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

180 Abstracts 13471-13475

12th World AIDS Conference

been used to develop an implementation manual to facilitate future broad-scale
dissemination efforts.
Conclusions: Working with state and local providers as well as clients of community health services, a replication package has been developed to support the
dissemination of VOICES/VOCES, a proven HIV prevention intervention. Input
from HIV, STD, and Family Planning services has been incorporated into a product that addresses the concerns and needs of potential users and will facilitate
the adoption and maintenance of improved, culturally and gender-appropriate
prevention services.
113471 1 Evaluation of occupational exposures to HIV, HBV and
HCV notified in San Martino Hospital, Genoa, Italy
Luca Garra, F. Bassignana, R. Balestrino, M. de Stefani, C. Penna, M. Rossi,
C. Giordano. Institute of Hygiene and Preventive Medicine-University of Genoa
Via Pastore 1 16132, Genoa
Objective: To evaluate the occupational exposures to HIV, HBV and HCV in
Health Care Workers (HCWs) in SanMartino Hospital, which is the biggest Ligurian Hospital accounting for 2670 beds and 5150 HCWs.
Methods: Since January 1989, according to National Guidelines, a surveillance programme started in order to evaluate exposures to HIV-infected blood
and biological fluids. In 1992, the infection control practices were extended to
occupational exposures to HBV and HCV. Anagraphic and professional data and
a detailed report on the accident were collected for each exposed HCW. Besides,
a serological follow-up was planned at time 0, 1, 3 and 6 months and counselling
was given. The opportunity of chemoprophylaxis and of HBV vaccination were
evaluated in each single case.
Results: In the study period, the notified occupational exposures to HIV, HCV
and HBsAg-infected blood and/or biological fluids were 153, 379 and 77 respectively. Most accidents occurred in nurses (67.7%) and in physicians (26%). Cuts
and needlesticks accounted for 70.5% of exposures and 25.3% of the latter were
due to recapping of needles. Universal precautions (UP) were followed in almost
58% of cases. It is noteworthy that in 26.5% of cases UP were not correctly
adopted even if the HCWs were aware of the seropositivity status of the patient.
Almost 61% of HCWs resulted vaccinated against HBV and the follow-up was
completed in more than 90% of cases. During the study period no anti-HIV seroconversion was observed, while two HCV infections were registered in a nurse
and in a physician, respectively. Negative anamnesis for previous occupational
exposures in the 2 HCWs and molecular biology studies in both source patients
and HCWs confirmed that needlestick and HCV infections were related.
Conclusion: Our study confirms that several occupational exposures are related to carelessness or omission of UP, even though some accidents occurred
during emergency. Considering that the strict adoption of UP is the only preventive measure able to reduce the occupational risk of infections through blood
and contaminated fluids, it is strongly advisable that HCWs strictly adhere to
guidelines and control programmes suggested by the Ministry of Health.
13472 Sociological study of sexual behaviour in the group of
people asking for anti-HIV antibody testing for preventive
reasons
Danica Stanekova', S. Wimmerova1, M. Habekova', I. Gramblickoval,
E. Tomasik2. Inst. Prev. Clin. Med. Natl. Ref. Centre, HIV/AIDS Limbova 14,
83301 Bratislava; 2Natl. Prog. AIDS Bratislava, Slovak Republik
Objectives: To describe sexual behaviour and risk factors in the relationship to
HIV infection in the group of people voluntarily asking for HIV testing for the
preventive reasons.
Design: Prospective study.
Methods: Participants were cruited in National reference centre /NRC/ for
HIV/AIDS in Bratislava in the period of December 1, 1995 to December 1, 1996.
Serum samples were collected and subsequently tested using commercial ELISA
tests. Simultanously an anonymous questionnaire regarding sexual behaviour
was completed.
Results: In the period of one year 570 people attending NRC HIV/AIDS were
tested for the presence of anti-HIV antibodies for preventive reasons, one of
them was found anti-HIV positive. 412 of all attenders fulfilled the anonymous
questionnaire. Mean age of the responders was 23.8 (14-68) years, 53.6% of
them were men. Sexual orientation of participants was following: 76.9% heterosexuals, 11.7% homosexuals, 6.3% bisexuals. Most responders were single
(83%) and have got 2-5 sexual partners in the last period of 3 years (49.3%).
The figures for sexual intercourse were: steady partners: 45.4%, non-steady
partners: 40.8%. Most individuals were using condoms (67.5%), while only 10.4%
were using them by each chance sexual intercourse. 3.9% responders suffered
from other STD in the past and 3.2% were taken drugs intravenously. The main
reasons for testing of anti-HIV antibodies were following: non-protected sex with
random partner (43.9%), prevention against HIV infection before entering to the
partner's relationship (29.4%). The number of sexual partners depended on sexual orientation: homo/bisexuals have got significantly more sexual partners then
heterosexuals. Unprotected sex with random partner was reported significantly

more by homo/bisexuals then by heterosexuals.
Conclusion: Results obtained in this study show that people asking for anti-HIV
antibody testing for preventive reasons are in various risk of HIV infection, most
of them do not belong to the groups with the highest risk behaviour. Therefore
more propagation of anti-HIV antibody testing in preventive activities seems to be
important.

13473 Factors affecting provision of sexual risk assessment and
HIV/STD preventive counseling by primary care clinicians
Daniel Montano, D. Kasprzyk, W.R. Phililips, N. Fisher-Allison. Battelle 400 NE
41ST Street, Seattle, WA 98105, USA
Background: Primary care clinicians are in a unique position to provide behavioral risk assessment and preventive counseling to individuals who are at risk for
contracting HIV. The objective of this study was to obtain information from clinicians and their patients about factors underlying the provision of risk assessment
and preventive counseling services.
Methods: Qualitative interviews were conducted with 54 primary care clinicians
(family physicians, internists, obstetrician/gynecologists, nurse practitioners) and
103 of their patients from rural and urban areas in Washington State, USA.
Interviews were designed to elicit positive and negative beliefs about providing
risk assessment and preventive counseling services, as well as barriers and facilitating conditions, from the standpoint of clinicians and their patients. Interviews
were transcribed and content analyzed.
Results: A broad range of factors affecting provision of the two services were
mentioned by clinicians and their patients. These included factors concerned with
patient reaction, role of the clinician, education opportunity, impact on patient
behavior and transmission, impact on public health, clinician discomfort, time
and cost, early diagnosis and treatment, confidentiality and ethical concerns. An
important barrier to providing risk assessment mentioned by clinicians is concern
that low risk patients will be upset. By contrast, patients indicated that they would
not be upset if they knew that their clinician asked questions assessing risk of
everyone rather than singling them out. The most frequent issues mentioned by
clinicians and patients for both services will be presented and compared.
Conclusions: Findings from this study are essential to direct further quantitative research to understand and explain provision of these services in primary
care settings. These findings are being used in a quantitative phase of the study
to measure the factors affecting provision of these services. In addition, findings
will be used to guide the development of interventions to encourage primary
care clinicians to assess risk and provide preventive interventions to combat the
spread of HIV and other sexually transmitted diseases.
S134741 Christian hospitals in Nigeria provide integrated
postabsortion care and STD management
Catherine Plewman', Niyi Ogundiran2, A. Tubi3, S.O. Shittu4, R. Booth5,
T. Baird6. international Family Health, Parchment House, 13 Northburgh Street,
London EC1 V OAH; 2Ministry of Health, Ibaden, Oyo; 31PAS, Ibaden, Oyo;
4Ahmadu Bello University Teaching Hospital, Zaria; 5Christian Health
Organisation of Nigeria, Jos; 6IPAS, North Carolina, USA
Issue: An estimated 20,000 Nigerian women die of complications of unsafe abortion each year, and many more suffer short and long term health complications.
Project: Improved postabortion care (PAC) -comprising manual vacuum uterine
evacuation, comprehensive postabortion family planning and STD management,
and links to other reproductive health services - is a "low tech" strategy to reduce maternal mortality due to abortion complications. In rural areas of Nigeria
postabortion care remains unavailable, unskilled or unaffordable and the vast
majority of women seek health care from clinics and hospitals in the religious
sector. A pilot project was undertaken to train health care providers from 11
hospitals (300+ beds) within the Christian Hospital Association of Nigeria (the
largest health care provider in the country) in order to extend their postabortion
care services and incorporate STD management and HIV prevention. This project
was the first to work with religious staff to improve postaborion care, and has
now received extended funding to reach an additional 5 hospitals and incorporate
the training within CHAN's strategic plan. The programme is also unique in its
full-scale integration of STD diagnosis and treatment into PAC training.
Highlights and results of the programme include: (i) Christian hospital staff
are enthusiastic to meet women's needs for PAC, contrary to some expectations,
and they see incomplete abortion, STDs and AIDS primarily as health problems,
and not as moral or religious issues; (ii) coordination with public sector health
facilities can improve PAC family planning services; (iii) non-governmental health
associations can conduct their own training and monitoring (iv) and STD management and HIV prevention are logical components of the PAC model. The
authors hope that the successes and lessons learned from the project will lead
to further collaborative efforts between public health organisations and religious
health systems.
Religious hospitals provide a significant portion of health services around the
world, especially in rural areas. This project is an exciting and successful approach to improving women's health through a private-public partnership and
referral network. Based on the Nigeria experience, religious organisations in
many countries may be appropriate partners for expanding postabortion care (in
a context of comprehensive reproductive health) to the facilities and communities
where it is most needed to save lives.

13475 Impact of training in sexually transmitted diseases (STD)
quality care to private medical practitioners in Tamil
Nadu, South India
Vijaya Sri Nivasan, Krishnamurthy Palanivel. APAC Project, Voluntary Health
Services, Adyar TTTI Post, Chennai-600113, India
Issues: We attempted to study the impact of a systematic two day training to
Private Medical Practitioners (GP) on providing STD quality care for prevention of