Change is a constant factor in the HIV/AIDS epidemic and people's lives. An organization must respond to changes in the community it serves. From time to time, it will also need to assess whether change is necessary within its own organization. Some unexpected changes may happen, but some can be predicted and plans can be made to deal with them.
As changes occur, new assessments of needs and resources should be made, to check that the treatment needs of the community are still being met. It will be helpful to return to the original assessments of needs and resources that were made before work began (see Chapter 3 on page 55) to evaluate the progress and assess whether the questions that were asked and the methods that were used are still appropriate or should be updated.
Changes that can affect HIV/AIDS-related treatment work:
• changes in the pattern of the HIV/AIDS epidemic - for example, the numbers and type of people affected;
• changes resulting from treatment work - for example, some successful programmes have seen a reduction in problems such as diarrhoea and oral thrush but also, because more people are now living longer with HIV/AIDS, have seen more cases of unusual opportunistic infections that require specialist treatment;
• changes in relationships within your group and with other individuals and organizations;
• changes in key material resources for treatment, such as new ways of using old drugs, the introduction of new drugs, and changes in drug prices;
• changes in other resources, such as funding, referral systems and human resources; and
• political and economic change, whether local, national or global.
Responding to change is not a fixed event; it can occur at any time during the cycle of work.
Changes should be seen as opportunities to improve treatment access for people living with HIV/AIDS. The effects of change on your organization must also be managed, as change that is too much, too fast or not enough can be confusing and stressful for staff and service users alike.