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The AIDS pandemic is a human tragedy that is threatening development in the poorest countries. There is no cure or vaccine, but the tools to control the epidemic already exist. Nevertheless, there are few examples of national AIDS control programmes that have had an impact on the epidemic. We (an economist and a planner) attribute this to the reluctance of governments to confront AIDS and a failure to prioritise activities in the face of severe financial and administrative constraints. When implementation capacity is weak, expanding the number of activities may not improve programme effectiveness. Rather, by implementing a smaller, core set of the most cost-effective activities on a national scale, policymakers could have a huge effect on the overall epidemic in a sustained way and provide a foundation for expansion. We propose three core priorities for AIDS control in poor countries for prevention, treatment, and mitigation of the impact.

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PIP: This article assesses the abstinence-based programs developed by family life educators and the factors associated with positive results through a review of abstinence promotion programs of the federal government. In 1996, Section 510 was added to Title V of the Social Security Act allocating US$50 million annually from 1998-2000 to fund abstinence education programs, while in 1997, a National Strategy to Prevent Teen Pregnancy was launched by the Office of Adolescent Pregnancy Prevention to provide teen pregnancy programs to at least 25% of the communities. Presented in this paper is a discussion of the Abstinence Only programs, which focus on the prevention of pregnancy and sexually transmitted disease among adolescents, and the Abstinence Plus programs, which emphasize other prevention methods as well as abstinence. Evaluation of Abstinence Only programs include Success Express, Project Taking Charge, Sex Respect, Teen Aid, Values and Choices and Facts and Feelings. Moreover, programs such as Reducing the Risk, Postponing Sexual Involvement, Project Education Now, and Babies Later were evaluated under the Abstinence Plus programs. Several programs evaluated have shown to have a positive effect on attitudes among adolescents, but are not proven to have a significant effect on sexual behavior. In conclusion, this article encourages exploration of new approaches to address teen pregnancy and the increasing incidence of sexually transmitted diseases among adolescents, while the federal government must utilize the implementation of existing programs with positive effects.^ieng

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PIP: In its effort to fight HIV/AIDS epidemics in Papua New Guinea (PNG), in August 1997 the Prime Minister directed the Department of Health to mobilize all sectors of the community to develop a National Plan of Action. Along with other government and nongovernmental organizations, the correction service was set up to take charge of the prevention and management of HIV/AIDS and sexually transmitted disease related issues in the PNG prison institution. Among its prevention activities includes establishment of Aid Post in each prison, and correctional officers trained as Aid Post leaders or nurses to provide basic services. The Department of Health trained the correctional service health workers as peer educators. The success of the program is yet to be determined but initial assessment indicates the need for a wider community support for the correctional service of HIV/AIDS and general health services to grow in different areas.^ieng

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PIP: The Jefferson County Department of Health and Environment in Golden, Colorado, is the first in its state to offer low-cost no-scalpel vasectomy (NSV) procedures. Training for the Colorado NSV program is part of a project coordinated by AVSC International in New York City. AVSV pioneered the introduction of NSV in the US in 1988 after its 1985 visit to China to learn the vasectomy technique that was developed by Li Shunqiang, MD. Compared to the traditional vasectomy procedure, the NSV technique is less invasive, less painful, heals more quickly, and has fewer complications. At the Golden department, an NSV procedure is broken into three office visits: 1) initial counseling, 2) actual NSV procedure, and 3) testing of sperm specimen to ensure the procedure has proven effective. As with conventional vasectomy, NSV must be considered a permanent form of contraception even though advanced microsurgical techniques offer better chances of restoring fertility.^ieng

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On 21 April, 1999, the Namibian press reported that the government was going to declare AIDS a notifiable disease. This announcement sparked much debate about the role of confidentiality in a sound public health approach to the prevention and control of HIV/AIDS. It also became apparent that in Namibia people's understanding of the principle of confidentiality varies widely. Many seem to confuse the concepts of secrecy and confidentiality. They see preserving confidentiality about HIV/AIDS information as strengthening the "veil of secrecy" that surrounds HIV, reinforcing stigma and undermining efforts to control the spread of HIV. A consultative process, initiated by Joint UN Program on HIV/AIDS, led to the formulation of a much needed policy framework for reporting and notification of HIV/AIDS. A task force was established to identify, discuss and report on national issues, policies and experiences that could inform the discussion on HIV reporting and confidentiality.

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PIP: In 1998, the Health System Research Institute of Thailand conducted a comprehensive review of the health services available to elderly people. As part of this review, data were gathered based on the services provided in public facilities. Four methods of data gathering were used; namely, 1) interviews with policy-makers and implementers, 2) surveys of elderly people in the community, 3) exit interviews with patients at hospitals, and 4) observations in hospitals. Results of this review were summarized, which includes findings obtained through the latter three methods in the following areas: coverage of elderly people's card scheme, payments, travel to a health facility, care provided at the facility, and outreach services. The paper concludes with a discussion of policy recommendations.^ieng

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PIP: In response to the HIV/AIDS epidemic that struck the African countries, researchers are advised to study Uganda, which has cut its HIV infection rate from 33% to 12%. In a short period of time, this East African country was able to produce such a dramatic drop by recognizing the gravity of the problem, adopting an open public policy, and waging a vigorous AIDS prevention campaign. Consequently, the AIDS Control Program was established in the country as a model for the rest of Africa. This enabled the country to combat the problem together and curtailed the duplication of very meager resources. In addition, the government appointed a Presidential AIDS Commission and adopted an approach to AIDS that involved all government agencies and the private sector in the fight against the disease. The open public policy encouraged a candid discussion of the AIDS problem at political rallies, religious ceremonies, schools and civic activities. Overall, by studying Uganda's successful AIDS prevention campaigns, other countries can learn practical and theoretical lessons that can effectively fight AIDS.^ieng

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PIP: In the 1998 food crisis in Rumbek county, South Sudan, Dinka mothers began voluntarily to remove their malnourished children from Oxfam's therapeutic feeding programs. This article explains how the incident has led Oxfam to re-examine its ideas about food aid in the region and to take a fresh look at Dinka ideas of need. It was shown that Dinka ideas of vulnerability do not always coincide with the norm when it comes to food aid distribution. Dinka life revolves around the cattle, which provide milk for the children and the elderly. Thus, they believed that a child whose family or clan has sufficient cattle should not need special attention, even if they happen to be thin occasionally. In view of this, Oxfam decided that the best way forward was to discuss these issues and set up a workshop of women and men involving food decision making. In the workshop, Oxfam explained the purposes and outcomes of giving food to the malnourished, or the ¿weak¿ as the Dinka termed it and this became a negotiation over feeding attendance. It was finally agreed that the chiefs would allow ¿weak¿ children to receive double rations, on the condition that Oxfam discuss the issues with the World Food Programme.^ieng

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PIP: This paper concerns the administration of governmental and nongovernmental programs for the prevention of HIV/AIDS in Africa. A 1986 government campaign in the prevention of HIV in Senegal has been initiated and has been guided consistently. The Society for Women and AIDS in Africa (SWAA) is a nongovernmental organization (NGO) which assembles young population, women, and communities, towards their goal to prevent HIV infection. Marocaine de Lutte Contre le SIDA (ALCS), another NGO in Morocco believes that early intervention and education could help prevent further spread of infection. ALCS focused on the education of sex workers and the use of condoms. They also work with a group of men to promote safe sex and tackle the need for better testing facilities. In Uganda, the focus of the organization is to control the high incidence found in couples with only one infected partner. Another organization incorporates accurate HIV/AIDS information during prayers and other religious activities. Another approach was adopted by teaching English in secondary schools with AIDS information, values on education, family, and employment as content. An NGO in Cape Town was established to form loose cooperative to exchange information and resources within the community. An ongoing nationwide campaign for HIV prevention and control especially among high-risk groups and an effort on STD treatment is being organized.^ieng

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PIP: The Integrated Project (IP) on Reproductive Health/Nutrition (RH/N) in Batangas Province in the Philippines was launched on December 2, 1999. This project is a new form of collaboration, joining government agencies, nongovernmental organizations, and corporate forces to promote a RH/N project in six municipalities in Batangas. The Ajinomoto Company, one of the largest food companies in Japan, decided to support the project because of its emphasis on training of trainers such as local leaders, community health workers, and volunteers, which is the key to self-sustainability. Another reason for support was that nutrition education is considered an integral part of the IP in the Philippines, which in some way is in line with the company's mission to contribute to the improvement of the people's quality of life. The IP on RH/N is designed to expand the successful IP model achieved in villages in the municipalities of Malvar and Balayan during the past 6 years, while reinforcing the capacities of these model areas to lead in transferring their lessons and experience with successful IP to four other municipalities in Batangas. Attention will also be given to promoting the use of integrated information, education, and communication materials for RH/N.^ieng

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PIP: Research findings of the Centre for Health and Population Research in Bangladesh have always been instrumental in strengthening national health programs in developing countries. In accordance with the fundamental mission of the Centre, the Health and Population Extension Division (HPED) has primarily conducted operations research and has disseminated the findings to program managers and policy-makers. In addition, it has provided technical assistance to the Government of Bangladesh (GoB) and nongovernmental organizations working in the health and population sector. This paper reports the contributions of the HPED and the Centre's Epidemic Control Preparedness Programme (ECPP) in improving national health programs in Bangladesh. Overall, it is noted that the HPED and the ECPP have conducted field-testing of interventions and provided technical assistance to GoB concerning the community clinics and the unified management information system. Moreover, the HPED, through its Operations Research Project has successfully disseminated lessons learnt from its applied research activities. Future plans of the HPED include continuing such activities and help translate the findings into policy actions, aiming at improving the effectiveness and efficiency of large-scale national programs.^ieng

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An overview is presented of a multifaceted intervention to promote consistent condom use by female commercial sex workers in Thailand, in the context of the government's 100% condom use policy for preventing spread of human immunodeficiency virus (HIV) infection. The project is described with reference to a succession of stages including pre-programme needs assessment, intervention design, implementation and evaluation. The key elements of the intervention were video scenarios and discussions coordinated by health personnel, and video-depicted open-ended narratives aimed at helping sex workers to explore their personal and work-related dilemmas and concerns. A core objective was to enhance sex workers' self-esteem and perceived future with a view to strengthening their motivation to take preventive action against HIV infection. The intervention was evaluated using a combination of qualitative (process evaluation) and quantitative (outcome) methods. The outcome evaluation was undertaken using a pretest, post-test intervention and control group quasi-experimental design. There were significant increases in consistent condom use among the intervention groups but not among the controls. Pragmatic stability is advocated for the Thai sex industry and recommendations are offered for good quality HIV prevention activities.

PIP: This paper presents an overview of a multifaceted intervention project to promote consistent condom use by female commercial sex workers in Thailand. This project is in context of the government's 100% condom use policy for preventing the spread of HIV. It involves a succession of stages including preprogram needs assessment, intervention design, project implementation and evaluation. A total of 222 cases involving equal proportions of high-income and low-income commercial sex workers were classified into intervention and control groups and completed the pre-test and post-test surveys. The intervention consisted mainly of video scenarios and discussions coordinated by health personnel and of video-depicted open-ended narratives. These methods were aimed at helping sex workers' self-esteem and perceived future with a view to strengthening their motivation to take preventive action against HIV infection. Using a combination of qualitative and quantitative methods in the evaluation process, significant increases in consistent condom use were noted among the intervention groups but not among the control groups.

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PIP: This article highlights the challenge made by Chinese AIDS experts to intensify the education campaign against HIV. Professors Zeng Yi and Xu Hua expressed their opinion on the probable arrest of the spread of AIDS if the government makes an effort in HIV education and prevention campaign. Indifference of some government officials, lack of financial resources, misconceptions on the severity of the situation, and lack of a good HIV epidemiological surveillance system are among the obstacles encountered in stopping this disease in China. Moreover, the biggest challenge of any prevention effort will be to reach the millions of migrant workers who are usually in their sexually active years and are most probably the carriers of the disease.^ieng

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PIP: South African Health Minister Manto Tshabalala-Msimang has asserted that her top priority is to combat HIV/AIDS in South Africa. She predicted that by the year 2005 6 million South Africans will be infected with AIDS. Without government intervention, there would be about a million orphaned children. The quest for affordable antiretroviral drugs will continue. In the absence of a cure for AIDS, the government needs to focus on public awareness campaigns and changing the behavior of the public concerning the disease. A unified intersectoral approach with community organizations, the promotion of sexual abstinence, and the use of condoms are very essential factors in fighting the epidemic.^ieng

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PIP: As part of its nationwide campaign to eliminate iodine deficiency disorders in China by the end of the year 2000, the government has announced the opening of the National Iodine Deficiency Disorders Reference Laboratory. The laboratory will provide the 31 provincial laboratories and hundreds of local facilities in China with reliable reference standards and quality control indicators to help address the problem. Additionally, the laboratory would also be tasked to develop nationwide training programs, teaching materials and report to the Chinese Ministry of Health on the progress of the campaign against iodine deficiency. National Iodine Deficiency Disorders Reference Library director Li Sumei admits that there are many problems associated with local-level laboratories due to the low quality of technicians and the fact that they receive less training. The incidence of iodine deficiency among children aged 8-10 years, according to Li, has decreased from 20% in 1995 to less than 10% in 1999 as a result of governmental campaigns against the disease. Iodine deficiency can cause hypothyroidism, complications during pregnancy, and cretinism in infants and is considered as a factor in more than 90% of the 11 million cases of mental disability.^ieng

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PIP: This brief article identifies new levels of government funding for health and more specifically AIDS programs in South Africa. Health allocations were increased from R23 billion in 1998 to R24 billion during 1999. Health funding will increase in 2 years to R28 in 2001. AIDS programs will receive R110 million (US$17.7 million) in 1999, of which R58 million will be directed to the government's AIDS Awareness Action Plan. South Africa has one of the fastest growing epidemics in the world. The government is responding to its needs and the pressure from activists for its failure to sufficiently address the spread of HIV/AIDS. AIDS activists have criticized the government decision not to fund pilot projects that would give HIV-positive pregnant women free access to zidovudine. General elections are scheduled for April 1999 and the ruling African National Congress could be attacked for failing to support AIDS awareness. The Western Cape province's AIDS program director was pleased with the level of support, since international donors had previously funded AIDS programs. The Democratic Party was pleased with the government's funding of nongovernmental organizations (NGOs) with HIV/AIDS programs. A party spokesperson thought that the government's inefficiencies in preventing the spread of HIV/AIDS indicated that it is now up to NGOs to show their strengths in combating HIV/AIDS.^ieng

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PIP: The deleterious social and health outcomes of unplanned pregnancy have been recognized internationally for some time. In UK, birth rates among teenagers have not decreased; every year about 90,000 teenagers in England become pregnant. Of these, 7000 are under 16 years old. A report from UK government's Social Exclusion Unit sets out a comprehensive analysis of the problem and offers far-reaching recommendations on how the extent and consequences of the problem can be reduced. The recommendations cited take a determined multisectoral approach. As part of a national campaign, parents will be encouraged to talk with their children about sex, young men are motivated to be more responsible in their sexual behavior, and those who father children of teenage mothers are pursued vigorously to ensure the provision of continuing financial support. At the local level, local authorities and health authorities will have to develop a local strategy involving the wide range of groups that have an interest on the issue. Efforts must also be made to refute the idea that sex education lowers the age at first intercourse. In addition, it is suggested that the sexual health in UK adopt the integrated approach to produce an effective sexual health service.^ieng

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PIP: In the South African province of KwaZulu Natal, 1 in 3 adults are believed to be infected with HIV; 1500 people are infected daily. According to an unpublished governmental HIV antenatal study, the incidence of HIV in the province has increased by 20% in the past year. According to a Natal University virologist who attended a recent HIV/AIDS Update Symposium held by the university and the provincial department of health, the province has the highest HIV incidence in South Africa, and prevalence there grew from 26.9% to 32.4% during 1997-1998. 16% of South Africans were HIV-positive in 1997. The latest HIV figures for the province indicate the failure of the government's HIV/AIDS prevention campaign, which promotes the use of condoms and the practice of safe sex. Other major problems are a lack of effective education, young people's ignorance, and the stigma associated with HIV/AIDS; in a December 1998 incident, a young woman who had admitted having the disease on a radio talk show was subsequently murdered. Women between 15 and 25 years of age are most vulnerable to infection; although women are aware of condoms, their male partners refuse to wear them. It is warned that the prevalence of HIV/AIDS would increase until women were able to control their own lives.^ieng

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PIP: This paper sheds lights on long-standing issues and new proposals on family planning and adoption promotion. The spate of bills promoting adoption in Title X family planning clinics and federally funded health centers by opponents of family planning programs raise a significant concern in the family planning community. This concern gave rise to questions on the nature of adoption counseling that should be offered to pregnant women in government-funded programs and the extent to which family planning programs should assume the duties of adoption agencies. Budgetary constraints also raise a serious question on the degree to which family planning funds should be rechanneled to serve this purpose. One more immediate issue, however, is the fact that two of the proposed strategies deny women facing pregnancy crisis the right to informed decision on their options by preventing family planning providers to discuss on abortion. Other measures set include the revival of the abortion "gag rule" previously imposed by the Reagan and Bush administrations and promoting a program of direct federal subsidy to organizations which provide counseling to women provided that these organizations shall provide full information on pregnancy options.^ieng

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PIP: This article presents the result of a study conducted by Miriam N. Jato on the impact of multimedia family planning communication campaigns on contraceptive use. The study was conducted in Tanzania, where a government program integrated family planning into maternal and child health care services in 1988, while in 1992 a private-sector condom-marketing program begun and a national population policy for wider distribution of family planning information was adopted by the government. In less than 3 years, contraceptive use was found to have doubled to a level of 11.3% and the total fertility rate declined from an average of 6.3 to 5.8 live births. The result of the study indicates that exposure to media sources of family planning messages was directly associated with increased contraceptive use. Moreover, the use of modern methods increased among women who were exposed to a greater number of media sources, as did discussion of family planning with spouses and attendance of health facilities. The programmatic implications of the results confirm that utilization of multiple media channels in the promotion of family planning and other reproductive issues must be continued, with emphasis on media sources that reach large audiences.^ieng

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