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

12th World AIDS Conference

Abstracts 23445-23449 431

23445 | Awareness of HIV/AIDS among pregnant women in the
peoples Republic of China
Tian Yue Wen, A.S.M. Abdullah. 'Shenzhen Maternal and Child Health Hospital,
De Xing Hua Yuan, Defu Bldg - 1 MO. 803 Buji, Cao Pu, Long Gang District,
Shenzhen - 518112, PR China
Aims: The increasing trend of the infection of sexually transmitted diseases (STD)
including HIV among pregnant women in China and their limited access to the
scarce STD prevention programme prone them to become vulnerable to the HIV
infection. The aim of this study is to assess knowledge, attitudes and risk taking
behaviour concerning HIV infection among Chinese women attending a antenatal
clinic in the southern China where the prevalence of HIV is higher than other
province.
Methods: A total of 200 questionnaires were randomly distributed among
women attending the antenatal clinic of a Maternal and Child Health Hospital
in the southern China and was collected upon completion during the month
of November 1997. A structured self-administered questionnaire was used for
data collection. The purpose of the survey and the instructions to complete the
questionnaire was explained by the doctor in charge.
Results: Of the 200 questionnaires collected 19 were excluded due to missing
information in most of the sections leaving 181 for analysis. Eighty percent of
the respondents were aged 25-34 and most (90%) attained an education to
secondary school level or above. Although above 90% of the respondents had
heard about AIDS, a substantial proportion possessed misconceptions in different
aspects of AIDS such as, HIV infected people can not appear to be normal (16%),
there is a medical cure for AIDS (10%) and AIDS is only a disease for gay men
(6%). Interestingly, about one-third of the respondents did not know that HIV
can be transmitted from mother to her child during pregnancy or through breast
feeding. Even though a substantial proportion suspected their husband having an
extra-marital relationships with other women, about one in ten believed that they
will not be infected if they only have sex with their husband. These women were
also reluctant in using condoms with their husbands during sexual intercourse.
Conclusion: The study showed the misconception and the lack of awareness
among women in the antenatal clinic, and indicates need for detailed study targetting this group to well understand the situation before designing an effective
interventions to reduce the risk of HIV infection among women and to minimise
the risk of perinatal HIV transmission.
23446 Does co-morbidity affect HIV risk reduction outcomes
among women substance abusers in the southeast
United States?
WendeeMara Wechberg'2, M.L. Dennis3, R.F.R. Rasch4, R. Perritt2,
N.F. Rodman2, E. Coleman2. 13040 Cornwallis Road Research Triangle Park,
NC; 2Research Triangle Institute RTP NC; 3Chestnut Health Systems
Bloomington IL; 4 School of Nursing, Univ. of Chapel Hill Chapel Hill NC, USA
Issues: Although the incidence of AIDS is leveling out among most risk groups in
the United States, it is still escalating among substance-abusing minority women.
However, HIV-prevention campaigns targeting substance abusers have typically
not provided interventions specific to women's patterns of HIV risk and sexual
behavior related to HIV transmission and have not addressed the co-morbid
conditions typical among women.
Project: African American women street addicts (n = 264) in the southeast
United States were enrolled in an intervention research project funded by the
National Institute on Drug Abuse to reduce HIV risk behaviors. The study provided
a brief intervention (including testing for HIV antibodies and pre- and post-test
counseling) to address both drug and sexual risk behaviors. Risk behaviors and
co-morbid conditions were assessed at intake and at 3-month follow-up.
Results: Using Ward's method of cluster analysis for clinical symptoms of distress (physical health, depression, anxiety, post-traumatic stress disorder, general
victimization, and general conflict), four groups of women were identified from
low co-morbid/low crack use to high co-morbid/high crack use and high trading for sex. Outcomes measured at follow up included crack frequency, needle
frequency, trading sex, sex while drug impaired, unprotected sex, and injecting
risk behaviors. The women overall demonstrated significant reductions in crack
use, trading sex behaviors, and unprotected sex. However, important differences
in outcomes by cluster demonstrated that women with the greatest crack use
and higher levels of co-morbidity at intake also made the greatest strides in risk
reduction.
Lessons Learned: Although the follow-up period was short, the results suggest a link between co-morbid conditions and predisposition to change. It may
be that the most impaired women with the most serious preexisting problems
are also more ready to benefit from treatment. However, the intervention did not
specifically address the women's co-morbid problems. Further studies are need
to assess and address the role of co-morbid conditions as a factor in women's
readiness for treatment and long-term recovery.

S23447 Retention of (HIV-) high-risk women enrolled in the
HIVNET vaccine preparedness study
Patricia Affleck', T.P. Flanigan', E. Huang2, P. Brown-Peterside3, C. Smith4,
C. Clark5, D. Metzeger6. 1Brown University, The Miriam Hospital 164 Summit
Avenue Providence Rhode Island; 2FHCRC-HIVNET Statistical Center Seattle
WA; 3Bronx Clinic Project Achieve Bronx NY; 4 University of Illinois Chicago IL;
5University of Pennsylvania Philadelphia PA; 6Philadelphia Medical Center
Philadelphia PA, USA
Issues: To determine factors which correlated with 24 month follow-up among
865 women at risk for HIV enrolled in a Vaccine Preparedness Study (VPS).
Project: 865 high risk HIV (-) women were recruited in 1995 in Rhode Island,
New York City, Chicago, and Philadelphia. The enrolled cohort was scheduled
to be seen a minimum of two times every six months over two years. The
study visits included HIV testing, pre/post test and risk reduction counseling, and
assessments of knowledge and attitudes towards HIV and vaccines.
Results: At baseline, the 865 study participants (women ages 18-60) were
55% African American, 29% Caucasian, 12% Latina, and 3.5% Other; 41% were
recent IVDs, 20% had a recent STD, and 31% recently had 5 or more sexual
partners. Follow-up at 12 months was 86%, and at 24 months 70%. Women over
the median age of 35, with a history of injection drug use or in a relationship
with an IVD were significantly more likely to follow up. Race, educational level,
employment, crack use or a history of an STD did not significantly effect retention
rates. Those who stated altruistic reasons for entering - stop the epidemic, help
find a vaccine, help the community - were no more likely to follow up.
Lessons Learned: 24 month follow up of high risk HIV (-) women in a VPS
was 70%. Future efforts to retain high risk women in HIV prevention interventions
may need to target younger women. IVDs, women in a relationship with an IVD
and older women were more likely to follow up. Attitudes towards an HIV preventive vaccine trial, race, education, employment, or crack use did not significantly
affect follow up.

S23448|

Increasing the risks for the female partner: Perception
and decisions related to risk for HIV infection among
bisexual men in a cohort for incidence and preparation
for HIV vaccine clinical trials in Belo Horizonte, Brazil

Marilia Greco, R.C. Domingues, C.M. Antunes, E. Oliveira, D.B. Greco. Federal
University of Minas Gerais; Rua Gongalves Dias 3144 Apto: 701, Belo
Horizonte, MG, CEP: 30140-093, Brazil
Problem: Men engaging in bisexual practices report a differentiated perception
and risk related decision according to the partner gender and this probably constitutes an important component not only for the maintenance of the chain of
transmission of HIV but also to influence the apparent changes in the epidemiological profile in Brazil with an increase in the number of infection among women.
Project: The project HORIZONTE, started in October 1994 has as its objectives: a) follow up 500 homo or bisexual males, not infected by HIV, to determine
file incidence of the infection in this population; b) evaluate (discuss) novel techniques for risk prevention; c) discuss the possibility of future trials with candidate
HIV vaccine. It is here discussed a segment of the project, namely men with bisexual behavior and their expected (possible) behavior changes when the partner
is a female.
Results: The analysis of data collected from 105 volunteers shows:
a) Reduction of non protected anal sex (active and passive) after joining the
project. There is a definite increase in oral sex with a tendency for the practice of
protected oral sex;
b) There is an increase on the frequency of unprotected vaginal sex, especially
with the fixed partner;
c) There is an increase on the report of higher risk perception in homosexual
relations but there was also an increase of unprotected sex in heterosexual
relations.
Conclusions: The apparent shift of unprotected sexual practices from the homosexual to the heterosexual partner seems to reflect the social representation
of AIDS, where the risk is not related to the unprotected sex per se but to the
partners involved, evidencing the vulnerability of women to risks of HIV infection
(related not exclusively to their lesser role in the decision of when to use a
condom).
S23449 Vulnerability to HIV among disadvantaged women in
Kenya: Implications for interventions
Mark W. Tyndalli2, N. Kidula3, J. Sande3, K. Fonck4, J.O. Ndinya-Achola4,
M. Temmerman5. 1St. Josephs Hospital 50 Charlton Ave. E. Hamilton, Ontario
L8N 4A6; 2McMaster University, Hamilton, O.N., Canada; 3Kenya Medical
Womens Association, Nairobi; 4University of Nairobi, Nairobi, Kenya; 5University
of Ghent, Ghent, Belgium
Background: Vulnerability to HIV is determined by a complex interaction of social,
economic, cultural, and political factors, that conspire to produce powerlessness,
poverty and high rates of HIV infection for many women in developing countries.
This study was conducted to measure social and economic predictors of HIV
infection in two distinct populations of women in Nairobi, Kenya.
Methods: This cross-sectional study included a random selection of 528 women
from a private family planning clinic (FPC) and 520 women from a government
STD clinic (STDC). The protocol included a physical examination, screening for
STDs, HIV testing, and in-depth individual interviews.