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

238 Abstracts 14278-14281

12th World AIDS Conference

Design: Pre-post test design, non-randomized controlled study
Methods: In 1995 a close collaboration between school and health workers
led to the definition of a HIV curriculum and of a training course for educators,
and to the production of a handbook of learning activities. The program targeted
the 16-aged, and consisted of 5 sessions of 2 hours each. For the purpose of
evaluation an intervention group (6 schools) and a paired no-intervention control
group (4 schools) were chosen. Within the intervention group, a group of high
quality of implementation was defined through qualitative analysis (group "A",
2 schools). A questionnaire testing changes in knowledges, attitudes, perceived
self-efficacy and behavioural intentions towards HIV-preventive individual choices
was administered anonymously. Pre vs. post test percents of correct answers to
the items, chi-squares and ORs were calculated for the design groups.
Results: The program reached 1084/1256 students. A total of 551 students
in the intervention group (183 in the "A" group) and 400 students in the control
group were analyzed. The intervention (but not the control) group showed an
improvement of knowledges (+12.2%, p < 0.001), attitudes (+19.6%, p < 0.001)
and self-efficacy towards refusal skills (+5.3%, p < 0.05) and towards condom
skills (+10.5%, p < 0.001). The intention of using condoms consistently (among
the students intentionally sexually active) didn't improve significantly in the intervention group (+3.9%, N.S.S.). Though, the group "A" showed better results
in knowledge and attitudes changes, and a clear improvement in (intentional)
consistent concom use (+10.9%, p < 0.05).
Conclusions: The intervention reached a 86.3% population coverage, and
obtained relevant changes in knowledge, risk perception and self-efficacy towards HIV-preventive skills. Though, only a group of high quality of program
implementation (33.2% of the intervention group) showed a clear improvement
of (intentional) consistent condom use. The reprogrammation of the intervention
provided art-laboratories on HIV prevention (theatre and graphics) to strenghten
students' participation and to influence the school environment.
14278 Perceived stigma associated with participation in HIV
vaccine trials in Uganda
Emmanuel Mugisha1, M. Kabugo2, J. McGrath3, R. Senvewo2, K. George3,
J. Ellner3. 1 PO. Box 10005, Kampala; 2Joint Clinical Research Centre Kampala,
Uganda; 3Case Western Reserve University, Cleveland, OH, USA
Objective: To assess whether concerns about stigma may influence willingness
to participate (WTP) in an HIV vaccine trial in Uganda.
Methods: A cohort of 1220 young men (19-30 years) enlisted in the Uganda
Peoples Defense Forces were followed from 1995 to 1997, as part of the preparation for AIDS vaccine evaluation (PAVE) study. Subjects were questioned at
baseline and every six months for two years of follow-up.
Open-ended questions were coded and descriptive statistics for all variables
were generated using SAS.
Results: At baseline 79% of the men stated WTP in a vaccine study. Of those
who stated WTP, 44% said they would tell their wife/girlfriend that they were in
a trial, 18% would tell no one, 13% would tell doctors, 10% would tell friends,
and 9% would their parents. Of those not willing to participate, 38% would tell
their wife/girlfriend and 27% would tell no one. In addition, 82% of the men said
they would participate even if their wife/girlfriend did not want them to. Forty five
percent of the men believed that if they participate in an AIDS study people will
think they have AIDS, but only 11% of these men reported that this would affect
their WTP. Eighty percent of the men said they would be favorable or neutral to
having their wife be in a trial. The most common reasons given were that it would
help them both (19%), it would protect her from AIDS (17%), and it would enable
them to get more knowledge about AIDS (13%). Together these data indicate
that the men do not anticipate a negative social cost, such as stigma, from being
known to be a trial participant.
Lessons Learned: It does not appear that fear of stigma associated with being
a trial participant constitutes a significant barrier to participation in HIV vaccine
trials in this cohort in Uganda.
14279 Outcome of a cognitive-behavioral HIV prevention
intervention tailored to the needs of seriously mentally ill
adults
Laura Otto-Salaj, J.A. Kelly, R. Hoffmann, L.Y. Stevenson. Center for AIDs
Intervention Research, 1249 N. Franklin Place Milwaukee WI 53202, USA
Background: Numerous independent investigations have found that a significant
proportion of people with serious mental illness (SMI) are at elevated risk for
HIV infection. The purpose of this study was to evaluate a randomized outcome
trial of an HIV risk-reduction intervention for SMI adults living in the inner city,
incorporating cognitive-behavior and skills-building elements and using sexual
risk behaviors as study endpoints.
Methods: One hundred forty-nine adults (68 men and 81 women) presenting at
inner-city community mental health clinics were randomly assigned to one of two
seven-session, skills-building interventions, focusing on either HIV prevention or
general health-related information. At pre- and post-intervention, all participants

were individually assessed on HIV risk knowledge and attitudes, and sexual
practices; follow-up assessments were also conducted three, six, nine and 12
months post-intervention.
Results: Compared to participants in the general health skills group, participants in the HIV risk reduction skills intervention showed significant increases 3,
6, and 9 months post-intervention in the mean frequency of vaginal intercourse
occasions that were protected (9 mo.: p <.02), and significant decreases (3

and 6 mo. post-intervention) in the percentage of unprotected vaginal intercourse
occasions (6 mo.: p <.03). Analysis of results by participant gender revealed
that females in the HIV intervention showed significant increases 3, 6, 9 and 12
months post-intervention in frequency of protected vaginal intercourse occasions
compared to their general health counterparts (12 mo.: p <.05), and significant
decreases at 3 and 6 month assessments in the percentage of unprotected vaginal
intercourse occasions (6 mo.: p <.01). Males showed no consistent effects in the
percentage or frequency of unprotected vaginal intercourse occasions. Gender
differences in substance use and diagnosis at baseline may in part explain these
results.
Conclusions: Small-group HIV prevention interventions based on cognitivebehavioral and skills building principles appear to be quite effective in assisting
SMI adults decrease their HIV behavioral risk. Interventions that address the
association of HIV risk behaviors with substance use appear especially pertinent
for this population. Community-based mental health programs are an effective
venue for the delivery of HIV prevention interventions targeted to the needs of
inner-city adults with serious mental illness.
14280 AIDS related knowledge, attitudes and practices (KAPs)
on the Caribbean Coast of Nicaragua, 1991-1997
Matthias Egger1, Marc Isler2, B. Borel3, B. Stoll3. 1Department of Social
Medicine, University of Bristol, Bristol BS8 2PR, UK; 2Silais Raas, Bluefields,
Nicaragua; 3 University of Geneva, Geneva, Switzerland
Objectives: To examine levels of HIV/AIDS related KAPs among barrio dwellers
in Bluefields, a port town on Nicaragua's southern Caribbean coast, prior to and
after a prevention campaign.
Methods: Surveys using an interviewer-administered questionnaire were performed in the same 6 barrios of Bluefields in 1991, 1994 and 1997. Houses were
visited, a list of inhabitants aged 15-45 years was compiled and the interviewee
selected at random. The interview was conducted in creole-english or spanish.
Results: A total of 2650 interviews were performed. In all surveys mean age
was 26 years, 51% were male, 49% were creole and 51% hispanic. Unemployment increased from 66% in 1991 to 85% in 1997. After the first survey a mass
prevention campaign was launched. This included radial programmes, school
visits, activities in discos, sport events, etc. Free condoms were made available
in health centres and discos. STD services were improved. See table for selected
results.
1991 (n = 874) 1994 (n = 893) 1997 (n = 883) p
"HIV is transmitted by sex" 84% 93% 94% <0.001
"Prostitutes spread HIV" 3.1% 1.7% 1.2% 0.016
"Homosexuals spread HIV" 6.2% 4.3% 1.1 <0.001
"Condoms protect" 51% 83% 58% <0.001
"I use condoms" 16% 27% 29% <0.001
"I use condoms"* 35% 55% 71% <0.001
respondents with >1 partner during last year
Conclusions: Results from 3 identical KAP surveys in the general population
of Bluefields, Nicaragua indicate that a campaign with emphasis on young people
increased HIV-related KAPs, including condom use. Effects were similar among
different ethnic groups. Self-reported condom use among people with multiple
partners was high in 1997. Discriminatory attitudes such as 'prostitutes and homosexuals spread HIV' decreased. These results are encouraging but efforts
must continue to curb the heterosexual HIV epidemic.
S14281 Evaluation of the impact of an educational program for
AIDS prevention
Rosalina C. Silva. FFCLRP Universidade e Sao Paulo, Rua Bernardino de
Campos 50 Ap. 802 14015-130 Ribeirao Preto-SP, Brazil
Objective: To ascertain differences in the acquired knowledge on HIV/AIDS and
changes happened in relation to the believes, attitudes and self-reported behavior by young participants and non-participants of an educational program for
STD/AIDS prevention.
Method: In a public school, 463 students, 13 to 25 years old, of low income,
answered to a test applied before and after an intervention program: 230 participants (169 of 13 to 18 years; 61 of 19 to 25 years) and 233 non-participants (173
of 13 to 18 years; 60 of 19 to 25 years). The HIV/AIDSprevention program was
accomplished through 12 workshop, for 4 months, with each one of 11 groups,
Participative methodologies were used for discussion about subjects of interest
of each group: believes, myths, taboos and values in general related to themes
like sexuality, reproductive health and forms of HIV transmission.
Results: Pre to post-test analysis indicate that statistically significant (p _
0.005) increments were observed among the participants in both age groups in:
a) its levels of referring information about polemic or imaginative forms on the
transmission of HIV/AIDS; b) its attitudes of acceptance of the daily coexistence
with HIV seroposive people; c) increments, in general, in the levels of information
about HIV transmission and protection against it; and, d) however, there were

not found significant differences among levels of self-related behaviors and more
consistent adoption of the condom use.
Funding: FAPESP;CNPq
Conclusions: 1) Increment in knowledge and of appropriate attitudes don't
necessarily lead to desirable behavioral changes; 2) The use of quantitative
analyses for Program evaluation is appropriate to capture only specific and momentary aspects; 3) There is need of development of studies using qualitative