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

12th World AIDS Conference

Abstracts 14253-14257 233

40* /14253 Evaluation of a brief general practice-based
intervention to reduce STD (sexually transmitted
disease) risk behaviour among adults aged 18-25
years
Elizabeth M. Proude, J.E. Ward. CSAHS Needs Assessment & Health
Outcomes Unit (NAHOU) Locked Bag No. 8 Newtown NSW2042, Australia
Objectives: To design and evaluate a GP-initiated counselling intervention.
Design: Randomised controlled trial.
Method: A consecutive sample of patients aged 18 to 25 years complete
self-administered waiting-room questionnaires and agree to a 3-month follow-up.
The questionnaires assess HIV/STD risk behaviour, knowledge, and attitudes;
stage-of-change; perception of personal risk for STDs, unwanted pregnancy; drug
use. Patients give their completed questionnaires to the GP in a sealed envelope.
A code on the envelope randomly allocates the patient to "Safe Sex" counselling
by the GP (Intervention group) or to Control. GPs complete a checklist indicating
whether the intervention was used as allocated by code and patients' estimated
'stage of behaviour change'. Three months later, patients complete an identical
questionnaire allowing paired analysis of reduction in STD risk behaviour.
Results: This paper will present all available data. So far, 198 patients (68
male, 130 female; 95% consent rate) have been recruited; 103 in the Intervention
group (39 males, 64 females) and 95 in the Control group (29 males, 66 females).
At pretest, 65% and 64% of females and males respectively had used a condom
at first intercourse with a new partner. Of the sexually active 95 females and 41
males, 13 (14%) of females and 7 (17%) of males said that their partners also
had other partners, and 9 (9%) and 6 (16%) did not know. GP checklists indicate
full compliance with the randomisation procedure. Three-month data collection is
underway. Changes in patients' knowledge, stage of change and actual behaviour
will be reported.
Conclusion: Data will be presented to confirm or reject our hypothesis that
brief intervention by GPs will reduce STD risk.
142541 HIV/AIDS risk behaviour assessment, education and
counselling: Vital components in a vaccine trial
preparation
Richard Kiwanuka1, B.R. Byaruhanga2, B.M. Muwanga2, T.C. Turyatemba2,
A.C. Akola2, M.P.N. Mugyenyi2, A.J. Anecho2. 1PO. Box 16644 Kampala; 2Joint
Clinical Res. Centre P.O. Box 10005, Kampala, Uganda
Issue: Education, counselling and risk behaviour assessment within selected
cohorts are vital components in evaluating a group's preparedness for a vaccine
trial.
Project: Joint Clinical Research Centre-Kampala, Uganda conducted a World
Health Organisation funded project titled Preparation of AIDS Vaccine Evaluation
(WHO-PAVE) in an open Military cohort aged 23-26 years. The objective was to
evaluate preparedness for a vaccine trial. Strategies included HIV/AIDS education, counselling, vaccine attitudes and risk exposure assessment and periodical
phlebotomy.
Results: After a follow up of 12 months, those who at enrollment thought that
vaccines cause AIDS reduced from 27.1% tto 1.2%, those willing to be the first to
participate in an HIV-1 vaccine trial tremendously remained high i.e 88.3%-83.2%.
After 24 months follow-up, from enrollment, the rates of new genital discharges
reduced from 24.4% to 2.8%, new genital ulcers from 18.8% to 6.1%, new STDs
reported from 38.5% to 0.8%. Total number of seroconverters was 41 (3.8%).
Lessons learned: Contineous follow-up on selected cohort/s helps in identifying risk factors which can point at how successful a vaccine trial will be.
14255 Disclosure model for pediatric patients living with HIV
Ileana Blasini', C. Chantry2, C. Cruz2, L. Ortiz2, I. Salabarria2, N. Scalley2.
1University PED Hospital 4th Floor, Southwing, PO Box 365067, San Juan, PR;
2U. Puerto Rico Medical School Ped Hosp., San Juan, USA
Issues: The consequences of disclosure to children living with HIV on their illness
course, psychosocial functioning and overall quality of life for both the child and
family are largely unknown. Because of stigma often associated with HIV and it's
modes of transmission, secrecy often surrounds the diagnosis; significantly less
children are told of an HIV diagnosis than of cancer.
Project: A standardized clinical model for disclosure was developed. 26 participating families with HIV infected children ages 4-18 years of age were recruited
from families receiving clinical care at ACTU. Our model uses the following strategies to prepare staff and families for full disclosure: 1) in-training seminars for
health professionals with strategies for developmentally appropriate pediatric disclosure, 2) parent education and peer support groups for longitudinal assessment
and intervention along the phases of disclosure, and 3) longitudinal individual
assessment/intervention and teaching-support groups for HIV infected children in
order to optimize the effect of early disclosure.
Results: This clinical model has facilitated the disclosure process. Only 3 families deferred the disclosure process for later. Staff attitudes have changed from

initially fearing and resisting the disclosure process to a positive accepting and
participating role. Families have reported that peer support from other families who
have disclosed the HIV diagnosis has strengthened them for disclosure. Children
have shown good psychosocial adjustment post disclosure with the exception
of one adolescent who became clinically depressed. Compliance of medication,
with the same exception, has improved post disclosure. The children's support

group has proven to be excellent vehicle for expressing their emotional needs,
clarifying their fears and favoring good psychosocial adjustment.
Lessons Learned: In general, children were significantly unaware of their HIV
diagnosis. Family resistance to disclosure can be lessened with parent education
and peer support. Clinical staff's fears and resistance can be overcome using this
model. Teamwork by a multidisciplinary staff proved to be an essential component
of this process. Finally, we have observed good psychosocial adjustment in the
children and a sense of family empowerment post disclosure.
114256 Behavioral surveillance surveys (BSS) on specific target
groups: A valuable complement to standardized general
population surveys
Tobi Saidel', Stephen Mills2, Joseph Amon', Thomas Rehle'. 'c/o M. O'Grady,
IMPACT/Family Health Int'l, 2101 Wilson Boulevard, Arlington, VA 22201, USA;
2IMPACT/Family Health International, Bangkok, Thailand
Objective: To describe how Behavioral Surveillance Surveys (BSS) on target
populations can complement standardized general population data and improve
the interpretation of seroepidemiological HIV trends.
Design: Analysis of the extensive body of risk-related behavioral data generated by AIDSCAP/FHI.
Methods: The AIDSCAP project conducted 167 KAPB surveys during a sixyear period, gradually shifting from pre-post surveys to BSS systems for collecting
data on target groups. These surveys provide a more efficient means to monitor
trends and generate relevant, high quality data. Distinguishing factors of BSS include: 1) its ability to provide trend data on high risk, vulnerable and low-risk target
populations, 2) its improved approach to probability sampling for hard to reach
groups, 3) its ability to provide sensitive information on groups not identifiable
through household surveys, and 4) its ability to provide more frequent information
about behavior change among groups that are the focus of interventions.
Results: Preliminary analysis of target group specific data from 3 Asian and
2 African countries revealed interesting differential patterns. Two indicators from
the minimum set recommended by UNAIDS were analyzed. The percent of target
group members who had at least one "occasional" or "non-regular" partner in
the last 12 months was as follows: among students, 3-46% (male) and 0.2-24%
(female), high risk males, 48-82% and among factory workers 15-28%. The percent of males engaging in "transactional" sex during the past 12 months ranged
from 0.2-14% in students, 57-68% in STD patients and potential clients of sex
workers, 30-40% in transport workers, 43-60% in military men and 2-30% in
factory workers.
Conclusion: Interpretation of the findings suggest that data collected on specific target groups show patterns that are different but complementary to those
of general population data and that behavior change can be documented over
relatively short periods of time in high risk or vulnerable target populations.
14257 Influence of role-model stories and condom availability
on condom use by female sex workers
Nancy H. Corby, F. Rhodes. 'CSULB Center For Behav Research & SVCS 1090
Atlantic Avenue, Long Beach, CA, USA
Background: As a part of the Long Beach AIDS Community Demonstration
Project, a targeted intervention was developed for female sex workers (FSWs) to
increase the general level of condom use with their main and paying partners.
The AIDS Community Demonstration Projects, sponsored by the Centers for
Disease Control and Prevention, promoted salient HIV risk-reduction behaviors
in specific at-risk populations using principles of the transtheoretical stage model,
social cognitive theory, and the theory of reasoned action.
Methods: An intervention using trained peer volunteers to distribute packets
containing role-model stories and condoms was conducted in neighborhoods of
Long Beach having a high prevalence of prostitution. Role-model stories portrayed successful experiences of local FSWs in progressing toward consistent
condom use for vaginal sex with their main and/or paying partners. The study
was conducted over three years employing a quasi-experimental longitudinal design with matched intervention and control neighborhoods. Condom-use stage of
change (SOC) and frequency, condom carrying, and intervention exposure were
assessed cross-sectionally at 10 intervals by street interviews with 1,778 FSWs
(eliminating repeats) who reported vaginal sex in the past 30 days.
Results: Condom carrying increased (p = <.001), as did SOC and intention
with paying (p <.001) but not main (p >.05) partners, controlling for secular
effects and respondent characteristics. Condom carrying was related to intervention exposure (r =.18, p =.034) and SOC (paying partners) (r =.22, p =.011)
in the intervention area, and to condom intention (r = 19, p =.005) in the control
area, partialling out differences in respondent demographics and drug-use.
Conclusions: This targeted intervention for female sex workers (FSW proved
effective in increasing condom carrying as well as stage of change for using
condoms with paying (but not main) partners. The results suggest that condom availability alone may be an important mediator and possible determiner of
condom intentions and behaviors among FSWs.