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The AIDS Pandemic pp 171–196Cite as

Containing the Global Spread of HIV

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Abstract

The pandemic continued to wreak havoc across the world as the number of AIDS cases increased, especially in Africa. Each country had its own unique epidemic, and thus national governments needed to tailor their programs accordingly. This chapter details the efforts made in particular countries, their successes and challenges, and the assistance provided to them by the Global Programme on AIDS. In particular, we focus on programs in Uganda, Thailand, Brazil, and Senegal as successful case studies in HIV prevention. All were characterized by strong national commitment, a multisectoral response, participation of non-governmental organizations, and sufficient resources. However, despite these successful examples, most countries were still struggling to slow down the spread of the disease within their borders and provide care and support to those infected.

Within this chapter the singular pronouns I and my refer to Michael Merson alone, whereas the plural pronouns we and us generally refer to Michael Merson and Stephen Inrig jointly. Where we or us refers to Michael Merson and his colleagues at WHO, the object of the pronoun is clarified by context.

The original version of this chapter was revised to correct misspellings.

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Notes

  1. 1.

    For the purposes of this text, we will use the term AIDS to encompass both AIDS and HIV unless otherwise specified.

  2. 2.

    Adapted from Neil Henry, “Africans, Facing AIDS, Haltingly Talk of It; Tanzanian Counsel Service Struggles Against Despair, Official Apathy,” The Washington Post, September 17, 1990, sec. A.

  3. 3.

    Ervin Dyer, “Soldier in War against Disease Plaguing Africa Is Studying Here,” Pittsburgh Post Gazette, December 1, 2001; Neil Henry, “Africans, Facing AIDS, Haltingly Talk of It; Tanzanian Counsel Service Struggles Against Despair, Official Apathy,” The Washington Post, September 17, 1990, sec. A.

  4. 4.

    Neil Henry, “Africans, Facing AIDS, Haltingly Talk of It; Tanzanian Counsel Service Struggles Against Despair, Official Apathy,” The Washington Post, September 17, 1990, sec. A.

  5. 5.

    G.N. Padayachee and R. Schall. “Short-term predictions of the prevalence of human immunodeficiency virus infection among the black population in South Africa.” S Afr Med J. 1990 Apr 7;77(7):329–33.

  6. 6.

    Anne Buvé, “The HIV Epidemics in Sub-Saharan Africa: Why So Severe? Why So Heterogeneous?” in Philippe Denis and Charles Becker, eds., The HIV/AIDS Epidemic in Sub-Saharan Africa in a Historical Perspective. Senegalese Network “Law, Ethics, Health” Online edition, 2006, pp. 41–56; http://www.dphu.org/uploads/attachements/books/books_1448_0.pdf

  7. 7.

    Noerine Kaleeba, Frontline: The Age of AIDS, May 5, 2005, http://www.pbs.org/wgbh/pages/frontline/aids/interviews/kaleeba.html

  8. 8.

    “The AIDS Service Organization: Celebrating 25 Years of Positive Living and Great HIV and AIDS Service,” New Vision, September 24, 2012. http://www.newvision.co.ug/new_vision/news/1307287/aids-support-organisation#sthash.MFBoLV3r.dpuf

  9. 9.

    Noerine Kaleeba, Frontline: The Age of AIDS, May 5, 2005, http://www.pbs.org/wgbh/pages/frontline/aids/interviews/kaleeba.html

  10. 10.

    These were TASO Mulago (November 1987), TASO Masaka (May 1988), TASO Tororo (November 1988), TASO Mbarara (January 1989), and TASO Mbale (March 1990). Peter Kitonsa Ssebbanja, United against AIDS : The Story of TASO, 1st ed. Oxford, UK : Strategies for Hope Trust; 2007.

  11. 11.

    Noerine Kaleeba, Interview by Michael Merson, Geneva, October, 2001.

  12. 12.

    Joep Lange, Africa on the Rise, University of Amsterdam, Sept, 2014 http://www.pharmaccess.org/Images/Joep_Lange_-_Africa_%20on_the_Rise.pdf

  13. 13.

    Gary Slutkin et al., “How Uganda Reversed Its HIV Epidemic,” AIDS and Behavior 10, no. 4 (July 2006): 351–60, doi:10.1007/s10461-006-9118-2; Jonathan M. Mann and Daniel Tarantola, AIDS in the World. Cambridge, MA: Harvard University Press., 1991; World Health Organization, “WHO Global Programme on AIDS 1987–1995: Final Report with Emphasis on 1994–95 Biennium” Geneva: World Health Organization, May 1997.

  14. 14.

    Jonathan M. Mann and Daniel Tarantola, AIDS in the World. (Cambridge, MA: Harvard University Press., 1991); “A Measure of Success in Uganda: The Value of Monitoring Both HIV Prevalence and Sexual Behaviour” (Geneva: The Joint United Nations Programme on HIV/AIDS (UNAIDS), May 1998), http://www.unaids.org/en/resources/documents/1998/19980530_value_monitoring_uganda_en.pdf

  15. 15.

    Gary Slutkin et al., “How Uganda Reversed Its HIV Epidemic,” AIDS and Behavior (July 2006) 10(4):351–60, doi:10.1007/s10461-006-9118-2.

  16. 16.

    Ibid.

  17. 17.

    Ibid.

  18. 18.

    Moira Farrow, “AIDS & Africa; In Uganda, the Epidemic Is a Plague. The Country Has an Estimated 1.5 Million AIDS Orphans,” The Ottawa Citizen, February 3, 1992.

  19. 19.

    Gary Slutkin et al., “How Uganda Reversed Its HIV Epidemic,” AIDS and Behavior (July 2006) 10(4):351–60, doi:10.1007/s10461-006-9118-2.

  20. 20.

    Anthony Swift, “AIDS: Courage of a Country Where Thousands are Facing Death; Uganda/A Special Report,” The Guardian (London), April 23, 1992, p. 12.

  21. 21.

    “Life and Death in Africa: In the AIDS Capital of the World, the Dying Are Children and Grandmothers and Everyone in between,” The Vancouver Sun (British Columbia), February 1, 1992, http://www.lexisnexis.com.msmc.idm.oclc.org/lnacui2api/api/version1/getDocCui?lni=3SR8-V1X0-002F-R4CV&csi=270944,270077,11059,8411&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=true

  22. 22.

    Mark Douglas, “Ugandan AIDS Epidemic Warning,” The Advertiser, May 11, 1992.

  23. 23.

    “Life and Death in Africa: In the AIDS Capital of the World, the Dying Are Children and Grandmothers and Everyone in between,” The Vancouver Sun (British Columbia), February 1, 1992, http://www.lexisnexis.com.msmc.idm.oclc.org/lnacui2api/api/version1/getDocCui?lni=3SR8-V1X0-002F-R4CV&csi=270944,270077,11059,8411&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=true

  24. 24.

    Robert C. Hornik, Public Health Communication: Evidence for Behavior Change (L. Erlbaum Associates, 2002).

  25. 25.

    Gary Slutkin et al., “How Uganda Reversed Its HIV Epidemic,” AIDS and Behavior 10, no. 4 (July 2006): 351–60, doi:10.1007/s10461-006-9118-2.

  26. 26.

    Frances Williams, “New chief for world anti-Aids campaign,” The Independent (London), May 15, 1990, 3.

  27. 27.

    Deborah Mesce, “WHO Predicts AIDS Will Increase in Developing Nations, Among Heterosexuals,” The Associated Press, June 12, 1990.

  28. 28.

    “AIDS Takes a Heavy Toll in Africa,” St. Louis Post-Dispatch, August 21, 1990, 2B.

  29. 29.

    “New Estimates on Child Victims Push Up Global Total,” The Associated Press, September 25, 1990.

  30. 30.

    “WHO warns of AIDS spread in Brazil ,” Agence France Presse, August 16, 1991.

  31. 31.

    For the purposes of this text, we use the term sexually transmitted disease(s) and the abbreviation STD rather than the other term sexually transmitted infection(s) or STIs.

  32. 32.

    Guido Carlos Levia and Marco Antonio A. Vitoria, “Fighting against AIDS: the Brazilian experience,” AIDS 2002, 16:2373–2383.

  33. 33.

    Ibid.

  34. 34.

    GC Levi et al., “Fighting Against AIDS: the Brazilian Experience,” AIDS 2002 16:2373–2383.

  35. 35.

    Jinkie Corbin et al., “HIV/AIDS in Latin America and the Caribbean” (Health Studies Branch, U.S. Bureau of the Census, November 1995).

  36. 36.

    Ibid.

  37. 37.

    Ibid.

  38. 38.

    Gary Slutkin, “Global AIDS 1981–1999: The Response [The Pittsfield Lecture],” The International Journal of Tuberculosis and Lung Disease 4, no. 2 (February 1, 2000): S24–33.

  39. 39.

    The numbers came from 18 drug treatment centers across the country. Wiwat Rojanapithayakorn and Robert Hanenberg, “The 100% Condom Program in Thailand ,” AIDS, 1996, 10:1–7.

  40. 40.

    Gary Slutkin et al., “Sentinel Surveillance for HIV Infection : A Method to Monitor HIV Infection Trends in Population Groups” (Geneva: World Health Organization, 1988), http://www.who.int/iris/handle/10665/61728; Gary Slutkin et al., “Use of HIV Surveillance Data in National AIDS Control Programmes : A Review of Current Data Use with Recommendations for Strengthening Future Use” (Geneva: World Health Organization, 1990), http://www.who.int/iris/handle/10665/59785#sthash.gF0ZEhU0.dpuf; G. Slutkin, “Global AIDS 1981–1999: The Response [The Pittsfield Lecture],” The International Journal of Tuberculosis and Lung Disease (February 1, 2000) 4(2): S24–33.

  41. 41.

    Gary Slutkin, “Global AIDS 1981–1999: The Response [The Pittsfield Lecture],” The International Journal of Tuberculosis and Lung Disease (February 1, 2000) 4(2): S24–33.

  42. 42.

    Deborah Mesce, “WHO Predicts AIDS Will Increase in Developing Nations, Among Heterosexuals,” The Associated Press, June 12, 1990.

  43. 43.

    Malcolm Gladwell, “AIDS Spreading ‘Dramatically’ Worldwide; WHO Estimates Up to 10 Million Infected; Cases in Asia Surge,” The Washington Post, August 1, 1990, A1.

  44. 44.

    Michelle Hardy, “Help urged in AIDS fight,” The Advertiser, August 6, 1990.

  45. 45.

    Werasit Sittitrai, “HIV Prevention Needs and Successes: A Tale of Three Countries,” Geneva: UNAIDS , 2001, 9–14.

  46. 46.

    Ibid.

  47. 47.

    Wiwat Rojanapithayakorn and Robert Hanenberg, “The 100% Condom Program in Thailand ,” AIDS, 1996, 10:1–7.

  48. 48.

    What does it take to control an epidemic? Learning from Thailand’s experience. Mastro, T, November 15, 2016. FHI 360. http://degrees.fhi360.org/2016/11/what-does-it-take-to-control-an-epidemic-learning-from-thailands-experience/; accessed February 10, 2017.

  49. 49.

    The following paragraphs on the 100% Condom Programme in Thailand adapted from Wiwat Rojanapithayakorn, “Description on the Development of the 100% Condom Programme in Thailand,” unpublished document, n.d.

  50. 50.

    Wiwat Rojanapithayakorn and Robert Hanenberg, “The 100% Condom Program in Thailand ,” AIDS, 1996, 10:1–7.

  51. 51.

    Werasit Sittitrai, “HIV Prevention Needs and Successes: A Tale of Three Countries,” Geneva: UNAIDS , 2001, 9–14.

  52. 52.

    Wiwat Rojanapithayakorn and Robert Hanenberg, “The 100% Condom Program in Thailand ,” AIDS, 1996, 10:1–7.

  53. 53.

    Lawrence Altman, “Former Model of Success, Thailand’s AIDS Efforts Falters, UN Reports,” The New York Times July 9 2004.

  54. 54.

    “WHO assessment of AIDS epidemic grows grimmer,” United Press International, July 31, 1990.

  55. 55.

    Malcolm Gladwell, “AIDS Spreading ‘Dramatically’ Worldwide; WHO Estimates Up to 10 Million Infected; Cases in Asia Surge,” The Washington Post, August 1, 1990, A1.

  56. 56.

    R. C. Bollinger, S. P. Tripathy, and T. C. Quinn, “The Human Immunodeficiency Virus Epidemic in India. Current Magnitude and Future Projections,” Medicine (March 1995) 74(2): 97–106.

  57. 57.

    Ibid.

  58. 58.

    Rod Mickleburgh, “WHO reports million more AIDS-virus infections Figures since last April buttress grim predictions,” The Globe and Mail, February 12, 1992.

  59. 59.

    Olavi Elo, Interview by Michael Merson, Geneva, September 21, 2001.

  60. 60.

    Dimsa Sachan, “India’s AIDS department merger angers activists.” The Lancet, 384(9946):842, 6 September 2014.

  61. 61.

    Elizabeth Rosenthal, “In Rural China, a Steep Price of Poverty: Dying of AIDS,” New York Times, Oct 28, 2000.

  62. 62.

    Werasit Sittitrai, “HIV Prevention Needs and Successes: A Tale of Three Countries,” Geneva: UNAIDS , 2001, 1–4; Gary Slutkin, Sam Okware, Warren Naamara et al., “How Uganda Reversed its HIV Epidemic,” AIDS Behav. 10(4): 351–360 2008.

  63. 63.

    Gary Slutkin, Sam Okware, Warren Naamara et al., How Uganda Reversed its HIV Epidemic, AIDS Behav. 10(4): 351–360 2008.

  64. 64.

    Elizabeth Pisani, “Acting Early to Prevent AIDS: The Case of Senegal ,” Geneva: UNAIDS , 1999, 99.34E, 11.

  65. 65.

    Clare Nullis, “Health Agency Urges More Promotion of Condoms,” The Associated Press, June 22, 1992.

  66. 66.

    Jeff Gow, “The HIV/AIDS Epidemic in Africa: Implications for U.S. Policy,” Health Affairs (Project Hope) 21, no. 3 (June 2002): 57–69; see UNAIDS, Guide to the Strategic Planning Process for a National Response to HIV/AIDS, Module 4: Resource Mobilization, Best Practice Collection Geneva: UNAIDS, 2000.

  67. 67.

    Jacques du Guerny, “AIDS and agriculture in Africa: can agricultural policy make a difference?” Food and Agriculture Organization of the United Nations, 1999, Rome, Italy. See also Rand L. Stoneburner and Daniel Low-Beer, “Population-Level HIV Declines and Behavioral Risk Avoidance in Uganda,” Science (April 30, 2004) 304(5671): 714–18, doi:10.1126/science.1093166.

  68. 68.

    F. S. Mhalu and E. Lyamuya, “Human Immunodeficiency Virus Infection and AIDS in East Africa: Challenges and Possibilities for Prevention and Control,” East African Medical Journal (January 1996) 73(1): 13–19.

  69. 69.

    Ibid.

  70. 70.

    “HIV/AIDS epidemiological surveillance report for the WHO African Region: 2007 update.” World Health Organization. Regional office for Africa, 2008, p. 25.

  71. 71.

    Lucia Cornoa and Damien de Walqueb, “Mines, Migration and HIV/AIDS in Southern Africa,” J Afr Econ (2012) 21(3): 465–498.

  72. 72.

    Ibid.

  73. 73.

    Stephanie Nolen, “Mandela arrived late to the fight against HIV-AIDS,” The Globe and Mail, December 4, 2013. http://www.theglobeandmail.com/news/world/nelson-mandela/mandela-arrived-late-to-the-fight-against-hiv-aids/article548193/

  74. 74.

    Gary Slutkin et al., “How Uganda Reversed Its HIV Epidemic,” AIDS and Behavior (July 2006) 10(4): 351–60, doi:10.1007/s10461-006-9118-2.

  75. 75.

    Ibid.

  76. 76.

    Ibid.

  77. 77.

    Ibid; See also G. Slutkin, “Global AIDS 1981–1999: The Response [The Pittsfield Lecture],” The International Journal of Tuberculosis and Lung Disease (February 1, 2000) 4(2): S24–33.

  78. 78.

    Mort Rosenblum, “U.N. AIDS-Fighting Agency Having Problems; With AIDS-Losing Battle.” The Associated Press, July 5, 1992.

  79. 79.

    Gary Slutkin, Interview by Michael Merson, New Haven, CT, February 3, 2003; Helene Gayle, Interview by Michael Merson, New Haven, CT, February, 2002.

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Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Michael Merson (Wolfgang Joklik Professor of Global Health)

  2. Mount Saint Mary’s University, Los Angeles, CA, USA

    Stephen Inrig (Director, Health Policy and Management Program)

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Merson, M., Inrig, S. (2018). Containing the Global Spread of HIV. In: The AIDS Pandemic. Springer, Cham. https://doi.org/10.1007/978-3-319-47133-4_10

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  • DOI: https://doi.org/10.1007/978-3-319-47133-4_10

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