Lessons learnt from ongoing counseling during follow-up visits by men and women attending a VCTC

Abstract

Abstract. Documenting behavior change through ongoing counseling is critical when HIV counseling strategies are being formulated. This study aims to demonstrate risk reduction behavior in a year in the context of HIV related problems in men and women attending ongoing counseling at a Voluntary Counseling and Testing Centre  during their regular follow-ups. This is a descriptive study based on one year observation of  253 HIV infected men (112) and women (141) attending a Voluntary Counseling and Testing Centre for ongoing counseling  of a  research institute in Pune during six-monthly follow-up visits. A face to face interview using a 22 item semi-structured questionnaire administered after an informed consent to collect data on sexual history since last visit, condom use, HIV related problems etc. SPSS and Pearson’s chi-square test Association was used. The HIV infected ever married men (91%) and women (98% married including widows) have significant differences with respect to age, marital status, occupation (p < 0.01), and similarity in education. There is an increase in condom usage with spouse with advancing follow-up i.e. increasing dose effect through ongoing counseling is observed, it being statistically significant for men (P value < 0.004). Consistent condom use with other partners is reported by men and widows. The participants reported problems  ranging from health, economic, social, support issues like stigma and  concerns of future. Economic problems are reported in those having frequent follow-ups, being more in men than women (34%, 29% resp.).An ongoing counseling of follow-up participants is a useful opportunity to reinforce behavior change, demonstrated by safer behaviors, especially reduction in partners, consistent condom use with spouse and other partners. The problems faced by HIV infected require support of Non- governmental organizations to address their problems like alternative source of incomes, health care, children’s education, and women’s right to property etc. Networking of Non- governmental organizations for support, capacity strengthening including gender sensitivity should go hand in hand with ongoing counseling to bring sustained behavior change when other interventions are planned for HIV infected persons.

Key words:  Behavior change, consistent condom use, dosage effect of counseling, HIV infected widows, human rights, Stigma

Keywords

• Behavior change, consistent condom use, dosage effect of counseling, HIV infected widows, human rights, Stigma

Kaynakça

1. 1. UNAIDS (2007, 6th July.) Press release: 2.5 million people in India living with HIV, according to new estimate. //www.avert.org/aidsindia.htm access on 17th September 2009.
2. 2. UNAIDS (2008) India: Country Situation, http://www.avert.org/aidsindia.htm access on 17th September 2009.
3. 3. HIV/AIDS Statistics; India http://www.avert.org/aidsindia.htm access on 17th September 2009.
4. 4. NACO (2008), UNGASS country progress report 2008:Indiahttp://www.avert.org/aidsindia.htmaccess on 17th September 2009.
5. 5. Matovu JK, Gray RH, Makumbi F, et al. Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS 2005; 19: 503-511.
6. 6. Drainoni ML, Dekker D, Lee-Hood E, Boehmer U, Relf M. HIV medical care provider practices for reducing high-risk sexual behavior: results of a qualitative study. AIDS Patient Care STDS 2009; 23: 347-356.
7. 7. Turner AN, Miller WC, Padian NS, et al. Unprotected sex following HIV testing among women in Uganda and Zimbabwe: short- and longterm comparisons with pre-test behaviour. Int J Epidemiol 2009; 38: 997-1007.
8. 8. Mola OD, Mercer MA, Asghar RJ, et al. Condom use after voluntary counselling and testing in central Mozambique. Trop Med Int Health 2006; 11: 176- 181.

9. 9. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bull World Health Organ 2004; 82: 454- 461.
10. 10. Arthur G, Nduba V, Forsythe S, et al. Behaviour change in clients of health centre-based voluntary HIV counselling and testing services in Kenya. Sex Transm Infect 2007; 83: 541-546.
11. 11. Lifshay J, Nakayiwa S, King R, et al. Partners at risk: motivations, strategies, and challenges to HIV transmission risk reduction among HIV-infected men and women in Uganda. AIDS Care 2009; 21: 715- 724.
12. 12. Sherr L, Lopman B, Kakowa M, et al. Voluntary counselling and testing: uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort. AIDS 2007; 21: 851-860.
13. 13. Gregson S, Garnett GP, Nyamukapa CA, et al. HIV decline associated with behavior change in eastern Zimbabwe. Science 2006; 311: 664-666.
14. 14. MacPhail CL, Pettifor A, Coates T, Rees H. "You must do the test to know your status": attitudes to HIV voluntary counseling and testing for adolescents among South African youth and parents. Health Educ Behav 2008; 35: 87-104.
15. 15. Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997. Am J Public Health 1999; 89: 1397-1405.
16. 16. Cremin I, Nyamukapa C, Sherr L, et al. Patterns of self-reported behaviour change associated with receiving voluntary counselling and testing in a longitudinal study from Manicaland, Zimbabwe. AIDS Behav 2010; 14: 708-715.
17. 17. The Voluntary HIV-1 Counseling and Testing Efficacy Study Group. Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trial. Lancet 2000; 356: 103-112.
18. 18. Skinner D, Mfecane S. Stigma, discrimination and the implications for people living with HIV/AIDS in South Africa. SAHARA J 2004; 1: 157-164.
19. 19. Simbayi LC, Kalichman SC, Strebel A, et al. Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa. Sex Transm Infect 2007; 83: 29-34.
20. 20. Mawar N, Joshi PL, Sahay S, Bagul RD, Paranjape RS. Concerns and experiences of women participating in a short-term AZT intervention feasibility study for prevention of HIV transmission from mother-to-child. Cult Health Sex 2007; 9: 199- 207.
21. 21. Clark LR, Brasseux C, Richmond D, Getson P, D'Angelo LJ. Effect of HIV counseling and testing on sexually transmitted diseases and condom use in an urban adolescent population. Arch Pediatr Adolesc Med 1998; 152: 269-273.
22. 22. Voluntary HIV Counselling and Testing Manual. WHO 2004.
23. 23. HIV Counselling Training Modules for VCT, PPTC and ART Counselors’, NACO, Ministry of Health and family welfare, Government of India 2006.
24. 24. Patel SN, Golin CE, Marks G, et al. Delivery of an HIV prevention counseling program in an infectious diseases clinic: implementation process and lessons learned. AIDS Patient Care STDS 2009; 23: 433- 441.
25. 25. Kawichai S, Beyrer C, Khamboonruang C, et al. HIV incidence and risk behaviours after voluntary HIV counselling and testing (VCT) among adults aged 19- 35 years living in peri-urban communities around Chiang Mai city in northern Thailand, 1999. AIDS Care 2004; 16: 21-35.
26. 26. Zukoski AP, Thorburn S. Experiences of stigma and discrimination among adults living with HIV in a low HIV-prevalence context: a qualitative analysis. AIDS Patient Care STDS 2009; 23: 267-276.