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

280 Abstracts WePeF6796-WePeF6799

XIV International AIDS Conference

training of counsellors and the necessity for supervision and support. HIV/AIDS
counselling training courses appear to be developed in relative isolation and are
argued to be deficient in several respects. Amongst these is a critical reflection element of counselling that facilitates conceptual and process skills and the ability
to respond to critical factors of context and culture. Counsellors may be inadequately prepared to render a service that matches the emancipatory primary
health care agenda.
Description: This paper reviews HIV/AIDS counselling with reference to counsellor training and training models.
Criticism of the conceptual frameworks and training processes evident in the review is highlighted. Strategies derived from psychiatric nurse training are presented and critical discourse analysis as a method for training, peer-supervision
and supervision is proposed.
Lessons learned: Training in critical discourse analysis in counsellor training
models holds the capacity to yield HIV/AIDS counsellors engaged in what Latvala
(1999) in the context of nursing training refers to as a catalytic or emancipatory
practice.
Recommendation: HIV/AIDS counsellor training should be informed by various
professional training theory and methods. Psychiatric nurse training for catalytic
practice together with the incorporation of a critical discourse analysis capacity
can help accomplish an emancipatory counselling practice. This is more likely to
yield the primary health care outcomes envisaged by both the PHC policy and
the counselling in HIV strategy in South Africa.
Presenting author: Lyn Middleton, School of Nursing, University of Natal, Durban, 4041, South Africa, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
WePeF6796I NGO operated, privately supported Center for
Comprehensive Ambulatory Care (CCAC) for
people living with HIV/ AIDS (PLWHA's) in Caracas,
Venezuela: a successful and novel model of care
in a developing country
J.L. Medina, L.J. Rodrfguez-Adrian, M.C. Bello, A.I. Correia,
C.T. Fernandez-Ramirez, E. Gayoso, C.G. Torres-Viera, F.J. Reyna. Acci6n
Solidaria, Av Orinoco, Ota. Los Olivos, Bello Monte, Caracas 1050, Venezuela
Issues: Medical care for PLWHA's in Caracas is offered by public and private
hospitals. Public settings have overall limited resources and manage large number of patients. These factors imposed long waits between consultations. Some
private hospitals offer first class but expensive attention ($50/conslt), paid by the
patients. The Social Security system, a managed care organization supported by
the government and public and private employees, offers intermediate service.
30% of workers are covered by this service.
Description: CCAC is the care component of Accion Solidaria's Care and Prevention Center (CPC), a 400m2 facility located in an area easily accessible by
mass transportation. CCAC is opened 5/week, 8 hours/day. CCAC has a nursing
room, 3 exam rooms for infectious disease specialists (IDS), separated rooms
for dermatology and gynecology (with a last generation ultrasound), psychology/psychiatry office, lab, and ambulatory treatment area. The multidisciplinary
team has 3 nurses, 8 IDS, dermatologist, gynecologist, psychologist, psychiatrist,
social worker, lab technician, and ultrasound specialist. Volunteers provide support services. The social worker's evaluation determines fees, which range from 5
to $20/conslt. 50% of fees is donated to the CPC. The CCAC opened in February
2001, has filled 164 medical records and the number of consultations by specialty
so far is: psychology, 386; ID, 275; dermatology, 59; and gynecology, 25.
Lessons learned: CCAC has proven to be efficient and is welcome by PLWHA's
as an alternative to deficient public medical services. Private funding and volunteer work have so far helped support the CPC as a whole. Multicentric international research activities would further guarantee operations of the CCAC.
Recommendations: We encourage activists, volunteers, health workers, private
companies and foundations to implement this model in areas where quality attention for PLWHA's is not fully provided by the public health system.
Presenting author: Jose Luis Medina, Av. Orinoco, Qta. Los Olivos, Bello Monte,
Caracas 1050, Venezuela, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
WePeF6797 Immigrants with non b subtypes in New York City
M.N. Kahirimbanyi, E.F. Brutsaert. African Services Committee, New York, NY
United States
Issues: African Services Committee (ASC) a 20 year old NGO, provides health,
social and legal services to African and Caribbean immigrants living in the New
York City (NYC) metropolitan area. The prevalence of non B subtypes amongst
African and Caribbean immigrants is high, however, the only FDA approved viral
load test (Roche Ampiclor HIV-1 Monitor Test 1.0), widely used to monitor HIV
positive clients, under quantifies non B subtype viral loads which may lead to

inaccurate monitoring of clients with non B subtypes.
Description: With funding from HIV Care Services, ASC started an Access to
Care program (ATC) to ensure our clients receive appropriate health care. After
being counseled clients undergo a voluntary HIV subtype test. For clients with
a non B subtype, the health care provider is informed about the test result and
appropriate viral load monitoring. Presentations to health care providers, to educate them about HIV diversity and appropriate viral load monitoring, resistance

and treatment are carried out regularly We work with researchers in HIV vaccine
development to ensure that future vaccine development includes diverse strains
of HIV.
Lessons learned: In the 3 years since the ATC Program started (1999), 83 clients
have received a subtype test. Over 90% of the clients have a non B subtype. They
have be referred to appropriate health care. 15 presentations to the community
and health care providers in NYC have been made. The agency has developed an
ongoing relationship with health care providers in NYC greatly benefiting clients
and the providers, increasing referral rates.
Recommendations: The ATC program will do more advocacy to ensure access
to appropriate health care for our clients and appropriate vaccine development.
We will increase our education activities with cCBO's serving immigrant populations to educate them about HIV diversity.
Presenting author: martha kahirimbanyi, african services committee, 429 west
127th street, floor 2, new york, ny 10027, United States, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WePeF6798I Expanding AIDS prevention programmes to
incorporate care and support
R. Kathuria, P. Mukwashi, N. Dube, H. Chimuka, R. Kathuria, L. Mhuriyengwe,
R. Marima, C. Oosthuizen, D. Wilson. UNZA/HRT UNZA, Lusaka, Zambia
Introduction: Since 1996, peer education projects in Southern African have recruited over 12,500 peer educators, held over 1,240,000 community education
meetings, reaching 41 million people (including repeat attenders) and distributed
over 114,000,000 condoms. These projects have contributed to declines of up to
85% in STI rates. In response to an evolving epidemic, the projects have incorporated care and support.
Methods: Initially, counseling was offered to HIV positive peer educators. Projects
then developed benevolent, then bereavement, funds, together with home care
services. The projects fostered neighbourhood self-help associations, to provide
psychosocial support and home care. Studies indicate that these associations
significantly improve their members' psychosocial adjustment and coping skills.
Next, home care services for the wider community were developed, with peer educators in designated projects being retrained as caregivers. Finally, a further tier
of community care volunteers were recruited.
Results: To date, approximately 1,400 care supporters have been recruited. The
care supporters reach over 46,000 clients and have conducted over 680,000
home care visits within their communities. Projects which established a reputation
as economical, effective, large-scale prevention projects have become comprehensive prevention and care projects.
Conclusions: Through the evolution described above, the prevention projects
have remained responsive and credible in the context of a mature AIDS epidemic.
The principles and procedures underpinning the prevention programmes have
contributed to effective models of home care. In addition, the increased scope of
services provided has led to new opportunities for the promotion of prevention in
primary care.
Presenting author: Ravinder Kathuria, UNZA, Lusaka, Zambia, Tel.: [phone]
238, Fax: [phone], E-mail: [email protected]
WePeF6799I Toward a new approach to psychosocial
intervention through the evolution of the demands
of people living with HIV/AIDS in the south of Spain
A. Alcaide. NGO Convihda, C6rdoba, Spain
Issues: Since 1996, the year in which we implemented a service of Psychological Advice in Cordoba, until 2001 we have observed a substantial modification
in the demands generated by the clients. In 1996 the emotional support required
came from a need to affront uncertainty and death. Since 1999 the demands of
people living with HIV/AIDS has changed in response to their changing needs for:
1) integration into the working world and mainstream society 2) advice in dealing
with treatment. These changes have made us reflect upon the necessity for a new
focus of intervention.
Description: This study is based on an examination of the following factors in the
lives of the clients: social and family situations, healthcare, economic status, work
experience and educational background,between 1996 and 2001. The tools we
have used to assess these factors are: the clients personal records, the record of
demands made, the interventions executed, follow-up reports, and direct observation.
Lessons learned: The multitude of drugs that make up TARGA, along with the
side effects produced, make the adherence to a treatment program a basic intervention of the Advice program. On the other hand, increased life expectancy together with restrictions on social protection obligates people living with HIV/AIDS
to pay special attention to seeking employment that does not persecute their
health.
Recommendation: This study recommends the continuation of the services pro
vided by the Advice program as the best tool available to guarantee the integration of people living with HIV/AIDS, through providing work preparation skills and
helping them accept their health as a personal responsibility.
Presenting author: Ana Isabel Alcaide, C/Las Acacias, 13 - 1' C, 14006 C6rdoba, Spain, Tel.: [phone], Fax: [phone], E-mail: convihda@mx3.
redestb.es