Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 44299-44303 995

Conclusion: Finally, we argue that in order to increase the number of receiving
patients and avoid budget constraints, the drug distribution program will need
more social pressure on government and more administrative innovation. Social
activism and practical results are the more solid ways to program legitimacy in
the public arena.
Evaluation supported by UNAIDS
44299 HIV/AIDS prevention among IDUs in Belarus
Alexander Pimenov. UL. Fabriciusa 28 Room 401, Minsk, Belarus
Issue: With the explosion-like spread of HIV-infection among IDUs in the country,
it was extremely important to start the first prevention project.
Project: The most important and difficult problem was, under the conditions
of the extremely complicated economic situation in the country and lack of the
basic resources for health care, to convince the officials at the highest level on
the necessity to turn to the HIV/AIDS problem and make them understand that
it is a menace to the whole country, but not just to some vulnerable groups.
The WHO and UNAIDS support the project in the most affected town of Svetlogorsk, Gomel Region. Alongside with drug-injection, at present in Svetlogorsk
both heterosexual way of transmission and the vertical - from mother to child are
realized, so not only medical problems, but social problems as well are expected.
For the first time on the territory of the former Soviet Union massed work on
lobbying the project among local authorities and the Government. During 8 years
of the existing of AIDS service the main success was in turning attitude of society
towards persons living with HIV/AIDS from negative to tolerance to these people.
But the authorities were still not ready to accept the AIDS problem as a threat to
their own town and, in particular, the preventive measures-distribution of syringes
and condoms (as part of harm reduction). The IDUs' parents created the NGO
"Parents for the Future of Their Children".
Results: There is the almost two-fold decrease of HIV-infection detection in
Svetlogorsk not only due to the reduction of testing, but due to the efficient work
of the project, at least because dirty used syringes disappeared not only from the
streets, but from the entrances of the buildings as well.
Lessons Learned: The most difficult work on lobbying to make the authorities aware of the HIV/AIDS can bring the results even in the countries with the
economy in transition.
44300 Creating an employment opportunity for PLWHIV/AIDS a
local government initiative
Angelina Andrada', J.P. Asuncion2, B.V. Leoligao2. City Health Department;
20longapo City AIDS Foundation Inc., Olongapo, Philippines
Issue: An out-break of HIV/AIDS in the locality left the infected individuals jobless, depressed, fearful and homeless considering that those afflicted by HIV are
natives of our city adding the fact that infection rate increases each year.
Project: The local Government thru the City Health Department decided to
begin a long term planning and Expansion of AIDS prevention efforts thru educational information mobilizing the Barangay (VILLAGE) Health Workers and came
up with a special program for PWHIV/AIDS. Since stigmatization and discrimination are some of the common problems of PWAs, the City government out of
compassion and care, initiated a rehabilitation program consisting of financial assistance, health care, educational subsistence, housing and spiritual assistance.
They were employed in some local government offices trained to do clerical, utility
and janitorial jobs. The job qualification was based on their educational attainment
and special skills. Simple check-ups and other medical assistance are given by
the city health department depending on its availability. Some were housed in
an old government owned building just near their workplace. Their children were
given school supplies, allowance, clothes and other things pertinent to daily needs
of our PWAs and their children.
Result: Because of the non-discriminatory attitude they received from their
co-employees, the original core of six (6) HIV+employed encouraged the others
to take also the opportunity until the number increased thru the years to a total of
15 enrolled in the program. Committed NGOs, Civic, professional and religious
organization who likewise, gave their support to the government initiatives.
Lessons Learned: Given proper counseling, unselfish motivation and opportunity, the PLWHIV/AIDS could be productive members of the society.
44301 A woman, before whore!
Ana Elusa Sperb Rech, P.C. Bahia, F.D. Malaguez, M.C. Pegorario,
S.S.S. Lopes. GAPA, Augusto Melechi, Porto Alegre, RS, Brazil
Problems: Difficulty of the target population (whoring women in Porto Alegre,
Brazil) to negotiate the use of condom with steady partners.
Project: During the execution of the project for the prevention of STD/AIDS,
in 1997, among sex workers, developed by volunteers of the NAESP (Group of
Action and Studies about Prostitution) from GAPA/RS (Support Group for the
Prevention of AIDS), a significant increase in the occurrence of pregnancy was

detected, as well as IIIV+ diagnoses among female prostitutes from the identification of the newly bores as cariers of the IIIV virus. These data are relevant once
these women take part in the activities developed by NAESP and are supposed
to have enough information and awareness on HIV/AIDS prevention.
The goal of the project is to redirect the activities in order to comprehend principally the negotiation of condom use with steady partners as well as with clients.
There is also an emphasis in the importance of the early IIIV/AIDS diagnosis

for a better quality of life and the prevention of vertical infection. To accomplish
this goal, new strategies have been developed aiming at reaching the target
population and making them aware of the importance of safe sex in all sexual
relations.
Results: (1) The intervention in areas of prostitution should be more frequent.
(2) The intervention should include the discussion of themes related to gender
and empowerment.
(3) Sharing of experiences on safe sex negotiation with steady partners (nonprofessional relationship) is an important strategy.
(4) Public policies should consider effective comprehensive health services for
women.
(5) Emotional ties can be a strong barrier to condom use
The traditional approaches in relation to female prostitutes are usually restricted
to a concerning for the client's safety and do not take into consideration the emotional ties of these women with their steady partners, which make them more
vulnerable to HIV injection.
256* /44302 Improving HIV/AIDS prevention interventions
through program evaluation at the community level
Anton Somlai, J.A. Kelly, K.L. Hackl, L.L. Otto-Salaj. CAIR Med College
Wisconsin, 1201 N Prospect Ave, Milwaaukee, WI, USA
Issue: Community based organizations (CBOs) are increasingly expected to
evaluate the effectiveness of their HIV/AIDS prevention programs in order to assure the appropriate use of limited resources and determine whether prevention
programs are changing the risk behaviors of targeted populations. Program evaluation provides community based organizations a systematic process to assess
the effectiveness of HIV prevention programs and help guide the decision making
process in improving those efforts.
Project: Twenty-one community based organizations received training in evaluating HIV prevention programs over a two year period following a six-step
program: 1) baseline needs assessment; 2) on-site visit; 3) one-day training; 4)
on-going consultation; 5) one-day follow-up training; and 6) data analysis.
Results: Baseline needs assessment and on-site visits revealed four major
evaluation needs: data collection, analysis, and interpretation; assessment of atrisk behaviors using valid and reliable pre-post measures; strategies for evaluating
program planning, implementation, and reporting; and, agency capacity building
for staff training in evaluation methodologies and techniques. After the introductory seminar, on-going consultation, and follow-up training all 21 CBOs reported
improvement in overcoming resistance to evaluation; increasing resources for
program evaluation (n = 15); more effectively identify at-risk populations through
marketing and recruitment strategies (n = 12); and implementing behavioral outcome measures (n = 11). Assistance in data analysis of behavioral measures
provided 7 CBOs with risk characteristics for improving programs targeting men
who have sex with men, African American men, public sex environments, and
youth.
Lessons Learned: On-going technical assistance was able to link evaluation
efforts to program effectiveness by translating "theoretical" evaluation concepts
into multiple community-level strategies of program improvement. Intensive training in the systematic evaluation of HIV prevention programs can improve the
delivery of services and the targeting of programs to at-risk populations.
254*/44303 A review of HIV interventions with adult
heterosexually active men
Theresa M. Exner1, P. Gardos, A.A. Ehrhardt, D. Seal. HIV Center NY State
Psychiatric Institute Unit 10. Columbia University 722 West 168th Street, New
York, NY, USA
Objective: To review published evaluations of North American programs to
change sexual risk behavior among heterosexually active men, from the onset of
the AIDS epidemic through December, 1997.
Method: All reviewed interventions had to describe a psychological, behavioral
or educational component that addressed sexual risk reduction and included a
behavioral evaluation component. Manual and computer searches identified 19
peer-reviewed studies that included adult heterosexually active men and provided
a male-specific analysis of intervention effects. Studies targeted IV drug users
(7), HIV infected men (3), STD clinic populations (4), and college students (3). In
only 2 studies were men specifically targeted; all others included women as well.
Results: Findings show that HIV prevention programs can be effective in reducing men's heterosexual risk behavior: 14 of 19 studies showed significant effects,
although effect sizes typically were modest. Outcomes varied and included biological markers as well as self-reported behavior. No clear feature distinguished
effective from ineffective interventions. Each type of intervention (information-only;
condom skills/distribution; behavioral skills-focused; HIV counseling and testing:
individual risk counseling; street outreach) showed some efficacy. Whether group
or individual format is more effective remains unresolved, since all individual-format interventions were HIV counseling or street outreach, while all group-based
interventions were of a different type. Number of intervention sessions (range: 1

to 8) was unrelated to effectiveness, although failure to provide attendance rates
makes it impossible to be sure that men assigned to multi-session interventions
actually received them. Additional methodological limitations were identified (e.g.,
lack of randomized controls; failure to clearly specify loss to follow-up rates) that
further limit the ability to draw definitive conclusions.
Conclusion: More evaluative research is needed to allow identification of
interventions that would be maximally effective with specific populations of het