Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts WePeD6408-WePeD6411 185

terials for migrant workers in Myanmar. The campaign was able to select which
messages were most important in changing risk behavior related to HIV using
qualitiative research tools with migrant workers themselves. Quantitative analysis
allowed effective prioritization of variables that affected each of the messages. A
campaign was then designed to reach migrant workers. Evaluation of of the campaign showed the campaign to be effective. Expansion of BCSC as a planning
tool for 12 additional risk groups for HIV prevention campaigns is under development in Myanmar.
Presenting author: Steven Honeyman, 36 Golden Hill Ave, Bahan Township,
Yangon, Myanmar, Tel.: [phone], Fax: [phone], E-mail: steven@psi.
org.np
WePeD6408 Towards developing strategic response for dual
epidemic of Tuberculosis & HIV in high population
density city of Mumbai, India
G.T. Ambe. Mumbai District Tuberculosis Control Society, F3, sahayog, ratan
nagar four banglow, andheri(w), Mumbai - 400 053, India
Issue: With advent of HIV infection the situation of Tuberculosis Control has become more acute with increasing MDR-TB, low adherence to treatment & shortfalls in programme management. The need was felt to concentrate efforts for
complementing support for both these epidemics. However, it was not focused
hence strategies were adopted with joint comprehensive programme policies.
Description: Mumbai with population of 12 million has a prevalence of 2% of
TB infection. The number of TB cases reported are around 1,50,000 & TB mortality is around 1/1000 population. Also the prevalence of HIV infection in general population is 3.5%, in high risk group viz. MSM (24%), IVDU (23%), CSW
(64%). There was no scientific data available for exact incidence of TB-HIV coinfection in Mumbai. Therefore, strategies were adopted to control TB epidemic in
collaboration with AIDS Society. Which are -1.Formation of 6 District TB Units
for taking programme to the beneficiaries:2.Adopting treatment pattern under
RNTCP with DOTS as one of the component;3.Establishment of 100 Sputum
microscopy centres;4. Follow up of treatment failures and relapse cases to see
whether they are MDR - TB cases; 5. Utilizing VCTC services for TB patients &
HIV Chest symptomatic for sputum microscopy; 6.Sensitization of staff of TB &
AIDS Programme;7.Advocacy with governments at all levels for joint collaborative
programme.
Lessons learnt: HIV epidemic has changed the pattern of TB epidemic in the
form of increased morbidity & mortality for failure of effectively adopting collaboration in these two programs. There are conflicting policies in these two programs,
which needs to be addressed.
Recommendations: A joint collaborative effort of national programs viz.
HIV/AIDS & TB in the form of convergence at implementation level with complementary & supplementary policies can become strength of both these programs
with maximum reach out having optimal utilization of funds.
Presenting author: Guirish Ambe, F3, sahayog, ratan nagar four banglow, andheri(w), Mumbai - 400 053, India, Tel.: +91+22+6354181, Fax: +91+22+4901167,
E-mail: [email protected]
WePeD6409 Tuberculosis and HIV/AIDS are like co-wives: The
conception of HIV/AIDS and Tuberculosis among
the urban Turkana poopulation at Lodwar
Township, Kenya
J.A. Owiti. Department of Anthropology, McGill University Department of
Anthropology, McGill University, Leacock Building, 855 Sherbrooke Street West,
Montreal, Quebec, H3A 2T7, Canada
The project was carried out among the Turkana population of Turkana District
in Kenya. Drought and famine recur regularly in Turkana District. Though most
Turkana are still pastoralists, about 40% have become sedentary The district has
recurrently experienced drought resulting in famine and dislocation of many. The
district has few biomedical services concentrated in settlements. The study was
situated in Lodwar Town, with 34,904 inhabitants.
This study utilises an ecosystemic approach to human health and illness. Using cultural interpretative and medical ecological conceptual frameworks on local
knowledge on illness framework, the project gathered data on local knowledge
and practices on HIV/AIDS and TB and on the link between the two.
The seroprevalence of HIV among the Turkana populations is 3.4%. TB is prevalent in Turkana due to social conditions of living and ecology. Nearly 80% of the
TB patients at Lodwar District Hospital were HIV positive. Biomedical research indicates that there is a link between TB and HIV/AIDS. Virtually TB is re-emerging
as a major health issue due to HIV/AIDS. However, in the arena of local knowledge, it emerged that people recognise these links in subtle ways that are both
convergent and divergent from the biomedical conception. As I was told, TB and
HIV/AIDS are like 'co-wives'. A person infected with HIV/AIDS must have TB, and
the two are inseparable. Many who have, or have died of HIV/AIDS disguise their

sero-status or death with TB. While some conceptions were true, some were erroneous and could lead to victimisation of TB cases as HIV infected. On the other
hand, many of HIV infected persons would hide under the umbrella of TB. This
study reveals that war against TB must be carried out in tandem with that on
HIV/AIDS. The education and information aimed at HIV prevention must encompass TB as well. The similarities and differences between HIV/AIDS and TB must
be clarified to the local populations.

Presenting author: John Owiti, Department of Anthropology, McGill University,
Leacock Building, 855 Sherbrooke Street West, Montreal, Quebec, H3A 2T7,
Canada, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeD6410 Integrated conseling and screening of
tuberculosis and HIV among household contacts
of tuberculosis patients in epidemic area of HIV
infection: Chiang Rai, Thailand
P. Suggaravetsiri1, H. Yanail, V. Chongsuvivatwong2, P. Akarasewi3,
R. Khuptarat 1, D. Chaisangrit', P. Sawanpanyalert1. 1 TB/HIV Research Project,
Chiang Rai, Thailand; 2Prince Songkla University, Hat Jai, Thailand; 3Ministry of
Public Health, Bangkok, Thailand
Background: There is limited information how to conduct the integrated TB and
HIV screening for household contacts of TB patients in HIV epidemic area in Asia.
Method: Household contacts of new smear-positive TB patients were screened
for TB including tuberculin skin test (TST), with TB suspected symptoms or induration of TST>15 mm or anergic skin test were screened by chest radiography
(CXR), sputum examinations and TB culture. Voluntary HIV testing with individual
informed consent was also performed.
Results: The 221 household contacts of 88 HIV-positive TB patients and 269 contacts of 117 TB patients were screened. HIV-positive TB patients were younger,
less proportion of hill tribes, higher proportion to be single or separate or divorce, compared to HIV-negative TB patients. Monthly household income of HIVpositive TB patients were lower (3,484 Baht) compared with HIV-negative TB patients (4,005 Baht, p<0.001). Among household contacts >15 and <70 years old,
92.9%(302/325) of them voluntarily agree for HIV-testing. Higher HIV prevalence
was found among household contacts of HIV-positive TB patients, 16.8%(23/137)
compared with 2.4%(4/165) among contacts from HIV-negative TB patients (OR
8.1, 95%CI 2.7-24.1, p<0.001). Spouse of HIV-positive TB patients were highest, 61.3%(19/31). Also there was 3 vertical transmitted children in household
of HIV-positive TB patients. We found 4 new active TB cases (12.9%) among 31
HIV-positive contacts and 7 (1.5%) of 459 HIV-negative or HIV-unknown contacts,
respectively (OR 9.6, 95% CI 2.6-34.7, p<0.003).
Conclusion: We found high number of HIV-infected household contacts of TB
patients, especially among spouse of HIV-infected TB patients. Many household
contacts voluntarily agree to be HIV-testing after explaining the higher risk of active TB among HIV-infected person. Integrated counseling and screening program
for TB and HIV for household contacts of TB patients in HIV epidemic area should
be strengthened
Presenting author: Hideki Yanai, TB/HIV Research Project, 1050 Satarn
Payabarn Road, Muang District, Chiang Rai, Thailand, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
WePeD6411 1Expanding access to tuberculosis preventive
therapy and cotrimoxazole prophylaxis in
KwaZulu-Natal, South Africa
M. Colvin', C. Connolly', L. Campbell2, H. Hausler3. 'Medical Research
Council, Medical Research Council, PO Box 70380, Overport, 4067, South
Africa; 2South Coast Hospice, Port Shepstone, South Africa; 3Chief Directorate
HIV/AIDS and TB, Dept of Health, Cape Town, South Africa
Background: Although 33% of antenatal clinic attenders in KwaZulu-Natal, are
HIV infected, access to voluntary counselling and testing is limited to the major
cities. Programmes providing isoniazid for TB prevention and co-trimoxazole are
almost non-existent. The purpose of this study was to expand access to VCT and
preventive treatment through public sector clinics in the Ugu-South sub-district
with an urban and rural population.
Methods: VCT was provided by trained nurses and lay-counsellors inl7 hospitals and clinics. All health service clients at participating sites who were referred
by clinicians or were self referred for HIV testing were recruited into the study.
Records were kept of those who accepted counselling, accepted testing, were
eligible for prophylactic treatment and who were adherent to treatment.
Results: During the 18 month study period, a total of 8 359 individuals received
counselling. The prevalence of HIV among 7 495 clients who had HIV tests was
49.9% with 3.1% of tests being indeterminate. Of a total of 1058 patients who
were eligible for isoniazid prophylaxis, 893 started treatment. Only 132 (14.8%)
of the 893 completed 6 months of treatment. Of a total of 260 patients that were
eligible for co-trimoxazole prophylaxis, 174 started treatment with 108 (62%) stopping after one month's course.
Conclusions: By using lay counsellors, this study greatly expanded access to
VCT for this community. Reasons for the relatively low uptake of and poor adherence to prophylactic therapy need to be explored.
Presenting author: Mark Colvin, Medical Research Council, P0 Box 70380,
Overport, 4067, South Africa, Tel.: [phone], Fax: [phone], E
mail: [email protected]