Tools and Curricula

Fast-Tracking Combination Prevention: Towards Reducing New HIV Infections to Fewer Than 500 000 by 2020

Joint United Nations Programme on AIDS (UNAIDS) (2015). 

This paper lays out the rationale and specific actions for fast-tracking combination HIV prevention to meet the UNAIDS target of reducing new HIV infections to fewer than 500,000 by 2020. Each section synthesizes and presents key epidemiological, clinical trial, and programmatic data; and uses examples and graphics to illustrate key points. The paper focuses on HIV prevention in adolescents and adults, and is broken down into six sections: commitment, focus, synergies, innovation, scale, and accountability. National commitments to HIV prevention need to be renewed through a focus on specific targets and resources, including program packages for policymakers to consider. Efforts should focus on key locations, priority populations, and high-impact programs and interventions. Synergies can be found in HIV prevention packages tailored to specific user groups and settings; the document provides examples for high-prevalence settings in southern Africa for men who have sex with men, young women and their male partners, people who inject drugs, and sex workers. It describes innovations in prevention tools, delivery approaches, and integration, including medical male circumcision, pre-exposure prophylaxis, digital social media, and cash transfers. Using examples, the paper underscores the importance of delivering products and programs at scale and with the intensity needed for impact. It concludes with an accountability framework that can be used to ensure that each program does its part and has the appropriate resources to do so.

Comprehensive HIV Prevention for People Who Inject Drugs, Revised Guidance

U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) (2010).

This guidance was updated in response to the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, signed into law in July of that year. PEPFAR supports three core elements in comprehensive HIV prevention programming for people who inject drugs (PWID): community-based outreach programs, sterile needle and syringe programs, and drug dependence treatment, including medication-assisted treatment with methadone or buprenorphine and/or other effective medications. These elements are globally recognized as best practices with populations of PWID, and are endorsed by diverse international organizations. An estimated 5 million PWID live in the 13 countries where PEPFAR supports HIV prevention programs, mostly in Eastern Europe and East and Southern Africa. The sexual partners of PWID are also at risk of acquiring HIV, and act as a bridge population to groups that conduct less-risky behaviors, which can fuel the epidemic. Therefore, the evidence base for programs for PWID supports a comprehensive HIV prevention program that includes behavioral, biomedical, and structural interventions as a means to reduce HIV transmission. The guidance includes 10 core interventions. PEPFAR recommends choosing a combination of these 10 interventions, based on the epidemiological, social, legal, and cultural environment of the country and region, and implemented with a human rights approach.

Technical Guidance on Combination HIV Prevention, Men Who Have Sex with Men

U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). (2011).

This guidance was developed in response to PEPFAR’s second five-year strategy, which outlines priorities and plans for countries that implement HIV programs. The guidance is one component of an effort to support comprehensive combination prevention programs. It was found in a review that men who have sex with men (MSM) are 19 times more likely to have HIV compared to the general population. PEPFAR is working to ensure that key populations, including MSM, are a prevention priority in epidemics where MSM are shown to be key drivers of transmission. The guidance reviews the evidence base for HIV prevention programs with MSM, and supports five key elements of a comprehensive response: community-based outreach; distribution of condoms and condom-compatible lubricants; HIV testing and counseling; active linkages to health care and antiretroviral treatment; targeted information, education, and communication; and prevention, screening, and treatment for sexually transmitted infections. The document describes how to support effective HIV prevention for MSM, and offers key points on how to optimize prevention programs. PEPFAR budgets will support implementation, training, collection, and use of strategic information, research, monitoring and evaluation, and commodity procurement of/for MSM programs. Additional resources are listed at the end of the document to provide PEPFAR country teams with information that may be useful for strategizing their MSM combination prevention portfolios.

Guidance for the Prevention of Sexually Transmitted Infections

U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). (2011).

The August 2011 guidance aims to help PEPFAR country teams to identify the best combination of HIV prevention strategies, based on country-specific epidemiology. It describes the overarching principles for prevention programs, and then summarizes the evidence base and implementation guidelines for specific interventions. Biomedical interventions included in the guidance are male and female condoms, voluntary medical male circumcision, HIV testing and counseling, diagnosis and treatment of sexually transmitted infections, and antiretroviral drug-based prevention. Behavioral interventions include the different channels of communication (e.g., mass media, community-level, interpersonal) and types of messages (e.g., addressing multiple partners, intergenerational and transactional sex, and alcohol use). The document also details creating demand for biomedical services. The structural interventions described address legal and policy reforms; stigma and discrimination against people living with HIV and marginalized groups; gender inequality and gender-based violence; education; and economic empowerment and other multisectoral approaches. The guidance also includes comprehensive packages for: key populations; positive health, dignity and prevention for people living with HIV; and prevention interventions for young people.

Manual for Reducing Drug Related Harm in Asia

Centre for Harm Reduction, Macfarlane Burnet Centre for Medical Research, & Asian Harm Reduction Network (2003).

This comprehensive manual grew out of the combined efforts of people in Asia to stop HIV. The first section presents background information on drug use and HIV vulnerability, the rationale for harm reduction, and balancing and integrating the approaches of supply, demand, and harm reduction. Briefing papers on critical issues, such as mapping drug use in Asia and care and support of people who inject drugs with HIV, are included for use as advocacy tools in the region. The second section contains nine chapters on program design, implementation, and maintenance, including rapid assessments, voluntary counseling and testing, and addressing the needs of specific groups. The third section contains appendices with information on hepatitis A, B, and C; HIV; illicit drugs and their characteristics; and sexually transmitted infections. 

Training Guide for HIV Prevention Outreach to Injecting Drug Users: Workshop Manual

World Health Organization (2004).

This training package is for workshops orienting and training public health policymakers, program developers, program managers, implementers, and field workers on outreach to injecting drug users (IDUs) to prevent HIV transmission. The training package has four workshop modules. Orientation to Outreach among IDUs provides evidence for the effectiveness of outreach programs and assists decisionmakers in introducing and developing such programs. Developing Outreach Programs for HIV Prevention among IDUs provides assistance to individuals interested or involved in developing outreach programs. Managing Outreach Programs among IDUs is for those who have never managed an outreach program, but can also be used as additional training for current managers and outreach field supervisors. Core Skills in Outreach among IDUs is designed for initial training of outreach workers, or as a resource for ongoing training and review among experienced outreach workers.

Opioid Overdose: Preventing and Reducing Opioid Overdose Mortality

United Nations Organization on Drugs and Crime (UNODC) and World Health Organization (WHO) (2013).  

This discussion paper was developed in response to a 2012 resolution that called on UN Member States to include effective measures to prevent and treat drug overdose in national policies. In that resolution, the Commission asked the UNODC and WHO to review scientific evidence on preventing and treating of drug overdose, especially opioids, and derive best practices. This paper outlines what is known about opioid overdose and gaps in knowledge; and identifies approaches to preventing and treating opioid overdose. It includes information on risk factors: availability, combining opioids with other psychoactive substances, lack of treatment, and reduced tolerance following abstinence. The paper describes how to recognize and react to overdose, including use of naloxone, as well as policy and program strategies that could help prevent fatal overdose, such as reducing availability of opioids and increasing availability of treatment. It identifies gaps between current practice and recommendations, and outlines a number of potential new areas of work, including addressing overdose of prescription opioids.

Advocacy Guide: HIV/AIDS Prevention among Injecting Drug Users

World Health Organization (WHO), U.N. Office on Drugs and Crime (UNODC), and Joint U.N. Programme on HIV/AIDS (UNAIDS) (2004).

This guide provides a systematic approach to advocacy for HIV prevention and care among people who inject drugs (PWID) that can be replicated and adapted to various cultural, economic, and political settings. General principles of advocacy for HIV prevention and care for PWID are presented first. The guide provides a step-by-step process for establishing advocacy groups with specific goals, undertaking a situation analysis, developing a strategy, and implementing the strategy. It also contains descriptions of many tools and methods for achieving advocacy goals, and examples of their use in various country settings. Frequently used arguments related to HIV prevention among PWID are also included. Most methods in the guide can be used, after adaptation, at community, district, and national levels. 

Guide to Starting and Managing Needle and Syringe Programmes

World Health Organization (WHO), U.N. Office on Drugs and Crime (UNODC), and Joint U.N. Programme on HIV/AIDS (UNAIDS) (2007).

This guide is designed to help programs expand the response to HIV among PWID. Many more needle and syringe programs (NSPs) will need to be established to meet the harm reduction needs of the growing population of people who inject drugs. Sections I and II of this guide describe how to foster this process. Sections III and IV discuss how existing NSPs can expand the services that they offer and greatly increase their coverage. Scale-up of such programs must include establishing more NSPs in prisons and detention centers. Section V presents the particular needs of NSPs in such “closed settings.” A list of useful websites, publications, and networks appears at the end of the guide.

Technical Guide for Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users

World Health Organization (WHO), U.N. Office on Drugs and Crime (UNODC), and Joint U.N. Programme on HIV/AIDS (UNAIDS) (2009).

This guide explains the rationale for including nine different evidence-based interventions in a comprehensive package of HIV prevention, treatment, and care for people who inject drugs. Recommended interventions include harm reduction measures, HIV testing, counseling and treatment, and prevention and treatment of sexually transmitted infections, viral hepatitis, and tuberculosis. Frameworks are given for each recommended intervention. A checklist offers guided assessment of the availability, coverage, and quality of each intervention. 


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