Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Track D: Social Science: Research, Policy & Action
diversity of possibilities for living with HIV.That way it contributes to the empowerment of
PLWHA, their families and friends.
Alexandre do Valle Menezes, Grupo Pela Vidda. Av. Rio Branco, 52/14. Centro, 20090-002,
Rio de Janeiro, RJ. Brazil. Ph: 55-21-5 18-3993 Fax: 55-2 I-518-1997
Mo.D.1743
OF THE USE OF AN INFORMATION CENTER AS PART OF THE STRATEGY OF
STDS/AIDS PREVENTION PROGRAMMES
Talom J.M.*, Kaptue L**, Afane Ze***, Kuate J.R.***, Kembou E.'. 'SidAlerte Cameroon,**
FMSBM Universitd de Yaounde; *** H6pital Jamot de Yaounde
Objectives:To review strategies of the STDs/AIDS prevention pro r amnie among rural and
towns populations.
Methods: SidAlerte Cameroon is an NGO working within the framework of the
Programme against STDs/AIDS. In its information center specialists (physicians, psychologists, nutritionists, jurists..) provide visitors with information on STDs/AIDS in French, English
and local languages. After counselling infected people care management is ensured. - each
visitor to the center has to fill in a form in which he writes down what service he needs:
films, general information, documents.
- The center has a "hot line" open to the public (from 8 a.m. to 6 p.m., from Mondays to
Fridays).
Results:There was an important increase of visitors during 1995 (I 370 compared to 605 in
1994).The main reason for it is that since mid 94 our video-tape recorder has been often
requested by visitors to the center ( 1154 compared to 400 in I1994) who want to watch
infected people or sick people before believing it. In addition, those who come to get oral
information about STDs/AIDS are in an increasing number (889 compared to 321I in 1994)
merely because they have the opportunity to speak with specialists on the premises, which
is an improvement considering the usually cold and remote contact with media. Even if
written information (leaflets, magazines..) is in increasing number (275 compared to 258 in
1994), people are less spontaneously attracted.This is due for people's weak interest for
reading. By and large and considering the enormous need of people for information, the
amount of those who phone through the "hot line" to get information is low even if it is
higher (43 compared to 28) in 1994.This is because every phone call is costly in an economic situation of recession.
Conclusions:- In a country where the majority is illiterate, where there is suspicion about
STDs/AIDS and where the main communication factor is by way of speech, it is essential
that audio-visual documentation and community based information are given priority in the
IEC strategies.
- A free phone line allowing people to get information on STDs/AIDS without paying
would be an interesting initiative.
Talom J.M., BP 1937 Yaounde - Cameroon; Tl/Fax: [phone]
Mo.D. 1744
COUNTERTRANSFERENCE ISSUES IN THERAPY WITH HIV POSITIVE STREETINVOLVED INDIVIDUALS
Scott. Margaret,Tucker P Flood K, Rodrigues Jennifer. The Street Project
Issue: Creating and maintaining a therapeutic alliance with HIV positive street-involved individuals involves unique issues of countertransference for the therapist.
Project: In a group discussion format, therapists with different levels of experience in this
field examined and identified factors and issues specific to working with street-involved HIV
positive persons, what our responses are, how they affect the course of therapy, identifying
problem areas in the therapeutic relationship, and what to do about them.
Results: Factors identified which contribute to the uniqueness of therapy with this population in addition to their HIV status include the frequency and severity of past and present
stressors in our clients' lives, their lack of resources, and the prevalence of violence and
early death in their lives. A survey of issues our clients face reveals recurrent themes: multiple trauma, multiple losses and chronic grief, addictions, isolation, poverty identity issues, system involvement and dependency (i.e. social services, child welfare, judicial), other health
issues and mental heath concerns. Add to this list HIV/AIDS related issues such as confidentiality and disclosure, fear, anticipatory grief, body image, family and relationship issues, and
future planning, among others.The interaction between these issues and the therapist's
cumulative experience evokes intense and sometimes overwhelming countertransference
responses and may contribute to 'burn-out'. Feelings of isolation, withdrawal, helplessness
and powerlessness, chronic anticipatory grief reactions, 'blaming the victim', 'heroic' rescue
efforts, and blurred boundaries have been noted in our work. Incidences of vicarious
traumatization were also observed. Strategies to work through countertransference included a high level of immediacy with clients, extensive case review, case conferencing and peer
support, clinical supervision, education, and self-care.
Lessons Learned: Therapeutic relationships with street-involved People Living with
HIV/AIDS necessitate therapists' observations of and working through intense countertransference responses.
Margaret Scott, M.Ed., #2, 219 Main Street, Vancouver, British Columbia V6A 257
Telephone: [phone]
Mo.D.1745
HIV INFECTION IN YOUNG HAEMOPHILIACS: PSYCHOLOGICAL ASPECTS AND
CONFLICTS BETWEEN HEALTH WORKERS AND FAMILIES
Boen. Elio Montalcini, F. Moroni. P Zarri D.*, Mori, PG. Massimo L.*Department of Pediatric
Haematology/Oncology G. Gaslini Children's Research Hospital, Genova, Italy
**Department of Infectious Disease, S.Martino General Hospital, Genovd, Ilaly
Issues: The aim of this study was to define an adequate strategy to communicate HIV seroconversion to a group of 8 haemophiliacs ranging from I I to 2 I years of age and to help
parents to overcome their emotional resistance and fears. In fact during the last 10 years
the family was the only interlocutor with the medical team and the sole keeper of "the
secret" about the HIV infection.

Project: TAT and Rorschach tests were administered to patients and, at the same time, psychological interviews were carried out with both patients and parents.The evaluation of the
personality allowed us to identify some peculiar aspects of the PVWA status and its impact
on haemophilia and AIDS treatment compliance.

Mo.D.1743 - Mo.D.1748
Results: Data show that all patients and their families experienced deep feelings of anxiety
and death fantasies with an ambivalent attitude towards both haemophilia substitutive treatment and towards physicians. Intensive and personalized psychological training altowed parents to understand that adolescent patients need to be informed by physicians about their
real immunological condition, thus improving their compliance with therapies and clinical follow-up required by AIDS.
Lessons learned: All information on AIDS status should be given at the end of a complex
process where the family becomes the first ally of physicians and other health care professionals who are responsible for constant care, education and psychological support of the
haemophilia patient.
Dr E. Boeri, Department Ped. Haematology/Oncology G. Gaslini Children's Research
Hospital. L.go G.Gaslini 5, 16148 Genova, Italy Telephone: ++39/10/563655 I Fax:
++39/1 0/3776590
Mo.D. 1746
AN EVALUATION OF GROUP COUNSELLING FOR CHANGING HIGH RISK
SEXUAL BEHAVIOUR
BalmerDonald~.H. Kihuho. F. Gikundi, E. Plummer, F.A. (*)Kenya Association of Professional
Counsellors,,)Dept. Microbiology University of Nairobi, Nairobi, Kenya
Objective: To investigate the efficacy of group counselling as a method of changing high risk
sexual behaviour.
Methods: A sample of 240 men with a STD was drawn from the Special Treatment Clinic,
Nairobi.The men were medically examined and completed a battery of psychological questionnaires.The sample was randomised in equal numbers into a counselling arm and a control arm.The counselling arm was divided into I12 equal groups and led by a trained counsellor for I hour per week for 26 weeks.The counselling was based on an unified theory
for HIV/STD counselling. Progress was monitored by triangulation during weekly meetings
of the counsellors and researchers.
Results: The quantitative results were based upon the medical monitoring and the psychological questionnaires.The medical monitoring showed that the counselling arm had 3 times
fewer reinfection episodes and that they used condoms in high risk situations more often
than the control arm.The psychological questionnaires showed that they had improved on
all measures.The qualitative results offered strategies regarding the understanding and negotiation of safer sexual practices, and ways of initiating a dialogue between sexual contacts.
Conclusions: Group counselling can initiate and sustain behaviour change which results in
safer sexual behaviour.
D.H, Balmer, P.O. Box 55472, Nairobi, KenyaTel: 254 2 562616, Fax: [phone],
Email: [email protected]
Mo.D. 1747
A BEHAVIOURAL INTERVENTION PROGRAMME TO INCREASE CONDOM USE
AMONG SEX WORKERS IN SINGAPORE
Chan RKW*,Wong ML#, Lee J+, Koh D#,Wong C#. *Department of STD Control,
National Skin Centre Singapore, #Department of Community, Occupational and Family
Medicine, National University of Singapore. +Epidemiology Programme, Cancer Research
Centre of Hawaii, University of Hawaii.
Objective To evaluate the impact of a behavioural intervention programme on condom use
and gonorrhea incidence among brothel-based sex workers (SW) in Singapore.
Methods: All 128 SW from one locality were assigned to the intervention group (I) and I125
SW from another relatively comparable locality served as controls (C).The intervention programme concentrated on developing SWs' condom negotiation skills and on gathering support from peers, brothel keepers, and health staff in promoting condom use. It comprised 2
two-hour small group sessions conducted by trained health advisors. Instructional methods
used included video presentations with local SW as actresses to demonstrate negotiation
skills, role play, peer group discussion of problems arising from self-monitoring of condom
use, group discussions with brothel keepers to support condom use, individual counselling to
all gonorrhoea-positive subjects in the experimental group.The 3 outcome variables measured were negotiation skill as measured by the average success rate in persuading clients to
use condoms, behavioural change as measured by the percent always refusing vaginal sex
without condoms, and the cumulative gonorrhea incidence rate. Measurement of programme effect was by a self-administered questionnaire at base-line and at 5 months after
the intervention, and by the comparison of gonorrhoea incidence 5 months before and 5
months after the intervention for both control and intervention groups.
Results: The I group showed a considerable improvement in negotiation skill with an average success rate rising from 66.1% to 80.2% post intervention (p=0.0001 ). In contrast the
C group showed only a small improvement of 3.2% (p-0.05 I ).The proportion of SW
who reported always refusing sex without a condom rose friom 44.4% to 65.2% in the I
group, compared to a decline from 40.2% to 35.2% in the C group.The cumulative gonorrhoea incidence in the I group declined significantly from 10.5% to 2.4%, compared to the
non-significant decline from 19.7% to 12.3% in the C group.
Conclusions: This behavioural intervention programme resulted in considerable improvement in negotiation skills, self-reported behaviour of refusing unprotected sex that was corroborated by a decline in gonorrhoea incidence.This programme will be expanded to all
brothel-based SW in Singapore.
Dr Roy Chan Kum Wah, National Skin Centre, I Mandalay Road, Singapore 308205
Mo.D. 1748
NUTRITIONAL COUNSELLING AND SUPPORT FOR HIV OUT-PATIENTS
Kruseman Maaike, Sudre P Pichard C, Hirschel B. University Hospital, Geneva. Switzerland.
Issue: HIV-infected persons often are concerned about their weight, healthy eating and food
contamination. Many physicians are at a loss in responding to specific dietary questions and
the role of diet in preventing weight loss.
Project: In May I995, a nutrition counselling service for HIV outpatients was established at
our Hospital.This new activity has 3 main objectives: I) to provide specialised advice to

patients and their caregivers, and assist them in reducing the severity and the consequences
of HIV nutrition-related symptoms; 2) to prevent weight loss and improve nutrition/healthrelated quality of life,and 3) to evaluate the adequacy, usefulness and quality of this service.
This is done by monitoring nutritional impact and quality of life of patients as well as users'

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