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

12th World AIDS Conference

Abstracts 24325-24330 503

[24325 What should a counsellor do if volunteer refuse to share
his/her HIV test result with his/her partner?
Damata Badini Yendifimba, Aprodec, Traore Madina. Assistante Sociale
01BP2700 Bobo 01 Bobo-Dioulasso, Burkina-Faso
Introduction: Refusal to share HIV test result with the partner is a frequent
feature and place the counsellor in a difficult position.
Methods: Our Voluntary Counselling and Testing Centre (VTC), created by our
association APRODEC is functional since April 1996, in Bobo-Dioulasso, Burkina
Faso. VTC volunteers are mainly Muslims and of low socio-economic status.
Misconceptions about modes of transmission of HIV and fear of stigmatisation
are common.
Results: As of October 1997, 394 volunteers have been tested (201 men and
193 women). 293 volunteers (74.5%) were HIV seropositive and 101 (25.5%) HIV
seronegative. Out of 76 HIV seropositives who were married or lived in union, 18
(24%) accepted to share their test result with their partner, 55 (72%) refused and
3 had not decided. It was considered by the counsellors that this refusal, although
potentially justified in some situations (coercion, violence,...) impaired the global
management of HIV.
Conclusions: How to improve sharing of test result, when appropriate? How
should the counsellor evaluate when sharing is not recommended? Possible solutions may include reinforcement of community information/education on HIV and
human rights, networking with other associations involved in the battle against
AIDS and discrimination, creation of post test clubs, sharing of experiences and
skills between counsellors and other actors of HIV management.
24326 The role of peer counselling on HIV/AIDS education
among prostituted women in Davao City
Candeliria Cantillo. #2 Sputnik St. Dona Vicenta Village davao City 8000,
Philippines
Objective: To analyze the role of peer counselling on HIV/AIDS education
dessimination
Methods: Peer counsellors are also prostituted women and are trained in counselling. Prostituted women will seek peer counsellor for counselling on Sexually
Transmitted infections and unwanted pregnancies. A pre-test will be administered
to the women to gauge their basic knowledge on STDs including HIV/AIDS and
the mode of transmission. This is done to measure their knowledge and attitude
towards STDs and HIV/AIDS. Follow-up sessions through home visits to the
women are done to have additional information on the status of the client.
Results: Seventy-one (71) prostituted women have availed of the services
since 1995 with five peer counsellors attending the women. Clients on their own
accord visit the drop-in center for counselling. These clients shared the information they received during the counselling to their peers in the establishments.
They also share the IEC materials they received. These women also refer their
peers who wanted to undergo counselling.
Conclusion: Peer counselling in the case of Davao City becomes an effective
tool in dessiminating basic information on HIV/AIDS among prostituted women.
24327 Training "testcounselling for drugusers" on a national
level
Julieta Tiemeijer1, Hannah Bouman2. 1 Trimbos-lnstituut Netherlands Inst. CF,
MH & A - PO. Box 725 - 3500 AS Utrecht; 2Jellinek Prevention, Amsterdam, The
Netherlands
Issue: Drugusers require specific HIV testcounselling from professionals, working
in drugservices.
Project: In The Netherlands a restrained HIV testing policy is being practised,
also towards drugusers. Due to new medications and better prognosis for HIV
positive people, this policy tends to change into a more active approach. Drugusers are more at risk for HIV infection than the general population. Therefore
the test is offered to them more often than before. Drug users require specific
testcounseling, because of special needs and issues such as information about
safe use and prostitution. Further the organisation of the setting in which the
counselling takes place is important. Drug service organisations are best equiped
to handle testcounseling.
The project consists of three components: a methodology, a training manual and a model for implementation. The methodology is both innovative and
based upon existing methods (e.g. theory of Prochaska and DiClemente and the
methodology of Miller). The trainingmanual consists of a reader, a set of exercises
with a newly developed checklist, a discussion module on ethics and scripts for
roleplays, which need to be played with actors. The implementation is carried out
via an existing network of drugservice organisations and local health authorities.
Results: The methodology is well received by counselling- and drugservice
professionals. The trainingmanual is part of a national trainingprogramm for
HIVtestcounsellors in drug service organisations. The implementation is structural because of the existing network of trainers, who all work within the relevant
organisations.

Lessons Learned: Drugusers require specific HIV testcounselling via drugservice organisations, especially when the national HIV testpolicy is changing.
Methodology, training and structural implementation in the appropriate workfield
are equally important for potentially successful testcounselling for drugusers.

24328 | Being tested for HIV does not increase the incidence of
negative life events in three developing countries:
Results from the voluntary HIV counseling and testing
study
Steve Gregorich1, Olga Grinstead1, M. Hogan3, D. Balmer2, G. Sangiwa3,
C. Furlonge4, T. Coates1. 1 UCSF Center for AIDS Prevention studies 74 New
Montgomery San Francisco, CA, USA; 2Kenya Assn. of Professional
Counselors, Nairobi, Kenya; 3Muhimbili University College, Dares Salaam,
Tanzania; 4 Voluntary Counseling & Testing Centre, Curepe, Trinidad WI
Objectives: To describe positive and negative life event outcomes among individual and couple participants in a randomized clinical trial testing the efficacy
of voluntary HIV counseling and testing (VCT) in Dar es Salaam, Tanzania (N =
1427), Nairobi, Kenya (n = 1515) and Port of Spain, Trinidad (N = 1351).
Methods: Study participants were randomized to receive VCT or standardized
health information (HI) and to return for VCT in 6 months. Positive and negative
life events were measured at the 6-month follow-up; occurrence of each life event
was compared across treatment group, gender, enrollment status (couple versus
individual) and baseline serostatus among those who received VCT at baseline.
Results: The most commonly endorsed life events were positive: strengthening of a sexual relationship (39%, more common among couples) increased
emotional support from peers (29%) and increased emotional support from family
(23%). With the exception of break-up of a sexual relationship (22%), negative life
events were uncommon (1%-4% overall). There were no significant differences
between those who received VCT versus HI in reported levels of positive or
negative life events. Among those assigned to VCT at baseline, seropositives
were more likely than seronegatives to be estranged by peers (1% v. 2%, p <.01), discriminated against by employers (1% v. 2%, p =.06) and neglected by
their family (2% v 4%, p <.05). HIV+ women who enrolled in a couple reported
higher rates of physical abuse (18% versus 5% overall, NS) and break-up of
marriage (15% versus 3% overall, NS). Women in female positive serodiscordant
couples were the most at risk.
There was no evidence that participating in VCT increased negative life events.
With the exception of break-up of a sexual relationship, negative life event outcomes were rare in both treatment groups; ending a sexual relationship may be
a risk reduction strategy rather than a negative outcome. Women who enrolled
in couples are at increased risk for physical abuse and break-up of the marriage
when they were in female positive discordant couples; additional services may
be needed for women in relationships who test positive for HIV.
24329 To tell or not to tell: A review of HIV disclosure patterns at
a London teaching hospital
Riva Miller1, C.A. Sabin2, C. Leask3. 1Haemophilia Center, Royal Free Hospital
NHS Trust, Pond Street, London, NW3 2 RQ; 2Department of Primary Care and
Population Sciences, Royal Free Hospital School of Medicine, London; 3HIV
Counselling Unit, Royal Free Hospital NHS Trust, London, England
Issues: It is known that HIV disclosure patterns differ according to culture, gender, HIV transmission risk and stage of illness. Further, most disclosures usually
follow a precipitating event (for example, the need to start treatment, illness or
admission to hospital). Partner notification may be facilitated and enhanced if use
can be made of these events when counselling patients.
Project: In order to investigate to whom patients disclosed their HIV status and
what prompted the disclosure, a cross-sectional study was carried out among
consecutive attenders at an HIV counselling unit in a large teaching hospital.
A questionnaire was completed by counsellors with both in- and out- patients
attending the centre.
Results: Almost all patients reported having disclosed their HIV status to at
least one person. However, the reasons for disclosing status depended on a
number of factors, including advancing HIV disease and the need for treatment,
and also depended on whom the disclosure was made to. Those patients who
disclosed their status to sexual partners usually did so only as part of a close
relationship. Disclosure rates to casual sexual partners were low.
Lessons learnt: Disclosure of HIV status enables individuals to begin to deal
with the issues of reducing transmission and obtaining support. The prompts
which lead to disclosure of HIV status can be used more effectively to address
situations where people may need to disclose HIV status in casual relationships.
124330 1 Counselling PWAs on adherence issues
Serge Le Coz, M. Rebillon, C. Tourette-Tureis, J.M. Bithoun, T. Burnel,
J. Doazan, J.L. Fraysse. Actions Traitements, 75020 190 bd. de Charonne,
Paris, France
Issue: How to address adherence issues through an HIV Treatments peer counselling Hotline
Project: In 1997, ACTIONS TRAITEMENTS with the help of certified counsellors from COMMENT DIRE initiated peer counselling protocols on adherence
through its hotline which reaches an average of 120 people with HIV per month.

The counselling was focused on four components: information on treatments
assessment of ways of coping with HIV, self report of missing doses, immediate
support. Peer counsellors decided during one week to ask all their clients to do a
self report of the last time they missed a dose? (which regimens, when did they
miss their last dose, In which circumstances?
Results: A sample of 20 people provide detailed and precise data. Four people
reported that they never missed a dose (25%). These persons had a very high