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

12th World AIDS Conference

Abstracts 60335-60339 1061

New Castle disease virus and sequences of the Japanese Encephalitis virus.
This common motif among neurodegenerative entities may indicate that it is a
relevant fragment for neurodegeneration. Our preliminary in vitro results show
that the pentapeptide GAIIG decreases the PC12 neuronal cell line viability in a
concentration-dependent manner.
Conclusion: Our findings show that a part of HIV-1 gp120 V3 region, GAIIG,
may be an important fragment for the pathogenicity of this virus in the brain.
60335 1Recommendations for HIV education in the early
elementary grades: A review of US policy and evaluation
practice
Beatrice Krauss, S. Huie, R. Weidner, L. Goldsamt. NDRI, Two World Trade
Center 16 Th FL, New York, NY 10048, USA
Issues: Two literatures on US school-based HIV education exist side by side:
1) recommendations for curricular practice made by front line educators or professional bodies, and 2) evaluations of educational impact on skills, intentions or
attitudes conducted largely by social scientists. Differences in these two literatures
are examined.
Project: Two quality-controlled databases were created for documents published 1988 to 1995. Potential recommendation documents were excluded because of irrelevance to school sites (50%), lack of community input (37.5%),
insufficient detail (37.5%) or lack of medical input (25%). Evaluation documents
were excluded because they had no comparison group (43.2%); reviewed or
described, rather than evaluated, education (40.5%); were pilot studies (18.9%);
or provided insufficient detail about study characteristics (13.5%). Interventions
unlikely to be replicable or measuring only knowledge were also excluded (5.4%).
Results: Recommendations outnumbered evaluations 3:1. 21.7% of the recommendations were targeted toward college students or future teachers, 19.5%
Junior High students, 30.4% High School students and a surprising 26.2% children
Grade 6 and below. Early, continuous HIV education was advocated because
students are exposed throughout development to multiple sources of influence
and (mis) information regarding HIV, persons with HIV and HIV risk. In contrast,
38.7% of evaluations were performed with college students, 38.7% with High
School students and nearly all the remainder above Grade 6. Outlets for recommendations are widespread (62 journals); evaluations are less readily available
(34 journals), both appear in only 15, 11 of which focus on health promotion.
Lessons Learned: The literatures of researchers and practitioners are relatively isolated from one another and differ in age focus and comprehensiveness.
While most recommendations concern design or implementation of programs and
policies to prevent HIV, a growing number wish to assist with the adjustment of
and social reactions to persons who are infected with HIV or are HIV-affected.
Supported by US MHSB56340.
60336 Patients declining highly active antiretroviral therapy
(HAART): Who are they and why?
Jin S. Suh, K.A. Sepkowitz, M. Carrow, D. Armstrong. Memorial Sloan-Kettering
Cancer Center 1275 York Avenue New York, NY, USA
Background: It is now well established that survival and morbidity of HIV patients
have dramatically improved with HAART However, despite encouraging results, a
significant proportion of pts continue to decline treatment. We therefore, examined
the demographic make-up and perceived obstacles in pts declining HAART.
Methods: Data from HIV+ patients followed by the infectious disease clinic at
MSKCC was extracted, including demographic and clinical information through
patient interview.
Results:
HAART offered

60337 The use of program indentifiers as a social networking
tool
Kristen Weeks-Norton, T. Reynolds, J.A. Finney. Prevention Marketing Initiative,
Ste 203, 909 12th Street, Sacramneto, CA, USA
Issue: Program indentifiers enable communication regarding HIV prevention
between program participants and their peers, partners, parents, and service
providers.
Project: Teens Stopping AIDS is a project of US Centers for Disease Control
and Prevention's Prevention Marketing Initiative in Sacramento, California. The
goal of this project is to develop a program to reduce the sexual transmission of
HIV in young people utilizing social marketing, behavioral science and community
involvement. Skills-building workshops, a toll-free information line and a media
campaign are combined to educate teens and their families about the health risks
of unsafe sexual activity. Program identifiers or incentives such as caps, dog tags,
T-shirts, safer sex packs, and delay packs are given to each participant attending
a Teens Stopping AIDS workshop. Worn or distributed the identifiers, are seen in
the neighborhoods that young people live in or frequent during their daily routines.
Results: Information exchange occurs as a direct result of program indentifiers.
Participants act as an extension of the project by informal outreach that promotes
program components, provides prevention information, recruits new participants,
and presents an opportunity to further dialogue with partners and other interested
parties (in this case parenting adults).
Lessons Learned: Research and pretesting with the target audience reveals
program identifiers that are far more likely to be effective. Maintaining consistent
design elements with every aspect of the program including the identifiers allows
for greater program recognition, credibility and reach.
60338 1 Attitude of French GPs towards care for HIV infected IDU
patients
Noelle Escaffre1, M. Souville1, J.P. Moatti1, M. Morin2, J.A. Gastaut3. llnserm
Research Unit 379 (ORS-PACA), 23 Rue S. Torrents-13006 Marseille;
2Laboratory of Social Sciences, Aix en Provence; 3lnstitut Paoli Calmettes,
Marseille, France
Objectives: To assess attitudes and practice of French General Practitioners
(GPs) toward drug users according to their experience of HIV care.
Methods: Data were collected by telephone interviews in a national random
sample of French GPs (n = 1, 186 response rate = 70.3%) carried out in April
1996. The questionnaire included questions dealing with the sociodemographic
professional and personal characteristics of GPs, attitudes and experience of
GPs with care for IDUs and/or HIV-infected patients as well as ethical and public
health issues.
Results: During the previous year, a majority of GPs (53.3%; n = 632) had at
least one consultation with an IDU. Only 24.0% of the total sample had taken
care of an IDU patient and 8.4% (n = 100) had taken care at least of three
or more IDUs. Overall, 59.1% (n = 169) of GPs who took care of IDUs also
participated in care for HIV-infected patients. On the other hand, only 35.2% of
the 480 GPs involved in HIV care have also taken care of IDUs. About a third of
GPs who took care of IDUs had regular collaboration with specialist services for
drug users; only 35 of them (12.3%) were members of formal "HIV care networks"
supported by public health authorities in order to organize collaboration between
primary care physicians and hospitals specialist services. GPs involved in IDUs
care have a higher proportion of patients with HIV-related risk behaviours in their
practice (31.9% vs 12.2%); the expressed a greater comfort level with care for
IDU patients (55.6% vs 42.5% "felt rather or totally at ease in consultation with
IDU patients"); availability of condoms in their office for preventive counselling
was more frequent (49.1% vs 37.0%).
Conclusion: Many problems of drug abuse and HIV infection should be dealt
with in general practice, therefore it has been suggested that linking primary
medical care with drug maintenance treatment can bring critical services to
HIV-infected IDUs. This study indicates that only a minority of motivated GPs is
involved in care for IDUs and that policy improvement for HIV treatment must be
based on this minority.
|60339 Privatizing Medicaid: The implications for HIV prevention
of privatizing government financing for health care
services for low income populations
Elizabeth Wehr1, K.J. Rauch2. 12021 K Street NW Suite 800 Washington DC
20006; 2Centers for Disease Control & Prevention Atlanta GA. US
US states are privatizing Medicaid, the primary program that finances health
care services for low-income populations at heightened risk for HIV infection. To
receive covered services, many Medicaid beneficiaries must now join managed
care plans, a privately-administered form of insurance that furnishes all needed
health care services for a fixed premium. Difficulties in insuring the high costs of
HIV and AIDS-related services are well reported. But little is known of the implications of managed care for population-based HIV and AIDS prevention activities,

i.e. risk reduction counseling, screening, surveillance and partner notification.
To ensure continuation of population-based HIV and AIDS prevention activities
in a managed care environment, the US Centers for Disease Control and Prevention (CDC) has supported analyses of the Medicaid managed care contract
documents that set out service, reporting and other health care duties of plans.
Analysis by the Center for Health Policy Research at the George Washington
University Medical Center indicates that in purchasing managed care services,

Total= 97 Accepted = 82 (84%)

Sex
male
female
Race
African-American
Hispanic
Caucasian
Risk Factor
heterosex.
homosex.
IVDU
Viral load (median)

65
32
27
27
43
44
45
8

55
27
18
25
39

Declined = 15 (16%)
10
5
9
2
4.005
NS

38
37
7
24K

6
8
1
41K

Common reasons for declining HAART included the following: fear of medication side effects (5 pts), denial of one's medical condition (4), negative feedback
from peers (4), awaiting resolution of other medical issues (2).
Conclusion: The benefit of HAART has been well demonstrated and its use
is a community standard in most US cities. However, similar to a decade ago,
when AZT monotherapy was introduced, a significant proportion of patients (15%
in this study) continue to decline therapy despite MD recommendation. Additional
studies are needed to define demographic determinants of declination and to
develop targeted, effective interventions to improve acceptance of HAART.