Differences in physiotherapy training, work environment and role in HIV/AIDS management around the world were highlighted during a panel discussion.
In Africa, challenges included limited human resources and space in facilities, delegates heard. Panellist Esther Nkandu of Zambia, which is in that part of Africa with the highest incidence of HIV/AIDS in the world, said that poverty, wars and cultural beliefs contributed to patient non-compliance with treatment. 'In some cases, patients must choose between travelling for treatment or buying food,' she said. This meant that African physiotherapists had to focus on improving a patient's overall quality of life, not simply treating symptoms. Panellist Ed Mills, who works with Dignitas International in Malawi, where transmission of tuberculosis among HIV/AIDS patients is a concern, said: 'Home-based and community care is often the only option, especially in areas where there are no doctors. 'There is no physiotherapy training in Malawi, he told delegates, though a three-year rehabilitation technician programme had recently been funded. Many of Malawi's 22 physios were trained in nearby Zambia, he said. Ms Nkandu said that even despite the prevalence of HIV/AIDS in the region, African physiotherapy students often found their clinical placements traumatising, while a delegate from South Africa said many students were terrified of contracting tuberculosis. Both Mr Nkandu and Ms Mills said that properly structured exchange programmes, involving students and health professionals from other parts of the world, could be of great benefit to Africa. However, they warned against creating situations where the costs associated with the programmes - for translators, security, and transport - were greater than the potential benefits. In Canada, the incidence of HIV/AIDS was lower and people with the condition tended to live longer, said panellist Irene Goldstone. The use of injected drugs is one of the main factors in HIV transmission, so students had to understand the social issues involved. Panellist Francisco Ibanez-Carrasco from Canada, who has been living with AIDS since 1985, said that physiotherapy had featured little in his care. He suggested that physiotherapists increased connections with community-based AIDS organisations. 'In urban areas the focus had shifted to AIDS being an episodic rather than chronic disability,' he added. However, in rural areas the stigma against HIV/AIDS patients still existed, and there was a shortage of health professionals, particularly those trained in HIV/AIDS care.
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