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close this bookGuidelines for HIV Interventions in Emergency Settings (Joint United Nations Programme on HIV/AIDS - United Nations High Commission for Refugee - World Health Organisation, 1996, 62 p.)
View the document(introduction...)
View the documentAknowledgements
View the document1. Introduction
View the document2. Why is HIV/AIDS a priority in emergencies?
View the document3. The importance of advocacy
Open this folder and view contents4. Stages of an emergency
Open this folder and view contents5. The essential minimum package
View the document6. Mobilization of the minimum package
View the document7. HIV/AIDS-Related human rights and ethics during emergencies
View the document8. Comprehensive care for people with HIV/AIDS in the post-acute phase
View the document9. Needs assessment for HIV interventions in emergencies
Open this folder and view contentsAppendix 1
Open this folder and view contentsAppendix 2
Open this folder and view contentsAppendix 3
View the documentAppendix 4 - How to use the right condoms the right way4
View the documentAppendix 5 - Example of a brochure on safer sexual behaviour
View the documentAppendix 6 - Needs assessment: continuous and discontinuous data
View the documentReferences

8. Comprehensive care for people with HIV/AIDS in the post-acute phase

Comprehensive care for people with HIV-related illnesses should be seen as a essential component of basic curative care in any refugee situation. This is especially important when refugees come from an area where HIV-related illnesses have become a predominant cause of morbidity and mortality. As tuberculosis is one of the main presenting problems in people with HIV, serious consideration must be given to the feasibility of introducing a tuberculosis diagnosis, management and control programme.

The elements of comprehensive care include: clinical management - early diagnosis, rational treatment and planning for follow-up care; nursing care to promote and maintain hygiene and nutrition, provide palliative care, educate individuals and families on AIDS prevention and care; counselling to help individuals make informed decisions on HIV testing when available, stress and anxiety reduction, and promoting safer sex; and social support -information and referral to support groups, welfare services and legal advice.

The introduction of comprehensive care for HIV-infected persons in refugee situations involves:

· Sensitizing health workers to HIV-related illnesses and AIDS.

· Adapting existing clinical and nursing guidelines for case management in primary and secondary care in refugee settings. This should include guidelines on discharge and referral of people with HIV-related problems.

· Drawing up an essential drugs list for treatment of HIV-related illness and establishing mechanisms to ensure the procurement and supply of these drugs.

· Training health care workers in the use of the clinical guidelines and essential drugs list.

· Introducing counselling training for health and lay workers, and developing guidelines for the provision of counselling. This can be integrated into counselling for other stresses related to the refugee situation.

· Ensuring that HIV-related care is fully integrated into basic curative services, and that prevention components (e.g. supply of condoms) are part of the care.

· Developing community support for AIDS care by:

- exploring community capacities and commitment;

- encouraging the development and training of self-help and other community-based support groups;

- starting community-based care and support activities, using the self-help groups that have been established.

· Developing a tuberculosis control policy which includes: case definition and diagnosis of tuberculosis in a refugee situation, appropriate regimens to be followed, supervised ambulatory care, mechanisms to ensure case-holding, especially where refugee populations are likely to move, management of complications and side effects of drugs, and tracing of contacts and case-finding.

· Collecting data on numbers of AIDS cases, using the WHO clinical definition.

Further reading

1. Guidelines for the clinical management of HIV infection in adults. Geneva, World Health Organization, 1991 (document WHO/GPA/IDS/HCS/91.6).

2. Guidelines for the clinical management of HIV infection in children. Geneva, World Health Organization, 1991 (document WHO/GPA/IDS/HCS/93.3).

3. HIV prevention and care: teaching modules for nurses and midwives. Geneva, World Health Organization, 1991 (document WHO/GPA/CNP/TMD/93.3).

4. Slide set on Clinical aspects of HIV infection in adults (document GPA/IDS/HCS/93.4).

5. HIV/AIDS counselling: A key to caring: guidelines for policy makers and planners. Geneva, World Health Organization, 1995 (document WHO/GPA/TCO/HCS/95.15).

6. AIDS home care handbook. Geneva, World Health Organization, 1993 (document WHO/GPA/IDS/HCS/93.2).

7. Sourcebook for HIV/AIDS counselling training (document WHO/GPA/TCO/HCS/94.9)