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

Tuesday, July 9, 1996

Tu.D.242 -Tu.D.250

Conclusions: Refugee populations are at great risk for HIV/STD transmission. High-density
habitation and unemployment lead to boredom and probably to an increase in sexual activityThese factors, added to the high HIV and STD prevalence in Rwanda, point to a highly
volatile situation.Women and adolescent refugees are especially vulnerable.Women may be
powerless to exert any choice in practicing safer sex.Without the protection of adult family
members, they are vulnerable to violence, coercive sex and rape. Results from this pilot
intervention point to a special need to target women and youth in program design. Lessons
learned from this intervention can be used to improve strategies and develop model programs for other refugee and displaced persons settings.
Judy A. Benjamin, c/o Alfred Nimocks, AIDSCARP 2 10 I Wilson Blvd., #700, Arlingotn,VA, USA,
22201; tel. [phone]; fax. [phone]I
Tu.D.242
HIV/STD INTERVENTION IN RWANDAN REFUGEE CAMPS IN TANZANIA
Msuya, Wences,* Mayaud, P,, Mkanje, R.,* West, B.,,Todd J.,, Lisekie, F.,*
Grosskurth H. ' *AMREF, Mwanza, Tanzania; "London School of Hygiene & Tropical
Medicine, UK
Objectives: To establish an HIV/STD intervention program for the Rwandan refugee camps
in Tanzania (est. pop. 350,000).To evaluate the impact on STD prevalences.
Methods: The program was launched 4 months after the start of the Rwanda crisis and it
had 3 components: (A) IEC: refugee health behaviour promoters conducted mass education
campaigns; health learning materials were produced in Kinyarwvanda. (B) Peer educators
were trained among bar and brothel workers to educate their peers and distribute condoms. (C) The STD intervention consisted of training of health workers (HWs) in syndromic STD case management at all OPDs, regular supervision, supply of STD drugs, and
syphilis screening at antenatal clinics (ANC).We monitored clinical efficacy of algorithms,
drug susceptibility to Neisserir gonorrhoee (NG) and quality control of syphilis testing.
Impact on STD was determined through an initial and an I 8-month follow-up rapid STD
surveys among ANC patients (n= 100), male OPD patients (n=250) and males at community level (n=300).
Results: 140 IEC campaigns were conducted in 18 months, reaching about 220,000 sexually
active persons. 300,000 condoms were distributed. During the initial rapid STD survey all
groups reported frequent experience with STDs and risky sexual behaviour. Over 50% of
ANC attendees were infected with agents causing vaginitis (TV/BV/CA) and 3% were
infected with NG.The prevalence of active syphilis was 4%.Among males, prevalence of
urethritis was 2.6% and 2.9% among OPD and community respectively Prevalence of
syphilis was 6%. Following the intervention, the number of self-reported STD cases at clinics
increased from 20 to about 250 per week; over I 1,000 cases were treated in 12 months.
Syphilis prevalence among ANC attendees remained low at around 4-5%. Presence of
multi-drug resistant NO strains was observed. Results from the 18-month follow-up survey
are currently being collected.
Conclusions: Refugee populations are at increased risk for STDs and HIV. STD case detection and management should be improved by training HWs using the syndromic approach
and through IEC campaigns encouraging attendance at clinics, Rapid epidemiological methods provide quick, cheap and useful information in refugee crisis.
Wences Ch. Msuya, AMREF, PO. Box 1482, Mwanza,Tnzania Ph: 255-68 50220 OR 5229 I;
Fax: [phone]
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SERVICE NEEDS OF THE AFRICAN COMMUNITY IN UK;THE UGANDAN REFUGEE
COMMUNITY AS A CASE STUDY
Keefa Kiwanuk. Project Co-ordinator Uganda Community Relief Association (U.K.)
Issue: Because of the conditions in which refugees and asylum seekers live in UK, they have
always missed out in the mainstream HIV/AIDS prevention, care and counselling programmes.
Project: Our HIV/AIDS community based programme, targeted at the Ugandan Refugees
and the recently arrived East and Central African communities, is undertaken by a team of
nine specially trained Health Outreach workers, supported by a network of volunteers. It
offers an HIV/AIDS prevention, care and counselling programme culturally sensitive to the
C. assessed needs of the communityThis includes dissemination of information on primary
and secondary HIV/AIDS prevention, safer sex and reduction of risky behaviours; maintains- ing of a referral service system; and peer advocacy and support to those in the community
a)
> living with HIV/AIDS, and training and consultancy to service providers working with the
O African Community
0
u Results: We are witnessing an increasing awareness of the services available, HIV/AIDS
M issues, safer sexual practices and a reduction in risky behaviour.There is an increased uptake
> of services and an interest to learn more about HIV/AIDS issues. Our volunteer network
provides the family support structure that enables our service users access the traditional
V)' methods of care and support that is culturally appropriate, and helping rebuild the clients'
self esteem.
S Lessons: Living with HIV/AIDS in a foreign country is particularly distressing.The need for
C culturally customised information, care and support services, in a foreign country can not be
0
over emphasised. Differences in culture; values, family life, language and even perception of
a)
u illness requires a culturally sensitive approach.
a) Keefa Kiwnauka Project Co ordinator Uganda Community Relief Association Selby Centre
a Selby Road, London N 17 8JN Tel: [phone] Fax: [phone]
O Tu.D.244
THE FARMWORKER WOMEN'S INITIATIVE ON AIDS
e Lago, Mia,* Wilk, V.A.,Trevino Sauceda, H.,0* Marentes,A.* *DHHS/Health Resources
O and Services Admin., Bethesda, ME), USA, *Farmworker Justice Fund
-U Issue: HIV infection is incr easing dramatically among Hispanic and African American women
re
c- in the U.S., two groups to which the majority of farmworker women belong. Recent studies
3 show that HIV infection rate among migrant and seasonal farmworkers may be as much as
0 times the national rate.
- Project: This project consisted of collaboration with two Hispanic farmworker womens
' groups, one in California and the other in Texas, to convene farmworker women for
HIV/AIDS prevention training.The have the women make also make recommendations to

256 policy makers about access to comprehensive services and developed model education and
prevention programs for their communities.

Results: Over 70 low -income Hispanic farmworker women of all ages participated in the
conferences which were conducted in Spanish.The women learned how AIDS is spread and
discussed cultural taboos and barriers (like domestic violence or religious beliefs) that prevent
them fr-om getting information or help.The women developed comprehensive recommendations and strategies to provide HIV/AIDS education and services to migrant farmworkers.
Lessons learned: (I) There is a great need and eagerness for AIDS prevention training and
follow-up support for farmworker women and their families. (2) Farmworkers face very
serious problems of access to AIDS services. (3) These trainings promoted leadership development and increased self-esteem among organizers and participants alike. In 1996-97,
these groups will implement their recommendations.
M. Lago, HRSA/BPHC, 4350 East West Hwy Bethesda, MD, USA 208 I 4
Telephone: [phone] Fax: [phone], ernail: [email protected]
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A LOW-COST METHOD FOR ASSESSING MIGRANTS AIDS AWARENESS
Haour-Knipei, M., Fleury F., Jeannin, A., Dubois Arber, F. University Institute of Social and
Preventive Medicine, Lausanne, Switzerland
Objectives: To find an inexpensive, reliable, and repeatable way of constituting a representa
tive sample of community members to assess the impact of the Swiss, government spon
sored, AIDS prevention programme for Spanish, Portuguese and Turkish migrants.
Method: 70 individuals were trained to each recruit 10 30 respondents meeting quota cri
teria defined on the basis of easily identifiable demographic variables (age, sex, marital status, time of migration) drawn from official statistics. A questionnaire, adapted from that used
in telephone interviews with the Swiss, was auto-administered, and returned in a sealed
envelope to maintain confidentiality in regions with a high density of Spanish, Portuguese
and Turkish, and where there had been either many or few programme activities, two to
four regions were studied for each community
Results: Potential questionnaire respondents were recruited starting with friends and family
but filling quotas required going beyond acquaintance networks, to strangers in public gath
ering places, clubs, waiting lines etc.The questionnaire was well accepted.The quota procedure and multiple points of entry yielded a total of 980 usable questionnaires over a onemonth interval, with respondents representative on defined characteristics. Responses are
comparable to those of a sub-sample of people of the same nationalities contacted in the
course of random digit dialing for another study
Conclusions: Method assures a more representative sample than that recruitable by pure
convenience, can take into account clandestine populations, is relatively inexpensive, and can
be used in interaction with the programme, for example to permit volunteers to earn small
sums, and to raise awareness.
Mary Haour-Knipe Institut universitaire de medecine sociale et preventive, Rue du Bugnon
17, CH- 1005 Lausanne, Switzerland
Tu.D.246
MEXICAN MIGRANT HIV ISSUES: PROBLEMS AND STRATEGIES
Muiz-Marteldn Melba.* Baez-Villasenor J.* del Rio C.* GTuzman J.* Figueroa R.**
*CONASIDA. National AIDS Council **Ministry of Foreign Affairs. Mexico.
Issue: Temporary migrant workers from Mexico to the United States face several cultural
and psychosocial conditions that put them at risk for HIV infection. About 25% of AIDS
cases in Mexico have a history of being workers in the US for long periods so there is a
strong relationship between number of AIDS cases in the Mexican states that export
migrants and the states where migrants arrive to in the U.S.
Project: To find out what these factors are through surveys, facetoface interviews, meetings
with community leaders and talks to migrant and general population in order to increase
HIV awareness and diminish the risk of infection to this target group.
Results: The most important problems detected were: sexual practices of Mexican migrants
are different than those at their home places. Most of these migrants are usually young, they
travel alone and live in very crowded places with little or no privacyThey lack information
about HIV/AIDS transmission, they did not get it in Mexico and cultural & ideological differences as well as language difficulties make it impossible to get it afterwards. As most
migrants are illegal aliens, they fear being identified and deported, they lack access to health
care which results in self medication and use of ased syringes/needles as they can not get a
prescription to buy them.Terminal AIDS patients very often wish to come back to Mexico
to die at their home place.
Lessons learned: Acknowledging that HIV/AIDS among Mexican migrants to the U.S. has
special characteristics the first step was to develop a specific program consisting of an information campaign, using Spanish language with appropiate Mexican slang and dire by popular
wellknown characters.This campaign is being broadcast through Hispanic TV and radio stations, in the U.S. printed material is also being distributed through Mexican consulates and
local NGO's providing services to Mexicans. Also to conduct a program that enables PWA
migrants to return to Mexico we designed & promoted a program to provide them with
legal counseling coordinated between Mexican and American NOO's. All activities are coordinated by the Mexican consulates in the US to provide support to Mexicans abroad and
decrease HIV infection risk as a result of temporary migration.
Melba Muniz Martelon, Calz. de Talpan 4585 2do Piso. Col.Toriello Guerra, Deleg.Tialpan
Mexico City. Mexico Tel:[phone]'18 Fax: [phone]
Tu.D.250
AN ANALYSIS OF THE DIRECT AND INDIRECT COSTS OF HIV INFECTION/AIDS
IN THE PHILIPPINES
Aplasca, Mari Rose A.,0 Monzon O.T,* Mapua C.A.,m ].in-TorresT,** Romano E.,O Solon
0.*** *Research Institute for Tropical Medicine, Alabang, Muntinlupa City Philippes;
o*University of the Philippines Philippine General Hospital, Manila, Philippines;
*University of the Philippines, Dilimrn, Quezon City, Philippines.
Objective: To measure the direct and indirect costs of HIV infection/AIDS in the Philippines.
Methods: A retrospectee and prospective study on the costs of HIV infection and AIDS was
conducted between May 1993 to June 1994 in a government infectious disease hospital.
Data of patients were obtained fhom patients' records and interview of patients and house
holds. Direct costs of illness were analyzed on the three categories of the disease such as I)
the asymptoratic stae, 2) early syrpomatic st e and 3) late symptomatic stage (AIDS)