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

12th World AIDS Conference

Abstracts 43139-43143 875

been analyzed for clients reporting marriage planning as the reason for testing
compared with all other reasons given.
Results: There was a steady increase in demand for CT for marriage plans,
from 16% in 1992, 17% in 1993, 21% in 1994, 28% in 1995, 33% in 1996 and
32% in 1997. In 1997, of those coming because they wanted to get married, 64%
came with their prospective partners. Males coming for premarital testing were
slightly younger (29 years vs 31) than males coming for all other reasons, and
the same trend was observed amongst females, (22 years vs 29). Seropositivity
was much lower among clients intending to get married (6.3% vs 25%).
Conclusion: In Uganda, there is a growing trend among parents and clergy to
demand that intending couples get tested for HIV before marriage. The increasing
numbers of AIC clients requesting pre-marital CT reflect these social pressures;
and most (94% in 1997) learn that they are not infected. Pre-marital CT at AIC
helps couples make informed marriage decisions and adopt HIV risk reduction
strategies.
43139 HIV seropositivity and outreach-based counseling and
testing services: A program evaluation
Wayne Difranceisco1, D.R. Holtgrave2, N. Hoxie3, W. Reiser3, R. Resenhoeft1,
S.D. Pinkerton1, J. Vergeront3. 1 Cair, Med College Wi, 1201 N Prospect Ave,
Milwaukee, WI 53202; 2Centers Disease Control & Prevention, Atlanta, GA;
3 Wisconsin Division of Health, Madison, WI, USA
Background: To evaluate the effectiveness of outreach in attracting high risk
clients for HIV counseling and testing (CT), the study examined whether clients
in outreach-based CT service settings had higher HIV seropositivity rates than
clinic-based contacts.
Methods: Between January 1992 and June 1995, the Wisconsin Bureau of
Public Health provided anonymous CT services for 62,299 client-contacts. Approximately 20% of these contacts took place in outreach settings (e.g., STD
clinics, bars); the remainder, at 56 traditional and clinic-type testing sites located throughout the state. Data collected for each contact included demographic
background, mode of HIV risk exposure, service setting, and HIV test result.
Results: During the study period, 488 anonymous clients tested HIV seropositive. Bivariate analysis showed marginally higher HIV seropositivity among outreach contacts (OR = 1.23; 95% Cl = 1.0 to 1.5). However, findings from multiple
logistic regression indicated that, within at least some sub-population(s), outreach
CT clients were actually less likely to test HIV positive than clinic-based clients
(OR = 0.65; 95% Cl = 0.5 to 0.8) when controlling for demographic and contextual differences. Tests on the interactions between outreach and other predictors
revealed race to be a significant co-determinant in the relationship between
seropositivity and service setting. Further analysis suggested that this finding
was related to an under-representation of non-white outreach clients within some
categories of higher HIV risk exposure-in particular, men who have sex with men.
Conclusions: The research shows that outreach programs for HIV counseling
and testing may fail to attract clients from some minority populations with high HIV
seroprevalence. Constant monitoring of client outcomes and the timely reallocation of program resources are recommended for more efficiently delivering CT
services in various communities. Also needed are better "marketing" strategies for
tailoring outreach programs to operate more effectively among socially isolated
and/or stigmatized groups.
43140 HIV testing history among adults in the United States
Guijing Wang. 1600 Clifton Road MSE 44, Atlanta, GA 30333, USA
Objective: To investigate the HIV testing status among the general population in
the United States based on a national representative survey.
Methods: Using the 1992 National Health and Social Life Survey, a national
representative sample of individuals aged 18-59 living in the United States, we
estimated the HIV testing status of the general population (N = 2,921). Among
those who did and did not report having been previously tested for HIV, the
following 4 HIV risk factors were examined by univariate analysis: male-to-male
sex, IV drug use or had sex with IV drug user, ever had syphilis or genital herpes,
and receipt of blood products in 1978-85.
Results: 797 (27%) individuals reported having been HIV tested. 5 (0.6%) of
those tested reported having a positive result. 339 persons (11.6%), including all
5 persons reporting a positive result, reported having at least one of the 4 risk
factors. 52% of persons reporting at least one of the 4 risk factors had not been
HIV tested. Persons who were tested were more likely to be IV drug users or
have had sex with IV drug users (6.4% vs. 2.6%, P = 0.001); to have had syphilis
or genital herpes (4.3% vs. 1.5%, P = 0.001); to have received blood products
in 1978-85 (6.1% vs. 3.4%, P = 0.001); and among men, to have had sex with
other men (5.6% vs. 0.7%, P = 0.001).
Conclusions: Those who reported having been HIV tested were more likely
to report having a HIV risk factor. Because more than half of persons with HIV
risk factors have not been tested and all HIV positive cases were found in these
individuals, HIV testing programs should continue to target the individuals with at
least one of the HIV risk factors.

S43141 Feasibility and drawbacks of HIV home testing in rural
Uganda
Robert Ssengonzi1, M. Morris1, N. Sewankambo2, M.J. Wawer3, R. Gray4.
1Penn State University 601 Oswald Tower University, Park, PA; 3 Columbia
University, New York, NY; 4 Johns Hopkins University, MD, USA; 2 Makerere
University, Kampala, Uganda
Objective: To examine whether HIV home testing could be used to encourage
behavioral change and reduce HIV transmission in a rural Ugandan population.
Methods: Focus groups were conducted in 12 villages in Rakai District, including rural, intermediate and trading centers. The focus groups of 10 participants
were stratified by age (18-30 and 31-49) and gender. Respondents were asked
to comment on the drawbacks and advantages of HIV home testing.
Results: Motivation to take conventional clinical HIV tests is still very low
among the rural population, and home testing is not perceived as a more beneficial alternative. Most participants believe that nearly every one in the community
is HIV positive, though prevalence in these communities typically lies between
10-30%. Residents are concerned that testing positive can lead to destructive
behaviors, especially for males, like intentional unprotected sex and raping young
girls so as to spread the virus. On the other hand, they also believe that testing
negative can lead to protective behavior, like reduction of the number of outside
partners for married people, and an increase in condom use for the youths. While
the convenience and privacy of the home test was recognized as a potential
benefit, the primary concern was that those who tested positive would respond
by putting others in danger, and that clinic-based testing offered counselling that
might help prevent such a response.
Conclusion: Residents did not perceive home HIV testing to be a useful tool
in motivating behavioral change, but this was largely because they believed that
nearly everyone was infected, and that testing positive would lead to dangerous
behaviors. This suggests that better access to testing could help to correct the
misperception of universal infection, and provide positive motivation to reduce
risk.
43142 Acceptance of HIV testing among women in prenatal care
in Miami, New York City, and Connecticut
M. Isabel Fernandez1, T. Wilson2, J. Moore3, K. Ethier4, E. Walter5. Perinatal
Collaborative Group; 1 University of Miami, PO. Box 019132 M880 Miami, Florda
33101; 2State University of New York, Brooklyn, NY; 3Centers for Disease
Control & Prevention, Atlanta, GA; 4Yale University, New Haven, CT; 5University
of North Carolina, Chapel Hill, NC, USA
Background: United States Public Health Service (USPHS) guidelines recommend that pregnant women be offered HIV testing. This study examines test
acceptance rates among women in prenatal care in Miami, New York City (NYC),
and Connecticut (CT).
Methods: A systematic sample of 830 women who had been offered HIV
testing were interviewed. The racial/ethnic distribution was: 48% Hispanic (44%
of whom were immigrants), 35% Black, 4% White, 3% Other. More than 50% had
less than a high school education; 74% were unemployed; 66% were not married.
Results: 81% of the women across the 3 sites accepted HIV testing. Sites
differed in acceptance rates (x2 = 61.982 p = 0001). Miami (92%, OR 1.31) and
CT (90% OR 1.29) reported higher test acceptance than NYC (70%). Hispanics
(84%) were more likely to accept testing than Blacks (78% OR 1.08, x2 = 4.551,
p =.03).
Women who did not have a sex partner at risk for HIV (i.e., injection drug user)
in the year before they were pregnant were more likely to accept testing (82%)
than those with a partner at risk (72% OR 1.14, x2 = 5.721, p =.02). Stronger
provider recommendation for testing was associated with higher test acceptance
(84%) than weaker recommendations (73% OR 1.15, X2 = 12.171, p =.000).
Similarly, women who perceived that their provider strongly believed in testing
(83%) were more likely to accept than those who believed their providers did
not (71% OR 1.17, x2 = 8.881 p =.003). In multivariate analyses site, race and
provider belief in testing were the most significant predictors of testing. The most
frequently reported reasons for not getting tested were being married, not seeing
the need, and previously having been tested.
Conclusion: The results suggest that a majority of women in prenatal care
settings voluntarily accept HIV testing. Womens' perception of how strongly her
provider believed that she should be tested and recommended that she be tested,
emerged as significant predictors of test acceptance. These findings point to the
importance of provider training in the implementation of USPHS counseling and
testing guidelines for pregnant women.
43143 Comparison of a home HIV test system to public health
HIV test services
Katarzyna E. Kruzel, A.P. Frank22, B.M. Branson, D.K. Boyd, M.G. Wandell22.
12401 W Hassell Road Suite 1510, Hoffman Estates IL 60195-5200; 2Home
Access Health Corporation, Hoffman Estates IL; Center For Disease Control &

Prevention, Atlanta, GA; Arizona Department of Health Services, Phoenix AZ,
USA
Objective: To compare a commercially available home HIV test system (Home
Access HIV-1 Test System) to public health test services for utilization and
receipt of results.
Methods: Five health departments conducted a randomized controlled trial
of home HIV collection kits (Kit) from January 1-December 31, 1997, in three