Palliative care has been largely ignored by the Global Fund and other international international organisations. This was clearly seen in a recent consultancy commissioned by DFID. This has also been reflected in the minimal attention paid historically to palliative care at International AIDS conferences. The involvement of people who require palliative care is more difficult than with most sectors - however the vital role of hospice and palliative care as an essential component of the continuum of quality, integrated management of HIV disease is increasingly being recognised and it is important that this essential component is given due attention by the Global Fund. Hospice and palliative care embodies the holistic approach to the care and support of people living with HIV/AIDS (PLWHA) and their families that everybody strives for, embracing the relief of pain and other distressing symptoms, psychological, social, emotional and spiritual support of the PLWHA and their family. In the era of antiretroviral therapy it is important for a number of reasons that hospice and palliative care is widely available from diagnosis through to bereavement. Firstly, pain and symptoms are experienced throughout the disease trajectory. Secondly, antiretroviral therapy is associated with significant side effects that need to be managed to maintain adherence and maximize quality of life. Thirdly, access to antiretrovirals is limited globally and mortality is still higher for the infected even in countries with universal access. Therefore terminal care, the historically defining element of hospice and palliative care, is still necessary. Fourthly, as life expectancy increases, co-morbidities, particularly cerebrovascular disease, end stage liver disease, and malignancies are increasingly apparent. Resource-poor countries, particularly Sub-Saharan Africa and India, are leading in the integration of hospice and palliative care into the continuum of care for people with HIV/AIDS. Affordable and culturally appropriate models have been developed, adapting easily to the home-based care model and to the community response to HIV/AIDS ]. These services are integrating well with antiretroviral rollout programmes to ensure seamless and high quality management. The vast majority of hospice and palliative care providers now work with people with HIV/AIDS, in some developing countries almost exclusively, and its importance has been recognised at government level. It is, for example, in the health sector strategic plan for Uganda and the UK Government’s Department for International Development (DFID) HIV and AIDS treatment and care policy. UNAIDS, however, recognises that it “is one of the most neglected aspects of health care”. It is imperative that the Global Fund does not allow this neglect to continue. The fund's Partnership forum in December provides a crucial opportunity for all those involved in the HIV/AIDS field to learn of the great contribution hospice and palliative care makes to the care of patients and families, and to forge partnerships for the future, which will substantially improve care provision. Analysis up to now as a result of a Help the Hospices OSI funded project demonstrates that the Global Fund has not supported palliative care in a significant way. We would welcome the Fund's support in the future and would be interested to get other views from this forum.

The effective involvement of relevant governmental,non-governmental, public and private sectors in the empowerment of the community is the base for positive social change through mass literacy, enhanced quality of education, universal primary health and grass roots economic development The involvement would no doubt be undertaken but the actors who are indulge in the process should be fully involved with the core of their hearts.The issue of improvement should be taken seriously and we have to look whether work we observe in the papers really exists on the ground or not.

effective involvement of government and NGO, public sector organization and health organization should totaly invove to built our nation free from the sti/std disease.NGO which have interest to do something for nation and it public primarly calculate the public knowledge bout the common and effective disease. firstly aware the people on the camp basis/melas. constitute the people which are already suffering and futurely suffered. the way of work should have constituecy and effective so that people can took benefit without the extra knowledge applying.all the sectors and actors of the country should spend their time for the control and stimulation of the GF . GF is heartly working the multicountry but it is depends upon the various sector how to utilise the fund. GF team wish solve the problems of nation partially as well as totaly as tne need of that area. team of GF having the global knowledge . i specialy thanksfull to the team of GF. so many experience wish to discuss with GF team but some of my negligency that are effective and harshly. it an opportunity to prove ourself which is given by the GF. the doctors of country, social working organization, health organization will effective for the development of this program. NGO is the heart of the work it can carried out the all activity related with public demand. public need fast and effective treatment. they are not in interesting for expending the time and work. they need to prominent and resulted action.

Involvement of other actors/sectors will no doubt improve better performance, there are actors in field not visible but very active and respected in thier teritories. it is important to carry out environmental scan in any region to identify who the actors are and where they are located including the strong focal areas in development work. it may be good to collaborate with credible personalities and or organizations, the actors's voice may not be convetional or look ideal but that is what work for the communites, thier leadership and responsiveness must also be consider.