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

486 Abstracts 24233-24237

12th World AIDS Conference

the "Framework for Action." Provincial and municipal governments have been
responsive to some extent. Of the five national partners of the National AIDS
Strategy, the Canadian AIDS Society (CAS) took the lead in responding to HIV
and mental health issues. Comprehensive response to HIV and mental health
'bridges the gap' to a much more holistic care for HIV/AIDS.
S24233 Retrospective analysis of the psychosocial profile of
HIV-infected adults in Montreal, 1990-1997
Marc Hamell, H. Ladd1, N. Gilmore2, D. Lamping3, C. Pepler2, E. Seguin4,
L. Edgard2. 1Concordia University 7141 Sherbooke W, Montreal, Quebec;
2McGill University, Montreal, QC; 4Royal Victoria Hospital, Montreal, QC,
Canada; 3London Sch Hygiene & Tropical Medicine, London, UK
Issue: To determine if the psychosocial profile of HIV-infected adults in Montreal
has changed over the past seven years.
Project: A series of studies of structured psychological intervention to improve coping skills began with a pilot study in 1990-91, followed by one using
individual counselling in 1992-93 and one using a day-long workshop format
in 1995-97, provided three independent samples for comparison. Each subject
could participate in only one study. Pre-intervention, baseline data (mean ~ SD)
were analyzed separately for subjects who completed a study (completers) and
for those who did-not (drop-outs). Data are only available, at this time, for male
subjects in the 1995-97 study.
Results: Repeated sampling showed no appreciable demographic or HIVrelated differences, other than for an increase in reported symptoms, whereas
Quality of Life (QL-Index) appears to have decreased, accompanied by an increase in mood disturbance (POMS) and possibly in depression (CESD).
1990-91 Study 1992-93 Study 1995-97 Study
Completers Drop-outs Completers Drop-outs Completers Drop-outs
Subjects (n) 64 9 62 19 127 30
Caucasian (%) 82 11 69 20 75 18
Homo/Bisexual (%) 69 8 59 16 75 15
Age (yrs) 37~8.6 40~8.8 38~8.1 32~4.5 38~7.1 39~8.8
HIV+ duration (yrs) 3.7~2.0 3.3+2.1 3.0~2.3 2.3~2.2 4.8~3.6 4.4~3.9
HIV symptoms (n) 1.2~1.8 2.1 2.9 2.2~2.0 2.2~2.0 5.2~3.0 5.3~3.0
CD4 cells/mm3 311~230 314~358 213~140 241~171 312~259 206~158
HIVIS (total) - - 2.1~0.6 2.2~0.7 2.1~0.7 2.3~0.7
Spitzer QL-Index 8.6~1.7 7.9~2.0 8.3~1.5 8.3~1.4 7.6~1.9 7.2~1.8
CESD (depression) 17.4~7.2 17.8~4.3 16.7~9.1 14.7~8.7 19.4~11.9 20.7~10.2
POMS (total) 36.9~39.1 48.3~52.2 39.9+34.4 43.4~30.6 47.6~38.8 54.0~40.0
Lessons Learned: Repeated sampling is a potentially useful way to assess,
over time, the psychosocial profile of HIV-infected adults in the same population,
while avoiding cohort effects. It suggests that in the past seven years, quality
of life may have decreased and mood disturbance and depression may have
increased.
24234 Some consequences of psychoanalytic intervention in
the psychic life of HIV-positive pregnant women
Jacqueline Paschoal1, Cleia Cerqueira2. 1Rua Itabaiana, 256-A, apl02 Grajau
Rio de Janeiro 20561-050; 2Univ Estado do Rio de Janeiro Rio de Janeiro RJ,
Brazil
Objective: to show how psychoanalysis can help HIV-positive pregnant patients
in the setting of a general hospital. To discuss the range and the limitations of the
method.
Method: we interviewed 15 HIV-positive pregnant women from the 5th month
of pregnancy to the 1st month after childbirth between may 97 and jan 98. They
were being followed in a specialized pre-natal outpatient care for HIV-positive
women offered by a public general hospital in Rio de Janeiro. All but one were
from a very low socio-economic status.
Results: 87% of the women were deeply frightened and developped fantasies
about the child fearing that he/she will be born with some anomaly. For a better
understanding, we point out 3 moments of the work: M-1. The pregnant woman
comes to the first psychological interview: she is in great distress for having caught
HIV. M-2. A series of interviews is carried out according to each patient's needs.
They start elaborating the distress. M-3.(post-partum) an effective transformation
of the distress occurs, because the patients were able to speak about their problems in M-1 and M-2, and because the babies, in nearly all cases (93.5%) were
born with no anomalies and asymptomatic.
Conclusion: Psychoanalytic intervention is suitable and helps significantly the
HIV-positive women during their pregnancy even in the setting of a general public
hospital.
24235 1 "Learning to live together" - Psychological support to
families of HIV+ children and adolescents
Juliana Martins de Mattos, MHL Mendonga. Rua Marquesa de Santos 42 apto

306 Laranjeiras, Hospital Universitario Gaffree E Guinle, Rio de Janeiro, RJ,
Brasil
Issue: When working with HIV+ children and adolescents it is indispensable to
also create a space for emotional support to their family members, who find
themselves unstructured to face the emotional upheaval and foundational impact
caused by the diagnosis.

Project: "Learning to live together" is an initiative of "Living" - Psychotherapeutic Services for HIV+ Children and Adolescents Project, developed at the Gaffree
and Guinle University Hospital, Immunology Unit, and operating since October
1994. In doing this Project, it became clear that there is a need to provide services
to the parents/guardians as frequently and regularly as to the children and adolescents. This work, done in group, gives the parents/guardians a space to share
their anxieties, dreams, fears of death and discrimination, difficulties relating to
the child/adolescent, and difficulties coming to terms with the diagnosis.
Results: With this work, the support to children/adolescent is guaranteed and
preserved, and also making the attachment to the medical treatment easier.
Additionally, parents/guardians develop a strong solidarity and companionship
ties with one another, finding support and learning creative ways of dealing with
challenges, lack of resources and Hospital adversities. Finally, they begin to
emotionally prepare themselves to openly talk about HIV and AIDS with their
children, finding adequate and safe ways of revealing the diagnosis which take in
account the age and emotional, cognitive and motor development of the child.
Lessons Learned: The well being of HIV+ children/adolescents will greatly
depend on the reaction of the family to the infection. By offering emotional support to this family, the affective relationships can be renewed, reestablished and
transformed, thus truly making the family the foundation, center, and source of
support to the child/adolescent throughout his/her life.
24236 "Living with biodiversity" - Capacity building and
psychological assistance for professional caregivers
Maria Helena L.C. Mendonga1l2, J.M. Mattos2. 1Rua Eng. Coelho Cintra 185
casa 101 1ha Do Governador, Rio de Janeiro - RJ 21920-420; 2Hospital
Universitario Gaffree E Guinle, Rio De Janeiro, RJ, Brasil
Issue: Professional caregivers who work with HIV+ individuals are at risk of experiencing high levels of stress, anxiety and emotional exhaustion, thus in need
of psychological support to better cope with the diverse factors, implications,
barriers and difficulties present in AIDS work.
Project: AIDS is a unique pandemic disease whose specifics characteristics
greatly affect not only the individual living with the virus and his/her family, but
also the professional caregivers who works with that individual. The "Living with
Biodiversity" Project is an extension of "Living" - Psychotherapeutic Services for
HIV+ Children and Adolescents Project, developed at the Gaffree and Guinle
University Hospital, Immunology Unit, and operating since October 1994. This
project encompasses diverse works, such as clinical meetings, trainings and
workshops. The approach is a holistic one - it provides professional caregivers
with learning experiences and enables them to change attitudes and behaviors.
The goal is to build the professional caregiver's capacity, both professionally and
personally, to deal with such hard issues as: witnessing experiences of extreme
suffering; lack of preparation for dealing with death; feelings of isolation; difficulties
with constantly having to update information and networking; lack of medications,
resources and support from the Institution; lack of emotional consistency when
relating to the patient and his/her family, and internal fears, prejudices and old
paradigms.
Results: With this initiative, professional caregivers are able to gain a better
perception of themselves and others, a greater integration with their team, higher
quality of interpersonal relationships, and self-awareness and recognition of new
talents and abilities.
Lessons Learned: Psychological support to professional caregivers who work
with HIV+ individuals - through self-awareness, consciousness raising, personal
development, and professional growth - enables them to actively participate in the
search of creative solutions for living with the constant challenges of AIDS work.
This helps prevent and diminish emotional stress and leads to the improvement
of the relationship with and support to the patient and family.
242371 The psychosocial impact of HIV and pregnancy
Vicci Tallis. 33 Fairfield Raod, Hillary 4094, South Africa
The study examined the psychological and social consequences of the receipt of
an HIV positive diagnosis during pregnancy. The research focused on women's
experiences of pregnancy, their experiences surrounding their HIV diagnosis and
the interplay between pregnancy and HIV. Feminist theory, which provided an
analysis of women's oppression and the vulnerability of women in relation to
this oppression, was used to guide the research. The theory offered an understanding of motherhood, as a defined role for women, and the universality of this
understanding was questioned.
The phenomenological approach was used. This qualitative methodology allowed the researcher to gather in-depth data necessary for the study of psychological and social phenomena. The study made use of non-probability purposive
sampling. Data were collected by use of in-depth interviews. Fifteen women were
recruited for the interviews.
Conclusion: The data reflected the powerlessness of women; the lack of
women's control over fertility and sexuality and that pregnancy was experienced
negatively by the majority of women. The receipt of an HIV positive result exacer
bated the "crisis" of unwanted and unplanned pregnancies. In addition, the study
highlighted the inadequacies of the present health system to deal with complex
consequences of pregnancy and HIV.