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

12th World AIDS Conference

Abstracts 43512-43516 947

reorganized and equipped to facilitate community planning of multisectoral action.
Systemic measures to ensure continuity of care are needed. Staff development
should emphasize client -oriented attitudes.
43512 AIDS mortality in the city of Sao Paulo, Brazil: trend and
impact of combined anti-retroviral therapy
Marcos Junior Drumond. Rua Martiniano de Carvalho 676 Ap. 11, Bela Vista,
Sao Paulo 01321000, Brazil
AIDS mortality in Sao Paulo City was on the rise until 1995. In 1996, for the first
lime in do history of the AIDS epidemic in the city, deaths from AIDS dropped.
However, this decline occurred for males only. Among females, the tendency
to increase was maintained, albeit at a slower rate. These circumstances show
the overall pattern of AIDS mortality in the city, although they do not reveal the
intra-urban differentials.
Project: The main objectives of this study are to analyze the AIDS mortality
trend in Sao Paulo City (SP) between 1991 and 1996 and to assess the impact of combined triple anti-retroviral therapy (CTT) on AIDS mortality between
1996 and 1997, by gender and social groups. AIDS mortality data was obtained
from PRO-AIM (Program for the improvement of death statistics in the SP). The
PRO-AIM assesses all death certificates, an average of 200 per day, in SP,
24 hours after death occurs. This prompt access has allowed the Program to
undertake actions for an improvement in the quality of mortality information, for
monitoring of mortality trends and patterns of AIDS, and other diseases, and
for epidemiologic investigation on deaths. In order to analyze social inequalities
and describe intra-urban differentials, the division of the city into districts and
sub-districts was instrumental. The following death certificate variables were considered: sex/gender, occupation, degree of instruction and residential area of the
deceased. These same variables were important to assess the AIDS mortality
impact of CTT. Thus, a comparison of AIDS mortality data between the first third
of 1996 and that of 1997 - the period when public health services introduced CTT
- was made. Deaths from HIV/AIDS between 1991 and 1996 in the districts and
sub-districts of SP were higher where residents lived under the worst environmental and socioeconomic conditions. The same tendency was observed among
lower qualification workers and lower instruction degree groups. Deaths from
HIV/AIDS in the first third of 1996, compared with the same period in 1997, was
31.5% lower. This occurred after the introduction CTT. However the decrease
differed markedly by gender. Among males, this decline was 35.7%, whereas
among females it was 19.0%. Also, the decline was lower in social groups in
which the mortality trend had been rising.
Lessons learned: The impact of combined anti-retroviral therapy on AIDS
mortality in Sao Paulo City was very marked. Nevertheless, the differentials observed between gender and social groups may be due to previous differences in
the rising of the epidemic and/or to the different levels of compliance and availability of access to the treatment offered by the public health system, which, in
turn, contribute to increase the social differentials observed in the trends. Further
analysis is necessary to assess the role of each factor in this trend.
43513 Evaluation for improving program management and
development of national and regional minority
organizations to deliver technical assistance and training
G. Aisha Gilliam1, Samuel Taveras2, Thompson P. Imani2, Daniel Gentry3.
1CDC/PERB/DHAP MS E59 1600 Clifton Rd, Atlanta GA 30333; 2Centers for
Disease Control and Prevention, Atlanta GA; 3Saint Louis University, Saint Louis
MO, USA
Issues: Evaluation is important in strengthening organizations that provide technical assistance and training (T/TA) to health departments and community based
organizations to help them meet the HIV prevention needs of racial and ethnic
minority communities in the USA.
Project: The evaluation integrated qualitative methods such as focus groups,
site visits and document reviews with quantitative methods such as surveys, to
determine specific ways to improve NRMO's T/TA in organizational development,
program management and services integration. Performance indicators and critical success factors were developed as observable measures of the progress
toward program goals, objectives and performance targets, and were used as the
basis for judging NRMOs success in delivering T/TA. Twenty NRMOs and 300
of their client agencies throughout the US were involved in this study conducted
during the 1995-1996 fiscal year.
Results: Preliminary results yield frequencies on the types of T/TA provided by
NRMOs, - cultural sensitivity 47%, program development 72%, service integration
34%, and fiscal management 11%. Client agencies identified the ways that T/TA
can be improved through increased follow-up after initial contact (33%), more tailored/specific T/TA (11%), and longer sessions (12%). For NRMOs delivering the
T/TA, critical success factors identified in the organizational literature, and through
an expert panel were used as benchmarks as attainment of organizational success for delivery of T/TA. Through use of these critical success factors, variation
was delineated in in key areas: e.g., 73% of the agencies collaborated with other

organizations, 79% involved the community in needs assessments, 62% used
a service model for guiding the provision of T/TA, and 71% had comprehensive
T/TA plans.
Lessons Learned: As a result of this evaluation we were able to: (1) determine
the distribution of types of T/TA services delivered; (2) determine the T/TA needs
of client agencies (3) identify the critical success factors for building organizational
capacity for the delivery of T/TA.

43514 Does safer sex survive the therapeutic optimism in the
general public?
Juergen Toeppich1, G. Christiansen2, W.H. Meller2, E. Pott2. 1Postfach 910152
D-51071; 2Federal Centre for Health Education, Koeln, Germany
Issues: This study is focussed on the thesis that the new therapeutic options
and belief in their effectiveness may reduce the individual preventive behavior
and thus lead to a severe backlash of preventive behavior in the general population. Contradictory findings about this issue have been published by different
authors. A contribution to this acute discussion will be presented which is based
on evaluation data of the German AIDS-prevention campaign.
Project/Methods: The German national HIV-prevention campaign is monitored
by an annual representative population survey. As part of an "early warning system" each year a proportion of new questions is included which are targeted
towards topics of specific or urgent interest. In the 1996 and 1997 survey a set of
questions concerning the beliefs about the new therapeutic options or even the
curability of AIDS was integrated and then controlled against several "early" and
classic indicators for protective intentions or behavior.
Results: In 1996 the public's conceptions about the mortality, treatability or
curability of HIV/AIDS have not significantly changed compared to 1987. Those
who believe in successful treatment or the (possible) curability showed no significant difference in the key indicators intention for protection, acceptance/rejection
of (un)safe sex, and condom use. The results of the 1997 in-depth study of this
question will be presented and discussed.
Lessons learned: Though on the individual level in 1996 no evidence was
found that optimism in HIV/AIDS-therapies leads to a decline protective intentions
and behavior, it could be that such an unlearning process is slower and therefore
was not yet detectable. The late-1997 follow-up evaluation with the "early indicator" system is expected to give more evidence about the stability of the results of
the social learning processes towards effective prevention.
43515 Do people with HIV/AIDS get what they need from the
health sector in Abidjan, C'ote d'lvoire? An assessment
of present coverage
Agnes Soucat1, Daniel Levy-Bruhl2, E. Malville3, J. Aka Kacou4, H. Rossert3,
M. Coulibaly5. 139/111 Ladphrao S0133 Bangkok10900, Thailand; 2Reseau
National De Sante Publique Saint Maurice; 3Cidef Paris, France; 4Smit Chu De
Trichville Abidjan; 5PNLS Abidjan, Cote D'lvoire
Objectives: to assess the present coverage of health care needs linked to AIDS
and HIV by the public health services in the capital of Cote d'lvoire, Abidjan.
Design: transversal study comparison of projected needs to actual utilization
of services.
Method: the study "AIDS and the health sector: analysis of consequences and
strategies of response, a case study of Cote d'lvoire" estimated the proportion of
needs for health care of AIDS patients (stage II to IV) covered by the public sector
in Abidjan in 1996. To estimate the actual use of health care (both consultations
and hospitalisation) by AIDS patients the study exploited routine service data of
activities for each source of care and surveyed the proportion of health services
linked to AIDS. To determine health care needs for HIV/AIDS, the study used
Epimodel to estimate the number of AIDS patients and expert advice from an
ad-hoc panel to estimate the number of diseases episodes per patient.
Results: the Epimodel projected for 1996 in Abidjan 18,156 AIDS cases at
stage IV and 23,746 cases at stage II and III. The expert group estimated the
number of annual episodes of opportunistic infection requiring health care to about
13 and 4 for the stages IV and I1-111 respectively. The number of hospitalisation
days for an AIDS patient at stage II or III was neglected. For a patient at stage IV,
this number has been estimated to 10 days per year. For coverage of 100% of
needs this would represent 331,012 consultations and 181,560 hospitalisations
days linked to AIDS. The actual number of consultations in Abidjan in 1996 due to
AIDS was estimated to be 32,238 and 67,102 and the number of hospitalisation
days around 33,096. The coverage of needs linked to AIDS by the public health
sector is therefore estimated at 10 to 20% for the consultations and about 18%
for the hospitalisation days.
Conclusion: the public health sector of Abidjan needs to improve both access
and quality of HIV/AIDS care as a matter of urgent priority. Only in that case will
the dramatic projected increase in needs for HIV/AIDS related care be met.
S43516 Capacity building as a means of better sexual health
programme management
Niraj Agrawal, S. Sengupta, J. Hague, K. Verma. W.B.S.H.P 9A Little Russel
Street Calcutta 700071, India
Issue: Strengthening NGOs and other organisations technically and institutionally using innovative approaches, so that they can provide effective sexual health
services.
Project: The West Bengal Sexual Health Project aims to reduce the future
burden of STD and HIV by improving the sexual health of people at heightened

risk of infection. Capacity building programmes for project partners have been
undertaken to build conceptual, technical and managerial competencies, which
will ultimately enable partners to design and implement effective sexual health
interventions. The various mechanisms for capacity building include 1. Training
programmes focusing on mutual and experiential learning, 2. Exchange visits
placing representatives from one organisation to another for a specific period for
on the job training enabling them to exchange ideas, experiences, knowledge,