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

1104 Abstracts 60563-60568

12th World AIDS Conference

I60563 DST/AIDS: Epidemiological profile, spacial distribution
and informal treatment practices in a poor comunity, Rio
de Janeiro, Brazil
Valeria Rosa Bicudo1, V.S. Noronha2. 1Av. Leopoldo Bulhoes 1480,
ENSP-Cesteh; 20swaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
Issue: the sexually transmited diseases (STD), including AIDS has been assuming a greatepidemiological relevance in the Manguinhos/RJ area. In this area,
since formal care is not able to resolve this problem the population developed
alternative strategies to take care of themselves.
Project: To study the dynamic, from the epidemiologic point of view, of
STD/HIV/AIDS in the Manguinhos area and the socio-cultural representations
of gender and the informal practices of health. Data was colected from the
public health center reporing system; local drugstores through a specifically designed instrument and interviews carried out with analyzis using EPI INFO and
ARQUI-VIEW.
Results: The population of the studied area has been looking more frequently
for the local drugstores to treat their STD than for the Public Health Center itself.
We can say also that the men appears infected first and does not tell his partner
who suspec later, when the opportunist symptoms appears or when the partner
health become worse.
Lessons Learned: This work contributed to the knowledge of the manguinhos
area as far as the epidemiological conditions and comunity perception of risk for
acquiring DST/AIDS. The Results pointed out the need for better articulated work
between the Public Health Center and the community to develop educational
practices and indicators that allow a better assessment to the assistence offered
by HIV/AIDS Program.
60564 1 Fatherhood living with HIV
Pablo Mesa-Martinez. Concepcion de la Valla 3 Int. 8 Centro Habana, Cuba
Issue: To overcome the challenges of fatherhood living with HIV in common
agreement with an HIV negative partner.
Description: To successfully achieve procreating an HIV negative child, being
an father HIV+ and an HIV negative mother. To reach this aim, we (my wife and
me) had to go through the following process:
- We talked among ourselves and identified a common desire to procreate a
child.
- We made a bibliographic search and documented ourselves on cases of
children born HIV- when one of the parents is HIV+.
- We discussed about the risk of transmission and the ways of risk reduction,
which included:
(a) Medical advise on ovulation control and fecondation process.
(b) Informed decision of the need of having procreative sex and suspend the
sexual activity during the pregnancy.
(c) Dialogue around the possibility of missing one of the parents.
- Analysing economic conditions, well-being and quality of life to assume with
responsability the upbringing and education of the child.
- A medical follow-up of the mother during pregnancy and childbirth.
- Medical surveillance of mother and child and periodical check-ups during the
first 24 months.
Results: Birth of an HIV negative baby girl and persistance of her serological
status (currently, Marian is three years old). Girl's mother is still HIV negative.
Lessons Learned: It is possible to bear HIV negative children from an HIV+
father and an HIV negative mother. Being a father living with HIV will be an
encouraging and empowering experience and an important reason to live that will
involve the mother and strengthen the relationship.
S60565 Mobilizing youth for peer-for-peer fund raising
A. Kelly Wolfslehner. #203-319 West Fender, Vancouver, BC V6B 1T4, Canada
Issue: How to involve youth in peer for peer fundraising process that supports
the organizations financial goals as well as the members need for experience so
as to provide them with transferable skills.
Project: Given that raising funds has become much more difficult and highly
competitive with many organizations often applying to the same funding source,
YouthCO, who's mandate is to provide services for youth, has focused specifically
on peer for peer fundraising. The Fund Raising Committee consists of volunteers,
members staff and board between the ages of 15-29 from within the organization.
This Committee sets out to raise funds for the organization as needed from within
the youth community as well as to acquire and learn new skills for each of the
committee members. Many of the youth who attend or participate in the fund
raisers have attended educational speaks, another service that YouthCO offers,
within their high schools and know who we are. This translates into a genuine
partnership between YouthCO and the youth community.
Results: Our experience indicates that that youth are willing to support and
donate both skills and talent in order to raise money for a cause that directly affects
them. Fund Raising needs to be a collaborative effort within the organization as

well as and with the youth community. It should create an opportunity for youth
to learn new skills. Youth learn transferable skills needed for the job market and
larn more about HIV and AIDS.
Lessons Learned: By using a peer for peer model and applying it to the
Fund Raising Committee, we have an opportunity to become more visible to, and
relevant for the youth community that we serve.

S60566 Attitude of families towards the death of an AIDS patient
Christiane Nyassa Messina, Affana Ngaska Ada. B.P 2338 Yaounde, Cameroon
Issue: The death of an AIDS's patient always lead to curiosity of the family,
obliging the Physician to reveal its official cause. It unfortunately leads to an
attitude which, disrupt the sensitization's campaigns against AIDS.
Project: The objectives of this survey was to examine the attitudes of families
towards the death of AIDS's patients, determine their causes, list their consequences and propose some solutions. Although the National AIDS Control
Program Statistics reveals 2766 cases of diagnosed AIDS, the empirical observation shows very little cases of death linked to AIDS. This great discordance is
due to the fact that families does not talk about the real cause of the death, at the
funeral oration, for many reasons: shame, stigmatization, fear.
Results: - The deceased partners's are not informed of their serological status
and can transmit the disease.
- Some risk of contamination are linked with early manipulation of the corpses.
- AIDS is not real for the community, reducing the power of the sensitizations's
campaigns.
Lessons learned: By caring about the deceased's memory and moral interests of its family, the strategy testimony on the reality of AIDS is not reinforced,
weakening the sensitization campaigns. The community should then be trained
on counselling of people living with AIDS and banalisation of the disease.
S60567 Non-Kaposi's cancers in HIV infected patients at an
urban teaching hospital
Louis J. Martinez1, G.R. Lynch2, R.M. Grimes1. ' UT-Houston School of Public
Health, PO Box 20186, Houston, Texas 77225-0186; 2Baylor College of
Medicine, Houston, TX, USA
A review was conducted of the records of oncology patients who did not have
Kaposi's sarcoma and were HIV infected at a 500 bed teaching hospital in Houston, Texas, USA. 98 patients were identified between 1990-1997. They were
examined for tumor type, primary site, sex, ethnic background, age, and whether
HIV status was determined prior to the diagnosis of cancer.
Results: 64 lymphomas, 4 non-lymphoma hematological malignancies, and
30 solid tumors were identified. While immunoblastic and Burkitt's lymphoma
were the most prevelant lymphomas (n = 26), Hodgkin's disease (n = 6) and
Mantle cell lymphoma (n = 9) were noted more often than expected. Extranodal
presentations were common (n = 26). Of the 30 solid tumors, anal (n = 6), lung
(n = 6), cervix/vulva (n = 5), head and neck (n = 3), and unknown primary (n = 3)
were most common. 25% had local disease, 26% had regional disease, and 49%
had distant disease. 20 patients were women. 41% were African American, 24%
Hispanic, and 35% were Caycasion. The median age of solid tumor patients was
39 and for lyphoma patients was 37. A significant number of patients had HIV
diagnosed at the time of their diagnosis of neoplasia.
Solid tumors made up a significant per centage of non-Kaposi's neoplasms
(30.6%) in HIV patients at an urban hospital. Mantle cell lymphoma comprised
16% of non-Hodgkin's lymphomas. A solid tumor was often the first sign of HIV
infection.
S60568 Emergence of syncytium-inducing HIV-1 variants
coincides with a transient increase in viral RNA level
Igrid Spijkerman1, F. De Wolf2, M.W. Langendan3, H. Schuitemaker4,
R.A. Coutinho3. 1Nieuwe Archtergracht 100, 1018, Municipal Health Service;
2University of Amsterdam; 3Central Laboratory Blood Transfusion Service,
Amsterdam, The Netherlands
Background: To describe the dynamics of HIV-1 RNA level around non-syncytium-inducing (NSI) to syncytium-inducing (SI) phenotype conversion and to
study the predictive value of SI phenotype for progression to AIDS after adjusting
for RNA level and CD4+ T-cell count.
Methods: Sequential samples of 123 HIV-infected homosexual men with documented interval of seroconversion were tested on HIV-1 RNA level (NASBA),
viral phenotype and CD4+ T-cell count. Median values of the two markers within
fixed time periods were determined around phenotype conversion and in a control
group who did not convert and who were matched on follow-up time and CD4+
T-cell count at 1 year before conversion. Kaplan-Meier survival analysis and Cox
proportional hazard analysis with time-dependent covariates were used to study
the predictive value of the 3 markers.
Results: The NSI to SI phenotype conversion (n = 39) occurred at all levels
of RNA above the quantification limit. The conversion coincided with a three-fold
increase in median RNA level and an accelerated CD4 decline, which was not
observed in matched controles in whom a viral phenotype conversion did not
occur (p < 0. 05). This increase was followed (after 15 months) by a decrease to
a higher steady state RNA level than before the conversion. From seroconversion
onwards no difference was observed in median RNA level between those who
will ultimately convert from NSI to SI phenotype and those who did not. After
adjusting for RNA level (>4.9 log RH 3.0, 95%CI 1.3-6.7) and CD4+ T-cell count

(<300 RH 8.8, 95%CI 2.4-32.1), SI phenotype was an independent marker for
progression to AIDS (RH 2.0, 95%CI 1.0-3.7).
Conclusion: The increase in RNA level coinciding with NSI to SI conversion
might be biologically explained by a broader T-cell host range for SI variants
(CXCR4 and CCR5 expressing cells). The effect of SI phenotype on disease
progression was partially mediated by its effect on RNA level and CD4 cell count
(accelerated decline) but certainly added distinct and important information about