Palliative care aims to achieve the best quality of life for patients (and their families) suffering from life-threatening and incurable illness, including HIV/AIDS. Crucial elements are the relief of all pain-physical, psychological, spiritual and social and enabling and supporting caregivers to work through their own emotions and grief.

Palliative care has relieved the intense, broad suffering of people living with HIV/AIDS but the latter brings a number of challenges to its philosophy and practice including:

The complex disease process with its unpredictable course and wide range of complications, which means that palliative care has to balance acute treatment with the control of chronic symptoms;

• Complex treatments which can overstretch health services;

• The stigmatization and discrimination faced by most people living with HIV/AIDS;

• Complex family issues, such as infection of both partners;

• Role reversal in families, such as young children looking after their parents;

• Burdens on health care workers.

A wide range of palliative care is needed for people living with HIV/AIDS, including:

• Pain relief;

• Treatment of other symptoms such as nausea, weakness and fatigue;

• Psychological support for psychological problems;

• Spiritual support and help with preparation for death;

• Support for families and carers-help with nursing, infection control and psychological support.

To ensure that effective palliative care is provided for all people living with HIV/AIDS, governments must tackle the misconceptions that palliative care is only for people approaching death. They also need to:

• improve the training of health and community workers, and general health education, including tackling stigmatization;

• make good palliative care widely available in hospital, hospices and in the community for people living at home;

• provide access to the necessary drugs;

• provide support for carers, counsellors and health care workers;

• recognize the special needs of children.