Any work on HIV/AIDS-related treatment must respond to the real needs of people living with HIV/AIDS and of the community. Therefore, an assessment should start by looking at the HIV/AIDS situation in the community, the impact of HIV/AIDS on the community, the type of treatment people need, what they currently do when they need treatment, and what existing resources are available.

An assessment can also look at what a person does about illness and how that is influenced by different factors and people, including family, friends and the community. Learning what happens to people on their journeys to seek treatment helps to build an understanding about the overall strengths, weaknesses and gaps of existing services in the community. It is also important to understand the community's attitudes towards illness and the community's perceptions of risk that those involved in providing treatment may face.

An assessment of the treatment needs and resources of people living with HIV/AIDS and of the community could involve some or all of the following:

• people living with HIV/AIDS
• families
• health workers
• community leaders
• caregivers
• traditional healers.

It could focus on three key questions, each of which can form the basis of both focus group discussions and participatory group activities:

• Question A.1: What are the treatment needs of people living with HIV/AIDS in your community?

• Question A.2: Where do people get HIV/AIDS-related treatment in your community?

• Question A.3: How do people living with HIV/AIDS seek and use treatment in your community?

Question A.1: What are the treatment needs of people living with HIV/AIDS in your community?

Questions for focus group discussions:

• What is the range of HIV/AIDS-related treatment needs in your community?
• What are the most common treatment needs of people living with HIV/AIDS in your community?
• What are the most effective treatments for people living with HIV/AIDS in your community?

Participatory group activity

Aim

To assess the HIV/AIDS-related treatment needs of people living with HIV/AIDS in your community.

Instructions

1. Explain the aim of the activity.

2. On a large piece of paper, draw a long line to represent the lifeline of a typical person living with HIV/AIDS in your community. For example, it might start with when they are diagnosed as HIV-positive and end with their death.

3. Ask participants to suggest the name of a health problem experienced by a person living with HIV/AIDS. Examples might include fever or TB. Write each suggestion down on a small piece of paper.

4. Ask participants to place the pieces of paper on the lifeline, according to where the health problem might occur during the life of the person living with HIV/AIDS.

5. Ask participants for suggestions of treatments for each of the health problems. Examples might include paracetamol or TB drugs. Write them down next to the health problem on the lifeline.

6. Discuss what can be concluded about the treatment needs of people living with HIV/AIDS in your community.

Facilitators' notes

• Encourage participants to think of both traditional treatments (such as herbs) and 'western' treatments (such as pharmaceutical drugs).

• Encourage participants to assess the scale of each health problem, such as how severe it is and how many people living with HIV/AIDS experience it.

Example

Question A.2: Where do people living with HIV/AIDS get treatment in your community?

Questions for focus group discussions:

• Where is HIV/AIDS-related treatment available in your community?
• Where can people living with HIV/AIDS access HIV/AIDS-related treatment?
• What are the barriers to people accessing HIV/AIDS-related treatment?

Participatory group activity

Aim

To assess what treatment is available and accessible to people living with HIV/AIDS in your community.

Instructions

1. Discuss with participants what is meant by 'available' and 'accessible' in relation to HIV/AIDS-related treatment (see Chapter 1.3.A and 1.3.B, on pages 24 and 26). Brainstorm about some local examples of what they mean in practice in your community.

2. Ask participants to draw a map of their community on a large piece of flipchart paper or on the ground. Ask them to include all the key features such as roads and clinics.

3. Ask participants to mark with stars the places where different types of HIV/AIDS-related treatment are available in their community, such as in the home or from a traditional healer.

4. Ask participants to assess how accessible each of the treatments is for people living with HIV/AIDS. If a treatment is not accessible, ask them to identify why.

5. Discuss what can be concluded about the availability and accessibility of HIV/AIDS-related treatment in the local community.

Facilitators' notes

• Ensure that participants mark both formal sources of treatment (such as hospitals) and informal sources (such as traditional healers).

• Help participants to think critically about whether all treatments that are available to people living with HIV/AIDS are also accessible to them.

Example

Question A.3: How do people living with HIV/AIDS seek and use treatment in your community?

Questions for focus group discussions:

• How easy is it for people living with HIV/AIDS to use different types of treatment?
• What prevents people living with HIV/AIDS from using treatment properly?
• How do social, financial and cultural factors affect how people living with HIV/AIDS use treatment?

Participatory group activity

Aim

To assess how people living with HIV/AIDS seek and use treatment in your community.

Instructions

1. Explain the aim of the activity.

2. Brainstorm about the different places where people living with HIV/AIDS seek treatment in your community and write them down on the lefthand side of a large piece of flipchart paper. Examples might include a pharmacy or hospital.

3. Along the top of the paper, write down the reasons why someone would choose to seek treatment from a particular place. Examples might include good location or low cost.

4. Draw lines to make a grid. Then take participants through the grid, assessing each place and ticking the boxes beside it if the reasons apply.

5. Ask participants to share typical stories of people living with HIV/AIDS using treatment effectively or not effectively. Ask them to identify factors that prevent people from using treatment effectively.

6. Facilitate a discussion of what can be concluded about how people living with HIV/AIDS seek and use treatment in your community.

Facilitators' notes

• Support participants to focus on the 'real life' reasons that affect people's decisions about using treatment, such as money and time.

• Support participants to really discuss (rather than just tick the box) why people would access treatment from a particular place.

Example