14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. TuPeG5665

ISSUES: The South African (SA) province of KwaZulu Natal (KZN) is at the epicenter of the HIV epidemic in sub-Saharan Africa. 1 in 4 adults in SA are HIV-infected, with estimates of 1 in 3 in KZN. Over 35% of pregnant women in KZN test HIV+. By 2010 it is estimated 500,000 or 20% of the province's children will be orphaned, and in 10 yrs, half of today's 15-year olds will die. To date, no effective interventions have been made. Studies show HIV/AIDS educ/risk reduction programs alone, can transmit the information, but have no effect on behavioral change. Opponents of widespread ARV provision emphasize: high cost, lack of infrastructure to provide care/monitoring, risk of poor adherence with development of drug-resistant virus, drug toxicity, and 'more pressing' issues such as hunger.

DESCRIPTION: The Harvard U Partners AIDS Research Center, USA and U of Natal, Durban, SA are starting treatment with ARVs in 2 outpt HIV-clinics associated with private hospitals in KZN. 1,000 HIV+ pts will receive ARVs with close clinical and lab/resistance monitoring as part of a 10-yr plan. Areas served: poor, predominantly Zulu communities surrounding inner city Durban. Funding: Doris Duke Charitable Foundation, San Francisco AIDS Foundation, Bristol-Meyers Squibb, Elizabeth Glaser Pediatric AIDS Foundation.

LESSONS LEARNED: Pre-ARV assessments reveal multiple challenges: (1)stigma and fear of disclosing HIV status, especially women, who risk ostracisation from spouse/family/community and possible violence/death (2)lack of educ (3)distrust re:safety of ARVs (4)reliance on traditional medicine (5)superstition (6)lack of transport (7)poverty and hunger with 60% unemployment.

Recommendations: Provision of effective ARV therapy in resource-poor KZN requires a multi-disciplinary approach including: intensive educ/counseling, work/employment initiatives, support groups, nutritional counseling, community-based caregivers to assess ARV tolerance/adherence and sustainable ARV provision.

Presenting author: Krista Dong

1Harvard Medical School/ Massachusetts General Hospital, 74 New Place Street, Wallingford, CT, 06492, United States.

2University of Natal, Durban, South Africa.

3Harvard Medical School/ Massachusette General Hospital, Boston, MA, United States.

4Harvard Medical School / Massachusetts General Hospital, Boston, MA, United States.

5Harvard Medical School / Massachusetts General Hospital, Boston. MA, United States.

6Oxford University, Oxford, United Kingdom.

020708
TuPeG5665

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.