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

Tuesday, July 9, 1996

Tu.D.365 -Tu.D.470

(A), and negatively valued (N) terms respectively Ss estimated the lii,t. t tt rraron
described was HIV infected, on a scale from 0="impossible hie is irnfetrd ic i0 r "certain
he is infected"
Results: Ratings were analysed using ANOVA and planned cormpa cr-<. 5 i;rnt differences were obtained across the 3 versions for every characteristic ex ept wealth. In 4 out
of the 5 cases for which differences were found, the N version elicited higher ratir gs than
either the P or the A versions. A different pattern was obtained for psic;l attractiveness:
here the P version elicited higher ratings than the A version.
Conclusions: That the tendency to infer antibody status from perceptiiie cliaricter istics
was present even in Ss making judgments about men they had never iret sugfr.Is that the
self justifications we recorded previously were not merely post hoc ratioraisatiosis devised
to cope with anxiety and guilt after risk-taking.The types of inferences r corded were
broadly consistent with those we found earlier However, the result [hat a phyrkailly attractive man was regarded as rmore likely to be infected contrasts with the repo ted use of the
self justification "He's so beautiful, he can't be infected."This may be a n exi aple of how the
thought processes that are present "on line" (in actual sexual encour ters) Can differ from
those that occur "off line" (in the cold light of day).
Ron S. Gold, School of Psychology Deakin University, 221 Burwood Highway Butiwood,
Victoria 3 125, Australia, Phone and fax: [phone] I email: rongoldlcrdelin redu.au
Tu.D.365
WHY SOME GAY MEN CHOOSE CONDOMS AND OTHERS SWITCH TO "SAFER" SEX
Ostrow, David G., DiFranceisco W. Center for AIDS Intervention Ree "'rich, M'edical College
of Wisconsin
Objective: To determine the general patterns of change in sexual behavior s ranid their relationships to attitudes and beliefs about the safety of sexual practice';, betw veen 1984 and
1992 among men participating in the Chicago MACS/Coping and Change Study (C&CS).
Methods: All of the men participating at each semi-annual assessment were assesscd using a
self-administered take home questionnaire (GC&CS) and a face-to-fice interview (MACS) to
determine current sexual practices, attitudes towards the safety and satisfaction of each practice, sexual adventurism and satisfaction with safer sex, psychological dirtr e. AIDS 'related
distress, sexual partnership types and demographics. Spearman rho corni elatio, I-oefficients
assessed the relationship of each behavior with perceived risk of anrd atisfaction ii o engaging in that behavio r. In addition, men engaging in any unprotected receptive anal sex (RAS)
during the first four assessments (N=600) were divided into three subgro.ups on the basis of
their sexual behavior choices during the following four assessments and compared on the
basis of their baseline demographic and attitudinal variables using onew y AvNIOV/\s.
Results: The proportion of men reporting any unprotected RAS in the prinor 6 rmonths fell
rapidly firom 45% to 10-15% by visit 6 and remained relatively constant therealter; receptive
oral sex fell from 85+% to 70% by visit 6, whereas celibacy gradually incrreascd fiomn <10%
to 25% during the 8 years of observation. Perceived satisfaction of oral sex aiid protected
RAS remained stable, while that of unprotected RAS decreased by bout 1/3.1lhere was a
trend towards decreasing perceived safety of protected RAS over time, which was the converse of the increasing perceived safety of oral sex. At all time points, satisfaction ratings
correlated more strongly with behaviors than did risk perceptions. Men who adopted condoms for- RAS were younger, less affluent, less educated, had less AIDS worries were more
likely to be seropositive at baseline. more sexually adventurous, and less sati sfie:d with safer
sex than men who switched to oral sex and insertive anal sex.
Discussion: Long-term patterns of sexual behavior change among a cohort of gay/bisexual
mren indicate that switching to forms of intercourse other than RAS is at least as popular as
adopting the consistent use of condoms during RAS. Comparisons of the behavioral typolo
gy groups indicate that sexual attitudes (perceived satisfaction and adventurismt) are impor
tant choice determinants and potential behavior change intervention targets
David G. Ostrow, M.D., Ph.D. Center for AIDS Intervention Research (CAIR), lMedicial
College of WI. 1201 North Prospect Avenue, MilwaukeeWl 532021
Tu.D.460
MARSHALING THE INFLUENCE OF CHURCH LEADERS IN AIDS PREVENTION AND
COUNSELLING: LESSONS LEARNED FROM KENYA
Dortzbach, Deborah A., Njorge, L., Kiiti, N., Robinson, P., Amalemba,.- llet, S., MAP
International, Nairobi, Kenya; AIDSCAP/FHI//USAID, Nairobi, Kenya.
Issue: Church leaders are found everywhere in Africa.They are powerfu inflleriicers in
communities and are often strongly committed to serving others as volunteer. frhey are
formal and informal counselors with little or no training. Harnessing the rotential and providing pastoral counselling training in AIDS may produce lifelong comternrrriirent and action
based on sound knowledge.
Project: An intensive AIDS pastoral counselling course was developed lor church leaders in
Kenya and workshops were held in four separate regions in Kenya, iccorirodatin over 8
different ethnic groups.The goal was to provide training in basic pastoral and ISlS ounselling skills and to increase the number of Kenyan church leaders effect'ively involved in
pastoral AIDS counselling at thre local church level.The course was divided i- rt two seetions of one week each, separated by three months of hands-on iir.ciie arid application at
the community level and follow up visits from a regional coordinato.
Results: Church leaders trained numbered I 54, from 34 different denonatins inrcluding
crajor Protestant, Catholic, and various independent denominations in Ke ya. Hear ly onethird were women. Post test evaluations showed participants were able to enall lhe counselling process, basic facts about AIDS and stated a beginning ability to addrs-, sesitive
issues in AIDS such as the condom issue, and the 'AIDS is a curse corcep. In two regions
studied, 60 participants reached a total of 30,000 people during the i ree rinrth interval
between workshops. Involvement included providing instruction and counseln tirough
school visits, hospital staff in service education, church functions, public gati enn rg' or
bhrzrs, and individual counselling sessions. A Christian AIDS Network vIs f...n,d.icross
the country with 10 branches.
Lessons Learned: Church leaders are recognized and trusted autho /ti n i trained in
facts on AIDS, AIDS counselling, and given opportunity to discuss si-i.t.. s openly,
they not only learn themselves but broadly pass on the informatior,.,d ti. others in
their communities.
Deborah A. Dortzbach, MAP International, PO. Box 21663 Nairobi, Ker,.t i: 25 1-2 714422

Tu.D.46 I
SOCIAL CULTURAL AND PSYCHOLOGICAL FACTORS AFFECTING THE SPREAD
AND PREVENTION OF AIDS AND OTHER STD IN MEDITERRANEAN AND ISLAMIC
CULTURES:THE CASE OF TURKEY
Diane Sumar, Svsi Aral. Bogazici University Istanbul,-Turkey CDC, Atlanta, Georgia, USA
Objectives: to determine the salient factors in the social structure, culture, and dominant psychological fe, ules of Turkish society which I) contribute to or 2) limit the spread of AIDS
anrid SI); rnd I ) have implications for prevention efforts.
Methods: /A, systematic survey of existing social, political and psychological analyses and empirical lit' ature re'levant toTurkish attitudes and behaviours regarding sexuality and health.
Results: Turish society is: I) collectivistic; 2) restrictive of sexuality; 3) subordinating of
wornen ar i1) eltatist.These features necessitate: a) reliance on social surveillance for control of sexual behaviour; b) tolerance of intervention in individual behaviour by state, family
and other iautorintie's; c) channelization of sexual behaviour by relatively impermeable
boundaries between social groups, so that sexual links across boundaries (e.g.,
nmarried/unnrarried, heterosexual/homosexual, urban/rural) often involve a partner fiom an
explicitly illeditinmate or devalued status such as prostitute or foreigner; consequently, d) high
volurns of female and male prostitution; and e) the seeking of sexual contact with tourists
and other fore ignrers.
Conclusions: I) Existing and predictable networks of sexual interaction direct the threat of
HIV infection mainly to deviant and marginal sectors of the population. 2) Effective prevention pro r an in mu't Ifocus more on public policy than individual behaviour:
tDiane Sunar, Dept of Psychology Bogazici University, Istanbul,Turkey 808 15
Tel: [phone] f6 1500 ext. 2052, 90-2 2 274-052 I
Tu.D.462
THE UN CONVENTION ON THE RIGHTS OF THE CHILD AND CHILDREN
AFFECTED BY HIV
e-on ie.t'mL.Iaoi. Or Neil (European Forum on HIV/AIDS, Children and Families)
Issue: The UN c onvention on the Rights of the Child has been signed or ratified by 180 of
the world's 19 I governments, but its implementation has been very variable. Nowhere is
this more app-rent than in relation to children affected by HIIV, whose rights to participation, protectionI aid provision continue to be denied in rmany parts of the world.
Project: The Furospearn Forum on fHIV/AIDS, Children and Families is a multidisciplinary network estabis hed in 1994.The experience of service users and professionals throughout
Europe has iprompted the Forurn to make promoting the legal and social rights of children
affctcd by HIV an urgent priority Among the key areas are the child's right to participate
in decsions that affect them; to protection from discrimination and neglect; and to the provision of housing, health services and social support.The European Forum is addressing
these ssues through a number of projects, in collaboration with both HIV organisations and
human rights NG()s. A questionnaire to examine how children rights are being implemented or denied in rrdillerent European countries has been developed, using the UN
Cornvenrtion onr the Rights of the Child as a framework. In addition a detailed comparative
study of children's rights and HIV in Italy and the UK is being undertaken. A parallel project
underLakenr by the National Forum on AIDS and Children in the UK has resulted in the
publication of Children's rights and HIV: a firamework for action'. Practical models of facilitating rhildrenl,'s participation have been developed through the Forum's programme of
rneetinrgs anid conferences, and it is planned to increase children's involvement through the
developmnt of a European children's panel.The Forum has assisted with the "Children's
Voices" project, through which children affected by HIV are encouraged to express themselves thr ough poetry painting, etc.
Results: Evidence from across Europe suggests that many children affected by HIV are
being denied r ights guaranteed under the UN Convention. For instance many children are still
facing discrimination, and do not have access to quality health and social services.
Lessons learned: The UN Convention on the Rights of the Child is an important tool for
those camnpaigning for the rights of children affected by HIV internationally Campaigning for its
fll irnplernerntation will be strenghtened by the direct involvement of children and families.
Naomi Honigsbaum.n, European Forum on HIV/AIDS, Children and Families, National Children's
Bureau, 8 VWa iy St. London ECIV 7QE, England.Tel: [phone] Fax:[phone] I 2
Tu.D.470
SEXUAL BEHAVIOUR AND HIV/AIDS IN EUROPE: COMPARISONS OF
NATIONAL SURVEYS
Hube Iichel C., Bajos N.**, SandfortTh.G.M.***, European collaborators.
*Facultes universitaires Saint-Louis, Brussels, Belgiumn; **INSERM U.292, Paris, France;
***Utrecht University The Netherlands.
Objectives: i.To describe sexual behaviour in Europe in the context of HIV/AIDS, 2.To
identify differences and similarities between countries that may highlight some differences in
the dynamics of the epidemic and prevention policies.
Methods: As part of the European Union (EU) 'Concerted Action' on 'Sexual Behaviour
and Risks of HIV Infectrion', fifteen na.tio.nal pop.ulation surveys from ten European countries
were compar ed. Questions fiom the various surveys were integrated in a 'bank of indicators 'ti assess their comparabilityThe different survey investigators took part in nine working pa ties which were able to cairry out specific comparative data analyses on the populations aged I8- 9.
Results: mm >ati re data analyses were rade (and are being published) on the following
topics tht ae relevant for HIV/AIDS: first sexual experiences, sexual orientation, sexual
pintiers, se'uri prctices, 'at risk' behaviour and risk contexts, risk reduction strategies, social
networks and sexual norms, knowledge and discriminatione.
Tis pre;entatiorm will point out the rnain results of these analyses and focus on the interpretation:ind discussion of key variations between countries (for example, the proportion
of female r eporting 5 or more partners over life ranges flom 16 to '40,% while it is close
to m amo. iinn es), as well as key cormorn trends (for example, in all European countries, f l ow to o Ihgh eduation, the inn-oportion of multipartners increase much more
among wor ern ttn Ir men).
Conclusions: Tiis collaborative work provides for the first time in Europe a large data base
on sexual beviour i i tire era of AIDS that can be used for different purposes and comp r cd with data fiom other continents.This experience has also shown the difficulties and

O
0
O,
ua
u
0
O)
U
nO
c
C6
0
ua
c
IL)
us_
c
0
U
0
c
0
cusa
c
x
260