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

612 Abstracts 32451-33103

12th World AIDS Conference

Objectives: to evaluate HIV-1 vertical transmission when incomplete ZDV
treatment was prescribed.
Methods: records of 95 children born to HIV-1 infected mothers were analyzed.
In order to assess vertical transmission 24 mothers and their corresponding children with complete treatment (CT), 17 mothers with incomplete treatment (IT) and
54 with no treatment (NT) were compared. Treatment was considered incomplete
when women were enrolled after week 34 of gestation and/or intravenous ZDV
was not administered, and/or the baby did not received the ZDV.
Results: Transmission was 12.5% for CT, 41% for IT and 31.5% for NT. Significant differences (p = 0.03) in decreasing perinatal transmission were observed
between the IT versus CT groups with no significant differences between IT and
NT groups. Different types of incomplete, treatment were not analyzed separately
due to the small number of patients in this group.
Conclusions: Partial adherence to the ACTG 076 protocol did not result in
decreasing HIV vertical transmission.
32451 Medical care of HIV-infected and HIV-exposed children
Magdalena Marczynska, M. Szczepahska-Putz. 37 Wolska St, Warszawa
01-201, Klinika Chorob Zkaznych Wieku Dziecipcego AM, Poland
There were 132 children from all over Poland observed (92 infants born to
HIV-positive mothers and 40 children exposed in different ways). From 1994
laboratory tests, including virus culture, polymerase chain reaction (PCR) p24
antigen detection has been carried in the AIDS Diagnosis and Therapy Center.
We are trying to establish diagnosis of HIV infection in children born to HIV-positive mothers within 3 months. Infection was confirmed in 21 children (18 children
infected vertically, 2 patients with haemophillia and 1 child with unknown source
of infection). According to the Centers for Disease Control and Prevention (CDC)
regulations vaccination program, with the BCG vaccine added (in children without
severe immunodeficiency) is being realized. Ambulatory treatment is preferred.
Children are hospitalized only if it is necessary.
Conclusions: Treatment program realized in the Department of Infectious Diseases in Childhood, Medical Academy of Warsaw, seems to comply with criteria
of proper health care for children born to HIV-positive mothers.
32452 Holistic approach to management of health care for sex
workers who are HIV+ in a multi-ethnic/religious
environment
Irene Fernandez1, C.A. Arumanayagan2. 11 th Floor, Wisma Yakin, Jalan Masjid
India; 2 Tenaganita, Kuala Lumpur, Malaysia
Issue: Sex workers, especially women who are HIV+ are very much discriminated, alienated & subordinated. They face numerous barriers in seeking and
getting support and health care.
Project: A culturally sensitive, holistic approach support service through a HalfWay House that delivers comprehensive care with psycho-social support was
established in Kuala Lumpur. Sub-programs include harm reduction programs,
family reunification, care maangement, counseling, taking control of one's sexuality & reproductive health, advocacy & sisterhood, alternative job placement &
skills development.
Results: 112 CSWs have obtained our services. 45 were reunitede with family.
10 place in care of communities. 25 left voluntarily after recovery from poor
health. Many have been empowered, self-esteem built, & behavior change has
taken place. This paper will share how one deal with issues related to CSWs
in a multi-ethnic/religious reality that contributes to policies and programs that
discriminate, isolatethese women and increase gender subordination. It will also
deal with the numerous challenges faced in the process of empowering CSWs.
Lessons Learned: Due to multiple problems & discrimination confronted by
the women in a multi-religious reality, HIV care management is not adequately
addressed. HIV management is separated from harm reduction with STD clinics
again being isolated. Needs include stronger advocacy & education in relation
to the life of the sex worker and the need to develop community care and
support.
33101 Trends in condom use between 1991 and 1997 and
obstacles to 100% condom use in female sex workers
(FSW) in Abidjan, C6te d'lvoire
Peter Ghys1, Guessan Mah-Bi2, M. Traore2, Y. Konan2, B. Vuylsteke1,
A. Tiemele3, K. Kale2, O. Tawil4, I.M. Coulibaly3, S.Z. Wiktor5, M. Laga1.
Institute of Tropical Medicine Antwerp, Belgium; 2lnstitute National de Sante
Publique Abidjan; 3National AIDS/STD/TB Control Program Abidjan; 4UNAIDS
Abidjan, Cote d'lvoire; 5Center for Disease Control and Prevention Atlanta, USA
Objective: To describe trends in reported condom use by FSW between 1991
and 1997, to study the impact of targeted interventions on condom use, and to
identify obstacles to condom use by FSW in Abidjan in 1997.
Methods: Since 1991 the Ivorian Ministry of Health has sponsored an HIV/AIDS

prevention campaign targeted at FSW that includes group health education sessions in sex work sites, peer education, and referral of FSW to a confidential
STD/HIV clinic that offers health education, STD diagnosis and treatment, HIV
counseling and testing. In 1991, 1993, 1995 and 1997 community-based surveys
were conducted among Abidjan female sex workers. During the survey questions
were asked about condom use with the last client, attendance at the education
sessions and the clinic, and in 1997, about obstacles to condom use.

Results: Reported condom use with the last client was 63% in 1991 (N =
294), 78% in 1993 (N = 602), 76% in 1995 (N = 828) and 91% in 1997 (N =
500) (p < 0.05; test for trend). Condom use was more frequent among women
who had attended community health education sessions than among those who
had not attended (90% vs 72% in 1993 and 81% vs 73% in 1995; p < 0.05).
Condom use with the last client was also more frequent among women who had
attended the clinic than among those who had not attended (91% vs 77% in
1993; 87% vs 72% in 1995; 95% vs. 89% in 1997; all p < 0.05). In 1997 condom
use was less frequent in women working in high class hotels and night clubs
compared with women working in other types of sites (71% vs 92%; p < 0.05)
and in Ivorian women compared with other nationalities (87% vs 94%; p < 0.05).
The most frequently cited reason for not using condoms was the client's refusal
(40%), followed by failure of the sex worker to propose condom use (32%) and
non-availability of a condom (28%).
Conclusion: Condom use among FSW in Abidjan has increased dramatically
between 1991 and 1997 and is associated with exposure to a targeted intervention program. It is important to continue targeted prevention efforts comprising
community-based and clinic-based activities, and to extend these to clients of sex
workers.
33102 Experience of "Condom Bank" on the National Highway
Rajiv Gupta1, S.V. Barge2. 1 Collector & District Magistrate Kothi Building
Vadodara; 2Centre for Operations Research & Training, Vadodara, India
Objective: In India truck drivers and Commercial Sex Workers (CSW) are at
high risk for infection of HIV/AIDS than other groups of population because of
their sexual behaviour and lack of awareness. As part of preventive measures
"Condom Bank"were started on eleven gas refuelling stations located on National
Highway No. 8 - the busiest highway in India - passing though Vadodara District,
by the Collector and District Magistrate (Chief of District Administration). The
objective being, to make condoms available to the truck drivers/cleaners and
ultimately to CSW. Evaluation by Centre for Operations Research and Training
(CORT), proves that during last eight months of its regular functioning 90,000
condoms have been distributed. The concept has been well accepted by the
owners of gas refuelling stations, who have integrated this with their "Free Air",
"Free Water" and "Free Condom" marketing strategy.
Method: Study of sexual behaviour of more than 250 truck drivers/cleaners
interestingly reveals the positive attitude of the truck drivers towards these "Condom Bank". Discussion with the person in-charge of the "Condom Bank" shows
that initially they provided condoms to everyone who came to cash counter, but
now over 50 per cent of the drivers demanded the supply on their own. As an extension to this a medical cum educational/counselling service is being extended
through an STD clinic, named "Apna (Ours) Clinic" (in vernacular) at one of
the refuelling stations in collaboration with Society for Operations Research and
Training (SORT). Around 400 drivers/cleaners have utilized the services there. Of
the 20 per cent who revisited the clinic reported behavioural changes to the extent
of reduction/discontinuation in visits to CSWs. Survey of CSWs by CORT on this
highway reveals that use of condoms by truck drivers visiting them has increased.
Lessons Learned: (1) Increasing availability, accessibility and visibility of
condom leads to greater usage by risk population. (2) Networking between government agencies and voluntary organizations may lead to effective results in HIV
prevention and control. (3) Hence, "Condom Bank" model could be replicated on
National Highways in different districts.
208*/33103 Whose turn tonight? An appropriation of the
circumstances of condom use (purchase,
proposal, donning) by gender
Brenda Spencer, A. Jeannin, F. Dubois-Arber. Inst Univ de Medecine Sociale et
Preventive 17, Rue du Bugnon, CH-1005 Lausanne, Switzerland
Background: It has been suggested that women have difficulty protecting themselves against HIV because the condom is a male method. To date, no representive data have been available on which partner buys or proposes the condom, or
which partner actually puts it in place.
Methods: Questions on condom use at last sexual intercourse and on condom
purchase, proposal and donning were included in the 1996 AIDS-related KABP
telephone survey of Swiss residents ages 17-45 (n = 2359), obtained from a
nationwide random sample of households. These surveys are repeated biannually
as part of the global evaluation of the AIDS prevention strategy in Switzerland.
Respondents were asked whether they, their partner or both were responsible for
purchase, proposal and donning at last sexual intercourse, so providing figures on
men and women's behaviour as reported by self or as a partner of an interviewee.
Results: Condom use at last intercourse was reported by 31% of the sample.
Men reported themselves having bought the condom in 72% (17-30yrs) -66%
(31-45) of cases; figures for women were 26% (17-30) -34% (31-45). If one
bases male and female purchase figures on the accounts of the partner, these
figures would be reduced by some 20-23% for men and 15% for women. Similar
proportions of men and women report having themselves suggested condom use

(24%-30%), but mainly this is seen as a shared decision (17-30, m: 60%, f: 65%;
31-45, m: 51%, f: 60%). Approximately 60% of men said they themselves put the
condom on the penis, whereas 19% (31-45) of women claim to have done this.
Respondents reporting of partners' donning the condom result in similar estimates
of level of male and female participation. Men and women's accounts also concur
on donning as a shared activity (14%-18%). Over all questions, younger women
more often saw activities as shared.