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

228 Abstracts 14227-14231

12th World AIDS Conference

206*/14227 Gender and STD/HIV risk in nine populations in
Nepal: Challenging the ideal of a woman of "good
character"
Dhana Malla Shrestha1, W.B. Thompson1, L. Weeden2. 1Save the Children U.S.
PO. 2218 Mahajgunj Kathmandu, Nepal; 2 Port-au-Prince, Haiti
Issue: It is difficult for women in Nepal to practice safer sex be-because of their
low status generally and because of cultural norms regarding women's sexuality
in particular.
Project: Focus group research was conducted in nine different population
groups throughout Nepal in order to better understand the complex ways in which
gender influences how men and women of different ethnic and caste groups
interpret and experience sexual relations generally and STD/HIV risk in particular.
NGOs collaborating with Save the Children U.S. on a nation-wide HIV prevention
program conducted the research in their own project settings. Data are used to
design better HIV prevention programming.
Results: The prevailing notion of a woman of "good character" in Nepal prevents women from taking measures to protect themselves from STDs and HIV. By
discussing sex generally or condom use in particular, women define themselves
as sexual beings and thereby call into question their own character and fidelity.
A woman of questionable character is a clear liability to her husband's family
and risks violence and community reproach. Women are further at risk because
of their limited access to information about STDs and HIV and because it would
be considered shameful for women to obtain condoms in public venues. The
research further demonstrated that Nepali men and women are willing to discuss
sexual ideology and behavior in small group fora.
HIV prevention strategies that simply focus on condom promotion and treatment
of STDs will have limited impact in contests where unequal power relations exist
between men and women. Any serious STD or AIDS prevention effort in Nepal
must challenge the notion that women's value is in their submissiveness to men
and their sexual powerlessness.
14228 Learning from AIDS: An experience in community
education in Risaralda, Colombia
Lina Maria Velez Hoyos. Carrera 7a #24-32, Pereira, Colombia
Background: Provide the community with a participatory educational experience
to prevent HIV/AIDS; reflect on the subject in terms of its social and medical
representations transcending the medicalized vision of the sickness through a
comprehensive and humanized approach to AIDS.
Methods: The methodology, "Meeting Spaces to Learn Together," enables an
approach to HIV Prevention through community based education, working from
the actual needs of the participants' particular context and the present historical
moment in society. This approach attempts to generate a pluralist educational
experience, respecting each persons individuality and centered on reflection,
analisis and empowerment. The target population was youth and health care
workers (n = 1800). In order to give the strategy continuity and structure, the
following four phases were developed: 1. Coming closer and contact: Identification of individuals, groups, and institutions. In this phase, meeting spaces were
arranged, working groups formed, elements identified to strenthen the process.
2. Negotiation: Each groups inividual needs were identified and agreements were
established as to the contents, strategies and joint actions. 3. Education: Different subjects were dealt with relating to HIV/AIDS: sociaoanthropology, biology,
medicine, human development, health, sickness, healthy life styles, life, sickness,
death and others that were proposed by the working groups. 4. Joint implementation: Feed-back sessions were held with individuals, group, and institutions which
generated plans, activities and educational proposals which in turn spur their
development in their communities.
Results: In this approach to educational work, we found that a lot is gained
to work with the ideas and counscious and subcounscious images on AIDS,
with people living with HIV/AIDS. Proposal to change language centered on the
following phrases: HIV is the same as AIDS > HIV is different from AIDS, High
risk groups > Vulnerable groups, HIV carriers > People living with HIV, AIDS is
transmitted > HIV is transmitted.
Conclusions: This strategy enables the construction of educationsl tools which
adjust to the conditions and speceifc context of each community; it is a space
where we can reflect on concepts, attitudes, and emotions which promote critical
thinking, change in attitude and empowerment; joint reflection on images and
social representations of AIDS is a primary necessity in developing educational
approaches to AIDS because it is these images which in the end are preventing
AIDS prevention and positive attitudes towards people living with HIV/AIDS.
14229 Understanding the social construction of sexuality and
sex negotiation to further HIV/AIDS prevention among
Puerto Rican college students
Blanca Ortiz-Torres, D. Perez-Jimenez, I. Cunningham, J. Coss-Rodriguez,
J. Velazquez-Lopez, M. Franco-Ortiz, C. Vazquez-Rivera. HIV Research Center

UN. of Puerto Rico, Rio Piedras Campus Po Box 23345, Puerto Rico
Objectives: To identify the contextual variables that influence and determine the
social construction of sexuality and gender roles and their relationship with sexual
negotiation and safer sexual practices.
Methods: Nine focus groups were conducted with 66 students of diverse sexual
orientation at the University of Puerto Rico. Patterns of interactions with microsystems such as: family, peers and church, as well as with macrosystems such as

the media, and their relationship with sexual practices and sexual negotiation,
were explored.
Results: 49% of the participants reported being sexually active. Reported rates
of sexual activity were almost identical for men and women. Although both men
and women talked frequently about condoms and safer sex, it was not necessarily to endorse their use. Condoms are most often construed as a contraceptive
method rather than protection against STDs or HIV. Participants characterized
condoms as a problem and many of them perceived safer sex practices as a
woman's issue. Sexual negotiation is more frequent in the context of casual
encounters, not in serious or stable relationships. Our participants reported that
although there is a greater openness in talking about safer sex, there are, still,
many and important barriers that prevent effective sexual negotiation. Most of our
participants identified the family microsystem as central in their construction of
sexuality. Family's discourse regarding sexuality emphasizes control, the need to
preserve virginity (among women), the negative aspects of sex and censorship
to non-heterosexual orientations. In-depth interviews are being conducted with
the objective of developing and pretesting a curriculum for an intervention aimed
at enabling young men and women to negotiate more successfully and enhance
safer sexual practices.
Conclusion: The social construction of sexuality and gender roles among
college students in Puerto Rico reinforces sex as a taboo and safer sex as an
obstacle for respect, intimacy and trust. This construction prevents safer sex
negotiation and practices.
S14230 The sexual behaviour of Swedish men abroad
Marianne Faber. National Institute of Public Health S-103 52 Stockholm,
Sweden
Background: The main objectives of this study are to improve our knowledge
of how men think, feel and act with regard to sexual contacts when travelling
abroad, and how their behaviour and attitudes are affected by their being abroad.
Methods: Three qualitative methods were used, namely field studies, and
observations and interviews in Sweden and in Thailand. Ten in-depth interviews
were conducted in Sweden with men who had engaged in casual sexual relationships while travelling on business. In addition, a three-week field study was
carried out in Thailand, for the purpose of studying, through on-site interviews
and observations, Swedish men's casual sexual encounters with Thai women.
Twenty-seven men were interviewed, either singly or in groups or two or three.
Results: Many men who travel meet women who provide sexual favours in
return for some form of economic reward. Some men did not realise that their
temporary holiday romance was a prostitute. They fell in love with the woman, saw
her as "an ordinary girl" and, consequently, underestimated the risk of becoming
infected with HIV. There were also cases of men fully realising that the women
were prostitutes but still underestimating the risk. They reasoned that, since the
women looked young and healthy, and different from prostitutes in Sweden, the
risk of HIV could not be all that great. Consistent use of condoms was more
common among the younger men in the study.
Conclusions: Certain men regarded their casual sexual relationship in Thailand as a mutual romance, not realising that the woman was a prostitute. This
led them to underestimate the risk of HIV infection. Many men neglected to use
a condom, especially when falling in love.
14231 Implications of first sexual intimacy for later sexual risk:
Results from an urban low income community in Sri
Lanka
M.W. Amarasiri de Silva1, S.L. Schensul2, Miguel Munoz-Laboy2, B. Nastasi3,
P. Nedisinghe1. CICHS Kandy, 327 Peradeniya Road, Kandy, Sri Lanka;
2University of Connecticut Sch. of Medicine, Parmington, CT; 3State University
of New York at Albany, New York, USA
Objectives: To test the hypothesis that the type of sexual initiation in terms of
behavior involved, contextual factors (e.g. location, relationship, sex of partner)
and post episode feelings and attitudes have implications for sexual behavior and
sexual risk in later adolescence and young adulthood.
Design: Descriptive study
Methods: Data were collected in three different phases using qualitative and
quantitative methodologies. The first stage involved in-depth interviews (n = 159),
free-listing and pile sorting (n = 132), informal group discussions (n = 8 groups)
in which a sequence of sexual behaviors were identified and validated using
consensus analysis by age and gender. Second, using the information collected
at the formative phase, a semi-structured interview schedule was developed to
obtain information on variations of sexual practices of the adolescents during
their first sexual intimacy. Third, using focus group discussions, peer researchers,
diaries, and observation, data were collected on aspects of negotiation, motivation
and post-episode feelings and current memories.
Results: The study results show that there is a significant correlation between
early and riskier sexual initiation and later sexual risky behavior. Early sexual
initiation involving male to male and female to female sex also shows a significant

relationship to later risky male-female sexuality. Sexual initiation which begins
outside of a love or friendship relationship tends to be of higher risk, has a significantly greater component of coercion, and has a more negative aftermath. Sexual
partners who were significantly older, identified as extended family members or
neighbors were generally associated with more negative evaluations of sexual
initiation. Female adolescents reported a general lack of physical, psychological
or social preparation for their first sexual encounter.