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

12th World AIDS Conference

Abstracts 60207-60211 1037

should focus on young gay and bisexual men with histories of sexually transmitted
disease, alcohol abuse, and low self-efficacy for adopting HIV preventive methods.
60207 Males who have sex with males (MSM): Promoting
supportive social environment and strategies for sexual
health interventions
Ananya Banerjee1, S. Sengupta2, K. Verma3. 15 Dr TN Mazumbar Street,
Calcutta; 2Project Officer WB. Sexual Health Proj., Calcutta; 3Asst. Project
Officer WB.S.H.P, Calcutta, India
Issue: Understanding social response to same sex relationships and determining
what need to be done to promote a supportive social environment and design
effective sexual health interventions for MSMs.
Project: Denial of sex between males in India has made it difficult to undertake
sexual health interventions amongst MSMs. This paper is the result of desk research on gay movements in India and focused group discussions and interviews
undertaken with MSMs during which, using the "problem analysis" approach,
MSMs came up with strategies for designing sexual health interventions and
promoting social change.
Results: Strategy for promoting supportive environment could include:- 1.
Mainstreaming MSMs and neutralising homophobia through greater interactions
with the larger society through media advocacy and campaigns, talk shows. 2.
Support through sibling/family support groups 3. Creating MSM support groups,
newsletters 4. Advocacy at the political level for repealing laws criminalising
homosexuality 5. Mobilising legal support 6. Sensitising journalists, writers, film
makers, artists etc. The strategies for sexual health interventions could include:1. Increased awareness generation and outreach amongst MSMs in cruising
spots through peer education, counselling and support. 2. Establishing drop in
centres (for counselling) and telephone hot-lines for MSMs, 3. Promotion of safer
sex practices and condom use through Behaviour Change Communication (BCC)
4. Distribution of quality condoms appropriate for anal sex and lubricants at affordable rates 5. Organising safer sex work shops modelled after the "eroticising
safer sex" model. 6. Advocacy with local STD practitioners and making referrals
to "friendly" doctors for treating STIs.
Conclusion: It is essential to consider the social and legal situation and their
implications for sexual health interventions. The more repressive the societal
response to sex between males, more will it be difficult for implementing sexual
health interventions. There is a need to develop local strategies for sexual health
interventions with MSMs and simultaneously create a supportive social environment through advocacy, activism, networking and support groups at the local and
national levels.
60208 Early participation in a HIV cohort study slows disease
progression and improves survival
Manuel Battegay1, M. Wirz2, M.H. Steuerwald1, M. Egger3. 1 University Hospital
of Basel Petersgraben 4, 4031 Basel; 2University of Berne, 3000 Berne,
Switzerland; 3University of Bristol, Bristol, UK
Objectives: Experience of physicians may be associated with differences in
survival of patients with HIV-infection. We examined whether early participation in
the Swiss HIV Cohort Study (SHCS), a prospective study with regular follow-up
visits at specialized centres, improved survival.
Methods: We studied 3553 HIV-infected participants (pts) joining the SHCS
with different levels of immunodeficiency: mild (CD4 - 500 cells; N = 2038),
severe (100-199 cells; N = 960) and very severe (50-99 cells, N = 555). Characteristics at different CD4 cell levels were compared and Cox proportional hazards
regression was used to examine the mortality experience during a total of 16201
person-years.
Results: Pts joining the cohort early with mild immunodeficiency were younger
and more likely to be female. At comparable levels of advanced immunosuppression they were less likely to have a history of (PCP) or AIDS, more likely to be
on prophylaxis against PCP and more likely to be on antiretroviral therapy than
those joining with severe or very severe immunodeficiency. At the time of the
first CD4 cell count in the range of 50-99 cells, 8.9%, 15.0% and 21.6% of pts
who joined with mild, severe and very severe immunodeficiency had a history
of PCP. In Cox models adjusted for CD4 cell count at entry, age and year of
enrollment, mortality was increased among pts who joined with severe and very
severe immunodeficiency. Hazard ratios (95% confidence interval) were 1.71
(1.21-2.42) for pts with severe immunodeficiency at entry and 2.61 (1.70-4.01)
for those with very severe immunodeficiency as compared to 1.0 for those with
mild immunodeficiency at entry.
Conclusion: Individuals who had been seen regularly at specialized HIV units
since the early stage of HIV infection were, at comparable levels of immunodeficiency, less likely to progress to AIDS and mortality was reduced.
60209 Pelvic exam performance improvement campaign - New
York State Department of Health AIDS Institute

(NYSDOH/AI)
Robert N. Gass, B.D. Agins1, P.A. Simino Boyce1, R. Glaros2, D.J. Jemiolo2,
M.D. Waters1. 'AIDS Institute, NYS Department of Health, 5 Penn Plaza, New
York, NY; 2AIDS Institute, NYSDOH, Albany, NY, USA
Issue: HIV-infected women have increased rates of HPV and cervical dysplasia,
which if left undetected, can rapidly progress to cervical cancer. Pelvic exams (PE)

with PAP smears are standard clinical practice, yet are provided inconsistently
warranting implementation of a statewide performance improvement campaign.
Project: The NYSDOH/AI's Continuous Quality Improvement (CQI) Program
conducts reviews based on quality indicators linked to clinical care outcomes at
facilities providing HIV care. Performance data on the provision of PEs have remained between 66% and 79% over the last 5 years. To improve PE performance,
a campaign launched in 1997 will: 1) identify correlations between service delivery
models and PE performance, 2) determine and disseminate examples of best
practices, 3) support use of CQI methods by providers through free consultation
services and QI software, and 4) publicly release facility-specific performance
data.
Results: Annual pelvic/PAP exam performance:
Performed 1993 1994 1995 1996 1997
66% (N = 888) 77% (N = 1075) 76% (N = 1880) 79%, (N = 1661) 79%0 (N = 786)
Incomplete data for 1997.
PE data through 3/98 and broken down by facility type (hospitals, community health centers, drug treatment programs), exposure category (IVDU, sexual,
other), and geographical location (urban, rural), to be presented at Conference
along with results regarding correlations between service delivery models and
pelvic exam performance.
Lessons Learned: State health departments may play an important role in
promoting improved pelvic exam performance by encouraging use of effective
service delivery models, engendering competition through public release of data,
supporting the use of CQI methods by providers, and promoting innovative
approaches related to the provision of GYN care.
60210 HIV, syphilis and HTLV prevalence and risk factors in
food handlers in Kajiado District, Kenya
Thomas Verstraeten, A. Keya1, A. Vandamme2, F. Nang'Ole1. PO. Box 30461,
Nairobi; Ministry of Health, Kajiado, Kenya; 2Catholic University Leuven,
Leuven, Belgium
Objective: To assess the prevalence of HIV, syphilis and HTLV infection in a population of food handlers in Kajiado district and identify possible factors increasing
the risk of infection.
Methodology: Serum samples were taken from 514 food handlers from seven
different sites from the district, after administration of a questionnaire including
questions on age, education, marital status, condom use and number of partners.
Samples were screened for HIV I or II by EIA (Abbott), positives confirmed by
Serocard rapid test, for HTLV I or II antibodies by EIA (Abbott) and positives
confirmed by Western Blot, for Syphilis by RPR, positives confirmed by TPHA.
Results: The male/female ratio was 1.8, the mean age 26 yrs. Marital status:
34% single, 63% married and 2% divorced or widowed. Education: 5% none,
63% primary, 29% secondary and 2% a higher level of education.
The following prevalences were found: HIV I-l1: 13.0%, HTLV I: 0.4~0, HTLV II:
0. 0%, Syphilis 0.9%.
Significant risk factors for HIV infection were: female sex (OR = 3.2, p - 0.001)
and number of new partners last 3 months (OR = 2.1, p = 0.001)
Conclusion: HIV infection is highly endemic among food handlers in Kajiado
district. HTLV and syphilis prevalence rates are low in this population. Efforts to
diminish the spread of HIV should focus on the female food handlers and aim at
reducing the number of non-regular partners.
60211 Acupuncture treatment in people with HCV and HIV
co-infection and elevated transaminases
Misha Cohen, C.J. Wilson, A. Surasky. Quan Yin Healing Arts Ctr. Suite 202,
1748 Market Street, San Francisco, CA, USA
Objectives: To compare the results of acupuncture treatment versus no treatment
in patients dually infected with HIV and hepatitis C virus (HCV) or hepatitis B virus
(HBV) and who have elevated hepatic transaminases.
Design: Prospective, randomized controlled pilot study.
Methods: Fifteen patients with confirmed HIV and either HBV or HCV were enrolled into a sixteen week pilot study to determine whether acupuncture treatment
was useful in reducing elevated hepatic transaminases. Included were patients
whose alanine aminotransferase (ALT) levels were more than 2.5 times normal
levels. Patients were excluded who were already receiving acupuncture treatment, herbal treatment or pharmaceutical treatment for chronic viral hepatitis.
A sub-study compared a group receiving Korean acupuncture treatment versus
Chinese acupuncture treatment. Subjects were tested at week 0 and week 17 for
ALT levels.
Results: Of the fifteen patients enrolled, eight were randomly assigned to the
acupuncture group and seven to the control group. In the acupuncture group
5 out of 8 patients (62.5%) had significant drops in ALT levels, with 2 (25%)
whose levels dropped to within the normal range. All 8 in the acupuncture group
completed treatment. Also, 2 (25%) of the acupuncture group had ALT levels drop

more than 200%. There was no difference between the Korean style and Chinese
style treatments. In the control group, there was only 1 (14%) patient whose ALT
level dropped, but not significantly. In the control group. 4 (57%) persons did not
complete the study. There were 2 drop-outs, 1 death, and 1 person too ill to have
labs drawn at the end of the study. In natural history studies it has been found
that only 10% of untreated infected patients will have a significant drop in ALT
levels over a one year study period.