|Guidelines for HIV Interventions in Emergency Settings (Joint United Nations Programme on HIV/AIDS - United Nations High Commission for Refugee - World Health Organisation, 1996, 62 p.)|
Comprehensive care for people with HIV-related illnesses should be seen as a essential component of basic curative care in any refugee situation. This is especially important when refugees come from an area where HIV-related illnesses have become a predominant cause of morbidity and mortality. As tuberculosis is one of the main presenting problems in people with HIV, serious consideration must be given to the feasibility of introducing a tuberculosis diagnosis, management and control programme.
The elements of comprehensive care include: clinical management - early diagnosis, rational treatment and planning for follow-up care; nursing care to promote and maintain hygiene and nutrition, provide palliative care, educate individuals and families on AIDS prevention and care; counselling to help individuals make informed decisions on HIV testing when available, stress and anxiety reduction, and promoting safer sex; and social support -information and referral to support groups, welfare services and legal advice.
The introduction of comprehensive care for HIV-infected persons in refugee situations involves:
· Sensitizing health workers to HIV-related illnesses and AIDS.
· Adapting existing clinical and nursing guidelines for case management in primary and secondary care in refugee settings. This should include guidelines on discharge and referral of people with HIV-related problems.
· Drawing up an essential drugs list for treatment of HIV-related illness and establishing mechanisms to ensure the procurement and supply of these drugs.
· Training health care workers in the use of the clinical guidelines and essential drugs list.
· Introducing counselling training for health and lay workers, and developing guidelines for the provision of counselling. This can be integrated into counselling for other stresses related to the refugee situation.
· Ensuring that HIV-related care is fully integrated into basic curative services, and that prevention components (e.g. supply of condoms) are part of the care.
· Developing community support for AIDS care by:
- exploring community capacities and commitment;
- encouraging the development and training of self-help and other community-based support groups;
- starting community-based care and support activities, using the self-help groups that have been established.
· Developing a tuberculosis control policy which includes: case definition and diagnosis of tuberculosis in a refugee situation, appropriate regimens to be followed, supervised ambulatory care, mechanisms to ensure case-holding, especially where refugee populations are likely to move, management of complications and side effects of drugs, and tracing of contacts and case-finding.
· Collecting data on numbers of AIDS cases, using the WHO clinical definition.
1. Guidelines for the clinical management of HIV infection in adults. Geneva, World Health Organization, 1991 (document WHO/GPA/IDS/HCS/91.6).
2. Guidelines for the clinical management of HIV infection in children. Geneva, World Health Organization, 1991 (document WHO/GPA/IDS/HCS/93.3).
3. HIV prevention and care: teaching modules for nurses and midwives. Geneva, World Health Organization, 1991 (document WHO/GPA/CNP/TMD/93.3).
4. Slide set on Clinical aspects of HIV infection in adults (document GPA/IDS/HCS/93.4).
5. HIV/AIDS counselling: A key to caring: guidelines for policy makers and planners. Geneva, World Health Organization, 1995 (document WHO/GPA/TCO/HCS/95.15).
6. AIDS home care handbook. Geneva, World Health Organization, 1993 (document WHO/GPA/IDS/HCS/93.2).
7. Sourcebook for HIV/AIDS counselling training (document WHO/GPA/TCO/HCS/94.9)