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

12th World AIDS Conference

Abstracts 60898-60902 1165

Data were collected using a structured pre-tested self-administered questionnaire
during November 1997.
Results: The initial analysis which was performed among 181 respondents
completed all the sections of the questionnaire. The findings of the study revealed
that a higher proportion of the respondents held moderate level of knowledge
concerning HIV transmission and prevention, even though a small proportion
possessed misconception in certain HIV related issues. Majority of the respondents (70%) disapproved of becoming pregnant if a women or her husband is
HIV positive, 14% approved so and the remaining 16% were unsure. Of the
respondents only 50% were willing to participate in any interventions while 60%
were willing to be tested for HIV antibodies if it was available freely.
Conclusion: Women attending antenatal clinics should be encouraged to learn
more about the transmission and prevention of HIV/AIDS to reduce the risk of
HIV infection among themselves and to the newborn.
S60898 Plasma leptin levels in AIDS-associated wasting
Francisco Arnalich14, P.L. Martinez-Hernandez1', C. Montiel5, A. Hernanz2,
J. Gonzalez-Garcia1, R. Madero3, J.M. Pera Sanchez De Ribera1. 1AIDS Care
Unit, 2Clinical Biochemistry Service, 3Biostatistic Unit - Hospital Universitario "La
Paz", Edifico H. Maternidad Planta 8, Madrid; 4Unidad de Infeccion HIV, Paseo
de la Castellana 261, Madrid; 5Department of Pharmacology, Facultated de
Medicina, Universidad Autonoma, Madrid, Spain
Background: Plasma concentrations of leptin are correlated with body fat mass
in normal and obese individuals, but little is known about the regulation of leptin
in patients with AIDS-associated wasting.
Objective: To evaluate the possible role of leptin in the weight loss of patients
with AIDS-associated wasting, and to examine the relationship between plasma
leptin and the tumor necrosis factor system.
Design: Cross-sectional analysis.
Participants: 30 randomly selected AIDS patients without concomitant diseases or secondary infections were classified into two groups: 16 patients with
wasting and 14 with normal body weight, and 18 healthy controls.
Measurements: Nutritional status was evaluated by anthropometry and laboratory parameters. Plasma levels of TNFa and soluble TNF receptor (sTNFR)
proteins p55 and p75 were determined by enzymoimmunoassay, whereas leptin
were measured by RIA technique.
Results: AIDS patients with wasting had decreased concentrations of leptin
(4.66 ~ 1.55 ng/mL) when compared to well-nourished AIDS patients (6.77 ~ 2.8
ng/mL, p - 0.01) or controls (8.5 ~ 1.2 ng/mL, p < 0.001). Plasma leptin levels
correlated with body fat in well-nourished AIDS patients (r = 0.423, p = 0.013) and
healthy controls (r = 0.517, p = 0.003) but not in AIDS patients with wasting. Mean
levels of TNFa, and sTNFR-p55 and sTNFR-p75 were greater in AIDS patients
with wasting than in asymptomatic AIDS patients or in controls. No significant
association was observed between plasma leptin and TNFo, or sTNFR-p55 and
-p75.
Conclusions: Plasma leptin levels were low and did not correlated with percent
body fat in AIDS patients with wasting, whereas they correlated in well-nourished
AIDS patients. The activation of the TNF system found in wasting patients did not
seem to affect plasma leptin concentrations.
60899 AIDS in the US: Still an exceptional disease needing
exceptional solutions that protect human rights
Eileen Hansen. AIDS Legal Referral Panel 582 Market Suite 912 San Francisco,
CA, USA
Issue: With the availability of new combination therapies and other treatments in
the United States, the public policy environment surrounding the human rights of
people with HIV has dramatically changed. Based on the assumption that the US
is in a "new AIDS era" and that those who are eligible for therapy will both desire
treatment and be able to avail themselves of treatment, the focus on protection of
privacy and confidentiality and on voluntary approaches to HIV testing has been
severely diminished.
Project: The ethical and legal ramifications, as well as the public health implications, of policy makers deferring to politicians instead of to public health and
human rights experts regarding initiatives such as those 1) mandating testing
of newborns and/or pregnant women; and 2) promoting reporting by name of
people with HIV were assessed in the context of the availability of combination
therapies and other treatments. Position changes within the public policy arena
and the response to these policy initiatives on the part of 20 national and local
community-based AIDS organizations, along with individuals affected by HIV,
were surveyed.
Results: New public policy initiatives regarding sensitive issues related to testing, reporting and surveillance are generally seen as draconian and have not been
well received by AIDS organizations and individuals affected by HIV. However,
attempts to diminish human rights protections, displace AIDS as an exceptional
disease needing specific, exceptional solutions, and criminalize those who would
resist testing and treatment are rapidly moving forward.

Lessons Learned: HIV treatment advances, while tremendously exciting and
hopeful, cannot be used to diminish human rights protections of people with HIV.
The belief that individuals will willingly give up their constitutionally protected
rights to privacy and bodily integrity in order to access testing and treatment is
inaccurate and unacceptable. Ethics surrounding such issues as testing, reporting
and surveillance must be of paramount importance as a new era of therapy dawns
in the US.

60900 Impact of treatment with zidovudine during pregnancy in
reducing perinatal tranmission of HIV-1
Jose Tomas Ramos1, R. Bastero1, V. Rodriguez-Cerrato1, J. Saavedra1,
A. Bodas1, E. Ruiz-Chercoles1, J. Ruiz-Contreras2. 1CTRA De Andalucia KM5,
4 Madrid 28041 Hospital 12DE Octubre DPTO Pediatria; 2Departamento De
Pediatria. Hospital 12 DE Octubre, Spain
Background: Despite the proven efficacy of zidovudine (ZDV) in ACTG 076
protocol for reducing perinatal transmission of HIV-1, questions remain about its
implementation and effectiveness in routine practice.
Objectives: To assess the impact of ZDV administered during pregnancy in
preventing perinatal HIV-1 transmission, and to determine the proportion of early
identification of maternal HIV-1 infection over time.
Methods: We prospectively followed from birth a cohort of children born between 1/1/1987 and 31/10/1997 to HIV-1-infected mothers. Infant infection status
was assessed by follow-up beyond 18 months or HIV-PCR up to 3 months of age.
Results: Overall 229 mothers and 248 infants were identified in the cohort.
ZDV was administered during pregnancy as monotherapy to 34 mothers for a
mean of 4.7 ~ 3.1 months prior to delivery. Seven women received ZDV only
during pregnancy and 7 had been treated with ZDV before pregnancy. Mean
CD4 cell count in treated mothers was 465 ~ 247. There were no differences in
lymphocytes count, nor viral load (PCR-RNA) among the treated and untreated
groups. Transmitting mothers had a significantly more prolonged time of rupture
of obstetric membranes than non-transmitting mothers (11.1 ~ 15.2 hours vs 5.6
~ 12.1 hours, p: 0.023). Among the treated mothers only one child was infected
(2.9%), whereas 37 children born to 212 untreated women became infected.
(OR: 0.14, 95% Cl:0.07-0.92). From 1987-91, 9.7% of infected women were nor
identified at the perinatal period, as compared to 2.5% in the last 5 years of the
study period. (p: 0.03).
Conclusions: ZDV during pregnancy significantly reduces perinatal transmission in our setting. The awareness of an effective treatment might have contributed
to the increased identification of HIV-infected mothers prior to delivery observed
over time in our cohort of children born to HIV-infected mothers.
S60901 1Reaching out to men who have sex with other men (MSM)
in a conservative society
U. Aung Swe. 93B Inya Myaing Road, Yangon, Myanmar
Issue: Like in many other Asian societies, the practice of men having sex with
other men, though not uncommon, is not tolerated socially, culturally and religiously. Those who indulge in this practice themselves never consider themselves
to be gay or homosexuals and thus do not consider themselves to be at risk from
HIV/AIDS. Some are even married and with ignorance and indifference to the
problem, they put their sexual partners and family members at risk also. Measures
to prevent spread of HIV/AIDS will neither be complete nor comprehensive if this
group is left out of the present project's advocacy and educational process. A
pilot seminar for MSM was conducted with much difficulty but this was not due
to lack of support from the National AIDS Program and project officials. On one
hand, most of MSM themselves have difficulty in accepting their own sexual
orientation and on the other, fear from being legally prosecuted once they have
been identified kept many away from this kind of activities. Thus the success of
the seminar was not based on the number of participants but on level and variety
of social strata they represent.
Results: It can be fairly concluded that the degree to which an individual
practice safe sex is not directly correlated to the level and extent of their knowledge on HIV/AIDS but more or less on level of education and the social circle
they belong. However, commitment for further dissemination of information as
well as to cooperate and work together in future was obtained at the end of the
day.
Lessons Learned: Sensitivity to the issue and open-mindedness are the two
most important elements to reach out to MSM. Formal discussions and workshop
like environment is not favourable for this group of people. Diversity - in terms of
appearance, mannerism and attitudes - among participants cannot produce best
result in this case. Peer education program need to be introduced.
S60902 Epidemiology and the problem of STDs leading to
increased risk of HIV infection among street children of
Calcutta
Rakesh Agrawal. Amderbari, 63, Rafiahmadkidwai Road, Calcutta, India
Background: Study of the Prevalence of STD's among the Street Children
population of Calcutta (First study of this kind among street Children).
Method: Clinical Examination, medical history and KABP study of 750 street
(ages between 6-16 yrs.) children attending the two clinic's run by CINI-ASHA
(urban project of Child in Need Institute).
Results: Starting facts were revealed:
(i) Almost 90% of the children between (8-16 yrs) are sexually active, out of
which 70% have suffered with STD's at least once.

(ii) boys have clinical presentations in forms of ulcers, chischargs, warts, inguinal buboes, etc. though ulcers and discharges are commonest (40% and 40%
respectively).
(iii) Girls mostly present with discharges (vaginal or cervical or both 70%).
Sub-clinical cases are maximum in this population, so chances of incomplete
treatement and mis-diagonsis is maximum other presentation are pelvic, ulcers,
UTI etc.