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

224 Abstracts 14208-14212

12th World AIDS Conference

The locus of control is within society. Modification of society's perception and
structures that enhance or mitigate the impact of the disease are paramount before individual behaviour change can take place. Social scientists see HIV/AIDS
as closely linked to poverty and development. The need to address the social
and behaviourial factors can either enhance or restrict the spread of HIV. More
particularly regional co-operation and policy formulation focusing on the multisectoral approach as well as research, technical support and advocacy at the
highest level are also strategies that seem effective for the prevention, control
and management of the future course of the epidemic.
This paper highlights some examples of Kenya's experience with the HIV/AIDS
in the light of the above mentioned issues demonstrating challenges, constraints
and fundamental issues.
569*/14208 Implications of living with HIV/AIDS as a
transitioning transsexual woman
Danny Anderson. 105-825 East, 7th Avenue, Vancouver, British Columbia,
Canada
Issue: Transsexuals requiring medical care are often treated with a lack of
professionalism before, during and after transition of their biological sex. This
jeopardizes their human right to optimum health, dignity and quality of life.
Projects: Information has been gained through informal interviews with HIV
positive transsexuals and one nurse. A condition of the interview, and the collection of information, has been a promise of privacy and confidentiality. Therefore,
this research may only be considered experiential and anecdotal. The participants
in the interviews ranged in age from nineteen to forty-six. I dealt with male to
female transsexuals only because they were the only respondents to my request
for information.
Results: The TS (transsexual) women who were willing to participate gave
candid accounts of their experiences with the medical establishment and in-home
health service providers across Canada. Most of the women spoke of discomfort,
at a basic social level, caused by doctors, lab technicians, nurses, ambulance
attendants and home care workers. Incidents ranged from benign to hostile.
These include situations of doctors insisting on using the transitioning women's
legal male names during office visits instead of the new, chosen name reflecting
her gender identity; being referred to as 'it' in front of hospital staff and emergency
room patients; refusal by home care workers to provide service in the home of a
TS woman.
At a medical level of care, most doctors and specialists in both transsexual care
and HIV care do not fully know the implications of mixing HIV treatments with the
drugs TS women require to meet their transitioning objectives. The population of
patients who are both transsexual and HIV positive is insufficient and renders a
study of this nature improbable.
Conclusion: There are few centers of medical care that are knowledgeable
regarding transsexuals. Fears of stigmatization, imagined and real, prevent TS
women from receiving full and satisfactory medical attention. In the global community this would be a disgrace. In the HIV/AIDS community it is dangerous and
potentially life threatening.
14209 Male STD patients in Mumbai, India, are in urgent need of
culturally specific and feasible AIDS prevention programs
Maria Ekstrand1, C. Lindan1, G. Bhave2, P. Gupte2, D. Javeri2, E. Hudes1,
J. Mandel1. 'Ctr for AIDS Prevention Studies UCSF S-600 74 New Montgomery
SF CA 94105, USA; 2GS seth Medical School KEM Hospital Mumbai, India
Objectives: 1) To examine rates of unprotected sex and sociocultural issues
among male STD clinic patients in Mumbai India; 2) To develop, implement
and conduct a process evaluation of a culturally-specific AIDS/STD prevention
intervention for this population.
Methods: We interviewed 362 primarily low income male outpatients in a
Mumbai municipal STD clinic. We used the interview data to develop and process
evaluate a pilot AIDS prevention intervention
Results: 32% of this sample was HIV positive, Prevalence of self-reported risk
behaviors are as follows:
Lifetime history of sex with sex workers: 95%
Lifetime history of male-to-male sex 12%
Frequent intoxication before sex worker visits: 54%
Often/always use condom with sex worker: 8%
Often/always use condom with wife/primary partner: 3%
Virtually all men reported that it is very important for an Indian man to be able
to have and take care of his family. Based on the interview data, we designed
a culturally specific intervention that focused on risk reduction as a way of improving one's ability to get married, have children, and take care of one's family.
This one-day, 6 hour program included a combination of lectures, multimedia,
presentations, and interactive components. Misconceptions regarding transmission routes, effective prevention strategies, and fears associated with carrying
condoms were addressed. An HIV infected patient described the impact of living

with HIV on himself and his family. Participants discussed obstacles to condom
use and practiced putting on condoms while blindfolded, since they reported that
much sex happens quickly and in the dark. The participants rated each program
component as 3 = "good", 2 = "neutral" or 1 = "not very good". Mean scores for
the 6 components ranged from 2.6 to 2.9.
Conclusions: Their high rates of HIV and unprotected sex put male STD outpatients in Mumbai in urgent need of culturally specific HIV prevention programs

that can be easily incorporated into the current clinic structure. Presenting risk
reduction as a way of achieving culturally valued goals appears to be acceptable
to this population. Process data show that the pilot intervention was well received,
It now needs to be tested in a rigorous clinical trial, using both behavioral and
biological outcome indicators.
1152*/142101 HIV/AIDS, risk perception and adolescents in Lima,
Peru
Alicia Quintana1, E. Vasquez2. 1Pablo Bermudez214 Oficina 1001, Lima 11;
2 Instituto de Educion Y Salud, Peru
Objective: To explore the social construction of sexuality in adolescents through
the evaluation of their knowledge, attitudes, experiences and conceptions regarding sexually transmitted diseases including HIV/AIDS.
Method: Triangulation of qualitative and quantitative methods in a representative sample of 528 adolescents (284 girls and 244 boys aged 15-19) in the
district El Agustino of the city of Lima, Peru. Quantitative instruments included validation and reliability: questionnaire on knowledge (alpha cronbach.90), scale of
attitudes (alpha cronbach.80), and a survey on sexuality and sexual experiences.
Qualitative methodology included a workshop where some PRA (Participatory
Reflection and Action) tools were used such as: daily, activity, profiles, role plays,
and problem trees, as well as in depth interviews and focus groups.
Results: No relationship was found between knowledge, attitudes and sexual
experiences. HIV/AIDS transmission is not perceived as an actual risk by adolescents, while pregnancy is. They have knowledge about protection methods and
the condom is the most frequently mentioned. Although, "intention" to avoid risk
behaviours is present safer sex practices are not. Reasons for not using condoms
are: unplanned sexual relations, they, seem to happen by accident in a context
of opportunity rather than planned; fear of becoming impotent, lack of experience using condoms and, cultural seduction games where the male pressures
the female and she should show resistance in order not to be socially judged.
Additionally, risk perception is not linked to stable relationships. It is difficult for
females to negotiate safer sex as they hardly acknowledge their sexual desire
and are considered "easy girls" if they suggest condom use to their partners. "A
boy who has a number of girls is a winner, a girl who has a number of boys is
easy, a nobody".
Conclusions: Finally, safer sex practices depend on male decisions and as
results demonstrate condom use is a very limited practice. All theses factors contribute to enlarge female vulnerability to HIV/AIDS infection, and it puts women
in a very powerless position. The gender approach is crucial to understand adolescent sexuality and allows to formulate prevention programmes that are in tune
with adolescents needs.
S142111 Social-cultural determinants of sexual behaviour: A case
study of Mwingi and Homa Bay, Kenya
Dorothy A. Mbori-Ngachal, Monica I. Aoko2, B.O. K'oyugi3, R. Mutemi4. 1PO
Box 19804, Nairobi; 2Ministry of Planning, Nairobi; 4 University of Nairobi,
Nairobi; National AIDS Control Program, Nairobi, Kenya
Background: HIV/AIDS control activities in Kenya have resulted in increased
knowledge about HIV/AIDS but this has not translated into appreciable behavior
modification. In part this may be due to the fact that activities have focused on
changing individual sexual attitudes and behavior. However behavior is often
embedded in the social and cultural context. Therefore the understanding of
socio-cultural norms is central to the success of intervention programs.
Methods: Qualitative methods were used to describe socio-cultural norms that
influence sexual behavior and to explore the patterns associated with high risk
sexual behavior in three Kenyan communities, (Nyakach, Bul Bul and Matuu).
Results: Sexual behavior was found to be highly regulated by the society
culturally with severe penalties for misconduct. Premarital and extramarital sex
was perceived to be on the increase due to a collapse of societal regulatory and
sex information systems, as a result of modernization. Many rituals involving high
risk sex were identified (with some variation noted among the 3 sites). Underlying
reasons given for continuance of these practices included a strong belief in good
and bad omens; and the maintenance of societal order. Although there was some
perception of the HIV risk inherent in these practices, change was felt to be only
possible by the dictates of community elders.
Conclusions: HIV prevention programs need to take cognizance of the prevailing cultural context to maximize their impact. New culturally sensitive sex
information models need to be explored with communities. Dialogue to change
risky practices must target community elders who are most influential.
| 14212 HIV risk reduction strategies by Asian, Black, Hispanic,
and White young men, age 18 to 25 years, 1986-1995
Vickie M. Mays1'2, S.D. Cochran3. 1UCLA 405 Hilgard Ave. Box 951563, Los
Angeles California 90095-1563; 2Univ. of Calif. Los Angeles Dept. of Psych., Los
Angeles, CA; 3UCLA Schl. of Public Health Dept. of Epi., Los Angeles, CA, USA

Background: The risk of HIV infection, particularly in young heterosexual ethnic
minorities, is a growing concern in the United States. Existing cultural differences
in sexual behaviors may lead to differences in preferred sexual risk reduction
behaviors.
Methods: Questionnaires assessing, in part, HIV sexual risk reduction strategies were completed by ethnically diverse samples of sexually active, unmarried