[procaare] HCC:Post Conference discussion -35

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

HCC: Post Conference discussion - 35
- HDN Key Correspondents/Rapporteur Team,Thailand
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Successful formulas to HCC for PLHA: The experiences of four countries.

In the south of Thailand, holistic home and community care for PLHA's strengthened
communities who were actively working with the hospitals through a referral-sustained
system. It also enhanced understanding and mutual collaboration between communities and
the PLHA's.

"The aim was to develop innovative strategies to empower communities, health teams and
PLHA's in providing holistic and continuous care," says Arphorn Chuprapaisilp of the
Prince of Songkla University. "It was needed in this part of Thailand where PLHA's were
not accepted and no systematic and realistic approach to their care existed. There was
also no continuum of care between hospitals and communities."

The program started off with a thorough understanding of the community, creation of a
self-sustaining fund, collaboration with existing AIDS networks and eventually, resource
mobilization. "It was a difficult start, 10 years back," says Chuprapaisilp. "People
thought that HIV/AIDS was a problem only of the north."

The focus on skills in caring for infectious diseases also proved to be beneficial to the
whole community.

Alternative medicine combined with the local wisdom learned from running a community
savings fund turned out to be the perfect solution in sustaining holistic continuous HCC
care for PLHA's.

Namakkal, South India is a different scenario. HIV prevalence was linked to the high-risk
behaviour of lorry drivers and cleaners who comprised 70% of the population. Their regular
access to cheap commercial sex made women and children vulnerable to the disease, a
situation already worsened by the strong stigma attached to HIV/AIDS in this highly
conservative society.

This provided the canvass Anbu Illam, a charitable foundation, working to promote and
implement social welfare programmes for those infected and affected by HIV, needed. Sekar
Balasubramaniam, "Counselling (general, pre-and post-testing, MTCT (Mother to child
transmission) plays a major role in our activities supplemented by condom use promotion,
advocacy, education, and facilitation of care and support."

It is not an easy task since the people rely mostly on doctors and consider counsellors a
waste of time. There is also the lack of specialized treatment centres and the fear of
disclosure when visiting health care providers.

Despite heavy restraint among its female staff who are mostly HIV positive, support from
the local community has been gained. Burn out was also experienced.

Presently, support groups have already minimised the sense of isolation among PLHA's.
Active community involvement has decreased the stigma and prejudice and promoted awareness
about HIV prevention, care and treatment among PLHA's. "It also determines the success of
any interventions," says Balasubramaniam. Ironically, healthcare providers in Namakkal
also need education to change negative attitudes.

Before the local healthcare system is overwhelmed, Anbu Illam advocates more HCC
programmes including AIDS orphans' care. Strategies for HCC in a cultural setting have yet
to be implemented, and which must go hand-in-hand with hospital-based care.

"At Kayamandi in Stellenbosch, South Africa, organizing the community was a huge task due
to the lack of baseline research," explains Jan DuToit a professor of Psychology at
Stellenbosch University. The poverty levels in this area are very high. Nearly 70% of the
population earn below US$50 per month and 34% of school leavers (including housewives) are
unemployed, the highest proportion being women and youth.

The KAP(Knowledge,attitudes and practice)2001 study revealed that only 10.3% of the
population knew about AIDS, with the vulnerability high among women and young girls due to
the low status accorded them, and because of a dislike towards condom use among men. With
increased unemployment, men have also been moving to other cities and room in cramped
motels.

Mobilising the community required research and intervention the latter including a
four-day peer workshop, home-based care training, and the help of the Stellenbosch AIDS
action and hospice. There was also a forward plan to link friends, school and the
community with AIDS service organizations.

Results were positive. An ongoing AIDS awareness was created, attitudes were changed,
there was greater respect and compassion for PLHA's and people either sought or requested
advice voluntarily. Condom use has also increased especially due to increased fund
allotment to condom promotion, and in schools, surprisingly, majority of the educators are
boys. Says DuToit, "At least people are talking about sex and HIV now, and getting them to
talk is achieving something. If you start talking about condoms then usage will follow.

Church based organisations are mostly involved in HCC and provide 'train the trainers'
programmes. Hospitals however preferred their staff not to work in the community.

In the Philippines, according to Jason Encabo, youth involvement in HIV/AIDS care and
support is neglected, thus the recent creation of the Positive Action Foundation
Philippines, Inc. (PAFPI).

He was the sole youth representative in a UNFPA observation study tour that went on to
promote the integration of STI (Sexually Transmitted Illnesses) and HIV/AIDS into local
reproductive heath programs.  The study tour highlighted the fact that care and support
programmes for PLHA's in the country lacked the same attention as information promotion.

Filipino migrant workers are considered as among the high-risk groups. PAFPI has involved
affected children and relatives as STI/HIV/AIDS health educators in pre-departure
orientation seminars to promote acceptance and advocacy.

"The role of the youth is also important if we look at the rates of HIV infection," says
Encabo. "Prevalence is greater among females aged 10-29, and the highest infection across
genders is during the productive age, 20-49. Further, despite increased knowledge (among
the youth) about the disease, there has been no translation into practice. Also, being
predominantly catholic, there is still a conservative attitude towards sex that has lead
to stigma against PLHA's."

The session concluded with these words from DuToit,"These universal experiences about
mobilising communities highlight the fact that eventually, we all speak the same language.
Community work is a learning experience,"  "Always expect the unexpected. What is
important is how communities can be mobilised."

Presenters: Arphorn Chuprapaisilp (Prince of Songkla University / Thailand), Sekar
Balasubramaniam (Anbu Illan / India), Jan DuToit (Stellenbosch University / South Africa),
and Jason Encabo (Positive Action Foundation Philippines, Inc. - PAFPI)


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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