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

Description: Stepping Stones and REFLECT (STAR) is an approach that uses
relevant participatory tools and techniques to analyze and tackle issues that
affect communities from basic agriculture to war, within the context of HIV/
AIDS and to facilitate a process of exploring how these issues link with HIV/
AIDS and how to take effective action to improve or solve them. Community
people work in peers and separate gender and meet at times of their choosing
to reflect and share experiences & learn about HIV, analyzing their local realities
and challenges within a context of HIV/AIDS. Communication skills, Power
analysis, and gender empowerment underpins most of the HIV/AIDS education
discussions.
Lessons learned: Creating a safe space using participatory approaches for
people to discuss sensitive sexual issues is a strong factor in breaking the
silence on HIV in religious communities and speaking out against discrimination
of PLWHA.
Recommendations: HIV/AIDS education programmes should encourage joint
working between different peers, men and women, boys and girls in creating
a better integrated response to the epidemic at individual, household and
community levels.
TUPE0806
Dreams and desires: exploring the sexual and
reproductive choices of HIV positive men and
women - a qualitative perspective
K. Osborne. International Planned Parenthood Federation, HIV/AIDS, London,
United Kingdom
Issues: With increasing access to ARV treatment, acknowledging and
responding to the sexual and reproductive health (SRH) choices and desires of
PLHIV is vital for policy and programme reform. Yet, little is known about the
fertility desires and SRH perspectives of PLHIV.
Description: IPPF, collaborating with GNP+, undertook qualitative research
into the experiences of HIV positive fathers around the world. This highlighted
the complexity of parenting for a range of fathers. It showed how they play a
pivotal role in the lives and health of their children and families, and how HIV
had shaped these relationships. A separate study with ICW analyzed the fertility
desires of HIV positive women. These two studies emphasise a number of areas
neglected in our response to date.
Lessons learned:
1. Increased parenting in the age of AIDS: PLHIV increasingly face decisions on
parenting - yet their status creates additional challenges and difficulties.
2. Policy Gaps and Policy Champions: A lack of attention to the SRH needs of
PLHIV leads to stigmatisation and denial of essential services. Yet, key HIV
positive individuals are acting as champions for policy change, and also as role
models in their communities.
3. Stigma and Discrimination is becoming more subtle: HIV positive fathers
play a central role in their children's lives, yet the stigma they face is a disabling
factor (e.g. denial of access). HIV positive women also face a range of hurdles
in accessing SRH services (e.g. health care provider attitudes).
4. Status and Disclosure: Disclosing their HIV status is a turning point for
many people, in how they view themselves, and how they are viewed by their
children
Recommendations: Action is needed to ensure HIV/AIDS responses
acknowledge and address the SRH needs and desires of PLHIV. This should
include an emphasis on choice; addressing provider attitudes and biases and
the importance of positive prevention.
TUPE0807
HIV positive women's reproductive rights and
choices
U. Kanungsukkasem. Mahidol University, Institute for Population and Social
Research, Nakornpathom, Thailand
Background: This study examined how HIV impacts on women's sexual and
reproductive rights and choices.
Methods: A participatory research was conducted in 3 regions of Thailand. A
survey of 329 positive women aged 15-49 years and 60 in-depth interviews
were carried out by trained positive women with technical assistance from
academic institutions.
Results: The majority of women were diagnosed after their husbands became
ill or when they went for antenatal care. Only 16% decided to be tested on their
own. After diagnosis, about one-half of the women continued to have sexual
relations; yet, 39% did not practice safe sex. 21% of not currently married
women wanted to have spouses because they wanted to have companion
or family. One major concern of positive women was how to simultaneously
manage motherhood and the risks of HIV. Consequently, over half of the
positive women terminated their pregnancies because of medical or social
reasons. Lack of confidentiality was also critical since some women reported
that family members, friends, or health providers revealed the women's status
without their consent. Women thus felt threatened, which blocked their right to,
desire for, and accessibility to health services. Women who used reproductive

health services, despite receiving good care, noted that their rights were
violated through the poor attitudes and lack of interpersonal communication
skills of health providers.
Conclusions: The study recommended several concerted actions to increase
women's accessibility to simple, accurate, and up-to-date information; to enforce
strict confidentiality on the part of health personnel; and to raise community
awareness and acceptance of positive persons to reduce stigmatization and
discrimination

TUPEO808
How aware of current sexual health issues are
HIV+ gay men (MSM) at a central London clinic?
R. Ferrand, S. de Silva, A. Ezeokoli, J. Cartledge. Camden Primary Care Trust,
Mortimer Market Centre, London, United Kingdom
Background: Health promotion campaigns are underway to alert HIV+ MSM to
current STD outbreaks in this group, and to inform MSM about post-exposure
prophylaxis. We asked patients attending our HIV clinic about their knowledge
and risks relating to these issues.
Methods & results: A healthcare worker-completed questionnaire was answered
by 90 HIV+ MSM, of whom 34% reported unprotected anal intercourse (UPAI)
& 8% fisting in the preceding 3 months. 28% reported UPAI and more than one
partner in that time frame. 14% of patients had had UPAI with a contactable
HIV-discordant partner to whom they had not disclosed their HIV+ status.
Half the patients had a current regular partner to whom 44/45 had disclosed
their HIV status, 41/45 knew their partner's status (25 HIV+ve, 16 HIV -ve).
Although overall 72% of men were aware of post-exposure prophylaxis (PEP),
40% (8/20) of patients with sero-discordant regular partners were unaware of
PEP. Overall 77% were aware of HIV super-infection.
When questioned about current STD outbreaks among HIV+ MSM, 69%were
aware of hepatitis C (HCV), 78% of syphilis, but only 48% of LGV.
Overall 75% had been screened for sexually transmitted infections in the past
12 months, although 5% of men had never been screened. There were 26
episodes of sexually-transmitted infections diagnosed amongst 14 of the 90
MSM in the past 12 months.
Conclusions: Although Sexual Health-Promotion messages are reaching many
HIV+ MSM, a significant minority remain unaware of PEP & superinfection..
Half of our sample were unaware of LGV and 20-30% were unaware of current
HCV and syphilis outbreaks. Staff providing HIV care to MSM cannot assume
awareness of these issues, and need to continue to ask about sex when seeing
patients to advise about STD outbreaks and screening, ongoing notification of
new partners, and PEP.
TUPE0809
Reproductive behaviors of HIV-infected women
before and after the availability of HAART
A. Sharma', J. Feldman2, E. Golub3, M. Cohen4, N. Nathwanis, S. Silver6,
E. Robison', H. Minkoff0, Women's Interagency HIV Study. 'SUNY Downstate
Medical Center, Infectious Diseases, Brooklyn, United States, 2SUNY
Downstate Medical Center, Preventive Medicine, Brooklyn, United States,
3Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore,
United States, 4Cook County Hospital, Medicine, Chicago, United States,
5University of Southern California, Los Angeles, United States, 6George
Washington University Medical Center, Pathology, Washington D.C.,
United States, 7Albert Einstein College of Medicine, Bronx, United States,
8Maimonides Medical Center and SUNY Downstate Medical Center, Obstetrics
and Gynecology, Brooklyn, United States
Background: Using a large cohort study of HIV-infected and at-risk women,
we compared the influence of HIV infection on childbearing before and after the
availability of HAART.
Methods: Enrollment in the Women's Interagency HIV Study (WIHS) took
place between 1994-1995 (pre-HAART era), and again between 2001-20002
(HAART era). Live birth rates prior to study enrollment were compared for
women aged 15-44 years between pre-HAART and HAART era cohorts for HIVinfected and HIV-uninfected women using Poisson regression models. For HIVinfected women we included live births between the time of HIV diagnosis and
study entry; for those in the HAART era cohort, only live births after 1996
were included. Potential interactions between therapy era, HIV serostatus, and
selected covariates were examined.
Results: Subjects at risk for pregnancy included 2012 HIV-infected and 569
HIV-uninfected women in the pre-HAART cohort, and 476 HIV-infected and 405
HIV-uninfected women in the HAART era cohort. Among HIV-uninfected women
enrolled during the HAART era, the live birth rate per 1000 person-years was
5% higher than among those enrolled during the pre-HAART era (106.7 versus
101.6), whereas among HIV-infected women, the HAART era rate was 150%
higher (142.5 versus 57.0, p=.001). Among HIV-infected women, the largest
increases in live birth rates between the two eras were seen in age >35 years
(+306%), >high school education (+286%), absence of depressive symptoms
(+225%) and heterosexual exposure (+164%). Interactions were significant
between therapy era, HIV serostatus, and covariates age and education,
reflecting a higher rate of change in live birth rate for women >35 years (vs
<25, p=.02), and >high school education (vs <high school, p=.05.)
Conclusions: The live birth rate for HIV-infected women was dramatically
higher in the HAART era than it had been pre-HAART, suggesting that the
availability of effective therapeutic interventions has profoundly impacted the
reproductive decisions of HIV-infected women considering childbearing.

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