WHO and the global AIDS strategy

WHO and the Global AIDS A s the specialised agency of the United Nations with reSponsibility for directing and coordinat-ing international health work, WHO has a central role in developing, coordinating and leading the global response to the acquired immunodeficiency syndrome (AIDS) epidemic. After the first, "silent" phase of the HN I AIDS epidemic (mid-1970s to 1981), during which the human immu- nodeficiency virus (HN) which causes AIDS spread unnoticed to five con- tinents, a second phase developed. From roughly 1981 to 1985 there was a period of discovery - of the HN virus, of the modes of HN transmis- sion, and of the large numbers of people infected with HN. This period was also marked by uncertainty: there were widely varying estimates concern- ing HN infection rates, the precise numbers of AIDS cases and the social implications of the epidemic. In many cases, individuals, communities and governments were reluctant to respond to, and even to acknowledge, the AIDS epidemic. In the face of this uncertainty and in the absence of a unified response ·to the spread of HN, in 1985 WHO drafted . a global strategy for AIDS prevention and control. This marked the beginning of the third phase of the AIDS epidemic, that of global mobili- sation. The Global AIDS Strategy was reviewed and revised and, in May 1987, it was approved and adopted by the Fortieth World Health Assembly as the basis for a worldwide response to the HN I AIDS epidemic. This unanimous endorsement of the Global AIDS Strategy has been further stressed by the Venice Summit of the Heads of States or Governments (Venice, June 1987), the UN Economic and Social Council (Geneva, July 1987, July 1988), the UN General Assembly (New York, October 1987, October 1988), and the World Summit of Ministers of Health on Programmes for AIDS Prevention (London, January 1988). Needles and other skin-piercing instru- ments should be sterilised after each use. They should never be shared. 4 Three objectives The Global AIDS Strategy is built upon three broad objectives: - prevention of HN infection - reduction of the personal and social impact of HN infection - unifying national and international efforts against AIDS. Preventing IDV Infection Even in the absence of an effective vaccine against AIDS, we know that it is possible to prevent the spread of HN infection through individual beha- viour. Information and education about personal habits are therefore essential to the Global AIDS Strategy. These information and education measures, designed to assist people to modify or to refrain from behaviours that carry a risk of HN infection, stress the following messages: - sexual intercourse is the most common route of HN transmission. The sexual spread of HN can be avoided by remaining with a faithful, uninfected partner or by not having sexual intercourse at · all. Otherwise, people should restrict their number of sexual partners as far as possible, and should always use a condom - properly - whenever having sexual intercourse with someone who might possibly be infected with J-IN; - HN can be transmitted through infected blood. As far as possible, blood for transfusion should be tested for infection with HN, and discarded if it is found to be conta- minated. Needles and other skin- piercing instruments should be sterilised after each use. They should not be shared with other people; if they are, they must first be properly sterilised; - an infected mother can pass HN infection to her foetus or infant. Women infected with HN should therefore consider avoiding pregnancy. Information and education are essential to AIDS prevention program- mes; but alone, they are not sufficient. Counselling and other forms of health and social services must be provided in order to motivate and encourage people to avoid the behaviours that carry a risk of HN transmission, and to provide those who are infeCted with HN, as well as their families and friends, with practical assistance and psychosocial support. Finally, to be successful, AIDS pre- vention and control measures must be introduced and implemented in a social environment that is conducive to risk reduction. This means social norms and policies which respect and uphold the rights and dignity of people WORLD HEALTH, October 1989 infected with HN, including people with AIDS. Measures such as isolation, quaran- tine, and other forms of discrimination on the grounds of a person's infection status are harmful. They cause unnecessary additional suffering to people infected with HN; and they also threaten public health more gen- erally: thus, discriminatory policies can have the effect of discouraging people at risk of HN infection from seeking advice and information on risk reduc- tion, including HN testing, and this in turn can lead to an increase in the spread of infection. The 41st World Health Assembly, which met in May 1988 in Geneva, expressed the conviction that respect for the human rights and the dignity of HN-infected people and people with AIDS is vital to the success of AIDS control programmes. It therefore adopted a resolution on the avoidance of discrimination in relation to HN- infected people and people with AIDS, and this now forms an integral part of the WHO Global AIDS Strategy. Reducing the impact The Global AIDS Strategy seeks to minimise the negative impact of HN infection, both on individuals and on societies. In order to achieve this, people infected with HN, including people with AIDS, need to be given personal support and care by the people around them. They also need WORLD HEALTH, October 1989 to be provided with health care of a standard similar to that made available in any given society to people with other diseases. Unifying efforts The Global AIDS Strategy aims to unite countries all over the world in a rational, coordinated and effective way to prevent the spread of AIDS and to reduce its impact on individuals and societies. The worldwide effort against AIDS which is under way was highlighted on 1 December 1988, when people in every country observed the first World AIDS Day. This in itself showed that it is possible to unite the world in the fight against AIDS. The second World AIDS Day will be marked on the same date this year. Global Programme on AIDS (GPA) WHO's GPA was established in Feb- ruary 1987 as the vehicle for putting into effect the Global AIDS Strategy. GPA has provided a practical frame- work for national efforts around the world, as well as for international programmes. Today, GPA is working with over 150 countries around the world, helping them to develop strong national AIDS programmes. It has provided financial support worth over US $60 million to 127 countries, and technical support through more than 1,000 consultant and expert missions Health promotion measures are essential to AIDS prevention. In Uganda, young people use mime and theatre. for planning, training and imple- menting in the field. National AIDS programmes have been developed with great energy and much local creativity. Such programmes now exist in most countries and should be in action in all of the world's 187 coun- tries and areas by the end of this year. WHO facilitates and promotes biomedical, social, behavioural and epidemiological research on HN infec- tion and AIDS. It designs strategies for health promotion in a variety of social and cultural contexts. And it produces guidelines on a series of complex and difficult policy issues to assist local, national and international agencies in their AIDS prevention and control work. WHO will continue to develop the Global AIDS Strategy in collaboration with national and international organi- zations. By continuing to collaborate with national AIDS committees, plan new programmes, design research stu- dies, provide policy guidelines and recommendations, and maintain the struggle against discrimination, together we will contribute to the control of the new global health threat of AIDS and foster the creation of a safer, healthier world for the benefit of all. • 5 j I