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

464 Abstracts 24117-24121

12th World AIDS Conference

24117 Health care workers sexual behavior and risk of acquiring
STDs/HIV/AIDS in Colombia
Ivan Perea1, J. Reyes2, G.M. Villa2, O. Solano2, I.E. Mejia2, N.A. Perez2,
L. Aja2. 1Calle 33 A No 13-58 Santafe de Bogota; 2Psicdlogo Investigador
Universidad de los Andes Bogota, Colombia
Objective: To study the sexual behavior of health care workers in Colombia and
the risk they may have to acquire STDs/HIV/AIDS.
Design: An STDs/HIV/AIDS risk assessment questionnaire was given to 666
health care workers coming from all states of the country, attending a training
course for prevention of sexually transmitted diseases.
Method: Demographic and behavioral data was analyzed searching for promiscuity, sexual practices and condom use in the last five years.
Results: There were 450 women and 216 men. The group were composed
by 210 (33.3%) physicians, 105 (16.6%) nurses, 75 (11.9%) dentists, 47 (7.5%)
nurse assistants, 44 (7.0%) psychologists, 26 (4.1%) laboratory technicians and
159 (19.6%) other related paramedical health care workers. 379 (58.6%) health
care workers with a stable partner never used condom for insertive penile/vaginal
or penile/rectal intercourse. 171 (26.4%) of individuals with a stable sexual partner
reported using condoms. Among those with a stable partner, 49 (7.6%) did not
have insertive practices. 321 persons with a stable couple had oral sex without
condoms (49.8% of cases); 55 (8.5%) had oral sex using a condom. 213 (33.0%)
reported never having had oral sex. 59 (9.1%) did not have a stable sexual partner
With respect to individuals who had sex with occasional partners, 30 (4.6%)
never used condoms for penetrative intercourse, either vaginal or rectal, whereas
137 (21.0%) did use it. 39 (6.0%) never had insertive relations with occasional
partners. 46 (7.1%) of those having occasional partners had oral sex without
condom and 27 (4.2%) did use it. 111 (17.1%) denied having oral sex with occasional partners. 455 (69.7%) never had occasional partners. Only 67 (10.7%) of
all individuals surveyed reported using condoms for every insertive intercourse.
Conclusion: Although it is estimated that health care workers should have better knowledge and attitudes on the prevention of STDs/HIV/AIDS, an important
number of individuals in this study are putting themselves and their couples at
risk.
24118 Role of development activities in the programme of
education and prevention in regard of HIV/AIDS among
tribal sex workers
Mahesh Kumar Jain. B1 Deep Apartments, Opp Ramand Kot Temp Le
Maniagar, Ahmedabad, India
Issue: Assessment of impact of development activities during intervention among
the tribal sex workers in regard of HIV/AIDS.
Project: One hundred twenty tribal sex workers and their family members were
interviewed personally. Fifteen small group discussions were organised to identify
and evaluate the impact. Also the general behaviour of sex workers with the
GVKS personnel and sexual behaviour with the clients pre and post carrying out
the developmental activities was observed and evaluated. Discussions were also
held with community people, condom venders, local traditional healers, etc.
Results: The study was not only very much interesting, but encouraging for
NGOs like ours working in the preliminary phase of education, counselling and
prevention in regard of HIV/AIDS. During survey the response of sex workers
was very poor. They reacted that their priority was safe drinking water, medicines
for general diseases and education for children and not the condom or HIV/AIDS.
After carrying out developmental activities ie digging a bore well for potable water,
hiring a doctor for general health care and establishing a non formal education
centre there was a tremendous response. The major impacts were: a good bridge
between sex workers and GVKS could be made, one sex centre adopted 'condom
only' policy, induction of teenagers in sex trade reduced, etc.
Lessons Learned: Developmental activities prioritised on the basis of needs
of sex workers can lead to successful education and prevention.
1 24119 | The AIDS and development indicators
Alan Whiteside. Health Economics and HIV/AIDS Div., ERU University of Natal -
4041 Durban, South Africa
Issues. Two decades into the epidemic it is clear that the impact in the developing
world is complex. AIDS is a disaster for an individual or household, but effects
on national economies, communities, and firms are harder to discern. National
development is measured through means other than the traditional GNP and
GDP per capita. The impact will be felt here, but its effect on these indicators may
be misleading and have unanticipated consequences.
Project. The aim of the research was to assess how impact could be measured
and the effect of the measures on response. The evidence for impact was reviewed and the ways in which policy-makers, planners, and leaders incorporated
this into their activities assessed.
Results: There is little evidence of impact on GDP or GDP per capita, although
economic models indicate AIDS may cause GDP growth rates to slow, and may

affect per capita income. The impact on other measures of development such as
infant and child mortality is considerable. The most dramatic is the impact on life
expectancy, which in the case of Botswana fell from 65.2 in 1993 to an estimated
52.3 in 1994 and a projected 46 years in 1996.
The impact on life expectancy is significant for the Human Development and
Human Poverty Indices, measures developed by the UNDP to give a more balanced view of development gains (and losses) than simple economic measures.

The effect of AIDS is considerable, and some of the more successful countries
are most adversely affected. The question is are these measures appropriate?
Do they need to be revised? It points to some unexpected and negative effects in
policy-makers responses.
Lessons Learnt: Impact issues are complex, and other than at individual,
household and health infrastructure level, long-term. The development impacts
are great, but existing indices may be over-sensitive resulting in denial. Measuring
of impact must be refined.
S24120 Treatment guidelines in HIV: Self reported physician
practices
Robert Kristofco', L. Howell2, K.E. Squires3, L.L. Casebeer1, A.S. Carillo1,
J. Shapiro2. 1UAB School of Medicine Division of CME, 1521 11th Ave. S.,
Birmingham, AL 35294; 2Alliance-Scientific-Affairs-Publication Parsippany NJ;
3UAB School of Medicine-Infectious Dis. Birmingham AL, USA
Objectives: To learn more about antiretroviral therapy practice patterns of
HIV/AIDS providers in light of issuance of draft NIH Principles of HIV Therapy
guidelines. To assess practitioner knowledge of guidelines, perceived barriers to
optimal management and confidence in treatment.
Methods: A case-based survey was developed to measure self-reported practice patterns related to draft principles of HIV therapy in the following areas: 1)
What to treat, 2) When to change, 3) What to change to, and 4) Management
of special populations as well as barriers to optimal management. The survey
was administered by facsimile to 1800 US HIV/AIDS physicians in the period
immediately following release of draft guidelines.
Results: The survey had a 34% response rate with a nearly equal split of I.D.
specialists and primary care physicians. Results indicated little variation between
draft guidelines and self-reported applications of anti-retroviral therapeutic regimens in the management of HIV/AIDS patients. Variations between providers
appear when dealing with more complex cases and are associated with the size
of the practitioners HIV/AIDS caseload. Barriers to optimal management include
lack of patient adherence, complexity of treatment regimens, and medication
side effects. Respondents were most confident in discussing the importance
of patient options and least confident in detecting patients who are at risk for
non-compliance.
Lessons Learned: The survey provides important insights into practitioner
thinking about HIV/AIDS therapies. Information on barriers, confidence in treatment, and educational preferences is valuable for program design to better target
physician education for HIV/AIDS.
24121 Measuring the net hospital costs and physician billings
for the last three years of life for HIV patients using a
linked administrative database
David G. Schneider, R.A. Hanvelt, T.T. Copley, N.L. Meagmer. BC Centre for
Excellence in HIV/AIDS at St. Paul's Hospital 613-1018 Burrard Street,
Vancouver, British Columbia V6Z1Y6, Canada
Objectives: To measure net hospital costs and physician billings for the last three
years of life.
Design: Retrospective using linked administrative data
Methods: Incidence costs for hospitalizations and physician services are based
on the British Columbia linked administrative database covering the period April
1985 to March 1996. Gross cost estimates are based on data for individuals with
an ICD-9 code for HIV ever recorded on a hospital separation (ICD-9 HIV codes
{042-044, 798.5} have been coded since 1987). Episodic cost are based on
those who were deceased as of December 1995 based on Vital Statistic Records.
This data file contains hospital and physician resource utilization data for 1807
HIV-positive individuals. In 1997, BC Vital Statistics reports 1874 person died
due to HIV during the period 1987 to 1995. The sample selected based on hospital diagnostic information includes 96.4% of the reported HIV deaths in British
Columbia. The missing cases may be due to reporting delays, under-reporting of
HIV diagnoses, or that these cases never involved a hospitalization related to HIV.
The net incidence resource use and costs are estimated by using an anonymous
1% sample of all individuals in British Columbia totaling 50,565 individuals. This
sample provides a baseline estimate of direct costs for the general population at
each age.
Results: On average 93.4% of all acute hospital days (42.2/45.2 days) occur
in the last three years of life. For years 1, 2, & 3 before death cummulative acute
hospital costs are $24,000, $28,000 & $30,000 respectively. Aggregate physician
costs are $4,350, $6,700 & $8,500 respectively. Total net costs are $28,200,
$34,400 & $37,400 respectively. In the 3 years before death medical billings have
remained constant over time & acute hospital days have decreased 19% from
1990/91 to 1995/94. In the final 3 months of life physician costs are $1,560 and
hospial costs are $14,760 for a total cost of $16,320. Dollar amounts are 1997
standardized CDN.
Conclusions: The nearly complete population sample minimizes bias. This is
significantly different from most other cost studies which have smaller sample

sizes and have generally sampled from within a clinical environment. Importantly,
this sample likely includes those who might have a very limited interaction with
the medical system. An expected positive cost bias in this literature is consistent
with out findings. This study also shows that, on average, the vast majority of
acute hospitalizations occur in the final three years of life.