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

502 Abstracts 24321-24324

12th World AIDS Conference

them who do not live with their partner, the fear they would quit them. Their main
problem is to be completely dependant of their partner for living. Two women,
living in polygamous home, are scared to be repudiate. Others donot want to tell
their status in relation with the shame associated with AIDS, a disease considered
to bring deshonour.
Six women did inform their husband or a family member about their HIV infection. Three remained with their partner but the persisting refusal of the partner
to realize his own HIV test raises numerous problems in the couples. Two of
the women have been send back to their own family by their husband with their
children either in Abidjan or in their village. We have lost to follow-up the sixth
one.
Conclusions: most of the women living with HIV in Africa are every day scared
to be judged by people that could know their HIV infection. This knowledge can
carry divorce and disgrace of the woman at home. HIV infected women need to
be helped to acquire more power and economic independancy.
592*/ 24321 Counseling strategies: they work! Results from the
voluntary HIV counselling and testing (VCT) study
Don Balmer1, E. Van Praag2, O. Grinstead3, S. Gregorich1, G. Sangiwa4,
C. Furlonge5 and VCT Study Group. Kenya Assn. of Professional Counselors,
Nairobi, Kenya; 2UNAIDS/World Health Organization, Geneva, Switzerland;
3UCSF Center for AIDS Prevention Studies, 74 New Montgomery, San
Francisco, CA 94105, United States; 4Muhimbili University College, Dar Es
Salaam, Tanzania; 5 Voluntary Counseling & Testing Centre, Curepe, Trinidad WI
Objectives: To describe the counseling process used in the VCT study and to
report on utlization of counseling services in the study.
Methods: The multicentre study was conducted in a low income area in Nairobi
and at the teaching hospital in centre Dar Es Salaam. Participants were randomized to receive VCT or health information and return in 6 months. A client-centered
counseling approach was used which emphasised a confidential relationship in
which clients assessed their behaviour, formulated a risk reduction plan, addressed worries and emotions and learned to cope with test results. Counsellers
(nurses and health workers) were retrained during 5 days and were the ones to
break the news of the test result. Clients were encouraged to return for more
counselling sessions. 716 clients in Tanzania and 761 in Kenya received VCT at
baseline.
Results: 95% of those assigned to VCT were actually tested; 75% (Tanzania)
and 85% (Kenya) of those tested returned for their test results. In Tanzania, those
who enrolled as part of a couple (16%) and those who were HIV sero-positive
at baseline (21%) were less likely to return for their test results (OR = 0.64 &
OR = 0.60, respectively); none of the explanatory variables (i.e., age, gender,
couple/individual, serostatus) reached significance in Kenya. The numbers of
post-test sessions among those returning for test results ranged from 1 to 8,
median 1. Using more post-test counseling sessions was predicted by being
seropositive (Tanzania OR = 11.11: Kenya OR = 8.54) and by being older (Tanzania, OR = 1.04 per year of age). Group and individual supervision for counselors
was appreciated, reduced stress and enabled handling emotional situations.
Participants accepted counseling and testing-most randomized to VCT were
tested, and most returned for their test results. When allowed unlimited access to
counseling, most clients chose to attend only two sessions. In Tanzania, seropositives were less likely to return for test results, but when they did return used more
counseling sessions which strengthened coping and allowed for an early entry
into care and support. Findings support the feasibility of client-centered VCT in
developing countries.
S24322 Importance of counselling children/orphans
Gerida Birukila. PO. Box 1038, Mbabane, Swaziland
Issue: Children in families affected/infected by AIDS need counselling in order to
cope with fear of unknown.
Project: Given the fact that children suffer emotionally like adults, counselling
was given to children and orphans of AIDS It was discovered that children were
suffering from fear, grief, poor school perfomace, night mares and headache.
They had questions like who will take care of me and why me? Some had anger
and bitterness towards the family members and God. Counselling gave them the
opportunity to voice out their feelings and fears which made them feel heard and
understood.
Results: Children were able to smile again, their school performance improved
and they showed tremendous change towards life without their loved parents.
Lessons Learned: Children/orphans can cope better with stress if counselling
is provided to them before and after the death of their parents through AIDS.

I593*/ 24323 Confidentiality and couple HIV counseling
encourage client disclosure of serostatus and risk
behavior: Results from the Voluntary HIV
counseling and testing study
Olga Grinstead1, M. Hogan2, S. Gregorich3, D. Balmer3, G. Sangiwa2,
C. Furlonge4, T. Coates1 and VCT Study Group. 1 UCSF Center for AIDS
Prevention Studies, 74 New Montgomery, San Francisco, CA 94105, United
States; 2Muhimbili University College, Dar Es Salaam, Tanzania; 3Kenya Assn.
of Professional Counselors, Nairobi, Kenya; 4 Voluntary Counseling & Testing
Centre, Curepe, Trinidad WI
Objectives: To describe the experience of HIV counseling and testing in East
Africa from the perspective of clients receiving services and from the perspective
of counselors providing services. This report focuses on disclosure of serostatus
and risk behavior.
Methods: A multi-center randomized controlled study was conducted in Nairobi
(Kenya), Dar es Salaam (Tanzania) and Port of Spain (Trinidad). Study participants were randomized to receive HIV C&T or a standardized health information
intervention (with 6-month wait period for C&T). Focus groups and semi-structured interviews were conducted with counselors and counseling supervisors in
Nairobi and Dar es Salaam. Participants who received C&T at baseline were also
interviewed in Tanzania. Interviews included: problems and benefits of study participation, disclosure of test results, social support and how counseling reduces
sexual risk behavior. Findings are based on 11 counselor interviews, 2 counselor
focus groups and 39 client interviews.
Results: 1) Disclosure of risk behavior to the counselor depended on the
establishment of a trusting relationship. Confidentiality was central to establishing
trust, distinguished counseling from other forms of communication and allowed
clients to keep control over sensitive information. 2) Counselors saw client disclosure of serostatus to their sexual partners as central to risk reduction. All
felt that couple counseling facilitated disclosure more than individual counseling.
Counselors unanimously felt that couple counseling was more difficult, because
of the ethical issues raised when one partner refuses to disclose serostatus. 3)
Clients' fear of and experiences of stigma impaired disclosure of serostatus to
family/social network.
Clients and counselors perceived that confidentiality facilitated trust, trust facilitated disclosure of serostatus and disclosure facilitated risk reduction. Couple
counseling was favored over individual counseling because it was believed to facilitate disclosure and to reduce disruption of relationships. Client concerns about
stigma were common. Findings underline the importance of training counselors
to protect client confidentiality. Findings also support the practice of HIV testing
and counseling with couples.
S24324 Voluntary HIV counselling and testing in Zambia and
women's needs
Sonja Weinreich1, R. Baggaley2, I. Kayawe1, G. Mutale1, S. Chama1,
M.T. Kelly1. C/O Kara Counselling, PO Box 37559, Lusaka, Zambia; 2 WHO,
Geneva, Switzerland
Objectives: 1. To determine factors that influence women's decisions to seek
Voluntary HIV Counselling and Testing (VCT) in a high prevalence area. 2. To
determine the impact of VCT on behaviour of women.
Methods: A random sample of 377 attenders of VCT were interviewed using
in-depth interview techniques at 3 times: time 1 (one week after having received
their test results), time 2 (1-6 months after), time 3 (7-12 months after)
Results: 32% of the study sample were female. 26% of the females tested
seropositive. Women who tested seropositive were more likely to seek counselling
and testing because they were worried about chronic sickness of themselves or
their partner. Whereas seronegative women were more likely to attend VCT following encouragement by an outreach team. Women who were worried about their
sexual behaviour were more likely to test seronegative. Over time the majority of
women, particularly those who tested seronegative, disclosed their serostatus to
their partner. The most common reason of seropositive women for not sharing
their test result was the fear of negative consequences such as domestic violence.
Seronegative women who did not disclose their result said that they feared being
rejected because they had gone for an HIV test. Many said that they were not
in a position to make decisions in sexual behaviour. Women were more likely
than men to report problems in implementing safer sex practises. The majority
of women said that they had decreased the number of their sexual partners.
Some women said that they practised faithfulness to their partner as a "safer sex"
method. However few women knew the HIV serostatus of their partner. Women
were less likely to report condom use than men. Often the partner did not like
them. Fewer women than men were able to make changes in financial planning.
Conclusions: Women are less likely than men to seek HIV counselling and
testing. The most common reasons of women to attend VCT are worries because
of chronic sickness and sexual behaviour. Counselling enables women to share
test results with their partner and to change sexual behaviour over time. However
many women face considerable constraints to disclose their status and to change
behaviour. To encourage women to seek VCT and to sustain behaviour change,

counselling has to address women's needs.