[ThPeF8059] Voluntary counseling
and testing programs in an agricultural community in Rift Valley Province,
Kenya
L Langat1, W Langat1, A Kirui2, W
Odonde3, F Sawe4, L Elson1
1US Military HIV
Research Program / KEMRI, Kenya P.O. Box 1357 Kericho. 2The African Highlands
Produce Company Ltd. P.O. Box 140 Kericho Kenya.
3Brooke Bond Kenya Ltd.
P.O. Box 20 Kericho Kenya. 4Ministry of Health-Kericho District Hospital
P.O. Box 1851 Kericho Kenya.
Issues
•Employees of large-scale agricultural companies are at increased risk of HIV infection.
•Voluntary counseling and testing (VCT) is being promoted for its reported potential to induce
behavior change to prevent
HIV transmission.
Increased Risk of Large-Scale Agricultural
Communities
•High
density housing.
•Migrant
labor.
•Many
families remain in rural home.
•Lack
of entertainment on days-off.
•Large population with income attracts prostitution in surrounding market settlements.
•Lack of
normal traditional restraints on behavior.
Description
•Two
large agricultural companies.
•Support an adult population of 40,000 employees and their dependants.
•Community
composed of four major tribes.
•Community
living in company housing.
•Many travel frequently to their homelands elsewhere in Kenya.
•Companies have their own hospital with laboratory services and an extensive infrastructure of
outlying and mobile clinics.
VCT is being promoted with an
extensive community education campaign
within the worker villages, factories, schools, hospitals and churches using:
•Drama.
•Presentations.
•Video
shows.
•PLWA
personal testimonies.
•Songs.
•Question
& answer sessions.
•A
football team entering the local league.
•Fact
sheet distribution.
VCT has been set up in the
antenatal and outpatient clinics within
the hospitals of the two companies.
•4 WRP counselors initiated counseling in specially assigned small rooms.
•Total of 30 ANC & MCH nurses trained as counselors for 3 hospitals, (4-week training with break for supervised practice).
•Companies established a confidential system for paid leave for VCT visits and access to hospital
transport
•Nevirapine
introduced with PMTCT program
Lessons Learned
•Initially there were widespread misconceptions about HIV and its transmission, but people were very keen to learn more.
•Initial problems of confidentiality and hospital staff attitudes overcome with staff meetings
after nurses trained as
counselors
•Videos and PLWA personal testimonies drew the largest crowds.
•Successive meetings in the same places have drawn increasing numbers with increased community participation in discussion.
•Initially all clients were patients referred by doctors, giving the counseling rooms a
reputation
•Gradually VCT & PMTCT clients asked for tests after community meetings
Recommendations
•High quality, 4 week training essential to achieve highly motivated counselors for VCT and PMTCT to
succeed.
•Support services, access to drugs, help with access to VCT all help to promote use of VCT
•A proportion of donor funds is going to be needed to increase the staff numbers in developing country
hospitals to cope with the
extra work load of VCT and PMTCT.
•Dedicated,
respected coordinator necessary
Summary of
Counseling Records
for Sept 2001–June
2002
Note: 3 mothers aborted at
28 weeks, I mother died, 1 baby died, 5 have declined to take NVP and the rest are either
below 28 weeks or have been lost to follow-up.
Problems
Encountered
•Burden
of work for all concerned
•Lack of facilities/space to conduct confidential counseling
•Supply
of test kits and nevirapine
•Behavior
of hospital staff regarding confidentiality
•Fear of stigma and job loss preventing workers accessing services
•Management was hesitant to introduce VCT for fear of reducing attendance to clinics and jeopardizing worker-management relations.
