Communities play a vital role in promoting ARV adherence
(This is an HDN KC report from the 2nd South African AIDS Conference Durban, South Africa, 7-10 June 2005)
The WHO target of providing antiretroviral (ARV) drug treatment to three million people living with HIV/AIDS in poor countries by 2005 (‘3 by 5’) is falling far short of the mark in many places This is especially so in South Africa, where – according to the country’s Minister of Health – around 53,000 patients have been enrolled in treatment programmes to date.
With the 3 by 5 deadline looming, there are bound to be attempts to dissociate from what looks like an increasingly frail target. Reiterating similar comments she made during a UN General Assembly meeting in New York last week, the health minister took the opportunity to repeat that the 3 by 5 goals are not South African targets, and that the country would determine their own in due course.
As the political posturing persists, the daily reality is that millions of people are precariously waiting for effective HIV treatment and care services, and thousands are dying in the meantime. A further emerging concern is how to ensure that the chosen few who have been enrolled in ARV programmes remain on treatment.
There are no easy solutions, but as the conference proceeds this week it is becoming clear that there are additional resources that can be mobilised to assist. The community sector is reportedly still only consulted way down the implementation path, and particular when services begin to fail.
This was clearly demonstrated during a seminar organised by the Secure the Future initiative, where ARV country project reports were presented and discussed.
Success stories presented at the meeting showed that if communities are consulted and see the relevance of interventions early, then they will rise to the challenge, take ownership of programmes and find their own solutions to prevailing challenges.
So what are the key elements that ensure that communities are involved in treatment and adherence programmes?
Communities should be mobilised through awareness, advocacy and lobbying. Widespread understanding that ARV therapy can save the lives, but requires a lifetime commitment from the client, family and community, must be created. Fostering this kind of ‘treatment literacy’ among communities can only happen if an environment has been created that reduces HIV-related stigma and encourages acceptance.
If this can be supported then “the community becomes the advocate”, says Mxolisi Khutama of the ACHIVA project in KwaZulu Natal province – one of the areas of the country with the highest HIV prevalence.
This is can be achieved through community consultative meetings and adopting a multidisciplinary approach. It is vital to involve the private sector and facilitate collaboration and networking through establishment of appropriate local forums. Social marketing campaigns can also assist in the process.
Empowerment and development of clients, family members and the community through literacy workshops can also help to promote the necessary understanding among increasingly large numbers of people.
Psychosocial support can be created through the use of lay counsellers in the community, who can also encourage people to find out their HIV status through voluntary counseling and testing (VCT), and refer clients and families to health facilities – as well as provide on going treatment adherence counselling. Once more the selection of lay counselors from within the community facilitates local empowerment and community acceptance. Counselling is geared towards disclosure of HIV status, and during the assessment phase clients are encouraged to identify a treatment supporter to whom they are able to disclose.
Post-test clubs and support groups can be linked to VCT sites and provide valuable support to people infected and affected by HIV. Additionally, treatment buddies, who are people living with HIV and are successfully adhering to ART, can be used to help support newer clients.
The session also highlighted the importance of home-based services and support in maintaining adherence levels. It was reported that home-based care groups provide valuable support through home and follow-up visits. Care-givers provide treatment support and refer clients to health facilities for monitoring and treatment of side-effects.
Nutritional support can be provided through establishment of home and community gardens. This helps to ensure sustainability, promotes a spirit of self determination and partly alleviates immediate poverty.
Each of these key elements provides a sound basis for implementing ARV programmes with high levels of adherence, and also help the thousands of people who are waiting for treatment programmes to deliver on their promises.
As stated by Minister Manto Tshabalala Msimang, providing ARV treatment is not just about numbers of clients on treatment, but equally about the quality and comprehensiveness of the range of services that are provided.
As South Africa strives to meet its needs for AIDS-related care and support services, programmes must address all of these elements, take cultural practices and diversity into consideration and involve all stakeholders. Communities are doing more than just waiting – they are actively preparing for the day ARVs will be made accessible – whoever’s ARV target happens to be on the horizon.
HDN Key Correspondent Team
Email: correspondents@hdnet.org
(June 2005)
The WHO target of providing antiretroviral (ARV) drug treatment to three million people living with HIV/AIDS in poor countries by 2005 (‘3 by 5’) is falling far short of the mark in many places This is especially so in South Africa, where – according to the country’s Minister of Health – around 53,000 patients have been enrolled in treatment programmes to date.
With the 3 by 5 deadline looming, there are bound to be attempts to dissociate from what looks like an increasingly frail target. Reiterating similar comments she made during a UN General Assembly meeting in New York last week, the health minister took the opportunity to repeat that the 3 by 5 goals are not South African targets, and that the country would determine their own in due course.
As the political posturing persists, the daily reality is that millions of people are precariously waiting for effective HIV treatment and care services, and thousands are dying in the meantime. A further emerging concern is how to ensure that the chosen few who have been enrolled in ARV programmes remain on treatment.
There are no easy solutions, but as the conference proceeds this week it is becoming clear that there are additional resources that can be mobilised to assist. The community sector is reportedly still only consulted way down the implementation path, and particular when services begin to fail.
This was clearly demonstrated during a seminar organised by the Secure the Future initiative, where ARV country project reports were presented and discussed.
Success stories presented at the meeting showed that if communities are consulted and see the relevance of interventions early, then they will rise to the challenge, take ownership of programmes and find their own solutions to prevailing challenges.
So what are the key elements that ensure that communities are involved in treatment and adherence programmes?
Communities should be mobilised through awareness, advocacy and lobbying. Widespread understanding that ARV therapy can save the lives, but requires a lifetime commitment from the client, family and community, must be created. Fostering this kind of ‘treatment literacy’ among communities can only happen if an environment has been created that reduces HIV-related stigma and encourages acceptance.
If this can be supported then “the community becomes the advocate”, says Mxolisi Khutama of the ACHIVA project in KwaZulu Natal province – one of the areas of the country with the highest HIV prevalence.
This is can be achieved through community consultative meetings and adopting a multidisciplinary approach. It is vital to involve the private sector and facilitate collaboration and networking through establishment of appropriate local forums. Social marketing campaigns can also assist in the process.
Empowerment and development of clients, family members and the community through literacy workshops can also help to promote the necessary understanding among increasingly large numbers of people.
Psychosocial support can be created through the use of lay counsellers in the community, who can also encourage people to find out their HIV status through voluntary counseling and testing (VCT), and refer clients and families to health facilities – as well as provide on going treatment adherence counselling. Once more the selection of lay counselors from within the community facilitates local empowerment and community acceptance. Counselling is geared towards disclosure of HIV status, and during the assessment phase clients are encouraged to identify a treatment supporter to whom they are able to disclose.
Post-test clubs and support groups can be linked to VCT sites and provide valuable support to people infected and affected by HIV. Additionally, treatment buddies, who are people living with HIV and are successfully adhering to ART, can be used to help support newer clients.
The session also highlighted the importance of home-based services and support in maintaining adherence levels. It was reported that home-based care groups provide valuable support through home and follow-up visits. Care-givers provide treatment support and refer clients to health facilities for monitoring and treatment of side-effects.
Nutritional support can be provided through establishment of home and community gardens. This helps to ensure sustainability, promotes a spirit of self determination and partly alleviates immediate poverty.
Each of these key elements provides a sound basis for implementing ARV programmes with high levels of adherence, and also help the thousands of people who are waiting for treatment programmes to deliver on their promises.
As stated by Minister Manto Tshabalala Msimang, providing ARV treatment is not just about numbers of clients on treatment, but equally about the quality and comprehensiveness of the range of services that are provided.
As South Africa strives to meet its needs for AIDS-related care and support services, programmes must address all of these elements, take cultural practices and diversity into consideration and involve all stakeholders. Communities are doing more than just waiting – they are actively preparing for the day ARVs will be made accessible – whoever’s ARV target happens to be on the horizon.
HDN Key Correspondent Team
Email: correspondents@hdnet.org
(June 2005)
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