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

12th World AIDS Conference

Abstracts 33264-33267 645

33263: Table
Strategy

Cases of Incremental Incremental*
STD/HIV STD averted HIV averted

US$ per patient

$ per STD averted

$ per HIV averted

Total Incremental Total Incremental Total Incremental

Educational Messages
Brief Counseling
Enhanced Counseling

211/1438
173/1447
165/1443

38

$58
$66
$179

$8 $2,513
$113 $5,615

$304 $95,502 $12,098
$3,102 $258,297 $162,795

Incremental, i.e. Brief Counseling is compared with Educational Messages, and Enhanced Counseling with Brief Counseling.

costs (overhead, personnel, materials, and participant costs). Assuming HIV
cases were averted at the same rate as STDs, we conducted an incremental
cost-effectiveness analysis from a societal perspective.
Results: After 12 months, compared with Education Messages, 19% fewer
patients in Brief Counseling and an additional 3% fewer in Enhanced Counseling
had new STDs. We found 5 new HIV cases in Educational Messages, thus
estimate 1 case of HIV prevented in each counseling intervention (see table).
Conclusions: Brief Counseling, if adopted, could prevent 20% of new STDs at
$304 per case prevented and (we estimate) 20% of new HIV infections at $12,098
per case prevented. Compared to direct medical costs of STD and HIV, this is a
small investment. Enhanced Counseling may be slightly more effective but at a
much greater cost.
33264 Experience of the establishment of an HIV/AIDS hot-line
and counselling center in Egypt
Jocelyn Dejong1 4, Mervat Gueineidy2, N. AI-Sayed3. 1PO. Box 2344, Garden
City, Cairo; 2National Society Facing AIDS, Cairo; 3Ministry of Health-National
AIDS Program, Cairo; 4Ford Foundation, Cairo, Egypt
Issue: Since addressing sexuality and sexual issues is considered taboo in the
conservative cultural context of Egypt and of other Arab countries, interventions
are needed to provide information in a confidential manner re HIV/AIDS
Project: According to official statistics, Egypt has a low prevalence of HIV/AIDS,
yet there is every reason to believe that the HIV/AIDS incidence will continue to
increase. However, culturally, risky behaviours in terms of HIV/AIDS transmission are subject to taboo and stigma and therefore are not addressed openly.
There are few opportunities for person-to-person discussion of sexual matters
and AIDS-related issues. The establishment of a confidential and anonymous
AIDS telephone hot-line and counselling centre was therefore seen as a necessity. Opened in September, 1996, by the Egyptian National AIDS Program of
the Ministry of Health in Cairo, this hot-line is the first of its kind in the Arab
countries. Demand for the hot-line services has surpassed expectations, at 1,000
calls on average per month. Calls have been received from every governorate of
Egypt and also from other Arab countries, where Arabic newspapers from Egypt
are also read. Calls have come from both men and women, often unmarried
youth, who lack other channels of accurate information about AIDS and basic sex
education. The hot-line has provided means for HIV-positive/PWAs and those
who are socially marginalized to obtain information, counselling and support.
A hot-line counselling service can be successful if it is culturally sensitive,
addresses specific needs of individual callers and focuses not only on information
provision but also on counselling and support. The experience in Egypt has
illustrated that, even in a "conservative" cultural context, ensuring confidentiality
and anonymity can inspire trust and create a climate where people can talk freely
about their most intimate behavior.
134* / 33265 Client's views on HIV counselling and testing - Is it
helpful?
Ignatius Kayawe1, S.C. Weinreich1, S. Chana1, R. Nsiska1, W. Mulongo1,
R. Baggaley2. 1Kara Counselling and Training Trust, PO Box 37559, Lusaka,
Zambia; 2 WHO, Geneva, Zwitzerland
Objectives: 1. To determine if attenders of VCT found the counselling they
received helpful. 2. To determine how it had helped them.
Methods: A random sample of 377 attenders of VCT was interviewed using
in-depth interview techniques: time 1 (one week after having received their test
results), time 2 (1-6 months after), time 3 (7-12 months after)
Results: 68% of the study sample were male and 32% female. 14% of males
and 26% of females tested HIV seropositive. 53% of seropositive and 29%
of seronegative clients received follow-up counselling (more than one posttest
counselling session). Virtually everyone found counselling a useful experience.
The majority of people valued in counselling that they could talk freely with the
counsellor. Many people said that counselling had helped them to plan things and
to stop worrying. Seropositive people valued the support of their counsellor, and
the link that counselling provided to medical services. Many said that it helped
them to cope and to plan for the future, particularly for their dependents. Many
seronegative people said that counselling helped them to remain seronegative.
94% of all interviewees said that they discussed safer sex with their counsellor,
and 89% found the discussion helpful, particularly in making decisions on "safer
sex". The majority said that they had reduced the number of their partners. 24%
of people attended a self-help/support group. The majority of those said that the
counselling they had received on self-help groups had been useful. Few people
said that counselling had helped them in decisions on family planning.
Conclusion: Most attenders of VCT found counselling a useful experience,
particularly in making decisions on sexual behaviour. Seropositive people valued
that counselling helped them to cope with their status and its link to support

services. Seronegative people valued the assistance that counselling provided
in remaining seronegative. For VCT to be effective in HIV prevention and mitigating the impact of HIV, the benefits of counselling for both seropositive and
seronegative people have to be promoted.
261*/33266 Prevention of stresses in families of HIV-infected
patients
Natalya Pidlisna, N.L. Lukyanova. 5A Demiyivkiy Side Alley, 252039 Kiev,
Ukraine
Objective: To provide teaching of HIV-infected people and their families to manage stresses.
Problem Description: HIV-infected patients very often become exiles in their
own families because they are unable to cope with stresses, and because families
are not ready to support their HIV-infected relatives. In such way HIV-infected
person becomes excluded from society and even tears the most close social links
- family links.
Methods: Major methods of work with a given problem are:
(a) consulting patients about stress and its consequences;
(b) family consulting;
(c) group family sessions in stress-management training;
(d) study of possible stress-provoking life situations of each concrete family;
(e) patient and family acquirement of conflict-solving skills.
Results: 70 families were consulted and trained and 59 of them notice that after
two consultations of patient and two group family sessions psychological climate
in the family had some changes. Alienation, anger and despair emotions have
almost completely disappeared. Patients reported that their families rendered
great help and support to them, and conflicts were solved easily. 54 patients
believe that they had already learnt how to cope with stress; they are not afraid of
situations which provoke stresses. 112 members of 62 families confirmed some
changes in their attitude towards HIV/AIDS and problem of cohabitation with
HIV-infected family members.
Conclusions: To prevent stresses in families with HIV-infected patients it is
necessary to provide trainings with patients and to involve members of their
families into that work. Study of stress-management skills has positive influence
upon all family members. Work with situations that provoke stresses and stressmanagement work must be included into day-to-day practice of psychologists
dealing with HIV-infected patients.
S33267 Need assessment for HIV counselling of blood donors
Neelam Dhingra-Kumar1, K. Chatterji2, S. Gururaja3, V. Doda4. 1301 SFS DDA
HAUZ KHAS Apartments, University College & Regional Blood Cnt, New Delhi;
2All India Institute of Medical Sciences, New Delhi; 3G B Pant Hospital, New
Delhi; 4R M L Hospital, New Delhi, India
Issues: Counselling blood donors about HIV is essential to achieving a safe
and adequate blood supply. Lack of education and awareness, inability to take
decisions and inaccessibility to information has aggravated the problems of transfusion transmitted infections in developing countries. HIV has necessitated a
reappraisal of BTS responsibilities towards donors and of donors towards BTS.
Project: In the absence of a programme on donor notification and counselling
in India, the present study was planned to determine the counselling needs of
blood donors. A total of 12 846 donors (voluntary & replacement) were provided
predonation information and counselling over a period of 6 months in 4 blood
transfusion centres in Delhi. The psycho-socio-educational status and donor
awareness about HIV was assessed using a uniform questionnaire. Predonation
information and counselling dealt with increasing the existing knowledge of donors
about HIV, discussing the need for regular and safe donations, informing them
about their blood being tested for HIV and also to discourage donations from
unsafe donors.
Results: Of the 12 846 blood donors, 82% had heard about HIV/AIDS, 28%
were aware of the causative agent of AIDS, 23% knew about the modes of
transmission whereas only 18% were familiar with the methods of prevention.
Fifteen percent knew the effects of HIV on body. One hundred and fifty five (1.2%)
of donors accepted to practice high risk behaviour and were therefore rejected
from blood donation and 3.2% self-excluded. Forty six percent donors wanted to
be told the results of the HIV tests. Thirty two percent donors agreed that HIV
counselling of blood donor would assist in facilitating life style changes.
Lessons Learnt: Considering the general lack of awareness about AIDS, there
is a tremendous need to develop HIV counselling services for the donor population in India. It would definitely be helpful in providing donor care, creating a safe
non-paid regular donor pool and discouraging blood donation from unsuitable
donors.