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

12th World AIDS Conference

Abstracts 13570-13574 199

counselling provided, a training programme for counsellors and mediators working with the necessaire is being implemented as one important complementary
measure within this intervention programme.
Results: A feasibility study conducted in 1996 has shown the lack of adequate
information material and supportive material for counsellors as well as for the target group itself. An overall of 150.000 copies of the necessaire will be distributed
from April 1998 on, reaching almost 75% of this age-group living in Switzerland.
Lessons Learned: A scientific evaluation being carried out will show if abetter
response to the underlying factors that influence young women's decisions about
their reproductive health as well as a rethinking of the state-of-the-art of contraceptive counselling as a first choice for youngwomen will be promoted through
this broad public-health intervention.
13570 Developing a comprehensive reproductive health
program for street youth involved in sex work
Ferdinal Fernando1, J.B. Fleras2. '2F 7880 Polaris Cor. Jupiter St. Bel Air 2,
Makati City 1200; 2ReachOut Foundation, Makati, Philippines
Issue: Many children and adolescents living and working in major streets of large
cities are engaged in risky sexual behaviours such as commercial or freelance sex
work. These expose them to the dangers of unwanted pregnancy and sexually
transmitted diseases. None of the existing local programs for street youth provide
reproductive health services.
Project: To address these issues, ReachOut Foundation developed a street
youth project in the city of Manila with the assistance of Family Planning International Agency. The project serves a hard-to-reach population of indigent and
low-income street-based and community-based youth especially those involved
in sex work between the ages of 10 to 24 years of age. This provides previously
unavailable reproductive health services in catchment areas such as squatter
settlements in port areas and city parks. The street youth are currently being
served through the community-based outreach and peer education work, the
back-up clinic at the project's youth center and the outreach medical mission
van. Contraceptive services, STD/RTI medical treatment, sexuality education,
counseling services and laboratory testing for HIV/Syphilis/Hepatitis B are being
provided. These activities are facilitated by both the project's medical staff and
field staff which are composed of youth themselves.
Results: The use of youth as peer educators facilitated delivery of integrated
services in cruising areas where the street youth congregate and trade sex. A
larger population of mobile street youth were served. The conduct of community
based distribution of contraceptive commodities such as condoms was widely
accepted through the promotional activities of the peer educators. Referral systems from the local health officials and other youth organizations have been
established through the project's activities.
Lessons Learned: Reproductive health interventions for street youth involved
in sex work only addresses the risks brought about by their situation. Risks for
STDs/HIV/AIDS and unwanted pregnancies will always be present if other direct
factors affecting the demand for child prostitution are not addressed such as poor
enforcement of laws against prostitution, child trafficking, and lack of regulation
for abused over-the-counter drugs and solvents.
13571 Reproductive health teaching AIDS for rural adolescent
girls
Himalini Varma. Thoughtshop Foundation., 2G Maurya Cent Re, 48 Gariahat
Road Calcutta, India
Issue: Rural adolescent girls have poor awareness about the body and its functions and responses. A majority of them cannot assert themselves or take control
in sexual situations and often face the risk of unwanted pregnancies, sexual
violence and STD/HIV/AIDS. Such an environment makes reproductive health
education imperative for this population.
Project: Reproductive health education can act as the first step towards selfesteem, safety and empowerment for rural girls. It can help them to make informed
choices whenever possible. But the main obstacle in the way of imparting such
education is the lack of literacy among many rural adolescent girls and their
limited exposure to the mass media. Thus it was decided to develop a kit of
teaching aids which would help health workers in creating awareness and generating discussions on reproductive health issues. The kit deals with issues related
to self-esteem, puberty, menstruation, conception, child birth and contraception
which are presented in five flip charts. The key issues covered in the flip charts
are highlighted through easy-to-use activities which involve the target audience.
The language for the kit is Bengali.
The strategies involved in developing the kit included field visits to girl child
centres in villages on the outskirts of Calcutta. Rapport-building exercises were
conducted with the girls to assess their awareness levels and attitude towards
reproductive health issues. In-depth research was conducted and meetings held
with doctors and health workers to gather information to be imparted. The story
script and the activities were tested with the girls, their educators and the health
workers.

Results:The testing of the kit and the responses from the NGOs planning to
use the kit point at the need for extensive teacher training on reproductive health
issues. It also uncovered the latent demand among NGOs dealing with adolescents for innovative communication tools to impart reproductive health education.
As a result, the kit now needs to be tested in other socio-economic scenarios
to see what adaptations would be needed in terms of language, story script and
illustrations.

Lessons Learned: To make health education teaching aids for adolescents
as visual and interactive as possible. To elicit the queries they may have on any
particular issue, rather than deciding the information content in isolation.
S13572 Integrating HIV/AIDS services into existing family
planning programs
Elizabeth Lule1, W. Kisubi1, R. Sturgis2. ' Pathfinder International, PO. Box
48147, Nairobi; 2USAID/Red So, Nairobi, Kenya
Issue: Family planning and maternal and child health (FP/MCH) services have,
over the past 30 years, developed a solid infrastructure in sub-Saharan Africa. The
magnitude of the HIV/AIDS pandemic in the region, and very limited resources,
have made it essential for ministries and non-governmental organizations to
find low-cost ways of combating and hopefully curtailing the rapid increase of
HIV. While the integration of HIV and STD services with existing FP/MCH has
been a focus for just a few years, there has been a concerted effort among a
group of FP/MCH organizations to share experiences and develop guidelines for
integration.
Project: This paper focuses on lessons learned from a regional partnership,
formed to better understand regional efforts at integrated HIV/STD/FP/MCH services, and to share the best practices. In 1995, a regional workshop was held
in Nairobi that included 165 health professionals from 17 African countries to
set a three-year agenda of collaborative activities for understanding the advantages, disadvantages, and limitations of integrated services. Specific research
and programmatic activities were identified as part of the Agenda.
Results: (1) 4 case studies (one country-wide program and 3 clinics with outreach services) and one intervention study; (2) a manual providing introductory
conceptual and strategy information for integrated services for program managers; (3) an assessment of regional curricula being used to inform and train
practitioners about integrated services, and a resulting set of recommendations.
Conclusions: (1) Although different service delivery settings have different
strategies and problems, a general model for integrating services has emerged,
which will be presented.
(2) Integration takes place at all levels of service delivery from communitybased delivery to more sophisticated settings with laboratories, and a paradigm
reflecting these levels will be included.
(3) The recommendations that emerged after reviewing regional integration
training curricula will also be presented.
13573 Comparative study of sexual and reproductive healf of
adolescents and youth
Lyudmila Asanova1, I.A. Manuilova2. Moscow 11745 4 pr Vern Adskogo 68
apt. 67; 2Gynecologist; Moscow, Russia
Recently the number of HIV-infected in Russia has increased more than two times.
According to the literature, an increasing of the STD precedes an increasing of
the HIV-infected. The International Association "Family and health" during the
period from 1993 to 1996 had anonymously questioned 2500 adolescents, and
conducted the clinical laboratory and sociological examinations of 694 girls under
25 years of age (old).
Methods: All the patients filled out the cards of anonymous questionnaire. We
used method PCR for diagnosis STD.
Results: 37% of adolescents had the sexual experience, 81% of them - notmarried. Among all examined 206 (30%) had the STD, it is every third patient.
39% of them - adolescents and 60% - young people. The most widespread
STD-infections were chlamydia trachomatis and gardnerella vaginalis: 108 cases
(53%), ureaplasma urealyticum was detected in 30 (15%). It is important to say
that in 184 cases (89%) from 206 it was monoinfection and in 22 cases (11%)
the associated ones. The associated infection took place more often at the age
under 18 years old, and this persons had several sexual partners. The pregnancy
was in 49 women (24%): 6 (27%) adolescents and 43 (53%) young women. At
the same time, only every fifth woman had delivery and another 36 women had
an artificial abortion. Only 1 (4.5%) from pregnant adolescents had delivery, and
among pregnant young women this per cent was 28% (12 cases).
Conclusions: The high risk factors of STD among adolescents are the early
sexual experience and a high number of sexual partners. In overwhelming majority
(95.5%), abortion is the end of the pregnancy in adolescents.
13574 Adolescent's health reproduction in Cameroon: The case
of Bafia
Simon-Pierre Tegang12, A.H. Deffo3, E.J.P. Edjoa3. 1BP 13888 Yaounde;
2Association Jeunes Contre Sida, Douala; 31RESCO, Yaounde, Cameroon
Objectives: The main objective was to look out the level of knowledge, attitude,
and practices of adolescents facing STD and AIDS in 1998 (this study was
completed in November 1997)
Methods: Quantitatives data were collected from 800 adolescents aged betwen

12 and 22 years in Bafia a small town in Cameroon. These data were based on a
standard questionnaire with 10 items: General informations - Oneself perception
- Risk behaviour - Prevention methods - Perception and use of condoms -
Distribution and promotion of condoms - Aknowlegment and antecedent of STDs
- Knowledge on AIDS - Communication.
Data were analysed on Statistical Packages for Social Sciences (SPSS).
Results: In Bafia it was found that: