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

480 Abstracts 24199-24204

12th World AIDS Conference

in birth rates can be explained by an increased likelihood of induced abortion
in infected women, rates of recognized pregnancy begin to decline as many as
7.5 years before AIDS. Further work is needed to determine the role of nutritional status, illicit drug use, contraceptive use, and sexually transmitted disease
associated pregnancy loss and infertility.
S24199 Is antiretroviral MCT prophylaxis provoking increased
pregnancy incidence in women living with HIV?
Catherine Hankins1, T. Tran1, N Lapointe2, L Hum1, J Samson2. Can. Women's
HIV Study Group; 1Montreal Regional Public Health Dept., 1616 Rene-Levesque
West, Montreal, QC, H3H 1P8; 2Hopital Sainte-Justine, Montreal, Canada
Objectives: To compare pregnancy incidence and outcome in women participating in the Canadian Women's HIV Study for the periods before and after
HIV diagnosis and before and after recommendations were made concerning
prevention of mother-to-child transmission (MCT) using antiretrovirals (ARV).
Methods: For 320 HIV-positive women age 15-44 years we documented pregnancy incidence pre- and post-HIV diagnosis per 100 person years (PY) and
compared pregnancy outcome according to time of conception: 12 months to
20 weeks before HIV diagnosis (period 1), the 20 weeks (maximum duration
allowable for legal therapeutic abortion [TA]) prior to HIV diagnosis (period 2),
and the time since HIV diagnosis to last study visit (period 3). The data were then
stratified with respect to conception before March '94 and during/after March '94
to examine the impact of publication of results of the zidovudine prophylaxis trial
(ACTG076).
Results: The incidence of pregnancy in the year before HIV diagnosis was
27.5/100 PY (95% C.I. 22.1-33.9) compared with 8.3/100 PY (95% C.I. 6.8-10.2)
in the time since HIV diagnosis (p < 0.001), with the annual incidence post HIV
diagnosis remaining stable. The incidence of TA was 10.6/100 PY (95% C.I.
5.6-18.1) during period 2 versus 3.1/100 PY (95% C.I. 2.2-4.2) during period 3
(p = 0.001). After HIV diagnosis pregnancy incidence was similar before March
'94 (8.5 per 100 PY) (58/681) to that during and after March '94 (8.1 per 100 PY)
(39/483). The incidence of TA fell from 4.3/100 PY before March '94 to 1.4/100
PY (p = 0.009) after March '94 such that 50% (29/58) of HIV-aware women who
conceived prior to March '94 underwent TA versus 17.9% (7/39) of HIV-aware
women conceiving during and after March '94 (p = 0.001).
Conclusion: The advent of ARV prophylaxis of mother-to-child transmission
of HIV has not lead to increased pregnancy incidence; however the incidence of
therapeutic abortion has declined as more HIV-infected women opt to continue
their pregnancies.
24200 Incidence of pregnancies in HIV-infected women between
1988 and 1996
Laurence Meyer, F. Fourquet, J. Le Chenadel, M.J. Nayaux. Inserm U292
Hopital de Bicentre 82 Rue du Gal Leclerc 94276 Kremlin-Bicentre, France
Background: In order to describe the impact of HIV diagnosis and improvements
in vertical transmission in women from different socio-cultural levels, we compared the incidence in pregnancies before and after HIV diagnosis according to
their geographical origin (sub-Saharian Africa versus others).
Methods: 533 women infected by HIV through sexual contact were followed
in the French cohorts SEROCO and SEROGEST between 1988 and 1996. SEROCO is a cohort of HIV+ adults comprising 29% of women, mostly French.
SEROGEST is a cohort of HIV+ women enrolled while they are pregnant, this
pregnancy having led to the HIV diagnosis or occurring thereafter; 40% of them
were from sub-Saharian Africa. Women enrolled in SEROGEST because of a
pregnancy occurring after the HIV diagnosis were excluded from the analysis in
order not to overestimate the incidence after. The period surrounding the pregnancy having led to the test + (prenatal HIV testing being widespread in France)
was excluded from the incidence estimation. A multivariate Poisson regression
analysis was conducted to compare incidence before and after diagnosis independently of the socio-economical level and geographical origin (fixed variable)
and age and parity (time-dependent variables).
Results: In French women, the pregnancy incidence significantly fell from
11.2/100 person-years (p-y) before the test to 6.5/100 p-y after (p = 0.02). In
contrast, incidence remained stable in African women (15.5/100 p-y before vs
18.1/100 p-y after), the interaction term with geographical origin being significant.
After the test, birth delivery as well as voluntary abortion rate was 3 times greater
in African women than in others; the % of sexually active women was similar
in the 2 groups, but African reported less frequently having a contraception.
Finally, in HIV+ French women, the birth delivery rate increased in the 1994-96
period compared to before 1994, probably due to the large improvements in the
prevention of mother-to-child transmission. Such a trend was not observed in
African women.
Conclusion: This description of behaviour of HIV-infected women towards
pregnancy and contraception should allow improving counselling of HIV-infected
women in France.

24201 Motives for having babies as an HIV-infected woman in
eastern Uganda
Kirsten Madsen. MS att. Kirsten Madsen, PO Box 2519, Dar es Salam, Tanzania
The fieldwork was carried out in Mbale, in close collaboration with TASO-Mbale in
February 1997. It consisted of 47 group and individual interviews with HIV-infected

women, who were all clients of TASO. Twenty HIV-infected mothers were chosen
for in-depth analysis. Their age ranged from 21 to 49 years, and two-thirds were
living alone (eleven were widows and six separated or divorced; out of those
seventeen, only one widow lived with her family). Those twenty women gave birth
to 77 children (3.9 average) out of which 61 survived; Four of those vomen had
children after they had tested positive to HIV. HIV-test was related to pregnancy
and childbirth for eight women, and for six it followed husband's death. Out of
those twenty women, only two were employed, while for the majority a survival
strategy consisted of combining various sources of support (ten earned some
income by working within TASO, six had a small plot of land, while only one was
supported by her husband).
Constraints are embodied in well-documented familial, community and societal
structures, while the work of organizations such as TASO provides an alternative
structure.
Many of the women at TASO managed to stay alone without getting more
children in spite of the shared consensus that women's reproductive behaviour
results from familial and/or societal pressure towards childbearing rather than
individual woman's choice
S24202 AIDS orphans - A shared responsibility Botswana
experience
Khnezi Felicity Mbonini1, P.M. Motlhabani2. 1Bobirwa AIDS Home Based Care,
Box 595 Bobonong; 2 University of Botswana, Francistown, Botswana
Issue: As AIDS problems continued to escalate in Botswana communities began
to realise the burden and heavy responsibility of caring for orphans.
Project: The community is responsible for registration and screaning of orphans for relevant assistance and also to mobilise resources from the community,
NGOs, Donor community and accessing government relieve programmes to the
needy in their respective homes. In Botswana there did not exist any policy in
relation to care of the disadvantaged children. As the problem of orphans became
evident the government of Botswana in 1997 found it necessary to formulate
policies which will be addressing the child in difficult situations including AIDS
Orphans. This included adoption, Fostering and institunalisation which should be
the last resort.
Results: AIDS ORPHAN TRUST was well recieved by the communities as
indicated by their participation. Resources mobilised from various sectors of the
community and assistance to needy orphans in their respective homes. Policy on
needy children and AIDS orphans formulated by the government
Lessons Learned: Needy orphans can be assisted within the communities if
participatory methods are used in resource mobilisation and project management.
S24203 Developing family-centred care for HIV/AIDS orphans -
A collaboration across discplines
Stephen Kaggwa, D. Nyakenda Banage, S.M. Mugisa, V.C. Kakande,
P. Wawala. Uganda Social Research and Education Center, Plot 14 Kampala
Road, 2nd Floor Insurance House, P.O. Box 3512, Kampala, Uganda
Issue: The Multi-generational impact of HIV/AIDS Disease on families in Uganda
demand a creative multi-disciplinary programme that will ensure that bereaved
orphans receive appropriate care at the lowest cost.
Project: Statistically, there is over 3 million orphans in Uganda as a result of
the HIV/AIDS epidemic and their ever increasing numbers has created stressful
situations on the extended families and thus calling for an Innovative programme
to meet their health and socio-economic needs. Notably this programme on
managed care was initiated at our centre with collaboration from local support
organisations and charities to support the orphans in terms of providing medical
care, education requirements, feeding and clothings.
Results: The Implementation and successful operation of this programme has
tremendously improved the health status of the 268 orphans and a total of 424
orphans receiving education, Feeding and clothing support. It is also anticipated
that more 1000 orphans will be registered in the programme in the next one
year.
Lessons Learned: With the increasing numbers of HIV/AIDS deaths and hence
orphans there is urgent and great need to establish care centres for orphans which
have been seen as a way forward to a resourceful future generation inspite of the
lackuster resources to efficiently operate these centres.
|24204 The legacy project: Therapeutic videotaping with HIV+
parents
Holly Dando, G. Ilaria, J. Jacobs. Center for Special Studies NY Hosp. -CUMC,
155 West 20th St. Apt. 5 J New York, New York, 10011, USA
Issues: Parents living with HIV/AIDS sometimes struggle with how to discuss
issues surrounding their illness with their children. Therapeutic videotaping is an
effective means of helping patients process their feelings about HIV/AIDS and
communicating vital messages to their children.

Project: In an urban HIV primary care clinic serving 1,100 patients, caregivers
and posted flyers inform patients of this service. Before taping, patients meet
with a social to discuss goals of tape. Based on patient preference, the format is
interview or monologue. After editing, tape is reviewed in supportive session with
social worker.
Results: Patients have used this resource to address multiple concerns. For
example, one mother created a loving farewell, which was played at her funeral,