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

544 Abstracts ThPeE7817-ThPeE7821

XIV International AIDS Conference

ThPeE7817I Which comes first: patient satisfaction with care or
antiretroviral therapy use among women with HIV?
J. Burke', J.A. Cook1, M.H. Cohen2, S. Urwin2, N. Hessol3, E.A. Piessens4,
J. Richardson5, P.D. Williams6, T.E. Wilson7. 1University of Illinois at Chicago,
104 S. Michigan Ave, Ste. 900, Chicago, IL 60603, United States; 2CORE
Center, Chicago, United States; 3University of California at San Francisco, San
Francisco, United States; 4 Georgetown University Medical Center, Washington,
DC, United States; 5University of Southern California, Los Angeles, United
States; 6Montefiore Medical Center, Bronx, United States; 'State University of
New York Health Science Center, Brooklyn, United States
Background: Research has shown that satisfaction with medical care can be a
predictor of patients' use of treatment. However, the reciprocal effect of treatment
utilization on satisfaction with care is less well documented. This analysis examines the direction of this relationship in a cohort of women with HIV by testing the
hypotheses that: 1) greater satisfaction with care predicts antiretroviral therapy
(ART) use; and 2) ART use predicts greater satisfaction with care.
Methods: Data are from the two most recent biannual study visits (Time 1 and
Time 2) of 1183 participants in the Women's Interagency HIV Study, and include
information on therapy and healthcare utilization, insurance status, drug use and
other behavioral factors, clinical status, demographics, and satisfaction with care.
Multivariable regression models were used to test whether satisfaction at Time 1
predicted new or ongoing ART use at Time 2, and whether ART use at Time 1
predicted higher satisfaction at Time 2.
Results: Controlling for other relevant factors including CD4 and viral load, satisfaction with care was not a significant predictor of subsequent HAART, combination ART, monotherapy or non-use of ART However, HAART and combination therapy were both significant predictors of subsequent satisfaction with care
(p<.01 and p<.05). Non-use of any ART significantly predicted less satisfaction
with care (p<.001).
Conclusions: Satisfaction with care is not a significant predictor of women's decisions to use or stay on ART; however, ART use does predict satisfaction with
care. Despite difficulties associated with use of HAART and combination therapies, women are much more satisfied when they use these advanced therapies.
Better information on the dynamics of this relationship, including the role of health
status, will contribute to the quality of health care services for women with HIV.
Presenting author: Jane Burke, 104 S. Michigan Ave, Ste. 900, Chicago, IL
60603, United States, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeE7818 Women, AIDS and poverty in the south suburban
district of the Province of Buenos Aires
G. Colman. Red PLHIV-AIDS, Ciudad de Buenos Aires, Argentina
Background: the increases in poverty and unemployment along with the lack
of work -coordination among public institutions and NGO's make women more
vulnerable to high-risk HIV factors.
Description: Basic unmet needs increase the vulnerability of women regarding
hiv-aids prevention and assistance, because: 1- their problems are not specifically contemplated by prevention campaigns - making all aid to them inoperative
in terms of their actual living conditions, 2-because they have no access to nor
can they maintain prescribed treatments.
Lesson Learned: My work with low-income community health centers, local hospitals, rehabilitation communities, public schools and family abuse services has
revealed that health and community professionals have defficient training in order to effectively work with women with basic unmet needs, since no workable
prevention strategies can be articulated for them when their specific needs are
disregarded.
Recommendations: Health and community outreach professional training must
accommodate for this social sector's specific needs through appropriate work
strategies that contemplate such vital socio-economic-educational factors as well
as provide for fora in which public institutions and NGOs may optimize their use
of human and financial resources towards this end.
Presenting author: Gilda Colman, Cabrera 3531 A, -1186, Ciudad de Buenos
Aires, Argentina, Tel.: [phone], Fax: [phone], E-mail: nrevsin
@arnet.com.ar
ThPeE7819 Reconstructing occupation after HIV infection:
Lessons from the lived experience of women
K.J. Opacich1, M. Cohen2. 1UIC, CORE Center, 4127 N. Dickinson Ave.,
Chicago, Illinois, 60641, United States; 2CORE Center, Chicago, United States
Issues: Quality of life is highly contingent upon the extent to which individuals
can fulfill their life plans. Since HIV insinuates itself into the fabric of everyday life,
understanding the ways women reconstruct their lives to accommodate the asso
ciated challenges and disruptions is critical. For the majority of HIV+ women in
the U.S., social and economic circumstances have limited options in meaningful
occupation and access to health related services.
Description: This triangulated study explored relationships among HIV status, engagement in meaningful occupations, health related services, and selfreported quality of life. Fifteen women representing three cohorts along the illness trajectory were recruited from an urban health care facility designed to
provide AIDS related services. Participation entailed two semi-structured inter
views: 1)the nature of daily occupations 2)experience obtaining health care; a
self-administered quality of life survey; and responses to a brief symptom survey.
Qualitative data and health indicators were used to inform self-reported quality of
life.
Lessons learned: Most women in the study relayed a protracted process of
learning to live with HIV. Several viewed HIV infection as an event that led to
enhanced quality of life. Many of the women confronted substance abuse and
concomitant destructive behaviors. Consistent relationships with caring health
professionals and other HIV+ women were considered critical to achievement and
maintenance of health. Issues related to parenting, housing, vocational training
and employment, and alternative health services arose as the women told their
stories. The need for comprehensive health and support services beyond medical
management was evident in every case regardless of health status.
Recommendations: In order for HIV+ women to lead coherent occupational
lives, all factors contributing to health must be considered and addressed.
Presenting author: Karin Opacich, 4127 N. Dickinson Ave., Chicago, Illinois,
60641, United States, Tel.: [phone], Fax: [phone], E-mail: kjothinkingl @aol.com
ThPeE7820 Attitudes among wives of migrant workers towards
condom use
Y.S. Singh1, R.V. Nair1, C.J. Mora2, M.R Rajpurohit1. IFXB Rajasthan Society,
Sumerpur, India; 2AFXB US Foundation, Boston, United States
Background: Women are particularly vulnerable to HIV infection in rural India
due to their lack of education and empowerment on sexual issues. High numbers of males who migrate from the villages to the big cities and then come back
for the holidays add another risk for HIV infection among these women in rural
Rajasthan.
Methods: An in-depth survey was conducted among 110 rural Rajasthani women
regarding attitudes toward condom use. The questionnaires were filled out by our
trained peer educator through oral interviews with these women.
Results: Of the women interviewed, 72 out of 110 were illiterate. The rest, thirtyeight women, had received education below class 5th. 100% of women reported
some knowledge of condom use. However, eighty-nine (89%) percent of women
had knowledge of condom use only for contraceptive reasons. Just 11% of women
reported some knowledge of condom use to avoid sexually transmitted diseases
(STDs), including HIV. Most women were not allowed to talk in detail regarding
condom use in front of their spouses.
Conclusions: Rural women need to be educated about HIV/AIDS/STIs issues.
They also need to be motivated to speak up regarding condom use and preventive methods to avoid sexually transmitted diseases and HIV infection. Migrant
male workers should also be part of awareness campaigns regarding condom
use to avoid STDs and HIV.
Presenting author: Yashpal Singh, FXB Rajasthan Society, 385, B.S. Colony,
Opp. DYSP Office, Sumerpur, India, Tel.: [phone], Fax: [phone]
54564, E-mail: [email protected]
ThPeE7821 Knowledge and awareness of HIV/AIDS among
women in India
M. Duraisamy1, P. Duraisamy2. 'Indian Institute of Technology-Madras,
Professor of Economics, Dept. of Humanities and Social Sciences, Indian
Institute of Technology-Madras, Chennai 600 036, India; 2University of Madras,
Chennai, India
Background: The experience of several countries show that women are more
vulnerable to HIV/AIDS infection. The prevention and the impact of the epidemic
critically depend on the knowledge and awareness about the disease and on how
it can be prevented. The objective of the present study is to examine the distribution and determinants of knowledge and awareness of AIDS/HIV among women
in India and also study the effectiveness of awareness programs.
Methods: Data from the National Aids Control Organization (NACO) at State
level and the National Family Health Surveys (NFHS) for 13 States at the individual level are used to empirically examine the determinants of women's knowledge, awareness and program effectiveness. Multivariate analysis, besides tables, graphs and summary statistics are employed.
Results: The data indicate that in 1998/9 about 40% of women 15-49 years in
India reported knowledge of AIDS and this has increased over time. For instance,
in Delhi 79% of women reported knowledge of AIDS in 1998/99 compared to only
36 percent in 1992/3. Similar improvement is evident in other major Indian states
like West Bengal, Gujarat, Maharashtra and Tamil Nadu where the proportion of
women with knowledge about AIDS increased from 10, 11, 19 and 23 percent
respectively in 1992/3 to 26, 30, 61 and 87 percent in 1998/9. Television is the
major source of information on the disease. Multivariate analysis shows that female education significantly influences the knowledge and awareness. The other
important determinants are per-capita income/assets, caste and religion.

Conclusions: There is convincing evidence that committed efforts by NACO and
other NGOs have contributed to substantial increase in the knowledge and awareness of AIDS/HIV among women in India. Women's education plays a key role,
besides other cultural factors, in determining the knowledge about the disease.
Presenting author: Malathy Duraisamy, Professor of Economics, Dept. of Humanities and Social Sciences, Indian Institute of Technology-Madras, Chennai