Lessons learned from a review of interventions for adolescent and young key populations in Asia Pacific and opportunities for programming.

BACKGROUND: Over a third of new HIV infections globally are among 15-24 year-olds and over 20% among adolescents aged 10-19 years in Asia Pacific. The review was initiated to identify interventions in the region with demonstrated or potential impact for adolescent and young key populations (YKP) looking at the role of individual and structural factors in accessibility and delivery. The review is a component of a more comprehensive review undertaken by UNICEF and partners in the region. METHODS: This was a desk review of over 1000 articles, and 37 were selected. Journal articles in PubMed, Cochrane Library, Cochrane DARE, EMBASE, PsycINFO, CINAHL, and Web of Science databases were searched for HIV intervention-related information for adolescent and YKP. RESULTS AND DISCUSSION: Findings showed that except for low levels of risk perception, most individual decisions regarding safe behavior and testing uptake were mediated by structural factors. Critical enablers such as design and delivery of services, peer education, and condom policies were associated with the uptake of high-impact interventions. Synergistic development interventions such as sexuality education, rights-based enforcement of antitrafficking laws, and addressing violence and abuse could increase safer behaviors. CONCLUSIONS: Although structural factors play a key role in access and uptake of HIV prevention services for adolescent and YKP, further qualitative research is needed to understand and mitigate the drivers of vulnerability and constructed perceptions of risk.

Is there a gender gap in the HIV response? Evaluating national HIV responses from the United Nations General Assembly Special Session on HIV/AIDS country reports.

BACKGROUND: The Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), in 2001, sets out several policy and programmatic commitments that pertain to women and the gender aspects of the HIV epidemic. Some of them are general, whereas others are more specific and include time-bounded targets. This article summarizes data on policies and strategies affecting women and men equity in access to antiretroviral treatment and other HIV services, as reported by countries but do not address other issues of gender, such as men having sex with men. METHODS: The analysis includes data from the National Composite Policy Index as reported by 130 countries in response to 14 questions relating to progress in creating an enabling policy environment for women. Additional data on gender equity in knowledge of HIV and access to HIV testing and antiretroviral treatment is obtained with other core UNGASS indicators. The review aggregates countries according to regions. RESULTS: A total of 147 countries provided national reports in which 78% of relevant UNGASS indicators were either completely or partially disaggregated by sex. However, 16% of countries did not report any HIV indicators by sex (with a range of 0%-29% across regions). A total of 82% (108 of 130) of countries report having policies in place to ensure that women have equal access to HIV-related services, but 14% of reporting countries also had laws and policies in place that hinder their ability to deliver effective HIV programs for women. About 80% of countries report having included women as a specific "sector" in their multisectoral AIDS strategies or action frameworks. However, only slightly more than half (53%) of those countries report having a budget attached to programs addressing women issues. As of the end of 2007, antiretroviral therapy reached 33% of people in need, and women represent a slight majority of those on treatment. The gender gap on HIV knowledge has narrowed, but overall levels of knowledge on how to prevent HIV remains at low levels, with only about 40% of young men (aged 15-24 years) and 36% of young women with correct comprehensive knowledge about HIV prevention. CONCLUSIONS: Since 2001, a large majority of countries have integrated women-related issues into their national HIV policies and strategic plans. However, countries and regions with low-level or concentrated HIV epidemics lag behind countries with generalized epidemics in integrating women-focused policies into national frameworks. The lack of budget support for women-focused programs in half of the countries indicates that those policies have not been sufficiently translated into multisectoral activities. The engagement of development ministries in women's social and economic empowerment is largely still lacking, which raises the concern that strategies to reduce gender inequality may also be lacking in broader development plans. The apparent attainment of gender equity in HIV testing and the delivery of antiretroviral treatment is an important achievement. There has also been a significant increase in countries' abilities to collect and report data disaggregated by sex and age. The monitoring of women's progress in HIV responses via the UNGASS reporting system provides important insights but should be complemented with data that strengthen understandings of the actual implementation of strategies, as well.

Are we on course for reporting on the Millennium Development Goals in 2015?

OBJECTIVES: At the 2001 United Nations General Assembly Special Session on HIV/AIDS (UNGASS), Member States agreed to regularly review progress made in national responses to HIV. This article provides (1) a brief overview of how the resultant global UNGASS reporting system was developed; (2) the origins, background, limitations and potential of that system; (3) an overview of the articles in this supplement; and (4) crosscutting institutional and methodological issues. METHODS: United Nations Member States biennially provide The Joint United Nations Programme on HIV/AIDS (UNAIDS) with data on 25 core indicators of national responses to HIV, collected in Country Progress Reports. This article critically reviews and interprets these data in light of international political considerations and overall data needs. RESULTS: There has been a considerable improvement in response rates, accompanied by an increase in data quality and completeness. Both nationally and internationally, the UNGASS process is viewed as being more substantial and important than a reporting exercise to the United Nations General Assembly. The process has catalyzed the development of national monitoring systems and has created opportunities for civil society to monitor and challenge government commitments and deeds. CONCLUSIONS: Although the UNGASS global reporting system now comprises an unequaled wealth of data on HIV responses, collected from a broad range of countries, it cannot yet answer several critical questions about the progress and effectiveness of those responses. Evaluation studies that go beyond indicator monitoring are needed, but they will take time to design, fund, implement and interpret. In the meantime, this global monitoring system provides a good indication of the overall progress in the global response to HIV and whether Millennium Development Goal (MDG) 6 (to halt and reverse the HIV epidemic) is likely to be reached by 2015.

The uneven impact of AIDS in a polarized society.

Literature on the impact of serious AIDS epidemics anticipates severe outcomes, and places special emphasis on the epidemic's likely effects on productive and governance capacities. Implicit in many impact scenarios is the assumption that the effects are distributed more or less uniformly across society, and are channeled 'naturally' through and across sectors. This article examines evidence of the AIDS epidemic's impact at household level, and in the health, education and economic sectors of South Africa. It shows that the epidemic's impact is strongly shaped by the highly unequal distribution of power, entitlement, risk and responsibility in South Africa. The article concludes that many of the costs associated with the AIDS epidemic are being displaced into the lives, homes and neighbourhoods of poorer South Africans, especially black African women - thus deepening poverty trends, as well as reproducing and hardening the polarized character of South African society. Priority steps to remedy these trends are outlined.