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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


United Nations



General Assembly
Economic and Social Council Part 1

Distr. GENERAL  

16 May 1995


Fiftieth session                        Substantive session of 1995
Item 12 of the preliminary list*        Item 6 (l) of the provisional
  COUNCIL                               ECONOMIC AND ENVIRONMENTAL
                                          QUESTIONS:  REPORTS OF
                                          SUBSIDIARY BODIES, CONFERENCES
                                          AND RELATED QUESTIONS:
                                          PREVENTION AND CONTROL OF
                                          ACQUIRED IMMUNODEFICIENCY
                                          SYNDROME (AIDS) 
          Progress in the implementation of the global AIDS strategy
                        Note by the Secretary-General
 Sections: 1 2 3
    The Secretary-General has the honour to transmit to the General Assembly
and to the Economic and Social Council, pursuant to Assembly resolution 47/40
of 1 December 1992 and Council resolution 1993/51, the report of the
Director-General of the World Health Organization (WHO) on the progress made
in the implementation of the global AIDS strategy.
     *  A/50/50.
    **  E/1995/100.
95-14693 (E)   020695                                                     /...
                          I.  GLOBAL AIDS SITUATION
1.  The cumulative number of AIDS cases reported to the WHO Global Programme
on AIDS through the WHO regional offices and WHO collaborating centres on
 AIDS, as of 31 December 1994 was 1,025,073 from 192 countries.  However, the
actual total at the end of 1994 was estimated to be over 4.5 million. Reasons for 
the discrepancy include less-than-complete diagnosis and
reporting to public health authorities, as well as delays in reporting.
2.  WHO estimates that 19.5 million men, women and children had been infected
with the human immunodeficiency virus (HIV) worldwide by the end of 1994. 
Two thirds or more of all HIV infections to date have been the result of
heterosexual transmission, and this proportion will increase to 75 per cent
or 80 per cent by the year 2000.  By the end of 1994, about half of all HIV
infections in the world had been acquired in adolescence and young adulthood.
3.  Approximately one out of three children born to an HIV-infected woman is
HIV-infected and dies of AIDS, usually by the age of five years; the
remainder eventually become orphans when their mothers or both parents die of
AIDS.  By the end of 1994, about 1.5 million infected children had been born
to HIV-infected women, and over half of them had developed AIDS.  Most of
these children are in sub-Saharan Africa.
4.  Conservatively, WHO projects that by the year 2000 a world total of at
least 30 to 40 million men, women and children will have been infected with
HIV since the start of the pandemic.  Even as a conservative estimate, this
represents double the present total.  If these estimates are accurate, by the
end of the 1990s, nearly 10 million AIDS-related deaths may be expected.
                   II.  ACTIVITIES CARRIED OUT IN 1993-1994
                        BY THE WHO GLOBAL PROGRAMME ON AIDS
                          A.  Technical cooperation
        1.  Coordination and monitoring of national programme support
5.  During 1993-1994, technical cooperation provided to national AIDS
programmes was closely monitored to ensure that it responded to priority
needs identified by countries, whose activities continued to involve an 
increasing number of participating sectors, funders and implementers.  The
Programme's computerized database containing "country profiles" initiated in
1993 was further developed to meet the needs of users - national programmes,
donors and staff at headquarters and in regional offices - and now includes
information from WHO and other sources on demographic, socio-economic and
epidemiological trends, sexually transmitted diseases (STDs), condom
programming and blood transfusion services, among others.  The following are
some examples of activities in the different WHO regions.
6.  Despite the distribution of information and educational materials for
AIDS prevention and care, behaviour change remains a challenge for national
AIDS programmes in the region.  Nevertheless, there has been a dramatic rise
in the number of condoms sold or distributed over the past five years.  Some
countries made special efforts during the year to assess the safety of blood
transfusion in health-care settings with a view to developing a national
policy.  Sentinel surveillance activities are being implemented as planned in
many countries, but in some they are hampered by a lack of resources to
purchase HIV test kits or maintain equipment.  Community mobilization
continued to receive attention at the national and district levels with the
active participation of the United Nations Children's Fund (UNICEF), the
United Nations Development Programme (UNDP), the World Health Organization
(WHO), many non-governmental organizations (NGOs) and other partners.  World
AIDS Day activities and consensus workshops for the preparation of updated
medium-term plans were often presided over by heads of State or ministers of
health.  The number of women's organizations and associations becoming
involved in AIDS work is growing rapidly, and more external resources are
required for their support.  Several models of community-based home care now
exist that aim to provide a continuum of care for AIDS patients and their
The Americas
7.  During 1993, second-cycle medium-term plans were completed for Chile,
Ecuador and Uruguay, initiated in Bolivia, Colombia, Paraguay, Peru and
Venezuela and revised in five Caribbean countries.  During 1994, protocols
for HIV sentinel surveillance were prepared and implemented for the first
time in Argentina, Bolivia, Chile, Paraguay, Peru and Uruguay.  An external
review was carried out in Mexico; and Cuba prepared a draft of its first
medium-term plan.  Training activities included two programme management
courses (Antigua and Barbuda in June 1994 in English; and Uruguay in November
1994 in Spanish); a workshop on applied epidemiology and strategic planning
for Central American and Andean countries in March 1993 in Honduras;
workshops for blood safety and quality assurance (Brazil, Chile and Uruguay,
1993); a workshop on surveillance (Chile, October 1994); a condom promotion
and logistics workshop (Costa Rica, November 1994); and a course on
home-based care for HIV-infected children (Bahamas, June 1994).  Protocols to
determine the effectiveness of syndromic STD clinical management were
developed in Brazil and Peru; and Honduras and Suriname will submit similar
protocols shortly.
South-East Asia
8.  In 1993, support was given to Bhutan, Indonesia, Mongolia, Myanmar and
Sri Lanka to carry out external programme reviews and initiate the process of
formulating their second medium-term plans.  The Programme continued to
emphasize HIV prevention and care and the improvement of AIDS programme
planning and management, providing technical support in various fields to all
countries of the region.  Guidelines for national programme managers on HIV
sentinel surveillance were prepared and a training manual on counselling was
finalized and distributed to all countries of the region following
field-testing in India and Nepal.  Intercountry training activities were
conducted on programme management (Thailand, April 1994); HIV prevention
indicators (India, July 1994); and condom marketing (Nepal, November 1994). 
A consultation was organized to develop an information, education and
communication strategy for AIDS prevention (India, March 1994).
9.  In order to support the countries of Central and Eastern Europe in the
mobilization of national and international resources, a meeting of ministers
of health and of finance on investment in health was held in Latvia in April
1993.  The major outcomes were the Riga statement and the introduction of the
Riga initiative.  In 1994 country workplans for HIV/AIDS activities were
agreed with 26 member States in Central and Eastern Europe.  Assessment
visits were carried out in Armenia, Belarus, the Czech Republic, Kazakstan,
Kyrgyzstan, the Republic of Moldova, Turkmenistan and Uzbekistan.  The trend
is towards giving more emphasis to health promotion and ensuring the
participation of NGOs in programme implementation.  A Russian version of the
WHO Global Programme on AIDS management course was produced and used to train
staff from Belarus, the Republic of Moldova, the Russian Federation and
Eastern Mediterranean
10. During 1993-1994, health promotion activities continued to receive the
highest priority, particularly for the prevention of sexual transmission of
HIV.  Technical support was provided to national AIDS programmes in the areas
of health education, clinical management of HIV/AIDS, planning and evaluation
and STD control.  Iraq, Lebanon and the Libyan Arab Jamahiriya drew up their
first medium-term plans, and second medium-term plans were prepared by
Cyprus, Djibouti, Egypt, Jordan, Morocco, Pakistan, the Sudan, the Syrian
Arab Republic and Tunisia.  External reviews were carried out in Cyprus, the
Islamic Republic of Iran, Jordan, Morocco, Pakistan and the Syrian Arab
Republic.  Intercountry and regional training activities were conducted on
the following subjects:  epidemiological surveillance (Egypt, April 1993);
programme management (Cyprus, April 1994); management of HIV/AIDS and care of
persons with HIV (Tunisia, September 1994); and the role of media in AIDS
prevention (Egypt and Pakistan, November 1994).  Other activities included a
regional meeting on the role of women in AIDS prevention and control (Egypt,
May 1994) and a meeting of directors of national AIDS reference laboratories
(Egypt, November 1994).
Western Pacific

11. During 1993-1994, the national AIDS plans of China, Cook Islands, Fiji,
Kiribati, the Lao People's Democratic Republic, Marshall Islands, Papua New
Guinea, the Philippines, Samoa, Tonga, Vanuatu, Viet Nam and the territories
of French Polynesia and New Caledonia were reviewed, and China formulated its
second medium-term plan.  Three workshops were held on the improvement of
counselling skills (Cambodia, February 1993; Viet Nam, August 1993; and Guam,
October 1993).  A regional workshop on condom logistics (Manila, February
1994) emphasized the importance of condom quality and the continuity of
supply.  Two meetings of national AIDS programme managers were held during
the year (Guam, March 1994; Manila, August-September 1994).  Viet Nam and
Papua New Guinea introduced HIV/AIDS into the curriculum of secondary schools
as part of health education or science subjects.  In the Philippines the
secondary school curriculum was revised to include HIV/AIDS.  STD prevalence
studies were conducted in Fiji and the Philippines.  Technical support was
provided to Cambodia on STD case management.
                    2.  Planning, management and training
12. One of the major achievements during 1993 was the field-testing and
finalization of the programme management training course, which provides a
comprehensive approach for the development of national AIDS programmes. 
During 1994, 30 facilitators for the course were trained in 4 courses; they
in turn helped to train participants from 80 countries in 7 intercountry
courses and 2 national courses (Botswana, Kenya).  Translations of the 12-
module course were completed in Chinese, French, Russian and Spanish. 
Arrangements were made for field-testing of the first training modules for
strengthening district-level management of AIDS prevention, care and support
activities in one country of Africa during the fourth quarter of the year. 
The first course for training trainers on safe blood and blood products,
using distance-learning materials, was held in Zimbabwe in October.
13. The procedures for national AIDS programme reviews and medium-term
planning were updated to reflect the changed environment facing national
programmes.  External programme reviews were carried out in 55 countries
during the biennium 1993-1994.  Of the 129 countries and Territories that had
prepared an initial medium-term plan, 70 have used a consensus-building
approach to formulate a multisectoral strategic plan.
14. Support was provided to strengthen the managerial and technical skills of
national networks of NGOs in India, Kenya, Malaysia, the Philippines and
Zimbabwe.  A list of essential AIDS information resources was prepared and
distributed in English, French and Spanish in collaboration with the
Appropriate Health Resources and Technologies Action Group (AHRTAG), United
Kingdom.  A workshop for training trainers in NGO management and project
development was conducted in Bratislava in November 1994.
                                3.  Prevention
15. A meeting to examine broader, policy-oriented approaches that attempt to
alter the social or physical environment or circumstances in which
risk-taking occurs was convened in September 1993.  Case studies from 12
countries with diverse risk situations were analysed and a research agenda
drawn up to evaluate such approaches further.
16. A guide on designing and conducting interventions for young people not
attending school will be completed by mid-1995.  A supplement on youth peer
education was published in August 1994 in the AHRTAG newsletter AIDS action,
and plans for the expansion of peer education interventions in Ghana and
Jamaica are under way.  A workshop to promote greater involvement of the
private sector was held in Uganda (December 1994).  In collaboration with an
international insurance company, a series of national workshops were
organized in Hong Kong, Indonesia and Malaysia to encourage the private
sector to play a more active role in AIDS prevention and care.  In April the
technical content and format of the WHO specifications and guidelines for
condom procurement were revised.  A set of condom programming materials for
national managers, including manuals on rapid assessment, promotion and
logistics, was finalized and will be available in 1995.  A study was
conducted to project future condom needs, as part of an overall contraceptive
needs study.  Global requirements for STD and HIV/AIDS prevention through the
year 2005 were estimated to be as high as 20,000 million condoms, costing
some US$ 1,200 million.
                         4.  Health care and support
17. Guidelines for the clinical management of HIV infection in adults 1/ were
field-tested in national consensus workshops in Barbados, Burundi and
Thailand.  Based on the result of the field-test, a guide for facilitators of
these workshops was prepared, which outlines the methodology for adapting
these guidelines to country needs.  A similar document, entitled "Guidelines
for the clinical management of HIV infection in children" has been
finalized. 2/  The AIDS home care handbook was finalized 3/ and the booklet
Living with AIDS in the community was revised. 4/  Both are intended to
assist district health-care workers in providing HIV/AIDS care, in teaching
persons with AIDS and their family members to cope at home, and in
encouraging communities to help those infected with and affected by HIV to
adopt a positive approach to life.
18. An expert consultation on care held in September re-emphasized the
rationale for giving access to comprehensive care, including clinical,
nursing, counselling and social support in a continuum from home to hospital,
and stressed the close link between such care and prevention.  The report of
an evaluation of medical, counselling and social services rendered by The
AIDS Support Organisation (TASO), Uganda, will help NGOs and Governments to
learn from a success story and a participatory approach to evaluation.
19. A handbook on integrating comprehensive AIDS care into district health
services was prepared for Ghana and district planning of care is under way in
Thailand and Uganda.  The development of clinical guidelines was completed
with the printing of a French version of the WHO Global Programme on AIDS
paediatric guidelines.  Additional material to facilitate adaptation of the
clinical guidelines to country needs was produced, including a short guide on
adapting flow-charts; a clinical slide set for teaching purposes; and a paper
on selecting commonly used drugs in HIV/AIDS care.  Guidelines for policy
makers, programme managers and service providers on appropriate infant
feeding modes in the light of the HIV epidemic were finalized and will be
available in 1995.
20. Technical support was provided to India on the training of trainers in
care and counselling for all States, including an evaluation of methodology
at state and district level.  Operational studies are in progress in Kenya on
the feasibility of integrating HIV/AIDS care into the existing urban
governmental and non-governmental health systems, and in India on the
training of hospital personnel and community volunteers to provide care at
the appropriate level and refer patients when necessary.
                 5.  Surveillance, evaluation and forecasting
21. By the end of 1994, sentinel HIV surveillance had been implemented in 80
developing countries, 17 of which now have extensive systems in place. 
Trainers from all WHO regions attended a course on surveillance data
management (United States of America, June) organized with financial support
from the World AIDS Foundation.  To assist national AIDS programmes, a
methods package for the evaluation of preventive activities was finalized,
and training workshops in its use will be conducted in all regions.  In
addition, protocols were developed for measuring indicators related to
discriminatory practices and care for HIV/AIDS patients in health facilities,
and they will be field-tested in two countries.
22. Collaboration began with the London School of Hygiene and Tropical
Medicine to develop techniques for estimating the cost-effectiveness of six
HIV prevention strategies relating to mass media communication, social
marketing of condoms, blood safety, school health education, STD services and
sex worker projects.  Costing guidelines for each strategy have been
prepared.  Techniques to estimate effectiveness, now being designed, will be
field-tested next year.
23. HIV/AIDS forecasting research has focused on achieving a better
understanding of the changing patterns of HIV incidence in diverse epidemics. 
Through collaborative investigations with national AIDS programmes, HIV/AIDS
case data from Rwanda, Uganda, the United Republic of Tanzania and Zambia
have been analysed.  The resulting epidemiological model of HIV incidence
suggests a dramatic shift of new infections to younger populations in these
countries and provides insight into the dynamics of endemicity.  A
computer-based programme management information system was field-tested in
Namibia and Uganda.

                  B.  Research and intervention development
                1.  Clinical research and product development
24. An inter-agency working group on the development of vaginal microbicides,
established in collaboration with the Special Programme of Research,
Development and Research Training in Human Reproduction, established
prototype protocols for safety and efficacy testing of such products.  A
safety study of a vaginal microbicide containing a low dose of the spermicide
nonoxynol-9 was successfully completed in several European countries and
Thailand, paving the way for a study in Asia and Africa on its efficacy in
preventing sexual transmission of HIV and other STDs.  A comparative trial of
the user-effectiveness of two strategies using male and female condoms to
prevent gonorrhoea, chlamydial infection, vaginal trichomoniasis and genital
ulcer diseases among sex workers began in Thailand.
25. A meeting to discuss prevention of mother-to-infant transmission of HIV
by use of antiretrovirals was convened in June; protocols were prepared for
research on short-term peripartum antiretroviral interventions that are
feasible, affordable and sustainable in developing countries and the studies
will be initiated shortly.  An inter-agency working group on the prevention
of mother-to-infant transmission of HIV was established to ensure suitability
and complementarity of worldwide research efforts in this field.
26. Research on the prevention of tuberculosis continued in Thailand and
Zambia, and studies on cost-effective maintenance treatment were started in
Uganda for oropharyngeal candidiasis and in Thailand for Penicillium
marneffei infections.  Protocols on cost-effective prophylaxis of multiple
opportunistic infections were developed.
27. A meeting on implications of the newly identified HIV-1 subtype O viruses
for HIV diagnosis was convened in June.  An inter-agency working group has
been established to expedite and coordinate global surveillance and
characterization of newly recognized HIV subtypes and to facilitate timely
adaptation of HIV antibody tests.  Evaluations of such tests in oral fluid
(saliva) in Burundi and Rwanda were successfully completed.  Field
assessments of WHO testing strategies were started in Argentina, Mexico and
Uruguay.  Field assessments of alternative simple methodologies for CD4+
lymphocyte determinations were initiated in Brazil, Thailand, the United
Republic of Tanzania and Venezuela.