Care and support for people living with HIV/AIDS

National responses to the epidemic: factors that make a differenceSuccessful programmes impart knowledge, counter stigma and discrimination, createsocial consensus on safer behaviour, and boost AIDS prevention and care skills.These can be accomplished cost-effectively through mass media campaigns, andthrough peer/outreach education and life-skills programmes in schools and workplaces.Programmes such as TASO in Uganda have demonstrated the enormouslypositive impact of openness and honesty in facing HIV. Ensuring that counsellingand voluntary HIV testing are available, so that an individual can find out her or hisHIV status, is a further critical ingredient in counteracting denial.3. A strategic responseA single, powerful national AIDS plan involving a wide range of actors – government,civil society, the private sector and (where appropriate) donors – is a highlyvaluable starting point. The development of a country strategy begins with ananalysis of the national HIV/AIDS situation, risk behaviours and vulnerability factors,with the resulting data serving to prioritize and focus initial action. It isessential to find out where people in the country are already infected, where theyare most vulnerable, and why. Effective strategy development then involves drawingon evidence-based methods of HIV/AIDS prevention, care and impact alleviation– “best practices” – recognizing that some of these may be culturally sensitive(e.g. sex education in schools) or require hard political choices (e.g. needleexchange for injecting drug users). At the same time, attention needs to be givento ensuring that the relevant services and commodities such as condoms or STDservices are acceptable, affordable and available. Given the resource constraintsfacing many countries, the development of a strategy will also involve some prioritization.Effective strategies offer both prevention and care. As illness mounts in the epidemic,so does the need for health care and social support. Care services havebenefits that extend beyond caring for sick individuals. They help convince othersthat the threat of HIV is real and they therefore make prevention messagesmore credible. Messages and programmes that build compassion and skills inhealth care settings, communities and families are needed right from the start,and combined training for prevention and care helps reduce costs.An important point about programme elements is that they tend to work in synergy.Individual features of effective action can be found in most programmes.The tragedy is that in many countries, action remains sporadic and patchy ratherthan comprehensive. “Boutique” projects may provide services for one or twocommunities, while large areas of the countryside have nothing. Many programmeshave yet to become comprehensive in either geographical coverage orcontent. The national response may focus solely on sex workers, for example;elsewhere, efforts may go into AIDS and life skills education among the young inschools and out of schools, but the risks and vulnerability of men who have sexwith men are ignored. While human and other resource constraints may hamper109