Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts WePeD6417-WePeD6420 187

Methods: A multimethod approach, including structured observations of clientservice provider interactions (325 at baseline; 289 15 months later), client exit
interviews, clinic service statistics, provider interviews, and focus groups, was
used to assess promotion of dual protection.
Results: Following intensive training, providers delivered dual protection counseling to a majority of clients and demonstrated the female condom with 80% of new
clients observed. Significant increases were found in discussion of clients' (19%
to 34%) and partners' sexual behavior (16% to 36%), the relative HIV protective
effects of different contraceptives (7% to 42%), how clients can initiate discussion
of HIV/STIs with partner (3% to 24%), negotiate condom use (0% to 18%), and
STI assessment (4% to 22%). Condom acceptance increased to 9% of all family
planning visits between January-June 2001 from a baseline of 2% in 1999, and
was mainly due to female condom introduction and use of a condom along with
another contraceptive in half of the condom visits.
Conclusions: The increase in condom acceptance points to the value of dual
protection counseling and the female condom. Providers' internalization of the
importance of HIV prevention facilitated their commitment to changing their practices. However, the mainly married clinic population was seriously limited by their
husband's objections to condom use. Results indicate the feasibility of implementing dual protection counseling within family planning services.
Presenting author: Joanne Mantell, HIV Center for Clinical & Behavioral Studies, Unit 15, New York, NY 10032, United States, Tel.: [phone], Fax: [phone], E-mail: jmantell @cnvlz.com
WePeD6417 Reducing the risk of HIV infection by reducing
reproductive tract infection in Yunnan, China
K.M. Rou1, Z. Wu2, L.M. Duan3, Q.S. Wang4. 1National Center for AIDS
Prevention and Control, 27 Nanwei Road, Beijing, China; 2National Center for
AIDS Prevention and Control, Beijing, China; 3 Ruili Health Department, Ruili,
China; 4Ruili Maternal and Child Health Care Institute, Ruili, China
Background: Reproductive tract infections (RTIs) are a major risk factor for sexually transmission of human immunodeficiency virus (HIV) infection. The objective
of study is to reduce the risk of HIV infection by reducing RTIs among rural women
in Ruili, Yunnan, one of HIV epidemic center in China.
Methods: The study went through five phases: 1) community assessment of
RTIs/STDs/AIDS issues; 2) development of RTIs, STDs, and HIV/AIDS packages
for premarital counseling, maternal child health (MCH) and family planning (FP)
programs based on the community assessment; 3) training on RTIs/STDs/HIV
prevention counseling and diagnosis and treatment of RTIs/STDs for staff from
premarital counseling, MCH and FP programs; 4) Implementation of incorporation RTIs, STDs and HIV/AIDS prevention counseling into the current pre-marital
counseling, MCH and FP programs and incorporation of the diagnosis and treatment of RTIs/STDs into routine MCH and FP services; and 5) evaluation. Four
townships were selected for the project with two in the intervention group and two
in the control group.
Results: Hygienic practices and health care seeking behaviors improved more
in intervention than in control groups. Bacterial Vaginitises were similar among
intervention and control groups before intervention, but dropped in both groups
after intervention with more drop in intervention than in control (39.7% vs. 21.6%,
P<0.001). Similar result was observed for trichomoniasis (P<0.01).
Conclusion: Community-based interventions are effective in reducing common
RTIs among rural women. It should be used as a strategy for control epidemics
of HIV through sexually transmission.
Presenting author: Keming Rou, 27 Nanwei Road, Beijing, China, Tel.: [phone], Fax: [phone], E-mail: [email protected]

Strengthen the infrastructure, trainers and curricula in pre-service training of service providers; 2) Motivate health-workers sufficiently through core incentives and
salary adjustments; 3) Enhance clinical supervision mechanisms; 4) Address prescriptive authority (for nurses in particular); 5) Promote partnerships in health service delivery with the community being served; 6) Support civil society in their advocacy roles, so as to influence policy and practice and hold leaders and donors
accountable.
Conclusions: After 7 years of integration talk and many health reforms, there is
little evidence of widely implemented comprehensive quality RH care in the Tanzanian PHC system. Policy and strategies should refocus the lens on the goal
and the target populations, rather than on the integration process itself. The six
key opportunities must be exploited in order to allow for the long-term provision
of comprehensive, quality, reproductive health services at the PHC level.
Presenting author: Monique Oliff, Clinical Research Unit, London School of Hygiene & Tropical Medicine, Keppel St London, WC1E 7HT, United Kingdom, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeD6419 Quality of counseling in a prevention of mother to
child transmission (PMCT) of HIV-1 pilot site in
Kenya
D.A. Mbori-Nqacha1, R.W. Nduatil, S. Kalibala2, J. Oyieke3, C. Mwai2,
N. Rutenberg4. 1University of Nairobi/Kenya PMCT Project, Department of
Paediatrics, University of Nairobi, PO Box 19676, Nairobi, Kenya; 2Population
Council, Nairobi, Kenya; 3NARESA, Nairobi, Kenya; 4Population Council,
Washington DC, United States
Background: Counseling is major component of PMCT services. The quality of
counseling may directly influence uptake of testing and of specific interventions
for PMCT. Modalities of evaluating the quality of counseling include direct observations or exit interviews with clients. There has been considerable debate on the
optimum duration of training that health workers require to enable them provide
adequate PMCT counseling. Objective: We carried out an observational study of
the quality of counseling before and after implementation of a PMCT program in a
rural district hospital in Kenya. Methodology: Nurse midwives received a 2 -week
training on PMCT that included 30 hours of training on counseling. We used standardized instruments to observe their counseling practice before training and 9
months after they had began implementing a PMCT service.
Results: At the follow-up observation we noted a significant improvement in the
quality of counseling within the facility The counseling environment assured adequate privacy in all the 64 (100%) sessions that were observed at follow-up
compared to the 22% sessions at baseline (p<0.001). There was significant improvement in the quality of communication as measured by the ability to establish rapport (44% vs 97%, p<0.00001), assure confidentiality (33% versus 88%,
p=0.001) listening (33% versus 86%, p=0.0002), exploration of the problem (44%
versus 75%, p=0.06), appropriate use of silence (29% versus 80%, p=0.05), nonverbal communication (11% versus 77%, p=0.01) and clarification of misconceptions (33% versus 85%, p=0.00001). At baseline 33% of the observed sessions
were rated as good compared to 98% at follow-up (p<0.00001).
Conclusion: Nurse midwives who have received approximately 30 hours of counseling training are capable of providing good quality service within busy maternal
child health clinic in a resource constrained setting.
Presenting author: Dorothy Mbori-Ngacha, Department of Paediatrics, University of Nairobi, PO Box 19676, Nairobi, Kenya, Tel.: [phone], Fax: [phone], E-mail: imani @ iconnect.co.ke
WePeD6420 Men's Invovlement in Women's Reproductive
Health
S.D. Pongurlekar, P.M. Kukade, G.D. Pilankar. Women Centred Health Project,
Women Centred Health Project, 1st Floor, BMC building, Nehru Road, Vile
Par/e (F), Mumbai - 400 057,/India
Issues: Men's involvement in women's reproductive and sexual health is crucial in promoting reproductive and sexual health of the couple. Community male
health workers can play important role in addressing reproductive health issues
by changing their affitudes towards men's involvement, in their personal as well
as professional life.
Description: Male workers from primary health centres and men and women
from poor socio-economic background were interviewed using semi-structured
questionnaire. A committee of male health workers was formed to discuss issues
that arose from the interviews and to revise the role of male health workers in
addressing those. Training in gender and sexuality were conducted for the male
workers to develope the perspective.
Findings: Men in the study lacked information about women's reproductive bodies and health problems. Men wanted health workers to talk to them on issues of
reproductive health. Apart from giving financial support and accompanying to the
clinic during illness, women expect men to support them in daily household activ
ities including child rearing. Men felt that societal gender construct prevents them
from fulfilling expectations of women related to reproductive health. The timings
of the health workers does not suit men and health workers can meet them only
late evenings or on holidays.
Recommendations: Male health workers can work effectively as change agents
for increasing men's involvement in reproductive health. Talking to men on reproductive health at the gynaecology Out Patient Department in hospitals is an entry

I WePeD6418

Integration of STI prevention and care into
reproductive health services in Tanzania: an
analysis of barriers and opportunities for
comprehensive, quality reproductive health
services

M. Oliff, PR Mayaud2, V. Pieroth3, O. Sepere3, A. Semakafu4, D. Bukenya3,
A. Ndyetabula3. 'AMREF-Tanzania & London School of Hygiene & Tropical
Medicine, Clinical Research Unit; 2London School of Hygiene & Tropical
Medicine, London, United Kingdom; 3AMREF-Tanzania, Dar es Salaam,
Tanzania; 4Muhimbili University College of Health Sciences (MUCHS), Dar es
Salaam, Tanzania
Background: The Tanzanian government has embraced the concept of integrated reproductive health (RH) care since the ICPD 1994. However, recent
health reforms may have compromised these efforts. The study aimed: 1) to
assess this process, taking the integration of STI prevention and treatment into
family planning or pre-natal care as the 'tracer' conditions; 2) to identify barriers
to, and opportunities for, long-term improvements in RH delivery at the primary
health care (PHC) level.
Methods: A participatory, operational and action-oriented approach was followed.
Using qualitative and quantitative tools, data was gathered at the national, donor,
NGO level; the regional (3 regions) level, and in 9 randomly selected districts,
focusing on the PHC facility and community levels, including alternative sources
of care.
Results: Six major barriers to integration of comprehensive RH services in the
PHC system were identified, and consequently 6 key opportunities exist: 1)