Care and support for people living with HIV/AIDS

Prevention: daunting challenges aheadFigure 26. HIV prevalence rate and frequency of sexually transmittedinfection (STI) episodes, Carletonville miners, South Africa,901991-1998807060HIV-infected (%)504030201001 2-4 5-9 10+number of STI episodesSource: Ballard R, 2000 (unpublished data)If effective prevention measures were directed at men presenting with their firstepisode of sexually transmitted infection, many would be able to prevent subsequentepisodes and avoid becoming infected with HIV. Standard guidelines for themanagement of such patients do call for counselling patients about prevention,including the use of condoms and the referral of sex partners for treatment. But serviceproviders regularly score very poorly on this part of patient management. Referralfor HIV testing has rarely if ever been assessed, but anecdotal evidence suggeststhat it is rare.Fortunately, good training can make a big difference in performance 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 – performed adequatelyin providing prevention advice to patients with a sexually transmitted infection. TheZambian study found that training did not make much difference to already goodperformance in other aspects of patient care, such as history-taking and 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, and 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 and women presenting with urethritis weresatisfactorily managed in public and private health facilities. Thus, while a greateremphasis on prevention is desperately needed, much also remains to be done toensure the proper diagnosis and treatment of curable infections such as syphilis andgonorrhoea.73