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

434 Abstracts 23460-23465

12th World AIDS Conference

S23460 Female condom: Exploratory study in Sao Paulo-Brazil
Suzana Kalckmann', M.F. Rea1, W.V. Villela, E.M. Vieira2, M.E. Fernandes2,
E.M. Ankrah3. 1 MCCS and Instituto Saude, R. Claudino Alves 44 apt,
34-02-037-010; 2Associagao Saude Familia, Sao Paolo, SP, Brazil; 3Family
Health International AIDS CAP/FHI, Arlington, VA, USA
In Brazil, an estimated 100 thousand women are HIV infected, the larger part
being young and or poor. Among these, the power relations between males and
females express themselves in a clearer and more dramatic way. In Sao Paulo,
AIDS is the first cause of death in the 15 to 44 years age group.
Objectives: Evaluate the first impressions caused by using the female condom;
identify the factors determining use and nonuse of safer sexual practices; explore
the opinions of sexual partners.
Design: Prospective study, after intervention
Methods: This first exploratory study in Brazil adopted a quantitative and
qualitative methodology. The volunteers, 103 women, were recruited through the
media and NGOs and, having given their informed consent, were allocated in
8 homogeneous groups, stratified according to socioeconomic status and age.
They responded the interviews, focus groups and peer support groups, when
they received the female condoms (donated by USAID).
Results: At the end of the study (112.2 days in average), 75% were using the female condom. The evaluation was positive: 75% liked it very much and 5% did not
like it. Positive aspects: confers greater autonomy (38%), offers double protection
(31.5%), does not alter sensibility (26%) and is comfortable (22%). Negative aspects: aesthetic interference (28%), displacement of the device during intercourse
(15%) and difficult to manipulate (13%). Women adopted negotiation strategies
which emphasized seduction, avoiding confrontations and discussions with their
partners. Participation in the support groups was fundamental in overcoming
initial difficulties in manipulating the device.
Conclusion: The female condom will be highly accepted when placed at
women's disposal, in an adequate manner, increasing the number of safer sexual relationships. Since it facilitates negotiation with partners, it can become an
important ally in the prevention of HIV/AIDs, particularly among women, as well
as reducing their greater vulnerability to STDs and undesired pregnancies.
23461 Women and HIV/AIDS rural Nyanza province of Kenya
Lorna Yongo. PO. Box 19463, Kisumu, Kenya
Issues: The project analyses the impact of HIV/AIDS among the women living in
rural Nyanza Province of Kenya. East Africa.
Project: Thirty-six [36] Women groups were involved. A questionnaire asking about the extent of HIV/AIDS among the rural women, response [if any]
was administered. This was followed by an organised focus group, participatory discussions on the matters arising from answers brought forward from the
questionnaires sent out. Other strategies include; a rural workshop with the main
objective of looking into what can be done at the grassroots using locally available
resources to combat the identified problem [s]
Results: The women living in the rural Nyanza believes that they have got a
role to play in combating the rocketing trend of HIV/AIDS in their respective areas.
But to be specific, that role is rarely practiced due to a number of factors; Rural
woman do not have access to appropriate knowledge to can enable them design
suitable programs. They mentioned training as a number one need and a first step
to help in addressing the identified problems. The women development groups
existing throughout the province provides a good ground of reaching them out,
the study noted. Many women registered their concern about lack of HIV/AIDS
interventions in the rural areas, a thing that has reduced their understanding
about the disease to zero.
Lessons Learned: Rural women groups can provide the very best channel
in reaching out to thousands of women living in remote parts of the world. The
service providers should also show their commitment by supporting the rural
based women's initiatives.
23462 Use of the long-acting injectable contraceptive Depo
Provera and integrity of the cervical epithelium
Louise Kuhn', L. Denny2, A. Pollack3, T.C. Wright4. IColumbia University
Sergieysky Center 630W 168 Street, NY, NY; 2AVSC Inc. NY NY; 4Columbia
University Dept Of Pathology, NY NY, USA; 4 University Of Cape Town Dept
OBGYN, Cape Town, South Africa
Objectives: To investigate associations between use of the long-acting, injectable,
progesterone contraceptive, Depo Provera, and integrity of cervical epithelium.
This study is motivated by the hypothesis that any potential increase in HIV transmission associated with use of Depo is secondary to disruption of the cervical
epithelium.
Methods: As part of a cervical cancer screening study undertaken in a periurban, informal settlement (Khayelitsha) outside Cape Town, South Africa, women
were interviewed about their current and past birth control use, and underwent
a gynecologic exam that included cervigrams (photographs of the cervix) taken

following application of 5% acetic acid. Cervigrams of the first 488 patients
(35-45 years) were blindly reviewed for evidence of epithelial inflammation,
disruption, and atrophy according to specific criteria developed prior to review.
The percentage of the cervix covered with columnar epithelium (cervical ectopy)
was estimated from each cervigram. A random sample of 85 cervigrams was
re-reviewed to measure reliability.

Results: The prevalences of endocervical inflammation was 16% and 14%, of
ectocervical inflammation 25% and 19%, and of atrophy 1% and 2% among 115
current users of Depo and 373 non-users, respectively (ns). 45% of current users
and 38% of non-users had severe ectopy. Neither endocervical (OR = 1.1 95%
CI 0.6-2.1) nor ectocervical (OR = 1.4 95% 0.9-2.4) inflammation was increased
among current users of Depo after controlling for age and parity. Adjustment for
current or past numbers of sexual partners, marital status, age at first intercourse,
or smoking had no further influence. Reliability of the diagnosis of ectocervical
inflammation (kappa [k] = 0.9), atrophy (k= 0.8) and ectopy (r = 0.9) was excellent,
but of endocervical inflammation was moderate (k= 0.5).
Conclusion: The prevalence of macroscopically-visible disruption of the cervical epithelium was very high in this sample of African women. However, current
use of Depo Provera did not appear to be associated with any additional increase
in the occurrence of visible inflammation of the cervix.
23463 Reaching unreached women - An Indian experience
Malarmangai Venkatachalam. 8/116, Annapoorna Layout, Thiruppur, India
Issue: To reduce the risk of HIV/AIDS among young women by reaching them at
workplace.
Project: An assessment among women working in textile industries of Tiruppur, Tamilnadu, India, revealed (a) 30% of the employees were women, (b) they
were between 15 and 35 years of age (c) were from low socio economic strata,
with very low literacy level (d) have very poor access to health information (e)
had several risk factors that made them vulnerable to STDs/RTIs, therefore to
HIV. A series of consultation was held among them, which revealed that their
main concern was reproductive and sexual health. In order to access them there
was difficulty in obtaining permission from the owners of the companies but it
was overcome through continuous advocacy efforts and orientation. A module
(90 minutes) that addressed issues of RTIs, STDs and HIV was developed and
implemented in small groups. Sexual health concerns of woman being triggered
led them to demand services to reduce their reproductive and sexual health morbidity. A local practitioner (female doctor) was identified and oriented to deliver
non judgemental, good quality service to provide treatment.
Results: In 9 months, 1300 women participated in the vulnerability reduction
programme at their work. Confidence and comfort level were raised changing their health seeking behaviour. Women suffering from RTIs and STDs took
referral seriously and accessed treatment. Acceptance level to HIV/AIDS education/information and discussion on sexual matters increased, leading to a dialogue
on safer sexual practices through negotiation.
Lessons learned: Targeting women in workplace is of strategic importance.
Addressing RTIs and STDs before beginning to educate them on HIV/AIDS is
crucial. Testimonies can influence peers to access treatment thereby reduce
vulnerability.
23464_ Genital tract diseases in women undergoing anonymous
HIV counseling in Brazil
Ayrton-Daniel Ribeiro-Filho1, B. Larouze4, A.C. Cremieux5, M.R. Naves2,
J.N. Lima3, A. Neur6, P.C. Giraldo6. 'Rua Prof Luversi Pereira de Souza 1827
Cidade Universitaria, SP Campinas; 2Prefeitura Municipal De Campinas,
Campinas SP; 3Universidade Estadual De Campinas, Campinas SP, Brazil;
4lnserm U13-Hopital Bichat-C-Bernard, Paris; 5CDAG Hopital Bichat Claude
Bernard, Paris, France; 6Cornells University, New York, USA
Issues: The incidence of HIV infection in women is increasing worldwide. The
prevalence of HIV infected women is higher in Anonymous Counseling and Testing
Centers (ACTC) than in the general population. Diagnosing and treating genital
tract diseases has been shown to reduce HIV transmission. It is assumed that
established gynecological risk factors for HIV infections are not readily addressed
by most ACTCs.
Project: The preliminary results of a prospective study at the ACTC for HIV infection in Campinas (Brazil) are described. The aims of this project are to establish
the prevalence of gynecological and behavioural risk factors for HIV infection in
this population. Structured anamnesis, vulvovaginal, cervical and microbiological
examinations in 250 voluntary patients are planned.
Results: At present the results of 130 women were analysed. Genital gynecological disorders were detected in 50% of all participants. Half of them were
free of symptoms. The most common disorders were: vaginal discharge, ectopy,
clinical and subclinical HPV infection, genital ulcers and signs of inflammation.
No correlation between gynecological and behavioral risk factors was found.
Lessons Learned: Women undergoing anonymous counseling and testing for
HIV have a significant amount of gynecological problems. Since behavioral risk
factors do not nescessary correlate with gynecological findings, it is suggested
that offering gynecological service could be beneficial to diminish the risk of HIV
infection in this population. Thus, the function of anonymous counseling centers
could be optimized.

23465 1 Drug abuse and sexual behaviour of young males: A risk
factor of HIV infection among young females
Vijaya Lall Gurubacharya, R.L. Gurubacharya, J. Shrestha. SACTS, P B. No.
7314. GPO. Kathmandu, Nepal
Objective: - To asses the risk of HIV infection in young women as a result of risk
behaviour of young married and unmarried males.