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

1064 Abstracts 60351-60355

12th World AIDS Conference

Results: Of 604 women, 70% had douched in the previous 6 months, 25% had
douched in the past but not in the past 6 months and 5% had never douched.
Among 417 women who recently douched, 83% were <20 years old when they
first douched and 64% learned to douched on their own; 87% of the remaining
women learned to douche from a family member. Most women who douched in
the last 6 months (55%) douched >2 times/month; the main reasons for douching were to clean after menstruation (92%) or sex (73%). One-third of women
douched to prevent infection. 56% of women who recently douched had been told
that douching was unhealthy. Of the 150 women who douched in the past but not
in the past 6 months, 76% stopped douching because they heard it was better
not to and 41% because it caused irritation or discomfort. Women who douched
in the last 6 months were more likely to report unprotected vaginal sex in the
previous 6 months compared to women who douched in the past but not recently
(66% vs. 57%; p = 0.07).
Conclusion: A large proportion of women at high risk of HIV infection continue
to douche despite prevention messages encouraging them not to do so. Better
educational approaches need to be developed to result in significant change in a
widely performed practice.
-60351- Collaboration on HIV/AIDS education, research, policy
and treatments among medical students in Jodhpur, India
Anil Purohit 3, K.K. Sharma4, S.D. Purohit6, K.R. Joshi7, K. Bhardwaj4,
K.C. Joshi5, J. Chakraborty2. 'c/o Judy Suleski, Dept. of Physiology & Molecular
Medicine, 2Medical College of Ohio, 3035 Arlington Avenue, Toledo, OH;
3BIDMC, Harvard Medical School, Boston, MA, USA; 4Dr. S.N. Medical College,
Jodhpur; 5Joshi Pediatric Clinic, Jodhpur, RA; 6JLN Medical College, Ajmer, RA;
7Kota Medical College, Kota, RA, India
Issues: To conduct an open discussion session regarding the need of education,
research, policies, treatments and surveillance on HIV/AIDS in Jodhpur.
Project: A new approach of interactive and open discussion sessions were
used during a course offered to undergraduate and postgraduate medical students at Dr. S. N. Medical College, Jodhpur, Rajasthan, India during 1997. Topics
of discussion included: (i) global and national epidemiology; (ii) HIV testing and
policies; (iii) available treatments and counseling; (iv) collaborative efforts and
networking; (v) spread of knowledge on HIV/AIDS among lay population; and (vi)
training of peers.
Results: Topics discussed during the workshops contributed to the improvement of knowledge of the students regarding the prevention and management of
HIV/AIDS. Physical, social and psychological support of persons with HIV/AIDS
were major concerns. Participants were also concerned about the availability of
family support and counseling services. Generating motivation, collaboration and
networking among the students and faculty were recognized. Availability of drugs,
adequate nutrition and improvement of quality of life were other concerns. It was
felt that use of local resources and better interactions of health care professionals
at all levels may be highly effective for the management of people with HIV/AIDS.
Lessons Learned: Medical students in India have limited opportunities to interact and collaborate professionally with each other. Discussions and workshops
on various issues of HIV/AIDS are appreciated and encouraged. International
collaboration and exchange of ideas are very important components of spreading
AIDS education in India and other countries.
S60352 HIV/AIDS training workshop for physicians in Fiji Islands
Anil Purohit'3, Raghwa Sharma6, V. Rabukawaqa7, S. Kalla5, J. Chakraborty2,
A. Kiessling3. 1 c/o Judy Suleski, Dept. of Physiology & Molecular Medicine,
2Medical College of Ohio, 3035 Arlington Avenue, Toledo, OH; 3BIDMC, Harvard
Medical School, Boston, MA; 4Dept. of Surgery, Cambridge Hospital,
Cambridge, MA; 5State University of New York, Syracuse, NY, USA; 6Colonial
War Memorial Hospital, Suva; 7Ministry of Health, Tuvalu, Fiji Islands
Issues: Although education and prevention programs have been established by
the Ministry of Health in Fiji, standardized training programs for physicians have
not yet been fully developed. Therefore, it was important to develop, initiate and
implement a training program for the physicians who would provide the medical
care and support services needed for the HIV infected people and people with
AIDS in Fiji.
Project: Thirty physicians were recruited by the Ministry of Health of the Government of Fiji. Selection procedure was based on ability, interest and desire for
continuing the work. The topics during this workshop ranged from scientific and
medical implications to cultural, psychosocial and human rights issues. Pre- and
post-tests were given before and after the workshop.
Results: Physicians were trained in a highly focused workshop format by
experienced, culturally sensitive HIV educators from the United States. Interactions between the United States HIV educators, leaders in Fiji and newly trained
physicians are continuing to support the ongoing work in Fiji. It was clear from
the course evaluations that the workshops were quite successful. Every trained
physician was required to go in the field and train at least 10 more physicians,
which also resulted in a great success and training of every single physician in

Fiji.
Lessons Learned: HIV/AIDS is a growing problem in Fiji. Combined effort of
international and national agencies can only reduce the risk of HIV transmission.
Although the Ministry of Health of Fiji is doing excellent work to combat the
disease, such workshops could contribute a great deal to achieve that goal.

60353 1 "Getting the Sex you want": A cognitive behavioural
group for gay men
Andrew Billington1, C. Rodger1, S. Wanigaratne2. 1 The Mortimer Market Centre,
Off Capper Street, London WC1E 6AU; 2/nstitute of Psychiatry, London, UK
Issue: Group interventions aimed at facilitating sexual behaviour change and
maintaining safer sex in gay men require ongoing analysis and development in
order to remain responsive to the changing pattenr of HIV infection and thus
provide appropriate HIV prevention interventions.
Project: Groups have taken place over seven years at the Mortimer Market
Centre, a London GUM clinic and are based on a cognitive behavioural approach.
Changes have been made to the content and format over this period. Theoretical
concepts informing the group have also changed. Using facilitators notes and
participants feedback the evolution of the group was analysed within the context
of gay men's experience of the HIV epidemic. In-depth interviews were conducted
with ten participants and analysed using a discourse analytical approach.
Results: Changes to the intervention occurred as a result of both gay men's
experience of living with the epidemic and the increasing need for more complex
prevention messages. Analysis of interviews revealed an array of meanings participants ascribed to sexual behaviour and sexual relations. The interviews also
revealed largely positive evaluation of group participation.
Lessons Learned: Group work with gay men can be an effective method of
promoting behaviour change and conveying complex prevention messages. A
reflexive approach enables the most effective and appropriate intervention to
be delivered ensuring it remains sensitive to social, psychological and cultural
changes.
60354 Rates of receiving the result of an HIV test: Data from the
US National Health Interview Survey
Guoyu Taol, W.J. Kassler2, B.M. Branson3, T.A. Peterman3, R.A. Cohen4
'CDC, 1600 Clifton Road, Atlanta; 2Division of STD Prevention, CDC, Atlanta,
GA; 3Division of HIV Prevention, CDC, Atlanta; 4National Center for Health
Statisics, CDC, Hyattsville, MD, USA
Background: HIV testing has several important benefits, including risk reduction
through prevention counseling and referral of infected persons for medical and
psychological services. These benefits occur only if persons tested receive their
test results.
Methods: To determine the frequency and predictors of receiving HIV test
results (excluding blood donations), we analyzed 19,127 adults in the 1994 US
National Health Interview Survey, a population-based, probability sample household survey. We used multinomial logit model to determine factors independently
associated with the rates of receiving HIV test results.
Results: HIV testing was reported by 24.3% (~ SE = 0.8%) of persons in the
survey (46 million US adults). Of those tested, 43.0% (~ 0.9%) had primarily compulsory tests (military, employment, insurance, immigration, or hospitalization);
26.5% (~ 0.8) had primarily self-initiated tests ("just to find out/I am worried that I
am infected"); 9.1% (~ 0.5%) acted on advice of a doctor, health department, or
sex partner; and 21.4% (+ 0.8%) were tested for other reasons. Of those tested,
78.6% (~ 0.7%) reported receiving their results; 12.0% (~ 0.6%) reported not
receiving their results; and 9.4% (~ 0.6%) reported being told that they would be
notified if their test results were positive. The logit model revealed that persons
were more likely (p <.05) to receive their test results if they believed they had
good knowledge about AIDS, they lived alone or with non-relatives, their tests
were self-initiated, or their tests were performed at public clinics, community
health centers, or private physician offices rather than at hospitals or emergency
rooms. Compared with those who did not receive their test results, persons were
more likely (p <.05) to report being told they would be notified only of a positive
result if they believed they had good knowledge about AIDS, or if their tests
were performed at military, immigration, or private physician settings. The rates
of receiving the test results did not differ by age, gender, race, education level,
health status, or the number of previous HIV tests.
Conclusions: More than one in ten persons tested for HIV did not receive their
test results. Measures to increase the number of tested persons who receive
their results, such as adding and enhancing pre-test counseling, or using rapid
HIV-screening tests that provide results at the time of testing, are urgently needed.
60355 Risk profile of female sex workers who participate in a
routine penicillin prophylaxis program in Surabaya,
Indonesia
Mriduan Joesoef', L.A. Valleroy3, T.M. Kuntjoro4, A. Kambodji3, M. Linnan',
Y. Barakbah4, M.E. St. Louis'. 'Division of STD Prevention, CDC, Atlanta;
2Centers for Disease Control Prevention, Atlanta, GA, USA; 3Ministry of Health,
Surabaya; 4Prospektiv Foundation, Surayaba; 5Airlangga University, Surabaya,
Indonesia
Objectives: To describe the risk profile of female sex workers who participate in
the routine penicillin prophylaxis program in Surabaya, Indonesia.

Design: Cross-sectional study.
Methods: We measured reported risk factors and STD prevalence among 1867
female sex workers, some of whom reported participation in a routine penicillin
prophylaxis program.
Results: In Surabaya, 34% of female sex workers had received a prophylactic
penicillin injection program from the government within 28 days. Sex workers who
had received routine prophylaxis injection were more likely to be less educated,