bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional neurosurgical intervention: neuroethics in the operating room
Authors: Ford Paul J. , Henderson Jaimie M.
Published: September 2009

This chapter covers ethical challenges faced by surgeons practicing functional neurosurgery. The exploration of issues surrounding this set of surgeries presents especially interesting problems given the effects, potential or actual, on patient's quality of life in the attempt to restore or normalize a function. The chapter sets the context by briefly discussing the special challenges of surgical ethics in general, defines ‘functional neurosurgery’, and reviews the past, present, and expected future of functional neurosurgery. After setting this context, it addresses a variety of prominent ethical issues. It pays special attention to the context in which issues arise and reflect on ethical challenges to functional neurosurgery as a discipline.
Neuroethics in education
Authors: Sheridan Kimberly , Zinchenko Elena , Gardner Howard
Published: September 2009

This chapter argues that, in the coming years, educators and the general public will look increasingly to discoveries from the neurosciences for insights into how best to educate young people. It considers how educators can navigate change and opportunities of scientific discovery. The chapter proposes a new cluster of professionals: neuro-educators. The mission of neuro-educators will be to guide the introduction of neurocognitive advances into education in an ethical manner that pays careful attention to and constructively capitalizes on individual differences. The uniquely honed skills of these neuro-educators will enable them to identify neurocognitive advances that are most promising for specific educational goals and then, even more broadly, to translate basic scientific findings into usable knowledge that can empower new educational policy for a new neurosociety.
Religious responses to neuroscientific questions
Authors: Wolpe Paul Root
Published: September 2009

This chapter explores the three areas where neuroscience challenges religion. First, in religion's ethical response to neuroscientific findings; secondly, how religion responds to the claims of some neuroscientists that current research refutes ideas such as ensoulment; and finally, through the field that has come to be known as neurotheology, the neuroscientific study of the religious impulse itself.
A Role For Stage 2 Sleep in Memory Processing
Authors: Nader Rebecca , Smith Carlyle
Published: September 2009

Stage 2 sleep is the classification given to approximately 50 percent of the night of sleep in humans. It is recognized as having very salient features that distinguish it from other sleep stages. This chapter provides a brief history of the research examining stage 2 sleep, with an emphasis on cognitive studies. This is followed by a number of recent findings that implicate the importance of stage 2 for memory of certain kinds of tasks, focusing on the stage 2 spindle. The spindle, a basic component of mammalian sleep, may indeed be a perfect time for synaptic plasticity to take place.
The Rem Sleep Window and Memory Processing
Authors: Smith Carlyle
Published: September 2009

This chapter begins with a discussion of the rapid eye movement (REM) sleep window (RSW). It then discusses stress as an explanation for memory loss, the mechanisms of action during the REM sleep window, and specific neuroanatomical structures active during the RSW.
Activation of Phasic Pontine Wave (P-Wave): a Mechanism of Learning and Memory Processing
Authors: Datta Subimal , Patterson Elissa H.
Published: September 2009

Combined animal and human studies support the concept that rapid eye movement (REM) sleep contributes importantly to the process of memory consolidation, especially of a procedural learning task. This chapter presents arguments and supporting data for the hypothesis that the activation of phasic pontine-wave (P-wave) generating cells in the brainstem is critical for sleep-dependent learning and memory processing. Since the focus of this chapter is on the P-wave, and it is most frequent during REM sleep, the brainstem structures that are critical for REM sleep are briefly described.
The Role of Sleep in Memory Processing: the Sequential Hypothesis
Authors: Giuditta Antonio , Mandile Paola , Montagnese Paola , Piscopo Stefania , Vescia Stefania
Published: September 2009

Slow wave sleep (SWS) was the first type of sleep to be described in human subjects by its high-amplitude, low-frequency electroencephalographic (EEG) waves, that sharply contrasted with the low-amplitude, high-frequency waves of active waking or wakefulness (W). Conversely, the later discovery of REM sleep was based on the occurrence of periodic episodes of rapid eye movements (REM) associated with a desynchronized EEG pattern resembling W. As this similarity envisaged an obvious paradox, REM sleep came to be also known as paradoxical sleep (PS). It is perhaps less well known that the discovery of PS elicited a remarkable wave of interest in its features that greatly contributed to highlight their relevance but, by contrast, outshadowed the role of SWS. This chapter discusses the evidence supporting the participation of SWS in memory processing, and the hypotheses concerning the roles of SWS and PS.
The Role of Sleep in the Development of Central Visual Pathways
Authors: Frank Marcos G. , Stryker Michael P.
Published: September 2009

This chapter reviews evidence in support of the hypothesis that sleep may play an important role in brain maturation. It begins by reviewing the role of endogenous neural activity and experience in the development of central visual pathways. It then discusses current findings that support a role for sleep in visual system development. The chapter concludes with a discussion of several theories regarding the functions of sleep in developing animals; specifically, it reviews the ‘Ontogenetic Hypothesis’ that posits REM sleep as an important source of endogenous activity in the developing brain, and a second view which states that NREM sleep promotes the consolidation of waking experience; a process which begins at certain stages of development, but is retained throughout the lifespan.
Off-Line Reprocessing of Recent Memory and its Role in Memory Consolidation: A Progress Report
Authors: McNaughton B. L. , Barnes C. A. , Battaglia F. P. , Bower M. R. , Cowen S. L. , Ekstrom A. D. , Gerrard J. L. , Hoffman K. L. , Houston F. P. , Karten Y. , Lipa P. , Pennartz C. M. A. , Sutherland G. R.
Published: September 2009

This chapter reviews the theoretical considerations for why the brain might require an active reprocessing of memories during periods when it is relatively ‘disconnected’ from external input. It summarizes the current understanding of the phenomenon based on neurophysiological investigations in animals.
Theoretical underpinning for the use of intergenerational studies in life course epidemiology
Authors: Lawlor Debbie A , Leary Sam , Smith George Davey
Published: September 2009

Intergenerational studies have been widely used in life course epidemiology both to examine primary research hypotheses and to explore underlying mechanisms for established associations. This chapter describes the theoretical underpinning for using different types of intergenerational studies in life course epidemiology and discusses how results from such studies should be interpreted. Specifically, it considers the use and interpretation of cousin, sibling, and twin intergenerational studies; egg donation/surrogate mother intergenerational studies; maternal-paternal comparisons; and intergenerational migrant studies and Mendelian randomization in intergenerational studies in life course epidemiology.
Theoretical underpinning for the use of twin studies in life course epidemiology
Authors: Loos Ruth J F , Ridgway Charlotte L , Ong Ken K
Published: September 2009

The classical twin design is used in genetic epidemiology to estimate the heritability of a trait or disease. Despite potential biases for certain traits at specific stages during the life course, the classical twin method remains a robust and useful tool in human genetics when interpreted with care. Twins have also been applied to study the fetal origins of adult disease hypothesis. Twins have unique genetic and prenatal characteristics, which can be modelled to disentangle the complex mechanisms that underlie the ‘fetal origins’ of later disease risks. However, these models have important caveats. This chapter explores how twin-specific characteristics allow a unique insight into the balance of genetic and environmental influences that underlie early-life associations with later disease risks. It also describes how the unique determinants of birth weight in twins necessitate caveats in the interpretation of twin studies in life course epidemiology.
Discussant chapter—summary of the theoretical approaches to family-based studies in life course epidemiology
Authors: Inskip Hazel M
Published: September 2009

Chapters 2 to 4 describe three specific approaches to family studies, namely, intergenerational, sibling, and twin studies. All can be used to assist in distinguishing between genetic and environmental influences mainly within the classical nature-nurture paradigm. This chapter summarizes the three approaches, describes links across the methods, and draws on other examples to highlight some of the areas discussed and to explore other issues, such as birth order effects. All three chapters use the example of influences on birth weight to exemplify the use of their specific study types, intergenerational, sibling or twin, but they also consider outcomes occurring later in the life course. As in all branches of epidemiology a variety of methods in different contexts is required for us to see consistent patterns emerge. Conflicting evidence points to our lack of understanding and for alternative hypotheses to be explored.
Birth cohorts: a resource for life course studies
Authors: Andersen Anne-Marie Nybo , Madsen Mia , Lawlor Debbie A
Published: September 2009

This chapter discusses issues concerned with the design and practicalities of setting up birth cohorts for life course epidemiology. The demand for a blueprint of the ideal birth cohort study is perhaps intuitive, but the chapter questions the extent to which standardization of data collection and study protocols across contemporary and planned birth cohorts is desirable or feasible. The chapter discusses different approaches, difficulties and strengths of these different approaches, the determination of scientific priorities, definition of the birth cohort (including which family members are key participants), data collection and samples size, as well as the ethical considerations specific to the establishment of a birth cohort. The advantages of a scientific focus on specific exposures in each birth cohort study, of documentation of birth cohort data, and of collaborative studies using data from several birth cohorts are emphasized.
Family-based life course studies in low- and middle-income countries
Authors: Batty G David , Victora Cesar G , Lawlor Debbie A
Published: September 2009

This chapter briefly describes the growing impact of non-communicable disease in low- and middle-income countries (LMIC) which, together with existing infectious illnesses and a rising incidence of violence, represents a triple health burden. Birth cohort studies, and in particular those with family-based elements, clearly have a role in identifying risk factors for chronic disease. Existing studies from LMIC are described. The chapter advances a number of reasons for adding to the very sparse research base outside of industrialized nations, and attempts to provide solutions for some of the methodological complications that might accompany such endeavours.
Using available family members as proxies to provide information on other family members who are difficult to reach
Authors: Tomkins Susannah
Published: September 2009

In life course epidemiology studies, the use of proxy (secondary) respondents may be an integral part of the study design or a consequence of not being able to reach or obtain information from the index subject. Based on the available evidence, the main factors that increase validity and reliability of proxy responses are broad categorization of, and focus on, directly observable characteristics and behaviours; questions requiring a binary response; recent characteristics and behaviours; face to face interviews; spouse/partner selected as proxy. Certain issues remain unaddressed by the available literature, including subject areas such as diet, the choice of proxy beyond spouse/partner, validation of responses when the index is unavailable and the effect of index characteristics on proxy responses. Finally, practical tips are presented in this chapter from a case study that successfully employed proxy respondents.
Discussant chapter—the practicalities of undertaking family-based studies
Authors: Hardy Rebecca , Kuh Diana
Published: September 2009

This chapter summarizes the origins of some of the existing life course studies and the current potential for using these studies to address family-based life course questions. It also highlights important methodological and practical issues for the future conduct of such studies. It has to be considered carefully whether it is worth collecting more prior generation and/or offspring generation data in these established cohorts given the practical difficulties and costs associated with such an undertaking as detailed Chapters 6, 7, and 8. The chapter concludes that there is a growing need to build infrastructure across cohort studies to encourage and support collaborative research. It is also clear that there is a great need to value and support the lifelong volunteers and the researchers who initiate and run longitudinal studies in order to realise the full scientific potential of life course research.
How family-based studies have added to the understanding of life course epidemiology of mental health
Authors: Hatch Stephani L , Mishra Gita D
Published: September 2009

This chapter reviews some of the key family-based studies that have identified links between various illnesses and behaviours in parents and siblings with psychiatric disorders in study members. It also describes how sibling and twin studies are beginning to produce results that quantify the relative contribution of genetic and environmental effects. The chapter concludes with recommendations from the perspective of life course epidemiology to move beyond the established associations and to increase our understanding of the underlying mechanisms involved in psychiatric disorders. Specifically, it describes the range of characteristics in terms of study design, and type and scope of data that should be incorporated in future large population based studies.
How family-based studies have added to understanding the life course epidemiology of reproductive health
Authors: Morton Susan MB , Edwards Janet Rich
Published: September 2009

Reproductive events throughout a woman's life course tend to be both a product of the cumulative exposures a woman has been subject to before that event, as well as a marker for her likely future health. While genetic contributions influence the fertility, development, growth, and reproduction of the next generation, all of these critical events in life are subject to external, environmental influences. This is true for individual women and within families of individuals. Perhaps given the shared genes and environments within and across generations in a family it is therefore not surprising that family studies consistently demonstrate a higher degree of consistency in reproductive outcomes at all points in the life course for those who share a family connection, than for individuals who do not, and that the closer that connection (e.g., monozygotic twins) in general the greater the similarities.
Reliabilism and the Value of Knowledge
Authors: Goldman Alvin I. , Olsson Erik J.
Published: September 2009

It is widely agreed that knowledge has greater value than mere true belief. This chapter begins by identifying a weak sense of ‘know’ (in which it means ‘believe truly’) under which knowledge cannot have greater value. There is a stronger sense of ‘know’ for which the value superiority thesis is plausible. The chapter offers two solutions to the swamping problem. The conditional probability solution states that reliabilist knowledge is more valuable than true belief because the former is a better indicator than the latter of future true belief. The second solution explains how a reliable process token can bring independent value into the picture. This can happen either because the value of a token process derives from the type it instantiates (type-instrumentalism) or because the value associated with a reliable process acquires independent, not merely derivative, value (value autonomization). The chapter's final section contrasts our approaches with those of virtue epistemology.
Testimony and the Value of Knowledge
Authors: Kusch Martin
Published: September 2009

This chapter gives substance to the idea of a ‘communitarian value-driven epistemology’ by developing and combining ideas from Edward Craig's and Bernard Williams' ‘epistemic genealogy’ and Barry Barnes' and Steven Shapin's ‘sociology of knowledge’. In order to make transparent how this project might slot into more familiar, or more mainstream, projects, the paper maintains throughout a critical dialogue with Jon Kvanvig's position. The chapter is structured around an attempt to defend Craig's position against Kvanvig's criticisms: by treating the institution of testimony as a collective good underwritten by the intrinsic and interrelated values of accuracy and sincerity; by rendering protoknowledge attributions as ascriptions of honour; and by allowing attributions of protoknowledge to be intertwined with attributions of freedom. The view that emerges is that the core of our knowledge practices comprises institutions of testimony, and that these practices are a collective good.
The Value of Understanding
Authors: Kvanvig Jonathan
Published: September 2009

Understanding has a special kind of value that other epistemic states such as knowledge do not, and this fact threatens the justification for the focus on knowledge that the history of epistemology displays. Elsewhere it has been argued that knowledge does not possess this special value. There are a couple of lines of argument, however, that threaten to extend the denial of this special value for knowledge to a denial of a special value for understanding. Underlying all such challenges is the obvious fact that the language of knowing and the language of understanding are closely related. In this discussion it is argued that the kind of understanding that we prize most is immune from the concerns that have plagued the theory of knowledge.
The Goods and the Motivation of Believing
Authors: Jones Ward E.
Published: September 2009

This chapter begins with an argument to the effect that some doxastic goods are surreptitious motivators: in so far as they work to bring about belief, they must do so without the agent herself being aware of their so working. The existence of surreptitious motivators raises two questions. First, ‘Do surreptitious doxastic goods provide us with reasons to believe?’ Recent work in value theory suggests an argument for the following claim: if a good cannot consciously motivate a believer to believe, then that good cannot provide a reason to believe. The second question raised by surreptitious motivators is the following, ‘Is it possible that important values governing our doxastic lives can only motivate surreptitiously?’ Discussion of this second question interrogates the so-called credit account of the value of knowledge, which conceives of the value of knowledge as a surreptitious motivator. The chapter ends with a brief look at an alternative approach towards conceiving of the value of knowledge.
Practical Reasoning and the Concept of Knowledge
Authors: Weiner Matthew
Published: September 2009

Hawthorne has argued for subject-sensitive invariantism, on which whether a speaker knows that p depends on whether her practical environment makes it appropriate for her to use p in practical reasoning. It may seem that this view yields a straightforward account of why knowledge is epistemically valuable, based on the role of knowledge in practical reasoning. In this chapter it is argued that, on the contrary, practical reasoning does not motivate us to care about knowledge in itself. At best, practical reasoning motivates us to care about several other concepts in themselves, and ascriptions of knowledge provide economical summaries of these independently epistemically valuable desiderata.
Pragmatic Encroachment and Epistemic Value
Authors: Engel Pascal
Published: September 2009

Some philosophers, who defend ‘pragmatic encroachment’ and ‘subject-sensitive invariantism’, argue that changes in the importance of being right and significant increases of the costs of error in given contexts can alter the standards of knowledge. If this view where correct, it could explain to some extent the practical value of knowledge. In this chapter it is argued that the pragmatic encroachment thesis is wrong. Three possible sources of encroachment on epistemic notions are discussed, relating to, respectively, belief, justification, and knowledge. The idea that epistemic standards change with practical stakes is rejected. Pragmatic factors can be relevant to the formation of belief and to the context of inquiry, although they are not relevant to epistemic evaluation. Epistemic value cannot depend upon such factors.
Curiosity and the Value of Truth
Authors: Brady Michael S.
Published: September 2009

This chapter focuses on the question of whether true belief can have final value because it answers our ‘intellectual interest’ or ‘natural curiosity’. The idea is that sometimes we are interested in the truth on some issue not for any ulterior purpose, but simply because we are curious about that issue. It is argued that this approach fails to provide an adequate explanation of the final value of true belief, since there is an unbridgeable gap between our valuing the truth on some issue for its own sake, and that truth's being valuable for its own sake.
What is a public health brand?
Authors: Blitstein Jonathan L. , Evans W. Douglas , Driscoll David L.
Published: September 2009

Branding can be viewed by public health practitioners as a tool that will allow them to influence the perceived costs of engaging in health promoting behaviours. Branded campaigns promote a consumer orientation that emphasizes the nature of the exchange by appealing to the individual's self-interest. This approach will become increasingly important to the field of public health as individuals are required to take a more active role in the production of their health. We can differentiate commercial brands from public health brands by recognizing that the brand object of a public health brand is the voluntary health promoting behaviour the individual is being asked to take up or maintain. In order to be successful, public health practitioners need to consider carefully factors such as demand, competition, and timing in order that consumers perceive the brand as delivering its promised benefits.
Help:A European public health brand in the making?
Authors: Hastings Gerard , Freeman Jo , Spackova Renata , Siquier Pierre
Published: September 2009

HELP is the first attempt to build a pan European public health brand. This chapter analyzes its progress in terms of three key branding constructs: recognition, promise, and delivery. A mixture of qualitative and quantitative research suggests that it is making progress in all three areas. HELP suggests that international public health brands can be successfully built and deployed. However, it also suggests that building these brands presents unique challenges. In particular, it is difficult to pull together like minded but nonetheless independent Government and NGO tobacco control stakeholders behind a cohesive brand strategy; a corporation, such as Philip Morris or BAT, with its more hierarchical and clearly defined structures does not face these problems.
Branding play for children: VERBTM It’s what you do
Authors: Huhman Marian , Price Simani M. , Potter Lance D.
Published: September 2009

The VERB campaign used a branding strategy closely modeled after the methods used to brand commercial products in the private sector. The VERB brand was the organizing element for the campaign's marketing approach and advertising platforms to reach its target audience of tweens. A continuous tracking survey monitored the VERB brand's performance, giving feedback about the reach, appeal, and relevance of the brand and the TV commercials. Using the VERB brand for different behaviours and in different settings were examples of opportunities that were considered; some were implemented, with lessons learned for other public health campaigns.
Branding through cultural grounding: Thekeepin’ it REALcurriculum
Authors: Hecht Michael L. , Lee Jeong Kyu
Published: September 2009

Culture plays an important role in commercial as well as public health branding. A cultural grounding approach to branding appeals to the cultural/social elements of the target population and nurtures a relationship with audiences by calling up their own meanings, messages, and identities. The cultural grounding approach was used to develop the keepin' it REAL curriculum, an efficacious, multicultural, substance abuse middle school prevention program. The keepin' it REAL curriculum culturally grounded its branded health promotion messages through narratives and community-based participatory research. Cultural grounding to branding is a method for developing culturally grounded health brand and provides useful insights for health message design centered on social and cultural forces.
Public health brands in the developing world
Authors: Evans W. Douglas , Haider Muhiuddin
Published: September 2009

Public health brands are a rapidly growing social marketing strategy in the developing world. There are parallels between public health brands in the developed and developing worlds in terms of health issues addressed and difference in terms of channels used and social context. Care studies from HIV/AIDS, malaria prevention, and reproductive health illustrate public health branding in the developing world. There are important research questions concerning the marketing mix and effects of social context in brand equity.
The HIV pandemic and health systems: an introduction
Authors: Beck Eduard J , Mays Nicholas
Published: September 2009

This chapter introduces the book. The book focuses on relating different countries' responses to their HIV epidemic and focuses on four specific questions. Which health systems have done well in responding to their country's HIV epidemic and why? To what extent do country's GDP per capita, prevalence of HIV, quality of health system or other factors predict success of failure? Can ‘lessons’ be drawn and are there specific factors that are universally positive or negative for HIV control? Are the ‘lessons’ that have been drawn from the most celebrated country responses correct, and, if so, are they helpful to a wide range of countries? Looking across countries should help enlarge the policy repertoire and spur improvements within countries as they discover more about the potential range of responses to common issues that have been tried in other places.
Social and economic impact of the HIV pandemic
Authors: Quinlan Tim , Whiteside Alan
Published: September 2009

In early 2003, an outbreak of a new disease, severe acute respiratory syndrome (SARS), caused panic around the world. When the disease was finally brought under control and the costs were totalled, SARS had claimed 321 lives in twenty-six countries. The estimated cost to the global economy was between US$40 billion and US$140 billion. In contrast, HIV has been recognized for more than twenty years. Since the epidemic began, more than sixty million people have been infected and twenty million died. The HIV pandemic has not been brought under control, and the toll continues to mount. Yet, this disease has not had the level of global, social, and economic response that SARS had. This chapter explains why this is the case, by first looking at the social and economic impacts of the pandemic.
Legal and human rights implications
Authors: Patterson David , Forman Lisa
Published: September 2009

Any discussion of the relationship of law to HIV and health systems must situate the national legal framework that regulates the provision of healthcare and services within the international legal and human rights framework by which all countries are bound. Domestic law is directly and indirectly influenced by international treaty and customary law, and there is no policy in the world that operates outside the parameters of international law. The international system is overseen by specialized treaty committees, which have given guidance on national obligations relating to HIV in both their general comments and when reviewing periodic country reports. This chapter discusses both the content and implications of international law for the provision of national HIV services. It considers the linkages between health and human rights; limitations on rights to protect public health; law and human rights on HIV-related health services in resource-poor countries; and international and domestic accountability mechanisms.
Strategic information for HIV programmes
Authors: De Lay Paul R , Massoud Nicole , Rugg Deborah L , Stanecki Karen A , Carael Michel
Published: September 2009

The concept of a country-based HIV strategic information system described in this chapter encompasses a much broader scope than the monitoring of behavioural and epidemiological trends. The notion of strategic information is derived from the military and the private sectors, where information plays a crucial role in formulating, implementing, and evaluating strategies. In HIV, strategic information is now being seen as the cornerstone of an evidence-informed approach to the decision making required for designing and implementing effective prevention, treatment and care programmes. The data sources and methods used in collecting strategic information vary, but typically rely on data from surveillance systems and special surveys, health management information systems, programme and service monitoring, and operational research. It can be defined as acquiring, analyzing, and making use of relevant, consistent, accurate, timely, and affordable information from multiple sources in support of HIV strategies for the purpose of programme and service improvement.
Ethiopia
Authors: Kitaw Yayehyirad , Mariam Damen Haile , Demissie Araya , Wolday Dawit , Messele Tsehaynesh , Aberra Endalamaw , Belay Teklu , Kassa Afework
Published: September 2009

This chapter reviews Ethiopia' response to its HIV epidemic. Overall, the government of Ethiopia has shown great commitment in tackling the problems posed by the HIV epidemic in the country. The magnitude of the epidemic in the major urban settings appears to be stabilizing or even lessening, but in rural settings it is on the increase. Although much effort has gone into overcoming the problems described above, much still needs to be done to strengthen these efforts, particularly to reduce the effects of HIV in rural areas. This will call for more national, international, and bilateral organizations to work together.
Uganda
Authors: Parkhurst Justin O , Ssengooba Freddie , Serwadda David
Published: September 2009

This chapter reviews Uganda's response to its HIV epidemic. While Uganda has been widely praised for its political response to the HIV epidemic, and has seen substantial reductions in its HIV prevalence across the population, the roles of the political environment and health system must be assessed to understand what happened in the country. A key challenge now facing Uganda is how to develop a health system that is currently characterized by drug shortages, even observed for basic treatments like chloroquine, and difficulties in delivering relatively simple interventions such as immunizations, in order to deliver complex, resource-intensive, high-tech services such as management of opportunistic infections, voluntary counselling and testing, ART and prevention of mother-to-child transmission programmes will require the developments in all societal systems influencing health and healthcare.
Cambodia
Authors: Morineau Guy , Pelt Maurits H van , Bourdier Frédéric , Wolf R Cameron
Published: September 2009

This chapter reviews Cambodia's response to its HIV epidemic. Donors need to have both short-term and long-term objectives and an appropriate health sector development vision. While some positive and urgently needed services have been provided to PLHIV in Cambodia, integrated strategies are vital in order to address the immediate needs for HIV prevention, care, treatment, and support while building a sustainable response for the future of the health system and other societal systems influencing health and healthcare.
China
Authors: Shao-Jun Ma , Hillier Sheila , Kong-Lai Zhang , Shen Jay J , Fan Lu , Min Liu , Cheng-Gang Jin
Published: September 2009

This chapter reviews China's response to its HIV epidemic. It urges the government to initiate strong programmes of health promotion throughout China, using all the sophisticated means of communication available; promote cross-ministry cooperation with joint planning groups at each level, with an emphasis on the involvement of civil society, non-governmental organizations, and local businesses in health planning; increase the overall investment in health from its current 5.3 percent of GDP and place it mainly in training and preventive health; and improve the legislative framework and protection of vulnerable people and those most at risk for HIV infection.
India
Authors: Priya R , Kumarasamy N , Qadeer I , Ganesh AK , Solomon S , Crowe SM
Published: September 2009

This chapter reviews India's response toits HIV epidemic. It argues that the provision of prevention and treatment services for HIV-infected people through non-government organizations (NGOs) or the private sector is not an adequate solution in the Indian context. The scale of operations required; the social, religious, economic, and geographical heterogeneity of India; and the low income of the majority of India's citizens mean that the only solution to effective prevention and treatment of HIV infection is to develop public systems linked with community support structures.
The Philippines
Authors: Monzon Ofelia T , Poblete Roderick E
Published: September 2009

This chapter reviews the Philippines's response to its HIV epidemic. Based on the AIDS Registry numbers, the Philippines remains a country with low HIV prevalence with a seroprevalence rate of 0.01 percent concentrated among vulnerable populations. This can be attributed to early recognition by the government, complemented by strong community interventions by non-government organizations (NGOs) and the strategic infusion of external resources from partners and donors. Collaboration among stakeholders led to sound policy formulation and comprehensive responses to HIV. Thus, although the current health system is insufficient to meet the needs of the country as it continues to undergo reforms, it has, nevertheless, been able to cope with the challenges of managing a relatively small number of affected individuals in partnership with local NGOs and external organizations.
Haiti
Authors: Augustin Antoine , Fitzgerald Daniel W , Pape Jean William
Published: September 2009

This chapter reviews Haiti's response to its HIV epidemic. Haiti has demonstrated that effective services can be implemented despite political unrest and limited financial support. Haiti has had fourteen governments in eighteen years, but the political commitment to fight HIV has been a constant: the HIV epidemic was recognized and defined very early in its course in Haiti, and a coordinated public and private response was quickly mounted. This response would have been unsuccessful were it not for the effective participation of the private health sector and the recognition of the importance of public and private philanthropic partnerships. This was evidenced by Haiti's successful Global Fund application, which was the result of close collaboration between the public and private sectors in Haiti.
Costa Rica
Authors: Martínez Jessica Salas , Echeverria Ignacio Salom
Published: September 2009

This chapter reviews Costa Rica's response to its HIV epidemic. The country's most important achievement in dealing with the epidemic thus far has been ensuring access to affordable antiretroviral drugs for all patients who need them. It must be remembered that Costa Rica is a developing country with limited resources to spend on services, and yet it prioritized and managed this problem as though it were part of the wealthier, industrialized world and did so without any foreign financial support. What made this possible was the country's focus on developing social services for its populatin and the size of the epidemic: by the time HIV patients started receiving HAART in November 1997, there were no more than 400 patients requiring it. As soon as they appeared, antiretrovirals were purchased as generics, with optimal results in terms of CD4, viral load and health recovery.
France
Authors: Flori Yves-Antoine , Moty Céline , Patouillard Edith , Dabis François , Salamon Roger
Published: September 2009

This chapter reviews France's response to its HIV epidemic. France's response to HIV involved many actors including those from government, non-government organizations, clinicians, and social scientists, among others, and produced responses ranging from access to care to the protection of patients' rights. As in other European countries, the availability of HAART has led to a significant reduction in mortality as well as improvement in the health status of all HIV-infected patients. As a result, HIV is considered to have moved from an acute to a chronic disease in France. The fact that most patients have been covered by social security has been a key factor in effective treatment efforts.
Italy
Authors: Taroni Francesco , France George , Tramarin Andrea , Conti Emma , Donatini Andrea , Compostella Fernando Antonio
Published: September 2009

This chapter reviews Italy's response to its HIV epidemic. More than twenty years after the diagnosis of the first case of AIDS, the pattern of the HIV epidemic in Italy has significantly changed. A particular feature of the Italian case is that heterosexual transmission has been increasing, mainly as a result of sexual contact with injecting drug users (IDUs). This reflects the fact that, despite a number of local success stories, Italy has not been successful in preventing the spread of HIV infection both among and from IDUs.
Russian Federation
Authors: Stachowiak J , Peryshkina A , Lessof S
Published: September 2009

This chapter reviews the Russian Federation's response to its HIV epidemic. The Russian experience has particularly demonstrated: that Russia's infectious disease control measures not only violate human rights but are ineffective in limiting the spread of HIV; that case-finding surveillance in itself is not HIV prevention and can be misleading; and that punitive legislative approaches in the absence of accurate information about the epidemic and education of people at risk serve to increase stigma, make the most vulnerable people even more difficult to reach and raise the risk of further HIV infection in these groups.
Spain
Authors: Castilla Jesús , Noguer Isabel , Repullo José Ramón
Published: September 2009

This chapter reviews Spain's response to its HIV epidemic. The Spanish National Health System provides a framework that can respond quickly to the growing need for HIV control within the population. Its HIV-related interventions have always been based on the principles of free access, universality, and equity. In order to decrease delays in HIV diagnosis, offering confidential and anonymous HIV testing and counselling as widely as possible has also proven highly effective. In particular, providing free antiretroviral drugs to all patients who can benefit from this treatment has proved to be effective in reducing AIDS, premature death, hospital admissions, and length of stay due to opportunistic infections.
The United Kingdom
Authors: Imrie John , Dougan Sarah , Gray Kimberly , Adler Michael W , Johnson Anne M , Evans Barry G , Peters Barry S
Published: September 2009

This chapter reviews the United Kingdom's response to its HIV epidemic. Even with a relatively small HIV epidemic, which is being fuelled by ongoing transmission by people living in the UK and some coming from endemic areas, and a stable socio-political and economic position, the UK's National Health Service (NHS) is experiencing some problems meeting increased costs for HIV prevention, treatment, care, and support.
Canada
Authors: Rusch Melanie , Alfonso Victor , Hankins Catherine , Montaner Julio , O’Shaugnessy Michael , Hogg Robert
Published: September 2009

This chapter reviews Canada's response to its HIV epidemic. The Canada Health Act, with its five principles, has broadly influenced the response to the HIV epidemic. The CSHA and Health Canada provide guidelines for various HIV-related policy issues, while each province and territory develops its own response to the epidemic. Canada's universal healthcare system has not eliminated inequity in access to treatment and care, although it is not as marked as that observed in other systems. Other problems include complacency and resurgence in the third decade of the HIV epidemic, despite prevention and education programmes, and the cost of healthcare.
The United States of America
Authors: Fetter Bruce , Morgan Douglas , Levi Jeffrey
Published: September 2009

This chapter reviews the United States' response to its HIV epidemic. The USA does not have an integrated healthcare delivery or financing system, even within public sector programmes. Many have noted that the challenges faced by people with HIV are simply a lens through which one can see the larger challenges of the US healthcare system. This is indeed true. However, as challenging as things are for people with HIV, the presence of multiple HIV-specific programmes provides access to more services for poor people with HIV than for those with other chronic conditions. Indeed, while there are probably few lessons to offer other countries regarding HIV care financing, given that many other nations rely on a publicly financed system, the US recognition of a need for a broad continuum of services does provide a model for care delivery for nations across the world.
Fiscal and macroeconomic aspects of the HIV pandemic
Authors: Haacker Markus
Published: September 2009

This chapter is concerned with the implications of HIV on ‘public policy’, which comprises all areas of government activities, including but beyond the administration of health systems, the delivery of public health services, or the national response to HIV. The first section describes the impact of HIV on the ability of governments to provide public services. In countries facing an HIV epidemic, this is compromised because HIV results in a slowdown in government revenues and higher deaths among public servants. The subsequent section discusses the fiscal dimension of the national response to HIV. In particular, the financing of health expenditures in low-income countries, both generally and in the context of HIV, is considered. The response to HIV also has important macroeconomic implications, beyond mitigating the macroeconomic costs of the epidemic, owing to reduced incidence of infections and improved availability of treatment, which are addressed in the third section.
Trade, intellectual property and access to affordable HIV medicines
Authors: Fleet Julian , N’Daw Béchir
Published: September 2009

This chapter situates intellectual property issues within the context of efforts to expand on a vast scale access to HIV medicines. Secondly, it summarizes recent developments regarding the affordability of HIV medicines in general. Thirdly, the chapter surveys the major international trade and intellectual property agreements that affect the ability of governments, non-governmental organizations (NGOs), and international organizations to procure HIV medicines at affordable prices. Fourthly, it presents a few concrete examples of the ways in which these agreements are or are not being used by governments to expand access to HIV treatment. Lastly, it traces some of the more important recent regional, bilateral, and national developments in international trade and intellectual rules.
Developing human resources for the HIV pandemic
Authors: Dreesch Norbert , Dal Poz Mario R , Gedik Gulin , Adams Orvill , Evans Timothy
Published: September 2009

At the beginning of the 21st century, health systems in both industrialized and developing countries are becoming increasingly pluralistic, with diversified public, private, non-governmental organizations, community, and home provision of care leading to greater complexity of health service organization. At the same time, political stewardship is often weak and challenged by strong interest groups. To manage the challenge of HIV better, countries need to strengthen various aspects of their health systems. Specific investments in strengthening health systems may improve the capacity of the system to plan and deliver services. Reforms at the sector level may strengthen incentives for efficiency; these include, for example, introduction of contractual relationships, decentralization of decision making, increased autonomy for health providers and integration of services. Also training capacity must be sufficient to respond to train appropriate healthcare personnel. Combating HIV calls for innovative, socially responsible and flexible approaches to human resources development and use.
The contribution of civil society
Authors: Zuniga José M
Published: September 2009

The involvement of civil society organizations with the HIV response, is arguably the largest ever seen in both breadth and depth. Never before have civil society organizations (CSOs) done so much to contribute to the fight against a global health crisis, or been so included in the decisions making process by policy-makers. The direct involvement of CSOs in the treatment and care of people living with HIV is partially related to the nature of the pandemic. Less tied to bureaucracy than the more institutionalized actors in domestic healthcare systems and intergovernmental organizations, CSOs operate more nimbly and are often better able to respond quickly to needs created by HIV. This can be true in the case of local CSOs, which are more attuned to the community, or international CSOs, which are able to transfer and employ global expertise and monetary resources better than many domestic health systems can do unaided.
Some lessons learned
Authors: Beck Eduard J , Mays Nicholas
Published: September 2009

This chapter summarizes ‘lessons learned’. The health systems of affected countries are at the forefront of national responses, and both formal and informal systems, private as well as public sectors all have important roles to play. However, the response to the HIV pandemic requires a wider, multisectoral response, since the pandemic is deeply rooted in the socio-economic conditions within and between nations. The extent and nature of the response required will depend on the type of HIV epidemic and populations infected or affected, the resources available, the country's health service infrastructure, and prevailing cultural norms. To produce a sustainable response to HIV that reaches those in need, HIV programmes will need to be progressively integrated with the rest of the health system. Though there is no attempt to prioritize the different elements, an increasingly salient aspect of a country's response relates to the provision of appropriate health services.