I agree with Warren Feek’s summary of the approach to eradicating small pox. This was essentially a military style action – ‘targeting’ at risk people -- those who were not immunized – undertaken by experts in the name of public health, a public good in economic terms.

I am sure that many will highlight the differences between addressing small pox, a highly infectious, commonly but not inevitably rapidly fatal infection with a highly effective preventative intervention (vaccination), and addressing HIV/AIDS a far less infective, fatal after only a long delay and commonly a chronic illness, that currently does not have an effective preventative vaccine.

As prevention of HIV infection needs sustained adoption of healthy behaviour – I would argue with social and political change to enable individual behaviour change – and economic change to sustain individual health behaviour – I suggest that the military style expert driven model is not appropriate. I believe that we should not target risk groups for prevention but should adopt an empowerment paradigm for our work in HIV. All people, including the most vulnerable, have strengths and are resourceful. We should be facilitating local responses that draw upon individuals, families and communities strengths and resourcefulness. The added benefit of this approach, which is essentially a human capacity development approach as defined at the Barcelona International AIDS Conference in 2002, is that people families and communities learn problem solving from each other and are empowered to address stigma and other barriers to accepting care and treatment. With the current unprecedented global mobilisation of resources for care and treatment in the most AIDS-affected countries, barriers to care and treatment have assumed huge significance. Thus the empowerment paradigm is important for the whole treatment to prevention spectrum, and some clinicians might say for ensuring concordance rather than compliance with antiretroviral therapy.



Yours, Ruth Hope

Social & Scientific Systems, Inc., an employee-owned company

Ruth Hope, Senior Technical Specialist

The Synergy Project (www.SynergyAIDS.com)

SSS/1101 Vermont Ave NW, Suite 900, Washington, DC 20005