There will always be a need for self-management skills for people living with HIV/AIDS. This need does not diminish with improving treatments though the skills and knowledge required may change. Self-management reflects and supports the opportunities offered by better treatment.

Self-management may play a role in developing a new activism among people living with HIV/AIDS. Active involvement in ones own health is often a significant step towards a desire for involvement in the health care system as a whole. There has been an increasing emphasis on public and patient involvement in the management of health services in recent years and many people who have been involved with the CDSMC and PSMP have gone on to roles in formal involvement structures.

The introduction of the PSMP to the UK is an opportunity to build on other approaches to self-management which have always been available to people with HIV/AIDS. The links between the PSMP and the CDSMC can contribute to this opportunity particularly given the importance of the EPP in future arrangements for the management of long-term conditions.

Many course leaders who live with HIV/AIDS now deliver CDSMC programmes. This can assist in breaking down barriers between people living with HIV/AIDS and people with other conditions.

Opportunities exist to use the approach to help other groups affected by HIV including young people living with HIV and partners and families of people living with HIV. It will be possible to integrate the PSMP with wider service packages. Already the NHS Living Well Programmes in London use the PSMP as part of an overall approach to supporting people.

At present the development of the PSMP on a national basis is held back by the lack of a central co-ordinating body. While there have been developments in parts of London and in Manchester it is difficult to see rapid national progress without the support of a national HIV organisation or possibly the EPP. At the very least this central co-ordinating function is necessary to ensure that consistency and quality standards are maintained and that research and development into the approach continues.

Further reading

From Patient to Person: The Living Well Report – Jane Cooper, LMCA, 2004

Living Well with HIV and AIDS – Allen L. Gifford, Kate Lorig, Diana Laurent, Virginia Gonzalez – Bull Publishing 2000

Partnerships for Successful Self-Management – The Living With a Long Term Illness (LILL) Project Report – Jane Cooper, LMCA, 2001.

Patient Education: A Practical Approach- Thousand Oaks Publications 2001

Self-Management of Long-term Health Conditions A Handbook for People with Chronic Disease – NHS Expert Patients Programme – Bull Publishing, 2002

Stepping Stones to Success – An Implementation, Training and Support Framework for Lay led Self-Management Programmes – Department of Health, 2005

Supporting Expert Patients – How to develop lay led self-management programmes for people with long-term medical conditions, LMCA/NHS 2003

The Expert Patient: A new approach to Chronic Disease Management for the 21^st Century – Department of Health, 2001

References

Lorig KR, Sobel DS, Stewart AL, Brown BW, Ritter PL, Gonzalez VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management group intervention will improve health status while reducing utilisation and costs. Medical Care 37(1): 5-14, 1988.

Gifford AL, Laurent DD, Gonzalez VM, Chesney MA, Lorig KR. Pilot randomised trial of education to improve self-management skills of men with symptomatic HIV/AIDS. Journal of Acquired Immune Deficiency Syndrome and human Retrovirology 18(2): 136-144, 1988

Gifford et al. Effects of Group HIV Patient Education on Adherence to Antiretrovirals: A randomised control trial. Paper presented to the 8^th Conference on Retroviruses and Opportunistic Infections 2001.

Websites:

Stanford University Centre for Patient Education Research: www.stanford.edu

Long Term Medical Conditions Alliance: www.lmca.org.uk

Expert Patients Programme: www.expertpatients.nhs.uk