Providing HIV prevention, care and treatment services at well-equipped local clinics could be the key to success in fighting the pandemic in the developing world, a new report by the international anti-poverty NGO, ActionAid, has said.
"We need to target and mobilise people at the most basic level of healthcare," said Miriam Were, chair of the Kenya National AIDS Control Council, at the launch of the report, Primary Concern: why primary healthcare is key to tackling HIV and AIDS, in Nairobi, Kenya.
"HIV care is much broader than just ARVs [antiretrovirals]. People living with HIV need comprehensive healthcare; health centres should have the capacity to deal with opportunistic infections."
Handling easily treatable illnesses such as tuberculosis [TB], diarrhoea and malaria at primary healthcare level would leave tertiary institutions free to deal with more serious infections.
ActionAid's report notes the example of Cuba, where huge investment in primary healthcare has seen the relatively poor country achieve health indicators that rival the United States and other countries in the developed world.
Investing in health workers and health systems
Speakers at the launch called for more training of primary healthcare workers. "What we are doing now is training lay people for a couple of weeks and then calling them expert counsellors, while we don't bother to train the primary healthcare nurses," said Leonard Okello, head of ActionAid's global HIV team. "We should be equipping health professionals with the skills to integrate HIV management into their other work."
He recently visited a clinic in western Kenya, where an international NGO had installed a condom dispenser but the nurse had never been trained to advise people on correct condom use.
"The machine sat there idle because the NGO project had trained its own people and was using the government facility, but not its staff - we need much better integration if we are to have any impact," Okello said.
The activists pressed governments, particularly in Africa, to broaden access to basic healthcare by building more health centres and improving those that already existed.
Linda Mafu, Africa regional coordinator of the World AIDS Campaign, a global coalition of national, regional and international civil society groups, said: "Health centres need to be spread out and properly equipped, so they have the capacity to deal not only with HIV, but with other diseases that affect the population. That way, people don't need to walk such long distances and queue for hours."
Okello described an initiative in Uganda to reduce transport costs. "HIV-positive people visit the health centre once every three months, unless there is an emergency, and nominate one person to bring their drugs to the village once a month," he said. "These sorts of innovations can only come from the community, because they know their situations."
The report envisions a long-term future with an efficient public health sector providing HIV services, but said there would still be a need for private sector and NGO involvement in HIV service delivery for the foreseeable future.
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"Many people, including those most vulnerable to HIV infection, such as sex workers, currently choose to opt out of the public health system," the report said. "Delaying HIV programmes until stronger health systems are in place will lead to high numbers of AIDS-related deaths."
The report's launch comes ahead of the Global Citizens Summit for Social Mobilisation to End AIDS, a meeting of civil society, international development organisations, community organisations and networks of people living with HIV, to be held in Nairobi to discuss people-centred approaches to tackling the pandemic.
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