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

598 Abstracts ThPeF8034-ThPeF8038

XIV International AIDS Conference

ThPeF8034 VCT clients' experience of HIV- related stigma and
resulting discrimination
J. Mbwambo', L. Nyblade2, S. Mathur2, G. Kilonzol, P. Kopoka3,
K. MacQuarrie2. 1Muhimbili University College of Health Sciences, Tanzania;
21CRW, Washington, DC, United States; 3University of Dar es Salaam, Dar es
Salaam, Tanzania
Issues: HIV-related stigma plays a critical role in the VCT process. Documenting
and understanding perceived and actual stigma and discrimination in the lives of
VCT clients will help improve provision of VCT services.
Description: A cohort of PLHA (15 men, 45 women from VCT and ANC clinic
sites) is being followed for a year, with an enrollment interview pre-VCT and follow up interviews at 1, 4, and 6 months post VCT to document perceived stigma
and then actual experiences with stigma and discrimination.
Lessons Learned: Individuals seek VCT for a variety of reasons (pre-marriage,
pre-childbearing, own or partner illness, partner death, pressure from family/partner, suspect HIV due to risk factors-behavior or profession) all of which
have differing implications for the disclosure process, fears and expectations of,
and experiences with, stigma and discrimination. VCT clients testing prior to marriage or childbearing were more apprehensive about the results and experienced
more discriminating acts than VCT clients who had come for other reasons. Most
individuals come for VCT with the knowledge of at least one person they feel close
to (parents, partners or another close family member), but do not want others
(neighbors, employers, friends) to know of their testing and status because of fear
of being mistreated or ridiculed. Disclosure and stage of disease is closely linked
to experiences of stigma and discrimination. Self-stigmatization was present with
PLHA attributing their status to "bad, immoral" behavior and isolating themselves
from interaction with others.
Recommendations: VCT has to be sensitive to the differential motivations for
testing, the consequent degree and way in which the client may experience
stigma and discrimination, and the resulting differential counseling needs.
Presenting author: Laura Nyblade, 1717 Masschusetts Ave, NW, Suite 302,
Washington, DC 20036, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeF8035 The development and use of a computerised
management information system (MIS) for the
Tebelopele voluntary HIV counselling and testing
(VCT) network in Botswana
V.I. Mwasallal, K. Bussell2, M.G. Alwanol, R. Molosiwa', M. Mokomane',
TA. Kenyon'. 'ThedBOTUSA Proect/CDC, Gaborone, Botswana; 2Centers for
Disease Control and Prevention, Atlanta, United States
Issues: A VCT network of 15 free standing sites and several satellite and mobile
sites has been rapidly implemented in Botswana as part of the national response
to the severe HIV/AIDS epidemic. The monitoring and evaluation (M&E) plan of
the VCT network included a computerized MIS, which plays an important role
in the collection, processing, dissemination, and use of information on key VCT
indicators.
Description: Technical assistance for the development of the MIS was obtained
from the Centers for Disease Control and Prevention (CDC). An MIS manager
for central level and data entry clerks for local level were hired and trained on
data management using the Epilnfo software package. Key VCT indicators had
been developed within the M&E plan. The data collection instruments (i.e. client
intake sheet, reception and laboratory logbooks, guidelines/manuals) were developed with a standard format for all VCT centers. Methods and schedules of data
transfer were selected considering factors, such as reliability and costs.
Lessons learned: The MIS has facilitated the timely generation of monthly, quarterly, and annual VCT reports at local and national levels. Therefore, data on
key VCT indicators is now readily accessible, allowing timely feedback to service
providers and other stakeholders.
Recommendations: An MIS is essential in the implementation of any VCT network. Therefore, establishment of MIS should be done concurrently when establishing the network.
Presenting author: Vidah Mwasalla, The BOTUSA Project/CDC, P0 Box 90,
Gaborone, Botswana, Tel.: [phone], Fax: [phone], E-mail: tbr6@cdc.
gov
ThPeF8036 An exploration of the psychosocial consequences
of the rapid result HIV test in the antenatal setting
in Soweto, South Africa
A. Deverell', J. Mcintyre2, G. Gray2, J. Fisher', R Fridjhon'. 1 University of the
Witwatersrand, Wits Universi, Department of psychology Private bag 3, Wits
2050, South Africa; 2Chris Hani Baragwanath Hospital Johannesburg, South
Africa

Background: The primary objective of this study was to compare the effects of
receiving same day versus delayed HIV diagnosis in pregnant women. The impact of test result delivery on post-test satisfaction, disclosure, partner reaction,
self-reported coping, social support and failure to return for results was explored.
Methods: In phase one of the research, subjects received pre-test counselling,
completed a pre-HIV test survey, had an HIV test and received post-test counselling. In phase two, a post-HIV test survey was administered to subjects.

Results: 524 pregnant women from the ante-natal clinic at The Chris Hani Baragwanath Hospital (CHBH) in Soweto, South Africa participated. Of these, 443 subjects (84.5%, p<0.0001) chose to receive their results on the same day. 67 subjects (12.8%) chose to delay receiving their results. 9 subjects (1.7%) refused to
be tested and 5 subjects (0.95%) selected a delayed test date. Overall, the vast
majority of subjects were satisfied with their result delivery selection. No significant differences, in terms of disclosure and partner reaction, between same day
and delayed results were found. No significant relationship between HIV infection
and failure to return for results was found. Patients who selected same day diagnosis and tested HIV positive, showed higher levels of post-test dissatisfaction,
questioning the accuracy and validity of the test. Selection of delayed result led
to a higher failure to return for results.
Conclusions: The proportion of subjects who chose to receive their results on
the same day is, in itself, an indication of patient preferences. It is suggested that
individuals have different coping mechanisms and styles, and that to accommodate these, both same day and delayed result options should be made available
to patients.
Presenting author: Andee Deverell, Wits University, Department of psychology, Private bag 3, Wits 2050, South Africa, Tel.: [phone], Fax: +27 11
7174559, E-mail: [email protected]
ThPeF8037 The elderly population and a Voluntary Counselling
and Testing (VCT) Centre: an intervention to
assesse the risk of HIV infection
M. Silva', D.S. Fontenelle', S.F. Cabral', M.E. Maganhal, F.A. Nascimento',
R.C. Jaegger', A.R. Rodrigues2, L.O. Souza2. 'Counselling and Testing Centre
of Madureira/Rio de janeiro City Health Secretariat, Rua Alexandre de Gusmao
11 ap 101 - Tijuca, Rio de Janeiro, Rio de Janeiro, cep:20520-120, Brazil;
2 RNP+, Rio de Janeiro, Brazil
Background: HIV infection in the elderly (60 or more) has been largely unappreciated in the design of prevention. It is imperative that health care/social providers
be made aware that HIV/AIDS is not just a disease of the young.
Methods: Perform retrospective analysis of data from elderly users'promptuaries
of the VCT Centre of Madureira (Rio de Janeiro) between January 2000 and December 2001.
Results: During the course of 2000 and 2001, 3024 people attended the VCT
Centre of which 93 were elderly people. Promptuaries were analyzed showing the
following results: *Sex - 66 males (70,9%) and 27 females (29,1%). *Age - 60-65
years, 51 (54,8%); 66-70, 32 (34,4%) and more than 70 years, 10 (10,8%). *Eight
(8,6%) were found to be HIV positive. The main reasons for HIV antibody testing
were the following: health care provider asked for a HIV testing during a clinical
investigation, 35 (37,6%) of which 17 to pre-surgery screening for HIV; unsafer
sex, 24 (25,8%); prevention, 14 (15,1%); prevention against HIV infection before
entering to new partner's relationship, 8 (8,6%).*Self-identified as homosexual: 2
(2,1%). *Safer sex: 85 (91,4%) older adults use not to have safer sex. The main
reasons for unprotected sex were do not like to use condoms, steady partner and
confidence/fidelity. Only 8 (8,6%) claimed to have used condom.*History of a sexually transmitted diseases: 10 (10,7%). *Alcohol abuse: 4 (4,3%).*Sexual activity:
Only six (6,4%) older adults do not have sexual activity anymore.
Conclusions: Prevention campaigns should address elderly people. There are
some evidences showing that older adults are not much concerned about their
risks of being infected with HIV. Therefore health professionals should provide information about HIV/AIDS to this population. Counselling as a strategy can contribute to the adoption of preventive practices. Thus, a more informed community
can better protect itself from the disease.
Presenting author: Debora Santos Fontenelle, Rua Alexandre de Gusmao 11
ap 101 - Tijuca, Rio de Janeiro, Rio de Janeiro, cep:20520-120, Brazil, Tel.: +55
21 2567-0355, Fax: [phone], E-mail: [email protected]
ThPeF8038 The importance of nurses for voluntary counseling
and testing efforts in a rural South African hospital
A T. Welz, D. Haran2. 'Africa Centre for Health and Population
Studies, 7629 North 22nd Place, Phoenix, Arizona, 85020, South Africa;
2Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Background: The HIabisa District Hospital has 9 wards and 14 clinics. It caters
for approximately 200 000 people in rural KwaZulu-Natal, an area with an antenatal HIV prevalence of 32%. Nurses handle the vast majority of outpatient and
inpatient demands. Anecdotal evidence has suggested that knowledge and beliefs among nurses may impede voluntary counseling and testing programs (VCT)
through a reluctance to recommend patients to VCT and a fear of testing themselves.
Methods: A questionnaire-based survey among approximately 200 nurses examined knowledge, attitudes and beliefs regarding the benefits and harms of VCT
and risk perception of occupationally-acquired HIV. All accidental exposures to

blood, including needle stick injuries, were also recorded for nurses by ward and
duration of employment.
Results: Preliminary results show that 42% of nurses do not recommend patients
to VCT due to the lack of anti-retroviral treatment. They also claim that the health
of HIV positive patients deteriorates rapidly after VCT. Among nurses, 25% said
that they would not have an HIV test if they were to suffer a future needle stick injury. 40% of all nurses have had a needle stick injury-only 25% of nurses correctly