This article describes the activities of the "Universities Talk AIDS" (UTA) program in India. The program is run by the Indian government as a strategy to prevent HIV/AIDS by informing students and encouraging discussion about healthy human sexuality. UTA works through the National Service Scheme (NSS), Department of Youth Affairs and Sports, which has a student network of 1.25 million volunteers operating in nearly all India's universities. UTA began on an experimental basis in 1991 in 59 universities. Each college campus received US$90/year. UTA has trained 7000 educator-facilitators who are active in 7500 colleges affiliated with 158 universities. Almost 75,000 peer educators (PEs) have been trained. About 10 million students were made aware of the causes, consequences, and prevention of HIV infection. UTA maintains a campus-to-community link called "Concerted Action by Universities upon Silent Emergencies" (CAUSE-2000). UTA developed knowledge, attitudes, and practices surveys, evaluation reports, IEC, training manuals, modules, and documentary films. Training camps are conducted on campuses, followed by intensive orientation workshops for field officers and selected PEs from various colleges. Discussion topics include medical facts, global scenarios, human sexuality and development processes, responsible sexual behavior, values, misconceptions/beliefs, prejudice and its impact, attitudes toward condom use, and the cultural impact of HIV/AIDS counseling. Workshop participants prepared education messages in local dialects for the larger community. NSS will be withdrawing support at the end of the 3-year period, which creates the need for sustainably trained facilitators.
This article describes the efforts of local Philippine HIV/AIDS programs to widen their reach and sustain their efforts. The model assumes that the engagement of an ever larger number of institutions that understand HIV/AIDS issues and are committed to prevention and care will help foster safer sexual behavior. The Philippines HIV/AIDS Nongovernmental Organization (NGO) Support Program (PHANSuP), with the support of the International HIV/AIDS Alliance, developed skills and strategies workshop sessions. This pilot training program builds and strengthens local NGO capacity and partnerships between sectors. The Alliance in 1993 raised funds for PHANSuP, and PHANSuP supported local NGOs, including the Olangapo City AIDS Foundation (OCAFI). OCAFI was forced to stretch the new funding over a longer period and agreed to be a resource for a wide variety of local institutions rather than a single AIDS project. In this way, resources were complementary and more broadly distributed. OCAFI built partnerships with a variety of institutions ranging from the local Rotary Club to the casino. The result was wider financial, political, and practical support in Olangapo City, and improved access to vulnerable groups. The pilot program proved that local NGOs could reduce their dependency on PHANSuP financial support. The links between NGOs and government health services have led to a wider reach of the education programs and the use of mass media. PHANSuP has developed several initiatives to promote the view that partnerships between different sectors are possible and that sustainability is possible. Programs must sell themselves to the local community, which in turn will support the programs.
Without significant reductions in maternal-infant HIV transmission, infant mortality may increase by as much as 75%. This article reviews briefly the range of interventions that have been proposed to prevent HIV transmission during pregnancy and delivery. These include the provision of HIV/AIDS counseling in family planning programs, promotion of consistent condom use, vitamin A supplementation during pregnancy, adequate prenatal care, Cesarean section delivery, vaginal lavage, and zidovudine treatment. The efficacy of mandatory HIV testing of pregnant women and zidovudine administration to HIV-positive pregnant women has not been confirmed, but both strategies should be available. Antenatal screening for this purpose should be promoted, however, only if free drug treatment for the mother and child can be offered for at least 2 years (the 9 months of pregnancy and the 18 months until the infant can be tested for HIV). Although HIV-infected pregnant women should have the option of induced abortion, termination should never be coerced. Only 10% of HIV-infected pregnant women select this option, and those who do tend to have another pregnancy within the next 2 years.
The International Community of Women Living with HIV/AIDS (ICW) is the only international network run for and by women living with HIV infection and AIDS. This network of women educates, supports, and advocates for each other on local, national, and global levels. HIV-positive women often report feeling that everyone has an opinion upon how they should behave, especially with regard to pregnancy. Doctors and other health care workers often have moral and discriminating attitudes toward such women which often interfere with the standard of health care and information HIV-positive women receive in order to make informed choices. ICW is planning to explore the experiences of HIV-positive women with regard to their sexual and reproductive rights. Many women have experienced rejection, fear, and ignorance because of their HIV serostatus. Women should therefore not be singled out for HIV testing when they face such risks and violence. The counseling of couples and testing with joint consent could reduce women's vulnerability. Finally, there may be many reasons why a woman does not tell her children that she is HIV-positive. However, without being open about illness, it is very difficult to plan for the future.
The potential capability of the drug zidovudine (ZDV) to reduce the maternal-fetal HIV transmission rate from 25% to about 8% has raised complex questions about mandatory HIV testing of pregnant women and newborns. Advocates of this strategy equate mandatory HIV testing with interventions such as vaccination and quarantine, where expected health benefits are assumed to compensate for the associated loss of autonomy. At present, however, data on the effects of ZDV administration on vertical HIV transmission are incomplete and inconclusive. Moreover, concerns have been raised that ZDV treatment during pregnancy may compromise a woman's future treatment and have an adverse effect on infants likely to be born HIV-negative even in the absence of treatment. HIV testing of newborns indicates only maternal HIV status, since maternal antibodies are present for up to 18 months of age. If compelling evidence were available of a treatment likely to reduce significantly the risk of vertical transmission without adverse long-term effects for mother or infant, then the case for mandatory HIV screening would be stronger. At the present time, however, the infringements of civil liberties inherent in such a strategy outweigh its potential benefits.
