Myanmar is experiencing an HIV epidemic documented since the late 1980s. The National AIDS Programme national surveillance ante-natal clinics had already estimated in 1993 that 1.4% of pregnant women were HIV positive, and UNAIDS estimates that at end 2005 1.3% (range 0.7–2.0%) of the adult population was living with HIV. While a HIV surveillance system has been in place since 1992, the programmatic response to the epidemic has been slower to emerge although short- and medium-terms plans have been formulated since 1990. These early plans focused on the health sector, omitted key population groups at risk of HIV transmission and have not been adequately funded. The public health system more generally is severely under-funded.By the beginning of the new decade, a number of organisations had begun working on HIV and AIDS, though not yet in a formally coordinated manner. The Joint Programme on AIDS in Myanmar 2003–2005 was an attempt to deliver HIV services through a planned and agreed strategic framework. Donors established the Fund for HIV/AIDS in Myanmar (FHAM), providing a pooled mechanism for funding and significantly increasing the resources available in Myanmar. By 2006 substantial advances had been made in terms of scope and diversity of service delivery, including outreach to most at risk populations to HIV. More organisations provided more services to an increased number of people. Services ranged from the provision of HIV prevention messages via mass media and through peers from high-risk groups, to the provision of care, treatment and support for people living with HIV. However, the data also show that this scaling up has not been sufficient to reach the vast majority of people in need of HIV and AIDS services.The operating environment constrains activities, but does not, in general, prohibit them. The slow rate of service expansion can be attributed to the burdens imposed by administrative measures, broader constraints on research, debate and organizing, and insufficient resources. Nevertheless, evidence of recent years illustrates that increased investment leads to more services provided to people in need, helping them to obtain their right to health care. But service expansion, policy improvement and capacity building cannot occur without more resources.
The number of people in Australia living with HIV is growing. This reflects a consistent rate of new HIV infections combined with an increased life expectancy of people with HIV. Dentists are ideally positioned to identify, manage and treat HIV‐associated oral manifestations and have a responsibility to themselves and to their patients to be up‐to‐date with the evolving area of HIV and related issues. Those issues include medico‐legal implications associated with HIV diagnosis and treatment. This article provides a review of the current clinical and medico‐legal aspects of HIV in Australia. The oral manifestations of HIV can be divided into five categories: microbiological infections (fungal, bacterial and viral); oral neoplasms; neurological conditions; other oral conditions that may be associated with HIV infection; and oral conditions associated with HIV treatment. Current treatment options in the scope of general dental practice are outlined. Medico‐legal issues related to the management of patients with HIV are explored, including rights of the patient regarding disclosure of HIV status; an algorithm for the management of a patient with signs or symptoms indicating possible HIV infection, including referral pathways; and an algorithm for dealing with patient management and referral issues.
Over 20,000 people are living with HIV infection in Australia. From the early days of the epidemic general practitioners (GPs) have been closely involved in providing HIV care including antiretroviral therapy (ART). Training programs began in 1990 with about 200 GPs currently trained to provide ART. However there are limited data available on uptake and outcomes of GP HIV care. This review will present data on current GP involvement in providing HIV care as well as treatment outcomes. A Medline search was conducted using the terms general practice, HIV and Australia. Abstracts from local conferences were also reviewed. The major identified study of treatment uptake is HIV Futures [1], a national survey of approximately 1000 HIV+ve people performed every 2 years. Over the last 10 years this study consistently reports that about 50% of all HIV specific care is provided by GPs. One study describes an audit of 500 HIV+ve patients starting treatment in primary and hospital sites [2]. This found that there were comparable and high levels of adherence to guidelines on ART initiation in both general and specialist practice. A cohort of 168 patients followed for over 10 years in an Australian GP reported that 24% had been lost to follow-up, 7% died and 68% continued in care with 98% receiving ART with 96% having an undetectable viral load (<400) [3]. These outcomes were similar to those reported in the long-running national Australian HIV Observational Database (AHOD). Robust data show that about half of all HIV care in Australia is provided by GPs. Limited published data on adherence to guideline and treatment outcomes suggest comparable result in general practice versus specialist settings. GP care appears to be an acceptable and effective approach to HIV management although more research on treatment outcomes is needed
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