The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 19: Palliative Care in Resource-Poor SettingsIn resource-poor countries, where both cancer and AIDS are typically diagnosed very late in thecourse of a patient’s illness, palliative care services may dominate the available services. Insettings where disease-specific therapies are available, palliative care services are balancedwith26disease-specificpicastherapies.It is important to stress that National AIDS Programs should avoid viewing palliative care anddisease-specific therapies as an either/or phenomenon. The more modern and ethically appropriateapproach is to view active disease-specific therapies and palliative care as part of a continuumin which patient needs and available resources determine the prioritization and balanced use ofcare strategies. Attention must also be given to how the available resources can be fairly distributedto the largest population in a cost-effective and efficient system of healthcare delivery.Barriers to Implementing Palliative Care in Resource-Poor SettingsNumerous reports have outlined the major barriers in resource-poor settings to implementingthe key elements of HIV/AIDS care and support. 9, 10 These barriers range from serious limitationsposed by scarce monetary, nutritional, and human resources to the low priority placed onAIDS care in national health budgets. Medical, religious, gender, social, and cultural barriersalso exist—including the social- and self-stigmatization of HIV/AIDS—as well as behaviors andpractices that impede the implementation of prevention and care policies.People with HIV/AIDS often suffer significant psychosocial distress related to their experienceof serious life-threatening illness at an early age, social ostracism associated with their illness,and the common and concurrent organic mental disorders caused by the HIV infection. Theyalso suffer significant physical distress due to complications of opportunistic infections andtumors, which may include major symptoms such as pain, nausea and vomiting, fatigue, insomnia,anxiety, depression, and delirium. 11 In addition, major environmental and geographical factorsmay add barriers to providing HIV/AIDS care and treatment; for example, many peopleliving with HIV/AIDS in the developing world reside in rural areas far from available treatmentresources.An estimated 50% to 60% of people with HIV/AIDS worldwide have no access to healthcare professionalsto address their medical needs. In Uganda, for instance, 88% of the population livesmore than 10 kilometers from any kind of health facility, and many of these facilities lack trainedpersonnel and the most basic medical supplies and medications. 12 This lack of medical resourcesoccurs in a setting where many people are also deprived of the most basic necessities of food,water, housing, and income.WHO and UNAIDS have summarized major barriers to implementing the key components ofHIV/AIDS care and support: 8• Low priority of financial support to the health sector nationally and internationally• Low priority of HIV care within national health budgets• Globalization policies that prohibit a strong emphasis on HIV care in practice• Lack of investments in building infrastructure• Serious managerial weaknesses at all levels of the health sector• Insufficient remuneration and support for care professionals• Loss of staff due to high HIV-related mortality and morbidity390U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau