By Syed Akbar
BALI, Aug 13: The Asia Pacific Coalition on Male Sexual Health (APCOM) will
conduct a full-day forum on August 8 on the unique challenges posed by
HIV infection among men who have sex with men (MSM) and transgenders
(TG) in the region.
The interactive consultation is an official pre-conference activity of the 9th International Congress on AIDS in Asia and the Pacific (ICAAP 9) being held in Bali. Authorities from around the world armed with the latest epidemiological data will provide important new insights into the directions the epidemic is taking in the region.
Every 7.5 minutes in Asia Pacific, a man who has sex with men, irrespective of their being homosexual or heterosexual, gets infected with HIV. APCOM, a regional coalition focusing on HIV and MSM of community-based organisations that includes the government sector and the United Nations system, will target its day-long forum squarely on this key affected population.
It will bring together a diverse mix of experts, from developers of national HIV response programmes to scientific researchers to those involved in the UN’s global and regional response to HIV among MSM and TG. They are joined by community leaders from the Asia Pacific region involved in local, national and sub-regional service delivery and community mobilization.
Asia Pacific faces a number of hurdles that make HIV prevention among MSM particularly difficult, including religious and cultural attitudes, legal,
economic and social discrimination, linguistic challenges and varying levels
of awareness. Highly concentrated and severe HIV epidemics among MSM in urban areas across the region are well documented, yet investment in HIV programming for MSM and TG remains limited, ranging from 0% to 4% of the total spending for HIV programming in countries region-wide.
Several major cities across the region are now experiencing HIV epidemics
among men who have sex with men. Recently released data from Myanmar, for example, shows the estimated HIV prevalence rate among MSM in Yangon to be hovering near 30%. In Bangkok, it is 30.7%, Phnom Penh 8.7%, Mumbai 9.6%, and Beijing 5.8%.
Showing posts with label AIDS. Show all posts
Showing posts with label AIDS. Show all posts
Wednesday, 12 August 2009
ICAAP9: Call for stronger commitment to universal access
By Syed Akbar
Bali, Aug 9: The 9th International Congress on AIDS in Asia and the Pacific (ICAAP) opened Sunday with calls for a strengthened commitment to achieving Universal Access and providing prevention, care, support and treatment for those who need it most.
Indonesian First Lady and AIDS Ambassador, Her Excellency Hj. Ani Bambang Yudhoyono, and other AIDS Ambassadors also urged nations to work towards implementing the Declaration of Commitment adopted at the UN General Assembly Special Session on AIDS in 2001 and the Political Declaration of 2006, despite the pressures of the global economic crisis.
More than 3,000 delegates are taking part in ICAAP at the Bali Convention Centre in Indonesia. This year's theme is "Empowering People, Strengthening Networks."
In a message to the Congress, UNAIDS Executive Director Michel Sidibé said some countries in the Asia Pacific were beginning to see success in their efforts to reverse the spread of HIV, but not enough to break the trajectory of the epidemic.
“We must transform the AIDS response in Asia so that it works for people — especially for people who have been marginalized and without a voice," he said.
"This means protecting sex workers, men who have sex with men, transgender, injecting drug users and their intimate partners.”
A meeting of AIDS Ambassadors discussed ways of mobilizing greater action and putting in place stronger accountability measures in responses to the continuing epidemic.
ICAAP is a biennial gathering for the release and discussion of scientific, programmatic and policy developments in the global response to HIV/AIDS and is convened by AIDS Society of Asia and the Pacific (ASAP).
Local Organizing Committee Chair Prof. Dr. Zubairi Djoerban said,
“The 9th ICAAP takes place when this region, like much of the world, is challenged by stability threats and of a new variant of influenza which have claimed lives while leaving many others severely ill the world over.
“For this very reason, let me express my gratitude to all of you who have unaffectedly shown your greatest courage to be here and enhance our commitment to reverse the course of the AIDS epidemic in the region,”
Bali, Aug 9: The 9th International Congress on AIDS in Asia and the Pacific (ICAAP) opened Sunday with calls for a strengthened commitment to achieving Universal Access and providing prevention, care, support and treatment for those who need it most.
Indonesian First Lady and AIDS Ambassador, Her Excellency Hj. Ani Bambang Yudhoyono, and other AIDS Ambassadors also urged nations to work towards implementing the Declaration of Commitment adopted at the UN General Assembly Special Session on AIDS in 2001 and the Political Declaration of 2006, despite the pressures of the global economic crisis.
More than 3,000 delegates are taking part in ICAAP at the Bali Convention Centre in Indonesia. This year's theme is "Empowering People, Strengthening Networks."
In a message to the Congress, UNAIDS Executive Director Michel Sidibé said some countries in the Asia Pacific were beginning to see success in their efforts to reverse the spread of HIV, but not enough to break the trajectory of the epidemic.
“We must transform the AIDS response in Asia so that it works for people — especially for people who have been marginalized and without a voice," he said.
"This means protecting sex workers, men who have sex with men, transgender, injecting drug users and their intimate partners.”
A meeting of AIDS Ambassadors discussed ways of mobilizing greater action and putting in place stronger accountability measures in responses to the continuing epidemic.
ICAAP is a biennial gathering for the release and discussion of scientific, programmatic and policy developments in the global response to HIV/AIDS and is convened by AIDS Society of Asia and the Pacific (ASAP).
Local Organizing Committee Chair Prof. Dr. Zubairi Djoerban said,
“The 9th ICAAP takes place when this region, like much of the world, is challenged by stability threats and of a new variant of influenza which have claimed lives while leaving many others severely ill the world over.
“For this very reason, let me express my gratitude to all of you who have unaffectedly shown your greatest courage to be here and enhance our commitment to reverse the course of the AIDS epidemic in the region,”
UNAIDS guidelines on terms to be used for HIV/AIDS patients
Summary of preferred terminology for use in HIV/AIDS reporting
HIV/AIDS;
HIV and AIDS
Use the term that is most specific and appropriate in the context. Examples include people living with HIV, HIV prevalence, HIV prevention, HIV testing, HIV-related disease; AIDS diagnosis, children made vulnerable by AIDS, children orphaned by AIDS, the AIDS response, national AIDS programme, AIDS service
organization. Both HIV epidemic and AIDS epidemic are acceptable.
There is no “AIDS virus”. The virus associated with AIDS is called the Human Immunodeficiency Virus, or HIV. Please note: “virus” in the phrase “HIV virus” is redundant. Use HIV.
Avoid the term infected. No one can be infected with AIDS, because it is not an infectious agent. AIDS is a surveillance definition meaning a syndrome of opportunistic infections and diseases that can develop as immunosuppression deepens
along the continuum of HIV infection from primary infection to death. Use person living with HIV or HIV-positive person.
There is no test for AIDS. Use HIV or HIV antibody test.
The word “victim” is disempowering. Use person living with HIV. Use the term AIDS only when referring to a person with a clinical AIDS diagnosis.
Use the term patient only when referring to a clinical setting. Use: patient with advanced HIV-related illness (or disease) or AIDS-related illness (or disease).
Use risk of HIV infection; risk of exposure to HIV.
Use key populations at higher risk (both key to the epidemic’s dynamics and key to the response). Key populations are distinct from vulnerable populations, which may be subject to societal pressures or social circumstances which may make them more vulnerable to exposure to infections, including HIV.
Use sex work or commercial sex or the sale of sexual services.
Use only in respect to juvenile prostitution; otherwise use sex worker.
Use injecting drug user. Drugs may be injected subcutaneously, intramuscularly or intravenously.
)
Use using non-sterile injecting equipment if referring to risk of HIV exposure; use using contaminated injecting equipment if the equipment is known to contain HIV or if HIV transmission has occurred.
Use response to AIDS. Use evidence-informed.
Use HIV prevalence. The word “rates” connotes the passage of time and should not be used in most instances.
ions
Please spell out all abbreviations in full.
----------
Background for commonly used terms and abbreviations
ABC
Prevention strategies: abstain from penetrative sexual intercourse (also used to indicate delay of sexual debut); be faithful (reduce the number of partners or have sexual relations with only one
partner); condomize (use male or female condoms consistently and correctly). ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Not…immune deficiency. . .
ADVOCATE
As a verb: write ‘advocate change’ (rather than advocate for change).
AIDS CARRIER
This term is often used to mean any person living with HIV. However, it is stigmatizing and offensive
to many people living with the virus. It is also incorrect, since the agent being carried is HIV not AIDS.
AIDS- or HIV-RELATED ILLNESS OR DISEASE
Although ‘the person died of AIDS’ is commonly said or written, actually people do not die of AIDS, they die of HIV-related or AIDS-related disease. The expression AIDS-related illness can be
used if a person has an AIDS diagnosis.
AIDS RESPONSE
The terms AIDS response, HIV response, response to AIDS and response to HIV are often used interchangeably to mean the response to the epidemic.
AIDS VIRUS
Since AIDS is a syndrome, it is incorrect to refer to the virus as the “AIDS virus”. HIV (the human immunodeficiency virus) is what ultimately causes AIDS (acquired immunodeficiency syndrome).
In referring to the virus, write the full expression at first usage and then use HIV; avoid the term HIV virus (which is a tautology, i.e. it is saying the same thing twice).
ART
Spell out in full, i.e. antiretroviral therapy or antiretroviral treatment. The term ART can be used if it clearly refers to a triple antiretroviral drug combination.
BEHAVIOUR CHANGE (NOT ‘Behavioural Change’)
There are a number of theories and models of human behaviour that guide health promotion and education efforts to encourage behaviour change, i.e. the adoption and maintenance of healthy
behaviours.
CLIENT-INITIATED TESTING
Alternative term for voluntary counselling and testing (VCT). All HIV testing must be carried out under conditions of the “three Cs”: i.e. that it be confidential, accompanied by counselling and
conducted only with informed consent.
CONTAMINATED and NON-STERILE
Drug injecting equipment was “contaminated” if it caused infection, that is, the equipment contained HIV; “unclean”, “dirty” or “non-sterile” if it carried the risk of HIV exposure: that is, it may or may not have carried the virus.
COSPONSORS
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has the following ten cosponsors, listed in the following order (according to UN rules): United Nations High Commissioner for Refugees (UNHCR) http://www.unhcr.org/ United Nations Children’s Fund (UNICEF) http://www.unicef.org/ World Food Programme (WFP) http://www.wfp.org/ United Nations Development Programme (UNDP) http://www.undp.org/ United Nations Population Fund (UNFPA) http://www.unfpa.org/ United Nations Office on Drugs and Crime (UNODC) http://www.unodc.org/odccp/index.html International Labour Organization (ILO) http://www.ilo.org/ United Nations Educational, Scientific and Cultural Organization (UNESCO)
http://www.unesco.org/ World Health Organization (WHO) http://www.who.int/en/ World Bank http://www.worldbank.org/
CRIS
Country Response Information System. Developed by UNAIDS, CRIS provides partners in the global response to HIV with a user-friendly system consisting of an indicator database, a programmatic database, a research inventory database and other important information. The indicator database provides countries with a tool for reporting on national follow-up to the United
Nations General Assembly Special Session on HIV/AIDS (June 2001) Declaration of Commitment on HIV/AIDS. The country-level CRIS will be complemented by a Global Response Information Database (GRID), which will support strategic analysis, knowledge-based policy formulation and subsequent programming. At country and global levels a Research Inventory Database (RID) is also being developed.
CULTURAL DOMINANCE
Familiar terms used in some cultures may not be appropriate in other cultural contexts e.g. seasons of the year—avoid “fall” or “autumn” and prefer instead last quarter of the year or instead of summer prefer mid-year. Similarly remember that different cultures celebrate the New Year at different times and that seasons in the northern and southern hemispheres are opposite to each other.
DESCRIBING AIDS
AIDS is often referred to as a “deadly, incurable disease”, but this creates a lot of fear and only serves to increase stigma and discrimination. It has also been referred to as a “manageable, chronic illness, much like hypertension or diabetes”, but this may lead people to believe that it is not as serious as they thought. It is preferable to use the following description: AIDS, the acquired immunodeficiency syndrome, is a fatal disease caused by HIV, the human immunodeficiency virus. HIV destroys the body’s ability to fight off infection and disease, which can ultimately lead to death.
Currently, antiretroviral drugs slow down replication of the virus and can greatly enhance quality of life, but they do not eliminate HIV infection.
DRIVER
The term relates to the structural and social factors, such as poverty, gender, and human rights abuses that can increase people’s vulnerability to exposure to HIV. It is often reserved to describe underlying determinants.
EPIDEMIC
In epidemiology, an epidemic is a disease that appears as new cases in a given human population (e.g. everyone in a given geographic area; a university, or similar population unit; or everyone of a certain age or sex, such as the children or women of a region) during a given period, at a rate that greatly exceeds what is “expected” based on recent experience. Defining an epidemic is subjective, depending in part on what is “expected”. An epidemic may be restricted to one locale (an outbreak), more general (an epidemic) or global (a pandemic). Common diseases that occur at a constant but relatively high rate in the population are said to be “endemic”. Widely known examples of epidemics include the plague of mediaeval Europe known as the Black Death, the influenza pandemic of 1918–1919, and the current HIV epidemic which is increasingly described as a pandemic (made up of distinct types of epidemics in areas across the globe).
EPIDEMIOLOGY
Epidemiology is the branch of medical science that deals with the study of the incidence, distribution and determinants of patterns of a disease as well as its prevention in a population.
EVIDENCE-INFORMED
This term is preferred to evidence based in recognition of the fact that several elements may play a role in decision making, only one of which may be evidence; others may include cultural appropriateness, cost, feasibility and concerns about equity and so on.
FAITH-BASED ORGANIZATIONS
Faith-based organization is the term preferred instead of e.g. church, synagogue, mosque or religious organization, as it is inclusive (non-judgmental about the validity of any expression of faith) and moves away from historical (and typically European) patterns of thought.
FEMINIZATION
Referring to the pandemic, feminization is now often used by UNAIDS and others to indicate the increasing impact that it has on women. It is often linked to the idea that the number of women
infected has equalled, or surpassed, the figure for men or that women and girls are bearing the brunt of the epidemic in many settings.
FIGHT
Avoid using words such as “fight” and other combatant language e.g. struggle, battle, campaign or war, unless in a direct quotation. Alternatives include: response to; management of; measures against; initiative; action; efforts; and programme. One rationale for this is to avoid a transference being made from the fight against HIV to a fight against people living with HIV.
GAY MEN
Write “men who have sex with men” unless individuals or groups specifically self-identify as
gay. The broader community of men and women and transsexuals should be described as lesbian, gay, bisexual and transgendered—the abbreviation LGBT is often used for such communities, but
UNAIDS’ general preference is to spell out all terms in full.
GENDER and SEX
The term “sex” refers to biologically determined differences, whereas the term “gender” refers to differences in social roles and relations between men and women. Gender roles are learned through socialization and vary widely within and between cultures. Gender roles are also affected by age, class, race, ethnicity and religion, as well as by geographical, economic and political environments. Since many languages do not have the word gender, translators may have to consider other alternatives to distinguish between these concepts.
GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA
The Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2001, is an independent public-private partnership. Its purpose is to attract, manage and disburse additional resources to make a sustainable and significant contribution to mitigate the impact caused by HIV, tuberculosis and malaria in countries in need, while contributing to poverty reduction as part of the Millennium Development Goals. Since 2001, the Global Fund has attracted US$ 4.7 billion in financing through 2008. In September 2007, donors provided initial pledges to the Global Fund worth US$ 9.7 billion over three years. These pledges constitute the largest single financing exercise for health ever and they will allow the Global Fund to move towards annual commitments of US$ 6–8 billion by 2010. http://www.theglobalfund.org/en/
GIPA
An acronym for the “greater involvement of people living with HIV/AIDS”. In 1994, 42 countries prevailed upon the Paris AIDS Summit to include the Greater Involvement of People Living with
HIV/AIDS Principle (GIPA) in its final declaration. http://www.unaids.org/en/Issues/Affected_communities/gipa.asp
UNAIDS does not use the term “high-risk group” because it implies that the risk is contained within the group whereas, in fact, all social groups are interrelated. It may also lull people who don’t identify with such groups into a false sense of security. As well it can increase stigma and discrimination. It is often more accurate to refer directly to “higher risk of HIV exposure”, “sex without a condom”, “unprotected sex”, or “using non-sterile injection equipment” rather than to generalize by saying “highrisk
group”.
Membership of groups does not place individuals at risk, behaviours may. In the case of married and cohabiting people, particularly women, it may be the risk behaviour of the sexual partner that places them in a “situation of risk”. There is a strong link between various kinds of mobility and heightened risk of HIV exposure, depending on the reason for mobility and the extent to which people are removed from their social context and norms. UNAIDS prefers the term “key populations” because it emphasizes that these populations, while being important to the dynamics of HIV transmission in a setting, are equally essential partners for an effective response to the epidemic.
HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)
This term is now infrequently used in favour of antiretroviral treatment or therapy (ART). It referred to treatment regimens recommended by leading HIV experts to aggressively suppress viral replication and slow the progress of HIV disease. The usual HAART regimen combines three or more different drugs such as two nucleoside reverse transcriptase inhibitors and a protease inhibitor, two nucleoside analogue reverse transcriptase inhibitors and a non-nucleoside reverse transcriptase inhibitor or other combinations. More recently, new drugs have been developed to prevent the virus from entering the cell. These treatment regimens have been shown to reduce the amount of virus so that it becomes undetectable in a patient’s blood.
HIPC INITIATIVE
The Heavily Indebted Poor Countries Initiative is a debt relief tool for increasing the funds that countries have available and for ensuring that they are channelled to core human development
priorities, such as basic health care. The HIPC initiative, created in 1996 by the World Bank and further enhanced in 1999, has already helped some of the poorest nations in the world to free up precious resources for human development that would otherwise have been spent on servicing debt.
Fully funded and implemented, the enhanced HIPC initiative has the potential to be an even more powerful tool to allow countries to devote more resources to combating infectious diseases.
HIV-RELATED DISEASE
Symptoms of HIV infection may occur both at the beginning of HIV infection and after immune compromise sets in, leading to AIDS. During the initial infection with HIV, when the virus comes
into contact with the mucosal surface, it finds susceptible target cells and moves to lymphoid tissue where massive production of the virus ensues. This leads to a burst of high-level viraemia (virus in the bloodstream) with wide dissemination of the virus. Some people may have flu-like symptoms at this stage but these are generally referred to as symptoms of primary infection rather than HIV-related disease. The resulting immune response to suppress the virus is only partially successful and some virus escapes and may remain undetectable, sequestered in reservoirs for months to years.
As crucial immune cells, called CD4+ T cells, are disabled and killed, their numbers progressively
decline. In this manner, HIV-related disease is characterized by a gradual deterioration of immune function. Eventually high viral turnover leads to destruction of the immune system, sometimes
referred to as advanced HIV infection, which leads to the manifestation of AIDS.
HIV-INFECTED
As distinct from HIV-positive (which can sometimes be a false positive test result, especially in infants up to 18 months of age), the term HIV-infected is usually used to indicate that evidence of
HIV has been found via a blood test.
HIV-NEGATIVE
Showing no evidence of infection with HIV (e.g. absence of antibodies against HIV) in a blood or oral fluid test. Synonymous with seronegative. An HIV-negative person can be infected if he or she is in the window period between HIV exposure and detection of antibodies.
HIV-POSITIVE
Showing indications of infection with HIV (e.g. presence of antibodies against HIV) in a blood or oral fluid test. Synonymous with seropositive. Results may occasionally be false positive.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
The virus that weakens the immune system, ultimately leading to AIDS. Since HIV means “human immunodeficiency virus”, it is redundant to refer to the HIV virus.
HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 (HIV-1)
The retrovirus isolated and recognized as the etiologic (i.e. causing or contributing to the cause of a disease) agent of AIDS. HIV-1 is classified as a lentivirus in a subgroup of retroviruses. Most viruses
and all bacteria, plants and animals have genetic codes made up of DNA, which is transcribed into RNA to build specific proteins. The genetic material of a retrovirus such as HIV is the RNA itself. The viral RNA is reverse transcribed into DNA, which is then inserted into the host cell’s DNA preventing the host cell from carrying out its natural functions and turning it into an HIV factory.
HUMAN IMMUNODEFICIENCY VIRUS TYPE 2 (HIV-2)
A virus closely related to HIV-1 that has also been found to cause AIDS. It was first isolated in West Africa. Although HIV-1 and HIV-2 are similar in their viral structure, modes of transmission
and resulting opportunistic infections, they have differed in their geographical patterns of infection and in their propensity to progress to illness and death. Compared to HIV-1, HIV-2 is found primarily in West Africa and has a slower, less severe clinical course.
INCIDENCE
HIV incidence (sometimes referred to as cumulative incidence) is the number of new cases arising in a given period in a specified population. UNAIDS normally refers to the number of people (of
all ages) or children (0–14 years) who have become infected during the past year. In contrast HIV prevalence refers to the number of infections at a particular point in time (like a camera snapshot). In specific observational studies and prevention trials, the term incidence rate is used to describe incidence per hundred person years of observation.
INJECTING DRUG USERS (IDUs)
This term is preferable to drug addicts or drug abusers, which are seen as derogatory terms and which often result in alienation rather than creating the trust and respect required when dealing with
those who inject drugs. UNAIDS does not use the term “intravenous drug users” because subcutaneous and intramuscular routes may be involved. It is preferable to spell out in full and not use the abbreviation. An acceptable alternate phrasing is people who inject drugs.
INTERVENTION
This term conveys “doing something to someone or something” and as such undermines the concept of participatory responses. Preferred terms include programming, programme, activities, initiatives, etc.
MILLENNIUM DEVELOPMENT GOALS (MDGs)
Eight goals developed at the Millennium Summit in September 2000. Goal 6 refers specifically to AIDS but attainment of several goals is being hampered by the HIV epidemic. http://www.un.org/millenniumgoals/
MONITORING AND EVALUATION REFERENCE GROUP
Established by UNAIDS, the Monitoring and Evaluation (M&E) Reference Group (MERG) has a broad membership of national, bilateral agency and independent evaluation expertise, enabling it to assist in the harmonization of monitoring and evaluation approaches among collaborating organizations
and in the development of effective monitoring and evaluation of the response to the epidemic.
MSM
Abbreviation for “men who have sex with men” or “males who have sex with males”. This term is useful as it includes not only men who self identify as gay or homosexual and have sex only with other men but also bisexual men, and heterosexual men who may, nonetheless at times have sex with other men.
MTCT
Abbreviation for “mother-to-child transmission” (PMTCT is the abbreviation for “prevention of mother-to-child transmission”). Some countries prefer the term “parent-to-child transmission” to
avoid stigmatizing pregnant women and to encourage male involvement in HIV prevention.
OPPORTUNISTIC INFECTIONS
Illnesses caused by various organisms, some of which usually do not cause disease in persons with healthy immune systems. Persons living with advanced HIV infection may have opportunistic
infections of the lungs, brain, eyes and other organs. Opportunistic illnesses common in persons diagnosed with AIDS include Pneumocystis carinii pneumonia, cryptosporidiosis, histoplasmosis, bacterial infections, other parasitic, viral and fungal infections; and some types of cancers. Tuberculosis
is the leading HIV-associated opportunistic infection in developing countries.
ORPHANS
In the context of AIDS, it is preferable to say “children orphaned by AIDS” or “orphans and other children made vulnerable by AIDS”. Referring to these children as “AIDS orphans” not only stigmatizes them, but also labels them as HIV-positive, which they may not necessarily be. Identifying a human being by his/her medical condition alone also shows a lack of respect for the individual.
Contrary to traditional usage UNAIDS uses “orphan” to describe a child who has lost either one or
both parents.
PANDEMIC
A disease that spreads across an entire region, continent or the whole world. Preferred usage is to write “pandemic” when referring to global disease and to use “epidemic” when referring to country or regional level. For simplicity, UNAIDS often uses “epidemic”,
PATHOGEN
An agent causing disease.
PEOPLE LIVING WITH HIV
Avoid the expression “people living with HIV and AIDS” and the abbreviation PLWHA. With reference to those living with HIV, it is preferable to avoid certain terms: AIDS patient should only
be used in a medical context (most of the time, a person with AIDS is not in the role of patient); the term AIDS victim or AIDS sufferer implies that the individual in question is powerless, with
no control over his or her life. It is preferable to use “people living with HIV” (PLHIV), since this reflects the fact that an infected person may continue to live well and productively for many years.
Referring to people living with HIV as innocent victims (which is often used to describe HIV-positive children or people who have acquired HIV medically) wrongly implies that people infected in
other ways are somehow deserving of punishment. It is preferable to use “people living with HIV”, or “children with HIV”.
PREVALENCE
Usually given as a percentage, HIV prevalence quantifies the proportion of individuals in a population who have HIV at a specific point in time. UNAIDS normally reports HIV prevalence among adults, aged 15–49 years. We do not write prevalence rates because a time period of observation is not involved. “Prevalence” is sufficient, e.g. the Caribbean region, with estimated adult HIV prevalence of 2.3% in 2003, is an area to focus on in the future”. HIV prevalence can also refer to the number of people living with HIV as in “by December 2007 an estimated 33.2 million people were living with HIV worldwide.
PROSTITUTION
Use this term in respect to juvenile prostitution only. Otherwise for people of older ages use “commercial sex” “sex work” or “the sale of sexual services”.
PROVIDER-INITIATED TESTING
Under certain circumstances, when an individual is seeking medical care, HIV testing may be offered. It may be diagnostic—as when a patient presents with symptoms that may be attributable to HIV or has an illness associated with HIV such as tuberculosis—or it may be a routine offer to an asymptomatic person. For example, HIV testing may be offered as part of the clinical evaluation of patients with sexually transmitted infections and pregnant women. HIV testing may be offered to all patients where HIV is prevalent. Regardless of the type of testing and the location of the offer,
All HIV testing should always be carried out under conditions respecting the three Cs—confidentiality, informed consent and counselling. Testing without counselling has little impact on behaviour and is a significant lost opportunity for assisting people to avoid acquiring or transmitting infection.
RISK
Avoid using the expressions “groups at risk” or “risk groups”. People with behaviours which may place them at higher risk of exposure to HIV do not necessarily identify themselves with any
particular group. Risk refers to risk of exposure to HIV which may be high as a result of specific behaviours or situations. Examples of the latter include risk in discordant couples unaware of their
serostatus and recipients of unscreened blood or blood products. Behaviours, not memberships, place individuals in situations in which they may be exposed to HIV. Some populations may be at
increased risk of exposure to HIV.
RISK COMPENSATION or RISK ENHANCEMENT
A compensatory increase in behaviours which can result in exposure to HIV brought on by reduced perception of personal risk e.g. uptake of a 50% effective preventive HIV vaccine might tend to encourage abandoning condom use.
SAFER SEX
Use by preference the term safer sex because the term safe sex may imply complete safety. Sex is 100% safe from HIV transmission when both partners know their HIV-negative serostatus and
neither partner is in the window period between HIV exposure and appearance of HIV antibodies detectable by the HIV test. In other circumstances, reduction in the numbers of sexual partners and
correct and consistent use of male or female condoms can reduce the risk of HIV transmission. The term safer sex more accurately reflects the idea that choices can be made and behaviours adopted to reduce or minimize risk.
SEROPREVALENCE
As related to HIV infection, the proportion of persons who have serologic evidence of HIV infection, i.e. antibodies to HIV at any given time.
SEROSTATUS
A generic term that refers to the presence/absence of antibodies in the blood. Often, the term refers to HIV antibody status.
SEXUALLY TRANSMITTED INFECTION (STI)
Also called venereal disease (VD), an older public health term, or sexually transmitted disease (STD), terms that do not convey the concept of being asymptomatic in the same way that the term sexually transmitted infection does. Sexually transmitted infections are spread by the transfer of organisms from person to person during sexual contact. In addition to the “traditional” STIs (syphilis and gonorrhoea), the spectrum of STIs now includes HIV, which causes AIDS; Chlamydia trachomatis; human papilloma virus (HPV) which can cause cervical, penile or anal cancer; genital herpes; chancroid; genital mycoplasmas; hepatitis B; trichomoniasis; enteric infections; and ectoparasitic diseases (i.e.
diseases caused by organisms that live on the outside of the host’s body). The complexity and scope of sexually transmitted infections have increased dramatically since the 1980s; more than 20 diseasecausing organisms and syndromes are now recognized as belonging in this category.
SEX WORK
“Commercial sex work” is considered a tautology, which is saying the same thing twice over in different words. Preferred terms are “sex work”, “commercial sex”, and “the sale of sexual services”.
SEX WORKER
The term “sex worker” is intended to be non-judgmental, focusing on the conditions under which sexual services are sold. Alternate formulations are: “women/men/people who sell sex”. Clients of
sex workers may then also be called “men/women/people who buy sex”. The term “commercial sex worker” is no longer used, primarily because it is considered to be saying something twice over in different words (i.e. a tautology).
SHARING
When referring to injecting equipment UNAIDS does not use the word “sharing” in its publications. Instead, “use of contaminated injecting equipment” is preferred if referring to actual
HIV transmission and “use of non-sterile injecting equipment” if referring to risk of HIV exposure. This is because injecting drug users uncommonly “share” their needles in the usually understood
sense of the word—with the exception of sexual partners who inject together. In the absence of needle exchanges, people may use discarded needles (which are anonymous) or bargain away
drugs for a needle or are injected by professional injectors. They do not regard this as sharing.
Neither does “sharing” distinguish between needle borrowing and needle lending; this is important because (usually) different dynamics are at work. A person aware of his or her HIV-positive status may try to avoid lending, but may continue to borrow or vice versa. Also “sharing” has positive connotations in injecting drug use communities (and wider communities also), e.g. sharing a meal, which are not appropriate in writing about HIV risk.
STIGMA and DISCRIMINATION
As the traditional meaning of stigma is a mark or sign of disgrace or discredit, the correct term would be stigmatization and discrimination; however, “stigma and discrimination” has been accepted in everyday speech and writing, and may be treated as plural.
SURVEILLANCE
Continual analysis, interpretation and feedback of systematically collected data, generally using methods distinguished by their practicality, uniformity, and rapidity rather than by accuracy or
completeness.
VERTICAL TRANSMISSION
Sometimes used to indicate transmission of a pathogen such as HIV from mother to fetus or baby during pregnancy or birth but may be used to refer to the genetic transmission of traits. UNAIDS
primarily uses the term mother-to-child transmission.
HIV/AIDS;
HIV and AIDS
Use the term that is most specific and appropriate in the context. Examples include people living with HIV, HIV prevalence, HIV prevention, HIV testing, HIV-related disease; AIDS diagnosis, children made vulnerable by AIDS, children orphaned by AIDS, the AIDS response, national AIDS programme, AIDS service
organization. Both HIV epidemic and AIDS epidemic are acceptable.
There is no “AIDS virus”. The virus associated with AIDS is called the Human Immunodeficiency Virus, or HIV. Please note: “virus” in the phrase “HIV virus” is redundant. Use HIV.
Avoid the term infected. No one can be infected with AIDS, because it is not an infectious agent. AIDS is a surveillance definition meaning a syndrome of opportunistic infections and diseases that can develop as immunosuppression deepens
along the continuum of HIV infection from primary infection to death. Use person living with HIV or HIV-positive person.
There is no test for AIDS. Use HIV or HIV antibody test.
The word “victim” is disempowering. Use person living with HIV. Use the term AIDS only when referring to a person with a clinical AIDS diagnosis.
Use the term patient only when referring to a clinical setting. Use: patient with advanced HIV-related illness (or disease) or AIDS-related illness (or disease).
Use risk of HIV infection; risk of exposure to HIV.
Use key populations at higher risk (both key to the epidemic’s dynamics and key to the response). Key populations are distinct from vulnerable populations, which may be subject to societal pressures or social circumstances which may make them more vulnerable to exposure to infections, including HIV.
Use sex work or commercial sex or the sale of sexual services.
Use only in respect to juvenile prostitution; otherwise use sex worker.
Use injecting drug user. Drugs may be injected subcutaneously, intramuscularly or intravenously.
)
Use using non-sterile injecting equipment if referring to risk of HIV exposure; use using contaminated injecting equipment if the equipment is known to contain HIV or if HIV transmission has occurred.
Use response to AIDS. Use evidence-informed.
Use HIV prevalence. The word “rates” connotes the passage of time and should not be used in most instances.
ions
Please spell out all abbreviations in full.
----------
Background for commonly used terms and abbreviations
ABC
Prevention strategies: abstain from penetrative sexual intercourse (also used to indicate delay of sexual debut); be faithful (reduce the number of partners or have sexual relations with only one
partner); condomize (use male or female condoms consistently and correctly). ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) Not…immune deficiency. . .
ADVOCATE
As a verb: write ‘advocate change’ (rather than advocate for change).
AIDS CARRIER
This term is often used to mean any person living with HIV. However, it is stigmatizing and offensive
to many people living with the virus. It is also incorrect, since the agent being carried is HIV not AIDS.
AIDS- or HIV-RELATED ILLNESS OR DISEASE
Although ‘the person died of AIDS’ is commonly said or written, actually people do not die of AIDS, they die of HIV-related or AIDS-related disease. The expression AIDS-related illness can be
used if a person has an AIDS diagnosis.
AIDS RESPONSE
The terms AIDS response, HIV response, response to AIDS and response to HIV are often used interchangeably to mean the response to the epidemic.
AIDS VIRUS
Since AIDS is a syndrome, it is incorrect to refer to the virus as the “AIDS virus”. HIV (the human immunodeficiency virus) is what ultimately causes AIDS (acquired immunodeficiency syndrome).
In referring to the virus, write the full expression at first usage and then use HIV; avoid the term HIV virus (which is a tautology, i.e. it is saying the same thing twice).
ART
Spell out in full, i.e. antiretroviral therapy or antiretroviral treatment. The term ART can be used if it clearly refers to a triple antiretroviral drug combination.
BEHAVIOUR CHANGE (NOT ‘Behavioural Change’)
There are a number of theories and models of human behaviour that guide health promotion and education efforts to encourage behaviour change, i.e. the adoption and maintenance of healthy
behaviours.
CLIENT-INITIATED TESTING
Alternative term for voluntary counselling and testing (VCT). All HIV testing must be carried out under conditions of the “three Cs”: i.e. that it be confidential, accompanied by counselling and
conducted only with informed consent.
CONTAMINATED and NON-STERILE
Drug injecting equipment was “contaminated” if it caused infection, that is, the equipment contained HIV; “unclean”, “dirty” or “non-sterile” if it carried the risk of HIV exposure: that is, it may or may not have carried the virus.
COSPONSORS
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has the following ten cosponsors, listed in the following order (according to UN rules): United Nations High Commissioner for Refugees (UNHCR) http://www.unhcr.org/ United Nations Children’s Fund (UNICEF) http://www.unicef.org/ World Food Programme (WFP) http://www.wfp.org/ United Nations Development Programme (UNDP) http://www.undp.org/ United Nations Population Fund (UNFPA) http://www.unfpa.org/ United Nations Office on Drugs and Crime (UNODC) http://www.unodc.org/odccp/index.html International Labour Organization (ILO) http://www.ilo.org/ United Nations Educational, Scientific and Cultural Organization (UNESCO)
http://www.unesco.org/ World Health Organization (WHO) http://www.who.int/en/ World Bank http://www.worldbank.org/
CRIS
Country Response Information System. Developed by UNAIDS, CRIS provides partners in the global response to HIV with a user-friendly system consisting of an indicator database, a programmatic database, a research inventory database and other important information. The indicator database provides countries with a tool for reporting on national follow-up to the United
Nations General Assembly Special Session on HIV/AIDS (June 2001) Declaration of Commitment on HIV/AIDS. The country-level CRIS will be complemented by a Global Response Information Database (GRID), which will support strategic analysis, knowledge-based policy formulation and subsequent programming. At country and global levels a Research Inventory Database (RID) is also being developed.
CULTURAL DOMINANCE
Familiar terms used in some cultures may not be appropriate in other cultural contexts e.g. seasons of the year—avoid “fall” or “autumn” and prefer instead last quarter of the year or instead of summer prefer mid-year. Similarly remember that different cultures celebrate the New Year at different times and that seasons in the northern and southern hemispheres are opposite to each other.
DESCRIBING AIDS
AIDS is often referred to as a “deadly, incurable disease”, but this creates a lot of fear and only serves to increase stigma and discrimination. It has also been referred to as a “manageable, chronic illness, much like hypertension or diabetes”, but this may lead people to believe that it is not as serious as they thought. It is preferable to use the following description: AIDS, the acquired immunodeficiency syndrome, is a fatal disease caused by HIV, the human immunodeficiency virus. HIV destroys the body’s ability to fight off infection and disease, which can ultimately lead to death.
Currently, antiretroviral drugs slow down replication of the virus and can greatly enhance quality of life, but they do not eliminate HIV infection.
DRIVER
The term relates to the structural and social factors, such as poverty, gender, and human rights abuses that can increase people’s vulnerability to exposure to HIV. It is often reserved to describe underlying determinants.
EPIDEMIC
In epidemiology, an epidemic is a disease that appears as new cases in a given human population (e.g. everyone in a given geographic area; a university, or similar population unit; or everyone of a certain age or sex, such as the children or women of a region) during a given period, at a rate that greatly exceeds what is “expected” based on recent experience. Defining an epidemic is subjective, depending in part on what is “expected”. An epidemic may be restricted to one locale (an outbreak), more general (an epidemic) or global (a pandemic). Common diseases that occur at a constant but relatively high rate in the population are said to be “endemic”. Widely known examples of epidemics include the plague of mediaeval Europe known as the Black Death, the influenza pandemic of 1918–1919, and the current HIV epidemic which is increasingly described as a pandemic (made up of distinct types of epidemics in areas across the globe).
EPIDEMIOLOGY
Epidemiology is the branch of medical science that deals with the study of the incidence, distribution and determinants of patterns of a disease as well as its prevention in a population.
EVIDENCE-INFORMED
This term is preferred to evidence based in recognition of the fact that several elements may play a role in decision making, only one of which may be evidence; others may include cultural appropriateness, cost, feasibility and concerns about equity and so on.
FAITH-BASED ORGANIZATIONS
Faith-based organization is the term preferred instead of e.g. church, synagogue, mosque or religious organization, as it is inclusive (non-judgmental about the validity of any expression of faith) and moves away from historical (and typically European) patterns of thought.
FEMINIZATION
Referring to the pandemic, feminization is now often used by UNAIDS and others to indicate the increasing impact that it has on women. It is often linked to the idea that the number of women
infected has equalled, or surpassed, the figure for men or that women and girls are bearing the brunt of the epidemic in many settings.
FIGHT
Avoid using words such as “fight” and other combatant language e.g. struggle, battle, campaign or war, unless in a direct quotation. Alternatives include: response to; management of; measures against; initiative; action; efforts; and programme. One rationale for this is to avoid a transference being made from the fight against HIV to a fight against people living with HIV.
GAY MEN
Write “men who have sex with men” unless individuals or groups specifically self-identify as
gay. The broader community of men and women and transsexuals should be described as lesbian, gay, bisexual and transgendered—the abbreviation LGBT is often used for such communities, but
UNAIDS’ general preference is to spell out all terms in full.
GENDER and SEX
The term “sex” refers to biologically determined differences, whereas the term “gender” refers to differences in social roles and relations between men and women. Gender roles are learned through socialization and vary widely within and between cultures. Gender roles are also affected by age, class, race, ethnicity and religion, as well as by geographical, economic and political environments. Since many languages do not have the word gender, translators may have to consider other alternatives to distinguish between these concepts.
GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA
The Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2001, is an independent public-private partnership. Its purpose is to attract, manage and disburse additional resources to make a sustainable and significant contribution to mitigate the impact caused by HIV, tuberculosis and malaria in countries in need, while contributing to poverty reduction as part of the Millennium Development Goals. Since 2001, the Global Fund has attracted US$ 4.7 billion in financing through 2008. In September 2007, donors provided initial pledges to the Global Fund worth US$ 9.7 billion over three years. These pledges constitute the largest single financing exercise for health ever and they will allow the Global Fund to move towards annual commitments of US$ 6–8 billion by 2010. http://www.theglobalfund.org/en/
GIPA
An acronym for the “greater involvement of people living with HIV/AIDS”. In 1994, 42 countries prevailed upon the Paris AIDS Summit to include the Greater Involvement of People Living with
HIV/AIDS Principle (GIPA) in its final declaration. http://www.unaids.org/en/Issues/Affected_communities/gipa.asp
UNAIDS does not use the term “high-risk group” because it implies that the risk is contained within the group whereas, in fact, all social groups are interrelated. It may also lull people who don’t identify with such groups into a false sense of security. As well it can increase stigma and discrimination. It is often more accurate to refer directly to “higher risk of HIV exposure”, “sex without a condom”, “unprotected sex”, or “using non-sterile injection equipment” rather than to generalize by saying “highrisk
group”.
Membership of groups does not place individuals at risk, behaviours may. In the case of married and cohabiting people, particularly women, it may be the risk behaviour of the sexual partner that places them in a “situation of risk”. There is a strong link between various kinds of mobility and heightened risk of HIV exposure, depending on the reason for mobility and the extent to which people are removed from their social context and norms. UNAIDS prefers the term “key populations” because it emphasizes that these populations, while being important to the dynamics of HIV transmission in a setting, are equally essential partners for an effective response to the epidemic.
HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)
This term is now infrequently used in favour of antiretroviral treatment or therapy (ART). It referred to treatment regimens recommended by leading HIV experts to aggressively suppress viral replication and slow the progress of HIV disease. The usual HAART regimen combines three or more different drugs such as two nucleoside reverse transcriptase inhibitors and a protease inhibitor, two nucleoside analogue reverse transcriptase inhibitors and a non-nucleoside reverse transcriptase inhibitor or other combinations. More recently, new drugs have been developed to prevent the virus from entering the cell. These treatment regimens have been shown to reduce the amount of virus so that it becomes undetectable in a patient’s blood.
HIPC INITIATIVE
The Heavily Indebted Poor Countries Initiative is a debt relief tool for increasing the funds that countries have available and for ensuring that they are channelled to core human development
priorities, such as basic health care. The HIPC initiative, created in 1996 by the World Bank and further enhanced in 1999, has already helped some of the poorest nations in the world to free up precious resources for human development that would otherwise have been spent on servicing debt.
Fully funded and implemented, the enhanced HIPC initiative has the potential to be an even more powerful tool to allow countries to devote more resources to combating infectious diseases.
HIV-RELATED DISEASE
Symptoms of HIV infection may occur both at the beginning of HIV infection and after immune compromise sets in, leading to AIDS. During the initial infection with HIV, when the virus comes
into contact with the mucosal surface, it finds susceptible target cells and moves to lymphoid tissue where massive production of the virus ensues. This leads to a burst of high-level viraemia (virus in the bloodstream) with wide dissemination of the virus. Some people may have flu-like symptoms at this stage but these are generally referred to as symptoms of primary infection rather than HIV-related disease. The resulting immune response to suppress the virus is only partially successful and some virus escapes and may remain undetectable, sequestered in reservoirs for months to years.
As crucial immune cells, called CD4+ T cells, are disabled and killed, their numbers progressively
decline. In this manner, HIV-related disease is characterized by a gradual deterioration of immune function. Eventually high viral turnover leads to destruction of the immune system, sometimes
referred to as advanced HIV infection, which leads to the manifestation of AIDS.
HIV-INFECTED
As distinct from HIV-positive (which can sometimes be a false positive test result, especially in infants up to 18 months of age), the term HIV-infected is usually used to indicate that evidence of
HIV has been found via a blood test.
HIV-NEGATIVE
Showing no evidence of infection with HIV (e.g. absence of antibodies against HIV) in a blood or oral fluid test. Synonymous with seronegative. An HIV-negative person can be infected if he or she is in the window period between HIV exposure and detection of antibodies.
HIV-POSITIVE
Showing indications of infection with HIV (e.g. presence of antibodies against HIV) in a blood or oral fluid test. Synonymous with seropositive. Results may occasionally be false positive.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
The virus that weakens the immune system, ultimately leading to AIDS. Since HIV means “human immunodeficiency virus”, it is redundant to refer to the HIV virus.
HUMAN IMMUNODEFICIENCY VIRUS TYPE 1 (HIV-1)
The retrovirus isolated and recognized as the etiologic (i.e. causing or contributing to the cause of a disease) agent of AIDS. HIV-1 is classified as a lentivirus in a subgroup of retroviruses. Most viruses
and all bacteria, plants and animals have genetic codes made up of DNA, which is transcribed into RNA to build specific proteins. The genetic material of a retrovirus such as HIV is the RNA itself. The viral RNA is reverse transcribed into DNA, which is then inserted into the host cell’s DNA preventing the host cell from carrying out its natural functions and turning it into an HIV factory.
HUMAN IMMUNODEFICIENCY VIRUS TYPE 2 (HIV-2)
A virus closely related to HIV-1 that has also been found to cause AIDS. It was first isolated in West Africa. Although HIV-1 and HIV-2 are similar in their viral structure, modes of transmission
and resulting opportunistic infections, they have differed in their geographical patterns of infection and in their propensity to progress to illness and death. Compared to HIV-1, HIV-2 is found primarily in West Africa and has a slower, less severe clinical course.
INCIDENCE
HIV incidence (sometimes referred to as cumulative incidence) is the number of new cases arising in a given period in a specified population. UNAIDS normally refers to the number of people (of
all ages) or children (0–14 years) who have become infected during the past year. In contrast HIV prevalence refers to the number of infections at a particular point in time (like a camera snapshot). In specific observational studies and prevention trials, the term incidence rate is used to describe incidence per hundred person years of observation.
INJECTING DRUG USERS (IDUs)
This term is preferable to drug addicts or drug abusers, which are seen as derogatory terms and which often result in alienation rather than creating the trust and respect required when dealing with
those who inject drugs. UNAIDS does not use the term “intravenous drug users” because subcutaneous and intramuscular routes may be involved. It is preferable to spell out in full and not use the abbreviation. An acceptable alternate phrasing is people who inject drugs.
INTERVENTION
This term conveys “doing something to someone or something” and as such undermines the concept of participatory responses. Preferred terms include programming, programme, activities, initiatives, etc.
MILLENNIUM DEVELOPMENT GOALS (MDGs)
Eight goals developed at the Millennium Summit in September 2000. Goal 6 refers specifically to AIDS but attainment of several goals is being hampered by the HIV epidemic. http://www.un.org/millenniumgoals/
MONITORING AND EVALUATION REFERENCE GROUP
Established by UNAIDS, the Monitoring and Evaluation (M&E) Reference Group (MERG) has a broad membership of national, bilateral agency and independent evaluation expertise, enabling it to assist in the harmonization of monitoring and evaluation approaches among collaborating organizations
and in the development of effective monitoring and evaluation of the response to the epidemic.
MSM
Abbreviation for “men who have sex with men” or “males who have sex with males”. This term is useful as it includes not only men who self identify as gay or homosexual and have sex only with other men but also bisexual men, and heterosexual men who may, nonetheless at times have sex with other men.
MTCT
Abbreviation for “mother-to-child transmission” (PMTCT is the abbreviation for “prevention of mother-to-child transmission”). Some countries prefer the term “parent-to-child transmission” to
avoid stigmatizing pregnant women and to encourage male involvement in HIV prevention.
OPPORTUNISTIC INFECTIONS
Illnesses caused by various organisms, some of which usually do not cause disease in persons with healthy immune systems. Persons living with advanced HIV infection may have opportunistic
infections of the lungs, brain, eyes and other organs. Opportunistic illnesses common in persons diagnosed with AIDS include Pneumocystis carinii pneumonia, cryptosporidiosis, histoplasmosis, bacterial infections, other parasitic, viral and fungal infections; and some types of cancers. Tuberculosis
is the leading HIV-associated opportunistic infection in developing countries.
ORPHANS
In the context of AIDS, it is preferable to say “children orphaned by AIDS” or “orphans and other children made vulnerable by AIDS”. Referring to these children as “AIDS orphans” not only stigmatizes them, but also labels them as HIV-positive, which they may not necessarily be. Identifying a human being by his/her medical condition alone also shows a lack of respect for the individual.
Contrary to traditional usage UNAIDS uses “orphan” to describe a child who has lost either one or
both parents.
PANDEMIC
A disease that spreads across an entire region, continent or the whole world. Preferred usage is to write “pandemic” when referring to global disease and to use “epidemic” when referring to country or regional level. For simplicity, UNAIDS often uses “epidemic”,
PATHOGEN
An agent causing disease.
PEOPLE LIVING WITH HIV
Avoid the expression “people living with HIV and AIDS” and the abbreviation PLWHA. With reference to those living with HIV, it is preferable to avoid certain terms: AIDS patient should only
be used in a medical context (most of the time, a person with AIDS is not in the role of patient); the term AIDS victim or AIDS sufferer implies that the individual in question is powerless, with
no control over his or her life. It is preferable to use “people living with HIV” (PLHIV), since this reflects the fact that an infected person may continue to live well and productively for many years.
Referring to people living with HIV as innocent victims (which is often used to describe HIV-positive children or people who have acquired HIV medically) wrongly implies that people infected in
other ways are somehow deserving of punishment. It is preferable to use “people living with HIV”, or “children with HIV”.
PREVALENCE
Usually given as a percentage, HIV prevalence quantifies the proportion of individuals in a population who have HIV at a specific point in time. UNAIDS normally reports HIV prevalence among adults, aged 15–49 years. We do not write prevalence rates because a time period of observation is not involved. “Prevalence” is sufficient, e.g. the Caribbean region, with estimated adult HIV prevalence of 2.3% in 2003, is an area to focus on in the future”. HIV prevalence can also refer to the number of people living with HIV as in “by December 2007 an estimated 33.2 million people were living with HIV worldwide.
PROSTITUTION
Use this term in respect to juvenile prostitution only. Otherwise for people of older ages use “commercial sex” “sex work” or “the sale of sexual services”.
PROVIDER-INITIATED TESTING
Under certain circumstances, when an individual is seeking medical care, HIV testing may be offered. It may be diagnostic—as when a patient presents with symptoms that may be attributable to HIV or has an illness associated with HIV such as tuberculosis—or it may be a routine offer to an asymptomatic person. For example, HIV testing may be offered as part of the clinical evaluation of patients with sexually transmitted infections and pregnant women. HIV testing may be offered to all patients where HIV is prevalent. Regardless of the type of testing and the location of the offer,
All HIV testing should always be carried out under conditions respecting the three Cs—confidentiality, informed consent and counselling. Testing without counselling has little impact on behaviour and is a significant lost opportunity for assisting people to avoid acquiring or transmitting infection.
RISK
Avoid using the expressions “groups at risk” or “risk groups”. People with behaviours which may place them at higher risk of exposure to HIV do not necessarily identify themselves with any
particular group. Risk refers to risk of exposure to HIV which may be high as a result of specific behaviours or situations. Examples of the latter include risk in discordant couples unaware of their
serostatus and recipients of unscreened blood or blood products. Behaviours, not memberships, place individuals in situations in which they may be exposed to HIV. Some populations may be at
increased risk of exposure to HIV.
RISK COMPENSATION or RISK ENHANCEMENT
A compensatory increase in behaviours which can result in exposure to HIV brought on by reduced perception of personal risk e.g. uptake of a 50% effective preventive HIV vaccine might tend to encourage abandoning condom use.
SAFER SEX
Use by preference the term safer sex because the term safe sex may imply complete safety. Sex is 100% safe from HIV transmission when both partners know their HIV-negative serostatus and
neither partner is in the window period between HIV exposure and appearance of HIV antibodies detectable by the HIV test. In other circumstances, reduction in the numbers of sexual partners and
correct and consistent use of male or female condoms can reduce the risk of HIV transmission. The term safer sex more accurately reflects the idea that choices can be made and behaviours adopted to reduce or minimize risk.
SEROPREVALENCE
As related to HIV infection, the proportion of persons who have serologic evidence of HIV infection, i.e. antibodies to HIV at any given time.
SEROSTATUS
A generic term that refers to the presence/absence of antibodies in the blood. Often, the term refers to HIV antibody status.
SEXUALLY TRANSMITTED INFECTION (STI)
Also called venereal disease (VD), an older public health term, or sexually transmitted disease (STD), terms that do not convey the concept of being asymptomatic in the same way that the term sexually transmitted infection does. Sexually transmitted infections are spread by the transfer of organisms from person to person during sexual contact. In addition to the “traditional” STIs (syphilis and gonorrhoea), the spectrum of STIs now includes HIV, which causes AIDS; Chlamydia trachomatis; human papilloma virus (HPV) which can cause cervical, penile or anal cancer; genital herpes; chancroid; genital mycoplasmas; hepatitis B; trichomoniasis; enteric infections; and ectoparasitic diseases (i.e.
diseases caused by organisms that live on the outside of the host’s body). The complexity and scope of sexually transmitted infections have increased dramatically since the 1980s; more than 20 diseasecausing organisms and syndromes are now recognized as belonging in this category.
SEX WORK
“Commercial sex work” is considered a tautology, which is saying the same thing twice over in different words. Preferred terms are “sex work”, “commercial sex”, and “the sale of sexual services”.
SEX WORKER
The term “sex worker” is intended to be non-judgmental, focusing on the conditions under which sexual services are sold. Alternate formulations are: “women/men/people who sell sex”. Clients of
sex workers may then also be called “men/women/people who buy sex”. The term “commercial sex worker” is no longer used, primarily because it is considered to be saying something twice over in different words (i.e. a tautology).
SHARING
When referring to injecting equipment UNAIDS does not use the word “sharing” in its publications. Instead, “use of contaminated injecting equipment” is preferred if referring to actual
HIV transmission and “use of non-sterile injecting equipment” if referring to risk of HIV exposure. This is because injecting drug users uncommonly “share” their needles in the usually understood
sense of the word—with the exception of sexual partners who inject together. In the absence of needle exchanges, people may use discarded needles (which are anonymous) or bargain away
drugs for a needle or are injected by professional injectors. They do not regard this as sharing.
Neither does “sharing” distinguish between needle borrowing and needle lending; this is important because (usually) different dynamics are at work. A person aware of his or her HIV-positive status may try to avoid lending, but may continue to borrow or vice versa. Also “sharing” has positive connotations in injecting drug use communities (and wider communities also), e.g. sharing a meal, which are not appropriate in writing about HIV risk.
STIGMA and DISCRIMINATION
As the traditional meaning of stigma is a mark or sign of disgrace or discredit, the correct term would be stigmatization and discrimination; however, “stigma and discrimination” has been accepted in everyday speech and writing, and may be treated as plural.
SURVEILLANCE
Continual analysis, interpretation and feedback of systematically collected data, generally using methods distinguished by their practicality, uniformity, and rapidity rather than by accuracy or
completeness.
VERTICAL TRANSMISSION
Sometimes used to indicate transmission of a pathogen such as HIV from mother to fetus or baby during pregnancy or birth but may be used to refer to the genetic transmission of traits. UNAIDS
primarily uses the term mother-to-child transmission.
ICAAP9: “Journalists can save more lives than doctors”
“Journalists can save more lives
than doctors”
Dr. Peter Piot
The Former Executive Director of UNAIDS
=================
Challenges facing by media
• Editors don’t prioritize HIV and AIDS stories, media need to find new angles on coverage to make it newsworthy
• Need for separate media strategies to reach different audiences (policy makers, PLHIV, youth)
* youth are currently underserved by current media outreach
* not enough new media is directed towards AIDS awareness, prevention and reduction of stigma and discrimination
• Not only report program, but also analyze the legal and policy issues
• Information needs to be more widely available in local languages
---------
Challenges faced by media
Standardized terms for discussing the issues that are non-discriminatory, nonambiguous and accessible
• Raising standards of ethics among journalists for covering PLHIV is necessary
• Coverage still tends to be sensational
• Coverage is still concentrated around World AIDS UNAIDS Day
--------
Possible roles for media
• Give a voice to affected communities
• Humanize affected and infected persons – portray consequences of stigma and discrimination, and reduce distance
• Focus on legal issues which are impediments
• Address fears and misconceptions through accurate information
• Discuss taboo topics
• Inspire partnerships
• Keep the AIDS issues alive – AIDS is not going to go away so soon
-------
Achievements by media
Coverage:
HIV kept visible and high in people’s minds
HIV kept on national and International agendas
Partnership:
• Multi-sectoral cooperation between government, media, NGOs, CSOs, and the
private sector for raising awareness,
* regional and sub-regional networks and alliances are empowering and effective
Involvement of PLHIV in media outreach for reducing
stigma
• Humanizing PLHIV through profiles and articles that focus on their personal stories and portrays them as productive and active members of society
* readers respond to stories that tug at the heartstrings
* coverage that gives voice to PLHIV decreases stigma
• Involvement of celebrities helps reduce stigma
than doctors”
Dr. Peter Piot
The Former Executive Director of UNAIDS
=================
Challenges facing by media
• Editors don’t prioritize HIV and AIDS stories, media need to find new angles on coverage to make it newsworthy
• Need for separate media strategies to reach different audiences (policy makers, PLHIV, youth)
* youth are currently underserved by current media outreach
* not enough new media is directed towards AIDS awareness, prevention and reduction of stigma and discrimination
• Not only report program, but also analyze the legal and policy issues
• Information needs to be more widely available in local languages
---------
Challenges faced by media
Standardized terms for discussing the issues that are non-discriminatory, nonambiguous and accessible
• Raising standards of ethics among journalists for covering PLHIV is necessary
• Coverage still tends to be sensational
• Coverage is still concentrated around World AIDS UNAIDS Day
--------
Possible roles for media
• Give a voice to affected communities
• Humanize affected and infected persons – portray consequences of stigma and discrimination, and reduce distance
• Focus on legal issues which are impediments
• Address fears and misconceptions through accurate information
• Discuss taboo topics
• Inspire partnerships
• Keep the AIDS issues alive – AIDS is not going to go away so soon
-------
Achievements by media
Coverage:
HIV kept visible and high in people’s minds
HIV kept on national and International agendas
Partnership:
• Multi-sectoral cooperation between government, media, NGOs, CSOs, and the
private sector for raising awareness,
* regional and sub-regional networks and alliances are empowering and effective
Involvement of PLHIV in media outreach for reducing
stigma
• Humanizing PLHIV through profiles and articles that focus on their personal stories and portrays them as productive and active members of society
* readers respond to stories that tug at the heartstrings
* coverage that gives voice to PLHIV decreases stigma
• Involvement of celebrities helps reduce stigma
Sunday, 26 November 2006
World Aids Day: AIDS emerges as the leading cause of death in WHO updated projections of global mortality
By Syed Akbar
As the world observes the AIDS Day on December 1, the World Health Organisation projects AIDS as the leading cause of death, followed by depression, heart diseases and road accidents.
The WHO’s updated ‘burden of disease’ projections released this month gain significance in the backdrop of India emerging as one of the few countries with projected large population suffering from AIDS/HIV infection. India at present has 3.5 million people afflicted with the disease and the number is fast increasing. Andhra Pradesh leads the States in the country.
The WHO’s projections also assume importance as India accounts for 16 per cent of the world’s population and 21 per cent f the world’s global burden of disease, including AIDS. The WHO’s projection is for the year 2030 and its statistics are based on the 2002 figures.
The WHO revised this November its projection on global burden of diseases giving AIDS the status of the Killer No. 1. With fast paced life, depression, particularly of the unipolar (single mood) variety has emerged as the second leading cause of death. Depression includes trouble sleeping, loss of weight and agitated and irritable behaviour. One of the characteristic features of unipolar depression is that people who suffer from it put on a "happy face" in front of others, while deep down they feel quite depressed and disinterested in life.
Cardiac diseases particularly of the ischaemic type and road accidents occupy the third and the fourth slot in the updated projections of global mortality and burden of diseases, 2002-2030 released by the WHO a few days ago.
According to the WHO report, global HIV/AIDS deaths may rise from 2.8 million in 2002 to 6.5 million in 2030 if the anti-retroviral drugs reach 80 per cent of people by 2012. In the most optimistic scenario with increased prevention activity, HIV/AIDS deaths may drop to 3.7 million by the projected year.
Another disturbing factor is the emergence of tobacco-related deaths. The WHO projects total tobacco-attributable deaths to 6.4 million in 2015 and 8.3 million in 2030 from the present 5.4 million. Tobacco is projected to kill 50 per cent more people in 2015 than HIV/AIDS, and to be responsible for 10 per cent of all deaths worldwide.
Eminent sexologist Dr K Swayam Prakash says that the regulatory mechanism has to be strengthened to a great extent to detect and stop malpractices in blood banking. “Greater coordination between national/ state blood transfusion councils and drug control authorities is needed. Training and orientation of drug inspection in the field needs to be speeded up and made more effective in fulfilling their regularly functions,” he pointed out.
The latest UNAIDS report on the global AIDS epidemic estimates that 65 million people have been infected with HIV, of whom some 25 million have died since the start of the epidemic 25 years ago. The rate of new HIV infections continues to climb every year, with an estimated 4.1 million people having been infected in the twelve months ending December 2005. Globally, the total number of people living with the virus also continues to grow, reaching 38.6 million at the end of 2005 and trends indicate that left unchecked the epidemic will continue to increase.
In other words, at this stage of the global AIDS epidemic there are more HIV infections every year than AIDS-related deaths.
With the WHO projecting an alarming scenario for AIDS, the National AIDS Control Organisation has increased its efforts to move towards centralizing blood transfusion services and to reduce fragmentation in management, especially in urban areas. In rural and difficult to access areas, stand alone or small blood banks will be encouraged. It will also continue to have quality management in blood banking.
“All aspects like processes, products, equipment, consumables etc. would increasingly be subjected to quality assurance procedures, so that a safe and reliable transfusion services can be provided,” says a NACO strategy report.
As the world observes the AIDS Day on December 1, the World Health Organisation projects AIDS as the leading cause of death, followed by depression, heart diseases and road accidents.
The WHO’s updated ‘burden of disease’ projections released this month gain significance in the backdrop of India emerging as one of the few countries with projected large population suffering from AIDS/HIV infection. India at present has 3.5 million people afflicted with the disease and the number is fast increasing. Andhra Pradesh leads the States in the country.
The WHO’s projections also assume importance as India accounts for 16 per cent of the world’s population and 21 per cent f the world’s global burden of disease, including AIDS. The WHO’s projection is for the year 2030 and its statistics are based on the 2002 figures.
The WHO revised this November its projection on global burden of diseases giving AIDS the status of the Killer No. 1. With fast paced life, depression, particularly of the unipolar (single mood) variety has emerged as the second leading cause of death. Depression includes trouble sleeping, loss of weight and agitated and irritable behaviour. One of the characteristic features of unipolar depression is that people who suffer from it put on a "happy face" in front of others, while deep down they feel quite depressed and disinterested in life.
Cardiac diseases particularly of the ischaemic type and road accidents occupy the third and the fourth slot in the updated projections of global mortality and burden of diseases, 2002-2030 released by the WHO a few days ago.
According to the WHO report, global HIV/AIDS deaths may rise from 2.8 million in 2002 to 6.5 million in 2030 if the anti-retroviral drugs reach 80 per cent of people by 2012. In the most optimistic scenario with increased prevention activity, HIV/AIDS deaths may drop to 3.7 million by the projected year.
Another disturbing factor is the emergence of tobacco-related deaths. The WHO projects total tobacco-attributable deaths to 6.4 million in 2015 and 8.3 million in 2030 from the present 5.4 million. Tobacco is projected to kill 50 per cent more people in 2015 than HIV/AIDS, and to be responsible for 10 per cent of all deaths worldwide.
Eminent sexologist Dr K Swayam Prakash says that the regulatory mechanism has to be strengthened to a great extent to detect and stop malpractices in blood banking. “Greater coordination between national/ state blood transfusion councils and drug control authorities is needed. Training and orientation of drug inspection in the field needs to be speeded up and made more effective in fulfilling their regularly functions,” he pointed out.
The latest UNAIDS report on the global AIDS epidemic estimates that 65 million people have been infected with HIV, of whom some 25 million have died since the start of the epidemic 25 years ago. The rate of new HIV infections continues to climb every year, with an estimated 4.1 million people having been infected in the twelve months ending December 2005. Globally, the total number of people living with the virus also continues to grow, reaching 38.6 million at the end of 2005 and trends indicate that left unchecked the epidemic will continue to increase.
In other words, at this stage of the global AIDS epidemic there are more HIV infections every year than AIDS-related deaths.
With the WHO projecting an alarming scenario for AIDS, the National AIDS Control Organisation has increased its efforts to move towards centralizing blood transfusion services and to reduce fragmentation in management, especially in urban areas. In rural and difficult to access areas, stand alone or small blood banks will be encouraged. It will also continue to have quality management in blood banking.
“All aspects like processes, products, equipment, consumables etc. would increasingly be subjected to quality assurance procedures, so that a safe and reliable transfusion services can be provided,” says a NACO strategy report.
Friday, 24 February 2006
HIV/AIDS: Problem spreads to children and adolescents
2006
By Syed Akbar
Hyderabad, Feb 24: Even as the State is battling to control HIV which is assuming monstrous proportions, the infection has spread to new population groups affecting children below 14 years of age.
According to the latest Sentinel Surveillance Report of the Andhra Pradesh State AIDS Control Society, about four per cent of all HIV positive cases are children below 14 years. Officials are surprised at the spread of HIV in small children as Andhra Pradesh is primarily a "heterosexual State" where 90 per cent of the HIV/AIDS cases are through heterosexual transmission and just 0.46 per cent cases are through gay relationships. They believe that the streetchildren factor might have contributed to the high incidence of HIV in small children along with mother-to-child transmission route.
What is horrifying is that the State has fast moved from the "high risk groups" phase to "bridge population and vulnerable groups" phase. The State no more has any identifiable high risk groups like truckers and prostitutes. The infection has become quite common and everyone irrespective of social background in the State is at risk.
"We have five lakh HIV cases in the State and of this four per cent are children below 14 years of age. It is affecting women and children, both vulnerable groups, adversely. We do not have data on the exact cause of spread of HIV to this group of population. We cannot say for sure that HIV in small children is through sexual contact. There is no provision in law for a random survey on HIV/AIDS and hence we depend on the cases visiting voluntary counselling centres, STD clinics or prenatal test units", says APSACS joint director Padmavathi.
Andhra Pradesh is one of the States where HIV has become generalised epidemic with a prevalence rate of above one per cent. The prevalence is above one per cent in 18 districts and above two per cent in the districts of Kadapa, Nellore, Prakasam, Gutur, East and West Godavari and Srikakulam.
Another factor troubling APSACS is the spread of HIV among teenagers. About 50 per cent of the new infections reported are in the age group of 15 to 24 years. Taking prevalence into consideration, 45 per cent of the infections are in the age group of 15-29 years. About 90 per cent of the infections are in the age group of 15-49 years.
According to official statistics for 2004-2005, 3.66 per cent of HIV patients are below 14 years, 44.89 per cent in the age group of 15-29 years, 35.23 per cent (30-39 years), 12.45 per cent (40-49 years) and 3.77 per cent (above 50 years).
Probable modes of transmission as per the information reported in voluntary counselling and testing centres are: heterosexual transmission - 89.23 per cent; homosexual transmission - 0.46 per cent; infected syringes and needles - 0.80 per cent, blood and blood products - 0.98 per cent and others 8.5 per cent.
By Syed Akbar
Hyderabad, Feb 24: Even as the State is battling to control HIV which is assuming monstrous proportions, the infection has spread to new population groups affecting children below 14 years of age.
According to the latest Sentinel Surveillance Report of the Andhra Pradesh State AIDS Control Society, about four per cent of all HIV positive cases are children below 14 years. Officials are surprised at the spread of HIV in small children as Andhra Pradesh is primarily a "heterosexual State" where 90 per cent of the HIV/AIDS cases are through heterosexual transmission and just 0.46 per cent cases are through gay relationships. They believe that the streetchildren factor might have contributed to the high incidence of HIV in small children along with mother-to-child transmission route.
What is horrifying is that the State has fast moved from the "high risk groups" phase to "bridge population and vulnerable groups" phase. The State no more has any identifiable high risk groups like truckers and prostitutes. The infection has become quite common and everyone irrespective of social background in the State is at risk.
"We have five lakh HIV cases in the State and of this four per cent are children below 14 years of age. It is affecting women and children, both vulnerable groups, adversely. We do not have data on the exact cause of spread of HIV to this group of population. We cannot say for sure that HIV in small children is through sexual contact. There is no provision in law for a random survey on HIV/AIDS and hence we depend on the cases visiting voluntary counselling centres, STD clinics or prenatal test units", says APSACS joint director Padmavathi.
Andhra Pradesh is one of the States where HIV has become generalised epidemic with a prevalence rate of above one per cent. The prevalence is above one per cent in 18 districts and above two per cent in the districts of Kadapa, Nellore, Prakasam, Gutur, East and West Godavari and Srikakulam.
Another factor troubling APSACS is the spread of HIV among teenagers. About 50 per cent of the new infections reported are in the age group of 15 to 24 years. Taking prevalence into consideration, 45 per cent of the infections are in the age group of 15-29 years. About 90 per cent of the infections are in the age group of 15-49 years.
According to official statistics for 2004-2005, 3.66 per cent of HIV patients are below 14 years, 44.89 per cent in the age group of 15-29 years, 35.23 per cent (30-39 years), 12.45 per cent (40-49 years) and 3.77 per cent (above 50 years).
Probable modes of transmission as per the information reported in voluntary counselling and testing centres are: heterosexual transmission - 89.23 per cent; homosexual transmission - 0.46 per cent; infected syringes and needles - 0.80 per cent, blood and blood products - 0.98 per cent and others 8.5 per cent.
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Mother's Care
Minnu The Cat & Her Kittens Brownie, Goldie & Blackie
Someone with Nature
Syed Akbar in an island in river Godavari with Papikonda hills in the background
Recognition by World Vegetable Centre
Under the shade of Baobab tree
At Agha Khan Akademi in Kenya
Gateway to the Southern Hemisphere
Convention on Biodiversity
Syed Akbar at the 11th Conference of Parties to the United Nations Convention on Biological Diversity