Article

Making HIV prevention programmes work

Instituto Nacional de Salud Pública, Cuernavaca, Mexico
The Lancet (Impact Factor: 45.22). 10/2008; 372(9641):831-44. DOI: 10.1016/S0140-6736(08)60889-2
Source: PubMed

ABSTRACT Even after 25 years of experience, HIV prevention programming remains largely deficient. We identify four areas that managers of national HIV prevention programmes should reassess and hence refocus their efforts-improvement of targeting, selection, and delivery of prevention interventions, and optimisation of funding. Although each area is not wholly independent from one another, and because each country and epidemic context will require a different balance of time and funding allocation in each area, we present the current state of each dimension in the global HIV prevention arena and propose practical ways to remedy present deficiencies. Insufficient data for intervention effectiveness and country-specific epidemiology has meant that programme managers have operated, and continue to operate, in a fog of uncertainty. Although priority must be given to the improvement of prevention methods and the capacity for the generation and use of evidence to improve programme planning and implementation, uncertainty will remain. In the meantime, however, we argue that prevention programming can be made much more effective by use of information that is readily available.

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    • "vention distribution will require the revitalization of sustainable national pri - mary health care systems . Long programmatized in iso - lation from systems for sexual and reproductive health , HIV policy implementation is inhibited by an absence of systemic infrastructures for the targeting , selection and delivery of prevention interventions ( Bertozzi et al . , 2008 ) . With the weakening of health systems and work - force resources limiting HIV testing and treatment ( Schneider et al . , 2006 ) , health system strengthening will be necessary to undertake interdependent interven - tions for universal testing , treatment and prevention – further integrating these services to sustain funding for all "
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    ABSTRACT: Given current constraints on universal treatment campaigns, recent advances in public health prevention initiatives have revitalized efforts to stem the tide of HIV transmission. Yet, despite a growing imperative for prevention-supported by the promise of behavioral, structural and biomedical approaches to lower the incidence of HIV-human rights frameworks remain limited in addressing collective prevention policy through global health governance. Assessing the evolution of rights-based approaches to global HIV/AIDS policy, this review finds that human rights have shifted from collective public health to individual treatment access. While the advent of the HIV/AIDS pandemic gave meaning to rights in framing global health policy, the application of rights in treatment access litigation came at the expense of public health prevention efforts. Where the human rights framework remains limited to individual rights enforced against a state duty bearer, such rights have faced constrained application in framing population-level policy to realize the public good of HIV prevention. Concluding that human rights frameworks must be developed to reflect the complementarity of individual treatment and collective prevention, this article conceptualizes collective rights to public health, structuring collective combination prevention to alleviate limitations on individual rights frameworks and frame rights-based global HIV/AIDS policy to assure research expansion, prevention access and health system integration.
    Public Health Ethics 11/2012; 5(3):263-282. DOI:10.1093/phe/phs034 · 1.27 Impact Factor
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    • "Consequently, there is a need for strategies that maximise their programmatic effectiveness , when introducing additional resources (Bertozzi, Laga, Bautista-Arredondo, & Coutinho, 2008). A growing body of evidence has identified a range of constraints to successful scaling up of global health initiatives at the country level, such as a lack of resources, weak policies at the health and cross-sectoral levels, weak systems and regulations, weak incentives to use inputs efficiently and bureaucratic and capacity problems (Bertozzi et al., 2008; Bourguignon & Sundberg, 2006; Brugha, Donoghue, & Starling, 2005; De Renzio, 2009; Halmshaw & Hawkins, 2004; Hanson, Ranson, Oliveira-Cruz, & Mills, 2003; Lu, Michaud, Khan, & Murray, 2006; Oomman et al., 2007; Radelet & Siddiqi, 2007; Stillman & Bennett, 2005). Others have pointed out the constraints generated by donor behaviour, such as un-harmonised donor interventions, long and tedious negotiation procedures with new donors and unclear and changing donor guidelines (Brugha et al., 2005, 2004). "
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    Social Science [?] Medicine 08/2011; 74(3):381-9. DOI:10.1016/j.socscimed.2011.07.020 · 2.56 Impact Factor
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    • "complexity and unclear implementation conditions encourage the use of irrelevant selection criteria like the public visibility of decision-makers and their agencies, the image and customer loyalty of health insurance companies, and personality profiling of managers (Bertozzi et al. 2008; Kliche 2011 "
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