Care and support for people living with HIV/AIDS

National responses to the epidemic: factors that make a differenceNational responses to the epidemic:factors that make a differenceThis report demonstrates that the AIDS epidemic is a true development crisis thatthreatens the social and economic fabric, and the political stability, of whole nations.Yet this report also shows that the epidemic is not out of control everywhere; somecountries and communities have managed to stabilize HIV rates or achieve a turnaround,and some have maintained very low prevalence rates, due to a range of factorsthat are not yet fully understood. Other communities have made significantprogress on care and support for people both infected and affected. A closer look atindividual country responses, and at the corresponding achievements and failures,helps pinpoint some of the factors behind these successes.Looking back over past efforts against the epidemic the initial reaction of manycountries was to try to persuade individuals and selected groups to change theirbehaviour by providing information about HIV/AIDS. Gradually, however, behaviourchange was understood to require more than mere information; the importance ofdecision-making and negotiation skills, accessibility of commodities and services,and supportive peer norms became increasingly apparent.By the mid-1980s, it was well appreciated that individuals do not always control theirown risk situations. This led to the development of prevention programmes aimed atenabling particular groups or communities such as sex workers and men who havesex with men to adopt safer behaviour. At the same time, as individuals infected withHIV earlier in the epidemic gradually fell ill and died, challenging family and communitystructures alike, the need to provide health care and cushion the epidemic’simpact became increasingly obvious. Simultaneously, the importance of work onnon-discrimination, protection and promotion of human rights, and against thestigmatization brought by HIV/AIDS, was more widely recognized, including theimportance of involving different sectors of society.With the mid-1990s, and deepening epidemics in many countries, came a growingrealization that HIV/AIDS is also a development challenge. To the extent that people’svulnerability to infection has social and economic roots, often including marginalization,poverty and women’s subordinate status, these conditions need to be tackledas a way of making society as a whole less vulnerable to HIV over the long term.107