开始从高危人群向一般人群扩散,应采取有效的综合干预措施,以控制AIDS迅速蔓延的态势。     

Overview on Current HIV/AIDS in Asia: "Some Implications for Food and Nutrition Security"

Although Asian countries in general face relatively low national HIV/ AIDS prevalence rates, there are serious localized epidemics in some countries that have important implications for food and nutrition security. The rapid development of the HIV/AIDS epidemic in African countries should serve as a warning to Asian countries. While some of the important modes of transmission of relevance to Asia are highlighted, the focus of this article is on the impact of the HIV/AIDS epidemic on the food security and nutrition situation at the household and community levels. Acknowledging the fact that HIV/AIDS is not merely a medical problem, the impact of the epidemic on nutritional issues, food production, income and the difficulties of poor households in coping with the situation are discussed. The article concludes with some remarks in relation to possible actions to mitigate the HIV/AIDS epidemic before it escalates beyond control in Asia.     

Diffusion of innovations and HIV/AIDS

As the HIV/AIDS epidemic continues its relentless spread in many parts of the world, DOI provides a useful framework for analyzing the difficulties in achieving behavior change necessary to reduce HIV rates. The DOI concepts most relevant to this question include communication channels, the innovation-decision process, homophily, the attributes of the innovation, adopter categories, and opinion leaders. The preventive measures needed to halt the transmission of HIV constitute a "preventive innovation." This article describes the attributes of this preventive innovation in terms of relative advantage, compatibility, complexity, trialability, and observability. It reviews studies that incorporated DOI into HIV/AIDS behavior change interventions, both in Western countries and in the developing world. Finally, it discusses possible reasons that the use of DOI has been fairly limited to date in HIV/AIDS prevention interventions in developing countries.     

Reporting of newly diagnosed HIV infections in Catalonia, Barcelona, Spain. Implementation and results

OBJECTIVES: To describe newly diagnosed HIV infections from the HIV Reporting System in Catalonia (2001-2003), and to compare the characteristics of the epidemic based on the use of the HIV Reporting System and the Catalonian AIDS Registry versus those based on the Catalonian AIDS Registry alone. METHODS: Data were collected from newly diagnosed HIV infections and AIDS cases between 2001 and 2003 in Catalonia. RESULTS: Among the newly diagnosed HIV infections (1,765) the most frequent route of HIV infection was heterosexual transmission (46.8%), followed by men who had sex with men (26.7%), and injecting drug use (19.9%). Out of the 1,210 AIDS cases, the most common route of HIV transmission was injecting drug used (42.2%), followed by (heterosexual transmission 34.5%) and MSM (18.0%). Comparison of routes of HIV transmission in the two reporting systems (HIV/AIDS versus AIDS) revealed statistically significant differences. CONCLUSIONS: The HIV/AIDS Reporting System based on reporting of newly diagnosed HIV infections is feasible, since it has been useful in achieving the objectives of epidemiological HIV infection surveillance. It also provides more accurate information than does the AIDS Registry, which can be used to describe recent patterns of HIV transmission. The completeness of the new reporting system may be enhanced by including the diagnosis of HIV infection among the diseases of mandatory notification.     

Women's Rights and Women's Health During HIV/AIDS Epidemics: The Experience of Women in Sub-Saharan Africa

Twenty-five years have passed since HIV/AIDS was recognized as a major public health problem. Although billions of dollars are spent in research and development, we still have no medical cure or vaccination. In the early days of the epidemic, public health slogans suggested that HIV/AIDS does not discriminate. Now it is becoming clear that HIV/AIDS spreads most rapidly among poor, marginalized, women, colonized, and disempowered groups of people more than others. The HIV/AIDS epidemic is exacerbated by the social, economic, political, and cultural conditions of societies such as gender, racial, class, and other forms of inequalities. Sub-Saharan African countries are severely hit by HIV/AIDS. For these countries the pandemic of HIV/AIDS demands the need to travel extra miles. My objective in this article is to promote the need to go beyond the biomedical model of “technical fixes” and the traditional public health education tools, and come up with innovative ideas and strategic thinking to contain the epidemic. In this article, I argue that containing the HIV/AIDS epidemic and improving family and community health requires giving appropriate attention to the social illnesses that are responsible for exacerbating biological disorders.     

2002-2010年鹰潭市HIV/AIDS疫情分析

目的分析鹰潭市HIV/AIDS流行现状及影响因素,为制定艾滋病防治措施提供科学依据。方法用描述流行病学方法分析鹰潭市HIV/AIDS流行现状。结果 2002-2010年鹰潭市累计共有HIV/AIDS 97例,以性传播途径为主,年龄分布以中老年人为主,50岁以上中老年人占58.76%,职业以农民为主,占38.14%;样本来源以检测咨询及医院就诊者检测为主。结论鹰潭市艾滋病流行已进入快速增长期,中老年人艾滋病例所占比例偏大,应有针对性的开展艾滋病防治工作。     

Market incentives, human lives, and AIDS vaccines

For many, an AIDS vaccine holds the promise of intervening in a widespread epidemic because it is not predicated on changing economic structures and social contexts underlying vulnerability to HIV for millions of individuals. Yet 20 years into the AIDS epidemic, there is still no vaccine. Based on interviews of AIDS vaccine researchers, watchdog organizations, and ethics groups from the United States, South Africa, and Kenya conducted between August and December of 2003, this paper explores possible answers to the question of why there is no vaccine, looking in particular at contradictions between a biomedical research industry increasingly driven by market incentives and a disease that primarily affects individuals living in low-income countries with little vaccine purchasing power. Producing a vaccine that could be effective in low-income regions requires new kinds of initiatives that can coordinate research nationally and globally, and circumvent current regulatory mechanisms that dictate against the development and dissemination of low-profit medical technologies. Until such initiatives are supported, however, vaccine research will continue at a devastatingly slow pace at the cost of millions of lives annually.     

HIV epidemic and human rights among men who have sex with men in sub-Saharan Africa: Implications for HIV prevention,care, and surveillance

Recent research has presented evidence that men who have sex with men (MSM) bear a disproportionate burden of HIV and are at increased risk for HIV in sub-Saharan Africa (SSA). However, many countries in SSA have failed to address the needs of MSM in national HIV/AIDS programmes. Furthermore, many MSM face structural barriers to HIV prevention and care, the most significant of which include laws that criminalise male-to-male sexual contact and facilitate stigma and discrimination. This in turn increases the vulnerability of MSM to acquiring HIV and presents barriers to HIV prevention, care, and surveillance. This relationship illustrates the link between human rights, social justice, and health outcomes and presents considerable challenges to addressing the HIV epidemic among MSM in SSA. The response to the HIV epidemic in SSA requires a non-discriminatory human rights approach to all at-risk groups, including MSM. Existing international human rights treaties, to which many SSA countries are signatories, and a ‘health in all policies’ approach provides a strong basis to reduce structural barriers to HIV prevention, care, surveillance, and research, and to ensure that all populations in SSA, including MSM, have access to the full range of rights that help ensure equal opportunities for health and wellness.     

The HIV/AIDS epidemic in Africa: implications for U.S. policy

Political will or commitment toward the HIV epidemic has been lacking in most African countries. Although most countries are in denial, a few have moved into recognition of the epidemic. Only two countries, Senegal and Uganda, have moved into mobilization. Ineffectiveness is judged by increasing HIV prevalence rates and declining life expectancy. Countries without active national leadership to fight the epidemic have seen deterioration in these criteria. In addition to its toll in Africa, this epidemic threatens U.S. political, economic, and security interests. Political responses to manage the risks to the United States have revolved around much increased development assistance through traditional channels and financial support for the United Nations' Global Fund to Fight AIDS, Tuberculosis, and Malaria.     

U.N. official urges business to support HIV prevention

Executive Director Peter Piot of the Joint United Nations Programme on HIV/AIDS called on companies to initiate aggressive measures to prevent the further spread of HIV. The global total of HIV cases reached 23 million in 1996. The epidemic threatens the growth of the global economy, particularly in developing nations where private corporations are seeking new markets. The economic toll due to AIDS is devastating because it affects young people who are at the height of their earning power. Piot offered examples of prevention initiatives that have been undertaken by companies to control the epidemic.     

The hidden dimension: sexuality and responding to the threat of HIV/AIDS in South Sulawesi, Indonesia

Particular Asian countries (notably India, Thailand and Burma) are now estimated to have substantial numbers of HIV positive cases. The critical interacting factors which shape the HIV/AIDS epidemic in specific settings are the sexual and injecting drug using cultures and the governmental and societal responses to the threat of AIDS. This paper explores these factors in South (S.) Sulawesi in Eastern Indonesia. The paper presents recent quantitative and qualitative research findings on sexual culture, AIDS awareness and public health response in relation to the distinctive features of S. Sulawesi's geographical and socio-cultural setting. The paper concludes by discussing the major factors impeding and facilitating HIV/AIDS policy and programme implementation in S. Sulawesi.     

中国艾滋病健康教育与行为干预综述

艾滋病是一种由HIV感染引起的疾病,已经流行了20多年,而且目前还没有办法对它进行根本性的治疗。预防和控制艾滋病,健康教育和行为干预是最有效的方法之一。中国是HIV检测阳性率增长最快的国家之一,正面临着全国范围内的艾滋病流行。通常情况下,多性伴者和静脉吸毒者是高危人群,他们也是健康教育和行为干预的主要人群,在多种形式的健康教育和行为干预中已经取得了明显的效果,健康教育和行为干预必须从科学事实出发,遵循一系列策略从各个方面进行执行,并要求全社会的人都来参与。