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

1102 Abstracts 60553-60557

12th World AIDS Conference

titre of infectious virus in plasma. Individual isolates show only one V2 length
variant. Each isolate has a slow/low growth curve in human PBMC in contrast to
cell-associated viruses where only a minority show this phenotype. The infectivity
of plasma virus from month 41 is enhanced by plasma taken prior to its isolation
and neutralized by later plasma.
Conclusion: Viraemia and cycling of genetic diversity of SIVcpz envin natural
infection may be controlled by both antibodies and CD8 cells. A genome in which
some regions cycle while others progressively accumulate mutations implies recombination events. One possible such event was seen in co-cultured viruses
involving recombination at month 33 of the V1 region from the month I isolate
with the V2 region of the month 22 isolate.
60553 Connecting future outcomes with present actions:
Predicting the sexual risk-taking of gay and bisexual men
Robert Appleby1, L.C. Miller2, S.T. Murphy2, G. Marks3, G. Mansergh3.
'Department of Psychology-USC; 2Annenberg School-USC, Los Angeles, CA;
3Centerts for Disease Control & Prevention, Atlanta, GA, USA
Background: Decisions about sexual behavior are often influenced by events in
the immediate sexual encounter. Nevertheless, individual differences in the tendency to consider future consequences of one's actions may provide additional
explanatory power. Are gay and bisexual men who consider the consequences
of their behaviors more likely to practice safer sex than are men who do not?
Methods: 193 white gay or bisexual men (18-41 years old) were approached
in street locations in West Hollywood, California and agreed to complete a selfadministered questionnaire. They answered a range of questions including items
on sexual practices and the Consideration of Future Consequences Scale (CFC)
(Strathman, Gleicher, Boninger, & Edwards, 1994). The data were analyzed using
Spearman correlations and chi-square tests.
Results: The CFC scale had high internal reliability (a = 0.77). The men who
tended to think about future consequences of their behavior (scored high on the
CFC) had significantly higher incomes, were older, and had more education compared with those who scored low on the scale. Although high scoring respondents
were no less likely to have had anal intercourse in the past year (r = -0.09), they
had fewer partners with whom they had unprotected anal sex (r = -0.27) and
with whom anal sex was always unprotected (r = -0.24). Among those who had
anal sex with a primary partner in the past year, those high on the CFC were less
likely to be the receptive partner in unprotected anal sex with ejaculation (x2 =
5.08, p < 0.05). For men who had anal sex with non-primary partners those high
in CFC were less likely to have either receptive anal sex (x2 = 4.97, p < 0.05) or
insertive anal sex (x2 = 4.97, p < 0.05) without a condom.
Conclusion: Gay and bisexual men who consider the future consequences of
their behaviors seem to take fewer sexual risks. The findings suggest that sexual
risk reduction programs might be enhanced by adding components that motivate
individuals to consider the potential future consequences of their actions.
60554 Capacitation to health care workers in risk groups
Roberto Leon. Apdo. Postal. 1289 Guatemala, 01001, Guatemala
Issue: Senzibilizate health-care workers who are doing education, counceling
and phone counceling to gay and bisexual people and vulnerable population to
HIV infection, so they can provide a better service.
Proyect: Homosexuality and sex working are still taboo issues in countries
like ours, that's the reason because many straight people working in counceling and education for HIV/AIDS/STDs aren't giving a good service. Our project
seeks to educate this people through a participative technic in: 1) The origins of
homosexuality, 2) Lesbianism, 3) Homosexual behavior, 4) sexual relationships
among homosexuals, 5) transvestite, transgeneric and bisexual population. For
the training we have prepared a pre and post-test to evaluate the prejudices that
this people might have about homosexuality and the impact that these activities
had in their lives.
Results: The results of the pre and post-test shown that the knoledge incresed
about homosexuality and homosexual practices, that made their work easier. Their
resistence to work with gay and lesbians in counceling and education decreased
notoriously. They shown a better attitude when working with gay/lesbians.
Lessons Learned: We learn that is necessary and important to capacitate
health care working groups doing counseling and education-prevention in behaviour of specific risks groups, so they can make a better job. We understand
that we most go on with capacitation in other areas like sex workers, drug users,
etc. so that way we can stop the spread of the HIV/AIDS/STDs infections
60555 Formulation of a normative body on HIV/AIDS in
Honduras
Jorge Fernandez Vasquez1, P. Rivera Scott2, F. Altamar2, R. Romero2,
A. Delcid3, A. Hernandez-Cordova4, X. Bu3. 1P.0 Box 3966 Tegucigalpa;
2Proyecto BID-OPS Tegucigalpa; 3Comisionado Derechos Humanos;
4Congreso Nacional Tegucigalpa, Honduras

In 1985, Honduras began to live the experience with the notification of the first
cases of AIDS, endeavouring the sanitary authorities to stipulate the measures
related to notification, confidentiality, serologic screening, information and education, and attention of cases. A negative social environment with a rampant
epidemic, pose a threat that requieres a national response with committment of
the national authorities and the society.

Project: The Ministry of Health has been involved in the iniative to produce
a juridical frame, working in alliance with the Health Commission of the National Congress, and the Commissioned of the Human Rights, in a wide social
consultation, directed to arrange the national response.
Results: Currently, a project of the "Special Law on HIV/AIDS", has been
introduced to the Plenary of the National Congress. Guided by the principles of
universality, respect to human dignity, law and order, and no exclusion, the aim
is to guarantee the health protection throughout regulatory norms on behaviours,
action, activities and procedures to address the epidemic control, establishing
mechanisms to promote coordination, define responsabilities, and functions and
set rights and duties.
Conclusion: Once approved the Law, with a superior structure of response,
the country will enhance the strategies to cope the epidemic.
60556 Determinants of geographic mobility in a
population-based HIV/AIDS drug treatment program
Robert Hogg, Benita Yip, E. Wood, N. Gataric, J.S.G. Montaner,
M.V. O'Shaughnessy, R.S. Hogg. B.C. Center for Excellence in HIV/AIDS,
Vancouver BC, Canada
Objective: To characterize the demographic and clinical determinants of geographic mobility among men and women in British Columbia (BC) enrolled in a
population-based anti-HIV treatment program.
Methods: Our analysis was restricted to program participants who were aged
18 years and over, prescribed any anti-HIV therapy, and had completed an annual
participant survey. Changes in a participant's place of residence were documented
for the period 07/95-09/97. Movers were defined as those who changed census
subdivisions during the period of study. Statistical analyses were carried out using
parametric and non-parametric methods and multivariate logistic analyses.
Results: The analysis was based on 1,627 participants 18 years and over
who completed the participant survey. Of these, 189 (12%) moved census subdivisions during the period 07/95-9/97. Subjects who moved were more likely to
have acquired HIV through injection drug use (p < 0.001), to have resided in
census subdivisions less than 100,000 population (p < 0.001), to have graduated
high school (p = 0.008), and to be of first nation or aboriginal descent (p = 0.027)
than those who did not move. With regard to clinical characteristics, participants
who moved were less likely to have AIDS at baseline (p = 0.013) and to have
an HIV-experienced physician (p = 0.017). There was no significant difference
between the two groups with respect to CD4 cell count at time of enrollment,
gender and age. In the final multivariate model, residing in census subdivisions
with a population of 100,000 or less (p < 0.001), the acquisition of HIV through
injection drug use, and the absence of AIDS (p = 0.026), were independently
associated with moving census subdivisions during the period of observation
after adjusting for the number of months participants have been enrolled in the
program.
Conclusion: Our population-based analysis demonstrates that program participants who choose to migrate are more likely to be intravenous drug users,
to come from census subdivisions with populations less than 100,000 and less
likely to have AIDS. Overall, this analysis revealed that the majority of participants
changing residences do so prior to AIDS diagnosis and are moving from rural to
urban census subdivisions, especially those urban areas with a high concentration of HIV/AIDS-related programmes, health care resources and HI-experienced
physicians.
60557 Hospital-based CTRPN: Uncoupling diagnostic testing
from prevention counseling at SFGH (San Francisco
General Hospital)
Jennifer L. Perlman1, Jennifer Perlman2, M.S. Tellez2, N. Hirdler2,
C. Beauchamp2, E. Humphreys2, D.A. Rose2, J.L. Gerberding2. 'ePI - Centerat
SFGH Bldg. 100, Room 301 1001 Potrero Ave, San Francisco, CA; 2University
Of California, San Francisco, San Francisco, CA, USA
Issues: Access to CTRPN (HIV counseling, testing, referral, partner notification)
is imperative for hard-to- reach high risk urban patients (pts) need early treatment
(if infected) and prevention interventions (if at behavioral risk). Hospitals are
important but overlooked CTRPN venues for those who lack access elsewhere.
At SFGH, a 1994 assessment showed: a) newly diagnosed pts had mean CD4 =
284/ml (delayed diagnosis); b) 50% prevalence of injection drug use (IDU)/sexual
risk among "never tested SFGH patients"- most stated provider "never asked
about risk"/"didn't offer testing"; and c) <50% of tested patients received test
results. The SFGH HIV Assessment and Prevention Service (HAPS) was reorganized in 1995 to improve hospital-based CTRPN and uncouple diagnostic testing
(providers) from prevention counseling (HAPS).
Projects: 1) outreach (Emergency Department, wards) to promote HIV testing
of higher risk pts; 2) training/CTRPN "demystification" to promote routine risk
assessment & testing (with consent) by providers & referral to HAPS prevention
counseling for higher risk pts; 3) computer tracking to improve result disclosure rate; 4) enhanced prevention counseling for higher risk pts ("Prevention

Clinic").
Results: In 1997, 323/2965 (10.9%) tested SFGH pts had HIV; 39% of tests
were obtained by HAPS. Compared to 1995, in 1997 1) providers tested 40%
more & HAPS tested 48% more pts; 2) 12% more patients at higher risk were
tested and 1002 infected pts were diagnosed; 3) HAPS results disclosure rates
increased to 79% for all pts and to 99% for those with HIV; 3) higher risk referrals
to HAPS increased by 29%, 4) 53% of 496 pts who negotiated safer sex self