Presentation Abstract

Barriers to Building a Comprehensive System of HIV Counseling and Testing by Consent to Women of Reproductive Age in Chicago, Illinois. A Rahimian, M Driscoll, D Taylor, M Cohen. University of Illinois and Cook County Hospital, Chicago.

Issue: Women of reproductive age often receive health care services at Family Planning and Maternal Child Health (MCH) sites, making these ideal places for HIV education, counseling, and testing. MCH sites could also be effective in the early identification of HIV positive women and provision of ZDV to reduce perinatal HIV transmission. To best serve women and their children MCH sites should provide HIV-related services.

Project: The Women and Children HIV Program of the Primary Care Center at Cook County Hospital was funded in 1994 to work with MCH sites and Ryan White funded primary care agencies in the greater Chicago area to: 1) provide or improve HIV counseling and testing by consent during perinatal care; 2) educate and train perinatal and family planning providers, outreach workers, health educators, and case managers in HIV prevention, early identification, and care; and 3) develop linkages between perinatal care sites and Ryan White funded primary care agencies. A survey was administered to all perinatal networks, their affiliated hospitals, and community-based health centers (N=100) to document their HIV counseling and testing practices. Qualitative interviews (N=20) were conducted with key personnel in selected hospitals, local and state public health agencies, and non-profit AIDS advocacy and service providers to better understand the barriers in creating a comprehensive system.

Results: Of the 87 respondents so far analyzed, only 36 (41%) offered HIV testing as part of their perinatal care or family planning programs, some without patients' consent. Of these, only 60% offered HIV pre- or post-test counseling and most had no formal protocols. Less than half (43%) of the providers reported being aware of the 076 trial and only 9% reported implementing its findings regarding ZDV therapy. Over two-thirds of respondents reported that a lack of training was the greatest barrier to offering comprehensive HIV counseling and testing by consent as part of perinatal care. Barriers to the proposed system included physicians' attitudes toward HIV testing, denial of HIV as a major problem by suburban providers, lack of trained staff, the logistics of obtaining and recording test results, and a lack of time, money and local care for all HIV positive women especially the suburbanites.

Implications: MCH sites need considerable assistance to provide adequate, informed HIV counseling and testing to women of reproductive age, and there are significant barriers to building a system that offers comprehensive care to HIV positive women.

Contact: Afsaneh Rahimian, UIC-School of Public Health, 2121 West Taylor Street, Chicago, Il 60612 USA. Telephone: 312.996.3198, Fax: 312.996.1450.

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