Prevention and ART counselling

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Prevention and ART counselling

• Opportunities and challenges in high HIV
  prevalence-resource-poor settings
• Anita Hardon

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(No Transcript)
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WHO treatment guidelines 2003

• Engage family and community in adherence
  education
• Minimize stigma though psychosocial support
• But
• No mention of need to prevent re-infection
• No attention for prevention technologies

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UNAIDS Policy 2005

• Exploit synergy prevention and treatment
• By training health sector personnel and community
  care providers
• Offering HIV preventive counselling in treatment
  settings
• Ensuring availability of HIV prevention
  commodities and services in all health care
  settings

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Preventive effects of ART

• Increased uptake of testing?
• Lower viral loads?
• Increased disclosure?
• Less stigma?
• More hope motivation to prevention?

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Counselling in ART programs current practice

• pre-treatment
• focus on need to adhere
• Often treatment buddy required
• monthly follow-up
• Conducted by nurses
• Often discriminates against specific groups like
  drug users and alchololics.

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Opportunities Preventive counselling

• Prevent resistance thru adherence
• Promote use of range of preventive technologies
• Promote positive prevention
• Encourage disclosure, reduce stigma
• Enhance uptake of testing
• Prevention of parent to child transmission
• Prevention and treatment of STDS

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Constraints

• Variations in uptake of ART
• ART supply plus adherence come first
• Lacking supply of preventive technologies
• Lack of counsellors
• Lack of approriate training
• ART guidelines do not mention prevention!
• ART programs target oriented
• Negative attitudes of HWs and communities towards
  sexuality and fertility of PLWA.
• High cost of HIV and viral load tests

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Integration Prevention in ART Appropriate?

• lower quality of adherence counselling?
• Lower acceptability of ART counselling?
• Staff overloaded?
• Requires more training?
• Human resource costs?

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Recommendations ART counselling

• Needs to be supportive and empowering
• Should be dynamic consistent with changing
  clients lives aimed at changing habitus
• Messages should be evidence based
• Include new technologies (f.e.sperm washing)
• Fits clients everyday lives, respects privacy
• Linked to community-based prevention advocacy and
  treatment literacy.
• Sensitive to diversity in target population
• Engage a range of counsellors, support them