Learn More About HIV/AIDS

The total number of people living with HIV stands at 40.3 million, double the number (19.9 million) in 1995. Despite increased attention on AIDS in developing countries and access to anti-retroviral treatment, the AIDS epidemic is outpacing global efforts to contain it. “To get ahead of the epidemic, there is growing recognition that HIV prevention efforts must be scaled up and intensified, as part of a comprehensive response that simultaneously expands access to treatment and care (UNAIDS, 2005). Evidence indicates that simultaneous concerted efforts in these three areas, does yield results. UNAIDS predicts a comprehensive strategy of treatment, care, and prevention would avert 55% of the new infections predicted up to 2020.

Challenges to Prevention

Several challenges to prevention exist: the lack of concern regarding the epidemic, the stigma associated with being HIV positive, and the lack of education about HIV.
People often try to distance themselves from the disease by associating the disease with specific behavior such as injecting drug use, sex between men, and prostitution. People believe that because they don’t engage in these behaviors, they aren’t at risk. This perception of low-risk results in little concern or panic around the epidemic by the public. And because these behaviors are already stigmatized in many societies, HIV becomes stigmatized by association. As a result, many people are in denial about their HIV positive status and have no public forum in which to discuss it. The only people who tend to speak about HIV in public or openly are foreigners (working for NGOs), local doctors, nurses and professionals in the social change work.
Fear of the repercussions, if found HIV positive prevents many people from being tested to determine their status. If a person suspects or knows they are HIV positive, they are reluctant to change behavior or seek treatment that may lead family or community members to outcast them. Even people who are sick and dying of AIDS at times don’t acknowledge their condition to seek treatment and care.
Owing to the stigma around HIV/AIDS, knowledge about HIV is still inadequate (UNAIDS/WHO, December 2005 Update). Lack of myth-free, factual information about HIV and how it is spread is another key reason that poses a challenge to prevention efforts. Today, less than 20% of the people can accurately articulate how the infection can be prevented. Additionally, myths such as, the ineffectiveness of condoms in prevention of the disease, that if you have not sinned, you need not fear infection - all lead to a casual approach toward condom use and other preventive measures.

Our response
POL programs work to increase awareness about the disease so that some of the challenges to prevention are reduced. Some of the ways that our programs work towards reduction of stigma are:

• With proper treatment and nutrition, community members who are HIV positive are still able to work, go to school, and be an active part of the community.
• We move care giving into the community and make it a family and a community concern. PLWHA are not isolated at home or in an institution. They are still interacting with family and community members.
• Our programs have a strong education component built into them so that family members get accurate information about HIV that they can pass on to other members of the community. Community health workers, trained within our programs, provide factual information to community members. Additionally, we foster an open atmosphere where discussing HIV/AIDS and related issues is not only accepted, but encouraged.

All the above measures have a significant impact in raising awareness about the disease and reducing the fear and stigma around HIV.

Challenges to Treatment

One of the greatest challenges to treatment is identifying people who are HIV positive, provision of ART to those who need it, and strict adherence to the medication regime.
Studies have shown that only one in ten people living with HIV has been tested and knows that he or she is infected (USAIDS, 2005). As a result, people unknowingly continue to spread the disease. This can be avoided by voluntary testing, and if found positive by getting treatment and adhering to it.
If a person gets tested and is found to be HIV positive, the next step is to provide her/him with anti-retroviral (ARV) treatment. ARV’s have an immediate benefit on the health and quality of life of the PLWHA because they strengthen her/his immune system. However, ARV distribution centers are not easily accessible to community members as they are located far away from the community, patients have long waits, and there is a shortage of drugs.
Once the person begins ARV treatment, it is important that she/he maintains a strict adherence to the medications. Evidence indicates that if PLWHA do not properly take the drugs during the first week, they will have continuous difficulty with the drug regimen. For children, the process of taking the drugs is more complicated than for adults and is often difficult for caregivers to administer.
After three months of ARV treatment, the immune system has strengthened to the point that it can fight the virus. At this stage in treatment, the PLWHA may develop a high fever and show signs of sickness as their body kills the virus. Without proper education and reassurance, the patient or caregiver can interpret this as a negative impact of the medication and may discontinue the use of ARV’s and go back to traditional remedies. This can lead to several side effects including the patient’s body building up resistance to the administered drugs so that these drugs will be ineffective at a later point in time. On the other hand, if the patient continues the drug regimen, he/she starts to feel better. But after 10 months or so, the patient may again discontinue ART assuming that it is no longer needed when, in fact, ARV treatment is a lifelong commitment.

Our response
Stigma and lack of factual information are the greatest inhibitors to people getting tested. Our pilot program includes an initial training session to caregivers that discusses how the conditions that the child is experiencing could be related HIV/AIDS and the importance of testing. The first set of caregivers who have completed training have been providing future trainees, personal testimonies regarding their experience of testing, ARV treatment, and the positive effects on their children. As a result, 50% of the children were tested within the first two weeks of the initial training.
Our programs include a process of monitoring, ongoing training, and building a caregiver network that emphasizes HIV testing and ARV treatment. This constant reinforcement has resulted in 96 of our 100 children being tested, and high adherence rates for anti-retroviral therapy.

Challenges to Care

PLWHA have high risk of getting opportunistic infections (cerebral malaria, tuberculosis, meningitis, skin infections and diarrhea). If left unattended, these infections quickly escalate requiring intensive hospitalized care, often unavailable in the overburdened health care systems of most developing countries.
Traditionally, Africa has had extended family and community structures that provide care; these structures have crumbled under the weight of HIV/AIDS. The severe shortage of health care workers and facilities further deprives people of timely intervention and quality care.

Our response
POL believes that the solution to the lack of healthcare infrastructure still lies within the community. Based on this belief, we provide training to family members of sick children. The training includes information about HIV/AIDS, information on early detection of opportunistic infections and training on treatment and care at home. Our pilot program has proven that by training caregivers (members of the family of the sick child), the intervention needed by health workers has been dramatically reduced and the patients are able receive timely, quality care in their own homes.
By reducing the frequency and severity of opportunistic infections, people living with HIV/AIDS have an opportunity to lead normal, productive lives: working, attending school, and maintaining their family structure. We believe that this will eventually lead to the reparation of the social fabric of the community.