Looking ahead to AIDS 2010 in Vienna next week, I have also been looking back, thinking about how HIV/AIDS is the health crisis that truly galvanized international attention. It has become a cause célèbre that Hollywood stars and world leaders alike speak openly about, red ribbons tied to their lapels. It wasn’t always this way.

I remember in my early days working in family planning, mostly in West Africa; the fear and panic about new symptoms and, eventually, a new syndrome, was palpable when I talked to health workers and patients in local clinics. The stigma around HIV and the initial preference for vertical programming meant that HIV services, and the clients seeking them, were segregated. On my visits to clinics, the staff would show me the shelf of condoms for contraception and then a separate shelf, sometimes in another room, of condoms for HIV prevention. Now I can shake my head about it, but then it was standard practice to separate HIV services and patients from everything else, even when it made no practical sense, even when it was perhaps discriminatory, encouraging stigma.

Recently, I visited a clinic in the Gicumbi District of Rwanda, which IntraHealth supports. I met with health workers who talked to me—all in one breath—about HIV/AIDS testing, contraceptive services, reproductive health care. I saw people living with HIV come to the clinic to get their antiretrovials (ARVs) and, during the same visit, contraceptives and nutrition counseling. Pregnant women who came in seeking antenatal care, most of whom were accompanied by their spouses, were also offered couples’ HIV counseling and testing and, if necessary, treatment including drugs to prevent vertical transmission. The contrast was striking compared to my work in Rwanda and other countries  in the late 1980s, when many clinics offered  HIV and family planning services on different days of the week or at different times of the day, forcing a client who needed both to make the long walk to the clinic twice in the same week.

Over the last 30 years, from the early days of the HIV epidemic and from IntraHealth’s early years, I see now how much HIV/AIDS has changed the health workforce. By the 1990s, the scientific research had gotten better, and people quickly realized that it was only a matter of time until we found the right cocktail to prolong people’s lives. But if we were going to support people in getting tested, teach them how to protect themselves and their loved ones, and get life-saving medicines into the hands of those who desperately needed them, we needed to do something to support the health workers providing the care. We needed to get creative and expand beyond the formal categories of doctors, midwives, and nurses.

The World Health Organization has since defined health workers more broadly to include all people whose main focus is on improving people’s health, which includes traditional health professionals as well as other types of community health workers. Health workers are the foundation of the health system, and we desperately need more of them—and we need to support those who are there, on the frontlines especially in sub-Saharan Africa. If we are going to change the realities of today’s HIV epidemic, we need more well-supported and highly-qualified health workers. Today, more than 9 million people living with HIV will not get the ARVs they need. For every person we put on drugs, two or three more people are newly infected. What lies before us is a daunting task.

Occasionally, I see this challenge reflected on the faces of the local health workers I meet in my travels. They know all too well what it means to not have enough drugs in the clinic to treat everyone, to see another baby born with HIV, to watch a patient die of AIDS. 

More often what I see now is something that continually inspires me. I see health workers in the most remote areas who struggle every day to make sure their communities get the care they need.  They go about their work, day after day, with a smile on their faces. There is a formidable strength in these individuals, even in the most trying circumstances. They see what I have seen, that the needs are pressing but we are both preventing more infections and putting more people on ARVs. These patients regain weight and eat again and live normal lives. There is a sense of hope, a sense that there is something that can be done. I truly don’t know how health workers do it everyday, and I admire them. I am energized by the resilience of their spirit in the face of HIV/AIDS and the depth of their commitment to saving lives in their communities.

Just as the HIV epidemic has changed the world, organizations like IntraHealth have adapted and evolved to meet the changing needs of health workers and the people they serve. Please check back soon at the Global Health blog for more from me on IntraHealth’s response to HIV/AIDS.