1308-CD2.1: The importance of integrated and participative health-services to public health in HIV
- HIV is an infectious, behaviourally-driven pandemic. Its acquisition, course, and effects are influenced or mediated significantly by behaviour.
- Both clinical and public health-services need to address behaviour to achieve the best possible health-outcomes.
- 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.
- As health is biopsychosocial, not just biological, both clinical and public health-services need to be biopsychosocial.
- Integrating biological, behavioural, and social health-services clinically achieves optimal health-outcomes. It also promotes public health-outcomes.
- 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.
- Linking clinical health-services with community-based organisations increases significantly the health-effectiveness of clinical services as well as affecting public health’s outcomes.
- 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.
- 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.
- 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.
- 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.
- We make three recommendations.
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