Report on the Global HIV/AIDS epidemic

Report on the global HIV/AIDS epidemic - June 2000

There is also evidence that continued vigilance is critical even when behaviour
change appears to have become established. The use of condoms among a newly
sexually active generation of men who have sex with men for example cannot be
assumed, just because an older generation changed its behaviour.
Gradually, without losing focus, action must expand steadily until complete country
coverage is achieved.
8. Learning from experience
The last 15 years of HIV prevention and care have led to the development of a rich
body of experience and expertise. While it is essential that individual countries
"own" their response there is a great deal of evidence that some policies, strategies
and technologies are particularly effective: that which UNAIDS calls "best practice".
Drawing on best practice and adapting it to local circumstances is valuable both at
the outset, and as the response matures. Learning within a national context is also
important.
District bureaucracies provide the critical link between local and national activities.
The district level is well placed in many countries to analyse, document and disseminate what they learn from the local responses. They can then press for, and
negotiate with, the national authorities the changes and reforms needed in key sectors to sustain local responses. There are multiple examples of good HIV "projects"
- successful interventions that have identified the recipe for success in a given environment. They can provide valuable insights to national programmes.
Similarly, national programmes are in a strong position to scale up local responses
to the national level by incorporating local lessons into their strategic planning and
reform processes. For example, governments can effectively adopt policy changes
and programme approaches that have "passed the test" at the local level.
Box 21. International support for national responses
Donor assistance to HIV/AIDS has increased substantially over time. In 1998, 14 of
the largest donors in the OECD Development Assistance Committee provided
US$ 300 million for HIV/AIDS activities. In 1987 - soon after it was first recognized
that HIV had spread massively in many developing countries - levels of official development assistance (ODA) funding to AIDS were only at 20% of the levels seen a
decade later. This increase has occurred at the same time that overall ODA contributions to developing countries have steadily declined.
Unfortunately, as spectacular as this increase appears, it has not kept pace with the
spread of the epidemic - or even the most basic requirements for HIV programmes
of the most-affected countries. During the same period, the number of infections has
risen from 4 million to over 34 million, a figure that continues to grow given the more

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