Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000could be used to identify priority areas for expanding the coverage of micro-financeinstitutions.In parallel, since the micro-credit approach will not be feasible everywhere, governmentsand other institutions should step up direct humanitarian aid to families inneed through outright grants of food or cash. The two approaches must remain separate,however, if micro-credit schemes are to maintain their credibility.Finally, in high-prevalence countries where the epidemic risks destroying the veryfabric of society, the impact of AIDS has to be mitigated through intensified developmentstrategies. Teachers, extension workers and other human resources who arecrucial to development are falling ill and dying, sometimes at even higher rates thanthe general population. To minimize this impact, countries need urgently to establishhuman resource policies on absenteeism and recruitment while stepping up AIDSprevention and care programmes at the workplace. The coverage of social assistanceprogrammes must be expanded to a wider group of households, defined byboth poverty and AIDS indicators. And existing mechanisms for improving access toland, capital, education and other limited resources must be intensified and appliedmore widely. AIDS is a development problem.Improve health service deliveryThe inadequacy of health service delivery to people living with HIV can be redressedby rationally selecting the services to be offered, upgrading the human resources ofthe health system, improving its infrastructure (e.g. buildings and laboratory equipment),and ensuring the availability of HIV test kits, drugs and other essential commodities.These things have a cost, and therefore a prime consideration is to securefinancing for the health system.An in-depth study of total spending on AIDS – both public and private – in four countriesand São Paulo State, Brazil, found that expenditure ranged from 60% of percapita gross domestic product in Tanzania to 300% in São Paulo, with averageexpenditure being about 150% of per capita GDP.In Thailand, a policy of making zidovudine and didanosine (an antiretroviral regimennow recognized as suboptimal) available to patients free of charge would require apublic subsidy amounting to six times that country’s entire AIDS budget, and wouldtherefore be unaffordable for the Government. Even with this subsidy patients wouldhave to pay just under US$ 500 a year for the related health care required – a sumthat only around half of them could afford.An analysis presented at a WHO/UNAIDS workshop concluded that, in most developingcountries, antiretroviral treatment programmes aiming at universal coverage96