Care and support for people living with HIV/AIDS

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Prevention: daunting challenges aheadThe Belarus campaign was bolstered by a change in the law, which made it legal tocarry syringes. A legislative change that facilitated the funding and implementationof AIDS education and needle exchange among drug users has also been broughtabout in Brazil.Drug treatment is another approach to preventing HIV infection among injecting drugusers. This includes helping users to switch to substances that do not need to beinjected. Methadone treatment, which involves giving oral doses of methadone as asubstitute for the injection of heroin, has been associated with reduced risk behaviourand lower HIV infection rates. In an 18-month study of 255 drug users inPhiladelphia (USA) in the early 1990s, only 3.5% of the drug users on stablemethadone treatment became infected with HIV, compared with 22% of those whowere not being treated.Clearly, greater efforts are needed to reduce both injecting drug use and the risk ofHIV infection among drug users, especially in the many countries where drug injectionis a major driving force for the spread of HIV. Like other marginalized groups,drug users can often be reached more easily by nongovernmental organizations.National AIDS programmes in some countries, including several in central and easternEurope and a few in Latin America and Asia, are actively supporting such organizationsin their efforts to prevent HIV infection among injecting drug users and transmissionfrom them to their sex partners. Their prevention efforts should beapplauded, but above all they must be expanded.77
Report on the global HIV/AIDS epidemic – June 2000Opening new doors with counselling and testingMost of the 34.3 million people worldwide now living with HIV do not know they arecarrying the virus. The proportion is highest in the countries worst affected by theHIV epidemic.There are many reasons for this state of affairs, including ignorance about HIV, lackof suitable counselling and testing services, and the still widespread stigma attachedto AIDS which can result in rejection and even violence against people known to beHIV-positive. People also fear that a positive result means an immediate death sentence,although this is not true. In a developing country someone who has just beeninfected with HIV can expect to live nine years on average before falling seriously illand to survive up to a year beyond that, even in the absence of antiretroviral therapy.As daunting as the barriers to HIV testing are, it is important to tackle them. Whenpeople learn their infection status early on, there can be important benefits for bothprevention and care. People who discover they are HIV-negative can take moreenergetic measures to remain uninfected, including negotiating with their partner togo for testing or use condoms. People in a stable relationship who test positive forHIV can take steps to protect their partner from becoming infected through sexualtransmission and avoid mother-to-child transmission of the virus. Access to lifeprolongingtreatment is an incentive for testing: new research shows that, even indeveloping countries, inexpensive medication can improve survival and help an HIVpositiveperson to stay healthy and productive longer (see pages 105-106). The familyalso stands to benefit when an infection is discovered early enough to permitadvance planning for the financial security of the survivors. Finally, important benefitsto the community flow from HIV counselling and testing, especially when peoplewith HIV feel safe enough to be open about their infection and become involved inthe fight against the epidemic – the GIPA principle (see page 87). People living withHIV can bring first-hand experience to AIDS action and help neighbours, institutionsand policy-makers face up to the reality of the epidemic.When properly carried out, voluntary HIV testing and counselling can help break thevicious circle of fear, stigma and denial. The benefits are both individual and collectiveand extend beyond the immediate value of knowing one’s own infection status.An interesting example comes from Uganda’s AIDS Information Centre, an organizationthat has provided confidential counselling and HIV testing to 350 000 clients78
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