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

306 Abstracts WePeG6892-WePeG6896

XIV International AIDS Conference

WePeG6892I Death by Aids or maternal death: the classification
of mortality as a social practice
R.D.F Boncianil, M.J.P. Spink2. 1Col/etivo Feminista Sexualidade Saude, Rua
Nicolau Jacob Filho, 34, CEP 05012-030, Sao Paulo, Sao Paulo, Brazil;
2 Pontificia Universidade Catolica de Sao Paulo, Sao Paulo, Brazil
Issues: This study analyses the decision to include or exclude cases of death of
HIV+ pregnant women in the classification of maternal mortality
Descriptions: It focuses on the deaths of women of reproductive age that occurred in the city of Sao Paulo in 1998 and were investigated by the Central Committee of Maternal Mortality (CCMM). Of the 4,347 deaths (including 403 HIV+
women), 741 were chosen for further investigation by the CCMM. However, only
five cases associated with HIV+ were included in this investigation. Based on documental analysis and interviews with the president of the CCMM and members
of one of the regional committees, the research led to the conclusion that:
Lessons learned: a) several factors affect the process of classification; b) whenever present, the HIV+ status has precedence in the classification of cause of
death; c) the moral and symbolic aspects of Aids also contribute to the difficulty
of classifying the cause of death as maternal death, and c) perfecting statistics
through a better understanding of decisions to include or exclude cases is only
one side of the issue; it is also important that the quality of the care given in
pregnancy and childbirth is improved so as to prevent maternal death.
Recommendations: The creation and improvement of social control mechanisms for the prevention of maternal mortality
Presenting author: Rosa Dalva Bonciani, Rua Nicolau Jacob Filho, 34, CEP
05012-030, Sao Paulo, Sao Paulo, Brazil, Tel.: +(11) 3862-7180, Fax: +(11) 3862 -7180, E-mail: [email protected]
WePeG6893 Improving the sexual health of Indigenous
Australians: an evaluation of the Tri-State HIV/STD
project
J.M. Willis1, G. Wilson2, I.P. Anderson3, D. Rosenthal4, A. Smith1, C. Fairley5.
'Australian Research Centre in Sex, Health & Society, Australian Research
Centre in Sex, Health & Society, La Trobe University, 1st Floor, 215 Franklin
Street, Melbourne, Victoria, 3000, Australia; 2Australian Insitute for Primary
Care, Melbourne, Australia; 3 VicHealth Koori Health Research and Community
Development Unit, Melbourne, Australia; 4La Trobe University Melbourne,
Australia; 5Melbourne Sexual Health Centre, Melbourne, Australia
Background: The Tri-State HIV/STD Project, a joint initiative of Australian Health
Ministers, implemented in 1994 to respond to three key imperatives: Aborigines in
the central desert region of Australia experienced endemic rates of STDs far in excess of non-Indigenous rates; health services in the region were under-resourced,
with little collaboration; and the population was highly mobile. This paper evaluates the program from 1996-2000.
Methods: We examined the performance of the project, and barriers to its success across 5 key result areas: clinical STD management; health provider training; surveillance; community education; and regional coordination of STD/HIV
control activities. Suveillance data were analysed, as well as 15 key informant
interviews.
Results: Key successes were: enhanced integration of sexual health into comprehensive local primary health care delivery; expanded and coordinated active
case finding; sustained regional commitment/approaches to STD control; & crossborder standardisation of sexual health procedures. Particular techniques including clinic audits, sub-regional population-based screening, and centralised followup databases were effective at reducing ulcerative STD incidence. The use of
PCR to detect chlamydia and gonorrhoea in urine was both effective and acceptable in community-wide screening, but sustained regional efforts are needed if
prevalences are to be reduced. Key barriers identified were inconsistent pathology services, and recruiting and retaining appropriate health staff, especially men.
Conclusions: The findings of this evaluation emphasise the contribution of STD
information systems in the improved management of positive patients and their
primary contacts, the need to develop locally appropriate models for active case
detection and follow-up, the importance of education and support for practitioners
in the field, and the value of regional forums for sharing information and experience in relation to STD control.
Presenting author: Jon Willis, Australian Research Centre in Sex, Health & Society, La Trobe University, 1st Floor, 215 Franklin Street, Melbourne, Victoria, 3000,
Australia, Tel.: [phone], Fax: [phone], E-mail: jon.willis @latrobe.
edu.au
WePeG6894 Viral risks and medical support of couples
intending to procreate in France
J.A. Gastaut J.F. Bloch-Laine, FB Brun-Vezinet, D. Costagliola, C. Herzlich,
C. Katlama, C. Leport, A. Molla, P. Urfalino, F Buton, A. Marijnen, M. Thevenin.

CNS, Conseil national du sida, 25/27 rue dAstorg, 75008 Paris, France
Issue: In 2001, The National Aids Council (NAC) studied ethical, legal and scientifical aspects of medical support in all cases of viral risk. Since HAART has given
new life expectancy for PLWAs, medically assisted reproduction (MAP) has been
particularly requested by PLWAs. Two years after access to MAP for couples in
which the male partner was HIV-positive, we examined the case of the couples
where the female partner is.

Description: The NAC is an independant and pluralist authority, created in 1989
by the French government to give advice to public bodies on any subject concerning AIDS in our society. After two past reports on the MAP (1998-2000), the
NAC consulted a large spectrum of PLWA's associations, physicians involved in
HIV infection and reproductive health, public and ethical bodies. Considering the
exclusion of HIV+ women from MAP as discrimination and as risk factor when the
partner was HIV-negative, the NAC accompanied the changes of reglementary
provisions that took place recently
Lessons learned: Ethical questions do not limit themselves to MAP, but may be
tackled in the general frame of medical support in a context of viral risks (HIV
and hepatitis viruses). Common principles can be established and disseminated
about patient information, consent and orientation; they insist on the need of an
interdisciplinar support. Remaining questions on MTC transmission and effects
of HAART during pregnancy call for the respect of accurate clinical and biological
criterias that should be regularly updated.
Recommandations: The NAC opinion deals with problems of processes and organisation of praticioners on the one hand. On the other hand, it insists on specific requirements in situations where the woman is HIV +, where both man and
woman are, and where the couple is also affected by hepatitis.
Presenting author: Jean-Albert Gastaut, Conseil national du sida, 25/27 rue
d'Astorg, 75008 Paris, France, Tel.: [phone], Fax: [phone], Email: [email protected]
WePeG6895 RCH Model for HIV/AIDS a shift in Policy
J.P. Saulina Arnold. TNVHA, TNVHA, 18, Appadurai Main Street, Ayanavaram,
Chennai - 600 023,India
Knowledge and commitment is needed for action. But one must analyse what
knowledge and what type of commitment. The planners and policy makers at
present are dealing with one type of knowledge that HIV infection in community is
dangerous, it affects those in reproductive age and so affects the production and
developments. The commitment is to identify those with high-risk behavior and
have intervention as action. But that is like treating symptoms and not the root
cause. It is time the planners and policy makers work for tackling the root cause.
In another issue in tackintg MR and MMR. This association, Tamil Nadu Voluntary Health Association (TNVHA) had experience in integrating and strengthening
Primary Health Care as well as ensuring promotion of Mother and Child Health.
This shift from FP and MCH to a total Reproductive and Child Health Policy gives
a good example for tackling control of HIV/AIDS in the community.
There is a need for integration of HIV/AIDS issue in Primary Health Care and
strengthening the basic health care in rural and urban area. This will work for a
long run sustainable action. Under Primary Health Care special intervention for
prevention has to be evolved to promote healthy behaviour among the children
and adolescent. For the next 10 - 20 years to reduce incident of HIV/AIDS, this
type of shift in policy is a must. We are sure that this initiative can motivate both
Government and Voluntary sector to work for comprehensive health care promotion.
Presenting author: Saulina J.P. Arnold, TNVHA, 18, Appadurai Main Street,
Ayanavaram, Chennai - 600 023, India, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeG6896I Contraception and pregnancy in the HIV/AIDS
context: between mishappenings and planned
decisions - A qualitative study in specialized
healthcare clinics of the city of Sao Paulo - Brazil
N.E. Kurokawa e Silva', A.T. Alvarenga2, L.A. Oliveira1. 'ISTD/AIDS
Coordination of Sao Paulo City Health Department, Rua Voluntdrios da Patria,
4.130 - ap. 124-B - Santana - S&o Paulo - SP - CEP 02402-500, Brazil;
2University of S&o Paulo, S&o Paulo, Brazil
Introduction: It is possible to make some recommendations to prevent motherto-child transmission and to promote more appropriate contraception methods,
considering that most of them implicate in some risk of infection or re-infection
of the sexual partner. However, people living with HIV/AIDS seem not to necessarily act according to these clinical recommendations. This research intends to
understand how people infected by HIV and/or their sexual partners make their
reproductive choices.
Method: A qualitative study was carried out through semi-structured interviews
of nine heterosexual persons under follow-up at healthcare clinics specialized in
AIDS, infected by the HIV or their sexual partners. The analysis of the material
was based on the theoretical referential by Agnes Heller about everyday life.
Results: Pregnancy and the possibilities of contraception are surrounded by lack
of appropriate information. It is hard for the clients to talk the subject with the
health care workers, mainly because their hegemonic speech promoting condom
use may inhibit the conversation about pregnancy or other contraceptive methods. The fear that a pregnancy of a seropositive woman could lead to an HIVinfected child is not followed by the seeking of alternatives contraceptive methods

or the regular use of condom. Both conception and contraception seem deeply
immersed on everyday of HIV-infected people without special attention. When a
pregnancy happens, usually not planned, they behave in a mix of conforming and
expectation regarding the baby's serological status.
Conclusions: In order to make reproductive decisions, considering both HIVinfected people's life and clinical recommendations, it is necessary to rise above