7 INTEGRATION OF HIV VOLUNTARY COUNSELING AND TESTING IN ANTENATAL CONTROL IN COMMUNITY CLINICS IN RURAL GUATEMALA M.L. Sac Ixcot 1, J.M. Ikeda 2, N. Hearst 3 1 Asociación de Investigación, Desarrollo y Educación Integral (IDEI), Monitoreo y Evaluación, Quetzaltenango, Guatemala, 2 Asociación de Investigación, Desarrollo y Educación Integral (IDEI), Dirección, Quetzaltenango, Guatemala, 3 University of California at San Francisco, United States

7 Prevention of mother to child transmission in Guatemala   Almost 80% of the antenatal control and deliveries are carried out in the distant communities and not in the national hospitals. Thus, we integrated HIV voluntary counseling and testing (VCT) among pregnant women who attended antenatal control in community clinics in rural Guatemala, through bilingual counselors.   From October to December 2007, we integrated HIV voluntary counseling and testing in three rural community clinics in Southwestern Guatemala. The pregnant women were provided with voluntary counseling and informed consent before taking 5 ml of blood and testing it with the Abott Determine rapid test.

7Objectives   Prevent HIV mother to child transmission by offering confidencial and free HIV counseling and testing as part of antenatal control in rural, community health clinics that provide maternal and child health services.   Inform pregnant women during their antenatal control about HIV prevention and treatment for mother to child transmission.   Provide counseling and testing in maternal mayan languages for HIV, Hepatitis B and Sifilis and refer HIV positive pregnant women to integrated care clinics for follow-up and antirretroviral therapy to prevent mother to child HIV transmission.

7 Lessons learned All 114 pregnant women (17 to 42 years old) who were given voluntary counseling provided informed consent for the HIV exam. Only 0.9% was HIV positive and referred to the integrated care clinic. 64% could mention at least 3 symptoms of STIs; 83% mentioned that HIV is transmitted by sexual relations, however only 24% of the women mentioned that HIV could be transmitted by blood transfussion. 23% knew that women could transmit HIV from mother to child, and. 73% reported being at risk for HIV infection due to the fact that they have unprotected sex with their husbands. And more than one-half of the interviewed women stated that they knew o were victims of sexual violence or cohersion. The basic HIV knowledge was poor and requires follow-up:   HIV transmission forms and principally mother to child transmission that can affect the woman and the child while pregnant.   Being able to identify sexually transmitted infections symptoms and receive adequate and opportune treatment.   The importance of using a condom with their partner as a measure of HIV prevention.

7 Next steps: The community clinics are an effective space for offering voluntary counseling and testing to pregnant women in rural areas. The majority of these women did not know about mother to child transmission, thus it is necessary to raise the consciousness of rural women so that they can prevent HIV transmission 97 % wish to have more information regarding STIs and HIV/AIDS, stating that it is important to know about these infections and provide our children and others with orientation so that we can prevent these infections. Prevention strategies and detection of STIs and HIV in rural area of Guatemala should take into account the cultural characteristics of the population such as: Language, beliefs, places where pregnant women go for antenatal care so that the intervention is effective.