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

12th World AIDS Conference

Abstracts 14153-14156 213

two-thirds of HIV positive interviewees (64%; n = 61) reported unprotected sex
since diagnosis.
Results: Two types of risk management were observed. First, the negotiation
of sexual safety in discordant and concordant relationships. Second, the management of risk and uncertainty to sexual relationships themselves. This latter form
of risk management provided the context within which HIV-risk was perceived.
Crucially, unprotected sex may be viewed as a symbol of 'security' and 'trust' in relationships which can serve to protect relationships from 'risk'. This was found to be
the case in discordant relationships, but was more pronounced in concordant relationships where unprotected sex was also seen to constitute an 'acceptable risk'.
Conclusions: The lived experiences of risk, HIV-risk and unprotected sex are
'socially organised', and the sexual relationship is an important intervening variable in this process. It is extremely important to recognise that HIV positive people
and their partners may associate unprotected sex with a variety of meanings in
their relationships, including both 'risk' and 'safety'.
14153 Safer sex, relationships and other stories by gay and
bisexual men: Results from the MARS project
Stephen Samis', K. Whyte. AIDS Vancouver Island, 1704-1035 Belmont
Avenue. Victoria, BC, Canada
Issue: To explore feelings and beliefs about sexuality and relationships as well
as safer sex practices amongst men who have sex with men (MSM) in urban and
rural communities.
Project: The Men's Attitudes about Relationships and Sexuality (MARS) project
was an innovative research project based at AIDS Vancouver Island in Victoria,
British Columbia. Between July 1996 and September 1997, 80 unstructured and
conversational interviews lasting 1-3 hours and 2 focus groups were conducted
with primarily gay and bisexual men in metropolitan Victoria and across Vancouver Island. Men were encouraged to tell their stories, reflect on sex and sexual
relationships in their lives and discuss issues related to safer sex.
Results: Feelings about safer sex and barriers to practicing safer sex are intricately linked to a complex web of psychological and social issues. Specifically,
self-identity, self-worth, trust and intimacy, social and internalized homophobia,
notions of masculinity and femininity, childhood sexual abuse, coming out experience for gay and bisexual men, social support, ethnicity, and place of residence
represent key determinants of (sexual) health. The methodology facilitated honest
"admissions" and open discussion about sexuality and unsafe sex.
Lessons Learned: HIV prevention education involves more that condoms,
posters and typical safer sex messages. The emphasis on verbal negotiation in
safer sex education for MSM is incongruent with the largely non-verbal ways
in which men communicate about sex. Some men see safer sex education as
an attempt to "feminize" sex between men. We need to re-think the general
"de-gaying" of AIDS service organizations (ASOs). HIV- men feel neglected by
ASOs.
14154 Incorporating behavioral science into HIV prevention
planning: Promising research tools for NGOs and health
departments
Susan E. Middlestadti, R. Gilad2, E. Hanlon2, A. Jimerson2, J. Rosenbaum2,
J. Strand2. 11255 23rd NW, Washignton, DC2Academy for Educational
Development, Washington, DC, USA
Issue: Prevention program effectiveness suffers when planners jump to developing activities without a thorough articulation of behavioral objectives and
identification of the associated behavioral determinants for a given audience.
Community-based organizations in the US, in Latin America and in the Caribbean
are making new efforts to apply behavioral science to HIV prevention programming, yet few practical tools exist to help them.
Project: Collaboration with prevention planners in both the north and the south
has resulted in a model and tools to aid in application of behavioral science.
With user-friendly research, the model leads planners to define an audience in
some detail, to select a behavior to promote that which will directly prevent HIV
transmission, and to identify the most salient determinants of that behavior for
that audience. In other words, to apply findings to craft activities which spark
"a chain reaction" leading to behavior change. Only then are program planners
encouraged to develop the prevention activities for that audience. The tools were
developed as a result from an "elicitation study" which was carried out to explore
the determinants of condom use, communication and refusal behavior for young
adults. The protocol has since then been adapted to a question and coding
template to allow program planners with only moderate research capabilities to
apply and code an otherwise complex methodology of open-ended interviews. A
second tool provides a menu of validated survey questions exploring behavioral
determinants such as self-efficacy, knowledge, attitudes, skill levels, etc. which
can be easily adapted for diverse audiences and study objectives.
Results: Community-based organizations applied the model and tools with
varying results. In the US, community-based prevention planners participated in
two-day workshops using their own audiences as case studies. In Central Amer
ica and the Dominican Republic, finalists in small grants programs followed the
adapted training sessions with intensive technical assistance in order to improve
their proposed projects and to build local audience research into program design.
Lessons Learned: The model and tools provide an important mode for technology transfer, and their use ensures a greater behavioral focus for interventions.
All organizations found the tools allowed them to readily apply new planning
concepts into their process, although limited data analysis capabilities within

many organizations did not allow for autonomous application of the tools without
on-going technical assistance.
14155 Predictors of condom use intention to prevent HIV/AIDS
among Taiwanese college students
Chao-Hsing Yeh. Graduate of Nursing, Chang-Chung University, 249 Wei-Hwa,
1st Rd, Kwei-San, Tao-Yuan, Taiwan (Republic of China)
Objectives: To investigate Taiwanese college students' condom use intentions
to prevent HIV/AIDS.
Design: Cross-sectional study.
Methods: Questionnaires and semi-structured interviews were employed in
this study. Variables for the survey were selected from the Theory of Reasoned
Action and the Self-Efficacy Theory. HIV/AIDS Prevention Surveys were selfadministered to students during health-related classes at north and south regions
of Taiwan. In addition, twenty students (male = 9, female = 11) were purposively
selected for interviewing among those who indicated they had had sex.
Results: Of 2015 respondents, a 94% returned rate, 115 (9%, n = 1326) females and 187 (27%, n = 689) males who reported ever having sex and were still
sexually active at that time, were used for the data analysis. Overall, the application of the Theory of Reasoned Action and the Self-Efficacy Theory in describing
variation in intent to use condoms showed mixed results. Results from the logistic
regression analysis showed that male students and those in the north region
were engaged more in HIV risk behaviors (less intent to use condom and more
sexual partners) than were females. Positive attitudes towards condoms, stronger
perceived self-efficacy to use a condom, and prior experiences of condom use
are significantly associated with condom use intention. The gender difference is
not significant. Region, an indicator of the social-cultural environment, is associated with the intention. Findings from the interview data have emerged into two
core categories: factors related to student's HIV/AIDS risk behaviors and norms
affecting student behaviors.
Conclusions: The implication from the results suggested that educational interventions could focus on increasing students' positive attitudes, confidence and
skill development in condom use and prevention of pregnancy, building strong
negotiation skills with sexual partner, and increasing students' perception of their
own risk factors for contracting HIV/AIDS.
S14156 Perception of HIV transmission risk among regular
partners and prospects for the evaluation and use of
vaginal microbicides in northern Thailand
Kanokwan Tharawan1, C. Manopaiboon2, K. Limpakarnjanarat2, C. Ellertson3,
T.D. Mastro2, C.J. Elias2. 1The Population Council PO Box 11-1213 Nana Post
Office Bangkok 10112; 2HIV/AIDS Collaboration, Thailand: 3The Population
Council, New York NY, USA
Objective: For many women in Thailand, the most substantial risk for HIV infection is sexual transmission from their husband or regular partner. We sought
to investigate women's perception of such risk, husband's HIV risk behavior
(particularly in the peripartum period), and women's and men's attitudes toward
the clinical evaluation and use of vaginal microbicidal products to limit sexual HIV
transmission between regular partners.
Methodology: In Chiangrai, 8 focus group discussions (FGDs) with women,
and 8 FGDs with men were conducted, each with 6-8 participants. In-depth
interviews were also conducted with 40 women and 40 men. The women for
these FGDs and interviews were identified through antenatal and post-partum
care clinics. The men were selected to represent a range of occupations, and
each was married to a woman of reproductive age.
Results: Findings indicate that women perceived they were at risk for HIV on
the basis of the husband's sexual behavior. Both men and women reported low
levels of marital condom use and expressed considerable interest in the potential
use of vaginal microbicide. They described a peri-partum sexual abstinence norm
and said it is possible that men may seek alternate sex partners during this period. Both men and women reported that use of microbicide should be discussed
among partners and expressed many concerns that must be addressed before
trial enrollment. Paramount among these would be providing a better understanding of the research process accurately describing the safety profile of the products
to be tested, and designing trial logistics that minimize disruption of the women's
daily schedule.
Conclusion: Both men and women recognized women's risk of HIV and expressed considerable interest in the potential use of vaginal microbicide. Important
factors influencing a woman's decision to use a microbicide include its safety and
side effect profile, its effectiveness for preventing HIV infection, the cost of the
product, and their husband's consent. Men shared many of these concerns and
expressed a willingness to support their partner's participation in microbicide
efficacy testing.

14157 Co-occurring HIV and methamphetamine epidemics:
Results of a US multi-site rapid assessment and
implications for prevention and treatment
Michael Gorman, A. Pach1, R.N. Needlb2, E.Y. Lambert2, C. Sterk3. 3937 15th
Avenue, NE Seattle, Washington; 1NORC, Washington, DC; 2NIDA, Rockville,
MD; 3Emory University, Atlanta, GA, USA
To identify individual risk factors, patterns, frequency, duration, dose according to