Reducing HIV/AIDS risk, impact and vulnerability.

Content Provider	Semantic Scholar
Author	Tarantola, Daniel J. M.
Copyright Year	2000
Abstract	Around the world, the initial assumptionupon which many early community-basedhuman immunodeficiency virus/acquiredimmunodeficiency syndrome (HIV/AIDS)prevention programmes were based wasthat self-awareness of risk behaviours andknowledge about modes of preventionwould suffice to stop the spread of the virus.By the mid-1980s, recognition of the riskbehaviours associated with infection hadbegun to shape the response to the expand-ing epidemic. This approach met withsome success among politically organizedcommunities such as white gay men inAustralia, North America, and WesternEurope. This was not the case, however,in communities marked by lack of accessto information and services, in an adversesocial environment and with fragileor nonexistent community organizationmechanisms.The late 1980s witnessed a dramaticrise in the spread of HIV: the pandemicbegan to affect disproportionately womenand men in developing countries as well asthe marginalized and poor in high-incomecountries. This massive epidemic shift calledfor a new understanding of the root causesof the pandemic and a realization of themagnitude and diversity of efforts neededto bring it under control.A strategy for a global mobilizationagainst AIDS was proposed by WHO,resulting in January 1987 in the launchingof one of its largest initiatives, soon to becalled the Global Programme on AIDS (1).By the early 1990s, however, it had becomeclear that what was being done in the areasof HIV prevention and care, even ifreplicated many-fold, would not sufficeto curb the spread of HIV and mitigate itsimpact. The global pandemic was simplyspinning out of control. While the publichealth approach to the reduction of riskneeded to be strengthened, replicated,adapted to local and evolving needs andresources, and sustained over time, it becameclear that this approach was necessary butnot sufficient. It was recognized that HIVtransmission was associated with specificrisk-taking behaviours, but that thesebehaviours were influenced by personaland societal factors that determined people’svulnerability to infection. To be effective,risk-reduction programmes had to bedesigned and implemented in synergy withother programmes which, in the short andlong term, increased the capacity andautonomy of those people particularlyvulnerable to HIV infection. This ‘‘risk-and-vulnerability’’ paradigm, aimed at sheddinglight on the root-causes of the pandemic,commended a broad social response farbeyond the capacity of the health sector (2).To uproot the pandemic would involveattention to civil, political, economic, socialand cultural determinants of vulnerabilityto HIV/AIDS, best understood underuniversal human rights principles.Building on a health and human rightsmovement that had originally been centredon women’s health, rights and dignity,Jonathan Mann spearheaded a new under-standing of the pandemic which recast theHIV/AIDS paradigm within a human rightsframework: ‘‘the continuing challengesof HIV/AIDS have brought public healthto the threshold of a new era, based onthe inextricable connection between healthandhumanrights.Forhumanrightsprovidespublic health with an explicit response toits central dilemma: how to address directlythe societal forces which determine, morethan anything else, vulnerability to preven-table disease, disability and prematuredeath’’ (3, 4).In 1994, in Paris, a Summit of Headsof Governments recognized that a meaning-ful response to HIV/AIDS necessitatedexpanded efforts in prevention and care,along with social changes aimed at loweringpeople’s vulnerability to infection (5).Unfortunately, the call for this enhancedglobalresponsedidnotsucceedingeneratingthe needed international resources. TheJoint United Nations Programme on HIV/AIDS (UNAIDS) in 1996 constructed itsglobal strategy around the principles ofcombined risk-reduction and vulnerabilityreduction approaches, upholding thecentral role of human rights in the publichealth response to the pandemic (6).Today, almost two decades afterthe emergence of the HIV/AIDS pandemic,two important facets have led to two newand diverging definitions of the responseto the HIV/AIDS epidemics, applicableseparately to high- or low-income countries.In high-income countries, progress achievedin developing and using highly activeantiretroviral therapies has broughtbiomedical tools into the focus of attentionand hope. In such countries, the biomedicalparadigm, as characterized by Wolffersin his article in this issue of the Bulletin(pp. 267–273), shines in all its splendour.Access to multi-regimen therapies, adher-ence to treatment, resistance of HIV tonew drugs, and resumption of activeeconomic and social life overshadowthe continuing spread of HIV amongyoung populations, the upsurge of unsafebehaviours in vulnerable populations,and the need for sustained preventionprogrammes. In contrast, in developingcountries, access to effective preventionand treatment of some of the commonestopportunistic infections associated with HIVinfection remains very limited. Highly activeantiretroviral drugs and the biomedicalservices needed to ensure safe and effectivetherapy are generally unavailable. Thedevastating impact of HIV/AIDS has setback the hard-earned health, social andeconomic progress that had been achievedby many countries over decades of invest-ments and efforts. AIDS has becomea development issue in the severely affectedcountries (7).The relevancy of Wolffers’ develop-ment paradigm to developing countrieshard hit by HIV/AIDS underscores thereality of the impact of AIDS and also,tragically, the current unavailability ofa biomedical solution for most of the world’spopulation.The rich and the poor have becomefurther divided by a common HIV/AIDSpandemic. The world’s expanded responsemust concurrently address prevention andcare needs, the reduction of the individual
File Format	PDF HTM / HTML
DOI	10.1590/S0042-96862000000200013
PubMed reference number	10743296
Journal	Medline
Volume Number	78
Issue Number	2
Alternate Webpage(s)	http://www.scielosp.org/pdf/bwho/v78n2/v78n2a13.pdf
Alternate Webpage(s)	https://doi.org/10.1590/S0042-96862000000200013
Journal	Bulletin of the World Health Organization
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article