Ukrainian Doctor Learns to Answer the Tough HIV/AIDS Questions
Dr. Antonina Skripka has directed the Mykolayiv Antenatal Clinic No.2 for 21 years and has been a doctor for 30. Despite more than 10 years of experience working with HIV/AIDS patients, she still feels uneasy when informing pregnant women that they are HIV-positive. Even as she has helped them cope with potential psychological stress, she has always had more questions than answers on the proper way to deal with the situation.
“In my clinic, we conduct HIV post-test counseling very often. No matter how long you have worked in this area, it’s still very hard to be the one to inform a young pregnant woman about her positive HIV status,” Dr. Skripka said.
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| Dr. Skripka practices counseling skills at voluntary counseling and testing training |
While men historically account for the majority of HIV cases in Ukraine, women now account for about 40 percent of known infections. The prevalence of HIV infection among pregnant women more than tripled from 1998 to 2003, and the number of HIV cases among infants due to mother-to-child transmission (MTCT) have increased from 12 in 1995 to nearly 2,300 in 2004. In 2004, the total number of HIV-positive pregnant women in Ukraine was 3,238. The MTCT rate for 2004 is estimated at 10 percent.
When a USAID-supported voluntary counseling and testing (VCT) training was announced in Mykolayiv, Dr. Skripka was one of 19 obstetricians-gynecologists and midwives from Mykolayiv maternity homes who expressed a desire to participate.
During this three-day training, Dr. Skripka worked on refining her counseling and interpersonal communication skills, which are an integral component of the voluntary counseling and testing procedure. The training curriculum covered a broad range of topics, focusing not just on how HIV is transmitted and the trajectory of infection, but also on the stigma and discrimination that many people living with HIV/AIDS experience, and which can be as harmful as the disease itself.
Most medical facilities in Ukraine do not provide VCT at all. Access to knowledge and skills in this area is available through international and national projects such as the USAID-supported project “Increasing Women’s Access To and Use of Prevention of Mother-to-Child HIV Transmission Interventions in Ukraine” implemented by the Program for Appropriate Technology in Health (PATH), an international, nonprofit organization that has worked in Ukraine for many years.
This project seeks to strengthen Ukraine’s ability to make MTCT interventions a regular part of maternal and infant health services. Specifically, the project focuses on improving the quality of VCT, as well as interpersonal communication and family planning counseling skills, among obstetricians-gynecologists and midwives, and on strengthening community-based support for HIV-positive pregnant women and mothers in the cities of Mykolayiv, Odesa, Sevastopol, and Crimea.
“Voluntary counseling and testing training changed me a lot. First of all, it changed my attitude toward HIV-positive people and my understanding of the problem,” said Dr. Skripka. “In addition, it gave me the structure and guidelines for conducting pre- and post-test counseling.”
Following her training Dr. Skripka gathered her staff and conducted a mini-training for them.
“I just shared my feelings and thoughts about the importance of a proper VCT process and explained the main ideas,” she explains.
As a part of the first visit, it is now routine for a doctor to conduct pre-test HIV counseling. Only after this counseling is the woman asked whether she wishes to be tested for HIV.
“Some women are just not ready to do this on the spot,” Dr. Skripka notes. “They need to take their time to think, but almost all come back and take the test to ensure their future child’s health.”
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