Expanding the care continuum for HIV/AIDS: bringing carers into focus

This review explores the specific issues that cluster around the provision of 'care' in the context of the global HIV/AIDS pandemic. We argue that the economic concept of the 'care economy' provides a useful lens through which to view the HIV/AIDS pandemic, as it illuminates the increased labour, time and other demands placed upon households and shows that the assumptions on which norms and expectations of care provision are based are increasingly being challenged. While some strides are being made in policy and programming around HIV and AIDS-related care, much more needs to be known and done to enable individuals, families and households to survive in a world shaken by AIDS. Care, we argue, provides fundamental public goods. A strategy of simply downloading responsibility for care onto women, families and communities can no longer be a viable, appropriate or sustainable response. And this is no less true in this current era of expanding treatment options for people living with HIV and AIDS. Our analysis suggests that there are two distinct but inter-related areas for policy intervention and development. The first concerns international health policy and we argue that the international 'care agenda' needs to incorporate an understanding of the care economy into its frameworks and strategies for action, giving particular focus to the caregiver. The second area encompasses a broad national healthcare policy agenda, where a range of public, private and non-governmental sector actors come together with common purpose to ensure that households affected by HIV and AIDS are protected and enabled to survive.