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

12th World AIDS Conference

Abstracts 22477-22482 359

22477 Training needs of the nursing workers who care for HIV+
clients
Anna L.F.P. Lins Gryschek, J.C. Domingos, C.R.L. Figueiredo, L.Y.I. Nichiata,
L.M. Osorio. Av Dr. Endas de Carvalho Aguiar 419, CEP 05403-000,
EEUSP/Programa Municipal DST/AIDS - SP, Sao Paulo, SP, Brazil
Issue: Specific training needs of nursing workers of the Centers of Reference
of Sexual Transmissible Disease (STD)/AIDS of the Health Secretary of the
Township of Sao Paulo - Brazil, for the development of actions foreseen by the
Program of STD/AIDS of the city of Sao Paulo.
Project: Starting in 1996, the Program of STD/AIDS of the city of Sao Paulo
implemented the Centers of Reference (CR) of STD/AIDS. Considering the majority of the actions proposed by the Program concerns the nursing team. Most of
this team workers were not fully qualified to develop this care. This situation lead
us to elaborate a training process focusing these workers. The present study was
designed to recognize the contents of this training. Questionnaires were send to
671 nursing workers in January of 1997 in order to identify some characteristics
of that population and its demands for training.
Results: 453 nursing workers answered (nurses, auxiliary nurses and nursing
attendants). Most of them were female, ages ranging from 35 to 45 years, working in the Health Secretary of the Township of Sao Paulo for about 10 years.
Half of them had experience in the care of HIV+ clients and the majority (80%)
had already participated in "sensibility courses in AIDS". They identified the following needs: contents related to the use of standard precautions; preparation
and administration of specific drugs and other general nursing care to HIV+
clients.
Lessons Learned: This situational diagnosis allowed the planning of a nursing
team training program that considered the needs manifested by the workers
involved, privileging the themes that were identified by them. We also concluded
that programs of professional training are more effective when they take in
consideration the needs and the realities of the people involved.
22478 Auxiliary cabinet like a substitution of the laboratory
hood in preparation of chemiotherapics
Adriana Guzzo Mucke1, R.M. Figueiredo2, M.R.C. Colombrini2. 1State University
of Campinas Unicamp, Rua Doutor Quirino 959 apto. 11 Centro Campinas SP
CEP 13015 -081; 2Unicamp, Campinas, Brasil
Issue: The preparation of the ganciclovir depends on the appropriated technique
with utilization of laboratory hood. To present an alternative to this equipement
with a high cost, wich is a duel to the brazilian reality and ather countries from
third world too.
Project: We reviewed the applications numbers of the intravenous ganciclovir
in the Hospital day at the State University of Campinas - Unicamp - in 1997,
totalizong 2659 being avarage 222 a month. How na equipament to an individual
protection is to recommended publicly the use of the apron with long sleeves,
surgery gloves and mask. The dilution must be realized in the laboratory hood
wich is an expensive equipment and the cost it isn't acess to a Day Hospital.
Like an alternative we suggest a trabparent acrylic cabinet with exhauster, high
potencial fluorescent ligth, and two windows for hand manipulation of materials.
Lesson Learned: The cupboard appears as an alternative to minimize the ocupation risk during the preparation of the chemiotherapics and it's ecconomically
viable.
22479 1 Bringing together care providers and PWAs to improve
care in an advancing pandemic: Theta speaker's bureau
Teopista T. Nakyanzi1, R. King1"2, T. Mutebi3, D. Kabatesi4. 1Theta PO Box
21175, Kampala; 2MSF CH and Theta, Kampala; 3 Traditional Healer Association
Theca, Kampala; 4STD/AIDS Control Programme Mo Health, Uganda
Issues: Exchange of AIDS care and support information by traditional healers
(TH), conventional health practitioners (CHP), and people with AIDS (PWAs).
Recognised information gap between TH, CHP and PWAs.
Project: A forum for TH and CHP and PWAs in and around Kampala was
initiated in September 1995 for information exchange on social, cultural, economic and health aspects of HIV/AIDS and STDs. 25-30 participants including
healers, health workers, social workers, researchers and PWAs meet monthly
in "a speaker's bureau". Information is generated through presentations, brainstorming, testimonies, demonstrations and interviews on AIDS related topics.
Expert guest speakers are identified among TH, CHP, PWAs and researchers.
Results: Traditional healers confirmed that they treat AIDS related conditions.
With continuous exposure, information and experience over the last 10 years, TH
have improved their management of AIDS illnesses. CHP have noted that clients
receiving information and counselling, learnt to be efficient in managing their
illnesses and are able to better cope with their HIV status, seeking appropriate
treatment, eating a balanced diet, and having protected sex compared to clients
who are not counselled. Clients of TH and CHP cited poverty as a major challenge
to care and support due to lack of means to get appropriate medical investigations

and treatment. Poor ethical standards and research skills have high implications
on human rights of PWAs.
Lessons learnt: For the first time in Uganda TH, CHP and PWAs collaborate in
AIDS work. PWAs experience enormous care needs leading to self-medication.
Discussions between TH and CHP on available therapies and client needs, can
improve quality of care, health seeking behaviours, and reduce dangers of self-medication, a critical issue besetting over 1.5 million PLWHIV/AIDS in Uganda.

Lack of committed care-providers in both sectors, and lack of information about
available treatment options, are needs to be addressed.
S22480 Rehabilitation services for people living with HIV
Gerry Bally1, A. Phillips2, S. Thomas2, A. Craig2, J. Flannery3. 1Jeanne Mance
Building, Tunney's Pasture, Postal Locator, Ottawa, Ontario; 2 The Wellesley
Central Hospital, Toronto, Ontario; 3Casey House Hospice, Inc., Canada
Issue: HIV infection leads to impairments, disabilities or handicaps in a majority
of people living with HIV during the course of their illness. The most common
rehabilitation conditions include pain, fatigue, weakness, weight loss, breathing
problems, cognitive impairments and visual loss. Treating disabling conditions
leads to improvement in quality of life, functional capacity and social integration.
Rehabilitation interventions are low technology and are feasible in developed and
developing countries.
Project: A multi-sectoral, interdisciplinary national working group, representing
community representatives and care providers, developed a clinical resource
which describes appropriate rehabilitation services for people living with HIV.
Results: The national working group developed a 90 page clinical resource
targeted to rehabilitation professionals new to the care of people living with HIV.
The book addresses the context of HIV disease, describes adult and pediatric
rehabilitation interventions for the most common impairments observed in HIV
disease, and describes preventative rehabilitation and vocational rehabilitation.
This resource is available in English and French.
Lessons Learned: Community representatives and care providers can work
together to introduce rehabilitation into the continuum of HIV care. This clinical
resource describes appropriate rehabilitation services which address common
impairments in HIV disease. Rehabilitation is compatible with patient-centered
models of care. The low technology focus of rehabilitation permits the application
of these interventions in developed and developing countries.
S22481 1 Community care for slum dwellers with HIV/AIDS in the
slums of Nairobi
Alice Njorge, E.J. Phillips. Eastern Deanery AIDS Relief Program, Nairobi, Kenya
Issue: On the Eastern side of Nairobi there is a population of 1.5 million people
with about 500,000 of these people living in slums. These people are not able to
access easily the health system and thus are left on their own to deal with all the
AIDS related issues.
Project: The Archdiocese of Nairobi Eastern Deanery has developed a holistic
community based program to respond to their medical, social, psychological and
spiritual needs until death. A key component in the delivery of all the services
are volunteer community based health workers who are chosen by their slum
communities.
Results: Over a three and a half years the program has been able to care for
approximately 3,800 patients. 350 volunteer health workers have been trained
and are caring for the sick within their neighborhoods of the slums. Program is cost
effective by being community based and following WHO drug list for treatment.
Lessons Learned: The only answer for caring for HIV/AIDS patients in a slum
situation is to provide delivery of all the services within the slum communities.
To be successful in the delivery of services you need community health workers
chosen by the communities who play the primary role in care giving and referral
of other professionals for services.
S22482 Children living in a world with AIDS
Ruth Sims. Mildmay International, 1 Nelson Mews, Southend on Sea, Esses,
SS1 1AL, UK
Issue: The emotional and physical risks to children caused by lack of relevant
communication between parent and child.
Project: Mildmay International were requested to provide workshops on 'working with children' in East Africa. In order to confirm and assess the need for this
intervention a study tour of East and South Africa and Zambia was undertaken. 39
parent groups and projects involved in the care of children infected or affected, by
AIDS were contacted and most were visited. It was unanimously confirmed by all
those visited that: a. children who are not prepared for the loss of family members,
or who are unaware of how to protect themselves from becoming infected, are at
great risk emotionally and physically, b. Little is currently being done to address
these issues in those countries visited. There is therefore an urgent need to
facilitate appropriate communication within families, as well as amongst health
care professionals (hcp's) and others who currently feel ill equipped to undertake
this work with children.
Programmes for residential workshops on "working with children in different
circumstances" were developed and conducted in partnership with mothers with
HIV disease and carers working with children in East Africa. Three workshops for
24 participants were offered: 1. For mothers who were HIV positive; 2. Training of
trainers (TOT's) course for hcp's, e.g. paediatricians and paediatric nurses; and

3. TOT's course for non-medical personnel, e.g. school teachers, youth leaders.
Results: Follow-up information clearly indicates that the quality of life of parents
with HIV disease and their children is improved when (a) they can communicate
with each other about the impact of AIDS on their lives and, (b) those caring for
them have skills in communicating about difficult issues.
Lessons Learned: Mothers, in Africa, who are HIV antibody positive are desperate to communicate with their children about the issues despite the personal