Prevention Of HIV/AIDS

Although global commitment to control the HIV/AIDS pandemic has increased significantly in recent years, the virus continues to spread with alarming and increasing speed. By the end of

2005, an estimated 40 million people worldwide were living with HIV infection or disease, a notable rise from the 35 million infected with HIV in 2001 (UNAIDS 2005). In 2005, close to 5 million new HIV infections and 3 million AIDS deaths occurred, more of both than in any previous year. Sub-Saharan Africa remains the region most affected by HIV/AIDS; however, the virus is now spreading rapidly in Asia and parts of Eastern Europe. Despite the rapid spread of HIV, several countries have achieved important success in curbing its transmission.

The extraordinary

Thesedeclinesalsoposedifficultquestionsregardingtheoptimal allocation of limited resources for

HIV/AIDS, as well as the potential impact on already strained health care infrastructures.

OBSTACLES TO HIV CONTROL Obstacles to effective HIV control include lack of prevention and care coverage and lack of rigorous evaluations. Both are discussed below. Lack of

Coverage and Access to Prevention Services Notwithstanding these treatment strides, global efforts have not proved sufficient to control the spread of the pandemic or to extend the lives of the majority of those infected. The desired level of success has not yet been achieved for several reasons.Most people who could benefit from available control strategies, including treatment, do not have access to them. Modelers commissioned by the World Health

Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) determined that existing interventions could prevent 63 percent of all infections projected to occur between 2002 and 2010 (Stover and others 2002). Nonetheless, a 2003 survey

Summarized below is what is known with regard to the burden of disease, the determinants of transmission, and the effectiveness and cost-effectiveness of existing prevention interventions. Burden of Disease As a result of large-scale implementation of data collection methods for surveillance worldwide and enhanced methods for validating and interpreting HIV-related data, the HIV/AIDS epidemic is probably one of the best documented epidemics in history. An increasing number of data sources contribute to reasonably accurate estimates and a more nuanced understanding of the epidemic’s trends. Unfortunately, this relatively accurate picture of where the epidemic is and has been is not matched by similarly convincing maps of the factors that explain its spread. Although no single country has been spared the virus, the epidemic has affected certain regions of the world disproportionately, and

Sub-Saharan Africa remains by far the hardest hit region (table 18.1). With only 10 percent of the world’s population, it accounts for more than 75 percent of all HIV infections worldwide and more than 75 percent of AIDS-related deaths estimated for 2003. Asia and the Pacific,