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

12th World AIDS Conference

Abstracts 60590-60595 1109

S60590 Intensive counselling at STD clinics
Shyamala Ashok12, S. Ram Kumar2. 124 Vihayalakshmi Street,
Mahalingapuram, Chennai - 600 034; 2Society for Development Research and
Training, Pondicherry, South India
Objective: To upgrade the facilities for increasing patients attending the STD
clinics.
Design: Comparative study
Methods: Inspite of early increase in the prevalence of HIV/AIDS from 1986-96
to 1996, the STD clinic had a decline of 45% of clients in comparison to the previous years. In 1996 SFDRT started its indepth counselling sessions with the STD
patients at the clinic simultaneously with the preventive work in the community.
The counselling of STD patients took through the following process:
Establishing a firm cleint/counsellor relationship through maintaining high levels
of confidentiality, informing and clarifying myths and misconceptions with regard
to the related issues of STD/HIV/AIDS, help perceive individual risk, motivate
partner notification, helping in doctor patient relationship, improve quality of life
and excerise stages of health seeking behaviours.
Results: Yearly increase of 25% in STD patients attending the clinic. Increase
of 35% of female patients attending the clinic through partner notification. 45% of
follow up in patients was achieved, which was never noted in any of the previous
years.
Lesson Learnt: Confidentiality, return package of information and motivation
alone can enhance followup.
60591 Outcome of HIV infected children at an intensive care
unit in a 6-year period
Marcelo G. Vallada1, M.C.A. Moreira2, P.P.D. Peron2, H.H.S. Marques2. 1Rua
Georgina De Albuquerque 73, 04355-080 Sao Paulo SP; 2Instituto Da
Crianqa-HCFMUSP, Brazil
Background: There is a sharp controversy about the admission of HIV infected
children at the Intensive Care Unit (ICU), specially in developing countries, where
the lack of resources is greater, about the cost-effectiveness for a stated poor
prognosis due to the HIV infection.
Methods: The charts of every HIV infected child that was admitted at the ICU
between January, 1992 and December, 1997 were retrospectively revised.
Results: Throughout this period, 26 children accounted for 33 admissions. The
male gender represented 21 of the 26 patients. The HIV serology was already
known at the time of the admission at the ICU in 21 of the children. The age varied
between 1 and 124 months (median 19.5). The CD4 cell count was below 200
cells/mm3 in 14 patients, 17 were taking antiretroviral therapy and 14 were taking
P. carinii prophylaxis. Severe malnutrition was present in 21 children, leucopenia
in 11 and thrombocytopenia (less than 100,000 platelets) in other 11. In 12 of
the 33 admissions, the patients came from the Emergency Department, while the
other 21 were already in the Pediatric Ward. Pneumonia was the most common
diagnosis at the admission. The length of stay at the ICU varied between 1 and
24 days (average 6.24 and median 5); among the 13 admissions in which the
patients died, the median of the length of stay was 2 days, while among the other
20 in which the patients were discharged, the median of the length of stay was 6
days. The time of survival after the ICU discharge varied between 15 days and 72
months (average 15 months, median 8 months). PRISM-III Score was calculated
and varied between 6 and 23 in the group of children that died (average 12.07;
median 10; standard deviation (SD) 5.62) and between 0 and 24 months in the
group that was discharged (average 8.6; median 8; SD 4.06).
Conclusion: The mortality rate in this study was 39%, demonstrating that the
presence of HIV infection is not determinant of a bad prognosis, neither of a
prolonged hospitalization and, therefore, it should not be used as a reason for the
denial of admission of these children at the ICU.
S60592 Bridging the gap with immigrant African communities in
developed countries
Esther Tharao', N.R.B. Manatsa2. 1Suite 219-339 Bloor Street West, Toronto,
Ontario, M5S1W8; 2African Community Health Services, Toronto, ON, Canada
Issue: Addressing service delivery for members of immigrant African communities
while realizing the fundamental differences of language, culture and religion.
Project: Given the high prevalence of HIV/AIDS in Africa and the advent of
ever-increasing population migration, serious attention should be paid to creating effective programs for these populations while they are living in developed
countries. Considerable effort is put into bridging the gap between north and
south without the realization that the needs of immigrant communities in the
north are not dealt with, if at all, effectively. These communities are, however,
key in realizing effective models for implementation in their homeland. Issues
confronting immigrant communities are dynamic and diverse and they include:
historical perspectives, culture, religion, language, gender inequity, racism and
other forms of discrimination which influence community response and access
to services. Strategies include: addressing racial stigma, creation of language

specific and culturally sensitive programs, addressing community development
versus individual behaviour, partnerships and network building, providing ethnocultural education for service providers, and using our "grandmothers" way to
disseminate information.
Results: An increase in the participation of African Persons living with HIV/AIDS
(PWAs) in AIDS Service Organizations ASOs) and more compassion in our
communities towards PWAs. This has also helped reduce the fear, ignorance,

prejudice and phobia around HIV/AIDS and has led to an increase in community
participation in activities organized to combat the epidemic. Culturally sensitive
delivery of programs by mainstream ASOs.
Lessons Learned: The full participation and ownership of affected African
immigrant communities in identifying and addressing social and health problems
while realizing language, culture and religion.
S60593 1DAAIR project to provide free, comprehensive and
balanced information on alternative/complementary
therapies for HIV/AIDS
George M. Carter', Fred Bingham2. '31 East 30th St., Suite 2A, New York, NY
10016; 2DAAIR, New York, NY, USA
Issues: While HAART therapy has provided significant improvements in HIV
disease management, it has serious limitations, including cost, toxicities and
failure. Many people with HIV use non-patentable approaches, dietary supplementation, botanicals and other interventions to slow progression of offset drug
toxicities. No US federal mechanism exists yet for evaluating and making claims
of medical benefit for dietary supplements. Evidence of early micronutrient deficiencies, and various retrospective and prospective studies indicate a role for
vitamin supplementation to a healthy diet. Treatment choices are rendered difficult by limited HIV-specific information or often unbalanced industry-sponsored
material.
Project: The Direct AIDS Alternative Information Resources (DAAIR) is a notfor-profit buyers club of alternative/complementary therapies run by and for people
with HIV/AIDS. To address HIV-specific issues, DAAIR produced a free, 150-page
self-care manual called the Membership Outreach Pack (MOP). One sections is
a Comprehensive Goals for HIV Management, based on cited literature. Another
developing project is the Treatment Information Pack (TIP). DAAIR collected and
reviewed data to evaluate the uses, limitations, risks, toxicities and open clinical
questions regarding dietary supplements.
Results: DAAIR has distributed over 10,000 MOPs worldwide. The Centers for
Disease Control and Prevention in the United States now includes it in their document distribution list. MOPTTIP material is available at http:/www.immunet.org
(daair. Immunet has received over 4 million "hits" (visits) in its first 18 months.
DAAIR's site currently contains over 600 pages of information.
Future Plans: The need for balanced information is an ongoing process. Language barriers continue to pose a problem and there is a need for translaton of
materials. An updated MOP should be available by Conference time. Funding is
being sought for printing and distribution of TIP. DAAIR anticipates increasing to
over 1000 the number of pages on its web site in the coming year.
160594 Data as a tool in surveillance, programme planning and
management of HIV/AIDS today
Martin Okia, Grace Namwanje, Godfrey Olupot, Lydia Tamale, Erasmus Otolok.
'Taso Mulago, PO. Box 11485, Kampala, Uganda
Issue: To observe the impact of Counselling on Sexual behaviour and to examine
what extent the reported cases (PWA) vulnerable to STD.
Project: Client Registration, Counselling and Medical services provided to
Clients visiting Mulago TASO Centre is being monitored by the TASO Management Information System (MIS). In 1997 Data collected on Mulago Counselling
services totalling 5,625 and Medical Services totalling 7,898 were entered into
MIS Computer and analysed. This Data was collected from standardised Data
Collection instruments completed by Service providers.
Results: In one year; some variables were taken into consideration in first
and fourth Quarters. For sexual behaviour; No sex was 24%-37%, Use condom
47%-51.5%, Don't use condom 3.5%-2.5%, Preventive counselling 28%-54.5%,
Condom distributed 51%-81.8% respectively.
Examination on HIV/AIDS verses other diseases: Genital Urinary; 13 Sessions:
0.7%-8.3% for 151 sessions, STD Diagnosed; 32 Sessions: 1.8%-3.5% for
63 sessions. STD Syndrome; 0%-2.4% for 43 sessions in the first and fourth
Quarters respectively.
Lessons Learned: The sexual behaviour of the Client over the period of time
after counselling changed. And there is a close relationship between STD and
HIV/AIDS within the community of people with AIDS (PWA).
| 60595 | Anti-AIDS activity of the St. Petersburg Gay and Lesbian
Association "Krilija"
Alexander Koukharski. Volinsky Pereulok, St. Petersburg, Russia
The St. Petersburg Gay and Lesbian Association "Krilija" was founded in summer-1990 and after a difficult struggle with the courts was officially registered on
the 9th of October 1991 for the first time in Russian history. Our main objective
was to help homosexuals at the critical moments of their lives, including the
problem of AIDS, At our monthly roundtable meetings (there have been about
70 of them up to now) we organize lectures on sexually transmitted deseases

and safe sex practices, distribute condoms and visit infections disease hospitals
with gifts to HIV positive gays being treated there. We are planning an early
intervention project to organize a temporary social rehabilitation center for HIV
positive residents in the city.
The activity of "Krilija" association helps to HIV positive gays, who are deprived
any other social support, to survive after being treated at the infectional hospitals
of St. Petersburg.