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
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Prevention: daunting challenges aheadFigure 26. <strong>HIV</strong> prevalence rate <strong>and</strong> frequency of sexually transmittedinfection (STI) episodes, Carletonville miners, South Africa,901991-1998807060<strong>HIV</strong>-infected (%)504030201001 2-4 5-9 10+number of STI episodesSource: Ballard R, 2000 (unpublished data)If effective prevention measures were directed at men presenting <strong>with</strong> their firstepisode of sexually transmitted infection, many would be able to prevent subsequentepisodes <strong>and</strong> avoid becoming infected <strong>with</strong> <strong>HIV</strong>. St<strong>and</strong>ard guidelines <strong>for</strong> themanagement of such patients do call <strong>for</strong> counselling patients about prevention,including the use of condoms <strong>and</strong> the referral of sex partners <strong>for</strong> treatment. But serviceproviders regularly score very poorly on this part of patient management. Referral<strong>for</strong> <strong>HIV</strong> testing has rarely if ever been assessed, but anecdotal evidence suggeststhat it is rare.Fortunately, good training can make a big difference in per<strong>for</strong>mance in the area ofprevention. A recent study in Zambia found that 61% of trained health-careproviders – but only 35% of those who had not been trained – per<strong>for</strong>med adequatelyin providing prevention advice to patients <strong>with</strong> a sexually transmitted infection. TheZambian study found that training did not make much difference to already goodper<strong>for</strong>mance in other aspects of patient care, such as history-taking <strong>and</strong> physicalexamination. Depressingly, however, only one-fifth of the cases were correctlytreated – probably because the correct drugs were rarely available. Almost all theservice providers reported serious shortages of drugs in the past year, <strong>and</strong> almostall were out of stock of at least one essential drug at the time of the study. A studyin India showed that only 10% of all men <strong>and</strong> women presenting <strong>with</strong> urethritis weresatisfactorily managed in public <strong>and</strong> private health facilities. Thus, while a greateremphasis on prevention is desperately needed, much also remains to be done toensure the proper diagnosis <strong>and</strong> treatment of curable infections such as syphilis <strong>and</strong>gonorrhoea.73