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

12th World AIDS Conference

Abstracts 60470-60475 1087

There is not much literature on AIDS for children. Much of what has been
writted is outdated and cannot be use anymore in order to inform children. We
believe that there is a great need for books like ours.
60470 AIDS prevention program targeting travellers to oversea
destinations: Check-in Gesundheit at Zurich airport
(second phase 1996/1997)
Mark Baecher, F. Schlegel, J. Widmer. 'Balmweg 11, 3007 Bern; 2Swiss Federal
of Public Health, Bern; 3Institute for Social and Preventive Med., Zurich,
Switzerland
Objectives: To reduce the number of new HIV-infections among travellers by providing them information about the risks of unsafe brief sexual contacts abroad. To
update and increase knowledge about safer-sex-rules and appropriate behaviour
in risk situations.
Design: Prevention program based on personal counselling, accompanied by
an evaluation study
Project: The program, financed by the Health Department of the Canton of
Zurich, was situated at the boarding gates of Zurich International Airport, where
passengers were given a handout with a contest. While waiting to board the
aircraft, they were asked to hand in the answers to the questions concerning HIVand health risks abroad at a central information booth. By discussing the answers
the trained staff got the opportunity to provide participants with latest information
and brochures on HIV/AIDS and general health risks related to travelling. In addition, they distributed small give-aways as preservatives, Stop-AIDS-Postcards
and chocolate.
Results: On six weekends throughout one year's time about 10'000 airport
passengers passed the information booth. The response of the contest cards was
up to 68%. As well as for the first phase, the intervention was highly accepted
by travellers and by the airport/airline staff. As a consequence of the intervention, one third of the participants were later discussing HIV related questions with
someone else. Looking back, about 10% of the participants attributed a behaviour
modifying effect to the intervention.
Lessons Learned: The intervention turned out to be a suitable instrument to
personally spread information and to motivate discussions on HIV/AIDS. Knowledge improvement happened especially with first time travellers. The target group
of travellers who intend to have unsafe sex contacts, are hard to reach because
they intentionally do not participate. The program should be continued with punctual interventions in different contexts as airports, travel fairs or railway stations,
possibly with newly integrated elements as cultural performances.
60471 MAC prophylaxis: Application of guidelines
Irving Salit, A. Tseng, S. Minor. The Toronto Hospital, 200 Elizabeth Street,
Eng-216, Canada
Objective: We aimed to determine how widely MAC prophylaxis (prx) recommendations are followed.
Design: Retrospective chart review.
Methods: Pts. with a CD4 count. 100 (332 pts.) were included. We collected
chart information and a questionnaire was also given to 100 pts. to determine
their knowledge of HIV, MAC and MAC prx.
Results: MAC prx was used at any time in 72/225 (32%) pts. with CD4
50, 82/294 (28%) pts. with CD4 - 75 and 87/332 (26%) pts. with CD4 - 100.
The original regimens were: rifabutin in 73 pts. (84%), azithromycin in 10 pts.
(11%), clarithromycin in 3 pts. (3%). Rifabutin was stopped in 44 (66%) of these
pts. usually due to drug interactions or adverse reactions. Of these 44 pts. who
discontinued rifabutin, 14 (32%) switched to azithromycin and 3 (6.8%) switched
to clarithromycin. Rifabutin usage decreased and azithromycin increased with
the advent of protease inhibitors; currently, only 46/332 (13.8%) of pts. with CD4
100 are on MAC prx. The current regimens are: rifabutin in 24 pts. (52%),
azithromycin in 20 pts. (43%) and clarithromycin in 2 pts. (4.3%). The mean
number of months of follow-up was 32.9 months. MAC developed in 13% of
all pts. and in 18% who had stopped their prx. Patients' knowledge about MAC
significantly correlated with CD4 - 100, use of MAC prx or MAC therapy. Only
38% who were not on MAC prx, had had MAC explained to them.
Conclusion: MAC prx is not commonly used because of the use of numerous
other medications, drug interactions and lack of knowledge of the condition by
pts.
60472 Tissues affecting gay health care workers caring for
people with HIV/AIDS
Mark Bloch, S. Jenkinson. Holdsworth House General Practice, Sydney; 32A
Oxford St., Darlinghurst NSW 2010, Australia
Objectives: To describe the personal and professional experiences of gay health
care workers in HIV/AIDS and how boundaries between the personal and professional are negotiated. To highlight the rewards and difficulties of working in

this field. To determine the impact of working in HIV/AIDS on development as a
health professional and as a person.
Design: Descriptive Study
Methods: 24 gay health care workers in Australia were selected to obtain
a cross section of ages, length of experience, occupation and HIV serostatus.
All agreed to be interviewed. Tape recorded interviews containing open ended
questions including: basic demographics, reasons for working in HIV, joys and re
wards, risks and difficulties, effects of HIV serostatus, social life, coping strategies
and changes in the epidemic.
Results: Gay health care workers were involved in HIV/AIDS care because
they identified with the issues. They wanted to contribute to their community and
work in a 'gay friendly' environment. They gained personal satisfaction from the
intimate level of interaction. Workers found they were able to explore their own
identity through their work in HIV/AIDS. 5 of 24 interviewed identified as HIV
sero-postive and they were helped through their work to come to terms with their
own diagnosis. All workers at times felt overwhelmed, affecting their ability to
care. They had to temper their 'expert' status while simultaneously dealing with
grief.
Conclusions: The work in HIV/AIDS had an immense impact on the lives of the
gay health care workers interviewed. There was a rich store of experiences, both
painful and rewarding. Rewards were large and focused on ability to make a contribution, direct care and personal growth. Risks and difficulties were emotionally
centred on issues of personal and professional loss and grief.
60473 Assessing the current incidence and prevalence of the
AIDS epidemic in Australia
John M. Kaldor, J. Cui, M.G. Law, A.M. McDonald. National Centre in HIV
Epidemiology and Clinical Research 376 Victoria Street, Darlinghurst 2010.
Australia
Objective: Current trends in AIDS incidence and prevalence are important for
a number of purposes, including formulation of strategies for therapy treatment
of AIDS patients and prediction of future AIDS cases. However, due to reporting
delays, information about AIDS cases diagnosed most recently is usually unavailable in the AIDS registry. This paper adjusts for the effect of reporting delays and
estimates the current incidence and prevalence of the AIDS epidemic in Australia.
Design: Retrospective study of AIDS surveillance data.
Methods: Influential factors on reporting an AIDS diagnosis are adjusted by
a regression method, the proportional retro-hazards model. AIDS incidences are
obtained by inflating each reported individual by a factor which depends on these
factors. Prevalence here is regarded as the number of people living with AIDS
since the size of some AIDS risk groups is usually unknown.
Results: Overall AIDS incidence in Australia is declining from the peak of about
950 cases per year in 1994 to about 720 cases per year in 1996. The number
of people living with AIDS is increasing from 1050 cases per year in the early
nineties to 2160 cases per year in 1996.
Conclusion: The declining AIDS incidence and increasing prevalence is a
result of the availability of treatment of the HIV infectives and the natural consequence of the declining HIV incidence since the mid-1980's.
60474 The issues and needs of drug users living with HIV in HIV
care, treatment and support
David Garmaise. 1338 Kingston Avenue, Ottawa Avenue, Ontario. Canada
Objectives: (1) To describe the special issues and needs of drug users living with
HIV in HIV care, treatment and support. (2) To prepare a plan for the development
of resource materials dealing with these issues and needs.
Methods: (1) Review of the literature. (2) Contacts with people knowledgeable
in this area in Canada, the US and Australia, using the snowball technique. (3)
In-depth interviews with key informants.
Results: Drug users living with HIV have difficulty accessing quality HIV care,
treatment and support because of issues that relate to their drug use or to the interaction netween their drug use and HIV. Barriers were identified in 12 categories:
stigmatization and negative attitudes; legal issues; lack of knowledge and training
on the part of service providers; lack of 8services for drug users living with HIV;
lack of information for drug users living with HIV; inflexibility of the system: physical effects of drug use; lack of finances; misdiagnosis; lack of support networks;
and lack of access to clinical trials. Other needs were identified in the categories
of pain management; drug interactions and the effects of drugs on the body;
maintenance of medication regiments; and bingeing. The report on this research
includes a plan for the development of resource materials targetting drug users
living with HIV and reflecting a health promotion and harm reducation approach.
Conclusion: Drug users living with HIV have HIV care, treatment and support needs that are unique to this population. Resource materials need to be
developed targetting this population.
|60475 Geographic variations in quality of care for HIV-related
PLP
Elizabeth Calhouni, R. Weinstein2, S. Miles3, J. Dehovitz4, R. Curtis5,
G. Dickinson6, C.L. Bennett2. 339 E. Chicago Ave. #119, Chicago, Illinois;
Northwestern Univ., Chicago, Illinois; 2Rush/Presbyterian/St. Luke's Medical Ctr..
Chicago, IL.; 3UCLA, Los Angeles; 4Downstate Medical/SUNY. New York. NY,
5Marborview Medical Center, Seattle, WA; 6University of Miami, Miami. FL, USA

Objective: To evaluate geographic variations in severity of illness, comorbidity,
and mortality for HIV-related PCP.
Methods: Chart reviews of a random sample of hospitalized patients and
with PCP from 50 hospitals in New York, Los Angeles, Miami, and Seattle from
1995-1997.
Results: The overall mortality rate was 9.5%, with significantly higher death
rates for age -41 years (17.0%), comorbidities (hematocrit. 30 mg% (18.1%)