Physical Therapy Leadership in Disability and HIV: Sharing International Perspectives

Nixon S.^1,2,3, Abbud G.⁴, Hard J.⁵, Myezwa H.⁶, O'Brien K.⁷

¹University of Toronto, Department of Physical Therapy, Toronto, Canada, ²University of KwaZulu-Natal, Health Economics and HIV/AIDS Research Division (HEARD), Durban, South Africa, ³University of Toronto, International Centre for Disability and Rehabilitation (ICDR), Toronto, Canada, ⁴Infirmary of Infectious Contagious Diseases, São Paulo, Brazil, ⁵Canadian Working Group on HIV & Rehabilitation, Toronto, Canada, ⁶University of the Witwatersrand, Department of Physical Therapy, Johannesburg, South Africa, ⁷McMaster University, School of Rehabilitation Science, Hamilton, Canada

Learning objectives:

1. To provide an overview of evidence regarding the growing intersections between disability, HIV and physiotherapy. 2. To illustrate examples of physiotherapy leadership in research, clinical practice and education on disability and HIV in 3 regions, with a focus on South Africa, Brazil and Canada. 3. To highlight areas for future collaboration between regions to advance HIV and disability research, practice and education in the field of physiotherapy. 

Description:

Overview
Around the world, recognition is growing regarding the significance of HIV and disability. In April 2009, following years of excluding concern for disability within major HIV reports, UNAIDS released the Disability and HIV Policy Brief calling for immediate attention to this neglected issue. Furthermore, former UN Special Envoy for AIDS in Africa, Stephen Lewis, recently identified disability and HIV as “one of the most critical issues facing populations from Africa to the Caribbean, Asia and beyond” in the work of his new organization, AIDS-Free World (www.aids-freeworld.org). Physical therapists have played an historic role in developing the field of HIV and disability. Attention first focused on disability resulting from HIV, its secondary effects, and the side effects of treatment. This field was ignited in wealthy countries in the mid-1990s when people who could access the new HIV treatments began living longer lives, but with complex and unexpected experiences of disablement. More recently, attention has turned to people with pre-existing disabilities and their experience of HIV. This newfound emphasis on people with disabilities has largely been motivated by advocacy in Southern Africa where rates of both disability and HIV are relatively high (http://www.dhat.org.bw/up_mgr/file_doc24.pdf). Physiotherapy has important roles to play across these continua. This symposium will demonstrate leadership emerging from three WCPT regions, including the following examples.

Research Leadership in South Africa
Southern Africa remains the epicentre of HIV worldwide. The challenge to physiotherapy leadership in Africa is how to influence policy and intervention strategies. Physiotherapists have played leadership roles through production of new knowledge, including Myezwa who used the ICF framework to explore rates of disability among adults living with HIV (African Journal of AIDS Research, 2009,8(1): 93-106.). Potterton (2001,2006) contributed to understanding developmental delay among HIV-infected children. Mutimura (2008) demonstrated how cardiorespiratory exercise training positively alters body composition, decreasing waist circumference, waist-to-hip ratio, and percentage body fat mass in HAART-treated HIV-positive Rwandan participants with body fat redistribution. Research is also underway to understand the effect of physiotherapy on peripheral neuropathy among people living with HIV in Rwanda and Zimbabwe.

Practice Leadership in Brazil
Government, community groups and NGO's have been acting collaboratively to control the epidemic and provide treatment and care for those living with HIV in Brazil. Actions on prevention, treatment and care are provided by Reference Centers on HIV/AIDS (CRAIDS). Although physiotherapy is recognized as a fundamental part of treatment and care for HIV-related disabilities, however, physiotherapists are not always part of the multidisciplinary team within CRAIDS. Thus, rehabilitation interventions are often delegated to university clinics and other local health centers. However, efforts are underway to include physiotherapists as integral actors at CRAIDS, including the city of Santos, where the prevalence of HIV is one of the highest in the country. Early physiotherapy intervention has been engaged to facilitate normal neuropsychomotor development of HIV-positive children.

Education Leadership in Canada
Research, advocacy and education on disability in the context of HIV motivated creation of the Canadian Working Group on HIV and Rehabilitation (CWGHR) in 1998. CWGHR then engaged research to investigate the extent of disablement experienced by adults living with HIV in British Columbia. Results revealed overwhelmingly high levels of disablement highlighting the role for physiotherapy (Rusch, Nixon et al. Health and Quality of Life Outcomes, 2004,2:46). Despite this need, few rehabilitation professionals actually work with people living with HIV (Worthington, C., Myers, T., O'Brien, K., Nixon, S. 2005, AIDS Patient Care and STDs, 19(4), 258-271). This led CWGHR to develop a national interprofessional curriculum on HIV to enhance the capacity of rehabilitation professionals to address the disablement needs of people living with HIV, e.g., in-person interprofessional course; a professional mentorship program; and, an online course.

Implications / Conclusions:

HIV and disability is emerging as a major issue worldwide, yet insight is limited amongst physical therapists regarding clinical, research, education and advocacy opportunities. This symposium will provide both basic information as well as cutting-edge examples of physiotherapy leadership from three regions, noting synergies in our efforts around the world.

Keywords:

HIV; AIDS; disability

Funding acknowledgements:

Kelly O’Brien receives Postdoctoral Funding from the Michael DeGroote Postdoctoral Fellowship (McMaster University) and Canadian Institutes of Health Research, HIV/AIDS Research Program. 

Relevance to WCPT and expected audience:

This symposium has been specifically designed for the WCPT insofar as it focuses on the role of physiotherapy in a global health context, with a spotlight on HIV. The expected audience is physiotherapists and others interested in both learning about and contributing to a dialogue on HIV.

Target audience:

Anyone interested in advancing her/his knowledge of the role of physiotherapy in HIV and AIDS, whether new to the field or experienced in this area.

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