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

848 Abstracts 42254-42374

12th World AIDS Conference

42370 1 Some medicinal plants commonly used for female
genital hygiene may contribute to the vaginal
transmission of HIV
Georges Mvumbi Lelo, M.M. Mwema Mukalamunsi, M.W.K. Mushiya Wa Kalonji,
P.S.T. Pukuta Simbu Temo, M.W.T. Mbaya Wa Tshibangu. 1 Institut National
Recherche Biomedicale Huileries Kin Gombe BP 1197 Kinshasa; 2INRB BP
1197 Kin 1, Dem. Rep. of Congo
Objective: To find out whether medicinal plants used for female intimate hygiene
contribute to the vaginal transmission of HIV.
Method: During the period of April to October 1997, 199 female patients over
815 ladies attending the National Institute for Biochemical Research at Kinshasa
(RDC) for HIV test accepted to be recruited into a study based on a questionnaire
related to medicinal plants and on subsequent (para)clinic evaluations of genitalia.
The following parameters were collected: age, number of male partners during
the 6 months preceding the date of survey, type of substance commonly used
for hygiene, use mode, duration time of the medicine into the vagina and dual
reactive Elisa.
Results: The mean age of respondents was 29 years (SD:2.2) and the mean
number of partners was 2.5, varying from 1 to 4 partners. According to the type
of substance used for the intimate hygiene, the sample was divided into three
groups: water (W) n = 94 (47%); medicinal plants (MP) n = 78 (39%) and modern
antiseptic (MA) n = 27 (14%). The most frequent plants used by the respondents
are the following: Zingiber officinalis n = 33 (42.5%), Aframomum stipulatum n =
22 (28%), Alchornea cordifolia n = 9 (11.6%), Hymenocardia acida n = 8 (10.2%)
and Ocimum gratissimum n = 6 (7.5%). For a period of time varying from 0.5 to
2 hours, a woman could keep the herbal ovule like form into her vagina, before
and after the intercourse n = 111 (55.8%), one's a week n = 44 (22%), before the
intercourse n = 40 (20%) and after the intercourse n = 4 (2.2%). The seroprevalence of HIV+ into the three groups was distributed as followed: W, n = 5 (5.3%);
MA, n = 11 (40.7%) and MP, n = 48 (61.5%) (p <.02). The main clinic parameters
were: pelvic inflammatory disease (PID), abnormal vaginal discharge and itching,
genital ulceration, condyloma accuminata, inguinal bubo, and condition with no
evident signs. It is shown in this study that PID appears to 64% HIV+ respondents
who used Zingiber officinalis, 28% HIV+ women with Aframomum stipulatum and
8% with Alchornea cordifolia.
Conclusion: Besides the known antibacterial effect of the medicinal plants used
for female hygiene, attention should be paid for their use modes and dosages.
The main side effect on genitalia of these plants which contain principally tannin
and essential oils with terpene, may be inflammation. The so weakened tissue
becomes an easy way of HIV transmission.
S42371 Effects of self-management training on quality of life,
mood, coping and CD4 levels
Jillian Inouye1, K.J. Flannelly2, L. Flannelly3. 13280 Pauma Place, Honolulu
Hawaii; 2Center for Psychosocial Research, Honolulu, HI; 3University of Hawaii,
Honolulu, HI, USA
Background: Psychological distress and related symptoms are formidable in HIV
positive individuals. These stressors are ongoing now that the disease can be
controlled with new therapies. Because of the relationship of psychological and
physiological effects on the immune system and quality of life, new demands
for self-management are placed on the individual. This study explored the relationship of self management and coping skills training to immunocompetence,
cognitive-attitudinal features, moods and quality of life.
Methods: An experimental research design was used to assess the effects of
self-management and coping skills training on a sample of 40 subjects. The 20
randomly assigned treatment subjects were taught self-management strategies
which included biofeedback with breathing, progressive relaxation, autogenic
training, cognitive behavioral management skills, problem solving, anxiety, anger,
depression management and educational classes in a seven week program.
The 20 control subjects were given the usual treatment regimen. The sample
consisted of 29 (72%) Caucasians, six (15%) Asian-Americans, and five (12%)
Hawaiians/Part Hawaiians, four (20%) females and 36 (80%) males with a mean
age of 37 years.
Results: Subjects' frequency of HIV-related symptoms was found to be significantly related to their CD4 levels, quality of life ratings, mood and various
measures of coping. Treatment was found to significantly improve the quality of
life (p <.01), mood (p <.001), and coping skills (p <.001) of subjects with the
highest number of symptoms. CD4 values were also found to vary by treatment
and number of symptoms (p <.05), but no significant treatment effect was found.
Conclusions: The results indicate that self-management strategies involving
biofeedback, cognitive restructuring and coping skills training are effective in improving the quality of life, affect, and coping strategies of HIV-positive individuals.
42372 Management of STD and AIDS by the traditional healers
in an urban area of Cameroon

Joseph Kemmegne1, A. Touko1, F. Nguemen2, A. Perr'tiangha3. 'Cameroon
Psychology Forum, Yaounde; 2University of Yaounde I, Yaounde; 3Crescent
Fellowship Foundation, Yaounde, Cameroon
Background: Traditional medicine remains one of the major sources of healing
in Cameroon. Among factors that have enhanced the attendance to traditional
medicine are the ineffectiveness of conventional health services, the economic
crises and the devaluation of the CFA Franc. Despite the interest paid to traditional

medicine in Cameroon, there is scarcity of data as to the ability and capacity of
traditional healers to manage STD and AIDS.
Objectives: 1) To assess the conceptions and knowledge of traditional healers
on STD and AIDS 2) To determine their skills to manage these diseases.
Methods: Traditional healers in Yaounde town in Cameroon, also known as
herbalists, soothsayers, witchdoctors, "naturopathes" were interviewed during
a cross-sectional survey using a non-structured questionnaire. The data was
collected using a tape recorder and analysed with Text Base Alpha software.
Results: Traditional healers received their training either from divine call or
drew their inspirations from other traditional healers. In most cases, the diagnosis of STD was mainly clinical and based on the interview of the patient or
spiritual examination. None of them made use of laboratory technics. As to their
knowledge of STD symptoms, they cited among others painful urination, painful
intercourse and discharge. Most of them never insisted on the treatment of the
partner. Questioned on the cause of AIDS, very few traditional healers mentioned
HIV. According to the majority, AIDS is due to: lack of hygiene, a curse, bad spirits.
They all affirm treating opportunistic diseases including diarrhoea, anaemia, lost
of weight etc. They rely on their experience, the spiritual examination and the
patient's interview for the diagnosis of AIDS. For the treatment of opportunistic
infections, they administer plant extracts and some invoke spiritual forces or
advice patients to make sacrifices to their ancestors.
Conclusion: The ability of traditional healers in the effective management of
STD and AIDS patients in the present state of their knowledge and some of their
practices is uncertain. These can compromise the success of the fight against
STD and AIDS in our region and thus, underline a need fortraining of the traditional
healers on these diseases.
42373 Effect of dehydroepiandosterone (DHEA) on clinical and
laboratory parameters in female patients with AIDS
(FPWA)
Sanusi Umar, G. Feleke, M.S. Roginsky, P. Schaeffer. Department of Medicine,
Nassau County Medical Center, East Meadow, NY, USA
Objective: To determine the effects of DHEA in FPWA, a drug that is widely used
by AIDS patients based on results of uncontrolled studies.
Design: Prospective, randomized double blind.
Methods: 29 FPWA, CDC stage Ill-IV who were administered DHEA 50 mg
(16) daily or placebo (13) for duration of 6 months was studied. All were on the
same 3 antiretroviral medications (protease inhibitors and Reverse transcriptase
Inhibitors for the study duration and 10 ~ 7.72 mo. prior. Parameters measured
included a Medical Outcome Study (MOS) instrument as modified by Bozette et
al. and body weight. In the laboratory, Viral load, CD4 and CD8 counts, cytokines
that included IL-la, IL-1I, IL-1ra, IL-2, TNF-a, IFN-gamma and IL-6. Serum levels
of hormones of DHEA pathway, DHEA, DHEAS, andostendione, 17 hydroxyprogesterone and testosterone, as well as serum cortisol, estradiol, IGF-1, IGFBP-1,
transthyretin and albumin were measured.
Results: Significant difference (mean ~ SD; Cl at 95% confidence level) was
observed in subjects receiving DHEA (Rx) as compared to placebo (PI) in the
following: (i) Increase in body weight in kg (Rx + 1.36 ~ 1.03, PI -1.19 ~ 2.68;
CI 0.73, 4.39). (ii) Improvement on a scale of 0-100, in energy (Rx +8 ~ 16.53,
PI -12 ~ 25.12; CI 3.08, 35.00), Physical functioning (Rx +10 ~ 17.21, PI -18 ~
21.97; CI 12.51, 42.43), cognitive functioning (Rx +8 ~ 17.87, PI -5 ~ 17.87; CI
2.02, 23.24), emotional wellbeing (Rx +8 ~ 14.27, PI 7 ~ 15.51; CI 3.72, 26.46)
and current health perception (Rx +2 + 11.16, PI -8 ~ 17.72; CI 1.26, 19.40). (iii)
Increased CD4/mm3 (Rx +107 ~ 115, PI -11 ~ 113; CI 30, 206). (iv) Cytokines
showing an increase included, IL-1ra in pg/ml (Rx +779 ~ 892, PI -13 ~ 467; CI
228, 1356), and TNF-a (Rx +1.56 ~ 1.95, PI -0.24 ~ 2.14; CI 0.24, 3.36). (v)
Increased somatotrophic activity of IGF-1 is implied by an increasing trend (Rx
+19 ~ 53, PI -16 ~ 55; CI -6, 76) and a significant fall in IGFBP-1 (Rx +7 ~ 25,
PI -18 ~ 19; CI 1, 35). There was a trend to a decreased viral load in the active
group, whereas in the placebo group the trend was to increase but did not reach
significance.
Conclusion: Oral DHEA administered for 6 months in doses shown to restore
to physiologic levels, diminished DHEA (the case in AIDS), produced in FPWA,
beneficial effects in CD4 count, weight and 5 of the 9 parameters of health status
assessment. Observed weight gain might be attributable to somatotrophic activity
of IGF-1. IL-lra which has been shown to have antiretroviral effect on HIV was
also increased. TNF a, which is believed to have a negative effect in HIV, was
increased in the DHEA-treated group.
242374 Reducing emotional distress in individuals who are
HIV-positive
Jillian Inouye1,2, Laura Flannelly2, K.J. Flannelly3. 13280 Pauma Place,
Honolulu Hawaii; HI; 2University of Hawaii, Honolulu, HI; 3Center for
Psycholosocial Research, Honolulu, HI, US
Background: Emotional distress can be a very debilitating secondary symptom
for many individuals who are HIV positive. Because of the relationship of psycho
logical and physiological effects on the immune system, there is a continuing need
to provide effective interventions to help individuals with HIV reduce psychological and emotional distress. The present findings are part of a broad intervention
program to educate and train HIV-positive individuals in self-management and
coping skills.
Methods: Forty subjects were randomly assigned to treatment (n = 20) and
control (n = 20) conditions. Treated subjects received a 7-week program, involving