Involving the community in HIV/AIDS Prevention and Care
Community participation encourages the development of crucial strategies designed to protect and promote human rights.

• The utilisation of multiple health promotion channels including community participation in research, involvement of peer educators and caregivers, and reliance on community staff and genuine community-based organisations constitute effective ways to respond to the HIV/AIDS epidemic.

In Senegal, community organisations efforts improve prevention and care through training, advocacy and technical support.

• It concluded that community capacity building is essential, and that social change occurs if reflection exists in individuals and organisations.

• Communities need to create spaces for discussions on relevant HIV/AIDS issues to allow a common understanding of the epidemic in the community and lay the foundation for strategic alliances between men and women, those who are infected and those who are not, and between this generation and the next.

In Tanzania, a programme promotes community mobilisation through a strategy of risk behaviour mapping.

• The analysis of the maps showed discrepancies in the perspectives of men and women. These discrepancies illustrate the need for a gender sensitive approach in programme design and implementation.

Some community programmes integrate care and prevention and strengthen community members and AIDS activists in their roles as social actors and change agents.

Stigma, as conceived by Erving Goffman, touches on the physical, behavioural and social aspects of life.

• HIV/AIDS creates physical stigma (fear of contagion), behavioural stigma (moralistic judgement on homosexual practices and injection drug use), and social stigma (discrimination).
• Resulting isolation has serious implications, for example, on identification of vaccine trial participants.

• Ethical principles such as respect, solidarity, and justice should be guiding our response to stigmatisation. Education and advocacy is crucial for eliminating discriminatory policies.

Equity issues appear in the administration of combination therapy in resource-rich societies.

• A U.S. study found that while more than three-fourths of PWAs are currently receiving combination antiretroviral therapy, protease inhibitors may be less accessible to persons of low socio-economic status.

Another U.S. study found many people continue to believe that mandatory testing of specific groups should be pursued.

• Many people still express discomfort about personal contact with PWAs.
• Surprisingly, the belief that HIV can be transmitted through casual contact is more widespread than at the beginning of the decade, and that the public continues to strongly associate AIDS with gay and bisexual men.

In a presentation from Tanzania, AIDS stigma is also found to persist.

• This is apparently due to a complex blend of traditional, religious, medical and other societal factors.
• The effectiveness of voluntary HIV testing and counselling is very much threatened by denial, which is still a dominant reaction to HIV/AIDS.

• In Ontario, medication costs were 57% of total HIV costs in 1997 (McMurchy et al.).
• A scenario for Mexico indicates that HIV/AIDS costs will rise up to at least 2% of total health-care budgets by the end of the century.

• Major problems in affordability are reported for developing countries. With percentages up to 67% of GDP, Africa seems to face the greatest problem.

• Price reductions of antiretrovirals might improve this situation. Reductions can be expected from the experience with AZT, which dropped dramatically in price since its introduction on the market.

Benefits of HAART translate in increases in family stability, quality of life, productivity. Unplanned outpatient visits and inpatient care needs are reduced. HAART may produce benefits that exceed costs from a societal perspective.

• It was argued that several unethical aspects are related to these type of studies, such as uncompleted informed consent, lack of continuity in treatment after the study-period and provision of placebos.
• Several other arguments were presented in favour of these studies.

• The gap still remains. Debates such as this highlight the need for ethicists and researchers from both developed and developing countries to contribute to the design of clinical trials, particularly those taking place in developing countries.

• However, due to women’s lack of power, many times men determine whether this is an acceptable option or not.
• This issue has proven to be especially difficult for women in stable couples since it bring up issues of fidelity and trust.

In response to these issues, the need for women-centred control methods has been clearly expressed.

• In a project, it was shown that providing women with information about their anatomy, reproductive physiology and different STD prevention methods is empowering .
• Female condom is an acceptable prevention method for women.

Microbicides development, especially the ones that allow conception, is one of the fundamental items on the agenda of HIV prevention for women. But it seems that this research has not advanced because of lack of resources.