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

Track D: Social Science: Research, Policy & Action
(N1=4.26, SD= 1.73) compared to counselors who scored low on the survey (M=3.33,
SD= 1.80; t(65)=-2.01, p<.05). Qualitative data indicate that counselors are hesitant to
openly discuss issues surrounding sexual relationships and specific sexual acts when counseling; their clients.
Lessons Learned: Chemical dependency (CD) counselors lack knowledge specific to
HIV which may impede effective treatment for CD clients with HIV. Training for CD
treatment providers should focus on helping counselors to discuss issues of sexuality
when counseling clients.
Meredith Portnolf, 0350 Santa Monica Blvd., #330, Los Angeles, CA 90025, U.S.A.
Telephone: [phone]; Fax: [phone] I 65; E-mail: javadog [email protected]
Mo.D. 1755
COMPARISON OF STANDARD AND AUGMENTED HIV COUNSELING AT A PUBLIC
HEALTH CLINIC AMONG MEN WHO HAVE SEX WITH MEN
Goldbaum Gary M, Dunphy C,Wood R. Seattle-King County Department of Public
Health, Seattle,WA, USA
Objective: To assess the feasibility and effectiveness of theoretically-based HIV counseling in
public health settings.
Methods: Two hundred forty nine HIV men who have sex with men were randomly
assigned to standard or augmented counseling accompanying HIV testing in a fieestanding
HIV testing clinic. Provided by public health workers, the augmented counseling consisted of
standard counseling plus 1) a computerized individualized report of risky behaviors and their
triggers, 2) a daily log of sexual activities and triggers, and 3) one and three month return visits. Outcomes of interest were stages of change for condom use with primary or casual
partners for receptive and insertive anal and oral sex. Eighty four men (34%) returned (without incentives) for a routine six month follow-up. Counselors and clients reported that the
intervention was easy to use and relevant to a wide range of sexual behaviors.
Results:There were no significant demographic or behavioral differences between men
who followed up and those who did not or (among men who followed up) between intervention and control groups.With respect to condom use for insertive anal sex with pririnary partners and for both insertive and receptive anal sex with casual partners, mean stages
of change increased more for the intervention group than for the control group, but the
changes were not significant. A similar pattern was noted for condom use for receptive oral
sex with casual partners. Although pre-and post intervention differences in mean stage of
change for condom use were positively correlated for both insertive and receptive anal and
oral sex with primary partners, mean stage of change differences were negatively correlated
for insertive anral and oral sex with casual partners.
Conclusions: Augmented counseling delivered by non professional staff is feasible within
public health settings. Such counseling appears to promote changes along a behavioral continuum, but more powerful studies are needed to confirm this and to identify the most
effective elements of such strategies.
Gary M. Goldb aum, MD, MPH AIDS Prevention Unit/SKCDPH 2 124 Fourth Avenue, 4th
floor- Seattle.WA 98121 USATEL: 206.296.4649 FAX: [phone]
Mo.D. 1756
BELIEF CLUSTERS AMONG HIV-SEROCONVERTING DRUG USERS: IMPLICATIONS
FOR COUNSELING
Harrison, Cynthia*, Marmo; M*,Titus, S*, Cord-Cruz, E*, Des Jarlais, DC**. NewYork
University Medical Center, NewYork, NY USA; *"Beth Israel Medical Center, New York, NY
USA
Objectives: (1) To describe the beliefs and self perceived risks held by HIV seroconverting
drug injectors both before and after HIV infection. (2) To identify limitations in the current
risk reduction counseling protocols.
Methods: An HIV vaccine feasibility study conducted during July 1992 - March 1995 recruited 366 drug injectors and 21 I1 sexual partners of drug injectors or known HIV positives at
3 methadone maintenance treatment programs and at an out-of-treatment site in New
York City All subject s were asked to assess their risk of being exposed to the HIV virus in
the succeeding six months. Any self-assessments that seemed unrealistic to the HIV counselors were discussed in depth and attempts were made to guide the participant toward a
more realistic evaluation. Participants were then counseled according to the standard CDC
risk reduction protocol. Intensive unstructured interviews were conducted with subjects
who seroconverted after their first H IV positive test result.
Results: I I seroconversions occurred, all among individuals who had injected drugs or had
sex with partners lknown to be infected in the previous 6 months.The II seroconverters
decreased their injection frequencies less than drug injectors who remained HIV seronegative.
At pre-seroconversion interviews, 8 of the I I HIVseroconverters felt they were "unlikely or
only "somewhat likely" to become exposed to HIV All 8 expressed a belief that they were
somehow "immune" to HIV because they had taken substantial risks in the past and remained
uninfected. 3 subjects who felt they were "very likely" to become infected nonetheless did not
reduce isk behaviors. 7 of the I sero onverters had life situations that may have made it
esperiarly drfhqcult to chainge belaivior (2 were commercial sex workers, 2 were unstably domaicied and 3 were in sexual relationships with known HIV postive partners).
Conclusions: Dur HIV vounseling failed to alter the belief or the behaviors of ublect
who ri~bsequently sor ovonver ted. lndividually tailored counseling based on persoralized
asesr ent deal ng with specifir ife situatisons ad beliefs, and referral of some patient for
rnensme, prolonsged iterventrocs roay be necessary and costeffective in preventing DIV
infect on amon those at greatest risk.
Cynthia Harrison, NYU Medical Center, 341 E. 25th Street, New York, NY 10010 2598
Telephone: [phone] Fax: [phone], email: [email protected]
Mo.D. 1757
CLIENT-CENTERED COUNSELING UTILIZING A HARM REDUCTION APPROACH
FOR POPULATIONS RESISTANT TO BEHAVIOR CHANGE
Brooknan aklyn. Health Initiatives for YouthWalden House

Issue: Many clients seeking HIV related services are resistant to changing high risk behaviors
despite having sufficient knowledge about the behaviors consequences.
Project: A client centered model can help human service providers to work more effectively with clients resistant to behavior change. In this model, counseling interactions are tai
Mo.D.1755 - Mo.D.1760
lored to assess the client's needs, including behavioral risks and contextual issues (social,
psychological and economic factors, etc.). Use of a harm reduction approach (gradual miinimization of risk behavior over time) as the basis for interventions encourages the cient and
counselor to work together to select specific behavior changes which realistically reflect the
clients' circumstances and willingness to change.
Results: Counselors who are adequately trained and supported to use a client centered
counseling model are more skilled and prepared to assess the contextual issues related to
increased risk of HIV, constructively confront resistance to behavior charge, and help clients
design alternatives to high risk behaviors.
Lessons Learned: Behavior change can occur when the skilled provider,rd the lient work
together to design a realistic behavior change plan that is implemented over time.
Jackie Brookman, PO. Box 3164 Moss Beach, CA 94038. Tel; (4 15) 728 2734
Fax:-415-728-2734
Mo.D. 1758
WHO USES HIV PREVENTION COUNSELING FOR WOMEN?
Milstein, Bobby*, Cabral, R*, Kelsch.C*, Galavotti,C*, Lupton, K', Green, B*, Gielen, Au*,
the Project CARES Investigators. *Centers for Disease Control and Prevention, Atlanta,
GA, USA; W*FP Council of SE PA, Philadelphia, PA, USA; ***Johns Hopkins. Baltimore, USA.
Objective: Understanding factors that lead to greater service use among women at risk for
or infected with HIV can help service providers more effectively allocate resources and target intervention efforts.This study identifies demographic, HIV risk, and psychosocial factors
associated with participation in an HIV counseling intervention delivered to women by peer
paraprofessionals (Advocates) in two U.S. cities.
Methods: During 1993-1994, women at risk for HIV infection recruited from homeless shelters, drug treatment facilities, and public housing projects (n= 225), and HIV+ women
recruited from outpatient HIV clinics (n=91), were enrolled in an HIV prevention project
(Project CARES). Participants received a baseline interview and were offered (I) support
and referrals for health and social service needs, and (2) individual and iroup counseling on
reproductive decision- making, condom use, contraceptive use, and reproductive health service use.The intervention was delivered by specially-trained Advocates over a period of 6
months. Differences in mean number of contacts with an Advocate were evaluated (t test)
for women who received >_1 contact.
Results: Women were ages 15- 44 and predominantly African American (88%). Of women
with at least one contact (77%), the median was 7 (range= 1-56). For women at risk, mean
number of contacts was greater for women living with children under 18 (p.00 I; x contacts= 13 vs 8) and involved in support groups, mental health counseling, or other HIIV -related projects (p<.01; x contacts= I I vs 8). Among HIV+ women, more Advocate contacts
occurred among those with high self efficacy for condom use with a main partner (p<.0 I; x
contacts-- II vs 5), no speedball use (p<.05; x contacts= I I vs 7) and no cocaine use
(p<.0 I; x contacts= II vs 7) in the last month.
Conclusion: Nearly 8 in 10 women took advantage of available services, and most had multipe service contacts.Factors associa tedwith reater service use varied forwomen at risk for
HIV compared to HIV+ women. Findings sumkgest that women who use peer counseling ser
vices most intensively may have greater needs for service (e.g. child-related concerns), be
willing to seek external support, and not be currently using drugs. Interventions seonsitive to a
range of needs may be most attractive to women at risk for HIV infection or-transmission.
Bobby Milstein, CDC, 4770 Buford HIwy NE. MS:K 34, Atlanta, CA 3034 I, U.S.A.
Telephone:[phone]: Fax:[phone]; E -mar il:[email protected]
Mo.D. 1759
THE ROLE OF COUNSELLING TRAINING IN AIDS PREVENTION
Szabo, Zsuzsa. Saint Liszlo6 Hospital, Immunological Department, Budapest,. Hungary
Objectives: The aim of present study was I/ to assess the knowledge of social workers
about AIDS, how well they are informed 2/ their attitude to positive people 3/ to study the
effect of three-day counselling workshops organized for social workers
Methods: A three day counselling workshop was organized for 160 nurses to gain knowledge about AIDS and experience in counselling.They were divided into small groups where
they participated in role plays, situational plays and communication exercises. Before and
after the workshop they filed in questionnaires and attitude scales
Results: The results of the studies performed before the workshop showed that participants generally were aware of what AIDS mneans, however 20% of them significantly overestimated its occurrence in Hungary. 95% of the participants considered the care of AIDS
patients as task of health care, but 32% of the refused to take part in this work. 36% of
them showed expressed homophony A study following the workshop showed that knowledge on AIDS became more accurate, they had increased empathy towards HIV positives.
Conclusion: The change in the attitude, behavior and increased empathy may in crease the
effectivity of primary prevention work with patients living with HIV/AIDS.The results urge
us to regularly organize workshops of these type for nurses.
Zs. Szabo, Gyili ut 5-7, Budapest, 1097, Hungary Tel.: [phone] Fax. (36 I)217 1422
Mo.D. 1760
PROCESS INDICATOR INFORMATION SYSTEM: ATOOL FOR MONITORING AND
EVALUATING HIV/AIDS PREVENTION PROGRAMS
D'An elo, L.A., urMVea,., Fernandes M.E.L. 2 I Associ aao Saude da Famila;
2Family Health International
Objective: To monitor and supervise the implementation of 39 subprofects with local government and non government organizations for HIV/AIDS/STDs prevention in collaboration
with Family Health International with funds from USAID.
Methods: Brazil is a AIDSCAP priority country. In order to supervise and monitor the
implementation of subprojects it was created a local infrastructure with qualihed team.This
team developed together with local GO and NGOs a total of 17 large subprojects and 22
small projects (funds up to 5,000 USD). Each sub proect summarizes in the Ioframe table
the measurable indicators and the means of verincation that ultimately will assess the over

all project implementation.
In order to register properly process indicators for each large and small subproject, a
process indicator form (PIF) was developed.The large projects based their PIFs in the pro
jects logframe table and a standard form was created for the small projects.The form is an

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