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

240 Abstracts 14287-14290

12th World AIDS Conference

14287 Alternative IEC interventions for promoting behavioural
changes on HIV/AIDS/STDS prevention and control in
Tanzania
Mwita Nyang'Anyi1, G. Lwihula2, R.O. Swai1, S. Hanson3, M.A. Msahana1,
S. Ngahyoma1, L. Lengaki1. 'National AIDS Control Programme,
Dar-es-Salaam; 2Muhimbili Medical Centre, Dar-Es-Salaam; 3C/O European
Union, Dae-Es-Salaam, Tanzania
Issue: In spite of increased levels of awareness and considerable knowledge
on HIV/AIDS/STDs created earlier by information, education and communication
(IEC) activities in various segments of our population still their impact on eliciting
desirable behavioural changes and practices have been inadequate with subsequent exponential increase of AIDS cases in the country. This called for an action
to identify alternative IEC interventions of improved performance.
Project: A retrospective review of existing IEC activities on HIV/AIDS/STDs
which had been offered by the major community organisations since the beginning
of the epidemic (1983) through 1997 was conducted out.
Results: It was observed that most people had been adequately informed
and educated about HIV/AIDS/STDs on its transmission, prevention and consequences. However, there were slight desirable changes in those IEC programmes
which were initially information driven, focusing solely on individual vulnerability to HIV infection. Furthermore, it was learned that IEC messages in those
programmes were vertical in nature, donor dependent, not culturally appropriate and sensitive, one way communicated, uncoordinated and neglecting some
marginalised segments of the society. In contrast, there were marked increase
in behavioral changes and practices, including abstinence, fidelity and condom
use, among individuals who received IEC messages through organisations which
opted to change from information driven IEC programmes to interventions that
aimed at community mobilization behavioural change communication. These programmes disseminated their community based IEC messages through informed
dialogue in a two-way communication approach.
Lesson Learned: Community based IEC initiatives are culturally relevant and
have great potential for influencing individuals to develop and adopt desirable bahavioural changes against HIV/AIDS/STDs transmission to a sustainable degree.
14288 The qualitative assessment of intervention programme in
the largest demarcated red light district in the in the
world
Shilpa Merchant1, Lalita Shankar2. 1149/151 Cursondas Natha Bldg Raja Ram
Mohan Roy Rd, Bombay; 2PSI, Bomabay, India
The Bombay Project aims at helping to reduce the rate of HIV transmission
amongst female sex workers, pimps, 'madams', clients and others associated
with the trade. An impact evaluation for the valid assessment, of the intervention
efforts towards the complex and uneven process of behavioral change, within
the target population in the past 6 years, was undertaken using a combination of
quantitative and Qualitative data gathered included:
(a) detailed macroenvironmetal assessment of target population.
(b) Analysis of microenvironmental factors that influence high risk behavior
(c) focus group discussions
(d) indepth individual (key informant) interviews.
The hall mark of this evaluation has been the involvement of the project implementors the interpersonal educators, the peers, the CSWs and most importantly,
the pivotal decision makers themselves-the clients. By including these people in
the evaluation, it was possible to detect movement in the directions of change
that may not have been discernible using only quantitative techniques of KAB
surveys or seroprevalance studies.
Thus, the data obtained has also enabled to interpret the context in which
behaviour changes occurs and serve as a basis for the future strategic planning
by revising present efforts to maximize reach and influence those at most risk.
Results of the Impact Assessment: (1) The personal communication at a
level that addresses cultural differences and language barriers to provide an
interface that complements the intervention activities has been a positive effort to
influence individual behaviour in the target population.
(2) Our experience in the project has made it clear that any change in behaviour
especially within the CSW community warrants a refinement of traditional communication to include the broader aspects that govern their squalid lives including
their political, economical and social circumstances like the Mafia-police nexus,
violence, sexism and grinding poverty.
(3) Since the inception of the project, a two-pronged approach to reach both,
the CSWs and their clients, in tandem has been the USP of the intervention
programme and has met with equal success in both groups.
(4) By disgressing from the usual pedantic rhetoric employed by routine government health programmes, the use of 'infotainment' (information interspersed
within entertainment) programmes has assured a reponse that helps create an
environment that facilitates learning along the behaviour change continuum from
knowledge to awareness to action.
Conclusion: The assessment suggests that the Project effort have a positive
impact on knowledge of HIV, perception of individual risk, attitude towards those

affected and change in sexual behaviour among the target population.

14289 Emotional envolvment, love, and commitment:
Psychosocial and cultural obstacles for HIV/AIDS
prevention among youngs
Rosalina C. Silva. FFCLRP Universidade de Sao Paulo, Rua Bernardino de
Campos 50 Ap. 802 14015-130 Ribeirao Preto - SP Brazil
Objectives: To analyze the reasons or obstacles for the inconsistent use of the
condom presented for youngs.
Methods: In a public school, 230 students, 73.4% 13 to 18 years old and
26.6% 19 to 25, were included in the study. 65.5% of them maintained regular
sexual relationships already, and participed in a HIV/AIDS prevention program.
The Program was accomplished by 22 Psychology trainees of the Nucleus of
Studies for the Prevention to the use of drugs and the AIDS (NEPDA) -University
of Sao Paulo, under three professional psychologists' supervision, through 12
workshop 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 linked to themes like sexuality, reproductive health, and HIV
transmission. In this work we discuss the contents of the events registered during
the 120 workshops and the transcriptions of the 11 focal groups
Results: The quantitative analyses have demonstrated that happened significant increase in the information level, in the positive attitudes in relation to
HIV/AIDS prevention, and in the knowledge on the use of contraceptive methods.
In fact, they start to adopt the use of oral contraceptives. In spite of this, significant
increase is not verified in the consistent use of condoms.. It was observed, in the
answers to the post-test, a significant increase of reports of stable involvement,
and emotional relationships. The analyses of the contents of the youths' speeches
make clear that: to be there is to be together plenty of time, but the medium time
the youths feel "together a lot of time" is something like three months; they must
trust the partner, girlfriend or boyfriend; to have the certainty there won't be
betrayals; to know the partner very well; and other similar reasons. It is observed
that is easier the adoption of negotiation for condom use when the relationship
don't involve commitments, or are beginning. The stable relationships demand
trust proofs. To continue asking for condoms is like a distrust proof.
Conclusions: The values, norms and emotions involved in relationships, sexuality, love, romance, and intimacy does not change with the discussion of scientific
information. It is necessary to develop research perspectives that try to explore
the meanings of such complex aspects of the human life. That is to say, it is
necessary to develop culturally sensitive measures to subsidize AIDS prevention.
Funding: FAPESP, CNPq
14290 Why the prevention works differently among men and
women? Effects of an AIDS prevention program for
young adults in Brazil
Maria Cristina Antunes1 2, R. Stall3, N. Hearst3, C.A. Peres4. 1R. Cel. Gordinho
Filho, Sao Paulo; 2NEPAIDS-University of Sao Paulo, Sao Paulo; 3CAPS-UCSF,
San Francisco; 4NEPAIDS-University of Sao Paulo, Sao Paulo, Brazil
Objectives: To understand the gender differences and obstacles to adopt consistent safer sex practices among youth who had participated in a AIDS Prevention
Program in So Paulo inner-city.
Methods: A longitudinal using a wait-list control design with pre and post-intervention measures. Students in two schools participated in four 3-hour workhops
about Safer Sex, Reproduction, and AIDS. The workshops used an interactive
approach to talk about issues such as sexuality, gender sexual scripts, AIDS
symbolism, risk perception, knowledge, sexual scenes, and condom negotiation.
Of 394 young adults who participated in the baseline survey, 304 completed a
post intervention questionnaire, and 136 attended the workshops sessions after
the first wave. We interviewed 10 students that participated in the workshops
to explore aspects of perceived norms, sexual practices, risk perception, and
barriers to condom use.
Results: At baseline we found statistically significant differences among men
and women. Men use to know more about sexual practices and HIV transmission
through anal sex. Women feel more responsible to the sex consequences, to
avoid pregnancy; sex is related to love and they don't have large experiences
in different sexual practices. They talk more to avoid pregnancy and HIV test
with partners than men, that conduct more the sexual act and say what will be
done. We found statistically significant effects from the workshops for females,
who improved communication with partners about sex and AIDS, increased belief
on condom efficacy, improved negotiation of sex/pleasure with their partners and
reported less unprotected sex with non-monogamous partners after the interventions. The unique statistically significant effects to males were to decrease the
perceived self-efficacy to protect against HIV. Preliminary data from deep-interviews showed that the denial of the AIDS risk infection and the gendered sexual
scripts are important barrier to adopt safer sex practices, and that it is essential
to develop continuous intervention and involve all the community on the AIDS
prevention program.
Conclusion: To be in contact with sexuality and to break the prohibition and
pleasure taboo makes these women able to think, decide, communicate, and
negotiate in the sexual context. They feel less guilt and more confident with their

own desires. Male gender norms in this community dictate that any man should
be sexual experts and so less interested in learning about the sexual issues in
which they are unfamiliar. They are also oppressed by very rigid gender norms
that make difficult for them to think about risks for HIV transmission, condom use,
or responsibility about sex.