1308-CD2.1: The importance of integrated and participative health-services to public health in HIV


  1. HIV is an infectious, behaviourally-driven pandemic. Its acquisition, course, and effects are influenced or mediated significantly by behaviour.
  2. Both clinical and public health-services need to address behaviour to achieve the best possible health-outcomes.
  3. As clinical and public health’s goals are the same (i.e., health), their outcomes should be the same and they should exploit common aspects and methods.
  4. As health is biopsychosocial, not just biological, both clinical and public health-services need to be biopsychosocial.
  5. Integrating biological, behavioural, and social health-services clinically achieves optimal health-outcomes. It also promotes public health-outcomes.
  6. Clinical health-services are a key point of intervention for people with HIV and at-risk of HIV-infection yet clinical health-services are inadequately utilised for the delivery of public health’s outcomes.
  7. Linking clinical health-services with community-based organisations increases significantly the health-effectiveness of clinical services as well as affecting public health’s outcomes.
  8. The empowerment of the individual and community through participation in the design and delivery of services is a key requirement of such effectiveness. This promotes ownership of solutions to health-problems, creates generalisable health-protective skills, protects rights, enables responsibilities, and promotes healthy community-expectations and standards.
  9. These observations were evident in the era before 1996. We now have even better technologies to achieve these outcomes, but we use them less than before 1996.
  10. Reducing patients to dependent consumers — whether in physician-centred clinics or in community-focused organisations — disempowers patients and promotes public health-problems. Solutions that are not owned by the affected patient or the affected community, but are simply delivered to them, are both poorly effective and counter-productive.
  11. Empowerment enables health-promoting behaviours and a supportive social context, which happens most effectively through clinical services that use behavioural medicine. Behavioural medicine translates clinical health-outcomes to public health’s outcomes in behaviourally-driven illnesses such as HIV.
  12. We make three recommendations.

Date: 09.08.2013

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