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

12th World AIDS Conference

Abstracts 60739-60743 1137

Results: Over two hundred reports of HIV and HCV infections were examined. The axiomatic framework, when coupled with meta-analyses, provide strong
evidence supporting a claim that HCV is a slow virus. Structural differences in
prions, lentiviruses and HCV provide compelling evidence of a need to identify a
functional basis for slowness and progressiveness in slow virus infections. Prevalence rates for co-infections of HIV and HCV could not be established. In reports
of co-infections of HIV and HCV, seemingly paradoxical reports of increases or
decreases in viral titers in response to combination drug therapies, vaccines and
other antivirals (e.g., molecular species of interferons) are shown to be consistent
with the axiomatic framework. The design suggests that vaccines against opportunistic pathogens in HIV infections are likely to provide a safe approach with the
least likelihood of complications in situations involving co-infections of HCV and
HIV.
Conclusions: Co-infections of HIV and HCV provide an important framework
for investigating slow virus mechanisms. This report provides the first evidence
that HCV may be a slow virus. If HCV is a slow virus, this could provide prima facie
evidence that 'slow virus' is fundamentally a functional designation. Co-infections
of HIV and HCV also provide clues to safe and efficacious approaches to drug and
vaccine therapies. These studies provide additional support for use of multivalent
(killed) vaccines against opportunistic pathogens in all HIV infections.
[60739 HIV-positive persons' experience with HIV testing and
counselling in Latvia
Melita Sauka, G.T. Lie. University of Bergen, Christiesgt: 13 N-5015 Berger,
Norway
Objectives: Retrospective exploration of HIV-positive persons' experience with
HIV-testing, counselling and social support groups.
Design: Qualitative study, purposeful sampling, semi-structured in-depth interviews.
Sample: 13 HIV positive persons above age 18, selected from all 47 HIV-positive persons diagnosed in Latvia in the period 1987-1996.
Results: The interviewees had been tested either based on their own decision
to go for HIV-testing, or they had been tested as part of STD screening or general
health check-up, but without informed consent for HIV-testing. Regardless of how
testing came about there had been no pre-test counselling, meaning that even
those who had decided to ask for testing had not been prepared for a potential
HIV-positive test result. When returning for the test-results the majority of the
interviewees had been offered to stay for a week in an infectious disease hospital
in Riga for health check-up and for counselling. The benefits for staying in the
hospital as seen by the HIV positive persons were: a) avoiding loneliness, b) getting time to accept the fact of HIV infection while in a protected situation, c) getting
to know the medical staff d) building trustful relationships with the medical staff
e) choosing whom to confide in among the medical staff, f) getting contact with
social support groups. Access to support groups and HIV-related information differed among the interviewees according to their educational and socio-economic
status. Small self-help groups of HIV positives persons with similar background
were experienced as most appropriate.
Conclusions: It is necessary to improve testing services in Latvia to include
pre- test counselling and to secure informed consent. In a low HIV-incidence area
where HIV pre-test counselling is inappropriate, staying for a week in a hospital
immediately after getting the HIV-positive result was experienced as helpful in
order to accept and cope with the HIV diagnosis and future prospects.
F60740 Condoms for HIV/AIDS prevention: Failure vs. success
Sachin M. Changedia1, I.S. Gilada2. lBai Jerabai Children's Hospital, Acharya
Dhonde Marg, Parel, Bombay; 2Indian Health Organisation, Bombay MS, India
Issue: In a developing country with taboos in discussing sex, ridden with illiteracy, poverty, population explosion, double moral standards, poor health care
seeking behaviour and limited outreach for marginalised groups - it is ridiculous
to stress on only purist messages of Celibacy or Monogamy. Compliance from
target population on 'Safe-Sex' is difficult hence switch over to 'SAFER SEX' is
imminent.
Methods: After evaluating multi-pronged approach from street-corner meetings to the World Congress on AIDS in its 12 years of fight against AIDS in
India; our NGO has chosen peer education in marginalized groups and condom
promotion as two most important strategies. In 1991, Project Saheli, a peer-based
intervention program among sex workers was launched for methodical condomdistribution program aimed at its optimal and correect usage, among other things.
Success and failure rate of condoms studied.
Results: A replicable model identified community leaders and enterprising
NGOs for sensitization to effectively utilize them in AIDS prevention & control
programs. Highest achievement was getting AIDS and 'condoms' on political
agenda. We distribute nearly one million condoms monthly (60% of state quota).
Wider, sustainable base was created through sheer hard work against all odds.
Marginalised groups are brought in mainstream to increase their health care
seeking behaviour and condom usage. Failure rate was 1-4%; which was quality

and user dependent.
Lessons Learned: To achieve behaviour modification, one needs knowledge
of local customs, beliefs, languages, experience and practices. For evolving
cost-effective harm-minimisation strategy, we started aggressive promotion of
state-subsidised condoms in 1991. Though condom can 'fail' in its duty; as do the
helmet, umbrella, raincoat and gloves; benefit outweigh its failure. Imported condoms offer no supremacy. Even WHO supplied condoms were found un-suitable

for local usage. Colours, flavours, packing, illustrations on its usage increase the
acceptability.
60741 1 Behavioral beliefs and situational factors influencing HIV
risk reduction among crack users
Fen Rhodes, M.M. Wood, C.K. Malotte. CSULB Center for Behav Research &
SVCS 1090 Atlantic Avene Long Beach, CA, USA
Background: High-risk sexual activities are characteristic of substance abusers
whose drug of choice is crack cocaine. Attempts to promote changes in sexual
behavior that would reduce the risk of HIV transmission among crack users have
met with limited success. For interventions to be effective, information is needed
regarding specific cognitive and situational factors that define the context in which
individual risk-reduction occurs.
Methods: Structured elicitation interviews were conducted with 67 primary
crack smokers to obtain information on perceived outcome expectancies, barriers
and facilitators, expectations of significant others, social supports, peer norms,
and environmental factors associated with seven behaviors to reduce HIV sexual
risk. The sample included 67% females, 37% African-Americans, 33% whites,
and 28% Hispanics; 46% were sex traders.
Results: Advantages of using condoms with main sex partners were, in order,
STD/HIV protection and pregnancy prevention; disadvantages were mechanical
difficulty using condoms, reduced pleasure, and presumption that respondent
had engaged in sex with another. For those with paying partners, STD/HIV protection, improved hygiene, and pregnancy prevention were main advantages,
with mechanical difficulties and partner displeasure being disadvantages that
were believed to result in reduced income. Family members were believed to be
the best providers of social support for condom use with main partners; other
drug partners, paying sex partners, and family members were best providers of
support for using condoms with paying partners. Individuals who were viewed as
particularly wise/experienced or caring were preferred as sources of support for
behavior change.
Conclusions: These results confirm the importance of obtaining specific information concerning the cognitive, social, and environmental context in which
specific behaviors to reduce HIV risks are adopted by and engaged in by special
populations, in this case, drug users who primarily smoke crack cocaine.
S60742 Plasma viral load in HIV-1 and HIV-2 co-infected TB
patients before after TB treatment
Ousman Jobe1, K. McAdam1, N. Berry2, K. Ariyoshi1, S. Sabally1, A. Marchant1,
H. Whittle1. 'Medical Research Council Laboratories, Banjul, The Cambia, 2Div.
of Virology UCLMS, London, UK
Objectives: To study the effect of TB co-infection on HIV replication in HIV/TB
dually infected patients
Methods: 13 HIV-1 and 8 HIV-2 positive patients with active TB were recruited
from the MRC hospital. Blood was taken at recruitment and 2 months following TB
chemotherapy. 59 HIV-1 and 49 HIV-2 positive patients without TB were included.
RNA was extracted from plasma [Boom 1990] and reverse transcribed into cDNA
before PCR with LTR primers. The PCR product was quantified by hybridisation
with alkaline phosphatase-labelled DNA probes in a chemiluminescence assay.
Reference plasma of known number of copies were included.
Results: A significant decrease (>4-fold) in viral load was observed in 3 of
4 patients with a high CD4 (:14%) but not in any of the 9 patients with a low
CD4 (<14%) among HIV-1 patients. In HIV-2 patients, a significant decrease
in viral load was observed in all 3 patients with a high CD4 and a detectable
HIV-2 viraemia but not in two patients with a low CD4. Plasma viral load of HIV-2
co-infected TB patients after TB chemotherapy was not significantly different from
viral load of HIV-2 patients without TB in either CD4 category. In contrast, plasma
viral load of HIV-1 co-infected TB patients with low CD4 after TB chemotherapy
remained significantly higher than that of HIV-1 patients without TB
Discussion and Conclusions: A significant reduction of viral load by TB
chemotherapy was observed in both HIV-1 and HIV-2 infection but only in lessimmunocompromised patients. This finding indicates that TB-coinfection is a
major factor increasing viral load among less-immunocompromised HIV-patients.
S60743 Self-advocacy: Negotiating barriers related to
homophobia and heterosexism in health care settings
Jeremy Buchner', Donna Huen2. 11-222 Osborne Street South Winnipeg
Manitoba R3L 1Z3; 2 Winnipeg Gay/Lesbian Resource Centre Winnipeg MB,
Canada
Issue: When an HIV+ person is gay, their diagnosis may also result in feelings of
self-loathing and disgust as a by-product of homophobia in society, and therefore
internalized homophobia. Similarily, an HIV+ person who is not gay may have to
cope with homophobia in society and their own internalized homophobia as they
discover that assumptions are being made about their sexual orientation by the

health care and helping professions.
Project: This participatory workshop outlines barriers experienced by gay,
lesbian, bisexual and HIV+ persons when seeking health and social services.
Homophobic attitude by caregivers, and internalized homophobia, may prevent
the individual from asserting their right to be involved in their own or their partner's
health care, and may even prevent the individual from providing the caregiver
with the pertinent information they may need to diagnose or treat appropriately.