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

Tu.C.2660 - Tu.C.2664

Tuesday July 9, 1996

Lessons Learned: Despite awareness of the modes of transmission of HIV, men often f ai to
use condoms with sexual partners including commercial sex workers, whose rate of sero
prevalence in Kaolack is nearly 30%. Interventions designed to change men's behavior will
be most effective if based on an assessment of their readiness to adopt condom use with
different types of sexual partners.
L Leonard, Department of Health and Social Behavior, Harvard School of-Public Health, 677
Huntington Avenue, Boston, MA 02115. UiSA Telephone: [phone] Fax: [phone]
e-mail: [email protected]
Tu.C.2660
RISK FACTORS FOR NON-CONDOM USE IN COMMERCIAL SEX CONTEXTS IN
THAILAND.
BrownTim*, Sittitrai VW/*, Phadungphon C*, Carl 5G, Sirimahachaiyakul W- *, Jittangkul
D*, Komatsu R*. *East West Center, Honolulu, USA; "Program on AIDS,Thai Red Cross
Society, Bangkok, Thailand.
Objective:To investigate factors associated with commercial sex workers' failure to use condoms with clients in different commercial sex settings in Bangkok and a Northeastern
province.
Methods: Between 1994 and 1995, a total of 1281 women in Bangkok and 192 women in
one Northeastern province working in the sex industry completed face-to face interviews
with a structured instrument designed by the research team of the Multisite Intervention
Research Project on Sex Workers and HIV Transmission (MIRP) funded by AmFAR and the
Rockefeller Foundation.
Results: A total of I 226 respondents who had sold sexual services within the lasl month
reported on 3395 individual sexual interactions with their last 3 clients. Reported non-use
of condoms was low, only 5.6% of all interactions. However, substantial variation was seen
between different classes of sites: 0.4% non-use in brothels and I. I% in massage parlours,
versus 5.8% in bar type sites, 6.8% among freelance worlkers, and 26.9% in sites disguised as
restaurants. If sex occurred at the workplace reported non-use was only 0.7%, versus 8.9%
in hotels, 28.8% at the customer's residence, and 40.4% at the women's residence. In 75. I
of interactions without condoms, the women reported no condom was available. Non-use
was higher with Thai clients than with foreigners (6.0% vs. 3.4%), higher with regular clients
than with transient clients (10.4% vs 3.2%), and with drunk than non drunk clients (8.3% vs.
4.7%).
Conclusions: Although the Thai I100% condom use campaign has been successful and condom use has become the norm in commercial sex interactions, unprotected sex still persists under certain circumstances. Working at disguised sites, being with regular clients, and
having sex off site are other important factors. Women in commercial sex should be
encouraged to always have condoms with them and to use them with all clients regardless
of their relationship or where the interaction occurs.
Tim Brown, Program on Population, East-West Center, 1777 E ast- West Road, Honolulu, HI
96848 USA. Phone: [phone], Fax: [phone], email: [email protected]
Tu.C.266 I
DIVERSITY IN THE COMMERCIAL SEX INDUSTRY IN BANGKOK,THAILAND.
Komatsu, Ryuichi*, Sittitrai W**, Brown T*, Sirimahachaiyakul W**, Jittangkul D*,
Phadungphon C", Carl G * v*East West Cente', Honolulu, USA; **Program on AIDS,Thai
Red Cross Society Bangkok,Thailand.
Objective: Commercial sex occurs in a diversity of settings and sites with wide variation in
actors, social support and autonomy for the workers, economic pressures, and access to
tools for HIV/STD prevention.This study, a component of a comparative 3 country study
known as the MIRE examined intervention relevant variations among 4 categories of sex
work sites in Bangkok.
Methods: A sample of 1231 women from 4 strata of the commercial sex industry (brothel
type sites, massage parlours, disguised sites offering additional services, and bar type sites)
completed face-to-ftace interviews in late 1994/earl 1939.
Results: Substantial differences were seen between the setting categories in the responses
of 1040 women who reported selling sex in the last rronth.

Methods: A descrnptive pIidenriologic study based on a personal interview, a standardized
questionnaire administered in ain HIV outpatient clinic, and medical chart review
Results: Over a four month period, 73 tattoos were studied in 29 HIV infected patients:
69% were mare, 45% vv,,, e nonwhite, and 79% were prior or active injection drug users.
Patients obtained t'e first' tattoo at a mean age of 17 years; 96% reported no knowledge
of health risks assoca iec h.'.Intattooing, 48% regretted hasing the tattoo, and 31 c wanted
the tattoo removed.trites vere applied for a variety of reasons, usually for cosmetic put
poses (3 %), conistrnient to another person (28~0), or as a personal symbol (I 8%). Of the
73 experiences, 44% nvolved the use of illicit drugs or alcohol, and 77% were performed
illegally 25% of which occurred in prison Although tattoos often provide important psychosocial insights into the patient, only 14% of the patients stated their primary care physiciar had discussed or acknowledged their tattoo, and only 2 (9%) of the 22 medical records
that had a comprehensive history and physical exam rioted the presence of the tattoo.
Conclusions: Ttteoos inourn IV-infected patients were commonrly obtained during adoles
cence for a variet Sy of reaso ns and weore often regretted laterTattoos were usually obtained
illegally ard fiequently under the influence of alcohol or illicit dru igs. Although trhe hi story of
the tattoo, and its method of placement, m ay provide important psychosocial insights, health
care pro viders often do enot discuss the tattoo with the patient or document it in the medcal record.
Christopher J. Perkins, MD Boston Cit y Hospital 818 Harrieson Ave. Boston, MA 02118 USA
Tu.C.2663
A COMMUNITY ORGANIZING EFFORT TO INCREASE HIV/AIDS SERVICES TO
PEOPLE IN JAIL OR NEWLY RELEASED FROM JAIL
Bisarra, Elmer*, Pediin-Cizoni, M*,Wiiains N. **. Uptown Interfaith Service Center: San
Diego, California, USA ** Kalinga Associates, San Diego, California, USA
Issue: The number of people with HIV/AIDS in America's jails is alarming. Historic allyt there
has been little attention paid by local cor I munities to the health care needs of jail inmates.
There has also been little coordination of health,care betweenr ails and local health
providers when inmates are released.
Project: Beginning in 1992, ttre San Diego County jails and the local HIV/AIDS service community have worked together to improve health care for Jail inmates and coordination of
cares when inmates are released fom jail.
Results: During the 4 year duration of this community organizing effort, 25 government and
non-government agencies, along with 10-15 ex-offenders released fSom jail and prison, have
actively participated in the Sin Diego Community Coaltion for Inmate Health.l he activities
of this group have brought over $200,000 per year-in additional HIV/AIDS services into the
San Diego Jails.These serOvices have included a 24 hour AIDS hotline, publicaon and distribution of 5000 "Get the Facts" about HIV/AIDS handbooks (specific to local jail inmate
needs), a women's clinic staffed by Pclanned Parenthood, and numerous HIV/AIDS educational activities for inmates and deputies.
Lessons Learned: Community organization strategies acimed at developing colelabor iton
between local jails and ecommurnicty HIV/AIDS service organizations can greatly ncrease
access to service for inmates w ohile they are incarcerated and after they are released.
Elmer Bisarra, 41 92 33rd St. # I, ISan Diego CA USA 92104 Phoane: 619-29 I- -9 I
Tu.C.2664
MEETING THE HIV/AIDS PREVENTION NEEDS OF HIGH RISK INCARCERATED
POPULATIONS ACROSS FLORIDA'S CORRECTIONAL CONTINUUM.
Sandra Schoenfisch, R.N., Ph.D.. Michael A.Walsh. State of Florida, Department of Health
and Rehabilitative Services, HIV/STD/eB Program
Issue: High risk inc iarcerat ed individuals do not have access to traditional health, education
and risk reduction programs.
Project: The objective of the p rojlect is to establish a con-iectional H IV/AIDS per eventions
educaton ion and risk reduction model for high risk inma tes and correctional staff within the
Florida correction systen (prisons, jails, and detention facilities). In January 1995, the Florda
Department of Health and Rehabilitative Services (HRS) initiated an HIV prevention pilot
prolect in cooperation with the Florida State Departrent of Corrections in the
Correctional Facility at Iawtey, Florida. The project was designed to provide a peer-based
approach to HIV and AIDS prevention and risk reduction for-inmates and correctional facility security and health care staff During the first year of the project. the primary focus was
on the development, implementation, and evaluation of a 20 hour enhanced counseling
peer education model directly addressing prevention and risk reduction education for
inmates within one year of release from prison. Upon release from prison, individuals who
have successfully completed the prograrm are prepared with the information and skills need
ed to prevent HIV transmission and decrease personal risk upon return to their local com
munity.
In October 1995, the Tamrpa-Hillsborough Action Plan, Inc., a community based organization,
adopted a rnmodified program model to be used in county and city jail settings. Adjustments
in program length are being made to accommodate shorter sentence length. Prevention
case management will also be highlighted rboth during rand after incarcertion.
Results: The collaborative effort between the Florida Department of Correction and the
Florida Department of Health and Rehabilitative Services during this project has introduced
opportunities for the departments to interface HIV/AIDS prevention and intervention activ
ities while decreasing costly service duplication.The enhanced counseling appr-oach has
been eatremely a-ol accepted by inmates and staff alike nd prevention saff from oth
depacrtments are sea- evasluatinag several additionsal sites far pirogirass replicatioan. Siton unader
censideratren incluade three women's prisons, one of which houses all pregnant fnmales, and
two other men's prisons.
Lessons Learned: HIV/AIDS hea th education and risk reduction messages directed at high
rink incarcerated individus nccn be especially successful arc-ens all venues at the canrsectional
centinsuu. Enhasceents durag the econd year of the poect will include scested
emphasis on correctional staff involvement in the program.
Michael Walsh, State of Florida, Department of Health and Rehabilitative Services, 317
Winewood Blvd., Room 407, Fallahassee, Florida 32303, Felephone, 904-922-6675, Fax,
904.922.4202.

Peers suppot clien ref,l for Condom non use
Management suipport client refusal for condom non use
Feeling their familys standard of rng unpr oved
Urprotected iuntercouse with one f last 3 chient;
VDRL positive (Of 727 tgiving infor med consent)
Weekly checkups for ITDs
Condom break i the lait month

Brothel Massage
92.1 % 90.7 '
90.1 % 91.7 %
85.1% 83.5
1.3% 24%
105% 5.3%
27.5% 75.5%
42.4'% 1.0 %

Bar Disguised
84.2% 74.0%
74. 3% 61.6%
64.8% 64.4%
10.3 4I.I%
4.7% 7,4
38. % 6.2%/
I0/% 6.8%

Conclusions:Thai national efforts to promote condomr use in brothels appear to have
greatly raised awareness and use of condoms among commercial sex workers, however: not
uniformly across all types of sites. Workers at indirect sites receive much less support for
use of condoms from peers and n managers and are less likely to use condoms consistently
Perceived economic pressures are much higher on workers in direct sites.The rise in numbers of less direct sites in recent years calls for expanded efforts and new strategies to
reach women and managers in these sites.
Ryuichi Komatsu, Program on Population, East-Nest Center: 1777 East-West Road,
Honolulu, HI 96848 USA.Tel: [phone], Fax: [phone], email:
ryuich i ahawai i.edu.
Tu.C.2662
TATTOOS IN HIV-INFECTED PERSONS: NEW INSIGHTS INTO AN OLD ART
Christopher-J Perkins, MD/, Sarah Schiff, MPH2, Kathleen A. Steger RN, MPH 1,,23, Donald
E. Craven, MD 2 3 Department of Medicine, 2Adult Clinical AIDS Program, Boston City
Hospital, 3Epidemiology and Health Services Section, Boston University Schools of Medicine
and Public Health: Boston, MA 02 11 8
Objective: To study the epidemiology of tattoos in persons with human inmmunodeficiency
virus (HIV) infection, assess the patient's awareness of health risk and evaluate the health
care worker's interest in the tattoo.

379