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

12th World AIDS Conference

Abstracts 43129-43133 873

Conclusion: Over time the majority of people who received HIV counselling
and testing were able to disclose their HIV serostatus to their partner. However
there are considerable constraints in sharing test results in both seropositive and
seronegative people. An enabling environment including support by the counsellor
has to be created that enables recipients of VCT to share their test results.
43129 Effect of name reporting on HIV testing rates among
women in prenatal care in Miami
Yvette Rivero', M.I. Fernandez2, M.J. O'Sullivan2, M. Acosta2, E. Bital2,
T. Pratt-Fernandez2, D. Deweese-Gatt2. 115260 SW 57 Street Miami, Florida
33193; 2University of Miami, USA
Background: As of June 1, 1997, HIV infection is a name reportable disease in
the State of Florida.
Methods: At three publicly funded clinics in Miami, 1543 women receiving
prenatal care were interviewed using a brief questionnaire to determine whether
they had been tested for HIV during their current pregnancy as part of a CDC
project (Acceptance and Adherence to HIV Treatment Guidelines for Pregnant
Women in Miami). This interview took approximately five minutes to complete. Of
this sample 31% (476) were interviewed in the year prior to the implementation of
name reporting; 69% (1067) were interviewed in the first eight months following
the required reporting. The majority (59%) of the sample were Hispanic. The
remainder is distributed as 36% Black, 3% White, and 2% Other. Age wise, the
majority (60%) were between 19 and 24 years old, 10% were <18 years and the
remainder were -25 years of age. A minority of the women (21%) were US born,
57% were born in Spanish speaking countries and the remainder were from the
Caribbean basin.
Results: Test acceptance rates prior to the initiation of name reporting was
87% as compared with 86% after the law was implemented. Risk Behavior (sex,
drugs) for HIV was denied by 97% of the women.
Conclusions: Name reporting did not have an impact on test acceptance
among women receiving prenatal care in Miami. It is better to screen women and
be able to treat them and prophylax than do neonatal testing. That 97% denied
risk behavior, suggests either real denial of high risk behavior or a problem with
the risk assessment portion of the questionnaire used.
S43130 Young gay men attending a dedicated service are less
likely to test for HIV than peers using routine clinic
services: Why?
Andrew Billington', J.C.G. Imrie2, A.G. McOwan', S.J. Paragreen', C. Rogers1,
L.A. French1. Camden & Islington Health Services NHS Trust, Mortimer Market
Centre, London, 2University College London Medical School, London, UK
Background: Axis is a weekly sexual health clinic targeting young gay men (<26
years). Clinical audit revealed lower uptake of HIV testing and higher STD rates
among Axis clients than other young gay men (<26 years) attending routine clinic
services. Our project was set up to explore why young gay men using a dedicated
service were less likely to undergo HIV testing.
Methods: We reviewed STD rates and HIV testing rates among young gay
men ( 26 years) using either routine clinic services or Axis clinic over one year
(3/96-4/97). One-hundred questionnaires and ten in-depth interviews were conducted with Axis attenders to identify reasons for not testing and attitudes and
beliefs about testing and new treatments.
Results: 767 attendances involving 306 clients were recorded in Axis during
the review period compared with 1225 attendances involving 487 clients in the
routine service. New STDs were diagnosed in 36% of Axis clients (110/306)
compared to 12.5% (61/487, p < 0.001) among routine service users. Rectal
gonorrhoea rates (a proxy marker for unprotected anal intercourse) were higher
(6% (19/306), p 0.0001) and HIV testing rates lower (12.6% (97/767), p = 0.007)
among Axis clinic attenders than gay men of the same age attending the routine
service (Rectal GC - 1% (3/487); HIV tests 17.2% (211/1225). Questionnaires
and interviews identified anxiety about testing, the possibility of a positive result,
a previous bad testing experience, fear and uncertainty about sexual behaviours
and transmission risks as the main impediments to HIV testing. Respondents also
made inaccurate assessments and incorrect assumptions about HIV transmission
and specific sexual behaviours.
Conclusion: Axis clients are at higher risk of STD and HIV infection than young
gay men using our routine service. Uncertainty about transmission risk and oral
sex, transmission risk and greater numbers of partners, and fear of a positive
result contributed to their decisions not to have an HIV test, even when they knew
they had been at risk. Further development of appropriate sexual health services
and health promotion addressing HIV testing issues for this group is required.
43131 Missed opportunities for HIV diagnosis at an inner city
hospital in the United States
Lorraine Alexander1, M. Sattahr, D.B. Ziemer2, C. Del Rio1. ' Emory University
School of Medicine 69 Butler Street Atlanta, GA 3030; 2Dartmouth College

Hanover, NH, USA
Objectives: To determine if patients newly diagnosed with HIV infection during a
hospitalization had accessed the healthcare system in the 12 months prior to the
admission leading to HIV diagnosis, and therefore, could have been diagnosed
earlier, referred to outpatient services, began on therapy and potentially averted
unnecessary visits and hospitalizations due to opportunistic infections.

Methods: Retrospective review of medical charts and computer records of patients diagnosed with HIV infection while hospitalized at Grady Memorial Hospital
in Atlanta, GA. USA, during 1997.
Results: Of 117 patients diagnosed while in the hospital during this 12 month
period, 47 (40%) were female and 105 (90%) were African American. Their mean
age was 42 years (range 22-77), but 24 patients (21%) being 50 years-old or over.
The median CD4 count was 47 cells/ pL. The most common discharge diagnosis
was pneumonia in 65 cases with 38 of them due to P carinii. Hospital mortality
was 8.5%. Hospital days totaled 2124, including 200 days in the Intensive Care
Unit. The estimated cost of these hospital days is $1.4 million USD. Out of the
117 patients, 72 (62%) were found to have accessed the healthcare system in the
12 months prior to admission, with a mean of 4 visits (range 1-16) per patient,
for a total of 264 medical encounters. The most frequented department was the
Emergency Care Center (ECC) with 147 visits; in addition, 16 patients had been
hospitalized in the year prior to the admission where HIV was diagnosed.
Conclusion: In a city with a high HIV prevalence, voluntary testing of all adult
patients admitted to an inner hospital or who visit the ECC - which often serves as
the primary health care for the under-served population- should be encouraged.
Regardless of age, gender, or lack of identifiable risk factors, HIV infection should
be in the differential diagnosis in patients presenting to an acute care facility. We
must view every hospital encounter as an opportunity to educate about HIV/AIDS
and intervene sooner.
143132 Home specimen collection for early detection of HIV:
Feasibility and acceptability among those at risk
Freya Spielberg', C. Critchlow', E. Vittinghoff2, K. Mayer3, F. Judson4,
A. Schwartz Coletti5, R. Scotti6. 1University of Washington, Seattle; 2San
Francisco Department of Public Health, San Francisco, 3Brown University,
Pawtucket; 4 Denver Department of Public Health, Denver; 5ABT Associates,
Inc., Cambridge; 6University of Pennsylvania, Philadelphia, USA
Objective: To assess the feasibility and acceptability of bimonthly home oral fluid
(OF) and dried blood spot (DBS) collection for early detection of HIV infection
among individuals at high risk.
Methods: Potential participants were randomly selected from four sites in the
NIH/HIV Network for Prevention Trials (HIVNET) Vaccine Preparedness Study.
Successive recruitment continued until a total of 241 participants (140 men who
have sex with men (MSM), 72 injection drug users, and 29 women at heterosexual
risk) accepted randomization to a six month study requiring home collection of bimonthly OF or DBS specimens. Participants could select telephone calls or clinic
visits to receive HIV counseling and test results. The HIVNET central laboratory
(CL) monitored receipt of bimonthly specimens and adequacy of specimens for
testing. Acceptability of bimonthly home oral fluid and dried blood spot collection
and telephone counseling was assessed in an end-of-study self-administered
questionnaire.
Results: Among those approached, 84% agreed to be randomized to either OF
or DBS collection; 95% of participants chose results disclosure and counseling
by telephone. Overall, acceptance of home specimen collection and selection
of telephone counseling did not differ by sex or risk behavior. The CL received
96% and 90% of expected OF and DBS specimens, respectively; 99% of each
specimen type was adequate for testing. Most participants reported that OF (97%)
and DBS (89%) specimen collection kits were easy to use; 85% reported that
bimonthly testing did not make them worry more about HIV, and 98% judged that
with bimonthly testing their risk behavior remained the same (77%) or became
less risky (21%).
Conclusions: Bimonthly home specimen collection of both OF and DBS is
feasible and acceptable among individuals at high risk. Participants clearly prefer
telephone counseling to on-site counseling when bimonthly testing is required.
S43133 The use of home collection HIV tests in the US: Barriers
and solutions
Kathryn Phillips', B. Branson2, S. Fernyak', R. Bayer3. S. Chang4, S. Morin'.
1USCF/Center for AIDS Prevention Studies 74 New Montgomery San Francisco
94105; 2 Centers for Disease and Prevention, Atlanta, GA, 3Colombia, New
York, NY; 4Kaiser Family Foundation Menlo Park CA, USA
Issues: After 10 years of debate, the US Food and Drug Administration approved
the first home collection HIV test (HCT) in 1996. We examined how many people
are using HCTs, the barriers to their use, and potential solutions to those barriers.
Project: We reviewed data from the US Centers for Disease Control and Prevention and other studies to assess the number of HCT users and barriers to use.
Results: In the first year of use, 152,000 individuals used HCTs (0.06% of
the US population). Although HCTs are being used by persons who do not access other testing and those who are at-risk for HIV with few reported negative
consequences, the actual number of users was much lower than expected. The
currently low numbers of users, which lead to the withdrawal of one product, may
lead to the withdrawal of other HCTs and new HIV tests from the US market.
Barriers to use include the high price of the test ($40-$50), consumers' lack of

knowledge about HCTs, the 3-7 day wait for results, and consumers' aversion to
fingersticks. Solutions include: (1) increasing consumers' knowledge about HCTs,
(2) making HCTs widely available through different mechanisms, (3) subsidizing
the costs of tests for low-income individuals, and (4) exploring the ability of other
new HIV tests - rapid blood tests, oral fluids tests, urine tests, and true home
tests that enable users to obtain results without counseling to overcome barriers
to testing.