Do we need to take HIV outside the exclusive public health domain ?

Dear All,

The epidemic of HIV is a genuinely cross-cutting issue knowing no real or notional borders in its progression or the adverse outcome(s).

There is no denial of the fact that HIV/AIDS does have a strong biomedical component, say in terms of laboratory testing for HIV in ICTCs and the blood banks, treatment of
sexually transmitted infections/reproductive tract infections (STIs/RTIs) and
management of AIDS as a chronic manageable disease through the anti-retroviral
therapy (ART) and what have you.

The issues like promotion of condoms, controversial ‘recommendation’ of abortions or otherwise, facilitation of male circumcision as a proven strategy for prevention of HIV and
other interventions do, however, have many determinants outside the health
sector.

The writing on the wall is therefore writ large-take HIV and AIDS outside the exclusive public health domain.

The problem of HIV/AIDS must be perceived from the following perspectives

and the approaches must be designed accordingly (the list is obviously not exhaustive because of the existence of myriad
determinants of the pandemic)in the presumably decreasing order of
p
ertinence:

· Communication

· Public health

· Human rights

· Health care service delivery

· Economic

· National vs regional/state

· Political

· Legal

· Socio-cultural/religious

This epidemic demands that all the stakeholders work in unison and in complete

synergy so as to ensure an effective response in a mainstreamed manner -requiring

directed and sustained efforts to take HIV and AIDS outside the exclusive domain of just the medical/public health professionals and the health sector per se for that
matter.

A realist review of the activities in preference to clinical/medical approaches towards development of evidence base, corroborates the same and necessitates the need to
dedicatedly work for a comprehensive approach.

Best wishes,

Dr.Rajesh Gopal.


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Comment by Gaston on August 29, 2011 at 11:15am
Dear Rajesh, Geoff. For the video, click the second video on this page: http://constellation.helsekompetanse.no/atutor/9/content/288/
Comment by Geoff Parcell on August 28, 2011 at 5:57pm

Agreed Rajesh. What small step can each of us take to help us all work in union, since change starts with ourselves? I know that when I find myself acting like an expert I re-look at the video of Usa Dongsa reminding us that "Some people think they are they expert......." [Phil do you know where that is on line? I only have it on my laptop and I couldn't find it on Ning.]

 

Geoff

Comment by Dr Rajesh Gopal on October 25, 2010 at 10:43pm
It is a big challenge to work to remove the mindset that ONLY doctors can and should work for HIV and AIDS.
The need to have a multi-disciplinary team as HIV implementers including PLHIV working on GIPA for prevention,care,support and treatment services,people from different walks of life with varying experincea and or expertise in communication,professional social work,gender and rights perspective,inclusive development are areas still to have proper place at different quarters.

They are are still not preferred to the 'twice born' medical fraternity.A person with public health qualifications is automatically assumed to be an expert and 'know all' to take care of the myriad aspects and determinants which may (even if partially) addressed only by a committed team.

My personal experience,I am afraid , is more of some efforts in that diection with only partial success.

Regards and best wishes,

Rajesh Gopal.
Comment by Phil on October 25, 2010 at 5:01pm
Rajesh,
You say that we need a sustained effort to take HIV/AIDS outside the exclusive domain of medical/health professionals. I would be very interested to hear of a personal experience where your efforts have started to achieve this.
Best regards.
Phil
Best regards
Phil
Comment by Dr Rajesh Gopal on October 22, 2010 at 12:46pm
Thanks Dr Rajesh,

I have always viewed the medical / public health responsibility as being about 10% of the solutions although I continue to despair at the rampant unprofessional fear still being exhibited around people living with the Virus and trying to live as normal a life as possible.

The rest of the management process which obviously must include the patients and their physicians is quality nutrition, safe hydration, access to health care, education, housing and employment, updated knowledge, individual support, family support, community support and freedom from harassment, victimisation, stigma and discrimination.

They should be able to discuss their future sexual capacities and regardless of their gender orientation, be able to co-exist in an educated community.

The doctors don't have near enough of those capacities or the time to
provide them. Self help programs free of domination and publicly funded legal support is also highly desirable.

The accountability of the PLWHA's to cohabit in a non destructive way
follows from that kind of acceptance and support but a converse situation will likely lead to fear and frustration and destructive behaviour which perpetuates the pandemic.

It is possible for +ve and -ve people to live together and provided they are all familiar with the ways the virus transmits the epidemic can stop and when the last infected person dies the virus will no longer be around to taunt us. Contagion in any form is just not possible so behaviour and education is the key.

Careless or substance affected behaviour is a weakness but it is a two way process. Taking a risk in ones sexual behaviour, sharing injecting equipment or allowing untested and untreated blood product to be administered are the main vehicles for transmission. Everyone shares the responsibility.

Negative person who has indiscriminate unprotected consentual sex is just as liable as their partner whether disclosure has or could have been given.

For the negative citizen behaviour and knowledge is crucial. For the
positive person behaviour and knowledge is also crucial.

Myth, fear, nonsense and cultural factors impact on the knowledge and
behaviour change paradigm and since I left India where I spent 6 months a year from 2001 to 2005 working in communities, for the most part not much has changed apart from those people who manage to network effectively.

I hope that one day I will get to return but I couldn't pass up the
opportunity to commend Dr Rajesh in his accurate observations.

The biggest problem is that even to the highest levels of the Republic, rebuke, rejection, ignorance, prejudice, and insulting views about infected Indians abound and the fact that progress is so slow and convoluted comes about primarily because +ve people and excluded from the decision making processes.

I have extolled long and hard that at least 50% of the competent members of NACO should be Indians who are living with the Virus. If looks could have killed I would have been dead on the spot when I suggested this before.

Best wishes

Geoffrey

--
Geoff Heaviside
Convenor - Brimbank Community Initiatives Inc
Convenor - Brimbank International Student Support Services
Secretary - International Centre for Health Equity Inc
Member - Australasian Society for HIV Medicine Inc
P.O. Box 2400 Taylors Lakes 3038
Melbourne Victoria. Australia.
Ph: +61 418 328 278
Ph/Fax : (61 3) 9449 1856
Ph: India : 9840 097 178
Ph: Nepal : 9849 174 329

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