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

1086 Abstracts 60466-60469

12th World AIDS Conference

England in partnership with the Massachusetts Department of Public Health has
initiated a statewide effort to develop innovative model programs to improve
adherence to HAART.
Project: At each of the 15 diverse community based sites, we will evaluate a
standardized adherence survey to characterize how HIV+ individuals take medications and identify the frequency and importance of numerous potential obstacles
to medication adherence. The survey will describe the participant demographics,
descriptors of medication adherence and personal obstacles before and after the
unique adherence intervention implemented by each site. Participating sites will
include primary care centers, as well as homeless shelters, drug treatment and
AIDS service organizations, visiting nurse and nurse practitioner teams and home
care programs, a peer drop-in center and a multi service center for offenders
and ex-offenders. We will describe planned efforts including technical assistance
conferences utilizing HIV clinicians and adherence experts and peer educator
training. Adherence/compliance materials have been distributed to all providers.
Initial survey results will be analyzed in 3/98.
Lessons Learned: Cross sectional analyses of site and participant demographics, identified obstacles to adherence according to participant demographics will
be presented. We will summarize categories of interventions by population served.
60466 Eroticizing condom use in France: Putting cinema at the
service of prevention
Luc Speisser1, M. Arnaudies2, A. Ramon1, N. Ballereau2, F. Belingard
Deybach2, B. Roussille1, C. Renard1. 1CFES 2, Rue Auguste Conte 92170
Vanves; 2Direction Generale de la Sant6, Paris, France
Issue: Though well portrayed as a tool of prevention of HIV, condoms are yet
regarded as an obstacle to eroticism. This anti-erotic image is considerable
detriment to prevention among those not of the condom generation (over 30s),
a problem particularly poignant for those among this group who have multiple
partners (or exchange partners).
Project: To eroticize condoms while concretely showing their proper use,
the Ministry of Public Health and the French Committee for Health Education
(CFES) have come together with Canal+, the French paid channel. Initiated by
the Euro-RSCG agency, the partnership realized the direction of erotic shorts.
Their originality rests in their being done by famous directors rather than porno
directors. It was a true exercise in cinemagraphic style in service to prevention.
Methodology: the Ministry of Public Health and the CFES provided the directors five thematic configurations, each portraying one sexual practice (vaginal
intercourse, anal intercourse, oral sex, use of sex toys, masturbation) corresponding to a particular prevention issue. The directors were entirely free to create a
1'30 to 5' short provided that certain acts of prevention such as putting on a
condom were clearly shown.
Five reknowed directors were mobilized in the creation of these erotic prevention films unique in their genre: each turned out a short broadcast in "Le journal du
hard" on Canal+, a monthly program dealing with the latest in porno production.
The self deprecating humour and its presenter make the program among the
most watched of the channel, and by an audience that goes far beyond X film
fans.
Affinity more than visibility to serve the purpose: to further the purpose, the
Ministry of Public Health and the CFES decided not to undersign the shorts which
are thus identified as artistic creations introduced by a personality in the form of
a star program and more on an "in" channel.
Optimization: beyond the broadcast on Canal+, these shorts will be broadcast
free on certain cable channels. More, some video cassettes with all five films will
be provided to grassroots activists to be shown in sex clubs.
Results: A qualitative evaluation is planned to measure the effects of these
shorts in representing condoms and particularly their erotic dimension.
60467 1 Behaviours and practices of heterosexuals attending a
pornographic video exhibition in Paris
Michelle Arnaudies1, A. Serre1, C. Guyomarch'2, R. Mallimo3, A. Bonelli4,
J. Baratta5, P. Urroz2. 1French Ministry of Health/AIDS Division 8 Avenue de
Segur 75350 Paris 07 SP; 2Sida Info Service Paris; 3Couples Contre Le Sida
Paris; 4Le Kiosque Info Sida Paris; 5Aides Federation Paris, France
Objectives: to describe sexual practices and preventive behaviours of porno
video's consumers in order to adapt prevention strategies for heterosexuals with
multiple partners.
Methods: self-administered questionnaire was distributed during a pornographic video exhibition held in Paris, in february 1997. Data analysed were
related to erotic preferences (situations, media), number of partners during the
past year, protective behaviours according to sexual practices, reasons for non
protection (when applicable) and socio-demographic status.
Results: Among 2093 respondants, 1904 (92%) were heterosexuals (196
women and 1708 men). Median age was 25 (18-67). 73% had at least a secondary school degree. The most used erotic media were videos (84%), magazines
(74%) and television (72%). 119 (6%) had no partner in the past year, 556 (31%)

had 1,528 (30%) 2 or 3 and 589 (33%) more than 3 (unknown for 112). Among
individuals having had 1, 2-3, >3 partners, respectively 12%, 28%, 52% had
sexual practices involving more than 2 persons (p < 10 8). Among those with
one partner, 41% never used condoms for vaginal sex, 74% never used condoms
for fellatio, 51% practised anal sex of whom 51% never used condoms. Among
those with >3 partners, 6% never used condoms for vaginal sex, 48% never used
condoms for fellatio, 74% practised anal sex of whom 10% never used condoms.

Reasons for not using condoms were being in a stable relationship (54%), knowing the partner (18%), having asked the serological status of the partner (16%), it
is difficult to use condoms systematically (10%), choosing partners in good health
(8%); very few considered that they are not at risk (5%) or that condoms are not
reliable (1%). 85% would be in favour of using films and magazines as supports
for prevention.
Conclusion: Compared to national statistics (ACSF sexual survey), the population interviewed appears to be sexually very active (number of partners and
diversity of practices). Frequency of condom use increases when number of
partners increases. Not using a condom is highly related to strategies of partners
selection. Few individuals deny the risk of HIV infection or do not rely on condoms.
Erotic magazines, TV shows and videos seem to be good supports for preventive
messages.
60468 Early diagnosis - A program involving the whole field of
fight against HIV infection
Suzanne Guglielmi1, Franooise Belingard-Deybach1, A. Laporte2, S. Fegueux1,
C. Thiaudiere3, G. Feyfant-Raymond4, J.M. Faucher5, P.M. Girard6.
1DGS/Division Sida/French Ministry of Health 8 Avenue Segur 75350 Paris SP;
2Reseau National de Sante Public Saint Maurice; 3Direction Generale de la
Sante Paris; 4 Drass Midi Pyrenees Toulouse; 5Arcat Sida Paris; 6Hopital
Rothschild Paris, France
Issues: Early proceedings are to be promoted to allow, depending on circumstances, prophylaxis or early diagnosis, before AIDS and preferably during primary
infection.
Program Goals: - allow people's diagnosis and treatment before AIDS by
improving primary infection diagnosis, decreasing late diagnosis, and therefore
have people acceed to medical care with the most promising prognosis. - improve
acces to individualized prevention among people with high risk exposures and
reinforce long term prevention. - promote prophylaxis and preventive improvement after a sexuel or drug exposure. - support individuals engaged in long term
treatment and prevention. - help acces to a globalized prevention and treatment
of STD, reducing uneaqual access to health care and considering causes of
vulnerability among groups of population.
Program Components: - Recommendations of new procedures, clinical practices and biological tools need improvements in competences and are to be
relayed by intensive training programs. It includes guidelines for MD, and health
workers involved in HIV. - Accurate informations must be permanently provided.
Concerned people have to integrate appropriate proceedings with the help of
community actors and social workers. - A transformation of anonymous and
free Diagnosis Centers has to be promoted so that they could take care of any
transmitted deseases and work with grassroot non profit organisations recognised by desadvantaged people. - Developping a program to support people's
needs (psychological, environnemental, social...) in order to guarantee long term
compliance to treatment and preventive behaviour.
Conclusion: early diagnosis imposes to restructure the whole field of fight
against HIV infection. Primary prevention remains essential. A program is developed to support people's needs with emphasis on long term compliance to
treatment and preventive behaviour.
60469 The Blue Horse, a book for children affected by HIV/AIDS
Ton Honig1, C.J. Honig2. I Vrije Universiteit, c/o AIDS Fonds Keizersgracht
390-392 1016 GB Amsterdam; 20nze Lieve Vrouwe Gasthuis Amsterdam, The
Netherlands
Issue: Finding ways to inform children about HIV/AIDS and help them to cope
with the emotions involved; to enable adults to help children in this proces.
Project: A book has been written for children in the age from 8-15 years old.
It contains fictitious stories and interviews. The book explains what HIV is, why
people become ill and what needs to be done to prevent HIV/AIDS. But even
more important, it is meant to help children understand about the difficulties in
coping with this disease. Topics raised are:
- grief and mourning
- whether to inform children
- losing a family member
- The Names Project
- children in Africa
- adopted children in a strange country
- AIDS Memorial Services
- The doctor's feelings.
The book is written with the Dutch situation in mind. The majority of children with HIV in the Netherlands is from foreign countries, with different cultural
backgrounds. While writing the book the authors have consulted doctors, social
workers and nurse specialists working with children in the HIV-field, patient organisations and organisations for people from foreign countries living with AIDS.
The cultural backgrounds of different people with HIV has been acknowledged.
The book also contains a list of other children's books about AIDS, with a short

description and the themes that are raised.
Results: The book is now available in the HIV-specialized hospitals in the
Netherlands. The AIDS-consultant nurse can hand out a copy of the book to
people who want to talk with children about HIV. This can be someone who is
ill and wants to talk in his or her surrounding, it can also be a child being ill or
a parent of a child living with HIV/AIDS. This project is sponsored by the Dutch
AIDS Fonds in Amsterdam.