AEGiS-15IAC: Challenges of and possibilities for HIV prevention in the clinical care setting in KwaZulu-Natal, South Africa.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Challenges of and possibilities for HIV prevention in the clinical care setting in KwaZulu-Natal, South Africa.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrC1409)

Kiene SM, Fisher JD, Cornman D, Friedland G, Moll A
Center for Health/ HIV Intervention and Prevention, University of Connecticut, Storrs, CT, United States

ISSUES: A significant minority of HIV+ individuals (30%) engage in sexual activities that place others at risk for HIV infection and themselves at risk for infection with other pathogens. Reducing HIV-risk behavior among HIV+ persons constitutes a highly efficient avenue of prevention. Recent data in a western population supports the effectiveness, in terms of reducing HIV sexual risk behavior, of integrating a theory-based, brief clinician-delivered intervention implemented as a component of clinical care for HIV+ persons. Implementing such interventions within clinical care in South Africa has enormous potential benefit; however, the South African setting and culture may present particular challenges.

DESCRIPTION: Focus groups were conducted with clinicians, nurses, & VCT counselors in KwaZulu-Natal, South Africa to assess the feasibility of integrating an HIV prevention program into routine clinical care for HIV+ persons.

LESSONS LEARNED: Barriers to HIV prevention among South African clinical care patients include: women's lack of sexual decision making power, denial of HIV, mistrust of condoms, and stigma. Logistical and clinician's barriers include: lack of time, migrant labor, discomfort discussing sexual matters, and a relatively small number of HIV+ persons in care due to low availability of ARVs. Nonetheless, clinicians are eager to participate in prevention.

RECOMMENDATIONS: As ARVs are becoming more widely available in South Africa, it is likely that more HIV+ persons will seek clinical care and denial of HIV may decline, representing a timely opportunity to develop HIV prevention programs as part of clinical care for HIV+ persons. Similar logistical challenges have been successfully overcome in western countries, however, future research should modify successful interventions for appropriateness in the South African culture and health care setting and then evaluate the feasibility and efficacy of clinical care-based HIV prevention in South Africa.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Infections, HIV Seropositivity, Condoms, Sexual Behavior, South Africa, Counseling, Infection, Culture, Population, Transients and Migrants, Research, Humans, Female, prevention & control

040711
ThOrC1409