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

474 Abstracts 24167-24171

12th World AIDS Conference

touching on sex and sexuality, using the principles of sociolinguistics during 'safer
sex' promotion.
24167 The health seeking behavior of STD patients in
unlicensed private clinics in China
Ying Wang. Nanwei Road 27, National Center for AIDS, Chinese Academy of
Preventive Medicine, Beijing 100050, China
Objective: To test the hypothesis that many STD patients visited unlicensed
private clinics by advertisement posted on the walls in cities other than hospitals
in order to avoid the stigma.
Method: qualitative study with grounded theory, in-depth interview, non-participant observation.
Result: 9 clinics were found regarding its location in suburbs and urban areas.
11 persons running clinics and 15 persons visiting here were interviewed during
2, months study. All of the persons opening the clinics but one had no medical
training and even never heared of NGU. STDs were diagnosed by observation
and treated by so called antibiotic. The clinic settings were poor, including hygiene and facilities. Only a few persons visited clinics during the study. For fear
of stigma was not exclusive reason to choose private clinics. Among motives
with the behavior, patients mentioned two times that they did not know where
to get better treatment, eight times they needed more counseling after going to
hospitals, two times they could not afford costs of hospitals, three times they were
introduced by friend, three times they were willing to get treatment as quickly as
possible, three times they were afraid of bumping into acquaintance.
The qualitative study was more feasible when it was difficult obtaining enough
data to perform quantitative analysis. The factors influenced health seeking behavior of patients with other diseases also played role on those of STD. The
number of patients in such clinics were not as the same as people expected.
Such sort of clinics may increase the incidence of harmful consequence and
complication of the disease due to its poor service.
S24168 Wife inheritance and 'Chira' cultural impediments in HIV
and AIDS control, prevention and management: A case
study of the Luo community in Kenya
John P. Owino. PO. Box 4580 Kisumu, Kenya
Wife inheritance is a practice among the Luo traditions and customs which gives
for a provision for a continuity in the family. When a husband dies, his wife is
expected to be inherited for continuity of the family, more so women who are
within the bracket of child bearing age. In the olden days, the inheritor, was strictly
expected to come from within the clan and next of kins to the dead husband i.e.
his brothers or cousins, but this is nolonger the case as they can be inherited
by those who are outside the clan. It therefore means that if the late husband
died of HIV and AIDS related deaths, then if the surviving wife is HIV Positive the
inheritor will be infected or vice versa and they will also subsequently infect their
spouses. On the other hand 'Chira' is a curse which befalls people who are seen
to have gone against the customs and traditions of the society. The affected persons, develop similar signs and symptoms of full blown AIDS. Conflict therefore
does exist between 'Chira' and AIDS among the luo community. According to luo
traditions and customs HIV and AIDS does not exist, it is 'Chira' and 'Chira' is
not transimited through heterosexual relationship but through going against the
social customs and traditions.
The paper therefore examine how wife inheritance and 'Chira' as cultural
practices are impediment in HIV and AIDS control, prevention and Management.
258*/24169 Methodologic issues in outcome measures of HIV
prevention research: Behaviors of serodiscordant
heterosexual couples
Heather Huszti1, J.T. Parsons1, B.E. Gage2. 1Div HEM-ONC, Health Sciences
Center, Univ of Oklahoma, 940 NE 13th St, Oklahoma City OK; 2Jersey City
State College, Jersey City, NJ, USA
Objective: To determine efficacious methods to accurately measure consistent
condom use in heterosexual couples.
Design: Cross-sectional survey.
Methods: A sample of 50 HIV positive (HIV+) heterosexual men with hemophilia
and 46 HIV negative (HIV-) female partners of HIV+ men with hemophilia were
recruited from Hemophilia Treatment Centers across the United States for the
Hemophilia Behavioral Intervention and Evaluation Project (HBIEP) funded by
the US Centers for Disease Control. Participants completed a quantitative survey
examining factors associated with the long term (6 months or longer) consistent
use of condoms. Consistent condom use was assessed via self-report of the
percentage of times condoms were used, whether any act of unprotected sexual
intercourse took place over the past 6 months, and the use of specific behaviors
associated with correct and safe condom use, such as putting on a condom prior
to insertion of the penis into the vagina.

Results: The sample included 43 matched couples, of these 2 of the men
and 6 of the women who reported consistent condom use had a partner who
reported less than consistent use, resulting in a 19% rate of inconsistent dyad
reporting. In addition, 2 of the female partners who reported consistently using
condoms for the past 6 months, also reported at least one act of unprotected
intercourse during that time. Fourteen (15%) of the 96 participants (3 couples
and 8 additional participants (4 men, 4 women)) report insertion of the penis

without a condom into the vagina at least occasionally for purposes of foreplay.
Eighteen (36%) of the HIV+ men reported that they did not put on a condom
when their erection first occurred, and 20 (43%) of the women reported this same
behavior in their partners. According to the participants in this study, a significant
number of HIV-partners are still at risk for HIV infection, while thinking that they
are protected.
Conclusions: The efficacy of many HIV prevention programs are judged by
self-report of condom use. The current study, which compared dyadic data, found
inconsistent reporting in 19% of the matched couples, suggesting that the accuracy of reports of consistent condom use vary according to the members of the
dyad. In addition, the results of this study suggest that multiple questions about
condom use must be asked in order to ascertain whether consistent condom use
is actually occurring and whether or not the individual's behaviors actually are
protective.
S241701 Impact of effective therapy on retention and future
composition of HIV cohorts
Lisa P. Jacobson1, T Yamashita1, J.B. Margolick1, B. Visscher2, Q. AI-Shboul3,
J.P. Phair4, A. Muhoz1. 'Johns Hopkins School of Public Health, 615 N Wolfe
Street, Baltimore, MD; 2UCLA School of Public Health, Los Angeles, CA;
3 University of Pittsburgh, Pittsburgh, PA; 4 Northwestern Univ Medical School,
Chicago, IL, USA
Background: Cohort studies, such as the Multicenter AIDS Cohort Study (MACS),
are valuable for outcomes research including use and effectiveness of therapies.
Attrition in long term cohorts compromises power. The goal was to assess the impact of effective therapy on cohort retention and provide a method for estimating
the future cohort.
Methods: The MACS enrolled 4954 men in 1984-85 and 668 men in 1987-91;
study population was 2195 HIV seroprevalent and 555 HIV seroconverters. Clinical events are actively and passively ascertained. If AIDS occurs, telephone
contact is at least once every 3 months. An inactive visit was defined as no
contact (visit, telephone or mail) in the year prior to the end of the visit. Frequencies of 6 month changes between mutually exclusive states (inactive, AIDS-free,
AIDS, and death) were determined. Transition probability matrices between semiannual visits during 1991-1995 were compared to those observed in 1996-1997.
To predict the number of participants to be seen at future visits, we used the
transition probability matrix obtained from combining visits 25 to 26 and 26 to 27
probabilities.
Results: A dramatic increase in the percent remaining alive with clinical AIDS
and active in the study was observed; from a stable average of 75% in 1991-1995
to 89% in 1996-1997, the time that highly effective therapy was available and being used. Correspondingly, a decrease from 22% (1991-1995) to 6% (1996-1997)
in the rate of death among AIDS cases was observed. At visit 27 (4/97-10/97),
when viral load measurements were first offered, the percentages becoming
active from inactive also increased. At the end of visit 27, a total of 714 AIDS-free
seropositive men and 168 men with AIDS were active in the study. Using the
current transition probabilities, we estimate that 593 AIDS-free seropositive men
and 140 men with AIDS will be followed in the study in the year 2003. In contrast,
the estimates would have been 374 AIDS-free and 96 men with AIDS, had the
transitions from 1991-1995 persisted.
Conclusions: Retention in long term cohort studies is substantially improved
by the beneficial impact of therapies and by the offering of clinically relevant
information (e.g., HIV RNA) to participants and health care providers for closer
monitoring of disease progression. A consequence of improved retention is to
facilitate the elucidation of the natural history of HIV infection in the era of highly
effective therapies. Given the power associated with large cohort studies, they
will be also useful for promoting and monitoring adherence to such effective
therapies.
S24171 Theory driven determinants of condom use intention and
behavior: A cross-sectional and prospective design
comparison
Daniel Montano, D. Kasprzyk. Battelle, 400 NE 41ST Street, Seattle, WA 98105,
USA
Background: The objectives of this study were: 1) to use components from
multiple behavioral models to explain condom use intention and behavior, and
2) to assess whether the components of the model are differentially important in
explaining condom use with different types of partners and different types of sex.
Methods: A qualitative phase was conducted to develop a questionnaire measuring components from an integrated behavioral model including: condom use
intention and behavior, attitude, social norm, facilitating conditions, perceived
control, and alternative protective strategies. The survey was administered to
individuals at risk for HIV: injection drug users, sex workers, men who have sex
with men, and multi-partnered heterosexuals. A prospective design was used
with 993 individuals surveyed at Time 1 and 686 returning for Time 2 interviews
3 months later. Correlation and regression analyses were conducted to identify

model components measured at Time 1 that best explain Time 1 condom use
intention and Time 2 behavior for vaginal, anal and oral sex with regular and
casual partners (i.e., 6 behaviors).
Results: Attitude, social norm, facilitating conditions and perceived control
were significant determinants of intention to use condoms for all six behaviors.
This was not the case for predicting behavior. Attitude was a strong predictor
of all six condom use behaviors reported at Time 2. Social norm obtained best