25 Years of HIV/AIDS – What Lessons Have We Learnt?
HIV and AIDS continue to infect people who have never seen a doctor or learned how it is transmitted, people who face enormous barriers to practicing preventive behaviors, people whose immediate need for food and security is so profound that long-term concerns like HIV prevention and treatment seem irrelevant.
Even where resources are plentiful, many people with HIV disease do not receive the prevention and care interventions they need. In the United States, more than one-third of all HIV infections are undiagnosed and a large portion of the HIV-positive population receives substandard care. Across the globe, many people in need do not receive services simply because services do not exist.
AED works in the U.S. and in developing countries around the world to develop such approaches. What we have learned in Nashville, Tennessee, informs our work in Central America, just as our experience in African nations enhances our ability to design interventions for U.S. programs. As the impact of HIV/AIDS intensifies in many U.S. communities, and many countries begin to struggle with the pandemic, we cannot afford to overlook the lessons learned in fighting HIV/AIDS in any single country, city, or village.
HIV/AIDS Lessons Learned…
“Arguably, the biggest challenge to the science of HIV prevention is the need to implement, in full, what has already been learned.”1
AED believes that integrated and comprehensive HIV/AIDS prevention programs reinforce messages, prevent missed opportunities, and provide realistic options for infected and at-risk individuals.
Moving forward to the next phase in HIV prevention and care requires us to recognize what works, document lessons learned, and incorporate these lessons in future programs.
AED is pleased to share the following key lessons gained from our domestic and international program experience in HIV/AIDS prevention and care.
Although not exhaustive, these lessons provide a comprehensive platform of key drivers and linkages for change to support successful efforts in HIV/AIDS prevention and care.
* HIV prevention activities must be a cornerstone of HIV/AIDS programs. Until the advent of an effective preventive AIDS vaccine, the battle for adoption of low-risk behaviors must be continual and adaptive to meet new perceptions and needs of ever-changing populations.
* Multi-sectoral approaches offer realistic opportunities to link prevention to treatment. The immediacy of the AIDS epidemic for HIV-positive and high-risk negatives makes school settings, family-focused health services, and workplaces critical venues and options for ensuring access to linked prevention-treatment interventions. Engaging PLWHA in HIV prevention is critical to successful interventions. PLWHA involvement supports effective advocates for change, increases adoption of prevention behaviors, and reduces transmission.
* Diffusing effective interventions and approaches increases the likelihood that effective programs will be carried out. Documenting, sharing, and replicating successful behavioral interventions results in more effective use of resources, builds local capacity, and sustains successful models.
* HIV/AIDS prevention for women and PMTCT is most effective when integrated into pre-existing sites and services. A comprehensive approach supports women through a “one-stop shop” option, and increases the likelihood of reaching families.
* Community involvement is critical in all phases of HIV prevention. Local involvement in planning, implementation, and evaluation promotes greater acceptance of behavior change strategies and assures contextually relevant approaches.
* Programs for orphans and vulnerable children (OVC) must be comprehensive. Providing care and support to OVCs through multiple outlets, including schools, community, and caregivers creates a network that improves the child’s chance of survival and success.
* HIV prevention and care must be linked—we need a flexible but responsive mix of prevention, treatment, and care interventions. After 20 years, we still lack an understanding of what specific interventions (i.e., the exact mix, the intensity, and the duration) are needed in a given country to effectively combat HIV/AIDS. With access to effective treatments increasing, and PLWHA living longer and healthier lives, the importance of integrating prevention and treatment has never been more urgent.
The Academy for Educational Development (AED) is a non profit organisation working to resolve critical social problems throughout the world