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

232 Abstracts WeOrF1328-WeOrF1331

XIV International AIDS Conference

accounting for an adjusted R2 = 0.21, overall F (3, 152) = 14.50, p < 0.001. Individuals who regretted telling their HIV status to someone reported significantly
greater depressive symptoms (Wald (df = 1) = 7.92, p < 0.01), overall model (df
= 2) = 12.16, p < 0.01).
Conclusions: Many HIV-positive people were indecisive about disclosure.
Greater depressive symptoms were reported in individuals who experienced regret after disclosure. Those who were more satisfied with their social support
disclosed to more people. These findings suggest the need for interventions that
guide people through the disclosure process in order to minimize the risk of negative consequences and maximize opportunities for social support.
Presenting author: Rachel Power, 711 Ursula Avenue, Pacifica, California,
United States, Tel.: [phone], Fax: [phone], E-mail: Rpower
@stanford.edu
WeOrFi328 The Toy Library: a model of intervention that
makes the therapeutic-entertaining approach of
children affected by AIDS more human
G.M.A. Santos. Gapa-Ba, Barris, Salvador - Bahia, Brazil
Issue: The phenomenon of "feminization" of the AIDS epidemic in Brazil, characterized by the high increase of the infection among women, has also brought an
increase in the number of children who are born with the virus or who become orphans due to the death of one or both parents. This situation has caused a series
of economic, social and psychological restrictions to the lives of those children.
Description: The Toy Library Program is an innovative intervention for the care
of impoverished children affected by AIDS in the Brazilian Northeast. The Toy
Library encompasses a series of actions of an entertaining and therapeutic nature, providing experiences in groups or individually, acess to the magical world
of toys, games, books, songs and art, thus allowing the expression of emotions,
words and ideas. This way, socialization, creativity and the cognitive, psychomotive and affective aspects of children between 03 and 12 are worked upon, with
the aim of helping them to overcome the difficulties brought by living with AIDS.
Home visits are carried out and food baskets are distributed. The activities of the
Toy Library take place in facilities especially installed to attend to the children,
and interventions are also performed in the waiting room of the public hospital for
pediatric AIDS.
Lessons learned: In 2 years, we were able to carry out 240 group interventions
and 45 individual sessions; 77 families were benefited, with 154 food baskets
being distributed; 80 interventions in the waiting room of the hospital were performed, reducing tension and anxiety while waiting for attendance; more than 300
children were reached; 54 volunteers were mobilized and joined the actions at the
hospital by co-managing them.
Recommendations: Providing creative workshops with the aim of working on
self-esteem; the creation of a group of mutual help for the caretakers, allowing
the sharing of experiences.
Presenting author: Gladys Santos, Rua Comendador Gomes Costa 39 - Barris,
Cep 40070120, Salvador - Bahia, Brazil, Tel.: [phone], Fax: +55 071
328 4623, E-mail: [email protected]
WeOrF 329 How can you give hope to HIV-positive children in
resources-poor settings?
M.G.A. Ponnet, N. Ounjit. Medecins sans Frontieres - Belgium, Medecins sans
frontieres-Belgium, 311 Ladprao road, Soi 101, Wangtonglang, Bangkok 10240,
Thailand
Issues (Problems): Thai nurses and a social worker visit HIV-positive children
at home in metropolitan Bangkok. Besides medical problems the children have
psychosocial problems of multifactoral origin. The children are orphans and miss
strong family links; they are often sick and drop out of school; they don't have any
friends and the other kids make fun of them and they need good medical follow-up
and (antiretroviral) drugs lifelong but they face difficulties to access care.
Description: A multidisciplinary team of nine counselors, consisting of medical
doctors, nurses and social workers, organized a two day Children's Weekend
where fun and social support were the key words. Eight HIV-positive children attended the weekend.
The highlight of the weekend was a game about medicines counseling. The social
worker handed out a big envelope containing a letter. A child living in the North
of Thailand asked the children for help taking the medicines. To maintain the children's attention and to facilitate the conversation each child expressed its feelings
using a hand puppet, made out of paper bags. The children wrote their answers
down in a letter.
Lessons learned: A link between the children was established: the participants
realized they were not the only ones with HIV. Their family members made the
same reflection later on. The medical professionals organizing the weekend realized that the children talk very openly about their disease and the medicines they
have to take.

Because the children speak the same language, have the same age, the same
problem and same feeling, the next step planned is to set up a peer support
group.
Recommendations: Thai HIV-infected children find social support in peer-driven
setting facilitated by professionals in pediatric HIV. This example is reproducible in
other resources-poor settings and shows how you can give hope to HIV-positive
children.

Presenting author: Mieke Ponnet, Medecins sans frontieres-Belgium, 311 Ladprao road, Soi 101, Wangtonglang, Bangkok 10240, Thailand, Tel.: [phone]
91, Fax: [phone], E-mail: [email protected]
WeOrF1 330] Vulnerability of men who have sex with men in
disclosing HIV-positive status to sexual partners
and significant others: Need for support and
assistance in disclosure decision-making
W. Medved, L. Calzavara, K. Ryder, T Myers. HIV Social, Behavioural and
Epidemiological Studies Unit, Faculty of Medicine, University of Toronto, Banting
Institute, Room 525, 100 College Street, Toronto, Ontario, M5G 1L5, Canada
Background: To examine patterns of disclosure of HIV-positive status to sexual
partners and significant others by MSM.
Methods: Recently infected men and women enrolled in the Polaris cohort are
recruited through Ontario's HIV diagnostic laboratory, physicians and community
organizations. In-depth qualitative interviews were conducted with a random subsample of enrolled MSM (n=20). They were asked to describe their reasons for
and against disclosure, the process of telling, and the impact on self and relationships. The constant comparative method of analysis was used to identify
emerging themes.
Results: Most were quick to disclose (immediately/same day or within days of
diagnosis) to those they had a close/intimate relationship (i.e. close friend or current partner). Family members were often the last people in the social network to
be told, unless the family member was also seen as a "friend". The first person
told was chosen based on perceived "safety". Reasons for disclosure to intimates
included: the "right" to know, need for emotional support, and to access practical HIV-related resources. Timing of disclosure to family members was related to
previous experience (or lack of) sexual-orientation disclosure, and acceptance of
diagnosis. The initial period after diagnosis was used as an opportunity to come
to terms with the diagnosis before having to contend with anticipated negative
reactions of family. Most experienced positive reactions from friends and partners, leading to strengthened relationships. Family members were more likely to
respond negatively.
Conclusions: HIV disclosure is a unique and varied experience, often preceded
by anguish and uncertainty Health service providers need to have a better understanding of the psychosocial issues related to disclosure of HIV-positive status so
they can provide support to persons living with HIV/AIDS and assistance in disclosure decision-making.
Presenting author: Wendy Medved, Banting Institute, Room 525, 100 College
Street, Toronto, Ontario, M5G 1L5, Canada, Tel.: [phone], Fax:
[phone], E-mail: wendy.medved @ utoronto.ca
WeOrF 331 The dynamics of self-help in Africa: what makes
support groups of people living with HIV/AIDS
sustainable or not
C. Cornu1, C. Castle2, T. Chabala3, D. Mwanza4, A. Ouedraogo5. 1'International
HIV/AIDS Alliance, Brighton, United Kingdom; 2Horizons/International HIV/AIDS
Alliance, Washington DC, United States; 3Horizons Consultant, Lusaka, Zambia;
4Lusaka, Zambia; 5Horizons consultant, Ouagadougou, Burkina Faso
Background: In 1994 42 national governments committed to support greater
involvement of PLHA, and to strengthen networks of PLHA & PLHA support
groups. However, there has been little research exploring dynamics of self-help
among HIV+ people, particularly factors affecting success & sustainability of
PLHA groups.
Methods: A diagnostic study examined PLHA involvement in prevention & care
programs carried out by NGOs in two African countries, Burkina Faso and Zambia. Qualitative data were collected through interviews & focus group discussions
with 433 respondents. They included NGO service providers, PLHA & others who
use the services, relatives of PLHA involved in NGOs, health workers, policymakers & community leaders. Study NGOs were PLHA groups & AIDS Service
Organizations (ASOs), some of them supporting small self-help groups of PLHA
or PLHA & affected people.
Results: Most groups include infected & affected people, & sometimes other
community members. Beyond supporting their members many groups provide
care in the community & work to raise awareness. Factors that limit the sustainability of support groups include: lack of common objectives & expectations; lack
of clarity about roles & responsibilities of members, groups & ASOs; high levels of morbidity & mortality among HIV+ members; lack of effective leadership &
succession planning; few financial resources. Factors that enhance sustainability of support groups include: common member objectives & expectations; real
community base; benefits for members; clear responsibilities & decision-making;
mechanisms to cope with member death; skills building; clear relationship with
the ASO.
Conclusions: Self-help groups provide a non-discriminatory & supportive environment in which PLHA can improve morale by sharing experiences & infor
mation. However, many support groups fail & need technical support to improve
planning, although technical support should always respect the groups' own priorities.
Presenting author: Christophe Cornu, International HIV/AIDS Alliance, Queensbury House, 104-106 Queens Road, Brighton BN1 3XF, United Kingdom, Tel.: +44
1273 71 8900, Fax: [phone], E-mail: [email protected]