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

650 Abstracts 33287-33290

12th World AIDS Conference

with transmission routes, risk behaviours, seroconversion interval, risk reducing
strategies, current therapeutic options. Demographic data, sexual behaviour, former HIV antibody determinations and reasons for current testing, clinical signs
and symptoms (physical examination was also performed) were evaluated. If a
negative result was obtained, further controls at 3rd, 6th and 12th month were
programmed.
Results: Tests obtained were 482. Subjects' mean age resulted 27.8 yrs (range
17-72) and male/female ratio 0.76. Reasons for testing were heterosex, exposure in 174 cases (36.1%), HIV+ partner in 86 (17.8%), homosex. exposure in
91 (18.9%), iv drug abuse in 26 (5.4%), referring MD request in 71 (14.7%),
exposure in health setting in 26 (5.4%), accidental exposure in 8 (1.7%). Subjects
with a previous test were 116 (24.1%); many (79 i.e. 68.1%) reported recurrent
sexual exposures and 12 (10.3%) came to confirm a previous positive result.
Most individuals (403 i.e. 83.6%) were asymptomatic. Among the 79 symptomatic
patients (16.4%), fever (in 63 cases i.e. 79.7%) and lymphoadenopathy (in 35
i.e. 44.3%) were the main symptoms. At the ELISA test 22 patients (4.6%) tested
positive (only 3 were symptomatic); among these 3 had an indeterminated Western blot assay and a negative serum PCR. Of 460 negative patients, 358 (77.8%)
subsequently repeated testing; none seroconverted.
Conclusions: 1) Even a easily approached and free HIV testing is of limited
value if an adequate counselling is not coupled with testing; 2) a part of sexuallyexposed individuals seek repeated testing because of i) wrong information on
latency period; ii) ongoing sexual promiscuity with maintained exposure to HIV;
3) physical evaluation on testing is of limited value in predicting the true infected;
4) previous or current iv drug abuse appear to be less prominent than before in
the population asking for the screening test at our Institution.
33287 Safe sex practices among sex workers at risk of HIV
infection
Neetha Shagan Morar1, G. Ramjee2, S.S. Abdool Karim2. 1771 Umbilo Road,
Congella, 4013 Durban; 2Medical Research Council Durban, South Africa
Issues: Condom use is not always negotiable by many African women especially
high risk groups such as sex workers. As one of the participating centres of a
randomised trial of the efficacy of a vaginal microbicide among sex workers, researchers documented women's perceptions of condom use and HIV prevention.
The aim of the project was to investigate the extent of condom use by sex workers
with their clients and regular partner and to explore their responses to HIV pre
and post test counselling.
Project: 108 women from truck stops in the KwaZulu Natal Midlands in South
Africa participated in the study. Focus group discussions were held with 12 groups
during pre-test counselling. Open ended interviews were held with 54 women
during the post test counselling session.
Results: Mean age of the women of whom 78% had a steady partner, was 24
years. Average number of clients per day was five. Average charge per client for
sex, with condoms was R25.00 and without condoms was R50.00. The prevalence of HIV infection among these women was 61%. Condom use was minimal
where 77% never used condoms with regular partners, 66% used condoms sometimes with clients. 48% of the respondents used condoms to protect themselves
against sexually transmitted diseases. During post-test counselling, 82% of the
HIV infected and 60% of the non-infected women, said they will continue sex
work at the truck stops. 71% of the women who received a HIV positive result
were emotionally traumatized and displayed a sense of disbelief. The women
expressed concern that the men, especially their steady partners refused to use
the condoms.
Consistent condom use was minimal with clients as well as regular partners.
Women who received a HIV positive result did not appear to be motivated to
adopt safe sex practices ie. increase negotiation of condom use, or leave sex
work. This may be related to their need for economic survival.
33288 Impact of HIV counseling and testing on married couples
in three developing countries: Results from the voluntary
HIV counseling and testing study
Steve Gregorich1, Claudes Kamenga2, G. Sangiwa3, C. Furlonge4, D. Balmer5.
1UCSF Cente r for AIDS Prevention Studies 74 New Montgomery San Francisco
CA; 2FHI/AIDSCAP Arlington VA; 4 Voluntary Counseling & Testing Centre,
Curepe, Trinidad, WI, USA; 3Muhimbili University College, Dar Es Salaam,
Tanzania; 5Kenya Assn. of Professional Counselors, Nairobi, Kenya
Objective: To determine if voluntary HIV counseling and testing (VCT) has an
effect on marital and extramarital sexual behaviors.
Methods: A multicenter randomized controlled study in Nairobi, Kenya, Dar
es Salaam, Tanzania, and Port of Spain, Trinidad. Participants were randomized
to VCT or standardized health information (HI) (with 6 month wait for VCT). 429
married couples joined the study; 211 were randomized to VCT. Standardized
interviews were administered at baseline and 6 months.
Results: 87% of couple members returned at six-month follow-up. The main
reasons given for seeking VCT were "just wanted to know serostatus," 86%,

"planning on having children" and "planning for the future," both 26%. Both VCT
and HI couples reduced reports of any intercourse and any unprotected sexual
intercourse with their spouse, p's <.01. VCT men were less likely than HI men
to report having any sexual intercourse with their spouse at 6-months, p =.06.
VCT couples were more likely to report a reduction of unprotected intercourse
with their spouse (from 89% to 65% for men and 92% to 70% for women) than HI
couples (from 89% to 73% for men and 88% to 71% for women).

There was no change in extramarital sexual behaviors, except women in VCT
were less likely to report having any commercial sex partners and any unprotected
commercial sex, p's <.05.

Men

Any sex with spouse
Any unprotected sex w/spouse
Any commercial sex
Any unprot. commercial sex

VCT
HI
VCT
HI
VCT
HI
VCT
HI

Baseline
96%
94%
89%
89%
7%
6%
4%
5%

6-Months
76%
85%
65%
73%
7%
7%
4%
4%

Women
Baseline 6-Months
96% 82%
93% 82%
92% 70%
88% 71%
5% 3%
4% 6%
3% 2%
2% 4%

Both interventions were successful in reducing reports by couples of any sexual intercourse and any unprotected intercourse with their spouses with a trend
toward more change among VCT couples. These results point out the importance
of couple counseling as it provides the two partners with a chance to negotiate a
risk reduction plan with the assistance of a counselor.
33289 | Strengthening counselling services through a
government-non-government collaboration
Niraj Agrawal1, J. Hague, S. Bhattacharya, S. Sengupta. WB.S.H.P 9A Little
Russel Street Calcutta 700071, India
Issue: In the context of a relative lack of knowledge and skills in counselling,
enhancing capacity in counselling and developing a core group of trained counsellors for better sexual health service delivery through collaboration between
Government Organisations (GO) and Non- Government Organisations (NGO)
Project: The West Bengal Sexual Health Project (WBSHP) promotes managed
networks between different stakeholders for increasing access to sexual health
services. Under the WBSHP, a counselling initiative is being implemented for: 1.
Enhancing and strengthening counselling skills of sexual health service providers
in the GO and NGO sector, 2. Strengthening training skills for counselling among
a cadre of trainers, 3. Ensuring the availability of trained counsellors to meet the
needs of sexual health service users in line with strategic development of services
across all sectors. The pilot stage of the initiative is focusing on 1. training representatives from GOs, NGOs, local governments, and private sector on counselling
and 2. developing a cadre of trainers responsible for training functionaries at the
district level. The substantive phase will focus on pooling of the relative strengths
of NGOs (in outreach and motivation) as well as GOs (in providing infrastructure
and specialised services). The initiative is being undertaken by the West Bengal
State AIDS Cell (SAC) and an NGO - Child In Need Institute (CINI), with support
from the Project Management Unit of the WBSHP.
Results: Social welfare officers, paramedics in the public sector, health workers
in NGOs and doctors are being trained through input sessions, group work, practical observation sessions for counselling people for increasing health seeking
behaviour, treatment compliance, partner notification and adoption of safer sex
practices.
Lessons learnt: To make sexual health counselling services effective, it is
important to enhance knowledge and skills of service providers from different sectors. This can be achieved and made sustainable through appropriate GO-NGO
collaboration, joint training and cross sectoral linkages
33290 1 Anonymous counselling and testing clinics for HIV/AIDS
in Thailand
Lisa Guntamla, G. Chaiyawan, C. Yachompoo. AIDS Division Dept CDC Ministry
Of Public Health Tivanont, Nonthaburi 11000, Thailand
Objective: The purpose of this study was to assess the ACT programs in Thailand
in the following aspects: service pattern, limitation and problems observed in the
program, and suggestion for future appropriate developments.
Design: Descriptive Survey Research.
Methods: The questionnaires were distributed to 820 governmental and non
government health service offices. The 668 offices (81.4%) replied the questionnaires. Data were also obtained from personal indepth interviews from 38
governmental offices and 3 non-government organizations.
Result: ACT clinics are available in 81.3% of all service offices. The average
monthly number of anonymous/non anonymous client to visit each service office
for HIV testing during the past 3 months was: Regional Communicable Control
Office 21.4/61.9, Provincial Chief Medical Office 12.9/10.7, Regional or General
Hospital 13.3/23.9, Community Hospital 4.5/8.1. Among anonymous clients from
all clinics, 54% were persons who recently practiced high risk behaviour, 18.6%
were house-wives suspicious of exposure to HIV from their husband, 16.5%
were women expecting pregnancy and 9.5% were those wanted premarital test.
Number of anonymous clients in 1996 was observed to be much higher than the
number in 1995. One of the obstacles found in the governmental hospital service
was the long period of time (average 20 days) needed to obtain blood result.
Some clients prefer to get a quicker result from private service which obviously
be given with less counselling. Other major problems resulted from counsellor
shortage.
Conclusion: More appropriate policy are needed to clarify the scope and responsibilities of the counsellor so that better development on counselling skill and
confidence can be achieved. Public relations should also be emphasized to allow