[procaare] HCC:Summary 5: Post Conference Discussion

[Insight Initiative Team <insight@hdnet.org>]

HCC:Summary 5: Post Conference Discussion
- Insight Initiative, Thailand
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Introduction:

We have concluded the post conference discussion on Theme 1:Care, treatment and support in
which we highlighted a few of the key issues that were discussed in this area during the
HCC Conference in Thailand.The discussion commenced on the 23 rd January 02 and concludes
today, the 1 st February 02.

Theme 1: Post Conference Discussion Summary

We commenced our review by looking backward at the previous conferences that were held and
reiterating the need for continuity and to move from discussion to implementation. The
words of Mr Werasit echo this sentiment: "The challenge," said Mr. Werasit,"is how to turn
this discussion and commitment into action - into more resources - and into support and
commitment from the community and the family."

We asked Dr. Elizabeth Lindsey,(Key Resource Person :Insight Initiative Project),her
opinion of the conference. She said: "I think this past conference was exactly what it
said it would be--"The power of Humanity". I found it to be a passionate and caring
conference with a great deal of sensitivity and compassion. There really aren't many
conferences that fit that bill. Dr Lindsey added that we need to incorporate compassion
with responsibility for good, effective and responsive care.

We looked firstly at ARV's. It was felt that the debate had moved on. People at the 5th
HCC in Chiang Mai no longer seem to be asking whether anti-retroviral (ARV) drugs can be
introduced at scale into resource poor settings. The discussion is rather focusing on the
practicalities - what is the best way to use ARVs, what regimes are appropriate and how to
monitor treatment.

Dr van Praag urged caution on two counts, however. Firstly the introduction of ARVs into
health systems may still take some time. Secondly, and more importantly, care and support
is about much more than ARVs. A "comprehensive approach" based on home and community based
care is the way ahead and we should not forget that.

Some concerns were raised about the feasibility of ARV delivery in resource-poor countries
those being that ARVs are developed for subtype B, but this is not the subtype that
prevails in recourse-poor settings ARVs.

Questions were asked about the level of success achieved with the provision of ARVs been
in the West? It was said that the treatment activists in the West fought a battle and won
universal access to ARVs but the clinical care they fought so hard for is pushing PLHAs
away from ARV treatment because it is so cold and impersonal. We have seen that in the
absence of clinical strategies to manage HIV/AIDS, Africa and Asia have evolved wonderful
programmes for palliation, care and support. They are now fighting their battle for
treatment. The lessons we have learnt from the West are to hold on to human-centred
approaches to care and that ARVs are not the panacea we believe them to be.

We next looked at the availability and feasibility of universal guidelines for the
prevention and management of opportunistic infections (OI's). Dr. Kaplan when interviewed
after the session on this said that he believes that no "global scheme" for the
prophylaxis can be developed due to especially very different prevalence of different
pathogens in different parts of the world and different access to anti-retroviral
therapies in these areas. He suggested that countries should follow two goals in reducing
the risk of OIs in PLHAs - better access to potent treatments including HAART and the
development and implementation of "national guidelines" for the prevention of OIs in their
particular context.

Nenet L. Ortega, Philippines indicated that her country is one among those advocating for
affordable, available and accessible ARVs for Filipino positives. She felt however that it
would be vital to develop systems for regular monitoring of the health of those taking the
ARVs.

Caroline Maposhere, Zimbabwe shared the responses of her countryman to the news of the
future availability of antiretrovirals in Zimbabwe.

The discussion then moved to the co-infection of Tuberculosis and HIV/AIDS. Dr Andrew
Furber, Nepal discussed the importance of preventing tuberculosis in people living with
HIV/AIDS. It was said firstly that adequate treatment of TB in PLHA is a highly effective
way of improving both their quality and quantity of life is essential. Additionally the
provision of the anti-TB drug isoniazid (INH) to PLHA for a period of time to reduce the
chances of active TB occurring (INH prophylaxis or preventative therapy) should be
considered. In this regard it should be remembered that preventative therapy will only be
a small part of the care package that needs to be offered to PLHA.

The differences between the management strategies utilized in the TB and HIV/AIDS
programmes were examined. It was suggested that the future of effective TB/AIDS programmes
lies in the integration or at least improved cooperation, based on mutual understanding,
not only for TB/STI/AIDS programmes, but also for government departments and NGO's.

Chris Green, Indonesia stressed the importance of noting the risks of TB exposure to PLHAs
undertaking peer support.

MTCT (Mother to child transmission) received some attention. Concerns were raised about
the mutations to Nevirapine which are being located which impacts on the effectiveness of
the drug. The problems involved in the use of monotherapy and two drug combination therapy
were noted.

Emphasis was placed on the vulnerability of women and children who have lost their
husbands and fathers respectively to AIDS.
Strategies that were used to address the problems caused by this included sustained
development, which emphasized education and training. Women needed to be offered realistic
business and employment opportunities, and that vocational training needed to be backed
with ongoing support and advice. Integration of HIV/AIDS programmes into existing local
programmes is recommended as it is more cost-effective, and also promotes the acceptance
of these programmes by local communities.

The importance of the provision of quality counseling to PLHAs was emphasized as well as
allowing PLHA's to determine their own needs in all aspects of care, treatment and
support.

Thank you once more for your continued support and commitment throughout this discussion.
We look
forward to your contributions as we move through the post conference discussion on Theme
2: Stigma and care.

With best wishes

Insight Initiative Team, Thailand
Health & Development Networks
Email: insight@hdnet.org
Web: www.hdnet.org

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The Insight Initiative Project is managed by Health & Development Networks (HDN) in
collaboration with the Thailand Red Cross Society, the World Health Organization and the
Royal Thailand Government, with financial support from AusAid and UNAIDS.

For more information about this project (the 'Insight Initiative'), visit the HDN website
at: http://www.hdnet.org

Fifth International Conference on Home and Community Care for Persons Living with HIV/AIDS
Chiang Mai, Thailand - 17-20 December 2001
Website: http://www.hiv2001.com


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