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

202 Abstracts 13586-14103

12th World AIDS Conference

of 40 churches represents over 5,000 residents of Nashville, 90% of whom are
African American, resulting in over 100 hours of training and education per year.
Lessons Learned: The church is an effective site for HIV/AIDS education for
African Americans. There is tremendous potential to educate thousands of African
Americans as this program is replicated.
13586 An assessment of the US substance abuse treatment
system and efforts to improve access to primary and
secondary HIV prevention
Brad Austin, J. Sayers. Substance Abuse and Mental Health Service
Administration, 808 17th Street NW Suite 820 Washington D.C. 20006 Rockville,
MD, USA
Issue: With concern that the US substance abuse treatment system was not
adequately responding to the shift in the HIV/AIDS epidemic to the drug-abusing
population, the Substance Abuse and Mental Health Services Administration surveyed all 50 States on the current HIV/AIDS policies/procedures required of their
drug treatment centers.
Project: A survey was distributed to all 50 States concerning guidelines and
procedures for HIV risk assessments, counseling, testing and treatment of HIV+
clients, as well as general HIV/AIDS training required of clinic staff. Additional
questions were asked concerning funding priorities within States for HIV Early
Intervention Projects. These projects provide HIV primary and secondary prevention services for substance abusing clients in substance abuse treatment sites.
Additional information was collected on whether these HIV Early Intervention
projects are geographically located in areas of highest need, the types of secondary prevention interventions which are offered and their ability to coordinate
with other health and social service organizations.
Results: We present a descriptive and qualitative analysis of HIV/AIDS policies
found in the State substance abuse treatment system. Data will be presented
on the networks that drug treatment sites are developing with HIV testing, counseling and treatment facilities, types of HIV risk assessments which are done,
and the types of risk reduction interventions supported. Information which States
use to prioritize programs and areas of highest need for primary and secondary
prevention services will be presented. Finally, the percentage of substance abuse
treatment centers which perform HIV risk assessments, as well as the prevalence
of staff training on HIV will be examined.
Lessons Learned: The most effective State policies are those which require
drug abuse sites to network in order to reach and serve this vulnerable, high risk,
and hard-to-reach chronic substance-abusing population.
S13587 1 Do middle-aged people care about HIV/AIDS in Brazil?
Elson Lima1, S.B. Belluci2, M. Manfrinatti2, J.A.G. Silva2, E. Martins2,
P. Zambori2. 1Rua Luiz Otavio, 471 J. Santa Candida 13088-130 - Campinas -
SP; 2Centro Corsini, Campinas, SP, Brazil
Issue: In Brazil, there are some evidences showing that people in their mid 40's
and 50's are not much concerned about their risks of being infected with HIV.
Why are they unaware of their risks? What can be done?
Project: DISK-AIDS is a hot line service sponsored by Centro Corsini, a NGO
located in Campinas, a large city in Southeast part of Brazil. The service is accessible to anyone throughout the country, and its purpose is to clarify doubts about
HIV/AIDS. It has received more than 10,000 calls in 1997. Whenever possible,
since callers may stay anonymous, some KAB questions were asked.
Results: The univariate analysis of crude data, from 1997 callers who agreed
to answer some questions, showed: 57% of subjects are male, among those
64% aged 15-39 years, against 6% aged 40 and over. The authors analysed
questions more frequently asked, among the various age groups and there were
no significant difference (p <.05) of matters addressed by respondents in age
group 15-39 from those in the age range 40 and over; other demographic characteristics of the sample include: 63% are single, 29% attended high-school and
32% has completed only elemental education.
Lessons Learned: There are recent data showing the number of AIDS cases
in Brazil is increasing in people over 55 years, which indicates those persons
might have been infected while in their mid 40's. However, much of prevention
efforts in Brazil have been directed to people under 30 years of age; therefore
different approaches in HIV/AIDS should be tried in the former age group.
| 14101 Establishing an HIV-related risk behaviour surveillance
system
Shui Shan Lee1, T.M.Y. Choi1, K.H. Wong1, M.H. Ng2. 1AIDS Unit 5/F Yaumatei
JCC 145 Battery Street, Yaumatei Kowloon; 2University of Hong Kong, Hong
Kong
Issue: HIV surveillance is an insensitive method for monitoring the potential
spread of the infection. There is the need of making regular measurement of
HIV-related risk behaviours to help identify emerging problems in the commu
nity.
Project: In view of the small geographical size of Hong Kong, sentinel sites
were chosen based on the profile of risk factors associated with the subjects, and
in consideration of the epidemiological situation and practical feasibility. There
were five such sites or groups: STD clinics, HIV screening clinic, correctional
institutes, methadone clinics, and an inpatient drug treatment centre. A trial round
was conducted in homosexual community. Data were collected using structured

questionnaires through face-to-face interviews or self-administered forms. Three
major indices were chosen: (1) partner exchange; (2) condom use; and (3)
needle-sharing.
Results: As of the end of 1997, questionnaires returned included: 2254 from
HIV testing clinic, 6103 from STD clinics (3 waves), 903 from correctional institutes (2 waves), 9545 from methadone clinics, and 12599 from an inpatient drug
treatment centre. It was found that partner exchange rate was an insensitive indicator in trend analysis; the reliability of self-reported condom use rates could be
improved; and the differential condom use rates would become a major indicator
in some groups. Data on needle-sharing were useful in trend analysis.
Lessons Learnt: Establishment of a risk behaviour surveillance system is
feasible and may help predict the potential of HIV spread in the community.
Resource could be minimised through collaboration with service providers. An
incremental approach, and attention to technicality, logistics and sensitivity on the
subject concerned are crucial in developing a sustainable system.
S14102 How reliable are sexual behavior self-reports? Instrument
format and social desirability influences on survey data
Wayne Difranceisco, T.L. McAuliffe, K.J. Sikkema. Cair Med College W1, 1201 N
Prospect Ave, Milwaukee, WI 53202, USA
Objective: To assess the impact of variations in survey question format and socially desirable responding on the reliability of self-reported sexual risk behavior
data.
Methods: Sixty-five men who have sex with men (MSM) were randomly assigned to assessment conditions differing only on the format for questions about
their sexual behavior. For Group 1, the instrument tested responses to items
directly addressing the issue of unsafe sex: men reported absolute frequencies
of sexual activities engaged in "with" and "without a condom." For Group 2, questions were framed more positively with respect to condom use: participants were
instructed to report total number of intercourse occasions, and then indicate on a
scale the relative frequency (percentage) of times "condoms were used." It was
anticipated that Group 1 participants would feel more inhibited about reporting
episodes of unprotected sex, particularly, unprotected anal intercourse (UAI). The
Marlowe-Crowne scale was used to control for general tendencies toward socially
desirable responding within the sample.
Results: Analyses revealed no significant group differences on any demographic, psychosocial, or sexual behavior variables-except for UAI occasions
as a percent of all anal intercourse. Group 1 participants reported a median
percent UAI of 0%, compared with a median of 50% for Group 2 (p < 0.085).
Stepwise weighted regression was performed to model percent UAI, weighted
by total 3-month frequency of anal intercourse. Assessment condition and social
desirability were the two most significant predictors, together accounting for more
than half of the total explained variance in percent UAI (total R2 = 0.57; p <
0.0001).
Conclusions: Comparisons between randomly matched groups of MSM suggested that sexual behavior survey questions framed in more negatively charged
terms - i.e., anal sex "without a condom" - resulted in substantial under-reporting
of high risk activity, independent of one's predisposition for socially desirable
responding. HIV/AIDS prevention researchers need to develop instruments and
analysis methods that reduce the potential for self-presentation bias in measures
of high risk behavior.
S14103 HIV risk through drug use and sexual behavior in the US
population
John E. Anderson1, P. Barker2, R.W. Wilson3. 1CDC, 1600 Clifton Road, Atlanta,
GA; 2SAMHSA, Rockville, MD; 3CHEVY CHASE, MD, USA
Objectives: To measure the size of the 1996 US population at increased risk for
HIV infection through specific sexual and drug risk behaviors.
Methods: Questions on sexual risk behaviors related to HIV were added to the
1996 National Household Survey of Drug Abuse (NHSDA), an annual householdbased probability sample of the US population. The sexual behavior questions
were completed by 12,381 respondents age 18-59. Combined with drug use
information on the survey, these data allow for a comprehensive estimate of HIV
risk behaviors in the general US population.
Results: 2.8% of respondents (95% C.I., 2.5-3.4%) reported some degree of
increased risk through sexual behavior (in the past year: 6 or more partners, sex
with an HIV-infected person, sex in exchange for money or drugs, male same sex
partner). 2.4% (1.9-2.8%) reported drug risk (defined here as lifetime history of
injection, past year use of crack or exchange of sex for drugs). By our definition
4.7% of adults (4.1-5.3%) had increased risk for HIV infection, representing 6.5
million persons (5.6-7.5 million). Persons reporting drug use risk were much more
likely than others to be at risk through sexual behavior, but were not more likely
to use condoms.
Conclusions: These estimates of the number of persons at risk for HIV in 1996
support the need for strengthening primary prevention programs. Increasing condom use among drug users should be an important goal for programs. Monitoring

behavior through surveys of general and high risk populations is essential for
designing and evaluating prevention programs.