HIV/AIDS is a major global health emergency. HIV infection also fuls other epidemics of global concern-most notably tuberculosis, which gas become a leading cause of death not only among people living with HIV, but also among their HIV-negative family members and contacts. But AIDS is not the same everywhere. Access to effective prevention and treatment, and consequently the fates suffered by individuals infected with HIV very widely.
People living with HIV but benefiting from the latest medical developments can hope to lead normal lives in many respects:
|Number of deaths in millions|
Although equity is the only acceptable end goal, it is nevertheless true that setting priorities is a key step in the crafting of sound policy. It is possible to identify a number of highly important considerations in implementing projects and national AIDS programmer in resource poor settings. Halt, one of the world’s poorest countries, again provides insights. Spiraling, entwined epidemics of TB and HIV and the worst poverty in the American did not stop Haiti from putting together a successful application to the GFATM called for expanding integrated HIV prevention and care and was linked to the existing national AIDS control plan. The Haitian model proposes a stepwise implementation, beginning with improved
voluntary counseling and testing and prevention of mother to child transmission and then unfolding progressively in several dimensions.
The first dimension includes a complete range of prevention services and products to reduce HIV transmission in all settings. Prevention activities are integrated with improved HIV care for people already integrated with improved people already infected. Prevention measures include culturally appropriate, community based HIV education, condom distribution and voluntary counseling and testing this component also embraces blood safety and the observance of universal precautions, including safe injection practices.
The second dimension is improved women’s health, including access to family planning and safe childbirth. Prevention of HIV transmission from mother to infant will have, as a “windfall benefit”, the improvement of women’s health in a broader sense. Indeed, it will be easier to met millennium Development Goals related to maternal mortality by improving capacity to scale up pilot programmers for the prevention of mother-to-child transmission.
The third dimension of integrated HIV prevention and care is improved TB case-finding and care. This is important in communities heavily burdened by both diseases, since in these settings-most of southern
Africa is a case in point-TB is the leading serious opportunistic infection among people living with HIV. Finally, the fourth component of this model is the diagnosis and treatment, preferably through algorithms reflecting local epidemiology, of all STIS. Numerous studies have shown that improving care for STIS will diminish the risk if acquiring HIV.
Local variation has always been a central faction in the HIV/AIDS story, so the relevance of any pilot projects should be scrutinized. Can such programs be scaled up distinct-wide or nationally? Can they be replicated in other heavily burdened and resource constrained areas? For example, where injecting drug use is the primary mode of transmission, harm reduction will be central to prevention efforts. There is also a need for greater focus on nutrition as a fundamental component of any approach to caring for people living with HIV/AIDS.