正しい方法がわかる臨床基本手技 : from the New England journal of medicine

Male circumcision for HIV prevention in young men in Kisumu, Kenya : a randomised controlled trial. Commentary

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report

Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013. Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships. The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.

/pdf/hiv-infection-and-aids-in-sub-saharan-africa-current-status-a8vco20pup.pdf

HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities.

Defeating AIDS—advancing global health

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)31509-X.pdf

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa.

Executive summary After more than a decade of major achievements, the AIDS response is at a crucial juncture, both in terms of its immediate trajectory and its sustainability, as well as its place in the new global health and development agendas. In May, 2013, the UNAIDS–Lancet Commission—a diverse group of experts in HIV, health, and development, young people, people living with HIV and aff ected communities, activists, and political leaders— was established to investigate how the AIDS response could evolve in a new era of sustainable development. The UNAIDS–Lancet Commission has come together at a moment when the lessons of the AIDS response, including its whole-of-society perspective, can be informative and even trans formational for other spheres of global health. The path to ending AIDS as a public health threat by 2030, as set out in this report, should be a major part of the post-2015 development agenda. Thanks to considerable resources, leadership, community mobilisation, and innovation, enormous gains have been made in controlling the HIV epidemic, saving millions of people from infection and AIDS-related illness and death. Thus, in 2013, the number of new HIV infections had decreased by 38% since 2001 to 2∙1 million, and the number of AIDS-related deaths decreased by 35% since 2005 to 1∙5 million. Anti retroviral treatment (ART) fundamentally changed the course of the epidemic by substantially reducing mortality from HIV infection and as part of HIV control strategies. However, many populations around the world are still highly aff ected by HIV, particularly young women in southern and eastern Africa, men who have sex with men (MSM), sex workers, and injecting drug users. Additionally, there are concerning signs of complacency and setbacks in countries and populations that had previously made substantial progress. A still expanding armamentarium of proven eff ective biomedical, behavioural, and structural interventions have been developed for the prevention and treatment of HIV infection. These interventions have a maximum eff ect when used in combinations that are tailored to the needs and contexts of specifi c populations. In addition, their programmatic eff ect is greatest when focused on populations at highest risk and in geographical hot spots, as is now policy in countries such as Kenya. However, as a result of poor strategy, absence of leadership, or Lancet 2015; 386: 171–218

Joanne McManus

Papers

Defeating AIDS—advancing global health

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa.

A UNAIDS-Lancet Commission on Defeating AIDS—Advancing Global Health Defeating AIDS—advancing global health