HIV counselling--a luxury or necessity?

WHO and UNAIDS have consistently promoted HIV counselling as a routine part of HIV testing in developing countries. Nevertheless, in many countries counselling is not considered a crucial accompaniment of testing services, and patients are tested without access to counselling during and after testing. Thus, information on the need for and results of counselling is needed to convince policy-makers and service managers to give greater priority to the development of counselling services. This qualitative study describes informational, social and emotional needs and problems of newly diagnosed seropositive patients attending public health services in Zimbabwe. Their basic factual information on HIV/AIDS was reasonable, but many patients equalled HIV to AIDS and conceptualized their infection as 'social and physical death'. This seriously impeded their capacity to use knowledge of their test results in a constructive way, and stimulated coping by denial and/or secrecy about their HIV status. These avoidant coping strategies discouraged clients from using condoms, seeking social support and taking measures to protect their vulnerable health. The complex and changing nature of clients' needs indicates that common short-cuts in counselling (e.g. giving brief information before and after the HIV test) are seriously flawed as a strategy to prepare clients for effective coping. Comprehensive pre- and post-test counselling are an essential preparation for coping effectively during and immediately after testing. Availability of supportive counselling beyond this first phase is essential to assist clients with needs and problems which will appear over time. Development of counselling interventions should be guided by research into their effectiveness and by national policy guidelines. Replacing fear-inducing HIV campaigns with interactive, constructive information about HIV prevention and care will increase the preparedness of the community as a whole for effective living with HIV.

Child sexual abuse in Matabeleland, Zimbabwe.

The extent, nature, causes and consequences of child sexual abuse in Matabeleland. Zimbabwe, are explored by an intersectoral working group consisting of health, legal and AIDS prevention workers who were struck in the course of their work by the regularity with which they saw sexually abused children infected with HIV and STDs. Methods used in this study are record review, focus group discussions, structured and in-depth interviews. Child sexual abuse cases form between 40-60% of the rape cases brought to the attention of hospitals, police and court and many more are believed to remain unreported. Half of the sexual abuse in children is detected through STDs and some have HIV. The majority of offenders are mature men known to the child. Factors influencing child sexual abuse are male dominance in society, men's professed inability to control sexual desire, and magic beliefs. Victims are traumatized by the abuse itself as well as by subsequent problems in family, health and in court. Since child sexual abuse may endanger the life and well-being of the child, it is a serious problem that requires urgent action.

Coping with HIV lives of HIV-positive people in Bulawayo; Zimbabwe

After one year follow-up of 72 recently diagnosed symptomatic HIV positive patients; an inventory was made of qualitative and quantitative results found up to date. RESULTS: - At present a more or less stable contact has been made with 72 clients; recruited between May 1991 and May 1992. - The most common reasons for refusal and not keeping contact were: denial of being HIV positive of the patient and/or the partner; fear of being detected by others as HIV positive; and practical problems in keeping contact; for example after having moved to distant rural areas. Informing the sexual partner and other relevant family or community members is an important step in coping with HIV. However; 17/39 patients with a steady partner did not inform their sexual partner. Among the patients who dropped out of the research; patients who did not want to inform anyone of their HIV status predominated. - Research clients had a high level of HIV-related problems and needs such as: need for more information; material needs; need for appropriate health care; need for conflict intervention and securing social support; need for help in legal and work-related issues; and need for emotional support. Many patients; however; felt that looking for help to secure these needs meant risking stigmatisation and rejection. Patients tended to hide their problems; or to look for help without revealing their HIV status even to medical sources and close family members. As a result some sources of help available to people with HIV were actually underutilised