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

Monday, July 8, 1996

Mo.D.580 - Mo.D.600

recognized as a full member of the French social space.They pointed out the fragility of
young gays towards the transmission of HIV.
Clouzeau Fabrice, Sida Info Service, 190 bd de Chdronne 75020 PARIS, France.
Tel:l -44931626 Fax: [phone]
Mo.D.580
THE AIDS COMMUNITY DEMONSTRATION PROJECTS (ACDP):A SUCCESSFUL
MULTI-SITE COMMUNITY-LEVEL BEHAVIORAL INTERVENTION
Fishbein, Martin, Johnson, W.D. AIDS Community Demonstration Projects, Centers for
Disease Control and Prevention, Atlanta
Objective: To evaluate a theory based, community-level intervention designed to increase
consistent condom and bleach use among populations at high risk for HIV infection (i.e.,
injecting drug users [IDU], female sex partners of IDU, commercial sex-workers, men who
have sex with men but who do not gay identify and street youth) in five U.S. cities.
Methods: Small media intervention materials (e.g., pamphlets, community newsletters) were
developed for each specific population.These materials, distributed in intervention communities by community volunteers, contained role-model stories focusing on key theoretical
behavior change variables as well as condoms and bleach kits. A series of ten cross-sectional
surveys (2 pre and 8 post intervention) were performed in each of ten intervention and
matched comparison community/risk group pairs. Progress toward consistent condom use
and consistent bleach use (to sterilize injection equipment) was measured on five-place
(I -no intention to use; 5=consistent use > 6 months) Stage of Change scales. Condom
carrying and exposure to the intervention were also measured.
Results: Linear regression and logistic analyses (Ns range from 4235 to 12346) were used
to test for a time by treatment (intervention vs comparison) interaction effect, as well as for
a main effect of exposure (vs. nonexposure) to ACDP materials or personnel. After controlling for Age, Gender, Ethnicity Risk Group and City significant interactions indicating greater
increases in intervention than comparison areas were found with respect to condom use
with non main partners (p<.0001), bleach use (p<.05), and condom carrying (p<.0001I).
There was a similar, but non-significant effect with respect to condom use with main partners (p=.0888). Furthermore respondents reporting ACDP exposure averaged higher on
the Stage of Change scale for all target risk-reduction behaviors, and were more likely to
possess a condom at the interview, than unexposed intervention area respondents.
Conclusions: Theory based, community-level interventions can significantly increase HIV
risk-reduction behaviors in historically underserved populations.
M. Fishbein, BIRB, DSTD, CDC, MS E-44, 1600 Clifton Road, Atlanta, GA, 30303, USA
Telephone: [phone] Fax:[phone] email:[email protected]
Mo.D.581I
COMMUNITY MOBILIZATION REDUCES HIV RISK AMONG YOUNG GAY MEN:
A TWO COMMUNITY STUDY
Kegeles Susan M, Hays R, Pol lack L, CoatesT Center for AIDS Prevention Studies (CAPS),
University of California, San Francisco, USA.
Objective: To evaluate an 8-month peer led community-level HIV prevention program for
young gay/bisexual men that we developed and implemented in 2 mid-sized U.S. communities.
Methods: The intervention, based on diffusion of innovations theory used 5 elements
designed to increase support for safer sex and to change community norms: I) a young gay
men's community center we created, 2) a core group of young men who ran the project,
3) informal outreach conducted among friends, 4) formal outreach conducted at gay venues
and social events we produced, 5) small groups which focused on safer sex and informal
outreach in the context of more salient issues to young gay/bi men. Independent of the
intervention, we recruited a longitudinal cohort of gay/bi men aged I 8-27 in the communities and resurveyed them annually twice prior to the intervention, and twice post-intervention (Baseline I N = 242 combined from the communities). Data from the communities
were combined to increase statistical power since we found no significant differences
between the communities on risk behavior, demographics, and psychosexual variables.
Results: Boyfriend analyses include only men with boyfriends.
Percent of Men Reporting Unprotected Anal Intercourse In the Past 2 Months

leaders as peer educators. A study project modelled on the approach was initiated among
the student body of Lund University (37,000 students) in 199 I.
Methods: The evaluation consisted of yearly focus group discussions with student organisa
tion and opinion leaders, anonymous questionnaire mail surveys in 1992, 1993 and 1995,
impact questionnaires at main HIV STD testing sites and qualitative interviews with student
community leaders, project peer educators and regular students.
Results:The surveys revealed the preoject had reached 50% of students in 1 99 Iand 70% in
both 1993 and 95. In all 3 surveys, respondents indicated project prevention messages to
be more personally relevant than those of central campaigns Reported consistent condom
use with new sex partners was significantly higher among project-contacted students than
non-contacted in 1992, 1993 and 1995 (62% vs. 47%).This was even the case for reported
condom use during the last intercourse with a new sex partner" in the I1995 survey (72%
vs. 58%). Bivariate comparison of the 1992 and 95 surveys revealed statistically significant
increases in consistent condom use, perceived safer sex social norms, subjective knowledge
and internal locus of control. Also found were decreases in between-partner communication barriers and in the percentage of students with a STD history Implementations found
to have the greatest impact on these variables were those involving direct peer educatorto-student contacts and student to student communication (diffusion).The project began as
a cooperative action between local health clinics and the leaders of 25 student organisations. In 1994 it was registered as a non-profit student organisation with an elected board
of directors representing these organisations.
Conclusions: The findings suggest that a HIV prevention approach based on community
action and organisation is feasible under the conditions of this study and may facilitate the
creation of prevention messages that are both relevant and culturally adapted to a target
group. Further, it could suggest that when actual implementations are designed and execut
ed by opinion leaders, they may effect condom use via a modification of normative, social
and self-efficacy perceptions.
Gary R. Svenson, Dept. of Community Medicine, Malmo University Hospital, -5 20502
Malmo, Sweden.Telephone: [phone]; Fax: [phone]
Mo.D.583
THE WOMEN'S SAFER SEX HIERARCHY: INITIAL RESPONSES TO COUNSELING ON
WOMEN'S METHODS OF STD/HIV PREVENTION AT AN STD CLINIC
Gollub, Erica L.*, French, P**, Latka, M.* Johns, L.* Blum, L.* O'Donnell J.* Stein Z.A.***.
*Phila. Dept. of Publi Health; **Medical College of PA., Pennsylvania, USA; ***Columbia
Univ., NY, NY, USA.
Objective: To measure differences in risk of reinfection with STD and unwanted pregnancy
in a clinical trial of three different counseling messages: full choice ("hierarchy") of women's
barrier methods (female condom, diaphragm, spermicides, etc.); enhanced male condom
counseling only, and female condom counseling only.
Methods: More than 1 600 STD clinic attendees have been randomized to receive 3 different counseling messages since May 1995. F ollowing counseling all anonymously rated the
intervention and answered knowledge questions based on the specific counseling received.
As of Jan I, 1996, 233 women have also enrolled in an intensive follow up (FU) cohort for
acceptability data. 2-week FU behavioral data on sexual risk were compared with intake
data. In addition, choices of the 119 in the hierarchy FU group were tabulated and were
evaluated for relationships to previous method use.
Results: Scored from I (highest) to 5 (lowest), mean responses ranged flrom. I to 1.9 for
rating of counselor, video and group discussion/interactive educational approach in the clin
ic. Among women counseled on the hierarchy of women's protective options. 74% understood the nature of hierarchical risk following counseling. Among the subset of 119, 87%
chose the female condom, 63% male condom, 6 1% spermicidal foam, 57% spermicidal film,
33% spermicidal suppository I I% diaphragm, and 6% cervical cap (choices non-exclusive).
The reduction in number of unprotected acts of intercourse at 2 wks by self report was
greatest in the hierarchy arm, as compared with female condom and male condom arms:
83%, 54% and 39%, respectively Male condom users at intake tended to supplement con
dom use rather than replace it with other methods. Enrollment for the female condom is
significantly easier than for the male condom.
Conclusions: Initial results from this large STD clinic-based intervention suggest that a video
+ group discussion design is well-liked. Furthermore, the hierarchical message appears to be
understood by a majority and the methods are used for risk reduction in the 2-wk FU period.When exposed to the hierarchy. male condom users tend to supplement rather than
substitute use of other methods.The female condom and other female barriers are viable
risk-reduction options at an STD clinic. Long-term acceptability and effectiveness will be
determined over subsequent FU's (up to I year).
E.L. Gollub, Philadelphia Dept. of Public Health/AIDS Activities Coordinating Office, 500
South Broad St., 2nd Floor, Phila. PA I 9 146 Telephone: 2 I 5-685-6560 Fax 2 I 5 685-67 I 4
email: 102027. [email protected]
Mo.D.600
HIV/AIDS INTERVENTION AMONG TRANSSEXUALS IN BANGALORE.
MEDICO - LEGAL IMPEDIMENTS FOR EFFECTIVE INTERVENTION
Saniay.. Samraksha - Bangalore,India (Ngo - Hiv/Aids Intervention/Prevention Project.
Objective: To provide HIV/AIDS information/counselling/STD treatment and condom distribution among transsexuals in, Bangalore - INDIA.
Methods: In Bangalore there are 7 families comprising of approximately 25 transsexuals
each, they are a very closely knit community After making the initial contact each group was
educated on HIV/AIDS.They have 10 times the number of clients compared to sex work
ers; Majority of homosexuals also visited them.They are at a much higher risk fiom HIV
They are distributed with condoms, and also treated for STDs.
Results: Evaluation of the transsexuals HIV programme after a year showed; a) 80 % con
dom usage among the community and the need for stronger condoms. b) A remarkable
decrease in STDs.
Difficulties/Drawbacks:The transsexual population have no STD treatment facilities, they
do not have access even to the Government STD clinics.They have to take treatment from
quacks thus persistent STDs.They have no legal status due to lack of voting rights, nor can
they make any complaints to the police if exploited.The condoms supplied lack the aecessary strength and lubrication thus greater number of breakage during sexual contact. They

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52

BaselineI
with casual partners 21%
with boyfnend 54%

Baseline 2 2-months Post intervention 12-months Post-intervention
19%5 13%* 10%*
57% 42%* 50%

*p<.05, differences between post-intervention assessment and Baseline 2
There were no significant differences between levels of unprotected anal sex at the 2 baselines, indicating no naturally occurring trends towards risk reduction. We found a 32% relative reduction in unsafe sex with casual partners and a 26% relative reduction in unsafe sex
with boyfriends from Baseline 2 levels at the 2-month post-intervention assessment.The
reduction in unsafe sex with casual partners was sustained one year post-intervention, but
there was a return to unsafe sex with boyfriends (many of which were new relationships).
Attrition does not appear to bias the results.
Conclusions: Mobilizing young gay men to encourage each other about the need for safer
sex and creating a center at which support can be expressed is an effective approach to
HIV prevention with young gay/bisexual men, but programs need to be sustained over time,.
Additional efforts particularly need to focus on risk reduction among boyfriends.
SM Kegeles, 74 New Montgomery #600, San Francisco, CA 94 105 USATeI: 415-597-9 I 59;
Fax: [phone] I 3; email: [email protected]
Mo.D.582
INCREASED CONSISTENT CONDOM USE AMONG STUDENTS IN A PREVENTION
STUDY BASED ON COMMUNITY ORGANISATION AND ACTION AND THE USE
OF PEER EDUCATORS.
Swvenson, Gary R,**, Johnsson K***, Hanson BS*. *Dept. of Community Medicine, Lund
University; Malm; **Dept of Infectious Diseases, Univ. Hosp of Lund, Lund; ***Student
Health Clinic, Lund University Lund, Sweden
Objective: To develop and longitudinally evaluate a HIV STD prevention approach based on
community organisation and action, target group empowerment and the use of opinion