The training provided by this program and others like it facilitates task-shifting from other medical professionals, such as doctors and nurses, to individuals without high-level medical qualifications. As a result, doctors and nurses have more time to devote to treating multiple patients. Therefore, task-shifting can help relieve the burden on doctors and nurses in settings where medical professionals are scarce.

The lack of medical professionals in many countries with a high HIV prevalence has led the WHO to make task-shifting a prominent goal in the improvement of HIV treatment in resource-poor settings, as detailed in the 2006 “Treat, Train, Retain” workforce plan. Two examples of successful HIV-focused programs that have used trained laypersons are an antiretroviral treatment program in Uganda and an HIV counseling and testing program in Zambia.

Having trained laypersons take over many of the tasks associated with the care of HIV-positive individuals does not come without its own set of problems. One problem is poor retention of trained HIV workers, which can limit the success of task-shifting programs. Poor pay (or no pay) can lead trained HIV workers to seek other employment, which might not even be related to medical care. The loss of HIV workers due to the lack of adequate wages was one of the primary concerns expressed by the health center managers interviewed in Zambia. The fact that the WHO made retention one of the three focus points of the 2006 workforce plan reflects the importance of these types of problems. Another concern with respect to task-shifting programs is maintaining the quality of care, a point highlighted in a 2006 Lancet Viewpoint piece.

Although there are many obstacles in the implementation of task-shifting programs, the introduction of rigorous training programs for HIV workers, such as the HIV Medics program at IGNOU, is an important step in ensuring the success of task-shifting programs and in providing proper care to people with HIV.

For more information, see the AIDS Healthcare Foundation’s India Factsheet.

“Criminalization would have created more problems than solving them,” Rama Valayden, Attorney General and Minister of Justice and Human Rights of the Republic of Mauritius declared in the document. Mauritius, an African country, has rejected HIV-specific criminal laws for the very reasons outlined in the publication, yet many countries throughout the world, including the United States, continue to utilize laws that are, in effect, a barrier to an effective response to the HIV/AIDS epidemic. The New York Times reported the May 2008 conviction in Dallas of Willie Campbell, 42, a homeless, HIV-infected man who was charged with harassment with a deadly weapon after he spat on a police officer. He was charged with a 35-year sentence (including other related charges). “The man was punished not for what he did, but for the virus he carried,” said Justice Cameron, a justice of the Supreme Court of Appeals in South Africa. While this publication is a critical step in highlighting the dangers of HIV-specific criminal laws, until countries eliminate or amend their laws, infected individuals will continue to be prosecuted rather than empowered to seek treatment.

Download the full Open Society Institute document here