Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

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MOPE0487
Enhanced access to antiretroviral therapy:
a qualitative study of community perceptions in
Kampala city, Uganda
L. Atuyambel, S. Neema2, E. Otolok-Tanga', G. Wamuyu-Mainal, S. Kasasa3,
F. Wabwire-Mangen3, Co-authors. 'Makerere University Institute of Public
Health, Community Health and Behavioral Sciences, Kampala, Uganda,
2Makerere Institute of Social Research, Kampala, Uganda, 3Makerere
University Institute of Public Health, Epidemiology and Biostatistics, Kampala,
Uganda
Background: Since 2001, antiretroviral Therapy (ART) has been integrated as
part of the Ugandan national program for comprehensive HIV/AIDS care and
support. This study examined community perceptions and beliefs on whether
enhanced access to ARVs increases risk behavior as well as fears regarding
HIV/AIDS infection and use of ARVs.
Methods: This exploratory study utilized Focus Group Discussions (FGDs)
and Key Informant (KI) interviews. Participants were purposefully sampled.
Twenty FGDs and 12 KI interviews were conducted. FGDs were conducted with
adult men (above 25 years), women and youth (male and female) while KIs
interviews were held with Kampala City Council officials, health workers, and
religious leaders. All data were tape recorded and transcribed thereafter. Text
data was analyzed using content analysis technique.
Results: Most participants felt that enhanced access to ART would increase
risk sexual behavior. Participants pointed out promiscuity, lack of faithfulness
among couples, multiple sexual partners, prostitution, unprotected sexual
practices, rape and lack of abstinence. Few FGD indicated that increased ART
access and counseling which HIV-positive patients receive promote positive
health behavior. Some participants expressed fears that with increased use
of ARVs, HIV transmission could be promoted because it would be difficult to
differentiate between HIV-positive and HIV-negative persons as they would
look healthier and live longer. Uncertainties were expressed about ARVs with
regard to compliance, sustained stable supply of ARV and capacity to ensure
quality of ARVs on the market. Most people were not taking HIV tests because
they were 'confident' about their sero-status; fear for the outcome; absence of
HIV/AIDS signs and symptoms; lack of money and time to go for testing; and
lack of knowledge on HIV testing centers.
Conclusions: There are fear and misconceptions about the effect of
enhanced access to ART concerning increases in risk behavior and increase
in HIV transmission. Information Eeducation Communication on ART use is
recommended.
MOPE0488
Sexual behaviours in the era of enhanced ARVs in
urban setting, Kampala
L. Atuyambe', S. Neema2, F. Wabwire-mangen', W. Maina', S. Kasasa',
E. Otolok-Tanga', Co-Investigators. 'Makerere University Institute of Public
Health, MUIPH, Kampala, Uganda, 2Makerere Institute of Social research,
Kampala, Uganda
Background: In Uganda antiretroviral Therapy (ART) was integrated as part of
the national program for comprehensive HIV/AIDS care and treatment in 2001.
However it has been postulated that introduction of ARVs could erode behavior
change achieved by HIV/AIDS interventions.To establish sexual behavioral
practices regarding HIV/AIDS in the context of increasing availability and use
of ARVs.
Methods: A prospective study was carried in Kampala, Uganda, between
October 2004 and 2005. 710 randomly selected respondents (266 community
members; 182 HIV-positive on ARVs and 262 HIV-positive not on ARVs) were
interviewed using interviewer-administered questionnaires and analyzed using
SPSS computer program. 12 Focus Group Discussions with 190 participants
and 21Key Interviews were conducted data analyzed using Nudist qualitative
computer analysis package.
Results: Of the sexual active, half (343/694) reported sexual activity three
month prior to study. About 10% (35/343) had sex with non-regular partners;
66% (23/35) were from the community arm. While 83% (26/35) had used
condoms with non-regular partner; those in community were less likely to use
condoms (78 vs.98%). 5% (19/343) reported commercial sex; almost all were
from two arms (not on ARVs; community). 40% (73/182) on ARVs reported
ARVs had affected their sexual desires; with 38 % reporting increased sexual
desires. Overall 31% (215/694) reported a sexually transmitted disease. Effect
of ARVs on sexual behaviours; abstinence (1%), non-regular partners (3%),
not using condoms (0%) was negligible. Fears existed in the community that
ARVs would influence sexual behaviours and promote HIV.
Conclusions: The effects of ARVs on sexual behaviour have not been observed,
however risk sexual behaviours exists both in the community and among
positives. It is recommended that prevention interventions continue.

MOPE0489
Results of sexual and reproductive health (SRH)
and HIV/AIDS knowledge, attitude, practices
and behaviors (KAPB) studies among in-school
adolescents in five provinces of Mozambique
A. Tivanel, L. Guirao2, C. Bilale3, C. Linha3, S. Espada4. 'Ministry of Education,
Maputo, Mozambique, 2Pathfinder International, Maputo, Mozambique,
3UNFPA, Maputo, Mozambique, 4Provincial Directorate of Education, Maputo,
Mozambique
Background: Gerag8o BIZ (GB) is a multisectoral youth program implemented
through the Ministries of Health, Education, and Youth and Sports in
Mozambique. The program receives financial support from UNFPA and technical
assistance from Pathfinder International. It seeks to improve knowledge of
Sexual and Reproductive Health (SRH), increase access to related education
and services, and change behavior. GB is implemented in eight provinces and
reaches 843,000 youth each year.
Methods: In 2003 and 2005 adolescent SRH and HIV/AIDS KAPB studies
were conducted in Maputo City, Zambezia, Gaza, Tete, and Maputo Provinces
to evaluate GB progress using random samples of students aged 10-24. To
compare results across cohorts and time periods, chi-square analyses were
applied.
Results: These studies showed marked improvements in lower-risk knowledge
and behaviors among youth from 2003 to 2005. Among those youth having
sexual intercourse, the percentage that had used contraception during the first
sexual experience increased from 35.7% to 60.2%. Knowledge of abstinence
increased significantly from 20% to 44%; general knowledge of contraceptive
methods also showed improvement. Condom use in the first sexual relationship
was found to be higher (43.4%) than oral contraceptive use (15%). Consistent
condom use even when "in love" increased from 70% to 83%. Respondents
who had had VCT jumped from 11% to 38%. Also, respondents who had
access to information through GB activists increased from 43.8% to 65.6%.
The percentage of respondents accessing information, education, and
communication materials increased from 13% to 44.8%.
Conclusions: The following conclusions can be drawn about GB's strategies
and impact: GB's strategy of improving general youth knowledge of SRH and
their options for disease prevention and contraception (including abstinence)
has shown that youth who choose to have sex are choosing to use protection;
GB's multisectoral, wide-scale model has proved successful and is appropriate
for scale-up and replication.
MOPEO490
Knowledge and attitudes towards HIV/AIDS of
migrant workers attending STD clinics in Dhaka,
Bangladesh
A.S.M. Zakarial, D.S. Sikder2, A.M. Chowdhury3,
A.Q.M.S. Islam4. 'Bangabandhu Sheikh Mujib Medical University, Asstt. Prof.
of Dermatology & STDs, Dhaka, Bangladesh, 2Bangabandhu Sheikh Mujib
Medical University, Asso. Prof. of Dermatology & STDs, Dhaka, Bangladesh,
3Bangabandhu Sheikh Mujib Medical University, Professor of Dermatology &
STDs, Dhaka, Bangladesh, 4Professor of Dermatology & STDs, Chittagong,
Bangladesh
Background: Bangladesh, still a country of low prevalence for HIV/AIDS,
cases are increasing day by day and all risk factors for epidemic exists here. At
present among PLWHAs in Bangladesh, migrant workers are highest in number.
So for designing an effective Preventive program this at-risk group should be
given priority. To support this a base line study was done.
Methods: From July 2004 to June2005 a cross sectional study was done on
300 male migrant workers aged from 24-55 years attending 2 private clinics of
STD Physicians in Dhaka, Bangladesh. A standardized questionnaire containing
questions related to basic knowledge of HIV/AIDS was used in the survey.
Results: Analyzed data showed 21 (7.0%) had not even heard about HIV/
AIDS. 198(66.0%) thought that the disease is fatal, 25(8.33%/) believed that
the disease could be cured. Regarding the mode of transmission there are
many misconceptions, 82 (27.33%) thought that it was not sex related, 155
(51.66%) did not think it could be transmitted through infected blood, 112
(37.33%) answered HIV could be transmitted by mosquito bites, 78 (26.0%)
through coughing and 82 (27.33%) by just living together. 156 (52.0%) agreed
that HIV-infected people should be isolated while 144 (48.0%) disagreed. 62
(20.66%) respondents perceived they had higher risk of getting HIV infection
than the average and 238 (79.33%) answered no risk. Respondents who scored
higher on knowledge had more positive attitude towards PLWHAs.
Conclusions: The result indicates that base line knowledge of HIV/AIDS is
very poor, mostly due to low education level. As, at present this group of people
are at the top of the PLWHAs list, this group must be educated under a special
pre-departure counseling program, which will contribute a lot in prevention of
STDs and HIV/AIDS in Bangladesh.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1