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

12th World AIDS Conference

Abstracts 43562-43567 957

43562 National public health policy for HIV/STDs
Annika Strandell, G. Rado, G. Winfridsson. National Institute of Public Health
S-103 52 Stockholm, Sweden
Issue: To develop strategies and methods of broad-based national public health
work concerning HIV/STD prevention.
Project: As national HIV prevention co-ordinator, the National Institute of Public
Health (NIPH) has developed a national public health policy and strategies for
HIV/STD prevention with a broad perspective on sexuality and reproductive health
and with particular emphasis on persons especially vulnerable to HIV infection.
This policy has been endorsed by national bodies and non-governmental organisations (NGOs). The NIPH is above all tasked with co-ordinating preventive HIV
work at all levels (national, regional and local), initiating and supporting research
and education programmes, supporting county councils, municipalities and NGOs
with knowledge and funding, collecting and disseminating knowledge and in various ways informing the general public and different occupational categories.
Results: The known transmission rates, both of HIV and of other STDs, in
Sweden are low by international standards. The state of knowledge among the
Swedish population concerning HIV/AIDS and transmission routes has been
monitored through national surveys since 1986. Knowledge has increased, and
fear of people living with HIV/AIDS has diminished. A large number of projects
and activities (totalling 152 in 1997) have been started nationwide as a result
of financial and technical support from the NIPH. Nearly every county council in
Sweden has a current plan of action.
Lessons learned: Local/regional preventive work - requiring financial and
technical support from a national co -ordinator - is highly important and should be
carried out by the county councils, municipalities and local/regional NGOs.
43563 Cowboys, condoms and complacency
Sara Dubik-Unruh. Wy AIDS Etc/UW Family Practice, 1522 East A St, Casper,
Wyoming, USA
Issues: Wyoming's HIV situation presents a rare opportunity to intervene in an
accelerating epidemic while reported numbers are still low (<200); however official prevention efforts ignore high-risk populations, reject targeted education and
foster perceptions of the state as "low-risk".
Project: Since 1984, Wyoming, a frontier state (less than 6 people per square
mile) has experienced a small but growing HIV epidemic fed by sex and drug
activity at truck stops, parks and tourist areas amid beliefs the state is "low risk"
due to low reported numbers. Confidentiality is questionable in rural areas: many
residents test anonymously in bordering states, to which results (and funding)
then accrue. Wyoming is a conservative ranching state; homophobia is rampant.
Though 3/4 of diagnosed AIDS cases and new HIV infections are attributed
to male-sex-with-males (MSM) with or without drug injection, a state "Cowboy
Condom" campaign was dropped as "bad for tourism". The minimal public school
HIV training alleges "condom failure rates" of 50%. 'Probablistic smearing' from
county centers along interstates indicates HIV follows main roads and population
centers, diffusing from high-incidence areas such as Denver (with its international airport 2 hours from Wyoming's border). Sequential maps depict continued
spread. Space-time plotting suggests that absent intervention, the epidemic may
double from 1995 figures by the year 2000, and double again by 2005.
Results: Downplaying the epidemic, providing minimal, misleading education
and fostering a climate where same-sex activity must be covert and anonymous
to insure safety, encourages the belief that HIV is not a problem. This fuels the
epidemic at a time when intensive, appropriate intervention might conceivably
reverse it.
Lessons Learned: Governments must act early in an epidemic and provide
appropriate education so those most at risk may protect themselves. Failing this,
they should enlist the efforts of community-based organizations who are willing
to take on these tasks, and support them. Official complacency is fueling a growing tragedy for Wyoming. The almost unprecedented opportunity to reverse this
state's HIV epidemic may soon be extinguished.
43564 HIV-1 seropositity among prostitutes in the Tenere
desert, Niger
Yves Pierre Alexandre1, D. Julvez2, A. Niamey3, G. Gragnic2. 1PO. Box 407,
N'Ddamena, Chad; 2Ministery of Health Niger, Niamey; 3Bilma Hospital; Bilma,
Niger
Objectives: To mesure the HIV 1 seropositivy among prostitute in the desert in
Niger.
Design: Seroprevalence study in a vulnerable population.
Methods: 122 prostitutes were examined in Dirkou, low temperature preservation of blood sample was made in the military camp of the area, and the collection
was carried back to Niamey by plane.
Various tests were performed at the national Hospital laboratory. Genolovia -
TM, vironostika TM a multi spot HIV 1-2 TM without control western blot.
Results: The result was 27.9 per cent rate of HIV 1 infection (34/122) and in 7

cases, a double positivity HIV 1 and 2.
Conclusion: This experience does not support the view that such desert zone
are at low risk for HIV transmission, even if the situation is worse on non-desert
West-Africa. Neverthless, the spread of HIV virus in the nomadic population
contitutes a public health problem. Chad has to do the same investigation. Both
contries have to give to these populations more support (iec and preservatives
promotions).

43565 Impact of the new trends of epidemic of AIDS on AP-HP, a
large hospital organisation
Francois Chieze1l2, Laure Beaujouan2, J.J. Guay2. 1AP-HP Mission
SIDA-TOXICOMANIE 3 Ave Victoria 75004 Paris; 2Assistance
Publique-Hopitaux De Paris, Paris, France
The Assistance Publique-H6pitaux de Paris (AP-HP) is the university hospital
structure of Paris region (12 million inhabitants) and is, with 18,000 acute-care
beds, the largest hospital organisation in Europe. AP-HP treats 24,000 HIV+
patients per year (one third of all HIV+ patients in France). This represents a
budget of US $ 167 million.
Issue: In this study we focus on the new trends of the AIDS epidemic, regarding
mainly medical organisation changes.
Project: From April 1996 onwards, AP-HP's patients can receive antiretroviral
treatment with protease inhibitor. The impact of these new treatments is studied
through the quarterly follow-up of various indicators. Epidemiological data about
patients becoming AIDS patients, are analysed to determine impact on health
care policies.
Results: During the past years, proportion of AP-HP's patients treated has
increased from 72.3%, in June 1995, to 83.7% in June 1997; in parallel proportion
of patients treated by an association of several antiretrovirals has risen to 98.3%
of treated people in June 1997. The impact of these treatments can be observed
on the hospital activity, so the number of hospitalisations has decreased by
about 30% in one year, while the number of consultations kept even. Beside the
global trends one can observe a large heterogeneity among the different centres,
especially between these located in the city and those in the suburbs where
PWA are more frequently drug users or in a precarious situation. 69% of people
becoming AIDS patients did not received any treatment. The majority of them,
59%, because they did not know their HIV status.
Lessons learned: AP-HP is running six centres for free and anonymous detection, and consultations for people in precarious situation. This organisation
must be improved to encourage early HIV detection. Significant effort should
be undertaken in order to provide more accessible care (treatment and follow-up).
S43566 HIV/AIDS policy development and advocacy: A Kenya
AIDS NGOs consortium initiative
Esther Wanjiku Gatua1, A.G. Ragi2. 1PO Box 69866, Nairobi; 2Kenya AIDS
NGOs Consortium, Nairobi, Kenya
Objective: To increase capacity of NGOs, religious and governmental organisations to initiate and sustain the process of policy development and advocacy.
Design: A process for capacity building, networking, identification of policy
issues and advocacy.
Methods: Following several questions on issues related to AIDS and NGOs
role in influencing policy, we initiated a process with distinct steps that included
pre-workshop and expert consultation meetings, identification and prioritisation of
issues, inclusion of issues in the Sessional paper and media advocacy strategies.
Outcome: 140 AIDS workers at District and National Institutions empowered
to facilitate policy development and advocacy. Acurate and increased media
reporting realised. Issues identified were incorporated in the 1997 Sessional Paper on HIV/AIDS in Kenya. 26 networks established to further HIV/AIDS policy
development and advocacy.
Conclusion/Lessons Learnt: Policy development is a process not always
understood by constituents and stakeholders. It requires capacity building, commitment and regular interaction with constituents at all levels. Media support,
training and involvement is essential. A bottom up approach provided experiential
inputs to the policy development process by grassroot NGOs and stakeholders
in Kenya.
S435671 Training for "safe blood" transfusion in sub-Saharan
Africa
E. John Watson-Williams12, P.K. Kataaha2, J.M. Goddard2, P. Ssenyoga2.
17020 Valley Greens Drive #6, Carmel, California, USA; 2Uganda Blood
Transfusion Service, Kampala, Uganda
Issue: Control of HIV transmission through blood transfusion (BT) has been
accomplished by wealthy countries, but is still far from being achieved in many
developing countries. Low economic level and less sophisticated infrastructure
makes technical transfer very difficult. Skills learned by attachment to, or training
in, BT programmes in Europe are frequently not usable on return to Africa, where
it is necessary to overcome social taboos, unreliable electricity and water supply,
poor or non-existent electronic communication, inadequate transport and long
distances and a severe shortage of skilled manpower.
Project: The EC (European Commission) contracted with UBTS (Uganda Blood
Transfusion Service) to develop a ten week course, to train a team of doctor,
administrator, technologist and donor recruiter from developing African countries.
The curriculum was designed to determine and solve problems of the local safe

BT programme. It addresses motivation of government, public leadership and voluntary blood donors, quality assurance and good laboratory and clinical practice
in the use of blood. After field work, the team is tutored to write a detailed plan to
improve their own country's BT programme.
Results: In the first year, teams from 6 African countries have completed the
course. All agreed that there was much that they could implement. Follow up on
the impact of changes made will be reported.