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

XIV International AIDS Conference

Abstracts WePeF6734-WePeF6738 267

selling and Testing specific to the pregnant woman, Labour and Delivery Care
and Post-Pregnancy Care for the mother and her infant. The guides are complemented by and linked to referenced background papers produced by UNAIDS,
UNICEF and WHO. The recommendations made in the documents are based on
currently available evidence as well as experience. A list of further readings is
included in each of the guides. The guides have been field tested for their appropriateness and relevance in the Bahamas, Ethiopia, Kenya and Thailand.
Lessons learned: (1) - In the countries there is need to have a team who will
adapt the generic guides to suit the local stage of development, resources and
priorities in Reproductive Health (RH). (2)- As the field of MTCT prevention is
evolving very rapidly the guides need to be updated, as new information on the
scientific, clinical and programmatic issues becomes available.
Recommendations: The guides should be used as a source of information on
HIV and pregnancy and as practical guides for obstetric and medical care of the
HIV infected woman and her infant during the antenatal, labour, delivery and postnatal period.
The guides should be used in combination with other guidelines for RH to support
the integration of MTCT interventions into RH settings.
Presenting author: Elizabeth Hoff, WHO/AFRO, Parirenyatwa Hospital, P.O. Box
BE 773, Belvedere, Harare, Zimbabwe, Tel.: [phone], Fax: [phone]
90 20, E-mail: [email protected]
WePeF6734 The Options Project: A healthcare
provider-initiated risk reduction intervention for
HIV-infected individuals in clinical care settings
D.H. Cornman', K.R. Amicol, J.D. Fisher', W.A. Fisher2, G.H. Friedland3.
'University of Connecticut, Center for HIV Intervention & Prevention, University
of Connecticut, 406 Babbidge Road, U-1020, Storrs, CT 06269-1020, United
States; 2 University of Western Ontario, London, Ontario, Canada; 3 Yale
University School of Medicine; Yale New Haven Hospital, New Haven, CT United
States
Issue: Prevention efforts must be expanded to include effective risk reduction
interventions for HIV+ patients (pts). Clinical care settings offer a prime opportunity for such interventions due to accessibility to large numbers of HIV+ pts and
long-term, ongoing relationships between providers and pts.
Description: A brief provider-initiated Information-Motivation-Behavioral Skills
model-based (Fisher & Fisher, 2000) intervention has been developed and incorporated into the standard healthcare visit at a Connecticut HIV clinic. Using Motivational Interviewing, providers assess pts' risk behaviors, elicit from pts strategies for change, and negotiate behavior change goals. A workshop with didactic
and interactive components is used to train providers. Intervention effectiveness
is evaluated using a quasi-experimental design with experimental and standardof-care control clinics, and assessment at 6-month intervals of risk behaviors,
physical and mental health functioning, stages of change, and ART adherence.
Lessons learned: As of 1/10/02, 16 providers had been trained in and were implementing the intervention with 226 HIV+ pts. At baseline, 109 (24.1%) of 452 pts
in the experimental and control groups reported risky sex behavior. 66 of those pts
reported 1674 unprotected sex events in the past 3 months with about 600 partners of negative or unknown HIV status. Younger age, better physical health functioning, and depressed mental health functioning predicted risk behavior. Quality
assurance measures indicate that providers are able to incorporate discussions
of HIV risk reduction into clinic visits.
Recommendations: HIV+ pts in clinical care are engaging in risky behavior at
a noteworthy rate. Developing effective interventions that take advantage of the
positive, ongoing relationships between patients and providers, and embedding
these interventions within the clinic visit appears to be a feasible and practical
option for reducing risk among HIV+ pts.
Presenting author: Deborah Cornman, Center for HIV Intervention & Prevention,
University of Connecticut, 406 Babbidge Road, U-1020, Storrs, CT 06269-1020,
United States, Tel.: [phone], Fax: [phone], E-mail: dcornman
@ uconnvm.uconn.edu
WePeF6735 Providing medical and nursing care for HIV/AIDS
patients in resource poor setting: Philippine
General Hospital (PGH)
D.C.G. Gomez. Hospital, Valenzuela City, Metro Manila, Philippines
Issue: What has been the PGH experience in overcoming the difficulties in providing medical and nursing care for HIV/AIDS patients?
The Experience: PGH is the country's premier national tertiary hospital. In 1994
an HIV/AIDS patient was referred for clinical management. The hospital was confronted with a reality: there was no prevention and treatment program in place.
Negative reactions from the administration and caregivers surfaced stemming
from fear of contagion, misconceptions and biases. The hospital was not ready.
Also, as the facility is supported through public funds, no allocation was allotted

from the meager budget for HIV/AIDS.
A group of doctors and nurses volunteered to develop and implement a program
of care. They did advocacy work, information and educational campaign, counseling, networking, clinical management and referral system. Innovation and costeffectiveness were integral part of the program.
Results: The hospital is now able to provide the medical and nursing care for
HIV/AIDS patients. It has opened STD/AIDS Guidance, Intervention, and Preven
tion Unit (S.A.G.I.PR)- an outpatient, inpatient and referral unit. It has also put in
place a program for pre and posttest counseling.
Lessons Learned Persistence is needed to sustain a program in a resource poor
setting like PGH. Also, the spirit of volunteerism and willingness to serve are important if we are to mitigate the effects of the infection in the country.
Presenting author: Dominga Gomez, Sampaguita St., Sta. Lucia VI, Punturin,
Valenzuela City, Metro Manila, Philippines, Tel.: [phone], Fax: +63 2
5261705, E-mail: [email protected]
WePeF6736 Comprehensive approach to prevention, care and
support has brought behavior change in Western
Kenya
G. Nyanjom', J. McWilliam2, P. Mwarogo2. 'Family Health International, PO.
Box 135, Kakamega, Kenya; 2Family Health International, Nairobi, Kenya
Issues: Pooling the efforts of government and non-governmental organizations
to implement a wide range of HIV and AIDS prevention care and support activities can be as challenging as it can be rewarding. The involvement of many key
players requires continuous and intensive coordination, follow-up and technical
support. At the same time, it leads to the realization of results (behavior change)
and greater ownership of the intervention by both government and community
members.
Description: This paper will describe the strategy that has been adopted by FHI
in working with its partners to identify, train and support-supervise community
level implementers (the peer educators, community health workers and other service providers) as well as upgrading prevention, care and support services of the
government and mission facilities in the same areas. This intervention is set in
the sugar belt bordering Uganda characterized by low incomes and inadequate
health care services. The close proximity to Uganda encourages cross border
trade and movement with its attendant problems. Preliminary data showing some
of the challenges faced and the benefits so far recorded will be shared.
Lessons learned: Early involvement of government department, and regular
coordination meetings are key to acceptance and success of such a complex
HIV/AIDS program. The range of services offered requires the input of organizations with different expertise.
Recommendations: A consortium approach with government and NGOs to build
a comprehensive program works most effectively with a strong central coordinating body controlling funds and providing technical and logistical support.
Presenting author: Gordon Nyanjom, P.O. Box 135, Kakamega, Kenya, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeF6737 Challenges of supervision HIV/AIDS counsellor
C. Rachier, E. Gikundi, D. Balmer. Kenya Association of Professional
Counsellors, Nairobi, Kenya
Issues: Counselling supervision promotes the counsellor's personal and professional development and thereby safeguards the client's welfare. In Kenya and
especially in the rural areas, there are very few qualified and experienced counsellor supervisors available. As VCT centres mushroom all over as a strategy for
prevention and care of HIV/AIDS, there is a danger of counsellors getting burnout
and offering substandard service to clients due to lack of supervision and supervisors.
Descriptions: Kenya Association of Professional Counsellors (KAPC) is involved
in the selection and training of counsellor supervisors for various districts in
Kenya. These supervisors from the districts supervise counsellors working in the
health centre and the community thereby ensuring quality counselling to VCT
clients.
Lessons learnt: Counsellors at health centre level in rural areas are now receiving supervision for their counselling work. They appreciate and find the meetings
helpful in terms of improving and maintaining their competence. Supervisors need
a lot of support as they begin their supervision work. Problematic issues for the
supervisors include role conflict, time constraints, inadequate support from superiors, transport and venue for meeting the counsellors.
Recommendation: Practising counsellors should have access to counselling supervision. Careful selection of counsellor supervisors for training is important.
Transport, meeting venue, time and managerial support must be available. Counsellor supervisors to receive consultative and peer support form other counsellor
supervisors.
Presenting author: Cecilia Rachier, Kenya Association of Professional Counsellors, P. O. Box 55472, Nairobi, Kenya, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
WePeF6738 Issues in MTCT program at Namakkal, South India
J.J. Vijaykumari, P. Udayakumari, R. Rukmini, N.M. Samuel. Tamil Nadu Dr.

MGR Medical University, Department of Experimental Medicine & AIDS
Resource Center, Chennai, Tamil Nadu, India
Issues: Repeated counseling, testing, interventions with antiretrovirals and follow
up of the mothers and their infants form important components in a successful
MTCT program. Issues in counseling, testing, drug adherence and follow up are
challenging in a resource constrained setting.