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Best practices and HIV/AIDS
(Not available in French and Spanish)
(Link to School-based prevention)
One of UNAIDS’ main tasks is to identify practices around the world that work in responding to the HIV/AIDS epidemic, and to examine how and why they work. Once these practices are identified, UNAIDS and its cosponsors promote the sharing of these practices, including through such means as documentation and widespread distribution of the lessons learned. This summary booklet is part of that effort.
What is meant by "best practice"?
The concept of best practice is not reserved only for "ultimate truths" or "gold standards." For UNAIDS, best practice means accumulating and applying knowledge about what is working and not working in different situations and contexts. In other words, it is both the lessons learned and the continuing process of learning, feedback, reflection and analysis (what works, how and why, etc.)
At its most basic, best practice suggests a simple maxim: Don’t reinvent the wheel: learn in order to improve it, and adapt it to your terrain to make it work better.
The process of best practice is manifested in three ways:
exchange of experience, including sharing between individual experts and Technical Resource Networks (TRNs)
pilot testing, operations research, and other projects and programmes
documentation (however, it is important to remember that best practice is not limited to documentation).
Identifying best practice that provides useful lessons learned means making judgements. To arrive at such judgements, two approaches may be used, each reflecting a different level of analysis.
The first approach is based on simple description of the practice's accomplishments. From this point of view, best practice can be anything that works, in full or in part, and that can be useful in providing lessons learned.
The second approach is to carry out a thorough analysis using specific, established criteria that look at strengths and weaknesses as well as successes and failures. UNAIDS uses a set of five criteria as a guide: effectiveness, efficiency, relevance, ethical soundness, sustainability. While candidate best practices should meet one or more of the criteria, they do not need to meet them all.
In summary, the best practice process helps to identify and describe the lessons learned and the keys to success of any given project, programme or policy.
Why document best practice?
Our UNAIDS cosponsors, in-country staff, and Secretariat in Geneva are constantly asked to provide brief and up-to-date information – "snapshots" might be a good description – about the constructive and creative things that people and organizations around the world are doing about HIV/AIDS. This is a practical illustration of one of the main reasons we document and disseminate best practice. Without access to existing knowledge and experience from the field of things that work, whether fully or in part, mistakes may be repeated and valuable time may be lost. Lessons learned must be widely shared and adapted to local conditions in order to enable an effective response to the epidemic.
The formal objectives of best practice are:
To strengthen capacity to identify, document, exchange, promote, use and adapt best practice as lessons learned within a country and inter-country as a means to expand the national response to HIV/AIDS.
To promote the application of the best practice process for policy and strategy definition and formulation.
To collect, produce, disseminate and promote best practice.
Where do best practices come from?
Sources of best practice are wide. They include UN system staff, non-governmental organizations (NGOs), government representatives and agencies, community groups, and individuals. Sometimes best practice is identified through small or mass media. UNAIDS gratefully acknowledges the work of its staff, but especially acknowledges the diligent efforts of the field staff of its cosponsors (UNICEF, UNDP, UNFPA, UNDCP, UNESCO, WHO, and the World Bank), the chairs of the United Nations Theme Groups on HIV/AIDS and other partners to provide the lessons learned for the summary booklet.
School-based interventions and services
There are more than one billion adolescents in the world. Their number in developing countries - over 800 million - will increase by 20 per cent in the next 15 years. Young people are very valuable to society. It is worth investing heavily in them so that they can protect their own health and influence and educate their peers. This can be done by promoting effective AIDS education programmes in school alongside preventive efforts in the community and the media.
Education is a national concern in all parts of the world, and so cooperation at the highest levels of government is important in making school AIDS education programmes work. Experience in various parts of the world indicates that, working in collaboration with ministries of education and with health and social services, each country's national AIDS programme should aim to provide 100 per cent of schoolchildren with AIDS education.
Good AIDS education covers effective prevention, care and support for people with HIV/AIDS, and non-discrimination. Education of this kind has been shown to help young people to delay sex and, when they become sexually active, to avoid risk behaviour. However, AIDS education in school is often denied to children and young people for a variety of reasons, including the sensitive or controversial nature of the subject in some societies, and the difficulty of finding time for AIDS education in an already overcrowded curriculum. In some places, schools may teach information on AIDS but not the behavioural skills needed for prevention and support.
Best practices in school-based interventions include:
Creating a partnership between policy-makers, religious and community leaders, parents, and teachers, and using this partnership to set sound policies on AIDS education
Designing a good curriculum and/or a good extracurricular programme, adapted to local culture and circumstances, and with a focus on life skills rather than biomedical information
Teaching primary and secondary students to analyse and respond to social norms, including understanding which ones are potentially harmful and which ones protect their health and well-being
Good training, both for the teachers themselves and for peer educators - young people from the same age group, specifically selected to educate their friends and acquaintances about AIDS
Starting HIV prevention and health promotion programmes for children at the earliest possible age, and certainly before the onset of sexual activity. Effectively, this means that age-appropriate programmes should start at the primary school level.
Children and young people
Young people are key to the future course of the HIV/AIDS epidemic. The behaviours they adopt now and those they maintain throughout their lives will determine the course of the epidemic for decades to come.
At the end of 1997, over one million children were estimated to be living with HIV and suffering the physical and psychological consequences of infection. Of the estimated 16,000 new infections daily, about 1,600 are in children under the age of 15 years. Young people between the ages of 10 and 24 account for more than 50 per cent of new post-infancy infections worldwide. As well, this age group constitutes more than 30 per cent of all people in the developing world, where the epidemic is concentrated. If HIV prevention in this huge population fails, developing countries will have to face the staggering human and economic costs of vast numbers of adult AIDS cases.
Increasingly, young people are being appreciated as a resource for changing the course of the epidemic. They are responsive to HIV prevention programmes and are effective promoters of HIV prevention action. Investing in HIV prevention among young people is likely to contribute significantly to a more sustainable response to HIV/AIDS. Several lessons have been learned over the past years that can be applied to planning effective actions to focus more on young people in the HIV epidemic.
Priority actions to be considered in the light of situation and response analysis in various countries, and feedback from youth organizations and young people, include:
Establishing or reviewing national policies to reduce the vulnerability of young people to HIV/AIDS and ensuring that their rights are respected, protected, and fulfilled
Promoting young people's genuine participation in expanding national responses to HIV/AIDS
Supporting peer and youth groups in the community to contribute to local and national responses to HIV/AIDS
Mobilizing parents, policy-makers, media, and religious organizations to influence public opinions and policies with regard to HIV/AIDS and young people ® Improving the quality and coverage of school programmes that include HIV/AIDS and related issues
Expanding access to youth-friendly health services including HIV and STD prevention, testing and counselling, and care and support services
Ensuring care and support of young people living with HIV/AIDS
Two particular groups of children and young people will require a special emphasis: AIDS orphans and young people living with HIV/AIDS. UNAIDS estimates that as of December 1998, the total number of AIDS orphans (defined as children having lost their mother or both parents to AIDS before the age of 15) since the start of the epidemic totalled at least 8.2 million. In many developing countries, extended family systems have traditionally provided support for orphans. However, AIDS, combined with other pressures such as migration, is pushing the extended family system to the breaking point in the worst-affected communities.
Like older HIV-positive adults, children and young people living with HIV infection require increasing health care as their immune system weakens and their health declines. However, they may face special obstacles in exercising their right to health. Young people may be too poor to buy care, or too afraid of disclosure by health providers who might not respect their confidentiality. The absence of youth-friendly services is an obstacle. In line with the United Nations Convention on the Rights of the Child, all children living with HIV/AIDS must have access to treatment, counselling, education, recreation, and social support, and be protected against any form of discrimination.
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