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

210 Abstracts 14138-14142

12th World AIDS Conference

14138 Parent-adolescent discussions about sexual initiation:
Reducing the impact on peer norms on early sexual
initiation
Daniel J. Whitaker, K.S. Miller. Center for Disease Control, Atlanta, USA
Objectives: To examine how parent-teen discussions about sexual initiation affect teens' beliefs about parents as a source of information about sex, teens'
age at sexual initiation, and the extent to which teens' age at sexual initiation is
influenced by peer norms about age at sexual initiation. Parent-teen discussions
were expected to be associated with teens' beliefs that parents are the best
source of information, later sexual onset, and a weaker association between
peers norms for age at sexual initiation and teens' age at sexual initiation.
Method: The sample included 372 sexually active black and Hispanic adolescents, aged 14-17, from Alabama, New York, and Puerto Rico who participated
in a cross-sectional interview study. Teens reported whether they had talked with
a parent about sexual initiation and responded to an open-ended question about
who they viewed as their best source of sexual information (coded as parent, peer,
or other). Teens also reported their own age at sexual initiation, and estimated
the average age their peers of their same gender initiated sex.
Results: Chi-square analyses showed that teens who had talked with a parent
about sexual initiation named a parent rather than a peer or someone else as the
best source of sexual information more often than teens who had not (p <.01). A
t-test showed a tendency for teens who had not talked with a parent about sexual
initiation to initiate sex at a younger age than teens who had talked with a parent
(13.5 vs. 13.8, p =.09). Finally, the relationship between peers' age at sexual
initiation and teens' age at sexual initiation was stronger (p <.01) among teens
who had not talked with a parent about initiating sex (r=.53) than among teens
who had (r = 16).
Conclusions: Parent-teen discussions about sexual initiation can affect the
age at sexual initiation by reducing the effect of peer norms. Parent-teen discussions about sexual initiation were associated with teens' beliefs that parents are
the best sources of sexual information, later sexual initiation, and lower conformity
to peer norms for sexual initiation. The public health message to parents is: If you
do not talk with your children about sex, others will (e.g., peers), and they may
not encourage delayed sexual onset.
244*/14139 "Implications of complex emergencies, uprooting
and forced migration on risk of HIV/AIDS: The case
of Bosnia and Herzegovina"
Manuel Carballo1, S. Puvacic2, D. Zeric1. 1International Centre for Migration &
Health; Route Du Nant-D'Avril, 11, CH-1214 Geneva, Switzerland; 2National
Committee for AIDS Prevention, Sarajevo, Bosnia
Issues: In the past ten years complex emergencies have been responsible for
the uprooting and displacement of over 60 million people. The social and health
conditions surrounding complex emergencies place people at high risk for diseases, including HIV & other sexually transmitted infections. To date there have
been few attempts to assess why and how complex emergencies affect HIV/AIDS
risk, or to define the dynamics of vulnerability in these situations.
Project: In a study of internally displaced people in Bosnia and Herzegovina
and repatriated refugees the perceptions of risk, knowledge of HIV/AIDS, relative
exposure to sexually transmitted infections, and attitudes to prevention and the
capacity to intervene in avoiding infection were assessed. The results highlight
the different patterns of understanding about HIV/AIDS and behaviour that have
emerged in the wake of the war there.
Results: There were major differences in the ways internally displaced persons (IDP), externally located refugees (ELR) and non-displaced people (NDP)
perceived the problem of HIV/AIDS, their own position vis a vis the epidemic,
their need and capacity to intervene, and the way in which their own behaviour
placed them at risk. Among IDP 21% had not heard of HIV/AIDS compared to
11% in ELR and 13% in NDP. Perception of moderately high risk for HIV infection
was 34% among ELR compared to 16% in NDP and 14% in IDP. Reported
causal sex was 21% in ELR, 14% in IDP and 10% in NDP. Among IDP 22%
knew someone who used drugs compared to 15% for NDP and 8% for ELR. The
proportion of drug users believed to inject ranged from 25% among IDP to 31%
in ELR. There were also significant differences in perceived locus of control and
the extent to which these groups felt that they were able to influence their lives
and life-styles.
Lessons learned: Changing patterns of sexual behaviour and drug use among
young people who were displaced by the war are contributing to risks of STIs and
HIV. The implications of this study raise questions about the impact of complex
emergencies and forced displacement on the risk of HIV. Steps should be taken
to introduce intervention programmes designed to address the unique conditions
in situations of civil conflict.
S14140 Injector network embeddedness inhibits effectiveness of
prevention efforts

James Hughes, D.D. Heckathorn, R.S. Broadhead, H. Madray, Y. Van Hulst.
Dept. of Sociology, Univ. of Connecticut, Storrs CT 06269, USA
Objectives: To examine the influence of injection drug users' (IDUs') embeddedness in drug using networks on their level of drug-related risk behaviors once
enrolled in a harm reduction intervention.
Design: An ongoing harm reduction intervention specifically designed for injection drug users.

Methods: Adult IDUs, N = 874, were recruited to drug education interventions
in several sites in Connecticut from 1994 to 1997. IDUs were educated about
HIV-related risk from drug injection and sex, and interviewed about their behavior. Six months later they were re-interviewed (N = 422). At both interviews the
subjects were asked questions about the frequency in which they share syringes,
cookers, and water, and the frequency in which they engage in unprotected sex.
They were also asked "Do you usually use alone or with others?" with response
categories of "Always with others," "Usually," "Half and half," "Occasionally," and
"Never."
Results: Injecting drugs with others is correlated with a similar question about
frequency of buying drugs with others (r = 0.32, sig < 0.001), and with the
likelihood that an IDU's regular sex partner also injects (t-test sig < 0.001). As
one would expect, using with others, or "social injecting," is a strong correlate
of sharing needles, cookers and water (r = -0.19, r = -0.26, r = -0.22, all sig
< 0.01). Controlling for social injectors' greater opportunity for sharing is taken,
social injectors reduce sharing less rapidly than less social injectors. Of IDUs who
injected with others half the time or more, 65% reduced their sharing of needles,
water and cookers, while of those who "occasionally" injected with others, 81%
reduced sharing of equipment (sig = 0.02).
Conclusion: When drug injection is embedded in social ties and habits of social
use, IDUs inject more often, and the effectiveness of risk reduction education is
significantly lower than for IDUs who tend to inject by themselves. Intervention
efforts will consequently have greater effect on solitary users.
Supported by the National Institute on Drug Abuse R01 08014.
14141 Access to health services for HIV positive chronic drug
users
H. Virginia McCoy1,2, I. Aversa, Sherril3, D. Chitwood, Dale3, R. Metsch, Lisa3
13000 N.E. 151 Street North Miami, Florida 33181; 2Florida International
University, North Miami, FL; 3University of Miami School of Medicine, USA
Background: Chronic drug users (CDUs) represent a vulnerable population that
has unique health care access problems, which HIV seropositivity exacerbates.
Previous studies have shown barriers to HIV services include low levels of insurance coverage and regular sources of care which vary by gender and race. The
analysis was guided by Equity of Access theoretical formulations of, which assumes that actual entry into the health care system is influenced by predisposing
and enabling characteristics, need for services, and resources.
Methods: Data collection was conducted from Apr. 1996 to Dec. 1997 from
a street-recruited sample of 926 drug users and 553 non drug users in Miami,
Florida. A one-hour interview elicited information on health status, utilization of
services, and patient satisfaction. Multiple regression was used to measure the
association of access to health services with gender and race as indicators of
predisposing characteristics; regular source of care, insurance coverage, and
income as enabling characteristics; and number of health problems experienced
in the past 12 months as need for care. Access was measured as utilization (the
number of times a subject saw a health care provider for health problems in the
past 12 months). The model controlled for drug use and HIV status.
Results: The results of the regression analysis yielded a multiple R of 0.749
(p <.0001), indicating that the independent variables in the model significantly
predicted the outcome. Enabling characteristics and need were more strongly associated with utilization than other factors. Specifically, the availability of a regular
source of care (t = 8.02, p <.0001), a greater number of months with insurance (t
= 8.28, p <.0001), greater need (t = 26.80, p <.0001), and non-drug use status
(t = -5.71, p <.0001) were significant predictors of the actual utilization of health
services.
Conclusions: Access to health services is limited for chronic drug users. While
services tend to be available, financial resources and having a regular source of
care remain as barriers. Interventions are needed to improve providers' skills in
working with difficult populations and to improve drug users' behavior in health
care settings. Public health insurance should consider the inclusion of chronic
drug user status as eligibility.
S14142 Relapse-prevention theory increases understanding of
consistent condom use with casual partners among gay
men
Ernest M.M. DeVroome1, T.G.M. Sandfort1, J.B.F. Dewit2, W. Stroebe2,
G.J.P. VanGriensven3. Utrecht University; Gay & Lesbian Studies, Box 80140;
3508 TC Utrecht; 2Utrecht University; Social & Organizational Psychology
Utrecht; 3Amsterdam Municipal Health Service, Amsterdam, Netherland
Background: Relapse-Prevention Theory (RPT) states that to maintain safe
sexual behavior, it is important that behavioral change becomes internalized (as
opposed to remain brooding over what has been 'lost'); to reinforce oneself when
reducing risk behavior; and to prevent an 'Abstinence Violation Effect'. This may
occur when a person attributes relapse to internal, uncontrollable and/or stable
factors, leading to helplessness and reduced self-efficacy, possibly followed by
even giving up trying. An appropriate coping-response in potential 'high-risk'

situations is also thought to be important in RPT. We investigated whether a
selection of factors from RPT increases explained variance in condom use with
casual partners among gay men, compared to the main factors from the Model
of Planned Behavior (MPB).
Methods: The current data were collected in 1996 with a self-administered
questionnaire among 331 HIV- and 82 HIV+ men who participated in the Amsterdam Cohort Study of gay men; mean age was 46 years.