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

12th World AIDS Conference

Abstracts 42456-42461 865

fear of death, stigma from family and community, fear of losing Job, fear of loss of
property, fear of being inherited, fear of not being able to support the family and
send children to school.
Results: The study shows that there is still lack of pre- and post test counselling
services. More than half of the cases are diagnosed for HIV/AIDS when they show
already symptoms and admitted in the wards. Only an Intergraged approach to
wards care for PWAs, their families and/or caretakers and with community participation, a developed referal system, good medical/nursing care counselling and
social.
42456 Demographic characteristics associated with late
initiation of health care in patients with HIV/AIDS in
Guatemala
Rosa Elena Morales Siliezar1, E.A. Arathoon2, A.H.S. H. de Salazar2,
R.Q. Quan2, B.S. Samayoa2. 11 Avenida 11-19 Zona 1 Guatemala; 2AGPCS
Guatemala, Guatemala
Objectives: To find the Demographic characteristics associated with late initiation
of health care in patients at the "Luis Angel Garcia" Family Clinic in Guatemala City.
Design: Prospective, cross sectional study
Methods: All patients seen at the clinic for two years, from January 1, 1996
until December 31 1997, were inteviewed during the first visit, following a pre
designed questionaire. We used the CDC definition for AIDS, without CD4 counts.
All data recorded was analyzed using the Epi-lnfo program.
Results: Of the 360 patients seen, 67 percent had ful blown AIDS at presentation (late initiation of health care) and 33 percent did not; 29 percent females,
71 percent males. From 158 clients with children, 90 percent had more than 3
and 10 percent less than 3 children. Eighteen percent were Mayans, 82 percent
were not. Only 43.5 percent were employed, 56.5 percent unemployed. Factors
associated with seeking late heath care were: -- than 25 years of age, OR =
2.05, 95% Cl (1.23-3.41), p - 0.05; Gender male, OR 1.80, 95% CI (1.07-3.01)
p - 0.05; Unemployed, OR 2.42, 95% CI, (1.46-4.03) p - 0.05; Drug abuse
(including alcohol) OR 0.54, 95% Cl (0.32-0.89) p - 0.05.
Conclusions: The late initiation of health care of our clients (67 percent),
decreases their quality of life, reduces the surviving rate and increases the dissemination of the epidemic. Programs of early detection through the Ministry of
Health should be designed to target males over 25 years of age, unemployed,
persons without children and drug abusers.
42457 The health team and its responsibility in networks
creation
Gloria Julia Daroch Merino. General Gorostiaga 208 Nuhoa Santiago, Chile
Issue: HIV/AIDS PROGRAM includes a team with 2 doctors, 1 nurse and 1 social
worker. This team attends people with HIV/AIDS, livig in an area of Santiago,
CHILE, and give information about AIDS and Elisa test to consultants. This program is inserted in a large hospital and its medical specialities are required to
diagnosis and the treatment of HIV/AIDS people.
A.- These patients were not well attended in the different services of the
hospital. They were discriminated and delayed in their needs.
B.- People interested in HIV/AIDS information or Elisa test were referred to the
wrong services where no pre-test couselling was given. In periods post national
of prevention campaigns; the HIV/AIDS program was oversaturated with low risk
people.
Project: The health team identified some situations that required information and standardization in the different services. Strategies were planned and
implemented to create networks.
A.- Since 1995, people with HIV/AIDS are receiving an optimum and personalized attention in the different services of the hospital.
B.- Consultantes are now personally attended by cousellors in the public health
centers nearer their homes.
Lessons Learnt: To establish a network means:
A.- To improve quality of medical care by incorporating more professionals and
the optimum resources utilization.
B.- The personalized attention to people with HIV/AIDS contributes to avoid
discrimination
42458 Drug users at the emergency room of public hospital in
the City of Rosario (Province of Santa Fe, Argentina)
Fabiana Cantero, Martin Edgardo Vazquez Acuha. Rioja 1758, Laccaso (Icaso),
Buenos Aires, Argentina
Issue: The idea physicians at the emergency rooms of public hospital usually
have of addicts as "marginal" restrict their attention at the emergency rooms and,
therefore, their inclusion in the health system with the consequent implications.
Project: Research was conducted during a one-year period at public hospitals
in the city of Rosario where more than forty on-duty physicians at the emergency

rooms were interviewed. In this city, 57% of HIV/SIDA cases belong to IDU
addicts. Addicts are accepted as patients at the emergency rooms for different
causes: overdose, HIV/SIDA associated diseases, etc.
Results: Addicts are considered "marginal and violent" and their specific problems are unknown. They are provided with insufficient treatment, are not derived,
are there is no worry for their pathology (HIV/AIDS, hepatitis, tuberculosis, etc.)
Physicians care for the symptom and expel addicts from the health system.

Lesson Learned: Authorities in charge of Public Health in the city of Rosario,
should encourage on duty personnel at the emergency rooms of public hospitals
to get instruction on the subject of addictions and thus allow drug users to gain
access to the health system.
142459 Counselling, care and rehabilitation of HIV/AIDS positives
Ramesh Babu Rayapu1, Kaja Ayodhya2. Chief Functionary 'Boss & Cipca'
organisation, 7-46, Vasavi Nagar, M.R. Palle-PB. No: 112, Tirupati-517502;
2 'Boss & Cipca' PB. No: 112, Tirupati 517112, Tirupati 517112, A.R (A.P) India
Issue: To provide counselling, care and rehabilitation of HIV/AIDS positives.
Identifying the educated HIV/AIDS positives among them and training them as
Peer Educators.
Project: The BOSS & CIPCA is a unique organisation consisting of 250 doctors
and 4750 blood donors as its members, involved in rehabilitating 1073 identified
HIV/AIDS positives in the State through a day-care-centre, a counselling wing and
a feasible treatment wing for HIV positives and an orphanage for AIDS positives.
It has been arranging institutional care which includes accommodation, food,
medical and nursing facilities through 10 trained doctors 16 trained social health
workers and counsellors. A hotline telephone counselling has been established,
the organization has trained 32 educated and willing HIV positives as Peer Educators who promote safer sexual practices and distribute IEC material on AIDS.
They also encourage the use of condoms and distribute them, establish positives
clubs and motivate persons living with HIV/AIDS towards rehabilitation.
Results: There has been very good response from more than 790 identified
HIV/AIDS positives. They are regularly visiting the centre, taking counselling and
feasible treatment for their general ailments. 32 Peer Educators are rendering
dedicated services with a sense of commitment. They have conducted 395 awareness campaigns in the State and educated 3 million people about HIV/AIDS. They
have also encouraged several HIV/AIDS positives towards care counselling and
rehabilitation.
Lessons learned: Most of the relatives of the affected persons and the community are creating psychological problems to AIDS positives by way of ill-treatment
and criticism because of panic and lack of proper understanding about the
disease. A massive awareness programme in the society, a community-based
rehabilitation and optimal care of HIV/AIDS positives should be encouraged all
over.
42460 Socio-economic burdens of HIV/AIDS and women's
empowerment
Andre Kakonku Lukusa. PO. Box 710226 Mansa, Zambia
Objective: To empower women as "Front Line Care Givers" both for PWA (People
with HIV/AIDS/and for orphans.
Design: Prospective.
Methods: From mid August 1994 to mid November, 1994, in Mansa District
Hospital/Zambia, in female medical ward, 135 patients (One hundred and thirty five
women) were enrolled in this study when fulfilling the criteria for ARC/HIV/AIDS.
A questionnaire about Socio Economic and Clinical Features was used.
Results: The majority (86%) of Care Givers for those patients were women
(As mothers 36%, sisters 13%, nieces 15%, other women (in-laws) 22%), against
14% of men.
In the offsprings, with the age limits of one (1) to thirty one (31) years old
orphans and to be orphans aged 15 years or less represented 74.6%.
Conclusion: A lot of burdens of HIV/AIDS are on women as they are in a front
line position as Care Givers both for PWA and orphans.
It is imperative to undertake a community based study for assessing women's
needs in those regards.
42461 Integration of out-patient care into home care for rural
community pwas minimises in-patient care
John Oguny Arudo. PO Box. 22981, Nairobi, Kenya
Issue: The integration of out-patient services into Home Care results in low frequency hospitalization and enhance the quality of life for PWAS in the rural poor
communities. However the programme may not be sustainable if a paternalistic
approach is used during the implementation stage.
Project: Due to the increasing number of PWAS in the Community served
by Kendu Adventist Hospital in Kenya, through the support of Christian Health
Association of Kenya as the implementing agency a Home Care project that also
incorporates out-patient services was launched in 1994 with the aim of reducing
the need for hospitalisation and also to improve on the quality of life among PWAS.
Results - 1994: Cost per visit averaged $6 (44 visits:) and $10 per PWA per
year of $267 for 27 pts.
1995: Cost per visit averaged $9 (86 visits) and $15 per PWA per year of $806
for 54 PWAS.
1996: Cost per visit averaged $9 (224 visits) and $18 per PWA per year of

$2036 for 116 PWAs
Lessons Learned: Because of the long term epidemic of the slow-acting virus
the issue about sustainability of Home Care/Out-patient care must be addressed
and be in place before mid-term evaluation which is possible if we empower
PWAS to come up with village pharmacies through Bamako Initiative. The two
intergrated approaches indeed help cut down on the need for hospitalization and
enhance PWAS health.