Care and support for people living with HIV/AIDS

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Care and support for people living with HIV/AIDSBox 16. Strengthening “horizontal” collaboration on HIV and sexuallytransmitted infections in Latin America and the CaribbeanBuilding on a long tradition of joint collaboration in the region, and the desire formore self-reliance and less dependency on donors, the Directors of national AIDSprogrammes from 12 countries agreed in 1996 to set up a new process for “horizontal”interregional technical cooperation. As part of the reciprocal process ofexchanging experience, information and technology on equal terms, for example, theHorizontal Technical Collaboration Group (HTCG) has encouraged intercountry visitsso that members can see first-hand how to improve drug management and distributionin rural areas. Through a multicountry survey conducted by the Group on theprices being paid for HIV-related drugs and commodities, countries became awareof major price differences and were in a better position to negotiate price reductionswith pharmaceutical companies. Argentina, for instance, was able to reduce the costof measuring viral load from US$ 250 to US$ 70. The HTCG also provided the initialimpetus for establishing a revolving fund for HIV-related drugs under the auspices ofthe Pan American Health Organization, WHO’s Regional Office for the Americas. Thefund is now in its initial trial phase.As of May 1999, 21 countries belonged to the HTCG* and efforts are now under wayto incorporate national AIDS programme Directors from Central America and fromthe English-, Dutch- and French-speaking countries in the Caribbean.* Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador,Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay and Venezuela.Comprehensive care and support strategy neededIn the early 1990s, WHO’s Global Programme on AIDS advocated that care and supportfor people living with HIV or AIDS should be comprehensive – embracing thepsychological/spiritual, social and medical dimensions – and integrated, with thevarious providers offering a “continuum of care” centred on the clients’ needs.This vision remains relevant today. As discussed earlier (see page 85), people withHIV infection need a range of measures to support them (and their families) in copingwith their situation and to enable them to live healthy, productive lives for as longas possible. Counsellors, religious communities and family members should providevital care and support at home and in the community. For diagnosis and therapy,patients and their carers must in turn be able to rely on the support of health services,such as home and community care programmes, private practitioners, localhealth centres, and clinics and hospitals.91
Report on the global HIV/AIDS epidemic – June 2000Since this vision was formulated, UNAIDS has identified new opportunities for prioritizingaction and accelerating progress. UNAIDS proposes to target action along fivestrategic axes. Two are dealt with elsewhere in this report, while the others are discussedin separate sections below:• creating political will and mobilizing resources (see pages 107-115)• increasing access to voluntary HIV counselling and testing: over and above thebenefits for prevention, discussed earlier (see page 78), individuals who learnthey have HIV can gain access to support at an earlier stage and, with new preventiveregimens, may live longer and healthier lives (see pages 105–106)• increasing access to psychosocial support and impact alleviation• improving health service delivery• increasing access to drugs of special interest to people living with HIV infection.When possible, it is best for countries to develop plans for care and support as partof their strategic planning on HIV/AIDS, whether at national or district level. Healthsystem reform can offer an opportunity to look at the range of care and supportneeds in a comprehensive manner (see Box 17).Box 17. Health reforms and HIV: experience from Phayao Province,northern ThailandThe Phayao Health Office undertook a review of its efforts to reform the health sectorin the light of the lessons learnt from reducing the spread of HIV and caring forpeople with AIDS in this badly affected province of the country. The Office posed anumber of questions to see whether the reform was really improving the health sector’scapacity to tackle the epidemic effectively.Quality of life and autonomy are important concerns of people with HIV andtheir families.• Does the health reform aim only to reduce rates of sickness and death?• Or is the reform also geared to better quality of life, less dependence and greaterautonomy?People with HIV require comprehensive support, and not just medicines.• Does the health reform aim mainly at better provision of health care?• Or does it also enable the health sector to catalyse community action and puthealth issues on the agenda of society and its decision-makers? –––>92
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Care and support for people living with HIV/AIDS

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