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

Track C
MOPDCOI
Do economic developement programmes reduce
vulnerability to HIV and intimate partner violence
(IPV): qualitative perspectives from a prospective
cluster-randomized trial
G. Phetla', J. Busza2, P. Pronyk3, J. Kim2, R. Euripidou4, J. Hargreaves2,
L. Morison2, C. Watts2, J. Porter2. '1Rural AIDS and Development Action
Research Programme (RADAR), School of Public Health University of the
Witwatersrand, Johanneburg, South Africa, 2London School of Hygiene and
Tropical Medicine, London, United Kingdom, 3Rural AIDS & Development
Action Research Programme, School of Public Health, University of the
Witwatersrand, Acornhoek, South Africa, 4Rural AIDS & Development Action
Research Programme, School of Public Health, Acornhoek, South Africa
Background: Poverty and gender inequality drive the HIV epidemic in much
of southern Africa. The Intervention with Microfinance for AIDS and Gender
Equity (IMAGE) study is a cluster randomised trial of a structural intervention
for the prevention of HIV and IPV that integrates gender and HIV education
into an existing microfinance (MF) initiative. Qualitative methods were used to
document changes in economic vulnerability, social capital, gender equity and
"diffusion-of-innovation" over a 3 year period.
Methods: Qualitative data comes from focus group discussions with loan
groups, in-depth interviews with both participants, dropouts and young people,
non-participant observation of bi-weekly loan centre meetings, and participatory
learning and action (PLA) workshops among young people in the communities.
Thematic content analysis outlines key changes at the individual, household,
and community level in response to the intervention.
Results: Among loan recipients, self-sufficiency improved both materially
(ability to provide) and socially (heading the household), including an increase
in self-confidence. Participants' exposure to the intervention has improved
many of their life skills, particularly their ability to communicate effectively
in their households and wider community. Participants and their household
members showed an increased awareness of HIV/AIDS and gender issues.
There was substantial evidence of diffusion through community mobilization
efforts around both HIV and IPV. In some centres, problems with financial
performance reduced intervention uptake. While the intervention has had
positive impacts on the lives of many participants and households, some see it
more ambiguously. Effects from education vs. those due to MF were inseparable
in the minds of participants.
Conclusions: Qualitative data suggests the intervention enhances selfsufficiency, self-confidence, and critical-thinking around issues including genderbased violence, gender roles and HIV/AIDS. There is evidence to support wider
changes at the household and community level. Quantitative results will also be
presented at the conference.
MOPDCO2
Sexual assault, sexual risks, and gender attitudes
among South African men
D. Cain', L.C. Simbayi2, C. Cherry', N. Henda2, S. Kalichman1. 'University of
Connecticut, Psychology, Storrs, United States, 2HSRC, Cape Town, South
Africa
Background: Sexual assault and HIV infection are both prevalent and related
social problems in South Africa. The current study examined attitudes toward
women, acceptance of gender violence, and masculine ideological beliefs in
relation to sexual assault history and HIV risk behaviors among men in a Cape
Town township. Also, based the results, an intervention was developed and
pilot tested.
Methods: Men (N = 435) completed anonymous surveys; 57% indigenous
African, 35% identified as Colored, and 8% White or Indian; 46% between
the ages of 18 and 26; 50% unemployed; median weekly income R420 South
African Rand (US$70).
Results: One in five men had either threatened to use force or used force
to gain sexual access to a woman in their lifetime. Men with a history of
sexual assault reported greater numbers of sex partners and higher rates
of unprotected intercourse in the previous 6 months than their non-sexually
assaultive counterparts. Men with a history of sexual assault were also more
likely to endorse hostile attitudes toward women and were more likely to accept
violence against women. Based on these findings a team of primarily South
African women and men developed and pilot tested a network-level intervention
model designed to both reduce violence accepting social norms and reduce
high risks sexual practices among men; 55 men were enrolled using chain
recruitment strategies. Results show evidence for the feasibility acceptability
of intervening with men for both sexual violence and HIV risk reduction in
South Africa.
Conclusions: These findings extend previous research to show that men who
have a history of sexual assault also exhibit elevated risks for HIV/AIDS and

that both sexual violence and HIV risk can be addressed in a single integrated
intervention model.

MoPDCo3
Post-exposure prophylaxis following sexual assault
in Cape Town: adherence and HIV risk behavior
M. Roland', L. Myer2, R. Chuunga3, L. Martin2, A. Maw2, T. Coates4,
L. Denny2. 'University of California San Francisco, Postive Health Program
at SFGH, San Francisco, United States, 2University of Cape Town, Cape
Town, South Africa, 3Jooste Hospital, Cape Town, South Africa, 4University of
California Los Angeles, Los Angeles, United States
Background: Post-exposure prophylaxis (PEP) use following sexual assault
in low HIV prevalence areas is associated with poor adherence and followup. Adherence, side effect rates and ongoing HIV risk behavior among sexual
assault survivors receiving PEP in high HIV prevalence areas are unknown.
Methods: Observational cohort of adult and adolescent sexual assault
survivors in Cape Town, South Africa. We describe adherence, side effects, HIV
risk behaviors and 6 month HIV testing outcomes. Predictors of adherence and
unprotected sex were evaluated in linear regression models.
Results: 135 subjects enrolled. Median days of PEP completed was 27, however
35% missed > one dose in the prior 4 days or discontinued PEP within a week.
No demographic, socioeconomic or risk predictors were associated with poor
adherence. Symptom rates were similar between those who did and did not
adhere. 58% reported unprotected intercourse in the 6 months prior to the
assault, 93% with a single partner of unknown HIV status. At months 1, 3 &
6 following the assault 37%, 53% & 66%, respectively, reported unprotected
intercourse. In unadjusted analyses, predictors of unprotected sex at 3 months
included baseline unprotected sex, older age, employment and higher income.
In multivariate analysis, prior unprotected sex was associated with subsequent
unprotected sex (OR 8.3; 95% CI 3.3, 20.9). There were 4 seroconversions at
6 months (risk = 3.7%; 95% CI 1.0, 9.1). Two were probable PEP failures, one
each with excellent and incomplete adherence. The other 2 seroconversions
probably resulted from ongoing exposures.
Conclusions: Although overall PEP completion rates were high, adherence
was often incomplete. Ongoing HIV risk behavior was common and probably
resulted in new HIV acquisition. To improve HIV prevention services for sexual
assault survivors, universal adherence interventions and targeted intensified
HIV risk reduction counseling should be provided.
MOPDCO4
A prospective cohort study of universal offering of
HIV- 1 post-exposure prophylaxis in sexual assault
victims/survivors
M. Loutfy', S. MacDonald2, T. Myhr3, H. Humphries3, J. Du Mont', T. Leeke3,
A. Rachlis'. 'University of Toronto, Medicine, Toronto, Canada, 2Sexual
Assault Treatment Centre Network, Toronto, Canada, 3Centre for Research in
Women's Health, Sunnybrook and Women's College Health Sciences Centre,
Toronto, Canada
Issues: Although HIV is a potential consequence of sexual assault, few
jurisdictions have guidelines on HIV post-exposure prophylaxis (PEP). We
carried out a large prospective study on counselling and offering HIV PEP
universally to sexual assault victims in Ontario, Canada.
Description: Sociodemographic, assailant, and assault data were collected on
serial clients from 24 hospital-based Sexual Assault Treatment Centres. Those
at high or unknown risk of HIV acquisition, presenting <72 hours post-assault
were offered PEP. Combivir~ 1 pill and Kaletra~ 3 capsules BID were given
for 28 days. Follow-up was provided at day 2-4, week 1, 2, 3 and 4; side
effects were assessed at each visit. Univariate analyses were carried out using
PEP uptake and completion rates as the endpoints and risk category (high-risk
versus unknown risk) as the primary predictor.
Lessons learned: Of 1,103 evaluable clients, 81 (7.3%) were at no-risk, 88
(8.0%) high-risk, and 934 (84.7%) unknown-risk of HIV acquisition. After
excluding clients who presented >72 hours, were HIV-positive or at no-risk,
900 (81.6%) were eligible for PEP. Rates of acceptance and completion were
remarkably high:
HIV PEP Offered HIV PEP Accepted 28-day Course
Completed

High-risk

97.2% (69/71) 66.7% (46/69) 23.9% (11/46)

Unknown-risk 87.9% (729/829) 41.3% (301/729) 33.2%/ (100/301)

Overall

88.7% (798/900) 43.5% (347/798) 32.0% (111/347)

Although not more likely to complete PEP, high-risk clients were 2.2 times
more likely to accept PEP than those at unknown-risk (p=0.01). Factors
that increased both acceptance and completion included being attacked by a
stranger and client anxiety. Side effects were common (77.1% experienced
grade 2-4 symptoms).
Recommendations: Since the universal counselling and offering of PEP to
sexual assault victims/survivors in our study appears feasible and warranted,
all jurisdictions should consider developing guidelines for this topic. Since we
found that although high-risk clients accepted PEP at a greater rate than those
at unknown-risk, equal numbers completed the course, a universal strategy for
offering PEP should be considered. Since our completion rate was three times
that reported in earlier studies, more rigorous follow-up should be considered
by all programs.

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