final exam guide for PERS 2002
final exam guide for PERS 2002 PERS 2002
Popular in HIV/AIDS in a Global Perspective
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HIV Infection and AIDS: Etiology, Epidemiology, Transmission and Testing Where did HIV come from? Present in US, Europe and Africa for many decades (1960s) Mutation First identified in 1984 Difficult to trace to one person Definitions HIV prevalence: The number of people living with HIV—with or without a diagnosis of AIDS—at a point in time. HIV incidence: The number of people who become newly infected with HIV in a given period. HIV diagnoses: The number of HIV diagnoses during a given period, regardless of when the persons became infected. AIDS diagnoses: The number of AIDS diagnoses during a given period. AIDS is diagnosed when an HIV-infected person’s immune system becomes severely compromised (measured by CD4 cell count) and/or the person becomes ill with an opportunistic infection. DEFINITION: HIV/AIDS HIV- stands for human immunodeficiency virus. This is the virus that causes AIDS. HIV is diff from other viruses because it attacks the immune system. AIDS-stands for acquired immunodeficiency syndrome. AIDS is the final stage of HIV infection. It can take years for a person infected with HIV, even without treatment, to reach this stage. HIV PREVALANCE 1.1 million adults and adolescents were living with diagnosed or undiagnosed HIV infection in the United States at the end of 2006 (CDC, 2008). The majority of those living with HIV were nonwhite (65.4%), and nearly half (48.1%) were men who have sex with men (MSM). The HIV prevalence rates for blacks (1,715.1 per 100,000) and Hispanics (585.3 per 100,000) were, respectively, 7.6 and 2.6 times the rate for whites (CDC, 2008) THE PROBLEM diagnosed to late for treatment to be effective 20% people infected with HIV don’t know it (including women) 1/3 are diagnosed so late that they develop AIDS within one year The states with the biggest epidemic and the greatest number of late diagnosis = Fla., NY, Texas, GA., NJ HIV overview Human Immunosuppressive virus (HIV) “This is the retro-virus that causes AIDS” HIV – 1 and HIV – 2 (mostly in West Africa) 1983 and 1984 (virus identified) Gallo, NCI (HTLV-111), Montagnier, Pasteur Institute (Lymphadenopathy Associated Virus), Levy et.al, (AIDS Associated Virus) Attacks and weakens the immune system Destroys “helper ‘T’ cells” (lymphocytes) Attaches to the CD4 (<200) VIRAL LOAD Measures the amount of HIV in the blood system An undetectable viral load does not mean you are cured. You can still infect others! Reservoirs Window period/sero-conversion During this phase, the infection is established and a proviral reservoir is created. This reservoir consists of persistently infected cells, typically macrophages, and appears to steadily release virus. Some of the viral release replenishes the reservoir, and some goes on to produce more active infection. Most convert by 3-6 months TRANSMISSION (body fluids, cells and tissue) Peripheral blood Lymph nodes Brain tissue Cerebral spinal fluid Tears Bone marrow Plasma Saliva Retina Cornea Ear secretions Bronchial fluid Semen Breast milk Mucous membranes Vaginal fluid How is HIV transmitted HIV is not transmitted through casual contact! Blood transfusion Sharing contaminated needles Unprotected sex (receptive anal) Needle sticks Receptive penile/vaginal Insertive (anal) Insertive (penile vaginal) Oral sex (male to male less) Bite injury (rare) Drug apparatus products, tissues, or organs Mother to child Female to female (0) Transmission (made easier?) Genital ulcers STI Trauma Presence of inflammation or exudates Menstruation Menopause (dryness) First sexual experience Lack of circumcision TREATMENT (MTCT) (stopped) Antiretroviral therapy- given to pregnant HIV-infected women reduced this type of HIV transmission Without (AT) 25% of pregnant HIV infected women will transmit the virus reduce the rate of HIV transmission to 2% or less!!!! MTCT Most perinatal transmission: occurs at the time of birth Post delivery breast feeding Other factors Younger maternal agree Increased maternal RNA viral load Increased maternal RNA viral load in breast milk Breast clinical condition (cracked nipples) Sub-optimal nutritional status Increased duration of breastfeeding The epidemic at a Glance How many people are infected worldwide? 33 million people live with HIV worldwide in low- and middle-income countries. An estimated 2.7 million people were newly infected with the virus in 2010. Facts HIV/AIDS is the world’s leading infectious disease killer 30 million people died to date. 1.8 million people die every year from HIV/AIDS. About 6.65 million HIV-positive people had access to ART in low- and middle-income countries at the end of 2010 Overall, the coverage of ART continued to increase and was 47% of the 14.2 million people eligible for treatment at the end of 2010. How many children are living with HIV/AIDS?—3.4 million!! According to 2010 figures most of the children live in sub- Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding. Almost 1100 children become newly infected with HIV each day. The number of children receiving ART increased from about 75, 000 in 2005 to 456, 000 in 2010. HIV is the strongest risk factor for developing active TB disease In 2010, more than 350 000 deaths from tuberculosis occurred among people living with HIV. The majority of people living with both HIV and TB reside in sub- Saharan Africa (about 82% of cases worldwide). Living 56,300HIV/AIDS Cases AnnuallyinUS with HIV Confidentiality 0 HIV information must be considered confidential 0 Faxing medical record information with HIV test results is prohibited in some states. Right to Know! 0 Healthcare workers have the right to know when they are caring for patients with highly contagious diseases 0 The duty to disclose and protect the rights of the caregiver outweighs the patient confidentiality issue 0 OSHA helps protect healthcare workers in this area and mandates employee training in the areas of epidemiology, modes of transmission, prevention, and universal precautions. The Person • The experience of living with HIV is extremely individualistic • Individuals should be looked at in terms of each individual’s personal, social, cultural, and spiritual context 0 A Diagnosis Forces PLWA to re-examine their lives 0 This reexamination may result in transformation Uncertainty of HIV 0 ability of virus to mutate/become resistant makes medical management a challenge 0 A person’s body / makeup determine a their response to HIV and treatment 0 Fear of disease progression a reality 0 PLWA anticipate the worst while hoping for the best 0 Quality of Life: ability to function in daily life 0 Self-transcendence (despair too challenge) 0 Psychosocial counseling and stress management 0 Will to live – social support 0 Diet and exercise (lipodystrophy and wasting) Stigma 0 Stigma has been defined as any characteristic, real or perceived, that conveys a negative social identity (Crocker, Major,&Steele, 1998; Goffman, 1963). 0 A process of devaluing a person base on characteristics, trait, or attributes of the individual (Durham, 2010) 0 Isolation, discrimination, homophobia, sexism, fear, shame, ridicule, avoidance 0 Younger = less stigma 0 Education = less stigma 0 Personal contact with PLWA = less stigma 0 HIV/AIDS transmission knowledge = less stigma 0 Attitudes toward homosexuality = more favorable attitudes, less stigma HIV Disease Trajectory WINDOW PERIOD (test) HIV-1 antibody test usually normal False neg Polymerase (detects RNA – 2 weeks); infants Can transmit CD4 normal Counseling important! Infants (2years) Diagnosis and testing Rapid testing, Ora-Quick (quick, inexpensive behavior change). Elisa Western Blot! Issues related to testing (discussion) HIV Testing Pre and post test counseling. Only if HIV+(CDC, 2006) Anonymous Testing (name, no ID) Confidential testing (Results given to pt., but protected by HIPPA) Goal is to provide test results to PT. Disclosure to partners PRIMARY INFECTION First stage of HIV disease (1-2 weeks) Virus first enters the body Lymphopenia Viral load surges (>50, 000) Fever, chills, night sweats, myalgias, arthralgias, pharyngitis, and rashes DIFFRENTIAL DIAGNOSIS MONO, Influenza, Streptococcal pharyngitis, Viral hepatitis, Toxoplasmosis (parasitic disease) , Secondary syphilis Asymptomatic Stage Look and feel great! Last many years HIV IS active- CD4 levels declines- Viral load stable (without treatment – set point) AIDS Must have a laboratory-confirmed HIV infection test Children <18mths: mother confirmed CD4 < 200/mm Viral load markedly increased Marked deterioration of the immune system Death in 3-5 years without treatment OPPORTUNISTIC INFECTIONS AND CANCERS HIV Among Children Every minute 5 people around the world b/w the ages of 10 - 24 are infected There are 2.5 million children under the age of 15 living with the disease In Sub-Saharan Africa, the of new infections occurs for people b/w 15 and 24. Most children >15 infected from MTCT this occurs during pregnancy, birth, or breastfeeding after birth. Sexual activity in adolescence for most people worldwide. Young uninformed about HIV/AIDS risk becoming infected. kids w/ H/A -> weaker immune systems & more susceptible to illnesses. may be stigmatized and/ or rejected from their families and communities. discrimination & stigma makes it difficult to prevent spread of infect. Children are orphaned when their parents die from HIV/AIDS. girls and young women - disproportionately high risk of contracting infec. Girls are physiologically more vulnerable to infection. Gender-based inequities mean “girls and women are more likely to be poor and powerless,” hence are more vulnerable to sexual exploitation and HIV/AIDS infection. Violence against girls in the form of forced or coerced sex, increase their chances of becoming infected. HIV AND YOUTH The US • In 2009, young persons accounted for 39% of all new HIV infections in US. • persons aged 15–29 comprised 21% of the US population in 2010. YOUTH ISSUES Early age at sexual initiation; unprotected sex; older sex partners • 46.0% of high school students have had sexual intercourse, and 5.9% reported first sexual intercourse before the age of 13. • Of 34.2% of students reporting sexual inter. 38.9% did not use a condom. YOUNG MSM AND HIV • Young MSM are at increased risk for HIV infection. In 2009, young MSM accounted for 27% of new HIV infections in the US and 69% of new HIV infections among persons aged 13–29. • for young black MSM, new infections inc. 48% from 2006 through 2009. SEXUAL ABUSE • Young adults who have experienced sexual abuse are more likely to engage in sexual or drug-related behaviors that could put them at risk for HIV. SEXUALLY TRANSMITTED INFECTIONS (STI’S) • presence of an STI greatly increases a person's likelihood of acquiring HIV. • Some of highest STI rates in the country are among young (minority)people. SUBSTANCE ABUSE • CDC's 2009 National YRBS found that 24.2% of high school students had had five or more drinks of alcohol in a row on at least 1 day during the 30 days before the survey, and 20.8% had used marijuana at least one time during the 30 days before the survey. • Both casual and chronic substance users are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol LACK OF AWARENESS • Research has shown that a large proportion of young people are not concerned about becoming infected with HIV. • This lack of awareness can translate into not taking measures that could protect their health. • Antiretroviral Therapy ADHERENCE • Viral resistance increases when doses are missed • Need 100% adherence to medication regimen • Family assessment of ability to adhere to treatment. • Adolescent may need additional support HIV AND YOUTH • Continual HIV prevention outreach and education efforts, including programs on abstinence, delaying the initiation of sex, and negotiating safer sex, are required as new generations replace the generations that benefited from earlier prevention strategies. NGOs and governments are working together to educate the public about HIV/AIDS and to direct individuals to clinics that offer free HIV testing. Researchers continue their efforts to find better treatments to help those with AIDS – and ultimately, a cure. however, new medicines are often too expensive for poor countries. intellectual property rights also block the production of more affordable, generic medicines. Some governments have increased funding and adopted legislation that help children with AIDS. • HIV/AIDS among LGBT Communities Craig Washington • An estimated 17,774 people with AIDS died in 2009 • Through March 2012, nearly 619,400 people with AIDS in the U.S. have died since epidemic began • U.S. HIV/AIDS Facts by Race/Ethnicity Centers for Disease Control and Prevention • Blacks represent 14% of the U.S. pop, but accounted for estimated 44% of new HIV infections in 2009. Blacks accounted for 46% of PLWH in 2008 • Since epidemic began, >250,000 blacks with AIDS have died • At some point in their life, approx.1 in 16 BM will be diagnosed with HIV, 1 in 32 BW • In 2009, the estimated rate of new HIV infections among BM was 6X as high as that of WM, and 2.5X as high as that of Hispanic/Latino men and of black women • Hispanics represented 16% of the pop. but accounted for 20% of new HIV infections in 2009 • an estimated more than 95,000 Hispanics/Latinos with AIDS have died • Georgia HIV/AIDS Facts • Ga: ranked 8 highest reported number of AIDS cases through . Dec. 2010 • 2010 # of ppl w/ HIV/AIDS in GA was 40,328. 44% had HIV. 56% had AIDS • In 2010, 66% resided in the Atlanta Metropolitan Statistical Area (MSA) th rd • In 2008, GA ranked 6 among states for AIDS cases, and 3 for syphilis cases • 55-61% of all new HIV or AIDS cases reported in GA are MSM Centers for Disease Control and Prevention (CDC) • Gay , bisexual and other men who have sex with men 2% of population. • MSM account for nearly half of the approximately 1.2 million people living with HIV in U.S. • In 2009, white g/b/MSM continued to account for the largest number of new HIV infections of any group in U.S. (11,400), followed closely by black MSM (10,800) • MSM account for more than half of all new HIV infections in the United States each year (61%, or an estimated 29,300 infections). • Gay, Bisexual MSM of Color Centers for Disease Control and Prevention (CDC) • More new infections among young black gay men (13 -29) than any group (nearly 2x white and >2x Latino) • Young, black MSM were only risk group U.S. with statistically significant increases in new infections from 2006–2009—4,400 new HIV infections in 2006 to 6,500 infections in 2009 • The odds of being infected with HIV are roughly 72 times higher in black MSM than in general populations in the US • Among Latino GM, largest number of new infections in youngest age group (13 -29 years old). Among Latinos, gay and bisexual men account for nearly 2/3 of all new infections • Factors: Gay, Bisexual Men and HIV Centers for Disease Control and Prevention (CDC) • High prevalence of HIV --greater risk of being exposed to infection • Co-infections with other STDs (i.e., syphilis) • Lack of knowledge of HIV status • Challenges of maintaining risk reduction practices over time • Structural factors of stigma, poverty, homelessness, limitations of prevention and treatment services. • Transgender Identity and HIV/AIDS • Individuals whose gender identity, expression or behavior not traditionally associated with birth sex. • Transgender people disproportionately affected by HIV and AIDS. • Estimated HIV rates range from 14 – 69% according to transgender HIV/AIDS needs assessments and sex risk behavior studies. • Risk factors may include multiple sex partners, irregular condom use, unsafe injection practices, lack of trans centered prevention activities. • Homophobia and Gender Oppression • Stigma sexual identity • race, ethnicity, gender identity • internalized stigma • stigma surrounding HIV testing • illness-related stigma • HIV status and the perception of HIV status AID Atlanta Overview • Founded 1982 • 100 Employees: • The mission of AID Atlanta is to reduce new HIV infections and improve the quality of life of its members and the community by breaking barriers and building community. • Education and Prevention Services, HIV Counseling and Testing, Primary Medical Care Clinic, Case Management. • Prioritized Populations for Prevention Services • Care/Member Services • HIV Prevention Education • Community Partnerships to help reach those at highest risk • Targeted programs that address the specific needs of high-risk communities • Curricula that have been proven effective • Various types of interventions to reach people in different ways • (groups, individuals, short and long-term counseling, social marketing, community outreach) Women with HIV US women represent 19% of all AIDS cases & 27% of adults and adolescents. In 2006, black women accounted for 65% of HIV/AIDS cases in women 13 years or older; Hispanics – for 15%, and whites – for 18%. In 2004 HIV was leading cause of death among African American women. For adolescent female, HIV rates are 3 to 6 times higher than for males. TRANSMISSION heterosexual contact accounts for 75% of new cases of AIDS in women. Women are more susceptible to heterosexual transmission of HIV than men: * Biologically: female anatomy /female genital tract, pH, vaginal fluid * physiologically: changes that occur with aging, sexual excitement, menstruation, contraceptive practices /barrier methods/, hygienic practices * sexually transmitted infections /STIs – syphilis, genital herpes, chlamydia, HPV,etc. inc risk for hiv. STIs are asymptomatic, which makes diagnosis diff. CONCERNS MENSTRUATION The interaction between HIV and don’t necc. experience menstrual problems. Menst. may enhance a woman’s infectiousness or susceptibility to infection. CONTRACEPTION Barrier methods /male and female condoms/ are recommended. Combination hormonal contraceptives can interact w/ ART Patches and injections do not interact with ART. PREGNANCY 2003:CDC rec. the HIV testing for pregnant women and use of rapid testing during and after pregnancy if the mother had not been screened. Pregnancy does not lead to HIV progression. Perinatal transmission risk dec > 2% with ART /if started by 28 wk gestation. Viral load needs 2b suppressed 2 undet. to dec the likelihood of transmission. Risk factors: low CD4 count, poor nutrition, drug use, STIs, vaginal delivery, invasive fetal monitoring, breast- feeding. MENOPAUSE Decreasing estrogen causes thinning of the vaginal epithelium, which becomes a less effective barrier. Concerns for women: bone loss, inc. heart disease risk /side- effects of ART/ PREVENTION The ABC approach – not effective, why? Female condoms Microbicides Prevention programs that are gender specific and culturally appropriate. Additional Threaded discussion topics Prevention Female condoms Microcides Psychological issues Violence HIV/AIDS around the Globe There over 42 million people living with HIV/AIDS today Over 19 million of those infected are women Everyday, there are 14,000 new infections HIV – A “disease of young people” 2.5 million of those newly infected each year are between the ages of 15-24 UN estimates 14 million children have been orphaned by AIDS In just 3 years, that number is estimated to reach 25 million HIV/AIDS in Latin America By 2006, 1.6 million people were living with AIDS in Latin America – While this is lower than Africa or India, these numbers are continually increasing and only expected to get worse Half of all those infected reside in the 4 largest countries of Latin America: Brazil, Argentina, Columbia and Mexico. – However – the most severe cases are where there is a higher prevalence, in smaller countries such as Belize and Honduras. Key Affected Groups: – Men who have sex with men (MSM) – Sex workers – Intravenous Drug Users (IDS) – Migrants Religion and HIV/AIDS Prevention Catholicism Says “NO!” to Condoms The Roman Catholic Church has been morally opposed to contraception for as far back as one can historically trace. Approximately 70% of people living in Latin American countries identify themselves as Catholic This predominantly Catholic population has remained both uninformed on safe sex practices and resistant to the use of condoms Homosexuality is a Sin Homosexuality is illegal in many Latin American countries – Homosexuals and bisexuals are often “underground” activities, increasing their likelihood of participating in high risk behaviors. – Bisexuality among married men is common, and studies have shown that while wives may be aware of their husbands’ other partners, they are generally not comfortable asking their husbands to wear condoms. – Social and Political Stigma Colombia – Ongoing war between left-wing guerrilla groups and right- wing paramilitaries – FARC (the Revolutionary Armed Forces of Colombia) is known to have forced residents of areas they control to take HIV tests – Gay men forced to wear signs around neck – Displacement and migration to other countries may have impact on epidemic – 86% infected are men….leaving little access to healthcare for women infected – Social and Political Stigma Guatemala – Mayans may be 3x more likely to develop HIV – Stigmatized population with less access to healthcare Nicaragua – Stigma around using condoms – One study showed that of adolescents who had been sexually active in past 3 months, only 21% used condom – Insufficient HIV Testing available Barriers to Overcoming the Crisis Regardless of differences in how each country handles this issue, there is consistent evidence of structural violence across the board: Poverty Migration Homophobia HIV-related discrimination BEADS FOR LIFE Beads for Life Ugandan – North American partnership to eradicate poverty Sustainable income generation as the core of its mission – 501c3 organization. Over 75% of the proceeds go directly to supporting their mission. “4 pillars” of community development- Health, Education and Vocational Training, Life Skills and Affordable Housing Beads for Health… Impoverished people àoften the victims of poor health. 43% of the BFL’s are HIV+ Beads for Life provides: – access to diagnosis and treatment services – HIV testing for BFL’s children – reproductive health services – health education – critical health products Meet Alice Aduna “Time for Hope for Young People” (PROTEJA) A social mobilization program for and by youth to promote healthy lifestyles Program implemented in the Dominican Republic PROTEJA Target: – Adolescents and young people between 10 to 19 years old, living in 10 communities, including poor communities of sugar cane cutters Objective: – Promote safe and healthy practices based upon values such as abstinence, delay of first sexual intercourse, sexual fidelity, and the correct use of condom. – . Methodology – Forty-five young leaders were trained as peer-educators in sexual and reproductive health (SRH), gender, effective communication, and self-esteem issues. Each one trained15 other youth, who in turn trained 10 others until more than 10 thousand young people involved. Main Concepts and Components Demystification of local taboos about sexuality and SRH Increased amounts of adolescents and young people who realize the risk of HIV/STI infection Adolescents and young people receive systematic information through a quarterly bulletin de-signed and produced by community reporters, who have been trained by the project Forty teachers have graduated from a qualified course called “diplomado.” They are now giving information on SRH in schools. A total of 6,750 trained young people currently promote healthy SRH practices Fifty thousand youths and adults have been informed through information campaign using multi-media, e.g., bulletins, brochures, etc. A Youth-Friendly Care Center directed and conducted by young people was established.- Ten thousand adolescents and youths using at least two AIDS prevention measures PROTEJA What they have learned from organizing this project is: Youth-friendly communication requires broad-based consultation with the community, e.g. church leaders, teachers and parents. With minimal inputs, thousands of youth could be reached through a “ladder strategy”. Training programs with professional credits are attractive incentives to involve teachers. Youth must plan and design youth-targeted programs, so that they act as owners and protagonists and process builders Proteja Conclusion The PROTEJA project, with a minimum investment of about US $50,000, has positively impacted more than 10,000 adolescents. Youth are a window of opportunity for HIV prevention. They must not only be targeted, they must own programs that affect them. Creative activities and value-centered education are major points of attraction to youth programs European Community Project 1997-1999 Educational Program in the Colombian cities of Bogotá, Cali, and Bucaramanga. School-based peer education program Main goals – HIV/STI-related education for adolescents and young adults – promote risk awareness and safer sexual behavior – build the capacity of local nongovernmental organizations responding to HIV/AIDS and improve national networks of HIV/AIDS NGOs. European Community Project Information and education sessions for teachers (focused on classroom communication skills relevant to reproductive health and using information/education/communication training materials). Training of teachers, students, and peer educators on HIV/STI prevention, reproductive health and the importance of safer sex. Peer educator-led campaigns among community groups. Lessons Learned There is a need to develop and conduct widespread school-based programs for sexual and reproductive health, including HIV/AIDS prevention. Trained teachers and peer educators can achieve high coverage in implementing HIV/AIDS prevention activities. Enhanced project success is associated with participant involvement in project design. Activities should be culturally sensitive and relevant to the needs of intended beneficiaries. The participation of national health authorities is important for the sustainability of HIV/AIDS education and prevention activities. AID for AIDS Aid for AIDS New York City Medicine Recycling Program Donating to Latin America since 1996 Drug donations from HIV/AIDS patients in United States who don't need them anymore for various reasons Partners with activists/organizations in countries to help lobby government for AIDS awareness-Brazil has developed national drug program Conferences in Latin America Our Plan Comprehensive approach to tackle all angles of the epidemic – Education, Education, Education – Removing the stigma – Help create sustainable income – Utilize local resources – Lobby for financial and legislative government support and funding – Utilize the crafts and talents of the people to foster motivation and empowerment – References and Resources UN Aids: www.unaids.org HIV/AIDS in Lithuania Irma In the Baltic states, as in another East European countries, the spread features of the HIV/AIDS pandemic are quite similar, but the spread of HIV in Lithuania has some peculiarities. HIV/AIDS Epidemiological situation in Lithuania In 1988 – 2007 1213 HIV infection cases and 126 AIDS cases were reported. Lithuania is surrounded by countries where HIV is widely spread. Nevertheless, Lithuania is still a country with a low HIV prevalence. HIV prevalence according to the way of transmission The main ways of HIV/AIDS transmission in Lithuania are: intravenous drug using (933 persons); heterosexual intercourses (136 persons); homosexual intercourses (79 persons); unknown (65 persons). HIV prevalence according to the age and gender HIV has been mostly reported in the age groups of 25 – 29 and 30 – 34. Up to the 1st of January in 2007, 1052 male and 161 female HIV cases were reported. It is important to notice that number of female cases is increasing. The prevention of HIV/AIDS in Lithuania. The prevalence of HIV depends on human interrelationships and their behaviour. So the main tool which can stop it is prevention. Systematic and methodical prevention of HIV infection and AIDS in Lithuania started in 1989, when Lithuanian AIDS Center was established. The main functions of the Center are: the development and promotion of HIV/AIDS prevention and control; performance and monitoring of testing and treatment in Lithuania; implementation of the national AIDS prevention programmes; cooperation with institutions involved in HIV/AIDS prevention; coordination of efforts with other related programmes; advocacy and lobbying, including legislative framework. The key strategical document on HIV/AIDS prevention and control in Lithuania is the National AIDS Prevention and Control Programme. This program has set the target to keep the country of a low HIV prevalence up to 2010. Key objectives of this programme are: 1. To reduce transmission of HIV/AIDS and related infections in Lithuania. 2. To mitigate negative consequences of HIV and related infections to an individual and society. 3. To provide appropriate health care services to people with HIV and AIDS. 4. To improve HIV/AIDS surveillance system. Decentralized actions – from the national level to the district and community levels are characteristics of the Lithuanian HIV/AIDS programme. The role of the municipal health programmes is very important to stimulate health promotion and local participation in design of the health policy. Other ways of HIV/AIDS prevention in Lithuania Issues on HIV/AIDS are integrated into various school curricula topics. Youth Health Centres take care of informal sexual education of young people. Non-governmental sector has been actively taking part: in organising of commemoration of the World AIDS Day; in actions “Get tested on HIV for free”; in implementation of the “Peer education” programmes; in organizing national contest for the schoolchildren on knowledge about HIV/AIDS; in organizing international Schoolchildren Drawing Competition “School Children Against AIDS”; in organising of debates of youth and policy makers in the municipalities; in organizing of a club “Journalists against AIDS”. Organisations trying to help people living with HIV/AIDS “Positive Life” – an independent, non-governmental organization founded by HIV positive people, their family members and other individuals that deal with the problems encountered by people living with HIV/AIDS (PLWHA) in Lithuania. Drug Users’ Social Rehabilitation Community where people dependent on drugs and psychotropic substances can get the Community’s support. The priority is given to drug users infected with HIV. Stigmatized HIV infected people Pervasive stigma has surrounded HIV/AIDS since the beginning of the pandemic. HIV infected people in Lithuania are not an exception too. In 2003 there the research was performed which examined the HIV related stigma among HIV infected prisoners. Research has shown that respondents feel personalized stigma. Another survey of the public opinion about vulnerable groups in 2003 has proved significant increase in tolerance towards the people with HIV in the last 13 years. Negative attitude of the society towards HIV infected people is determined by: the lack of information on HIV infection; preconcepion and stereotypes; fear of the desease which is incurable; irresponsibility of mass media; the attitudes about sexual life. The only way to overcome HIV/AIDS pandemic is to change the shame into solidarity and the fear into hope. This is what I wish for all of us.
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