On June 5, 1981, an article concerning five previously healthy, young gay men in Los Angeles diagnosed with Pneumocystis carinii pneumonia, an infection that usually appears only in individuals with substantial immune system damage, appeared in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention.
Soon more cases like these appeared, at first mainly in gay men, but then also in injection drug users, hemophiliacs and other recipients of blood and blood products, heterosexual men and women, and babies who acquired the infection from their mothers during birth or breastfeeding. We and our colleagues quickly began to confront the reality of a deadly new disease that would change the world. The disease ultimately would be referred to as AIDS.

Thirty years later, we are gratified by the progress that has been made in understanding, treating and preventing HIV/AIDS. We could not have imagined these advances during the early days of AIDS, when all we could do was provide palliative care to waves of dying patients. Whereas survival was once measured in weeks or months from the time of diagnosis, today, the critical discovery of antiretroviral drugs and their use in combination regimens has resulted in greatly improved life expectancy -- decades, rather than months -- for many HIV-infected people who have access to these medicines and adhere to treatment.

We take pride in the contributions of NIH-supported scientists who have been central to the investigation of the HIV disease process, the development of new therapies for HIV/AIDS and the design and validation of methods of HIV prevention. NIH scientists played a key role in demonstrating that HIV causes AIDS and in developing a diagnostic test for the virus. The ability to test the blood supply for HIV has nearly eliminated the risk of HIV transmission through blood transfusion.

NIH has supported basic and clinical research that provided pivotal data for many of the more than 30 drugs that have been approved by the Food and Drug Administration to treat HIV infection, as well as for strategies to address its associated opportunistic infections, malignancies and clinical complications. Clinical trials funded by NIH also have helped determine the most effective combinations of these drugs to slow or halt the progression of HIV disease. Additionally, NIH-supported studies were instrumental in designing effective strategies to virtually eliminate mother-to-child HIV transmission in developed nations and to dramatically reduce HIV transmission from an infected mother to her newborn or nursing child in the developing world. Many of these clinical trials were designed with the involvement and advice of HIV-affected communities, establishing a model for the conduct of clinical trials for other diseases.

NIH-supported, large-scale clinical trials have resulted in other notable achievements in HIV prevention. These studies sought answers to questions of critical importance to the global public health community. They proved that medically supervised adult male circumcision <http://www.niaid.nih.gov/news/newsreleases/2006/Pages/AMC12_06.aspx> more than halves the risk of female-to-male sexual HIV transmission; that needle and syringe exchange programs can reduce HIV transmission without increasing injection drug use; that a vaccine <http://www.niaid.nih.gov/news/newsreleases/2009/pages/thaivaxstudy.aspx> can achieve modest protection against HIV infection; and that taking an antiretroviral drug daily <http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx> can reduce the risk of HIV acquisition in men who have sex with men.

Most recently, an NIH-funded clinical trial <http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx> demonstrated that an HIV-infected individual can dramatically reduce the risk of transmitting the virus to an uninfected heterosexual partner by starting treatment when his or her immune system is relatively healthy. NIH also helped train the scientists and establish the infrastructure for an important clinical trial funded by the U.S. Agency for International Development showing that a vaginal gel containing an anti-HIV drug can help protect women from HIV infection. These multiple achievements are important because it is clear that controlling -- and ultimately ending -- the HIV/AIDS pandemic will require a combination of scientifically proven HIV prevention tools.

As gratified as we are by these accomplishments, we are sobered by some grim realities and remaining challenges. Despite the global public health community's best efforts to prevent new infections, 2.6 million people around the world became newly infected with HIV in 2009 alone. In developing nations, only about one-third of the 15 million people who need anti-HIV drugs have access to them. In addition, a growing proportion of patients receiving long-term antiretroviral therapy are experiencing treatment failure, drug toxicities, side effects and drug resistance. In this regard, recent studies have noted an increased incidence of malignancies, cardiovascular and metabolic complications and premature aging associated with long-term HIV disease or antiretroviral therapy.

NIH research will continue to address these issues as well as the causes of HIV-related health disparities, their role in disease transmission and acquisition, and their impact on treatment access and effectiveness. These include disparities among racial and ethnic populations in the United States; disparities between developed and resource-constrained nations, and disparities based on gender, age, or sexual identity. NIH research also will continue to play a critical role in providing the scientific foundation to achieve the goals of the President's National HIV/AIDS Strategy. Among the important scientific challenges that remain are the development of a safe and effective vaccine that can take its place among the combination of prevention tools as well as the possibility of curing at least a proportion of HIV-infected individuals.

The HIV/AIDS pandemic will remain one of the most serious public health crises of our time until better, more effective and affordable prevention and treatment regimens are developed and universally available. As the single largest public funder of HIV/AIDS research in the world, NIH is committed to advancing a comprehensive program of basic, clinical, translational and behavioral and social science research toward controlling and ultimately ending this modern plague. In memory of the patients, friends, loved ones and colleagues we have lost over these three decades, we wholeheartedly embrace this responsibility and opportunity knowing that history will judge us as much for what we accomplish during the coming years as for what we have achieved thus far.

Dr. Anthony S. Fauci is the director of the National Institute of Allergy and Infectious diseases. Dr. Jack Whitescarver is the NIH associate director for AIDS research and the director of the NIH Office of AIDS Research.

NIAID conducts and supports research -- at NIH, throughout the United States, and worldwide -- to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at <http://www.niaid.nih.gov/ >.

The Office of AIDS Research, a part of the Office of the NIH Director, coordinates the scientific, budgetary, legislative, and policy elements of the NIH AIDS research program.   OAR sets scientific priorities, enhances collaboration, and ensures that research dollars are invested in the highest priority areas of scientific opportunity that will lead to new tools in the global fight against AIDS.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
美国国家卫生研究院(NIH)医学博士Anthony S. Fauci、博士Jack Whitescarver为艾滋三十周年发表讲话。



    NIH支持的艾滋病预防大型临床实验取得了显著的成果。这些研究解答了很多全球卫生系统共同面临的问题,证明了在严格的医学监控下,对成年男性进行包皮环切手术能够降低一半以上由女性传染的艾滋病毒的风险(http://www.niaid.nih.gov/news/newsreleases/2006/Pages/AMC12_06.aspx );针头和注射器交换项目可以在不增加注射吸毒的基础上降低艾滋病毒的传播; 注射疫苗能在一定程度上防治艾滋感染(http://www.niaid.nih.gov/news/newsreleases/2009/pages/thaivaxstudy.aspx );每日服用抗逆转录药物能够降低男男性行为者感染艾滋的风(http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx )。

    最近,NIH支持的临床研究(http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx )表明,艾滋病毒感染者如果在自身免疫系统相对较健康的情况下开始治疗,其感染健康的异性性伴侣的可能性将大大降低。另外,NIH也协助美国国际开发署对其资助的临床研究人员进行培训,并提供研究所需的基础设施,该研究结果表明含有抗艾滋药物的阴道凝胶能够防治妇女感染艾滋。



    Anthony S. Fauci博士是NIH过敏症与传染病学部主管。Jack Whitescarver博士NIH艾滋研究部副主任以及NIH艾滋研究办主任。





主持人:Sen Lam




LAM: 那么你能不能简单地给我们介绍一下太平洋地区的情况?

WILSON: 太平洋地区的数据又有所不同。从2001年至2009年,艾滋病毒携带者的数量从2万8千人升至5万7千人。和亚洲相比较,这些数值并不高,但是对于本地区来说,这确实是一个不小的数字。对于某些社会来说,影响是巨大的。这个地区非常多样化。如果你从整体来看,巴布新几内亚是本地区艾滋流行度最高的国家,感染率达0.9%,但该数值目前日趋平稳,这是共同努力的成果。该区域艾滋感染主要通过性行为传播,特别是在巴布新几内亚。但同时我们也看到注射吸毒也是主要感染途径之一,尽管数值相对较小,但在某些社区和国家却造成很大的影响。


WILSON: 这真是个非常好的问题,因为当我们谈论覆盖率这个问题时, 尽管整个区域治疗率达31%,东南亚地区更是达到43%,但是更为重要的是如何维持现有的治疗率,如何保持我们目前所取得的成果。总体来说,性工作者、注射吸毒者、男男性行为者以及跨性别者是最容易感染艾滋病毒的群体,我们必须保证艾滋预防和治疗项目的持续性。例如,目前很多国家正在商讨自由贸易协议,这将严重威胁到病患获得药品的途径,这些协议将对整个区域产生可怕的影响。



LAM: 我知道在这些国家很多项目经费都来自外国援助,而非该国自己的财政。这将也是未来发展的趋势吗?


Asia Report 翻译

原文链接: http://www.radioaustralia.net.au/connectasia/stories/201106/s3236705.htm

  Hanoi authorities on Tuesday allocated VND5 billion (US$243,000) for a program to crack down on prostitution.

  Half of the funding will support a rehab center to treat sex workers, including those addicted to drugs, and HIV-infected children.

  Money will also be spent on propaganda such as leaflets, newspapers and documents aiming to raise awareness of sex workers.

  Hanoi police department will also be supported to strengthen crackdown on secret brothels and prostitutes in public places.

  On May 12, the government unveiled on its website a five-year plan to reduce prostitution by an initial 40 percent by 2015.

  With a budget of VND629 billion ($30.5 million), the program looks to free communes and towns from prostitution and minimize harms on society.

  Rehab and healthcare centers, job training for former sex workers and public awareness are among the measures the government said will be taken to battle prostitution.

Weblink: http://www.thanhniennews.com/2010/Pages/20110601115436.aspx

  In 2010, the Population Services International (PSI) program, Sun Quality Health (SQH), and its sister network of village health workers, Sun Primary Health, performed more than 2.1 million client consultations in Myanmar. John Hetherington, who has managed the network since 2007, talked to CHMI (Center for Health Market Innovations) about how--in the second-poorest country in the Asia-Pacific region--SQH has assembled one of the broadest service packages of any social franchise network operating today in an attempt to provide high quality, well regulated priority health services to local people.

CHMI: You offer a wide range of services under the Sun Quality Health brand. How do you select the services the brand will include?
John Hetherington: With a backbone of 1200 doctors in more than 200 townships, we can be entrepreneurial. We first ask, is there a need not being met? And is there an opportunity for a network of providers to offer that service? In Myanmar, the largest health concerns - malaria, family planning, pneumonia, diarrheal disease, TB - are either too expensive to treat, or doctors don't provide the right quality service. As in many places, we started with reproductive health and family planning, where there is a natural fit for social franchising.

Why is it that so many social franchising programs start by offering family planning?

JH: I think family planning is unlike other services because everyone from 15-49 is potentially a client - meaning, they are theoretically all fertile -- and this makes it different than addressing diseases which require many more inputs to be efficient, targeting, testing, etc., particularly in Asia, where many of the big diseases tend to be concentrated epidemics. With FP, you have the potential to offer (almost) anyone you interact with something that can be of service to them. You have the potential for large scale impact without the precise geographical targeting that you would need to treat an epidemic.

Without using the media to market to clients, how does your franchise attract clients?

JH: Advertising for medical services is illegal. Here, as in many countries, there are lots of people who go to their local doctors when they are ill or think they are ill. Many of these doctors have practiced for 20-30 years without continuing medical education. These are the doctors we retrain, so [with their clients] we have a captive audience, in a way.
How do you set prices?

JH: We set prices in a way that they are not a barrier to the poorest person we want to reach in the given target. We make services available at a price people are expecting--50 cents to a dollar for a malaria treatment, versus the five to six dollars it would cost otherwise. If we were not subsidizing these services, doctors would not provide them, or they might give patients the wrong drugs--give an injection, for example.

Speaking of which, how do you ensure quality?
JH: Social franchising is more complex to manage than other channels of social marketing--you need higher levels of training, monitoring and supervision.

On our staff, we have close to 80 doctors that, on average, visit each of the 1200 clinics every six weeks. They observe service delivery and answer the franchisee doctors' questions. We also send mystery clients to assure that the level of service quality remains intact. We use vignettes in training.

These techniques ensure that [franchisees] are not gauging people with prices or giving the wrong treatment. However, we don't own these clinics. We hope the training around good hygiene, infection prevention, client relationships, and counseling improves overall practices, since we don't monitor health areas outside the SQH basket of services.

Is it difficult to get providers to participate?

JH: No - their business increases. Their reputation is better, they have more services to offer, and their customers can get an IUD for 50 cents instead of 50 dollars.
In Myanmar, the public sector is not able to serve the needs of most people; 80-90% of people go to the private sector for health care. This is not unique. The private sector, while used by everyone, is atrocious in most places. With proper management, however, it can be made to do less harm--and even do very good work.
I have had surrealistic conversations with some country officials or [global health policy makers] where someone asks [a policy maker], what is your national protocol for first-line treatment for malaria? Yet, if you look at the data, 99% of people go to a pharmacy and buy drugs off the shelf. Some have to have a philosophical shift to understand this.

Describe your relationship with the Myanmar government.

JH: There is always a give and take between an NGO and the government. We have a longstanding relationship with the government in Myanmar and some of our staff are former civil servants. [Officials] appreciate that we are improving the quality of services by providing continuing medical education where there is none, and reporting on treatments not captured by the national health management information system.
The health minister has also seen the impact of Sun Quality Health. It's not minor--it's providing something like 25% of all family planning services, and we are detecting and treating more than 12% of all TB cases nationally.
We heard you are now offering screening for cervical cancer, which is very unusual even though 80% of cases occur in the developing world.

JH: Our franchising director at the time, Dr. Nyo Nyo Mihn learned a couple of years ago at a medical quality conference funded by one of our donors that you can screen [for abnormal cells] with acetic acid and treat abnormal cells with cryotherapy using Co2 in low resource environment, all without electricity. PSI's innovations fund allows us to be entrepreneurial without massive amounts of money, so we are now beginning training.

Some people in the health ministry are concerned that private sector doctors should be doing something they consider to be a hospital service. But almost no one is doing cervical screenings anywhere, so again, there is a choice of doing nothing, or doing something in partnership with the health facilities that are actually being accessed by people.

We are also piloting a basic package of anti-retroviral therapy with 100 clients, which hasn't yet been done in social marketing.

You also provide TB screening and treatment.

JH: Starting this intervention in 2004 was our biggest gamble. A recent study showed that the TB prevalence in Myanmar is five to six times higher than what was previously estimated. Now, our franchise does more than 12% of all case detection and treatment in the country.

Recently, in a village meeting, a woman spontaneously came up to us in tears. She told us she had been dying from TB and the treatment she got from a government clinic wasn't working for her. A PSI health worker told her to go to a [Sun Quality Health] doctor. She said, 'I'm healthy now and you saved my life'. I was thinking, that's one person, and there are 17,000 people every year getting that service that would otherwise die, and give TB to eight other people.

Yet, you still have people outside the country saying you can't work ethically inside the country, and the regime here can also be xenophobic. We can negotiate between those two things--the government doesn't see [the program] as impinging on their sovereignty and the opposition doesn't see it as giving succor to the regime. This model would be interesting to use in other difficult political situations, perhaps in Zimbabwe.

Organization: the Population Services International (PSI)

Learn more about Social Franchising

Weblink: http://healthmarketinnovations.org/blog/2011/may/26/how-engage-private-sector-doctors-deliver-high-quality-and-affordable-priority-care










香港特别行政区政府 卫生署 艾滋病网上办公室





    「曾有不安全性行为的人士应致电卫生署爱滋热线2780 2211,预约免费、不记名、保密的爱滋病病毒抗体测试。」









    亚太妇女资源和研究中心(ARROW--The Asian-Pacific Resource and Research Centre for Women)和本地合作机构共同致力于积极地、持续地倡导与研究工作,监督本地区各国政府实现在世界人口与发展行动项目(ICPD)大会上的承诺。该指数数据库运用79个国家的指数来跟进各国在实施ICPD会议有关生育健康与权力、性健康与权力、妇女赋权和健康投资等项目的发展情况与趋势。ICPD+14监测项目集合了亚洲地区12个国家22个合作机构共同努力的结果。最后呈现出性、生殖健康与权力指数数据库以供相关利益群体分享与交流。

Sexual and Reproductive Health and Rights Database of Indicators

   The Asian-Pacific Resource and Research Centre for Women (ARROW) and her partners in the region, have actively and consistently monitored the commitment of governments in the region towards fully implementing the International Conference on Population and Development (ICPD) Programme of Action. The present Sexual and Reproductive Health and Rights Database uses a set of 79 cross-country critical indicators, and measures progress and marks trends towards ICPD implementation in the areas of reproductive health, reproductive rights, sexual health, sexual rights, women's empowerment and health financing. The ICPD+15 monitoring project is a collaborative monitoring partnership with 22 partners(women's NGOs and research and academic organizations), across 12 countries in the Asian region.


Asia Report 编译

机构: 亚太妇女资源和研究中心(ARROW--The Asian-Pacific Resource and Research Centre for Women






2224 E NC Hwy 54
Durham, NC 27713 USA
T 1.919.544.7040 
F 1.919.544.7261

4401 Wilson Blvd, Suite 700
Arlington, VA 22203 USA
T 1.703.516.9779
F 1.703.516.9781

19th Floor, Tower 3
Sindhorn Building
130-132 Wireless Road
Kwaeng Lumpini, Khet Phatumwan
Bangkok 10330, Thailand

媒体联络: media@fhi.org
出版物联络: publications@fhi.org
与FHI合作: contact@fhi.org
网站管理: webmaster@fhi.org
工作机会: CareerCenterSupport@fhi.org





Pathfinder International
9 Galen Street, Suite 217
Watertown, MA 02472
Tel: (617) 924-7200
Fax: (617) 924-3833


Pathfinder International
Extending Services Delivery (ESD) Project
1201 Connecticut Avenue, NW, Suite 700
Washington, DC 20036
Phone: (202) 775-1977
Fax: (202) 775-1998/1988


加入邮件组: yzdc@asiacatalyst.org