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

Tu.C.324 -Tu.C.333

Tuesday, July 9, 1996

Tu.C.324
AN OPPORTUNITY LOST: ESTIMATING THE NUMBER OF HIV INFECTIONS DUE
TO THE U.S. FAILURE TO ADOPT A NATIONAL NEEDLE EXCHANGE POLICY
Lurie Peter, Drucker, E2. ICenter for AIDS Prevention Studies, University of California, San
Francisco; Department of Epidemiology and Social Medicine, Montefiore Medical Center,
Albert Einstein College of Medicine, Bronx, NY
Objectives: I.To estimate the number of HIV infections among injection drug users (IDUs),
their sex partners and their offspring that would have been prevented had the U.S. implemented needle exchange programs (NEPs) at the same rate as Australia. 2. To estimate the
cost to the U.S. health care system of treating these preventable HIV infections.
Methods: Preventable HIV infections were estimated according to the formula: (annual
number of incdent IDU infections)*(proportionate reduction in HIV incidence among participants in NEPs)I(proportion of IDUs using NEPs annually)*(I- proportion of HIV transmission among IDUs due to sexual behavior) (I +proportion of IDU infections transmitted
to sex partners and offspring). Data for the model were obtained from epidemiological
studies, mathematical models of NEP effectiveness, government reports and consultations
with IDU and NEP experts.The U.S. government estimates that the discounted lifetime cost
of treating an HIV infection is US$55,640.
Results: The effect of the U.S. failur e 0. -
to implement NEPs on a scale com 6.00
parable to Australia is illustrated in.0
the graph.The number of HIV infec.00~ %NEPfeve s
tions that could have been prevented 1
between 1987, wher hefirst.000
Australian NEP opened, and 1995, 000 --
when approximately 75% of IDUs 000
were using NEPs at least once annu 2 0~~.. 79 %Pe i9ea
ally, ranges from 8,36 1 (I 7% reduc, 99,0,,,,
tion in HIV incidence among NEP
participants) to 19,673 (40% reduction). Of these infections, 86% would occur among IDUs,
with the remainder among their sex partners and offspring.The cost of these infections to
the U.S. health care system is estimated at between $0.47 billion and $1.09 billion. With
current policies an additional 9,690 to 22,800 preventable HIV infections wilt occur by the
year 2000.
Conclusions:-rhe failure to implement NEPs, despite six government-funded reports sup
porting the prograrm, has led to the preventable HIV infection of thousands of IDUs, their
sex eartners and their- offspring and excess costs in the hundreds of millions of dollars.
Removing the U S. governrment ban on NEP funding is an urgent public health priority.
Peter Lurie, MD, MPH, 74 New Montgomery Street. Suite 600, San Francisco, CA 94 105
Phone: [phone] Fax: [phone] Email: peter [email protected]
Tu.C.330
PEER-LED AIDS PREVENTION DELAYS INITIATION OF SEXUAL BEHAVIORS
AMONG U.S. JUNIOR HIGH SCHOOL STUDENTS
Ekstrand Maria L, Siegel D, Nido V, Faigeles B, Cumremings G, Battle R, Krasnovsky F, Chiment
E, Coates T Center for AIDS Prevention Studies (CAPS), University of California, San
Francisco, USA
Objective: 7o evaluate the effects of a peer-led HIV prevention program on the initiation of
sexal activity among 199 7th grade urban African-American, Latino, and White junior high
school students.
Methods: Thirty-seven 9th grade peer educators were enrolled in a one seramester class in
peer helping. Students in the intervention school received a S session basic sex and drug
education curricslum in 7th grade taught by health educators.This was followed by 8 interactive sessions taught by the 9th grade peers, focusing primarily on peer norms, skills building, and mnotivatirg students to remrain abstinent, or have only protected sex. Control school
students received a standard, brief AIDS and sex education curriculum. Students in these 3
comparable schools were surveyed regarding sexual behavior prior to the intervention and
again in the fill of 8th grade. Only students who had not practiced each sexual behavior at
baseline are included in these analyses.
Results:
Initiation of sexual behaviors between baseline and follow up among inexperienced students
Intervention School Students Control School Students pValue
Initiated: % n % n
Deep kissing 12% 51 30% 57.02
Brerst Touching 10% 58 23% 70.06
Genital Touching 9% 70 20% 92.05
Vaginal intercourse 5% 98 18% 10.0 I
Control students were thus more than 3 tirmes ais likely to initiate vaginal intercourse compared to inter viention studenrts Between 7th nrid 8th grade, intervention school students
also developed sa fer sexual N orms, while control students' norms became riskier A longitudinai 9iltiple Igstir r eyre -sso eanlyss adfustiny for baseline variables, showed that control
students werecsignihicantly mie likely to riti atc svgmnal sex by follow up (Off.:8ff) thari
inert: unterventuos studenrts.
Conclusions: Tfrese r-esults suggest thast a schtool-based tpecr led AIDS prevcetion progr-aa
can reduice thre likelihood of cexvii iniirliorn red influencc per-ceived poor norms anmonig
young, nauftir-thnic cirbart adolescentts. Eutire rserch in nceded to study the effects of sireir interventions err the behaviier s of soyalsly experiecred teens.
M.L. Ekutruerd, S-ff00, 74 New Montgonrery, Sain Francetro, fA 941I0P, USA Telephone: 41I5 -5979 89 Fix 41IS-597 92 i3 em al: Man si kstrarndtoiquicknraiiucsf.edcr

Tu.C.33 I
LESSONS LEARNED IN SUSTAINABILITY OF YOUTH PEER HIV/STD PREVENTION
EDUCATION:A PVO/NGO PARTNERSHIP
Kauffman, Carole K*, Hue L,Widdus D"*, Randolph S' ", Fee N *.American Red
Cross, National Headquarters,Washington, DC. USA; "Jamaica Red Cross, National
Headquarters, Spanish Town, Jamaica; **Arcine, France: ""'University of Maryland, MD,
USA; " " London, UK.
Issue: Lessons learned from partnerships between non-government organizations from
developed anc developing countries in building sustainable HIV/STD programs need to be
explored and built upon.
Project: An island-wide training system in support of a youth peer HIV/STD Prevention
program was developed in Jamaica Red Cross and American Red Cross partnership and
funded by FHI AIDSCAPThis training system, based on an operation. research project,
involves young people extensively in the design, implementation and evaluation of the program.Working in pairs or triads, youth peer educators (PEs) deliver a series of fourteen
activities involving games and other participatory methods to their peers in small groups of
10 to IS people. Evaluation of the program consists of qualitative and quantitative methods
to assess the effectiveness of and provide operatinal feedback at three levels of nterven
tion: peer to-peer education, PE trainingr and instructor trainer preparation A radio enril
drama supports key messages.
Results: Over 30 trained volunteer instructors trainers have, to date, conducted 10 four-day
workshops; traIring over 200 PEs. Peer to-peer sessiorns are given in i wide variety of urbar
and rural settings, involving young people in school and out of school, nd f-cm a wide var
ety of socoeconoirnic levels and literacy levels.
Lessons Learned: Sustainabilty involves more than technical assnistance related to IltV/AIDS
prevention education anrid includes capacity buildin ingi program monitorrng and evalution,
project managemrnent, fnanciii rmanagement techniques. inventory and control of miteras,
fundraising, use of technology and creation of political aliances. Literacy of PEs and trainers,
volunteers, a structured program, print materials, standards of performance, evaluation, and
operational monitoring are all critical elements of this program. Investment of funds is high
at program design and start up; return on investment began in year three with exponential
growth. Donors need to recognize the necessity of allowing time and resources to build
replicable, sustaitable programs.
CK Kauffman, American Re d Cross, Health & Safety Services, 8I! I Citehouse Road, Fails Church,
VA, USA. tel.: [phone]; Fax: [phone]; Emil: KauffmanircUSA.RedCross.Org
Tu.C.332
EDUCATION ON HIV/AIDS PREVENTION FOR ADOLESCENTS
Chen JngiYe Guangjun. Institute of Child and Adolescent Heath,. Beijing Medical LUniversity
Objective: To help students to know the basic knowledge on HIV/AIDS/STD, where to
go when they need help and to delay the first sexual intercourse amrong the teenagers.
Methods: Two hundrect and fifty seven 8th graders (girls 130, boys I 27). from a city
school in the north part of China, were involved and divided into an experimiental group
and a control group by class, ranidomly.The education times were 5 hours for boys and 6
hours for girls. Pre-test, post-test and follow up test were conducted by intervals of 3
months respectively.
Results: I.The icrease in basic HIV/AIDS knowledge score is noticeable. In the experimental group, the percentage of girls and boys who correctly answered the three transmitted
ways (sex, blood, from mother to baby) of HIV increased from 13.8 37.9% in pre-test to
70.7 - 94. 1% n post-test, and 69.0 - 91.2% in follow up test, (significant, p0.0 I).The
scores of HIV/AIDS knowledge on post-test and follow up test in the experimental groups
were significantly higher than that in the pre-test (p<0.01), the increment of the scores after
education in experimental groups was significantly higher than that in the control groups
(p<0.0 1). 2.The percentages of students who answered 'go to hospital' if they had reproductive disease ncreased significantly from 60.3% (girls) and 65.5% (boys) in pre-test to
82.4% (girls) and 93.1 % (boys) in post test, 86.8% (girls) and 86.2% (boys) in follow-up test
in the experimental groups; in the control groups, the percentages were 59.7% (girls), 66.7%
(boys) in pre test, 56.5% (girls) and 62.3% (boys) in post-test, 67.7% (girls) and 62.3%
(boys) in follow up test, respectively There was no significant difference between expenmental and control groups in pre test, but after education, the differences were signficant
(p<0.0 I, p<0.05). 3. During the whole experimental process, there was no student who
had sexual intercourse in the experimental groups.
Conclusions: We can see that the HIV/AIDS prevention education at secondaryschooli s
essential, feasible and effective in China.The sex education does not lead early sexual ctiv
ties for adolescents.
Chen Jingqi, Inst tute of Child and Adolescent Health, Beijing Medical LUniversity, Beijing
100083, China.Telephone: [phone]. Fax: [phone].
Tu.C.333
RESPONSE OF YOUNG PEOPLE 15 - 19 TO HIV COUNSELING AND TESTING
IN UGANDA
ueumra Edwnund, AuwmnEdyogu M, Bryarae - Karue M rue, Moore
- *. *AIDS In-orsatons Centrno U8grnd r "COC/USAID tiand...ii CAtg
Issue: Much remans unknown regarding tse best methods to help maung peopie en delopung contres establish mric esaintame low mms eul e~~r whmch wI heltrp themr uvomP
HIV infection.
Project: The AIDS Information Centre (AIC) in Uganda has provided voluntary and nonyerous HIV counseling and testing (CT) to over 260,000 persons since 1990 irn urban, peruurban tnd rural sites in Uganda. Over 28,600 have been between i5 amsd I9 years of age.
All CT is voluntary and anonymous; since 1994 there has been a modest fee r-anmny up to
US $2 for this service. Since 1992 standardized data have been coleed on all c ents: we
compared young people under 20 to adults 20+.
Results: Trends over time sumrest a decrease in HIV infection rates among young people
requesting CT In 1992, 19% of females and 5% of males were HIV+; this stead ly decreased to
7% mn young women and 3% in young men by 1995.Among these youny people, 19,200
(67%) have been women.Young people (I 4%) are more lkely to report cons stent condom
use in the three months preceeding CT than adults (8%).An increasing number of young
people come as couples, and by I995 46 of all young people crme a couples, compared to

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