Report on the Global HIV/AIDS epidemic

Report on the global HIV/AIDS epidemic - June 2000

Box 20. Use of cotrimoxazole prophylaxis in people with HIV/AIDS in
Africa
In March 2000, UNAIDS and WHO brought together clinicians, public health specialists, national AIDS programme managers, people living with HIV/AIDS, donors
and AIDS activists to discuss the use of cotrimoxazole as preventive therapy for HIVpositive individuals in Africa. The outcome of this consultative workshop in Harare,
Zimbabwe, was that cotrimoxazole prophylaxis for people who have already developed symptoms of HIV infection should be part of the essential care and support
package. The participants recommended dosages, defined criteria for patient eligibility, and issued recommendations for training, education and capacity development in countries.
The UNAIDS Secretariat is working with WHO to ensure rapid implementation of
these recommendations through resource mobilization efforts. By July 2000, through
consultative meetings with national governments, 14 African countries participating
in the US Government's LIFE Initiative will have considered making cotrimoxazole
prophylaxis part of their care package.
A new incentive for testing?
Experience from around the world shows that seeking counselling and HIV testing is
not an easy step to take. In the high-income countries, the hope of benefiting from
early treatment created a major incentive for people to find out whether they were
infected. As therapies improved - even before the advent of antiretrovirals - people
who suspected they might have HIV saw that they stood to gain months or years of
life by getting tested.
Isoniazid and cotrimoxazole prophylaxis - which can only be offered to people with
proven HIV infection, in contrast to some other forms of health care described in this
chapter - may similarly increase people's interest and willingness to be tested for
HIV. If these preventive regimens are made more widely available along with HIV
counselling and testing services, the survival benefits for individuals and their families are likely to be compounded by the benefits of large-scale testing, including
reduced HIV transmission to partners and to infants, and greater visibility of the
insidious HIV epidemic.

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