AIDSLINK - "NCIH AIDS Network Newsletter #44, March/April 1977; published by The National Council for International Health, 1701 K Street, NW, Suite 600, Washington, DC 20006, USA Tel: (202) 833-5900 Fax: (202) 833-0075 Email: ncih@ncih.org
Ron MacInnis, Jr.

The dusty heat of Mali never dries out the charm and warm demeanor of the men and women who open their arms and hearts to visitors from abroad. What they showed to us during our brief visit was an ambitious national effort to respond to the AIDS epidemic in Mali; a national effort with a minimum of resources unable to support a holistic strategy.

By far, the largest contributor to HIV/AIDS-related programs in Mali is USAID which gives several million dollars annually to AIDS prevention efforts, half of which are funneled through private voluntary organizations, like Plan International, Africare, and World Vision. In some regions of Maii, 20 percent of the adult population is estimated to be infected with the H1\/ virus, yet a limited effort has been allocated to providing HIV/AIDS care and treatment programs in Mali. Under the current USAID mandate, care and treatment programs cannot be funded, and its programs are therefore exclusively focused on preventive education and condom social marketing.

It seems clear to me as it was to many of the Malian doctors and public health technicians I spoke to in Mali, that caring for and supporting those infected with the HIV virus is a crucial tactic in the struggle to prevent its spread. It needs to be emphasized that people living with HIV and AIDS can take measures to protect their own health and can learn to change their behavior to protect their sexual partners.

If greater efforts are put into diagnostic programming in places like Mali, then care and treatment for opportunistic infections can have a much more cost-effective and life sustaining impact. And, as is well documented, preventing opportunistic infection is less expensive than tertiary care for end-stage AIDS patients. As has been seen in countries like Uganda, only when communities truly experience HIV in their midst by acknowledging and participating in the care of those infected with it will they have embraced the problem, and can then begin to effectively think about and act on HIV prevention.

This is hardly a new concept, the prevention-to-care continuum. But it is a concept that has been hard to sell to donor agencies who have developed the preference to support and fund programs with discrete objectives rather than the more comprehensive goals of integrated prevention and care services.

In places like Mali, preventive education efforts have shown successes in promoting awareness among certain population groups. In a recent survey taken in Mali, 77% of women and 96% Of men had heard about the HIV/AIDS virus. This is not to be taken lightly, awareness is an important beginning to controlling an epidemic. Yet, in places like Mali, there are only three sites in a country of 9 million persons where men and women can be tested for their HIV-status. And if they are fortunate enough to have access to the test, then what? If theire positive what do they do? If they're negative, how are they motivated to stay that way?

The concept of care within the HIV/AIDS prevention-to-care continuum is frightening to a lot of donors and institutions who often equate it with procurement of medications) medical supplies, laboratory equipment, and expensive retroviral drugs.

In fact, care has many components to it, many of which are provided in other health and development programs. The challenge now will be to take into consideration the limited resources needed to develop innovative programs that meet these varying, but interrelated needs:

· Medical care - which includes appropriate diagnosis, rational treatment for opportunistic infection, and planning for follow- up, and treating for STDs to prevent easier spread of HIV and provide direct educational opportunity between care-giver and patient;

. Traditional care - which includes promoting proven and accepted local healing practices and alternative and complementary therapies that can benefit people living with HIV/AIDS, and allowing for spiritual support and participation of spiritual leaders;

· Nursing care - which includes providing health care, health mainte- nance, promoting hygiene and nutrition, counselling and educating family members on prevention as well as on how to care for the afflicted family member;

· Counseling - which includes facilitating informed decision making (e.g. whether to get tested), providing post-test counseling, promoting positive living and planning for the future;

Social support services - includes providing information, developing support groups, and helping those with HIV/AIDS to gain access to existing community services;

Many of these activities do exist in various forms in Mali and other developing countries in Asia, Latin America and Africa, depending on national commitments and international donor interests. There has not yet been however, an established integrated approach by donor agencies to launch HIV/AIDS programs using the prevention to care continuum model.

Donor agencies and PVOs that finance and implement HIVIAIDS prevention projects are beginning to examine the reality of AIDS as a development issue and are slowly adapting to respond accordingly.

USAID's global HIV/AIDS efforts are implementing care strategies as formal components of their objectives beginning this year. What they and other implementing agencies need to take into consideration is the community s ability to provide many of these services. Using people living with AIDS (PWAs) as peer educators in the community is important, and not just as a fear mechanism. It is just as important to have PWAs show how being HIV positive is not an automatic death sentence, if the individual's status is detected early enough.

What the AIDS epidemic has proven to us, is that concentrating our efforts on a single method of response is neither cost effective nor successful. The option of providing care and support services should not be weighed against funding and programming of prevention efforts, but should be seen as a necessary addition to strengthening the prevention of the spread of HIV/AIDS.

Copyright (c) 1997. Material from AIDSLINK may be reproduced but please acknowledge the source and send the editor a copy of the reprinted material. Opinions expressed in AIDSLink are not necessarily those of NCIH, the AIDS Program or USAID. The description of an event, organization, or publication does not necessary constitute an endorsement from NCIH.

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