University of Zambia Medical Library

Women and Living with HIV/AIDS (AIDS in Zambia Bibliography #159-60)

(#159) "Policy Implications of Reproductive Health Research Findings in East, Central and Southern Africa"
Likwa R., Mutale, C., Okong, P., Mirembe, F., Ndovi, E. et al., (1993) Commonwealth Regional Secretariat for East, Central and Southern Africa (ECSA), Arusha.
Geographical area: Regional; Keywords: Tuberculosis, malaria, mortality, policy; Location: Ministry of Health

A multi-centre case-control study to determine the risk factors associated with maternal mortality in Zambia, Lesotho, Malawi and Uganda was conducted during the periods of 1991 to 1993. The questionnaires were used to collect data at each selected hospital for each country to cover rural and urban health institutions. The objectives of the study were

• aimed at determining the association between demographic factors, socio-economic factors and maternal mortality;
• determining the association between health service factors and environment factors and maternal mortality
• the association between health service factors and environmental factors and maternal mortality.

A case-control study design was therefore used where women who died as a result of complication of pregnancy and childbirth (cases) were compared with women who were admitted to the same institutions because of pregnancy and childbirth, but did not die (controls). A sample size of 288 cases, 864 controls and 859 control proxies were obtained. Out of 288 cases, 81 were abortion cases. Data were collected using standardised structured questionnaires from the hospital institutions. A summary of findings show that pregnancy above 35 years appears to be a risk factor for maternal mortality. Long distances and cost play a major role in reducing the access and utilisation of health services. A higher morbidity due to anaemia, chest infection/tuberculosis and AIDS was found among the cases than the controls. Also a high prevalence of malaria was equally noted among cases and controls (80 per cent). Contraceptive use was very low among the cases compared to the controls, and abortion as a single entity contributed highly to maternal mortality.

(#160) "Women and AIDS, Challenges and dilemmas: Looking ahead (preliminary report)"
Macwan'gi, M., Sichone, M., Kamanga, P. (1995) Paper Presented at the Dissemination Seminar on "Socio-economic Impact of HIV/AIDS in Zambia", Lusaka, May 1995
Geographical area: Ndola; Keywords: KAPB; Location: Ministry of Health

Objectives:

• To examine the role of women as care providers for people living with HIV/AIDS.
• to assess the burden borne by women as care providers.
• To explore the perceived risks of HIV infection among women in caring for AIDS patients.
• To identify actual and potential sources of social and physical support for HIV/AIDS affected people and care providers.
• To explore the problems and challenges faced by women as people affected by HIV/AIDS and as care providers.

Method:
A descriptive, qualitative and quantitative study with collected data through a cross-sectional survey, focus group discussions (FGDs) and case studies. The survey was conducted through the administration of an interview schedule designed to collect: socio-demographic characteristics of the respondent; knowledge on HIV and attitudes; the (work) burden imposed on women in the course of caring for the sick; and the socio-economic consequences of HIV/AIDS on women. Focus Group Discussions were conducted in Ndola and the groups were stratified according to the age and socio-economic status. The FGDs were conducted for men in Ndeke and Chipulukusu. Case studies: in-depth interviews with a pre-determined number of respondents in order to obtain a more qualitative insight into the effect of AIDS on the individual and family.

Results:

• The majority of women had either primary (51 per cent) or secondary (38 per cent) education and only 10 per cent were in formal employment. There was a high level of knowledge on HIV/AIDS. More than half the women perceived themselves to be at risk of contracting HIV on account of an unfaithful partner and married women felt particularly more at risk than single women.
• The type of support rendered by men and women is perceived to be different with care women playing a greater role than men (89 per cent in women compared to 11 per cent in men) in providing physical and emotional care indicating that the brunt of caring for AIDS patients falls on women. Men are perceived to be contributing to the care of the patients through providing money and labour.
• Nearly one third of the women know someone who has AIDS and 13 per cent of them cared for an AIDS patient at some point in their lives.
• Ranking high on the type of care provided is the supply of food for the patient (43 per cent) and hygiene (30 per cent). Most care providers identify food as the most important component of providing quality care for the patient. Medical care and emotional support were also considered to be important elements of care. One-third of the women identified the most important problem/handicap to be the lack of food for the patient.
• The lack of resources (money, food, soap) continually confront women and hamper the provision of quality care for the patient. 5. Women suffer difficulties such as reduced ability to care for the family as a whole, reduced capacity to engage in income-generating and other productive activities as a consequence of caring for the sick.
• Only half of the women have received some kind of support from Government, NGOs or from the church, with the majority saying that the help was inadequate.
• The women feel that there is need for government and NGOs to re-examine services/support targeted to HIV/AIDS patients so that they meet the needs of the affected and care givers.

Conclusion:
HIV/AIDS has and will become an increasingly important problem in general and for women in particular because of the uneven vulnerabilities and impact it has on women compared to men.

Counselling and Living with HIV/AIDS (AIDS in Zambia Bibliography #161-73)

(#161) "Psychological Counselling of Patients Infected with Human Immunodeficiency Virus (HIV) in Lusaka, Zambia"
Peltzer, K., (1989) Unpublished
Geographical area: Lusaka; Keywords: Counselling, testing, traditional healers, churches; Location: UNZA-Institute of African Studies

The aim of the study was to enable HIV - infected persons to avoid behaviour that might damage their health, to minimise further transmission of HIV, and to prolong the period of asymptomatic HIV infection of life expectancy. The study was conducted from February to August 1987. Patients were eligible to participate if they had a positive serological test of HIV infection, confirmed by Western blot analysis and were outpatients attending the dermato-venereology clinic at the University Teaching Hospital. To make a psychosocial assessment, the researchers used the 'Inventory of Current Concerns' and psycho-social support was measured using the questionnaire called the People Around You'.

Both instruments were significantly modified to fit an African cultural context. Separate interviews were held with 25 traditional healers, community leaders and members of two healing churches' in Lusaka about their interaction with AIDS patients, to develop the information needed to modify these instruments. Of the 130 patients, 50 were female and 80 male; 68 were single and four were divorced or separated. Most couples had children (on average 3.8) and many had at least one child which is also infected with HIV. Of the 44 wives of HIV seropositive men 3 per cent were suffering from a mental disorder probably unrelated to HIV infection.

Psychiatric clinical officers are now being trained and assigned to take over the task of providing counselling services for HIV-infected people in health centres through Zambia. The emergency of AIDS in Africa has created an enormous demand for psychosocial counselling of persons infected with HIV. Although there is growing Western literature on the psychosocial symptoms, reactions and counselling of patients with asymptomatic HIV infection and AIDS, little has appeared from Africa, where a different, culturally sensitive and practical approach is required.

(#162) "Approaches to HIV counselling in a Zambian rural community"
Chaava, T. (l990) AIDS Care; Vol.2(1)1990; pp 81-7
Geographical area: Chikankata, Southern Province; Keywords: HIV counselling; Location: UNZA Medical Library

The counselling experience at Chikankata Hospital for the first year of the AIDS care and prevention programme is described. Members of the counselling team are selected according to specific criteria. The findings indicate that counselling is conducted in an integrated AIDS management context, at the individual, family, and community levels. Counselling emphases differ according to the clinical expression of the disease. Counselling is integral to comprehensive AIDS management which is inclusive of the disciplines of clinical care, education, counselling, pastoral care and administration.

(#163) "Response to counselling on HIV/AIDS by attendees of a general medical outpatients clinic in Zambia"
Mwinga, A., Elliot, A., Halwiindi, B., Luo, N., Pobee, J., et al. (1992), Paper presented to the VIIIth International Conference on AIDS, Amsterdam, 1992.
Geographical area: Lusaka; Keywords: Counselling, condoms; Location: Kara Counselling

Objectives:
To assess knowledge of HIV/AIDS and willingness to be screened among attendees of a general medical clinic.

Methods:
Patients attending the clinic were interviewed during recruitment for a pilot study for the prevention of HIV-related tuberculosis at the University Teaching Hospital. Questions were asked to determine the extent of knowledge, source of information and willingness to be tested for HIV infection.

Results:
A total of 154 patients were interviewed, 44 females (29 per cent) and 110 males (71 per cent). One hundred and fifty one (98 per cent) of the patients had heard of HIV/AIDS, 91 (60 per cent) of whom had obtained this information from the media. Modes of transmission were widely known, with 128 (83 per cent) considering it to be a sexually transmitted disease. One hundred and twenty six (82 per cent) thought it was sticking to one partner. Only 74 (48 per cent) thought condoms were effective. Females were significantly less likely to state that condoms were effective for prevention (13 [30 per cent] vs 66 [60 per cent], p < 0.05). One hundred and fifteen (75 per cent) of the patients were willing to be tested. Of the 38 not willing to be screened, 24 (62 per cent) felt they could not cope with the knowledge of their HIV status, 6 (17 per cent) felt it was futile, and 8 (21 per cent) thought they were negative.

Conclusion:
There is a high degree of knowledge of HIV/AIDS and modes of transmission and prevention among patients attending the outpatients clinic. Further studies are planned to determine the reasons for different attitudes to prevention between men and women

(#164) "Establishing and evaluating HIV counselling and testing (c&t) service in Lusaka"
Kelly, M., (1993) Paper presented at the IIIrd Southern Africa Network of AIDS Service Organisations, Windhoek, 1993.
Geographical area: Lusaka; Keywords: Counselling, testing, behavioural change, condoms; Location: Kara Counselling

Introduction:
The Kara-Zambart Project set up the first HIV counselling and testing (c&t) service in Zambia in November 1992. Kara Counselling and Training Trust (KCCT) had been carrying out HIV counselling since 1989. They established a need to offer confidential voluntary HIV testing. Previously people who had wanted to know their HIV status had to go to the blood bank to donate blood. Others had to test at private clinics which were often costly and not always accurate.

Methods:
Clients requesting HIV c&t attend for pre-test counselling with one of the counsellors. A pre-test semi-structured interview is carried out. Quantitative demographic and behavioural and qualitative knowledge, attitude and practice information is collected. Blood is taken for HIV testing by a clinic nurse. Blood is tested at the University Teaching Hospital (UTH). Two ELISA tests are used with confirmation by a Western Blot. The results are then given to the client by their counsellor and the post-test structured questionnaire filled in.

Results:

• Demographic Data: Data from the pilot study have not been used. The data presented represent 228 consecutive clients attending for HIV c&t. Clients who have previously tested positive and attend for a retest are not included in this analysis. There are more men than women attending for HIV c&t: Men = 72 per cent, Women =28 per cent. There is a wide age distribution of clients from 16-55 attending, with the most frequent attenders in the 26-30 age group. 50 per cent of the clients are single, 35 per cent married, and 7 per cent divorced. Although the clients come from a wide educational background 50 per cent have completed their school education. 45 per cent describe themselves as regular church attenders. Only 7 per cent say that they are non- believers. The clients come from a wide range of religious backgrounds, mostly Christian. Sexual Behaviour: There is a wide range of responses. As with most other studies of sexual behaviour male clients are reporting more partners than females. 50 per cent of the clients had never used a condom. When asked about condom usage with non-steady partner(s) only 8.5 per cent of the clients always use them. 48 per cent of the men and 7 per cent of the women had paid money for sex at some time in their life.
• Test Results: Overall HIV 40.3 per cent positive and 59.7 per cent negative. Men 35 per cent positive, women 52 per cent positive. Post behavioural changes (at Post Test): 1) Future child bearing. 93 per cent of those with positive results do not want further children compared with 27 per cent of those with negative results. This is very similar to what they had expressed at pre-test. 2) Sexual practices. People with positive results favour abstinence (35 per cent of 8 per cent HIV- negative clients). Whereas 73 per cent of HIV negative individuals (cf 41 per cent HIV-positive clients) propose to stick to one partner.

Conclusions:
The people attending for voluntary HIV c&t come from a wide range of backgrounds. However, more single men and more educated people seem to be reached. This has implications when considering expansion of the service. The fact that we are attracting more educated people leads to trying out peer education. We have established a Post Test Club for any clients whatever their HIV status. One of its main aims is to recruit and train appropriate educators.
One of the aims of HIV c&t is to enable people to make informed decisions about their sexual behaviour. Those who are HIV-negative to stay HIV-negative and those who are HIV-positive to reduce the risk of infecting their partners. Although our initial results are encouraging, the service has only been running since November 1992. Long term follow up is as yet extremely limited.

(#165) "A situational analysis of young people with HIV/AIDS in Lusaka, Zambia"
Macwan'gi, M., (1993) Paper presented at the Regional Networking of Young People with AIDS in Zambia, 1993.
Geographical area: NA; Keywords: KAPB, education, adolescents, condoms, PWA, behavioural change; Location: Kara Counselling

Objectives:

• To determine knowledge and attitudes towards HIV/AIDS.
• To assess socio-cultural and behavioural factors that facilitate the transmission of HIV infection among young people.
• To determine the needs and expectations of the youths that could be served by the establishment of a network of People With AIDS (PWAs).
• To determine whether youths are receptive to the idea of establishing a regional network of young people living with HIV infection.
• To conscietise the youth who participated in the study and prepare them for the proposed regional networking workshop for HIV-positive youths.
• To make specific recommendations for implementing a network of young people with HIV/AIDS.

Methods:
Qualitative data were collected using focus group discussions (FGDs). A comprehensive FGD guide was developed, based on current knowledge of the subject and experiences from Zambia. Data from FGDs were supplemented by an in-depth discussion with one mother who recently had an adult child die of AIDS. The study elicited information pertaining to various aspects of HIV/AIDS: general health problems, STD/HIV/AIDS knowledge and attitudes, sexual and reproductive behaviour, condom use, youths needs and expectations. A convenience sample of 182 youths (15 of whom were HIV-positive) aged between 15-30 years were systematically selected to participate in the study using pre-determined criteria. Although the proposed network is for HIV-positive youths, information was also collected from youths whose HIV status is not yet known. Youths who are sexually active also participated in the study because it is important to reach young people before they develop behaviours that will expose them to the risk of HIV infection. Parents of HIV/AIDS youths and health providers at community level also participated in the study. The role of parents or family members is central in HIV/AIDS prevention and care programmes.

Results:

• General health problems: The following health problems were identified: cholera, dysentery, malnutrition, STDs (AIDS, syphilis, gonorrhoea), TB, malaria and skin infections. Crime was also identified among health problems. The major causes and solutions of these diseases are also discussed.
• Specific health problems: These are discussed together with the causes, prevention and cure.
• Condom knowledge and use: Most youths in the study had heard about condoms but 25 per cent had never seen one. A few female youths reported that they had accidentally found condoms in their boyfriends' pockets. Two purposes of using condoms were clearly stated as prevention of unwanted pregnancies and STDs. Other issues on condoms are further discussed.
• Sexual behaviour: The practice of multiple sexual partners was reported to be very prevalent among both unmarried and married people. Others areas of sexual behaviour are reported.
• Networking and HIV/AIDS: Youths in the study revealed that there was a general consensus among youths that HIV-positive youths should be in touch with each other. The establishing of a network was well supported. The function of the proposed network are contained in the report.

Conclusions:

• Knowledge about HIV/AIDS is very high among youths although it is not accompanied by behavioural changes.
• Condom use among youths is also very low.
• There are a number of misconceptions and stereotypes about the causes, prevention and treatment of AIDS.
• Communication about sexuality and HIV/AIDS in general and between family members is lacking due to various socio-cultural factors.
• There is a need for networking among PWA in Zambia.

(#166) "The role of People Living with AIDS (PLWAs) "
Chiboola, H., Zulu, W., Kelly, M., (1994) Paper presented to the Xth International Conference on AIDS, Yokohama, 1994.
Geographical area: Lusaka; Keywords: PWA, counselling; Location: Kara Counselling

Objectives:
To review the role and activities of Positive and Living Squad (PALS) group of persons living with AIDS at Kara Counselling and Training trust between August 1991 and August 1992.

Methods: Interpersonal discussion and review of activity and progress reports.

Results:

• Involvement and participation of PLWAs in AIDS activities is necessary: It gives a human face to the mystic nature of HIV/AIDS.
• Over 100 organisations and 15000 persons have been reached through focussed and systematically sustainable community education interventions by PLWAs.
• . PLWAs play a leading role in the process of destigmatisation of AIDS at community level.

Conclusions:
The subjects' efforts are not only remarkable but challenging too. This shows that there is a need for more persons with HIV/AIDS to come out in the open and take a leading role in activities for AIDS prevention. The cardinal question though is how to facilitate this process of change.

(#167) "Skills training for people with HIV: Does it help people to cope?"
Zulu, W., Baggaley, R., Muluti, J., Macmillan, M., Kelly, M. et al. (1994) Paper presented to the Xth International Conference on AIDS, Yokohama, 1994.
Geographical area: Lusaka; Keywords: Counselling, PWA; Location: Kara Counselling

Background:
A skills training scheme for people with HIV was set up in 1992. The scheme offers training in various artistic skills as well as group and individual counselling and HIV education.

Objectives:

• To establish why people joined the scheme.
• To determine whether the training was relevant to their needs.
• To ascertain their future plans.
• To find out whether the project had helped them to cope with their positive status. Method: All the trainees on the scheme in November 1993 were interview by a researcher trained in qualitative techniques. The interviews were conducted in vernacular languages and lasted between 30-120 minutes.

Results:
All 32 participants agreed to be interviewed (19 female and 13 male). The men had joined because of unemployment, some having lost their jobs because of ill health or problems related to HIV. Many of the women joined because of death or ill health of their spouses and consequently a need for an income. All the participants enjoyed working on the training scheme. The majority of the participants wished to use the skills they had learnt to start small businesses but stated that it would be important to have loans and business advice. Although the scheme is for people with HIV, 40 per cent of the group had difficulties acknowledging their status at the onset of the course but by the end they were all able to talk about their HIV status outside the group and said how important it was to meet in a place where you were accepted and where HIV was not treated as a stigma. Although most of the men had been able to talk to someone about being HIV-positive, only two had been able to share this with their regular sexual partner. 11 of the women had told their partners (5 women were widowed and had no current sexual partner). 3 women and no men felt able to "go public" and help others by becoming peer educators.

Conclusions:

• Although the participants were enthusiastic about the training, they felt it would be wasted unless linked with a loan scheme enabling them to start up businesses.
• HIV remains a very stigmatised condition in Zambia and although many of the participants had been able to acknowledge their status following the course, many had no one they could turn to for support and expressed a need for continuing contact with a counsellor from the centre.

(#168) "Voluntary HIV counselling and testing (c&t) in Lusaka, Zambia: Who comes, why, and does it help?"
Kelly, M., Baggaley, R., Phiri, M., Bennett, J., Chanda, C., (1994) Paper presented at the Xth International Conference on AIDS, Yokohama, 1994.
Geographical area: Lusaka; Keywords: Testing, counselling, condoms; Location: Kara Counselling

Objectives:

• To establish why people wanted HIV C&T and why they felt at risk.
• To explore people's understanding of HIV and issues of HIV testing.
• To assess whether HIV c&t had helped people to make changes in their sexual behaviour. Methods: 500 consecutive people attending for voluntary confidential HIV c&t were interviewed by trained counsellors. The interviews were non-directive semi-structured lasting between 30-60 minutes. The interviews were carried out in the vernacular language or English as appropriate. The counsellors recorded their clients' comments verbatim and made additional notes at the end of the interview where necessary. Further interviews were carried out at the time of post test counselling and at 3-6 months follow up.

Results:
70 per cent of those attending were men. The most common reason for wanting to be tested was "to be able to make plans for the future" (23 per cent), these including specific plans for marriage (10 per cent), planning a pregnancy (1 per cent), plans for overseas study (3 per cent) or entering holy orders (<1 per cent). Current illnesses or worries about health, particularly amongst the men, was also a common trigger factor for wanting to be tested. Men wanted to be tested because of their previous sexual behaviour "moving around with women", whereas women frequently stated the illness or death of their husband as a reason for wanting a test. Knowledge about HIV was generally good with good understanding of the meaning of a positive and a negative test although there was much confusion over the window period. Many people felt that they knew what the results would be and in 69 per cent their prediction was correct (p<0.001). Few people regretted being tested and many who were seropositive said that it would help them cope with their health problems. However, less than 50 per cent felt able to share their result with their sexual partner. Most people stated that they intended to reduce the number of partners and use condoms but only 33 per cent of those with positive results and 26 per cent with negative results bought them at the time of post test follow up. 50 per cent returned for follow up counselling at 3-6 months. 50 per cent of the people were using condoms with their partner/s all or most of the time and 30 per cent of those with positive results and 3 per cent of those with negative results abstained from sex.

Conclusions:

• Some people had specific reasons for wanting to have an HIV test, men worried about their past sexual behaviour and women about their partner's behaviour.
• HIV knowledge in this selected group was generally good. People felt that they would be able to cope with a positive result. At follow up few regretted having had the test, even when found to be positive.
• Various sexual strategies were adopted and these varied depending on the result.

(#169) "Institutional and individual attitudes to the provision of counselling: results of a survey "
Haworth, A., Hamavhwa, C., Nyirenda, J., Kwapa, P., Chita, P., et al., (1994) Paper presented at the 4th National AIDS Conference, Lusaka 1994.
Geographical area: National; Keywords: Counselling, workplace; Location: Kara Counselling

Objectives:
To study the influence of attitudes at institutional and individual level to the establishment of counselling services.

Methods:
Data have been derived from a postal questionnaire returned to the NAPCP Counselling Unit by 284 basic counsellors trained by the programme. In order not to prejudice responses, open ended questions were used.

Results:
Within the section on attitudes of colleagues and seniors, answers cluster into several definite themes. Only 60.2 per cent found colleagues helpful/supportive as against 70.1 per cent of seniors. Of colleagues who were not positively helpful, 19.3 per cent were hostile and exhibited negative attitudes. Of all persons in the work environment less than half (47.2 per cent) understood the nature of counselling but an almost equal number (43.8 per cent) described themselves as "puzzled", overall 15.8 per cent were dismissive. Two scales constructed from the answers to this section of the questionnaire ("positive and negative") have allowed scores to be computed and cross-tabulated against other variables. The highest percentage reporting high positive score (63.6 per cent) came from church hospitals and the lowest (10 per cent) from mine hospital counsellors. Associations were also found between these scores and the amount of time allowed for counselling and related conditions of work, as well as with the counsellors' estimates of their ability to meet clients' needs.

Conclusions:
The understanding and approval of supervisors (administrators) are essential to the establishment of a counselling programme. At its inception positive steps must be taken to introduce the service and to explain what it can do and how it operates. Follow-up inquiries have indicated that in most settings, the actual activities of the counsellors have established the value of counselling and created an increased demand.

(#170) "Does counselling help to empower women to negotiate for safer sex?"
Chanda, C., Baggaley, R., Phiri, M., Kelly, M. (1994) Paper presented at the 4th National AIDS Conference, Lusaka, 1994.
Geographical area: Lusaka; Keywords: Counselling, condoms; Location: Kara Counselling

Objectives:
To assess behaviour change and barriers to behaviour change in women receiving voluntary HIV counselling and testing (C&T).

Methods:
A cohort of 152 women attending for HIV C&T were interviewed at the time of pre-test counselling. They were asked why they wanted to have a test, what behavioural strategies they would follow if they were found to be positive or negative. They were interviewed again at the time of post test and at 3-6 months following this. They were asked at this stage what they were doing and what barriers there were to changing behaviour.

Results:
At pre-test 16 per cent of women had more than one sexual partner, but only 3 per cent wanted a test because they were worried about their own sexual behaviour. Women with negative results chose condom use (29 per cent) and abstinence until they met the "right person" (24 per cent) as preferred strategies. Women with positive results opted for monogamy (58 per cent) and condom use (32 per cent).17 per cent of women bought condoms at the time of post-test counselling. At 3-6 month follow up both women with positive and negative results expressed difficulties in insisting on condom use. Some women in non-steady relationships said they had chosen to abstain from sex because of a partner's refusal to use condoms and this had lead to the break up of the relationship. They felt they would not have sex without a condom even if this decision deprived them of an intimate relationship. Women in stable relationships also expressed difficulties in persuading partners to practice safer sex and often felt vulnerable because of their partner's lifestyle.

Conclusions:
HIV C&T raises women's awareness about HIV and safer sex practices. Some women were able to insist on condom use, however many women are often unable to negotiate safer sex with their partners both steady and non-steady because of cultural factors and financial dependence. Many women needed continuing support from their counsellor to help them cope with and find solutions to these barriers.

(#171) "HIV Counselling and testing (c&t) in the private sector in Lusaka, Zambia"
Baggaley, R., Sulwe, J., Bennett, J., Ndovi-Macmillan, M., Kelly, M., (1995) Paper submitted to the IXth Conference on AIDS in Africa, Kampala, 1995.
Geographical area: Lusaka; Keywords: Counselling, testing, private sector; Location: Kara Counselling

Objectives:
To survey all private medical clinics registered by the Zambian Medical Council in Lusaka to establish what HIV c&t services they offered. To see if there was a demand for a private HIV c&t service.

Methods:
A senior nurse or doctor from each clinic was interviewed during January and February 1995.

Results:
39 clinics were visited and all agreed to take part in the study. 18 clinics already offered HIV testing, testing on average 4 people each week. The most common reason for carrying out an HIV test was for people who needed a compulsory test as part of a medical examinations for going abroad, for further training or entering new employment. Four doctors stated that they did HIV tests but did not convey the results to the client, only to the company or embassy requesting it. Five clinics offer HIV testing routinely to antenatal patients. Three clinics said that they test patients for HIV if they suspected HIV infection on clinical grounds, either with or without their patients awareness, to help in the medical management. Three clinics had had requests for HIV testing from "people who just wanted to know their status". 17 out of the 19 clinics offering HIV testing gave HIV results based on a single ELISA or a quick test result. Only two clinics performed a confirmatory test such as a Western Blot. All the clinics were questioned on the current demand for HIV testing. Ten of the 19 clinics offering HIV c&t said that although they had had people requesting HIV c&t voluntarily as opposed to as a prerequisite for a job, this was an infrequent request with less than 1 person a month wanting an HIV test voluntarily. Only one of the clinic staff interviewed thought that voluntary HIV c&t would be a useful service to have more readily available for their patients.

Conclusion:
Although half the private medical clinics in Lusaka offer HIV testing this service is predominately for medicals and there is very little demand for voluntary HIV c&t. The doctors and nurses interviewed, as well as the patient population they serve, seem unaware of the benefits of HIV c&t especially as a preventive intervention. They all emphasise the negative aspects of c&t such as possible depression and lack of medical treatment, and none discussed the potentially important role of HIV c&t in HIV prevention by reducing transmission. It is clear that education is urgently needed for both medical practitioners and the general public to promote HIV c&t.

(#172) "Barriers to HIV counselling and testing (c&t) in Chawama, Lusaka, Zambia"
Baggaley, R., Sulwe, J., Bennett, J., Ndovi-Macmillan, M., Kelly, M. (1995) Paper submitted to the IXth International Conference on AIDS in Africa, Kampala, 1995
Geographical area: Lusaka; Keywords: Testing, counselling; Location: Kara Counselling

Background:
Although in surveys we have carried out in many different settings in Zambia, most people express a positive attitude to HIV testing, the uptake for an easily accessible voluntary c&t service has been low. To increase demand, households are now visited and couples invited to attend group counselling sessions followed by individual c&t. However, couples who accept the invitation often do not attend and among those who do, many choose not to be tested.

Objectives:
To explore reasons why couples are reluctant to have HIV tests. Method: Semi-structured, in depth, interviews were conducted with i) 25 couples prior to being asked to attend; ii) 37 consecutive couples who had agreed to come but did not attend; iii) 27 consecutive couples who attended but then declined an HIV test. Interviews were tape recorded, translated into English and then transcribed and analysed by standard qualitative techniques.

Results:
Most people in the study worried about HIV. Awareness of HIV and knowledge about its transmission were good. Reasons for not wanting to have a test included being too frightened; the lack of perceived benefits if testing positive; fears of recriminations by spouse or family and the feeling that the knowledge of a positive status would merely be one among many other problems in their lives. Conclusions: This study highlights the differences between what people say and what they actually feel able to do. In Zambia, where there is a high HIV seroprevalence and little to offer those who are seropositive, many people are apprehensive about knowing their HIV status. HIV c&t is useful in HIV prevention, especially for the majority who test negative. If the barriers to testing are to be overcome there is a need for HIV education for the general public to raise awareness of the potential benefits of c&t and to create a supportive environment for those who test positive.

(#173) "HIV counsellors' knowledge, attitudes and vulnerabilities to HIV in Lusaka Zambia, 1994"
Baggaley, R., Sulwe, J., Kelly, M., Ndovi-Macmillan, M., Godfrey-Faussett, P. (In print, 1996) AIDS Care
Geographical area: Lusaka ; Keywords: Counselling, condoms; Location: Kara Counselling

Objectives: To see how HIV affected counsellors in their personal and professional lives and how they coped.

Method: 101 people who were currently working as HIV counsellors were interviewed.

Results:
70 had a relative who had died of HIV, but few had been able to discuss HIV with them. 72 worried about their HIV status but only 24 had had a test. 53 counsellors did not want to know their status. Women counsellors worried because of the sexual behaviour of their partners and often felt unable to discuss HIV with them. Although nearly all were in favour of promoting condoms as protection against HIV transmission only 27 had ever used one. Many HIV counsellors found it difficult to discuss sexual behaviour with their clients.

Conclusions:
HIV counsellors in Zambia worry about HIV in their personal lives and need continuing confidential support to help them cope with their own worries as well as the anxieties created by the job itself. They need more help and training in discussing issues around sexual behaviour with their clients. Women counsellors, in particular, need support in dealing with their personal sexual life.

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