1. Primary Care HIV-Net GP’s contribution 14.09.2007

2. GP’s work in Belgium. Features Individual doctors vs group-setting GP acts as a first step and refers to specialist if necessary (multidisciplinary) Preventive and curative care Highly confidential relationship Individual anonymous counseling Homevisits possible Working hours 24/24 hrs

3. GP’s work. Finances Most patients pay cash per visit and get ¾ paid back by mutuality 3th payment rule by OCMW or mutuality possible for migrants: patient pays nothing, doctor is reimbursed later Other payment systems: health centres (few), Artsen zonder grenzen, and ‘Medicine for the people’

4. GP’s and STD’s/HIV Every GP can offer and do a test for hiv/std’s Lab tests are to be paid by patient (bloodtest, urinetest); partly reimbursed by insurance (mutuality/OCMW) Follow-up and treatment can be done by GP in strict confidentiality

5. GP and HIV/STD test GP’s detect 60% of hiv cases in Belgium Screeningstest via private lab or via IMT Hiv test = STD test (blood and urine sample) Informed consent Pre- and postcounseling (VCT)

6. GP’s-HIV-Network Horizontaly (general practitioner’s Antwerp) Verticaly (patients/ sensoa/ ITM-ARC/ hospital/ university/ helpcenter/...) Peer review Productinfo Update hiv/std

7. GP’s and HIV-Net Since 1999 GP’s (15) in Antwerp meet 3x/yr for updating/ intervision Speakers from all levels are invited at regular bases Different groups of society are highlighted Hiv an std knowledge is updated Only a small amount of GP’s is interested!

8. HIV-Net and HIV-SAM In 12/2003 the HIV-SAM project has been introduced in Hiv-Net meeting Leaflets were made and explained to GP’s of the network GP’s went back to their practices with open attitude for counseling and testing Few patients consulted hiv-net members

9. Conclusion To pay cash at the GP’s office is a barrier To pay the lab separately is a barrier GP’s have good knowledge on prevention and VCT but people ask more for curative care

10. Suggestions Distribute (anthropological) knowledge of African culture and health beliefs among GP’s in their magazines/updating circuit Administration of 3th payment rule asks more time, but can be encouraged Private labs to be sponsered for hiv-tests to reduce the cost for the patient?

11. Precounseling Open questions, not convicting, discrete Clearing up fear(s), in dialogue! Listening in an active way (reflecting, making feelings and thoughts clear, summarize Make an inventary of barriers, intentions and choices, with respect for the proces of the patient

12. Postcounseling 1.Prepare yourself: timing!, own fear ? 2.Introduce with ‘I message’ 3.Tell the bad news shortly and immediately. Give time and space !! 4.React/reflect on emotions (‘I see that...’), reflect, mirror,.... Take time! 5.Give more explication on the result if necessary (shortly) 6.Make a summary and a plan (24 hrs); confidential/professional persons to inform?