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

XIV International AIDS Conference

Abstracts WePeF6725-WePeF6728 265

infected women and children in the context of PMTCT, with particular reference
to resource-constrained settings. This guide will assist policy-makers and programme managers of HIV/AIDS and reproductive health programmes. The manual will present a menu of key interventions that includes medical, nutritional, and
psychosocial interventions, based on an inventory of existing recommendations,
a review of evidence, and experience of what works in different settings. It will
also provide related norms and standards, highlight information gaps and establish research priorities.
Lessons learned: (brief description of the results of the project): The inventory
of existing recommendations will be presented, highlighting critical gaps and opportunities for improving care and support.
Recommendations: (brief statement of next steps): The menu of key interventions will be open for public comment and further development.
Presenting author: Halima Dao, Department of HIV/AIDS, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WePeF6725 High rates of depression, anxiety, past sexual and
physical trauma prompt development of
specialized mental health services for HIV+
adolescents & young adults
C.A.PR Kennedy, D. Johnson, G. Botwinick, R.L. Johnson. UMDNJ-New Jersey
Medical School, Newark, NJ, United States
Issues: High rates of mental health co-morbidities were identified among HIV+
adolescents and young adults (19 male, 15 female) attending an urban primary
health care clinic (85%
Black; 15% Latino). Over 40% reported depression, anxiety, sexual or physical
abuse and not using condoms at last sex. Of males, 44% reported having sex
with other males and females.
Description: This population had access to antiretroviral medication (50% on
combination treatment) & regular health care. It included some homeless (12%),
regular substance abusers (6%) and others with severe ongoing familial and financial disruption. The Direct Service Outreach Initiative was developed to engage HIV+ youth in a non-threatening, culturally meaningful and youth friendly
environment. Mental health treatment is offered through a variety of modalities
that include co-location with primary care services & home-based care (HBC) for
some.
Lessons learned: HIV+ youth have an urgent need for comprehensive care, including integrated and individualized treatment for mental health and substance
abuse. Despite multiple psychosocial challenges in addition to HIV, this population
responded positively to a comprehensive, yet targeted, convenient (co-located,
HBC) and consumer-centered model of care. Attendance at clinic & adherence
to medication regimens improved. Disturbing psychiatric symptoms were lessened. Young people have a better chance of successful coping and more positive
outcomes in the face of life long chronic illness if they can receive support for
adherence to treatments that ameliorate co-morbid conditions.
Recommendations: To improve outcomes in treatment and prevention efforts
for HIV+ youth, co-locate, integrate & flex mental health treatment with routine
primary medical care. There is a need to create alternative methods for mental
health treatments for HIV+ youth, especially those disenfranchised from mainstream models of care.
Presenting author: cheryl ann kennedy, umdnj-new jersey medical school, dept
of psychiatry ubsb 4th floor, 183 south orange avenue, newark, new jersey
07103, United States, Tel.: [phone], Fax: [phone], E-mail: kennedy
@ umdnj.edu
WePeF6726 Sustainable community based approaches to
address the needs of AIDS orphans and their
guardians in Uganda
R. Bekunda', J.M. Foex2, W. Kibalya3, A. Alimuwa3. 1Association
Francois-Xavier Bagnoud (AFXB), P:Box 258, Luweero, Uganda; 2AFXB, Sion,
Switzerland; 3AFXB, Luweero, Uganda
Issues: Luweero district population is faced with the vulnerability of AIDS orphans. This vulnerability partially arises from poverty, lack of knowledge, skills
and start up capital for income generating activities (IGAs). As a result of the
above, there are high levels of school dropouts, early marriages and increased
incidence of STDs /HIV/AIDS. AFXB AIDS orphan's program was started in 1991
to address the needs of AIDS orphans and their guardians.
Description: The goal of the program is to empower the people of the Luweero
district to develop community based solutions and acquire the capability to adequately meet the basic needs of the AIDS orphans under their care on their own.
Lessons learned: The program has enabled up to 4630 orphans to enroll in
primary and secondary schools respectively. The income generating component
has enabled 1240 out of 1556 guardians to earn sufficient incomes to enable

them meet other household needs of the orphans.
Due to the success of this program AFXB replicated it in two other Sub Counties
and one region in Rwanda while Alliance for the Youth Achievement replicated it
in another district.
Orphans, unable to continue their studies, were offered an apprentice-ship program. Twenty of them learned carpentry and have already established their own
workshops.

Recommendations: Community based initiatives in addressing the needs of orphans are much more sustainable and affordable.
This approach helps orphans grow up within the community and enables them to
learn how to survive on their own in the long term.
The provision of in-kind materials, rather than cash, is a good strategy for minimizing loss of funds before the beneficiaries gain anything.
It is possible to motivate volunteers in the community to continue performing their
roles.
AFXB is planning to strengthen the AIDS care component by introducing Antiretroviral therapy in order to have the impact of the IGAs sustainable on a long
term basis.
Presenting author: Remigious Bekunda, P:Box 258, Luweero, Uganda, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeF6727 Day care center network in Chiang Rai, northern
Thailand: The linkage of GIPA, multisectoral
cooperation, and integrating AIDS prevention and
care
B. Supawitkul1, S. Supawitkul2, S. Sinsomboontong2, S. Seesongsom'. 'Mae
Chan Hospital, Chiang Rai, Thailand; 2Chiang Rai Provincial Health Office,
Chiang Rai, Thailand
Issues: Greater involvement of PWAs (GIPA), multisectoral cooperation, and integrating prevention and care, are current major AIDS strategies. Day care center
services (DCCs) and networking may enhance effectiveness and scaling-up implementations in resources-poor setting.
Description: Chiang Rai, the HIV epicenter of Thailand, reported the 1988-2001
cumulative AIDS, AIDS related deaths, and AIDS affected children, as 20,600
cases, 5,287 cases, and 3,287 cases respectively The chronological responses
included AIDS education, counseling, universal precautions, risk reduction in high
risk population, and care for PWAs. DCCs were initiated in 1995 for increasing
care coverage, providing holistic care, increasing PWAs' roles in peer support
and community prevention, and linking AIDS prevention and care activities with
communities. Currently, the network composed of 71 DCCs and PWA groups,
3,523 PWA members. PWAs formed theirs own committee, self-administration
of PWA fund and activities, providing peer support and making peer-home visits to increase drug adherence in PMCT, ARV and Ols prophylaxis, working with
communities on AIDS education in schools and communities. Multisectoral cooperation among community members and religious organizations in providing care
for PWAs in hospitals-homes-DCCs yielded true understanding of HIV/AIDS and
leading to community prevention and creating supportive community The DCCs
network increased effective implementation coverage in the province by supporting each other. PWAs play vital roles in HIV/AIDS policy/strategy formulation and
interventions by representing in AIDS committee at all level.
Lesson learned: Day care center services and network encourage all stakeholders in working, learning, loving, and living together. The approach leads to effective and efficient AIDS prevention and care. The outcome of supportive community will lead to self-care, self-reliance and sustainability in confronting HIV/AIDS.
Presenting author: Bongkot Supawitkul, Mae Chan Hospital, 274 Moo-5, Phaholyothin Road, Mae Chan district, Chiang Rai, Thailand, Tel.: [phone],
Fax: [phone], E-mail: bongkots2001 @yahoo.com
WePeF6728 Adherence
M.P.I. FigueiroI, E.Z. Lopes', J.J. Gimenes1, S.L. Castro', M.I. Souza',
S. Chen2, N. Hearst3. 'Praia Grande STD/AIDS Program, Secretaria de Sadde,
Av Presidente Kennedy, 2030, Praia Grande - Sio Paulo, CEP 11702-200,
Brazil; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
United States; 3University of California, San Francisco, San Francisco, CA,
United States
Background: During the year 1998, we observed that HIV/AIDS patients receiving treatment in the public health clinics of Praia Grande were experiencing difficulties with treatment adherence and lack of trust in the services offered that
sometimes resulted in complete abandonment of treatment. In January 1999,
health care services for HIV/AIDS patients were reorganized and greatly strengthened with recruitment of qualified personnel and implementation of a model of
humanistic, patient-oriented care. Special attention was focused on supporting
patient adherence to increasingly complicated regimens of antiretroviral drugs.
Methods: We used pharmacy records to identify all patients receiving antiretroviral treatment in the years studied. Level of adherence (or death) through the end
of the year was determined through pharmacy records. Patients transferring care
to a location outside the city were excluded. Patients were considered to have
poor adherence if at any time during the year they returned for a refill of medication 15 days or more beyond the date in which their previous supply of medication
should have run out.
Results: Levels of adherence improved steadily from 1998 to 2001.

Year Received HAART Good Adherence Poor Adherence Abandoned Treatment Deaths
1998 102 39% 28% 19% 14%
1999 205 70% 22% 5% 3%
2000 244 74% 19% 5% 2%
2001 282 82% 12% 2% 4%