HIV/AIDS Counseling

Kurniawan Rachmadi SKM, MSi

Born in Jakarta on March 3, 1970. Kurniawan Rachmadi completed his study at the School of Public Health at University of Indonesia in 1994, and finished Magister Degree Strategic Studies National Resilience Program at University of Indonesia in 2008. Working at Pokdisus AIDS since December 1994, he joined many kinds of training on HIV/AIDS related issues in Indonesia and Australia. He gained worthy know- how on HIV/AIDS care and support programs at India, Thailand, Malaysia, Vietnam, Chile and Philippine. As the HIV/AIDS cases continue to rise in the country, he is one of the pioneers of initiative on providing ARV in Indonesia. Currently, he is Candidate Doctor on Health Politics at Gajah Mada University

Sumber: Laporan Rutin Depkes RI, 2007

Jumlah Kumulatif Kasus HIV dan AIDS di Indonesia

2000 20041987 2007

Log. FrameHealth Educator/Promotion

hotline

Pre Test Counseling

Test

Post Test Counseling

negative positive

Doctor, Nurse (hospital)

Buddies

Family

Holistic Treatment:•ARV Treatment •Viral Load •CD4-CD8•Supportive

Masa

3 bln

Quality of life PLWHA

Community support

Late of diagnosisCD4 <10 mm/mm3 will dieSurveillance in Indonesia? Estimation? Reported?

PREVENTIONPREVENTION VCT & PICTVCT & PICT CSTCST

KEY/GATE/ Bridge KEY/GATE/ Bridge

Initiative coming from clientVoluntaryConsent, Counseling, ConfidentialTake time Low coverage Access to treatment is very low

Initiative coming from providerEarly diagnosisInformation, Consent, Confidential, Post test Counseling Larger coveragePreventable deathIncreasing access to treatment and for all

“The process of helping a person (the client) to solve the problem with a counselor with the aim to empower clients to be able to face and take the best decisions for their own problems (client center)”

VCT/PICT only?Family CounselingARV Counseling PMTCT Counseling

1990, First Counselor Training 1994, WHO program on free VCT Before ARV program from our government only small number Only test for surveillance program2004, number of VCT site increaseNumber of people who want to get test are increase

Total participants VCT = 158 persons free = 80 persons male = 29 Female = 51Pay = 78 persons male = 41 Female = 37

Children = 300.

Blood bank : 1 time screening Survey test : 2 times screeningDiagnostic Test (prevalence <30 %) : 3 times screening

Primary/ community health careTBC Clinic Methadone ClinicMaternal clinic

Number of counselor : 5Information needed from our client: behavior risk assessment, HIV infection, test result, Married, children, PMTCT program, ARV drugs (adherents, resistance, etc)Capacity building for counselor related with quality of service of the clinic. Comprehensive Case Conferences

50 PLWHA actively Peer group supportAdvocacy Empowering

Since 1995Joint program with YPI 1999Increasing number (2008 around 60)Now we have 2 program (government & private)

VCT pay by themselves Free ARV CD4 pay by themselves Surgery pay by themselves Free formula milk (SGM)HIV test for children: VL pay by themselves (after 4 and 16 weeks)Free ARV drugs for children

VCT in private clinic (doctor / midwife) VCT in maternal hospitalsVCT in community (traditional midwife?)

Government and Donor Agency suppportneeded to build and developed laboratory (including HIV and CD4)Referall system for follow up VCT (especially VCT PMTCT) Comprehensive facilities can support access for all