Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 13476-13479 1 81

HIV and AIDS. The training included sessions on syndromic case management
and preventive services (partner treatment, compliance counselling and condom
promotion) on community SID care.
Project: We conducted training in Quality STD care to a group of 239 private
practitioners. The training included STD syndromic case management, prevention
of STD, that is partner treatment, compliance, counselling and condom promotion
using a standardised module and following a needs' assessment questionnaire.
We undertook an in-depth follow-up of a 10% random sample of doctors at their
practice setting after three to nine months of training to assess the change in
health providing behaviour. Data was collected using the mystery patient approach
and direct interviewing methods on shift-over to syndromic case management,
revised practices on ensuring compliance, partner treatment, condom usage and
counselling.
Results: Of the 25 doctors studied in depth, 40% of them reported that they
resorted to syndromic case management as against their previous practice. 62%
of them ensured compliance, 35% were able to treat partners for half of their
patients and 16% ensure condom use in less than a fourth of their patients. A fifth
of the doctors only provided counselling services. The reasons for their unavailability were disinterest in STD practice to non-recognition of certain conditions
such as white discharge and Pelvic inflammatory diseases as STD. Five doctors
desired supportive counselling and communication services.
Lessons Learned: We should consider providing support services for counselling and communication to the GP apart from training them in STD quality
care. Also adequate care in selection of practitioners for STD quality care training
is important to improve the rates of behaviour change of GP for implementing a
successful prevention program in HIV and AIDS.
S13476 1 Are Nigerian medical students adequately prepared to be
effective in HIV/AIDS prevention?
Charles Uwakwe1, I. Moody1, A.O. Ogundiran2, A. Mansaray1. 'Dept. of
Guidance and Counselling, University of Ibadan, 2Ministry of Health, Oyo State,
Ibadan, Nigeria
Objectives: Epidemiological data indicate that over.5 million Nigerians are
infected with HIV. Public awareness is low, even among health care workers
generally and physicians in particular, where recent research revealed important
gaps in their risk assessment and counselling skills. This study was designed to
ascertain the extent to which current medical students, whose medical education
commenced after the onset of the HIV/AIDS epidemic are adequately prepared
for their future role in HIV/AIDS primary prevention.
Methods: Anonymous questionnaires were distributed to all fourth and fifth
year medical students at the College of Medicine, University College Hospital,
Ibadan, Nigeria, yielding a sample of 477. Questions focused on: physicians role
in HIV/AIDS prevention, students knowledge (HIV/AIDS epidemiology, transmission, occupational risk), fear of contagion and resistance to working with AIDS
patients and ethical issues associated with AIDS, skills in sexual history taking,
HIV risk assessment and counselling, judgement on the quality of their medical
education.
Results: Medical students (85.7%) perceive the physician's role in the AIDS
epidemic as that of primary prevention, HIV infection diagnosis, general medical
follow-up and the provision of psychological support to HIV+ patients. The therapeutic dimension is considered as secondary. On risk assessment, only 37%
subscribe to looking for potential exposure to HIV in a new patient, 44% at a
check-up, and 32% in an unmarried patient. 62% of the students are unaware of
the necessity of pre-test counselling and lack communication skills.
Conclusions: Nigerian medical students aver that primary prevention should
be the physician's crucial role in HID/AIDS control. Significant gaps exist in their
assessment of HIV behaviour risks. Appropriate changes in medical education
curriculum should therefore be initiated and implemented in Nigerian medical
schools.
S13477 Pilot program in experiential HIV/AIDS education for
nurses in China
Jane Burgess1, C. Watkins3, N. Angoff2, Changju Zhou4, A. Williams1. 1 Yale
School of Nursing 100 Church St S., Box 9740 New Haven CT 06536-0740;
2Yale University, New Haven, CT, USA; 3 Yale China Assoc New Asia College,
Hong Kong; 4Hunan Medical University Changsha, Hunan, China
Issues: Estimates of the prevalence of HIV in China range from 100,000 to
300,000. Rapid social and economic changes have lead to an increase in the
social conditions that facilitate rapid spread of HIV infection. Because nurses represent the majority of health care providers, they are in a key position to provide
HIV education to the community. However, opportunities for Chinese nurses to
learn about HIV/AIDS have been quite limited.
Project: Funded by the World AIDS Foundation, a team of American nurse and
physician educators are collaborating with the Nursing Department of Hunan Medical University, Changsha, Hunan Province, P.R.C. to develop a train-the-trainer
program for Chinese nurses. The program includes didactic and experiential
learning activities intended to increase Chinese nurses' level of comfort when

discussing culturally sensitive issues such as sexual behavior and drug use. The
program emphasizes collaborative development of educational materials that
reflect the local cultural context.
Results: In a pre-program assessment, Changsha nurses demonstrated accurate knowledge about blood and sexual routes of transmission, but many
misconceptions about "casual" transmission. There was significant interest in ac
quiring skills to teach about HIV/AIDS. In the first of three week-long workshops,
30 nurses from Hunan province actively participated in demonstrations of teaching
methods and activities. At the conclusion of the workshop, the majority reported
that they felt confident that they would be able to obtain up to date information
about HIV, discuss high risk sexual behaviors and help patients develop skills to
practice safer sex. However, the majority still felt uncomfortable discussing sexual
intercourse, condom use, and male genitalia.
Suscessful HIV/AIDS education requires teachers and students to examine
personal and cultural values in order to address the affective learning domain.
Chinese nurses responded enthusiastically to a pilot program designed to encourage the development of such a program in China. Nurses remained somewhat
uncomfortable with sexual information after an initial workshop. Follow-up training
programs are essential.
S13478 Impact evaluation of targeted training in preparation for a
women HIV prevention programme in maternal and child
health centres
Teresa Man Yan Choi, Tinny Tin Yee Ho. AIDS Unit 5/F Yaumatei JCC 145
Battery Street, Yaumatei Kowloon, Hong Kong
Objectives: To determine the short and intermediate term impact of targetted
training programme to prepare nursing staff in primary care setting to implement
women HIV prevention programme.
Methods: A two-stage evaluation was designed to determine the impacts of a
full-day training conducted for primary health care nurses. The immediate impact
was measured by a pre- and post-seminar questionnaire which contained 20
knowledge questions. Three months after the training session, each was required
to return a worksheet recording her public health actions taken.
Results: Two training seminars were held in 1995 and 1996. The attendance
of each seminar was 120 and 104 respectively. Significant improvement in the
knowledge has been noted [figures indicating scores (sd)]:
Pre-seminar 1 Post-seminar 1 Pre-seminar 2 Post-seminar 2
General HIV knowledge 6.96 (2.68) 8.42 (1.60) 7.68 (2.07) 9.10(1.28)
HIV in women 5.21 (2.37) 9.32 (1.31) 5.68 (2.20) 9.28 (1.19)
HIV in babies 3.60 (2.30) 6.89 (2.02) 4.28 (2.58) 7.62 (1.65)
Perinatal transmission 3.37 (2.25) 7.10(2.20) 4.40 (2.40) 7.54 (2.18)
Total 19.16 (5.73) 31.81 (4.44) 22.04 (5.83) 33.54 (3.54)
Three months later, a total of 165 and 172 group talks had reportedly been
conducted for women. Half of those who did not provide any group talk claimed
that it was not their duty and half thought they were not experienced enough.
Counseling was rarely provided (8 and 23 individual counseling in 95 and 96) as
most reported their clients were not concerned about AIDS.
Conclusions: Although targeted training has significantly increased the knowledge of primary care nurses, the intermediate term impact evaluation has stronger
bearing indicating how the knowledge could be translated into action. The study
suggested that post-training follow up may enforce implementation of HIV education and counseling for pre-pregnancy and antenatal women attending maternal
and child health centres.
13479 AIDS counselling clinic outreach to private medical
centres: The Nigerian experience
Precious Ojor Alawuru1, M. Osahwanurhe2, F. Okoro3. c/o Jimon People's
Clinic, 104 Owina St., Off Ekenwan Rd., Benin City, Edo State; 2Staff Nurse c/o
Natho, 2 Ukpokiti St., PO. Box 1708, Warri Delta State; 3Nigeria AIDS Theatre
Org., c/o 2 Ukpokiti St., PO. Box 1708, Warri, Nigeria
Issue: Clients of private hospitals in poor nations with epileptic AIDS control programs are at high risk for AIDS due to ignorance, doubts, lack of AIDS education
outreach to private clinics and workplaces, their indulgence in alcoholic pastimes
and risky sex.
Project: An AIDS counselling clinic outreach program targetting clients (aged
18 to 50 years), that strictly attended a private clinic in Warn, for education and
prevention using a medical doctor, a psychologist (AIDS educators) and 4 nurses
(staff of the clinic but trained on HIV/AIDS) working within the clinic was initiated in
2 phases. 1st phase, April-September 1995, conducted without media publicity.
2nd phase, 1996, with full media glare, strategies include one-to-one counselling,
STDs examination, handbills, posters and condoms distribution, Blood pressure
and Body weight checks and Question and Answers sessions.
Result: The AIDS counselng clinic outreach program's 1st phase was well
accepted by clients which led to its extension from 3-6 months duration, clients
number rose from 30 to 300 by 3rd month. Some participants became clients of
clinic, eventually. 2nd phase (March 1996) had 300 participants at onset but it
dropped to 10 due to stigmatisation of clinic/clients by the public. Program was
terminated in the 3rd month; 2 months after, clinic folded up for lack of patronage.
95% of clients traced to their homes, blamed discrimination and stigmatisation
for their abandonment. A total of 1,500 attended program, 2800 condoms, 2000
handbills distributed, 905 persons counselled and 58 treated for STDs.

Lessons Learned: AIDS education and prevention outreach programs in private health clinics are successful if tacitly integrated and implemented without
media publicity, and there is an urgent need to address the issue of discrimination
and stigmatisation by the Nigeria government, private sector, NGOs, and CBOs
if we must win the fight against AIDS.