What are priority programmatic actions for the various epidemic scenarios?

Priority Programmatic Actions In Low-Level Scenarios

• Ensure high coverage of most-at-risk populations with acceptable and high quality HIV prevention, treatment and care services. See Tables 2.1–2.14 for descriptions of essential HIV prevention measures for various at-risk groups.
• Build the capacity of the most-at-risk populations to organize, advocate and deliver peer prevention; secure the active participation of these populations in designing, delivering and evaluating prevention services.
• Promote and provide access to comprehensive prevention, treatment and care services, including prevention of mother-to-child transmission, for people living with HIV.
• Provide training to law enforcement personnel to reduce harassment at prevention and treatment sites serving most-at-risk populations.
• Integrate HIV prevention issues, including the adverse effects of stigma and discrimination, sexual violence, gender inequality, homophobia and human rights violations in broader public health and development campaigns.
• Promote programmes aimed at promoting livelihood alternatives to transactional sex.
• Provide training of service providers (e.g. community, social and health-care workers) for working effectively with most-at-risk populations.
• Provide sexuality and reproductive health education, including HIV prevention information and education on issues such as dealing with stigma and discrimination, sexual violence and abuse as well as gender sensitivity and equality to young people through the school curriculum and to teachers through teacher education curriculum.
• Ensure adherence to blood safety standards (all blood and blood products tested for HIV before transfusion; all health care settings observe universal precautions).

Priority Programmatic Actions In Concentrated Scenarios

• All actions outlined in low-level scenarios.
• Provide and promote voluntary HIV testing and counselling with referral to services; begin in high-risk settings where HIV rates are high and expand within the public and private health sector as rapidly as possible.
• Provide prevention and care programmes focused on vulnerable and 'bridge' populations such as mobile populations, uniformed forces, clients of sex workers and most-at-risk young people (see Tables 2.11 and 2.14)

Priority Programmatic Actions In Generalized Scenarios

• All actions outlined in low-level and concentrated scenarios.
• Promote and provide quality HIV prevention, treatment, care and support for most-at-risk populations and people living with HIV. (See Tables 2.1–2.14 for descriptions of the essential measures for various at- risk groups.)
• Build capacity for HIV prevention planning and implementation in government, non-governmental organizations and civil society, including the capacity of most-at-risk populations and people living with HIV to organize and advocate; to deliver peer prevention and to lead "positive prevention programmes." Secure the active participation of communities in designing, delivering and evaluating prevention services.
• Plan and implement a long-term (for example, 5 years) national HIV communication programme to mobilize society and to create an enabling environment for prevention, treatment, care and support. Relevant themes include:
  • support for HIV testing and counselling and disclosure, delay of sexual debut, partner limitation, couples counselling and testing and  safer sex and normalising condom use;
  • expectations of bold and radical leadership by politicians and other opinion leaders;
  • promotion of principles and local action for human rights, gender equality and zero tolerance for
    gender-based violence; and
  • promotion of solidarity and support for affected families and young people, including children affected by HIV

• Provide evidence-based sexuality and reproductive health education through the school curriculum; ensure inclusion of sexuality education in teacher training curriculum and for out-of-school youth in high risk and high prevalence areas through peer education.
• Ensure universal access to HIV counselling and testing, including provider-initiated voluntary HIV counselling and testing according to national guidelines, beginning in areas of high concentration of HIV.
• Ensure universal and uninterrupted condom availability and integrate condom promotion into reproductive and primary health-care services in the public and private sector.
• Prioritize programmes for women and men that address risk behaviours and gender related vulnerability.
• Promote and provide full range of prevention of mother-to-child transmission services, beginning in urban areas and other areas with high concentration of HIV.
• Promote joint HIV/TB services and positive prevention services available at all hospitals.
• Provide prevention and care programmes focused on vulnerable populations (e.g. mobile populations, uniformed forces, clients of sex workers and most-at-risk young people such as street children and in- and out- of- school youth), on a national and regional basis.
• Partner with Ministry of Labour, employer associations and trade unions to promote the availability of HIV prevention and treatment services or referrals at the workplace.
• Ensure health-care, law enforcement and social services employees are trained on HIV issues, including gender
  and human rights.

Priority Programmatic Actions For Hyperendemic Scenarios

• All actions outlined in low level, concentrated and generalized scenarios.
• Ensure well informed, active and visible participation of leaders in HIV prevention and AIDS response.
• Develop and implement diversified programmes for young people, reaching both boys and girls that include gender equality and respect, access to comprehensive sexual and reproductive health services including access to treatment, ensuring access to information, sexuality education, life skills.
• Ensure special programmes for orphans, street children and others at high risk, balancing needs for risk, vulnerability and impact reduction.
• Promote and ensure male involvement in sexual and reproductive health programmes including HIV prevention, STI treatment, HIV testing and counselling, prevention of mother-to-child transmission services,
• Ensure health care and other social services employees are trained on HIV issues, including stigma, human rights and gender issues.