Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

1022 Abstracts 60120-60125

12th World AIDS Conference

Results: Majority of respondents (28%) were in the 25-29 year age group.
Fiftynine percent were not married and 41% were married. The mean ages of
first sexual intercourse in SG and CG were 22.8 and 21.34 years. Significantly
more respondents in SG (51%) had sexual relationship with a foreign woman
compared with 7% in CG during last 12 months. The condon use in last sexual
act in SG 35% and CG 38% and the difference was not significant. High risk
sexual behaviour of 48% was observed in SG compared with 19% in CG which
was highly significant.
Conclusions: This study highlights the high risk populations need to have
changed their behaviour in casual sexual acts, otherwise this type of behaviour
may contribute to the spread of STD/AIDS. To change the behaviour, it requires
continuous dialogue with than and intitate more counselling with them and easy
access to supportive services should be a priority.
60120 Designing new STD surveillance guidelines
Antonio Gerbase, S. Titan, W. Levine. Chemin De La Haute Belotte 7 Vesenaz
Ch 1222 Suisse, Switzerland; University of Sao Paulo Sao Paulo SP Brazil; CDC
Atlanta GE, USA
Issue: Sexually transmitted diseases are a very important cause of morbidity in
the world. Besides their serious complications and sequelae, STD have also been
implicated in HIV transmission, making STD control even more urgent and important. Data on STD are lacking, making difficult to plan and evaluate intervention
strategies.
Project: The objective was to produce STD surveillance guidelines, especially
for developing countries, defining the basic information needed for action. In a
process that involved WHO/UNAIDS staff and professionals at country, regional
and global level, different alternatives for performing STD surveillance (universal
versus sentinel reporting, syndromic versus etiologic reporting, connections to
HIV/AIDS surveillance, antibiotic resistance control, etiologic distribution for each
syndrome) were discussed and STD surveillance guidelines produced.
Results: A consensus on the minimum data necessary to evaluate the STD
situation for developing countries, despite lack of resources, was reached. A basic
STD surveillance should include information on: syndromic case report (genital
ulcers, urethral discharge and vaginal discharge) from sentinel sites; syphilis
prevalence in pregnant women attending antenatal clinics; universal reporting of
congenital syphilis; prevalence studies of gonococcal resistance and studies on
aetiology of genital ulcers, urethral discharge and vaginal discharge;Conclusion:
The recommendations on basic surveillance systems should be disseminated,
promoted and implemented at country level in order to generate the needed
information. Based on more accurate information countries will be able to better
plan and evaluate their STD control activities. At country, regional and global level
the generated information will also support advocacy and more efficient resources
mobilisation.
60121 HIV primary-care and family medicine in Toronto, Canada
William Seidelman, M Grondin. The Wellesley Health Centre 410 Sherbourne
Street Toronto Ontario, ON, CANADA
Issue: HIV primary-care within an academic department of family medicine in an
urban teaching hospital.
Project: In 1994 an HIV Ambulatory Program was established in the family
medicine department of a Toronto teaching hospital. Features include: Community Participation: An active Community Advisory Panel; Interdisciplinary Team:
Family physicians, nurses, social worker, pharmacist, dietician, occupational therapist and addiction counsellors; Integration: All health care providers in the clinic
see patients with HIV, HIV specialists see patients in consultation, members of
the ambul. team are involved in inpatient care; Comprehensiveness: Services
available around the clock and in the community; Education: Experiential training
is available for all the health professions including physicians in the community.
Results: Out of an active patient population of 10,000 (est.), 1156 people
with HIV have attended the program since its inception (354 for consultation
by specialists). In Nov. 1997 the 11% of patients with HIV accounted for 49.6%
(1790) of 3606 encounters with all health professionals. Visits with HIV specialists
accounted for 6.4% (114), and visits with family physicians for 47% (846) of
the 1790 encounters with HIV patients. The program attracts undergraduate and
postgraduate students in medicine, nursing, pharmacy, social work and occupational therapy. Every resident in family medicine in the clinic is involved in HIV
care.
The HIV Ambulatory Program of the Wellesley Central Hospital in Toronto has
become one of the largest HIV primary-care programs in Canada and one of the
few in the world within an academic department of family medicine.
Lessons Learned: A community-responsive interdisciplinary urban HIV primary care teaching and service program can be successfully established within
a university-affiliated hospital department of family medicine and integrated with
inpatient and specialty services.

60122 Correlation between basal HIV-1 viral load and CD4(+) T
cell subset in AIDS patients
Gustavo A. Barriga1, N.P.T. Castillo2. 'Avenida Maestros 505 02800 Mexico
City; 2Head Mol Biol Lab Inf Dis Hosp Mexico, DF, Mexico
Objectives: To evaluate the correlation between viral load and the percentage of
CD4(+) T cell subset in HIV-1 patients with different stages of disease.

Design: Prospective, controlled study.
Methods: A cohort of 64 patients; 52 males and 12 females, classified according CDC criteria were studied. The basal HIV-1 plasmatic viral load and CD4(+) T
-cell subset was determined by the NASBA method (O.T."), and flow cytometry
(Coulter E. T) the data were analyzed by a multiple regression analysis.
Results: We found that the HIV-1 RNA plasmatic levels correlated with the
clinical stage of all studied patients, in contrast with the CD4(+) T cell subset -
that correlated only in the 80% of them.
Conclusion: HIV-1 RNA basal levels was the best predictor of the clinical
outcome of the AIDS patients, CD4(+) T cell count subset alone, show substantial
- variability, exhibit a limited dynamic range and was not the best tool by which
stratify patients.
1 60123 _ Personal experience in coping with HIV
Sylvia Kagabane. Taso-Mbale-PO BOX-22 50 - Mbale, Uganda
Issue: The Role of spiritual faith in Living with HIV.
Project: When I tested HIV positive in 1991, I felt that the whole world was
collapsing under my feet. My hopes were shuttered and life seemed to have
come to abrupt stop. I tried several things to suppress the reality until finally I
surrendered into God's hands.
(1) I took to heavy drinking of strong alcohol which weakened me physically,
made me a misfit in society and unable to earn a living.
(2) I sought for comfort and understanding from friends and relatives who
however deserted me.
(3) I sought for HIV/AIDS counselling which however seemed to leave some
gap in me.
(4) I came to accept Jesus Christ as my Lord and Saviour.
Results: (1) I found God to be ever present during times of pain, sorrow, fear,
rejection, hopelessness and need.
(2) I resolved my fears of death because of the assurance of eternal life.
(3) I felt forgiven and at peace with God which helped me resolve my feelings
of anger against those who misunderstood and mistreated me.
(4) I found a new caring family in the church fellowship that I attend.
I have the courage and hope to face the uncertainty of being HIV positive
because I believe the future lies in God's hands.
Lessons Learned: Spiritual faith is an essential component in coping with
HIV/AIDS.
160124 AIDS awareness in the community cites
Joyce Wanjiku Kamondo, K.K. Kiriaithe, R.W. Nthiga. Kenya AIDS Society, PO
Box 76618, Narobi, Kenya
Issue/Objectives: To determine P.W.A. vital role on sharing life experiences with
HIV/AIDS in the community.
Project: Trained Public Educators living with HIV/AIDS reach the community
through Kenya AIDS Society Embu in collaboration with others working for AIDS
related projects. They are offered some allowance in return. Community members sometimes contribute spiritual, moral and material support hence motivating
them.
Results: Positive; People change their sexual practices. Misconceptions on
HIV/AIDS are reduced.
Risky traditional practices are reduced. Negative; Self blame by the family and
community members.
Orphans and P.W.A. Children are stigmatized.
Sharing of life experience is an effective way of giving AIDS a human face in
the community. It also sensitiese information on HIV/AIDS. Reduction of fear.
601251 Acquired oral hyper-pigmentation (AOP) in HIV +ve
patients: A prominent, frequent and multi informative
finding
Rashmikant Shah, B.S. Jobanputra. Kandivli Centenary Municipal Hospital,
Mumbai, MH, India
Objectives: AOP was common amongst our pts.. Our objectives were to find out
its (1) Frequency (2) Predictive value to diagnose HIV infection. (3) Corelation
with progression of HIV infection. (4) Etiology.
Method: High risk pts. with AOP (Developed in last 3 yr.) were tested for HIV
inf. to know predictive value. Frequency was found from serially registered new
HIV + VE pts. Control was HIV - VE pts with TB, CA & ohter medical diseases.
Grading of AOP GR.I = 1 + 04, GR.II = 4 to 8 & GR.III = >8 Patches & Intense
pig. (1 patch =.5 cm x.5 cm). Avg. CD4 Count, of pts with same grades of AOP,
their clinical stages of HIV inf. & grades of AOP were used for corelation. H.P.,
scrapping for candida, tests for Adernal insufficiency & TB were done for etiology.
Results: Predictive value of AOP 57% (20/35). Frequency of AOP in HIV
pts 29% (39/130), Highest in ARC pts 56% (14/25). In control freq. 9% (14/150)
Highest in TB pts. 12% (6/50). GR.I AOP was common in Asymptomatic 71%(5/7)

GR.II 57% (8/14), 44% (8/18) GR.III 21% (3/14), 50% (9/18) in ARC & AIDS pts
respectively AVG CD4 count of pts with GR.I AOP 414 (H720L 313) GR.II 309 (H
540 L 154) GR.III 140 (H 490 L 21). Histopathology appearance were of malanotic
macules in most pts. Only 4 had Adrenal insufficiency. 7 & 11 had cadida on patch
& TB elsewhere respectively. OHL was seen 4 pts. with AOP.
Conclusion: AOP is disinct clinical feature in 29% of HIV pts & seems seprate
entity from Addison's disease. Multiple factors including Human immunodefi