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

12th World AIDS Conference

Abstracts 14263-14266 235

by adults and adolescents, although attendance among males was less than
among females.
Lessons Learned: Participatory, small group interventions that address gender-related barriers to HIV prevention can be implemented successfully in difference contexts, although involvement of males in multiple group sessions poses a
challenge.
466* 14263 Free condoms/sold condoms: Which is actually
used? Lessons from the field in a remote district of
northern Uganda
Jacques Homsy1, J.W. Idro2, S. Tani2, A. Odule2, I. Juma2, R. King2,
D. Schopper3. Moyo AIDS Control Initiative (MACI), Adjaumani; 2MACI,
Adjumani; 3MSF-Switzerland, Kampala, Uganda
Issue: In 1991, an HIV/AIDS prevention education program including IEC and
condom promotion and distribution was initiated in the war-affected, resourceconstrained District of Moyo, Northern Uganda (pop 200,000, of which -50% are
Sudanese Refugees).
Project: Initially, the project distributed condoms freely until 1992. In 1993,
following national policy and based on the results of a baseline (03/1991) and
follow-up (10/1992) KAP survey, a subsidized marketing was attempted through
local hawkers and shops. Distribution and sales were monitored monthly by
project staff. Condom promotion campaigns continued throughout these periods.
Results: By the end of the free distribution period (1992), up to 11,000 condoms
were distributed monthly to both the Ugandan and Sudanese refugee populations.
When condoms started to be sold in 1993, sales were below 1,000 condoms a
month, and never reached the free distribution levels of 1992. A condom user
survey was conducted in 1995 and a 3-site comparative population survey in
1997.
The 1991 and 1992 KAP surveys (N = 1486 & 1744) had shown low levels
of both condom knowledge and usage ('ever used') of 3% and 6%. The 1995
user survey (N = 143) showed that accessibility to condoms remained difficult
for respondents located outside the main trading centers and that condom prices
were fluctuating. However, respondents also reported the use of several new
brands not introduced by the project. The 1997 3-site survey showed that despite
continued low sales recorded by the project staff, knowledge approached 90%
while 'ever usage' had increased to 30% on average among both nationals and
refugees. In all surveys, knowledge and use among women were lower than
among men.
Lessons learned: Condom usage can depend on a multitude of factors in
a sparsely-populated, poorly accessible region of Africa. In such areas where
social marketing techniques are not directly applicable, variables such as points
of sales, brand availability and reported usage may be more reliable indicators of
a condom promotion program's achievements than recorded sales.
153*/14264 Risk perception and condom use among
adolescents during summer vacations
Telma Cavalheiro, J. Pinheiro, M. Peixoto. Alameda Barros 86 CJ2B -
01232.000 Sao Paulo/SP; Osvaldo and Edith Cavalheiro, Sao Paulo SRP Brazil
Issue: Epidemiological data shows that the incidence of unwanted pregnancy,
sexual transmitted diseases and HIV infection are increasing considerably among
adolescents between 12 and 20 years old (SCHOR, 1992). These events are
particularly high during summer vacations (Health Department of Sao Sebastiao,
1994). Considering that these are special situations for young people to get
together, Barong project from APTA-Association for Prevention and Treatment
on AIDS recognised the need to develop education activities targeting the young
people on holidays.
Project: The project was developed in Maresias (Sao Sebastiao), one of the
trendiest and busiest beaches in the State of Sao Paulo, from January 9 to
February 12, 1997 as part of AIDSCAP Project/Family Health International. Using a well-equipped mobile unit to promote STD/HIV prevention several actions
were developed, such as video presentations, safer sex workshops and theatrical performances. Besides the distribution of educational material (folders and
booklets), peer educators carried out a survey on risk perception and condom
use among 324 adolescents, between 12 and 20 years old. Each interviewee received a condom sample. As a self-management initiative, BARONG Project also
sold Prudence condoms during the whole summer at an accessible, affordable
price for teenagers and low-income population, according to DKT International
principles of social marketing and community-based sales system.
Results: Most young people interviewed (83%) considered holidays as "exceptional situation" in which they perceive themselves as in higher risk to STD/HIV
because there is greater chance to have sex with unknown partner or a partner
from different social group. This awareness does not impede that situation go
"out of control" since by the beach is very common the use of drugs, alcohol
and a variety of sexual opportunities. In addition there is the problem of condom
availability. Having or having not condoms at hand seems to play an important
role on sexual decision and prevention. Young people reported an increase of

sex intercourse during summer vacations. Those who stated that always use
condoms in their sexual encounters (56%) tend to maintain the habit. Those who
stated that use condom sometimes (40%) increase condom use during summer
holidays but, due to the higher frequency of sex tend to have more unprotected
sexual intercourse. A subjective perception of the "safe partner" is decisive in
determining condom use ("it depends with whom"). Good behaviour, virginity,
beauty, cleanness, innocence, naivete, well known, family background, non use

of drugs and previous HIV test are the most frequent attributes regarding the
perception of a safe partner.
Lessons Learned: Although more than half of teenagers interviewed reported
a consistent condom use, still a great proportion are not protected from STD/AIDS.
The lack of protection is related to a false risk perception (44%) determined by
emotional and moral values and not to factual assumptions. Behaviour change
communication has to consider both individual risk perception and moral codes,
situations in which contextualized information and face to face counselling are
more appropriate.
Funded by USAID
S14265 HIV knowledge, condom use self-efficacy and intention
to practice safer sex among Asians in New York City
Mei-Ching Chou, J.J. Chin, T.R. Rodriguez. 275 7th. Ave. 12 Fl., APICHA, Inc.,
New York, NY, USA
Objectives: To measure the effect of HIV 101 workshops on HIV knowledge,
condom use self-efficacy, and intention to practice safer sex among immigrant
and US-born Asians in New York City.
Design: Quasi-Experimental One-Group Pretest-Posttest Design
Methods: Major target immigrant groups for HIV 101 workshops are Chinese,
Filipino, Indian, Korean, and Japanese. Outreach staff used a purpose sampling
strategy to recruit subjects during street outreach to participate in an HIV 101
workshop. A total of 235 people agreed to participate in the workshop sessions
in 1996. Training was conducted using a standardized HIV prevention curriculum
designed for Asians; the curriculum was developed by the Asian and Pacific Islander Coalition on HIV/AIDS (APICHA), the largest Asian community-based AIDS
organization on the East coast of the United States. All participants were given
a pretest questionnaire that contained questions on HIV knowledge, condom use
self-efficacy, intention to practice safer sex, and demographic background. Immediately after the workshop, a posttest questionnaire was given to participants.
A total of 205 Asians completed both the pretest and posttest questionnaires.
Results: US-born Asians had a higher HIV knowledge and condom use self-efficacy baseline than immigrant Asians. Paired t-test and Chi-square analyses
were used to compare pre- and post-training scores of immigrant and US-born
Asians. Data revealed that, after training, both groups significantly increased
HIV/AIDS knowledge and intention to practice safer sex (p < 0.001). Condom
use self-efficacy increased significantly only in the immigrant group.
Conclusions: US-born Asians had higher HIV knowledge and condom use
self-efficacy than immigrant Asians. HIV101 workshops appeared to be successful in increasing the HIV/AIDS knowledge and intention to practice safer sex in
both groups, but were successful in increasing condom use self-efficacy only
among immigrant Asians.
14266 Effect of the AIDS community demonstration projects on
intermediate outcomes targeted by interventions with
non-gay identified men who have sex with men
Danuta Kasprzyk, D. Montano, G. Goldbaum. Battlelle 4000 NE 41ST Street,
Seattle, WA 98105, USA
Background: The AIDS Community Demonstration Projects applied theorybased community interventions to reduce high risk behavior among high risk
groups in several cities. Two intervention cities targeted condom use for vaginal
sex with main partner and anal sex with other partners among non-gay identified
men who have sex with men (NGI-MSM). Secondary analyses were conducted
to: 1) test associations between intermediate and behavioral outcomes, and 2)
test the effect of the intervention on intermediate and behavioral outcomes.
Methods: The interventions targeted attitude, social norm, self-efficacy and
susceptibility in order to change condom use behavior; and were applied in multiple waves in two cities. Multiple waves of cross-sectional surveys (N = 1403) of
NGI-MSMs measured intermediate outcomes (attitude, social norm, self-efficacy,
susceptibility) and behavioral outcomes (behavioral intention, stage of change)
in treatment and control cities. Correlation and regression analyses were used to
assess associations between intermediate and behavioral outcomes. Analysis of
covariance (ANCOVA) was used to test for an intervention by wave interaction
effect on both intermediate and behavioral outcomes.
Results: All four intermediate outcomes were strongly correlated with behavioral intention and stage of change for condom use during vaginal sex with main
partner and anal sex with other partners, confirming the behavioral model rationale for the intervention. The ANCOVA analysis for one city and its control site
found no intervention by wave interaction for any outcomes. The analysis for the
second city and its control city obtained significant intervention by wave interactions for behavioral and intermediate outcomes for both behaviors. However, the
interaction patterns were not in the hypothesized directions.
Conclusions: The strong correlations between intermediate and behavioral
outcomes support the theoretic basis of the intervention to target intermediate
outcomes, thereby effecting behavior change. Non-significant and unexpected
interaction patterns indicate no clear evidence of an intervention effect on inter
mediate or. behavioral outcomes. The interventions may have been effective but
the quasi-experimental evaluation design relying on cross-sectional data result in
large within group variance and low power. to detect real effects.