Dionisio Daniele, Esperti Francesco, Messeri Daniela, Vivarelli Angela
Infectious Diseases Unit, Pistoia Hospital, Pistoia, Italy.
Curr HIV Res. 2004 Oct;2(4):377-93. doi: 10.2174/1570162043351057.
Response to HIV/AIDS epidemic in resource-constrained countries is still woefully disappointing. This paper highlights some priorities shared at recent Florence World Conference (Florence, Italy: January 21st-24th, 2004) on how to overcome the obstacles still delaying sustainable fight against HIV/AIDS in developing world areas. Messages reported here result from selection made by the authors among challenging topics by more than one hundred speakers and have been chosen because of their value as most practical ways to secure prevention, treatment and care and achieve self-managing in fighting epidemic in income-limited settings. Building for success means to set up combined strategies--actively involving people living with HIV/AIDS (PLWHA) and grounded on coordination, coalition and partnership among all players--to prevent HIV transmission at mother-to-child, young and adult levels and to improve availability and access to laboratory testing and monitoring as well as to essential drugs for HIV/AIDS and related diseases. Building for success also means to provide women with reliable and affordable vaginal microbicides and to look for control of co-infections such as viral hepatitis, intestinal and sexually transmitted diseases as well as tuberculosis and malaria. Among the measures taken into account, the need for education and training is emphasised because its value may be even more important than funding in some countries. Priorities suggested in this paper reinforce each other underscoring the bidirectional value and synergy of the treatment and prevention strategies together with the need for keeping prevention in people giving successful antiretroviral treatment. In the Author's opinion, the current HIV/AIDS scenario may be reversed if the priorities taken into account will entirely be applied through adaptation to the different cultural backgrounds and social settings, and based on achievement of government's political will and accountability as well as on properly coordinated technical, financial and human support from international health cooperation.
资源匮乏国家对艾滋病毒/艾滋病疫情的应对仍令人极其失望。本文重点介绍了在最近一次佛罗伦萨世界会议（意大利佛罗伦萨：2004年1月21日至24日）上共同提出的一些优先事项，内容涉及如何克服在发展中世界地区仍然阻碍可持续抗击艾滋病毒/艾滋病的障碍。这里报告的信息是作者从一百多位发言者提出的具有挑战性的主题中挑选出来的，之所以选择这些信息，是因为它们作为在收入有限的环境中确保预防、治疗和护理以及实现自我管理以抗击疫情的最切实可行方法具有价值。取得成功的关键在于制定综合战略——积极让艾滋病毒/艾滋病感染者（PLWHA）参与其中，并以所有参与者之间的协调、联合和伙伴关系为基础——以预防母婴、青年和成人层面的艾滋病毒传播，并提高实验室检测和监测以及艾滋病毒/艾滋病及相关疾病基本药物的可及性和获取机会。取得成功还意味着为妇女提供可靠且价格合理的阴道杀菌剂，并寻求控制诸如病毒性肝炎、肠道和性传播疾病以及结核病和疟疾等高发性感染。在所考虑的措施中，强调了教育和培训的必要性，因为在某些国家，其价值可能比资金更为重要。本文提出的优先事项相互强化，突出了治疗和预防战略的双向价值和协同作用，以及在接受成功抗逆转录病毒治疗的人群中持续开展预防工作的必要性。作者认为，如果所考虑的优先事项能够通过适应不同的文化背景和社会环境，并基于政府的政治意愿和问责制的实现，以及国际卫生合作提供的妥善协调的技术、财政和人力支持而得到全面应用，那么当前的艾滋病毒/艾滋病状况可能会得到扭转。
