What is a chronic disease? The effects of a re-definition in HIV and AIDS.
HIV disease has recently come to be defined as a chronic disease from both policy and clinical points of view. This paper investigates the meaning and some possible implications of the redefinition. The first section examines the features identifiable from medical texts used to define a disorder as either acute or chronic and explores some of the implications of the definition on patterns of care. In particular, different types of doctor-patient relationship are examined. The second section looks at the categorisation of HIV disease using these textbook definitions, finding that HIV is most appropriately labelled as chronic. The next section uses the clinical definitions to look at two conditions for comparison with HIV; testicular cancer and multiple sclerosis. In the fourth section the policy re-definition of HIV is investigated and one of the potential effects of a policy redefinition is discussed--a change in the extent to which services are centralised. The paper concludes that the policy and clinical communities confuse the picture of HIV disease as a chronic condition. There are strong parallels between care for people with HIV disease and care delivered for an acute condition. It therefore seems likely that the policy redefinition of the disease as chronic may not be entirely adequate to use as a current model for investigating or planning patterns of care in HIV disease.
Clarke
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Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, England.
D000163:Acquired Immunodeficiency Syndrome / Q000145:classification* / Q000628:therapy; D002497:Centralized Hospital Services / Q000331:legislation & jurisprudence; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence*; D004739:England; D015658:HIV Infections / Q000145:classification* / Q000628:therapy; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D008134:Long-Term Care / Q000331:legislation & jurisprudence; D013222:State Medicine / Q000331:legislation & jurisprudence