Bulletin of the World Health Organization

The HIV pandemic: local and global implications

Shabbar Jaffar a

This is a comprehensive authoritative monograph, consisting of 50 chapters, 22 of which are thematic and 28 of which are case studies. It was written by total of 165 authors, many of whom are world-renowned experts, from 30 countries. The book, which focuses on the response to HIV by health systems, governments and donor agencies, is divided into five sections.

Section 1 deals with the size of the pandemic and with its social and economic impacts. The four chapters in this section are concise and informative.

Section 2 describes HIV prevention, treatment and care. Among the topics dealt with in its seven chapters are HIV prevention strategies, antiretroviral therapy in resource-poor settings, HIV vaccines and cost-effectiveness analysis. Group-based and community-level interventions are discussed, as are the implications of the pandemic for health systems. There are also chapters on legal and human rights implications and on ethics.

This section, while informative, could also have examined the coverage of HIV prevention strategies, the barriers identified to increased uptake and the opportunities for integration of prevention with treatment. The section on antiretroviral therapy is largely clinical and does not discuss strategies for delivery and support. Nor does it mention monitoring of patients in resource-poor settings, especially rural areas, where health systems are particularly weak and travel to clinics is difficult.

Section 3 is the largest and consists of descriptions of 28 countries’ responses to the pandemic. It is not clear how the countries were chosen, but the selection represents a broad range of the developed and developing world. Most chapters were written jointly by HIV and health policy specialists, including at least one local author in each case. The topics covered include the epidemic’s evolution and impact in each country, the health system, the political response, and future challenges and priorities. These challenges and priorities are usually the opinions of the authors, based on their understanding of the local situation.

This section of the book is detailed and will serve as a valuable resource for those studying the global effects of HIV and for individuals who are new to any of these countries, especially those working for international and donor agencies. It would have been more useful had there been a summary chapter that contrasted the differences in response between countries and the effects of this on the epidemic. For example, what may have worked in some settings and what has not? This analysis is essentially left for the reader to do.

Section 4 deals with global and national responses. Each of these chapters is interesting and informative, and topics include the responses of the UN and donor, lender and research agencies; financing of HIV control; fiscal and macroeconomic aspects; public-private partnerships; development of human resources; and contributions of civil society.

Section 5 is on strengthening the response to the HIV pandemic. This is a short summary section on effective responses to the epidemic and on lessons learned. It covers a broad range of issues, including the roles of UNAIDS, other agencies and civil society; public-private partnerships; political commitment; decentralization; increasing capacity; and monitoring of programmes. There is also a short section on research, focused largely on data-collecting processes. Much of this material is the opinions of the authors rather than findings supported by evidence. The need for high-quality research to inform and prioritize the response to HIV, especially in resource-constrained settings, is not highlighted either here or elsewhere.

Overall, this is an informative and interesting book, with the case studies from the different countries being particularly interesting. It will serve as a valuable resource to individuals working for international agencies, donors and researchers in providing important background information on the HIV pandemic. ■


Affiliations

  • Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England (e-mail: shabbar.jaffar@lshtm.ac.uk).
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