Care and support for people living with HIV/AIDS

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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
Report on the global HIV/AIDS epidemic – June 2000efforts to scale up, a sound strategic plan based on epidemiological evidence andbest practices will at least ensure basic coverage.Strategic planning of national responses is neither easy nor quick. But as the experienceof a number of countries has proved – for example, Botswana, Cambodia,China, Côte d’Ivoire, Dominican Republic, Guatemala, Honduras, Malawi,Mozambique, Papua New Guinea, Romania and the United Republic of Tanzania –it can be done effectively, and the process itself is critical in bringing on board a widerange of actors whose commitment is key to successful outcomes.4. Multisectoral and multilevel actionSuccessful programmes involve multisectoral and multilevel partnerships betweengovernment departments and between government and civil society, with AIDSbeing routinely factored into individual and joint agendas. Only a combined effort will“mainstream” AIDS and establish it firmly on the development agenda.Multisectoral and multilevel partnerships make sense for all stakeholders.Government sectors and businesses are affected in multiple ways by a serious epidemicand hence have an important stake in participating in AIDS prevention, careand support at all levels, but especially in ensuring sustained, large-scale programmes.Ministries of Labour for example can mandate workplace prevention programmesin the private sector. Ministries of Defence can use their budgets to implementprogrammes for the military, and Ministries of Education for teachers, schoolchildrenand their parents. Private firms can contribute in cash and in kind. WhileMinistries of Health undoubtedly have a critical role to play in responding to the epidemic,leaving the management of the overall national response to them is unlikelyto prove effective in the longer term. NGOs, who are trusted by vulnerable populations,are best positioned to support prevention programmes in collaboration withthese communities themselves. The mass media can promote safer behaviour andtolerance through their own channels.5. Community-based responsesThe eventual outcome of the AIDS epidemic is decided within the community.People, not institutions, ultimately decide whether to adapt their sexual, economicand social behaviour to the threat of HIV infection. They are the subjects of theresponse to AIDS, not merely the objects of outside interventions. Therefore,responses to HIV are in the first instance local: they imply the involvement of peoplewhere they live – in their homes, their neighbourhoods and their workplaces.Community members are also indispensable for mobilizing local commitment andresources for effective action. In particular, people living with HIV/AIDS must play aprominent role and bring their unique experience and perspective into programmes,starting from the planning stage.110
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Care and support for people living with HIV/AIDS

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