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

Mo.D.1773 - Mo.D.1779

Monday, July 8, 1996

Mo.D. 1773
PREVENTING SEXUALLY TRANSMITTED DISEASE AMONG MINORITY WOMEN:
RESULTS OF A CONTROLLED RANDOMIZED TRIAL AT 12 MONTHS' FOLLOW-UP
Shain, Rochelle,* Piper, J.,* Newton, E.* Perdue, S.,* Ramos, R.,* Dimmitt, J.,( Guerra, F.,**
Porto, M.'- *(tniv. of TX I11th. Sci. ti, San Antonioa, TX; **Univ. ofTX Hlth. Sci. Cti.,
Houston. TX., * San Antonio Mietropolitan Filth. Dis.
Objective: To evaluate a theory-driven, small- group behavioral intervention designed to
reduce high risk sexual behavior. Because African Amnerican and Hispanic women are disproportionately affected by iheteroexually transmittled disease, including AIDS, interventions
were culture and gender specific to these gr oups.
Methods: Based on the AIDS Risk Reduction Model and extensive qualitative data on
beliefs, valres and existing be avioc, the intervention was designed to help women recognize they are susceptible to infection, commit to behavior change, and acquire the necessary
skills (e.g., sexial conunmnication) to effect cI inge. Separate sessions (once per week for 3
weeks) were held for each ethnic gro up and were facilitated by a group leader of the sanme
ethnicity. 325 Mexican and 195 Afhican-Amer ican women with gonotrrhea, chlamydia, acute
PID, syphilis nd/or Triclioronias were recruited frrom public health clinics. Each received
baselirne ex iation/uctic ion and conprehesive behavioral and clinical interviews; 306
were then raindonized (stratified by ethniity) to the control group aind 314 to the intervention. Patients were reexamined and reinterviewed at 6 and 12 months.The intervention
show rate was 90% and the 12 month retention rate was 88%. The major outcome variable
was infection with either gonorrhea or chlaorydia at follow-up.T tests, analysis of variance
and chi squae v'we i, iused to determine differences between groups. Logistic regression was
used to deterirnir itir vietion effects, controlling for differences in group characteristics
related to outcome
Results: Crude re'fection rates with either gonors hrea or chlamydia at I 2 months' followup are 1 6.8% for study I, *i. onen arid 24.7% for controls (p.02) on an intent to treat
basis. After excluding 23 womc who did niot attend even I intervention session, crude
reinfection rates were 15.8% vs 24.7 (p=.0 I). Group outcomes are significantly differ ent at
p=.01 (intent to treat) aind at p-.005 (for women who attended at least I session) levels,
after controlling for the following baseline variables: number of partners during the last 3
months, muteal monovgarmy of ait least 3 monrths duration, and age less than 24 years.
Conclusions: tFheory driven, culturally relevant behavior al interventions can effectively
reduce the ratile of recurent infection. These findings should apply to sexually transmitted
disease in general, including AIDS.
Rochelle N. Siain, Ph D The Unive rsity ofTexas I Icalth Science Center, 7703 Floyd Curl
Drive, San Antoio X 78284.7836 Phone: [phone] Fax: [phone]
email: s hainuthsc isa.ed u
Mo.D. 1774
PATIENT EDUCATION TO IMPROVE HEALTH-RELATED QUALITY OF LIFE IN
HIV/AIDS:A PILOT STUDY
Giffo__Allenri I* I orig, K. 1, hesne, M.j, Laul esnt, D., Gonizalez,V. VA Medical Center,
University of California, Sain Diego, CA, USA; Stanford t)niversity, Palo Alto, CA, UJSA: and
Center for AIDS P r e icti n Studies), Univeity of California, San Francisco, CA, USA.
Objective: To develop and plot-test an I IV/AIDS patient education program designed to
help lpitienls actively pa tipate in their care, and thereby increase self-efficacy reduce
symptoms, and inprove function.
Methods: We designed a 7-session volunteer led coirse taught in small groups, and included informationr (AIDS symrptomns, treatments, diet), skills (communication, relaxation, exercise) and self iffiicy' enhancement (setting and achieving goals, modeling mastery of behaviors). Course rmateriais were $18/subject. Adults with AIDS and AIDS related complex were
recruited for study by corc unity,, advertising. Subjects were r andomized to start the
course irnrrediately o to start after acting as controls for 3 ronths. Before randomization
(pre test) and at 3 mo it follow I p (post test), all subjects completed mailed questionnaires measuring synpiorms, fiunction, depression, stress, and self efficacy.We used validated
scales drawn from frv.ious I IIV/AIDS researcih. A suirnary health-related quality of life
(HIRQL) index was c eaited by combining 9 syrmptom and function measures, using equal
unit weights. Meas-rs of self efficac, psychological function, and physical function were corrected to 0-100. Analysis of covariance was used to compare mean post test scale scores
between groups, while adjusting for pre test scores.
Results: Seventy one subjects enrolled, of wvhore 54 (76%) completed follow-up. Subjects
were male (100%), gay (94%), and well educated (85% with some college); 52% had >2
AIDS diagrroses. Mean attendance amrong those starting the course was 5 of 7 sessions. At
post-test, intervention gyroup subjects had fewer symptoms rated "moderate" or worse
(3.28 vs 4.75; p"<003), iand had higher self- efficacy for controlling symptoms and health
problems (58 vs 18; p--0.05) than control group. A trend toward higher intervention group
HRQL was niot significant (66.5 vs 62.6; p<0.23). nor were differences seen in measures of
physical, psychological, and role function.
Conclusions: The study sample was limited in size and diversity and some subjects were
lost to follow up. Nevertheless, the HIV/AIDS patient education program is feasible, inexpensive, and accepted by stud1 participants. learning active participation in health care may
lower the inpact of chronic syrptoms experienced by people living with HIV. Effects of
such learning on function and on overall HRQL are unknown. Patient education programs
emphasizing self-care may be air effective componert of care for HIV/AIDS.
Allen I Giffod 3350 a jollaVillage DrII IN I San Diego, CA 92161 I USA
Tel: [phone] ex.767. F: (619) 552 432 I email: [email protected]
Mo.D. 1775
INVESTIGATION ON GENDER INFORMATION AND KNOWLEDGE ON HIV/STD
OF COMMERCIAL SEX WORKERS' ADOLESCENT DAUGHTERS
Pmrez Silva hMercedes M Miinistry of Health, Division AID/STD, Programme "Tu a Tu",
Ca acais/Venezrela
Objective: lo inveigate is geder iformatios n and knowledge on HIV/AIDS/STLD of 13 to
15 year s old dagt Iis of (onvrmercial Sex vorkers in order to create an effective instrument to preveit them fro iI infection and prepare them lor alternative life styles

Method: By means of vrba! and written interviews, on the basis of closed questions
designed by psychopedagogic specialists.The investigation was undertaken prior to authorization of mothe s, acd anonymously and individually.
Results: Until th e present, t',e investigation revealed that adolescent daughters of CSSW are
equally informed amnd ave krowledge on AIDS/STD as comparitive groups of adolescents
of the rest of ou soniietiValIable parallel information has been obtained on relationship
daughter - mother C SW- family and the situation of the daughter in its social circle.
Conclusions: The general sex education situation in Venezela suggests the necessity of a
revision and reinforcement of educational programmes.Though these programmes exist officially and are obligatory educational institutions do not comply, due to cultural and social rea
sons. Consequently, design and elaboration of information material on gender issues, specially
directed to this age/social group, based on their family and social situation, is imperative, in
order to protect them from activitiies that might endanger their lives and their health.
Perez S., Mercedes, Apartado Postal 35 10, Carmelitas I010, Caracas/Venezuela,
Tel.[phone],58-- 2-481 57 16
Mo.D.1776
COURAGE AND CARING:A PILOT PROJECT FOR COUPLES COPING WITH
HIV/AIDS
David, Chapman,, Ef.**, Cecchini, C.*,Wong- Rieger, D.**. *Canadian Hemophiia
Society Montreal, Quebec, Canada
Issues: In addition to coping with the disease, heterosexual couples dealing with IIV/AIDS
experience considerable stress on their manriage and family).
Project: The Canadian Hernmophilia Society sponsored a plot project based on a holrtlc
model of coping with HIV as a couple. A programn logic model was developed to identify
the desired outcomes, the intermediate attitudinal, motivation, and skills requirements, and
the appropriate workshop activities. Sixty couples participated in the three- day event which
focused on building individual capabilities, nutual support, and an extended network.The
workshop used a variety of techniques to lead couples through issues of disclosure, confronting personal fears, family dynamics and communications, intimacy and future planning.
Results: A follow-up evaluation was designed to test the logic model anrid to determine the
impact of the workshop.The results were very positive. Pirticipants reported changes in
insight, attitudes, and knowledge.They were better able tc express their own needs and to
respond to those of their partner and were more open with family and friends, thus
expanding their support network.
Lessons Learned: The results demonstrated the need for intervention with couples aind
family and the benefit of a holistic approach guided by the program logic nmodel. it also pro
vided suggestions for future activities.
L. David, Executive Director, Canadian Hemophilia Society 625 President Kennedy, Suite
1210, Montreal, Qc, H3A I K21elephone: 514 848 0503 ext. 24- Fax: [phone]
Mo.D. 1777
METAANALYTICAL FINDINGS WITH PSYCHOSOCIAL INTERVENTIONS
Hinsler, Gebhard.University Fribourg, CH- 1700 Fribourg, Germany
Objective: We analysed more than 40 studies. A total of about 1500 persons wiere tIated
in all the studies combined. In most of the studies (>20) the treated persons were
homo/bisexual men.The mean age is 35.1The mean, since time of diagnosis, was 28 months.
The average inamount of sessions was I 3.The control of nmedication was carried out only in
some studies. Classification of the studies to the types of intervention: I. Cognitive behavioral, 2. Stress-inoculation trainings, 3. Hypnotherapy/ Relaxation, 4. Humanistic (e g. Rogers),
5. Sports, 6.Aer obic.
Method: We calculated effects sizes separately for intervention and control groups and tested later for differences between the groups.
Results: There is an over all superiority of the cognitive beh.iivioral nterventons in the
domains of anxiety depression, partly in syrmptomns. The humanistic forms were better for
quality of life. Relaxation when systematically used, leads to a decr ease of anxiety (r.27) in
comparison with other interventions which do not use relaxation (r=. I 7), (p<. I0).
Concerning improvement of psychological and physical symnptornrs, interventions which sys
tematically used relaxation were more sucessfull (r--.20) than interventions without relaxation (r=-. I I), (p<.06)
Conclusion: Interventions using techniques like relaxation, cognitive changing strategies,
inner conmmunication were more successful in reducing anxiety (r=.26) than other inter
ventions (r=-.13), (p<.005). Differences in reducing depression were also statistically significant. Interventions using this type of technique showed a reduction (r-.29), without these
techniques (r=-. 15), (p<.05).
Dr: G. isle, University Fribourg, Rte Fifucigny CHI 1700 Fribourg Tel:[phone]. Fax:
[phone] email [email protected]
Mo.D.1779
EFFECTIVE HIV/AIDS PREVENTION INTERVENTIONS FOR ADOLESCENTS AND
WOMEN: RESULTS OF A DECADE OF RESEARCH
Jemmott, S. University of Pennsylvania, Philadelphia, Pen aylvania, USA
AIDS is a leading cause of death among Afvican American populations even though AIDS is
preventable through reducing HIV-related high risk behaviors.To reduce the further spread of
HIV infection, however requires building on the efficient and cost-effective theoretically based
behavioral interventions that have been developed and making them more relevant and cul
turally appropriate for the populations at risk in the second decade of the AIDS epidemic
Efforts at making behavioral prevention more relevant to populations have been impeded
because little is known about the human sexual behavior and the reasons people engage 5n
behaviors that increase risk of HIV infection.This dual presentation will review the tactors
that place African-American adolescents and adults at risk of HIV infection anit address some
of cultural and gender stereotypes that obstruct successful public health prevention cam
paigns for this vulnerable population internationally In addiion, effectve strategies for design
ing culturally sensitive theoretically based HIV risk reduction interventions based on experi
ence in multiple settings in multiple studies in the U.S and ASica will be discussed.
[oretta Sweet Jemmott, Ph.D., University of Pennsylvania, Philadelphia, PA 19101
Telephone: [phone], Fax: [phone]

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