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This chapter talks about research findings and observations of methods in which the HIV epidemic has infected gay and bisexual individuals and communities, and public representations of homosexuality. The effect of AIDS is reflected through gay communities at the individual level, social level, community level, and societal level. At the individual level, there are variations in the attitudes, behaviors, and well-being of bisexual and gay men. At the social level, variations are found in social networks, interpersonal relations, and social norms. Meanwhile, the structure of gay communities, institutions, and their bearings are influenced at the community level while the relationship of the community with the larger society is particularly affected at the societal level. Many of the studies conducted are done with white male participants mainly residing in large American urban cities.

This chapter examines the health profile of countries in Central and Eastern Europe and the former Soviet Union within the context of an emerging HIV epidemic. Unlike the epidemics in most of the developing world, the HIV epidemics in the transition economies of Europe are apparently fueled by drug use and commercial sex work. The emphasis on the behavioral conditions, however, masks the important role played by economic crises in the collapse of public health services and the increase in human trafficking. This chapter broadens the analysis of declining health in the former socialist economies and situates the study of HIV epidemics within a biomedical analysis of disease vulnerability, rather than the reigning behavioral model.

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.

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.

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.

This chapter reviews Thailand's response to its HIV epidemic. The Thai experience has provided several lessons on how the health system and health policy need to respond to the dynamic of HIV epidemics. The country's capacity to collect, analyse, and disseminate information and translate this information into policy and programme design, as well as the skill and capacity to influence policy-makers, has been a major factor in any effective health policy response to HIV.

This chapter reviews Barbados's response to its HIV epidemic. The World Bank loan has been instrumental in establishing expanded HIV response. However, such funding is a temporary measure and the government of Barbados must seek to establish the mechanisms necessary to continue funding the programme. Without a reduction in new HIV infections, the number of patients requiring ART, as well as its attendant costs, will continue to grow. Scientific methods must therefore be employed to monitor the HIV epidemic and put the programme in a position to respond appropriately.

This chapter reviews Brazil's response to its HIV epidemic. Brazil's reforms in the 1980s produced a healthcare system based on the principle that care should be delivered according to need rather than ability to pay. This commitment to equity played a major role in shaping the nation's response to the HIV epidemic, as is particularly evident in Brazil's provision of free antiretroviral therapy (ART) at the point of delivery. However, dramatic disparities between socio-economic groups and geographical regions in Brazil remain a challenge to the realization of this ideal, both within the HIV programme and across the Brazilian health system more generally.

This chapter reviews the Ukraine's response to its HIV epidemic. Despite the difficult transition towards a democratic system of governance and a struggling market-oriented economy, and the relative novelty of the HIV epidemic, the government of Ukraine engaged in numerous efforts to face the problems and respond to the epidemic, either directly or through partners and non-government organizations. At the same time, the country has recognized the need to step up its efforts to contain the epidemic and has successfully secured additional funding in order to do so. The biggest challenge is to scale up interventions that appear to be successful. Although some information is available, better understanding is required about the effectiveness and efficiency of interventions.

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.

This chapter reviews South Africa's response to its HIV epidemic. Within the current macroeconomic context, the public sector will find itself increasingly constrained in its ability to meet existing needs, let alone new demands generated by the HIV epidemic. There is a need to increase the portion of GDP spent on health, social and other support services. Critically, where operative the profound link between AIDS and poverty must be recognized and broken, and there is an urgent need for a national multisectoral response that goes well beyond the current public health response and engages the private sector and employers.

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.

This chapter reviews Bostwana's response to its HIV epidemic. To date, considering the limitations of its health system's capacity, Botswana has performed very well. In a two-year period, it has managed to create one of the fastest growing ART programmes in the world and has enrolled a large proportion of its HIV-positive population in therapy, compared with all other similar initiatives in Africa. The country will have to continue to face the challenges dictated by a complex disease affecting 35 percent of adults and still spreading. Based on the early and strong start that has been made, Botswana should continue to be a source of lessons and inspiration for many other initiatives across the continent.

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.

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.

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.

This chapter reviews Indonesia's response to its HIV epidemic. Since 2000, Indonesia has had a concentrated epidemic, and the total number of people living with HIV are estimated at around 110,000 (range 53,000 to 180,000), about 10,000 of whom have progressed to AIDS, while over sixteen million people are at increased risk of getting HIV. The launch in May 2003 of the new National AIDS Strategy for an expanded response in line with the global AIDS strategy of UNAIDS was a significant step to ensure a broader multisectoral response. Central government ministries and local governments in partnership with NGOs have to translate the strategy into realistic action plans.

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.

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.