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

Tuesday
15 August
Oral
Abstract
Sessions

living in France and diagnosed HIV positive for at least 6 months. This analysis
only included HIV-treated patients who declared sexual activity in the previous
4 weeks. Patients who declared sexual dysfunction in the previous 4 weeks
were compared with those who did not using chi-squared test and logistic
regressions.
Results: Of the 2,932 patients included in VESPA, 1,343 were included in our
study. Homosexual men accounted for 47% of the sample while 22% were
women. Steady partnership was found in 72% of patients and 46% reported
casual partners in the previous 12 months. Median number of sexual intercourse
was 5 (IQR=[3-10]) in the previous 4 weeks. Sexual dysfunction was reported
by 33% of the selected patients, and was more frequent in patients with low
sexual activity. Immuno-virological outcomes were not associated with sexual
dysfunction. After multiple adjustment for sexual frequency, a larger HIV
network, reporting HIV-discrimination from their friends and/or sexual partners
were all significantly associated with sexual dysfunction. In addition, suffering
from lipodystrophy and reporting very disturbing HIV-related symptoms were
also independently associated with sexual dysfunction.
Conclusions: HIV and treatment experience are associated with sexual
dysfunction. Psychological support focused on HIV experience should be tested
as a tool to improve sexual quality of life.
TUAD0 104
Perceptions of HIV positive swazi women on
childbearing
N.A. Sukati, P. Shabangu. University of Swaziland, Community Health Nursing
Science, H, Swaziland
Purpose: The purpose of the study was to identify and describe perceptions of
HIV positive Swazi women on childbearing. Specifically the study (1) assessed
their level of knowledge on mother-to-child transmission (MTCT) and its
prevention, (2) established the extent of contribution they have on reproductive
decision-making, and (3) ascertained their opinions of reproductive health
services.
Methods: A descriptive qualitative approach utilizing focus group discussion
was employed to collect data. Two focus group discussions were conducted with
women purposively selected through the Swaziland AIDS Support Organization
(Mbabane) and Zamimphilo Organization (Lobamba). Data was audio-taped,
transcribed verbatim in Siswati and translated into English. Qualitative data
and demographic variables were analyzed through generating themes and
descriptive statistics respectively.
Results: Twelve women (six per group) participated. Their ages ranged from
15 to 44 years, half (n=6) were married, four single, one cohabiting and one
widowed and all had children. Eleven of them were unemployed and seven were
on ART. Women mentioned that MTCT can be prevented by caesarian section,
exclusive breastfeeding for 6 months, condom use to decrease viral load
during pregnancy, and by God's grace. Fear of violence prevented women from
insisting on condom usage. Pressure from in-laws forces HIV positive women
to have children despite their status, the desire to portray "femininity" and
fulfill womanhood also contribute. However, women worried about the longevity
of theirs and children's lives and stigmatization by society. Many expressed
concern over nurses assigned to work with HIV positive women who do not
understand their needs for moral and emotional support.
Conclusions: Knowledge about one's HIV status had limited influence on
decision-making about childbearing, cultural expectations override. Status
disclosure is difficult for women for fear of violence, abandonment and financial
insecurity. Nurses need sufficient training to develop sensitivity toward HIV
positive women's reproductive needs.
TUADO 105
Reproductive desires of men and women living with
HIV in Brazil: a challenge for health care
V. Paival, N. Santos', I. Franca Jr3, V.-F. Elvira2, J.R. Ayres4,
A. Segurados. 'University of So Paulo, IP/NEPAIDS, Sao Paulo, Brazil,
'So Paulo State STD/AIDS Program, Prevention / NEPAIDS, So Paulo,
Brazil, 'University of S~o Paulo, Public Health/ NEPAIDS, So Paulo, Brazil,
'University of S~o Paulo, Preventive Medicine/ NEPAIDS, So Paulo, Brazil,
'University of S~o Paulo, School of Medicine/ NEPAIDS, So Paulo, Brazil
Introduction: People living with HIV/AIDS (PWAIDS) desire to have children
and do have them. The debate about fertility options for PWAIDS has not been
sufficiently addressed by health care providers. Rare studies have addressed
HIV-positive men in this regard, enabling analysis of gender differences.
Objectives: To describe attitudes toward future parenthood and to identify
predictors of the desire to have children of a sample of PWAIDS attending
two specialised AIDS care centres in So Paulo-Brazil, where antiretrovirals are
freely and universally distributed.
Methods: A consecutive sample of 729 women and 250 bisexual or heterosexual
men answered a questionnaire concerning demographic characteristics,
attitudes towards parenthood, length of time since diagnosis, sexual and
reproductive history, current use of antiretrovirals, evaluation of provided

reproductive health care and counselling and antecipation of physicians'
reactions to parenthood desires of PWAIDS. Prevalence of the outcome (desire
to have children) was estimated among men and women and associated factors
sought after using a multivariable logistic regression model.
Results: 27.9% participants reported desire to have children. Among men this
proportion was 50.1% in contrast to 19.2% of women. Bisexual men were
more likely to desire to have biological children. Variables shown independently
associated with desire to have children included: younger age, sex (male),

having no children, living with one or two children and having a heterosexual
partner. People with lower or ignored income were less likely to desire to have
children. MTCT knowledge was significantly lower among men.
Conclusions: In contrast with previous studies in developed countries, this
study demonstrated significant differences between men and women. Desire
may be stronger among men, but usually parenthood is integrated as a female
issue in most health services. Access to moral free objective information about
reproductive options and rights, and male involvement in reproductive health
care are important challenges for the organisation of services.
TUADO201
Cost-effectiveness of initiating and monitoring
HAART based on WHO versus US DHHS guidelines
in the developing world
A. Vijayaraghavan', M. Efrusy', P. Mazonson', O. Ebrahim2, I. Sanne3,
C. Santas', G. Sanders4. 'Mosaic Health Care Consultants, Larkspur, United
States, 2Brenthurst Clinic, HIV/Clinical Pharmacology & Therapeutics,
Johannesburg, South Africa, 3University of the Witwatersrand, Clinical HIV
Research Unit, Johannesburg, South Africa, 4Duke University, Duke Clinical
Research Institute, Durham, United States
Background: World Heath Organization (WHO) 3 by 5 guidelines recommend
initiating HIV treatment fairly late in the disease process. No studies have
compared the cost-effectiveness of this strategy to more inclusive developed
world guidelines.
Methods: We developed a lifetime Markov model of costs (direct and indirect),
quality of life, survival, and transmission to sexual contacts, associated with
treating HIV patients according to US Department of Health and Human Services
(US DHHS) guidelines (initiate treatment at CD4<350 or viral load>100,000
and monitor with CD4 counts and viral load every three months) versus WHO
3 by 5 guidelines (initiate treatment at CD4<200 or for patients with AIDS and
monitor using CD4 counts every 6 months). Costs and prevalence data came
from South Africa.
Results: Treating HIV patients according to US DHHS versus WHO guidelines
increased life expectancy by 2.09 quality-adjusted life years (QALYs), at an
estimated lifetime direct cost of US$10,323 per patient, for an incremental
cost-effectiveness ratio (ICER) of $4,939 per QALY. Incorporating the costs and
benefits of transmission lowered the ICER to $3,869 per QALY, while including
indirect costs (without transmission) lowered the ICER further to $1,305 per
QALY. Results were sensitive to the cost of second-line HAART regimens and
rates of transmission to sexual contacts.
Conclusions: Including the effects on decreased transmission, treating HIV
patients in some developing world countries according to US versus WHO
guidelines is highly cost effective, at 79% of South African per capita GDP.
Adding indirect costs (without transmission) makes implementing US DHHS
guidelines even more cost-effective at 27% of South African GDP. Over a fiveyear period, treating all HIV patients in South Africa according to US DHHS
versus WHO guidelines would increase direct medical costs by US$14.5 billion
but would result in approximately 400,000 fewer deaths and 1.1 million fewer
new AIDS cases.
TUADO202
Pharmaceutical patents and access to HIV/AIDS
treatments: the Brazilian experience
C.M. Meiners', J. Chauveau2, S. Luchini', J.-P. Moatti2, ANRS /
ETAPSUD. 'Ministry of Health, Brasilia, Brazil, 2INSERM-U379 / ORS-PACA,
Marseille, France, 3GREQAM / EHESS, Marseille, France
Background: Among Developing Countries, Brazil has pioneered in providing
free and universal access to antiretroviral (ARV) therapies. Brazilian procurement
strategy for ARV has been a key element to lower drug prices and to allow
success of its programme. This paper conducts econometric analyses on
determinants of HIV/AIDS drugs prices in Brazil in order to better understand
the pricing mechanism for these drugs.
Methods: Retrospective data on real ARV transactions purchased on behalf
of the Brazilian National STD/AIDS Programme between 1998 and 2002 were
collected. For every transaction, source prices and quantities were recorded
as well as precise characteristics of drug, involved parties and context of
transaction. Descriptive analyses were done using price per daily dose (PDD).
Logarithms of PDD were used as the dependent variable in multiple linear
regression model with the characteristics of products, transactions and contexts
being used as explanatory variables.
Results: An overall 65.1% decrease of mean PDD has been observed between
1998 and 2002. If all drugs have experienced such an evolution, the number
of off-patent interchangeable drugs within a therapeutic class has an important
downward effect on prices whilst drugs belonging to more recent therapeutic
classes remain more expensive. -estimates of multivariate analyses confirm a
significant price difference between therapeutic classes as well as a significant
impact on prices of both feasibility of drug substitution and patent protection. It
also highlights the role played by generic competition in Brazil (-0.236).

Conclusions: Generic competition generated by local ARV production has
been a key determinant of ARV price decrease. Nevertheless, ARV drugs still
account for almost half of the total cost of the whole Brazilian AIDS programme.
Issues regarding intellectual property rights remain crucial to allow long term
sustainability of price reduction and access to most recent therapeutic advances
in Brazil.

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