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

12th World AIDS Conference

Abstracts 60439-60443 1081

60439 Characteristics of AIDS patients referred to home care
service in metropolitan area of Rome
Giorgio Antonucci', N. Orchi2, E. Girardi2, M. Fantoni3, C. Del Borgo3,
G. Turbessi4. 1 Ctr Rif AIDS IRCCS L. Spallanzani Via Portuguense 292 00149
Rome; 2Centro Rif AIDS-IRCCS L. Spallanzani Rome; 3Universita Cattolica
Sacro Cuore Rome; 4 Universita La Sapienza Rome, Italy
Background: Home care for AIDS patients is highly recommended during chronic
phases of disease. A new model of hospital-based home care for AIDS patients
based on integration of private and public sectors coordinated by a public regional
center has been implemented in the metropolitan area of Rome. The aim of the
present study is to define specific characteristics of patients determining referral
to home care.
Methods: We conducted a case-control study of AIDS patients living in
metropolitan area of Rome, The case patients were all those discharged from
local hospitals and referred to home care during 1997. The controls were AIDS patients discharged but not referred to home care. Every case patient was matched
with two controls. Data on different demographic, social, economic and clinical
characteristics were collected at discharge.
Results: Univariate analysis based on 118 case patients and 236 controls
showed that significant (p. 0.05) characteristics for referral to home care were
housing, availability of housekeeping services, AIDS as defined by clinical condition, lower level of CD4+, lower scores of Karnofsky Index (p < 0.01) and
Functional Independent Measure. Moreover, intravenous drugs for citomegalic
disease or fungal infections, and HIV-related encephalopathy were significantly
related to referral to home care. Gender, age, marital status, ethnicity, HIV-transmission category, education, job status, living alone, and income status were not
significantly related to referral to home care.
Conclusions: Demographic, social and economic characteristics do not appear to affect demand of home care for AIDS patients. On the other hand, more
advanced state of disease and need of intravenous drug-therapy are strongly
related to referral to home care. Housing and availability of housekeeping services
seem to ease (make easier) implementation of home care. Our data could be
useful in planning home care services for AIDS patients in metropolitan areas.
60440 HIV, hepatitis B and C among drug users in methadone
maintenance treatment in Geneva between 1988 and 1995
Barbara Broers', C. Junet2, M. Bourquin2, J.J. Deglon2, L. Perrin3, B. Hirschel1.
Division of Infectious Diseases-AIDS Unit Hopital Cantonal 1211-Geneva-14;
2Phenix Foundation Geneva; 3Laboratoire De Jerologie Virale Geneva,
Switzerland
Objectives: To evaluate the prevalence and incidence rates of infection with
HIV, hepatitis B (HBV) and hepatitis C (HCV), in a cohort of drug users (DU) in
methadone maintenance treatment (MMT).
Methods: All consenting DU starting and in MMT in a private programme in
Geneva, Switzerland, between 1988 and 1995, were tested bi-annually for HIV,
HBV and HCV.
Results: Over 700 DU participated, the follow-up rate was 80%. Prevalence
rates at start of treatment, reflecting "out-of-treatment" risk behaviour, decreased
significantly over time:

explore the variety of ways the project had been influenced. The interviews were
thematically analysed and these preliminary results fed back to interviewees and
discussed in a focus group.
Results: (1) The evidence on which workers based projects was more likely to
be of a social, political, and psycho-social nature than a formal research nature.
(2) A broader definition of evidence allowed workers to be more innovative in their
project design. (3) Workers placed a high value on their personal experience and
intuition and many felt this was being increasingly devalued by the emphasis on
a narrow view of evidence.
Conclusions: (1) A project that reflects the identity of the worker can be an
appropriate intervention for that particular type of person, however there is no
evidence to suggest gay men's workers fully reflect the community they aim to
influence. (2) Worker training needs to explore the different definitions of evidence
and the appropriate use of the different types
L60442 Comprehensive and diversified HIV prevention in the
Czech Republic
Jaroslav Jedlicka12, M. Bruckova2, J. Vytlacil3, G. Walter3. 1NRL AIDS
Srobarova 48 100 42, Prague 10; 2National Institute of Public Health, Prague;
3 Czech Ministry of Health, Czech Republic
Issue: To review the wide spectrum of different HIV preventive activities in the
Czech Republic.
Projects: The first Medium-Term Plan for the Prevention of HIV/AIDS in the
Czech Republic (1993-1997), developed with support of the former GPA/WHO,
included wide range of structured preventive activities focusing on STDs/HIV
transmission in the country. The National Institute of Health Promotion and National Institute of Public Health were responsible for nation-wide activities such as
edition of preventive materials (brochures, leaflets, videos) and awareness-raising
campaigns in TV and radio. Sexual education was gradually implemented in the
curricula of primary and secondary schools. Several peer education programmes
and streetwork projects were developed by NGOs. Border-crossing social work
projects in cooperation with Federal Republic of Germany started to operate in
several places, focusing on multinational group of female commercial sex workers. Free of charge anonymous HIV tests and counselling were available in almost
100 testing sites in the public health sector. The National AIDS Helpline was set
up. Needle exchange programmes in larger cities were financially supported from
the National AIDS budget. NGOs' cooperation with the National AIDS Programme
was strengthened by establishing the NGO Umbrella organisation "Forum" and
its representation in the National AIDS Committee.
Results: We believe that HIV epidemic in the country was slowed down by the
comprehensive and diversified approach with active participation of the non-governmental sector. However, the true effectiveness of different activities aiming to
induce behavioural changes was difficult to measure.
Lessons Learned: Continuous monitoring of behavioural and HIV/STDs preventive indicators has to be more developed in order to reflect actual situation
in the society and population groups. More active involvement of PWHA in the
prevention process has to be reached and more intensive commitment from the
political platform is needed to consider AIDS as a priority objective.
60443 Congenital syphilis and funisitis: Detection of T. pallidum
using immunohistochemistry and direct fluorescent
antibody test in umbilical cords
Jeannette Guarner, K. Southwick, P.W. Greer, M. Fears, V. Pope, W.C. Levine,
S.R. Zaki. Center for Disease Control and Preven 1600 Clifton RD MS G32
Atlanta GA 30333, USA
Issues: Congenital syphilis continues to be a public health problem in many
parts of the world. Serologic diagnosis of this disease in the newborn lacks
specificity, and thus the use of other tissues and techniques needs to be evaluated. Umbilical cords are tissues usually discarded after birth, but can be studied
histopathologically since funisitis has been found in cases of congenital syphilis.
Objective: To determine the frequency of finding T. pallidum in umbilical cords
with funisitis in a population that has a high prevalence of congenital syphilis.
Methods: We selected 30 umbilical cords that had histopathologic evidence of
funisitis from seven hospitals in Bolivia, where the prevalence of reactive maternal
syphilis serology is 4 to 5%. Immunohistochemistry (IHC) and direct fluorescent
antibody (DFA) tests were performed on the cords.
Results: Mild funisitis was present in 20 of the umbilical cords. In none of these
was T. pallidum seen with DFA or IHC. All seven cases that had marked funisitis
with necrosis (necrotizing funisitis) were positive for T. pallidum by IHC, and five
were positive by DFA. When IHC was used, four cords had spirochetes in large
numbers in areas where there was little inflammatory infiltrate, fewer organisms
were seen in areas of marked inflammation, and none in necrotic areas. The
other 3 cords with necrotizing funisitis contained fewer visible spirochetes. In the
positive cords, granular staining was seen, which may represent spirochetes cut
in a plane that did not permit identification or antigen degradation products. Three
cases had marked funisitis without necrosis; in these cords no spirochetes were

identified with either IHC or DFA.
Conclusions: In this population, histopathological evidence of marked funisitis
with necrosis suggests the possibility of syphilis; thus, special techniques such
as IHC or DFA need to be used to detect T pallidum. IHC is a valuable tool
for studying syphilis in the umbilical cord since it permits the localization of the
infectious agent.

Year start methadone
S1986
1986-87
1988-89
1990-91
1992-93
1994-95

74
62
135
143
129
159

% HIV+
43.2
33.9
26.7
17.5
7.0
4.5

% HBV+
85.1
73.8
56.4
47.4
20.7
20.1

HCV+
93.2
90.0
78.2
57.6
36.3
29.8

2 test for trend 71.7, 132.9, 145.4 respectively, all p - 0.01.
The incidence rates for HIV and HBV, reflecting "in-treatment" risk behaviour,
were low (0.6% and 2.1%/person year of follow up). For HCV the rate remained
higher (4.2%).
Conclusions: These data show a spectacular decrease in HIV infection, suggesting that DU have changed HIV risk taking behaviour in response to HIV
prevention campaigns. Current prevention efforts should focus on improvement
of HCV prevention, identification of high risk individuals and maintaining safe
behaviour.
60441' "Evidence, what evidence?" An exploration of the factors
influencing the development of HIV health promotion
projects for gay men
Nick Corrigan', M. Dockrell2. 16/32 Golborne RD London W10 5PN; 2GMFA,
London, UK
Issues: The current climate demands an evidence base for HIV health promotion projects, but neither professionals nor volunteers in the field of gay men's
work have a shared understanding of what constitutes evidence. Many successful
projects seem to be built on intuition or heavily influenced by the worker's personal
experiences.
Project: 12 gay men's workers in Greater London (all gay men themselves)
were interviewed at length about a particular HIV health promotion project they
had developed. In an unstructured interview they were encouraged to describe
in detail the conception, development and realisation of the project and then