The challenges for the future are many:

• To continue offering quality services and that quality should not be sacrificed because of the steadily increasing number of clients. We believe that decentralization involving increased involvement from the community , rather than vertical expansion, will go a long way towards maintaining and improving the quality of services.
• The ART programme is of course essential in the fight against HIV/AIDS but its implementation is by no means simple, above all within a context of poverty in which many people do not even have enough to eat. It requires coordination at the national level, intensive staff training, increased workloads and committed efforts from clients and field workers with regard to adherence.

The risk is that other equally essential social aspects of the fight will be overshadowed and abandoned due to the efforts required to correctly implement ART.

• PASADA has a wealth of experience in HIV and AIDS service provision and much to offer other organizations willing to set up similar services. PASADA receives many requests for training workshops  from all over Tanzania in this sense. We answer yes to many, but are forced to say no to many others due to lack of resources and to overworked staff.

We believe that the solution is to set up a structured training unit having its own staff and its own budget to meet this need (this is currently being planned and funds are being sought for construction work).

• Stigma and discrimination are still serious obstacles to VCT  access and the cause of much pain, isolation and humiliation for clients. Much work still remains to be done with the communities on this issue.
• PLWHA involvement in as many activities as possible is essential for constant appraisal and improvement of services. More attention must be paid to this issue.
• HIV+ men seldom become involved in activities. They tend to hide their status from others and continue transmitting the virus. Yet they are the ones with decision-making powers in sexual relationships. Their non-involvement affects women’s health, but also their own. Strategies should be developed raising awareness and guaranteeing more transparency about their status with their partners and more active involvement in fighting transmission and the social impact of the pandemic.
• Orphans and Vulnerable Children are a particularly vulnerable group with regard to the stigma and discrimination associated with their social status. They are open to abuse of all kinds and sexual abuse, accompanied by the added burden of teenage pregnancies, is very common.  Lobbying within the legal and educational systems needs to be increased.