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

12th World AIDS Conference

Abstracts 22455-22459 355

Results: In less than a year time the project has made successful partnerships
and successful fund-raising to assure its continuity. The coordination on a professional basis guarantees the buddies the constant support needed to perform their
tasks. The projects first results are quite satisfactory, with clients mostly requiring
help to rebuild their private lives and looking for alternative life standards since
many have lost much of their previous patterns. The service has reached mostly
gay men with a history of losses related to AIDS. Curiously the project has
attracted many HIV positive people willing to volunteer who have faced the same
problem before, which has enormously enriched the service.
Lessons Learned: The keys we found to make possible settling a long term
help care projects were: firstly to have a coordination on a professional base (paid),
even if the service be offered in a volunteer base; secondly, a limited target population with clear profile and needs. This is making possible to carry on a project
highly needed and demanded, with guaranteed public and volunteers, as well as
great chances to raise financial support, both in the private and the public sectors.
S22455. The role of projects of therapeutical domicile
assistance-TDA to AIDS patients in Brazil
Claudia Cunha', V.G.V. Santos2, P.J.N. Chequer2. 'Brazilian AIDS Program
MOH Espl. BL. G Brasilia-DF Brazil-70058-900; 2Brazilian AIDS Program-MOH
Brasilia DF, Brazil
Objectives: National Program of STD and AIDS, of the Brazilian Ministry of
Health, led off starting from 1994 the Program of Alternative Assistance to the
patients with AIDS. Among the strategies, they are being developed, starting from
1995, 30 projects of Therapeutical Domicile Assistance-TDA- in 12 states of the
country. These projects should offer a quality attendance and they constitute a
reference system and against-reference with the public hospitals.
Methods: 08 projects, implanted in 04 states of the country in 1995, were evaluated. A standard questionnaire, included data as the patient's origin (from where
it came guided), number of previous hospitalizations in the last year, number of
days of admission in the service of TDA, and destiny of the patient in the moment
of the exit of the service.
Results: In 1997, of March to July, 118 patients were followed in these services.
We observed the following results: 75% of the patients had already been admitted
to patients in unit in the last year, among them, 66% had 01, 27% 02 and 8%
more than 03 hospitalizations in the last year. In the moment of the inclusion in
the service, 47% of the patients came guided of an internment, 28% of a national
health clinic, 10% of one Day-Hospital, 8% for the family, 3% of a private clinic
and 3% others. The medium duration of permanence in the service was of 59
days (of 03 to 120 days). In the moment of discharged of the service, the patients'
direction settled down in the following way: 41% were to hospital and, among
these, 30% dead during this internment, 16% were rehabilitated and guided for
accompaniment in national health clinic, 7% dead in the house, 3% were guided
for a Day-Hospital and 34% stayed in the service in the end of the evaluation.
Conclusion: The projects of TDA, it has been playing an important part in
the care to the patients with AIDS through the establishment of an relationship
with the public net of health, above all, the hospitals. Is this constituted in an
argument to favor the expansion of these projects, considering the bad quality
of the attendance offered in the public hospitals and the patients' preference for
care in the home.
22456 The burden of care on the rural woman
Jacqueline Kabambe. Actionaid-Malawi PO Box 30735 Lilongwe 3 Malawi,
Malawi
Issue: A Malawian woman is heavily burdened with caring role as a mother, wife,
sister, grandmother as the impact of AIDS grows every day. Its a high time men
get mobilized and start caring for the chronically ill.
Project: The NACP in conjunction with the UNAIDS conducted a rapid assessment on Improved Access to HIV related drugs in Chiringa area with an
intention of assessing the situation with regard to improving access to drugs by
the chronically ill, particularly in the rural Malawi.
Results: It was found that 7 out of 8 care givers interviewed were women
and mothers of the chronically ill person in their care. Only one care giver was
a husband of the ill patient. Five of the care givers were more than 50 years of
age. They devoted themselves to the care duties despite the lack of resources.
"I am trying hard but I do not have enough resources. If I was not alive, my son
could have suffered a lot. He depends on me for most of the care, an old woman
of my age", said one care giver of more than 80 years of age. Four out of the
chronically ill people were married women one of which was abandoned by the
husband and the three were divorced within the course of the illness.
Lessons Learnt: Female relatives were the ones who were primarily responsible for providing care. In the home care groups, women were predominant.
Divorce was common amongst the chronically ill women in this sample. These
points towards issues of gender relations and the status of women.

22457 Nurse's experiences caring for children with HIV infection
Sheryl Zwerski' 2, Wilson Margaret3. 1711 Carr Avenue, Rockville, Maryland
20850; 2National Institute of Health, Bethesda, MD; 3 University of Nebraska,
Omaha, NE, USA
Objective: To identify and describe the experience, both positive and negative,
of nurses who care for children with HIV infection.

Design: Qualitative, grounded theory study.
Methods: Nurses who care/have cared for children with HIV infection were
interviewed by the researcher using open-ended questions to explore their experiences. These interviews were audio taped and transcribed verbatim. The data
were then analyzed using the constant comparative method to discern a pattern
of theoretical meaning.
Results: The basic social psychological problem was danger. There is physical, psychological and social danger. Physical danger is small, but real with the
possibility of infection with needlestick or other incident. Psychological hazards
include anger, multiple loss and the struggle with unfairness. Social danger is
experienced through stigma, hopelessness and isolation. Balancing is the basic
social psychological process involved in caring for children with HIV. Nurses use
many strategies to balance, some of which include creating meaning from the
work, passing, disclosing, nurturing the self and escaping.
Conclusion: Balancing is a learned behavior which enables nurses to cope
and continue working in the field of HIV. Mentoring nurses coming into the field
and teaching balancing strategies could assist nurses in long term coping and
prevent early burnout.
22458 Randomized controlled trial of an innovative coping
intervention for HIV-positive individuals experiencing
symptoms
Jose K. Cote', Carolyn Pepler2. 1Univ. Montreal-Fac. Sciences Infirmieres C.P
6128, Succ. Centre-Ville, MTL, QC; 2School of Nursing, McGill Univ., Montreal,
Qc, Canada
Objectives: To test the effects of an intervention centered on cognitive coping
skills (IC) in comparison with an intervention focused on facilitating the expression of emotions (IE) in regulating the emotional response of HIV+ persons
experiencing an exacerbation of symptoms.
Methods: 90 HIV+ persons hospitalized for an exacerbation of symptoms
were randomly assigned to one of three groups: IC, IE or control group. Both
interventions were administered on three consecutive days in 20-30 minute daily
sessions. In the IE group participants were encouraged to express their feelings
about their current situation. In the IC group the process was taken further to
develop, maintain and strengthen cognitive coping strategies. Pre-intervention
(Day 1) and post-intervention (Day 5) measures were gathered on Mood and
Distress. Mood and Anxiety were assessed immediately before and after each
session on days 2, 3 and 4.
Results: Both interventions had a significant effect of the Negative Affect (one
outcome of Mood); but only the intervention centered on cognitive coping skills
decreased the Distress, especially Intrusion Thoughts. Participants in the IC group
experienced a greater decrease in Anxiety from pre to post-intervention and from
immediately before to immediately after each session compared to those in the
IE group.
Conclusion: The intervention centered on cognitive coping skills was effective
in enhancing HIV+ patients' regulation of emotional response to the exacerbation
of symptoms. It is an intervention that can readily be used by skilled practitioners
in the process of providing daily care.
62*/22459 Nursing care for persons with and without HIV
infection at the University Hospital Antwerp:
Compliance with universal precautions
R. Koeck1, Veerle Willaeys2, N. Debbaut', K. Depraetere2, Y. Fleerackers2,
R. Colebunders2. 1University of Hospital Antwerp, Edegem, 2Institute of Tropical
Medicine, Nationalestraat, Antwerp, Belgium
Objective: To compare the compliance with universal precautions during nursing
care for persons with and without HIV infection in a mixed ward of the University
Hospital Antwerp.
Study Site: Mixed ward for patient with HIV infection, tropical and pulmonary
diseases. In this ward the same nurses provide care for patients with HIV infection
and other diseases.
Methods: In July 1996 the following nursing procedures were observed: 113
blood drawings, 27 subcutaneous (SC) injections, 9 intramuscular (IM) injections
and 24 placings of intravenous (IV) lines.
Results: Gloves were used more frequently for drawing blood from a person
with HIV infection (88%) than drawing blood from a person without HIV infection
(50%) (p < 0.001). Gloves were used in 87% of the IV line catheterizations
and 15% of the SC and IM injections (HIV(+) and HIV(-) difference n.s.). When
drawing blood, a container for disposal of sharp objects was more frequently
within reach when the patient was HIV(+) (81%), compared with HIV(-) patients
(57%) (p < 0.05). Needle containers were not within reach for 50% of the IV
line catheterizations and 67% of the SC and IM injections (HIV(+) and HIV(-)
difference n.s.). Recapping was only observed after SC injections given to 1
HIV(+) and 2 HIV(-) patients.
Conclusions: Universal precautions at the University Hospital Antwerp are not
always applied. The compliance for the most high risk procedures is generally

better when the patients are known to be HIV(+).