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

1 98 Abstracts 13565-13569

12th World AIDS Conference

S13565 Reproductive choices in the Women and Infant
Transmission Study (WITS): Pre and post ACTG 076
results
Edna Pacheco-Acosta1, T. Antonella2, A. Higgins3, N.G. Moroso4, A. Buck5,
S. Bushur6, I.C. Hanson6, E. Matzen7, J. Moye8, V. Smeriglio7. 153 Plaza San
Thomas, Antillana, Trujilo Alto, Puerto Rico; 2New England Research Institute
Inc. Watertown, MA; 3Columbia Presryterian Medical Medical Center, New York,
NY; 4State University of New York, Brooklyn NY; 5Brigham And Women's
Hospital, Boston, MA; 6Baylor College of Medicine, Houston, TX; 7National
Institute 0 Health NIAID, Bethesda, MD; 8National Institute of Grug Abuse, USA
Background: HIV infected women's reproductive decisions for their current and
future pregnancies may be affected by the knowledge of a method of treatment
to reduce the risk of transmission of HIV to their offspring. We assessed whether
mother's choice to have a tubal ligation (TL) or abortion in the WITS cohort
differed before and after the publication of ACTG 076 results.
Methods: 1178 women were evaluated for TL within 6 weeks postpartum. The
analysis of elective abortions was restricted to 603 who enrolled at less than
or equal 22 wks of gestation. TL and abortion rates were compared in women
who enrolled before vs. after 3/1/94, approximately the date of public release of
ACTG 076 results. Proportions were compared using the Mantel Haenszel test
controlling for enrollment site, and with logistic regression.
Results: 23% of mothers enrolled before 3/1/94 versus 8% enrolled after had an
elective abortion (p >.001). 27% pre -vs. 24% post-3/1/94 opted to have a TL (p =.60). Adjusting for demographics/socio-economic status (site, age, #dependents,
income, marital status) and reproductive history (#live births, #prior pregnancies,
HIV status of prior children), the odds ratio (OR) is 0.43 (95% CI.24-.77, p =.004)
for abortion post 3/1/94. In a similar model, the OR for TL post 3/1/94 was 1.31
(95% Cl.93-1.85, p =.12). Older mothers with more dependents and previous
pregnancies as well as a previous HIV positive child were more likely to elect to
have an abortion, while older married mothers with more previous live births were
more likely to have a TL. CD4% was not associated with either endpoint.
Conclusions. Although TL rates have remained essentially unchanged, fewer
women elected to terminate their current pregnancies after the availability of
ACTG 076 results which demonstrated the usefulness of zidovudine in preventing perinatal HIV transmission. Women with prior infected children are more likely
to elect an abortion. Other correlates of reproductive decision making are not
HIV-specific.
135661 Developing a training initiative to support midwives in
implementing policy on universal choice of HIV testing in
pregnancy
Nuala McBennett. Room 17, Ground Floor, Memorial Hospital Shooters Hill,
London SE1832R2; Greenwich Healthcare NHS Trust, England
Issue: This abstract will outline and evaluate a midwifery education initiative
designed to prepare and support midwives in implementing imminent policy in
which universal HIV testing will be routinely offered to all women in ante-natal
settings in one London NHS Trust.
Project: Prevention measures which significantly reduce vertical HIV transmission are well documented. If service providers are reluctant to offer information
about, and the opportunity for, HIV testing as part of the ante-natal routine, does
this impact on the health of HIV seropositive women and their babies? Does it
deny them the opportunity to make informed decisions and take steps to reduce
the risk of maternal transmission? In view of these questions, plans to amend
current Trust HIV testing policy have been made, in a collaborative working
initiative between Genito Urinary Medicine [GUM] and Women's Services. For
future policy to be effective however, it was considered essential that all midwives
receive specific training on HIV testing issues.
Results: To accommodate all midwives, 10 one day courses were planned. Facilitators included midwifery staff, GUM Consultant/Health Advisors and Positively
Women. Fears/midwives role around policy and support issues were explored,
pre/post test discussion, confidentiality, service user perspective, medical interventions in HIV vertical transmission as well as role play to develop skills in
initiating discussion on HIV. Courses have been very positively evaluated with
fears allayed and stronger working relationships now in place between Women's
Services and GUM. A number of midwives have agreed to be key workers in their
teams and elected to access an intensive HIV course. Tentative plans to employ
a midwifery HIV counsellor to facilitate policy implementation are ongoing.
Lessons Learned: In implementing HIV testing opportunities in an ante-natal
setting it is essential to provide staff with information and skills to enable them
perform their role. Education programmes are most effective when they are a
collaborative effort between HIV and women's services, fostering stronger mutual
supportive links between both departments. The additional input of a service user
to such courses, where possible, greatly enhances participants understanding
and experience.

S13567 Current contraceptive practices and safer sex practices
in a well-motivated cohort of HIV-infected women
Anil Purohit12, Joan Duggan1, H. Walerius', J. Chakraborty', M. Carter',
S. Carter, S. Khuder. cJudy Suleksi, Dept. of Physiology & Molecular
Medicine, Medical College of Ohio, 3035 Arlington Avenue, Toledo, Ohio;
2BIDMC Harvard Medical School, Boston MA, USA
Issues: Patient educational objectives of HIV have focused on unsealing women

on consistent use of condoms, both to reduce the transmission of HIV and to
decrease the risk of conception in infected women. There is no data available on
the current contraceptive and safer sex practices in patient populations that have
access to physicians and other health care workers.
Project: A well-motivated cohort of 69 women attending HIV-related workshops
or an Infectious Disease clinic were surveyed about their contraceptive and safer
sex practices.
Results: 52% of the women surveyed were 26-35 years old; 43% were white;
45% were black; 75% earned <$20,000/year; 54% had post-high school education; 66% had HIV diagnosis <5 years ago; 92% had CD4 > 200. 25% said their
physician once or never discussed safer sex issues; these patients were more
likely to have an income >$20,000 compared with patients who were regularly
counseled. 60% of patients felt they had received adequate safer sex information
from their physician. 84% had received printed information about safe sex. 90%
of patients had access to the safer sex method of their choice, 77% of which was
condoms. 14% used no safer sex method such as condoms and 12% stated that
they did not practice safer sex since their partner was HIV positive. The majority
of these patients had post-high school education. 84% of this group had access to
the birth control method of their choice which again was primarily condoms. 36%
indicated that their physicians once or never spoke about birth control and only
46% felt, they had been given adequate information about birth control. Except as
previously indicated, there were no other significant differences in socioeconomic
demographics for responses to survey questions.
Lessons Learned: Physicians do not adequately counsel patients about safer
sex and contraceptive practices even among a well-motivated cohort of patients.
More education efforts need to be expended on the risks to women of having
unprotected sexual intercourse with both HIV infected and uninfected partners.
The vast majority of women feel that they have adequate access to the birth
control method of their choice and the contraceptive method of their choice.
S13568 Attitudes and practices of French
obstetricians-gynecologists regarding HIV prevention
and condom promotion
Dominique Rey', V. Perrin', C. Pradier2, Y. Obadial. 'Regional Center for
Disease Control (ORS PACA), 23 Rue Stanislas Torrents, 13006 Marseille;
2lnserm Research Unit 379, Marseille, France
Objective: To determine attitudes and practices of French obstetricians-gynecologists regarding HIV prevention and condom promotion.
Methods: During June 1996, a random sample (1/2) of obstetricians-gynecologists working in maternity hospitals and abortion clinics of South Eastern France
were interviewed by telephone about HIV prevention in their current practice. All
solicited physicians agreed to answer (n = 122).
Results: Eighty percent of respondents reported that they personally had taken
care of HIV-positive women during the last year. A majority (70%) supported antenatal mandatory HIV screening but only 50% were in favor of a mandatory
requirement to offer HIV screening to all women undergoing abortion; only 49%
declared always taking the opportunity of a negative HIV test result to provide
counselling about HIV infection.
Overall, 81% reported regularly providing HIV preventive counselling to women
asking for contraception: 47% to all women and 34% only to those considered to
be at risk for HIV infection. For a first contraception visit, 60% reported that they
always offer condom use, whether or not they prescribed oral contraception. A
minority of 24% declared that they never talk about condoms during a consultation
for contraception.
Logistic regression indicates that physicians who routinely provided HIV counselling were more likely to practice medecine for more than 20 years (OR = 2.2
CI 95% 1.3-3.8) and to always offer condoms for contraception (OR = 2.0 CI9
5% 1.2-3.3).
Conclusions: For many women, consultations for reproductive health and prenatal care are their only occasions of access to medical care. Our survey shows
that two major opportunities to develop HIV prevention for sexually active women,
which are the contraceptive advice and the communication of a prenatal HIV
negative test result, are often missed by the French obstretricians-gynecologists.
S13569 Towards a better integration of contraceptive counselling
and HIV prevention: The project "Necessaire"
Wiebke Twisselmann, Ch. Noestlinger. Institute of Social-and Preventive
medicine, University of Zuerich, Sumatrastrasse 30 CH-8006, Zurich,
Switzerland
Issue: The Swiss national umbrella programme "Women's Health: Focus on HIVPrevention" (1994-1998) has addressed the need to better integrate contraceptive
services and HIV-prevention. In this framework an intervention programme for
young women has been developed, the project "Necessaire". As family planning
programmes have begun to integrate HIV-prevention, they have been confronted
with the importance of addressing sexuality in a more comprehensive way.
Project: An attractive little bag (necessaire) is being distributed to young

women aged 14 to 19 years, including an information brochure, condoms and
the pill (if prescribed). It is given out for free but only if accompanied by adequate
counselling procedures. Thus, it will not only promote the counselling process
per se, but also help young women to negotiate safer sex and contraception
with their partners. Channels of distributing the intervention kits are: family planning centres, AIDS-service organizations, counselling centres for young people,
youth-clubs, gynaecologists, pharmacies etc. In order to ensure the quality of the