HIV Care Before answering the question on whether palliative
care should take on this role, let’s look at what unique skills set palliative care professionals could bring to the pre-ART patient. For the context of this debate, the pre-ART patient is the patient diagnosed HIV positive but not yet requir- ing treatment. Firstly palliative care providers could make a difference by assisting to identify these patients early by encouraging testing amongst asymptomatic family members related to an index case that may be a palliative care patient. Then of course bad news has to be broken to all these pre-ART patients and assistance given in dealing with the stages of acceptance of a loss (denial, anger, bargaining, depression, and acceptance). Adherence support should ideally begin at this stage too, ensuring that the patient goes for regular follow- up and CD4 count monitoring, so that treatment can be started as soon as it is necessary and before a major complication (along with its distressing symptoms) arises. Palliative care providers are well-equipped to address pain and other symptoms that pre-ART clients present. People living with HIV who are pre-ART also need to be advised as to how to maintain a good qual- ity of life through healthy living and practising safe sex (e.g. positive health, dignity, and prevention which is addressed in Smart’s article). So, how far should palliative care in South Africa
get involved? Given the close relationship between pal- liative care health professionals and their patients and families, there is an opportunity to make a contribution through pre-ART care management. Indeed there are examples in other African countries, including Uganda Kenya, and Tanzania, where palliative care programmes already run HIV testing and counselling programmes. It is becoming so easy to do this now with the increasing availability of rapid HIV testing. Is this our core business? Building on these experiences, in an era where ARVs are increasingly accessible, the palliative care approach can also help prepare health professionals to address
the needs of patients with other other non-curable life- threatening conditions. This includes adults with motor neurone disease, chronic obstructive pulmonary disease (COPD), progressive heart failure, and end-stage renal diseases – largely neglected in the wake of the HIV epidemic. To conclude, palliative care is well-positioned to
offer pre ART care, particularly where it is integrated into HIV clinical services. What palliative care has to offer is an approach to the care of people with chronic life-threatening illnesses. An approach that includes forgotten skills: how to communicate with patients and their families; how to focus on the patient with the disease rather than the disease that the patient has; and how, through a new developing science and art, to ame- liorate suffering in all domains (physical, psychological, social, and spiritual). We can only achieve this by sharing our knowledge and skills and integrating them into the formal (public and private) healthcare sectors through advocacy, ca- pacity building, and support.
References 1. MRC report. Orphans of the epidemic.
http://www.mrc.ac.za. 2.
National Health Insurance brief 18. Projected population and HIV/AIDS update.
http://www.imsa.org.za/national_health_insurance_policybrief_18_0.html
3. WHO. Global Burden of diseases report 2008. Geneva: World Health Organiza- tion.
http://www.who.int/healthinfo/global_burden_disease/en/.
Figure 1 Comparing the total of people living with AIDS and number receiving ARVs in 2003 and 2008 July 2012 Africa Health 25
© Nadia Bettega
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