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

234 Abstracts 14258-14262

12th World AIDS Conference

28*/14258 Study of dangerous behavioral patterns in teenage
boy sex workers and their clients in St. Petersburg
Sergey Scherbakov. "AIDS, Sex, Health" Society, Saint Petersburg; Pr.
Metallistov, Russia
Objectives: To outline the most realistic approaches to AIDS/STDs preventive
interventions in a relatively isolated community of adolescent male sex workers
and their adult male clients.
Methods: Personal live anonymous interviews with boy prostitutes, their pimps
and clients were tape-recorded or written just after the interview. Boys were
reached at three main places of their work and offered some food, preventive
tools, literature, anonymous and confidential access to qualified medical examination and in-patient treatment of STDs. After getting trust an access to pimps
was provided who in their turn acquainted the author with the key clients.
Results: 76 boys aged 11-17, 4 pimps and 19 clients were interviewed for
within I year period starting November 15, 1996. 52 of them have no parents
and housing, other 8 are from unfavorable or not full families. Educational level
does not exceed 6 forms of secondary school. 63 of them regularly use alcohol,
tobacco and some soft drugs and intoxicants. 2 are episodically injectors of home
made rude opiates (hanka). A newcomer usually passes through 3 stages of
his adaptation. Firstly he used to be picked-up by pimp at some places where
homeless youth is gathered and seduced by the latter. Then for 2-5 months he
daily changes clients playing passive role in anal intercourse for 5-100 USD.
During a second stage they find a permanent client at which place he lives, gets
food and clothes from 3 months to 3-4 years. Since 46% of them are involved in
stealing at their patrons homes, so the third stage for them is to be adapted either
to gay or criminal communities. No boys or clients ever used condoms before
the time of interview. 50 boys examined anonymously at STD clinic suffered
neglected syphilis, gonorrhea, trichomoniasis, herpes and genital warts.
Conclusions: AIDS/STD preventive activities seem to be the most effective
in newcomers at their first stage of adaptation. A special center for 15-20 boys
to provide temporary shelter, qualified medical service, social and legal counseling, laundry and shower facilities, availability of free food, drink, clothes as well
as education and prevention activities in a form of training sessions, literature,
provision by condoms, lubes and clean syringes is urgent.
S14259 Community-based evaluation of intensive street outreach
Judith Bradford1, M. Young2, T.J. Eller1. 'Survey and Evaluation Research
Laboratory, 901 West Franklin Street, Richmond, VA 2384-3016; 2Virginia HIV
Community Planning Committee, VCU Box 843016, Richmond, VA, USA
Issues: To justify funding for street-based HIV prevention interventions, implementation and evaluation data are critical, yet very difficult to collect. In this project,
the primary challenge was to implement and evaluate an intensive street outreach
intervention using the Stages of Change Model, targeting African-Americans in
low-income housing areas.
Project: With support from CDC, the Virginia HIV Community Planning Committee selected a prevention contractor (the Hampton Roads Urban League) to
work with its evaluation contractor (the VCU Survey and Evaluation Research
Lab) to implement a pilot project for its emerging outcome evaluation system. A
quasi-experimental design was implemented, with intervention and comparison
sites.
Results: After 700 individuals were screened for eligibility, 200 individuals were
successfully staged at each site. Intervention was provided according to a protocol
for each of 5 stages in the model. Pre-post staging data were collected on 39% of
the intervention sample. The effect of intervention on condom use for vaginal sex
was measured: 31% adopted safer behaviors; 56% did not show change from
pre- to post-test, and 14% were engaged in riskier behavior at post-test. Females
and individuals tested for HIV were more likely to change toward safer behavior.
Lessons Learned: Despite considerable difficulty, staging and data collection
were successfully implemented. A substantial proportion of participants demonstrated change from pre-post test. Barriers to successful implementation were
identified and to some degree were overcome.
14260 1 The results of the behavior risk factors and community
environment surveillance related STD/HIV in 8 cities of
China
Gonghuan Yang, H.S.H. Xue, Y.J. He, J.M. Ma. 27# Nanwei Road, Beijing,
100050; Chinese Academy of Preventive Medicine Beijing, PR China
Objectives: To monitor changing trend on behavior risk factors related STD/HIV,
find preventing target population and primary risk factors as to put reference for
make out preventive plan.
Design: Dynamic surveillance on behavior risk factors & related supporting
environment in Beijing, Tianjin, Shanghai, Chengdu, Kunming, etc.
Methods: The investigation carried out every month by three-stage sampling
on urban population as sampling frame, using the united questionnaire designed
by Chinese Academy of Preventive Medicine (CAPM). 400 people were surveyed

every month since 1996. Observation related policies, information communicated
by mass media, health service for STD patients and condom providing using
qualitative investigation.
Results: 38400 people were sampled, 29747 people were surveyed, 29740
records were used as analysis after re-cleaned by Center of BRFS of CAPM.
13017 men and 16723 women, the rates of correct awareness of routs of transmitting STD/AIDS are respectively 53% and 12%. The doctors and teacher did

not have more knowledge related STD/HIV than other people. Private doctors'
knowledge of prevention and treatment STD/HIV was very poor. Mass media
could effect people' knowledge and attitude, but sometimes it gave misleading
information on HIV/AIDS, which was unfavorable to access target population for
frightening people. 56% of people used condom when they had sex. Among
them, 98% did to prevent pregnancy, only 5% to prevent both pregnancy and
STD/AIDS. Half of observed 56 hospitals did not provide effectively service of
prevention and treatment for STD patients, namely, there was not a relaxed and
anonymous cure environment, efficient cure rate, cheap expense of treatment in
hospitals.
Conclusion: The first target population should be STD patients, unemployed,
prostitutes, Injecting drug users. The second target should be doctors and teachers who are providers of correct information of STD/AIDS to population. Mass
media should provide more exact information. The health service to treat patients
with STD need to be improved.
14261 Use of urine chlamydia screening as a biomedical
outcome marker for a community-level STD/HIV
prevention program
Cornelis A. Rietmeijer, S.S. Bull, J.M. Douglas. Denver Public Health, 605
Baanock Street Denver CO 80204-4507, USA
Objectives: Sexually transmitted diseases (STD) have been used successfully
as biomedical proxies for outcomes in clinic-based behavioral HIV prevention
studies. To be useful, these markers should have a reasonably high prevalence/incidence in the target population. Chlamydia trachomatis (CT) infection
fulfills these criteria in many high-risk populations. The availability of non-invasive
STD diagnostic techniques (e.g., urine PCR/LCR screening) has created the
opportunity to use these tests as markers to evaluate non-clinic based STD/HIV
behavioral interventions. We evaluated the utility of field-based urine CT testing
in a community-level behavioral intervention among high-risk adolescents.
Design: A community-level, peer-based intervention study with ongoing, crosssectional evaluation.
Methods: Based on models developed in the AIDS Community Demonstration
Projects, we developed a volunteer, peer-based, community-level intervention
for STD/HIV risk reduction. The program has a core-volunteer network of 65
members who are trained to educate their peers about STD/HIV prevention
and distribute condoms and role model stories, based on the Stages-of-Change
concept. The program is accompanied by an ongoing CT screening component,
which includes a 70-item questionnaire, eliciting extensive information on risk and
preventive behaviors, as well as exposure to the program's intervention.
Results: During a 12-month period in the 3d year of the project, 221 interviews and CT screenings were conducted. Urine screening was acceptable to
the population and was not influenced by fear of drugs screening. Overall, 25 CT
infections were identified during the year, for a prevalence of 11.3%. Of infected
individuals, 24/25 were traced back in the community and treated. In multivariate
analysis, controlling for previous screening in the project, presence of CT was
lower among those who reported exposure to the project (odd ratio, OR, 0.3; 95%
CI, 0.1-0.9) as well as among those who had a general health visit in the prior
year (OR, 0.1; 95% CI, 0.3; 95% CI, 0.1-0.8), but higher among those who had
an STD evaluation in the past (OR, 3.0; 95% CI, 1.2-7.5).
Conclusions: Urine screening for chlamydia appeared to be acceptable in this
community-level intervention among high-risk adolescents. Although no causal
relationship could be established from this cross-sectional evaluation, exposure
to the intervention was associated with lower levels of chlamydia infections. In
addition to identifying infections for treatment (with secondary benefits for HIV prevention), urine screening for STD may be an important adjunct to the evaluation
of non-clinic, community-based STD/HIV prevention programs.
203*/14262 Reducing gender-related barriers in HIV prevention
efforts: Findings from ICRW's women and AIDS
research program
Ellen Weiss1, B. Nastasi2. 11717 Massachusetts Ave NW 302 Washington DC
20036; 2Suny-Albany, Albany NY US
Issues: Gender differences in vulnerability to HIV infection and gender-related
barriers to HIV prevention are recognized increasingly as critical components to
planning effective HIV programs, but there is little experience on how to address
them.
Project: In response, the Women In AIDS Research Program at the International Center for Research on Women sponsored 9 teams in 7 countries to
develop and evaluate various gender-sensitive interventions to: improve peer and
partner communication; increase the use of barrier methods; and equip adults to
be sources of information and guidance to adolescents. Target groups included
community, school, and factory youths; STD and family planning clients; and
adults. Qualitative research findings guided the training of peer educators, teachers, and parents; the resource materials used with the target audiences; and the
intervention approaches.

Results: All projects used participatory, small group discussions which fostered
problem solving and peer support. Intervention content varied by target audience
and context, and included sexual behavior and risks, virginity, masculinity and
femininity, and sexual pleasure and coercion. Group discussions with same-sex
and opposite-sex peers fostered communication skills. Participation in same-sex
groups enabled adolescent and adult women to gain confidence to discuss sex
with men. Non-didactic approaches and mixed sex sessions were well accepted