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Public Health/HIV/AIDS
Co-facilitators: William Bicknell, Boston University;
Ngoyi Bukonda, Northern Illinois University
The moderators opened the discussion to topics that are especially interesting
or important to the participants:
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The relationship between traditional healers or traditional knowledge
and HIV/AIDS medicines. U.S. legislation and thus USAID programs
allow for traditional healers. This is important, because most people
tend to access traditional medicine at some point in their care seeking.
There are differing approaches to integrating traditional with Western-style
medicine. In Lesotho, traditional healers must be licensed. The Department
of Public Health has been giving workshops on how this might be done.
In Malawi, there are attempts to modify some traditional practices,
such as circumcision. In the Congo, they want to do a study of 4 plants
that seem to have changed individuals’ HIV sero status. Conclusion:
it would be helpful to take a more comprehensive look at the role
and types of traditional medicine.
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The implications of testing, when no or only limited treatment
is available. Also, how eligibility for treatment is determined.
For example, in Lesotho, 300,000 are HIV-positive, but only 10% are
likely to get ARVs. Which 10% will be chosen? Voluntary counseling
and testing (VCT) can be useful for changing the behavior of HIV-positive
individuals. Furthermore, the UNDP argues that it’s a right
to have testing, with or without counseling. One participant suggested
that we should not worry about counseling. Another said that individuals
have a right to information that comes out of testing, both for knowing
appropriate behaviors and for seeking health care. Another participant
asked how one should define counseling. This question is especially
pertinent in the context of low human resources. If health services
do not have the capacity, it was suggested that existing personnel
can be trained for brief periods. Or, as is done in Lesotho, no-charge
volunteer counselors are available because they are assigned for limited
periods of service, by day, hour, or week.
Counseling can help HIV-positives remain or become more productive.
On the other hand, it was suggested that information to take home,
such as written materials, might be an adequate substitute for counseling
where personnel is lacking. How VCT is conducted is important. Furthermore,
some countries have been successful in getting out messages to everyone
– for example, in Gambia, “don’t kill someone you
love”. Issues remain around “rights”, such as the
right to treatment. Conclusion: people do have a right to correct,
full information including all the options available to them –
about prevention, and about responses to HIV-positive status.
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Best practices. The topic of counseling raised a further
question of what is the best care/treatment where resources are scarce.
Counseling – a professional in a helping relationship –
is important, but in resource-poor settings, it is also critical to
identify individuals who can get basic skills for leading people to
accept testing and testing results. For example, one can take extension
agents in nutrition and agriculture and train them to help improve
nutrition – particularly for the HIV-positive population –
for better health status. In addition, it is important to re-professionalize
those in the medical professional, including pharmacists.
Thirdly, attention to nutritional state and intake is critical because
of their importance for the trajectory of the disease and of mother-to-child
transmission of HIV. For example, co-infection or exposure to other
pathogens that weaken an individual’s immune status are often
little heeded or even understood. Yet aflatoxins, for example, can
cause chronic or acute disease. They are especially an issue where
groundnuts, maize, or dried fruits and fish figure significantly in
the local diet. More research is needed in this area. Nutrition, furthermore,
can be helpful for obtaining further referrals. VCT centers can provide
malnourished individuals with a card for World Food Program supplements
(WFP does have dietary standards for HIV-positives) or provide kits
and vitamins supplements. In South Africa, where nutrition is an issue
for all, let alone good nutrition, sorghum was found to be useful
because it is especially nutrient-dense, especially when ARVs are
provided. The South African president said, in fact, that “nutrition
must go hand-in-hand with treatment. Improved nutrition will also
reduce opportunistic infections.
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Anti-retroviral drugs (ARVs). What criteria should be used
where ARVs are scarce compared to HIV/AIDS prevalence? In Swaziland,
ARVs are distributed equally across geographic areas, then according
to CD4-count thresholds (including a minimum count), and then on a
first-come first-served basis. Criteria in general should encompass
clinical status, individual health status, and social support systems
available to the patient. In addition, it was suggested that, as in
Lesotho, people who are working should pay some amount towards the
cost of the drugs. Conclusion: it is important to define the operating
principle that will guide selection – for example, the need
to maintain a healthy workforce in order to increase productivity
and economic growth.
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Other Issues.
o Prevention of Mother-to-Child Transmission (PMTCT) should be a first
consideration.
o Workforce: Are there enough ARVS? Also, the concept of a right to
drugs is new for HIV/AIDS as compared to other diseases.
o Prevention versus ARVS: if we don’t treat and prevent, we
face the extinction of countries from HIV/AIDS.
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