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One view voiced early in the project was that the issue of Integration versus Specialization is artificial and unnecessary because one needs both and in any case they are complementary.
However, it soon emerged that much of the new pressure for Integration came from government and was related to the need to reduce funds (see Dissonance on the Welfare State). There other important infectious diseases and there are other sexually transmitted diseases that have to be handled in state financed institutions. In the view of governments, it would save scarce resources if all health issues were integrated.
At the same time there were some practical reasons for integration in some circumstances, for instance in dealing with young people and with work in schools. A good practical case can be made for subsuming sex education within a broader subject like health particularly for schools. Such a more integrated schema will also be functional with, for instance, prostitutes or ethnic minority groups where specialized units are judged to stigmatize people who are seen to attend.
Furthermore, since the number of new cases is slowing down and the existing cases, while concentrating in large cities, are also dispersed over the country, specialization cannot always be justified.
Historically, Hiv/Aids as a new and threatening disease obtained specialized attention. Some people who have worked in this kind of setting for many years, have personal needs to continue in this way, are emotionally involved and resist change. Some of the original reasons for specialization are still valid and new reasons like the special skill to administer and monitor the triple drug treatment also argue for specialization (see Dissonance : Increased Life Expectancy).
The issue is clearly very complex. A distinction has to be made between prevention and treatment and primary and secondary prevention. (See Dissonance: Prevention versus Treatment).
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The need to avoid stigmatization in general and for culturally sensitive groups in particular are functionally relevant reasons for integration. Similarly, dealing with HIV/Aids within a broader topic like health in approaching young people and handling this sensitive subject in school functionally justifies integration.
However, outside these two specific situations, the argument that education about Hiv/Aids can be combined with other health care issues and include anti-smoking and healthy eating messages, etc. is not convincing and needs to be checked through research.
A functional case for specialization is particularly clear in relation to treatment and especially with the complex triple drug therapy and the necessary compliance procedures (see Increased Life Expectancy).
A functional case for specialization can also be made for attacking secondary prevention which is likely to be successful only under conditions where close contact and mutual confidence prevail. However, primary prevention can prosper under integration.
Specialization can be functional in relation to target groups like homosexuals, drug users, prostitutes and possibly women.
Specialization is functional with the use of care schemes like Buddies.
The second Dissonance Reduction derived from the suggestion to Specialize Integration.
The concept Specialized Integration recognizes the advantages of both approaches from the point of view of the client as well as the financial sponsor. Integrated organizations are economical to fund and can be established in areas of a country where few people suffer from HIV/Aids.
A specialized person would operate within such an Integrated organization either full time or part-time in relation to demand. The specialist might be peripatetic and operate in several units which combine Integration and Specialization.
Similarly, within an integrated unit catering for a community, specialized needs for ethnic minority language facilities and health advice, etc. can be provided by a specialist on rotation and in this way combine the economy of Integration with the advantage of Specialization.
The reader will observe that the Specialized Integration solution should be handled by what we call Optimization rather than Maximization. There are situations when neither Specialization nor Integration can be maximized on their own and produce the best results. A superior solution is achieved by Optimization which has to carefully assess the contribution each factor can make in collaboration with the other factor. Optimization, as we saw in the case of Increased Life Expectancy, is not a compromise, but an original and designed solution.
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