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

528 Abstracts ThPeD7773-ThPeD7777

XIV International AIDS Conference

ThPeD7773 Conjugal relationships in times of AIDS: some
aspects relating to serodiscordance in Brazil
I. Maksud', V. Terto Jr.', R. Parker1, C. Passarelli1, L. Murchison2. 'Brazilian
Interdisiciplinary AIDS Association, Rua da Candelaria 79, 10 o, Rio de Janeiro,
Brazil; 2Columbia University, New York, United States
Background: HIV/AIDS prevention work conventionally focuses on the individual.
Some actions prioritize family health, but in few cases is any emphasis given to
affective-sexual relations. This situation contrasts with the confirmation of qualitative studies that a great portion of the population sees the couple as an important
factor in building the values of being and feeling a person. This project sets out to
investigate the social meanings of conjugal relationships between partners with
different HIV serology, to make health professionals aware of the question, and to
help to publicize the issue and expand the multi-sectoral debate on the theme.
Methods: The project includes activities such as surveying the bibliography and
initiatives on conjugality and HIV/AIDS; evaluating the network of public health
care for HIV carriers; interviewing health professionals in hospital units (doctors,
social workers, psychologists and nurses); setting up focal groups with health
professionals and with seropositive persons; and holding workshops for discussion. To reflect the data produced by each of these areas of activity, a qualitativeanalysis methodology was used, supported by the theoretical-methodological
framework of the social sciences.
Results: An understanding of values and meanings related to conjugality; prevention of HIV/AIDS among partners; an awareness-raising seminar for health
professionals; interchange of professional services; including the theme in research agendas and program actions; specialized publication and making the
theme more visible.
Conclusions: The project showed that 'serodiscordance' is a category with differentiated aspects depending on the actors and places involved. One point that is
underlined is how prevention strategies preceded by an investigative phase tend
to be more successful than others because they have more access to information
on the reality upon which they wish to intervene.
Presenting author: Ivia Maksud, Rua da Candelaria 79, 10 ~, Rio de Janeiro,
Brazil, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeD7774 Involvement of private practitioners in referral
clinic for counselling and testing
N. Mawarl, J.K. John2, R.D. Bagul, S. Ranade', M. Thomas3, S.P. Tripathyl.
'National AIDS Research Institute(ICMR), G-73, BIE, Post Box 1895,
Pune411026, India; 2Christian Medical College, Vellore, India; 3Institute of
Research in Medical Statistics(ICMR), New Delhi India
Background: It is important to involve health practitioner in counseling process
before making referrals for establishing norms in good counseling practices in
HIV/AIDS.
Methods: Analysis of retrospective data of 955 men & 236 women (Oct.'92 -Dec.97) at a referral counseling and testing clinic where the protocol includes
informed consent, interview, pre and post-test counseling.
Results: Most referrals made by private (PP) & few government practitioners:
(70% & 8%), a fifth come voluntarily (more women than men); gender differences
in referral types observed (p<0.01). Clients in late twenties, were ever married &
unmarried men:57% & 43% and women mostly married/ widowed. Gap in 1st exposure & marriage more in men (3.6yrs) than women (0.6yrs), pre-& extra-marital
sex in men: casual / commercial sex reported; current condom use low. Counseling by PP before referring patients appeared limited, even after the screening test;
HIV-positives in PP referrals were 81% in men & 52% in women. Men's concerns
relate to future & present partners, as 58% unmarried & 71% in ever- married
were positive. Women's concerns related to reproduction and negotiating safe
sexual practices: 11/98 pregnant with 7/11 positive, 6 referred by PP & 1 voluntarily Women if referred by PP directly to specialized clinic could timely access
MTCT counseling to avail options like abortions or AZT/Nevirapine to avoid MTCT
PP can give timely counseling to patients/spouses to access specialized services
enabling decision making about themselves, their present/ future partners & children.
Conclusions: Study highlights increasing role of practitioners while referrals
made. PP should initiate counseling to prepare patients for opting timely health
services early. Additional training to PP focusing on sexuality, reproductive health
concerns and networking would enable in making referral services more effective,
an imperative ethical responsibility as VCTC are being up scaled.
Presenting author: Nita Mawar, G-73, BIE, Post Box 1895, Pune411026, India,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeD7775 Bridging the gap from receiving a positive HIV test
result to accessing services: 3 years of the linkage
program at AIDS health project in San Francisco

L. Loeb, S. Casey, J.W. Dilley, B. Adler, J. Orlando, J. Rinaldi. UCSF-AIDS
Health Project, Box 0884, UCSF AIDS Health Project, San Francisco, CA,
94143-0884, United States
Background: All HIV Counseling, Testing and Referral (HCTR) clients should
receive appropriate referrals, but clients receiving a positive HIV test result may
have specific medical, psychosocial, and transmission prevention needs.

Methods: All HCTR clients at AIDS Health Project who receive a positive HIV test
result are offered up to 4 extended counseling sessions with a Linkage Counselor. Linkage includes an extensive needs assessment (psychosocial/ medical/legal/prevention for positives), assistance in accessing appropriate services,
and follow-up. Extensive and ongoing relationships between Linkage counselors
and agencies throughout San Francisco enable name-based direct referrals and
ongoing quality assurance.
Results: Between 2/99 and 6/01, 238 clients received a positive HIV test result
at our clinics, and 184 (77%) accepted Linkage services. The majority of them
(74%) were linked to both primary health care services and psychosocial support
services (70%). Referrals for alcohol and other substance abuse services and
for housing services were also common. Acceptance of Linkage was significantly
higher among those who were receiving their initial positive result than among
those reconfirming a prior positive test (85% vs. 59% respectively). Among those
declining, most were already receiving services elsewhere, or were "too overwhelmed" to participate. African-American clients were less likely to accept Linkage (42%) than white (65%) or Latino/a (64%) clients.
Conclusions: Providing personalized Linkage to HIV services at the time of results disclosure was highly acceptable and succeeded in linking of a majority of
clients to primary medical care and psychosocial services. Personalized Linkage
may result in increased and/or earlier acceptance of services which in turn may
support both secondary and tertiary prevention efforts.
Presenting author: lisa loeb, Box 0884, UCSF AIDS Health Project, San Francisco, CA, 94143-0884, United States, Tel.: [phone], Fax: [phone]
7996, E-mail: [email protected]
ThPeD7776 The "Atlantis" network: collaborative study with
general practitioners to improve HIV counselling,
testing and early diagnosis
G.C. Orofino', L. Gennerol, M. De Agostini', P. Caramello 1, D. Sperone2,
M. Vianelli2, P. Leombruni3. 'Dept Infectious Diseases, Div. A, Amedeo di
Savoia Hospital, Dept. of Infectious Diseases, Turin, Italy; 2Generalpractitioner,
Turin, Italy; 3Dept of Neurosciences, University of Turin, Turin, Italy
Background: In the Turin area, like other Italian and world-wide western areas,
the numbers of patients with the first diagnosis of HIV infection coincident with
AIDS is still high, varing from 29% to 45% in the last five years. Many of these patients have been visited, in the years before HIV diagnosis, by their own General
Practitioner (GP), mainly for clinical problems jet HIV related but too aspecific for
this diagnosis. Moreover, the switching of infection from known risk groups to general population is another complicating factor. So, in 1999 we started a project,
aimed to promote HIV- counselling and early diagnosis, with a group of GPs.
Methods: We selected 40 GPs in the urban area. After preliminary educational
meetings, we elaborated a strategy that encode: depliants and brochures about
HIV infection, clinical and psychological approach to assess risk behaviors and
two diagnostic flow charts (based on preliminary signs and symptoms) for acute
and occult infection. In periodical meetings we have discussed data and news.
Until December 2001, 10 new infection cases (3 acute) have been diagnosed.
Results: These encouraging findings suggest that a focused measure to improve
communications skills for clinicians might be expected to have an important potential impact on discussion between doctor and patients on HIV risk behaviors.
On the other hand, the GPs should not avoid opportunities to help patients protect
themselves against disease, when some communication barriers are due to their
discomfort or lack of inadequate experience discussing.
Conclusions: It's very important that the GPs, interacting frequently with HIV
specialists and with high risk of HIV transmission patients, take opportunity to
promote primary and secondary prevention.
Presenting author: Gian Carlo Orofino, Dept. of Infectious Diseases, Div. A,
Amedeo di Savoia Hospital, Corso Svizzera 164, Turin, Italy, Tel.: [phone]
3883, Fax: [phone], E-mail: [email protected]
ThPeD7777 Enhancing the role of VCT to VCCTT
V.J. Dodiya', A. Purohit2, R.M. Shah'. 'FXB India Society, Mumbai Branch,
FXB India Society, 317/11, Nirlon CHS, S V Road, Goregoan (W), Mumbai -
400062, India; 2 World Wide Director, AFXB, Boston, United States
Issues: VCT is one of the best strategies for HIV prevention. Integration of Sexually Transmitted Diseases (STD) treatment services and other basic medical
care for persons living with HIV (PLWH) with VCT services enhances the prevention impact of the VCT centers. Unfortunately, insufficient attention to the
informed consent process, breaks in confidentiality & widespread stigmatization/discrimination towards persons living with HIV/AIDS (PLWHA) contribute to
public avoidance of HIV counseling and testing services.
Description and Results: This presentation will discuss the success of VCT,
started in the western suburb of Mumbai early in 1998. Response to the use of
VCT facilities was enhanced (By 60%) by providing extra facilities for the diag
nosis and treatment of STDs, TB and other Ols. This VCT center also serves as
a "Nutrition & Antiretroviral Guidance Centre". We also offer some specific monitoring tests that are 40% less expensive when compared to private laboratories.
This VCT center also works closely with higher care institutions for critically ill
PLWH and some private family physicians. Among the 3993 patients that have
been counseled in our centre, including couples and children, 16% have tested
positive for HIV, compared to 2% in the general population of Mumbai. This dif