In 1988, the Jamaican Ministry of Health developed the National HIV/STD Control Programme, which set up a Counselling and Community Outreach (CCO) Programme to help develop sustainable counselling and social welfare services for all persons affected by HIV/AIDS. Behind the establishment of the CCO Programme was the rationale that prevention and care are part of the same continuum. A compassionate community is more likely to care for people living with HIV/AIDS (PHAs). The more people understand PHA concerns and needs, the more they will provide support for, and reinforcement of, safe and socially appropriate behaviour.

This is particularly true in low prevalence countries, such as Jamaica, where interventions that directly target those already infected with HIV may be as cost effective as massive prevention education programmes. Such interventions should at least be an integral part of any community strategy. CCO staff therefore focused on promoting a referral network and team approach to the delivery of services for PHAs, appropriate referrals, confidentiality, and coping with the stress of caring for PHAs.

The development of the CCO Programme as part of the health-care system took place in collaboration with various entities. The CCO unit initiated interventions with health care and social welfare service providers, as well as with influential community leaders and concerned citizens.

The voices of PHAs were heard through AIDS support organizations such as the Family Center, Jamaica AIDS Support and Luke 6:38. Groups like these, that directly interact with people affected by HIV/AIDS, made a particularly important contribution to the development of the system.

The CCO team carried out a comprehensive training programme targeting health-care workers in the private and public sectors. The team held sessions with hospital and clinic staff in government facilities across the island. These sessions went beyond clinical care and universal precautions issues and dealt with PHA needs and referrals to appropriate service providers. The team addressed hundreds of physicians through collaboration with the Medical Association of Jamaica in a series of workshops. Other health-care workers targeted during this period were nurses, community mental health officers, contact investigators, as well as technical and administrative staff of some of these institutions.

A useful output from this process was the development of a simple annotated algorithm, i.e., an outline of steps in the process of providing support. It was used as a training tool to sensitize participants to the different needs of PHAs as the disease progressed. The algorithm was refined in collaboration with the Caribbean Regional Epidemiological Center and became part of the field guide distributed by that Center.

The next phase of intervention therefore targeted key gatekeepers, including physicians (public and private), STD contact investigators, blood bank nurses/counsellors, and appropriate hospital staff.

These providers indicated that sensitization to a team approach to support people affected by HIV/AIDS would be more readily translated into appropriate referral behaviour if they had an aide memoire (reminder document) listing the available resources. Consequently, the CCO team circulated a Referral Resource Manual developed by the Helpline staff. The providers were not especially responsive to the manual and some admitted that their heavy client load did not allow them time to refer to it. In response to their comments, a wall poster was developed. It provides an easy visual reference for the service provider, highlighting key concerns and needs of people affected by HIV/AIDS, listing service providers who can address these concerns and providing contact information. A section of the poster allows the service provider to fill in the names and contact information for the resource people with whom they are familiar.

It is believed that the combination of the algorithm and the referral poster will promote a team approach to management of whole health issues of a greater scope than those related solely to HIV/AIDS. The poster is presently going through a final testing phase and it is anticipated that it will be produced in collaboration with the Medical Association of Jamaica.