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

252 Abstracts 14347-14351

12th World AIDS Conference

S14347 Quality of life of HIV-infected school-age children with
home nutritional support
Isabelle Funck-Brentano1, M. Dabbas1, J.P. Teglas2, L. Mahi2, M.J. Mayaux2,
O. Goulet1, S. Blanchie1. 'Hopital Necker-Enfants Malades UIH, 149 Rue de
Sevres 75743 Paris Cedex 15; 21NSERM 292 Hopital Bicetre Kremlin, Bicetre,
France
Objectives: To examine whether home nutritional support has improved over
time the quality of life of a group of HIV-infected school-age children.
Design: Prospective study.
Methods: A total of 25 children (5.7 to 16 years) followed in a referred care
center were evaluated: enteral support n = 20, parenteral n = 5. Evaluations
were performed between January 1994 and January 1998 at regular times on
a 3 years follow up: 1) just before onset of treatment; 2) after 1 month; 3) 3
months; 4) and every 6 months. Qualitative interviews with open-ended questions
were used, one with the children and one with the parents/caregivers. Answers
were coded on a 5 point Likert scale to analyze the evolution of the answers.
Standardized measures were used to assess in the children their level of anxiety
and depression, type and severity of physical symptoms, type and degree of
functional limitations, children's attitude and feelings toward nutritional support.
The child evaluation also included a drawing of the self to provide additional
insights about the body image and self esteem.
Results: A total of 187 evaluations were analyzed, 88% of the children (22/25)
formulated positive expectations toward nutritional support before the onset of
treatment: a desire to gain weight, height and to recover energy as their peers
were the most frequent expectations listed. Half of the children (12/25) and their
parents considered that the children's quality of life had improved consistently on
a long term perspective as long as their medical condition was good enough to let
them enjoy life without additional physical and treatment limitations. Dissatisfactions and resentment appeared when objectives stopped to be fulfilled because
of the process of the disease (13/25).
Conclusion: Home nutritional support can improve the quality of life in children
as long as their medical condition remains free of long term infectious problems.
Children's attitude toward nutritional support and their medical condition before
onset are predictive parameters for positive outcomes. The unique aspects of
HIV are obstacles which can compromise provision of treatment. A decision of
nutritional support which would require to set apart the child from his/her family
should be questioned.
14348 One life time, twice orphan: AIDS and the rural elderly in
Africa
Gabriel Rugalema. Institute of Social Studies PO Box 29776 2502 LT The
Hague, The Netherlands
The problem: As AIDS continue to afflict young adults in Africa, it is increasingly
intensifying the vulnerability of the elderly who are left without social and economic
support. Yet, issues confronting the elderly in the face of AIDS remains largely
unaddressed.
Methods: A year long, ethnographic village-based study was conducted in the
northwestern part of Tanzania where AIDS prevalence is very high (over 20%).
The objective of the study was to find out how is the AIDS epdemic affecting
smallholder agriculture in various types of households in the study area. Households were categorised according to their AIDS status andthe study then analysed
household and survivors welfare in two temporal frameworks, that is, before and
after AIDS. This paper analyses the impact of AIDS to the elderly (65+) and the
difficulties they encounter in the process of coping.
Results: It is found that elderly who have lost adult children to AIDS were
invaribly destitute. In the process of coping with illness of their children, most
elderly had disposed of assets to generate money for paying medical bills and
purchase of foodstuff for the sick. After the death of adult children (who in most
cases were the carers of the elderly parents), theelderly were found to face acute
shortage of cash, food and other household necessities. All of them were found
to be much poorer and hence insecure than in the pre-AIDS period and about
25% had psychological problems such as crying spells
To the extent that AIDS intesifies the vulnerability of the elderly, there is an
urgent need both within communities and the state to rethink some new strategies
for the elderly care in areas hard hit by AIDS in Africa. One possibility could be
a community approach, another possibility could be partial old age benefits from
the state.
i 14349 | Involving the target population in carrying out study so
as to ensure the quality of data
Ishika Basu1, S. Jana2, R. Mtra3, M. Biswas3, K. Mukherjee2, S. Chakraborty3.
1A/l India Institute of Hygiene & Public Health, 8/2 Bhawani Dutta Lane, Calcutta
700073; 2STD/HIV Intervention Programme, Calcutta; 3Durbar Mahila
Samanwaya Committee, Calcutta, India
Issue: Rapid assessment of sex trade throughout the state of West Bengal

become imperative as part of the scaling up of HIV/STD prevention programme
among the female sex workers.
Project: Research methodology was designed to collect basic information regarding the sex trade and practices, including basic information about clients, local
power structure & availability of services and other relevant factors necessary
to start any HIV/STD Prevention programme among the sex workers. To do that

peer educators from an ongoing intervention project was recruited & they were
trained to use specific tools and techniques developed for the proposed study.
Result: About 32 peer educators (female sex workers) engaged in intervention
programme took part in the study and within the span of 5 months time they
could identify 254 red light districts & cruising spots. They could visit about 300
possible areas throughout the state. The information collected by them found to
be extremely important and the data collected by them when cross checked by
another group of social scientist found to be very accurate in nature.
To collect sensitive & personal information particularly from marginal groups
recruitment of field researcher from the same community is not only effective but
extremely useful for qualitative research.
14350 Quality of life correlates at an urban day treatment center
Cheryl Kennedy1, B. Holland1, L. Phillips2, P. Buersmeyer1, P. Ho1,
D. Harrison. 1 Dept Prev Med. NJ Medical School MSBF506 185 S Orange
Avenue Newark New Jersey; 2Rivington House New York NY, USA
Objective: To evaluate Quality of Life (QL) correlates in persons with HIV who
attend a New York City day treatment center. Medical (including mental health),
nursing, pharmacy, nutrition and social services are available. Recreational and
therapeutic groups meet.
Methods: Interviewers collected data on demographics, social support, food
frequency for calculated nutritional intake, psychological stress (Brief Symptom
Inventory-BSI) and QL (Short Form-36). Detailed medication information and CD4
counts were collected on a subset.
Results: To date 38 persons completed interviews: 78% male; 50% black; 38%
Latino; mean age, 40 years (range 18-59); 80% poor (income < $10,000); 90%
receive government health insurance for the poor (Medicaid). Mean total daily
calories = 1766, with dietary nutrient percentages (fat, protein, carbohydrate) all
above the recommended levels. The mean physical component (PCS:41) summary score of QL was significantly different from the general population but, the
mental component summary was not (MCS:47 at a = 0.05; general population
mean for PCS & MCS = 50). On bivariate analysis neither antiviral medication
use nor immune status had any effect on QL summary scores. On multivariate
analysis, greater attendance at the day treatment center and high perceived
social support were associated with a higher MCS and percent of dietary fat was
marginally, but not significantly associated with PCS (p = 0.08). Perceived social
support (p = 0.005) and percent carbohydrates (p = 0.0001) were significantly
inversely correlated with the GSI; while, income (p = 0.03) and percent dietary
protein (p = 0.02) were positively correlated with the GSI. The General Severity
Index (GSI) of the BSI was strongly associated with MCS (p = 0.0001). All BSI
subscales significantly predicted MCS (p = 0.004 or less).
Conclusion: Social support mediates Quality of Life in this group, particularly, for better mental health outcomes. Carbohydrates may also have important
mental health effects. A multi-functional day treatment model may improve quality of life for those without access to potent antiviral drugs and who struggle
against poverty. Culture sensitive, and multi-purpose community care models
may streamline access and enhance treatment adherence.
14351 Impact of risk factor, clinical category and
socioeconomic data on quality of life (QoL) in HIV
infected outpatients
Erika Manck2, C. Claes1, G. Gunther2, W. Wulff2, J.M. Graf von der
Schulenburg1, R.E. Schmidt2, M. Stoll2. 1University of Hannover, Hannover;
2Medical School Hannover, Egerweg 12, Hannover, Germany
Objectives: Increasing interest has been focussed on QoL in HIV infected patients. Our ongoing study will define different factors which may influence QoL.
Design: Prospective follow-up of patients in a single institution of an university
hospital in Northern Germany.
Methods: 1. "Scales for Examining Life Quality" (HIV-SELT). This questionnaire consists of the dimensions physical state, cognitive-emotional well-being
and social conditions. It is a measuring instrument with good values for reliability
(Cronbach's Alpha for internal consistency 0.48-0.85) and validity. 2. EuroQoL - a
second well-proved questionnaire for QoL. 3. Structured interview with questions
to socioeconomic data, e.g. employment, pension because of incapacity to work,
disabled pass, financial burden on HIV infection to the patient. HIV-SELT and
EuroQol were repeated every three months.
Results: At an interim analysis as of 1/15/98 the characteristics of 101 patients
were as follows: 18% CDC I, 43% CDC II, 39% CDC Ill. Risk factors: 59%
homosexuality, 13% IVDU, 10% heterosexuality, 7% haemophilia. Corresponding
to the clinical categories differences in QoL were observed. The best QoL-score
reached patients with CDC II (68.5 p.), followed by the patients with CDC III (65.4
p.). The lowest score (60.7 p.) was observed in the group of patient with CDC I. In
contrast we did not find statistically differences in QoL corresponding to the risk
factor. More intensive data to QoL and socioeconomic factors will be presented
and discussed, e. g. QoL-score of patients with and without employment (68.95
vs. 65.05 p.), with and without pension (65.51 vs. 67.51 p.) or QoL-score of patient

living in partnership or living alone (67.31 vs. 65.51 p.).
Conclusion: Our interim analysis supplies that the QoL in HIV infected patients
is influenced by the clinical category and various socioeconomic factors but not
by the risk factor for HIV infection.