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

XIV International AIDS Conference

Abstracts WePeF6698-WePeF6702 259

WePeF6698 Involving Primary Care Physicians (General
Practitioners) in HIV care in the United Kingdom -
what the Doctors say
J. Kinniburgh1, L. Power1, C. Nead2, A. Wyke2. 1 Terrence Higgins Trust,
Terrence Higgins Trust, 52-54 Grays Inn Road, London, WC1X 8JU, United
Kingdom; 2PatientView, London, United Kingdom
Issues The UK National Strategy on HIV has indicated that General Practitioners (GPs) should become more involved in the care of people with HIV. This will
provide opportunities and also a range of problems to primary care physicians as
they seek to meet the day to day healthcare needs of people with HIV.
Description This paper presents some of the issues identified by GPs in taking
a greater role in the care of people with HIV. It will highlight the problems GPs anticipate and demonstrate ways in which these may be overcome through a series
of recommendations. These include the need for GPs to be made aware of the
services required by people with HIV and HIV Consultants to keep the GPs infomred of their patients progress. There was also a call for more training and support
to be provided to GPs and their staff around issues of patient confidentiality In
particular, we found widely differing practices and perceptions of the appropriateness of providing patient information to insurance companies and employers.
This UK-specific system is proven to deter people from testing with their GP or
using them for HIV care. However, the practice does provide GPs with an extra
source of income and many are therefore reluctant to see the practice end.
Lessons Learned Some GPs already provide a range of health services to people with HIV but the quality of care varies considerably The willingness of GPs
to provide services vary depending on the extent to which they had built relationships with HIV specialist clinicians.
Recommendations Existing healthcare practice within primary care settings
must change in order that the needs of people with HIV can be more effectively
met. Ongoing training for GPs and their staff is needed and closer relationships
between GPs and HIV specialists must be encouraged.
Presenting author: James Kinniburgh, Terrence Higgins Trust, 52-54 Grays Inn
Road, London, WClX 8JU, United Kingdom, Tel.: ++44 20 7881 9417, Fax: ++44
20 7881 9411, E-mail: [email protected]
WePeF6699 Integration of HIV/STI prevention into sexual and
reproductive health services: best practices and
minimum standards
L. Tabac1, N. Costa2, M. Almeida2, C. Gras1. 'International Planned
Parenthood Federation/Western Hemisphere Region, 120 Wall Street, 9th Floor,
New York, NY 10005-3902, United States; 2Bemfam, Rio de Janeiro, Brazil
Issues: In accordance with the Cairo agenda and International Planned Parenthood Federation/Western Hemisphere Region's (IPPF/WHR) mission to
strengthen the capacity of its member associations, several countries in the
WHR are exploring innovative strategies through which they can better integrate
HIV/STI prevention services into their sexual and reproductive health (SRH) activities. Traditionally, these service areas have been separate, rather than integrated,
and therefore neither take advantage of the inherent synergy between preventing
unwanted pregnancy and preventing HIV/STIs nor respond to the ethical imperative to link contraception-provision with HIV/STI prevention. Through integration
an organization not only increases its roster of services, but also takes advantage
of economies of scale and can expand to reach youth and vulnerable populations.
Description: This paper offers a model of best practices and minimum standards on the integration of HIV/STI prevention into SRH services and programming. This model was developed based on the experiences of 4 IPPF/WHR Latin
American/Caribbean member associations that participated in a self-assessment
and training of trainers training on HIV/STI integration. The training was based
on an IPPF/WHR integration tool and was facilitated by BEMFAM, IPPF/WHR's
Brazilian member association, the association that has set the gold standard in
HIV/STI-SRH integration.
Lessons learned: The integration of HIV/STI prevention in SRH is critical for
the provision of holistic SRH services and programming. Best practices and minimum standards should be tailored to organizational context, but must incorporate
a rights-based approach and a gender perspective.
Recommendation: SRH organizations should assess their strengths and weaknesses to determine how to integrate HIV/STI prevention with their SRH services,
while also ensuring the existence of a referral network to meet client needs that
fall outside of their realm of action.
Presenting author: Lara Tabac, 120 Wall Street, 9th Floor, New York, NY 10005 -3902, United States, Tel.: [phone], Fax: [phone], E-mail: Itabac
@ippfwhr.org
WePeF6700 Tetanus and diphtheria antibodies and response to
a booster dose in Brazilian HIV-1 infected women

T.C.S. Bonetti, R.C.M. Succi, L.Y. Weckx, D.M. Machado, M.I. de Moraes-Pinto.
Federal University of Sao Paulo, Rua Madre Teodora, no - 450, Jd. Paulista, Sao
Paulo, zip code: 01428-010, Brazil
Background: Few data are available on tetanus and diphtheria seroepidemiology
in HIV-1 infected women and their response to a booster dose with dT vaccine in
developing countries. That knowledge is important for their own health and for
neonatal tetanus prevention in case of pregnancy

Methods: We have compared tetanus and diphtheria antibody levels in 181 HIV-1
infected women (HIV group) and 117 healthy uninfected women (Control group)
with similar previous immunization status, at the Federal University of Sao Paulo,
Brazil. 21 women from HIV group and 11 from Control group with antibody levels
lower than 0.1 IU/mL received a booster with dT vaccine, and had their antibodies
assessed after the procedure, by the double antigen ELISA.
Results: Before booster, mean tetanus and diphtheria antibody levels from HIV
group were significantly lower than those from Control group (tetanus: 0.33 x
0.83 IU/mL, t test: p=0.0002; diphtheria: 0.41 x 1.32 IU/mL, t test: p<0.0001,
respectively). Linear regression analysis showed that tetanus and diphtheria antibody levels were decreased by HIV infection and lack of previous immunization
(tetanus: p<0.001 and p=0.009; diphtheria: p=0.001 and p<0.001, respectively).
After a booster dose, both groups had an increase in mean tetanus and diphtheria antibody levels. However, whereas in the Control group only 25% of women
maintained diphtheria antibodies lower than 0.1 IU/mL, in the HIV group 45% and
33% of them kept diphtheria and tetanus antibodies below that level. Antibody
levels after an extra dT dose in HIV and Control groups were: tetanus: 0.31 x 2.03
IU/mL, t test: p=0.08; diphtheria: 0.14 x 0.96 IU/mL, t test: p=0.077).
Conclusions: HIV-1 infected women have lower mean tetanus and diphtheria
antibody levels when compared to healthy uninfected women. After an extra dT
dose, both groups respond with an increase in antibody levels. However, HIV-1
infected women tend to show a weaker response than healthy women.
Presenting author: Tatiana Carvalho S. Bonetti, Rua Madre Teodora, no - 450,
Jd. Paulista, Sao Paulo, zip code: 01428-010, Brazil, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
WePeF6701I Community based integrated approach an entry
point to care and support for PLHA/CAAAPAC-USAID project experience from rural india.
A.C.V. Arumugam Chettiar1, A. Bimal Charless2. 1Seva Nilayam Society in
Association with Ryder Cheshire Foundation, Tamil Nadu, India; 2Apac -Vhs
USAID Project, Chennai, India
Background: STD/HIV associated with social stigma in rural area which affects
the quality life of PLHA. To overcome this problem, a new strategy has been trying
by Donors and NGOs.
Methods: Seva Nilayam tried to integrate STD/HIV/AIDS prevention and control
services along with the existing primary health care and MCH and family welfare
services in Tamil Nadu with APAC-USAID as a pilot project. Important components are IECC,STD/RTI screening of all MCH and FW mothers, quality STD
treatment and management, partner notification & treatment, Referral services,
Social marketing of condom, Peer education, Operational research. All services
are being rendered under three tire system i.e. Community, Sub center and Base
Hospital level. Active community participation and networking with NGOs & CBOs
are being ensured at all levels.
Result: The integrated and non stigmatic approach was well accepted by the
community, which was reflected in terms of 96% ANC registration, 80% VDRL
Test, health seeking behaviour of women, increased partner notification treatment
up to 47% increased knowledge on dual protection of condom, empowerment of
women in condom usage etc. Non traditional condom outlet also increased from 5
to 67. Due to increased awareness on HIV/AIDS, attendance for Voluntary Counseling and Testing has got increased by which 62 HIV/AIDS cases were reported
with in 3 years. Out of them 47 PLHAs and *** CAA are being received home care
and support services. They avail micro credit - IGP activities from SHGs.
Conclusion: Integrated community based approach not only become an entry
point for Care and Support for PLHA/CAA but also made possible the community
acceptance of PLHA. It is also a proven fact that, it is a cost-effective & nonstigmatic method.
Presenting author: Vijayaraman Arumugam Chettiar, Seva Nilayam Society -
Seva Nilayam, Rajathani - 625512, Theni District, Tamil Nadu, India, Tel.: +91 45
464922, Fax: [phone], E-mail: [email protected]
WePeF6702 Tackling HIV-associated tuberculosis: a global
strategic framework
D. Maher, M. Raviglione, K. Floyd. World Health Organization, Geneva,
Switzerland
Issues: The unprecedented scale of the epidemic of HIV-related tuberculosis
(TB/HIV) demands effective and urgent action, through collaboration between TB
and HIV/AIDS programmes. The strategic goal is to reduce tuberculosis transmission, morbidity and mortality, as part of overall efforts to reduce HIV-related
morbidity and mortality in high HIV prevalence populations.
Description: The expanded scope of the new strategy to control TB/HIV comprises interventions against tuberculosis (intensified case-finding, cure and tuberculosis preventive treatment) and interventions against HIV (and therefore indirectly against tuberculosis), e.g. condoms, STI treatment, safe injecting drug

use (IDU) and highly active anti-retroviral treatment (HAART).
Lessons learned: In the past, tuberculosis and HIV/AIDS programmes have
largely pursued separate courses. However, to be more effective they need to
exploit synergies in supporting health service providers to deliver collaborative
TB/HIV interventions.
Recommendations: An effective comprehensive response to HIV/AIDS must
include effective action against TB/HIV Requirements to meet the challenge of