OpiniãoAs shown in the list of the members of the Guideline Group (GG) as well as the list of other organizations consulted, the development of these guidelines has been a collaborative process involving not only all regions of the WHO, several WHO departments, the ILO, UNAIDS (The Joint United Nations Programme on HIV), IOM, Global Health Workforce Alliance (GHWA), Public Services International (PSI), International Council of Nurses (ICN) and other international organizations, but also involved people living with HIV and AIDS.
Despite the varied backgrounds and perspectives of different partners in the guideline development, there was strong agreement on the values that underlie this process, and would be weighted heavily in formulating recommendations. These included the following:
- Human rights figure prominently in any discussion of TB and HIV. There is the right of all people to health - the Universal Declaration of Human Rights (UDHR) is a non-binding declaration adopted by the United Nations General Assembly in 1948. According to the WHO, every country in the world is now party to at least one human rights treaty that addresses health-related rights. This includes the right to health as well as other rights that relate to conditions necessary for health for all people.
- Gender equity and adopting gender-sensitive policies and programmes. The vast majority of health workers are women, and women bare particular concerns. The United Nations Development Fund for Women (UNIFEM) states that "Gender inequality and violations of women's rights make women and girls particularly susceptible, leaving them with less control than men over their bodies and their lives. Women and girls often have less information about HIV and fewer resources to take preventive measures. They face barriers to the negotiation of safer sex, including economic dependency and unequal power relations. Sexual violence, a widespread and brutal violation of women's rights, exacerbates the risk of transmission. In many cases, HIV-positive women face stigma and exclusion, aggravated by their lack of rights." UN Secretary-General Ban Ki Moon says: "Stigma remains the single most important barrier to public action. It is a main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer, because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the AIDS epidemic continues to devastate societies around the world" These guidelines will be particularly sensitive to these concerns.
- Involvement of people living with HIV and TB, both as a concrete manifestation of promoting human rights, as well as because existing evidence supports the effectiveness of greater involvement of people living with AIDS in implementing the guidelines proposed, this principle is embraced as a value underlying the recommendations as well. Ideally, all clinics would benefit from openly positive staff. Greater involvement of people living with HIV and TB provides human insight into all facets of these recommendations, particularly the unique sexual and reproductive health concerns of people living with HIV and how these issues can be adequately addressed in workplace based programmes for health workers.
- Worker rights also figure prominently in formulating these guidelines. As noted by the ILO and WHO in previous guidelines, all workers should have the right to a healthy and safe workplace. Adopted in 1998, the ILO Declaration on Fundamental Principles and Rights at Work is an expression of commitment by governments, employers' and workers' organizations to uphold basic human values.
- Following from the above, that reduction of health worker exposure to HIV and TB involve not only address non-occupational factors, but also occupational risks, and that, as embraced by existing WHO and ILO guidelines, Implementation of controls as a combination of measures reduces transmission of TB in health-care facilities. Administrative controls are needed to ensure that people with TB symptoms can be rapidly identified and, if infectious, can be separated into an appropriate environment and treated The administrative controls should be complemented by environmental controls and personal protective equipment, because evidence shows that these measures all contribute to reduction of transmission of TB
- A strong consensus exists that primary prevention is most important. While two of the three questions that were the focus of the Cochrane-style Systematic Review were oriented towards evaluating the effectiveness of programmes to diagnosis and treat HIV and/or TB, this was not a reflection of the greater importance placed on the secondary and tertiary prevention , but rather that guidelines supporting prevention measures are already well-researched and subject of other recent guidelines, which obviated the need for the Guideline Group to re-assess the effectiveness of these prevention measures at this time. The Guideline Group urges that there must be a coordinated effort between primary, secondary, and tertiary prevention.
- Efficiency and effectiveness requires transcending traditional boundaries: Finally, all parties need to work together to address this complex, multi-stakeholder, multi-disciplinary problem. Too often "turf issues get in the way of organizing and implementing a coherent efficient and effective programme. As a principle underlying these recommendations, the GG urges strong coordination between the different departments of ministries of health, and amongst ministry of health, ministry of labour, and other institutions or ministries with responsibilities in this multi-component area.