HIV and Rehabilitation

Bridging Policy and Practice in Canada and the United Kingdom

Investigators: J. Gahagan (Principal), K. O’Brien, C. Worthington, B. Merritt, W. Chegwidden, E. McDonnell, E. Zack, F. Ibanez Carrasco, L. Baxter, R. Siegert, N. Mngoma, & S. Nixon.

For the purpose of this research, we conducted an extensive scoping review of articles and reports from Canada and the UK related to HIV, disability, aging, and the concept of ‘chronic illness.’ We discovered that researchers, providers, and policy makers are generally aware of how the trajectory of HIV/AIDS has shifted from a life threatening condition towards an illness with features of manageable chronic illness. However, little is known about how this new illness trajectory fits into and/or merges with established models of treatment and supports for persons with other chronic illnesses characterized by episodic disability. This lack of experience and knowledge highlights possible areas of potential inequities related to the reclassification of HIV as an illness being on par with such illnesses as diabetes, hypertension, cancer, and arthritis. Specifically, we remain concerned with how historical issues such as HIV/AIDS stigma, discrimination, and the need for cultural competence in treatment settings will continue to be recognized and accounted for within new models of treatment and care for persons living with HIV/AIDS across the life span. This concern is the foundation for the development of appropriate policy and rehabilitation models of care that will necessitate evolving dimensions of training and awareness by a full range of stakeholders. No single continuum of care or set of policies that addressed each of our core ‘themes of access’ was discovered, however this study indicated that the UK draws on a more cohesive and integrated approach to providing care to PHAs than that which is currently utilized in Canada.

There is good news however, as Canada takes steps to develop new approaches towards the integration of HIV into established models of care. In addition to identifying a lack of knowledge and expertise, this study also identified a plethora of novel ideas based on the insight and experience of researchers, health providers and policy makers. This category, which emerged from our research, provides both theoretical and conceptual frameworks of embracive and integrated models of care, as well as strategies and new paradigms related to the ongoing training and education of providers. These frameworks, ideas, and strategies are the basis upon which we have made our recommendations towards the urgent next steps related to policy and service delivery in the context of HIV as a ‘manageable chronic illness’ across the lifespan.

Funded by the Centre for REACH in HIV/AIDS (Research Evidence into Action for Community Health) Development Grant for $16,000 (2011-2012).