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

438 Abstracts 23481-23485

12th World AIDS Conference

while gender sensitive services for them are not. This study describes sexual and
reproductive practices, attitudes and context for decision making by HIV+ women.
Design: Cross-sectional interviewer administered questionnaire
Methods: A total of 100 HIV+ women were recruited from the main public clinic
for HIV/AIDS patients (CRT-AIDS) in Sao Paulo. Women completed a private
face to face interview which included questions about: demographics, HIV risk
factors, perception of risk, access to care, relationship with the health provider,
and questions about sex and reproduction.
Results: Most women (72) were infected by their partners, of which 36 were
infected by an injecting drug user partner. Seventy-eight reported age at first sexual relationship between 14-19 years (mean 17 years old). Fortyseven currently
had a sexual partner. Of this, 45% had an HIV negative partner, 34% an HIV+
partner, and 21% did not know the partner's serostatus. Sixty-four percent of
women who had a sexual partner reported condom use always. The main reason
reported for partner's failure to use condoms was that partners did not enjoy
using them. Thirty-four women reported being coerced to have sex at some point
in their lives. Of these, 20 reported coerced sex by use of violence. Thirty-six
women got pregnant after being infected. Of these, 13 had had an abortion. Of
27 children born, 11 were HIV+. Of the 100 women, 79 did not desire another
pregnancy. Sixty-nine believed that they would be criticised by family or friends if
they decided to get pregnant.
Conclusions: The high proportion of women reporting unprotected and coerced sex, and their reported desire for not having more children in a country
where abortion is illegal, demonstrate how much they can benefit from sexual and
reproductive health counselling and education. Yet, the significant proportion of
HIV infected babies and number of women who want to get pregnant, stresses the
need for support of their reproductive rights. Health care providers, policy makers
and NGO's should focus on improving gender sensitive support and services.
23481 HIV sentinel surveillance in pregnant women 1992-97
Adela Ramirez. Mahatma Gandhi #351 Santo Domingo, Dominican Republic
Objectives: To monitor the HIV epidemic in pregnant women that attend public
health facilities.
Design: Sentinel surveillance
Methods: Six sentinel posts have been established in maternity hospitals in
different regions. Every year since 1992, a number of blood samples taken from
the umbilical cord of anonymous mothers were analyzed by the ELISA methods.
Those that tested positive and 10% of those that tested negative were validated
in an specialized laboratory.
Results: The HIV prevalence is growing in all the sentinel posts. The average
in 1992 was 0.3% and 1.7% in 1997. Prevalence varies according to regions. In
the city of Santo Domingo (population over 2 million) seroprevalence in 1997 was
1.9%, while in Puerto Plata (Touristic area of 400,000 habitants) seroprevalence
in 1997 was 8.4%; other regions showed 4.5%.
Conclusion: HIV epidemic is growing and prevalence varies according to
regions. The prevalence of 8.4% is one of the highest in the American region.
S23482 Psycho-social profile in Indian HIV seropositive women
Sharad Shah', A.K. Deshpande', A. Deshpande2, S.R. Joshi3. 1Professor &
Head, Gastroenterology Dept., GMC, SIR JJH, Mumbai; 2Associate Professor,
Medicine Deptr., GMC & SIR JJH, Mumbai; 3 Clinical Research Associate,
Medicine Dept, GMC & SIRJJH, Mumbai, India
Background: Indian Seropositive women are often innocent victims of seropositive husbands. The study highlights in the social factors in the environment of an
Indian HIV seropositive female.
Methods: 65 consecutive female Indian patients who voluntarily registered at
the HIV outpatient clinic at Sir. J.J. Group of Hospitals
Results: 49 were HIV seropositive and 16 were not. Amongst the seropositive
group the maximum age was 48 yrs and minimum 20 months. With 60% cases
in the third decade. Marital status analysis revealed 6 (9.23%) were widowed;
3/5 (7.69%) unmarried and 43/54 (83.07) married. All husbands in the widowed
group died due to HIV within a period of 15 days to 5 months of marriage. Only
2 were professional sex workers and one had husband & child positive. 33% of
husbands were alcoholis and most patients belonged to lower or lower middle
class groups.
Conclusion: The psycho-social profile of Indian women is complex and needs
special social intervention strategies. The joint family structure and low status of
women especially in rural India adds to the complexity of seropositive women.
|23483 Epidemiological profile of women over age 15 at risk or
infected with HIV in Belo Horizonte, Brazil -
January-December 1996
Dirceu Greco, U. Tupinambas, M.M. Menezes, L.F. Xavier, F.A. Ribeiro,
F.G.F. Ferreira, R.M. Ferraz. Federal University of Minas Gerais, Belo Horizonte,
MG; Rua Goitacazes 14, Brazil

Objectives: To evaluate demographic characteristics and epidemiological profile
of women at risk or infected with HIV followed at the Immunodeficiency Sector of
the Infectious Disease Service, an AIDS reference center.
Methods: The Immunodeficiency Sector was established in 1985 and is the
reference AIDS center for the metropolitan area of Belo Horizonte (Pop.: 2.8
million). Up to December 1996 it has attended 4,800 individuals at risk or infected

with HIV, and starting June 96 it is following up only those patients with confirmed
HIV infection or at higher risk of infection (e.g., sexual partners of HIV positive
patients). The first appointment records of 630 patients attended from January to
December 96 were evaluated.
Results: From the 630 records evaluated, 421 were male (66.8%) and 209
female (33.2%); 62.4% of the patients were between 25 and 40 years old, 20.8%
between 15 and 25, 15.9% between 40 and 60, and 1% older than 60. The
great majority of patients lived in Belo Horizonte or in the metropolitan area of
the city (80.2%), and 17.1% came from other cities of MG State. 371 (58.9%)
patients were single and 125 (19.8%) were married. As for education, 54.7%
(321) had not completed elementary school and only 12.6% (54) had finished or
were in university. A history of STD was reported by 40.5% (255) of the patients.
Among female patients, 38.3% (80) were single, 37.8% were married and marital
relation, 7.7% were separated and 16.3% were widowed. Over 73% of them
reported no risk for HIV infection. As for the category of exposure, 88.5% (185)
related heterosexual activity, 0.5% (1) homosexual activity; 2.9% heterosexual
activity associated with IV drug use; 16.7% (14) ignored, 1.0% (2) had received
a blood transfusion. Only 14.4% (30) related sexually transmitted diseases in the
past.
Conclusions: The ratio of men/women infected with HIV coincides with national tendency of decrease, that is 3:1. It is important to note that only 36.8% of
the women related risk behaviour for HIV infection and that 88.5% of the contaminations probably happened through sexual (heterosexual) activity, mostly with a
long time partner, showing that information campaigns pushing for decreasing the
number of sexual partners will have no impact to this female population. Another
important finding is that IV drug user is uncommon at this reference center.
123484 Target the woman and girl child; reduce on the
transmission
Samali Matovu, N. Nantamu. The AIDS Support Organisation PO. Box, 11485
Kampala, Uganda
Issue: It is estimated that over 18 million adults are today infected with HIV
worldwide, of which over 8 million are women. We expect the numbers to be
increasing everyday. In almost every society women face discrimination in education, employment, social status, property in rights and access to economic
opportunities. The resulting economic vulnerability increases women's risk of
infection and decreases their ability to say 'no' to sex and to cope if infected or
affected.
Research: A group of 40 anonymous women were followed for a period of 1
year. They were followed on their way of living, at work, home and were home
visited once in every month. They were always being given AIDS education and
AIDS counselling. A small evaluation was carried out at the end of the study on
factors that predispose women to HIV infection.
Result: After a period of 6 months 12 women had already taken an HIV test
and results showed that, 7 of them were HIV positive while 5 were HIV negative.
At the end of the study 27 out of the remaining 28 opted to take HIV test and 12
of them were HIV positive while 15 HIV negative. 1 woman did not take the test.
Most of the factors which predispose women to HIV infection mentioned were
more of social economic than cultural and legal factors.
Women are more vulnerable if they cannot sustain themselves. Women being
the mothers of the nation, should be empowered psychologically, economically
and socially in order to reduce the vulnerability. Special HIV education programs
should be initiated and target women in order to reduce on the HIV vertical
transmission and heterosexual HIV transmission.
23485 STD/AIDS intervention among wives of unfaithful men in
churches
Daniel Uduak. Nigeria Youth AIDS Programme, SLT Block University of Calabar,
CRS, Nigeria
Issue: Christian women married to unfaithful men are vulnerable to STDs/HIV.
Appropriate and innovative intervention is needed.
Project: 'Operation seduce' was initiated after having four FGDs with Christian
women from six churches. The project was designed to encourage condom use by
being more seductive and sedulous. Women leaders in the churches were trained
as peer educators while two social workers and two seduction skills instructors
worked as volunteers. Each church had a counseling centre. Strategies included
repeated sexuality and HIV/AIDs education at women meetings, encouraging after sex discussion with spouses, one-on-one counseling on condom negotiation,
seduction skills training and condom distribution.
Result: The number of counseling centres increased from six to 18 in one year.
A total of 76 seductresses emerged. Safer sex discussion with spouses helped in
determining condom negotiation approach. Many husbands now enjoy sex and
have stopped flirting.
Lessons Learned: Intervention programs that will not mortgage harmony in
the home as well as help the prevention of infection seems to be an effective way
of empowering women in churches.