July 11, 2002
Across the developed world, access to clinical and therapeutic care has dramatically changed the long-term quantity and quality of life for those affected by HIV-1 infection. Unfortunately a large proportion of HIV-infected persons (about one third) are under-diagnosed. This proportion is about the same in the United States and the United Kingdom (U.K.) -- for the U.K. this means that as many as 10,000 individuals may not know their HIV status. In the absence of this information, infected individuals can inadvertently place themselves at greater health risk (by not accessing care or antiretroviral therapy, when appropriate) or place others, their sexual or drug partners, at risk of acquiring HIV infection.
Many obstacles prevent access to care, including: social stigma and exclusion; lack of culturally sensitive education and health promotion; and a fragmentation of efforts between commercial, governmental and non-governmental entities can make the situation even more difficult.
The Embrace program is a multi-disciplinary coordinated program between pharmaceuticals, community and governmental agencies in the U.K. Based on a framework of information (patient-oriented and media), community-appropriate peer support and healthcare professional services, the program was launched in November 2001 -- targeting the large African population in the London area. As a result of these efforts, calls to the U.K. government-sponsored African AIDS Helpline increased 50 percent.
Lessons learned from the collaboration included a reemphasis for both public and private sector agencies to work in partnership and to recognize and overcome barriers to positive change. The message to me, as a community treater of HIV, is that each community has its own cultural issues and needs -- to misunderstand these needs can border on appearing insensitive and only alienate the very population that we seek to serve.
It will be important and worthwhile to learn of the longer-term implications of these collaborations -- do such low-cost efforts result in a greater proportion of HIV-infected persons under care? Will they result in improved resource utilization and improved quality of life for our community? Local efforts like these can serve as useful models for collaborations between the developed and developing world and I wish them limitless success.