course material

1. WHO and HIV/AIDS Policy
WHO and HIV/AIDS PolicyHIV/AIDS is an international pandemic that poses a great
challenge to the entire international community. The World Health Organization (WHO)
held the first international conference in 1983 in Geneva to discuss the AIDS pandemic.
Subsequently, the WHO established a special programme on AIDS in 1987with a view to
mobilize financial support and other resources that would help develop international AIDS
control strategy. The executive board named it “ Global Programme on AIDS” (GPA) in
1988, and later the UNAIDS programme. The main goal of the Global Health Program is to
mobilize and make use of scientific and technological developments to deal with the main
causes of illness and deaths in developing nations.The objectives of the global strategy
included general measures aimed at reducing HIV infections, minimizing the personal and
social effects of HIV, and mobilizing and integrating national and international efforts
against HIV/AIDS (WHO, 2004, 2006). This global strategy has been adjusted from time to
time to reflect the changing circumstances of the HIV/AIDS pandemic as well as the
changing needs of the HIV/AIDS patients. The WHO strategy emphasizes on the need for
prevention but also provides support to treatment and control efforts to HIV/AIDS patients
internationally including sponsorship for relevant research. This paper will outline and
discuss the HIV/AIDS prevention and treatment policy of the WHO as well as the role of
Gates Foundation, Clinton AIDS Initiative, Global Fund AIDS program and PEPFAR.2.0
Discussion2.1 The World Health OrganizationThe World Health Organization (WHO) was
established in 1948 as a specialized agency of the United Nations (UN) mandated to
coordinate international public health issues. With its headquarters at Geneva Switzerland,
the WHO is a member of the United Nations Development Group and it inherited its
mandate from the Health Organization (its predecessor), which was itself an agency of the
League of Nations. . Ever since its formation, the WHO has been instrumental on the global
front in promoting the “ health for all” strategy. Towards this end, WHO puts a lot of
emphasis on prevention and has pursued a number of essential measures aimed at
enhancing primary health care such as controlling outbreak of many infectious diseases
including malaria, tuberculosis, influenza and HIV/AIDS among others. Other than these, the
WHO also provides sponsorship to programs meant to prevent and treat these diseases,
(WHO, 2004, 2006).In 1992, the WHO HV/AIDS global strategy was modified in order to
include efforts to reduce the risk of infection of HIV/AIDS by women in developing
countries, treatment of sexually transmitted diseases, provision of health care for AIDS
patients and education provision regarding how to overcome HIV/AIDS related

2. stigmatization and discrimination. In 1989, the WHO put in place a Global Commission on
AIDS to facilitate establishment of AIDS programs in WHO member countries through
provision of multidisciplinary expert policy and scientific guidelines to the Director General.
These efforts led to establishment of AIDS programs in all the WHO member countries by
end of 1991. A declaration of commitment was adopted by 189 WHO member countries in
June 2001, following a General Assembly session on HIV/AIDS. This was intended to
establish binding timelines and targets to which the United Nations (UN) and respective
governments would be accountable (WHO, 2004, 2006).A new international alliance was
formed and launched in Geneva and Dakar in December 2002 and called “ International HIV
Treatment Access Coalition” (ITAC). The purpose for ITAC was to enhance the efforts to
improve supply and access to antiretroviral drugs to HIV/AIDS growing number of infected
people in the low and middle income nations. But even before then, the WHO had earlier on
in 1993 identified tuberculosis as closely related to HIV/AIDS and therefore declared it a
global emergency and a co-epidemic. At this point, it is important to mention that the WHO
has ever since expanded its HIV prevention and treatment policy to cover the other
opportunistic diseases such as malaria, smallpox, cholera and other communicable diseases
such as influenza, yellow fever, meningitis, viral hepatitis and streptococcal infections
(WHO, 2004, 2006).The WHO underscores need for behavior change in order to prevent
spread of HIV/AIDS. The behavioral prevention programs are designed to reduce
unprotected sexual behaviors and drug abuse that expose individuals to HIV/AIDS and
other related effects, (WHO 2006). Apart from prevention, the WHO recommends simple
and standardized treatment and monitoring measures. The WHO considers provision and
administration of antiretroviral therapy (ART) a vital measure to ensure access of effective
therapy by HIV/AIDS patients especially in settings with limited resources. For this reason,
the WHO’ s Guideline Development Group (GDG) had established ART guidelines in 2003 to
include; how to initiate the ART, how best to monitor the treatment, managing long term
toxicities of individual ARVS, identifying the preferred first-line and second-line regimens,
and the need for substituting toxicity or switching failure. In 2006, these guidelines were
reviewed with a view to elaborate on provisions regarding the second line alternatives;
assess special considerations for use of ART with major coinfections such as TB and viral
hepatitis, side-effects of ART on drug adherence and salvage strategies to be used., ((Global
HIV Prevention Working Group, 2008: WHO, 2004, 2006)Regarding when to initiate the
ART, the WHO advocates for use of clinical parameters together with additional information
on baseline and subsequent CD4 cell counts in order to improve decision making on when
to initiate and how to monitor the ART. The WHO therefore advocates for national
programs to enhance affordable access to CD4 measurement technologies. In implementing
the global health strategy, the WHO has teamed up with other organizations including the
Gates Foundation, the Clinton AIDS Initiative, the Global Fund AIDS program and PEPFAR
whose roles and contributions are discussed in the next sections, (WHO, 2004, 2006).2.2
The Gates FoundationThe Bill and Melinda Gates Foundation was established in the year
2000 to contribute towards developing sustainable improvements in health, education and
poverty reduction efforts. The Bill and Melinda Gates Foundation was driven by the belief
that every life has equal value hence the major aim of the Foundation is to help in the

3. attainment of healthy and productive lives for all people across the globe. To this end, the
Bill and Melinda Gates Foundation enacted a global health program geared towards
harnessing the advances in science and technology with view to help save lives in
developing nations. This is perfectly in agreement with the WHO’ s global health strategy.
Although the foundation largely focuses health problems affecting people in developing
nations, the lack of adequate attention and financial support limit their efforts. Therefore
the Gates Foundation either supports sustainable delivery where proven tools exist, but
where such tools are absent, the Foundation invests in research and development of new
interventions including drugs vaccines and diagnostics (Bill and Melinda Gates Foundation,
2010).The Bill and Melinda Gates is basically a private foundation whose delivery strategy
is based on funding technology based solutions targeting a limited number of long-term
priorities and solutions. In doing this, the Gates Foundation underscores the value of
partnerships. Therefore the Gates Foundation supports other multilateral initiatives such as
the Global Alliance for Improved Nutrition (GAIN), and the Global Fund (established to fight
AIDS, Tuberculosis and Malaria). The Gates Foundation also works in cooperation with
global coordinating groups such as the Stop TB Partnership, the Roll Back Malaria
Partnership and the Partnership for Maternal, Newborn and Child health in addressing
specific health issues affecting communities. The Foundation emphasizes that its role is
complimentary and not a replacement for that of the other key players such as the WHO,
(Bill and Melinda Gates Foundation, 2010).2.3 The Clinton AIDS InitiativeThe William J.
Clinton Foundation was established by President Bill Clinton in 2002 with a mission to help
“ alleviate poverty, improve global health, strengthen economies and protect the
environment” . This was to be achieved through deliberate measures designed to foster
partnerships among the various public and private stakeholders alongside mobilizing
resources and goodwill to help attain the desired objectives. One major initiative was to
pursue sustainable programs meant to enhance global accessibility to investment,
opportunity and lifesaving services across the generations. The Foundation mainly focuses
on working with diverse groups to address challenges with respect to education, nutrition,
environment, energy and economic empowerment. Basically, the Clinton Health Access
Initiative (CHAI) commits itself to strengthen integrated health systems and the expansion
of access to care and treatment of HIV/AIDS, Malaria and Tuberculosis in the developing
World. The Clinton Foundation is also a solutions-oriented organization and has since its
inception helped more than 2 million access medicines and treatment for the HIV/AIDS,
Clinton Health Access Initiative (2010).2.4 The Global Fund AIDS programThe Global Fund
was established in 2002 with a view to help fight AIDS, Tuberculosis and Malaria through an
innovative financing framework designed to disburse funding for programs which minimize
the effects of diseases. The policy of the Global Fund is to provide financial support to
individual country governments and in-country stakeholders determined primarily by the
proposals and implementation plans presented by the applicants. The Global Fund as grown
to become one of the biggest aid providers in the world; providing an estimated 20% of
world’ s HIV/AIDS funding, and 66% funding for Tuberculosis and malaria, (Schocken,
2005).2.5 President’ s Emergency Plan for AIDS Relief (PEPFAR)PEPFAR is a U.S
Government initiative aimed at saving the lives of HIV/AIDS patients all over the world. The

4. initiative focuses mainly on improving the health women, newborns and children. It aims at
developing sustainable country-owned programs to address HIV/AIDS within a wider
health and development context. PEPFAR aims at expanding prevention, care and
treatment. To this end, PEPFAR has invested heavily in innovation and operations research
tailored towards impact evaluation, service delivery improvement and result optimization.
PEPFAR has contributed in a major way in supporting life-saving antiretroviral treatment
globally, (PEPFAR 2008).3.0 SummaryThe WHO‘ s HIV/AIDS prevention and treatment has
been designed to enable the WHO work with countries in order to prevent HIV infections
through encouraging change of behavior and enhancing access to prevention facilities and
prevention programs. The WHO policy also aims at expanding availability of treatment for
HIV/AIDS patients across the globe. The WHO therefore focuses on measures to encourage
and improve access to HIV testing and counseling as well as strengthening the health care
systems to ensure delivery of sustainable HIV/AIDS services. Furthermore, the WHO
endeavors to improve HIV/AIDS information systems. To this end, the WHO focuses on
ensuring appropriate HIV surveillance, monitoring, evaluation and operational research.
The WHO has established a global health strategy which aims at working with the
developing world to attain the desired health results. The partnership with and
complimentary efforts of the other organizations including Gates Foundation, Clinton AIDS
Initiative, Global Fund AIDS program and PEPFAR have played a significant role towards the
attainment of the goal of delivering global health improvement programs. It was important
that these policies were expanded to cover not only HIV/AIDS, but also Tuberculosis,
Malaria and other communicable diseases, (Global HIV Prevention Working Group., 2008:
WHO, 2006).4.0 RecommendationsHIV/AIDS presents a global challenge that requires
maximum attention from the entire international community. Tuberculosis and malaria
have been equally challenging as far as global health is concerned. Because of this, the
initiatives by the WHO and contributions made towards improving health of the people
across the world are very significant and must be supported by all countries both financially
and morally. Millions of people suffering from HIV/AIDS, Tuberculosis, Malaria and other
diseases have significantly benefited from the global health programs thanks to these
organizations, (WHO, 2006). My opinion is that there is need to enhance accountability in
individual nations so that funds assigned to such important life-saving initiatives do not end
up being misappropriated by corrupt officials. Perhaps the Performance based funding
approach (PBF) used by the Global should be adopted by other organizations and/or
partnerships for purposes of accountability. There is need to support and invest more in
research and innovation to improve the services aimed at improving global health gains
pursued by these organizations.5.0 References:Bill and Melinda Gates Foundation, (2010).
Global Health: Strategy overview. Retrieved on 29/10/2011 from
http://www.gatesfoundation.org/global-health/Documents/global-health-strategy-
overview.pdfClinton Health Access Initiative (2010). About The Clinton Foundation.
Retrieved on 29/10/2011 from www.clintonhealthaccess.org.Global HIV Prevention
Working Group. (2008). Behavior Change and HIV Prevention: (Re)Considerations for the
21st Century. Retrieved on 29/10/2011 from www.globalhivprevention.orgPEPFAR
(2008). The U.S. Commitment to Global HIV/AIDS. Retrieved on 29/10/2011 from

5. http://www.pepfar.gov/Schocken C, (2005). Overview of the Global Fund to Fight AIDS,
Tuberculosis and Malaria. Retrieved on 29/10/2011 from
http://www.theglobalfund.org/en/World Health Organization (2004). Scaling up
antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health
approach; 2003 edition. Geneva: World Health Organization.World Health Organization
(2006). Antiretroviral therapy for HIV infection in adults and adolescents:
recommendations for a public health approach. – 2006 rev; Geneva, Switzerland