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

168 Abstracts 13406-13411

12th World AIDS Conference

I13406 United we prevent HIV/AIDS, divided we further spread it
(TASO experience)
Jovah Kamatene1, Rebecca Sebikejje2, Grace Namwaje2, Elly K. Sendi3. 1Taso
Mulago PO Box 11485 Kampala; 2 The AIDS Support Organisation (TASO)
Kampala; 3Kyanja Community Trainer Kampala, Uganda
Issue: AIDS care and prevention programmes that involve the community in
the whole implementation, process have more chances of succeeding than programmes that have the community participating only as recipients of intervention.
Project: It is based on a review sample of 3 AIDS management training seminars follow up evaluation reports and 2 process reports since 1990 when TASO
initiated AIDS community based programmes.
Results: Of the 7 AIDS programmes visited in Uganda in different districts
which were initiated by TASO since 1990 to 1997, 94% of them had included
the community in their AIDS care and prevention activities. 700% of them were
youth/women infected and affected people. In the present focus on the prevention
and care AIDS Programmes the infected and affected groups should be recognised, encouraged and enhanced in contributing towards AIDS Prevention by
reinforcing positive behaviour change.
To get meaningful AIDS care and prevention programmes, community members should be involved in the designing and implementation process for better
chances of succeeding and having a sustainable positive impact in the communities where they operate.
13407 Community outcomes in a five-year STD/AIDS training
intervention with traditional healers in rural Uganda
Donna Kabatesi Semucyo1 2, L.R. King3, M.J. Homsy3, P. Kyeyung4.
1 Traditional and Modern Health Practitioners Together Against AIDS, PO Box
21175, Kampala; 2Theta & STD/AIDS CP, Ministry of Health, Kampala; 3Theta &
MSF Switzerland, Kampala; 4 Theta, Kampala, Uganda
Issue: To improve access and quality of STD&AIDS education and care to rural Ugandan communities through training of traditional healers as community
STD/AIDS counsellors and educators. To assess the effect of the intervention on
the healers and their community.
Project: A participatory evaluation project was designed with staff, stakeholders, and target communities to assess the effect of a training intervention on
traditional healers and their communities. We used both quantitative and qualitative methods to obtain data from trained and untrained traditional healers (TH) in
5 districts of Uganda. We conducted focus group discussions (FGD) with village
communities where healers had been trained. Additional information was obtained
by using some participatory rural appraisal methods (PRA) such as mapping and
ranking exercises.
Results: Rural populations in Uganda have heard about AIDS but well-focused
community discussions conducted by the trained traditional healers help them
in personal difficulties like stigma towards infected family members; "how to live
with AIDS with hope", dealing with myths surrounding condom use, and coping
with bereavement and loss. TH know their community norms and concerns, they
incorporate this knowledge in their educational and counselling sessions. They
also identified the need for collaboration with the formal health sector to improve
access to information, condoms and appropriate care for PWAs through a strong
referral system involving them in the continuum of care.
Lessons learned: In a mature epidemic like in Uganda, educational interventions need to address personal fears and concerns, which determine choices
people make for prevention and care. TH have intimate knowledge and understanding of socio-cultural practices in their communities, and are therefore
well-placed to provide information and counselling to rural communities where
most formal services remain inaccessible.
372*/13408 Mobilization of communities for social change
through risk behaviour mapping
Jenance Nyomyo1, Hendrikus Schapink2. 1PO. Box 434 Mwanza;
2Tanes-Project Mwanza, Tanzania
Issue: In many communities in Africa, awareness levels of the general population
about HIV/AIDS is high. There is a need to shift the focus from AIDS education
towards social vulnerability and community mobilization.
Project: The TANESA project developed a low-cost intervention that can be
implemented without external facilitation and mobilizes communities for action.
Based on a pilot programme involving 22 communities, the Magu District Council, in Tanzania, was able to expand the programme to cover 80% of its 1000
communities. The intervention involves a group of men and a group of women,
who draw a map of their community in which they indicate places where they
feel to be at risk of contracting HIV. The maps are used as starters to discuss
the problems that men and women face in avoiding risk behaviour. Based on that
analysis, the two groups propose actions to change risk situations/behaviours in
their community and exchange their work. At a later stage actions are presented
to the whole community for endorsement and advocacy.

Results: The evaluation of the pilot programme showed that women have a
broader risk perception about HIV infection than men. Men indicated mostly bars
and guesthouses as places where they feel at risk, linking their risk mainly to
alcohol abuse and the practise of multiple partners. Women include these places,
but also indicate places like the water well where they feel at risk of sexual abuse.
Other places where the milling machine, shops, and fish selling spots linking
their risk to poverty. Exchange of the mapping results between men and women,

empowered women to demand behaviour change in the community and in turn
made men accept the need for change. Actions are location specific and the
traditional practise of community by- laws enforced the actions. The evaluation
was presented to the district council which appraised the programme as culturally
appropriate and financed the expansion to reach district coverage from district
revenues.
Lessons Learned: Men still underestimate the need for behaviour change.
Women are ready for change but need a platform to express their fears and be
given the chance to propose community action. The mapping programme allows
communities to develop a culturally appropriate and gender sensitive response to
the epidemic. The programme can be expanded to scale, if leadership at the local
level is supportive. Once mobilized, communities express the need for other steps
which gives opportunities for community care initiatives for PLHA, and action on
other reproductive health issues.
S13409 An HIV outbreak controlled - A multi-faceted community
approach that worked
Catherine Donovan. Community Health Eastern Region, Box 70 Holyrood,
Newfoundland, Canada
Issue: Between 1988 and 1994, 43 cases of HIV infection were reported from
a small rural community, 32 of the reported cases were women. Other than 3
perinatal related transmissions, all of the infections resulted from heterosexual
transmission. No injection drug use was identified. This area also had the highest
seroprevalence among pregnant women in the country at 28/10,000.
Project: Beginning in 1989, multiple strategies, primarily initiated by public
health workers with limited additional funding, were undertaken in this small
community to minimize the spread of HIV. These included: contact tracing/partner
notification, legal intervention, peer education with adolescence and preteens,
development of anonymous testing site options, Women and AIDS projects,
community peer programs, physician education, epidemiologic and behavioural
research, media campaigns and community group development.
Results: In spite of increased HIV testing including the use of HIV testing as a
routine prenatal test only 1 case of HIV infection has been reported from the community since 1994. The prenatal seroprevalence as determined by an anonymous
survey has decreased to less than 2/10,000 in the region. Recent surveys which
assessed behaviour and attitudes among youth indicated that young people from
this community had more positive attitudes and protective sexual behaviours than
youth in comparison communities not subjected to the same interventions.
Lessons Learned: HIV transmission can be controlled with a multi-faceted
approach, utilizing traditional public health measures and innovative health promotion and community mobilization techniques, particularly in small confined
communities.
S134101 HIV education in native North American communities:
Assessing geographic and cultural distances
Haftan Eckholdt1, Curtis Harris2, C. Elm3. 1Albert Einstein College of
Medecine/KC923 1300 Morris Park Ave; 2American Indian Community House
New York NY; 3American Indian Community House Syracuse NY, USA
Issues: Challenges to providing HIV/AIDS education and health care services
to indigenous communities in the United States include (1) the large geographic
distances associated with each tribe/nation, and (2) the diversity of cultures
between any two tribes/nations. These two factors create unique challenges to
those HIV/AIDS organizations serving native communities.
Project: An education and outreach network was established in four separate
Native communities in New York State to provide education and coordination
services to Native people affected by HIV/AIDS. Workers designed evaluation
systems for assessing their efficacy, as well as providing feedback to their communities.
Results: In an effort to describe the differences between the four sites and their
tribal communities, a survey was developed by the educators and administered to
community members. Analysis of quantitative data revealed large differences between and within community settings in terms of knowledge of HIV transmission,
attitudes toward people with AIDS, fear of HIV, and solutions to the epidemic. In
an effort to explain the differences between the four sites and their tribal communities, educators: (1) reviewed the quantitative data, and (2) conducted focus
groups with community members conducted. Analysis of qualitative data revealed
a need for trust between educators, community members, and consultants. Many
of the differences and explanatory mechanisms were reflective of the different
histories and governing strategies of each tribe.
Lessons Learned: There is a great deal of variability between and within Native American Communities that needs to be identified and incorporated into the
content and process of HIV/AIDS education, health care services, and evaluation
efforts.

13411 Friends-to friends for HIV prevention and care in slum
communities
Thongchai Sapanuchart. Social Health Development Foundation 1811/23
Charan 57/1 Bangkok 10700, Thailand
Issue: People in slum communities are at risk of HIV infection and ignorance
of care. Direct helping hands or interference from outsiders creates fears and
suspicion to the demolition or change of their settings and way of lives.