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

246 Abstracts 14317-14322

12th World AIDS Conference

14317 1Patterns and determinants of sexual behavior of
adolescents in a slum of New Delhi, India
Geeta Sodhi1, I. de Zoysa2, A. Sen3, M. Verma3. 1Flat G-4/S-565, Greater
Kailash Part 2; 2 Population Council; 3Swaasthya, New Delhi, India
Background: Adolescents are particularly vulnerable to HIV. Vulnerability is
determined by individual, societal and programmatic factors as described by
Tarantola and Mann (1995).
Methods: We examined the patterns and determinants of sexual behavior
amongst adolescents aged 12 to 19 years in an urban slum of New Delhi, India.
This was a qualitative study using key informant interviews (n = 32), in depth
Interviews with adolescent boys (n = 35) and girls (n = 37), and focus group
discussions (n = 8) with adolescents.
Results: Our data showed that interaction between boys and girls is considered taboo. Adolescents' access to information, resources and support in sexual
matters is limited. Controls on adolescent girls are tighter, not allowing them to
develop skills in sexual intimacy. Arranged marriages are the norm. The prospects
of marriage are dependent on the preservation of family "honor" ("izzat"), which
is therefore a high priority and closely guarded. Exposure to cinema and, for
some, to pornographic materials has a considerable influence in the aspirations
of adolescents and provides them with " scripts" for developing intimacy. Considerable sexual activity does take place but under cover. The main perceived risk
is not infection nor even unwanted pregnancy, but of being discovered as this
would lead to dishonour and defamation. We found some instances of clandestine
relationships leading to sexual coercion and rape.
Conclusion: Adolescents' vulnerability to HIV is determined by societal factors.
The controlling family structures and values while seeking to protect adolescents
may paradoxically increase their vulnerability. Adolescent sexual health intervention programmes need to address not just individuals but the social environment
as well.
96*/14318 Love magic and HIV risk in Papua New Guinea
Carol Jenkins. Int'l. Cent. Diar. Dis. Res. B. GPO Box 128, Dhaka 1000,
Bangladesh
Objectives: The problem of love magic, or 'marila' in Papua New Guinea and
other Pacific Island cultures is seldom raised as a risk factor for HIV or other
STDs. Because love magic is widely believed in and, in some of its forms, projects
responsibility for one's own actions in sexual encounters onto the substance and
its owner, love magic could be considered a cultural risk factor.
Design: The material analyzed in this paper is derived from two major studies
conducted in Papua New Guinea, one with a national rural and periurban sample
of people from 15 to 70 years old and another one focused on youth belonging to
a single Highlands language family, spanning urban, town and rural environments
Methods: Life history interviews and specialized interviews using vignettes
describing love magic-associated events were collected between 1991 and 1995.
Over 500 persons were interviewed and, among the youth, their opinions asked
regarding love magic and vulnerability to HIV infection. All interviews were tape
recorded and translated from one of 48 languages into simple English.
Results: While the reported practice of love magic appears to be diminishing
among young people, especially those in urban areas, belief that it exists and can
manipulate a person into uncontrolled sexual situations remains strong. Considerable amounts of money are spent by women to buy love magic from specialists
in attempt to control their men's sexual behaviours, to lift a spell placed on them
or to seduce a man of their choice. Men buy various spells for similar reasons, but
also to make their penises grow larger. While a minority of young people appeared
to recognize that such beliefs allow little room for safe sex, many thought love
magic would be useful to AIDS prevention because it would ensure more faithful
couples.
Conclusions: Love magic is one of numerous factors contributing to a high
risk of HIV, especially among the young people of Papua New Guinea. As a
strong cultural belief system, community-wide interventions may be suitable that
involve opinion leaders, sorcerers and other purveyors of the magic, as well as
young people. Materials, such as comic books, can be developed to illustrate the
vulnerability that the belief and practice of love magic creates.
14319 HIV dissemination among several subgroups of men who
have sex with men in Buenos Aires
Rafael Hector Freda1, E.A. Vazquez2. 1Humberto I 613 P B. "C". 1103; 2Sigla,
Buenos Aires, Argentina
Issue: Men who have sex with men in Argentina's big cities require specific
policies of intervention for sexual habits change and cultural innovation.
Project: Given the high HIV seroprevalence in the gay community, an intervention using a radio talk show and peer interaction was implemented. It included
free distribution of condoms and lube, and safe sex workshops at the pubs. A
description of the several population subgroups of men who have sex with men
was reached. A further explanation of interrelationships of those several sub
groups, according to class and race, was obtained. A description of the courting
procedures preceded an intervention for behavioural change, with trendsetters
and opinion leaders involved in it. A radio soap opera with gay characters was
recorded and broadcasted.
Results: Several leaders within the gay, transgender and bisexual communities
enrolled in the campaign. It was well received in the pubs. The number of HIV
related consultations to SIGLA's office increased 80 per cent in a six months

period, jumping from 182 to 340 from July to December. 12.000 condoms were
distributed and seven safe sex workshops held. Several transgenders offered as
volunteers.
Lessons Learned: Starting from a gay conducted campaign, vast numbers
of men who have sex with men can be reached with a safe sex message.
A description of the subgroups involved is needed in order to get behavioural
changes.
1 4320 Factors promoting safe sex in men - A Kerala study
Harikumar Sambasivankrishnakumar. Kerala Voluntary Health Services
Mullankuzhi Kottayam 686002 Kerala, India
Issue: Factors which can reduce risk in sexual behaviour are individual specific. So providing many alternative choices of factors for maintaining safe sex
behaviour based on the opinions of people will be more cost effective and popular
Project: Being the only 100% literate state in India and having most impressive
health indices, it looks ironical that HIV infection steadily increases in Kerala.
Hetrosexual promiscuity is found to be the cause of infection in about 98% of the
cases while organised sex trade is not identifiable in Kerala. In this context, sexual
behaviour being highly personalised, probing into factors which can promote and
maintain safe sex behaviour, as percieved by the peoples groups can help in
designing effective interventions.
From a group of NGO representatives attending on AIDS awareness programme in Kerala, through brainstorming, 8 factors which promote safe sex
behaviour as per their opinion were identified. The effectiveness and acceptability
of these factors in 92 men from different parts of Kerala belonging to different
religion and different age groups between the age of 28 & 51 was studied. A list
of these 8 factors were given to them to be relisted in order of their choice and
acceptance, for the promotion & maintenance of safe sex behaviour. The index
score (the sums of the products of their order of choice multiplied by bonus score)
of all these 8 factors were calculated.
Result: The factor with highest index score was enjoyable sex within marriage
(623) followed by knowledge on non-penetrative sex (575), Adolescent sex education (552), skill in sexual communication (502) condom use (413) information
on hazards on unsafe sex (331), Government owned commercial sex centres
(169) and legislation against sex crime and unsafe sex (147)
Lessons Learned: Enchancing the enjoyability of sexual relationship within
marriages and providing effective sex education to adolescents will help majority
of men to maintain safe sex behaviour. These factors can be used as cost effective, culturally compatible and need based intervention strategy. The components
of these factors could be integrated in HIV/AIDS and sexual health programmes
for better acceptance by people's group.
14321 Adolescent sexuality and vulnerability to HIV infection in
Mumbai, India
Shalani Bharat. Tata Institute of Social Sciences Sion Trombay Rd. Deonar
Mumbai, MM, India
Objective: To explore adolescent sexuality in low/lower-middle income communities in Mumbai with a view to assess their vulnerability to HIV infection and
suggest appropriate interventions for controlling the epidemic.
Design: Qualitative research design.
Method: Adolescent girls and boys from low/lower-middle income were enrolled for 10 Focus Group Discussions to discuss understanding of puberty
changes, patterns and contexts of adolescent sexual behaviour, gender roles and
relationships and awareness of STDs/AIDS. Indepth interviews (15) were also
held to probe into risk behaviour.
Results: Adolescents lacked proper understanding of sexual development,
sexual relationships and risk of STDs and HIV/AIDS. Gender biased norms
guided attitudes towards gender roles and curbed their desire to seek information
on sexual matters. More boys, than girls, reported early initiation into sex (as
early as age 13) usually unprotected sex. Sex partners included commercial sex
workers as well as older married women from the neighbourhood. The latter
highlighted the non-commercial context of sex.
Conclusion: Adolescents in low income communities are at risk of STDs and
HIV owing to lack of understanding of sex and sexuality, unprotected sexual
activity, and presence of noncommercial context of sex. AIDS intervention programmes in India need to be broadened to include aspects on sexuality and
gender roles and relationships.
114322 Serodiscordant encounters reveal a prevention paradox
Brenda Spencer, G. Meystre-Agustoni, R. Thomas, F. Dubois-Arber. Inst Univ de
Medecine Sociale Et Preventive 17, Rue du Bugnon, CH - 1005, Lausanne,
Switzerland
Issues: In the prevention discourse, all persons should use condoms with new
sexual partners, unless they have mutual knowledge of seronegative status.

Project: Data were obtained in the course of a triangulated study on the sexuality of persons living with HIV, which included a review of the existing literature,
in-depth qualitative interviews with 25 infected persons and with 19 professionals
working closely with infected persons. Interviews were carried out in the Frenchand German-speaking regions of Switzerland.
Results: Persons with HIV face the dilemma "to tell or not to tell" when seeking
to embark on a new sexual relationship. They fear disclosure of their status will lead