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

Track D: Social Science: Research, Policy & Action
Results: This study compared knowledge of HIV, risk behaviors, and beliefs about HIV and
HIV testing in a matched cohort of Indiana women accessing care in public women's health
clinics with those accessing services in dedicated HIV counseling and testing sites (CTS). An
anonymous survey method was employed for data collection.The quantitative survey
instrument measured knowledge, attitudes, behaviors, and intent to HIV-test int was developed using elements of tools with proven validity and reliability. A sample of 200 women
was obtained (n= 100 from public clinic sites, 100 from CTS sites). The data from the surveys was analyzed using standard comparative statistical measures. Diferences and similarities in the factors cited by women are discussed, especially those that pertain to the health
care setting and that are mediated by health care workers. A case example of how these
data currently are being used in Indiana State Department of Health's reproductive HIV initiatives will be reviewed.
Lessons Learned: Understanding women's beliefs around the personal efficacy HIV testing
assisted in the development and refinement of effective HIV coui'eling and testing interventions.
Ann Kurth, ISDH, 1330 West Michigan Street Indianapolis, Indiana 46206- i 964 Indiana State
Department of Health
Tu.D.2772
BARRIERS TO BUILDING A COMPREHENSIVE SYSTEM OF HIV COUNSELING
AND TESTING BY CONSENT TO WOMEN OF REPRODUCTIVE AGE IN CHICAGO,
ILLINOIS
Rahimian, A, PhD*, Driscoll, M, RN MPH**,Taylor, D, BS**, Cohen, M, MD1. *University of
Illinois at Chicago, Chicago, IL; ** Cook County Hospital, Chicago, IL
Issue: Women of reproductive age often receive health care services at Family Planning and
Maternal Child Health (MCH) sites, making these ideal places for HIV educatiorn, counseling,
and testing. MCH sites could also be effective in the early identification of HIV positive
women and provision of ZDV to reduce perinatal HIV transmission. To best serve women
and their children MCH sites should provide HIV-related services.
Project: The Women and Children HIV Program of the Primary Care Center at Cook
County Hospital was funded in 1994 to work with MCH sites and Ryan White funded primary care agencies in the greater Chicago area to: I) provide or impr ove HIV counseling
and testing by consent during perinatal care; 2) educate and train perinatal and family planning providers, outreach workers, health educators, and case managers ir, HIV prevention,
early identification, and care; and 3) develop linkages between perirnatal care sites and Ryan
White funded primary care agencies. A survey was administered to all perinatal networks,
their affiliated hospitals, and community-based health centers (N= 100) to document their
HIV counseling and testing practices. Qualitative interviews (N=20) were conducted with
key personnel in selected hospitals, local and state public health agencies, and non-profit
AIDS advocacy and service providers to better understand the barriers in creating a com--
prehensive system.
Results: Of the 87 respondents so far analyzed, only 36 (41%) offered HIV testing as part
of their perinatal care or family planning programs, some without patients' consent. Of
these, only 60% offered HIV pre- or post-test counseling and most had no formal protocols. Less than half (43%) of the providers reported being aware of the 076 trial and only
9% reported implementing its findings regarding ZDV therapy Over two-thirds of respondents reported that a lack of training was the greatest barrier to offering comprehensive
HIV counseling and testing by consent as part of perinatal care. Barriers to the proposed
system included physicians' attitudes toward HIV testing, denial of HIV as a major problem
by suburban providers, lack of trained staff, the logistics of obtaining and recording test
results, and a lack of time, money and local care for all HIV positive women especially the
suburbanites.
Implications: MCH sites need considerable assistance to provide adequate, informed HIV
counseling and testing to women of reproductive age, and there are sigrnificant barriers to
building a system that offers comprehensive care to HIV positive women.
Afsaneh Rahimian, UIC-School of Public Health, 2 I 2 I West Taylor Street, Chicago, Illinois
USA Telephone: [phone] Fax: [phone]
Tu.D.2773
UNIQUE ISSUES THAT CONFRONT WOMEN, CHILDREN & FAMILIES
IreneMilton.Being Alive Women, Children & Family Center,
Issue: We address the unique issues that confront Women, Children & Families, the under
served and people of colonr, infected and/or affected by HIV/AIDS.
Project: A Drop-in center for people impacted by HIV/AIDS (funded by Title I Ryan White
C.A.R.E. Act funding received through the San Diego County Office of AIDS Coordination
and private donations) that provides support and referral information to women and their
families. We've been in operation since April of 1993. Annually we've p ovided services to
I 1,000 clients.We provide support by providing peer and family advocacy support groups,
referrals to medical and dental care and by addressing the family unit, spouses, children, and
extended family members. The uniqueness of our program is that we not only recognize
and support the individual, but also that individual's needs in relationship to her/his family
unit.
Results: We provide services that many of our clients consider life saving: such as: bringing
people out of isolation, clothing for both children and adults, diapers, toiletries, day care,(in
extreme emergencies) food, and most importantly a "SAFE PLACE"where HIV/AIDS individuals and their families can feel OK about their status. Because the majority of our clients
are at basic survival levels, with out these services medical, dental, and psychiatric care will
be, in some cases, too late.Throughout the year (quarterly) WCF host a variety of social
events. On Valentines Day we provide the children, of all ages, with handmade valentines
and candies; SpringTime, we have an egg hunt and our bunny rabbit passes out candy; July,
we participate with the community in hosting a Christmas in July, (some clients may not
make it until December), Novemben we provide a church donor with a list of 100 of our
most needy clients to receive Thanksgiving baskets; Decembet we host our biggest event,
with the help of staff and volunteers ('95 we had a showing of more than 350 clients and
volunteers. Entrees, snacks, soft drinks, chips, dips, and condiments were from donor s).The

community has recognized our efforts which shows in generous contributions of clothes,
diapers, food, volunteer hours etc.There is no other organization in Sanri Diego County
(only 3 in the USA) that provides such an array of services to women and their families by
recognizing the family as an entity as important as its individuals.

Tu.D.2772 - Tu.D.2776

Lessons Learned: We've had to incorporate the family as a unit by providing comprehensive service to the entire family unit.We, also, need to continue to educate women and
their families by bringing them out of isolation so that we can empower them to access life
sustaining services.
Irene Milton, 3265 5th Ave., San Diego, Ca. 92103 Tel: [phone] Fax 6 19 298- I1734
Tu.D.2774
REDEFINING SERVICE DELIVERY FOR WOMEN LIVING WITH HIV
Saint CyrMarie. Executive Director - Iris I-louse, Inc.
Issue: In New York City AIDS is the leading cause of death for women between the ages of
24 and 44. However services for people living with HIV are based on a model designed for
men.
Project: Iris House, a center for women living with HIV, is based on a comprehensive service model. An array of services are provided to our clients including: child care, support
groups, nutrition counseling, transportation, clothing, housing, emergency food packages,
advocacy legal assistance, and referrals. We address the needs of the whole woman and the
whole family
Results: After working with 200 women and their families, we have learned a great deal.
We have witnessed that women who are living with HIV take more control of their lives.
They reach a point where they can participate in the planning process that provides for the
future of their children.They also become more active participants in their treatment and
more concerned about treatment options.
Lessons Learned: Clearly service delivery has to address the many roles women play with
the family and the community We must be prepared to face these needs or make the
appropriate referrals so that women receive the help they need. Serving women inevitably
means serving families because women come with other people's lives attached to their
own. Our comprehensive model has proven to work.
Marie Saint Cyrc/o Iris House, 227 I Second Avenue., NewYork NY 10035
Tel: [phone] Fax: [phone]
Tu.D.2775
GENDER POLITICAL ISSUES RAISED IN HIV COUNSELING OF 200 COUPLES IN
ZIMBABWE:
Maposhere, Caroline*, Mashayamombe S*, Zhou P*, Ray S,Van der Wijgert J, Mason P*,
Katzenstein D. *"University of Zimbabwe, Department of Community Medicine, Harare,
Zimbabwe
Issue: Gender issues of control and power within heterosexual relationships are important
in HIV transmission. Biologic and behavioral factors for HIV in HIV positive and negative
men and women in Zimbabwe in stable couples.
Project:The Zimbabwe AIDS Prevention Project (ZAPP) recruited subjects at 40 Urban
factories in Harare. Participants are given the option to know their HIV status through post
test counseling at the ZAPP Clinic. Spouses or regular sexual partners of the participants
were enrolled onto the study through the index client and offered STD treatment, barrier
contraception methods (male and female condoms) and HIV testing and counseling.
Results: Of 3000 male factory workers, 55% were married or in stable relationships.Twohundred and fifty (I 5%) of these brought their spouses for HIV testing and counseling and
233 couples have been enrolled in a longitudinal study Questionnaire data was analyzed for
risks for HIV infection and differences between concordant and discordant couples.

CONCORDANT

DISCORDANT

number of couples Both neg Both pos
134 57
separate residence 25 (REF) 40 (O.R=2)
In Males: condom use 14.8 (REF) 5 (O.R=0.3)
and mean sex ptns/yr. I1.6 2.9

Male pos Female pos
27 15
7 I (O.R=7.34) 33 (O.R= I1.48)
42.9 (O.R=4.27) 17 (O.R= I.08)
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Lessons learned: From the counseling sessions, it was noted that women had limited
options in the use of barrier methods, contraception and control of their partners sexual
patterns. Separation of spouses is an important question to address as well as condom use.
Empowerment of women must be an integral part of HIV/AIDS prevention programme.
Caroline Maposhere, Zimbabwe AIDS Prevention Project, 114 Baker Avenue, Harare,
Zimbabwe, Lel: and Fax [phone] email ZAF'[email protected]
Tu.D.2776
A POPULATION BASED STD INTERVENTION AMONG WOMEN IN A SUB URBAN
POPULATION IN CAMEROON
Torimiro Judith Ndong, Mpoudi N.E., *Ntsama L. AIDS Control Service, B.P 2039, Messa,
Yaounde, Cameroon. * Oyomabang Health Center, Cameroon.
Objectives: (I) Identify, assess and describe the women's knowledge, attitudes, behviours
and practices with respect to STDs (2) Determine the prevalence of gonorrhoea, syphilis,
chlamydial and HIV infections (3) Identify risk factors and factors that hinder and/or promote efforts to STD/AIDS prevention intervention (4) Institute a STD/AIDS educational in
the comrmunity
Methods: (I) A questionnaire was administered to 200 women (2) Clinical and laboratory
investigations for 200 women (for gonorrhea - by Gram stain and culture; syphilis - by RPR
and TPHA; chlamydia - ELISA; HIV infection - by ELISA and Western blotting). (3) In-depth
interviews for 10 Community Opinion Leaders (4 Group discussions for 12 groups (4)
women's CBO, 2 women's religious groups, 4 youth groups and 2 mixed groups).
Results: (1) 49% - married; 49% - single; 2% - widowed (2) No woman had more than secondary school education (3) 43% do not know any sign of STD (4) 10% had more than 4
sex partners in a week (5) 40% do nriot seek treatment fromr an authorised health care
provider (6) 60% did not inform their sex partners (7) STD prevalence: gonorrhea - 5%;
syphilis - 23%; chlarnydia - 5%; HIV - 3%.
Conclusion: (I) Women should be assisted with information, proper health services, and
education (2) local women's Community Based Organisations should be supported to give
women assess to skills, credit (3) Parents/adults should be trained and supported to develop and strengthen intergenerational communication in sex-related issues.
TORIMIRO JUDITH NDONGO, B.P 2039, Messa,Yaounde, Cameroon.Tel: [phone]
Fax: [phone]