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Palliative Medicine, Vol. 19, No. 3, 251-258 (2005)
DOI: 10.1191/0269216305pm1005oa

Reviews

Access and equity in HIV/AIDS palliative care: a review of the evidence and responses

Richard Harding

Department of Palliative Care and Policy, GKT Medical School, King's College London

Philippa Easterbrook

Department of HIV/GU Medicine, GKT Medical School, King's College London

Irene J Higginson

Department of Palliative Care and Policy, GKT Medical School, King's College London

Dan Karus

Victoria H Raveis

Centre for Study of Psychosocial Health and Illness, Mailman School of Public Health, Columbia University

Katherine Marconi

Office of Science and Epidemiology, HIV/AIDS Bureau, Health Resources and Services Administration, US Department of Health and Human Services

The high prevalence of pain and other symptoms throughout the HIV disease trajectory, the need for management of side effects related to antiretroviral therapy, the continuing incidence of cancers and new emerging co-morbidities as a result of extended life expectancy under new therapeutic regimes, and the ongoing need for terminal care all prove the curative versus palliative dichotomy to be inappropriate. Although there is evidence for both need and effectiveness of palliative care in HIV patient care, access is often poor and care less than optimal.

This review aimed to identify evidence of barriers and inequalities in HIV palliative care in order to inform policy and service development. Biomedical databases were searched using a specific strategy, and evidence extracted into the barrier and inequity categories of patient, clinician, service and disease factors. A model of the barriers and inequalities is presented from the evidence. Recommendations are made from the evidence for promoting access and outcomes through integrated palliative care from diagnosis to end-of-life, alongside antiretroviral therapy when initiated. Service responses that have attempted to increase access to palliative care are presented.

Key Words: access • HIV • hospice • pain • palliative • review


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A theme issue by, for, and about Africa: Palliative care and antiretroviral treatment can be integrated
BMJ, October 1, 2005; 331(7519): 778 - 779.
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