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

12th World AIDS Conference

Abstracts 24315-24320 501

S24315 Marriage: A risk in India for acquiring HIV
Suniti Solomon, Edwin R. Amalraj, N. Kumarasamy, B. Ravikumar. YRG Care, 1
Raman Street T Nagar, Chennai, Madras, India
Issue: Women acquiring HIV in monogamous married relationships
Project: HIV is now spreading among the general population in India, mostly
in conjugal relationships, through unprotected sex between infected husbands
and his uninfected spouse. YRG centre for AIDS Research and Education in
Chennai (Madras) South India, established an anonymous voluntary counselling
and testing centre in January 1994.
Results: Till December 1997, 1219 persons walked in for an HIV antibody
tests of which 263 were women. Among them 185 (70.3%) were monogamous, of
whom 92 (49.72%) were sero-positive. Of the women living with HIV 28 (30.4%)
were already widowed and were between the ages 17-22 years. 21 of them had 1
or 2 children. The various socio-economic, legal, ethical, medical issues of these
women will be discussed.
Lessons Learned: Premarital sexual behaviors among men place their spouse
at immediate risk of HIV. The system of arranged marriages in India, which is
based on study and matching of horoscopes and stars, seem to leave a void
in measuring HIV risks. Our centre is now increasingly placing emphasis on
premarital risk assessment and counselling.
24316 Perception of risk and delay for HIV testing
Susana Soriana', R. Cahn1, S. Weller2, C. Bloch2, P. Cahn'. 'Infectologia,
Hospital Fernandez, Angel Peluffo 3932 (1181), Buenos Aires; 2Fundacion
HUESPED, Buenos Aires, Argentina
Objectives: Population at risk for HIV frequently ask for testing with delay. The
time span between the first time they perceived to be at risk for HIV infection
and the moment they showed up to be tested, is of 3 years or more in a high
proportion of our patients. In this study we try to identify conditions associated
with more than 3 years of posponement of HIV testing (DEL > 3).
Methods: A total of 5361 individuals spontaneously consulting for testing and
counseling are studied in order to determine the relationship of DEL > 3 with
gender, risk behavior and educational level, and result of HIV test. Semidirected
interviews were performed, asking for time of first perception of being at risk.
Cases with DEL > 3 were analyzed. HIV positive and negatives were compared
for each item. Statistical significance was determined by chi-square test.
Results: Out of 5361 patients, 1018 tested HIV positive (19%), 2369 with DEL
> 3
% with DEL > 3
Female Male Homosex IVDA Heterosex Elementary High University
School School
HIV 46.7 53.2 10.6 7.1 68.3 18.4 50.6 29
HIV+ 27.9 73 24.4 27.3 26.4 23.9 56.8 17.5
In all cathegories, statistical differences were founded comparing HIV+ with
HIV-. Positive male, homosexuals, and IVDA are more prone to present with
DEL > 3. Negative heterosexuals delay testing more frequently than infected
ones. Overall, 67% of HIV+ and 39.4% of HIV- present DEL > 3 (p < 0.0005)
Conclusions: A high proportion of patients are behind time for testing, irrespectively of gender risk behavior and education. This setting shows the need for
preventive campaigns underscoring the advantages of early testing in order to be
eligible for early therapy and prophylaxis.
24317 The experiences of managing clients with AIDS dementia
complex (ADC) and dual diagnosis
Kerry O'Neill1, I. Ben-Nissan2, M. Jones3. 1301 Forbes St., Darlinghurst 2010,
New South Wales; 2AIDS Dementia & HIV Psychiatry Service, Sydney;
Issues: Working with clients with a complex clinical picture presents multiple
challenges for healthcare workers. The purpose of this investigation was to identify the complexities for healthcare workers and to assist in the development of
appropriate strategies.
Project: As a result of combination therapy people with HIV are living longer.
Consequently, service providers are faced with the new challenge of people being
physically well. When combined with a mental illness and drug & alcohol problems
healthcare professionals struggle to prioritise their client's needs and implement
effective management strategies. Semi-structured interviews were conducted with
ten healthcare professionals, currently providing direct care for clients with ADC
and dual diagnosis.
Results: Common themes identified were: (i) perceived lack of confidence, (ii)
conflict between client autonomy and duty of care, (iii) lack of clarity in determining
appropriate service provision across different healthcare settings, (iv) a perceived
lack of knowledge concerning the evolving nature of AIDS, (v) delineation of specific role responsibilities and (vi) appropriate therapeutic interventions for clients

with illicit substance use.
Lessons Learned: A number of recommendations and strategies have been
developed. These included the establishment of professional networks and peer
support. Seminars and workshops were developed based on addressing identified
needs.

24318 1Support group and strategies of coping with HIV +ve
patients
Mauro Santolamazza, Fabio Patruno, U. Ciervo, C. Perdighe, E. Rossi,
L. Grillenzoni, M. Del Matto. Villa Mariani Foundation via Bernardo Ramazzani,
31 00151, Rome, Italy
Introduction: The studies of patients (pts) with cronic diseases point out the use
of four strategies of coping: focalize the problem (FP), fatalism (F), negation (N),
desperation/impotence (D).
Objectives: Demonstrate that pts who receive a psycological treatment (support group) use different coping strategies in comparison with pts who don't receive
any treatment, besides there is a relation between coping and compliance to the
antiretroviral therapy.
Methods: 20 pts HIV+ve, split up in two groups, have been listed: 1st group (G1)
made up of 10 pts which attend for at least a year a psycological support group.
2nd group (G2) made up of 10 persons who attend a day hospital treatment and
don't receive any psycological treatment. The two groups have been interviewed
through a multiple choice questionarie, divided into 26 items, which inquire into
kind of coping strategy used (20 items) and into the compliance to the therapy (6
items).
Results: A significant relation has been pointed out between pts who were
attending a psycological group treatment and coping FP. In the first group (G1)
8/10 pts use a prevaling strategy, the FP strategy (at least 75% of the answers
corresponding to the FP strategy). The 2nd group (G2) differs from the other for
a major distribution of the replies on the four strategies, with a significant higher
number of answers N and D (an average of five times higher of G1).
Conclusion: The results emphasize that pts attending a support group are
using a more adaptive supporting strategy. In this work any significant statistical
relation between strategies of coping and compliance was not pointed out; it is
possible that this specification depends on the small number of tested pts.
S24319 Family caregivers of HIV/AIDS patients in rural Zimbabwe
Rosemary Mushonga. 3290 Warrensuille Center Rd H210 Shaker Hts, Ohio,
USA
Issue: The rising incidence of persons afflicted with HIV/AIDS places a significant
burden on the health care system of Zimbabwe. Ministry of Health Zimbabwe in
1997 reported 65939 HIV cases out a total population of 11.5 million people. This
figure is under estimated due to under reporting.
Project: The over population of HIV/AIDS patients in hospitals has resulted in
patients' early discharge to their homes for family care. In most cases, women
fulfill the role of caregivers for these sick family members because the Zimbabwean culture supports this categorization of caregiving responsibility. This is in
addition to their roles as mothers, wives, and in some circumstances, as wage
earners. To supplement their family income, most women in rural Zimbabwe live
on agricultural earnings rather than formal employment. Studies have not been
conducted in Zimbabwe considering the relationship between HIV/AIDS patient's
needs, household income, and social support affecting the perceived burden of
female caregivers. Thus, this pilot study examines how the relationship between
HIV/AIDS patient's needs, household income, and social support impact perceived burden of female caregivers. The study used a correlational design and a
convenience sample of female family caregivers to examine the relationship with
the sample size being determined via power analysis and face-to-face interviews
to collect the data. Data will be analyzed using Pearson r product-moment correlation and linear multiple regression. Pilot study (n = 20) of caregivers was carried
out in Zimbabwe in August 1997. Data coding currently being entered.
Preliminary Results: Patient care needs significantly impact caregiver burden.
Family income significantly impact burden. Social support has an inverse affect
on burden due to stigmatization.
Conclusion: There is a need for culturally sensitive strategies such as home-based care programs. Health educational programs should be enforced for
HIV/AIDS clients and their families to avoid stigmatization of the disease. To
economically empower caregivers and their PWAS, projects generating income
should be initiated to provide quality care to PWAS in Zimbabwe.
24320 1 Problems and needs of women living with AIDS in Africa
related to the knowledge by their partner or family of
their serostatus
Rose Dossou. Club Des Amis 06 BR 1021 Cidex, Abidjan 06, Cote d'lvoire
In Africa, women living with AIDS (WLWA) are feared to reveal their HIV serostatus
because of the expected consequences of this revelation on their life as woman
and mother.
What are the reasons given by the women not to tell anyone their HIV status
and the problems occurring when a woman informs her sexual partner or family
about her serostatus.
Methods: repeated qualitative interviews among members of an association
of people living with HIV and among pregnant women inolved in a clinical trial

in Abidjan, C6te d'lvoire in 1997. Globally, interviews were realised with twenty
women living with HIV about the information they gave or not to their partner in
relation with their HIV status and on the indirect knowledge their family can have
when they become ill.
Results: on the 20 women interviewed, 14 did not tell their HIV result to their
partner and do not plan to tell it. As a consequence, they can not negociate on
the long term protected sexual relations. The reasons they give are for some of