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

XIV International AIDS Conference

Abstracts WePeF6680-WePeF6683 255

Women did not disclose this behavior to health care providers, were not aware
of strategies for managing side effects, and did not know that they could develop
resistance to antiretrovirals by stopping and starting treatment.
Recommendations: Mexican health care providers and community based treatment activists need to develop and deliver treatment education targeted to HIVpositive women. This project is developing treatment information workshops for
women that address side effect management and adherence and is training HIVpositive women to deliver these workshops in their communities.
Presenting author: Tamil Kendall, Astronomos 38-5 Col. Escandon, Mexico, DF,
Mexico, 11800, Mexico, Tel.: [phone], Fax: [phone], E-mail:
tamil [email protected]
WePeF6680 In the words of the women: barriers to adherence
to HAART among HIV+ woman in Rio de Janeiro,
Brazil
M. Malta1, C. Carneiro-da-Cunha1, F.I. Bastos', S.A. Strathdee2, D. Kerrigan2.
1 Oswaldo Cruz Foundation, Av Brasil, 4365, Biblioteca de Manguinhos # 209,
21045-900, Rio de Janeiro, Brazil; 2Johns Hopkins School of Public Health,
Baltimore, United States
Issue: Women represent an increasing proportion of HIV/AIDS cases in Brazil.
Furthermore, HIV+ women from disenfranchised populations face multiple
lifestyle and psychosocial burdens. We explored these issues and the extent to
which they complicate effective access to health care and adherence to highly
active anti-retroviral therapy (HAART).
Description: Semi-structured in-depth interviews were carried out with 10 HIV+
woman from two public outpatient clinics in Rio de Janeiro, Brazil. The majority
of participants were 35-45 years old with less than 4 years of formal education,
unemployed, and had one steady partner. Half were in discordant relationships.
All were on HAART. Interview topics included both drug and sexual risk behavior,
HIV/STI knowledge and attitudes, access and adherence to HAART.
Lesson learned: Barriers to HAART adherence included: taking care of children
and struggling with multiple roles (home/work); and difficulties disclosing their HIV
status to partners, family and friends. Participants also reported that disclosure
difficulties influenced their ability to negotiate condom use with serodiscordants
partners. Although most women had been infected by a primary sex partner, all of
the interviewees lacked a perceived risk of STI infection with their current steady
partner. Several women reported instances of domestic violence related to the
alcohol/substance use of their current partners.
Recommendations: A comprehensive prevention and care approach for HIV+
women is needed that integrates psychosocial support with clinical care, and
targets specific gender-related barriers to increase adherence to HAART. Findings highlight the need for intensified interventions to address issues of traditional
gender norms and structural violence that affect low HIV risk perceptions and/or
protective behavior among socially disadvantaged women.
Presenting author: M Malta, Av Brasil, 4365, Biblioteca de Manguinhos # 209,
21045-900, Rio de Janeiro, Brazil, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
WePeF6681I Vulnerability and care of women living with
HIV/AIDS (WLWHA) in Sao Paulo, Brazil
J.R.C. Ayres', C.M. Buchalla2, M. Della Negra3, I. Franga Jr.4, R. Lacerda5,
M.R. Latorre2, H.S.M. MarqueS6, S.D. Miranda7, V. Paiva8, A.M. Pluciennik7,
M.L. Salomao9, A.C. Segurado1o, N.G. Silva5. 'Department of Preventive
Medicine, School of Medicine, University of Sao Paulo, Av Dr Arnaldo 455,
Brazil; 2Department of Epidemiology, School of Public Health, University of Sao
Paulo, Sao Paulo, Brazil; 3Emilio Ribas Institute for Infectious Diseases, Sao
Paulo, Brazil; 4Department of Maternal and Childs Health, School of Public
Health, University of Sao Paulo, Sao Paulo, Brazil; 5Santos Municipal STD/AIDS
Program, Santos, Brazil; 6Department of Pediatrics, School of Medicine,
University of Sao Paulo, Sao Paulo, Brazil; 7Sao Paulo State STD/AIDS
Program, Sao Paulo, Brazil; 8Department of Social Psychology Institute of
Psychology University of Sao Paulo, Sao Paulo, Brazil; 9Department of
Epidemiology and Collective Health, School of Medicine Sao Jose do Rio Preto,
Sao Jose do Rio Preto, Brazil; oDepartment of Infectious Diseases, School of
Medicine, University of Sao Paulo, Sao Paulo, Brazil
Background: Heterosexual transmission and female AIDS cases keep growing
in Brazil. The male/female rate has fallen to 2:1. Health services have been slow
to adapt to women's needs. Mortality has decreased more slowly among women
and MTCT is still higher than it should be, considering that all PLWA in the country
including pregnant women have free access to ARV.
Methods: We recruited 1184 WLWHA in 7 different AIDS Reference Centers in
3 cities of Sao Paulo State. They were interviewed about how they perceive their
vulnerability and AIDS care. The questionnaire covered: socio-demographics; risk
perception for HIV prior to diagnosis; knowledge and practices regarding sexual
ity, reproductive rights and adherence to treatment and perceived quality of counseling and care.
Results: Women identified poor access to psychological support, dental and nutritional care as major problems. In spite of high access (95%) to pre-natal care,
16% of participant women were never offered HIV testing while pregnant. Less
than 50% of the women had access to structured counseling and knowledge
about MCTI, reproductive care and rights was found inadequate. 55% have an

active sexual life, half with a regular HIV-negative partner. Consistent condom
use was reported by 67%. Disrespect for confidentiality and reproductive rights
by health care workers was described.
Conclusion: Health care services in Sao Paulo State face challenges in reorienting care to meet needs of WLWHA. Counseling and multidisciplinary approach
should be strengthened and expanded throughout the various moments of care.
There is an urgent need to integrate STD/AIDS and woman's reproductive health
programs, to build multisector networks and break the silence on reproductive
health and rights, sexuality and contraception. Enabling services to promote and
protect human rights of WLWHA and support their decisions would make an important difference in enhancing care and quality of life for the growing population
of WLWHA.
Presenting author: Jose Ricardo Ayres, Av. Dr. Arnaldo 455, Brazil, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeF6682 The plight of Khmer women - gender issues in
home base care
P. Pok, M. Dhaliwal. Khana, #25 Street 71, Boeung Keng Kang I, Chamcar Mom,
Phnom Penh, Cambodia
Issues: HIV/AIDS in Cambodia is the most severe epidemic in S.E Asia with a
prevalence rate of 2.8% in the adult population (15-49).The most vulnerable group
affected by the epidemic are woman who represent 55% of the population and
over 60,000 are infected by HIV/AIDS. The vulnerability of women is compounded
by low education,low access to information,a lack of bargaining power for safer
sex and is increased by social and cultural constructs: inequity in decision-making
power; the taboo of discussing sex and sexuality; the acceptance of male promiscuity; the unwillingness of men to be care providers and low levels of education
and poverty. These obstacles equate to a population of women unable to protect
themselves from men bringing home HIV/AIDS.
Description: The Khmer HIV/AIDS NGO Alliance (KHANA) supports a Home
Base Care (HBC) programme that represents a joint program incorporating local
NGO's and the Ministry of Health.The program addresses both men and women's
needs placing special emphasis on support to women and children infected and
affected by HIV/AIDS. HBC supports women through: increasing practical support in their role as caregivers; facilitating access to care and support services;
helping women to develop skills for income generation and planning support for
their family including supporting children to stay in school. The HBC program also
provides women with: preventative health information; improved access to treatment through appropriate referral; referral to income generation activities; and
some material support. The program activity helps to reduce the social isolation,
stigma and discrimination associated with HIV/AIDS.
Lessons learned/Recommendations: The important lessons learned are: challenging the traditional roles of men as they can provide support as care givers;
supporting women also means supporting the children and a recommendation
would be to assist women in developing planning and economic skills in order to
support their families.
Presenting author: Panhavichetr Pok, #25 Street 71, Boeung Keng Kang I,
Chamcar Mom, Phnom Penh, Cambodia, Tel.: [phone], Fax: +855 23
214 049, E-mail: [email protected]
WePeF6683 Gender-related causes and socio-economic effects
of HIV/AIDS in Zimbabwe
E. Chirebvul, M. Mahonde1, C. Maposhere2, P. Gwatirisa2. 1 UNIFEM, New
York, NY, United States; 2c/O UNIFEM, Harare, Zimbabwe
Issues: HIV/AIDS and its consequences exacerbate an already precarious economic situation. This applies especially to women, who remain to care for the
sick and orphaned without sufficient resources. Women are seeking alternative
means of economic support for themselves and their families. There is a need to
understand the nature of these moves and to build capacity of these women to
cope. Communities are creating self-help networks for the care of orphans, home
care for the sick, and economic support for families due to a lack of support from
social welfare services.
Description: The goal of this research was to identify the gender related causes
and consequences of HIV/AIDS at the household level in urban and rural Zimbabwe. Seven districts from five provinces were selected for the purpose of this
study. A total of 412 respondents participated in the questionnaire. Besides a total of 28 focus group discussions (FGD) were conducted as part of the qualitative
search.
Lessons learned: The findings of the study pointed out that women were moving into new occupations as a result of male deaths in the families. There was a
need to understand the nature of these moves and to provide capacity building to
women in these new areas. Life skills programs needed to be set up to address
issues such as low literacy levels and high unemployment rate in the formal sector especially among women. At the same time policies needed to be put in place

to safeguard the human rights of orphans.
Recommendations: The issue of women in the care economy needs to be addressed. Home based care givers need increased resources - including information and education programs, shared confidentiality, prognosis of diseases,
prevention of cross infection and counseling. Care givers require an adequate
structured support system designed for providing respite needs and to create an
enabling environment for the delivery of care and support services.