Linking care with prevention is the third practice in the Self Assessment framework for AIDS Competence. I have never found it an intuitively obvious practice.
Ian Campbell and others at the Salvation Army brought attention to the link between care and prevention. They published the results of their experiences at Chikankata Hospital in Zambia widely. For example:
Campbell, I.D., Care Leads to Prevention, London, Salvation Army, 1994.
Campbell, I.D and Williams G. An Integrated Approach, AIDS Management, London, ActionAid, 1992.
are widely referenced although I have not been able to obtain a copy of either paper.
Results from Chikankata
Weddy Zilomba wrote a review of progress at Chikankata Hospital in 2002 and I have found this paper to be very helpful. Its full title is:
Weddy Silomba, HIV/AIDS and Development:The Chikankata Experience
You can find a copy of this document in the Google docs site.
On page 5 of the document, Weddy describes how early in the work on HIV/AIDS, an international NGO offered to build a hospice for people with AIDS. Their experience with leprosy had taught them that isolating the issue caused more problems than it solved and so the idea was rejected.
Here are 2 quotations from the paper that, for me, make the idea of linking care with prevention clearer.
"The community gets engaged in the care process and this affects behaviour and attitudes that lead to prevention." (page 3)
and
"Taking care into the community and neighborhood had in itself an educational effect on both family and community members and therefore contributed to behavior change and prevention of HIV transmission in the long run." (page 5)
I also liked the discussion on the evolution of 'Care and Prevention teams'. There was an initial attempt to set up a system of home based care based on the idea of mobile hospital staff. The idea is made clear by this diagram:
This approach was not only unsustainable because it was so expensive, but it was unsatisfactory because 'it encouraged dependency on outside donors and community dependency on the health institution'. And so the Care and prevention team approach evolved. 'Through discussions with community members, it was mutually realized that the hospital/institution is just one of the many support pillars available to the community. Communities were encouraged (and facilitation was provided) to identify other support pillars that could be relied on to provide care and support to people living with HIV/AIDS. Eventually, a network of support mechanisms was identified by and for community members, as illustrated in the diagram below.;
Other views on 'Linking care with prevention'
I asked Ian Campbell for his thoughts on the practice of 'Linking care with prevention'. That conversation continues and I will update this content based on the discussion. He has given me a variety of different ways of thinking about the idea and here are some of them:
"WHEN we care with a person in the home...
THEN we will see prevention and care in the community."
OR
"WHEN a person is cared with in the home...
...AND there is a disposition in the carers for neighbourhood concerns...
...AND there is neighbourhood capacity for positive relationship...
THEN the community will also care and share ownership for the future through acting for prevention in the present."
A working statement on the practice of 'Linking care with prevention'.
Here is my current best effort that helps me to understand the idea of linking care with prevention:
"WHEN communities care for people who are infected or affected by HIV/AIDS...
...THEN one consequence of this care is that there are changes in behaviour within the community that encourage prevention."
Do you have any other ideas that would enrich the idea of 'linking care with prevention'?