Statement on IAPAC’s Priorities for Person-Centered HIV Care

Dr. José M. Zuniga, President/CEO, @IAPAC and @FTC2030

IAS Consultation Meeting – 30 July 2022 (#AIDS2022)

Good morning and thank you to the IAS for inviting IAPAC to participate in today’s consultation meeting on person-centered HIV care. I am Dr. José Zuniga, President/CEO of IAPAC as well as the Fast-Track Cities Institute.

I am happy to share IAPAC’s priorities for actioning person-centered HIV care through our 30,000-member clinician-members and the 400-plus Fast-Track Cities:

  • We advocate universal standards of care that are competency-based and developed with significant input from people living with and affected by HIV. These standards should address the pervasive issue of stigma, including by formalizing U=U as a clinical competence.
  • We urge greater integration between the clinical, behavioral, and social dimensions of HIV responses. Silo-ing continues to be a major barrier for people living with or affected by HIV to access and utilize the whole-person care they need to succeed beyond achieving viral suppression or avoiding HIV acquisition.
  • Moreover, we welcome the scale-up of innovations to make HIV services more affordable, accessible, and convenient. However, these innovations must be framed within the context of person-centered care and reflect the voice of those most affected by HIV.
  • We call for health systems strengthening focused on continuous quality improvement that prioritizes whole person-centered care. We note, however, that support for and an augmentation of the health workforce is critically needed, including due to significant burn-out resulting from the dual HIV and COVID-19 pandemics.
  • And, to strengthen our responses, we recommend the use of metrics to inform decision-making. Relevant indicators could include the proportion of people living with HIV who are involved in decision-making about their care, who are satisfied with their relationship with health professionals, and who are satisfied with services provided by their health facilities.
  • We must also prioritize community engagement in planning, delivering, and monitoring HIV services. True engagement that avoids tokenism is critical to facilitate accountability, build mutual trust, improve health outcomes, and contribute to our efforts to stem new HIV infections and avert AIDS-related deaths.
  • We advocate a disruption of a culture within health systems that facilitates inequities, stigma and discrimination, and poor health outcomes. We welcome, too, efforts to correct dominant (or malignant) narratives about race, gender identity, and sexual orientation so that we center care around lived experienced without reinforcing labels, objectification, stigmatization, and marginalization.
  • On that note, we place extraordinary value on a collective commitment to equity and the concept of leaving no one behind. When “patients” are seen as people rather than numbers, serving the most marginalized becomes a prerogative rather than a liability.
  • And, relatedly, we advocate a focus on the dignity of people living with and affected by HIV. We must honor the human right to dignity just as much as we honor the right to health and well-being. In doing so, we will gain the added benefit of better health outcomes and improved quality of life.

Those are IAPAC’s priorities as we progress on a trajectory from disease-oriented to patient-centered and now to person-centered HIV care. The distinction between the latter two may be more subtle, but it is nonetheless critical. Just as people are not experiencing HIV in a vacuum, they also do not experience life in a vacuum. Health is one part of their whole person – a star in a constellation of needs, hopes, strengths, and challenges – that we must strive to optimize a person’s within a holistic context.