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

12th World AIDS Conference

Abstracts 32415-32418 605

tural practices and gender inequality within tribal communities, or discrimination
against former sex workers require a supportive community in which to live and
die.
Project: The House of Love is a residential/hospice program for HIV ethnic
minority women and their children who have no families or communities to which
they can return. The center is staffed by ethnic minority women, most of whom are
also HIV infected who understand the languages and cultures of the residents.
Activities include teaching about proper physical care, child care and nutrition,
providing a means to make a small income, provision of emotional and spiritual
care, and provision of care for children who have become orphaned. The women
take care of each other under the direction of an ethnic minority nurse. Through
partnering with a community-based NGO which provides support for home care
within ethnic minority villages, the center also provides temporary shelter for
women until they can be reintegrated into their communities.
Results: The House of Love has empowered ethnic minority women living
with HIV/AIDS to care for themselves and others, to tell their stories so that they
can become a resource for AIDS prevention within ethnic minority communities,
to provide a home for for orphaned children, and to create a supportive, caring
community for women and children in their final stages of AIDS.
Lessons Learned: Ethnic minority women living with HIV/AIDS, and who have
no family or community support, can be helped to create a supportive community
in which they provide care for each other.

S32415

Differences in health care resource use between
sub-groups of persons living with HIV in Vancouver,
Canada

Tobin T. Copley1, D.G. Schneider2, N.L. Meagher2, R.A. Hanvelt2. 1Dept. of
Health & Epidemiology, University of British Columbia, 5804 Fairvaiew Ave.
Vancouver, B.C., V6T 1Z3, 2B.C. Centre for Excellence in HIV/AIDS Vancouver,
Canada
Objective: To identify whether differences exist in the frequency of use of a range
of health care resources between men who have sex with men and injection drug
users.
Methods: A convenience sample of HIV+ individuals 15 years of age or
older were enrolled from both clinical and non-clinical settings into a longitudinal
prospective study. Participants were interviewed face-to-face every three months.
Individuals were asked how frequently they had used a variety of health care
resources. Baseline responses of the first 500 participants enrolling in the project
were examined. Data from 19 cases were dropped from analysis due to poor
data quality; the resulting 481 cases are analysed here. To investigate whether
differences in use of health care resources exists between individuals who had
contracted HIV through different exposure routes, reported resource use was
compared between the two groups with the largest representation in the sample:
men who reported infection through sex with men (MSM) (n = 138, 28.7%), and
people reporting infection through injecting drugs (IDUs) (n = 237, 49.3%).
Results: IDUs and MSMs were found to have significantly different reported
use of health care resources in the previous 2 weeks. MSMs reported more visits
to medical general practitioners (76.1% vs. 45.6%, p - 0.001), hospital clinics
(44.2% vs. 19.8%, p - 0.001), psychological counselling (25.4% vs. 16.0%, p
= 0.028), and use of alternative therapies (20.3% vs. 3.0%, p - 0.001) than
did IDUs. IDUs reported accessing foodbanks more than did MSMs (77.2% vs.
55.1%, p - 0.001). These associations remained consistent when controlling for
stage of illness. There was no statistically significant association for services such
as hospital stays, residential care stays, use of home care services, or visits to
hospital emergency rooms, although the number of participants in both groups
using most of these services was small.
IDUs appeared more poorly integrated into the existing system of health care
delivery for people living with HIV as evidenced by lower rates of access; this
suggests there may be a relatively greater need for improvements to program
delivery for some groups than for others. Continued analysis may help identify
some of underlying causes for these differences in resource use, and may reveal
opportunities for improving health outcomes for people living with HIV/AIDS or
better management of costs for health care programs.
32416 The seroprevalence of HIV and other viral STDs in sexual
assault suspects and survivors
Hillary Larkin1, C. Cosby2, L. Petti2, L. Paolinetti2, N. Harada2. 1613 Blackstone
Drive San Rafael California CA, 2Highland General Hospital, CA, USA
Background: Sexual assault may expose survivors to a variety of viral sexually
transmitted diseases (STDs). Current sexual assault protocols make no definitive
provisions for the screening, prevention and prophylaxis for many of these STDs.
Objectives: To identify the seroprevalence of viral STDs, including HIV, Cytomegalovirus (CMV), herpes simplex-1 (HSV-1), herpes simplex-2 (HSV-2),
hepatitis B virus (HBV) and hepatitis C virus (HVC) in female survivors and
male suspects of sexual assault in a county emergency department, as a way to
evaluate transmission risks.
Methods: A prospective pilot study with serologic antibody testing during a 12
month period on 40 survivors and 20 suspects of sexual assault evaluated and
treated with existing sexual assault protocols by a multidisciplinary sexual assault
team.
Results: By chi-square testing suspect seroprevalence was:HIV 10% (n =
2/20), CMV 70% (n = 14/20), HSV-1 60% (n = 12/20), HSV-2 35% (n = 7/20),
Hepatitis B surface antigen 0% (n = 0/20), and HCV 15.8% (n = 3/19). Survivor

seroprepalence was: HIV 0% (n = 0/40), CMV 85.3% (n = 29/34), HSV-1 62.5%
(n = 25/40), HSV-2 75% (n = 30/40), HBV 30% (n = 12/40) and HCV 11.8%
(n = 2/17). The seroprevalence of suspects and survivors was similar with the
exception of HSV-2 and HIV.
Conclusion: Antibody to HIV was significantly more prevalent in suspects than
survivors of sexual assault (p = - 0.04) and antibody to HSV-2 was significantly
more prevalent in survivors than suspects (p = - 0.003). Definitive guidelines
are needed to address the screening, prevention, and treatment of viral STDs
following sexual assault.
324171 Geriatric AIDS population study (GAPS): The use of
highly active antiretroviral therapy
Joseph McGowan1, S.S. Shah2, C. Smith3, S. Blum1, A. Malik1, E.E. Telzak1
R.S. Klein2. 11650 Grand Concourse - Bronx-Lebanon Hosp., 8th Floor, Dept. of
Medicine-Bronx, N. Y. 10457; 2 Montefiore Medical Center, Bronx NY: 3Mount
Sinai Medical Center, New York, NY USA
Objectives: To describe the use of highly active antiretroviral therapy (HAART)
in HIV infected geriatric individuals receiving care at three major New York City
hospital clinics since July 1, 1996.
Design: Retrospective chart review.
Methods: The medical records of 100 HIV infected patients -55 years were
reviewed. Gender, ethnicity, AIDS defining conditions (ADC), HIV risk factors
(RFs), comorbid conditions (COs), HIV-1 viral load (VL), and use of concurrent
non-HIV medications (Comeds) were determined.
Results: The documented use of combination antiretroviral therapy (ARV) was
75/100 (75%) of which 16/75 (21%) consisted of dual nucleoside analog reverse
transcriptase inhibitors (NRTI) and 59/75 (79%) of HAART (NRTI in combination
with either non-NRTI or HIV-1 protease inhibitors). 63% of individuals had ADC,
of whom 71% received HAART. The use of HAART was not related to gender,
ethnicity, RFs, number of COs (-:2 or >2), number of Comeds (-2 or.2) or
age group (55-64 or:65). The likelihood of having an undetectable VL at most
recent measurement was not affected by use of multiple Comeds or presence
of COs. The mean number of COs was 2.1. 34% of patients receiving HAART
discontinued HAART at least once due to toxicity. The number of Comeds used
was not correlated with the discontinuation of ARV (including HAART) due to
toxicity or intolerance.
Conclusions: These findings demonstrate that presence of comorbid conditions and use of multiple concurrent non-HIV related medications did not adversely
impact upon the prescription of highly active antiretroviral therapy in an inner city
population of HIV infected elderly individuals.
S32418 Characteristics of HIV-infected patients hospitalized for
HIV care at Harlem Hospital in New York City
Jens L. Wennberg, C. NWAIGWE, C. Davis, W. El-Sadr. 1506 Lenox Ave. Room
3101A New York, NY 10037; 2Harlem Hospital-Columbia University New York
NY USA
Objective: With the advent of potent treatment for HIV disease and effective
prophylactic agents for opportunistic infections, a large segment of HIV-infected
patients are followed in outpatient settings. However, we noted that a significant
number of patients continue to be admitted to our institution with complications
of HIV disease. We conducted this study to determine characteristics of this
subgroup of patients.
Methods: A structured questionnaire was administered to inpatients with HIV
disease.
Results: Forty-eight patients were interviewed, 55% women and 85% African
American, with average age of 38 years (range 21-55 yrs). The median CD4+
count was 80 cells/mm3, with 41% of patients with CD4+ - 50, 23% CD4+ 50-200,
19% CD4+ 200-500 and 11% with CD4+ - 500 cells/mm3. Current cocaine use
was reported by 60%, heroin by 21% and 25% reported significant alcohol use.
Prior AIDS was diagnosed in 60%. Among those identified with HIV in prior year,
40% had CD4+ cell count <-200 cells/mm3. Prior homelessness was reported by
58%, prior incarceration by 31% and 17% had lived in a shelter. Prior psychiatric
hospitalization or use of psychiatric medications was reported by 22%. Among
44% of patients, current hospitalization represented the only one in previous
6 months, while 25% of patients had -3 admissions in the same time period.
Only 36% of patients reported visiting a clinician in the past 2 months. Half of the
patients reported that they were receiving antiretroviral therapy, 12% on proteasecontaining regimens and 12% on a two drug regimen. However, among patients
who reported no drug use, 62% were receiving protease-inhibitor containing regimens and 44% were on two drug antiretroviral combination. When asked if there
were useful medications for HIV disease, 62% agreed, 13% disagreed and 25%
were not sure.
Conclusions: This hospitalized population represents patients identified late
with HIV disease. These patients have a multitude of medical and social challenges that impact on their ability to benefit from advances in HIV care including
antiretroviral therapy. Substance use, unstable housing and mental illness appears to have a major impact on disease management. Innovative and intensive

efforts are needed to address specific barriers to care and to engage this group
in ongoing management of HIV disease.