AIDS, Poverty Reduction and Debt Relief - A Toolkit for Mainstreaming HIV/AIDS Programmes into Development Instruments (UNAIDS, 2001, 48 p.): 2. The National AIDS Programme as a Contribution to Poverty Reduction: 2.2. What works against HIV/AIDS?2: 2.2.2. Preventing HIV infection

AIDS, Poverty Reduction and Debt Relief - A Toolkit for Mainstreaming HIV/AIDS Programmes into Development Instruments (UNAIDS, 2001, 48 p.)

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Acronyms and abbreviations

Foreword

Summary

1. Introduction

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1.1. What is this Toolkit for?

1.2. To whom it is addressed?

1.3. Links between HIV/AIDS and poverty

2. The National AIDS Programme as a Contribution to Poverty Reduction

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2.1. Rationale

2.2. What works against HIV/AIDS?2

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2.2.1. An enabling environment across multiple sectors

2.2.2. Preventing HIV infection

2.2.3. Care, support and impact mitigation

2.2.4. Mobilization of resources

3. The Essential HIV/AIDS Content in the PRSP and HIPC Documents

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3.1. What are PRSPs?

3.2. An introduction to debt relief

3.3. Making the case for HIV/AIDS control in the PRSP and HIPC documents

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3.3.1. Aids as a cause of poverty and poverty as a contributor to AIDS

3.3.2. Strategies derived from the national AIDS plan

3.3.3. Medium-term goals and poverty monitoring indicators

3.3.4. Short-run actions that could be part of agreements for debt relief

3.3.5. How has HIV/AIDS been included in PRSPs?

3.3.6. HIV/AIDS conditionalities used in HIPC in 2000

4. Uses of Funds Released Through HIPC - Earmarking, Channeling, and Accountability

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4.1. Earmarking

4.2. Channeling funds to local initiatives

4.3. Accountability

5. Influencing Policies

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5.1. Building coalitions

5.2. Strengthening capacity

6. Conclusions

6.1. PRSP, debt relief and AIDS: Just another source of funding or a new opportunity?

6.2. Next steps

References

Appendix 1. Links between HIV/AIDS and Poverty

Appendix 2. Indicators

Appendix 3. Selected Websites on AIDS, Poverty and Debt Relief

Back Cover

2.2.2. Preventing HIV infection

There are still few systematic reviews of the evidence on preventive interventions in the published literature. Merson et al. (2000) reviewed the effectiveness of projects and programmes in developing countries that aim to reduce sexual transmission of HIV infection or transmission related to injection drug use. They found that behavioural change interventions are effective when targeted to populations at high risk, particularly female sex workers and their clients. Few studies have evaluated harm reduction interventions in injecting drug users (IDUs). Evidence on the effectiveness of voluntary counselling and testing programmes was mixed, and results varied according to the population being studied. STI treatment appeared highly effective in reducing HIV/STI transmission, particularly in the earlier stages of the epidemic. Structural and environmental interventions show great promise, although more evaluation is needed. Merson et al. concluded that:

· HIV prevention interventions can be effective in changing risk behaviours and preventing transmission in low- and middle-income countries;
· when the appropriate mix of interventions is applied, they can lead to significant reductions in the prevalence of HIV at the national level; and
· additional research is needed to identify effective interventions, particularly in men who have sex with men, youth, IDUs and HIV -infected persons.

In practice, countries will strike a pragmatic balance, based on the capacity for programme implementation, the expected effects of interventions, their political feasibility and the availability of financial resources. For practical purposes, countries would need to consider interventions aimed at reducing risk and those aimed at reducing vulnerability (Table 1).

Table 1. Interventions for prevention of HIV infection