Nordic Council of Ministers, Nordic-Russian Health Program, Inter-regional international conference "Collaboration across healthcare and social services in prevention of mother-to-child HIV infection" Kaliningrad, 13-14 June 2017 Ms Marina Mikhalchenko, chief of the counseling and psychological support department at the AIDS Centre of Kaliningrad Region

1. Psychological and Social Support to
HIV+ Women
Kaliningrad Regional AIDS Centre
June 2017

2. Features of the group –
HIV-positive women (behavioral studies – socio-medical
background)
1. Sub-group – conditionally adapted to maternal role
* already on records (family planning, regular visits to doctors, taking
therapy)
* placed on records (crisis – learnt about the diagnosis during the
pregnancy)
2. Sub-group - non-adapted
(Women who have difficulties of psychological and social adaptation to the
mother’s role)
*aggravated social history – low social status, alcohol or drug addiction,
asocial behavior
*psychiatric diagnosis
*distorted readiness to the mother’s role
(late identification of the pregnancy, unwanted pregnancy, elevated
anxiety during the pregnancy – do not see themselves as mothers, do not
comprehend their tasks at the moment and in the future)

4. Types of support to the group
Support and correction of disturbed adaptation to the mother’s
role :
 Psychological
 Social
 Humanitarian
 Legal
 Information
 Urgent (phone hotline, urgent measures)
 Relief of stress due to the diagnosis
 How to tell to the partner and family?
 What will happen to the child?
 Mother’s health is key for the child
 Selection of the child delivery method
 Treatment of alcohol and drug addiction
 Building adherence to the ARV therapy
 Teaching to avoid symptoms of side effects caused by ARV therapy
 Teaching to identify and prevent symptoms of opportunistic infections
 Counseling on child care, nutrition and feeding, follow-up

5. Algorithm of case management
1. First acquaintance
(at gynecologist, infectionist, at psycho-social consultation, at the consultation for discordant
couples)
2. Collection of social and medical history
 In case of negative history, the woman is placed on social case management
 An individual plan of rehabilitation is made
3. Psychological counseling
 Acceptance of the diagnosis
 Building of the conscious maternity – attachment to the future child
4. Social counseling
 Examination of the family situation and social and everyday life conditions
 Social case management (planned and urgent)
 Interaction with the social services
5. Development of a long-term contact with the patient and her family
6. Provision of information about available social and psychological services

7. * All pregnant women receive information material at the AIDS
Centre:
- List of benefits and pays due to pregnancy, child delivery, mother’s capital
- List of necessary documents for receiving statutory benefits and pays
- Families are given contact information of the organisations which provide social and
psychological support and care
* Target support to the pregnant women in hard life situation:
- Assistance in registration,
in receiving a medical insurance policy,
employment,
recovery of documents,
placement to rehab and crisis centres
- Humanitarian aid (on site or referral to humanitarian funds) – material, goods for
children: prams, beds, toys, etc.)
- Anti-drug programme – child clothes: blankets, hygiene, child care, diapers, etc.)

9. Institutional support
1. Inside cooperation:
* Requests from specialists
* Joint meetings (gynecologist, infectionist, pediatrician, social worker,
psychologist)
* Joint visits to the family (case management)
2. Working with authorised doctors and specialists at healthcare facilities
3. Use of the administrative resource: request letters, phone calls.
4. Partnership agreements
5. Collaboration with mother and child organisations subordinate to the
ministry of health, ministry of social care, ministry of education through
building a nhetwork of authorised specialists
6. Joint order of 18.11.2014 №458/782
«Collaboration of Kaliningrad Regional Ministry of Health, Ministry of Social Policy and their subordinate institutions in working with
pregnant women, women having children under 1 year old and women at risk.
7. Regional anti-drug programme for 2012-2016
Support to families with children, where parents have drug addictions

10. Municipal social care
authorities and organisations
Patients of
AIDS Centre
Church
organisations
NGOs
Commission on minors’
rights
Ministry of education
Ministry of social policy
Department of family policy
Municipal child protection
authorities
Social support centre for
families and children
Prosecutor’s
office
Employment
office
Social rehab
facilities
Non-for-profit
rehab centres
Humanitarian
funds
Private sector
Special medical
facilities
2nd ward
Regional
addiction
clinic
СХЕМА ВЗАИМОДЕЙСТВИЯ ОЦ СПИД С ДРУГИМИ УЧРЕЖДЕНИЯМИ И ОРГАНИЗАЦИЯМИ ПО
ОБЕСПЕЧЕНИЮ МЕДИКО-СОЦИАЛЬНОГО СОПРОВОЖДЕНИЯ

11. Implementation of the anti-drug programme
In 2015, were purchased and handed out:
child clothes sets
blankets for newborns
child overalls
school bags with school necessities
toys
vitamins for pregnant women
In 2016, were purchased and handed out:
sets of goods for discharge from the maternity house
child blankets
bottles and feeding nipples
bottles brushes
diapers
hygiene for newborns
shampoo, gels, cream
albums for painting, paints, pencils, pencil-boxes

12. Outcomes of informational, counseling and psychological support in 2016
Consultations on social issues - 1211
 Questions of social functioning - 601
 Housing and everyday life problems - 31
 Employment -54
 Recovery of documents - 48
 Obtaining a medical insurance policy - 58
 Getting social benefits -85
 Residential registration - 27
 Child’s placement to pre-school or school – 8
 Support to families of HIV+ patients -109
 Social case management – 80
 Support to pregnant women - 41
 Hotline calls - 1118
Psychological support provided - 735
to PLWHs- 508, their families -227
 Psychological counseling of PLWHs in conjunction with their placement under follow-
up care - 114
 Individual psychological consultations, including consultations on therapy and
prevention of interruption -334
 Psycho-social survey of PLWHs and their families to identify priority problems and
ensure adaptation to the diagnosis -310
 Psychological surveys (behavioral, anxiety, etc.) - 202
 Visits to the 2nd ward - 25
 Humanitarian aid delivered: 238

13. Tasks for the future
 It is necessary to continue improving collaboration of healthcare,
social and educational institutions in protection of mothers and
children health
 To improve the quality of family planning counseling at all stages
of medico-social care.
 Prevention of stigma and self-stigma
Birth of a healthy child

15. Thank you for attention!