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RHO archives : Topics : HIV/AIDS

Annotated Bibliography

This is page 1 of the HIV/AIDS Annotated Bibliography. This page contains:

To access more bibliographic entries, visit page 2 or page 3, or return to the complete list of topics covered in the HIV/AIDS Annotated Bibliography. Bibliographic entries related to additional HIV/AIDS-realted issues may be found on the Special Focus pages. Be sure to use the Glossary if you are unfamiliar with any of the terms on this page.

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Gayle H, Lange J. Seizing the opportunity to capitalize on the growing access to HIV treatment to expand HIV prevention. Lancet. 2004;364:6-7.
The authors of this piece argue that expanding antiretroviral therapy for HIV infection to developing countries represents an important opportunity to reinforce HIV prevention efforts. As millions of people access treatment in health-care settings, the opportunity will exist to deliver HIV-prevention messages and to offer HIV counseling and testing. As treatment becomes normalized, HIV-related stigma may decrease, as will the infectivity of people living with HIV/AIDS and taking antiretrovirals. Developing countries will need to heed the lesson learned by high-resource countries, where antiretroviral treatment has not been sufficiently linked to prevention, and increasingly sexually risky behavior has ensued.

Kaldor, J. et al., ed. HIV surveillance in hard-to-reach populations. AIDS 15 (Suppl. 3) (April 2001).
A supplement to the regular journal, this collection of articles examines a number of issues related to hard-to-reach groups, including surveillance during complex emergencies; injecting drug use; men who have sex with men; female sex workers; estimating the size of hard-to-reach populations; and laboratory testing and rapid HIV tests. In the introductory article, the authors (B. Schwartländer et al.) assert the need to focus HIV surveillance on population groups whose behavior places them at particular risk of acquiring or transmitting HIV. Patterns of sexual networking and condom use determine the extent to which HIV passes from these groups into the general population. Participation of vulnerable groups in prevention efforts is key.

Lamptey, P. Reducing heterosexual transmission of HIV in poor countries. British Medical Journal 324:207-211 (2002).
This review highlights the economic, social, and health impact of HIV/AIDS in developing countries. The author provides a discussion of factors facilitating heterosexual transmission of HIV and successful prevention measures based on an extensive literature search and review, and international experience. Among the six key factors listed that promote heterosexual transmission of HIV are frequent change of sexual partners; unprotected sexual intercourse; presence of sexually transmitted infections and poor access to treatment; lack of male circumcision; social vulnerability of women and young people; economic and political instability of the community. The article concludes with a discussion of challenges for the future of preventing heterosexual HIV.

PATH (Program for Appropriate Technology in Health). Preventing HIV/AIDS in low-resource settings. Outlook 19(1) (May 2001). Available at:
This article focuses on selected issues related to prevention of HIV/AIDS transmission, including strategies for strengthening women's ability to protect themselves and their infants. Topics include overcoming stigma and discrimination, communication for behavior change, voluntary counseling and testing, contraception, reducing STIs, reaching hard-to-reach populations, reducing mother-to-child transmission, male circumcision, and additional prevention measures.

Prah Ruger J. Combating HIV/AIDS in developing countries. British Medical Journal. 2004;329:121-122.
This brief article discusses the response to HIV/AIDS in developing countries in the context of efforts to prevent transmission and provide antiretroviral treatment. The author asserts that successful strategies are dependent on improving the conditions in which people live, including linking health to education, employment, and civil rights. In the author’s words, “human freedom is essential to policy change and political action and must be enabled through guaranteed human rights and democratic institutions.” People with and without HIV/AIDS must be empowered to advance their interests, control their destiny, and assist themselves and each other.

UNAIDS. Report on the Global HIV/AIDS Epidemic. Geneva: UNAIDS; 2004. Available at:
The latest UNAIDS global report updates 2003 end-of-year HIV/AIDS statistics for the world and each of its regions. The report also examines such specific topics as the impact of AIDS on people and societies; bringing comprehensive HIV prevention to scale; treatment, care, and support for people living with HIV; financing the response to AIDS, and national responses to AIDS. Special sections focus on AIDS and orphans; HIV and young people; AIDS and human rights; AIDS and conflict; and the essential role of people living with AIDS. Tables at the end of the document provide data on country-specific HIV/AIDS estimates as of the end of 2003, as well as a description of how UNAIDS attains its statistics. The report is available in English, French, Russian, and Spanish.

UNAIDS. AIDS Epidemic Update: December 2003. Geneva: UNAIDS; 2003. Available at:
The latest UNAIDS epidemic update reveals that as of December 2003, there were 40 million people living with HIV/AIDS across the world, with five million new infections in 2003, and three million deaths due to AIDS. Further sections detail HIV-related trends in Asia and the Pacific; Eastern Europe and Central Asia; sub-Saharan Africa; Latin America and the Caribbean; the Middle East and North Africa; and high-income countries. A special section on stigma and discrimination describes ongoing problems with prejudices against people living with the virus and speaking openly about it, as well as innovative approaches to defusing stigma and discrimination. The document is available in English, French, Russian, and Spanish.

UNAIDS. Report on the Global HIV/AIDS Epidemic. Geneva: UNAIDS (2002). Available at:
This document provides a comprehensive global summary of the HIV/AIDS epidemic as of the end of 2001. It also presents the most recent regional and national HIV/AIDS estimates and updates the epidemic situation in each region. Some of the issues focused on include human rights, young people, the workplace, mobile populations, and orphans, with special sections on prevention, the prevention-care nexus, voluntary counseling and testing, preventing mother-to-child transmission, care, treatment and support for people living with HIV/AIDS, and national responses to the epidemic. The document is available in English, French, Russian, and Spanish.

UNICEF/UNAIDS/WHO. Young People and HIV/AIDS: Opportunity in Crisis. Geneva: UNICEF/UNAIDS/WHO(2002). Available at:
This joint United Nations report describes the situation of young people living with HIV/AIDS (7.3 million young men and 4.5 million young women aged 15 to 24 at the end of 2001) as well as the urgency of prevention efforts for and with young people. The report affirms that, despite beliefs and wishes to the contrary, young people do have sex, yet they continue to lack information about protection from HIV/AIDS. Girls and young women are particularly vulnerable to the virus, although additional groups of young people are also at especially high risk. Despite the large numbers of young people infected and at risk, they are also key elements in reversing infection rates in such countries as Brazil, Thailand, Uganda and Zambia, where efforts are in place to support and include young people in prevention activities. The report concludes with a ten-step strategy for prevention HIV/AIDS, which includes such elements as knowledge, information and life-skills for young people; youth-friendly services; voluntary and confidential counseling and testing; the participation of young people; and the engagement of young people living with HIV/AIDS. The report is available in English, French and Spanish.

UNICEF/UNAIDS/The Synergy Project. Children on the Brink 2002: A Joint Report on Orphan Estimates and Program Strategies. Geneva: UNICEF/UNAIDS (July 2002). Available at:
This report details the many ways in which children are affected by HIV/AIDS. In addition to the more than 13 million children currently under 15 who have lost one or both parents to AIDS, the report asserts that children orphaned due to other causes need attention, and that the safety, health and survival of other children in affected countries are in jeopardy. Children are vulnerable to exclusion, abuse, discrimination and stigma because of HIV/AIDS. Communities need assistance in dealing with this crisis, an effective response to which is dependent on collaboration. The report proposes five strategies for assisting orphans and other children affected by HIV/AIDS, including increasing families ability to care for their children, mobilizing community-based responses, strengthening childrens capacity to meet their own needs, government policy-making to support vulnerable children, and raising awareness within societies. The report is available in English, French and Spanish.

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Overcoming stigma and discrimination

Brown, L. et al. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Education and Prevention 15(1):49-69 (2003).
This article reviews 22 studies that tested various strategies for reducing AIDS-related stigma among several population groups. Among these groups were mothers, pregnant women, university students, primary and secondary school students, dentists, and nurses. Many of the studies were conducted in the United States, but other sites included Canada, England, Nigeria, Scotland, South Africa, Thailand, and Uganda. Among other things, the authors found that information alone was insufficient in changing deep-seated fears about HIV/AIDS. One of the most successful strategies for reducing AIDS-related stigma appears to be contact with people living with HIV/AIDS, particularly those who disclose their status during educational sessions. The authors also recommend several areas for future research, including mass media programs to reduce stigma; reasons why women so often bear the blame for the spread of HIV/AIDS; and the effects of increased access to antiretroviral therapy on AIDS-related stigma.

Busza, J. Promoting the positive: responses to stigma and discrimination in Southeast Asia. AIDS Care 13(4):441-456 (2001).
This paper examines stigma and discrimination around HIV/AIDS in Southeast Asia, and how projects in the region have dealt with the problem. The paper focuses on community-level, or less formal discrimination. This type of discrimination occurs at the level of families, communities, workplaces, the health sector, religious structures, and the media. The author maintains that stigma and discrimination impede the creation of the supportive environment needed for effective HIV prevention and care. Interventions that have been successful in reducing stigma and discrimination are described. One example is the FARM project in Thailand, which offers training to communities and family members to help dissipate misconceptions and reduce isolation. The author finds that successful projects, regardless of the country in which they are implemented or the level of discrimination targeted, focus on process. Successful projects can be mainstreamed into community-development projects. Equally important are the participation of people living with HIV/AIDS, addressing the entire continuum of the epidemic, and making an effort to integrating various contexts (that is, building networks between family care and formal-sector service providers, religious leaders, schools and people living with HIV/AIDS). Further evaluation of successful efforts should enable projects and organizations to move forward in reducing stigma and discrimination related to HIV/AIDS.

Kalichman S, Simbayi L. Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa. AIDS Care. 2004;16(5):572-580.
The authors of this article report on the results of a study conducted among 487 men and women living in a black township of Cape Town, South Africa. The study examined the relationships between the belief that spirits and supernatural forces cause HIV/AIDS, HIV/AIDS-related knowledge, and AIDS stigma. Results showed that people who embraced the conviction that spirits and the supernatural are responsible for AIDS were more likely to be misinformed about the virus and were more likely to condone isolation and social sanction of people living with HIV/AIDS. The authors recommend enlisting the support of traditional healers in HIV-prevention efforts and condom distribution.

UNAIDS. An overview of HIV/AIDS-related stigma and discrimination. Fact sheet (October 2001). Available at:
This fact sheet describes the nature of stigma and discrimination, how they are related to human rights, and actions that can be taken to address stigma and discrimination. The latter include accessing procedural, institutional and other monitoring mechanisms to uphold the rights of people living with HIV/AIDS; utilizing reporting and enforcement mechanisms, such as legal aid services and hotlines; developing strategies to prevent stigma from occurring; and advocacy for non-discrimination by community and national leaders. This fact sheet is available in English, French, Russian and Spanish.

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Communication for behavior change

Karlyn, A. The impact of a targeted radio campaign to prevent STIs and HIV/AIDS in Mozambique. AIDS Education and Prevention 13(5):438-451 (2001).
This article is based on a radio campaign carried out by Population Services International (PSI) in Mozambique (where approximately 13 percent of people aged 15 to 49 are now HIV-positive) to prevent HIV/AIDS and other sexually transmitted infections through the promotion of behavior change. Based on interviews with 754 people aged 13 to 49, PSI found that more that half had heard the campaign and 45.5 percent of those could remember one or more radio messages. Of those who heard the campaign, 97.2 percent reported the intention of changing their sexual behavior (compared to 62.8 percent of those who had not heard the campaign). Of those who could remember campaign messages, over 86 percent made an effort to change their sexual behavior compared to 58 percent of those who could not remember the messages. Reported success in changing behavior was nearly 84 percent among those who remembered messages and about 57 percent among those who could not.

Kerrigan, D. Peer Education and HIV/AIDS: Concepts, Uses and Challenges. Washington, DC : HORIZONS/Population Council (1999). Available at:
Produced in collaboration with UNAIDS, Horizons/Population Council, FHI, the Jamaican Ministry of Health, PSI/AIDSMark, PATH, USAID, and UNICEF, this paper provides background information for planners and participants involved in the International Consultation on Peer EducationandHIV/AIDS, which took place in Kingston, Jamaica from April 18-21,1999. The overall goal of the Consultation was to reach consensus among program managers, peer educators, and researchers regarding the critical elements of HIV/AIDS peer education within the context of a comprehensive HIV prevention and care strategy as well as to identify research priorities. The paper introduces the goals and objectives of the meeting, discusses the definition of and the theory behind peer education, and presents findings or prior efforts to analyze HIV/AIDS peer education programs. It then presents the results of the needs assessment with peer education program managers from around the world, and the literature review based on major topics of interest. The results of the needs assessment paralleled those of prior research conducted to identify challenges and best practices of HIV/AIDS peer education programs. For example, it was found that peer educators are perceived as credible teachers and facilitators who possess critical and unique access to their intended audiences. The findings of the literature review suggest that peer education is a widely utilized component of HIV prevention programs across population groups and geographic areas, and that it is often part of a larger, more comprehensive approach to HIV prevention that includes condom distribution, STI management, counseling, and/or advocacy. The paper concludes with recommendations to further define a set of best practices in the area of HIV/AIDS peer education.

Macintyre, K. et al. "Its not what you know, but who you knew": examining the relationship between behavior change and AIDS mortality in Africa. AIDS Education and Prevention 13(2):160-174 (2001).
The authors of this article examine the behavior-change phenomenon, and to what extent it is influenced by knowing someone who has died of AIDS, as opposed to other factors meant to generate behavior change (i.e., age, education level, knowledge of HIV/AIDS, economic status, and marital status). The study conducted was based on data from DHS surveys in Kenya, Uganda and Zambia applied to a model predicting behavior change. Results indicate that men who know someone who died of AIDS are significantly more likely to curtail risk behavior. Other characteristics of men who reported behavior change included age (men aged 20 to 40 are more likely to report behavior change than younger men), employment, being married, and knowing two or more HIV-prevention methods. The authors encourage the development of health safe-sex messages and programs to reduce the stigma of AIDS and to discourage disclosure in a supportive environment for the sake of survival.

Simbayi L et al. Behavioral responses of South African youth to the HIV/AIDS epidemic: a nationwide survey. AIDS Care. 2004;16(5):605-618.
This article reports the findings of a survey of 2,430 young people aged 15 to 24 from across South Africa. The survey consisted of questionnaires that inquired about the sexual behavior and experience of the respondents. About half of the respondents reported having had some sexual experience, beginning on average at 16.5 years of age. Young men had had significantly more sexual partners than young women, and condom use was relatively common for both sexes. Most respondents reported having only one sexual partner, and most had discussed HIV/AIDS with their sexual partners. The authors conclude that the national HIV/AIDS prevention program has had some positive effects on young people, but that efforts to prevent HIV transmission among youth should intensify.

Taguiwalo, M. A Review of ASEP-Assisted HIV Prevention Activities in 3 Cities. Manila: PATH and AIDS Surveillance and Education Project (ASEP) (September 2000).
This report reviews HIV-prevention activities implemented by the AIDS Surveillance and Education Project (ASEP) in three cities in the Philippines. The work of local NGOs is presented as well as the broader response to HIV/AIDS in the community. Risky sexual behavior is recognized within these communities as a significant factor contributing to HIV transmission. Local responses to HIV/AIDS initially focused on commercial sex workers and confronting STIs as a way of preventing HIV. Prevention-education and health-promotion programs are utilizing the relationship between local hygiene clinics, registered entertainment establishments, and registered sex workers to address STI infection rates and HIV transmission. Additional efforts include community outreach to men who have sex with men and interventions for minors and children in sex work. This report also addresses the factors necessary for sustainable HIV prevention efforts, including local political support and social marketing for condoms and STI treatment packs. The authors recommend that particular attention be directed toward preventive-education programs for high-risk groups.

Valente, T. and Bharath, U. An evaluation of the use of drama to communicate HIV/AIDS information. AIDS Education and Prevention 11(3): 203-211 (1999).
This study evaluated the effectiveness of three dramas created to disseminate HIV/AIDS information in Tamil Nadu state, India. Pre- and post-drama interviews conducted with a cohort of randomly chosen audience members demonstrated a significant increase in HIV/AIDS-related knowledge. While audiences had a relatively high level of knowledge about HIV/AIDS before the drama, viewing the drama significantly reduced common misconceptions about HIV/AIDS and increased reported intentions to treat HIV-positive individuals kindly. The authors conclude that drama can be an effective medium for communicating HIV/AIDS knowledge and can reduce knowledge gaps associated with low levels of formal education.

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Voluntary counseling and testing (VCT)

Basset, M. Ensuring a public health impact of programs to reduce HIV transmission from mothers to infants: the place of voluntary counseling and testing. American Journal of Public Health 92(3):347-351 (March 2002).
In this article, the author questions the effectiveness of voluntary counseling and testing in programs to reduce mother-to-child transmission of HIV. There is a dearth of counselors available to provide such services in large-scale mother-to-child transmission prevention projects, and delays often occur in offering test results. It is often difficult for women to deal with the knowledge of HIV infection, and to confide this knowledge in their partners. The author proposes several possible approaches to HIV testing in the context of preventing transmission from mother to child: the universal offer of HIV testing with the option to forego testing; universal treatment of pregnant women, regardless of their knowledge of their HIV status; universal testing with the option of not learning results; and mass treatment with no testing. In conclusion, it would be best for women to know and accept their HIV status through voluntary counseling and testing, but it may be more important at present to reduce the risk of mother-to-child transmission of HIV on a large scale.

Ginwalla, S.K. et al. Use of UNAIDS tools to evaluate HIV voluntary counselling and testing services for mineworkers in South Africa. AIDS Care 14(5):707-726 (2002).
A team from South Africa and the United Kingdom conducted this cross-sectional study, based on a set of tools developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS) to evaluate HIV voluntary testing and counseling services. The team used the tools to interview 30 nurse counselors, community volunteers, and social workers providing VCT services to mineworkers employed by a company in the Free State region of South Africa. The team observed 24 counseling sessions and conducted 24 exit interviews with clients. The goals of the study were to evaluate counselor needs and satisfaction, counseling content and quality, and client satisfaction. The team found that the nurse counselors were more successful than community volunteers in establishing communication with clients, and more confident in giving information and answering questions. Clients generally felt that they had benefited from the counseling, for example, by learning about risk factors and possible treatment options, as well as calming their fears about losing their jobs. One barrier that caused clients to hesitate to accept VCT was concern about confidentiality. The recommendations of the study team included tailoring counselor training to the type of counselor in question, providing more medical information when training community volunteers, and providing anonymous testing through a numeric identification system to encourage more people to be tested. The team concluded that the UNAIDS tools were an effective way to monitor VCT services while using minimal resources and using the skills of existing personnel.

Maman, S. et al. HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing clinic in Dar es Salaam, Tanzania. American Journal of Public Health 92(8):1331-1337 (August 2002).
In this article, the authors posit a link between HIV/AIDS epidemics and violence against women. Violence and threats of violence are believed to fuel the epidemic among women, 10 to 50 percent of whom are physically assaulted by an intimate partner during their lifetime. A research study to define violence and measure its prevalence among 340 women enrolled at the Muhimbili Health Information Center in Dar es Salaam, Tanzania (a voluntary HIV counseling and testing clinic), was conducted in 1999. The study, based on interviews with the women, found that a significant proportion of women believed that partner violence was justified, and that a woman did not have the right to deny sex to her partner after he had beaten her. The study also found that women infected with HIV were considerably more likely to have experienced physical violence, sexual violence, or both, from their current partner. The authors conclude that HIV voluntary counseling and testing (VCT) play an important role in identifying and supporting victims of violence.

Painter, T. Voluntary counseling and testing for couples: a high-leverage intervention for HIV/AIDS prevention in sub-Saharan Africa. Social Science and Medicine 53:1397-1411 (2001).
This paper studies the available literature on voluntary counseling and testing in sub-Saharan Africa, with a view to strengthening a case for increased attention to VCT focused on couples. The author suggests that there is currently not enough knowledge about HIV risk and risk management by couples. Current HIV-prevention efforts such as media-based and facility-based interventions should be more responsive to couples needs. HIV/AIDS prevention has reached a critical juncture where voluntary counseling and testing services must begin to focus on couple relationships rather than only on safer sex. For this to occur, VCT procedures, staff capacity and performance, and efforts to recruit couples all need strengthening. VCT needs to be integrated with a broader range of health services. Better assessment of VCT processes and outcomes is in order. Governments must support HIV/AIDS prevention through policy-making. Research is needed on sexual relations and HIV-risk reduction by couples; gender, power and efficacy of HIV-risk management by couples; existing sources of support and constraints for HIV-risk reduction by couples; sources of support for coping and HIV-risk reduction by couples after HIV testing; strategies for disseminating VCT information to couples; VCT organization and processes; outcome successes and problems; and social impacts of voluntary counseling and testing.

Peck R et al. The feasibility, demand, and effect of integrating primary care services with HIV voluntary counseling and testing: evaluation of a 15-year experience in Haiti, 1985-2000. Journal of Acquired Immune Deficiency Syndromes. 2003;33(4):470-475.
This articles chronicles the experience of the Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (“Haitian Study Group for Kaposi Sarcome and Opportunistic Infections,” or “GHESKIO”) in progressively integrating primary care services into HIV counseling and testing activities at a voluntary counseling and testing center in Port-au-Prince, Haiti. GHESKIO gradually added services for adult and pediatric care, tuberculosis management, sexually transmitted infection management, and reproductive health. The authors hypothesize that “primary care services and HIV VCT are synergistic; the on-site availability of primary health care services attracts people to VCT, and VCT attracts people in need of primary health care services for other transmissible diseases.”

UNAIDS. HIV Voluntary Counselling and Testing: A Gateway to Prevention and Care. UNAIDS Case Study (June 2002). Available at:
In this collection of case studies, UNAIDS examines the role of voluntary counseling and testing in preventing mother-to-child transmission of HIV, tuberculosis management, working with young people, and reaching general population groups. The studies examine the work of the Demonstration of Antiretroviral Therapy Project in Soweto, South Africa; the Ndola Demonstration Project in the Copperbelt Province, Zambia; the TB/HIV pilot project in the Western Cape Province, South Africa; the Kara Counselling and Training Trust in Lusaka and Choma, Zambia; and the Zimbabwe AIDS Prevention and Support Organization, in several sites of Zimbabwe. The document describes general principles and approaches to voluntary counseling and testing that apply to all of the case studies, but stresses that such services should remain flexible and adapt to the needs of the populations they serve. In addition, voluntary counseling and testing are often only the first step in the care needs of people living with HIV/AIDS. While the report underscores the effectiveness of the profiled case studies, it concludes that there remain many challenges if voluntary counseling and testing are to be successfully scaled up.

Voluntary HIV-1 Counseling and Testing (VCT) Efficacy Study Group. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. Lancet 356(9224):103-112 (July 8, 2000).
In one of the most comprehensive studies of VCT, some 3,120 individuals and 586 couples in Kenya, Tanzania, and Trinidad were randomly assigned to participate in either VCT or a basic health education group with the option of VCT given at the one-year follow-up. The VCT group self-reported a 35 percent reduction in unprotected intercourse with both steady and casual partners during the year following the initial testing and counseling, compared with a 13-percent reduction in the group that received basic health information. Individuals in the comparison group who accepted counseling and testing at the first follow-up visit self-reported a drop in rates of unprotected intercourse to a level equal to that of the initial VCT group after one year. The findings of this study suggest that VCT for HIV should become an integral part of prevention programs in less developed countries.

WHO/UNAIDS. WHO/UNAIDS Technical Consultation on Voluntary HIV Counselling and Testing: Models for Implementation and Strategies for the Scaling Up of VCT Services. Geneva: WHO/UNAIDS (2001). Available at:
The document reports on a consultation held in Zimbabwe in July 2001. Participants discussed the following key areas: the quality of VCT service provision; training, support and supervision of counselors; VCT services for vulnerable groups; VCT and counseling services for children and adolescents; strengthening the health sector and reorganizing existing health services; community mobilization and communication strategies; and goals and targets to guide scaling up and facilitate monitoring and evaluation. The report also outlines several models of voluntary counseling and testing, and specifically examines VCT for preventing mother-to-child transmission of HIV, VCT for young people, and VCT for vulnerable populations. The report concludes by recommending the rapid scaling-up of voluntary counseling and testing.

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