Care and support for people living with HIV/AIDS
Care and support for people living with HIV/AIDS
Care and support for people living with HIV/AIDS
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Report on the global <strong>HIV</strong>/<strong>AIDS</strong> epidemic – June 2000Box 20. Use of cotrimoxazole prophylaxis in <strong>people</strong> <strong>with</strong> <strong>HIV</strong>/<strong>AIDS</strong> inAfricaIn March 2000, UN<strong>AIDS</strong> <strong>and</strong> WHO brought together clinicians, public health specialists,national <strong>AIDS</strong> programme managers, <strong>people</strong> <strong>living</strong> <strong>with</strong> <strong>HIV</strong>/<strong>AIDS</strong>, donors<strong>and</strong> <strong>AIDS</strong> activists to discuss the use of cotrimoxazole as preventive therapy <strong>for</strong> <strong>HIV</strong>positiveindividuals in Africa. The outcome of this consultative workshop in Harare,Zimbabwe, was that cotrimoxazole prophylaxis <strong>for</strong> <strong>people</strong> who have already developedsymptoms of <strong>HIV</strong> infection should be part of the essential care <strong>and</strong> <strong>support</strong>package. The participants recommended dosages, defined criteria <strong>for</strong> patient eligibility,<strong>and</strong> issued recommendations <strong>for</strong> training, education <strong>and</strong> capacity developmentin countries.The UN<strong>AIDS</strong> Secretariat is working <strong>with</strong> WHO to ensure rapid implementation ofthese recommendations through resource mobilization ef<strong>for</strong>ts. By July 2000, throughconsultative meetings <strong>with</strong> national governments, 14 African countries participatingin the US Government’s LIFE Initiative will have considered making cotrimoxazoleprophylaxis part of their care package.A new incentive <strong>for</strong> testing?Experience from around the world shows that seeking counselling <strong>and</strong> <strong>HIV</strong> testing isnot an easy step to take. In the high-income countries, the hope of benefiting fromearly treatment created a major incentive <strong>for</strong> <strong>people</strong> to find out whether they wereinfected. As therapies improved – even be<strong>for</strong>e the advent of antiretrovirals – <strong>people</strong>who suspected they might have <strong>HIV</strong> saw that they stood to gain months or years oflife by getting tested.Isoniazid <strong>and</strong> cotrimoxazole prophylaxis – which can only be offered to <strong>people</strong> <strong>with</strong>proven <strong>HIV</strong> infection, in contrast to some other <strong>for</strong>ms of health care described in thischapter – may similarly increase <strong>people</strong>’s interest <strong>and</strong> willingness to be tested <strong>for</strong><strong>HIV</strong>. If these preventive regimens are made more widely available along <strong>with</strong> <strong>HIV</strong>counselling <strong>and</strong> testing services, the survival benefits <strong>for</strong> individuals <strong>and</strong> their familiesare likely to be compounded by the benefits of large-scale testing, includingreduced <strong>HIV</strong> transmission to partners <strong>and</strong> to infants, <strong>and</strong> greater visibility of theinsidious <strong>HIV</strong> epidemic.106