[procaare] HCC:Post Conference discussion -31

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

HCC: Post Conference discussion - 31
- HDN Key Correspondents/Rapporteur Team,Thailand
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[Moderators note: Central to an enabling environment is ensuring sustainability of home
and community care projects. How have you addressed this issue in your work?]

"Donor fatigue" hits home care projects

With anti-retroviral drugs making their way onto the market place at so called affordable
prices, people with money for HIV/AIDS are beginning to say that community and home and
community care will not be an important factor in the near future in stemming the
epidemic.

"Donor fatigue" was how one journalist at a post plenary press briefing described it in
posing a question to Dr Eric Van Praag, Director of Family Health International, who had
sought earlier to debunk the notion of that home and community care programs may be less
needed. Dr Van Praag acknowledged that home and community care has never been popular with
donors. They preferred, he said, to direct their resources to prevention programs,
including voluntary counseling and testing, and prevention of mother-to-child transmission
of HIV.

An example emerging from Kenya suggests that the word "sustainability" is also used by
donors to mask their reluctance to back home and community care projects.

Dorothy Oyango, a founding member of the Kenyan non-government organization called Women
Fighting Against AIDS, and one of her colleagues with a counterpart organization,
described the impact of "donor" fatigue on their effort to care for children orphaned by
the HIV/AIDS epidemic. As many as 1100 children are affected, 700 of those are under
Dorothy's care, the others are with her colleague.

"Our biggest problem in trying to provide community care is that we work at the grass
roots level with people who live below the poverty line. We have not been able to access
funds. We have to look for food, clothes, and without money we do not know how to support
these orphans. Most donors refuse to support our projects, saying that our programs are
not sustainable," Dorothy said.

Dr van Praag was adamant that a case has to be made to correct the "gross misconception"
that with easier access to ARVs, home care programs may be less needed.

"If one looks to countries where ARVs have been made free or affordable such as the United
States, Europe, Australia, Brazil or Senegal, " he explained, " One sees an important
reduction in the hospitalization, while at the same time an important opportunity for
improved adherence through home care.

Home care for instance can facilitate better ARV adherence, according to Dr van Praag, and
mobilize the necessary family support for still complex treatment regimens, which cannot
be discussed in a busy outpatient clinic. He disclosed that recent studies in Switzerland
and the United Kingdom have shown that HIV positive persons need emotional support to cope
with renewed life perspectives, disclosure within the family, and physically visible side
effects of drugs.

"But even more important than that," Dr van Praag added, "Home care remains a palliation
necessity for those who start late on ARVs and are often less mobile, for therapy failures
and for the large majority of people who don't make it to have physical or financial
access to sites where safe and effective use of ARVs can be guaranteed."


HDN Key Correspondent Team
Rapporteur Team
E-mail: correspondents@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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