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

482 Abstracts 24210-24215

12th World AIDS Conference

laborative model. In order to be effective, services must address not only the legal
issues, but also the psychosocial issues affecting families. In addition, service
providers require specialized training and support; and public policies and laws
must be enacted to facilitate permanency planning.
|24210 An analysis of subject attrition in a longitudinal study of
HIV/AIDS caregivers
Phyllis Hansell, W.C. Budin. College Of Nursing, Seton Hall University 400
South Orange Ave. South Orange, New Jersey 07079, USA
Issue: In research on HIV/AIDS study results are often compromised by subject
attrition. In a study of caregivers of HIV/AIDS children, 122 subjects were entered
into the study, at 6 months 70 subjects remained and at 12 months 59 subjects
remained.
Project: This secondary analysis compared subjects who remained in the
study to subjects who became part of the attrition. Tests for statistically significant
differences were performed on the variables of: caregiver age; HIV status; marital
status; educational level, ethnic background; relationship to the child; housing;
sex; symptomatic disease; social status; network density; stress; coping and
social support.
Results: No statistically significant differences were found. Reasons for attrition included: progressive illness; loss of child custody, death of subject or child,
imprisonment, parental confusion, and seroconversion of child.
Lesson Learned: Subjects that became part of the attrition did not differ on
the demographic variables or on the study outcome variables. Most reasons for
attrition were secondary to HIV/AIDS. A year of follow up is probably too long to
maintain a sample. Thus, the recommendation is to follow subjects for 6 months
with outcome measurement at 3 month intervals in order to maintain a sample
and limit subject attrition.
24211 Trends in family structure in African populations affected
by HIV
Simon Gregson1, G.P. Garnett1, B.W. Zaba2. 1 Wellcome Centre for
Epidemiology, Oxford University, South Parks Rd. Oxford OX13PS2 Centre for
Population Studies, LSHTM, London, UK
Objectives: To review the evidence for the impact of HIV on orphanhood and
other indices of family structure.
Methods: Orphanhood measures from community studies of families and
households affected by HIV are compared with evidence of general population
trends in orphanhood from recent DHS surveys and model predictions made
in recent projections. We also use projection models to examine some of the
implications of current findings concerning the impact of HIV on fertility and the
age-sex distributions of adult deaths for future trends in orphanhood. The more
limited evidence concerning trends in widowhood, headship rates and household
size is also reviewed.
Results: Paternal orphanhood rates are generally higher than maternal orphanhood rates in the initial phases of the epidemic. Orphanhood prevalence levels
lag HIV prevalence by 10 years or more, so current rates are not a reliable guide
to future impact. Lower fertility among HIV+ women will lower the orphanhood
impact, though this will remain substantial. Changes in other indices of family
structure are less amenable to modelling or to generalization across populations.
Conclusions: The relationship between HIV prevalence, orphanhood and other
impacts on family structure will change as the epidemic develops. The mechanisms underlying such changes include the saturation of the epidemic in high risk
groups, and changing mortality and fertility among the infected.
24212 Caring and coping strategies of families living with TB
and AIDS in East Hararghe and Harar, Ethiopia
Michael Bailey1, Assefa Tolossa2, Nigussie Tena2, Berhane Degneh3, Fisseha4,
Save The Children Fund (UK) London, United Kingdom; 2Save The Children
Fund (UK) Harar; 3Family Guidance Association Ethiopia Nazareth; 4TTI Harar;
5 0rganisation for Social Support AIDS Harar; 6Finote Hiwot Anti AIDS Club
Harar, Ethiopia
Background: Communities in Ethiopia need to be informed of the impact of AIDS
on children and facilitated to identify priorities for action.
Method: Case studies of household size, income and expenditure, occupations
of breadwinners, education, accommodation, food security, facilities, possessions
and endowments for between twelve and thirty families living with tuberculosis in
each of three representative communities. Control case studies were conducted
on two families matched for size, occupation of principal breadwinner and locality
for each case study family. A structured interview with open-ended questions
on impact of illness was administered to the household head or principal carer.
Stakeholder workshops were held so that the results of the research could be
discussed with the communities involved. The aim of the workshops was to find

ways to work together to reduce the impact of AIDS on children
Conclusions: The impact of long term debilitating illness such as TB and AIDS
on the household environment of children is to make the poor immediately and
irreversibly poorer. Households sell possessions, reduce the quantity and quality
of food and, outside Harar, remove many of their children from schooling. When
parents die the children are left without adequate resources or assets.

24213 1 Experiencein "will" writing and impact of HIV/AIDS on
the household, family structure, orphans
Alice Akello. Taso Tororo PO. BOX. 777 Tororo, Uganda
Issue: Widows and Orphans without a Will are vulnerable to exploitation and
abuse.
Project: I was widowed with AIDS in 1993 leaving me 7 children. In his Will
only my children were indicated. I was tortured and thrown out of the home. I
rented a room to solve the situation, I later acquired a plot and built temporary
house.
Result: Consequently, my eldest daughter was defilled at 16 years the boy
left school and is a trailer driver. One is a street boy. The four are still with me
schooling. All those above expose them to HIV infection, exploitation and abuse.
Lesson: Will making is very necessary in case of death.
|24214 Survey of social problems among PWAs' children
Parichart Chantcharas, D.R. Phoolchareon, M.S. Kunthamala. AIDS Division,
Dept. of CDC, MOPH, Tivanond Road, Nonthaburi 11000, Thailand
Objective: To assess the magnitude and basic characteristic of social problems
among PWAs' children.
Method: The study was surveyed in 22 provinces purposively selected, during September-November 1997. The questionnaire was conducted and asked
Provincial Public Health Centers to coordinate their provincial, district and subdistrict organizations for collecting data of PWAs' children concerning life status
of their parents, age and education of children as well as assess basicly that Do
children encounter problem? The problems were classified in 3 issues; education,
daily life and others.
Results: 7,665 PWAs' children were reported from 22 provinces. Among these,
6,604 PWAs' children were completely reported life status data of their parents.
It was revealed that 62.96% (4158/6604) of these children were orphans (7.42%
were only father died from AIDS, 37.31% were only mother died from AIDS and
18.23% were both died from AIDS). 7,470 children were completely reported age
data. The distribution by age group found that 16.45% was under 1 years old,
41.87% was 2-5 years old, 24.35% was 6-10 years old, 13.86% was 11-15 years
old and 3.46% was >16 years old. The basic assessment found that 59.51% of
children encountered education problem and 90.37% have a daily life problem.
The orphans who only father or mother died from AIDS were mostly identified
as a group having both education and daily life problem. (Most of these orphans
were mother died from AIDS). When considered on age group, it found that
11-15 years old group and 6-10 years old group who studying in primary and
secondary school have to encounter an education problem (87.30% and 82.23%
respectively) more than the other groups; 2-5 years old group (50.11%) and >16
years old group (71.76%).
Conclusion: Despite the limitation of study design, the results of this survey
can show the basic characteristic of social problems among PWAs' children. It
indicate that more a half of PWAs' children are at risk for lack of opportunity
to continue their study and most of PWAs' children have a daily life problem.
The group of orphans who have only father died from AIDS and 6-15 years old
children need supportive service to maintain education status and growth with
quality of life. However, the support need numerous budget. So we have to seek
effective measures to ensure education for these children.
S24215 Asking for community assistance to prepare for large HIV
vaccine trials in San Francisco
Joe Wright. 25 Van Ness Avenue, Suite 500, San Francisco, California 94102,
USA
Issue: Large Phase III HIV vaccine trials could have substantial impacts on
the communities in which they take place. As a result, communities should understand the trials and, to some degree, collectively consent to their conduct.
Researchers must consider how to approach their relationships with communities
as they prepare for large HIV vaccine trials.
Project: Organizers working in community economic development efforts have
used resource assessments to focus on how the existing capacity of a community
can help to solve community problems. A community educator in San Francisco
used this technique in order to target efforts to prepare a community for Phase III
vaccine trials.
Results: Approaching a series of community groups and opinion leaders as
key resources for HIV vaccine trial preparedness often generated useful results. A team presented information to 16 community groups without directly
asking for help; only one of these groups responded with any independent action towards preparing for vaccine trials. Asking for help from six other groups
prompted independent action and more concrete contributions towards community preparedness in five of these six instances. For instance, a legal services
organization conducted legal research on vaccine-specific legal issues, prepared
a brochure on the topic, and offered legal assistance to trial volunteers; a hotline
prepared to answer questions; and a street priest offered help with recruiting sex

workers in his parish.
Conclusions: Researchers can help a community prepare for a large HIV
vaccine trial by asking for help from a wide variety of individuals, organizations
and institutions. This approach should in turn help the community prepare for
the impact of Phase III HIV vaccine trials and make informed decisions about
trials' community-level costs and benefits. Organizing community resources, as