Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Track D: Social Science: Research, Policy & Action
Results: The financial cost for implementing this activity was estimated to be 55% of the
economic cost with 69% of the MOH's financial cost being allocated to personnel and 21%
to technical assistance.The average financial cost per worker reached was EC$36.6 I and
the average economic cost was EC$66.50. If the Ministry of Health expands the activity the
average financial cost will be EC$28.51I and the average economic cost will be $71.14.
Contributions by the government will decrease from 73% to 47% whereas the private sector expenditure will increase from 15% to 48%.
Conclusion: The analysis provided an estimate of the future budgetary requirements for
expansion. It also outlined the costs of goods and services that were donated should the
Ministry of Health have to purchase these services in the future. If the activity is to be sustained, the business community should be encouraged to become actively involved.The cost
analyses of health programmes are critical to determining cost-effectiveness as countries
decide where to invest their scarce health care resources to achieve the maximum
improvement in the health of their population.
N.Taylor, CAREC/PAHO, 1 6- 18 Jamaica Boulevard, Federation Park, Port of Spain,Trinidad;
Telephone: [phone] I 53, Fax: [phone], email: [email protected]
Mo.D. 1847
COST-EFFECTIVENESS OF A COGNITIVE-BEHAVIORAL, HIV PREVENTION
INTERVENTION FOR GAY MEN
Holtgrave, David R.,* Kelly J.A.* *Center for AIDS Intervention Research, Medical College
of Wisconsin, Milwaukee,Wisconsin, USA
Objective: A previous study determined that a small-group, twelve-session, cognitive-behavioral, HIV prevention intervention for gay men was effective at increasing condom use
behaviors during anal sex at 4- and 8-month follow-up.The current study sought to retrospectively determine the cost-effectiveness of that intervention.
Methods: Standard methods of cost- and cost-utility analysis were employed. A societal perspective and a 5% discount rate were used. Cost categories assessed included the following:
staff salary fringe benefits, quality assurance, session materials, participant transportation,
participant time valuation, and costs shared with other programs (e.g., rent and utilities).The
behavioral effects of the intervention had been previously determined; these observed
effects were used in a Bernoullian mathematical model to estimate the number of HIV
infections averted among the experimental group (n=50) over the 8-month observational
period. For each infection averted, the direct medical costs saved were estimated, as were
the number of quality-adjusted-life-years (QALYs) saved.Taken together, these figures
allowed for the calculation of the cost-per-QALY saved by the intervention. One- and multiway sensitivity analyses were performed to assess the robustness of results to changes in
model assumptions.
Results: Under base case assumptions, the cost of the intervention was $24,000 (rounded
to the nearest thousand).The discounted medical costs averted by preventing HIV infection
were $42,000. Approximately 5.5 discounted QALYs were saved. Hence, the intervention is
cost-saving under base case assumptions.The results are moderately sensitive to changes in
certain epidemiological assumptions and participant time valuation estimates.
Conclusions: The intervention is cost-saving under base case assumptions. Hence, it compares very well to other health service interventions in which society currently invests.
Behavioral HIV prevention services such as those examined here should receive serious
consideration for investment by public health decision makers allocating fiscal resources.
D.R. Holtgrave, Med. Coll. of WI, 1249 N Franklin PI., Milwaukee, WI 53202 USA
Telephone: [phone] Fax: [phone] email: [email protected]
Mo.D. 1848
ZAIREAN VIH(+) PATIIENTS ABILITY TO AFFORD HEALTH CARE.
Mposo. Ntumbanzondo*/***, Mayala M*, Kapita, B. **, Mbaki**, Nzila, N.*. *Projet SIDA,
Kinshasa Zaire; **Hopital Mama Yemo, Zaire; ***Fac. Medecine, Universite De Kinshasa.
Objective: To estimate the HIV(+) patients ability to support health care cost.
Methodology: Patients admitted in internal medicine ward in Mama Yemo hospital were
tested at ELISA for anti-HIV antibodies until we had a total of 50 HIV(+) patients. A control
cohort had an HIV(-) related diagnosis. For each patient, we collected age, sex, civil status,
hypothetical prescribed cost HPC, total paid charges TPC, sources of funds (large firm LF,
small firm SF, own resources OR, extended family EF and other sources OS), clinical and
economic status.
Results: The average HPC was $170 for cases and $120 for control (p<.05). An average
TPC was $ 110 for cases and $90 for controls. (p<.05) Only patients from large firms (20%)
can afford all the prescribed health care.The remaining HIV(+) patients (80%) afford only
65% of medical care which mainly depends on patients own resources and the contribution
of extended family.
Conclusion:HIV(+) patients need more aid to obtain appropriate health care.The health
care management of HIV(+) patients needs either protection of their employ (LF) or the
contributions of OS for unemployed ones.
Mposo Ntumbanzondo, Projet Sida,C/O Jan Vielfont, I55,Nationale Straat, 2000 Anvers,
Belgium
Mo.D. 1849
EFFECTS OF EXPERIMENTAL PSYCHOLOGICAL STRESS ON DISTRIBUTION OF
PERIPHERAL BLOOD CELLS IN ASYMPTOMATIC HIV-INFECTED HOMO- AND
BISEXUAL MEN
Reimann, Georg,* Breukel, M.,** Mertins, L.,* Schaefer, A.,** Hengge, U.R.,* Brockmeyer,
N.H.* *Dept. of Dermatology **Dept. of Med. Psychology University of Essen, Germany
Objectives: To determine the influence of a short lasting mild psychological stressor on
immunological, cardiovascular and neuroendocrine parameters in asymptomatic homo- and
bisexual HIV-infected men.
Methods: I 2 HIV-infected (WR I-3, experimental group, EG) and 25 HIV negative (control
group, CG) homo- and bisexual men underwent an half-hour stressing interview, focussing
on a personal-related subject. Blood samples were collected before and after a first relax
ation period (15 minutes), after the stress session and after a second relaxation period.
Differential blood count, immunological parameters (CD2+, CD3+, CD4+, CD8+, CD20+,
CD56+ cells), blood pressure, heart rate and plasma levels of epinephrine, norepinephrine,

Mo.D.1847 - Mo.D.1852
cortisol and TNF-ca were determined. Statistical comparison within the experiment and
between groups was carried out using ANOVA.
Results: The psychological stress lead to significant increases in WBC, neutrophil count,
blood pressure and norepinephrine levels after the stress session in both groups.There was
also a statistically not significant increase of CD2+, CD3+ and CD8+ cells. No changes in
the number of CD4+ cells and B cells (CD20+) were found following the stressor for
either group.The increase of CD56+ cells was more pronounced in CG (26%) compared
to EG (I 3%).TNF-a level remained unchanged, whereas the cortisol level was decreased
during the stress experiment.
Conclusions: The results suggest that a mild psychological stressor is associated with some
rapid cardiovascular, neuroendocrine and immune cell changes. HIV-infected patients may
have a reduced capability to release natural killer cells into circulation.
G. Reimann, Dept. of Dermatology University of Essen Hufelandstr. 55, 45 I 22 Essen
Tel: [phone] Fax: [phone]
Mo.D. 1850
THE PRACTICE OF MONOGAMOUS RELATIONSHIPS AMONG MEDICAL
STUDENTS WITH REGARD TO AIDS/HIV
Wamola Betty. University of Nairobi, Medical School, Kenyatta Hospital, Nairobi, Kenya.
Issue: The low-keyed approach to heterosexual monogamous relationships among the
youth is attributed to the lack of trust between partners.
Project: This 6 month survey delved into the nature of monogamous relationships practised
by Medical Students with special emphasis on experiences, practicability trust level, practices, communication levels, and constraints.The overall goal was to assess its practicality visa-vis AIDS/HIV prevention. Five (5) couples were chosen. Specific strategies involved personal interviews of the couples, self administered questionnaires and anonymous views.
Result: The female partners were more likely to remain in the monogamous relationship
and less likely to be unfaithful.They valued emotional stability intimacy and open communication.Their male counterparts tended to be more susceptible to peer/social pressure,
equating virility with multiple sexual partners, practiced double standards and complained of
boredom and monotony Cases of extra-monogamous' sex were reported in 3 out of the 5
couples within the six months.
Lessons Learned: There is great need to change couple's attitudes with emphasis on mutual
understanding and greater commitment to monogamous relationships for greater acceptance.
Betty Wamola, P.O. Box 19676, Nairobi,Kenya.Tel:C/O Dean U.O.N. 254-2-725102,
Fax: 726 130
Mo.D.1851
VALUE FORMATION AMONG MALE AND FEMALE SEX WORKERS:
AN INTERVENTION SCHEME FOR BEHAVIOR MODIFICATION
Josefina G.,Tayag, D.PA. Center for Multidisciplinary Studies on Health and Development
Issue: Values form the basis of an individual's behavior and provide norms and guidelines for
his/her choices in life. In the case of both male and female sex workers, their value system
determines their choice of work and the adoption of high-risk practices in regard HIV/AIDS
and STDs.
Project: Intervention programs we conducted among male and female sex workers involve
a value fomation component.Their current value system, including the contributory factors
as culled from their life histories, are analyzed and checked out with them.The impact of
values on current behavior is discussed with theme and alternative value systems are proposed.The cognitive aspect of things is worked on initially through an increase of knowledge on the risks of their trade, the factors that make for good health, preventive measures
and the like.Their training as peer educators/facilitators contributes to value change and
ultimately behavior modification. Peer pressure, group interaction through focus group discussions, the regular submission of monitoring forms on their sexual behavior and activity
constant follow-ups and reminders are steps taken towards value formation.
Results: Some behavioral changes are noticeable which are definitely a product of value
change: enhanced self-esteem and a feeling of importance at being able to lectured;
reduced incidences of penetrative sex; if it occurs, ability to negotiate for condom use; outright refusal to do penetrative sex acts even it it means foregoing additional income; stopping bar-work altogether; guilt feelings if and when they do not practice what they preach;
being more health conscious and awareness of telltale signs of infection, among others.
Lessons learned: Value formation is crucial to behavior modification; it entails a prolonged
process of rapport-building, close monitoring and reminders and a strong peer support group.
Josefina G.Tayag, D.PA., UP Manila Information, Publication and Public Affairs Off ce, Central
Administration Building Corner Padre Faura and Ma. Orosa Sts., Ermita, Manila, Philippines;
tel. no.: 501385/5852 10: fax. no.: 5210184
Mo.D. 1852
SEXUAL BEHAVIOUR SURVEILLANCE OF FEMALE ATTENDERS AT A BUSY FAMILY
PLANNING AND SEXUAL HEALTH CLINIC - IS IT FEASIBLE?
rtS.. Taylo: A.2, Bigrigg, A., Goldberg, D.. ICentre for Family Planning & Sexual
Health, Glasgow 2Scottish Centre for Infection and Environmental Health, Glasgow
AIM:To assess the feasibility of establishing a system to monitor the sexual behavior of female
attenders at a large central clinic for contraception and sexual health in Glasgow during 1995.
Methods: Following formal ethical committee approval a sexual behavior surveillance programme was developed. A brief anonymous, self-completion questionnaire was developed
containing questions on contraception, condom use, sexual relationships and sexual activity
(in the last 4 weeks) and distributed to a systematic random sample (I in 20) of female
clinic attenders.The form was then completed by the patient on site, placed in an envelope,
sealed and deposited in a designated box. All completed forms for the six month pilot period were checked, coded and entered onto microcomputer for analysis.
Results: Over the study period 20,007 women attended the clinic and 9 I 2 questionnaires

were completed giving a 4.6% sample. 2 women refused (0.2%). Preliminary analysis
showed that 868 (95%) were white and the mean age was 25 years (range 11-57). 788
(86%) had a steady partner of whom 37 (4.6%) had another partner in the last 4 weeks. 4
(0.5%) had a steady female partner 764 (83.7%) were having regular vaginal intercourse
with their partner of whom 398 (52%) never used a condom. Anal intercourse was reported by 35 (3.8%) of the sample in the previous '4 weeks.

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