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

Track D: Social Science: Research, Policy & Action
This study examines the framework of the Theory of Reasoned Action (T,A) to guide
future behavioral interventions aimed at increasing use of NEPs,animo g New York City
injection drug users (IDUs).
Methods: An open-ended questionnaire based on the TRA was interviewer administered to
436 injection drug users (67.4% male, 32.6% female; 22% Cauc(isian, 32% Af rican American,
46% Hispanic; median age-40 years, range 23 to 67; median years of education= I 2, range
3 to 18) between November 1994 and May 1995,The response, were coded and checked
for reliability of the coding procedure. Perceptions were comp, ied beitween NEP users and
non-users who reported IDU in the prior 3 months.
Results: IDUs who use NEPs had different perceptions of the program than persons who
are injecting and have not used NEPs. Non-users of NEPs were ore likely to report that
structural barriers, e.g., hours/location and having a more convenient source for needles,
deterred their NEP use (88. 1% vs. 35.8%). Non-users of NEPs were less likely to report: (I)
perceived advantages of NEPs (3.4% vs. 25.8%, e.g., availability of clean/free needles, condoms, bleach, acupuncture, counseling or referrals at the NEP), (2) perceived social approval
for NEP use (62.7% vs. 78.3%), and (3) an intention to utilize NEPs in the future (47.6% vs.
88.5%). Eighteen percent of non-users ha rdnever heard of NEP rind were subsequently
provided with NEP information during risk reduction counseling.
Conclusions: In order to optimize the utility of NEPs in preventing I liv infection, health educators will need to foster positive community norms and perception, of IFPs. Policy makers will need to address structural barriers that hinder the efficiency of NEPs in the communityTailored interventions using theTRA framework may facihtate use o;f NEPs by changing inappropriate beliefs, perceived negative norms and structural barr iers
Stephen Titus, NYU Medical Center, 34 I E. 25th Street, #236, New York, NY 10010-2598
Telephone: [phone] Fax: [phone], email: stephen.titus(@ccmail.med.nyu.edu
Mo.D. 1859
WHEN YOU CAN'T BE A FLY ON THE WALL: IMPROVING MEASURES OF REPORTED
RISK BEHAVIOUR
Julia Rosenbaum*, Baume C Academy for Educational Development, Washington, DC
Issue: Social marketing and behavioral change approaches to HIV prevention have emphasized the importance of changing risk behaviors.Therefore, collecting accurate behavioral
information is the foundation of any AIDS prevention activityTo rite, KABP surveys, focus
groups, and other research methods have been applied in an attempt to capture behavioral
data.Yet all these methods depend on the respondents giving accurate and honest responses. Researchers, educators and counselors realize that reported behavior nray often vary
dramatically from actual behavior:
Project: In other areas of health communication research, direct observation strengthens
validity of behavioral data, and can assist in the critical interpretation of reported data. In
AIDS research, direct observation of sexual practices is nearly impossible.lo improve the
accuracy of behavioral data, AED researchers are utilizing a variety of techniques in applied
settings, to narrow the gap between reported and actual behavior.
Results: Headway has been made in improving techniques for measunrng behavior
Strengthening certain aspects of methodology improves respondent understanding and precision of responses. New methods, or new applications of existing methodologies have
improved credibility of self-reported data. (See below)
Lessons Learned: Elicitation surveys (qualitative surveys) allow for probing to elicit better
information on attitudes and behaviors, while allowing larger samples and more representative sampling techniques. Careful selection and pretesting of essential- words can improve
neutrality and understanding. Attention to recall period is essential, and varies for particular
behaviors.Triangulation of key behavioral data, achieved by combining methodologies, is crucial. An exchange of methods and strategies by researchers, educators and prevention professionals will help generate new ideas to improve our data collection methods in this area.
Julia Rosenbaum, AED, 1255 23rd St. NW Fourth Floor Washington, DC, 20037, USA
Telephone: [phone] Fax: [phone] email: [email protected]
Mo.D. 1860
COLLABORATION BETWEEN HEALTH SERVICES RESEARCHERS AND THEIR
TARGET POPULATION:THE HCSUS MODEL
Senterfitt, Walton, Lucey M, Eggan F, Ledesma J, Parish R, Cylar K. Colemnan JThomas D,
Vasquez R, Haas G*. Community Advisory Board of the HCSUS Consortiumrri, RAND,
California, USA. (*Deceased June, 1995)
Issues: The participation of HIV+ persons and their advocates in planning clinical research
has become well-established. Such participation in behavioral science anrid health services
research is much less common, though the knowledge, experience and maximal cooperation of HIV+ persons may be equally beneficial to social research.
Project: The HIV Cost and Services Utilization Study (HCSUS):s a comprehensive, longitudinal study of a national probability sample of 3300 adults in care for I IV infection, funded
hy the US Agency for Health Care Policy Research and other governnrent agencies via a
cooperative agreement with RAND, a non-profit research institution, and a consortium of
other institutions. Community collaboration, substantially more elaborate than was required
by funders, is in 3 structural levels: an HIV+ community leader with research training as a
resident member of the core research team and coordinator of liaison; a national
Community Advisory Board (CAB) of I2 diverse, experienced advocates (most HIV+); and
a network of local representatives and special advisors. Distinctive, fun tional features are:
patient/community input from inception of planning through publication of results; voting
membership of CAB members in each HCSUS sub-body including research content-area
teams and the external Scientific Advisory Committee: complete irdependence of voice
and input by the community coordinator and CAB; CAB participation in instrument design,
interviewer training and establishing held protocols; significant resource commitment to the
collaboration (ca. $350,000 over 4 years, I.5% of total budget), iccl-ding iodest but significant remuneration of all community advisors.
Results: The 15-month design phase concluded in January I996 when field work began.

HIV+ community members have been integrated into all aspects of HICSUS, including policy
making, research content determination and planning all operational procedures.The input
has led to many additions and changes to research domains and instruments, provided considerable operational assistance, helped avoid errors, and sensitized investigators and field
staff to perspectives of those living with HIV.

Mo.D. 1859 - Mo.D.1863
Lessons Learned: So far, we have demonstrated the possibility of integrating an elaborate
process cof substantive community involvement into a large, multi-center health services
study Such collaboration has been accepted as critically valuable by most of the project
investigators, despite the complications of dealing with a strong and independent constituencyrThie value to the study subjects and their communities must be assessed as
HCSUS generates completed products and, in the longer term, as the extent of their influence on public policy becomes apparent.
J.Walton Senterfitt, RAND, I1700 Main Street SP-7, Santa Monica, CA 90407-2138 USA.
Telephone: [phone] II x6237 Fax: 310-451- I 6921 E-Mail: JWaltonSenterfitt()rand.org
Mo.D.186 I
SELF-MANAGEMENT TRAINING AS A TREATMENT MODALITY
Inouyejlnlan. University of Hawaii at Manoa, Honolulu, Hawaii, USA
Issues: Self--marnagement training is a method for reducing stress and increasing coping skills
for a diverse ethnic group living with HIV/AIDS.
Project: This study investigates the use of self-management techniques with a sample of
tI-IIV/AIDS diargnosed individuals from different ethnic background to test the validity of the
Nakagawa Kogan & Betrus (1984) stress framework for persons with AIDS.1 he specific
aims are: to determine if self management and coping skills training will affect physical indicators of immunocompetence, cognitive-attitudinal features and behavioral habits in persons
svith HI!/AIDS; and to refine the self-management and coping skills training program.
Results: t-wenty subjects were randomly assigned into the experimental and control group.
The experimental group was taught self-management and problem solving techniques following a standard protocol to increase coping with stress and problem solving. The seven
week program includes breathing exercises, imagery progressive relaxation, autogenic training, cognitive restructuring, anxiety management, anger management, depression managemnent, problems solving techniques and educational classes.The control group followed their
usually treatment regime. Preliminary results suggest changes in physiological measures as a
result of the treatment protocol. Qualitative differences in causes and dealing with stressors
were identified for the different ethnic groups.
Lessons Learned: Individuals reported the breathing exercise as the most useful technique
for stress reduction.This treatment method can be adapted and used by nurses and other
health care providers as conjunctive treatment and provide services utilizing self care utilizing a collaborative model with consumers,
Jilian Inouye, University of Hawaii, School of Nursing, Honolulu, Hawaii 96822 USA,
telephone: [phone] FAX: [phone] email: jinouyefehawaii.edu
Mo.D. 1862
COMBINING QUANTITATIVE AND QUALITATIVE METHODS TO UNDERSTAND
UNSAFE SEX AMONGST GAY MEN
Flower s, Paul Sheeran, P**, Smith, J. A.**, Beail, N.***. *MRC Medical Sociology Unit,
University of Glasgow, **Dept. of Psychology University of Sheffield. ***Clinical Psychology
Consultancv, Barnsley, UK
Objective: To determine the utility of variables associated with HIV risk reduction amongst gay
men through iilustrating the synergistic effect of combining nomothetic and idiographic data.
Methods: Significance ratio's, which reflect the percentage of times hypotheses were significant, were calculated across a quantitative review of 36 papers which all addressed the
association of psychosocial variables with the occurrence of unsafe sex (study respondents
n -1.9f8).-fhese findings were compared and contrasted with data firoom qualitative indepth interviews with gay men (n = 20).
Results: Across the quantitative literature psychosocial variables were found to have weak
associations with the occurrence of unsafe sex (significance ratio's ranged from 3-5 I%). In
contrast, there was a robust association between the variable relationship status' and the
occurrence of unsafe sex. A significance ratio of 88% showed unsafe sex was far more likely
to occur within regular relationships than in casual sex. In-depth interviews described motivations to engage in unprotected anal intercourse within relationships.These motivations
drelited lo the prioritisation of the expression of love, commitment and trust above that of
disease prevention.
Conclusions: The role of traditional psychosocial variables in explaining unsafe sex amongst
gay men was limited and often contradictoryThe appropriateness of sexual health theory
and sexual health promotion practice will be questionable if it does not address the central
role of global motivations other than HIV risk reduction in understanding the occurrence of
unprotected anal sex.
Pau! Flowers, MRC Medical Sociology Unit, 6 ilybank Gardens, Glasgow G 12 BRZ Tel. 014 I
357 3949, ftax.0141 337 2389, E-mnail:PAULfolMSOC.MRC. CLA.AC.UK
Mo.D. 1863
SEXUAL BEHAVIOR AND BELIEFS IN MEN OF SAO PAULO, BRAZIL
Atoniso, Liza Klein. -'NEPAIDS, University of 53o Prulo
Objective: The number of HIV-infected Brazilian women reporting a single sex partner has
been rapidy increasing.While in 1985 there were 36 male AIDS cases for every woman, by
1994, this ratio had fallen to four to one.This shift indicates that bisexual and heterosexual
men ply air important role in the transmission of HIV Our purpose was to obtain informaton about the sexual behavior and HIV risk perception of Brazilian men.
Methods: A self,dministered questionnaire was applied to 2 I 6 men who work in the cenIn i business aer Alt men were recruited through letters of invitation.The sample included
men from I 8 to 57 years old, with varying educational levels, and partner status. Questions
egarding beliefs about risk of STDs and HIV, knowledge about HIV and AIDS, and preventon attitudes and practices were included in the questionnaire.They also answered questrons on sexuai activities, including masturbation, male-to-nmale sex, sex under the effect of
drugs inn alccial., the use of prostitution, and hfestyle.
Results: Knowledge of preventive practices varied from 67% up to I00%, but the levels of
misconceptions about safe sex" and 'casual sex" indicate that few men in fact practice safe
rex, wl'icfr inc eases their risk of becoming infected with HIVThe prevalence of sex with

non regular partners in the last year varied fhom 15% to 47%. Only 29% reported condom
use in their previous sexual intercourse considered to be at risk.The gap between sex and
love is important in prevention campaigns.When heterosexual men have sex with ordinary
women they rely basically on visual perception, seeking women who "look healthy".Thirty
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