Abstract

This article reports how a prenatal clinic in a major urban teaching hospital has developed and integrated an HIV education and counseling program into routine prenatal care. The patient population served are predominantly minority women living in an inner-city community that has been disproportionately affected by the AIDS epidemic. Implementation of the patient program has required training and support for all professional staff. Staff training served as a foundation for this comprehensive patient program, which has reached all prenatal patients regardless of risk behavior. The program has succeeded in involving a large population of women in an educational program, has identified HIV-1 seropositive pregnant women through voluntary testing, and has provided them with the necessary medical and social work services. Principles of program development are identified for use in other settings.

PIP:

The process of incorporating HIV education and counseling into the Mount Sinai Medical Center's prenatal clinic in New York City is provided in terms of background, the patient program, evaluation, and conclusions. There have been endorsements for inclusion of HIV testing and education in the practice of prenatal care and reported effectiveness in delaying the onset of AID's associated infections. The prenatal clinic provides health care to predominantly minority women (36% African American and 55% Hispanic) of whom 10-12% report intravenous or nonintravenous drug use; clinic births are about 1600 a year. Early attempts in 1986-7 to provide anonymous testing and counseling demonstrated the need to reach a large audience. Observations were that considerable staff training and support was needed for an effective patient program. Encouragement and support was also needed by patients. 8 one hour training sessions were provided to the nurses, as well as a 21 hour state certification program for the social workers, both groups of whom worked directly with patients. Intense reactions to caring for HIV infected persons occurs and emotional support must be included in the training. Additional staff support was provided through an AIDs prevention grant for a year. Continuous staff training is required. Another grant provided a clinical social worker and program coordinator who worked closely with the clinic director. The target was to integrate the HIV/AIDs information into routine clinic services; specifically, a 45 minute orientation session during patient's first medical visit. The groups discussion session is lead by the nurse's introduction to the clinic, patient care, and screening, and followed by the social worker's comments on voluntary HIV screening. Nonambiguous language which is understood by various educational levels was used. Patients needed more time to discuss the concerns for dealing with their partners about STD's and contraception. Testing was available throughout the prenatal clinic period. Posttest counseling is also provided as a review, and for those seropositive or high risk patients as initial crisis intervention and case management. There was nonjudgemental discussion about termination of pregnancy. 1453 patients out of 1600 were involved in the orientation, with 20% (297) rather than the preceding years 40 screened. Success is attributed to strong collaborative working relationships with medical, nursing, social work, and clerical staffs, and extensive prior education. Those identified as seropositive were followed up in a separate clinic.