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Global Programme on Aids (GPA) is one program created by the World Health Organization (WHO) wich directs and coordinates efforts worldwide to fight AIDS.

History and origin

HIV virus, a Lentivirus causes AIDS, originally from African continent, spread to the rest of the World since 1960s, at least that is what the scientific community believes. The exact time when the virus start infected humans is a subject of debate and conjecture. Although is believed that the first case was originated in Kinshasa, in The Democratic Republic of Congo, when the virus was transmitted from chimpanzees to humans around 1920.

The situation was getting worst in the coming years. And just in a few decades was practically present in most parts of the world.

In November 20, 1986 was the first announcement by the WHO to start a fight against acquired immune deficiency syndrome as a global concern.

In 1986 WHO created the Control Programme on AIDS. The first months of the program were very problematic. The new program had problems with raising the money from donors and to increase public awareness of the epidemic.

The Special Programme on AIDS was officially created in February 1,1987. A year later the Global Programme on AIDS was established by the WHO. Jonathan Mann was the first director of the GPA.

Phases of the program

The great magnitude of the problem and response of the international efforts to fight against HIV and the GPA itself has in general four phases in the evolution of the program itself:

Scientific discovery (1980-1985)

Around 1980, a number of physicians simultaneously in different parts of the globe began to recognize the existence of an ill apparently new. They found signs of the illness in the early 1970s and perhaps earlier. In the first years after the discovery of HIV the scientific and medical community was preoccupied on the understanding for the origin, epidemiology and pathology. A few time later the concern was how to prevent, diagnose and treat the illness. In 1983 the HIV virus was discovered. In 1985 the first serological test for HIV diagnosis became available.

Emergency response (1986-1987)

In 1986 WHO created an international campaign, the Special Programme on AIDS. to promote the fight around the world . This program effectively directed worlwide attention to the illnes and movilized urgent efforts to address what will become a global problem. There were two important patterns. The “developing countries pattern” make focus on the heterosexual transmission and the “developed countries pattern” centered attention on the homosexual and drug-related transmission. The program was responsible to reduce worldwide the percentage of people infected aged 15 to 49 who were infected with HIV.

Institutionalization (1987-1994)

Starting in 1987, the WHO use it as a forum to encourage coordination whit other UN agencies. The work of the program was incredibly successful because alerted world authorities to the danger of epidemics and pandemic. The program also launched a really extensive programme to assist Member States in establishing National AIDS Programmes (NAPs). By 1988, it was responsible for direct financial support to around 130 countries.

A very large quantity of the progress against AIDS was thanks to this program. For example: improving diagnosis, developing vaccines and therapeutics treatments around the World.

Multi agency coordination (1995 to present)

The donors were not pleased of the development of the GPA. And since 1993 different members involved in the subject were trying to look for a better organization to fight with the pandemic. In 1995 the process of improving UN agency coordination took a substantial momentum. And in January 1996 culminated in the creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS). This program joint UNICEF, UNDP, UNFPA, UNESCO, WHO and the World Bank. And this program ends with the GPA. The hopes of the program are finish with the global problem of HIV and AIDS.

Objectives of the program

• To prevent the HIV infection

• To give medical treatment to the HIV-infected people

• To unify national and international health efforts.

Subobjetives to prevent the HIV infection

• Promote the Adoption of Safer Sexual Practices

The studies revealed that in 1980’s between 75% an 85% of adult HIV infections have been transmitted by sexual intercourse. The GPA promoted the use of condoms, abstinence, fidelity between uninfected people and non-penetrative sexual practices. The GPA also discovered that was urgent to give the knowledge of the sexual activities to the young people. So an initiative took shape with the collaboration of UNESCO of preparing guidelines for school curriculum planners to incorporate information on HIV prevention. When it was discovered that HIV was transmitted through infected fluids from the human reproductive tract, the benefit of using condoms was realized as a really good method for preventing new infections. GPA helped NAPs to promote the use of condoms. The strategy was to asses on the appropriate use of condoms, reduce the cost of condoms, and to distribute free condoms in the developing countries. The result was a significant increase in the use of condoms around the entire world. This tendency was increasing in the future years, even after the end of GPA.

• Reduce the incidence of curable STD

It was discovered that the HIV transmission is facilitated during sexual intercourse when one or both of the partners also has an active sexual transmitted disease (STD) infection, especially one which causes purulent or exudative discharge or ulcerative erosions in the barriers of the male and female genital tract. In July of 1991, WHO’s Venereal Diseases and Treponematoses unit (VDT) was integrated into GPA to helped with the training of professional personnel, integrating services in the health centers to improve a first level diagnosis and improving condom supply and availability.

• Promote the adoption of safer injecting drug use practices

The HIV transmission through use of contaminated needles and syringes was discovered through the explosive growth of HIV among injecting drug users. Using trained stuff provided risk reduction messages, knowledge of risk behaviors and the use of bleach to clan injection equipment.

• Prevent transmission through blood in health care centers

In the first years of the discovery of HIV virus the transmission through the transfusion of blood and blood products was unknown. Around 1983 appeared evidence that there was a causal link between transfusions and acquisition of HIV. The cases of HIV infection related to transfusion grew notably between 1983 and 1986. It was estimated that blood transfusions were responsible for 5% to 10% of all HIV infections worldwide. The GPA took measures for reducing the risk: The recruitment of voluntary donors with no identifiable risk behavior; testing of all donated blood for HIV and other transfusion-transmissible agent and more rational use of blood products with recourse to simple alternatives.

• Ensure the development and availability of prevention technologies

The GPA between 1994 and 1995 biennium, took emphasis of new technologies for prevention of the HIV infection.

Vaccines: An effective vaccine was not possible to develop. But it was possible to create vaccines to reduce the infectivity of an HIV-infected person and vaccines to reduce the appearance of AIDS in a HIV infected person.

Microbicides: The GPA did a very intensive research of the microbicides for the use of women. It was discovered that microbicides increase the risk of HIV transmission because they cause lesions in the genital mucosa, for example nonoxynol-9. They continue with the research of a microbicide effective to prevent new infections.

Female Condoms: From 1994 to 1995 GPA efforts to promote de development and testing of the female condom or vaginal sheath for the prevention of HIV transmission. A Study initiated in 1993 showed a preliminary data: the female condom does protect against STD transmission and that it was useful adjunct to male condoms.

Improved Diagnosis: The GPA emphasized the importance of accurate and cost-effective laboratory methods for diagnosing HIV infection around the world. The program supported the development and supervised the applicability of these methods under field conditions, including ethical and human right considerations, the non-judgmental process facilitates the patient to make a decision of make or not make the test, and with the objective of taking information about the behavior of the patient . In the WHO collaborating center on AIDS and in Prince Leopold Institute of Tropical Medicine the researches gave information for the specificity and sensivity of assays to different viral strains, costs and laboratory infrastructure necessary for their use for make it available to all countries and all the national programs.

• Prevent Mother-to-Child Transmission

To prevent this consequence of HIV infection in adults, the GPA has encouraged the voluntary and confidential testing of pregnant women and counselling during the entire pregnancy period. The women who had the knowledge to be infected with HIV should be advised no to breast-feed their infants.

The GPA monitored a research on the use of pre-partum vaginal lavage and washing newborns with microbicides as another resource to reduce mother-to-child transmission.

Subobjetives to give medical treatment to the HIV-infected people

• Improve of the Organization and Adequacy of Health Care Services

Besides the searching of better ways to prevent more HIV infections the GPA took a serious concern of the HIV-infected people.

The GPA worked with national and local health officials to improve the organization of services to meet the demands of HIV/AIDS care and prevention included. One of the first activities was to ensure that health care workers were protected from exposure to HIVwhile they care of the patients.

Another important precaution was the blood and all the products and human tissues, all of them should be treated as potentially infectious for health hazards. The GPA gave an importance to the continuity of the care form hospitals to the home. It was really important to capacitate professional and voluntary personal to take care of the ill person. Decentralization of health centers has provided unique opportunities to implement these plans.

Also the GPA took programs and services for the treatment of Tuberculosis. Tuberculosis and HIV/AIDS were growing together in the quantity of infected persons.

• Improve Individual Care and Support

Developing and distributing guidelines for the clinical management of HIV infection and AIDS. The first guidelines were generic but in 1991 the GPA developed the innovative Guidelines for the Clinical Management of HIV Infection in Adults, this guideline includes recognition of symptomatic infection, laboratory evidence of HIV infection, chronic diarrhea, headache, fever, etc. The GPA did strategic reviews of existing national counselling activities from the traditional health education. GPA has work with national and international organisms in expanding understanding of the unique clinical care requirements peculiar to different geographic settings and creating the tools to confront them successfully.

• Counter Discrimination and Stigmatization

The GPA has sought to counter discrimination against and stigmatization of HIV infected persons promulgating international standards and norms to enhance respect for promotion of human rights; advocating tolerance in public forums; developing educational materials that promote attitudes of acceptance, inclusion, non-discrimination and support; making all the information, education and health services are available to all kind of people, monitoring government and private sector practices that increase the risk of more infected people and discriminate against infected persons and lobbying for legislation and policies and practices that protect the people affected by HIV/AIDS.

Subobjetives to unify National and International health efforts

• Strengthen National AIDS Prevention and Care Efforts

The first step of GPA was to help countries requiring assistance to establish National AIDS Programmes (NAPs) coordinated by ministries of health. This phase starts with a WHO-organized teams of consultants that visited concerned countries to help assess the epidemiologic situation and to gain the political support to create a national programme. Reporting AIDS cases was the key of the beginning.

GPA ensures communications between different health practitioners about their clinical assessment of patients, to serve as a prognostic guide in the care of individuals. These communications rates effective therapies. The GPA reviews the NAPs to ensure their progress and efficiency of activities and helping to standardize programme reviews. It was established three reviews: annual, after two or three years and after five years. In 1988 the GPA launched the WHO AIDS Series with the aim of providing information for all the people. Also created a variety of materials for the general public . The information distributed needed to be updated. This was a big spend for the organization and in 1994-1995 biennium, the 135 planned publications were reduced to 45 items. The GPA made available a series of comprehensive bibliography during 1994.

• Mobilize and Coordinate the Global Response to AIDS

The work of mobilizing global consensus on international policies and responses to the HIV/AIDS pandemic have been its most important challenge and its most recognized achievements. These responses were carried out in many forums. Five of them deserve special mention:

World Day: In 1988 at the close of the World Summit of Ministers of Health in London, the first day of each December was instituted the “World AIDS Day”. It was created as a vehicle to call attention on the scale of the pandemic and to focus discussion on specific programs worldwide.

AIDS Summits: Mobilizing high-level political support for programs against HIV/AIDS has been a very important part of the strategy on AIDS. Two “Summit Meetings” were the pinnacle of this effort. The fist “World Summit of Ministers of Health on Programmes for AIDS Prevention” took place between 26 and 28 January 1988. This meeting brought together a high number of ministers of health and representatives of UN agencies and intergovernmental and international nongovernmental organization to exchange views about the education and information programmes. It was created the “London Declaration on AIDS Prevention” which brought representatives of 149 States. AIDS it was recognized as a global problem.

Coorganized by WHO and the Government of the Republic of France, on 1 December 1994, in Paris, took place another AIDS Summit took place. In these meeting representatives from 42 States focused on five topics: blood safety; development and accessibility of preventive technology against HIV/AIDS; care and support of people infected with HIV; prevention and vulnerability to HIV/AIDS.

International Conferences on AIDS: The first “International Conference on AIDS” took place in Atlanta, USA, in June 1985. The GPA’s support for this international event was to advocate attention to HIV/AIDS and to facilitate dialogue between all countries about the pandemic. And the GPA supported financially to the participants from developing countries.

Private Sector: The GPA in 1989 worked with the international travel industry to disseminate information materials to their extensive network of publicity. In 1991 began a collaboration with major pharmaceutical companies to ensure that and appropriate and ethical research would be expanded in the areas of HIV vaccine, clinical research, drug development and diagnostic tests. In 1993 the International Federation of Pharmaceutical Manufacturers Associations (IFPMA) and WHO worked together toward the rapid discovery and development of new, safe and effective drugs and vaccines against HIV/AIDS.

Nongovernmental Organizations: The nongovernmental organizations (NGOs) have played an important role in the battle against HIV/AIDS. The GPA facilitated dialogue and partnerships between NGOs, the UN system agencies, bilateral agencies and funding institutions.

GPA launched the “Partnership Programme” (PP) to provide funding to NGOs replicable and innovative HIV/AIDS prevention and care activities in developing countries. Between 1994 and 1995, GPA focused support on facilitating collaboration and consultation between NGOs and NAPs.

GPA and the Human Rights

Since the begging of the HIV/AIDS pandemic the most notorious AIDS-related violations of human rights was the discrimination against HIV-infected people. Other problems were AIDS-related travel restrictions and coercive public health measures. It was an urgency to start a fight not only with the virus, also with the discrimination. The discrimination impedes the rights to work, housing and education.

Around 1988, 81 countries developed anti-AIDS immigration laws.

WHO call an International Consultation on WHO and Human Rights with leading international lawyers in order to confirm that AIDS-related discrimination violated existing international human rights standards.

The Consultation was held between 26 and 28 July 1989 at the UN in Geneva, in which Rights and Humanity proposed the preparation of guidelines to assist policy-makers in compliance with international human rights standards regarding law, administrative practice and policy. In 1992, published by de UN, The Rights and Humanity Declaration and Carter on HIV and AIDS appeared to the world. Years later, in 1996 it was created The International Guidelines on AIDS and Human Rights, also by the UN.

The creation of UNAIDS

With the push of donors and organization, it was resolved that it was necessary to the creation of a new organization capable to direct a global response with a better organization than GPA especially with other UN bodies for example, many national programmes had never been evaluated.. And in 1995 it was created the Joint United Nations Programme on HIV and AIDS (UNAIDS), it has the intention to lead an expanded and multispectral global response to HIV/AIDS , with the new program, surged the end of the GPA, after 8 years of duration.

Financial matters

The program starts with only a few members and achieving one million dollars in the first two years. Between 1897 and 1990 the donations increased from 30 million dollars to 90 million dollars. Only in 1990 received 80 million dollars. And from 1994 to 1995 the number grows to 149 million dollars. From the period of its duration the program had contributions to over 674 million dollars.

See Also

World Health Organization