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

[Guest guest]

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  pertinence:

 

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.

e-mail: <dr_rajeshg@...>

[Guest guest]

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 s Lakes 3038

Melbourne . Australia.

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