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

XIV International AIDS Conference

Abstracts ThPeE7922-ThPeE7925 567

Medecins Sans Frontiers pilot project in Khayelitsha. This is the only site in South
Africa where HIV positive adults can obtain free anti-retroviral medication.
Lessons learned: While access to anti-retroviral medication does not address
all of the needs of PLWHA's in poverty-stricken areas, treatment dramatically and
fundamentally improves the quality of people's lives.
Recommendation: The stories documented here speak to the urgent need for
the immediate and widespread provision of ART to all people who need them.
Presenting author: Kylie Thomas, 9 maple mews, maple ave, tamboerskloof,
cape town, 8001, South Africa, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeE7922 I nadequate HIV/AIDS care services in rural Uganda
R. Kalyesubula1, A. Haag2, F. Wagaba3, S.A. Kihembo1. 1AFXB, PO.Box258,
Luweero, Uganda; 2AFXB, Boston, United States; 3Ministry of health, Semuto,
Uganda
Issue: Since 1983, the government of Uganda has put up a strong fight against
HIV/AIDS and has become a beacon to the rest of the world. However, people
in the hard-hit and remote areas of the country continue to suffer tremendously
from this scourge, mainly due to poverty and lack of access to adequate, timely
and affordable health services.
Description: A review of data on HIV/AIDS in the Semuto Health center was
conducted. Interviews of people living with HIV/ AIDS (PLWHA), local community leaders and elders, Health Care providers, Opinion leaders and Health Care
workers coupled with group discussions were taken. This paper will summarize
the needs of the community and its view on how to improve the Health care services in rural Uganda.
Lessons learned: HIV/ AIDS is one of the major health and social problems
that the community is facing to day. Stigmatization and lack of knowledge about
HIV/ AIDS are still the major obstacles to prevention and management of the
disease. Providing counseling, adequate nutrition, treatment of opportunistic infections and developing positive leaving and auto-support groups help improve
the quality and prolong the life of PLWHA. Nevertheless, even these basic services and strategies are not currently available and / or adequate in the Semuto
area and, therefore their potential benefits have not yet reached those in need.
Recommendations: HIV/AIDS is still a major problem in Uganda despite the remarkable work being done. However, providing quality and access to care and
treatment (including HAART) should be an additional priority which will not only
positively impact PLWHA, but also the community at large by changing the current
"Nothing can be done" paradigm of HIV/ AIDS with in the most destitute communities of rural Uganda. In addition improvement of inaccessibility of preventive
campaigns by the community will eventually take place.
Presenting author: Robert Kalyesubula, PO.Box 258, Luweero, Uganda, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
ThPeE7923 Relationships between use of hospital services and
socio-economic status among HIV positive
individuals in the UK
S.C. Mitchell, P.A. Cook, A. Towle, P. Cosgrove, M.A. Bellis. Public Health Sector,
School of Health and Human Sciences, Liverpool John Moores University Public
Health Sector, Liverpool John Moores University 70 Great Crosshall Street,
Liverpool, L3 2AB, United Kingdom
Background: The strong link between inequalities in health and inequalities in
socio-economic status (SES) is well known. However, there have been few studies on inequalities in health of HIV positive individuals within developed countries.
Methods: Data on treatment and care, demographics and clinical stage for 487
HIV positive individuals in the North West of England were collected from hospitals. Deprivation (Townsend) scores were allocated on the basis of district of
residence.
Results: Preliminary univariate analyses suggest that there is no relationship between stage of disease or ethnicity and SES (p>0.05). Individuals living in more
deprived areas were more likely to have been infected through homosexual than
heterosexual sex (P= 0.001). Multivariate analysis shows that people who were
infected through blood/tissue were more likely to have had a stay of at least one
night in hospital compared to gay men (adjusted odds ratio= 5.8, P<0.0001).
Compared to asymptomatic patients, those with AIDS and those who were symptomatic were more likely to have stayed in hospital (adj. OR= 3.1, P= 0.002).
There was no relationship between ethnicity and hospital stay (p>0.05). However, those living in the most deprived areas were more likely to have required a
hospital stay (adj. OR= 3.2, P<0.001).
Conclusions: Contrary to commonly held stereotypes, HIV infected gay men
were more likely to live in deprived areas. Deprivation is a significant predictor
of likelihood of a stay in hospital after multivariate adjustment for clinical stage,
route of infection and ethnicity. Efforts are needed to target health care of HIV
positive individuals and prevention initiatives.

Presenting author: Suzannah Mitchell, Public Health Sector, Liverpool John
Moores University, 70 Great Crosshall Street, Liverpool, L3 2AB, United Kingdom, Tel.: [phone], E-mail: [email protected]

ThPeE7924 Factors affecting health seeking behavior of People
Living with HIV/AIDS (PLHA) in New Delhi, India:
Results of a qualitative study
V. Sharma Mahendra1, A. Kaushik Panda2, S. Bajaj2, R. Jakharia Mudoi2,
B. George2, L. Gilborn3, S. Bharat4. 1Population Council/Horizons Program,
New Delhi, India; 2SHARAN, Population Council/Horizons Program, 53 Lodi
Estate, New Delhi, 110 003, India; 3Population Council/Horizons Program,
Washington DC, United States; 4Tata Institute of Social Sciences, Mumbai, India
Background: Stigma and discrimination against people living with HIV/AIDS in
hospitals and clinics discourages many from seeking care. Better understanding of these and other barriers to health-seeking behavior could increase use of
services.
Methods: To enhance understanding of PLHA health care-seeking behavior and
factors affecting it, 6 focus group discussions with a total of 40 PLHA and 20 indepth interviews with PLHA and their caregivers were conducted in New Delhi.
Key informant interviews were conducted with 6 practitioners providing care to
PLHA.
Results: PLHA report confronting stigma and discrimination in several forms in
both public and private facilities. These include denial of and delayed treatment,
segregation and isolation from other patients, and early discharge. PLHA utilize
a number of strategies for accessing care without incurring negative repercussions including (1) concealing their HIV status as long as possible, (2) seeking
care outside their own community to protect anonymity, and (3) patronizing local
AIDS Service Organizations that provide nondiscriminatory care. Cost is also a
factor. Those who can afford to visit private clinicians do so to avoid long queues
in government hospitals and to receive timely care. As the costs for ongoing care
accumulate, PLHA eventually turn to the public sector for free or subsidized services. Other barriers to care include the misconception that AIDS is untreatable,
the lure of witch doctors who claim to have a cure, and lack of awareness on the
part of PLHA about their own needs and rights.
Conclusions: To increase PLHA's health-seeking behavior, stigma and discrimination, the cost of ongoing treatment, and hopelessness about treatment must
be addressed. This requires outreach to both PLHA and their caregivers, as well
as to private and public providers and facilities. Networks linking health care institutions and other care-giving systems need to be established to ensure PLHA
access to quality care.
Presenting author: Vaishali Sharma Mahendra, Population Council/Horizons
Program, 53 Lodi Estate, New Delhi, 110003, India, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
ThPeE7925 Physicians'attitudes toward HIV treatment in the
context of the UNAIDS drug access initiative in
Ivory Coast
M. Souville1, P. Msellati2, C. Malaval1, G. Tape3, J.RP Moatti. INSERM U379,
Marseille, France; 21RD/LPE, Marseille, France; 3Ecole Normale
Supdrieure/GIDIS, Abidjan, Cote d7voire
Background: Since August 98, the Ivory Coast Minister of Health has introduced
with the support of UNAIDS the Drug Access Initiative (DAI) to increase access
of HIV-infected patients to antiretroviral treatment (ARV). Similar biological eligibility criteria than in developed countries (CD4 <500/mm3 or/and viral load>
10,000/ml) have been adopted.
Objectives: To evaluate prescribing physicians' attitudes toward ARV in the context of DAI in Ivory Coast.
Methods: Self-administered questionnaires for all physicians working in 11 health
services taking care of HIV+ patients, including 6 reference centers of DAI.
Results: Among the 123 respondents, 45% took care of more than 20 HIVinfected patients during the prior12 months. Physicians were significantly more
likely to be older than 40, to have graduated in pneumology or infectious diseases, to work in a HIV specialized unit, and to have followed post-university
medical training on HIV infection, to know HIV infected persons outside occupational context. They had a better knowledge about cotrimoxazole prophylaxis
and ARV. A majority of respondents expressed discomfort about economic constraints limiting patients'access to ARV. Attitudes toward initiation of ARV were
variable and not related to practical experience with therapy: 31% were in favour
of early prescription of ARV, 34% to delay ARV prescription under 200 CD4 and
35% were unable to express any established attitude.
Conclusion: In the context of the DAI, Ivory coast physicians have been among
the first in Africa to be confronted to practical opportunities of prescription of ARV.
Better knowledge was associated with clinical experience which suggests that
scaling up of access to ARV necessitates training of professionals beyond specialised HIV centres. Application of international guidelines for initiation of ARV,
without adaptation to the context of limited resources of African countries, creates
variability of attitudes and controversies among prescribers
Presenting author: Jean-Paul Moatti, INSERM U379, 232 Bd Ste MARGUERITE, 13009 Marseille, France, Tel.: [phone], Fax: [phone]

04, E-mail: [email protected]