Report on the Global HIV/AIDS epidemic

National responses to the epidemic: factors that make a difference

Community mobilization against HIV/AIDS is taking place successfully all over the
world. The activities carried out in community projects are as diverse as the peoples
and cultures that make up these communities. Some are entirely "home-grown" and
self-sufficient, while others have benefited from external advice and funding. Some
are based in religious centres, others in medical institutions, and still others in neighbourhood meeting places. Many concentrate on public education, others on providing care, and still others on prevention and other goals.
6. Social policy reform to reduce vulnerability
HIV transmission is associated with specific risk-taking behaviours. These behaviours
are influenced by personal and societal factors that determine people's vulnerability
to infection. To be effective, risk-reduction programmes must be designed and implemented in synergy with other programmes, which, in the short and long term,
increase the capacity and autonomy of those people particularly vulnerable to HIV
infection. Therefore, the question is how to address directly the societal forces which /
determine, more than anything else, vulnerability to HIV/AIDS. Issues such as gender
imbalance and the inability of women to negotiate when, how and with whom they
have sex is a social policy issue. The chronic and acute poverty of urban households
that leads to their eventual breakdown and the migration of children to the street is
not an issue that can be easily addressed at a household or community level alone.
Addressing the societal forces which determine vulnerability to HIV requires engagement at the policy level and political will and resources. Effective social policy reform
is a long-term agenda, but even small-scale and incremental steps can send important messages about political commitment to reducing the vulnerability of individuals and communities to infection.
7. Longer-term and sustained response
Even a comprehensive response to HIV/AIDS does not yield immediate results.
Measurable impact may take four to five years to develop. Therefore, a long-term
approach must be taken, which involves building societal resistance to HIV.
Beginning with the youngest generation, the reinforcement of safer attitudes and
behaviour will gradually fortify a generation against the spread of AIDS, and in time
have a significant impact on incidence.
Effective programmes are characterized by focused action and steadily expanding
coverage. To begin with, using existing resources, it makes strategic sense to focus
on important vulnerable populations and geographic areas where rapid HIV spread
takes on the characteristics of an emergency. Planners must nevertheless take into
account the need to reach many different populations, including those who will
become exposed tomorrow: individual risk and vulnerability change over the life
cycle as children mature into adolescence and adulthood.
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