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

XIV International AIDS Conference

Abstracts WeOrF1288-WeOrF1327 231

Presenting author: Fern Terris-Prestholt, LSHTM-HPU, Keppel Street, WC1 E
7HT London, United Kingdom, Tel.: [phone], Fax: [phone], Email: [email protected]
WeOrF 288 Integrating Hepatitis C into HIV/AIDS programs
L. Schowalter. NASTAD, Washington, DC, United States
Issue: HIV and hepatitis C virus (HCV) overlap greatly in their modes of transmission and populations at greatest risk of infection. In the United States, 30-40%
of people infected with HIV are infected with HCV. The rate of co-infection among
injection drug users (IDUs) is estimated to be between 50%-90%. Due to lack of
adequate funding for stand-alone HCV programs, state HIV/AIDS programs are
increasingly challenged with how to best serve clients who are either co-infected
with HIV and HCV, or infected with HCV and at risk for HIV.
Description: In the United States, state health departments are integrating HCV
programs into existing HIV/AIDS programs, due to similarities between populations affected and lack of adequate funding for HCV programs. Despite many
similarities between HIV and HCV, HIV/AIDS programs face considerable challenges in integrating HCV services with limited resources. This presentation will
address the issues that HIV/AIDS programs face in integration, and describe how
HIV/AIDS programs across the United States have successfully integrated HCV
into their existing programs.
Lessons Learned: This presentation will address the lessons state HIV/AIDS
programs have learned in integrating viral hepatitis into their existing programs
and infrastructures, including, involvement of key stakeholders across HIV, viral
hepatitis, substance abuse and corrections; development of surveillance infrastructure and staff; provider training, education and awareness needs; and introduction and inclusion of vaccine education, training and strategies.
Recommendations: This presentation will discuss model programs and best
practices of HCV integration, including, involvement of diverse representatives
of the HCV-affected population; demonstration of cost-effectiveness of utilizing
existing infrastructure; importance of provider and staff support; and efficacy in
reaching populations at greatest risk.
Presenting author: Laurie Schowalter, 444 North Capitol Street, NW, Suite 339,
Washington, DC, 20001, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WeOrF1 289 Mildmay international/CDC paediatric HIV/AIDS
programme: needs assessment and impact of the
programme in Uganda
E. Asiimwe, F. Muwayi, C. O'Keeffe, J. Downing, L. Hiffler. Mildmay International
Kampala, Uganda
Issues: Since the beginning of the HIV/AIDS epidemic in Uganda, developments
have been made in the care of adults living with HIV/AIDS. However, little has
been done to cater for the growing numbers of children infected with HIV in terms
of care services, counseling and prevention.
Description: A one year pilot programme on Paediatric HIV/AIDS care, counseling and prevention commenced in January 2001. It was implemented by the
Mobile Paediatric Clinical Training Team (MPCTT) from the Mildmay Centre in
Uganda and funded by CDC. A needs assessment was carried out in five Districts and a number of Health institutions, non-governmental organisations and
District authorities were contacted. This revealed that there were major factors
lacking in the delivery of comprehensive care for children infected with HIV. These
included a lack of trained/ skilled health workers/ counselors, inadequate and irregular drug supplies, a lack of affordable HIV testing facilities for children, coupled with poverty. In response to this the MPCTT conducted a modular training
programme over 8 months, for 26 participants from these districts in order to train
them in paediatric HIV/AIDS care and then to train others. To date a further 162
health workers have been trained. Alongside this clinical guidelines and a training
manual on paediatric HIV/AIDS care has been developed.
Lessons learned: There is a need for awareness of the issues in caring for children infected with HIV. This has been created through this programme and the
negative attitudes of health workers and carers has changed. Capacity building
through training can be achieved along with the integration of paediatric services
into existing services. Training individuals from health units within the same districts also leads to improved referrals and networking amongst the health institutions.
Recommendations: Advocacy for more training, improved drug supplies and affordable HIV testing facilities for children is needed.
Presenting author: Francis Muwayi, P0 BOX 24985, kampala, uganda, Uganda,
Tel.: [phone], Fax: [phone], E-mail: mildint2 @ infocom.co.ug
WeOrF 290 Care of children infected and affected by HIV/AIDS:
Adapting the integrated management of childhood

illness strategy
A.E. Goga, S.N. Mazibuko, H.E. de Klerk, W.E.K. Loening. National Department
of Health, po box 1526, faerie glen, pretoria, 0043, South Africa
Issues: Infant care and follow up is crucial in programmes that prevent HIV transmission from mother to child (PMTCT). In many African countries including South
Africa (SA) PMTCT (and therefore infant follow-up) is being integrated into ex
isting routine maternal and child health services. The Integrated Management of
Childhood Illness strategy (IMCI) is often an essential component of these services. However, initially (1995), IMCI did not specifically include HIV Hence, SA
developed an algorithm enabling health workers at primary care facilities with
limited resources to identify children with suspected symptomatic HIV infection
(SSHI). Notwithstanding this, a South African (SAn) survey (2001) found that only
6% of these health workers correctly classified children with SSHI. This algorithm
was subsequently modified to simplify identification of children with confirmed (or
suspected) symptomatic HIV infection (CoSSHI) at these facilities. More recently,
guidelines on care of children infected or affected by HIV/AIDS (CIAHA) have
been developed for inclusion in IMCI.
Description: These guidelines: advocate for cotrimoxazole prophylaxis, routine
vitamin A supplementation, pain relief, and palliative care, and counseling for
CIAHA and their caregivers promote exclusive breastfeeding for about 6 months
in children with CoSSHI or when maternal HIV status is unknown or negative
Lessons learned: Non-ambiguous infant feeding guidelines, counseling skills
and on-going support for health workers are essential when managing CIAHA
Recommendations: Accelerate and monitor implementation of adapted SAn
IMCI guidelines; evaluate their impact on care for CIAHA, and share SAn experiences with organisations, and countries currently adapting IMCI guidelines to
include HIV
Presenting author: ameena ebrahim goga, po box 1526, faerie glen, pretoria,
43, South Africa, Tel.: [phone], Fax: [phone], E-mail: gogaa
@health.gov.za
WeOrFi 326 The opportunity of disclosure and the process of
telling to HIV children and adolescents
0. Chirila, S. Petrea, V. Cotoanta,1 I. Voicu. The Institute of Infectious Diseases
Matei Bals, Str. Dr. Grozovici nr. 1, sector 2, Bucharest, Romania
Background: HIV status is still associated with guilt, secrecy, social stigma and
discrimination. Many parents still believe they protect their HIV positive children
keeping the secret of diagnosis and they are resisting to disclosure. Some of them
are terrified about the children's reaction - exposure to a very painful experience,
the ostracization at school and in the community, the ignorance and what next
after telling, uncertainly about how disclosure.
Methods: In the Day Clinic we registered till now 985 HIV infected children. They
are 1-16 years old, most of them between 12-14 years. One psychologist and
four social workers perform the psychosocial activities related to disclosure. At
the beginning of the study only 27% of our patients knew their diagnosis. We established specific criteria for admission. Started with 2001 we included 64 HIV
infected children. We applied art-therapy method, using free or thematic drawing
technique, game's activities permitting the communication, disclosing their deep
emotional experiences.
Results: Disclosure was done for 30 children from the target group. For 34 of
them, in the process of telling we decided to delay the disclosure. Two of them
had negative reactions like anger, sadness, fear, betrayal, self-isolation that were
solved in time. No suicidal intension was registered. 28 had positive reactions as
understanding of what HIV means and the whole family dynamics was orientated
to a kind of normality: the tensions caused by the secrecy, the negative emotions
related to the unknown illness decreased or disappeared.
Conclusions: Helping children know their own diagnosis it's not only a right issue,
but also one of trust, need and responsibility. After the disclosure their attitudes
towards clinical process was better and the compliance to the ARV treatment
improved.
Presenting author: Odette Chirila, Str. Dr. Grozovici nr. 1, sector 2, Bucharest,
Romania, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WeOrF1327 Self-disclosure of HIV serostatus in relation to
depression and social support
R. Power1, R. Duran2, L. Palmer1, C. Koopman1, C. Gore-Felton3,
D.M. Israelski, J. Porter5, D. Spiegel1. 1Stanford University 711 Ursula Avenue,
Pacifica, California, United States; 2University of Miai, Coral Gables, Florida,
United States; 3Medical College of Wisconsin, Milwaukee, Wisconsin, United
States; 4San Mateo County Health Center, San Mateo, California, United States;
5Stanford Positive Care Clinic, Stanford, California, United States
Background: Persons living with HIV disease risk the possibility of negative consequences when revealing their seropositive status to people in their social network. This study examined disclosure of HIV status in relation to depression and
social support in an ethnically diverse sample of men and women.
Methods: We recruited 156 HIV-positive men and women who completed baseline measures of demographics, depression, social support and disclosure. Percentages of those who reported disclosure of HIV status to persons in their social
network were calculated. Multiple regression analysis examined demographic,

medical and psychosocial variables in relation to the disclosure variables.
Results: 98% of the sample reported disclosing their HIV status to one or more
people in their social network. Forty percent indicated indecision about disclosure, 28% desired to reveal their status, 21% regretted having told someone, and
31% planned never to tell certain people. Multiple regression analysis revealed
that individuals who reported greater satisfaction with social support disclosed to
significantly more people (Beta = 0.45, t = 6.11, p < 0.001) with the overall model