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

234 Abstracts WeOrF1367-WePpF2117

XIV International AIDS Conference

and the proportion who reported unprotected sex was 30% and 50% among those
who had and had not announced to their partners respectively; 77% of female patients reported sexual activity and the proportion reporting unsafe sex was 42%
and 60% respectively. Besides, non-disclosure (57%), the main other reason cited
for not using condoms was the desire to become pregnant.
Conclusion: Non-disclosure is still common among patients on ARV and contributing to high levels of unprotected sex. Intensive counseling about infectiousness of patients on ARV and safe sex in the context of reproductive needs remains
important.
Presenting author: m kabore, ngo-amepouh, 01 bp 1712, abidjan 01, Cote
d'lvoire, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WeOrF1367 Assessing and improving adherence to highly
active anti-retroviral therapy among socially
disadvantaged persons living with HIV/AIDS in Rio
de Janeiro, Brazil
C. Carneiro-da-Cunha1, D. Kerrigan2, M. Malta1, M. Fortuna3, S. Strathdee2,
F. Bastos1. 1Oswaldo Cruz Foundation, Rio de Janeiro - RJ, Brazil; 2Johns
Hopkins University, Baltimore, MD, United States; 3Ambulatorio do Banco da
Provid6ncia, Rio de Janeiro, Brazil
Issue: Adherence to highly active anti-retroviral therapy (HAART) is important
for both persons living with HIV/AIDS (PLWHA) as well as public health, since
non-compliance may promote transmission of HIV-resistant strains.
Description: 18 focus groups, consisting of 11 PLWHA on average, were conducted with socially disadvantaged PLWHA regularly attending a psychosocial
support group based in a public health clinic in Rio de Janeiro, Brazil. Focus
group participants were composed of a diverse range of low-income men and
women ages 19-63. All were currently on HAART In addition to open-ended questions/discussion, role-playing techniques were used to facilitate group communication and psychosocial support. Topics discussed include: daily life; relationships w/ partners, friends and family; HAART-related knowledge, attitudes, and
experiences; relationships with health providers; and previous/current protective
behavior.
Lessons learned: Key facilitators of adherence to HAART identified by participants include: communication and relationships with health providers as well as
emotional support and practical assistance provided by the support group itself.
Key barriers to adherence include: stigma and fear of rejection disclosing serostatus to partners, relatives & friends; low self-esteem associated with HIV-status
and symptoms; the complexity of therapeutic regimens and their side-effects; and
the concomitant use of alcohol and/or illicit drugs. According to participants, peerbased support groups function as a "broker" between providers and patients,
"translating" technical language into practical information and helping overcome
potential power imbalances between doctors and PLWHA.
Recommendations: Peer-based support groups represent an empowerment
tool for PLWHA to take an active role in the therapeutic process and should be
expanded to increase adherence to HAART and improve quality of life of PLWHA.
Presenting author: Claudia Carneiro-da-Cunha, Av. Brasil 4.365 - Biblioteca de
Manguinhos #209 - Manguinhos - 21045-900 - Rio de Janeiro - RJ, Brazil, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePpF2115 The potential of voucher schemes for the
prevention and treatment of sexually transmitted
infections amongst clients of sex workers.
A.C. Gorter, Z.E. Segura, E. Zuniga, R. Torrentes. ICAS (Instituto
Centroamericano de la Salud, Bery/dijk 4, 4706 EA, Roosendaal, Nicaragua
Background: In 1995 a voucher scheme for the treatment of sexually transmitted
infections (STIs) in sex workers (SW) was successfully developed in Managua.
Since then, over 15,000 vouchers have been distributed, over 6,000 consultations held with over 2,800 different SW. Prevalence of gonorrhoea reduced by
5% per year; of syphilis by 10% per year. Highest reduction amongst poorest SW
who had highest initial rates. HIV prevalence in SW increased slowly (0.8% in '91,
1.3% in '97 and 2% in '99). At the request of the SW their clients were involved in
the scheme.
Methods: Vouchers are biannually distributed to all SW at soliciting sites in Managua, entitling them to free care from a variety of 8-10 private, charity and public
clinics contracted in advance by competitive tender. Staff are required to follow a
treatment protocol based on laboratory and clinical diagnoses, clinic based masstreatment (single-dose azithromycin) and health counselling. Quality is monitored
and only the best clinics are contracted for subsequent rounds. Ethnographic research with clients was performed and several pilot voucher distributions. Since
'99 SW redeeming their voucher are offered 1 or 2 vouchers for their clients.
Results: For clients the low technical quality of existing sexual health services
is an important factor not to use them. Of 2,672 vouchers distributed to clients
512 (19%) were used. Of these men 49% had one or more STIs with 305 STIs

detected: 77% non-ulcerative and 23% ulcerative. Most prevalent were chlamydia, gonorrhoea, syphilis and chancroid. Sixty % of these men had never visited a
sexual health service before. Men who had once experienced an STI were more
prepared to use a condom. Median age was 25 (range 12 to 89).
Conclusions: Voucher schemes for clients should be considered as a new effective way to attract SW clients with high levels of STIs, providing also an opportunity for promoting safer sexual behaviour.

Presenting author: Anna Gorter, Beryldijk 4, 4706 EA, Roosendaal, The Netherlands, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePpF2116 Validation of syndromic algorithms to the
management of sexually transmitted diseases in
China
Q.Q. Wang, M.L. Tan2, D.M. Jian3. 1National Center for STD & Leprosy
Control, Nanjing, Jiangsu Province, China; 2Shanghai Hospital of Skin Diseases
and STDs, Shanghai, China; 3Sichuan Provincial Institute of Dermatology and
Venereology, Chengdu, China
Objective: To validate syndromic algorithms to the management of STDs which
was adopted from WHO recommendation.
Methods: Patients with three common syndromes were selected in their first visits to two STD clinics in Shanghai and Sichuan. The etiology of the syndromes
was detected by laboratory testing.
Results: A total of 851 patients were enrolled into the study. (1) There were 104
(35.7%) patients with gonorrhea, 79 (27.2%) with chlamydial infection, and 58
(20.0%) with both infections in 290 male patients with urethral discharge. Syndromic diagnosis had a sensitivity of 90.0% and specificity of 93.0% for gonococcal infection. The sensitivity for chlamydial infection was 100%. The total positive predictive value (PPV) was 83.1%. (2) The prevalence of gonorrhea and/or
chlamydial infection was 30.6% in 334 women with vaginal discharge. The sensitivity was 70.6%, specificity 54.7%, and PPV 40.7% for the diagnosis of gonorrhea
and/or chlamydial infection by syndromic approach. (3) Seventy-eight (34.7%) patients with syphilis, 43 (19.1%) with genital herpes, and 28 (12.4%) with both infections were found in 227 patients with genital ulcer. The sensitivities were 88.7%
and 69.0%, specificities 95.0% and 50.0%, and PPVs 94.0% and 38.6% for the
diagnosis of syphilis and genital herpes by syndromic approach, respectively. (4)
Cost-effectiveness analysis indicated that the average cost of a patient with urethral discharge was 41.4 RMB Yuan by syndromic management, in comparison
with 145.3 RMB Yuan by etiological management.
Conclusions: The syndromic management of urethral discharge is relatively effective and suited to clinical application. The specificity and PPV for syndromic
management of vaginal discharge are not satisfied. No chancroid is found in genital ulcer, suggesting revised flowchart of genital ulcer syndrome could be fit for
use in clinical settings. Further validation and revision are needed for syndromic
approaches of vaginal discharge and genital ulcer.
Presenting author: Qian-qiu Wang, National center for STD & Leprosy control,
12 Jiangwangmiao Rd, Nanjing 210042, Jiangsu province, China, Tel.: +86 25
547 0575, Fax: [phone], E-mail: [email protected]
WePpF2117 Regular visits by female sex workers for STI
control at special clinics are achievable on a
voluntary basis. MSF's experience in Cambodia
P. Ir Porl, W. Van Dammel, S.T. Kheang', J.A.G. Copp&1, L. Ettema',
F. Crabbe2. 1MSF Cambodia, MSF H/B, RO Box 840, Phnom Penh, Cambodia,
Cambodia; 2Institute of Tropical Medicine, Antwerp, Belgium
Issues: In Cambodia, adult HIV prevalence decreased from 3.9% in 1997 to
2.8% in 2000 (among brothel-based female sex workers 31.5%). The predominant mode of transmission is commercial sex. We share our experience on how
to reach sex workers at four STI clinics.
Description: We provide STI care at four clinics in locations with a brisk sex industry: Svay Pak (approx. 300 sex workers), Sisophon & Poipet (approx. 400)
and Siem Reap (approx. 200). Initially, three clinics catered for sex workers and
the general population. In Siem Reap, the clinic focused exclusively on sex workers from the start. The clinics also do active condom promotion, including day
and night-condom selling in entertainment establishments, and since 1999, give
counselling and basic AIDS care. Since 2000, MSF has focused more exclusively
on sex workers, and the clinics added social services, such as literacy classes,
safe sex negotiation skill training and empowerment. After analysing the reasons
for non-attendance by some sex workers, we decided (1) to extend the working hours; (2) to improve communication through outreach with sex workers and
brothel owners; and (3) to provide transport from sex establishments to clinics.
Lessons learnt: In 2000, the four clinics sold over 2 million condoms and provided 13,016 STI consultations. The average monthly attendance rate of sex
workers for STI screening, increased from 48% in 1999 to 80% in 2000 in
Sisophon, Poipet and Svay Pak clinic. The Siem Reap clinic had on average 97%
attendance. Self-reported condom use is well over 90%. Clinic staff reports improving self-esteem among sex workers.
Recommendations: It is possible to achieve regular attendance by sex workers
at STI clinics on a voluntary basis. But, such clinics have to focus on sex workers.
In our experience, to set up a clinic specifically for sex workers, as part of a wider
social and educational programme, and making access as easy as possible, has
contributed the most to our success.

Presenting author: Por Ir, MSF H/B, PRO Box 840, Phnom Penh, Cambodia,
Cambodia, Tel.: [phone], Fax: [phone], E-mail: depmed@msf.
org.kh