Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

302 Abstracts WeOrG1337-WeOrG1370

XIV International AIDS Conference

structure to enable First Ladies to more actively and effectively engage by providing information, support, and technical assistance. The Alliance also provides a
vitally important voice and vehicle for social and resources mobilization nationally,
regionally, and globally.
Recommendations: The approach illustrates how leadership from First Ladies
can play a new and key role in fighting AIDS and should be expanded to include
other influential women in donor nations and the developing world. A supported
leadership model merits replication with other key leaders, in a variety of sectors.
Presenting author: Michael Iskowitz, International AIDS Trust, 1627 K Street
NW, Suite 800, Washington, DC 20006, United States, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WeOrG1337 Parliamentarians Promoting Human Rights: the
UK's Parliamentary Inquiry into HIV/AIDS and
Human Rights
S. Wright. Mr, Office of Neil Gerrard MP, House of Commons, London, SW1A
OAA, United Kingdom
Issues: Members of Parliament play a vital role in determining the extent and
nature of political responses to HIV/AIDS. By forming all-party groups or committees, they can formalise this role and maximise their influence. Human rights must
be the framework for national and international action, rather than addressing HIV
solely as a health issue.
Description: In 2001, the British All-Party Parliamentary Group on AIDS held an
Inquiry into the UK Government's respect for and promotion of the International
Guidelines on HIV/AIDS and Human Rights, both in domestic and international
policy 31 witnesses gave evidence at three sessions of oral evidence; of whom
one-third were people living with HIV. The Report and transcripts of evidence
were published in July 2001 with 46 recommendations for changes to government policy The Report has been welcomed for its strong call for human rights to
be the basis for the UK's response to HIV/AIDS. Members of the All-Party Group
continue to advance these recommendations through contact with Ministers and
parliamentary questions.
Lessons Learned: The 2001 Inquiry by the All-Party Parliamentary Group on
AIDS showed that the International Guidelines are an effective tool for analysis
of government policy. Furthermore, the Guidelines successfully provided Parliamentarians with a role in considering and promoting the human rights of people
with HIV and vulnerable communities.
Recommendations: Parliamentarians in countries with both high-level and concentrated epidemics should be encouraged to form all-party groups or committees on HIV/AIDS to develop their knowledge and commitment. The International
Guidelines should be utilised as a tool to analyse and influence governmental
policies and ensure that parliamentarians make a meaningful contribution to the
fight against HIV/AIDS. This presentation, by the Group's Policy Adviser, will report on the Inquiry and its outcomes.
Presenting author: Simon Wright, Office of Neil Gerrard MP, House of Commons, London, SW1A 0AA, United Kingdom, Tel.: [phone], Fax: +44
20 7219 0072, E-mail: wrightsj@ parliament.uk
WeOrG1368 Non-sustained financing of HIV prevention
interventions: what do we lose?
L. Kumaranavake, C. Watts, P. Vickerman. LSHTM, Health Policy Unit, LSHTM,
Keppel Street, London WC 1E 7HT United Kingdom
Background The implementation of HIV prevention projects is often characterised by interruptions in financing or disrupted supplies of commodities. Reasons for these include delays in the receipt of donor money by the project, shortterm funding cycles with gaps between tranches of money, and external factors
such as fluctuating exchange rates and transportation logistics. This study looks
at the impact of such interruptions on a project's cost-effectiveness.
Methods Two projects characterised by non-sustained financing were used as
case-studies. A sex-worker peer education project in Cameroon suffered from
a disruption in condom supplies, and an IDU needle-exchange project (NEP) in
Belarus had an interruption in funding. Using HIVTools' SexWork and IDU mathematical models and existing cost data, we compare scenarios of with and without
the interruption to estimate the project's cost-effectiveness
Results In both projects the estimated financial gap due to the disruption was
less than US $4000, or about 13% of total expenditures. However, over a two-year
period the disruption in funding led to a significant impact on cost-effectiveness.
The NEP responded to the financial gap by reducing the purchase of syringes,
and this led to a 28-60% reduction in cost-effectiveness. Despite condom supplies
being disrupted, the sex worker project was still cost-effective, with a cost per HIV
infection averted of US $114-225. However, with a consistent supply of condoms
the cost-effectiveness of the intervention would have improved by 15-30%.
Conclusions The degree of impact of non-sustained financing depends on the
way the project adjusts its spending patterns. In both cases, the interruptions re
suited in a reduction of recurrent commodities that were central to the project's
impact on HIV transmission. The findings highlight how even small disruptions in
financing can have a large impact on overall cost-effectiveness.
Presenting author: Lilani Kumaranayake, Health Policy Unit, LSHTM, Keppel Street, London WC1E 7HT, United Kingdom, Tel.: [phone], Fax:
[phone], E-mail: [email protected]

WeOrG13691 Aligning the U.S. HIV prevention budget with
national goals to reduce new infections by half
R.O. Valdiserri, L. Ogden, R. Janssen, I. Onorato. Centers for Disease Control &
Prey., Centers for Disease Control & Prey., 1600 Clifton Road (E 07), Atlanta,
GA 30333, United States
Background: In January 2001, the U.S. Centers for Disease Control and Prevention (CDC) released a new five year strategic plan (SP) that seeks to reduce
the number of new HIV infections in the U.S. from an estimated 40,000 to 20,000
per year by 2005. Utilizing a national, iterative consultation process, specific objectives were developed for each of the plan's 5 goals and prioritized based upon
their contribution toward achieving the goal.
Methods: To establish a baseline and assess whether the distribution of national prevention resources reflects the priorities identified in the SP, an in-depth,
project-level review of CDC's 2000 HIV/AIDS budget ($707 million U.S.) was conducted.
Results: The total YR 2000 HIV/AIDS budget was characterized in terms of the
5 major goals of the SP as follows: 29% of the budget supported activities to
decrease high risk behaviors; 23% to improve linkages between prevention and
treatment programs; 19% to support voluntary counseling and testing; 16% to
strengthen surveillance and prevention capacity; and 8% to assist in international
HIV/AIDS prevention and care efforts. Four percent of the budget supported centralized operational costs. Examining the distribution of resources within goals
revealed a relative underfunding of prevention activities for HIV (+) persons and
men who have sex with men (MSM). For example, whereas MSM account for an
estimated 42% of all new HIV infections in the U.S. annually, only 15% of federal
risk reduction resources explicitly target this population.
Conclusions: Reducing new HIV infections requires allocating resources to interventions and activities that will have the greatest impact on transmission and
will require the realignment of federal resources to match the priorities of the US
SP. CDC's operational units will use the priorities of the SP to develop annual
spending plans. Local health authorities will use the federal SP to inform their
identification of local priorities.
Presenting author: Ronald Valdiserri, Centers for Disease Control & Prev., 1600
Clifton Road (E 07), Atlanta, GA 30333, United States, Tel.: [phone], Fax:
[phone], E-mail: rov1 @cdc.gov
WeOrG13701 Making a case: Using international data to lobby
for effective HIV prevention in low prevalence
countries
M. Rahman1, T. Azim2, P. Baatsen3, E. Pisani4. 1National AIDS Committee, c/o
FHI/IMPACT Bangladesh House#13/A/2, Kamal Ataturk Avenue (5th floor),
Gulshan-2, Dhaka-1212, Bangladesh; 2International Centre for Diaorrheal
Disease Research, Bangladesh, Dhaka, Bangladesh;
3FHI/IMPACT/Bangladesh, Dhaka, Bangladesh; 4Family Health
International/ASA Program, Jakarta, Indonesia
Issues: HIV prevention is most effective when it begins early in the epidemic.
However it has historically been difficult to put the epidemic on the political agenda
in a country before HIV prevalence is high and AIDS deaths become common.
Description: Recently, some countries have presented data on their own risk
profile in conjunction with data from other countries with similar risk profiles with
more advanced epidemics to make a case for early action. One such case is
Bangladesh, where a second generation surveillance system established in 1998
has continually recorded low HIV prevalence along with high levels of STIs, hepatitis and risk behaviour. This led to the belief that due to some unknown factors,
Bangladesh might be spared from an epidemic, which in turn resulted in complacency at the national level. In 2001, the National AIDS/STD Program published
a report putting the Bangladesh data in the context of data from another Muslim
country in Asia (Indonesia) where years of low prevalence and high risk have recently given way to sharp rises in HIV prevalence. The report made the case that
a similar rise was inevitable in Bangladesh unless quick action was taken to provide prevention services for those in need on a large scale. The report resulted
in an increase in donor funding, press attention and government commitment to
a response.
Lessons learned: Use of regional data in local settings does make a difference
and can be used to drive home the message that no country is immune from the
threat of HIV.
Recommendations: Countries with low HIV prevalence should systematically
collect data on risk behaviour and prevalence of STIs at home. Where risk is high,
data should be packaged together with information from countries with similar risk
profiles and more advanced epidemics to lobby for a more effective national response.
Presenting author: Major General ASM Rahman, c/o FHI/IMPACT, Bangladesh
House#13/A/2, Kamal Ataturk Avenue (5th floor), Gulshan-2, Dhaka-1212,
Bangladesh, Tel.: [phone], Fax: [phone], E-mail: fhidhaka
@bdmail.net