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

12th World AIDS Conference

Abstracts 60807-60812 1149

S60807 Service use by HIV positive women
Heather Jane Wells, J. Elford, R. Miller, M.A. Johnson, L. Sherr. c/o Garrett
Anderson Ward, Royal Free Hospital, Pond St. Hampstead, London, England,
UK
Objectives: To investigate service use of HIV Positive women attending a London
teaching hospital and to consider differences in service use according to ethnicity,
age, time since diagnosis, symptoms and bereavement.
Methods: In a hospital HIV outpatient clinic between October 1996 and March
1997, 81 consecutive female attenders were invited to complete a structured
questionnaire addressing hospital and community service use, emotional and
practical support and disclosure of HIV status. 72 (89%) HIV positive women
completed the questionnaire.
Results: Satisfaction with hospital and community services was high. Median
waiting times for services ranged from 0 to 20 minutes. Longer waiting times
were associated with decreased satisfaction with the care received (p < 0.05),
the running of the service (p. 0.01), and the clarity with which staff explained
things (p - 0.05). For most services women were likely to say that they planned
to use them less in the next 3 months than they had previously. White European
women were more likely to have used voluntary support groups than Black African
women (p - 0.05); symptomatic women were more likely to have used inpatient
services than asymptomatic women (p < 0.01); younger women were more likely
to have used their GP in the last month than older women (p < 0.05); bereaved
women had made more contacts with services overall in the last month (p < 0.01)
than women who had not been bereaved.
Conclusions: Overall, satisfaction with hospital and community services was
high, although waiting times for these services varied. That long waiting times
were associated with decreased satisfaction should be addressed when planning
service provision. HIV positive women attending a hospital centre are a diverse
group with varying service needs.
60808 Hyperbilirubinemia in patients treated with indinavir (IDV)
Renato Maserati, G. Mussati, L. Scudeller, L. Chiapparoli, R. Giacchino,
D. Zanaboni. Infect Dis Dept-Policlinico San Matteo Via Taramelli 5 Pavia, Italy
Background: Among pts treated with IDV, an increase of indirect bilirubin is
reported in around 15% of cases. We studied the clinical relevance of this event
in our population of HIV-infected pts treated with combo therapies containing IDV.
Methods: Seventy-eight pts started a combo anti-HIV therapy containing IDV
from October '96 through December '97. Demographic factors, CDC '93 classification, HBV and HCV coinfection, associated drugs (in particular nRTIs) and
biochemical values were evaluated. Blood tests (namely total and indirect bilirubin) were performed monthly during therapy. Two groups of pts were identified:
group 1 (pts who showed an increase of bilirubin levels above normal value of 1
mg/dL during therapy) and group 2 (pts who did not).
Results: Forty-three out of 78 (55.1%) pts showed an increase of bilirubin
levels with a mean peak time of 4 months (range 1-8) and a mean peak value
of 2.39 mg/dL (range 1.01-4.95). While most pts remained hyperbilirubinemic,
among the 14 who have so far reached the 12th month of therapy, 6 (43%)
show normal biliribin levels. No difference was seen between the two groups in
sex, age, risk factor, CDC classification, coinfections with HBV and HCV, nRTIs
associated. Group 2 had a significant lower mean duration of therapy than group
1 (4.1 vs 8.3 months; p - 0.001).
Conclusions: Bilirubin increase is a negligible and possibly reversible effect
of IDV administration and it doesn't cause a significant liver toxicity or any other
clinically relevant adverse event. The decision to discontinue IDV should not be
based merely upon the occurrence of hyperbilirubinemia.
60809 New treatments for HIV and sexual risk behaviour among
people seeking an HIV test in London
Jonathan Elford, H. Wells, L. Sherr, R. Miller, M.A. Johnson. Dept. of Primary
Care and Population Sciences, Royal Free Hospital School of Medicine,
Rowland Hill Street, London, UK
Background: To investigate whether people's views about new treatments for
HIV influenced their sexual risk behaviour we conducted a survey among those
seeking an HIV test at a London hospital clinic
Methods: Between October and December 1997, a questionnaire was completed by people attending a same-day HIV testing clinic in London (80% response). Questionnaire distribution will continue until June 1998. Clinic attenders
were asked if they had had unprotected penetrative intercourse (UPI) in the
previous 3 months; their reasons for seeking an HIV test; and to what extent they
were less worried about HIV now that treatments had improved
Results: Of the gay men, 11% (13/114) reported "new treatments for HIV" as
a reason for seeking an HIV test, compared with 1% (2/156) of heterosexual
men and 3% (4/151) of heterosexual women (p < 0.01). There was no significant
difference in the frequency of UPI between those who gave "new treatments" or
"it is better to be treated early" as reasons for testing and those who did not.

Overall, 40% (46) of gay men, 68% (104) of heterosexual men and 60% (90) of
heterosexual women reported UPI in the previous 3 months.
Of the gay men, 36% were less worried about HIV since treatments had improved compared with 21% of heterosexual men and 23% of women (p = 0.03).
There were no significant differences in the frequency of UPI between those who
were less worried about HIV and those who were not, although the frequency of
UPI was elevated for the "less worried" men (gay and heterosexual).

Conclusion: Over one-third of gay men seeking an HIV test said they were less
worried about HIV since treatments had improved and, compared to heterosexual
men and women, they were more likely to cite "new treatments for HIV" as a
reason for seeking a test. Sexual risk behaviour did not appear to vary significantly
according to beliefs around new treatments for HIV, although the frequency of
unprotected penetrative intercourse was elevated among "less worried" men (gay
and heterosexual).
608101 Recruiting peer educators for a community-based
intervention among gay men in central London gyms
Jonathan Elford', Mark Maguire2, G.J. Bolding', L. Sherr'. 'Dept. of Primary
Care and Population Sciences, Royal Free Hospital School of Medicine,
Rowland Hill Street, London; 2Camden and Islington Community Health
Services NHS Trust, London, UK
Issues: To highlight difficulties in recruiting peer educators ('project reps') for
a peer-led HIV prevention initiative among gay men attending gyms in central
London.
Project: This is a peer-led intervention based in central London gyms aimed
at: reducing the risk of HIV transmission among gay men through (a) unprotected
sex and (b) needle-sharing for anabolic steroids; providing up to date information
about new treatments for HIV, risk reduction and HIV testing.
Results: 63 gym members/staff were identified as potential peer educators
(project reps)
60 were contacted and provided with introductory information
44 expressed an interest in being trained as project reps
26 'booked in' for a training session (the remainder were unable to attend)
19 turned up for a training session
17 currently work as project reps (2 dropped out following training)
Lessons learned: Of 60 gym members/staff approached, 17 currently work
as project reps. When selecting potential peer educators, the number invited
should allow for up to two thirds not completing training due to high drop-out at
various stages of recruitment. The process of selecting and training potential peer
educators is challenging, complex and may take several months.
60811 Injecting behaviour among gay men using anabolic
steroids in central London gyms
Graham Bolding', L. Sherr', M. Maguire2, J. Elford'. 'Dept. of Primary Care and
Population Sciences, Royal Free Hospital School of Medicine, Rowland Hill
Street, London; 2Camden and Islington Community Health Services NHS Trust,
London, UK
Background: Little is known about needle-sharing among gay men who inject
anabolic steroids (AS) or other 'fitness enhancing substances' (FES). To investigate this, we conducted a survey into use of AS and FES and related injecting
behaviour among gay men.
Method: In September 1997, a baseline questionnaire was completed by gay
men attending one of 4 gyms in central London prior to the introduction of a peerled HIV prevention initiative (4 gym project). Men were asked about their use of
AS and FES, related injecting behaviour, levels of knowledge and perceptions of
other people's injecting behaviour.
Results: Of 996 gay men surveyed, 183 (18%) reported ever using AS or
FES while 128 (13%) were current users. Of the 183 ever users, 118 (65%) had
injected AS/FES. Although none of the 118 reported needle-sharing, 37 (31%)
reported a behaviour which could have presented a risk for HIV, e.g., reusing
needles, dividing multi-dose bottles, not always using disposable needles or needles from a sealed packet. Whilst the majority reported safe injecting behaviour,
there was a discrepancy between how they reported their own and other people's
injecting behaviour. 42 (36%) did not assume that everyone they knew used
sterile needles, 76 (65%) did not trust their friends to give them sterile needles,
and 5 (4%) reported having seen others share needles. More than half (69) said
they would appreciate more information about how to inject safely and 42 (36%)
did not know enough about AS/FES to avoid harming themselves. Only 30 (25%)
reported having regular health checks for steroid-related health problems.
Conclusions: In these gyms, nearly 1 in 5 (183/996) gay men had used anabolic steroids (AS) and other 'fitness enhancing substances' (FES) and 118 had
injected them. Although none of the 118 reported needle-sharing, nearly one third
reported an injecting behaviour in relation to AS/FES that could present a risk for
HIV transmission. A lack of knowledge about AS/FES was identified which will be
addressed by the intervention. There was a discrepancy between how the men
reported their own and other people's injecting behaviour.
60812 Virological response to protease inhibitor-containing
regimens according to initial CD4 count
Andrew Phillips', M.J. Gill2, W. Davidson2. 1Dept. of Primary Care & Population
Sciences Royal Free Hospital School of Medicine, London, UK; 2Southern
Alberta HIV Clinic, Calgary, Alberta, Canada

Background:- It is unclear whether the virological response to protease inhibitorcontaining regimes is the same at high and low CD4 counts.
Methods:- 223 patients from a large outpatient clinic were followed a mean of
8 months from the time of starting a protease inhibitor until 1 December 1997.
Viral load and CD4 count measurements were made at start of protease inhibitor
therapy and on average every 2.5 months.