Suchergebnisse

As of December 2001, the number of people living with HIV/AIDS is estimated at 40 million, and most live in the developing world. Advances in the development and availability of antiretroviral (ARV) drugs have led to a paradigm shift in most of the industrialized world, where highly active ARV therapy has resulted in a significant reduction in the prevalence of AIDS-related morbidity and mortality. In most of the developing world, however, the focus of national programs and international support continues to be on prevention and care in the absence of ARV treatment. While the moral imperative to provide the best possible treatment for people with AIDS-related disease is widely recognized, national governments and donors have been reluctant to enter into this endeavor citing numerous concerns. Ministries of health and the international donor community need guidance on developing and implementing effective HIV/AIDS treatment programs. To explore and prioritize operations research questions about access to treatment for HIV/AIDS, the Horizons Program convened a two-day meeting of international researchers and program managers in Washington, DC, on June 12–13, 2001. This report presents the findings and recommendations discussed at the meeting.

A recent Horizons study conducted jointly with two Dominican NGOs assessed the impact of two environmental-structural models in reducing HIV-related risk among female sex workers in the Dominican Republic and compared their cost-effectiveness. In the two cities studied, there were improvements from pre- to post-intervention in the key outcome variables, however the type and level of these changes varied by intervention approach. Based on our findings, program planners and policymakers involved in the study in the Dominican Republic agree that the integrated solidarity and policy model in conjunction with ongoing peer education and community mobilization activities is an appropriate, cost-effective, and ethical intervention package. The current dialogue is now focused on how to scale up this successful pilot experience in a way that continues to respect all members of the sex work community and to be effective in curbing the HIV epidemic.

Effective programs that avert new HIV infections among sex workers and their partners, and hence the general population, are critical components of national HIV-prevention strategies. Prevention efforts have frequently relied on interventions that reach members of these vulnerable groups as individuals, such as condom promotion and STI management. Now, many researchers and program implementers are increasingly turning to "environmental-structural" interventions that address the physical, social, and political contexts in which individual behavior takes place. A recent Horizons study conducted jointly with two Dominican NGOs—Centro de Orientación e Investigación Integral and Centro de Promoción e Solidaridad Humana—and the National Program for the Control of STDs and AIDS assessed the impact of two environmental-structural models in reducing HIV-related risk among female sex workers in the Dominican Republic and compared their cost-effectiveness. As detailed in this brief, the models, built on years of experience gained from sex worker peer education programs, drew from the strengths of both community solidarity and government policy initiatives and engaged community members in both program and policy development.

Programas efectivos para evitar nuevas infecciones del VIH entre trabajadoras sexuales y sus parejas, y por lo tanto la población en general, son componentes críticos de estrategias nacionales de prevención del VIH. Generalmente los esfuerzos de prevención se han concentrado en intervenciones que alcanzan a los miembros de estos grupos vulnerables al nivel individual, tal como promoción de condones y manejo de ITS. Actualmente, muchos investigadores y gerentes de programas se encuentran dirigiéndose a intervenciones "ambientales-estructurales" que toman en cuenta los contextos físicos, sociales y políticos en que el comportamiento individual ocurre. Un estudio reciente realizado por Horizons, en conjunto con dos ONGs dominicanas—Centro de Orientación e Investigación Integral y Centro de Promoción y Solidaridad Humana—y el Programa Nacional del Control de ITS y SIDA buscaba evaluar el impacto de dos modelos ambientales-estructurales en disminuir el riesgo de VIH entre trabajadoras sexuales en la República Dominicana y de comparar el costo-efectividad de los dos modelos. Como se detalla en este resumen, los modelos, construidos sobre la base de años de experiencia adquirida a través de programas de educación entre pares de trabajadoras sexuales, combinan las fortalezas de iniciativas de solidaridad comunitaria y de políticas gubernamentales, e involucran a miembros de la comunidad en el desarrollo de ambos programa y política. --- Effective programs that avert new HIV infections among sex workers and their partners, and hence the general population, are critical components of national HIV-prevention strategies. Prevention efforts have frequently relied on interventions that reach members of these vulnerable groups as individuals, such as condom promotion and STI management. Now, many researchers and program implementers are increasingly turning to "environmental-structural" interventions that address the physical, social, and political contexts in which individual behavior takes place. A recent Horizons study ...