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

956 Abstracts 43558-43561

12th World AIDS Conference

Project: In 1994, clients in the San Francisco Eligible Metropolitan Area (EMA),
frustrated with the repetitive, time consuming process of re-registering at each
non-profit agency, asked for a way to streamline the process and for better coordination among the agencies where they sought services. In response, the San
Francisco Department of Public Health, in cooperation with the HIV Health Services Planning Council and the Support Center for Nonprofit Management, has
planned and developed a computerized, centralized, client registration system
with decentralized access to track and link client and service data. The system,
named Project Reggie, uses database technology networked among the 70 HIV
service providers across the three county EMA and allows agencies to meet
federal and local reporting requirements for funding anonymously. The process of
developing Project Reggie has been critically important. Planning has proceeded
in incremental phases, each phase followed by a technical and programmatic
evaluation. Client confidentiality and security of the system have been the highest
priority. Client and provider input has been included from the very beginning.
Results: We will 1) display a database design which incorporates client choice,
2) describe the steps in its development and implementation, and 3) discuss the
ethical considerations in using public health databases.
Lessons Learned: include the identification of these critical ethical factors
in developing public health databases: 1) Incorporating client and provider involvement in the design of HIV/AIDS technical projects; 2) Insuring the highest
level of confidentiality and security; 3) Including in the software application client
choice for sharing or not sharing information across providers; 4) Consistently
employing a strict "need to know" criteria when determining access to information
by providers.
S43558 The world-wide challenge of treating HIV+ populations:
Treatment availability, accessibility, distribution and
compliance
Pierre Chauvin1, Jacques Lebas2, F. Lamara2. 127 Rue Chaligny 75012 Paris;
2lnstitut de I'Humanitaire Paris, France
Issues: For the next decade, the HIV pandemic faces a new challenge: applying
an ethical principle of solidarity to operational strategies in order that the greatest
number of HIV+ people have access to antiretroviral treatments. Today, it seems
that economical controversies obscure some key issues when addressing such
strategies:
(1) to what extent are these treatments available
(2) to what extent are these treatments accessible
(3) in what conditions should these treatments he issued
(4) what are the minimal conditions to ensure patients' compliance to treatment
Project: We integrated these 4 dimensions as determinants in a conceptual
model to describe various national situations (both in industrialised and emerging countries) as well as to emphasize some obstacles that future operational
strategies will have to take into account.
Results: Thanks to this 4-dimensional representation, we showed to what extent different countries and different health systems achieve this goal: to provide
their entire HIV/AIDS population with antiretroviral treatments. We showed how
these situations are more diversified than a rough distinction between the so-called
"rich" and "poor" countries, or between northern and southern hemispheres.
Conclusions: Beyond its economical aspects, providing the world-wide
HIV/AIDS population with antiretroviral treatments will need the development
of country-specific strategies, according to the structure and the technological
level of development of their respective health systems, the level of achievement
and coverage of their social protection system, and their involvement in patients'
health education.
43559 Waterborne diseases, cryptosporidium and water quality
laws
Zita Lazzarini1, L.O. Gostin2, D.G. Colley3, D.D. Juranek3, V.S. Neslund3.
1Harvard School of Public Health, 218 West Madison Ave., Holyoke, Boston,
MA; 2Georgetown University-Johns Hopkins School, Washington, DC; 3Centers
for Disease Control & Prevention, Atlanta, GA, USA
Background: Cryptosporidium is an emerging waterborne pathogen that can
cause chronic and life-threatening diarrheal illness in persons with HIV/AIDS.
There is no effective treatment for cryptosporidiosis. Up to 60% of persons with
AIDS in industrialized countries report diarrhea, 5%-16% of these cases may be
caused by Cryptosporidium. In the United States (US) waterborne outbreaks of
cryptosporidiosis have been linked to consumption of treated public tap water.
Policymakers need to assess adequacy of state and federal regulations to protect
the water supply, to improve methods for identifying outbreaks of waterborne
disease, and to develop effective strategies for rapidly responding to real or
perceived threats of waterborne disease.
Methods: I. Reviewed scientific data on risk of Cryptosporidium in tap water
and significance to persons with HIV/AIDS. II. Analyzed development of federal
water provisions and legal challenges to them. III. Surveyed 50 states and US
territories to collect laws, regulations and policies governing authority for wa
ter quality testing and treatment, cryptosporidiosis surveillance, and criteria and
procedures for emergency measures ["boil water advisories" (BWAs)].
Results: I. Current data are inadequate to assess the risk of small numbers
of Cryptosporidium oocysts in tap water. Persons with HIV/AIDS may be at
risk from low levels of contamination. II. The Federal Safe Drinking Water Act
has set standards for states regulating water quality for 24 years. Successful
constitutional and statutory challenges demonstrate limits of federal authority.

II. Primary authority for water quality rests with health departments (15 states),
environmental agencies (19), or shared (17). State testing, treatment and filtration
requirements closely adhere to federal standards. 35 states mandate reporting of
Cryptosporidium infections to health departments, 9 have reporting requirements
pending. 33 states and 4 territories give broad discretion to water authorities to
determine when to issue BWAs; 10 states' and 1 territory's policies specify criteria
for BWAs; and 9 states and 3 territories set criteria by formal laws or regulations.
Conclusions: 1) Persons with HIV/AIDS should receive special education
about potential risks from public water supplies. 2) Federal provisions provide
uniformity to water standards but are constrained by constitutional and procedural limits. 3) State provisions do not provide uniform criteria for issuing and
terminating BWAs; 4) State laws should provide clear authority for determining if
perceived or real changes in drinking water quality pose a threat to public health
and for deciding if a BWA is needed. 5) States should encourage mandatory
cryptosporidiosis reporting.
355*/43560 1 HIV/AIDS policy in Brazil
Richard G. Parker1, J. Galvao2. 1HIV Center NY State Psychiatric Institute Unit
10, Columbia University, 722 West 168th Street, New York, NY, USA; 2ABIA, Rio
De Janiero, RJ, Brazil
Objectives: To develop an assessment of HIV/AIDS programs and policies in
Brazil.
Design: Historical documentation and policy analysis of both governmental
and nongovernmental responses to the epidemic from its emergence in 1982 to
the present.
Methods: An initial pilot study was developed examining the epidemiology
of AIDS in Brazil, the public policy response to the epidemic, the response of
civil society through nongovernmental organizations, religious denominations and
private sector business and industry, as well as the linkages between HIV/AIDS,
reproductive health and reproductive rights. On the basis of this initial pilot study,
a more extensive investigation was undertaken. A team of consultants was
assembled to examine the developments of programs and policies. Research
focused on three key topical area (research, prevention, and care and treatment services) as well as three key interfaces or areas of interaction (national
and international policies and programs, the state and civil society, and AIDS
and reproductive health). National and International advisory committees were
formed, and a working group was created involving leading representatives from
governmental AIDS programs, nongovernmental AIDS advocacy organizations,
and health policy research institutions
Results: On the basis of work carried out thus far, it has been possible to
develop a clear periodization of distinct phases in the programmatic and policy
response to the epidemic in Brazil, to link these phases to both local political and
economic history (as part of a broader process of redemocratization in Brazilian
society) as well as to a number of key international developments (such as
the international debt crisis, structural adjustment policies, neoliberal economic
policies, and the changing shape of international development initiatives).
435611 A survey of women to determine perinatal provider
practice regarding HIV education, counseling and
voluntary testing
Mary Driscoll1, A. Cormack2, L. Garcia-Bunuel3, E. Joo2, D. Taylor3, C. Kelly2.
1Cook County Hospital, Chicago, IL; 2 Illinois Department of Public Health,
Chicago, IL; 3MCH/HIV Integration Project, Chicago, IL; 4 Illinois Department of
Public Health, Chicago, IL, USA
Objective: To analyze two year effects of MCH/HIV Integration Project to promote
universal education, counseling and testing of pregnant women.
Design/Method: A survey instrument was developed to elicit women's selfreport of HIV prevention services offered during their pregnancy. Survey questions
included: demographic data; entry into prenatal care; education about HIV and
perinatal transmission reduction; offering the HIV test; testing; receiving test results. Surveys were administered by nursing staff to post-partum women in 66
hospitals. Surveys were conducted for one month in each hospital over a 6 month
period (May-Oct. 1997).
Results: Sample size (n = 7,147) represents 76% of total deliveries in metropolitan Chicago hospitals (n = 9,791) during the 6 month period. Initial data analysis
shows 96% of women received some prenatal care with 80% entering in the 1st
trimester. 54% of the women agreed to test for HIV, of those 80% were educated;
of women who were counseled and agreed to test 88% received test results;
of women who were tested without counseling, only 68% received test results.
Survey data was linked to Project efforts and yielded results showing sites that
received most provider training had results >70% of women were counseled,
tested, and received results.
Conclusion: Education and counseling are important determinants of pregnant
women learning their HIV status. With US legislative mandates calling for 95% of
pregnant women to know their HIV status, it is important that testing be coupled
with education and counseling, for prevention purposes and for women to know

their HIV status. Universal voluntary testing with information for all pregnant
women will only become a reality if efforts are made to educate providers of
perinatal care to talk to women about HIV.