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

12th World AIDS Conference

Abstracts 60126-60131 1023

ciency virus may be responsible for it. The extent & intensify of AOP parallels
progression of HIV infection. Presence of AOP in high risk pts can predict HIV
infection in 57%.
60126 Impact of HIV/AIDS enlightenment on acceptability of
condom use among sex workers in Borno State, Nigeria:
An intervention trial
Mercy Wakili1, L.A. Bello1, T.O. Harry2, M. Bulterys3. 'State Specialist Hospital,
Maiduguri, Borno State; 2University Teaching Hospital, Maiduguri, Borno State,
Nigeria; 3 University of New Mexico, Albuquerque, NM, USA
Issue: Commercial Sex Workers (CSWs), being a population highly vulnerable
to HIV/AIDS, require proper education to understand the importance of insisting
on condom use in a community where men generally refuse the use of condoms.
Project: In sub-Saharan Africa, there is an urgent need to educate CSWs on
negotiation of safer sex. A community intervention trial was conducted among
female CSWs in Borno State villages, bordering Cameroon. CSWs in Zone A
received condoms (100 each) and intensive HIV/AIDS awareness and prevention
information, while CSWs in Zone B received only the condoms and information
on how to use them. Zones A and B were randomly selected. The project staff
included ex-CSWs, medical practitioners, and members of the Society for Women
and AIDS in Africa (SWAA), Nigeria.
Results: Out of a total of 300 CSWs recruited from village brothels during
August-September 1997 (150 in each group), 255 participated in the trial during
the entire one-month follow-up period. The majority of CSWs were Nigerian while
only 1.2% were from other African countries. Median duration of prostitution
(2 years) and average number of male clients per day (4-6) was not different
between the two groups. CSWs in Zone A used up 61.9% of condoms supplied
to them while CSWs in Zone B used only 30.9% of the condoms (p < 0.01).
Lessons Learned: A comparison study of female prostitution in villages in
Borno State, Nigeria, demonstrated that CSWs who received HIV/AIDS enlightenment used condoms more judiciously than the comparison group. The authors
conclude that education is a crucial step in HIV prevention through condom use.
|60127 I Risk taking behaviour of Delhi taxi drivers
Nalini Sahay. TORCH (Training Organisation for Research and Counselling in
Health) 45 Friends Colony East, New Delhi, India
Issues: Taxi drivers in Delhi are vulnerable to HIV/AIDS because they practise
multipartner sex.
Project: 2050 taxi drivers were identified as target group at 5 major stands.
These drivers are permanently based at these sites. Baseline survey revealed
that general HIV/AIDS awareness was 76%. 50% had never used condoms and
did not know how. 56% did not think that MSM could lead to HIV infection.
Awareness program, condom demonstrations, followed by STD checkup camps,
peer educators programmes and counselling at the venues were held on a regular
basis. Focus discussions were also conducted.
Results: After one year endline survey was conducted, 46.8% are using condoms every time, 19.4% are using condoms while having sex with men 47.2% are
still having unprotected sex with men because these are unplanned encounters,
89% know that if you do not use a condom you can get HIV/AIDS. 85.5% said
that if condoms were available at the stands they would use them.
Repeated intervention programmes with emphasis on condom use has lead to
acceptance of condoms as a means to prevent spread of HIV infection.
An extension of the project is being sought from NACO to increase condom
use during MSM.
60128 Government participation in improving quality of life
Rita S.C. Nyamayaro. 52 Wellington House, Fife and Mazde Avenue Harare,
Zimbabwe Africa
Issue: People living with the AIDS virus should get priorities in income generating
funding.
Project: As a social worker go into the community either assessing people's
living conditions or doing counselling programmes to people in general. Lately
i have found my attention to people with HIV/AIDS as they are increasingly
requerting my help. Many of these people cost of living rises once they know their
conditions as the try to keep themselves healthy or seek medication, yet most of
them are already out of employment. I then help these people to obtain Public
Assistance money from the government for self sustainance.
Results: Given the resources and strength PLWH a canengage in macro-pro-p
jects like informal trading fo facilitate for their own good health. Being economically
independent they actually live positively
Lessons Learned: Governments should be able to give priority and make
available small cash infection to PLWH/A and make them self reliant even on their
own primary health care and not rely on free medication and not having enough
food to eat.

60129 Adherence to anti-retroviral therapy: A four-country
comparison
E. Gir1, R. Pratt2, E.H. Bunch3, W.L. Holzemer4. 1 University of Sao Paulo,
School of Nursing, Ave. Bandeirantes 3900, Ribeirao Preto, SP Brazil; 2 Thames
Valley University London, UK; 3lnstitutt Sykepleievitenskap, Oslo, Norway 4Int.
HIV/AIDS Nursing Research Network; Univ. of California, San Francisco, San
Francisco, USA
Background: Non-adherence to anti-retroviral therapy is a well recognised phenomenon and may be the principal reason for an increasing incidence of newly
emerging drug-resistant strains of HIV. This study examined factors that may be
associated with adherence to therapy in different cultures.
Methods: A descriptive, questionnaire survey design was used to investigate
multi-centre differences in self-reported adherence to anti-retroviral therapy for
HIV disease in four centres: London, UK (n = 64); Oslo, Norway (n = 26); San
Francisco (n = 95); and Ribeirao Preto, Brazil (n = 50). Three indices to reflect
adherence were employed: The Moriksy Medication Adherence Scale (4 items,
alpha =.71); self-reported missed clinical appointments in the last month (5 items);
and whether the patient followed health care provider's advice and instruction (5
items). Using a one-way analysi of variance with Scheffe' post-hoc comparisons,
selected demographic characteristics adherence measureswere entered into the
model.
Results: The sample (n = 235) comprised 22.6% female, 58.3% white with a
mean age of 39 years (SD = 9.04, range 19-73) and a mean CD4 count of 236
(SD = 204, range 3-960). A total of 46% of the sample reported that they forgot
to take their HIV medications. Women reported higher medication adherence
than did men (t = 1.98, p <.05). There were no differences among centres on
medication adherence or missed appointments. There was a significant difference
among sites on following advice and instruction; San Francisco clients were more
likely not to follow advice & instruction (F = 301.1, p <.001)
Conclusion: Almost half of all persons in this cross cultural sample forgot, on
occasion, to take their HIV medications. No significant differences in medication
adherence to therapy or in keeping appoints could be dmonestrated among these
four centers. These results are consistent with estimates of adherence in other
chronic diseases.
60130 School and AIDS: Vulnerability reduction as a preventive
strategy
C.M. Jose Ricardo Ayres1, I. Franca Junior2, G.J. Calazans3, O.A.A. Valenca4,
H.C. Saletti Filho. Rua Cotoxo 799 AP.54 CEP: 05021-001 Sao Paulo/SP, Brazil
Issue: The epidemiological relevance of teenagers to the HIV/AIDS pandemic
is progressively higher, converting school into a strategic setting for prevention.
However, preventive activities carried out in schools, which are usually aimed at
risky bevaviours reduction, have been showing limited results.
Project: Seeking to contribute to the improvement of such results, a school
prevention programme was conceived, aimed at the production of structural and
sustained response in the school community rather than restricted to the binomial
'information/bevavioral change'. The project has been undertaken in a public high
school located in a disadvantaged neighborhood in Sa o Paulo city, Brazil. By
means of in-depth interviews with students and teachers, we gathered information
on behavioral, social and programme-related aspects wich make those students
more vulnerable to HIV/AIDS. This process led to the production of a video, used
as a basis for discussions with all school members, and to a local 'diagnosis'
based on wich medium and long term intervention could be planned.
Results: Fragile family backup, hopelessness in relation to the future and
restrict access to health care and health promotion resources were the main
vulnerability aspects identified. Among the first concrete responses to the intervention, was that students, teachers and staff worked together in a series of
educational games and activities in the community wich enabled them to collect
more than a ton of food, wheelchair, crutches, clothes and shoes, wich were
taken by the students themselves to children living with AIDS aid institutions at
the neighborhood.
Lessons Learned: Vulnerability reduction proved to be an innovative and productive approach to diagnose and set bounds for prevention programmes in the
school environment, guiding strategies capable of generating positive community
response. Setting up community networks pottentially enables changes in structural determinants of teenagers exposure to HIV infection and its undesirable
outcomes.
S60131 | Solutions to system failures: Abort, retry, ignore?
Chitra Subrahmanian. 3VA Ilankann I Pr Asad P Lot#575B Mori Road, Mahim,
Mumbai, India
Issue: An ecosystemic approach in the field of HIV/AIDS can serve as a model
for coordinated care. However, when multiple systems work together there arise
several opportunities for "system failure", which call for proper management if
system users are not to be severely inconvenienced.

Project: CASA is an NGO providing counseling and support services to individuals, couples, and families affected by HIV/AIDS. From inception, we have been
comitted to a systemic approach to working in the field. The bulk of our work has
been in the public hospital system. This paper is based on our experiences in
that system as well as on our involvement in a public interest lawsuit by the State
of Maharashtra, involving the "rescue and rehabilitation of underage female sex
workers.