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

876 Abstracts 43144-43148

12th World AIDS Conference

settings: (1) clinic participants receiving either traditional Clinic Counseling and
Testing (Clinic CT) or a Kit; (2) outreach participants receiving either Field CT or
a Kit; or, (3) outreach participants receiving either Referral to CT or a Kit. The
proportion of participants who were tested and who received results is presented.
Results: 40.3% (1024/2540) of the kits distributed were tested (Clinic CT
462/615 or 75.1%; Field CT 136/404 or 33.7%; Referral CT 426/1521 or 28.0%).

Test Sites Public Health Testing (CT)
Samples Tested Results Received
Clinic CT 205 149 (72.7%)
Field CT 368 213(57.9%)
Referral CT 878 (Referred) 1 (0.11%)

Home Test System (Kit)
Samples Tested Results Received
462 451 (97.6%)
136 123 (90.4%)
426 384(90.1%)

Conclusions: Randomization was not entirely successful, due to a number of
participants who would only consider testing if they received a home kit, though
many who accepted home kits did not use them. Compared to traditional public
health HIV test services, a greater proportion of persons who tested using home
kits received their results. This analysis suggests that home kits may be a useful
option in certain public health settings.
43144 Do people attending a same day testing clinic (SDTC)
discuss their need for an HIV test with their GP?
Sara Madge1, M. Jones2, A. Mocroft2, H. Wells2, M.A. Johnson2. 1c/o 11th
Floor, Garrett-Anderson Ward, Royal Free Hospital, Pond ST NW3 2Q9,
England; 2Royal Free Hospital London, UK
Background: Currently HIV testing infrequently takes place in Primary care in
England & Wales. We wanted to investigate if people attending the SDTC had
discussed HIV testing with their GP & if they had not, why?
Methods: Those attending were given a questionnaire which was linked to the
STDC counsellors form for demographics, risk & HIV result.
Results: Response rate 79.7% (n = 476). Data is analysed on 95.8% of
questionnaires. 3.3% tested HIV positive. 63.8% of all responders were male,
of which 40.5% were homosexual. Registration rates with a GP were 91.0%. Of
these, 65.8% had seen their GP within 6 months. 8.3% had discussed testing
with their GP & 3.5% with the Practice Nurse. The 3 most common reasonsfor
not discussing testing with the GP were: 232 wanted to use the STDC, 144 were
concerned about recording in medical notes & 106 expressed concerns about
future life insurance (369 responses from 402 respondents). Of those that had
discussed HIV testing with their GP, 33 respondents wanted to use a same day
result, & 25 stated that their doctor recommended the STDC. Homosexual men
(n = 116) were as likely to be registered with a GP (p = 0.40) & be as satisfied
with their GP (p = 0.097) as heterosexual men & women. However homosexual
men were less likely to discuss HIV testing in Primary care (p = 0.046). They were
also more likely to site disclosing main risk (p = 0.024) or sexuality (p = 0.028) as
inhibitors if HIV testing had not been discussed.
(We will have full data available [1000 cases] for presentation by June).
Conclusions: If earlier detection of HIV infection is to occur, it seems likely
GPs need to raise HIV testing more frequently. Homosexual men showed no
differences between heterosexual men & women in terms of GP registration rates
or satisfaction, but discussed HIV testing & associated risk behaviour less often.
This study highlights specific inhibitors in Primary care with respect to HIV testing.
These include accessibility, recording of risk in notes & perceived affect on future
insurance.
43145 Factors associated with prior HIV testing from the
behavioral risk factor survey in Rhode Island
Kai-Lih Liu1, K.H.M. Mayer2, P.G.L. Loberti3, J.E.H. Hesser3. 13 Capitol Hill
Room 106, Providence; 2Memorial Hospital of Rhode Island, Pawtucket; 3Rhode
Island Department of Health, Providence, USA
Objectives: To determine demographic and behavioral factors in relation to
self-reported prior HIV testing from a telephone survey of health behaviors.
Methods: The Behavioral Risk Factor Surveillance System (BRFSS), sponsored by the Centers for Disease Control and Prevention, monitors the prevalence
of behavioral risk factors for the leading causes of diseases and death among
adults in the United States. It is an annual state-administered, random-digit dialed
telephone survey. This study was based on AIDS-related questions from the 1995
RHode Island BRFSS conducted in adults aged 18 to 65 years old (n = 1409).
Results: The unweighted proportion of self-reported prior HIV antibody testing
(ever being tested for HIV) was 45.21% in RHode Island. After adjusting in the
multiple logistic regression model, factors significantly associated with prior HIV
testing were race (non-white vs. white: OR = 1.57, p <.05), age (40-9 us. 30-9:
OR = 0.50, p <.001; 50+ vs. 30-9: OR = 0.29, p -.001), period of time since
last checkup (1 year vs. 5+ years: OR = 2.85, p <.001; 1- years vs 5+ years:
OR = 2.03, p <.05), self-estimated risk of getting HIV (High vs. None: OR =
3.16, p <.05), and changing sexual behavior within the past 12 months (Yes
vs. No: OR = 1.70, p <.005). However, gender, marital status annual household
income, health insurance plan, and self-estimated meduim/low HIV risk were not
significant in this model.
Conclusion: Our findings indicate more educational strategies should be aimed
at the target population identified by the analysis to increase the awareness of HIV
risk and to promote routine HIV testing in different communities. The BRFSS data
can be used to set priorities in the developement of HIV Prevention Community
PLanning Group and HIV counseling and testing programs.

43146 HIV testing circumstances and sexual behavior change
among persons likely to be recently infected
Patricia Sweeney1, P.L. Fleming1, J.W. Ward1, J. Li2, J. Beil3, R. Holmes4,
H. Stone5. 1 Centers for Disease Control 1600 Clifton Rd MS-47 Atlanta GA
30333; 2TRW Atlanta GA; 3New Jersey Department of Health Trenton NJ;
4Alabama Department of Health Montgomery AL; 5 Tennessee Department of
Health Nashville TN, USA
Objectives: To describe HIV testing and behavior change among persons likely
to be recently infected with HIV.
Methods: Persons diagnosed and reported with HIV since January 1997 in
Alabama, New Jersey, and Tennessee who met our recent infection criteria were
asked to participate in an interview regarding their sexual behaviors before and
after learning of their infection and HIV testing history. Criteria for likely recent
infection included 1) young age (13 to 24 years) 2) CD4 Count >700 or % >36 or
3) seroconversion within 18 months of diagnosis.
Results: A total of 425 persons diagnosed and reported from 1/97 through
11/97 met the inclusion criteria; representing 20% of persons diagnosed and
reported from these 3 states in this period. As of 12/97, 77 of 129 (60%) eligible persons contacted thus far were interviewed. Characteristics of persons
interviewed do not differ from those sampled and remaining to be contacted.
Of 77 respondents, 52% were female; 60% were Black; females were younger
than males (male: mean age = 28.1; female = 23.8). Overall 75% had tested
more than once. Thirty-nine (51%) said they previously tested negative; most
tested negative in public CTS sites (31%) and STD clinics (18%) and hospital
inpatient settings (18%). Overall, 13% ever tested anonymously; the percentage
was higher in men (22%) than women (5%). Reasons for testing and test site
varied by sex. Pregnancy care was most frequently cited main reason for testing
among women (42%) while men cited being worried about HIV (26%) or being
told by a friend or doctor to get tested (19%). When they learned of their infection
74% discussed ways to reduce their risk to others. Sixty-one percent have had
sex since learning of their infection and 90% report making some change in their
sexual behaviors; not having sex at all or as often and using condoms more were
cited most frequently.
Conclusions: Preliminary findings indicate that among recently infected persons tested and reported, many previously tested negative for HIV and had
received counseling to reduce their risk. Evaluation of counseling messages for
high risk negative persons, particularly in public CTS and STD settings is needed
to identify more effective interventions to reduce transmission.
S43147 Voluntary prenatal testing as an alternative to mandatory
testing
Luis Freddy Molano1,2, D.E. Farley2, R.D. Lane2. 161 West 62nd. Street #26 B,
New York, NY 10023; 2Community Family Planning Council, New York, NY USA
Issues: This paper examines the experiences of a voluntary prenatal HIV counseling & testing program implemented by the Community Family Planning Council.
CFPC provides HIV pretest counselling to thousands of women and men and
hundreds of prenatal clients each year. THis paper uses this data set to examine
the overall success of this voluntary testing effort.
Project: Over the last three years CFPC provided HIV counselling services to
more than 13,000 women and men. The counselling is provided to all prenatal
clients seen at the clinics as well as all clients receiving an annual or semi annual
family planning examination. This report focus on prenatal clients and includes
all those who, after their initial pretest counselling session either accepted or
declined HIV testing. Women are compared by age, race, number of reported risk
factors, time spent on pre-test counselling and the type of health care professional
providing the counselling.
Results: 85% of CFPC's prenatal clients voluntarily agreed to HIV testing:
clients who agreed to testing differ significantly by race, number of risks and time
spent by counsellor. Although it is CFPC's policy to offer counselling to all prenatal
clients the final decision to test rests with the client without affecting access to
prenatal services.
Lessons Learned: It's CFPC's contention that a voluntary testing program can
be successful in achieving high levels of testing and is more flexible and responsive to the needs of pregnant women. Although some arguments for mandatory
testing have merit, the negative impact outweighed the benefits especially if
mandatory screening discourages women from seeking prenatal care.
43148 HIV anti-body test, a community perception
Onani Mughogho. Lilongwe AIDS Counselli G & Education Cent. PO. Box
31308, Lilongwe 3 Malawi, Central Africa
Issue: The critical concerns expressed by individuals/communities about HIV
antibody test.
Project: The problem of HIV/AIDS in Malawi still continues. The national seroprevalence rate now as estimated by the National AIDS Control Programme is
at 14% in the urban areas and 11% in the rural areas. HIV/AIDS education,

counselling and HIV antibody testing are some of the interventions put in place by
a combined force of government, non-governmental organisations and support
groups to contain the epidemic. A number of issues have been expressed by individuals/committees concerning HIV antibody testing in particular and HIV/AIDS
epidemic in general. These concerns were unveiled during a survey at Lilongwe
AIDS Counselling and Education Centre (LACE) through counselling and group
interviews from 900 clients.