pirical and modeling studies, then, demonstrates that HIV prevention activities must be strengthened and integrated into ART scale-up programs if success in combating the pandemic is to be achieved.

PALLIATIVE CARE FOR AIDS PATIENTS IN DEVELOPING COUNTRIES

Despite advances in the treatment of AIDS patients and the potential for adding even decades of additional quality life to what might have been the case without ARVs, many of these persons will eventually face death due to the infection. Thus a humane approach to this disease includes steadfast care not only while the patient is responsive to ARVs, but also when all that can be offered is palliative care. Comprehensive national programs to care for patients with HIV/AIDS should address the needs of those who are in the terminal stage of AIDS.

WHO defines palliative care as care that:

  • Provides relief from pain and other distressing symptoms.

  • Affirms life and regards dying as a normal process.

  • Intends neither to hasten nor to postpone death.

  • Integrates the psychological and spiritual aspects of patient care.

  • Offers a support system to help patients live as actively as possible until death.

  • Offers a support system to help the family cope during the patient’s illness and in its own bereavement.

  • Uses a team approach to address the needs of patients and its families, including bereavement counseling, if indicated.

  • Enhances quality of life and may also positively influence the course of illness.

  • Is applicable early in the course of illness in conjunction with other therapies intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

There are particular challenges to palliative care in developing countries. Palliative care of terminal AIDS patients often centers on pain management. A Ugandan study found that more than half of terminally ill patients cited pain as their chief problem (Kikule, 2003). Morphine and other analgesic opioids are inexpensive, though tight regulations hinder their availability in developing countries (Carlisle, 2003). Table 4-3, based on 2001 figures for per capita morphine consumption in African countries heavily affected by HIV/AIDS, highlights this problem. According to David Joranson of the Pain and Policy Studies Group, University of Wisconsin/



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