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

Track D: Social Science: Research, Policy & Action
done with the knowledge - or even participation - of regular partners. Fifty percent of
interviewees reported anal sex with heath partners as an unacceptably risky behavior while
only 6% (n= I) thought anal sex with regular partners to be too risky Further, 44% of interviewees reported strategies which included unprotected anal sex with regular partners.
Conclusions: Men involved in our research were rarely isolated or marginalised men
ashamed of their behaviourThey were overwhelmingly gay identifed with ties to gay society
and culture. Many respondents reported differentiating their strategies between "heath" and
"regular" partners. Many of these men were unable to implement their-desired risk reduction strategies reliably on the heath.They quoted various personal anid vitrtionral reasons
for their lapses.
James Fisher, AIDS Education Unit, Barnet Health Agency, Colindale Hospital, Colindale
Avenue, London NW9 5GH, United Kingdom.Tel.: 01 8 I 905 9/79 Fax: 01 8 I 905 9250
email: [email protected]
Mo.D. 1793
A STUDY OF THE DEVELOPMENT OF HIV PREVENTION WORKING PRACTICES IN
PUBLIC SEX ENVIRONMENTS IN THE UNITED KINGDOM
Holland, Paul Andrew, Keogh PG, Davies, PM. Sigma Research, London. United Kingdom
Issues: There are a number of detached outreach projects working with users of Public Sex
Environments [PSEs: public toilets (cottages), parks, saunas and sex rooms at gay clubs] in
the United Kingdom. Despite this there is very little documentary evidence or rationale for
working practices employed by these projects.
Project: Researchers investigated a number of HIV prevention projects at a range of PSEs.
Participant observation was conducted at the PSEs whilst outreach workers were present
and absent. In addition depth interviews were conducted with project personnel at all levels
in order to examine the development of working practices. Finally, self complete questionnaires were distributed to men using the PSEs in order to examine migration and level of
contact with the outreach projects.
Results: The projects had developed a diverse range of working practices. Selection of
working methods were influenced by the following factors: Physical (the size, the physical
layout, times and levels of activity and weather); Structural (the size and status of the host
organisation and the funding process); Financial (both lack of funds arnd uncertainty over
continued funding); Personal (individual attitudes and workers' professional backgrounds).
Lessons Learned: It is clear that many factors affect the selection of working methods at different PSEs. In many cases, methods are selected on criteria other than the needs of the
client group. In view of the difficulties associated with evaluating detached outreach work, the
authors recommend the development of stricter criteria for assessing need and appropriateness of working methods.The second stage of the project aims to develop these criteria.
PA Holland, Unit 64, 49 Effra Road, London SW2!BZ, UK.Tel: [phone];
Fax: 44-17I-737-7898
Mo.D. 1794
EVALUATION OF AN AIDS DEMONSTRATION MENTAL HEALTH PROGRAM
Grusky. Oscar, London, A. University of California, Los Angeles
Objectives: To evaluate the effectiveness after one year of a new program (SPECTRUM) in
South Central Los Angeles designed to integrate new mental health services into existing
medical programs that provide primary health care for persons with HIV/AIDS.
Methods: Data were collected through key informant interviews with 12 service providers
and support staff, focus groups, participant observation at team meetings and training sessions, and review of clinic protocols, MIS, and billing procedures.
Results: In its first six months SPECTRUM treated 76 (unduplicated) clients, organized a
new South Central Los Angeles AIDS Mental Health Consortium, added services, started a
new program to increase resources through a grant-writing training program, participated
in city/county planning and health fairs, and developed contacts with out-of-area AIDS
organizations.
Conclusions: Able leadership, well-designed programs, and effective network strategies can
assist development of AIDS mental health programs and reduce unmet need.
Grusky Oscar, Dept. of Sociol., UCLA, LA, CA 90024-155 I.Tel: [phone], Fax: [phone], email: [email protected]
Mo.D. 1795
INNOVATIVE BEHAVIORAL INTERVENTIONS TARGETING ENVIRONMENTAL AND
SOCIO-STRUCTURAL DETERMINANTS FOR HIV/AIDS PREVENTION IN THE
PHILIPPINES
Morisky, Donald E. Detels, R.Tiglao,T Baltazar, J.C.**,Tempongk.o, S. Stein, J. Liu, K. *UCLA
School of Public Health; **University of the Philippines. College of Public Health. Manila
Philippines
Objective: To evaluate the effectiveness and efficiency of targeted behavioral science based
approaches on the reduction of high-risked behavioral and STD infections among commercial sex workers employed in various establishments in the Phi ippines.
Methods: A quasi-experimental four-group design assessing the independent and combined
effects of EI ---peer education and counseling, E2.manager/supervisor support, E3 combination of EI and E2, and C1 -a usual care study control group ns iin tested over a twoyear period. Commercial establishments include bars, nightclubs, dance halls, massage parlors
and karaoke clubs. Outcome measures include changes in AID/S FU knowledge, attitudes,
beliefs, and practices, STD infection rates, attendance at Social Hygiene Clinics, implementation of educational policy in the various establishments and cost effectiveness evaluation of
the intervention approaches.
Results: A total of 1400 CSW and 200 managers/supervisors were followed a minimum of
12 months following the baseline survey (range-3.3- 13.2). Baseline interview results indicated significant predictions of condom use (OR- 1.54); if client requesied condom
(OR= 1.5); placing condom on partner (OR= I.7); and disagree that condoms make sex less
enjoyable (OR- 1.6). Multivariate statistical procedures, including structura equation modeling identified manager's attitudes regarding HIV prevention, self esteenr among CSWs and

HIV knowledge among CSW highly predictive of condom efficacy a nd use. Overall the
model accounted for 56% of the explained variability in condor~ efr;ac anid ise.
Conclusion: We have identified important environmental influences which are highly predictive of safe sexual behaviors among CSWs.The implementation of educatio)nal policy

Mo.D.1793 - Mo.D.1798
regarding condom use by employees in the establishments has been demonstrated to significantly improve condom use at every act of sexual intercourse and concomitant reductions
in STD among CSWs.
D.E. Morisky Box 951772, Los Angeles, CA 90095-1772 Telephone: [phone]
Fax [phone], email: [email protected]
Mo.D. 1796
PROSPECTIVE EVALUATION OF A LARGE-SCALE HIV EDUCATION PROGRAM:
UTILIZATION OF A PROCESS AND IMPACT METHODOLOGY
Skelly, Regina R*, Daniell F*, Fallon A*, Gorham E**. *Navy Medical HIV Program, Bethesda,
MD, USA; **Naval Health Research Center, San Diego, CA, USA
Objective: Design, develop, implement, monitor and evaluate an HIV education and prevention program for a population of 900,000 individuals.
Methods: Following a 199 I needs assessment, a community-centered HIV prevention effort
was developed for a decentralized population of US Navy military personnel and civilian
employees. A combined workplace and social oriented effort was implemented over a 36 -month period. Ongoing monitoring and annual in depth assessments utilized a series of
quantitative and qualitative parameters (process measures) which compared five regions at
50% and 100% of planned capacity HIV incidence (impact measure) was monitored in
selected populations through an ongoing screening program.
Results: During this period, 650,000 individuals (72%) received the intended HIV education.
The 1993 assessment (50% capacity) utilized nine parameters in five categories (capacity;
reach; infrastructure and personnel; diffusion; and instructional media) and informed corrective actions for five of nine parameters in one or more regions; as well as modification of
four parameters in two categories.The 1994 assessment (100% capacity) utilized the
refined parameters (capacity; reach; infrastructure and personnel; instructor assessment; and
barriers) and documented improvements following actions by program managers. During
this period, a significant decline in HIV incidence occurred overall, as compared to a 1989 -199 I baseline; though no differences were noted between regions despite their varied
intervention experiences.
Conclusions: Ongoing evaluation documented the utility of a defined parameter approach,
for both program managers and evaluators. Assessments resulted in problem identification,
corrective actions and retraining in the involved areas, and subsequent measured improvement in program delivery
R.R. Skelly Box 219, NNMC, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600 USA Tel.:
301-468-6527 Fax: [phone]
Mo.D. 1797
EVALUATION OF LOCAL BARRIERS TO HIV EDUCATION
Law, Wendy A*, Daniell F**, Schneider S*, Sharp-Breslau E*, Johnson A*. *HM Jackson
Foundation, Rockville, MD, USA; **Walter Reed Army Institute of Research, Washington,
DC, USA
Objective: Assess the barriers experienced by trained HIV prevention specialists as they
provide community-level HIV education.
Methods: Previous evaluations indicated that 36% of HIV educators in a US Navy program
had reported experiencing barriers which resulted in provision of less HIV prevention services than planned. Elicitation research involved a semi-random telephone survey of educators in two of the program's five regions and identified three initial areas of concern. A 29 -item survey instrument was mailed to 1615 eligible educators and utilized quantitative and
qualitative response measures in five content areas: demographics; teaching activity; populations reached; course design factors; and barriers.
Results: Twenty-four percent of educators responded within the time constraints and were
overall representative of this population. Seventy-seven percent reported that most or
nearly all of the individuals targeted were reached; however, significant barriers were experienced by 75%. Both personal factors for educators and factors related to attendees were
documented and included: multiple scheduling (time) issues; organizational support; supervisor issues; and interest factors. Respondents provided not only detailed documentation of
barriers, but also indepth interpretations of events and specific recommendations.
Conclusions: The design utilized in this assessment provided timely information and recommendations to program managers, with a time of six months from problem identification to
survey analysis and reporting.This replicable evaluation methodology provided field level information and local input for refinement and modification of this HIV prevention intervention.
F.D Daniell, Box 219 NNMC, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600 USA
Tel.: 301-294- I1880 Fax: 301-295- I1648
Mo.D.1798
THE IMPACT OF STREET OUTREACH FOR HIV PREVENTION IN 5 HIGH RISK
POPULATIONS
Anderson ohn F.* Greenberg, J.,* Valentine, J.,* Cheney R.,** Gleghorn, A.,** Kipke M.,
long, A.,** WiebelW** *CDC, Atlanta, GA, USA; **AESOP Project
Objectives: To measure the association between street outreach (SO) contact and condom
use using data from the multisite AIDS Evaluation of Street Outreach Project (AESOP).
Methods: A series of systematic, on-the-street, cross-sectional surveys measuring exposure
to outreach and risk behavior were conducted at each site in a study and a comparison area.
Results: On-the-street samples reported high rates of contact with outreach programs.
Percentages from the post-enhancement period study areas are shown:

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Condons fom SO worker in last month:
Condom last time main partner vaginal sex:

H-igh risk youth: IDU:
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42 29 39 22 53
29 48 39 32 24

In some settings enhanced outreach was directly associated with increased condom use.
Outreach also had an indirect association in every site: use of condoms was highly associated with respondents having condoms, which was associated with contact with outreach
programs.
Conclusions: High risk populations sampled in street settings had high rates of receiving
services from outreach programs. Enhancements to street outreach interventions were