20th International AIDS Conference - Melbourne, Australia


WEAD02 Living Better, Living Longer, Living Stronger: Women Living with HIV
  Oral Abstract Session : Track D
Venue: Plenary 3
Time: 23.07.2014, 11:00 - 12:30
Co-Chairs: Alice Welbourn, United Kingdom
Carol Nawina Nyirenda, Zambia

11:00
WEAD0201
Abstract
Powerpoint
Webcast
HIV infected women in Mexico: vulnerability, missed opportunities and late diagnosis
A. Martin-Onraët1, V. Alvarez-Wyssman2, P. Volkow-Fernandez1, A. Gonzalez-Rodriguez3, G. Velazquez-Rosas4, L. Rivera-Abarca4, I. Torres-Escobar5, J. Sierra-Madero6
1Instituto Nacional de Cancerología, Infectious Diseases, Mexico City, Mexico, 2Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, HIV Clinic, Mexico City, Mexico, 3Clinica Especializada Condesa, Mexico City, Mexico, 4COESIDA/CAPASITS, Oaxaca, Mexico, 5CAPASITS, Puebla, Mexico, 6Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Infectious Diseases, Mexico City, Mexico

11:15
WEAD0202
Abstract
Powerpoint
Webcast
Provision of information about safe conception, pregnancy and pregnancy prevention in Mesoamerican HIV care and treatment services: results from community-based research
T. Kendall1,2, C. Albert1, G. Garcia2, Mesoamerican Coalition for the Reproductive Rights of Women with HIV
1Harvard School of Public Health, Women and Health Initiative, Global Health and Population, Boston, United States, 2Balance, AC, Mexico City, Mexico

11:30
WEAD0203
Abstract
Powerpoint
Webcast
Unmet needs for health and social services and HIV risk behaviors among transgender women living with HIV in the San Francisco Bay area
T. Nemoto, M. Iwamoto, S. Suzuki, T. Cruz
Public Health Institute, Oakland, United States

11:45
WEAD0204
Abstract
Powerpoint
Webcast
Results of a brief intervention for reducing alcohol use among HIV positive women in Cape Town, South Africa
W. Zule1, I. Doherty2, B. Myers3, F. Browne4, T. Carney3, C. Parry3, W. Wechsberg2
1RTI International, Durham, United States, 2RTI International, Research Triangle Park, United States, 3Medical Research Council, Cape Town, South Africa, 4Harvard, School of Public Health, Boston, United States

12:00
WEAD0205
Abstract
Powerpoint
Webcast
Mortality and causes of death among women living with HIV in the United Kingdom in the era of highly-active antiretroviral therapy (HAART)
S. Croxford1, A. Kitching2, M. Kall1, M. Edelstein2, V. Delpech1
1Public Health England, HIV/STI Department, London, United Kingdom, 2Public Health England, London, United Kingdom

12:15
WEAD0206
Webcast
Moderated discussion

Powerpoints presentations
HIV infected women in Mexico: vulnerability, missed opportunities and late diagnosis - Alexandra Martin-Onraët

Provision of information about safe conception, pregnancy and pregnancy prevention in Mesoamerican HIV care and treatment services: results from community-based research - Tamil Kendall

Unmet needs for health and social services and HIV risk behaviors among transgender women living with HIV in the San Francisco Bay area - Tooru Nemoto

Results of a brief intervention for reducing alcohol use among HIV positive women in Cape Town, South Africa - William Zule

Mortality and causes of death among women living with HIV in the United Kingdom in the era of highly-active antiretroviral therapy (HAART) - Sara Croxford



Rapporteur report

Track D report by Shalini Bharat


The session theme was understanding vulnerability, unmet health and mental health needs, and mortality causes in relation to women living with HIV.

The paper by Martin-Onraet et al., on ‘HIV infected women in Mexico: Vulnerability, missed opportunities and late diagnosis’, highlighted the issue about missed opportunities of timely diagnosis and appropriate health care among women in a concentrated epidemic context, such as Mexico. The study conducted among 301 recently diagnosed Mexican women living with HIV showed that a majority (72%) were diagnosed due to HIV in partner or child, or being symptomatic, and some during pregnancy (11%). Despite high vulnerability due to sexual violence, early pregnancies, stable partner as source of infection, women were diagnosed late and were excluded from HIV care. Notable that nearly two thirds were not offered testing during pregnancy or when in medical care for HIV related symptoms. Deficiencies in health system and health policies combined with the perception that women in concentrated epidemics are less vulnerable explain women’s exclusion from HIV testing and care services. 

Kendall et al’s paper ‘Provision of information about safe conception and pregnancy in Mesoamerican HIV care and treatment services’ investigated if women living with HIV receive adequate information to make informed decisions regarding conception and fertility. 337 women living with HIV in Mexico, El Salvador, Nicaragua, and Honduras answered a questionnaire of whom 87% were on ART. Scientific information sharing was less than adequate for these women as less than half reported receiving information about prevention of mother to child transmission (56%), conception with reduced risk of transmission to sero-discordant partner (36%), or about bio-medical technologies about safer conception (21%). Likewise only about a fifth received information about dual protection measures or about ARV’s in relation to hormonal contraceptives to avoid pregnancy. Judgmental attitudes of health providers influenced what and how much information they gave to women with HIV, affecting women’ ability to make informed decisions. Training of health providers on Rights of positive women and on transmission within discordant relationships is essential.

In the paper ‘Unmet needs for health and social services and HIV risk behaviours among transgender women…’ Nemoto et al., reported results from a cross-sectional study of 573 transgender women living with HIV in the San Francisco Bay area. Nearly half of the transgender women reported unmet health and mental health needs with more African Americans, Caucasians and Latinas expressing these compared to Asian and Pacific Islanders. Findings have implications for interventions tailored to specific needs of diverse ethnic groups of transgender women and addressing ‘transphobia’ as a barrier to health care.

Zule et al’s paper ‘Results of a brief intervention for reducing alcohol use among HIV positive women in Cape Town, South Africa’ reported impact of a behavioural intervention among drug using women living with HIV in Cape Town area. Alcohol use was argued to harm the ‘treat and prevent’ program being linked both with HIV transmission risk and with poor treatment adherence. The intervention, Women’s Health CoOp (WHC), described briefly as using role play and individual counseling sessions, was shown to increase alcohol abstinence at 12 month follow up among HIV positive women in intervention arm compared to in the control arm.

Croxford et al’s paper ‘Mortality and causes of death among women living with HIV in the United Kingdom in the era of HAART’ highlighted the paradox of AIDS deaths among positive women in a developed country context and in an era of highly active ART availability when annual death rate among people with HIV has declined. Analyses based on national surveillance data on women (aged >15) diagnosed with HIV in England and Wales in HAART era (1997-2010) and linked to national death statistics, showed a five time higher mortality rate among women with HIV compared to deaths among general population women during the same period. CVD, liver diseases and mental health related death causes  pointed out to significance of managing co-morbidities in HIV services. Analysis underscored the importance of the issue of delayed diagnosis and low retention of women in HIV care in countries where focus is largely on key populations such as, MSM.

Overall, the session highlighted that in concentrated epidemics women with HIV are left behind and made more vulnerable due to deficient health systems and poor understanding about their specific health needs. This is unacceptable when evidence based HIV prevention and treatment services are available. Treatment is available but many women with HIV may be falling though the crack. Positive women in stable partnerships, with children or with fertility intentions, for example, are less likely to receive evidence based information on conception and contraception for positive people. Delayed diagnosis is adding to disproportionate AIDS deaths among women. Ethnic diversity among women with HIV requires interventions to be tailor made for their contexts and situations. Both from the perspective of human rights and science there is every reason why women living with HIV should be served as part of universal access to health care initiative. The key message ‘gender analysis of concentrated epidemics is important’ to have an inclusive HIV response.




   

    The organizers reserve the right to amend the programme.