This paper proposes a conceptual framework for an expanded response to HIV/AIDS and suggests the dimensions along which this response needs to proceed.

Around 340 million new cases of curable sexually transmitted diseases (STDs) are estimated by the World Health Organization (WHO) to have ocurred throughout the world in 1995 in men and women aged 15-49 years. In developing countries, STDs and their complications rank in the top five disease categories for which adults seek health care. In women of childbearing age, STDs - even excluding HIV - are second only to maternal factors as causes of disease, death and healthy life lost.

Gender roles and relations have a significant influence on the course and impact of the HIV/AIDS epidemic in every region of the world. Understanding the influence of gender roles and relations on individuals’ and communities’ ability to protect themselves from HIV and effectively cope with the impact of AIDS is crucial for expanding the response to the epidemic.

Mother-to-child transmission (MTCT) is by far the largest source of HIV infection in children under the age of 15. In countries where blood products are regularly screened and clean syringes and needles are widely available, it is virtually the only source in young children. In 1997, an estimated 600,000 infants worldwide were infected with the virus, bringing the total number of young children living with HIV to over 1 million at the end of the year.

This document is based on reports supplied at the request of UNAIDS from 13 countries in Latin America and the Caribbean. The countries are Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Guatemala, Haiti, Jamaica, Mexico, Peru, Puerto Rico, and Venezuela.

The business sector needs to be convinced that their participation is combating AIDS is essential in making a difference, not only to the larger national Endeavour, but also to their businesses.

While people living with HIV infection or AIDS may live many years before their infection leads to secondary diseases and eventually AIDS, survival with advancing HIV infection is complicated with symptoms and medical conditions. Many of these symptoms and conditions, and the advance of HIV itself, are manageable with drugs. However, access to even the most basic of drugs is seriously lacking in many parts of the world.

People with advanced HIV infection are vulnerable to infections or malignancies that are called “opportunistic” because they take advantage of the opportunity offered by a weakened immune system. Various treatments and prophylaxis—some simple and low-cost, others highly complex and expensive—exist to counter the most common opportunistic diseases, but delivery systems and funding are insufficient in many parts of the world to ensure their universal use.

A guide for health-care managers and supervisors

Strategic planning, as developed in the present guide, defines not only the strategic framework of the national response, i.e. its fundamental principles, broad strategies, and institutional framework, but also the intermediate steps that need to be achieved in order to change the current situation into one that represents the objectives to be reached.