Report on the Global HIV/AIDS epidemic

National responses to the epidemic: factors that make a difference

National responses to the epidemic:
factors that make a difference
This report demonstrates that the AIDS epidemic is a true development crisis that
threatens the social and economic fabric, and the political stability, of whole nations.
Yet this report also shows that the epidemic is not out of control everywhere; some
countries and communities have managed to stabilize HIV rates or achieve a turnaround, and some have maintained very low prevalence rates, due to a range of factors that are not yet fully understood. Other communities have made significant
progress on care and support for people both infected and affected. A closer look at
individual country responses, and at the corresponding achievements and failures,
helps pinpoint some of the factors behind these successes.
Looking back over past efforts against the epidemic the initial reaction of many
countries was to try to persuade individuals and selected groups to change their
behaviour by providing information about HIV/AIDS. Gradually, however, behaviour
change was understood to require more than mere information; the importance of
decision-making and negotiation skills, accessibility of commodities and services,
and supportive peer norms became increasingly apparent.
By the mid-1980s, it was well appreciated that individuals do not always control their
own risk situations. This led to the development of prevention programmes aimed at
enabling particular groups or communities such as sex workers and men who have
sex with men to adopt safer behaviour. At the same time, as individuals infected with
HIV earlier in the epidemic gradually fell ill and died, challenging family and community structures alike, the need to provide health care and cushion the epidemic's
impact became increasingly obvious. Simultaneously, the importance of work on
non-discrimination, protection and promotion of human rights, and against the
stigmatization brought by HIV/AIDS, was more widely recognized, including the
importance of involving different sectors of society.
With the mid-1990s, and deepening epidemics in many countries, came a growing
realization that HIV/AIDS is also a development challenge. To the extent that people's
vulnerability to infection has social and economic roots, often including marginalization, poverty and women's subordinate status, these conditions need to be tackled
as a way of making society as a whole less vulnerable to HIV over the long term.

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