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

898 Abstracts 43258-43261

12th World AIDS Conference

stantial. Interventions should focus on providing viable economic alternatives to
commercial sex and should address women's continuing risk for infection even
after leaving sex work.
43258 Reproductive intentions and practice of HIV-infected
women in Sao Paulo, Brazil: Better services are needed
LauraCunha Rodrigues1, B.H. Tess2, T.M.G. Lago3. London School of Hygiene
and Tropical Medicine Keppel St, Lononwchie 7HT, England; 2 Viral Epid Branch,
NCI, NIH, Rockville MD,, USA; 31S, Dept. of Health, State of Sao Paulo, Spaulo
Collaborative Study, A Consortium of Hospitals, Sao Paulo & others, SPR Brazil
Objectives: To describe the reproductive history of HIV-infected women in Sao
Paulo State, Brazil.
Methods: 340 women who learned of their HIV infection status during or at
delivery and who were include in a study of mother to child transmission of HIV
infection in Brazil, were interviewed after 18+ months of the index child's birth.
Information on their reproductive experience and intentions was collected.
Results: At the time of the interview, one third of the study women had a
subsequent pregnancy; 5% had two or more children after the index child. The
reasons for getting pregnant included: 14% stated that they wanted another child,
66% did not particularly want another child but did not use contraceptive methods,
and 20% experienced method failure. One third of all women had undergone tube
ligation, half of them after having one or more subsequent children. Women who
were more likely to have had another child were younger (p = 0.03), reported
low parity (< = 2) (p = 0.001), had a live-in partner (p = 0.01), or had 9 or less
years of education (p = 0.03); other social and demographic variables (ethnicity,
income, migration, number of sexual partners, history of prostitution, whether
partner was HIV infected, mode of HIV acquisition, and partner's education) were
not statistically significant. Sixty percent of the women reported no condom use.
The proportion using condoms for all or almost all sexual intercourses was higher
among those not sterilized, but this was only marginally significant (RR = 1.2,
95%CI 1.0-1.4).
Conclusions: To have control over their fertility, women require access to
appropriate contraceptive information, counseling and methods. There is a need
for family planning services to inform and support HIV-infected women in their
reproductive choices. This may lead to higher usage of condoms and lower sexual
transmission of HIV infection.
43259 Prevention of HIV/AIDS among migrant workers in
Myanmar
HIa Htut Lwin, Rai Mra, Myint Zaw, Khin Ohnmar San, Edward Zan. National
AIDS Program 36, Theinbyu Street, Yangon, Myanmar
Myanmar shares lengthy border with Thailand, Lao PDR, China, India and
Bangladesh. Both internal and trans-border population migrations are mainly due
to economic reasons. HIV prevalence is found to be higher in places with more
population migration than in other parts of the country. This situation is evidenced
by the findings of the HIV sentinel surveillance system commencing 1992. Since
1993, studies have been done on HIV related knowledge and behavior among
migrant workers in some border areas, jade and gold mines, cities situated in
economically strategic intersections, and in southern coastal region where fishermen are the difficult-to-reach migrant labourers. Based on the findings, specific
intervention programmes has been introduced to these population groups since
1994 in order to promote HIV awareness, to reduce transmission through unprotected sex, and to prevent women and children from getting HIV infection. With
the assistance of the National AIDS Program, both national and international
non-governmental organizations (NGOs) are working at the grass roots level in
some border areas such as Tachileik and Kawthoung, and in some mining areas
such as Pha Kant and Singu. Cross border programmes for HIV prevention has
been introduced by World Vision International in collaboration with local health
departments from both sides of the border. NGO activities have been extended
to Myanmar-China border in the north and Myanmar-lndia border in the west.
After advocating private fishing enterprises in the Tanintharyi coastal region, HIV
prevention programme for fishermen is now in progress although villagers along
the coast are still difficult to access. The impact of such programmes in Myanmar
is too early to say in terms of HIV transmission. In Kawthoung where one of the
earliest cross border programmes is being implemented, HIV prevalence among
some sentinel groups is found to be decreasing, and the community participation,
multisectoral cooperation and collaboration is well developed.
As migrant labour becomes important issue in the South-East Asia Region,
more emphasis should be paid to expand the coverage of HIV prevention for
this group. All the above mentioned are the on-going programmes and their
sustainability relies much on local and international assistance including support
from UN organizations. We have learnt that motivating local NGOs to develop
their own programmes and to work closely with international NGOs is the most
effective means to interrupt the growing HIV epidemic among the migrant workers
in Myanmar.

43260 The impact of new combination HIV therapies on
knowledge, attitudes, and behaviors among Chicago gay
men
David G. Ostrow1, D.J. McKirnan2, P.A. Vanable3, B.S. Hope3. 1HBHC AIM
Project 4334 N. Hazel Rm. 106-107, Chicago IL; 2University of Illinois,
Psychology, Chicago IL; 3Howard Brown Health Center, Chicago IL, USA
Objectives: To measure the current knowledge about, attitudes towards, and
sexual behavior changes attributed t the new combination HIV therapies in a
community-based sample of gay/bisexual men in Chicago.
Methods: Self-administered questionnaires assessing attitudes toward the
new treatments, sexual behaviors, and demographics were completed by 615
gay/bisexual men (m age = 35; 74% white) recruited during a street fair in August,
1997. A 4 item scale measured increased comfort with sexual risk occasioned by
the new HIV therapies.
Results: 93% of respondents (Rs) identified as gay, 7% bisexual; 90% reported
at least 1 episode of anal or oral sex with another male in the last 6 months. 16%
identified as HIV positive, while only 8% were untested and 2% did not disclose
their serostatus. Of the 97 HIV+ Rs, 64% were being treated by combination therapies. HIV+ men reported greater knowledge about new treatments and optimism
regarding their long-term efficacy than HIV- men, but the two serostatus groups
did not differ in terms of their levels of unsafe sex (46% vs. 48%, respectively). A
substantial minority of Rs reported modest shifts towards increased comfort with
sexual risk occasioned by the new treatments. Increased comfort with sexual risk
was a significant predictor of overall sexual risk (p <.001), especially among
HIV positive men (r = 0.22 vs. 0.49 for HIV- and HIV+ men, respectively). Only
33% of HIV+ Rs had heard about PET, but most Rs expressed a strong interest
in learning about it. (Funded by NIDA grant R01-DA09944 and an NIMH-OARS
supplement.)
Conclusions: Combination therapies are being rapidly adopted by HIV+ gay
men in Chicago, but most do not yet know about PET and report only modest
shifts in risk attitudes or sexual behaviors. A small subset of both HIV+ and HIVmen report recent increases in unsafe sex which correlate with their increased
comfort with unsafe sex. This reflects the uneven penetration of knowledge about
the new therapies among gay men and highlights the need for interventions aimed
at men who perceive the new therapies as lowering HIV transmission risk.
43261 An innovative needle exchange program exclusively for
women is well accepted by female injection drug users in
San Francisco
Paula J. Lum1, J.R. Guydish2, E. Brown2, R.A. Allen3. 1UCSF Ctr for AIDS
Prevention Studies, 74 New Montgomery Street, #600, San Francisco, California
94105; 2UCSF Inst for Health Policy Studies, San Francisco, CA; 3SF AIDS
FDN, HIV Prevention Project, San Francisco, CA, USA
Background: Needle exchange programs (NEPs) have gained increased acceptance in the US. An important challenge remains how to deliver HIV prevention
services at NEPs most effectively. One novel strategy is to target specific groups
at risk, such as women. A women-only NEP began operating in San Francisco in
1995.
Objectives: 1) Describe NEP utilization by women exchangers in San Francisco; 2) Assess the prevalence of their HIV-related risk behavior; 3) Determine
whether women-only clients receive more health-related services than women
attending mixed gender NEP sites.
Methods: We conducted a cross-sectional, observational study. A random
sample of 50 female injection drug users (IDUs) was recruited from each of
3 venues (indoor/women; indoor/mixed; outdoor/mixed) at all NEP sites in San
Francisco (N = 150). Subjects were interviewed using quantitative and qualitative
methods.
Results: 80% of eligible women agreed to participate. Mean age was 37, and
49% were white, 25% Black, and 12% Latina; 42% were homeless. Self-reported
HIV seroprevalence was 6%. There was no difference across venue in the number
of NEP visits per month (mean = 5.2), number of needles exchanged per visit
(mean = 33), or the prevalence of injection or sexual risk behavior. However, subjects recruited from the women's NEP spent more time on site than subjects from
either mixed gender venues (40 vs. 9 vs. 11 minutes; p =.0001). Furthermore,
subjects who ever attended the women's site (n = 82) were more likely than those
using only mixed gender venues (n = 68) to receive health care at any NEP (40%
vs. 24%; p =.03). They were also more likely to receive food, vitamins, coupons,
and clothing (p <.05), as well as conversational support (p =.06). Finally, among
the 104 subjects who reported using more than one NEP site, 41% preferred the
women-only venue to others.
Conclusions: (1) Most women needle exchangers in San Francisco use multiple NEP sites to meet their syringe needs.
(2) An innovative NEP specifically for women in San Francisco is well accepted
and utilized by female IDUs.
(3) Gender-specific NEPs may well serve as a community-based platform
for the delivery of additional health promotion and HIV prevention services for

injection drug-using women.