THf SOUTHER.N AFRICAN JOUR.NAL Of HIV MEDICINE ------------

FROM THE
EDITOR

COMBINATION COUNSElLING

One wonders how much influence the Iraqi war and

planned re-building of that country will have on

deflecting and redirecting international focus and

funding away from the war against HIV/AIDS in sub-

Saharan Africa. We have already seen the impact the

war has had on the travel plans of scientists from the

developed world (the United Kingdom and the United

States of America). As Gerald Friedland said at the
recent Boston Retrovirus Conference, 'perhaps more

progress would be made if HIV were declared a weapon

of mass destruction:

Highlights of the Boston Conference included

impressive presentations on antiretroviral therapy in

resource-poor settings, covered in more detail in an

article in this issue. At last, feasible, punitive obstacles

sudi as adherence issues were shown not to be the

bogeymen that we have all been led to believe. Patients

in southern Africa are as adherent as anywhere else in

the world.

Good but careful attention to counselling to obtain

commitment to lifelong treatment is required and

ongoing counselling regarding other associated issues is

essential. In other words, the message here is for

doctors not simply to write scripts but to counsel

patients on side-effects and toxicities [short- and long-

term), because once patients understand these issues

they are more than willing to commit to lifelong

therapy.

We are constantly told that directly observed therapy

(DOTS) for tuberculosis treatment has not been a huge

success in the developing world. But, once again, we

believe that not enough attention is given to counselling

around the tuberculosis treatment issue. It simply is no

good just to give patients the drugs and leave them to

thei r own devices. So the new catchword is not

combination treatment so much as combination

counselling. That combination is: time, effort, and

culturally appropriate counselling.

DES MARTIN
Editor, Southern African Journal af HIV Medicine
President, Southern African HIV Clinicians Saciety

MAY 2003