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

962 Abstracts 44120-44125

12th World AIDS Conference

where PWAs can live positively and the community plays a supportive role to
PWAs and all these who are affected.
Lessons Learnt: Law can be a useful instrument in promoting respect for
the rights of PWAs. However, in order for the Law to be effective it must be
appropriate to the existing social-cultural constraints to its use. In addition, the
community must be mobilized and influenced to appreciate and to participate
in the protection of legal rights of PWAs and other vulnerable members of the
community.
44120 Challenges of developing national legal frameworks in
response to HIV/AIDS
Sarah Baite. Uganda Network on Law Ethics and HIV, PO Box 3277, Kampala,
Uganda
Issue: Poor human rights literacy levels. Thus making it difficult to comprehend
human rights issues surrounding the HIV epidemic.
Project:Due to the low levels of literacy with regard to human rights, it has
become even harder to comprehend the inter-relation between human rights and
HIV/AIDS so as to develop an appropriate legal response to HIV/AIDS.
A project by the Uganda Network on Law, Ethics and HIV/AIDS aimed at building
institutional, organisational and individual capacity intended to raise awareness
about critical legal, and human rights issues as a forerunner for the development
of a legal framework was designed.
Results:lmproved levels among some sections of society about the human
rights issues in light of HIV/AIDS, also assisted in developing a consensus about
feelings of the masses about critical issues raised for incorporation in the proposed
legal framework.
Lessons Learnt: Whereas impact was created to some extent, there is need
for a back-up programme to ensure continuity of impact in the communities. For
instance, documentation and follow-up mechanism for identified and reported
cases.
44121 The construction of a legal framework to support AIDS
control and prevention from a human rights perspective
in Honduras, Central America
Jorge Alberto Fernandez, Norma Patricia Rivera Scott, Elizabeth Vinelli. Depto:
ETS/SIDA Tegucigalpa, Honduras Central America; Project Coordinator
PAHO/BID/SSH Tegucigalpa; Honduran Red Cross, Tegucigalpa, Honduras
Issues: The epidemic consecuences of AIDs in Honduras have made it an urge
nt need to develop a legal framework that can support and provide orientation
in the prefvention and control of the disease, from a humanistic approach. At
the moment, health workers have no adequate legal instruments available in this
field.
Project: National guidelines were define to work in two basic areas: the construction of a national blood bank system and the approval of a Law on AIDS
by the National Congress. Support has been provided in the elaboration and
consolidation of legal instruments on both perspectives, with broad participation
of local and international experts.
Results: The national blood bank system has been created by law in may 1997,
with a letter of intentions between de Red Cross and the Health Ministry signed
in october 1997 and regulations approved by the president of the country in dec.
The AIDS law is in discussion withing the Congress and includes fundamental
matter$ that will contribute to solve many of the problems which are daily faced
by health workers (public, private and NGOs) working in AIDS.
There has been much support and interest shown by public and private enterprise to count with regulations that help them orient their actions in a more
adecuate way. Actual procedures regarding the contracts and early retirement of
personnel are not sustainable and are not based on scientific procedures legally
and laborally established. Product marketing has been crucial in this process.
Lessons: There is public awareness of the need of a legal framework on AIDS.
However it has been less difficult to approach blood banks than laboral affairs.
S44122 Increasing electronic access to instruments/literature on
HIV-related ethics, human rights and law
Bruce Waring1, G. McNeil2, R.E.F. Jurgens. Canadian HIV/AIDS Legal Network,
14376 Wilson Montreal, QC; 2Canadian HIV/AIDS Legal Network, Ottawa, ON,
Canada
Issue: There has been a consistent call for increased access to instruments
and literature on HIV-related ethics, human rights and law in order to promote
observance of human rights, ethical and legal norms for PLHAs. The Canadian
HIV/AIDS Legal Network (CHALN) in collaboration with UNAIDS are undertaking
a pilot project to increase access to instruments and literature in this area.
Project: CHALN has produced a literature review and annotated bibliography
of Legal and Ethical Issues Raised by HIV/AIDS. Funding from UNAIDS has been
obtained to ensure that this document is expanded and access to it increased.
Results: The annotated bibliography was expanded by: i) identifying and sum
marizing instruments and literature originating from developing countries; and
ii) including the full texts of specific international and regional instruments that
explicitly address the ethical, human rights and legal aspects of HIV/AIDS. Access
to the annotated bibliography was enhanced by: i) placing the bibliography on the
internet; ii) providing guidance on how users can access full texts of materials

not contained within the bibliography; and iii) linking the site to other information
networks, clearinghouses, centres and key individuals.
Lessons Learned: i) the information included in the bibliography and contact
information must be regularly updated to ensure its accuracy and relevance for
individuals and organizations using the information; ii) the information must be
provided in a format which enables end users with low technical capacity (i.e., low
speed modem, modest computer capacity) to access the information efficiently;
and iii) on-going evaluation by and input from the end-user of the document on
both the utility of the information and their capacity to access the information over
the internet is a critical step in ensuring the on-going success of the project.
1471*/44123 Additional unethical aspects of vertical
transmission studies in developing countries
Peter G. Lurie, S.M. Wolfe. Public Citizen, 1660 20th St., NW Washington, DC,
20009, USA
Issues: After the publication of the ACTG 076 study, which demonstrated that
zidovudine caused a 2/3 reduction in HIV transmission from pregnant women
to infants, attention turned to identifying an affordable regimen for developing
countries. In April 1997, we identified a total of 15 studies involving over 17,000
developing country women that sought to identify such regimens (e.g., regimens
using zidovudine for 4-6 weeks antepartum) by providing placebos or interventions not yet proved effective to at least some women. We initiated a campaign,
both in medical journals and in the popular press, to redesign the studies so that
all women had access to at least some antiretroviral drugs. So far, one study in
Ethiopia has been redesigned to eliminate its placebo group.
Project: To determine whether the studies violate additional ethical guidelines.
Results: There are three additional unethical aspects to these studies. 1. The
informed consent form in at least one study fails to state that a pre-planned
subanalysis of data from ACTG 076 showed a 2/3 reduction in HIV transmission
among women receiving an average of only 7 weeks of zidovudine. 2. There
is no provision for the women to continue on antiretrovirals after the study is
completed, even though noncompliance with antiretrovirals (in this case, forced
noncompliance due to zidovudine being unaffordable in most developing countries) is a known cause of HIV resistance. 3. There is also an observational study
of 125 HIV-positive pregnant women, conducted by the Thai and US Armies, Thai
researchers and Johns Hopkins University, which has continued to provide the
subjects with no zidovudine, even though zidovudine is so available that Thai
researchers terminated their own placebo-controlled trial in January 1997.
Conclusion: The studies are unethical in a variety of ways beyond the provision
of placebos. This highlights the need for the studies to be redesigned and for a
renewed commitment to the conduct of ethical studies in developing countries.
44124 Perinatal HIV transmission: Ethical dilemma of a
scientifically sound multi-micronutrients intervention
study in Zimbabwe
Norman Nyazema. Dept Clinical Pharmacology, P 0 Box A 178, Avondale
Harare, Zimbabwe
Issue: Nutrition intervention studies in HIV/AIDS involving pregnant women have
moral obligations that are complex but have to be addressed.
Project: At the moment, in Zimbabwe, the ACTG 076 regimen is not part of
the standard care for pregnant women. Nutrition intervention has always been
felt to be useful in infection. A double blind placebo controlled nutrition study was
therefore carried out among pregnant women recruited at an ante-natal clinic.
Blood samples were collected and food frequency questionnaires administered
after an informed consent form had been signed. Each woman was counselled
and given the choice concerning disclosure of her HIV status result. Before leaving
the clinic the women collected either 110 placebo or multi-micronutrients tablets.
They were visited at least once a month by the research team until birth of the
child. Each woman regardless of her HIV status was encouraged to breast feed
and to use condoms.
Results: HIV prevalence in the 1800 women recruited was 33% and average
age was 24yrs. Some of the women appeared to have no access to adequate
nutrition. Some mother and child pair have since died.
Lessons Learnt: Young women were willing to know their HIV status. However
being ready to know was something else. This made it difficult to advise on
breastfeeding and use of condoms. To put the women and their babies on the
ACTG 076 regimen during the duration the study only would have been unethical.
|44125 Ethical principles to assure access to HIV treatments:
Recommendations of a workgroup of the New York State
AIDS Advisory Council
Guthrie S. Birkhead1, N. Neveloff-Dubler2, S.O. Noring3, B.D. Agins3, A. Small1,
B. Lerner4. 1NYSDOH AIDS Institute, Comrning Tower Rm 485, Esp Albany NY;
2Montefi Ore Medical Center, New York, NY; 3NYSDOH AIDS Institute, New
York, NY; 4 Columbia School of Health, New York, NY USA

Issues: Since introduced in the United States in 1995, highly active anti-retroviral
therapy (HAART) for HIV has improved the clinical status and slowed disease
progression in many persons living with HIV/AIDS (PLWH/A). However, reports
that some physicians, out of concern that drug resistance may develop, may deny
HAART to PLWH/As whom they consider unable to adhere to complex treatment