conclusion of hiv/aids essay

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Institute of Medicine (US) Committee to Study HIV Transmission Through Blood and Blood Products; Leveton LB, Sox HC Jr., Stoto MA, editors. HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking. Washington (DC): National Academies Press (US); 1995.

HIV And The Blood Supply: An Analysis Of Crisis Decisionmaking.

• Hardcopy Version at National Academies Press

8 Conclusions and Recommendations

The HIV epidemic has taught scientists, clinicians, public health officials, and the public that new infectious agents can still emerge. The nation must be prepared to deal with a fatal illness whose cause is initially unknown but whose epidemiology suggests it is an infectious disease. The AIDS epidemic has also taught us another powerful and tragic lesson: that the nation's blood supply—because it is derived from humans—is highly vulnerable to contamination with an infectious agent. A nation's blood supply is a unique, essential, life-giving resource. Whole blood and many blood products are lifesaving for many people. As a whole, our nation's system works effectively to supply the nation with necessary blood and blood products and its quality control mechanisms check most human safety threats. The events of the early 1980s, however, revealed an important weakness in the system—in its ability to deal with a new threat that was characterized by substantial uncertainty. The potential for recurring threats to the blood supply led this Committee to reappraise the processes, policies, and resources through which our society attempts to preserve its supply of safe blood and blood products.

• General Conclusions

The events and decisions that the Committee has analyzed underscore the difficulty of decisionmaking when the stakes are high, when decisionmakers may have personal or institutional biases, and when knowledge is imprecise and incomplete. The Committee attempted to understand the complexities of the decisionmaking process during the period analyzed in this report and develop lessons to protect the blood supply in the future. In retrospect, the system was not dealing well with contemporaneous blood safety issues such as hepatitis, and was not prepared to deal with the far greater challenge of AIDS .

By January 1983, the Centers for Disease Control (CDC) had accumulated enough epidemiological evidence to conclude that the agent causing AIDS was almost certainly transmitted through blood and blood products and could be sexually transmitted to sexual partners. The conclusion that the AIDS agent was blood-borne rested on two findings. First, AIDS was occurring in transfusion recipients and individuals with hemophilia who had received AHF concentrate; these AIDS patients did not belong to any other known high-risk group for contracting AIDS. Second, the epidemiologic pattern of AIDS was similar to hepatitis B, another blood-borne disease. However, the magnitude and consequences of the risk for transfusion and blood product recipients was not known at this time. Furthermore, the epidemiological pattern of the new disease was difficult to interpret because, unlike most infectious diseases, there seemed to be several years between exposure leading to infection and the development of symptoms. As a result, physicians and public health officials underestimated the large number of infectious people who had no symptoms of AIDS but could transmit the disease to others and therefore substantially understated the risk of infection.

Compared to the pace of many regulatory and public health decision processes, the federal government responded relatively swiftly to the early warnings that AIDS might be transmitted through blood and blood products. Public and private sector officials considered a range of clinical and public health interventions for reducing the risk of AIDS transmission through blood and blood products. This period, however, was characterized by a great deal of scientific uncertainty about the risks of HIV infection through blood and blood products and about the costs and benefits of the available options. The result, the Committee found, was a pattern of responses which, while not in conflict with the available scientific information, was very cautious and exposed the decisionmakers and their organizations to a minimum of criticism. This limited response can be seen in the refusal of blood banks in 1983 and 1984 to screen for and defer homosexuals or use surrogate tests ( Chapter 5 ), in the Food and Drug Administration's (FDA) cautious and inadequate regulatory approach to the recall of potentially contaminated AHF concentrate ( Chapter 6 ), and in the failure of physicians and the National Hemophilia Foundation to disclose completely the risks of using AHF concentrate and the alternatives to its use ( Chapter 7 ).

Blood safety is a shared responsibility of many diverse organizations. They include U.S. Public Health Service agencies such as the CDC, the FDA, and the National Institutes of Health (NIH), and private-sector organizations such as community blood banks and the American Red Cross, blood and plasma collection agencies, blood product manufacturers, groups such as the National Hemophilia Foundation (NHF), and others. The problems the Committee found were inadequate leadership and inadequate institutional decisionmaking processes in 1983 and 1984. No person or agency was able to coordinate all of the organizations sharing the public health responsibility for achieving a safe blood supply.

Decisionmaking Under Uncertainty

The management of a public health risk requires an evolving process of decisionmaking under uncertainty. It includes interpretive judgment in the presence of scientific uncertainty and disagreement about values. Public health officials must characterize and estimate the magnitude of the risk, which involves considering both the likelihood that infection might occur in various circumstances, and the costs and benefits associated with each of the possible uncertain outcomes. They must also develop and test public health and clinical care strategies, and communicate with the public about the risk and strategies for reducing it. When confronted with a poorly understood and anomalous public health threat, inertia often influences decisions. It is often easier to maintain the status quo than to make a change. In fact, regulatory policymakers, health scientists, and medical experts often require substantial scientific evidence before informing the public and adopting remedial action. Lack of scientific consensus becomes a kind of amplifier for the usual discord and conflict that can be expected whenever an important science-based public policy decision—one profoundly affecting lives and economic interests—must be made. First, uncertainty creates opportunities for advocates of self-interested and ideological viewpoints to advance plausible arguments that favor their desired outcome. Second, uncertainty intensifies bureaucrat cautiousness.

In the course of its investigations, the Committee learned several lessons about decisionmaking under uncertainty. These are set out here both as general lessons and to provide a framework for the recommendations that follow.

Risk Perception

Risk perception is shaped by social tensions, and cultural, political, and economic biases (Douglas 1985). It is important to understand the different contexts in which risk is perceived and the complex system of beliefs, values, and ideals that shape risk perception (Nelkin 1989). There are several other factors that influence risk perception, including locus of control, the type of risk posed by the threat, and the time interval involved in evaluating the risk. For example, people tend to underestimate risks that they perceive to be under their control, risks associated with a familiar situation, and low probability events (Douglas 1985). People have difficulty accepting estimates of a risk that is involuntary, uncertain, unfamiliar, and potentially catastrophic (Fischoff 1987). The epidemic caused by HIV in the blood supply illustrates these patterns of perception and behavior with respect to risk.

Risk Assessment Versus Risk Management

A central precept of risk management is to separate the assessment of risk from the management of its consequences (NRC 1983). Otherwise, risk managers tend to bias their estimates of the magnitude of the risk in favor of their preconceived notions about appropriate or desirable policy choices. The events that the Committee studied provide examples of what can happen when this precept is not followed. When there is uncertainty, it may be necessary to assess risk by making subjective estimates rather than by obtaining objective measures. Such was the case in 1983 when, as part of implicit risk-benefit calculations about donor screening and deferral, blood banks and blood product manufacturers had to make judgments about the risk that their products could transmit AIDS (see Chapter 5 ). Anticipating the consequences of taking action, which is in the domain of risk management, may bias risk estimates toward values that support risk-averse action. When blood bank officials estimated the risk of transmitting AIDS as ''one per million" transfusions, they chose a rate that was low enough to justify their reluctance to take further action. Despite mounting evidence that the risk was much higher, they maintained their original estimate throughout 1983. If the CDC had made numeric estimates of the risk, and the blood banks, blood product manufacturers, or the FDA had used these estimates in a formal analysis of the decision problem, they might have reached different conclusions about, for example, surrogate testing for AIDS.

Consider the Full Range of Possibilities

When there is uncertainty about the facts that will determine the consequences of a decision, a systematic approach is usually best (NRC 1994). One important principle is to consider the full range of assumptions and alternative actions, not only worst-case scenarios. In the events studied by the Committee, systematic denial of worst-case scenarios was a recurring theme, as can be seen in the way that the NHF and the FDA discussed the CDC's warnings in 1982 and early 1983. The plasma fractionators introduced a worst case scenario of their own at the July 1983 Blood Products Advisory Committee (BPAC) meeting, when they estimated that three or four suspect donors and an automatic recall policy could lead to recall of all of the nation's supply of AHF concentrate ( Chapter 6 ). A closely related principle is to scrutinize the evidence to ascertain what is based on fact, what is a "best-guess" estimate, and what is simply untested conventional wisdom.

One approach to such an analysis would be to use a formal group process to systematically sample expert opinion on relevant factors such as the probability of infection and the economic and noneconomic costs and benefits of each of the possible outcomes. Often these officials should use decision analysis, which takes into account the likelihood of events and the magnitude of their outcomes, as a tool to compare the expected value of the outcome of the policy alternatives under consideration. Two somewhat analogous models to consider include those used in Institute of Medicine studies to establish priorities for the development of new vaccines (IOM 1985) and to evaluate the artificial heart program of the National Heart, Lung, and Blood Institute (IOM 1991). The book Acceptable Risk (Fischoff, et al. 1981) also offers sensible approaches to dealing with this kind of situation.

Risk Reduction Versus Zero Risk

Decisionmakers tend to seek zero-risk solutions even when they are unattainable or unrealistically costly (NRC 1994). In doing so, they may run the risk of failing to implement solutions that are less effective but are certain to reduce illness. The failure to adopt risk-reduction strategies can be seen in the resistance of blood banks to screening for homosexual activity or using surrogate tests for AIDS ( Chapter 5 ) and in FDA's limited approach to product recall decisions ( Chapter 6 ). Chapter 7 also points out that many risk-reduction strategies for individuals with hemophilia were available but not fully disclosed or recommended. The perfect should not be the enemy of the good.

Risk Communication

Risk communication is a sensitive area because of its influence on the perceptions and behaviors of health professionals and consumers, regulatory policies, and public decisionmaking (Nelkin 1989). Many public health officials and physicians wish to appear in command and infallible. When uncertain, they remain silent rather than disclose their ambivalence (NRC 1989). In the Committee's view, however, the greater the uncertainty, the greater the need for communication. The Committee's analysis of physician–patient communications at the beginning of the AIDS era illustrates the tragedies that can accompany silence about risks ( Chapter 7 ). Risk-communication skills are equally important when presenting information to the general public. The blood banks' reluctance to acknowledge the risk of transfusion-associated AIDS ( Chapter 5 ) seems to have been due in part to the difficulties that they foresaw in presenting this information to potential donors and recipients.

Other important principles of risk communication are that the source of the information must be credible, the process should be open and two-way, and the message should be balanced and accurate (NRC 1989). When there was no other sources of information for physicians treating people with hemophilia and for their patients, the NHF and its Medical and Scientific Advisory Council (MASAC) took on an important risk-communication role—providing what would now be called "clinical practice guidelines." The NHF's credibility in this area was eventually seriously compromised by its financial connections to the plasma fractionation industry.

Bureaucratic Management of Potential Crises

Federal agencies had the primary responsibility for dealing with the national emergency posed by the AIDS epidemic. The Committee scrutinized bureaucratic function closely, and came to the following conclusions about the management of potential crises.

Coordination and Leadership

A crisis calls for extraordinary leadership. Legal and competitive concerns may inhibit effective action by agencies of the federal government. Similarly, when policymaking occurs against a backdrop of a great deal of scientific uncertainty, bureaucratic standard operating procedures designed for routine circumstances seem to take over unless there is a clear-cut decisionmaking hierarchy. An effective leader will insist upon coordinated planning and execution. Focusing efforts and responsibilities, setting timetables and agendas, and assuming accountability for expeditious action cannot be left to ordinary standard operating procedures. These actions are the responsibilities of the highest levels of the public health establishment.

The Public Health Service failed to bring these leadership functions to bear when CDC scientists raised concerns about the blood supply at the January 4, 1983 meeting but received no public support from the director of the CDC or the office of the Assistant Secretary for Health. Similarly, the record does not indicate that the highest levels of the FDA or the PHS were involved in responding to advice from the BPAC regarding donor deferral or product recall. Part of this leadership problem may stem from major changes in the PHS leadership that took place during this period: the leadership of the FDA, the CDC, and the NIH, and the person serving as the Assistant Secretary for Health all changed between 1982 and 1984.

Advisory Mechanisms

In the early 1980s, the FDA and other agencies did not have a systematic approach to conducting advisory committee proceedings. Such an approach requires that agencies tell their advisory committees what is expected of them, keep attention focused on high-priority topics, and independently evaluate the advice offered. No regulatory process should have its information base effectively controlled by an advisory panel. Public agencies must be able to generate and analyze the information that they need to assure that decisions serve the needs of the public. The FDA failed to observe this principle when it allowed statements and recommendations of the BPAC to go unchallenged, apparently because it could not independently analyze the information ( Chapter 6 ).

Because mistakes will always be made and opportunities sometimes missed, regulatory structures must be organized and managed to assure both the reality and the continuous appearance of propriety. The prominence of representatives from blood banks and blood product manufacturers on the BPAC, with no balancing influence from consumers and no process within the FDA to evaluate its recommendations ( Chapter 6 ), is a failure of advisory committee management. Perhaps advisory committees should contain fewer topical experts and more members with expertise in principles of good decisionmaking and the evaluation of evidence. A committee so constituted might run a reduced risk of standing accused of having conflicts of interest.

Analytic Capability and Long-Range Vision

Leadership passes to the organization that has access to information and the ability to analyze it. Federal agencies should avoid exclusive reliance upon the entities which they regulate for analysis of data and modeling of decision problems. The FDA should have had some independent capacity to analyze the information presented at the July 1983 BPAC meeting that suggested that with only three or four suspect donors, an automatic recall policy would completely deplete the nation's supply of AHF concentrate ( Chapter 6 ). In addition, there did not seem to be any focus within the Public Health Service prepared to, or charged to, analyze the options, costs, and benefits of the options for protecting the blood supply that were discussed at the January 4, 1983, meeting convened by CDC.

In addition, agencies need to monitor more systematically the long-term outcomes of blood transfusion and blood product infusion and to think far ahead to anticipate both new technologies and new threats to the safety of the blood supply. Because new pathogens can enter the blood supply and be propagated very rapidly through it, a low level of suspicion about a threat should trigger high-level consideration of how to manage and monitor the problem.

Through its fact-finding interviews and through written documents, the Committee found little evidence that the PHS agency heads and the Assistant Secretary for Health were involved in making decisions about protecting the blood supply in 1983 and 1984 when HIV was becoming increasing apparent as a threat. Most decisions and interagency communication seems to have occurred several levels below the top.

Presumptive Regulatory and Public Health Triggers

The Committee believes that the Public Health Service should prepare for future threats to the blood supply by specifying in advance the types of actions that should occur once the level of concern passes a threshold. In the face of scientific uncertainty, the PHS needs a series of criteria or triggers for taking regulatory or other public health actions to protect the safety of blood and blood products. The Committee favors a series of triggers in which the response is proportional to the magnitude of the risk and the quality of the information on which the risk estimate is based. Not all triggers should lead to drastic or irrevocable actions; some merely require careful consideration of the options or developing new information. This general principle is detailed by examples in each of the Committee's four areas of inquiry. Table 8.1 summarizes these triggers and corresponding actions.

Triggers for Taking Actions in Response to Uncertain.

Product Treatment

Whenever they propose new methods of protecting the safety of the blood supply, blood regulatory agencies must perform cost-utility or cost-benefit analyses to evaluate whether the intervention will advance the public health at reasonable costs. If manufacturers do not have market incentives, resources, or access to data to test promising methods, public agencies should create incentives or provide resources or access to data. In this case, the trigger is a new proposal to increase safety, and the action is for the public sector to assume responsibility for thorough analysis and development, or to create incentives for industry to do so.

When performing a cost-effectiveness analysis of new treatments for blood products, the potential to protect against other threats should always be a part of the analysis. Here, the trigger is the initiation of a cost-effectiveness analysis, and the action is to ensure that the analysis takes into account secondary benefits.

Donor Screening

Whenever epidemiologists identify a high-risk donor group, the FDA should immediately tell blood banks to create a way to defer that group and tell collection agencies to segregate and separately treat supplies obtained from those populations. Concerns about stigmatizing subpopulations and maintaining the supply of blood products should influence the means of taking actions, not whether to take action. In this case, the trigger to action is the identification of a high-risk population, and the action is deferral and segregation of lots.

Whenever any segment of the industry institutes a donor screening program, the FDA should require all segments of the industry to follow suit with actions that they believe will be at least as effective in promoting safety. Public regulators have a responsibility to monitor these efforts and to forge consensus or to impose the most effective methods as information concerning efficacy becomes available. Here, the trigger is one company's action to take an additional safety measure, and the response is for all companies to follow suit, or to be held accountable when they do not.

Blood banks should use a partially effective intervention that has little or no risk unless they can show that a better method will rapidly supersede it. In this case the trigger is the availability of an inherently risk-free, partially effective intervention, and the response to use that test/intervention unless it is certain to become redundant prior to realizing its full benefits.

When a test or treatment makes a product safer, manufacturers should withdraw all stocks of untested or untreated product as quickly as possible. Where immediate complete withdrawal might injure the public health, withdrawals should be partial or staged. Here, the trigger is the implementation of a new test or treatment process, and the action is to recall untested or untreated products as expeditiously as possible, given other considerations of public health.

A limited, staged, or selective recall places responsibility on public regulatory agencies to establish criteria for selecting lots for recall, to provide processes to permit effective implementation of the recall by industry, and to monitor the recall to assure that removal of the products occurs in the prescribed manner. In this case the trigger is the initiation of a recall action, and the response is to provide clear guidance and monitoring.

Communication to Patients and Providers

Whenever new information triggers inquiry into a possible threat to the blood supply, both patients and their physicians should have access to the information. Public officials should presume that candid statements and rigorous actions will enhance rather than erode public confidence and that persons using blood or blood products have the right to understand fully the risks and benefits of using these products. In this case, the trigger is new information relevant to the public health, and the action is to tell affected individuals what they need to make an informed choice: the facts, the gaps in knowledge, and the implications thereof.

• Recommendations

The Committee's charge was to learn from the events of the early 1980s the lessons that would help the nation prepare for future threats to the blood supply. The Committee identified potential problems with the system in place at that time (as summarized earlier in this chapter) and proposes changes that, if implemented in the early 1980s, might have moderated some of the effects of the AIDS epidemic on recipients of blood and blood products. This analysis has led the Committee to the following recommendations for Public Health Service agencies, for the blood and plasma fractionation industry, and for health care providers and the public. These recommendations address both public health options and individual clinical options.

The Committee is mindful of several caveats. First, the Committee is acutely aware of the difficulties of retrospective analysis, as described in Chapter 1 . Second, the Committee has not considered its recommendations from perspectives other than blood safety. Finally, the Committee tried to identify opportunities for institutional change that would respond to the problems that the Committee diagnosed. The Committee based its recommendations on the institutions as they functioned in the early 1980s, not as they exist now. The organizations responsible for blood safety and public health will have to evaluate their current policies and procedures to see if they fully address the issues raised by our recommendations.

The Public Health Service

Several federal agencies necessarily play important, often different roles in managing a public health crisis such as the contamination of blood and blood products by the AIDS virus. The National Blood Policy of 1973 charged the Public Health Service (including the CDC, the FDA, and the NIH) with responsibility for protecting the nation's blood supply.

The Committee has come to believe that a failure of leadership contributed to delay in taking effective action, at least during the period from 1982 to 1984. This failure led to incomplete donor screening policies, weak regulatory actions, and insufficient communication to patients about the risks of AIDS .

In the event of a threat to the blood supply, the PHS must, as in any public health crisis, insist upon coordinated action. The Secretary of Health and Human Services is responsible for all the agencies of the Public Health Service, 1 and therefore the Committee makes

Recommendation 1: The Secretary of Health and Human Services should designate a Blood Safety Director, at the level of a deputy assistant secretary or higher, to be responsible for the federal government's efforts to maintain the safety of the nation's blood supply.

Choosing a "lead person" is important because it is in the nature of federal agencies and their leaders to be at once competitive and protective. This condition is healthy in reasonable measure and in normal times. However, a serious threat to public health requires that agencies communicate, cooperate, and learn to view the world through each other's lenses. Once there is an action plan, the Secretary of Health and Human Services must hold the agency leaders accountable for enforcing cooperation in implementing the plan.

To be effective in coordinating the various agencies of the PHS, the Blood Safety Director should be at the level of a deputy assistant secretary or higher, and should not be a representative of any single PHS agency. When a threat does arise, the Blood Safety Director should create a crisis management team.

One such action was to establish, in July 1982, the Committee on Opportunistic Infections in Hemophiliacs (see Chapter 3 ). This group seems to have been organized by the CDC, but there is no record of its operations after August of that year.

Blood Safety Council

The AIDS crisis revealed that the institutions in place to ensure blood safety, both public and private, were unable to work cooperatively toward a common goal of a safe blood supply. The institutions were not accountable to anyone but themselves, and they failed to cooperate, to coordinate their activities, and to communicate effectively with physicians and the public. The Committee has become convinced that the nation needs a far more responsive and integrated process to detect, evaluate, and respond to emerging threats to the blood supply. To this end the Committee makes

Recommendation 2: The PHS should establish a Blood Safety Council to assess current and potential future threats to the blood supply, to propose strategies for overcoming these threats, to evaluate the response of the PHS to these proposals, and to monitor the implementation of these strategies. The Council should report to the Blood Safety Director (see Recommendation 1). The Council should also serve to alert scientists about the needs and opportunities for research to maximize the safety of blood and blood products. The Blood Safety Council should take the lead to ensure the education of public health officials, clinicians, and the public about the nature of threats to our nation's blood supply and the public health strategies for dealing with these threats.

Supplying safe blood and blood products to the nation—a public good—requires the cooperation of public and private institutions. The Blood Safety Council would give voice to the public's interest in having these institutions cooperate and would provide opportunities for them to do so.

The lessons of HIV transmission through blood and blood products show the need for an advisory council with a significantly greater level of diversity, responsibility, and authority than the current Blood Products Advisory Committee of the FDA. The BPAC is limited by the regulatory mission of the FDA which it advises, and there is no other body primarily concerned with blood safety as a whole. Representatives from governmental agencies, academia, the blood bank community, industry, and the public all have relevant expertise and perspectives and should be involved in the Blood Safety Council. A broad-based range of expertise in areas of hematology, infectious diseases, epidemiology, blood product manufacturing, blood collection and delivery, risk assessment, consumer advocacy, and cost-benefit analysis is essential.

The proposed Blood Safety Council would facilitate the timely transmission of information, assessment of risk, and initiation of appropriate action both during times of stability and during a crisis. The Council should report to the Blood Safety Director (see Recommendation 1). The Council would not replace the PHS agencies responsible for blood safety but would complement them by providing a forum for them to work together and with private organizations. The PHS agencies would be represented on the Council (see below and Figure 8.1 ). The Council would not have its own surveillance capability, but would work with CDC and FDA to interpret the information that those organizations can provide. It would not carry out or fund research itself, but would work with those at NIH and in the private sector to identify priorities for blood safety research. The Council would not have regulatory power, but would inform FDA actions from a blood safety rather than a product-specific perspective.

Figure 8.1.

Blood Safety Council relationships.

The organizations and groups that should be included in the Blood Safety Council, and the reasons for including them, are as follows:

• The FDA can provide a direct link between itself, the essential regulatory agency responsible for the safety of blood and blood products, and important sources of information, scientific support, and disease surveillance findings.
• The CDC can provide expertise in epidemiology, infectious diseases, and immunology as well as communicate the results of ongoing disease surveillance studies. The CDC's newly established emerging infectious disease program would also provide valuable information.
• The NIH can provide scientific expertise and the means to communicate information about essential research needs to the appropriate institutes for support of research.
• Representatives from academia can bring independent scientific and medical expertise, especially in hematology, infectious diseases, epidemiology, risk assessment, and cost-effectiveness analysis.
• Representatives from the volunteer blood collection community can bring experience with blood safety concerns and the knowledge of blood bank operations that is necessary to evaluate proposed change.
• Representatives from the private-sector blood product manufacturers and biotechnology companies can bring both experience with blood safety concerns and knowledge of plasma fractionation operations.
• Representatives of the general public (who may in the future require blood transfusions) and individuals who currently require frequent use of blood products, such as hemophilia patients, bring important perspectives on the trade-offs that must be considered in evaluating response options.

The Blood Safety Council should consider the following activities and issues:

Surveillance. Although the FDA and the CDC keep track of events in blood and blood product recipients, their surveillance systems are passive and incomplete. The Blood Safety Council should work with the CDC to design a system of active surveillance for adverse reactions in blood recipients, as described in Recommendation 5 below. If such a system is established, the Council would benefit from its results and should participate in its governance.

Expert Panel on Best Practices . Drawing on its members' knowledge about blood and blood product safety concerns, and about clinical alternatives, the Blood Safety Council could establish a panel of experts to provide the public and providers of care with information about risks and benefits, alternatives to using blood products, and recommended best practices, as described in more detail in Recommendation 13 below.

Investigate Methods to Make Blood Products Safer. The Council should evaluate new methods to make blood and blood products safer. One promising approach is double inactivation in the preparation of blood products, which minimizes the risk of transmission of infectious pathogens in the blood of the donor pool. At present, the FDA requires only a single inactivation process (usually solvent detergent or heat treatment) for most blood products manufactured in the United States. With the goal of maximizing the safety of the blood supply at minimal added cost, the Blood Safety Council should encourage the FDA to evaluate double inactivation methods and expeditiously relicense products manufactured by the improved technologies, if appropriate. The Blood Safety Council should also consider, at least yearly, in a public forum, opportunities to maximize the safety of the blood supply.

Another promising approach is to reconsider minimum pool size requirements in plasma product manufacturing. The FDA currently requires a large number of donors to be included in plasma pools used in the manufacture of plasma products in order to ensure a wide range of antibodies in preparations of intravenous gamma globulin. Pooling of plasma obtained from numerous donors, although permitting some economy of scale, also increases the risk that a large fraction of manufactured blood products will be contaminated by a single infected donor. The Blood Safety Council should consider this issue and address the safety and efficiency trade-offs in changing the minimum pool size.

The Blood Safety Council would provide information relevant to the decisions that individuals as well as public and private decisionmakers need to make. The forum would not have direct regulatory or other authority, but would function as a forum for holding the organizations with authority responsible for blood safety. In short, the Blood Safety Council could advocate the public's need for a responsible process for decisionmaking about public health policy. The following examples illustrate how regular public discussions of blood safety issues, in the presence of representatives from the relevant organizations' perspectives, could provide an opportunity to hold the organizations with authority accountable for blood safety.

If it had existed in the 1970s, for instance, the Blood Safety Council might have called for the development of heat-treated AHF concentrate to reduce the risk of hepatitis, which would have also reduced the risk of HIV transmission. It would have been able to do so if the NIH and blood products industry representatives on the Council had been called upon to make periodic reports to the Council during the 1970s about their efforts to deal with the hepatitis problem. These representatives would have fed the discussions of the Council back into their own organizations' decisionmaking.

In 1983, the Council could have provided a forum for CDC to present its concerns about HIV in the blood supply and held the FDA, the NHF, and the blood banks and fractionators accountable for responding constructively. CDC created a forum on its own by convening the January 4, 1983, meeting in Atlanta, but as the Committee's analysis indicates, the follow-up on this meeting was insufficient. If a standing Blood Safety Council had existed, the CDC scientists who had concerns about the safety of blood and blood products would have had an opportunity to hold blood collection organizations accountable for their decisions regarding donor deferral and surrogate testing. It would also provide an opportunity to hold plasma fractionators and the FDA accountable for its decisions with regard to heat-treated AHF.

Later that year, the Council could have provided a mechanism to evaluate the claims that automatic recall of AHF would have virtually eliminated the supply of AHF. As the analysis in Chapter 6 indicates, neither the BPAC nor the FDA staff had the capacity to analyze claims that a automatic recall would have such an effect. The Blood Safety Council could have insisted that the FDA commission a formal decision analysis of the options for surrogate testing, or the Council might have performed such an analysis itself. The FDA would retain its regulatory authority, and continue to get advice from the BPAC, but the Council would have provided critical information relevant to the agency's decision.

Finally, if the Council had established an expert panel on best practices as described above and in Recommendation 13, hemophilia patients and their physicians would have had a more credible source of information about the risks of HIV infection and their clinical options than the NHF was able to provide. The operations of such a panel are described below under Recommendation 13.

Compensation Policy

When a product or service provided for the public good has inherent risks, the common law tort system fails to protect the rightful interests of patients who suffer harm resulting from the use of those products or services. Each claim requires extended, costly, and complex adjudicative procedures to establish liability. The results are erratic and unpredictable, and therefore inequitable (IOM 1985).

The doctrine of strict liability holds manufacturers accountable for injuries that are incurred from products that are inherently dangerous because diligence cannot fully eliminate their risks. The public health imperative of assuring enough vaccine for widespread use argues for limits on the strict liability doctrine for vaccine-related injuries. The chief concern is that fear of liability will discourage manufacturers from producing a vital public good. To vitate this concern, a federal compensation system has removed vaccine-related injuries from the scope of strict liability laws (Mariner 1992). The federal government established a mechanism for compensating individuals suffering harm from vaccine-related complications. Its rationale is that consent to undergo vaccination confers benefits to the entire community.

Blood -product-related injuries have also been removed from the scope of strict liability law by blood shield laws, which are in force in most states, and which protect society's interests in having an adequate blood supply. The blood shield laws serve to protect providers and manufacturers of blood and blood products from liability claims in instances where they take all due care to ensure the safety of the product. These laws, however, are unique in the manner in which they limit liability. The shield laws have made it difficult, and often impossible, to obtain compensation for HIV infection acquired from blood or blood products. To address this asymmetry between the protection that blood shield laws offer for manufacturers and adequate protection of individual rights, the Committee makes

Recommendation 3: The federal government should consider establishing a no-fault compensation system for individuals who suffer adverse consequences from the use of blood or blood products. 2

An effective no-fault system requires prospective standards and procedures to guide its operations. In a no-fault system, individual plaintiffs would not have to prove that their adverse outcome was a result of negligence related to manufacture of a blood product. Therefore, there needs to be an objective, science-based process to establish which categories of adverse outcomes are caused by blood-borne pathogens and which individual cases deserve compensation. As with vaccines, a tax or fee paid by all manufacturers or by the recipients of blood products could finance a compensation system. Rather than attempt to allocate blame for HIV infections through blood and blood products, some countries have established such no-fault compensation programs for individuals infected with HIV as a result of their use of blood and blood products. Countries fund these programs in a variety of ways, including direct government support and joint public/private resources.

Making recommendations about compensating affected individuals for damages incurred in the past is outside the Committee's mandate. However, had there been a no-fault compensation system in the early 1980s, it could have relieved much financial hardship suffered by many who became infected with HIV through blood and blood products in the United States. The no-fault principles outlined in this recommendation might serve to guide policymakers as they consider whether to implement a compensation system for those infected in the 1980s.

The Centers for Disease Control and Prevention

The CDC has an indispensable role to play in protecting our nation's health: to detect potential public health risks and sound the alert. Because of its expertise in detecting and evaluating possible infectious disease outbreaks, the Committee believes that the CDC should take responsibility for a surveillance system to detect adverse outcomes from blood and blood products. The following two recommendations embody an important principle: separating the assessment of risk from the management of the consequences of risk. The FDA, in its role as guarantor of the safety of the blood supply, has the responsibility for managing threats to the blood supply. The CDC should detect potential threats and assess the magnitude of the danger.

Early Warning Systems

A nation needs individuals and organizations that identify problems and raise concerns that may be difficult to confront. The CDC plays this role in the Public Health Service. The CDC appears to have been prescient in raising the possibility that the blood supply was contaminated early in the AIDS epidemic, but it was relatively ineffective in convincing other agencies of the potential gravity of the situation. In order to improve CDC's efficacy in this critical role, the Committee makes

Recommendation 4: Other federal agencies must understand, support, and respond to the CDC's responsibility to serve as the nation's early warning system for threats to the health of the public.

Officials in the government, scientists, and physicians in the private sector seem to have discounted the CDC warnings about the transmissibility of AIDS through blood and blood products because the swine flu episode in the 1970s had cost the agency considerable credibility. If, in 1983, the involved public and private organizations had the attitude called for in this recommendation, CDC's recommendations regarding donor screening and surrogate testing might have led to earlier, more effective screening and donor deferral policies.

Consistent with the precept of separating risk assessment and risk management as described above, CDC's role is to characterize and assess risks, and communicate this to others. The FDA and other organizations have the responsibility to manage the risks through regulation, clinical practice guidelines, and other means. The Committee believes that CDC should be able to play its designated role without fearing loss of credibility if it sometimes proves to be wrong. Implementing this recommendation may be difficult. As a start, the Secretary of Health and Human Services should insist that an agency that wishes to disregard a CDC alert should support its position with evidence that meets the same standard as that used by the CDC in raising the alert.

Surveillance

In order to carry out its early warning responsibility effectively, the CDC needs good surveillance systems. Because blood products are derived from human beings and may contain harmful biologic agents that were present in the blood of a donor, blood products are inherently risky, a principle long recognized by blood shield laws. The Committee, believing that the degree of surveillance should be proportional to the level of risk, makes

Recommendation 5: The PHS should establish a surveillance system, lodged in the CDC, that will detect, monitor, and warn of adverse effects in the recipients of blood and blood products.

If such a system had existed in 1982, data about the risks of HIV transmission through blood and blood products might have been available sooner and might have been more definitive. In dealing with newly approved pharmaceuticals, the FDA increasingly demands careful post-approval study of potential adverse effects (the so-called ''Phase IV Trial"). Two existing systems for vaccine adverse events—the CDC/FDA Vaccine Adverse Event Reporting System (VAERS) and the CDC's Large-Linked Database (LLDB)—might be useful models (Institute of Medicine 1994).

The Food and Drug Administration

The FDA has legal authority to protect the safety of the nation's blood supply. Accordingly, it is the lead federal agency in regulating blood-banking practice, the handling of source plasma, and the manufacture of blood products from plasma. The Committee found cause for concern when it evaluated the FDA's actions in protecting the public from HIV in the nation's blood supply during the 1980s. The record reveals many opportunities to improve the agency's capacity to deal with crises involving the blood supply, most notably with respect to the safety of AHF concentrate. In responding to these opportunities, the Committee's recommendations focus on decisionmaking and the role of advisory committees in formulating the FDA's response to crises.

Risk Reduction

In a crisis, decisionmakers may become so preoccupied with seeking solutions that will dramatically reduce danger that they will fail to implement solutions that are less effective but are likely to improve public safety to some degree. Partially effective risk-reducing improvements, as described herein, can save lives, pending the development of more efficacious safety measures. In order that the perfect not be the enemy of the good, the Committee makes

Recommendation 6: Where uncertainties or countervailing public health concerns preclude completely eliminating potential risks, the FDA should encourage, and where necessary require, the blood industry to implement partial solutions that have little risk of causing harm.

In the event of a future threat to the blood supply, the FDA should encourage small, low-risk solutions to large, difficult problems. The FDA's actions during the early 1980s are evidence that the agency should change its attitude toward regulation in order to adopt this proactive approach. Some examples from Chapter 6 illustrate how the FDA might have encouraged practices that would have reduced the risk faced by recipients of blood or a blood product.

Example: Destroy Unscreened Blood When Possible . When hospital blood banks first started to screen donors by questioning them for risk factors, there was a period of transition during which its stocks contained two classes of blood or plasma: blood from screened donors, which was relatively safe; and blood from unscreened donors, which had a higher probability of containing HIV. Within a few weeks of starting to screen donors, blood from unscreened donors would have been either used or discarded. In the instructions contained in its letter of March 24, 1983, the FDA could have recommended that blood banks adopt a policy of using blood from screened donors whenever possible during the transition period, a policy that some blood banks may have adopted on their own. Requiring all blood banks to adopt this policy would not have compromised the nation's blood supply, and it would have prevented at least a few instances in which a patient received an infected unit of blood.

Example: Destruction of Potentially Contaminated Cryoprecipitate . Blood banks store cryoprecipitate from a single unit of donated blood in the frozen state for up to one year. The FDA could have issued a directive that required the blood banks to check their inventory of frozen cryoprecipitate and destroy possibly contaminated units whenever they learned of a previous donor who had AIDS or was strongly suspected of having AIDS.

Example: Phased Recall. In July 1983, there was considerable reluctance to recall untreated Factor VIII concentrate at a time when much of the supply was almost certainly contaminated with HIV. The FDA apparently feared that the ensuing shortage of Factor VIII would have caused more harm than the HIV virus. A phased withdrawal would have been a compromise between no withdrawal and immediate total withdrawal. This middle path might have avoided a factor concentrate shortage and still reduced the number of hemophiliacs who became infected.

Example: Lookback. The FDA formally instituted a "lookback" policy in 1991, years after it was clear that AIDS had a long incubation period during which a patient could transmit HIV through sexual contact or contact with blood. Lookback required blood banks to contact recipients of blood from infected donors and notify them that they might be a HIV carrier and should be tested for HIV antibodies. Earlier action on lookback might have reduced secondary transmission of HIV.

Decision Processes

In all fields, decisionmaking under uncertainty requires an iterative process. As the knowledge base for a decision changes, the responsible agency should reexamine the facts and be prepared to change its decision. The agency should also assign specific responsibility for monitoring conditions and identifying opportunities for change. In order to implement these principles at the FDA, the Committee makes

Recommendation 7: The FDA should periodically review important decisions that it made when it was uncertain about the value of key decision variables.

An example illustrates the principle of iterative decisionmaking. During 1983, most blood bank officials opposed asking prospective male donors if they had ever had sex with a man. They were worried that regular donors might take offense and stop donating blood. They were also concerned about some gays would lie about their homosexuality and donate blood in reprisal for being singled out as the target of the questioning. Eventually, some blood collection centers began to ask questions about sexual preference. If the FDA had carefully monitored these experiments, it would have soon learned that the blood bank officials' fears were groundless. The FDA might then have revised its requirements for donor screening to include direct questions about high-risk sexual practices.

Regulatory Efforts

Although the FDA has a great deal of regulatory power over the blood products industry, the agency appears to regulate by expressing its will in subtle, understated directives. This informal approach to regulation is often necessary to permit a timely response and to preserve needed flexibility. The FDA used this approach, for example, in July 1983 when it issued recommendations to withdraw lots of AHF concentrate that plasma fractionators had identified as containing material from a donor that had AIDS . The language in the July 1983 communication failed to specify, however, whether the agency considered the recommendations to be binding on industry. While most regulated industries might have interpreted these letters as mandatory, that question should not have been left to the judgment of individual entities. Taking this into account, the Committee makes

Recommendation 8: Because regulators must rely heavily on the performance of the industry to accomplish blood safety goals, the FDA must articulate its requests or requirements in forms that are understandable and implementable by regulated entities. In particular, when issuing instructions to regulated entities, the FDA should specify clearly whether it is demanding specific compliance with legal requirements or is merely providing advice for careful consideration.

In 1983, the FDA chose a middle ground when faced with the decision to withdraw all AHF concentrate. The agency recommended that plasma fractionators withdraw individual lots of AHF concentrate when a donor was suspected of having AIDS . This decision was certainly defensible. However, the process for this "case-by-case" withdrawal was seriously compromised by the vagueness of the criteria specified for a recall. The agency failed to specify a process for deciding whether a donor may have had AIDS. The agency should have specified a process for reviewing donors who did not fully satisfy the diagnostic criteria for AIDS but who were suspected of having the disease. When deciding whether to withdraw a lot of AHF concentrate, the FDA asked plasma fractionators to take into account the time of the donation in relation to the diagnosis of AIDS and the effect of the recall on product availability. However, the FDA did not specify parameters for assessing either of these decision criteria. With greater forethought, the FDA could have avoided the potential for a seriously flawed implementation of a policy that otherwise appeared to balance benefits, risks, and harms.

Advisory Committees

The FDA made several decisions in 1983 that appear to have been influenced by the blood-industry-based (profit and nonprofit) members of the BPAC. The BPAC membership did not include individuals with expertise in the social, ethical, political, and economic aspects of the issues that BPAC was deliberating at the time. The FDA apparently did not seek independent analysis of the recommendations made by the members of the BPAC, some of whom were employed by the blood industry. In the early 1980s, the FDA appeared too reliant upon analyses provided by industry-based members of the BPAC and the BPAC. For example, see the discussion in Chapter 6 of the July 19, 1983, BPAC meeting which resulted in the decision for case-by-case rather than automatic recall of lots of AHF when one donor was suspected of having AIDs. Chapter 6 also contains a discussion of the December 15, 1983, BPAC meeting, which effectively curtailed actions on surrogate testing of blood for months. The Committee's analysis of the FDA's management of its advisory committee leads to the following three recommendations:

Recommendation 9: The FDA should ensure that the composition of the Blood Products Advisory Committee reflects a proper balance between members who are connected with the blood and blood products industry and members who are independent of industry.

The FDA should select some BPAC members because they can provide independent judgment, question the analyses provided by blood-industry-based BPAC members, and hold the FDA accountable for a high standard of public responsiveness. The BPAC should have at least one voting member who is a representative of consumer interests. BPAC members who vote to establish policy should have neither the appearance of a conflict of interest nor a true conflict of interest.

An agency that is practiced in orderly decisionmaking procedures will be able to respond to the much greater requirements of a crisis. The BPAC meetings cited before Recommendation 9 above provide examples to support this recommendation. Applying this principle to the use of advisory committees, the Committee makes

Recommendation 10: The FDA should tell its advisory committees what it expects from them and should independently evaluate their agendas and their performance.

The FDA staff and its advisory committees should structure their relationship so that they invigorate each other. The agency should hold an advisory committee accountable for its performance through periodic independent evaluation. By placing unresolved issues on future agendas, the committee can hold the FDA accountable for taking follow-up action between committee meetings. The IOM Committee to Study the Use of Advisory Committees by the Food and Drug Administration makes further recommendations to strengthen the FDA advisory committee system (IOM 1992).

Advisory committees provide scientific advice to the FDA; they do not make regulatory decisions for the agency (IOM 1992). As Chapter 6 indicates, the FDA in 1983 did not independently verify the estimates of the risk of blood-product-related HIV infection. The FDA did not analyze the public health implications of the BPAC's recommendation against automatic recall of AHF concentrate that contained plasma from donors suspected of having AIDS . The FDA's lack of independent information and its own analytic capacity meant that it had little choice but to incorporate the advice of the BPAC into its policy recommendations. To ensure the proper degree of independence between the FDA and the blood products industry, the Committee makes

Recommendation 11: The FDA should develop reliable sources of the information that it needs to make decisions about the blood supply. The FDA should have its own capacity to analyze this information and to predict the effects of regulatory decisions.

Communication to Physicians and Patients

One of the crucial elements of the system for collecting blood and distributing blood products to patients is the means by which to convey concern about the risks inherent in blood products. In today's practice of medicine, in contrast to that of the early 1980s, patients and physicians each accept a share of responsibility for making decisions. Patients' informed consent is required for risky procedures. From early 1983, it was clear that AHF concentrate was a risky product. The failure to tell hemophilia recipients of Factor VIII concentrate about the risks of this treatment and about alternative treatments seems especially serious in the light of present-day emphasis on the autonomy of patients in decisions involving their health.

Clinical Practice

One powerful lesson of the AIDS crisis is the importance of telling patients about the potential harms of the treatments that they are about to receive. The NHF dedicated itself to providing information to individuals with hemophilia and their physicians. Their strategy, however, was seriously flawed. As discussed in Chapter 7 , the NHF provided treatment advice, not the information on risks and alternatives that would enable physicians and patients to decide for themselves on a course of treatment. Hemophilia patients did not have the basis for informed choice about a difficult treatment decision.

Considerable scientific and medical uncertainties characterized the early years of the AIDS epidemic. For individuals medically dependent on the use of blood and blood products, these uncertainties created complex dilemmas about clinical options for their continued care. In instances of great uncertainty, it is crucial for patients to be fully apprised of the full range of options available to them and to become active participants in the evaluation of the relative risks and benefits of alternative treatments. As the case studies in Chapter 7 indicate, the failure to communicate adequately about these options prevented many hemophiliacs from making choices in which they accepted responsibility for balancing the risk of AIDS and the risks of bleeding. Ultimately the failure to communicate led to a powerful sense of betrayal that exacerbated the tragedy of the epidemic for many patients and their families. To encourage better communication, the Committee makes

Recommendation 12: When faced with a decision in which the options all carry risk, especially if the amount of risk is uncertain, physicians and patients should take extra care to discuss a wide range of options.

Medicine has many "gray areas" in which the correct course of action is not clear. Guidelines should identify these areas and spotlight the importance of full disclosure of risks, discussion of the broadest range of clinical options, and incorporation of the patient's preferences into an individualized recommendation. Given the inherent risks and uncertainties in all blood products, the public and the providers of care need expert, unbiased information about the blood supply. This information includes risks and benefits, alternatives to using blood products, and recommended best practices. As Chapter 7 indicates, the NHF (the only organization that stepped in to provide information to hemophiliacs and the physicians who were treating them) focused on practice recommendations rather than complete information on risks and options. In order to provide the public and providers of care with the information they need, the Committee makes

Recommendation 13: An expert panel should be created to inform the providers of care and the public about the risks associated with blood and blood products, about alternatives to using them, and about treatments that have the support of the scientific record.

One lesson of the AIDS crisis is that a well-established, orderly decisionmaking process is important for successfully managing a crisis. This applies as much to clinical decisionmaking as to the public health decision process addressed by the earlier recommendations. As the narrative indicates, there are both public health and clinical approaches to reducing the risk of blood-borne diseases. The Blood Safety Council called for in Recommendation 2 would deal primarily with risk assessment and in the public health domain, actions that would reduce the chance that blood products could be vectors of infectious agents. The primary responsibility of the expert panel on best practices called for in Recommendation 13 would be to provide the clinical information that physicians and their patients need to guide their individual health care choices. To be most effective, this panel should be lodged in the Blood Safety Council (see Recommendation 2) so that both bodies can interact and coordinate their activities in order to share information about emerging risks and clinical options.

Any organization that supplies this information must adhere to accepted norms for documenting evidence. The Committee believes that the public's interest would be best served by creating one publicly accountable source of this information. This function would build on the experience of the Agency for Health Care Policy and Research, which has an established guideline development process and issues guidelines on topics such as the management of chronic pain, screening for AIDS , and management of urinary incontinence (El-Sadr, et al. 1994; Jacox, et al. 1994).

Experience in developing practice guidelines for hemophilia treatment and blood transfusion is an important element of preparedness for future threats to the blood supply. There are now well-established processes such as those recommended by the IOM Committee to Advise the Public Health Service on Practice Guidelines (IOM 1990, 1992) and used by the Agency for Health Care Policy and Research. The U.S. Preventive Services Task Force (1989) uses another system process. Guideline developers should perform a thorough literature search, identify well-designed studies, describe fully the evidence on harms and benefits, and explain the connection between the evidence and the recommendations. They should seek critical evaluation from a wide spectrum of individuals and organizations and should periodically reexamine the recommendations in the light of changing knowledge.

Credibility

During the early 1980s, in its role as the guardian of the interests of the hemophilia patient community, the NHF was the principal source of information about using blood products. The outcome of the NHF efforts was that individuals with hemophilia and their families lost faith in the NHF as the rightful steward of their interests. The reasons discussed in Chapter 7 include the NHF's unwavering recommendation to use AHF concentrate, its dependence on funds contributed by the plasma fractionation industry, and the composition of the NHF expert panel (MASAC) that formulated treatment recommendations (e.g., the panel's lack of infectious disease experts and decision analysts).

Toward the end of providing the highest-quality, most credible information to patients and providers, the Committee makes

Recommendation 14: Voluntary organizations that make recommendations about using commercial products must avoid conflicts of interest, maintain independent judgment, and otherwise act so as to earn the confidence of the public and patients.

One of the difficulties with using experts to give advice is the interconnections that experts accumulate during their careers. Organizations that regulate an industry may get advice from the same experts who advise the industries. Organizations that give treatment advice may rely on experts whose employer relies upon support from industry. As a result, an expert may have a history of relationships that raise concerns about whether he or she can be truly impartial when advising a course of action in a complex situation. The Committee believes that the best way to avoid these risks is to choose some panelists who are not expert in the subject of the panel's assignment but have a reputation for expertise in evaluating evidence, sound clinical judgment, and impartiality.

Financial conflicts of interest influence organizations as well as individuals. As indicated in Chapter 7 and above, the financial relationships between the NHF and the blood products industry seriously compromised the NHF's credibility. The standards for acknowledging conflicts of interest are higher than they were 12 years ago. Public health officials and the medical professions must uphold this new standard. Failure to do so will threaten the fabric of trust that holds our society together.

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Essay on AIDS for Students and Children

500+ words essay on aids.

Acquired Immune Deficiency Syndrome or better known as AIDS is a life-threatening disease. It is one of the most dreaded diseases of the 20 th century. AIDS is caused by HIV or Human Immunodeficiency Virus, which attacks the immune system of the human body. It has, so far, ended more than twenty-nine million lives all over the world. Since its discovery, AIDS has spread around the world like a wildfire. It is due to the continuous efforts of the Government and non-government organizations; AIDS awareness has been spread to the masses.

AIDS – Causes and Spread

The cause of AIDS is primarily HIV or the Human Immunodeficiency Virus. This virus replicates itself into the human body by inserting a copy of its DNA into the human host cells. Due to such property and capability of the virus, it is also known as a retrovirus. The host cells in which the HIV resides are the WBCs (White Blood Cells) that are the part of the Human Immune system.

HIV destroys the WBCs and weakens the human immune system. The weakening of the immune system affects an individual’s ability to fight diseases in time. For example, a cut or a wound takes much more time to heal or the blood to clot. In some cases, the wound never heals.

HIV majorly transmits in one of the three ways – Blood, Pre-natal and Sexual transmission. Transfusion of HIV through blood has been very common during the initial time of its spread. But nowadays all the developed and developing countries have stringent measures to check the blood for infection before transfusing. Usage of shared needles also transmits HIV from an infected person to a healthy individual.

As part of sexual transmission, HIV transfers through body fluids while performing sexual activity. HIV can easily be spread from an infected person to a healthy person if they perform unprotective sexual intercourse through oral, genital or rectal parts.

Pre-natal transmission implies that an HIV infected mother can easily pass the virus to her child during pregnancy, breastfeeding or even during delivery of the baby.

AIDS – Symptoms

Since HIV attacks and infects the WBCs of the human body, it lowers the overall immune system of the human body and resulting in the infected individual, vulnerable to any other disease or minor infection. The incubation period for AIDS is much longer as compared to other diseases. It takes around 0-12 years for the symptoms to appear promptly.

Few of the common symptoms of AIDS include fever , fatigue, loss of weight, dysentery, swollen nodes, yeast infection, and herpes zoster. Due to weakened immunity, the infectious person falls prey to some of the uncommon infections namely persistent fever, night sweating, skin rashes, lesions in mouth and more.

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AIDS – Treatment, and Prevention

Till date, no treatment or cure is available for curing AIDS, and as a result, it is a life-threatening disease. As a practice by medical practitioners, the best way to curb its spread is antiretroviral therapy or ART. It is a drug therapy which prevents HIV from replicating and hence slows down its progress. It is always advisable to start the treatment at the earliest to minimize the damage to the immune system. But again, it is just a measure and doesn’t guarantee the cure of AIDS.

AIDS prevention lies in the process of curbing its spread. One should regularly and routinely get tested for HIV. It is important for an individual to know his/her own and partner’s HIV status, before performing any sexual intercourse activity. One should always practice safe sex. Use of condoms by males during sexual intercourse is a must and also one should restrict oneself on the number of partners he/she is having sex with.

One should not addict himself/herself to banned substances and drugs. One should keep away from the non-sterilized needles or razors.  Multiple awareness drives by the UN, local government bodies and various nonprofit organizations have reduced the risk of spread by making the people aware of the AIDS – spread and prevention.

Life for an individual becomes hell after being tested positive for AIDS. It is not only the disease but also the social stigma and discrimination, felling of being not loved and being hated acts as a slow poison. We need to instill the belief among them, through our love and care, that the HIV positive patients can still lead a long and healthy life.

Though AIDS is a disease, which cannot be cured or eradicated from society, the only solution to AIDS lies in its prevention and awareness. We must have our regular and periodical health checkup so that we don’t fall prey to such deadly diseases. We must also encourage and educate others to do the same. With the widespread awareness about the disease, much fewer adults and children are dying of AIDS. The only way to fight the AIDS disease is through creating awareness.

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HIV/AIDS: A Postmodern Epidemic and Its Depiction (March 2016): Looking Forward and Conclusion

• A Brief Overview
• The Epidemic: A Time Line
• The Sociology of AIDS
• Global Health and Human Rights
• Cultural Responses
• Looking Forward and Conclusion

Works Cited

Looking forward.

Although new HIV infections have fallen by almost 40 percent since 2001, UNAIDS reported that an estimated 1.5 million people worldwide died from AIDS-related illnesses in 2013.  In the Western world, the sense of urgency about AIDS has decreased since combination therapy became available in the mid-1990s.  An unexpected consequence of the success of combination therapy is that people have become complacent about safe-sex methods—and the need to use them consistently—which has led to a resurgence in new infections.  As the Kaiser Family Foundation’s 2011 survey HIV/AIDS at 30: A Public Opinion Perspective makes clear, in the United States the stigma of HIV infection continues.

Many international agencies are working on vaccine development, prevention strategies, structural remedies, and poverty relief in the hope that by scaling up prevention and treatment programs they will eventually outpace and even eliminate the disease.  Nathalia Holt’s recent Cured: How the Berlin Patients Defeated HIV and Forever Changed Medical Science describes the cases of two men who were declared “functionally cured” of HIV infection, in one case following a painful and expensive bone marrow transplant of HIV-resistant stem cells.  Although the technique appears to have worked in one patient, the economic feasibility and logistics must be assessed.  Biomedical Advances in HIV Prevention: Social and Behavioral Perspectives , edited by Lisa Eaton and Seth Kalichman, focuses on biomedical technologies currently being researched (e.g., topical microbiocides/gels and vaccines) to help end the spread of HIV.  Pre-exposure prophylaxis (known as PrEP) and post-exposure prophylaxis (PEP) are other treatment options being explored.  Rethink HIV: Smarter Ways to Invest in Ending HIV in Sub-Saharan Africa , edited by Bjørn Lomborg, ranks HIV prevention and treatment policies using a cost-benefit analysis.  A priorities ranking report put together by the aids2031 Consortium, AIDS: Taking a Long-Term View , suggests that researchers take a fresh, proactive approach as well as a long-term approach.  The international organization UNITAID, launched by the United Nations in 2006, is using innovative financing to encourage pharmaceutical companies to participate in the Medicines Patent Pool, which allows drugs to be used on an open-access basis by researchers in developing countries.  And fast-track programs such as that initiated at USAIDS support scaling up HIV prevention and treatment programs with an eye toward ending the epidemic as a public health issue within the next few decades. [1]

[1] UNAIDS, Fast-Track—Ending the AIDS Epidemic by 2030 , http://www.unaids.org/en/resources/documents/2014/JC2686_WAD2014report

As this essay shows, the range of HIV/AIDS literature is broad and spreads across many disciplines.  Publication of monographs in the clinical sciences has slowed, with journals providing the most up-to-date research.  Most of the monographs fall under the heading of public health, although the sociology literature on HIV/AIDS is steadily growing as a generation of survivors reaches more milestones.  Stopping the disease will involve using all the techniques available—education, prevention, treatment, and research—and overcoming financial impediments.  The disease is still active, and academic interest in it will continue.  One hopes the literature will eventually move from such immediate topics as treatment and prevention to historical observations.

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AIDS status & challenges of the epidemic

• Level 1: Summary
• Level 2: Details
• Level 3: Source
• 8. Conclusion on progress made in the fight against AIDS

In 2001, leaders from 189 UN Member States unanimously recognized that AIDS is among the greatest development crises in human history and agreed to act nationally and internationally to stop the epidemic . They signed the Declaration of Commitment on HIV/AIDS to help reach the Millennium Development Goal of stopping and beginning to reverse the epidemic by 2015. They also agreed to meet detailed targets, for instance in terms of funding, provision of information to young people, and access to treatment .

A review of all the efforts made between 2001 and 2005 revealed that:

• There have been great improvements in the fight against AIDS , but progress varies greatly between countries and regions. In some countries, there is much better access to treatment but prevention programmes are not adequate. In others, the proportion of people living with HIV is falling, but progress towards greater access to treatment is slow. Only some countries have reached the key targets that had been set for 2005.
• In most countries, a strong foundation now exists on which to build an effective HIV response, with increasing political commitment and partner coordination at country level. The amount of government money available to fight HIV has increased significantly. There is now much better access to treatment, testing and counselling. More young people are given information on HIV and AIDS at school and blood collected for blood transfusions is now routinely screened for HIV in most countries.
• HIV prevention programmes do not reach enough of those at greatest risk. In 2005 for instance, less than 50% of young people were well-informed about HIV while only 9% of men who have sex with men and fewer than 20% of injecting drug users received any type of HIV prevention service. Only 9% of infected pregnant women were given antiretroviral drugs.
• The 15 million children orphaned by AIDS and millions of other children made vulnerable by the epidemic do not receive proper care and support.
• There is stigma and discrimination against people living with HIV.
• Half of the countries have policies that interfere with HIV-prevention and care programmes.
• The global AIDS response must become substantially stronger, more strategic and better coordinated in order to achieve the 2010 targets.

Today, the world possesses the means to begin to reverse the epidemic , but success will require unprecedented willingness on the part of all actors in the global response, including to sustain efforts over the long term. More...

• 1. Introduction: global targets on HIV/AIDS
• 2. What are the worldwide trends in the HIV/AIDS epidemic?
• 3. How has HIV prevention and treatment evolved since 2001?
• 4. Are human rights and vulnerable populations sufficiently protected?
• 5. What has been done in terms of funding and research?
• 6. What strategies are recommended by UNAIDS to halt and reverse the epidemic?
• 7. What should be done to improve prevention and access to treatment?
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Essay About HIV/AIDS

Introduction.

Human Immunodeficiency Virus, abbreviated as HIV, attacks the body’s immune system, and if left untreated, it can cause AIDS (Acquired Immune Deficiency Syndrome). HIV is a retroviral disease transmitted through unprotected sexual activity, from mother to child, blood transfusion, contact with infected body fluids, or hypodermic needles (Melhuish & Lewthwaite, 2018). The disease originated from a zoonotic animal, a chimpanzee in Central Africa. The virus version in chimpanzees, Simian Immunodeficiency Virus, is thought to have been passed to humans during their hunting activities way back in 1800. The disease has further been spread across Africa over the decades and eventually into other parts of the world. Its existence in the United States occurred between the mid to late 1970s.

Disease Manifestation

HIV weakens the immune system through infection and destruction of the CD4+ T cells, leading to immunodeficiency at the later stages of the disease. The virus adheres to the CD4+ protein on its surface and other cells to gain entry into the body  ( Melhuish & Lewthwaite, 2018 ).  Other coreceptors such as CCR5 and CXCR4 are essential in enabling the virus to gain complete access and cause infection to the body cells. HIV infection undergoes three stages: acute illness, chronic infection, and acquired immunodeficiency syndrome (AIDS) (Velloza et al., 2020). The first stage usually develops between 2 to 4 weeks after initial exposure. The stage often goes unrecognized because of the occasionally mild and nonspecific symptoms. Some of the clinical manifestations observed in the first stage include typical rushes distributed on the face and trunk, although they may also appear in the palms and soles. Oral and genital mucocutaneous ulceration is also another clinical manifestation that can be experienced during the first stage. In this stage, gastrointestinal manifestation, facial nerve palsy, acute encephalopathy, and many other clinical symptoms may participate.

In the second stage of infection, the virus continues to multiply but at low levels. Infected individuals who are in this stage may not have any alarming symptoms. The stage can last for up to 10 to 15 years, although it may move so fast in some individuals c. AIDs infection occurs in the third stage. The infection may be manifested by symptoms such as rapid loss of weight, recurring fever, extreme tiredness, prolonged swelling of the lymph glands in the groin, armpits, or neck, sores in the mouth, diarrhea that lasts for more than a week, or memory loss and other neurologic disorder (Nasuuna et al., 2018). When infected individuals are not treated, they may develop severe diseases such as serious bacterial infections, cryptococcal meningitis, tuberculosis, and cancers like Kaposi’s sarcoma and lymphomas.

Diagnosis and Treatment

HIV diagnosis can be made by a rapid diagnostic test that provides results on the same day. Individuals may also test themselves using an HIV self-test kit, although a confirmatory test has to be done later on by a qualified health professional (Mayo Clinic, 2020). The diagnostic test works by detecting antibodies produced by a person as part of their immune response to fight the virus. When the results turn out positive, immediate treatment should be done to manage the virus (Mayo Clinic, 2020). A combination of three or more antiretroviral drugs (ARVs) or antiretroviral therapy (ART) may suppress the symptoms and viral replication within an individual hence allowing recovery of the immune system and regain the ability to protect the body from opportunistic infections.

The public health measures of HIV prevention can be divided into three categories; primary, secondary, and tertiary prevention. Primary prevention measures protect an individual from acquiring HIV infection. It involves strategies such as abstaining from sex, not sharing needles and sharp objects and using condoms when engaging in sexual activities. Prevention medicines such as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) may also be used to protect yourself from the infection (Mayo Clinic, 2020). Secondary HIV prevention involves measures that should be directed to infected individuals to prevent transmission to negative people (Mayo Clinic, 2020). Strategies used in secondary prevention entails giving health education to those who are infected, supporting ART adherence efforts, providing ongoing risk assessment regarding substance use and sexual behavior, encouraging infected individuals to disclose their HIV status to their sexual and drug use partners, prescribing condoms for positive individuals and providing counseling to them (Mayo Clinic, 2020). Tertiary prevention measures ensure the improved treatment to reduce the impact of HIV/AIDS disease and promote recovery. A tertiary prevention strategy aims at reducing complications that may be caused by HIV infection.

Surveillance measures

Local surveillance of HIV may be carried out using various reporting tools to fill HIV infection cases and later submitted to the local health departments for further analysis. The Centre for Disease Control and Prevention (CDC) plays a big role in collecting, analyzing, and disseminating data for national surveillance on HIV/AIDS. The CDC’s National surveillance system monitors HIV trends in the U.S (CDC, 2020). Moreover, the World Health organization can conduct international surveillance of HIV/AIDS, which surveys on HIV sentinel, STDs, and behavior.

Prevalence and Incidence

According to WHO (2020), the global prevalence of HIV is estimated to be over 37.7 million people, including 1.7 million children. The percentage prevalence in adults is 0.7%. Additionally, the incidence of HIV infection was 1.5 million (WHO, 2020). Most people living with HIV live in low and middle-income countries, with East and Southern Africa being the most affected region globally. In 2020, there were 670,000 new cases which amounted to 20.6 million infected individuals in East and Southern Africa.

Interesting facts

According to the WHO, some of the current interesting facts about HIV/AIDS is that it has claimed over 36.3 million people since its emergence; hence, it is still a major public health concern (WHO, 2021). Additionally, over 37.7 million were HIV positive in 2020, whereby 25.4 million were in the WHO African region. WHO also reports that over 680 thousand individuals succumbed to HIV-related infections, and over 1.5 million people acquired HIV/AIDS.

CDC. (2020, June 19).  Tracking AIDS Trends . Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/statistics/surveillance/index.html

Eisinger, R. W., & Fauci, A. S. (2018). Ending the HIV/AIDS pandemic.  Emerging infectious diseases ,  24 (3), 413.

Mayo Clinic. (2020, February 13).  HIV/AIDS – Symptoms and causes . https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524

Melhuish, A., & Lewthwaite, P. (2018). Natural history of HIV and AIDS.  Medicine ,  46 (6), 356-361.

Nasuuna, E., Kigozi, J., Babirye, L., Muganzi, A., Sewankambo, N. K., & Nakanjako, D. (2018). Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda.  BMC Public Health ,  18 (1), 1-9.

Velloza, J., Kemp, C. G., Aunon, F. M., Ramaiya, M. K., Creegan, E., & Simoni, J. M. (2020). Alcohol use and antiretroviral therapy non-adherence among adults living with HIV/AIDS in Sub-Saharan Africa: a systematic review and meta-analysis.  AIDS and Behavior ,  24 (6), 1727-1742.

WHO. (2021, June 9).  HIV/AIDS . WHO | World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hiv-aids

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• Essay on AIDS

HIV (human immunodeficiency virus) is an infection that causes cells in the body that help it fight infections, making a person more susceptible to other infections and diseases. Interaction with certain bodily secretions of an HIV-positive individual, most commonly during unprotected intercourse (sex without the use of a condom or HIV treatment to prevent or treat HIV), or sharing injection drug equipment spreads the virus.

If HIV is not treated, it can progress to AIDS (acquired immunodeficiency syndrome). HIV cannot be eradicated by the human body, and there is no effective HIV cure. As a result, whether you have HIV, you will have it for the rest of your life.

Long and Short AIDS Essay in English

There are many diseases causing microorganisms, like bacteria, viruses, fungi etc. The symptoms of the diseases depend on the type of microorganism that is spreading it. It can vary from mild to severe. AIDS which stands for Acquired Immunodeficiency Syndrome is a viral disease that is rampant in growth. It was only in the last century that this viral disease has proved to be lethal and fatal, taking away about twenty million lives globally. The awareness about the disease and the virus causing it which is HIV or Human Immunodeficiency Virus is more now compared to earlier. In this HIV AIDS essay, we can go through the important information about it and burst some myths.

Below are different ways to write an AIDS essay in English. The essay on HIV AIDS can be of 2 formats, a long essay on HIV AIDS or a short AIDS essay.

Short Essay on Aids

This AIDS essay is a brief one and will cover the important notes about the disease and the ways one can prevent it.

The way of occurrence of this disease is in the name itself, AIDS stands for Acquired Immunodeficiency Syndrome. The disease is acquired via the virus which is called Human Immunodeficiency Virus. It is not an auto-immune disease in the early stages of infection where the immune system in the body fights off infection to protect the body from diseases that go against itself. The virus enters from an outside source and destroys the efficiency of our immune system.

AIDS is transmitted through contact. The contact with infected blood of the HIV OR AIDS patient in any form can easily transfer this viral disease. It can also be transmitted through contact with semen or vaginal fluids of the infected person. This occurs in the case when one is sexually exposed to a person with HIV.

HIV once enters the body, invades and conquers the immune system making the body susceptible to other diseases. It is then very easy for the simple flu or cold infection to be severe as the immune system is no longer fit to fight it.

When detected in the early period can be battled with, but more often than not people assume the symptoms to not be AIDS so it spreads and kills the individual. To be protected when having sex and not sharing any form of toiletries with others is the way to prevent and keep this deadly virus at bay.

Long Essay on AIDS

This is the long format of an essay on HIV AIDS where its workings, causes and effects and remedies are discussed.

There are some diseases that have been borne by the living in this world which has created a ruckus in human history and the struggle to find a permanent cure still exists. AIDS is one such disease. Acquired Immunodeficiency Syndrome is the name of the disease which is also shortened as AIDS.

It has since only the 20 th century affected the human race and many people lost their lives, more than 20 million of them. The virus that aids in the transmission of this disease is Human Immunodeficiency Virus or also called HIV. Due to the same property of immunodeficiency, it is referred to as HIV/AIDS.

Since it affects the immune system severely, the cells and the workings of it in our body must be clearly understood. The immune system’s role in the body is that of a soldier wherein it identifies any sort of anomalies that enters or infiltrates the body and prepares antibodies against it. And kills them in order to prevent infection that has the probability of causing a harmful disease.

Since the cells of the immune system have already created the antibodies, the cell memory is activated when the entry occurs again and the immune system fights and destroys such foreign and harmful matter.

What Happens when HIV Enters the Body?

When a person is infected with the Human immunodeficiency virus, it directly attacks the immune system making the cells weak and incapable of creating antibodies for this particular virus. As they become weak their function to perform the task of defending against other microorganism entrants is also weakened.

When the fighter in our bodies becomes weak, we are more likely to fall ill. The illness can be a simple flu or an allergy and our body cannot fight any further. The symptoms once infected will start to appear within the first two weeks. The symptoms are very flu-like for instance, one will be more tired than usual and fatigue will be more frequent and regular. Other symptoms include sore throat and fever. The risk of opportunistic infections like tuberculosis and herpes also increases. Some people however remain asymptomatic even for longer periods after being infected with the virus.

Cause of HIV/AIDS

The main and only cause of this dreadful disease is the contact through blood, semen, pre-seminal fluid, vaginal fluids, rectal fluids and breast milk. The semen and vaginal fluids are transferred through sex and rectal fluids through anal sex. When people have multiple partners, and they have unprotected sex the transmission is highly likely. The contact through blood can also be via the unhygienic practice of sharing an infected person’s razors, blades. Even unsterilized syringes while taking drugs or even a tattoo parlor where they use unsterilized machines on the body can transmit the virus easily. The transmission means are endless so one must proceed with utmost caution to keep themselves safe either way.

What is the Life Expectancy for the Patients Carrying HIV or AIDs with Them?

Many factors can affect the life expectancy of people living with HIV. Depending on these factors there are many differences in the outcomes between people, and other factors. The factors on which life expectancy depend are:

Access to effective HIV treatment and quality health care.

Start HIV treatment as soon as possible after HIV infection, before your CD4 cell count drops to a low level. The sooner you are diagnosed and start HIV treatment, the better your long-term chances are.

Having serious HIV-related illnesses in the past. This may occur before HIV is diagnosed and/or before HIV treatment is started. These diseases have a detrimental effect on life expectancy.

Results one year after starting HIV treatment. Studies show that life expectancy is better for people who respond well within a year of starting treatment than people who do not respond. In particular, people with a CD4 count of at least 350 and an undetectable viral load during the year have a much better chance long-term.

Year of Diagnosis - HIV treatment and medical care have improved over the years. People who have been diagnosed in recent years are expected to live longer than people who were diagnosed long ago.

Heart diseases, liver diseases, cancer and other health conditions are more likely to be the cause of death than HIV or AIDs.

Injecting drug use - Life expectancy is short for people with HIV who inject drugs, due to drug overdose and viral infections.

Social and Economic Conditions - there are significant differences in life expectancy depending on where you grew up, your income, education, social status and more.

Gender – Men are supposed to live for a shorter period of time than women.

Genetics - you may have certain conditions if close relatives have.

Mental and Emotional Well-being - high levels of stress are associated with reduced life expectancy.

Lifestyle - longevity for people who eat a balanced diet, are physically active, maintain a healthy weight, avoid alcohol abuse or use drugs, and stay in touch with the community. Avoiding smoking is very important in life.

There are a few myths surrounding this disease. It is believed earlier that AIDS can spread even through contact or touch without any exchange of fluids. Like through a hug or just by being near the infected person. That myth has been debunked and it is absolutely untrue. One can freely hug an AIDS patient without worry.

The other one was when kissing, there is an exchange of saliva which is also a fluid and AIDS can spread through kissing, which also proved to be untrue. And HIV always means AIDS that is fatal was another rumor or myth, and this myth is proven wrong where many people have lived longer with HIV by medication and taking care of their health.

There is no permanent cure yet for treating HIV/AIDS, so it is our responsibility to look out for ourselves. The way one can first prevent themselves from being infected is by getting vaccinated. It is important to get tested in your adult life if you have multiple sexual partners and also get your partner tested for the same. The other way is being monogamous. The most used form of prevention is having protected and safe sex and using condoms that creates a barrier for transmission. Do check for sterilized needles in case you decide to get a tattoo or injected.  Lessen the use of alcohol and drugs as that is anyway weakening and altering the immune system.

According to the estimates of the Indian government  2.40 million Indians are living with HIV wherein, the infected ones fall in the age group of 15-49, and 39 %of them that is 9,30,00 of them are women. The numbers are alarming and the rate of increase is not slowing down anytime soon. We as a country must break the traditions and conversations about sex should be open and safe. It is high time we lose our lives to this disease which can be prevented.

FAQs on Essay on AIDS

1. Is AIDS an Autoimmune Disease?

In the early stages of HIV infection that leads to AIDS, the immune system only weakens so it is not an auto-immune disease. But during the later and final stages, the workings of the immune system are similar to that of an auto-immune system where it works against itself. And in such cases, the body of the individual is susceptible to many more diseases. AIDS, a disease found in immune deficiency disorder, is caused by HIV and weakens the human immune system. Autoimmune diseases, on the other hand, are where the immune system turns, attacking healthy cells.

2. Does one die from HIV Infection?

The HIV infection results in many symptoms that make the body weaker day by day. But some do not even suffer those symptoms and they may live longer than the ones showing severe symptoms. In any case, it is important to take medications that are prescribed to reduce the severity of symptoms and live a little longer. The best way is to keep healthy and lead an active lifestyle as much as possible. Although the death toll from AIDS has dropped dramatically around the world, this situation increases the risk of contracting a fatal disease — potentially leading to death. No treatment or cure is present for HIV.

3. What method was adopted by the hospitals to report HIV or AIDs cases?

The doctors took the active initiative for the reporting and diagnosis of HIV or AIDs cases all over the world. The methods that all the French hospital wards were known for, for their role in controlling HIV infection, were asked to report the 2000 deaths among HIV-positive adults. The causes of death were recorded using a standard questionnaire. The Mortality 2000 study was launched to explain the distribution of the leading causes of death of HIV-positive people at the national level in France in the year 2000.

4. What is the way of determining the root cause of death in AIDs patients?

Following the International Classification of Diseases, 10th Revision (ICD-10) to death, the information contained in the questionnaire was used to determine the single cause of death. The causes of AIDS were categorized as one cause of death, followed by definitions of AIDS-related diseases. If a standard questionnaire was lost, summarized quarter notices were used to determine the underlying cause of death, if possible. Determination of the AIDs cases was set to the most important things in the list, which was done from the abstracted quarterly notifications from the questionnaires.

5. Is Vedantu a reliable website for knowing about AIDs disease?

Vedantu is the most reliable website for referring to information about AIDs disease. Being one of the most dangerous diseases in the world with no proper treatment or cure, the world's physicians are still under pressure to decipher the way to save a person from this disease. The Vedantu website contains authentic or updated information about this disease and thus the readers and viewers can rely on this source of information for perfect knowledge about the disease and its prevention also.

Development, Sexual Cultural Practices and HIV/AIDS in Africa pp 187–198 Cite as

Conclusion and Recommendations

• Samantha Page 2  
• Open Access
• First Online: 20 December 2018

7742 Accesses

In this conclusion I bring together the various threads of my argument. First, I summarise each chapter in relation to the themes identified and the analytical frame employed in this study. Second, I present my three key arguments. Third, I contextualise my study in terms of where we are today with AIDS at the global level and within Malawi. Fourth, I demonstrate how this study contributes to academic debates. Finally, I present recommendations to improve policies and programmes on HIV and AIDS at the international and national level.

You have full access to this open access chapter,  Download chapter PDF

The focus of this research was to examine how policies and programmes on HIV prevention and the sexual cultural practice of fisi have come to be linked. My findings show that policies have been constructed based on inaccurate imaginings of both the sexual behaviour of rural people, who have been primarily blamed for the spread of HIV, and the Malawian elites’ and international donors’ misunderstanding of the bio-medical evidence surrounding HIV transmission during one heterosexual act. I have shown this by using the example of the fisi practice; a practice that involves a man having sex with girls during initiation. Although there are many sexual cultural practices taking place in Malawi, I focused on this practice, as while I was in Malawi working as Programme Manager for a sexual and reproductive health NGO, it was this practice that was recounted to me at length by those working for NGOs and stimulated a desire to learn more.

According to work on sexual cultural practices, they act as a mechanism rendering women inferior to men, and it is this inferiority that renders them vulnerable to violence (Mkamanga 2000 ; Kamlongera 2007 ). For example, Anderson ( 2012 ) in her study on women’s bodies in Malawi, argues that most women who participate in sexual cultural practices are unable to refuse, as within wider society there is an understanding of a universal ‘masculine sex-right’ where men have the right to make decisions over what can be done with a female body, which makes women vulnerable to violence. Kistner and Nkosi ( 2003 ) argue that masculinity has emerged as one of the key factors at the interface between gender-based violence and HIV/AIDS. Thus, we can see that the practice of such sexual acts can lead to women’s susceptibility to violence.

This research draws attention to the fact that the probability of infection from one heterosexual act, such as the fisi practice, is very low: as reflected in the epidemiological evidence provided in this research (Gray et al. 2001 ; Powers et al. 2008 ). In light of this, the thrust of the study is the exposure of misconceptions among development practitioners and policymakers in Malawi concerning AIDS: this misconception is grounded in the view that certain cultural practices are fueling the HIV pandemic in Malawi. This research has predominately focused on revealing how very little if any bio-medical evidence is being used to inform current policies and programmes on AIDS in Malawi. Instead a handful of Harmful Cultural Practices have been targeted as the problem, which has led to a focus on eradicating those deemed dangerous. Yet I found that there is no evidence that the sexual practice of fisi has a higher transmission rate than other sexual practices that are common within Malawi. While a fisi may be more likely to be HIV positive than the average male, it is the case that intercourse with a fisi is usually a single act of intercourse and is far from an everyday occurrence: since intercourse within marriage is much more frequent and the use of condoms in marriage is infrequent (Chimbiri 2007 ), regular marital relations are thus more likely to lead to infection than intercourse with a fisi . For HIV prevention purposes, it would be far more useful to focus on more frequent practices, such as transmission within marriages or stable couples.

In the health sector, the concept of evidence-based policy has gained ground. Yet as I have demonstrated, a lack of capacity to make use of existing data in policy development and programmes imply that inefficiencies in the development process have not been properly identified and addressed. Most HIV prevention programmes in Africa have also arguably had limited impact because the research behind them focused primarily on risk groups, behavioural change models, and flawed understandings of cultural practices and economic conditions (Packard and Epstein 1991 ; Waterston 1997 ). In other words, the explanations given by the National AIDS Commission and non-governmental organisations for high rates did not rely enough on biomedical facts but rather on constructed categories of ‘at risk’ groups which once interrogated, can be seen to be inaccurate.

In this conclusion I bring together the various threads of my argument. First, I summarise the findings and discussion of this research in relation to the themes identified and the analytical frame employed in this study. Second, I present my three key arguments. Third, I contextualise my study in terms of where we are today with AIDS at the global level and within Malawi. Fourth, I demonstrate how this study contributes to academic debates. Finally, I present recommendations.

Summary of Key Findings

In Chapter 1 , I provide an introduction to the topic including motivation for this research and my methodological approach.

In Chapter 2 I reviewed the literature within the field of anthropology of development, with particular emphasis on the work of Mosse ( 2011 ) and Crewe and Harrison ( 1998 ). Both demonstrate that many actors are involved in the policy process, which is not linear or straight forward: this makes it hard to unravel by whom these policies are constructed. These scholars demonstrate the usefulness of ethnography as a way of understanding the threads that interlock in the formation of policies and thereby have helped me identify how misconceptions seeped into the policy process in relation to HIV prevention in Malawi; although I do not analyse the policy process elsewhere in sub-Saharan Africa, it is likely to be similar to that of Malawi. They critically analyse the complex relationships of power between global multilateral organisations, donors, governments of resource-poor countries and local communities, and their impact on development projects. They also demonstrate how to critically engage with development practice by combining academic development work with academic writing and reflection therefore they have insights due to their positioning. Their approaches have been instrumental in developing my own analytical framework, as my research looks at how different elites working within the field of AIDS are able to construct policies based on vested agendas and interests.

In Chapter 2 the work of Chin ( 2007 ) is also particularly relevant to the central argument of my research, that elites working on HIV and AIDS perpetuate the myth that the fisi practice contributes significantly to the spread of HIV in Malawi. I argue that Malawian elites perpetuate this myth to maintain their professional status and to secure external funding from donors for projects on HIV prevention. Chin ( 2007 ) argues that UNAIDS and AIDS activists accept certain myths about HIV epidemiology to keep the disease on the political agenda and, by implication, ensure funding and jobs.

In Chapter 2 , due to the inter-disciplinary nature of this research, I show how a number of theories influenced by argument. First, using the approaches used within the anthropology of development I provide a critique of HIV policymaking. Second, and in order to understand how policy was constructed based on misconceptions, I draw on elite and policymaking theories to demonstrate how the policy process is being mediated by the agendas of elites as opposed to bio-medical facts. Third, I use postcolonial theory to highlight how the elites are interpreting for themselves the colonial narrative that is founded on a binary opposition; civilised (the elites) and the uncivilised (the rural uneducated population) (Galtung 1971 ). This then enables the elites to distance themselves from those living in rural areas, allowing them to maintain a position of power and access to the resources flowing in from the aid community.

In this chapter I also review literature on HIV epidemiology. Epidemiological studies have estimated the risk of HIV-1 transmission. Although Malawians believe that HIV transmission is inevitable in a single act of unprotected intercourse (Anglewicz and Kohler 2009 ), epidemiologists found that the average rate of HIV transmission is 1 in 1000. These findings demonstrate that HIV is not easily transmitted. This is relevant to my study because the fisi practice occurs as a one-off heterosexual act and therefore it is statistically unlikely that this practice contributes significantly to the spread of HIV.

Moreover, the practice of fisi occurs in only a very small number of rural communities. In this chapter I also argue that the traditional practice of fisi is being utilised as a scapegoat for the spread of AIDS in Malawi to deliberately detract attention away from everyday sexual practices in urban areas of Malawi, such as extramarital relations and multiple sexual partners. As reflected in the evidence below, HIV prevalence is in fact higher in urban areas where the fisi practice does not take place.

In Chapter 3 I demonstrate the powerful and influential role that international donors (bilateral and multilateral agencies and INGOS) play in constructing AIDS policies and programmes. Additionally, this chapter emphasises that aid conditionality can fail to respond effectively to the AIDS epidemic by demonstrating how funding is often donor led. For example, if donors disagree with policies being implemented in the country to which they are supplying aid, whether it is the way money is being spent or the type of policies the government implements, then they will withdraw funds. I provide an example of the British Government suspending aid because it was unhappy with the President of Malawi’s autocratic management style. The paradox of such policies in practice is that they reduce the ability of nation states to be self-sufficient and instead put them in a dependency relationship with international donors.

Data from the Malawi Demographic and Health Survey ( 2004 ) shows that urban residents have a significantly higher risk of HIV infection than rural residents. While 18% of urban women are HIV positive, the corresponding proportion for rural women is 13%. For men, the urban–rural difference in HIV prevalence is even greater; urban men are nearly twice as likely to be infected as rural men (16 and 9%, respectively) (MDHS 2004 , p. 231). This is significant because harmful cultural practices are reported to be largely rural practices, yet infection rates are significantly higher in the urban areas where the majority of the elites—Malawians with at least a university education—live. This highlights the inaccuracy in the elites’ narrative, one that blames rural Malawians for high prevalence rates. The problem is conversely higher in urban areas where the elites live. Further, HIV prevalence rates are higher among women aged 30–34 compared to women aged 15–19 (there is no data for women under 15). The fact that data was not collected and yet this is the demographic that is partaking in initiation ceremonies supports my argument that those blaming the sexual cultural practice of fisi for the spread of HIV lack evidence to support their case. In terms of education and wealth, the HIV prevalence rate is highest among women with a secondary education and above (15.1%) compared to those women with no education (13.6%). In terms of income those women with the highest rates of HIV were in the top wealth quintile. The emphasis of AIDS policies should therefore in fact be attributed more to contemporary patriarchal constructions of gender and power than a one-off highly un-evidenced traditional sexual practice.

I also examined how the advent of AIDS has provoked a reinterpretation of the impact of certain sexual cultural practices, which have now been labeled ‘risky’ or harmful. Some studies carried out have used culture as an explanation for high-risk behaviour, which can lead to HIV infection (Rushton and Bogaert 1989 ; Rushing 1995 ; Caldwell et al. 1989 ). However, this research shows that targeting specific population groups as opposed to addressing gender inequalities and issues of sexual power to a general population can be ineffective and misleading. This book does not argue that the cultural practices such as the fisi practice are not harmful and violent towards women but that these are not adversely contributing to the spread of HIV. Incorrect messages regarding HIV transmission rates are relayed which inhibit effective programme implementation.

Chapter 4 began by reviewing national and international policies on gender-based violence, harmful cultural practices and HIV/AIDS to highlight how these policies have been constructed around harmful cultural practices. I then reviewed literature on elites and used this to inform my own argument that policy processes are driven by elites as opposed to the argument made by Lasswell ( 1936 ) that policy implementation is a linear, rational process. These policies are being constructed around narratives of blame, which portray rural communities as backwards and the parties responsible for spreading HIV. This chapter concludes that the elites use these narratives as an ‘imagined fact’ in terms of how they contribute to high prevalence rates.

In Chapter 5 I argue that elite Christian religious morality has played an active role in portraying indigenous cultural practices as negative and blaming them for the spread of HIV/AIDS. In this chapter I also demonstrate how Christian elites portray themselves and their theology as enlightened in comparison to the minority Muslim population. Thus, casting indigenous cultural practices as responsible for the spread of AIDS with the agenda to undermine forms of traditional culture and validate a Christian lifestyle as unproblematic in terms of AIDS.

In Chapter 6 I examine theories of policy implementation, arguing against scholars such as Lasswell’s ( 1936 ) presentation, that policy implementation is a linear, rational process. Instead, I agree with Lipsky ( 1980 ), Lindblom ( 1980 ), Shore and Wright ( 1997 ), and Sabatier ( 2007 ) who postulate that policy processes are less of a linear sequence but rather a political process underpinned by a complex mesh of interactions and ramifications between a wide range of stakeholders who are driven and constrained by competing interests and the context in which they operate.

I have argued that there are a wide range of stakeholders involved in policy construction and implementation. These stakeholders include large, and powerful bilateral and multilateral agencies, such as DFID, USAID and the World Bank, as well as international Non-governmental organisations, national NGOs, international and national faith-based organisations, and the organs of the Malawi government, both at the national and the district levels, each with its own vested interests and each with its own policies. Therefore I argue the evidence produced to apply policies is not objective evidence but narratives shaped by various policy agendas and interests of the elites. As a result policies are pushed in a direction that does not benefit the vast majority of Malawi’s population in terms of HIV prevention, but instead perpetuate these groups’ standings and beliefs.

The Three Main Arguments

In this book I argue that a complex interplay of interests has led to the construction of the narrative that the sexual cultural practice of fisi is contributing significantly to the spread of HIV and AIDS. I argue this interplay can be best understood through three sets of arguments. Although these three sets of arguments are presented separately here, in practice these are interlocking.

The first and main argument is that the ‘narrative of blame’ is maintained by the national elites in Malawi to ensure that HIV is kept on the development policy, thus attracting donor funding and retaining elites’ professional status. I place emphasis on understanding policy construction as a process mediated by stakeholders involved in the policy process and argue that one reason why national elites are able to influence the policy agenda on HIV is due to the narrative they have constructed that has been sold to the donors. Thus they have a vested interest creating and maintaining the narrative of harmful cultural practices as responsible for the AIDS epidemic. This agenda permits them to maintain their own status and positions. Therefore, by maintaining the narrative that the sexual cultural practice of fisi , as well as other cultural practices that the elites consider harmful, drive the AIDS epidemic, they try to ensure that the policies and programmes directed to reduce HIV transmission continue.

The second argument identified in this study is that AIDS is presented by national, urban elites as a rural disease because the sexual cultural practice of fisi is reported to take place in rural areas. Therefore the narrative told by the elites is that the disease is being spread by people living in rural areas who are mainly illiterate and uncivilised. This narrative distances the urban elite from the disease, thus detracting attention from the higher level of AIDS in urban than in rural areas. As I highlight in this study, this ‘othering’ is a result of those elites working in HIV prevention providing explanations to ‘problems’ that satisfy donors and therefore ensure continued funding. Therefore, educated, urban elites who perceive themselves as civilised distance themselves from rural people who they position as uncivilised. I argue that elites in Malawi maintain their positions through adopting concepts of modernity held by the donors that rely upon a binary that divides the modern from the un-modern. Thus, the Malawian elites present themselves to donors, and potential donors, as suitable partners.

The third argument is that the Malawian elites have constructed a category of ‘uncivilised’, populated by those with little education (the majority of Malawians). They contrast these with themselves: educated Christians who are modern and progressive. This leads them to assert their superiority by placing the blame for the AIDS epidemic on those who practice what they call ‘harmful cultural practices’ that they associate with Malawian traditional religions. Within this context, Christian leaders play a role in projecting the narrative of blame as an ideological tool to promote a Christian lifestyle.

Contribution to AIDS Policy in Malawi

I have argued that although findings from epidemiological studies have shown that the probability of infection by one heterosexual act is 1 in 1000, I demonstrate that epidemiological evidence is ignored by policymakers. The gap between research and policy therefore needs to be bridged by disseminating research findings to policymakers so that when development programmes are designed they are based on evidence. Therefore for policy to be effective it needs to be informed by objective, empirical research on the population as a whole. For example, epidemiological evidence is particularly useful when preventing and controlling disease in populations and guiding health and health care policy and planning. Therefore such evidence can enrich health policies and plans to improve the health of a population.

The second contribution I make is a methodological one, enabling an understanding of how policy translates into practice across levels from the global arena down to the community level. The analytical framework and approach I proposed intended to facilitate analysis in evaluative and formative studies of—and policies and programmes on—AIDS, to generate meaningful evidence to inform policy. Therefore this study is not just applicable to Malawi but may be used in any country in the Global South. It is an original contribution to research as it focuses on narratives told by actors working in organisations, which focus on AIDS, while also tracing the impact of these narratives on the production of policies and programmes, rather than on geographically bounded local communities. My analytical framework has built on theoretical propositions and empirical research in development studies, particularly the work of Mosse ( 2011 ) and Crewe and Harrison ( 1998 ). I show that narratives on AIDS and sexual cultural practices are an obstacle to the development process. I argue these narratives become the dominant themes in the construction of policies. As a result, other key themes such as gendered power relationships are ignored or overlooked.

Thirdly, this study demonstrates a contribution to ethnographic research as it has shown how ethnography can be used to help construct policy and practice, which responds to the complexity of peoples’ lives. Using this ethnographic approach has enabled me to highlight why progress is slow in terms of improving gender relations and has emphasised how these narratives of blame are used as a smokescreen to pursue government and donor interests.

The newspaper article by Nyasa Times ‘Gender Minister wants women to hurt “hyenas”’ tells the story of the Minister of Gender who, speaking at an event to commemorate 16 days of activism against gender-based violence, advised women to hurt the hyena. She is reported to have said ‘Hit them (those hyenas) hard in their private parts and I can assure you it hurts’ ( Nyasa Times 2011 ). Of course, advising women to carry out violent acts towards men is not particularly helpful and will not help improve women’s lives: to the contrary, it could leave them more vulnerable to abuse. But it is examples such as this one featured in the Malawi media that can be read by international donors and thereby influence international policy and programmes.

Recommendations

The following recommendations are based on the research I conducted for this study. What this research enabled me to do is develop my critical thinking on this issue.

Policies and programmes developed on HIV/AIDS at the international and national level need to be informed by rigorous evidence, collected through critical, reflexive methodologies.

To advance HIV/AIDS policies and programmes, stakeholders will need to embed policies in epidemiological evidence and pay greater attention to how the wider political contexts at national and international levels impact on the policy and implementation processes.

Stakeholders need to better articulate the link between sexual cultural practices, gender-based violence and women’s health.

Donors need to ensure they visit rural areas so that they understand the culture of the country and respond to local concerns and priorities.

Quantification of the risk of HIV infection after sexual intercourse is difficult to measure therefore more quantitative studies are also needed regarding the risk of HIV infection after sexual intercourse to inform policy.

Research needs to be accessible to non-academics. Researchers need to educate policymakers, by carrying out research that focuses on the ordinary cultural practices, such as extramarital relationships instead of the taken-for-granted understandings of rural people.

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Page, S. (2019). Conclusion and Recommendations. In: Development, Sexual Cultural Practices and HIV/AIDS in Africa. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-04119-9_7

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Essay on the HIV/Aids Health Issue in South Africa

The Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) is one of the major health challenges affecting public health in South Africa. Despite South Africa’s efforts to avail medications for controlling and reducing viral transmission, HIV/AIDS still poses a significant health challenge to the public. The disease has already devastated thousands of families across the country. Deaths resulting from HIV/AIDS have orphaned millions of children and disrupted the normal structure of the community. HIV/AIDS has affected almost every sector of life. The pandemic has largely contributed to the increase in health expenditures in South Africa. The critical level of care required by the patients is forcing the government to divert resources that would otherwise be used to finance other development projects. Apart from overburdening the overall health and social support expenditures in the country, the virus is claiming the lives of hundreds of health practitioners in South Africa. The HIV/AIDS pandemic in South Africa is a complicated public health issue that requires a strategic approach from the national governmental organizations, non-governmental organizations, and international organizations.

Historical Context of HIV/AIDS in South Africa

South Africa reported its first HIV case in 1982, a time when the country was fighting to end the apartheid system (Hodes, 2018). The government ignored the HIV/AIDS problem as the country was facing other serious challenges such as political unrest. The media outlets did not react to the pandemic immediately (Hodes, 2018). Politics dominated major headlines at the time and the public was not immediately made aware of the pandemic. HIV silently began to take hold mostly among the gay population of South Africa and the black population.

Three years after the first case was reported, the department of health initiated a public awareness campaign. The campaign included the use of coffins and skeletons to convey messages about HIV/AIDS in the country (Hodes, 2018). The campaign however did not convey messages on the mode of transmission. In 1987, the apartheid government sought to restrict the civil liberties of infected persons (Hodes, 2018). South Africans diagnosed with HIV were quarantined while immigrants who had the disease or were suspected to have been infected were deported back to their countries.

By 1990, HIV/AIDS prevalence in South Africa had reached an all-time high. The country was at this time transitioning from apartheid to democracy and the government was facing a myriad of challenges which included corruption and abuse of power (Hodes, 2018). There was no elaborate plan by the government to handle the HIV/AIDS issue. The department of health was unable to take the appropriate measures to curb the spread of the disease. Infected people could not access the life-saving antiretroviral treatment (Hodes, 2018). These factors led to the rise of public health activist movements in the country. Members of these movements sought to compel the government to enable public access to testing and treatment of the virus. The movements further sought to force the government to undertake the necessary steps to curb the spread of the virus.

The efforts of the activists saw the formation of The National Aids Convention of South Africa (NACOSA) in 1991 (Geffen and Welte, 2018). This organization sought to strengthen partnerships among civil groups, health workers, and development agencies in a bid to curb the spread of HIV on the. In 1993, the South Africa government published its first plan to intervene HIV/AIDS pandemic issue (Hodes, 2018). Despite all these activities, the response to the pandemic remained inadequate and ineffective. Cultural challenges impeded the government’s efforts in addressing the HIV/AIDS issue. For instance, it was a taboo among some South African communities to talk openly about sex.

Current Developments of HIV/AIDS Pandemic Issue

Currently, South Africa has the highest HIV prevalence rate in the world. Out of the 58 million people in the country, 7.7 million are estimated to have contracted the virus (Avert, 2020). In the Southern Africa region, South Africa alone accounts for 30% of all new HIV infections. Of the 240,000 new infections in 2018, 71,000 were from South Arica (Avert, 2020). The burden of the pandemic has profound implications on the development of South Africa. The high rates of HIV-related infections and deaths have compromised household stability and investments in children.

The government of South Africa has made commendable efforts to address the HIV/AIDS issue. Steps undertaken by the government include enhanced clinical testing and financing the anti-retroviral program (ART) (Avert, 2020). Today, South Africa has the largest antiretroviral treatment in the world (Avert, 2020). This program is largely financed from domestic resources. As a result of the ART program, the national life expectancy in the country has increased from 56 to 63 years.

There has been notable progress in the testing and suppression of the virus. A report by the world health organization indicates that 90% of the people living with HIV have so far been tested and 87% of them have enrolled in the treatment program (Avert, 2020). The prevalence, however, remains high especially in the Western Cape and in KwaZulu-Natal areas.

HIV/AIDS Health and Social Policies in South Africa and a Comparative Analysis with the United States

Access to Testing

The government of South Africa has launched a number of HIV testing and care programs. The two recent nationwide testing initiatives are the National HIV testing and the National HIV/AIDS counseling campaign (Avert, 2020). These initiatives were part of the government’s policy to have people working in the private sector and the higher education sector get tested for the virus. As a result of this policy, more than 10 million people have since been tested (Avert, 2020). There have however been discrepancies in the number of women when compared to that of men who present themselves for testing. More women are tested as compared to men. Men are reportedly worried about queuing outside the testing facilities.

Access to HIV testing is a priority in many other countries. In the United States, for instance, the government has undertaken measures to include annual HIV testing for people aged between 15-65 years (Avert, 2019). Such measures include the expansion of the national health insurance program. The rate of people who turn in for HIV testing in the United States of America is however low as compared to that of South Africa. In the United States, people have a low disease risk perception while others are afraid of being stigmatized after diagnosis.

Access to Care and Treatment

The United Nations program introduced the 90-90-90 targets to mitigate the adverse effects of HIV/AIDS (UNAIDS, 2017). In line with the UN’s program, South Africa guarantees free and reliable access to anti-retroviral treatment (ART) (Avert, 2020). At least 4.8 million people in the country are receiving HIV/AIDS treatment as a result of the free access to care and treatment policy (Masquillier et al., 2020). Studies reveal that more women than men are more likely to enroll for ART in South Africa and as a result, the mortality rate of men is twice that of women.

Just like in South Africa, there is free access to care and treatment policy for the people living with HIV/AIDS in the United States (Avert, 2020). Testing for HIV/AIDS in the United States has become widespread over time. However, more than half of the adult population are were yet to turn out for testing as at 2012 (Rizza et al., 2012). The number of people who turn in for these services in the United States is, however, lower when compared with that of South Africa. This can be attributed to lack of awareness and misconceptions related to the HIV/AIDS virus in the United States.

Education and Awareness

The government of South Africa has made numerous efforts to educate the masses and create awareness of the HIV/AIDS pandemic (Avert 2020). The government is determined to use the education policy to provide comprehensive sexuality education in both public and private schools. By the end of the year 2016, only 5% of the schools were offering sexuality education in South Africa (Avert 2020). The government is planning to introduce a system of education that will assist learners to prevent and report incidents of sexual violence.

In the United States, the status of sexual health education is insufficient in most areas. There are claims that sexual education is not taken seriously and in some cases, it does not start early enough for the learners. The number of schools where students are supposed to get advice on HIV prevention keeps decreasing in the United States. Offering HIV/AIDS education and creating awareness has not been taken seriously in the United States. According to the Centers for Diseases Control and Prevention (2016), many Americans have become complacent about HIV/AIDS and at least a quarter of the patients are not aware of their statuses.

Legislation

Through legislation, the government of South Africa has managed to minimize cases of discrimination on an HIV status basis. Section 6(1) of the constitution requires the public especially those at the workplace to desist from any form of unfair discrimination based on a person’s HIV status (Mubangizi, 2009). The constitution bars employees from dismissing employees who turn out to be HIV positive. These laws aim to promote a non-discriminatory work environment and curb the stigmatization of HIV patients.

HIV/AIDS Pandemic issue in the Context of Social Divisions in South Africa

Apart from HIV/AIDS being a medical problem in South Africa, it is a social problem. This is demonstrated by the virus’s widespread, ineffectiveness and the inability of the medical department to control HIV expansion in the country. South Africa is one of the world’s countries that have experienced gross social inequalities (Gordon, Booysen and Mbonigaba, 2020). Such inequalities are mostly based on racial, class, and gender factors. Apartheid for instance has for a long time shaped the social profile and as a result, derailed the efforts to deal with the HIV/AIDS pandemic.

Social divisions and issues related to it have been the major setback in the fight against the virus. Whereas anyone regardless of their social status can get infected with HIV/AIDS, certain groups of people are at a higher risk of getting the infection (Avert, 2020). These groups of people engage in high-risk behaviors while others experience stigma and discrimination. Stigma and discrimination are among the major hindrances for people to seek HIV testing and treatment. If the social issues are well understood and dealt with, the government and international organizations could effectively roll out prevention programs to the people at high risks.

Women in South African society have an unequal cultural, social, and economic status. This is largely a result of inequitable laws and harmful cultural practices that empower men and disempower women. Women are at a higher risk of contracting the virus as compared to men. By 2017, the percentage of women infected stood at 26% while that of men stood at 15% (Avert, 2020). Gender-based violence, poverty, and the low status of women in South Africa are largely to blame for the high disease prevalence among women. A third of women in the country have at one time experienced intimate partner violence.

A report by the world health organization indicated that the HIV prevalence among young women was much higher than that of young men in the year 2018. Intergeneration relationships between older men and young women were understood to be the major force behind this disparity. Discriminative social attitude towards women makes it harder for them to access testing and treatment services.

South Africa is among the countries with the highest unequal distribution of resources (Gordon, Booysen and Mbonigaba, 2020). The HIV/AIDS epidemic in the country has brought about huge demands for medical care in the public health sector. As a result, the disease is more prevalent among the middle class and lower class population.

Preventing early deaths arising from HIV-related infections requires a household member to first identify the infection through testing, and enroll in the treatment program. Though testing is free in South Africa, there are other related expenses such as transport fees. People of the lower class may have problems in financing such expenses. People of the lower social class report lower rates of HIV testing as compared to those of high social class.

Being of a lower social class in South Africa is associated with reduced or no food security, lack of food diversity, and increased chances of skipping meals. Poor women are forced to adopt behaviors that increase their risk of getting infected. These behaviors include commercial sex and early marriages. HIV patients require a balanced diet to boost their immune response to opportunistic infections. In addition, Low-class people may have difficulties accessing protection equipment such as condoms due to their reduced financial capability.

Globally, racial inequalities play a significant role in escalating the HIV/AIDS pandemic. Some ethnic groups are at a higher risk of acquiring and transmitting HIV when compared to other ethnic groups. This is because, in some places such as South Africa, some population groups have higher rates of HIV/AIDS prevalence. The risk of acquiring the infection in these groups is high.

In South Africa, Black African males have high HIV/AIDS prevalence as compared to their counterparts from other races (Avert, 2020). The high prevalence among blacks is created by historical social injustices and unequal social and economic status. The apartheid particularly has contributed significantly to the HIV prevalence among the black community in South Africa (Hodes, 2018). In a country where blacks are the majority, apartheid perpetuated HIV through denial of health services and access to quality education to the black community. Apartheid policies mostly addressed the social and economic advances for the minority white communities at the expense of the black race. Up to date, the black community is yet to recover from the burden of high HIV prevalence which would otherwise not be there had it not for the apartheid system.

Cultural Issues

The high prevalence of HIV/AIDS in South Africa has prompted speculations regarding risk factors that may be unique to the country. Some cultural practices increase the risk of HIV/AIDS in the region. These factors include polygamy, early marriages, and virginity testing. All these vices characterize most South African societies.

Polygamy is not primarily a harmful practice that can directly lead to the spreading of HIV/AIDS. However, how people in polygamous marriages conduct themselves ends up facilitating the spread of the virus. Wives in a polygamous marriage have little or no control over the sexual behaviors of their husbands or co-wives. Infidelity for instance could be a catalyst for the spread if the cheating partner gets infected. In the KwaZulu-Natal community of South Africa, there has been a resurgence of virginity testing (Ngubane, 2020). The public identification of a young girl as a virgin increases her risk of sexual abuse.

Age and Family Status

By 2018, the number of HIV-infected children in South Africa stood at 260,000 and 63% of them were on treatment. These were children of age 0-14 (Avert, 2020). The rate of infection among young children is lower as compared to that of people aged 15 years and above. The decline in new infections among children is attributed to the government’s efforts in preventing mother-to-child HIV transmission. Children are however mostly affected by the HIV pandemic through the loss of their parents and guardians. HIV/AIDS pandemic has orphaned At least 1.2 million children in South Africa (Avert, 2020). This creates another problem as these children lose their providers. They become insecure and vulnerable to HIV due to economic and social insecurities. Such children become targets of sexual predators who force them to have sex in exchange for support.

The Role of International Organizations and Aid Agencies in Addressing the HIV/AIDS Issue

There are many international organizations involved in the fight against the spread of the HIV/AIDS pandemic. These organizations engage in a coordinated effort to stop new HIV infections and ensure that everyone living with the virus has unrestricted access to testing and quality treatment. International Organizations such as the Joint United Program on HIV/AIDS (UNAIDS) are responsible for promoting human rights for the patients and producing data for decision making. Some of the prominent international organizations involved in this fight include The Global Fund, The World Health Organization (WHO), and UNAIDS. These organizations undertake the international role of policy formulation and legislation in matters concerning the HIV/AIDS pandemic.

Formulation of Policies

One of the policies adopted by international organizations is the creation of awareness about HIV/AIDS. Kaiser Family Foundation for instance focuses on the provision of the latest data and information about the virus (Kaiser Family Foundation, 2016). The organization conducts research and data analysis on regular basis. In addition, Kaiser Family Foundation works with major news organizations across the world to enable easy access to information. Its information is provided free of charge.

International health organizations aim to build a better and healthier future for people living with HIV/AIDS across the world. These organizations advocate for equality and preservation of human rights regardless of their health status. The World Health Organization particularly provides evidence-based technical support to countries across the world. The organization supports its members in the quest to scale up the treatment of the virus and slow down its spread. The mission of such organizations is to lead collective action on the global HIV response.

The United Nations General Assembly fully recognizes human rights and freedoms. The organization has formulated a number of international regulations and guidelines meant to protect HIV patients across the world. Following a global outcry against the high cost of HIV treatment, the ministerial council in 2001 made a regulation prompting its members to take measures to protect public health (Patterson and London, 2002). The United Nations members were required to allow easier access to medications for people living with the virus.

International organizations have made numerous efforts to form and support national organizations. These national organizations comprise professionals and HIV/AIDS victims who are united in advocating for the rights of patients. With the support of the United Nations Development Programme, many countries have been able to form law associations meant to oversee the implementation of the rights of patients. Organizations such as legal clinics promote laws and policies on human rights and freedom.

Global Issues in the Fight against HIV/AIDS

The global economic crisis is a major hindrance to the international fight against HIV/AIDS. The UNAIDS faces a greater challenge in ensuring that UN agencies heed their call of supporting developing countries that are severely affected by the pandemic. Financing a sustainable response to the disease is a hard task especially for developing nations. With the emergence of other pandemics that require huge financing, international organizations face a challenge in financing the HIV/AIDS control measures.

The emergence of other infections has derailed the international fight against HIV/AIDS. Currently, the world is battling a new virus. The COVID-19 pandemic has a serious impact on the most vulnerable communities and impedes the progress of the fight against HIV/AIDS. World resources are now redirected to the new virus. At the moment, there is no single country that is immune to the increasing economic cost of the new pandemic.

The HIV/AIDS pandemic poses a significant health threat to South Africa. The complex nature of the disease makes it even harder for the government and other international organizations to develop a comprehensive approach to addressing it. The government and other organizations, however, have made numerous efforts to intensify testing, treatment, and provision of care to HIV patients. All these efforts have been derailed by other social factors such as class differences, gender inequalities, ethnicity, and cultural issues. In its efforts to slow the spread of the disease and mitigate its adverse effects, the government has enacted a number of policies. The policies include free access to HIV testing, education, and the creation of public awareness. International organizations have made numerous efforts to help South Africa and other developing nations in fighting the virus. These include financing the war against the disease and developing policies meant to address the HIV/AIDS issue.

 Avert. 2019. HIV and AIDS in the United States of America (USA). [Online] Available at: <https://www.avert.org/professionals/hiv-around-world/western-central-europe-north-america/usa> [Accessed 17 April 2021].

Avert. 2020. HIV and AIDS in South Africa. [Online] Available at: <https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/south-africa> [Accessed 17 April 2021].

Centers for Disease Control and Prevention. 2016.  Challenges in HIV Prevention . [Online] Available at: <https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/challenges-508.pdf> [Accessed 6 May 2021].

UNAIDS. 2017. Ending Aids; Progress towards the 90-90-90 targets. [Online] Available at: <https://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf> [Accessed 17 April 2021].

Geffen, N. and Welte, A., 2018. Modeling the human immunodeficiency virus (HIV) epidemic: A review of the substance and role of models in South Africa.  Southern African Journal of HIV Medicine , 19(1).

Gordon, T., Booysen, F. and Mbonigaba, J., 2020. Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa. BMC Public Health, 20(1).

Hodes, R, 2018. ‘HIV/AIDS in South Africa’,  Oxford Research Encyclopedia of African History .

Kaiser Family Foundation. 2016. HIV Awareness and Testing. [Online] Available at: <https://www.kff.org/slideshow/hiv-awareness-and-testing/> [Accessed 17 April 2021

Masquillier, C., Knight, L., Campbell, L., Sematlane, N., Delport, A., Dube, T., and Wouters, E., 2020. Sinako, a study on HIV competent households in South Africa: a cluster-randomized controlled trial protocol. Trials, 21(1).

Mubangizi, J., 2009. HIV/AIDS and the South African Bill of Rights, with specific reference to the approach and role of the courts.  African Journal of AIDS Research , 3(2), pp.113-119.

Ngubane, L., 2020. Traditional Practices and Human Rights: An Insight on a Traditional Practice in Inchanga Village of Kwazulu-Natal, South Africa. The Oriental Anthropologist:  A Bi-annual International Journal of the Science of Man , 20(2), pp.315-331.

Patterson, D. and London, L., 2002. International law, human rights, and HIV/AIDS. [Online] Global Public Health and International Law. Available at: <https://www.who.int/bulletin/archives/80(12)964.pdf> [Accessed 17 April 2021].

Rizza, S., MacGowan, R., Purcell, D., Branson, B. and Temesgen, Z., 2012. HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions.  Mayo Clinic Proceedings , 87(9), pp.915-924.

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• The Relationship Between the High Rate of Urbanization in Africa and AIDS Spread This movement results in to increase in the number of people in the towns and cities in a particular year. The increased social interaction of people in towns has led to increased HIV/AIDS infections in […]
• Language and Stigmatization: Cancer, HIV, and AIDS Much has been written concerning the alarming spread and effects of HIV/AIDS in the society and the effects of cancer and the position of its victims and how to care for them.
• The Human and Economic Effects of AIDS on the United States The social impact of HIV has been well documented and widely distributed which has served to educate the public and acted to stem the tide of the epidemic.
• Workplace Stereotypes About People With HIV: Business Ethics After analyzing the every angel of the case, it can be said that this is the picture of the stereotyping prejudice of people with AIDS.
• Capitalism and Industrialization as a Cause of AIDS Spread Population growth rates are the highest in most of Asia, Africa, and Latin America due to the high degree of fertility and the dramatic decrease in mortality following World War II.
• The Pharmaceutical Industry Faces AIDS in Africa Food insecurity in these countries has to lead to the quick progression of patients to full brown AIDS and completely worsened the immunity of the patients.
• HIV, AIDS and the Social Environment The obvious place to start is to find out the sociological impact of HIV/AIDS with regards to the infected person. Thus, there is a tendency to concentrate on the scientific aspect of the disease as […]
• African Gold: Ethics and AIDS in the Workplace The issue that is troubling the management of the organization in the case, African Gold is that of the costs, medical costs and disability programs as a result of the rising workforce succumbing to the […]
• Center for Disease Control and HIV Prevention Goals The first short-term mission of the CDC Preventions is to increase the percentage of those HIV-affected people who indulge in such activities which alleviates the risks or dangers of HIV transmission.
• AIDS Infection in Europe Statistics: A National Disaster in Many Countries Most of these young men and women that engage in this business are end up being infected with HIV virus since they do not have the power to negotiate for safe sex and especially the […]
• Rational System of HIV Disclosure Laws Since the start of HIV pandemic, the humanity aimed to regulate and minimize the spread of the infection. The people, who became the victims, as they were unaware of the danger of the infection, finally […]
• World AIDS Day Celebration: Increasing the Awareness of the People About the Disease The World AIDS Day is not just celebrated in the United States, Europe, or Asia, it is observed all over the world because the disease does not only affect this part of the globe, but […]
• Public Policy Development. AIDS.gov Benefit Types CDC is a premier public health agency which undertakes the control and prevention of AIDS in US, and their mission is to promote health and quality of life.
• Public Policy. Eligibility Rules Used by AIDS.gov There are no restrictions that prohibit the tailoring of health care programs by clients and using various services and providers that are eligible for meeting the health care needs of individuals.
• HIV/AIDS and Orphans in Sub-Saharan Africa On the choice of orphans in sub-Saharan Africa as the topic for this research, it aims at addressing the cause of overwhelming numbers of orphans in the region and how this impacts society.
• Social Networks of People Living With HIV and AIDS The purpose of the study was to compare the social networks of younger patients with the older ones. The convoy theory of social support lent credence to the research.
• Changes in Prostitution and AIDS Epidemic in Thailand This provided information on commercial sex trends such as the types of CSEs in existence, the number of sex workers, and the price of sex. However, the decline in the number of sex workers was […]
• How AIDS.gov Fund Its Programs to Respond to the Impact of the Epidemic on Ethnic and Minority Populations Transportation costs to go to the clinic and lost wages should be accounted for and records kept acting as evidence of how the funds were used.
• The Pharmaceutical Industry and the AIDS Crisis in Developing Countries One of the reasons of this difference is that excise and custom duties that are responsible for the unaffordable prices of medicines have been avoided by the developed countries by the creation of pharmaceutical industries, […]
• Advancements in AIDS Research: A Potential Advancement in the Attempt to Cure HIV Infection After HIV’s genetic code is altered from a single thread to a double-strand by the reverse transcriptase enzyme, it gets included in the genetic code of the infected cell.
• Ethics of Leukemia Treatment With Disabled HIV Cells In recent years, the medical community has pondered the radically new approach to cancer treatment, which is isolating and collecting T-cells from the patient.
• AIDS: Emergence Factors of Infectious Disease Emerging diseases refer to the newly identified pathogens that have been recognized in the past few decades that lead to a new manifestation of diseases.
• AIDS and Its Impact on Humankind: The Leading Killer Disease in the World From these statistics, it is easy to deduce the effect of the disease of humankind. At the international level, more and more funds have been committed to the treatment of AIDS.
• AIDS in a Different Culture Review: Cultural Differences, Prejudice, and Racism Now, gay youth and men face the possibility of HIV infection in the course of sexual relationships. The pejorative view of gay men prevalent in some black and Hispanic communities can inhibit they are coming […]
• Lewis’ Race Against Time: Curbing HIV&AIDS in Africa Lewis points out that, “HIV/AIDS has sabotaged all of the socioeconomic indices, and the continued damaging western policies in trade and aid and debt, serve to drive the nails into the coffins”.
• Community Health. HIV/AIDS Prevention for the 50+ The specificity of the paper is that it relates the issue of HIV prevention for the people over 50. It is necessary to mention, that: 10% of all AIDS cases in the USA are people […]
• Microbiology. AIDS Vaccine Studies: Different Developments Strategy So far there is no practical hope that ongoing AIDS vaccine development will produce tangible results, According to one of the leading AIDS vaccine expert Mr. Clinical trials will have to continue as they will […]
• Medical Anthropology. HIV&AIDS Preventive Measures Since the detection of the first case of HIV in India, the government introduced both surveillance and preventative plans to reduce the risk of the disease spread.
• Drug Treatments for HIV/AIDS To lower the complacency of people to HIV/AIDS and change the perceptions about the condition for individuals with and without HIV/AIDS, health care professionals should focus on such aspects as safety, responsibility, and stigma.
• Descriptive and Analytical Epidemiology: Tuberculosis and HIV The establishment of trends in the epidemic process for the rapid introduction of adjustments helps optimize preventive and anti-epidemic measures alongside the evaluation of the effectiveness of the activities.
• AIDS and Its Related Aspects The report aims to show that clinicians and nurses should discuss AIDS and associated risks with their patients to enhance individuals’ health outcomes and eliminate the prevalence of the disease.
• Anti-HIV Nonprofit’s Organizational Design Particularly, three areas of concern are of the primary interest: the design and functional characteristics of NGOs, the problem of HIV in the context of NGOs, and differences between organic and mechanistic organizational structures.
• HIV and AIDS: Legal and Ethical Conduct
• OraQuick Home HIV Test and Its Pros & Cons
• Female HIV-Positive Patients’ Medication Adherence
• Immunology and Virology of HIV Infection
• Mandatory HIV Screening: Ethical Issues
• Spreading and Dying From AIDS and the Increasing Spread of the Disease
• Health Fraud: HIV/AIDS and Sexual Enhancement Scams
• HIV and AIDS Early History and Risks
• HIV Prevention Programs in Africa
• HIV and AIDS Infection Levels and Their Social Effects
• HIV Prevalence Among American Queer Communities
• HIV Testing Among African American Women
• HIV Rates Among African American Women
• HIV Prevention Policy Development for Chicago
• HIV Prevention Among Young Adults in Chicago
• Techniques for Helping Women With HIV
• Group Policy Regarding the HIV/AIDS Transmission Issue
• Pharmacology: HIV Drug Resistance
• HIV Prevention in Youth: Public Health Campaign
• HIV/AIDS as a Long-Wave Event in Politics
• Act Up Movement for Surviving HIV/AIDS Plague
• HIV/AIDS Activism in “How to Survive a Plague”
• HIV/AIDS Prevention by Anti-Retroviral Drugs
• The Impact of AIDS and Reasons Behind the Outbreak
• HIV/AIDS Policies in India and Antropological Study
• AIDS in New York in “How to Survive a Plague” Film
• ”The Cure for AIDS” by Apoorva Mandavilli and Various Ethical Issues
• Qatari Laws: HIV/AIDS Visitors, Pets, Dressing Code
• Legal Ethics, Patients’ Rights, and HIV/AIDS
• HIV/AIDS as a Communicable Disease
• Ancillary Services for HIV/AIDS Patients
• HIV/AIDS Patients: Legal Ethics and Patient Rights
• Medicine: HIV/ AIDS Campaign Slogan
• Medicine: HIV/AIDS as the Key Threat for the Kenyan Population
• HIV and AIDS in Kenya
• HIV/AIDS in Kenya: Evaluation Plan
• Health Promotion Program HIV/AIDS in Kenya
• HIV Among Adolescents – Treatment and Prevention
• HIV/AIDS Definition, Prevention and Treatment
• Medical Issues: HIV in the U.S.
• 5 Years Strategic Plan for HIV Prevention in Swaziland
• HIV and AIDS Prevention Among the Youth in Asia
• STD/HIV Health Promotion Evaluation Plan
• HIV and AIDS: an Evolving Global Response
• HIV Epidemic in Enrique’s Native Country
• AIDS: From the Perspective of Sociology
• Critical Analysis of Avahan – the India AIDS Initiative
• HIV/AIDS by Allan Whiteside
• The Rate of Smoking Among HIV Positive Cases.
• Critical Review of Chapter 5 and 6 of the Book HIV/AIDS
• AIDS Combating in the 21st Century: Issues and Challenges
• HIV/AIDS in the UK
• History of Treatment the HIV/AIDS
• Pathology of HIV and AIDS
• How the AIDS Epidemic Has Affected the World on a Political, Social, Economical Way
• The HIV and AIDS Problem Between Educated and Non-Educated Children in Uganda
• Implementation of AIDS Control Policies in Australia and South Africa
• HIV/AIDS Among African Americans
• AIDS: The Guilt and Failure of the West in a Spread of the Disease
• AIDS as an Epidemic of Signification: A Globally Potential Threat
• Key Drivers of HIV/AIDS in Sub Saharan Africa and in San Francisco
• Key Drivers of HIV and AIDS in Sub-Saharan Africa and in San Francisco and Church’s Response to the AIDS Pandemic
• Drivers of HIV and AIDS in Sub-Saharan Africa and San Francisco
• Impact of HIV/AIDS on Microeconomics
• Why Lack of Awareness Leads to the Spread of HIV/AIDS in New York Prisons
• Theory, Methodology and Human Development: HIV/AIDS and Education in African Countries
• Vital Signs: HIV Testing and Diagnosis Among Adults – United States, 2001-2009
• Community HIV/AIDS Mobilization Project (CHAMP)
• Communicable Diseases: HIV and AIDS
• Why HIV/AIDS Crises Are High in African-American Community
• A Project on Establishment of Jousing Flats Voluntary Counselling and Testing Centers in Njoro Area to Reduce Prevalence of HIV/AIDS and Provide Nutritional Support Among the Youths Aged Between 16-35 Years
• HIV/AIDS Issues in African Women
• AIDS in Lesotho, Africa: The Highest Prevalence Rate of HIV Infections in the World
• Prevention of HIV/AIDS in Rural Ethiopia: Identifying Risks
• Is Being HIV Positive a Disability?
• Why Does the Immune System Weaken With HIV Infection?
• What Is the Main Cause of HIV?
• How Does HIV Gain Entry Into the Cells It Attacks?
• What Can Gamma Delta T Cells Contribute to an HIV Cure?
• What Are the 4 Stages of HIV Infection?
• What Are the 5 Symptoms of HIV?
• Does the HIV Virus Evolve?
• What Is the Good News for HIV-Positive Patients?
• What Is the Impact of HIV on Society?
• What Are the Symptoms of HIV/Aids?
• How Long Will HIV Take to Show Up?
• Can Mosquitoes Transmit HIV?
• How Can You Get HIV?
• How Fast Does HIV Spread in the Body?
• What Can the Government Do to Stop HIV?
• When Did HIV First Arise?
• Why Are Child Victims of Sexual Abuse at Greater Risk of HIV?
• How Long Do HIV Symptoms Last?
• Will There Be a Cure for HIV by 2030?
• Can You Survive HIV-Positive?
• How Many Teenagers Are Affected by HIV?
• Is There Currently a Cure for HIV?
• What Age Group Has the Highest HIV Infection Rate?
• How Long Can You Live After Having HIV?
• What Are the Three Biggest Risk Factors for HIV?
• Which Antibody Functions Are Important for an HIV Vaccine?
• Can You Drink When HIV Positive?
• Why Is HIV Research Important?
• What Resources Are Available for HIV Patients?
• Chicago (A-D)
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IvyPanda . 2024. "264 HIV Essay Topic Ideas & Examples." February 29, 2024. https://ivypanda.com/essays/topic/hiv-essay-topics/.

1. IvyPanda . "264 HIV Essay Topic Ideas & Examples." February 29, 2024. https://ivypanda.com/essays/topic/hiv-essay-topics/.

Bibliography

IvyPanda . "264 HIV Essay Topic Ideas & Examples." February 29, 2024. https://ivypanda.com/essays/topic/hiv-essay-topics/.

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CSW68 session outcomes

Agreed conclusions.

The outcome of the Commission on the Status of Women’s consideration of the priority theme during its 68th session (2024) took the form of agreed conclusions, negotiated by all Member States.

The Commission adopted agreed conclusions on “Accelerating the achievement of gender equality and the empowerment of all women and girls by addressing poverty and strengthening institutions and financing with a gender perspective” on 22 March 2024.

• CSW68 agreed conclusions (advance unedited version)

Resolutions

The Commission on the Status of Women adopted the following resolutions:

• Resolution on women, the girl child and HIV and AIDS (E/CN.6/2024/L.5)

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