3.1 Access to medical care
In industrialized countries the development of highly active
antiretroviral therapy (HAART) has had a dramatic effect on the long-term
survival of people with HIV. This has meant that there is great benefit for
people with HIV to be aware of their seropositive status so that they can start
treatment earlier, thus avoiding HIV-associated illnesses and prolonging their
life. In Europe and the United States the death rate from HIV has fallen
significantly over the past five years as a result of the availability of HAART
(Carpenteret al., 200096). Ongoing counselling has been shown to be
an important factor in ensuring adherence (Revsin et al., 199897,
Greene et al., 200098).
Less costly interventions to reduce the incidence of
HIV-associated infections, such as tuberculosis preventive therapy (TBPT), have
been shown to reduce the incidence of TB among people with HIV (Mwinga et al.,
199899), (WHO/UNAIDS100). Two studies from sub-Saharan
Africa (Godfrey-Faussett et al., 1995 101, Aisu et al.,
1995102) have shown that VCT can be an appropriate site for screening
and treating people who test seropositive for active TB, and providing TBPT to
those without active TB. In Haiti, a community-based programme offering VCT and
screening for TB was effective in identifying early TB and instigating prompt
and effective treatment (Desormeaux et al., 1996103). In Zambia, a
pilot project of integrated HIV and TB counselling for families is being
developed. Early results demonstrate that this is to be acceptable but
longer-term follow-up is awaited (Ayleset al., 2000104). In Malawi,
the Malawi AIDS counselling and resource organization (MACRO) provides VCT at
two sites. It also provides TB and STI screening and treatment and family
planning. There is considerable demand for these services by people following
VCT, even among people who attend VCT for primarily non-medical reasons (Phiri
et al., 2000105).
Other preventive therapies such as cotrimoxazole prophylaxis
(Anglaret et al., 1999106, Wiktor et al., 1999107
Sassan-Morokro et al., 1998108) have also been shown to prevent
morbidity in PLHA in some settings (seropositive TB patients in CdIvoire and Senegal). Cotrimoxazole is cheap, easy to administer and
requires minimal monitoring. UNAIDS has recommended that it should be made more
widely available to PLHA.
Family planning services
Referral for other services, such as contraception, can help
couples (both seropositive and seronegative) make informed decisions about
family planning methods and having children (Pugh et al., 1998109).
In many high-prevalence countries the desire to have children is strong and
there have been no significant differences in the uptake of family planning
services for seropositive and seronegative women. In Rakai, Uganda, 13% of
positive women and 12% of negative women used female-controlled family planning
following VCT (Lutalo et al., 2000110).
Ongoing medical care
One of the most valued services offered to people following VCT
at Kara, Zambia, was the provision of basic, ongoing medical care for the
treatment of HIV-associated infections (Baggaley et al., 1998). Similar findings
were evident from The AIDS Support Organization (TASO), Uganda, evaluation.
Complementary medical services
In many countries where ARVs are not available because of cost
and lack of laboratory infrastructure PLHA may have symptomatic benefit from
complementary/traditional medicines (Gouskov, 2000111).
However, sometimes counsel-lors may have a role in challenging unrealistic
beliefs about complementary therapies or assisting clients in discussing the
pros and cons regarding decisions about allocating limited family resources to