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

12th World AIDS Conference

Abstracts 60303-60308 1055

60303 Integral health services for women sexual workers:
An alternative for the prevention and control
of STD/AIDS
Martha Londoho1, M. Gil2, M. Cardenas3, M. Martinez4. 1Directora Programas
Santa Ana CA, USA; 2Programa Sida Metrosalud Medellin AT; 3Sicologa
Programa Sida Methosalud Medellin AT; 4Medico Programa Sida Methosalud
Medellin AT Colombia
Issue: Medellin, Colombia has a population of 2,000,000 residents, current unemployment rate is 15%, sexual work has become an alternative as a means of
income for a group of women.
Project: For public health, sexual work is a conduct that helps the propagation
of diseases. There has been an attempt to address this threat by requiring a
certificate or an identification in order to be able to work. This requirement has not
only resulted m in being ineffective but also discriminative; reducing the health
status of women. This is evident in the periodic examinations performed on only
one part of the body. The health status of 180 women sexual workers who are
leaders was evaluated.
Results: With an interdisciplinary team we were able to serve these women
who were 100% HIV negative. 98% did not know how to perform a self breast
exam and they had never had a screening performed, 5.9% were diagnosed
positive with chlamydia, 1% with VDRL titulation, 88% had difficulty with their
vision, 5% had lesions in the gums and the soft tissues of the mouth, and 78%
had dental problems.
Lessons Learned: HIV/AIDS prevention should not focus on programs that
provide information and education. Instead, there should be an emphasis on
models with an integral focus in which the recovery and sustainability of health
is accessible to the underrepresented and discriminated human beings, like the
women sexual workers.
60304Antiretroviral treatment in HIV-infected children: Data
from Department of Infectious Diseases in Childhood,
Medical Academy of Warsaw
Magdalena Marczyhska1, M. Szczepanska-Putz1, A. Piasek2, A. Lipniacki2. 137
Wolska St, Warszawa 01-201, Klinika Chordb Zkaznych Wieku Dziecie AM;
2AIDS Diagnosis & Therapy Center, Warzawa, Poland
Objectives: The aim of this paper was to assess the effectiveness of antiretroviral
therapy in HIV-infected children.
Methods: Since January 1987, 21 HIV-infected children have been treated in
our Department. Initially zidovudine, as a single antiretroviral agent, was administered. Since 1994 two-drug regimen (zidovudine, didanosine) has been advised.
In 1997 combined therapy (two nucleosides, protease inhibitor) was started.
16 of currently treated children were infected vertically, 1 child suffered from
haemophilia, and in one case the source of infection is unknown. There are 16
male (9 infected vertically) and 6 female (all infected vertically) children in the
group. The oldest patient (with haemophilia) is 14 years old. The average age
among vertically infected children is 3 years and 9 months (the youngest is 3
months old, the oldest 8 years old). The average age when vertical tramsmission
of HIV infection was confirmed was 1 year and 2 months. Late diagnosis of
mother to child transmission was due to lack of availability of laboratory tests
before 1994. Vertically infected children have been receiving antiretroviral drugs
since the diagnosis was confirmed.
Results: Mild symptoms of HIV infection were observed often (currently there
are 7 patients in clinical category A), moderate in 7 children. AIDS diagnosis has
been established in 6 cases. Two children died. Combined treatment is usually
well tolerated. Anaemia is the most serious side effect. Blood tests of 3 children
treated with antiretroviral drugs showed no signs of viral replication.
Conclusions: Effectiveness of therapy depends of the availability of antiretroviral drugs. In Poland the accessibility of drugs necessary for HIV-infected children
is still insufficient.
60305 Vertical transmission of HIV: Data from Department of
Infectious Diseases in Childhood, Medical Academy of
Warsaw
Magdalena Marczyhska', M. Szczepahrska-Putz, A. Piasek2, A. Lipniacki2. 1 37
Wolska St, Warszawa 01-201, Klinika Chordb Zkaznych Wieku Dziecigcego AM;
2AIDS Diagnosis & Therapy Center, Warszawa, Poland
Objectives: The trial was to assess the risk of HIV infection in children born to
HIV-positive mothers.
Methods: There were 92 children born to HIV-positive mothers from 1987 to
1997. Laboratory tests, including virus culture, polymerase chain reaction (PCR),
p24 antigen detection, amount of CD4/CD8 lymphocytes, has been carried in the
AIDS Diagnosis and Therapy Center. In 18 cases HIV-infection was confirmed.
78% of HIV-positive women were intravenous drug users. Since October 1994 the
zidovudine prophylaxis has been administered in 32 women and their children. In
none of the children HIV infection has been confirmed till now. Unfortunately, there

are still many HIV-positive pregnant women who do not receive any prophylaxis.
Results: A transmission rate among mother-infant pairs was 31.5% (years
1989-1994) and 11.9% (years 1994-1997). The overall transmission rate was
19.5% (years 1989-1997).
Conclusions: AIDS Clinical Trials Group Trial 076 prophylaxis program reduced the transmission from mother to child. Tests confirming HIV infection in
pregnant women are not widespreadly used in Poland. It is very hard to decrease

vertical transmission, because offer of HIV infection screening is treated as a
restriction by most of patients.
S60306 The use of NASBA for monitoring plasma HIV-1 RNA
levels
Judit Segesdi1, A. Gyuris', D. Banhegdi2, D. Vodr6s', A. Bakos', J. Minarovits'.
1Microbiol. Res. Group, Natl. Center for Epidemiology, Piheno Ut 1 H-1529;
2Dept of Immunology, St. Laszlo Hospital, Budapest, Hungary
Objectives: NASBA was introduced at the end of 1996 in Hungary. We used
this method to monitor plasma HIV-1 RNA copy levels in 32 patients treated with
antiretroviral drugs.
Design: We obtained plasma samples from patients with ARC (CDC group B)
and AIDS (CDC group C) of the St. Laszlo Hospital, Budapest. They were treated
with AZT alone or in combination with ddl, ddC or lamivudine.
Methods: HIV-1 RNA levels were measured by NASBA according to the
recommendations of the manufacturer.
Results: All 4 patients treated with AZT alone showed a significant decrease
of plasma HIV-1 RNA level or a stable, low HIV-1 RNA level and required no
combination therapy. 21 of 28 patients treated with a combination of AZT and
another RT-inhibitor showed a similar response; a moderate increase of plasma
HIV-1 RNA was detected, however, in 5 cases. High and stable HIV-1 RNA level
was observed in 2 further patients undergoing combined therapy.
Conclusion: We concluded that NASBA is reliable method for the monitoring
of antiretroviral treatment.
-60307 A qualitative survey of STD facilities in Hanoi, Laocai,
Ninhbinh Provinces of Vietnam
Main Ngoc Que', Paula Quigley, Stephen McNally2, Nguyen Van Kinh3,
Lethuna'. 1GTZ/NAC HIV/AIDS/STD Control in Vietnam 16 PAAM Dinhho,
Hanoi Vietnam; 2The Australian National University Canberra; 3Hanoi Medical
University, Vietnam
Objective: To assess the quality of STD case management in three project
provinces in both public and private health facilities
Methods: A total of 97 health care providers (HCPs) were observed and interviewed in 79 STD health facilities (335 observations) using form 2 + 3 of the
WHO/GPA protocol (Evaluation of National AIDS program, A method Package,
Section 5)
Results: Fifty-five percent of HCPs specialised in obstetrics, gynecology and
68% of patients were female. Non-gonorrhoeal urethritis (NGU) was the commonest diagnosis (50%), followed by gonorrhoea (19%). The majority of HCPs
base their diagnoses on both a syndromic + aetiologycal approach, with 21%
relying entirely on the syndromic approach, only 5% entirely on an aetiological
approach. More than half of the clinics do not have a microscope and must refer
cases to another center for aetiological diagnosis. Just over half of HCPs follow
a specific treatment guideline in STD case management. Overall, 86% of observations were shown to have adequate history-taking, through examination and
appropriate treatment given. However, only 56% of observations were recorded
as having condoms promoted for STD/HIV prevention and partner notification
advised.
Conclusion: Appropriate STD case management should be reinforced by refresher training on the syndromic approach and the issues of condom promotion
+ partner notification should be stressed in future training programmes.
| 60308 Poor experiences of health care leads to avoidance by
HIV-positive gay men in youth, ages 18 to 27, and can
influence access and adherence
Arn J. Schilder', Christopher Buchner2, R.S. Hogg', I. Goldstone', T. Trussler3,
M.T. Schecter', M.V. O'Shaughnessy'. 'B.C. Centre for Excellence in HIV/AIDS,
613-1081 Burrard Street, Vancouver, BC, V6Z 1 Y6; 2 YOUTHCO, Vancouver, BC;
3Research & Ethnographic Consultant, Vancouver, BC, Canada
Issue: To support longer survival, it is necessary to reach an understanding of
the knowledge and the experience of HIV-positive gay youth of HIV antiretroviral
therapies and mainstream health care.
Project: This qualitative study utilized grounded theory with data collection
through a peer-facilitated focus group and 4 interviews. Demographic data were
collected using a questionnaire. Focus group and interviews elicited information
on experiences with: [1] health care; [2] primary care. Audio tapes were transcribed verbatim. Major themes were generated and sub-themes explored via
hierarchical branching schema.
Results: The study attracted 9 male gay youth ages 19 to 27; 5 took antiretroviral drugs. Barriers to adherence in therapy were conflicts with dosing and dietary
schedules impeding participation in community life which undermined self-concept
and social identity. Profound fear of side effects and disbelief in therapies delayed
therapy. Primary care physicians emerged as important figures. Youth reported

judgmental behavior and stereotyping within the health care system and were
unable to negotiate satisfactory doctor-patient relationships. Reference to sexual
misconduct by physicians surfaced with self-reported sexual ideation towards
the physicians. Hepatitis infections and HPV were common. Treatment for STDs
was given without counseling. When requested in the presence of depression
access to psychological care was denied. Current and past homophobic care with
no experience of acute care except poor emergency care. Insufficient physician