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

XIV International AIDS Conference

Abstracts WePeF6643-WePeF6647 247

- from professional care facilitators to volunteers
- from families receiving help to being main care providers,
- from PLWHA being "protected" to being active resource persons, and
- from external to local care traditions. Additional findings will be discussed. Some
negative aspects of HBC programs remain unchanged, such as lack of documentation of the effects and cost, as well as lack of research based knowledge in
important areas.
Recommendation: Mechanisms for better documentation and knowledge sharing across programs should be developed and funded as a matter of priority, in
order for HBC and community care to become as accessible and (cost) effective
as possible.
Presenting author: Birgit Westphal Victor, 14, Stengadevej, 5953 Tranekaer,
Denmark, Tel.: [phone], Fax: [phone], E-mail: birgit-westphal @ redcross.dk
WePeF6643 Reporting an experience in home-care at the
referral center on STDIAIDS Vila Prudente Sao
Paulo- Brazil - 1997 to 2001
F Bonasser, R.C. Freitas, S.G.C. Uchino. STD/AIDS Coordination of S&o Paulo
City Health Department, R General Jardim 36- 50 andar- Coordenagdo
Municipal DST/AIDS, Vila Buarque, So Paulo- SP, CEP 01223-010, Brazil
Issues: Home Care is an alternative to treat AIDS patients in the HAART era
Description: Home-Care is a modality of attendance to AIDS, stimulated by Ministry of Health in our country. The Referral Center on STD/AIDS Vila Prudente has
248 registered AIDS patients, 73 HIV+ without symptoms and 34 HIV+ with symptoms and no classified like AIDS. Home care is carried out by a multidisciplinary
team and it depends on integration with the other health care services, besides
minimum infrastructure that allows an appropriate attention to the patient. From
its begin, it assisted 38 aids patients. Patients' demographic profile shows 65,8%
(25/38) are men and 34,2% (13/38) women. The predominant (65,8%) age group
is 20-39 years, 31,6% are in the age group 40-59 years old and only 2,6% aged
60 years old and more. Most of the patients don't have a formal job and 73,7%
(28/38) depend on welfare benefits. 52,3% of the patients come from this service,
15,8% from other clinics and the others from spontaneous demand, hospitals and
NGOs. About patients' clinical condition, 16% have neurological sequels, 34% coinfection with TB, 10,5% co-infection with HCV, 5,2% co-infection with HTLV and
7,8% presented scares. Regarding the patients' evolution, 34 were discharged.
63,15% due to clinical improvement and 26,3% by death. The average under
home-care was to 2,5 months. Half of the patients have illicit drug use reported.
Almost all of then have no adherence to HAART therapy or have initiated aids
treatment late or were enrolled in Home-Care with advanced disease
Lessons learned: The commitment of all, patients and health care workers is
essential to the success of the home care
Recommendations: Home care is feasible, cheap, human and possible even under HAART, that is Brazil is distributed free of charge to all AIDS patients. Home
care can also improve adherence to the treatment
Presenting author: Francisco F Bonasser, R General Jardim 36- 50 andar- Coordenago Municipal DST/AIDS, Vila Buarque, Sdo Paulo- SP, CEP 01223-010,
Brazil, Tel.: [phone], Fax: [phone], E-mail: bonasserfilho@aol.
com
WePeF6644 Development and implementation of home
community based care models in South Africa
C. Lebeloe. South African Government, Department of Health, Department of
Health, AIDS Directorate, Private Bag X828, Pretoria, 0001, South Africa
Issues: The increasing number of HIV/AIDS patients placed an untenable burden
on formal health care facilities.
The cost of providing this service was becoming prohibitive.
An alternative care strategy had to be developed to support the formal HCS.
Description: Developed and costed 5 implementation models.
Provinces took elements from each model to customise a HBC service that would
best respond to the local need.
Implementation is through NGO partners.
Usage of community volunteer carers to minimise costs.
Lessons Learned: No one size fits all solution.
Utilisation of non-professional carers can optimise quality of care without inflated
costs.
NGOs are encouraged to share tasks and responsibilities to develop a holistic
service and reducing unhealthy competition. sustainability of the programme dependent on involvement of communities in all phases of development and implementation.
Recommendations: Establish local coordinating and monitoring structures to ensure buy-in from all sectors of the community.
Decentralisation to provide easy access to services for beneficiaries.

Creation of an environment that facilitates the sharing of learning and promotion
of good practice among all stakeholders.
Development of smooth referral systems to give a continuum of care.
Presenting author: Cornelius Lebeloe, Department of Health, AIDS Directorate,
Private Bag X828, Pretoria, 1, South Africa, Tel.: [phone], Fax:
[phone], E-mail: [email protected]

WePeF6645 A comparative study of the knowledge, attitudes,
beliefs and practices (KABP) of institution-based
and home-based caregivers of AIDS orphans in
South Africa
A.PR Steenhoff, H. Saloojee. University of the Witwatersrand, PO Box 2480,
Randburg, 2125, South Africa
IssuesStrengthening the capacity to care for Aids orphans (AO) is a worlwide
priority. Identifying, acknowledging and addressing caregivers' needs is a key element of this strengthening.
DescriptionPrevious research has focused on case studies. This questionnairebased study assessed the KABP of 60 primary caregivers of AO in Gauteng,
South Africa. 30 respondents were salaried caregivers at HIV orphanages, 30
caregivers of AO living at home. Institutional-based caregivers (IBC) were randomly selected from 5 institutions while home-based caregivers (HBC) linked
to one institution were selected as a convenience sample. Interviews were conducted by a single interviewer.
Lessons learnedlBC were significantly younger (mean age 33.9 vs 42.8 years),
had fewer offspring (mean 1.9 children per person vs 3.2) and had a higher level
of education (grade 8.8 vs 6.8). Both showed good knowledge of the seriousness
of the AIDS pandemic, modes of HIV transmission and the influence of behavior
on risk. Knowledge of basic healthcare issues was low in both groups (e.g. 43%
of IBC and 57% of HBC mixed oral rehydration therapy incorrectly). Practices differed too (e.g. glove usage of 83% in IBC vs 23% for HBC). Both felt appreciated
as caregivers (83.3% IBC, 100% HBC) and were coping adequately A third of
each group had been the subject of gossip, but few other societal stigma. Dealing
with illness/death was the most stressful part of caregiving for IBC, while HBC prioritized difficulties in meeting the child's material needs. Both groups agreed that
AO suffer lost IBC attributed this to recurrent illnesses whereas lack of material
resources again dominated in the HBC group.
RecommendationsCaregivers in both settings require more training in managing
common childhood diseases. Programs supporting HBC should prioritize meeting basic childcare needs (e.g. food). IBC require greater psychological support
to improve job satisfaction.
Presenting author: Andrew Steenhoff, PO Box 2480, Randburg, 2125, South
Africa, Tel.: [phone], Fax: [phone], E-mail: stoffap@hotmail.
com
WePeF6646 Estimating HIV/AIDS vulnerable households
J.W. Waimiri1, S. Oyombe2. PathfinderInternational, p.o. box 3532, mombasa,
Kenya; 2Central Bureau of Statistics, Nairobi, Kenya
Issues: Home-based care has emerged as an essential element of comprehensive care for People Living with HIV/AIDS (PLWHAs) in the continuum of care from
health-based institutions to community care in resource-constrained settings.
The diverse needs of PLWHAs include: clinical management; social support to
mitigate the socio-economic impact; psychological support to cope with its implications; protection against discrimination and support for orphans. Appreciating
these needs is fundamental towards developing results-oriented interventions.
Social mobilization empowers communities to identify health challenges in order
to promote the quality of life. Their participation is cardinal in fostering ownership
and sustainability of the program initiatives. This ensures a multiplicity of efforts
and skills needed for the scale and complexity of the pandemic.
Descriptions: Prior to the implementation of a Community-based HIV/AIDS Care
and Support project in response to the devastating human and development toll
of the pandemic, Pathfinder International conducted a Community Needs Assessment to:
Determine the extent to which households within the community are suffering under the burden of HIV/AIDS
Understand how the community is currently coping with the threat posed by
STIs/HIV/AIDS and the increasing burden of rising numbers of vulnerable households
Lessons learned: The Assessment provided invaluable baseline information to:
Estimate levels of vulnerability of HIV/AIDS among households in a community
setting
Identify the characteristics of vulnerable households
Identify sources of assistance provided to vulnerable households through community structures
Strengthen community-based structures and develop appropriate coping mechanisms for vulnerable households
Recommendations: The outcome of the Needs Assessment was a community
consensus on the care and support package, optimizing service delivery and accomplishing multi-sectoral partnerships.
Presenting author: john waimiri, p.o. box 3532, mombasa, Kenya, Tel.:
[phone], Fax: [phone], E-mail: [email protected]

WePeF6647 Establishment of community counselling services
in Tamil Nadu
L. Hemchand1, S. Nataraj1, R.W. Angeline1, M. John2. 1Institution(siaap), 4, 1
st street, Kamaraj Avenue, Adyar, Chennai, Tamilnadu, India; 2, Chennai, India
Issue: Counselling, as a concept, is new in India; access to institutional based
counselling services is limited and needs to be augmented with community based