USAID's Activities: Care and Treatment of HIV/AIDS

The Role of Care and Treatment

USAID's Response

Introducing antiretroviral drugs. In 2003, USAID’s care and treatment activities expanded to include the introduction of life-saving antiretroviral drug therapies in developing countries. Significant declines in the price of these drugs have enabled USAID and its partners to integrate antiretroviral treatment and management into relevant prevention and care programs. In its three introductory sites, USAID is creating models for antiretroviral treatment that governments and the private sector can expand to a national level. By the end of 2003, approximately 500 patients will receive treatment in the three countries.

• Ghana: In Ghana, the "Start" program is a comprehensive prevention, care and treatment program that is designed to define, refine and document approaches to HIV/AIDS service delivery in resource-poor settings. "Start" will begin in two districts in the Eastern Region of Ghana, where an estimated 18,000 people out of 240,000 are HIV positive. The government of Ghana will utilize funds from the Global Fund to Fight AIDS, Tuberculosis, and Malaria to expand the number of people treated at the three USAID supported sites. This will be the first example of USAID programs leveraging Global Fund resources for AIDS treatment. USAID assistance in developing the skills and infrastructure necessary to provide these treatment services will help ensure that the Global Fund resources achieve maximum impact.
  
  
• Kenya: On May 23, 2003, USAID started ARV treatment in Mombassa, Kenya, at the Coast Provincial General Hospital, and at two primary health care centers that have ongoing voluntary HIV counseling and testing services.
  
  
• Rwanda: On February 27, 2003 four HIV-positive patients at the Biryogo Medical and Social Center became the first to receive antiretroviral therapy under a new USAID-supported effort. These first four patients are women; three are widows caring for their own children as well as orphans from the 1994 war and genocide. None of them is able to work because of HIV-related illnesses. The fourth woman is a 20-year-old unmarried student who aspires to be a laboratory technician and continue her education at the university level. The treatment program will build on existing HIV counseling and testing services, and expand the range of medical care and support services that are available to HIV-infected individuals. In this site, a major focus will be on supporting community responses to provide home-based care as a complement to clinic-based services. A second site will begin treatment later in the year.
  


• The Costs of Antiretroviral Treatment in Zambia [PDF, 176KB]

Working with faith- and community-based organizations. While people of faith around the world hold differing views on how best to prevent HIV infection, all belief systems have compassionate care for the sick as a core value. As USAID expands its work in care and support for people living with HIV and AIDS, community and faith-based organizations will be essential partners in providing voluntary HIV counseling and testing, home care, clinical services, and advanced treatments. A USAID initiative, Communities Organized in Response to the HIV/AIDS Epidemic (CORE), strives to get resources and technical assistance to faith-based and community-based organizations, which are often best suited to provide care and support.

Home-based care. Home-based care allows AIDS patients to remain in the community, fostering better understanding of HIV/AIDS within families and the community and permitting questions and misunderstandings about prevention and care to be addressed as they arise. Home-based care for people living with HIV/AIDS is particularly important in developing countries where there is a severe shortage of hospital beds, inability to afford prophylactic drug therapies, and poor nutrition. In Cambodia, a USAID-supported organization sends home care teams to provide palliative care, counseling, education, and welfare support to patients and family members in the 16 provinces hardest hit by the HIV/AIDS epidemic.

Treating TB and other opportunistic infections. Almost one-third of people living with HIV have tuberculosis, and it is the leading cause of death in AIDS patients. Prevention and treatment of active tuberculosis is one of the most important interventions for increasing the length and quality of life of those infected with HIV. USAID is making significant investments in building the essential health care infrastructure to provide care and treatment of tuberculosis and other opportunistic infections. USAID is expanding implementation of the highly effective Directly Observed Treatment, Short Course (DOTS) strategy for treating tuberculosis and is investing in research to develop rapid, low-cost diagnostics, cost-effective new drugs, and improved approaches to implementing DOTS.

Support to children affected by HIV/AIDS. USAID is currently funding more than 77 activities in 24 countries to support children affected by HIV/AIDS. Many of these activities focus on strengthening the abilities of families and communities to provide care and support, and linking them with government social services; helping children and adolescents obtain an education; helping a family preserve their livelihood; and supporting policy development and research. USAID supports community- and faith-based organizations that have been the leaders in helping these children. In Romania, USAID-supported activities have included training of health care providers in pediatric AIDS care, creation of an outpatient care and treatment facility for HIV-positive children, social services and case management for families with HIV-positive children, and strengthening the ability of government and local organizations to effectively respond to the issues of children affected by HIV/AIDS.

Providing adequate nutrition. A USAID study found that, compared with an average adult, a person with HIV requires 10 to 15 percent more energy a day, and 50 to 100 percent more protein a day. USAID is now incorporating food security activities into care and support efforts. Since 2000, USAID has provided $10 million per year in food aid to children and families affected by HIV/AIDS.

Psychosocial and palliative care. Psychosocial support can help infected individuals and their families cope with a life-threatening disease and alleviate the economic loss and social stigma that often accompany HIV/AIDS. In addition, palliative care for HIV/AIDS symptoms can ease the physical discomfort caused by the disease. In Uganda, USAID supports The AIDS Support Organization in implementing activities such as succession planning, in which children and their HIV-positive parents are assisted in discussing HIV status and future plans; training for teachers, parents, and other caregivers in counseling skills; workshops for foster parents on key issues in caring for orphans; and support visits to schools and families.

Microfinance. The HIV/AIDS pandemic presents enormous economic challenges to households and communities. People living with HIV/AIDS may suffer discrimination from financial institutions and traditional credit schemes. To mitigate the economic effects of HIV/AIDS on low-income populations, USAID implements microfinance activities that give vulnerable households access to credit and enable them to generate income. In Zambia, USAID has provided training and grants to organizations to manage community-based revolving loans. The loans are given to individual vulnerable households to boost their income-generating activities so that they can meet the needs of children under their care.

May 2003

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