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

600 Abstracts ThPeF8044-ThPeF8047

XIV International AIDS Conference

Results: There were similarities in the socio-demographic contexts of HIV/AIDS
in the 3 countries which would make it possible to develop a common counseling strategy for Asia. The National AIDS Programmes were moving towards supportng the idea of counseling as a program strategy. However, there was little
attention given to training and support. Western models were implanted and the
training was dependent on western conceptualization. There was lack of infrastructre. Counselling was confused with information giving.
Conclusions: Counselling was viewed as essential in the context of the progression of the epidemic in the Asian region. As more and more infected persons
were being identified and the epidemic was being recognized as a public health
problem, there was a need for an adequate national response which should encompass voluntary counseling services based on emerging issues of migration,
trafficking, and stigma and discrimination against people living with HIV and AIDS.
Presenting author: Vimla Nadkarni, Family Planning Association of India, Nariman Point, Bajaj Bhavan, Mumbai 400 021, India, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeF8044 A thematic meta-analysis of voluntary counselling
and testing in africa
D. Gray, H. van Rooyen, V. Solomon, R.D. Griesel. University of Natal, School
of Psychology University of Natal, Private Bag X01, Scottsville, 3209, South
Africa
Issues: Voluntary Testing and Counselling (VCT) has emerged as a major strategy in the response to the HIV/AIDS epidemic in Africa. There is widespread
recognition of the important role that HIV counselling plays in both prevention
activities and alleviating the distress of those affected and infected with HIV or
AIDS.
Description: This investigation forms part of a wider audit of the VCT services in
South Africa. A thematic meta-analytic review of all published literature on VCT
in Africa is undertaken in order to present a summary of past findings, a critical
analysis of focal areas and main trends covered in previous research, and a review of some of the key and consistent omissions of this research. In addition,
this research attempted to answer the question: what drives the production of
research and whose interests are served in this?
Lessons learned: Despite the obvious importance attached to VCT in African
countries, it remains a surprisingly under-researched area and where research
exists, it appears to be shaped by specific research agendas. The result of such
a strategy is that while some areas of VCT are well understood, other areas remain unexplored preventing effective VCT delivery.
Recommendations: Based on the results of this study this paper makes a number of specific recommendations for future research. It is hoped that a study of
this nature will help to situate new research on VCT, point to areas where research is needed and help to avoid duplications where information has already
been collected.
Presenting author: Debra Gray, School of Psychology, University of Natal,
Private Bag X01, Scottsville, 3209, South Africa, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThPeF8045I Challenges in the implementation of Voluntary
Counseling and Testing of HIV at health facilities in
the Western Cape, South Africa
B. Patel1, D. Tsukudu2, N. Coetzee3. Public Health, University of Cape Town
and HIV Directorate, Western Cape Health department, PO.Box 13262,
Mowbray 7705, South Africa; 2 HIV Directorate, Western Cape Health
department, Cape Town, South Africa; 3Public Health, University of Cape Town,
Cape Town, South Africa
Issues: Data from annual antenatal surveys show an increasing prevalence of
HIV in SA. As part of the HIV Prevention Campaign, the Department of Health,
Western Cape (WC), SA, decided to offer a free VCT service at primary health
clinics. It was the first time such an initiative was undertaken where counselors
were lay persons and healthcare workers did on-site rapid testing. We will describe the operational and logistical challenges in implementing the programme.
Description: The lay counselors received intensive training before placement at
the sites. Weekly mentoring sessions with psychologists and ongoing training
was provided. After 6 months, a rapid appraisal done identified the operational
challenges experienced. We explored various elements such as site selection,
adequate facilities, employment and training of lay persons with minimal experience to do counseling, patient uptake and confidentiality. The main problems
included a shortage of resources, no space for counseling, the testing methods
used and stigmatization of counselors. The prevalence of Tuberculosis and Sexually transmitted infections guided our choice of VCT sites, but further analysis is
needed before incorporating other clinics. There has been an improvement in the
roll-out of the VCT program since its inception and we now have 100 counselors
servicing 120 primary health care sites. VCT is the cornerstone of the prevention

efforts against HIV and feeds into other key programs.
Lessons learned: Integrated planning is needed for the success of such a program within the budgetary, skills deficiencies and under-resourcing constraints.
By addressing these constraints, overcoming the challenges, and encouraging
the commitment of counselors to the program, smoother implementation is possible.
Recommendations: Expansion of the services together with effective planning

and constantly reviewing and addressing the challenges could assist in the prevention campaign to combat HIV/AIDS.
Presenting author: Bhavna Patel, P.O.Box 13262, Mowbray, 7705, South Africa,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeF8046 Investing in our future: Increasing access to
counselling and testing services for young people
D.K. Boswell1, R. Baggaley2, C. Kamenga3, G.M. Sangiwa1, E. van Praag'.
1Family Health International, 2101 wilson blvd, suite 700, arlington, va, 22201,
United States; 2 London, United Kingdom; 3Family Health International, Accra,
Ghana
Issues: Young people are at great risk from HIV and the importance of developing HIV prevention and care services adapted for their needs has recently been
increasing. Expanding access to counseling and testing (as well as care/support
services) for young people (including targeted interventions for young pregnant
women, couples, uniformed services, sex workers, and IDUs) is an urgent priority.
Description: This paper describes state of the art approaches to counseling and
testing services for young people. Barriers to accessing services and factors that
influence uptake by youth are explored. Examples of successful field efforts will
be cited including a freestanding youth center offering VCT in Rwanda, a school
based model linked to an adolescent clinic in Brazil, a health center for marginalized youth in North London, mobile services in Uganda and outreach services in
Zimbabwe.
Lessons learned: There is need for further learning by doing on how to offer
youth- friendly counseling, testing and care and support services. Few programs
demonstrate significant uptake by young people. Conducive policy development
and reform will increase uptake (especially capacity of young people to provide
informed consent without mandatory parental consent). VCT models must accommodate the needs of different groups of young people. Young people must be
assured of privacy, confidentiality, non-judgmental counseling responsive to their
expressed needs, and access to accurate information, preventive services and
effective referral (including clinical care).
Recommendations: Programs demonstrating uptake and acceptability must be
monitored, evaluated and documented. Lessons learned should be widely disseminated to encourage scaling up, adaptation and/or replication. Setting priorities to invest in VCT and associated care/support services for young people will
contribute significantly to a global prevention and care agenda.
Presenting author: deborah boswell, 2101 wilson blvd, suite 700, arlington,
va, 22201, United States, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeF8047 Is VCCT in YFS an obstacle for adolescents and
youth attendance?
N.B. Osman', B. Crahay2, D.M. Correia3, M.I. Zilhao4, A.H. Mussa5,
E. Almeida6, L. Van Veken2, D. Aurora1. MOH/Maputo Central Hospital,
Maputo, Mozambique; 2UNFPA, Maputo, Mozambique; 3MOH, Maputo,
Mozambique; 4MOH/UNFPA, Maputo, Mozambique; 5MOH/Maputo Health
Directorate, Maputo, Mozambique; 6MOH/Tete Health Directorate, Maputo,
Mozambique
Issue: Mozambique is one of the 10 HIV/AIDS most affected countries in the
world, with an overall prevalence of 12.2%. Since youth is thinking as a window
of hope, Mozambican National Strategic Plan formulated in 2000, considers the
protection of this group as one the priorities in the prevention of new infections.
In Mozambique, UNAIDS 2000 reported an estimate HIV prevalence for girls 15 -24 years old between 13.36 to 16.11% and for boys from 4.49 to 8.97%, which
shows a strong gender inequity and increased double vulnerability of girls against
boys, due to physical and social, traditional and cultural imbalance and norms.
Definition: Since 1999, a multi-sectoral project on ARH/HIV/AIDS supported by
UNFPA and Pathfinder International, was formulated and implemented in some
areas of the country, in order to strengthen the technical and institutional capacity of related government agencies and NGOs. Interventions for increasing the
competence in ARH looking for behavior change of school and out of schools
adolescents and the provision of specific YFS were implemented in a pilot basis.
In Maputo City there are 6 YFS in primary health Centers,1 in a youth vocational
craft center and a referral clinic at Maputo Central Hospital, where VCCT was
introduced at the end of 2001 as a youth felt need.The promotion of abstinence
and essages of delay of sexual activity for non sexually active youth and the consistent use of condom for the sexually active are the main prevention approaches
adressed for youth.
Lessons learned: In average 50 out of 700 adolescents who use the youth referral clinic services every month request VCCT. Data from the adolescents attendance in this site for contraception, information on SRH issues, counseling,
pre and post abortion care, shows that the attendance were not affected after the

introduction of the VCCT
Recommendations: Efforts should be made for advocating the need for human
and financial support for expanding VCCT for most YFS.
Presenting author: Ivone Zilhao, Rua Duarte Galvao,31, Maputo, Mozambique,
Mozambique, Tel.: [phone]/311164, Fax: [phone], E-mail: m.zilhao @ dnsdee.imoz.com