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

12th World AIDS Conference

Abstracts 24216-24221 483

opposed to simply disseminating information, can be a more focused approach
to preparing for large vaccine trials.
124216 The AIDS cases among IDUs in Brazil
Maria Goretti Fonseca, E. Castilho. Brazilian AIDS Program MOH, Espl.
Ministerios BL. G. Brasilia DF 70058-900, Brazil
Objective: To describe the AIDS cases among IDUs in Brazil.
Methods: National surveillance data on cases of AIDS related to IDUs were
analyzed (X2, ANOVA) according to age, sex, exposure category, schooling and
regional distribution.
Results: A total of 27,222 AIDS cases among IDUs has been reported in
Brazil, since 1982, representing 22.6% of all AIDS cases reported. From 1987
to 1992, the AIDS cases among IDUs were the 2nd most important category of
exposure. Twenty percent of that were women and 55% aged less then 30 years,
being younger 2 years then the AIDS cases reported due to homo/bisexual and
heterosexual contact. Those cases had less years of schooling when compared
with those two other categories, specially if compared with the homo/bisexual
cases. Among the IDU cases, women were less educated. The IDU cases were
reported from 641 municipalities of Brazil (12% of all municipalities), compared to
27% in the heterosexual and 20% homosexual categories of exposure. Forty two
percent of those municipalities were located in the State of Sao Paulo (Southeast
Region).
Conclusion: AIDS cases in IDU exposure category represent around 20% of
all cumulative cases reported in Brazil through 1997. The cases are younger, less
educated than homosexual category cases, and concentrated in municipalities of
the Southeast Region, mainly in the State of Sao Paulo.
24217 Motivations to continue fighting and plans for children
after death among HIV positive women in Sao Paulo,
Brazil
Rosa Maria Lima1, L.G. Tunala2, B. Leme2, V. Paiva2, N.J. Santos3, N. Hearst4,
C.M. Buchalla2. 1Av. Prof. Mello Moraes, 1721 bl. A PSTcep: 05508-900, Sao
Paulo-SP; 2NEPAIDS, Sao Paulo SP; 3CRTA, Sao Paulo SP Brazil; 4 University
of California, San Francisco CA, USA
Objectives: Rates of HIV infection are raising rapidly among Brazilian women
in Sao Paulo. Many of these women lead very difficult live, and most of them
have children. This study examined what HIV-positive women consider their main
reasons for continuing to fight HIV/AIDS, and, if they died, what would be their for
their children.
Design: Cross-sectional interviewer-administered questionnaire.
Methods: A consectuvive sample of women coming for ambulatory care to the
main public clinic for HIV/AIDS patients (CRTAIDS) in Sao Paulo was invited to
participate. Exclusion criteria included: age under 18, too ill to respond to the
questionnaire, children with them at the time of visit, emergency (unscheduled)
visit, having participated in a previous pilot study, or refusal to participate. 100
HIV+ women completed a private face-to-face interview.
Results: 59% of the women considered their children to be their main reason
to keep fighting against HIV/AIDS. Others answers were: 20% "wanting to live",
6% "faith in God", 6% "for friends and relatives", 1% "work", 1% "fear of death"
and 3% "other". Only 4% said that they would not have given up fighting. 78%
of the women have children. When asked the question "If you died, what would
be your plans for your children?", 48% said they would leave their children with
relatives, 9% have thought about this issue but haven't yet decided, and 8%
haven't thought about they would do. Only 2% claim that they don't have anybody
to whom they could leave their children.
Conclusion: Most of these women consider their children to be their main
reason to continue living, and most of them would leave children to their relatives
if they died. Those who cannot or would not leave their children with family
members do not know what they would do. These results reflect both the strength
of any real alternative from public social services. Such services need to be
improved, publicized, and made accessible to these mothers and their children.
24218 From household to community concern
Rebecca Joy Batusa. Church of Uganda PO Box 14297 Kampala, Uganda
Issue: Households alone can no longer cope with the growing number of children
orphaned by HIV/AIDS and yet many communities still percieve orphans as a
household concern.
Project: A Programme "Friends of Orphans", was developed in 7 communities
to have the communities participate in caring for the growing number of Orphans
in these communities. Through Sensitisation, Education and Awareness Campaigns, the Communities responded by offering moral, spiritual and economic
support to the Orphans.
Results: As a result, the 7 communities have started their initiatives to bridge
the gap that is created by the death of parents. 1123 Orphans in these commu
nities are now recieving school fees, food, clothing, accommodation or medical
support from the community.
Lessons learnt: Without intensive community involvement in the support of
the Orphans, many will continue to go without food, shelter, accommodation and
education.

422*/24219 AIDS orphans in Nairobi slums
Charles Thumi1, G.E. Horsfield2. PO. Box 53376, Nairobi; 2Kariobangi
C.B.H.C. Prog. Coordinator, Nairobi, Kenya
Issue: Many AIDS Orphans in Nairobi Slums have to face a life without either
parents, or a supportive family.
Project: Many of the orphans will end up in child headed households, those
who go to grandparents will still be given most of the responsibility for bringing
up their younger brothers and sisters. A programme has been developed to
assist children of AIDS patients to prepare for life without parents. The children
are invited to become Young Community Health Workers, they receive weekly
classes which teach them the skills they will need in order to care for their
siblings, and which also provide them with the support and encouragement they
need to cope in very difficult circumstances. The children are enthusiastic about
the programme, as they learn together they form support groups.
The programme also includes other activities to which their siblings are invited,
games, a library and other social events. A Social Worker and a Counsellor are
available to help the children.
Programmes for AIDS Orphans that are targetted on strengthening the childrens abilities to cope on their own are a constructive and sustainable alternative
when care situations are not available.
421*/24220 1 Preventing displacement of children orphaned by
AIDS in Brazil
Miguel Fontes. Srtn Qd. 701 Cj. C No. 124 Sala 314-A 70710-200, Brasilia-DF,
Brazil
Issue: Children orphaned by AIDS living in low-income settings of Brazil require
new interventions in their own communities to avoid displacement.
Project: Given the rapid increase in the number of children orphaned by AIDS
in Brazil, new community based interventions are necessary to reduce the number
of children becoming displaced from their families and communities. Presently,
the great majority of projects for children orphaned by AIDS focus on providing
assistance at institutions called "Casas de Apoio" (homes of support). However,
a paradigm shift is necessary for the development of new support strategies
at children's own homes. New strategies have been identified to help children
orphaned by AIDS to become displaced from their communities, including family
visits using "support vehicles," family support groups, popular religious networks
(e.g. Umbanda), and new psicosocial counseling programs.
Results: The Global Orphan Project has developed a partnership with UNICEF
and the local Ministry of Health STD/AIDS Program to identify new interventions
for orphaned and displaced children in Brazil. "Casas de Apoio" are normally
restricted to a maximum of 35-40 children per institution. Other community
projects, such as the ones being developed in the Northeast region, have exceeded that number by at least five times. Many children have been prevented
from displacement and their basic family structure has been maintained.
Lessons Learned: Even though "Casas de Apoio" represent an important intervention for children orphaned by AIDS from low-income communities in Brazil,
their success has been restricted in avoiding displacement. Multiple community
based strategies are necessary to prevent children orphaned by AIDS to become
also displaced from their families.
S24221 Psychiatric disorders in patients with HIV infection
Sophia Kantin1, M.A. Kolb1, G. Hudzik1, Gaillochon1,
Dao Castellana1, Semaille2, Prazuck2. 1 Psychiatrie-Centre Hospitalier 94915
Villeneuve St. Georges Cedex; 2lnfectieux-Centre Hospitalier Villeneuve St. G.,
France
Objectives: To describe psychiatric disorders among HIV infected patients followed up in a general hospital and to determine factors associated with these
psychiatric disorders.
Methods: A prospective study was conducted between September, 1997 and
January, 1998 among HIV infected patients in an infectious diseases department. Patients were evaluated using a one-hour standardized questionnaire,
psychometric scales and psychiatric diagnosis according to DSM IV and ICD 10.
Preliminary Results: 65 patients were included. Sex ratio was 1.32 and mean
age was 38.3 (SE = 11.2). Prominent modes of transmission were heterosexual
(53.1%) and IDU (29.7%). 51% of patients were unemployed or without occupational activities. WHO clinical stages of patients were respectively 41% (A), 31%/
(B) and 28% (C).73.8% of HIV patients presented a karnovsky score over 90.
54.7% of patients (n = 35) had antiretroviral (ARV) tritherapy. 57% of patients
presented psychiatric disorders. According to DSM IV, we observed mood disorders (40%, n = 26), anxiety disorders (7.7%, n = 5) and other disorders (9.2%, n
= 6). Psychiatric disorders were not associated with sex (p = 0.43), occupational
activity (p = 0.65), HIV clinical stage (p = 0.71), ARV therapy (p = 0.65), CD4 cell
T counts (p = 0.23), viral load (p = 0.36) and cognitive impairment - MMSE - 25 -(p = 0.07). Current psychiatric disorders (p = 0.004) were more frequent in active
drug users. Psychiatric disorders were more frequent in patients with Karnovsky

below 90 (p = 0.03) compared with those with Karnovsky above and equal 90.
Conclusion: More than half of HIV patients (57%) presented psychiatric disorders. Two factors were associated with psychiatric disorders: one related to
HIV disease (Karnovsky score) and the other related to drug abuse. Final results
concerning 90 patients will be presented later one.