Prevention to Care: USAID's Interrelated Strategies for
Fighting the HIV/AIDS Pandemic
Since 1986, the U.S. Agency for International Development
has provided over $2.3 billion for the fight against the
global AIDS pandemic, more than any public or private organization
in the world. This year, with a budget
of $795 million, USAID will assist more than 50 countries
with HIV/AIDS programs, with 23 of these countries considered
high priority.
USAID's strategy is to support those programs
that can save the most lives. In countries with a high-prevalence
of HIV/AIDS, USAID must help prevent new infections, provide
care and treatment and address the needs of children and
families affected by AIDS. These activities are multi-faceted
and interrelated. In countries with lower prevalence of
the disease, the emphasis is primarily on prevention. In
all countries, improving national surveillance, increasing
the capacity of health systems and working in partnership
with host country colleagues and other partners are essential
program elements.
USAID has been pursuing the following
interrelated strategies since 1997:
Prevention.
Preventing new infections continues to be the most urgent
priority in the fight against HIV/AIDS, with about 70 percent
of USAID's HIV/AIDS budget committed to this goal. Prevention
activities are designed to slow, and ultimately reverse,
rising HIV infection rates, so that fewer people will suffer
the dire consequences of AIDS. USAID's prevention programs
include:
- Developing interventions to change or prevent high risk
sexual behavior
- Treating other sexually transmitted infections, which
increase the efficiency of HIV transmission
- Increasing demand for and access to condoms and other
essential commodities
- Preventing mother-to-child transmission of HIV
- Promoting voluntary HIV counseling and testing, which
is an effective way to achieve sustainable behavior change.
Care
and treatment. Experience shows that individuals
will seek to learn their HIV status where care and treatment
are available. Today the fight against HIV/AIDS includes
providing care and treatment; both for humanitarian reasons
and because providing care enhances prevention efforts through
increasing use of voluntary counseling and testing. Care
and treatment interventions help to stabilize or improve
the physical or mental health of individuals infected or
affected by HIV/AIDS and reduce the burden on their families.
They provide hope to those who have or fear they may have
HIV/AIDS, destigmatize HIV/AIDS, prevent secondary epidemics
of TB, and stabilize communities. USAID supports 25 care
and treatment projects in 14 countries, with interventions
including:
- Treating tuberculosis and other opportunistic infections
- Providing psychosocial and palliative care for persons
with HIV-related symptoms such as pain, fever, or diarrhea
- Providing adequate nutrition
- Working with faith- and community-based organizations
to develop care and support systems
- Introducing
antiretroviral drugs at three sites in Africa
Supporting
children affected by HIV/AIDS.
USAID's assistance to children affected by AIDS draws upon
community resources to develop programs and solutions. USAID
currently has more 75 projects in 22 countries working with
children affected by AIDS, including material support, such
as food, school fees, shelter, clothing, in addition to
economic strengthening activities, counseling, psychological
support, and community care.
Increasing surveillance capacity to track the epidemic.
USAID supports programs to monitor the status of the epidemic,
measure the impact of prevention, treatment and care programs,
coordinate donor and other partner activities, and use resources
most effectively.
Increasing the capacity of developing
country health systems. Already overstretched health
systems in poor countries have difficulty responding to
the many issues raised by the emergence of HIV/AIDS. USAID
works with these countries to assist them in developing
guidelines about the kinds of care their system can provide
and organize support for those guidelines among health care
providers. USAID also assists in developing management systems
that support prevention and care and to regulate private
sector care.
Working in partnership. Collaboration with partners
is a distinctive feature of USAID's HIV/AIDS program. USAID
has worked extensively with other international donors,
national governments, and a range of host-country and U.S.-based
institutions and community organizations to build sustainable
systems, use participatory approaches and incorporate lessons
learned. USAID works to enlist the active, sustained and
visible support of national political leaders in mobilizing
their own governments to change people's behavior and to
address the pandemic. USAID also works to generate additional
financial and human resources from an array of sources,
including the private sector and international initiatives
like the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Providing technical leadership through
research. A hallmark of USAID's HIV/AIDS program is
ongoing biomedical and behavioral research to develop and
evaluate new tools for preventing HIV transmission and for
providing improved services for those living with HIV and
AIDS. This includes applied research in 21 countries, groundbreaking
research on microbicides, and funding the International
AIDS Vaccine Initiative to accelerate development of an
effective vaccine.
Creating a supportive environment.
Stigma and ignorance are the greatest barriers to containment
of the HIV/AIDS pandemic, and the provision of care for
those affected. Overcoming the stigma attached to HIV/AIDS
and the resulting discrimination is essential to combating
the pandemic. Protecting the human rights of persons living
with HIV/AIDS and their caregivers is an important concern
for USAID programs.
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