Ellen Campbell -Grizzle - PHARMACY TODAYINFECTIOUS HOPE is an antidote to the sense of despair that hangs over many Persons Living and Working with HIV/AIDS (PLWHA). This optimism arises with the awareness of new possibilities when PLWHAs take centre stage in the management of their illness.
Many are actively engaged in charting a course leading to improved quality of life. This was evident at the recently concluded meeting of a 'Multicultural Caribbean United against HIV/AIDS' held in Santo Domingo in the Dominican Republic. Over 1,800 persons, including PLWHAs and care givers, representing the French, Spanish, Dutch and English speaking Caribbean, met to exchange information about issues related to HIV/AIDS in this region. They were joined by experts from all over the world.
HIGH ON THE AGENDA WERE:-
Stigma and discrimination
Access and availability of life-saving antiretroviral treatment (ART) especially in rural areas
Cost of treatment and monitoring
Nutritional support
Drug abuse
Prevention programmes
Social support
Status of the search for a vaccine
The discussion mirrored the present debate in Jamaica but the work that is being done all across the Caribbean provides a reason for hope. The Haitian team braved the existing turmoil in their country to share experiences with the meeting. A central message that emerged is that PLWHAs enjoy a good quality of life when they have access to ART, adhere to treatment, receive monitoring for the effectiveness of therapy with nutritional and social support. This successful formula is being replicated in many places with excellent results.
A safe and effective vaccine is the major hope for the eradication of HIV/AIDS. Reports on the many vaccine trials were presented but it appears that there is no product on the immediate horizon. In the meantime, prevention programmes, patient-centred, multidisciplinary health teams and social agencies must carry the ball.
An interesting aspect of the medication challenge is the need to individualise treatment and doses. While combination ART is the state-of-the -art, blood studies are showing variations in reaction of individual patients to the same dose. In places like Martinique, as in the United States, the health care team is working to ensure that each patient receives the dose best suited to his or her needs.
The model of adherence being used should be of great value to Jamaican PLWHAs. This includes:-
A preparatory session (before any medication is given)
Provision of medication with consequent counselling and visits for counselling once per week for three consecutive weeks
Adherence counselling every quarter or with each dose adjustment
There is aggressive follow up and location of persons who have fallen out of treatment. Despite every best effort persons drop out of therapy because of clinical depression, financial difficulties, side effects of ART, lack of motivation and fear of stigma and discrimination. Good adherence counselling is able to anticipate these difficulties and prepare a plan of action with the patient to manage these eventualities.
The HIV/AIDS epidemic is pushing many health care providers to transcend the boundaries of traditional practice. Many innovative responses to the challenge of scarce resources were shared in Santo Domingo. The inclusive approach underpinned those efforts that are most successful. Everyone has a role to play. If you want to know more about ARTs and their side effects, ask your pharmacist you have the right to know!
Ellen Campbell Grizzle, President, Caribbean Association of Pharmacists (CAP) and Director, Information and Research, National Council on Drug Abuse (NCDA).
