The INFO Project Blog

So I finally ventured out of the Holiday Inn Tlalplan for dinner - not because of lack of wanting to but because of convenience.  The hotel is about an hour and a half away from the conference and with Mexico City traffic, by the time you get back you’re exhausted and just want to eat at the not very good hotel restaurant.  But I stopped at the metro at Zocalo, the main plaza and ate there.  Enough about food - here’s a round-up of today’s sessions that I attended.

Session 1: Impact of HIV/AIDS on Human Reproductive Development in the Social Context

• Prevention, treatment  and reproductive choices, M. Stevens, South Africa: The interaction between  ARVs and contraception, esepecially hormonal contraception is not very well understood.  There is a need for specific drug guidelines for pregnant women which will contribute to adherence and prevent resitsance.  Prevention messages need to be life affirming and not treat women solely as vectors of disease.  Positive women need to be given the correct information to make informed choices about motherhood.

• Women, AIDS, Fertility and desire: Vioelta Ross, Bolivia, member of Bolivian people living with HIV network:  Violeta, a positive women, discussed her intentions and desires to be a mother.  She could not discuss these with her father, as he is ap preacher, holiding conservative views about motherhood prior to marriage.  Violeta’s emotional charge stated that positive mothers should have the opportunity to have children.  She discussed her worries that her ARVs may not be available in Bolvia at the time she gets pregnant, as supply is not reliable.

• Mother and child dyad issues: Breastfeeding and child survival, A. Coutsoudis, UKZN, South Africa: Dicussed the change in UN/WHO guidelines which state that HIV positive women should exclusively breastfeed for the first six months of a child’s life, if there is not criteria in place for safe alternative feeding, including safe water.  Positiev women may treat their breast milk with the flash heating/pasteurization method to enusre safety.  HAART should be provided to breastfeeding mothers if possible to diminish the risk of transmission.

• The economics of social reproduction: inheritance, land, and emplyment ussues for women, P. Nanda, ICRW, India:  Property rights can protect women from HIV through giving them better decision making within the household and and economic security. More quantitative studies on land ownership and women and its relation to HIV transmission need to be conducted.

• Widowhood:  P. Koussalla, Positive Women’s Network, India: Widows living with AIDS face double discrimination - they are blamed for transmiting the disease to their deceased husband, and as a result of discrimination can not obtain services such as land rights and pensions.

 Sessions 2: Implementing Novel Prevention Programs.  This session presented examples from innovative HIV prevention programs from around the world.

• Community-based alcohol-related HIV risk reduction for men and women in Cape Town Africa, L. Simbayle, South Africa:

85 percent of new sex partners in Cape Town meet at “shebeens”, or small informal bars.  Research participants were recruited from the shebeens.  A test group was given a three hour HIV/alcohol  intervention and the control group received only 1 hour of HIV/alcohol education.  Participants were followed up for 3 and 6 month and were given questionnaires about their drinking habits prior to enrollment.  Those light drinkers showed decreased unprotected intercourse after the three hour session, however heavy drinkers showed no change.  Additionally, light drinkers showed a decrease in use of alcoholbefore sex after the intervention.

• Effects of peer-intervention on work-related HIV prevention for urban health workers in Malawi, C. Kaponda, University of Malawi:  This study examined the effect of of HIV peer intervention on health worker knowledge regarding universal precautions.  The intervention included 6 sessions on HIV/AIDS and condom use and four sessions related to AIDS treatment, compliance and universal precautions.  Participants exposed to the intervention had a s significant increase in knoweldge about universal precautions, increased hand-washing behavior and increased the amount of time they spent teaching their clients about HIV.   
• Building national capacity for the implementation of safer-sex mass media campaignss in Eastern Europe and central Asia, Tatiana Grechukhina, Russian Federation: Illustrated campaigns across Eastern Europe that promoted safer sexual activities. Yeah communication! This presentation seemed quite in line with what CCP does.  Russia and Moldova have a high literacy rate and developed mass media, making it easier for the message sto penetrate the youth market.  Communication messages were designed based on research, adapted to the local context and pretested.  There was a 12 step model that was utilized to create these messages which began with exploratory missions and ended with evaluation.  The Moldova clip previewed was entitled “Pay attention to every detail of your life: be fashionable, stylish and safe” and showed a couple discussing sexual health while looking through clothes in a closet.

The session I found most stimulating and exciting of the whole day was the last that I attended, The AIDS Epidemic in the USA.  Representative Barbara Jordan, pictured here, introduced the sessions.  Rep. Jordan is an advocate for domestic HIV prevention, and is pushing Congress and government agencies to approve a National AIDS plan and a single domestic AIDS strategy she dubbed “domestic PEPFAR.” The session focused on the new prevalence and incidence stats published by CDC this past week, which show that the true number of new infections each year has actually been underestimated. The session’s main point was that HIV/AIDS still remains a huge problem in the US especially among MSM and minority populations.

• HIV/AIDS in the US: Current Trends and Future Challenges, Dr. Kevin Fenton, Director of HIV/AIDS, TB, Viral Hepatitis, CDC: A new method has been employed to distinguish recent infections in the past 5 months from earlier infection.  The method, known as the STARHS method, along with surveillance was used retrospectively going back to 1977 to gain a better picture of the epidemic. Using the new methods, in 2006 56, 300 new infections occurred in the US, 40 percent higher than previously reported.  The highest incidence in 2006 based upon the data was among MSM, and MSM are the only group to show increases in prevalence since the early 1990s.  The largest percentage of incident cases are among African-Americans (45 percent).  Those age 13-39 bear the brunt of HIV incidence.  When looking at prevalence rates, it has been discovered that between 252,000-312,000 Americans do not know their status.  The overall prevalence is .047, however prevalence among blacks is two percent and among Hispanics is 3 percent.  14,000 AIDS deaths still occurred in the US in 2006, resulting from those diagnosed too late or not on treatment due to discrimination and stigma.  There is concern about complacency of HIV as a public health threat in the US.  HIV stigma persists, the Internet allows people to meet partners and structural factors such as poverty and homophobia exist.  The CDC will expand testing, expand access to effective programs, review their current prevention portfolio and create a new strategic road map for HIV prevention.
• The HIV Epidemic in MSM in the United States, Dr. Ronald Valdiserri: From 2001-2005 the number of new AIDS cases in MSM in the US hasincreased.  There has been a decline in white MSM cases, but an increase in African-American and Hispanic MSM cases.  Data from 33 states that have anonymous name based reporting show that two thirds of MSM infected between 2001-2006 were 25-44 years old., 42 percent were white, 36 perecnt were African American and 19 percent were Hispanic.  Blacks represent 13 percent of the total US population, and Hispanics represent 14 percent, thus both are disproportionately affected by HIV/AIDS.  Behaviotral surveys conducted by CDC in 2003-2004 showed that 47 percent of surveyed MSM reported that they had unprotected anal intercourse in the past twelve months.  On a positive note, greater than 90 percent of MSM surveyed said they had eve been tested for HIV.  Prevention needs to once again be brought to the forefront for MSM in the US - Funders and policy makers need to be informed and understand that HIV prevention is both effective and cost-savings.  Strategies must be implemented to make men aware of their serostatus.
• Trends in HIV-related  risk behaviors among US adolescents: is progress stalling? Dr. Laura Cahn, CDC Department of School Health: A national youth risk behavior was conducted among youth age 14-17 who attend school.  Results from 9 surveys conducted from 1991-2007 were analyzed.  Between this time period, the percentage of those having sexual intercourse decreased, the percentage of those having grater than 4 lifetime partners decreased, and the percentage of those who were currently sexually active at time of survey increased. Condom use increased from 1991-2003, however has remained stagnant since 2003.  The percentage of males who reported that they were sexually active decreased from 1991-1997 but then leveled off from 1997-2007.  The percentage of African Americans who reported that they were sexually active decreased from 1991-2001 but then leveld off from 2001-2007.  Renewed efforts need to be undertaken to delay onset of sexually activity and increase condom use among adolescents, especially among male, black and Hispanic adolescents.
• Efficacy of an intervention in reducing HIV risk behaviors, non-viral STIs and HPV among African-American women: Results of a randomized controlled trial, Dr. Gina Wingood, Emory School of Public Health: African American women in the deep South are severely affected by HIV infection.  An intervention was designed to foster ethnic and gender pride, foster self esteem, self worth and discourage unhealthy relationships.  The intervention conistsed of 2 4 hour sessions based on the AMOUR prevent package (Abstain, Mutual stimulation (non-penetrative), Oral sex (protected), Uninfected partner (STI free), Regularly use condoms and reduce partners).  The control group received 2 4-hour sessions on general health promotion.  Those in the intervention group were more likely to advise their main partner to get an STI test, more likely to get an STI test, more likely to reduce to the number of partners and less likely to engage in casual sex and acquire a non-viral STI.  Single prevention strategies may not be effective or feasible and the study showed that a package of female initiated control options can be effective.
• Housing status and HIV risk behaviors among homeless and housed persons with HIV in the United States, Dr. Daniel P. Kidder, HIV/AIDS, TB, Viral Hepatitis, CDC: Surveys conducted by CDC from 2000-2003 showed that compared to housed respondents homeless respondents had greater odds of having more sexual partners, exchanging sex for drugs, money or food, having unprotected sex with a partner of unknown serostatus, using injection and non-injection drugs and alcohol.  Little research has been reported on homeless people living with HIV in the US and results from this analysis show the importance of screening for housing status for people living with HIV/AIDS.