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

12th World AIDS Conference

Abstracts 60842-60847 1155

S60842 KAP study among nurses regarding HIV/AIDS in a
maternity hospital in Calcutta
Kausik Das', K. Misra2. 1228 Rabindra Sarani Calcutta-700007; 2MIVA
Foundations, India
Objective: To assess the knowledge, attitude and practice of base level health
care providers (nurses) involved in patient management, regarding HIV/AIDS.
Methods: 70 pre-structured questionnaires were distributed among the nurses.
Of those 50 completed responded were received and analysed.
Results: Of the 50 nurses whose responses were analysed 70% have been
working for more than 10 years. About 50% have secondary education; a substantial group comes from the villages (22% as compared to 38% from city and
40% from suburbs). 24% of the 50 are trainees. All of them have heard about
AIDS out of which 16% have not heard about HIV. Fourteen percent think AIDS
to be a contagious disease. Full and correct knowledge about HIV is found in
only 48%. Almost 30% think HIV to be a blood test for AIDS. Most of them
have heard about AIDS first from T.V. and consider T.V., newspaper and doctors
as important mediums of acquiring further knowledge. Only 40% are aware of
the routes of transmission and methods of prevention. Many think AIDS to be a
disease in which quality of life deteriorates (14%) as there is no treatment (32%)
and death is inevitable (46%). So far no one has cared for AIDS patients and 66%
of them want to avoid or deny looking after HIV positive and AIDS patients. More
than 60% of them think condom and ligation to be the most effective preventive
measures.
Conclusion: Knowledge is fragmented and misconception is rife among the
nursing staff. Intervention is urgently needed to update knowledge and skills in
order to change their attitude and practice
60843 Adherence evaluation of antiretroviral (ARV) treatment in
Santos: Qualitative approach
leda Goldemberg', R. Lacerda2, M.P. Mota3, R. Haysen2, N. Gravato2. Praca
Rui Barbosa No. 23, 4 Andar, Santos Sao Paulo; 2Programa Municipal
DST/AIDS, Santos SP; 3Universidade Federal Rio de Janeiro, Rio de Janeiro
RJ, Brazil
Issue: The adherence to the utilization of antiretrovirals, has placed the necessity
of identifying factors which may interfere with the treatment (emotional, cultural
and social-economical conditions). The qualitative methodology comes out as an
investigation possibility.
Project: Twelve wide-open semi-structured interviews were realized, making
use of a tape recorder to register, among users of "Centro de Referencia em
AIDS" (AIDS Reference Center), it was stated to be realized among people from
both sexual categories; following raised criteria such as: more than 60 worked
days fully proved, treatment peiod over 2 months; and more than 60 days not
worked.
Results: This study, still in data processing phase, revealed the proper adherence to ARV depends on determined life conditions whose quality is not only
defined by the income but also eucational level from users, which makes possible
a clear understanding of the disease. Factors like self-love, information level of
disesease also are fundamental to the dully adherence.
Lessons Learned: The qualitative study has provided a better approach of the
social, economical and cultural universe of the user, enabling a wide evaluation of
the adherence, as well as identifying positive and negative aspects of the usage
of ARV.
60844 1Gender and progression of HIV-associated
immunodeficiency
Mauro Schechter"2, Guilherme Lopes2, A.M.F. Pinho2, L.A.A. Lima2,
C.B. Hofer2, L.H. Harrison3, L.H. Moulton4. 'Rua Cardoso Junior 315 -
Laranjeiras, Rio De Janeiro - RJ - 22245-000; 2Universidade Federal Do Rio De
Janeiro, Rio De Janeiro RJ, Brasil; 3University of Pittsburgh, Pittsburgh PA;
4Jonhs Hopkins University, Baltimore MD, USA
Objective: To compare the progression of HIV-associated immunodeficiency
between genders.
Methods: Individuals admitted to a cohort study in Rio de Janeiro, Brazil,
between 1991 and 1995. Patients with a clinical diagnosis of AIDS according to
CDC 1987 criteria at entry were excluded.
Results: 617 patients (425 men, 192 women) were admitted to the cohort. Median follow-up times were 25 months for men and 24 for women. There were no
significant differences between genders regarding age at admission, initial CD8
count, PCP prophylaxis or anti-retroviral treatment. Admission at WHO stage I
was significantly more frequent among women (138 patients, 71.9%) than among
men (219 patients; 51.5%, p - 0.001). CD4+ cell counts were also significantly
higher among women (median 21% X 19%, p < 0.001). AIDS was diagnosed
in 124 patients (91 men, 33 women, p = NS) according to 1987 CDC criteria.
In a Cox proportional hazards model, the adjusted estimate for the hazard ratio
associated with female gender was 1.19 (Cl 95%: 0.79-1.8, p = NS).

Conclusion: In this Brazilian cohort, progression of the HIV-associated immunodeficiency was not influenced by gender.

S60845 HIV/AIDS prevention through community support
systems
Petronilla A. Achieng, M.A. Awuor, G.K. Kisai. Tapwak, Nairobi, Kenya
Issue: (i) Prevention through being with people where they live with inclusion
and support. (ii) Facilitation of choices for change by people, whether infected,
affected or not, in their homes and communities. (iii) Home visits opens communications for real prevention work. (iv) The experience of hope to live fully and
positively within various cultures and faith.
Projects: (1) Education and awareness raising is not enough for prevention
and control. (2) Visiting people where they live leads to real communication and
lessens the stigma of HIV/AIDS leading to more acceptance of those infected and
affected. (3) The community has the capacity to care. (4) Care extends beyond
boundaries of culture, faith and race. (5) Sustainability happens through touched
hearts of individuals, families and communities supporting each other bringing
sustained change.
60846 Cultural factors contributing to the vulnerability and
susceptibility of African women to HIV infection
Mariam Kasule1, Yusuf Nsubuga2, Anne Kaddumukasa3, Zaituni Nsubuga4,
Sarah Kitonsa5. 'PO. Box 12197, Kampala, 2Uganda AIDS Commission,
Kampala; 3 Taso, Kampala; 4Mawanga Rural Women Dev't Association,
Kampala; "Uganda Network on Law Ethics & HIV/AIDS, Kampala, Uganda
Issue: The HIV/AIDS pandemic is still a very big threat to mankind. It has brought
to the forefront the need for rethinking of our cultural practices. Some of these
provide a very conducive atmosphere to the spread of HIV. There is therefore a
need to bring on board heads of cultural and traditional institutions in a bid to
regulate some of those cultural practices that predispose our people particularly
the women to the spread of HIV.
Project: Mawanga Rural Women Development Association was formed to
among other things address the cultural aspects and that affect our lives.
Results: Members of our Association meet on Thursdays every week and
through focus group discussions we were able to identify those cultural practices
that contribute to the spread of HIV among other health hazards that affect us.
From there we started moving to the clan and cultural leaders sensitizing them on
these issues. The response was overwhelming as the clan heads didn't no only
introduce these issues within their meetings but even invited us to attend some
of their regular meetings and from there we have been able to modify some of
these cultural practices.
Lessons Learnt: Cultural norms and practices have a very important role to
play in either the controlling the spread of the HIV or increasing the spread of the
spread of the virus.
For positive and effective cultural reforms and other social changes there need
to bring the cultural heads of these institutions on board. Above all the involvement
and participation of those that are affected by the problem and in this case the
Women is very cost-effective.
60847 Mobilising resources, experience and support networks
to assist parents in disclosing HIV status
Vivienne J. Munro. PO. Box 350 Darlinghurst, New South Wales 2010. Australia
Issue: The desire of parents to protect their children from discrimination, worry,
and confronting issues of illness and death, prevents many parents from disclosing their HIV+ status. Women report, "telling their children is the hardest thing
they have ever had to do". Why are children the last to know?
Project: It is estimated that there are almost 1 million children with HIV/AIDS.
It is unknown how many know that they or their parents have HIV. Children are
not single entities. They are placed in the framework of the family. This family
includes blood, extended, chosen, foster or adoptive and care/support networks.
Often within this structure children are the last to know about HIV status, bringing
about anger, rejection, blame. Parents express the will, and want to be the ones
to tell, but often do not know how and avoid their children. There is no rule book
on when, where and how to disclose, but there is a growing body of documented
experience. Communication between families, groups and networks can bring
together existing resources. Videos, booklets and most importantly other PWA
experience. Group workshops assist to identify fears, explore difficulties and enable parents to understand the emotions of the child. Exchange of resources and
information allows parents to develop skills to talk to their children and anticipate;
what will they ask, what do they already know?
Results: Peer support and shared experience assist in developing strategies
and identify triggers for parents to start talking, providing an entry point. Demonstrates that children who know are more able to cope, seek support, access
treatment and information. Disclosing enhances communication and planning
for the future eg: developing memory books, access to peer support programs
for child/ren, familial environments for adoption, examining illness and death in
context.
Lessons Learned: Surmounting the impact of negitive messages and disclos
ing HIV status to a child can happen, even while society portrays us as bad
mothers. There is an urgency for normalisation of HIV in society, especially in
relation to children. Children are resiliant and have the capacity for understanding
and care. Networks, links and shared experience, from local to global are valuable
and cut across cultural and ethnic differences.