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

XIV International AIDS Conference

Abstracts ThPeD7758-ThPeD7763 525

ThPeD7758 Relevance of accountability in HIV/AIDS
associations
P.M. Ruban a. London School of Economics and political science, 109 bullhead
road, borehamwood-herts, wd 6 1 hr, United Kingdom
Issues: Accountability has increasingly become the byword for sustainability and
relevance in project design and policy formualtion. To what extent can accountability legitimise the non governmental organisations claim to relevance in different cultural and economic contexts.
Descriptions: This paper compares and assess efforts and achievements of
specific hiv/aids associations in their attempt to be more accountable. It provides a comprehensive evaluation of the debates and challenges faced by nongovernmental organisations and specifically hiv/aids associations in their attempt
to be relevant to the communities and individuals they serve. It looks at a complex
set of relationships that have relevance in todays efforts to link local realities to
national and ultimately global policy formulation and reform.
Lessons learned: Effective organisational adaptation and internal democritisation strongly influence the effectiveness and tranparency of hiv/aids associaitons.
Moreover Hiv/aids associations have a positive impact on policy formualtion and
social attitudes in more democratised instituttions.
Recommendations: This paper recommends that appropriate models of accountability need to be constructed for effective service delivery inorder to have a
tangible impact on policy formulation
Presenting author: paul-marti rubanga, 109 bullhead road, borehamwood-herts,
wd 6 1 hr, United Kingdom, Tel.: [phone], E-mail: [email protected]
ThPeD7759 Does availability of anti-retroviral therapy have an
impact on the AIDS-related risk behaviour?
A.S.M. Abdullah R. Fielding. The University of Hong Kong, Department of
Community Medicine, The University of Hong Kong, Patrick Manson Building
S/W, 7 Sassoon Road, Hong Kong
Background: Anti-retroviral therapy (ART) is useful in delaying the progression
of HIV and improving the quality of life of the HIV infected individuals.
However, misconception about the ART's impact might increase high-risk behaviour among the public. This study examined the awareness about treatments
of AIDS among a group of Chinese population in Hong Kong and assessed their
perceptions of ART.
Methods: A cross-sectional survey was conducted among 2,720 employees of
20 different business organisations in Hong Kong between August 1998 and May
1999. A structured self-administered questionnaire was used for data collection.
Results: A total of 442 completed questionnaires were collected with a response
rate of 16% (442/2720). Of the respondents, 58% were male, and most (99%)
attained education to college or above. Although 99% of the respondents had
heard about AIDS, a substantial proportion held misconceptions about different
aspects of AIDS.
Of the respondents about 75% knew that with the available ART, HIV infected people may live longer. However, a substantial proportion held misconception about
treatments and they thought that the AIDS treatments may cure AIDS (56%) and
eliminate transmission of HIV (28%). A substantial proportion were less afraid of
becoming infected with HIV (34%) and a small proportion (8%) reportedly took
less protection than before due to their belief in the effectiveness of AIDS treatments.
Conclusion: The findings of this study showed that a proportion of the population are misinformed about the ART which might prone them to involve in high
risk sexual activities. This reflects the need for carefully designed strategies for
the promotion of AIDS drugs among the public.
Presenting author: Abu S. M. Abdullah, Department of Community Medicine,
The University of Hong Kong, Patrick Manson Building SW, 7 Sassoon Road,
Hong Kong, Tel.: [phone], Fax: [phone], E-mail: asma@hkucc.
hku.hk
ThPeD7761 iCouncillors' perspective on the experience of
providing HIV counsellingsinfKhayelng insh itsha, Cape
Town, South Africa
S. Magwaza', C. Mathews2. 'Health Systems Trust, Health Systems Trust, Box
808, Durban, 4001, South Africa; 2Medical Research Council, Cape Town, South
Africa
Background: Voluntary counselling and testing (VCT) is the first entry point to
HIV prevention, treatment and care. Cape Town health department was the first
to pilot the prevention of the mother to child transmission (pMTCT) of HIV programme using AZT in two clinics of Khayelitsha Township, in January 1999. VCT
services are offered by lay counsellors employed by LifeLine.
Methods: As part of the evaluation of VCT after 1 year in operation, three fo
cus group discussions (FGDs) involving 11 lay counsellorswere conducted in December 2000. In addition, a semi-structured anonymous questionnaire were also
completed by counsellors immediately after the FGDs. The discussion guide and
questionnaire solicited views on: training, support and supervision; interaction
and experiences of providing the actual VCT service and quality of care.
Results: The findings show that eight counsellors perceived training to be good
and identified some of its strengths and weaknesses. The majority (n= 8) reported
having useful support and supervision mainly received outside their work stations.

Some of the stressors identified included: low salary, spill-over of HIV issues into
their private lives and fear of long-term psychological effects of providing VCT
Some barriers to quality of care included: lack of space and privacy; lack of sufficient knowledge about HIV transmission and lack of resources. Four counsellors
were unhappy to be referred to as "lay-counsellors" by nurses and most (n=8)
were concerned that some participants do not comply with the therapy.
Conclusions: The results suggest that programmes aiming to care for service
providers need to be structured such that maximum benefit is gained. Additional
and ongoing training together with on site supervision is necessary Team-building
programmes need to be arranged for all staff working attached to these services.
Presenting author: Sphindile Magwaza, Health Systems Trust, Box 808, Durban,
4001, South Africa, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeD7762 HIV prevention case management builds an
alliance with healthcare providers: focus on
adherence of antiretroviral therapy
MN. Rollison MSW, R.T. Higginson, PA-C, B.E. Mercier, MIS, C. Weir-Wiggins,
RN. Virginia Commonwealth University Health System Medical College of
Virginia Hospitals, PO Box 980413, Richmond, VA 23298, United States
Background: Prevention Case Management (PCM), a secondary prevention intervention, designed to assist those HIV infected who are having or likely to have
difficulty initiating or sustaining behavioral practices related to HIV transmission,
medication adherence, mental health, chemical addiction, and STD. In the Virginia Commonwealth University Health System Medical College of Virginia Hospital's Infectious Disease Clinic, 80% of PCM referrals relate to medication adherence. An interdisciplinary alliance between PCM and Healthcare Providers
evolved from the time-intensive education Antiretroviral therapy (ART) demands.
Methods: PCM, a client-centered model, utilizes a motivational interviewing theoretical approach towards developing goals. Progress is measured with a harm
reduction focus, in addition to clinical outcomes. The alliance between primary
provider and PCM provider enhances the quality and depth of education and
instruction provided, including a deeper understanding of medication resistance
and HIV super-infection.
Results: Active PCM patients experience reduction in HIV viral replication and
subsequent increases in CD4 cell counts. The past four quarters from 2001 have
averaged 42% patients achieving HIV viral load below the level of detection within
6 months of entering PCM (n=45), compared to 23% of patients in the clinic population identified with adherence issues currently not receiving PCM services
(n=492). During this same time period, patients also experienced a 4-fold decrease in STD incidence.
Conclusions: Integration of PCM interventions with medical care correlates positively with improved clinical outcomes. Reinforcement of issues related to disease
process, mechanism of action of ART, and HIV super-infection have been influential in achieving both clinical and behavioral outcomes. The successful outcomes
from integrating primary medical care and PCM intensive case management in
this model warrants future research.
Presenting author: Michael Rollison, PO Box 980413, Richmond, VA 23298,
United States, Tel.: [phone], Fax: [phone], E-mail: mrolliso
@ MCVH-VCU.edu
ThPeD7763 Physician characteristics associated with
discussing HIV prevention messages in a
multicenter study
L.I. Gardner1, C. Krawczykl, L. Metsch2, S.A. Strathdee3, C. del Rio4,
P. Mahoney5, S.D. Holmberg6. 'Centers for Disease Control, Division of
HIV/AIDS, Centers for Disease Control, Division of HIV/AIDS, Mailstop E-45,
Atlanta, GA 30333, United States; 2University of Miami, Miami, FL, United
States; 3Johns Hopkins University Sch. of Hygiene and Public Health, Baltimore,
MD, United States; 4Emory University School of Medicine, Atlanta, GA, United
States; 5Health Research Association, Los Angeles, CA, United States;
6Centers for Disease Control, Division of HI V/A IDS, Atlanta, GA, United States
Background: Physicians do not always discuss HIV prevention messages with
their HIV-infected patients, but the reasons for this are not well understood. We
sought to determine if provider characteristics are related to less than optimal
communication about HIV prevention by physicians.
Methods: The Antiretroviral Treatment and Access Studies (ARTAS) conducted
a mail survey of 317 HIV physicians in Miami, Baltimore, Atlanta and Los Angeles (U.S.) during 2000-2001. Physicians were asked to rate how frequently they
"discuss risk reduction regarding HIV transmission" and "substance abuse". Logistic regression adjusted odds ratios (ORs) of always vs. not always discussing
HIV prevention messages were calculated controlling for physician's gender and
age, patient load/month, medical board certification, years caring for HIV patients,
gender mix of patients, and study site.

Results. 37% of physicians always discussed HIV transmission risk reduction;
24% always discussed substance abuse. Compared to female physicians, male
physicians were less likely to always discuss risk reduction (34% vs. 44%,
ORadj=0.6, p=.06) and substance abuse (20% vs. 28%, ORadj=0.5, p=.04); each
ten year increase in age was positively associated with always discussing risk
reduction and substance abuse (ORadj=1.6, p=.02 and ORadj=1.9, p=.004, respectively); physicians with 20% or more male patients were less likely than care