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

446 Abstracts ThPeC7431-ThPeC7435

XIV International AIDS Conference

Conclusions: To reduce MTCT, we recommend increased formal education for
girls, improved negotiation skills and decision-making power by women, and an
emphasis on massive HIV public education that dispels misconceptions and provides messages that are understandable to illiterate and literate, rural and urban
communities.
Presenting author: Prasanthi Gondi, 154 Haven Avenue, Apt 911, New York, NY
10032, United States, Tel.: [phone], E-mail: [email protected]
ThPeC7431I Clinician perspective towards the provision of
prevention of mother to child transmission
(PMTCT) services in Southern India
P. Gondi', B. Fullilove', P. Balamba2, M. Vegunta3, H. Yelamanchali4,
S. Raghavan5. 1Columbia University, 154 Haven Avenue, Apt 911, New York, NY
10032, United States; 20smania Hospital, Hyderabad, India; 3Mythri Hospital,
Hyderabad, India; 4 Maternity Hospital, Hyderabad, India; 5 Columbia University
and Harlem Hospital Center, New York, United States
Background: India with 3.86 million ranks second in the world to South Africa in
number of HIV cases. Of these cases, 2.13% are attributed to vertical transmission. Few studies have attempted to explore the clinician perspective to vertical
transmission, a vital component to the prevention of MTCT.
Methods: This paper reports on the knowledge, attitudes, and practices of a
group of clinicians serving HIV + pregnant women at a maternity hospital in the
Southern city of Hyderabad. A cross-sectional survey was conducted among 35
clinicians, of whom the majority has been already sensitized on PMTCT issues
as part of a government sponsored PMTCT feasibility project.
Results: The mean age was 35 years, 37.1% were assistant professors and practicing OBGYN's, while 40% were postgraduate medical students with no clinical
experience. The remaining were practicing physicians in other medical specialties
and HIV counselors. The majority of clinicians seemed relatively knowledgeable
regarding MTCT with 100% awareness of the risk of HIV transmission through
pregnancy and 94% for breastfeeding. Additionally, 94 % of the clinicians indicated that HIV patients deserve same quality of care as other patients and 80%
felt they should be respected equally. Yet, survey results demonstrated that their
attitudes and practices counter these general beliefs. 54 % preferred working in
a ward without HIV patients, 83 % felt more sympathetic towards those who acquired HIV from blood than sex, and 17 % believed God was punishing those
infected with HIV. Moreover, 69 % attributed the HIV situation to westernization
and 20% felt uncomfortable speaking about sex.
Conclusions: It is crucial to include sessions on proper attitudes and practices
towards providing unstigmatized care and to effectively address sexuality issues
as part of PMTCT training for clinicians in India.
Presenting author: Prasanthi Gondi, 154 Haven Avenue, Apt 911, New York, NY
10032, United States, Tel.: [phone], E-mail: [email protected]
ThPeC7432I HIV infection in pregnant women and mother to
child HIV transmission in the Czech Republic,
1990-2001
M. Bruckovae, J. Vandasova', M. Maly', M. Stankova2, H. Rozsypal2. 1National
Institute of Public Health, Prague, Czech Republic; 2Faculty Hospital, AIDS
Centre, Prague, Czech Republic
Background: To establish: a) spread of HIV infection in pregnant women b) rate
of mother to child HIV transmission in the Czech Republic (CR) in 1990-2001. It
is estimated that more than 95% of pregnant women are undergoing HIV tests in
CR, a Central European country with low level of HIV epidemic.
Methods: HIV 1/2 antibody and confirmatory tests were carried out routinely HIV
positive women were given antiretroviral treatment. All of them delivered by Caesarian section. AZT treatment of newborns started to be used in the CR even
before the prophylactic scheme was globaly implemented. The virus load in pregnant women was followed up and qualitative PCR for HIV DNA and quantitative
PCR for HIV RNA were used to establish the HIV status of newborns.
Results: Since 1990 a total of 1.602 052 HIV antibody tests were performed in
pregnant women, 39 of them tested HIV positive. Moreover, 18 women got pregnant after first HIV positive diagnosis. Forty HIV positive mothers gave birth to 42
babies. In three newborns (7,14%) HIV infection was diagnosed. All three mothers of HIV positive newborns avoided the antiretroviral treatment from different
reasons (two of them were asylum seeking foreigners) and had a very high virus
load before and during delivery.
Conclusion: Antiretroviral prophylaxis reduces the mother to child HIV transmission if administered to both, pregnant women and their newborns, as needed.
High virus load in mother, especially during delivery, may predict HIV transmission
to the newborn baby. HIV testing of pregnant women and prophylactic treatment
of those who tested HIV positive as well as HIV prophylaxis in newborns play a
very important role in reducing HIV mother to child transmission. HIV antibody
routine testing of pregnant women is a rather costly but highly beneficial policy

even in the Czech Republic, which belongs to the countries with low level of HIV
epidemic.
Presenting author: Marie Bruckova, National Institute of Public Health, Srobarova 48, 100 42 Prague 10, Czech Republic, Czech Republic, Tel.: +420 2
67313075, Fax: [phone], E-mail: [email protected]

ThPeC7433 Common breakpoints among HIV-1 A/D
recombinant genomes transmitted perinatally in
Tanzania
B. Renjifo', I.N. Koulinskal, G. Msamanga2, D. Mwakagile2, W. Fawzi3,
M. Essex'. 'Harvard AIDS Institute, Boston, United States Territory; 2Muhimbili
Medical Centre, Dar es Salaam, Tanzania; 3Harvard School of Public Health,
Boston, United States Territory
Background: Human immunodeficiency virus type 1 (HIV-1) subtypes A, C and
D are co-circulating in Dar es Salaam, Tanzania, and large numbers of recombinant genomes have been generated and transmitted perinatally. Partial env and
gag gene sequences showed that the V3 region of subtype A was always selected in A-D recombinants. This selection suggested that the fitness of subtype
D-V3 in perinatal transmission may be reduced with respect to V3 from subtype
A. Full-length genome analysis was undertaken to help identify other genetic determinants associated with transmission.
Methods: Six samples from a pool of infants known to be infected by HIV-1 with a
subtype A env and subtype D gag were randomly selected for full-length amplification. Blood samples were drawn at 6, 13, 14, and 26-weeks of age. Full-length
PCR products were cloned, sequenced and used for subtype classification using
phylogenetic and recombination identification software.
Results: All six A/D genomes had distinct recombination patterns with crossover
points frequently located at the beginning or end of functionally defined regions. In
five of the six genomes, the majority of gag, pol, tat, rev and the intra-cytoplasmic
domain of gp41 belonged to subtype D sequences while the external domain of
gp41 and the majority of gpl20 belonged to subtype A sequences. A common
recombination site, in four of the six genomes, was located at the transmembrane
domain of gp41, at the end of the rex response element.
Conclusion: HIV-1 A/D recombinants from Tanzanian newborns were infectious
and selected for vertical transmission. The identification of common genomic subtype patterns among transmission-competent A/D recombinants may provide an
explanation about how such selection occurs.
Presenting author: Boris Renjifo, Harvard AIDS Institute, 651 Huntington Av,
Boston, MA 02115, United States Territory, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7434 The role of the Russian NGO working in Russian
prisons in policymaking, prevention and the
increase of the quality of life of PLWHA
T.V. Bakulina. Regional Charity Organisatin NAMES+", Hasanskaya ul, d. 8,
korp. 1, kv. 181, 195426, St. Petersburg, Russia, Russian Federation
Issues: Inspectors of the Council of Europe consider prisons in Russia as a place
which is a constant torture. The situations get worse due to the large number of
HIV positive inmates. In the correctional facilities of St Petersburg and region
there are 800 TB infected prisoners, 2500 HIV positive and 4000 drug users.
Description: The prisoners were questioned in order to study the problems of
HIV in prisons. The material assistance provided to the inmates, help in accessing the medication, help in further employment of the prisoners, the counseling of
the medical professionals, lecture son the HIV/AIDS issues, as well as the educational lectures for the prison staff.
Lessons learned: As a lesson there were discovered the services and programs
that PLWHA in prisons that they require. The self-support group has been created to help prisoners with HIV/AIDS improve the quality of life and help with
sociological adaptation. The current employment within the correctional facilities
is organized for some inmates.
Recommendatons: It is necessary to conduct regularly the seminars on HIV/AIDS
both for prisoners and the prison staff. The self help groups must be supported by
the administration of the prisons and by the city administration. The rights of the
prisoners should be observed as they are the citizens of the Russian Federation.
The medical care, socio-psychological assistance and the medical insurance for
ex-prisoners with HIV/AIDS should be provided.
Presenting author: Tatiana Bakulina, Hasanskaya ul., d. 8, korp. 1, kv. 181,
195426, St. Petersburg, Russia, Russian Federation, Tel.: [phone], Email: [email protected]
ThPeC7435 Hormonal contraception and the risk of HIV-1
acquisition: Design of a collaborative multi-site
prospective cohort study
B.A. Richardson, C.S. Morrison2, D.D. Celentano3, T. Chipato4, E Mmiro5,
N.S. Padian6, S. Rugpao7, R.A. Salata 8. 'University of Washington,
Harborview Medical Center, Box 359931, 325 Ninth Avenue, Seattle, WA
98104-2499, United States; 2Family Health International, Research Triangle
Park, NC, United States; 3Johns Hopkins University, Baltimore, MD, United
States; University of Zimbabwe, Harare, Zimbabwe; 5Makerere University,

Kampala, Uganda; 6University of California at San Francisco, San Francisco,
CA, United States; 7Research Institute for Health Sciences (RIHES), Chiang
Mai, Thailand; 8Case Western Reserve University, Cleveland, OH, United States
Background: Several previous studies have suggested an increased risk for HIV1 infection among women using hormonal contraception (HC).
Methods: We designed a longitudinal cohort study of HIV-negative women in
Thailand, Uganda, and Zimbabwe to compare HIV-1 incidence rates among