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

XIV International AIDS Conference

Abstracts WeOrG1371-WePpG2122 303

WeOrG1371 Cost measurement of HIV/AIDS prevention and
treatment in African countries: Lessons for
obtaining reliable estimates under international
collaboration
A.P Beaston-Blaakman1, M. Tselayakgosi2, R. Saint-Victor3, N. Traore4,
I. Semini5. 'Brandeis University, Schneider Institute for Health Policy, Waltham,
MA, United States; 2National AIDS Coordinating Agency Gaberone, Botswana;
3UNAIDS, Gaberone, Botswana; 4Department of Public Health, Bamako, Mali;
5UNAIDS, Geneva, Switzerland
Issues: Estimating the costs of HIV/AIDS prevention and treatment in Africa and
other parts of the world is critical for efficient resource allocation and effective,
organized care for those with this devastating disease. The process of estimating HIV/AIDS prevention and treatment costs is extremely complicated due to the
fragmented support of public, private, and non-governmental organizations, the
lack of an adequate health services infrastructure, and the inconsistency of perspective when calculating costs. Given these complexities in delivering HIV/AIDS
prevention and treatment, how do we obtain reliable national estimates of the cost
of HIV/AIDS?
Descriptions: This paper describes cost analyses of HIV/AIDS prevention and
treatment undertaken in Botswana and Mali at the national level under international collaboration and sets forth lessons for application to other countries. These
collaborations focused on estimating the broader institutional resources and costs
of HIV/AIDS prevention and treatment at the national level for a projected two-year
period. The cost measurement methods include identifying institutions involved
in the delivery of HIV/AIDS care, defining standard perspectives of costs, and
clearly understanding personnel and non-personnel resource allocation within institutions providing HIV/AIDS services.
Lessons learned: The authors present lessons learned regarding cost analyses
of HIV/AIDS from the national level and how these lessons might be applied to
future national level cost analyses of HIV/AIDS. National level unit cost estimates
of HIV/AIDS prevention and treatment based on these two case studies and in
the context of the HIV/AIDS literature are also presented.
Recommendations: The authors discuss necessary improvements in cost analysis techniques for obtaining reliable unit costs of HIV/AIDS prevention and treatment and examine how these techniques can be applied to other African countries
and elsewhere in the world.
Presenting author: Aaron Beaston-Blaakman, Brandeis University, Schneider
Institute for Health Policy, 415 South Street, MS 035, Waltham, MA 02454-9110,
United States, Tel.: [phone], Fax: [phone], E-mail: blaakman
@brandeis.edu
WeOrG1 372 How much will antiretroviral treatment programs
really cost? A policy tool for estimating annual
costs of providing treatment in the public sector in
a low resource country
J. Day, A.K. Nandakumar, C. Connor, G. Kombe, A. Frakt, M. Murphy,
C. Leighton. Abt Associates Inc., Bethesda, MD, United States
Issues: There is growing national and international pressure to make antiretroviral (ARV) treatment available to HIV/AIDS patients in low resource countries.
However, limited information exists on how much it would cost to effectively introduce ARV treatment in the developing world. Extensive data on cost and costeffectiveness of treatment are available mostly in industrialized nations; studies in
the developing world have focused more on costs of prevention than on treatment
programs. Studies addressing treatment have largely looked at global or regional
costs, and have focused mainly on drug costs.
Description: Many countries need better tools to guide ARV treatment program
planning and resource allocation. A new robust and comprehensive policy tool
has been developed to estimate costs related to ARV treatment provision by a
Ministry of Health in a developing country, under a variety of treatment policy scenarios. This interactive tool allows users to define policy scenarios and other assumptions that reflect local conditions in order to estimate the total program costs.
The main cost components include voluntary counseling, laboratory testing, ARV
drugs, drugs for opportunistic infections, treatment monitoring, outpatient and inpatient care, and provider training.
Lessons Learned: To date the tool has been validated in a few countries. Program planners and policymakers have found it useful in designing and strengthening ARV program implementation.
Recommendations: Further field-testing of the tool is recommended to determine ease of use, flexibility, and usefulness to policymakers in low resource countries.
Presenting author: Jennifer Day, Abt Associates Inc., 4800 Montgomery Lane,
Suite 600, Bethesda, MD 20814, United States, Tel.: [phone], Fax: +1
301 6523916, E-mail: jenniferday@ abtassoc.com

WeOrG1 373 Behavioural surveillance surveys in the Africa
region: how well do we understand the epidemic?
C. Pervilhac, J. Calleja, N. Walker, R Ghys. UNA/DS, unaids (wcc 329), 20 av
appia, 1211 geneve 27, Switzerland
Issues: Behavioural surveillance is an intrinsic component of HIV surveillance
contributing to an improved understanding of the HIV epidemic. Behavioural data

help explain trends in prevalence in mature epidemics, detect risk behaviour in the
populations and focus prevention activities in high risk groups in low or concentrated epidemics. Yet, current behavioural surveillance systems are still lacking.
Descriptions: We reviewed the current support and future plans in a recent inventory of Behavioural Surveillance Surveys (BSS) in Africa, and analysed the
early stages of BSS in a large project of second generation surveillance (4 countries in Africa).
Lessons learned: More than h alf of the countries with a generalised epidemic
(21 of 39) do not yet have any BSS among the general population or youth, and
a large proportion of those (14 of 21) do not yet have any plans or support in
the near future to launch any BSS. One third of the countries with low or concentrated epidemic among the high risk groups (2 of 6) do not yet have any BSS, and
among those, none have yet any plans or support either.
In all 4 countries where the EC project initiated the BSS component, all stakeholders reached a consensus on the key indicators to monitor behaviours and
delegated the implementation of the surveys to a local national competent partner.
Recommendations:
- International agencies (bi-laterals, foundations) need to provide support for
planning and implementing BSS and commit themselves on the long term both
for the present or new rounds
- To scale up BSS, capacity-building to support behavioural surveillance work
and training needs is a priority
- Ministries of Health need to invest more in human resources with social science
skills to link to epidemiology, while at the same time national capacities of local
NGOs, research institutions, universities can be further tapped
Develop common indicators that allow comparison over time in similar places and
populations.
Presenting author: cyril pervilhac, unaids (wcc 329), 20 av. appia, 1211 geneve
27, Switzerland, Tel.: [phone], Fax: [phone], E-mail: pervilhacc
@unaids.org
WePpG2121 Beyond the law? AIDS, islam and women
A.K. Ahmed. Positive Muslims, 121 Church Street, Cape Town, 8001, South
Africa
Issues: Despite the intervention of the Constitution of the Republic of South
Africa, the status of Muslim women in South African homes has undergone little
change. Religious and cultural practices continue to discriminate against women
and treat them unequally to men despite the general improvement in the status of
women in Muslim society. Religious and cultural practices that enforce and perpetuate the inequalities between Muslim women and men are therefore important
factors that should be examined in the context of HIV/Aids since these practices
may be responsible for the spread of HIV/Aids amongst Muslim women. These
practices should also be looked at in the context of South African law, since the
role and influence of the law on cultural and religious practices have been questionable.
Description: This paper will examine whether the law is able to influence religious and cultural practices that potentially discriminate against Muslim women
and that consequently make them more vulnerable to contracting HIV/Aids. In
order to answer this question, this paper will discuss the relationship between
Muslims and the Bill of Rights in the context of the culture / rights debate; focus
on specific religious and cultural practices that may expose women to HIV; analyse Muslim responses to HIV/Aids; and discuss the role of the law and the extent
to which it is able to influence discriminatory religious practices.
Lessons learned: Legal mechanisms have been an effective tool in influencing discriminatory religious and cultural practices and in reducing the risk of HIV
infection amongst Muslim women.
Recommendation: This research recommends that the law must intervene
where religious and cultural practices discriminate against women and may potentially cause them to be more vulnerable to contracting HIV.
Presenting author: Abdul Kayum Ahmed, 121 Church Street, Cape Town, 8001,
South Africa, Tel.: [phone], Fax: [phone], E-mail: ahmedl21
@yebo.co.za
WePpG2122 It's possible to develop a mass media campaign
based on condom use in a Catholic conservative
country?
M.B. Bianco1, C. Rodriguez2, I. Balido2. 'FEIM, Parana 135, Piso 3ro. Dpto. 13,
1017 Buenos Aires, Argentina; 2Proyecto Lusida, Buenos Aires, Argentina
Issues: No mass media campaign nor promotion of condom use was done by the
National Government in Argentina till 1999. Silence about HIV/AIDS and sexuality matters were characteristic. Conservative attitudes and the opposition of the
Catholic Church were considered unsolved obstacles.
Description: In 2000 the new government decided to promote condom use, dif
ferent strategies and approaches were used.1-to break the silence: periodically
epidemiological information was disseminated by the press,2-disclose gender inequalities and discrimination, 3-strenghthen importance of sexual transmission
and influences of sexual myths. During 2001 a mass media campaign was developed base in condom use without controversies nor opposition.
Lessons learned: It's possible to disseminate by mass media the use of condoms in a conservative country with a powerful Catholic Church. Political will and