The WHO 3 x 5 plan envisages that community-based organisations, including groups of people living with HIV, will play a key role in scaling up treatment. This is not just a measure to plug gaps in the health services of heavily affected countries, but a response to evidence from early pilot programmes. These programmes have demonstrated that community participation is a key element in ensuring the acceptability of treatment. Making treatment part of the social fabric rather than a hidden enterprise is the only way to ensure long-term adherence.
Before treatment is introduced, developing community capacity to carry out counselling for HIV testing will be essential. Basic symptom relief must also be taught, alongside nutritional support and skills in home care. Most important of all, treatment literacy – the basic understanding of HIV treatment – will need to be promoted, in order to convince people of the potential benefits of learning their HIV status.
An early activity in any national programme should be assessment of community capacity. Where are the community-based organisations, how many of them exist, and what are they doing? Health districts will be encouraged to develop plans for community training and a community coordination committee.
Once antiretrovirals arrive in a community, adherence counselling will need to be carried out by community members. It is hoped that people with HIV will play a leading role in this education process, as they have at MSF projects such as Khayelitsha in South Africa’s in Western Cape province.
Expanding the cadre of community health workers who possess basic skills in dispensing medicines will be necessary. These workers will also be involved in distributing drugs and monitoring for side-effects, as well as record keeping and HIV testing.
WHO also plans to fund community-based advocacy organisations that can galvanise government, NGO and private sector towards nationally agreed treatment plans. WHO recognises the importance of treatment advocacy networks in South Africa, Kenya and Thailand in forcing governments to act, and in developing treatment literacy campaigns that are owned by the community.
By the end of 2005, WHO believes that formal medical outlets will need to have formed partnerships with 30,000 community-based organisations in up to 60 countries delivering large-scale treatment programmes if the `3 x 5` target is to be reached.
Further information
International Treatment Preparedness Summit, Cape Town, March 2003 (link to pdf file)
This meeting gathered activists from all continents to discuss how communities could work to improve treatment literacy. The document includes recommendations on the types of treatment literacy activities that should be developed and funded.
WHO case study on MSF's Khayelitsha treatment project, South Africa" (link to pdf file)
WHO case study on Partners in Health treatment project, Haiti" (link to pdf file)