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

12th World AIDS Conference

Abstracts 60558-60562 1103

-reported compliance, and 42.6% of 61 who negotiated safer injection drug use
reported compliance.
Lessons Learned: At SFGH, uncoupling HIV testing from prevention counseling was associated with: 1) improved access to earlier diagnostic testing for high
risk/infected patients; 2) improved access to enhanced prevention counseling
and more self-reported behavior change among at-risk patients. Hospital-based
CTRPN programs such as HAPS can contribute to early HIV diagnosis and
prevention for hard-to-reach patients and merit expansion.
60558 Emotional control, pain, sleep, and depression among
HIV-positive persons
Cheryl Koopman', L. Stone2, DM. Israel Ski2, B. Elias Hof3, X. Chen',
D. Spiegel. ' Dept Of Psychiatry, Stanford, CA; 2San Mateo County AIDS
program, San Mateo, CA; 3San MAteo County psychiatry Residency San Mateo,
CA, USA
Objective: This study examined the relationships between emotional control,
pain, and sleep to depression among HIV-positive persons.
Design: We used a cross-sectional research design to examine relationships
between three independent variables, emotional control, pain, and difficulty sleeping with depression as the dependent variable.
Method: We recruited 103 HIV-positive subjects, 73 males and 30 females, into
a randomized clinical trial on the effects of group psychotherapy on health risk
behavior and quality of life. Half had been diagnosed with AIDS. Subjects' mean
age was 40 years, 47% were of low income, and subjects were predominantly
of white nonhispanic (63%%) and African-American (25%) ethnic backgrounds.
Measures included the Center for Epidemiological Studies-Depression Scale
(CES-D), Courtauld Emotional Control Scale, Pain Questionnaire, and Sleep
Questionnaire.
Results: In multiple regression analysis, we found that CES-D scores were
significantly related to emotional control (Beta =.20, p <.05), constant pain, (Beta
=.24, p =.01), and to difficulty sleeping (Beta =.21, p <-.03), overall adjusted R2
=.15 (overall F = 5.33, p <.001). The interaction between emotional control and
pain was not significantly related to CES-D score.
Conclusions: In addition to difficulty with sleeping and being in pain, controlling
painful emotions (anger, depression, and anxiety) is also related to depression
among HIV-positive adults. These results suggest that helping HIV-positive patients to express painful emotions, as well as treating their pain and sleeping
difficulties may help to alleviate depression.
60559 High-risk drug use and sex trading among women in
Harlem methadone clinics
Robert F. Schilling. CUS SW 622 West 113 the Street, New York, NY USA
Objective: To examine the association between drug use variables and sex
trading among women on methadone maintenance.
Design: Structured interview study.
Methods: Interviews, covering demographics, drug use and sexual behavior,
were conducted with 268 women. Recruited for an HIV risk reduction study, eligible women had been in treatment for at least one year, and reported engaging in at
least one of ten risk behaviors over the previous 12 months. First examined were
the univariate relationships between sex trading and the following drug-related
variables previously shown to be associated with sexual risk behavior: injecting or
sniffing heroin, smoking crack, sharing needles/cookers, visiting crack houses or
shooting galleries, in the past year. Drug-risk variables initially found to be associated with sex trading were entered into a multiple logistic regression equation,
controlling for demographic variables of ethnicity, having a current relationship
with a main sexual partner; and being homeless, or incarcerated, in the past
year.
Results: The women were of African American (48%), Hispanic (39%), and
white European (10%) backgrounds. Frequency of visiting a shooting gallery (OR
= 1.8, p -.004), smoking crack (OR = 1.3, p <.000), and visiting a crack house
(OR = 1.2, p -.05) were associated with sex trading.
Conclusion: Women on methadone who engage in sex trading are likely to use
crack cocaine and frequent "social" drug-use settings. Interventions to reduce HIV
transmission could efficiently target settings where high risk sexual and drug-use
practices interact as multiple vectors for transmission.
60560 Human papilloma virus (HPV) lesions in HIV+ and AIDS
patients
Carlos Leyria1, J.C. Flichman2, C. Wainstein2, C.C.E. Blumtritt2. Jefe U.
Ginecologia Hospital Muhiz; Buenos Aires; La Pampa 2119 15 B CP 1423
Buenos Aires; 2ULACETS Buenos Aires, Argentina
Objectives: To prove the increase of pathology due to HPV in the Lower Genital
Tract (LGT) in HIV+ and AIDS patients.
Design: Prospective and controlled study.

Methods: From September 1993 up to September 1997, 322 patients were
diagnosed. 259 HIV+ and 63 with AIDS. All patients were tested using Papanicolaou and biopsy of LGT, based in the presence of macroscopic or colposcopic
lesions related to HPV.

Results:
Cervical pathology related to HPV

HPV without SIL
SIL L.G
SIL H.G
lIE
CA. invasor

ASINT. AIDS
38 44
8 14
14 16
2 0
8 0

Total
82
6.83%
30
2
8

Percentage
25.46%o
9.31%
0.62
2.50
Percentage
0.65
0.3

Vulvar Pathology related to HPV
ASINT AIDS Total
Cond. Vulvar 20 26 46-14.40
VIN III 2 0 2
CA. Micro inv. 0 1 1

Treatment was based according to the severity of the pathology and localization:
Total Destructive Local (TDL), conization, Werthein procedure, partial resection
of the vulva, plain vulvectomy or radical vulvectomy with limphadectomy. After
surgery we consider it is important to treat the patients in the near future with
immunomodulator based in peptides and nucleic acids (PANs) in order to avoid
recurrences so frequent in HPV pathology.
S60561 Absolute integration to sensitization to HIV/AIDS to
community health program in rural sector
N'Dakonan Michel Yao. Croix-Rouge de Cote d'lvoire, 01 BP 1244 Abidjan 01,
Cote d'lvoire
Issue: Grass roots in Africa (the most infected continent by HIV) ignore in majority AIDS problem. Community health seems to be the best way to reach this
population.
Project: Getting health care and sanitary education is a real problem in Africa
especially in rural sector. Community view as stated in Alma-Ata and Bamako
initiative is one of the solutions to health problems in Developing countries. C6te
d'lvoire Red Cross initiated a community health program since July 1996 in the
west part of the country, where there were about 200.000 liberian refugees. This
program includes health huts building and equipping with a 30% of population
contribution. Two persons from the concerned village are trained per hut in order
to give first aid and also sanitary education with sensitization to HIV/AIDS and
STD. Payment system of care and medicines enables the village to support
community activities.
Result: It is a project with a big concern of the grassroots because they are
involved at every step. Sensitization about AIDS is achieved without any problem
by village agents who speak native languages and know very well all the customs.
An investigation in two villages Beablo and Guinkin (Guiglo: West of C6te d'lvoire)
shows respectively 90.1% and 97.1% of the population accept this sensitization
to HIV/AIDS which is a must. In fact, We have respectively 55.8% and 56% of
the population that don't know anything about AIDS and respectively 34.4% and
32% that have a vague idea of AIDS. Added to this traditional risky behaviors
and respectively 68.1% and 59.8% of the sexually active population are not using
condoms.
Lessons Learned: Community health program may be a support for sensitization to HIV/AIDS in rural sector. This sensitization is facilitated by the population
ready to take part in the program. The rural sector remains very vulnerable in
front of AIDS problems.
60562 Knowingly exposing others to HIV
Carlos Alberto Morais de Sal, Janete Hanan2, D.J.H. Signorini3, J.F.C. Pinto3,
F.S. Sion3. Rua Mariz Barros, 775-10 a enfermaria, Hosp. Univ Gaffree e
Guinle, Tijuca, Rio de Janeiro; 2Universidade Federal do Rio de Janeiro, Escola
Servigo Social, Rio de Janeiro, RJ; 3Hospital Universitario Gaffree e Guinle,
Uni-Rio, Rio de Janeiro, RJ, Brazil
Issues: Increasing number of HIV-positive individuals who willfully engage in
behaviours likely to transmit virus to others.
Project: Health care professionals at a Gaffree and Guinle University Hospital,
University of Rio de Janeiro, Rio de Janeiro, Brazil, have interviewed HIV-positive
patients who reported advertent risk behaviours and exposed their sexual partners to HIV. The issues studied were the characteristics of the persons and their
behaviours.
Results: Recently there have been an increasing number of HIV-positive persons assisted in the Outpatient Unit at the Gaffree Guinle University Hospital
who have infected or threatened to infect others. All were white people, both
genders, heterosexual and bisexual orientation, classified as median class based
on education and job history, none had drug dependency history, all of them were
aware of their HIV-positive serum status for a long time.All of them refused to
inform their sexual partner about their HIV seropositivity status.
Lessons Learned: It is important to formulate educational strategies for risk
reduction of partners of HIV-seropositive individuals as well an rights and duties
of HIV-infected individuals. The present data is consistent with those published in
the international literature.