Position of The Canadian Dietetic Association and The American Dietetic Association: nutrition intervention in the care of persons with human immunodeficiency virus infection

The goals of nutrition intervention in HIV disease include early assessment and treatment of nutrient deficiencies, the maintenance and restoration of lean body mass, and support for activities of daily living and quality of life. The maintenance and restoration of nutritional stores is closely interrelated and interdependent with each of the other recommended medical therapies. Therefore, it is vital to the health of persons with HIV/AIDS to have access to the services of a registered dietitian, who is the essential member of the health care team for providing nutrition care (48). The registered dietitian should take an active role in developing nutrition care protocols for HIV/AIDS in their practice setting. The dietetic professional must take responsibility for obtaining and maintaining current knowledge in this area and take the lead in translating current nutrition knowledge and research into practical and realistic nutrition guidelines for the individual with HIV/AIDS. Further research is needed in the area of HIV/AIDS and nutrition. Registered dietitians and other members of the health care team are encouraged to conduct nutrition research in the area of nutrition interventions and outcomes of nutrition therapy. Additionally, government health related agencies, national AIDS-related organizations, and private industry should be encouraged to provide funding sources and support to the issue of research in nutrition related problems and interventions in HIV/AIDS.     

Stronger health systems for more effective HIV/AIDS prevention and care

Of the 42 million living with HIV/AIDS world-wide some 90% live in developing countries. The international community acknowledges the devastating impact of HIV/AIDS on development and over the past few years resources to control HIV/AIDS have increased considerably. We argue that strengthening of health systems is a necessary prerequisite for improving the prevention of HIV infection and the care of HIV-infected persons. Sexual behaviour change requires a multidisciplinary approach, but health services play a crucial role in detection and treatment of other sexually transmitted infections; HIV counselling and testing; prevention of mother-to-child transmission of HIV; and care of HIV-infected patients. Increasing access to antiretroviral treatment especially poses formidable challenges to health authorities in developing countries. Additional resources for the prevention of HIV-infection and the care of HIV-infected persons may not have the desired impact if health systems in developing countries are not strengthened. Further, any activity in the area of HIV/AIDS prevention and care, carried out within health services, can have a positive ripple effect on other health care activities and vice versa. This interactive effect needs to be acknowledged and built on.     

艾滋病防治干预模式与社区能力建设

HIV感染已成为全球最严峻的公共卫生问题之一。以社区为基础的艾滋病综合防治干预可以普及艾滋病防治知识,并为个人、家庭、社区及艾滋病防治干预服务提供者之间的相互合作提供平台,为艾滋病患者提供物质、心理、经济、法律及医疗等服务并建立良好的反歧视环境。社区能力是影响艾滋病社区综合防治干预可持续发展的关键因素,影响社区为艾滋病患者提供全面、持久、完善服务和支持。此文对艾滋病防治模式的发展和社区能力建设途径及关键环节作综述。     

The development of a comprehensive interdisciplinary HIV/AIDS center: a community needs assessment.

Meeting the needs of HIV-infected patients in a focused, cost-efficient, coordinated manner is one of the most challenging problems in health care today. Before developing an intervention program, accurate surveys of need must be done. This article presents one such needs assessment conducted in a rural section of the Midwest. The assessment consisted of (1) surveys of HIV+ individuals/people with AIDS, area physicians, and local key informants and service providers, and (2) statistical data from health departments. Results of analyses suggest that access to primary care, self-care education, mental health and family support services, case management, financial assistance, community education, and home health services are this community's highest priority needs.     

Estimating resource needs for HIV/AIDS health care services in low-income and middle-income countries

As funding mechanisms like the Global Fund for HIV/AIDS, Tuberculosis and Malaria increasingly make funding decisions on the basis of burden of disease estimates and financial need calculations, the importance of reliable and comparable estimating methods is growing. This paper presents a model for estimating HIV/AIDS health care resource needs in low- and middle-income countries. The model presented was the basis for the United Nations' call for US dollars 9.2 billion to address HIV/AIDS in developing countries by 2005 with US dollars 4.4 billion to address HIV/AIDS health care and the rest to deal with HIV/AIDS prevention. The model has since been updated and extended to produce estimates for 2007. This paper details the methods and assumptions used to estimate HIV/AIDS health care financial needs and it discusses the limitations and data needs for this model.     

湖北省相关社区组织参与艾滋病防治项目活动模式调查分析

目的：调查分析湖北省社区组织（community-based organizations,CBO）参与艾滋病防治项目活动模式,为制定更为规范的 CBO 参与艾滋病预防干预、关怀支持模式与策略提供参考。方法自行设计调查表格,汇总分析46个 CBO 相关内容。结果对暗娼人群干预以同伴教育为主;男男性行为（MSM）人群干预在社区开展自愿咨询监测、扩大艾滋病病毒检测;吸毒人群干预以家庭走访、动员吸毒者家属教育;对艾滋病病毒感染者/艾滋病患者的关怀与支持以提供医疗和心理关怀,构建社区支持网络,开展生产自救为主要模式。结论 CBO 目前已针对不同类型的艾滋病相关高危人群形成了有针对性的干预模式,并开展了大量有效的干预活动,取得了明显成效,为卫生管理部门和专业机构分担了工作任务,达到了取长补短的作用。     

贵阳市HIV/AIDS社区支持与关怀项目研究

目的 总结分析2002年贵州省贵阳市实施HIV／AIDS社区支持与关怀项目取得的经验和存在的不足。为将来更好地开展城市HIV／AIDS社区支持与关怀提出相应的对策。方法 根据贵阳市的具体情况，采取开发决策层，动员大众媒体参与，组织社会各部门合作，建立感染自助组织，构建社区支持与关怀网络的措施，开展感染生产自救，引导家庭、社区和感染周围人群关心因吸毒而感染艾滋病病毒的病人。结果 通过关怀与支持项目的开展，使媒体和社区人群对艾滋病有了新的理解和认识，自愿检测咨询人数增加；部分感染家庭理解接纳了感染，感染自身的态度转变，积极参与各项活动并提出建议和想法。结论 开展HIV／AIDS社区支持与关怀，可以使社区群众提高对艾滋病的认识，消除对艾滋病病人、HIV感染的歧视。但试点工作是初步的，尚存在一些问题，需要进行深入的研究。     

Facing the HIV / AIDS challenge: a study on household and community responses

In countries where the health care system cannot cope with the growing number of AIDS cases, the family and the community are significant sources of care and treatment. A qualitative study conducted in Mumbai, India, in 1994 sought to identify household- and community-based strategies for effective AIDS care. Enrolled were 26 individuals with HIV or AIDS, 4 couples (both partners infected), and 25 members of households with an HIV-infected person; in addition, 18 focus group discussions were held with low-income youth. None of the households contacted had abandoned a member with HIV. Household dynamics played a crucial role in the nature and quality of care received, however. The most supportive care was received by men, even when their female partner was also sick. In-laws often showed little compassion toward widowed, infected daughters-in-law. Individuals without open sores or lesions were better accepted by family members and perceived as less likely to transit the virus. Concerns about social stigmatization and isolation prevented many family members from turning to their community for support. Recommended, on the basis of these findings, are measures such as support programs to reduce the burden on female caregivers, subsidized and appropriate medical care, support groups for people with AIDS, HIV/AIDS community awareness programs, and increased involvement on the part of nongovernmental organizations in integrated programming.     

Accès aux traitements antirétroviraux dans les pays en développement : quelles stratégies de financement ?

BackgroundIn low- and middle-income countries, access to combination antiretroviral therapy for all people living with Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) in need of treatment is a major public health challenge. The objective of this paper was to provide an overview of the different financing modalities of HIV/AIDS care at the microeconomic level and analysis their advantages and limitations.MethodsA review of the published literature using mainly Medline and Science Direct databases in English and French for the period 1990 to 2008 made it possible to explore different financing strategies for access to combination antiretroviral therapy using as case studies specific countries from different regions: Ivory Coast, Uganda, Senegal and Rwanda for sub-Saharan Africa, Brazil and Haiti in the Latin America/Caribbean region and Thailand for Asia.ResultsIn these settings, direct payment through user fees is the most frequent financing mechanism in place for HIV/AIDS care and treatment, including combination antiretroviral therapy. Nevertheless, other mechanisms are being implemented to improve access to treatment such as community-based health insurance schemes with free care for poor and vulnerable households and public-private partnerships.ConclusionThe type of financing strategy for HIV/AIDS care and treatment depends on the context. As direct payment through user fees limits access to care and does not enable programme sustainability, national and donor agencies are introducing alternative strategies such as community financing system (mutual health organizations, microinsurance, community health funds) and public-private partnership. Finally, access to combination antiretroviral therapy has improved in resource-limited settings; however, there is a need to introduce alternative financial mechanisms to assure long-term universal and equitable access to treatment and care, including combination antiretroviral therapy.     

Chaos, co-existence, and the potential for collective action: HIV-related vulnerability in Brazil's international borders

In a country where quality HIV/AIDS prevention and care has been foremost on the national agenda, Brazil's extensive and diverse borders are one of the last unstudied potential hotbeds of HIV vulnerability. We carried out a rapid assessment of HIV-related services and the social context of HIV/AIDS at the Brazilian borders including current governmental and community response. The assessment was implemented in six frontier municipalities using the WHO's strategic approach methodology, which combines existing epidemiologic data with field-based qualitative data collection techniques, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. This paper focuses on the qualitative findings regarding the role of the social context in shaping HIV vulnerability at the Brazilian borders. We documented a profound lack of governmental structure and response to HIV/AIDS at the borders as well as a notable absence of social cohesion and mobilization among the diverse population groups and communities situated at the borders with regard to HIV/AIDS. The weak governmental and community response is situated within a larger socio-political context of economic inequity and social division, which must be addressed if an effective response to HIV can be developed at Brazil's international borders. Possibilities for encouraging a collective response among the diverse border populations are explored.     

Access to antiretroviral treatment in developing countries: Which financing strategies are possible?

BackgroundIn low- and middle-income countries, access to combination antiretroviral therapy for all people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in need of treatment is a major public health challenge. The objective of this paper was to provide an overview of the different financing modalities of HIV/AIDS care at the microeconomic level and an analysis of their advantages and limitations.MethodsA review of the published literature using mainly the Medline and Science Direct databases for the 1990–2008 period in English and French made it possible to explore different financing strategies for the access to combination antiretroviral therapy using as case studies specific countries from different regions: Ivory Coast, Uganda, Senegal, and Rwanda for sub-Saharan Africa, Brazil and Haiti in the Latin America/Caribbean region, and Thailand for Asia.ResultsIn these settings, direct payment through user fees is the most frequent financing mechanism in place for HIV/AIDS care and treatment, including combination antiretroviral therapy. Nevertheless, other mechanisms are being implemented to improve access to treatment such as community-based health insurance schemes with free care for the poor and vulnerable households and public–private partnerships.ConclusionThe type of financing strategy for HIV/AIDS care and treatment depends on the context. As direct payment through user fees limits access to care and does not enable program sustainability, national and donor agencies are introducing alternative strategies such as community financing systems (mutual health organizations, micro insurance, community health funds) and public–private partnerships. Finally, access to combination antiretroviral therapy has improved in resource-limited settings; however, there is a need to introduce alternative financial mechanisms to ensure long-term universal and equitable access to treatment and care, including combination antiretroviral therapy.     

喀什市社区维吾尔族妇女艾滋病认知现状调查

目的 了解新疆喀什市社区维吾尔族妇女人群对艾滋病的认知水平．为在这一人群中开展艾滋病健康教育提供依据。方法 采用定量（问卷调查）与定性研究（小组访谈）相结合的方法时社区维吾尔族妇女人群进行调查。结果 约1／3的人认为日常生活接触可以传播艾滋病，84．1％的人认为艾滋病病毒感染者值得同情和关心。大多数社区维吾尔族妇女愿意参加到防治艾滋病的活动中。结论 喀什市社区维吾尔族妇女艾滋病知识缺乏，应加强对这一人群的艾滋病健康教育。并充分考虑新疆是维吾尔族聚集区，在内容和方法上要不断改进。     

The role of the American Hospital Association in combating AIDS

The American Hospital Association (AHA) has taken a leadership role in assisting health care providers in dealing effectively with the challenges of AIDS. Early work focused on preventing infection in the health care setting with the use of the Centers for Disease Control's recommended precautions concerning blood and body fluids. Supporting this effort were a number of live teleconferences, videotapes, and publications that addressed the use of precautions with AIDS patients, community issues associated with the disease, and the development of employee policies. In July 1987, a Special Committee on AIDS/HIV Infection Policy was formed by the AHA Board of Trustees and charged with developing recommendations on the issues that needed to be addressed if hospitals were to continue to meet the challenge of AIDS effectively. The committee's first set of recommendations, approved in November 1987, reaffirmed the use of universal precautions, provided guidance on the appropriate uses and application of HIV testing, and stated that the delivery of care should not be conditioned on the willingness of a patient to undergo testing. The second set of recommendations, which were approved in January 1988, focused on the need to distribute the responsibility for AIDS care among a wide variety of health care providers, to seek creative financing approaches that involve both the private and public sectors, and called on hospitals to provide leadership in ensuring that a continuum of services is available to AIDS patients. Continuing efforts to assist hospitals in the care delivery issues associated with AIDS are described.     

AIDS: an update

In sub-Saharan Africa, where the acquired immunodeficiency syndrome (AIDS) epidemic threatens to undermine the social and economic structure of society, there has been insufficient attention to health care demand, supply, and quality issues. Most of those currently infected with human immunodeficiency virus (HIV) will register their demand for increased health services within the next six years. A study of medical insurance claims in Zimbabwe indicated that the claims of HIV-infected persons in the last 7-15 months of their lives were 700% higher than the average claim for the same age group. Absenteeism by HIV-infected health care workers is affecting the quality of care in hospitals, and countries that provide sickness benefits for public sector workers face the double drain of financing these benefits and paying for replacement staff. Emerging evidence suggests that HIV screening and counseling is not an effective intervention in this culture. Pregnant Kenyan women screened for HIV tended not to want the results, failed to inform their partner of a positive result, or were subjected to violence and abandonment when they did inform their husbands. Most effective, in this region, have been programs aimed at improving the diagnosis and treatment of sexually transmitted diseases. Other recommendations include decentralization of care to district health systems where costs are lower, increased support for home-based care, AIDS education for traditional healers, and informational campaigns to counter discrimination against HIV-infected community members.     

云南边境少数民族艾滋病低流行地区预防保健工作者相关知识、态度及需求

目的了解云南边境少数民族艾滋病低流行地区预防保健工作者艾滋病知识、态度、开展宣传教育的困难及对艾滋病知识和信息的需求.方法选择怒江傈僳族自治州福贡县全体预防保健工作者作为调查对象,进行问卷调查及个人访谈,并对问卷进行统计分析.结果预防保健工作者对艾滋病传播知识掌握较好,但对艾滋病深入一点的专业知识知晓率却很低,问卷平均得分为56.71,知识知晓状况与是否参加过培训相关.结论应加强边境少数民族艾滋病低流行区预防保健工作者艾滋病的教育,传授宣传教育的技能.     

The diffusion of a community-level HIV intervention for women: lessons learned and best practices

Abstract Early in the HIV/AIDS epidemic in the United States, relatively few women were diagnosed with HIV infection and AIDS. Today, the epidemic represents a growing and persistent health threat to women in the United States, especially young women and women of color. In 2005, the leading cause of HIV infection among African American women and Latinas was heterosexual contact. In addressing HIV prevention needs among women, community-level strategies are needed to increase consistent condom use by women and their partners and to change community norms to support safer sex behaviors. The Real AIDS Prevention Project (RAPP) is a community-based HIV prevention intervention for women and their partners. RAPP is based on a community mobilization model that involves a combination of activities, including street outreach, one-on-one discussions called stage-based encounters, role model stories, community networks, and small group activities. The objectives of RAPP are to increase consistent condom use by women and their partners and change community norms associated with perceptions of condom use and high-risk behaviors in an effort to make safer sex practice more acceptable. This paper describes the Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention (DHAP) effort to nationally diffuse RAPP from March 2003 through May 2007 and lessons learned from that diffusion experience. The paper specifically discusses (1) collaborating and planning with researchers, (2) a diffusion needs assessment that was designed to assess prior implementation experiences among select agencies, (3) developing the intervention package, (4) developing and piloting training for community-based organizations (CBOs), (5) a rollout of national trainings for health departments and community-based organizations interested in implementing RAPP, and (6) ongoing quality assurance activities and the provision of technical assistance and support. RAPP has been proven effective in reducing HIV transmission risk behaviors and improving communication and negotiation skills necessary for African American women and Latinas to reduce their risk for HIV infection and improve their overall health status.     

Providing support to caregivers and self-care

The evolution of HIV/AIDS care has resulted in a wide range of caregivers who work out of public and private hospital facilities, nongovernmental organizations (NGOs) and community-based facilities. Others are volunteers and community health and social workers based at facilities or community sites. Many caregivers are family members or part of a client's close social network. Additionally, people living with HIV/AIDS (PHA) themselves engage in self-care and provide support to other PHA through support groups. In the best-case scenario the services of these caregivers are sometimes provided free of charge at one site by a specialized NGO. In many cases, however, a person wishing to gain access to care and social services may need an understanding how the systems and procedures of various institutions operate. Many PHA are unprepared for the administrative, financial, and legal barriers that they may encounter. To cope with this need, a new type of support service called the "buddy" system has emerged. Buddies are individuals who are less directly involved with, but who know about HIV/AIDS, the services available and the rights of PHA. A buddy is close enough for the PHA to approach, has sufficient time to devote to him/her and can be asked almost everything. The article on the Rio de Janeiro Buddy Project provides an example of a project for gay men in Brazil. In other parts of the world where the buddy system is non-existent, the PHA must often rely on support provided by family and friends.     

Epidemiology of HIV and sexually transmitted infections in Thailand

There are very few developing countries in the world where public policy has been effective in preventing the spread of HIV/AIDS on a national scale. Thailand is an exception, a massive program to control HIV has reduced visits to commercial sex workers by half, raised condom usage, decreased sexually transmitted infections dramatically, and achieved substantial reductions in new HIV infections. However, unless past efforts are sustained and new sources of infection are addressed, the striking achievements made in controlling the epidemic could be put at risk. There is a need in Thailand to continue strong HIV/AIDS prevention and education efforts in the future, as well as to provide treatment and care for those living with HIV/AIDS.     

基于农村社区HIV/AIDS患者关怀支持活动模式的研究

目的探讨基于农村社区HIV/AIDS患者关怀支持活动模式。方法以农村社区为基础,由艾滋病防治专家、志愿者、社区医务人员、患者家属等组成关怀支持团队,通过开展培训、社区宣传教育、心理支持、患者交流、营养支持活动,为HIV/AIDS患者提供情感关爱和心理支持。结果本活动目标人群为150例HIV/AIDS患者,平均年龄为(44.61±10.78)岁,男性65人,女性85人。活动结束后抽取目标人群60例,采用《生存质量测定量表简表》测量其生存质量情况。活动前生存质量总分为(74.30±12.64)分,活动后总分为(84.95±16.31)分,差异有统计学意义(P<0.01)。结论建立以社区为基础的关怀支持体系,对充分发挥社区在艾滋病控制方面的参与功能、互助功能、整合功能及动员社会力量控制艾滋病传播方面有重要意义。     

Delivering Care to Rural HIV / AIDS Patients

With HIV/AIDS on the rise in rural areas, health care providers must find ways of delivering care with little or no increase in resource support. This paper examines the evolution of a rural HIV/AIDS alliance using a life cycle model to identify each stage of the alliance development and the specific issues associated with each stage. The data were collected through structured interviews and by review of background materials, including budgets, grant proposals, and program reports. The findings identify alliance strategies that can be used in other rural communities facing the challenge of serving an increasing number of HIV/AIDS patients with limited resources. Differing from other models, this rural HIV/AIDS alliance emerged from local government and community support into an independent, nonprofit organization operating through a network of interorganizational relationships.