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

260 Abstracts WePeF6703-WePeF6706

XIV International AIDS Conference

TB/HIV include: changes in international and national policy away from specific
HIV/AIDS activities towards responding to the care needs of high HIV prevalence
populations; investment to improve the general health service capacity (human
resources, infrastructure and commodities) to deliver TB/HIV interventions; operational research on HIV/AIDS and tuberculosis programme collaboration; the
Global Working Group on TB/HIV to harness and coordinate the efforts of many
partners in implementing national TB/HIV strategies.
N.B. The authors are presenting this abstract on behalf of the Global TB/HIV
Working Group (one of the six working groups established under the auspices of
the Global Partnership to Stop TB).
Presenting author: Dermot Maher, Stop TB Department, World Health Organization, 20 Avenua Appia, CH1211 Geneva 27, Switzerland, Tel.: [phone]
2655, Fax: [phone], E-mail: [email protected]
WePeF6703 Combating resistance to HIV prevention messages
among gay men in San Francisco
G.J. Rowe. San Francisco Gay Men's Health Collective, 1125 Webster Street,
San Francisco, CA, 94115, United States
Background: HIV infection rates are rising among gay urban men (SF DPH)
despite continuous HIV prevention interventions. Dr Coates, Director of UCSF's
Center for AIDS Prevention Studies suggests the resistance is in part due to the
community's perception of HIV prevention agencies as being "outsiders". Objectives: Promote health education and wellness among gay men in San Francisco
via a series of community organized events. Methodology: 8 gay health workers (HIV / STD) agreed to come together as "concerned citizens" to organize a
health fair for gay men: sex-positive, interactive health and wellness workshops
in a neutral venue. The last five minutes of each workshop were used for anonymous satisfaction surveys.
Results: Fifteen workshop leaders accepted to conduct interventions on a variety
of wellness themes including: Yoga, Intimacy, Being over forty, and Internalized
homophobia. Neither the organizers nor the leaders proposed an HIV workshop.
80 participants attended in all. Outcomes: Satisfaction Level: Mean level of satisfaction for workshops (Contents and Facilitation Skills) was 4.53 (1 to 5 scale).
No workshop scored below 3. Health Issues: Participants were asked to indicate
three important health issues for future events. Of the 223 responses the top 4
were HIV: 36, General Health: 26, Substance Use/Abuse: 24 and Community Cohesion: 19 (105). Open Comments: Many participants expressed a yearning for
community and connection with other people. Conclusions/Lessons: The above
results allow the author to infer: gay men actually express a strong interest and
desire in discussing issues around HIV. Despite many solicitations, gay men in SF
will indeed participate in open forums on health if these are perceived as being
organized by peers without a specific HIV agenda. This seems to meet their need
for community cohesion.
Presenting author: Gregory Rowe, 1125 Webster Street, San Francisco, CA,
94115, United States, Tel.: [phone], E-mail: [email protected]

Lessons learned: Using total number of symptoms as a screen for treatment has
poor PPV with adequate NPV for screening tests. However, it is clear that pregnant women with zero symptoms have low VLs and high CD4+ count. Initiation
of treatment based solely on the presence or number of symptoms will likely over
treat because the majority of women with symptoms would not have been eligible
for treatment according to DHHS guidelines.
Recommendations: CD4+ or VL measurements are needed to identify HIV+
pregnant women eligible for ART Low-cost CD4+ testing as a screen for treatment eligibility is urgently needed.
Presenting author: Ruby Nguyen, Room W4030 Hygiene Bldg, 615 N. Wolfe
Street, Baltimore, Maryland, 21205, United States, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
WePeF6705 Introducing PMTCT services in Cambodia
S.W. Seng1, K. Koum2. 1National Centre for HIV/AIDS< Dermatology and STD,
Ministry of Health, PO Box 2480, Phnom Penh 2, Cambodia; 2National MCH
Centre, Ministry of Health, Phnom Penh, Cambodia
Issues: Preventing MTCT is one component of the Ministry of Health Strategic Plan for HIV/AIDS and STI Prevention and Care 2001-2005. The perceived
weaknesses of MCH services, however, suggest that it would not be practicable
to introduce PMTCT on a national scale without significant capacity-building for
provincial staff.
Descriptions: The Ministry has started a pilot project to assess the feasibility of
PMTCT Integrated activities are being developed in the project: training staff to include counseling on HIV/AIDS in mothers and children; voluntary and confidential
counseling and testing for HIV in antenatal services; introducing family counseling
and shared confidentiality; advising mothers about the benefits of breastfeeding;
providing on-going counseling and care for children born to HIV-infected mothers; and introducing prophylaxis for prevention of vertical transmission in referral
services. These are provided as a package of interventions, primarily through
ante-natal and post-partum care at hospitals. Given the present limitations of
these services in Cambodia, extending each of these activities is accompanied
by capacity-building for maternal services themselves.
Lessons learned: To introduce additional capacity and skills for health staff (for
PMTCT) in the MCH services, while these services are themselves being upgraded, has required collaboration between various programmes, eg the National
Centre for HIV/AIDS, Dermatology and STD, the National MCH Centre in Phnom
Penh, and Provincial MCH services. Where resources are limited, particularly human resources, consensus on prioritizing is essential.
Recommendations: There is desire to improve HIV services for women and
children, and make optimum use of women's contact with the health services.
If scarce resources are to be allocated to PMTCT, however, it is important to determine which of the interventions in the whole package are most effective, and
how best to deliver them.
Presenting author: Sut Wantha Seng, PO Box 2480, Phnom Penh 2, Cambodia,
Tel.: [phone], Fax: [phone], E-mail: [email protected]

WePeF6704 Sensitivity, specificity and predictive value of
using symptoms to screen for eligibility of lifelong WePeF6706 Use of the family planning counseling kit
anti-retroviral therapy among pregnant women to counsel clients on dual protection in

R.H.N. Nguyen1, F Wabwire-Mangen2, G. Kigozi3, D. Serwadda2,
N.K. Sewankambo2, T.C. Quinn4, M.J. Wawer5, R.H. Gray1. 'Bloomberg School
of Public Health, Johns Hopkins University, Room W4030 Hygiene Bldg, 615 N.
Wolfe Street, Baltimore, Maryland, 21205, United States; 2Makerere University,
Kampala, Uganda; 3 Rakai Project, Kalisizo, Uganda; 4 School of Medicine, Johns
Hopkins University, Baltimore, United States; 5Mailman School of Public Health,
Columbia University, New York, United States
Issue: Maternal-To-Child-Transmission Plus programs have proposed to identify ART eligible women through antenatal care. Identification using AIDS-related
symptoms is the most feasible screening procedure in resource-poor settings.
However among pregnant women attending antenatal care clinics, it is not known
how well symptomology is correlated to traditionally used markers such as CD4+
count and HIV viral load (VL).
Description: Using a population of HIV+ pregnant women from Rakai District,
Uganda (n=325), we calculated the sensitivity, specificity, positive and negative
predictive values of correctly identifying women for treatment using symptomology versus the DHHS criterion as a gold standard. Initiation of treatment using
DHHS criterion is at VL >55,000 cps/mL. For a sub-set of the pregnant women
(n=86), we also analyzed the correlation between symptoms and CD4+ count,
using <350 cells/mL as the gold standard for initiation of treatment. Symptoms
were self-reported and selected from 1993 WHO staging criteria. There was no
association between WHO major or minor criteria and VL or CD4+ count. Total
number of symptoms was used to calculate the validity. Using the cutoffs of >1
and >3 reported symptoms, the following were observed:

LZamla
U. Bharath Kumar, E.T. Serlemitsos, G.L. Sinyangwe. Johns Hopkins Univ.,
ZIHPCOMM, Johns Hopkins Univ, RO. Box 37230, Lusaka, Zambia
Issues: Only 14% of Zambians are currently using a modern method of family
planning. Most of these are hormonal methods which do not provide protection
against HIV/AIDS/STls. The HIV prevalence in Zambia is 20%. Some of the reasons for this include the difficulty service providers face in counseling clients on
the risk of contracting STls/ HIV/AIDS and the need for condom use even with a
steady partner like a spouse.
Description: The Zambia Family Planning Counseling Kit (with a companion
training video to show the providers how and when to use the kit) has been developed as a clinic based tool for use by service providers (nurses, doctors and
clinical officers) in family planning counseling. The kit uses a "Profiling Approach"
where the provider follows a flow chart with questions that help her know her
client better and meet his/her needs by counseling on profile appropriate methods. One profile category is the "Multi-Partners" one which helps the provider
determine whether the client may be at risk of contracting HIV/AIDS/STIs due to
his/her own or partner's risk behaviour. The kit also has a special counseling card
that helps the provider counsel for dual protection.
Lessons learned: The kit is currently being distributed country-wide to all the
facility-level service providers, with a short training. Pretesting and usage by a
small number of providers has indicated that the tool is really helping them better
address the issue of dual protection with their clients who they determine, through
the profiling process, are at risk. The training video for the kit is being used in other
African countries as it skilfully tackles the universal problem of counseling for dual
protection.
Recommendations: Further research with the providers after the kit has been in
use for a while, to see if there is an increase in the number of clients they counsel
on use of dual protection and an increase in client adoption of dual protection
associated with the use of the kit.
Presenting author: Uttara Bharath Kumar, ZIHPCOMM, Johns Hopkins Univ.,

Sensitivity (%)
Specificity (%)
PPV (%)
NPV (%)

Cut-off > 1 symptom
CD4+ (cells/mL) VL (cps/mL)
100.0 97.9
11.0 10.1
25.3 16.2
100.0 96.6

Cut-off > 3 symptoms
CD4+ (cells/mL) VL (cps/mL)
25.0 28.6
80.0 75.3
27.8 17.1
77.9 85.6