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

426 Abstracts 23420-23424

12th World AIDS Conference

use and douching was 5 years (range: 1-18 years). 65 (81%) of the 80 women
reported douching. 63% used antiseptics, 46% used detergents, and 51% used
traditional remedies. Reasons given for douching included improving hygiene
(68%), treatment of vaginal discharge (39%), to attract clients (43%) and to
prevent pregnancy (6%). 72% reported intravaginal substance use to make the
vagina dry and tight. Women used cloths, cotton wool, newspaper or fingers to
insert substances in the vagina. Most women douched and inserted substances
before each sexual act.
Lessons Learned: Prevalence of douching and intravaginal substance use is
high and it seems to be done not only for dry sex and to attract clients, but also as
a way of treating STDs. It seems likely that these women will be comfortable with
self inserting a vaginal microbicide, but this should not interfere with the sensation
of a dry and tight vagina.
23420 Barriers to condom use identified by HIV infected and
at-risk women
Jan Moore1, E. Schoenbaum2, D. Warren3, P. Schuman4, A. Rompalo5,
T. Fiore6, M. Kennedy3. CDC 1600 Clifton Road Mailstop, Atlanta; 2Montefiore
Medical Center, New York, NY; 3Centers For Disease Control, Atlanta; 4 Wayne
State University, Baltimore. MA; 5Brown University, Providence; 6Centers For
Disease Control, Atlanta, GA, USA
Objectives: To identify reasons for nonuse of male condoms reported by HIV
infected and at-risk women.
Methods: 871 HIV+ and 439 HIV- women with a history of injecting drug use
or high risk sexual behavior were enrolled in a prospective study of HIV infection
in women (HER Study). Data presented were collected from women who had
been followed in the study for one year and had received HIV counseling every 6
months.
Results: 59% of the total sample was African American, 16% Hispanic, and
25% white; 59% had a history of injecting drug use; and 72% had annual household incomes below $12,000. Of the women who had been sexually active with
a male in the past 6 months (N = 409 HIV infected women and 201 uninfected
women), 43% of HIV infected women and 62%, of uninfected women reported
inconsistent or no condom use with male partner. These women were asked to
indicate the factors contributing to their most recent nonuse of a condom. 41%
of HIV infected women reported that a condom was not used at last sex because their partner already had HIV. The remaining HIV infected women reported
that partner's lack of concern about getting HIV (61%), partner's refusal to use
a condom (60%), and desire to feel close to partner (36%) were reasons for
nonuse. Relatively few infected women reported that desire for pregnancy (7%),
nondisclosure of HIV status to partner (13%), use of drugs or alcohol (8%) and
fear of physical abuse from partner (3%) were reasons for nonuse. Among the
uninfected women, the most frequently reported reasons for lack of condom use
were belief that sex partner did not have HIV (82%) and partner's desire not to use
a condom (49%). Infrequently mentioned reasons for nonuse of condoms were
concerns about partner desertion (4%), physical abuse (1%) and embarassment
(5%).
Conclusions: Partner's lack of concern about HIV and his resistence to condom use were the main reasons HIV infected women gave for lack of condom use
by uninfected male partnerssuggesting the importance of involving male partners
in risk reduction counseling. Uninfected women reported that belief in partner's
negative serostatus and his resistence to condom use were primary reasons for
nonuse of condoms suggesting the need for prevention strategies that encourage
accurate assessment of partner's risk and development of women's negotiation
skills.
234211 HIV risk and alcohol use in out-of-treatment
African-American crack abusers
Randolph F.R. Rasch1,2, W.M. Wechsberg3, M.L. Dennis4, R. Perritt3,
N.F. Rodman3, M. Wood3. 13040 Cornwallis Road Research Triangle Park, NC;
2School of Nursing, Univ. of Chapel Hill, Chapel Hill, NC; 3Research Triangle
Institute, RTP NC; 4Chestnut Health Systems, Bloomington, IL, USA
Issue: Although interventions targeted at injecting drug users (IDUs) have been
effective at reducing HIV risk behaviors in that population, it is now well established that individuals who abuse crack cocaine are also at high risk for HIV
infection, primarily because of their high rate of unprotected sexual activity. Some
evidence further suggests that crack users are often heavy alcohol users, but the
relationship between crack use, alcohol use, drug-impaired sex, and other HIV
risk behaviors is not well understood.
Project: This study examined the relationship between crack use, alcohol use,
and HIV risk in a group (N = 495) of non-injecting African American substance
abusers in the southeast United States who reported both crack and alcohol use.
The sample was subsetted from a larger group of out-of-treatment substance
abusers enrolled in a research project funded by the National Institute on Drug
Abuse to reduce HIV risk behaviors. The group as a whole was at high risk for
HIV infection: over half the participants in this project reported previous diagnosis

of and treatment for sexually transmitted diseases, and the seroprevalence for
HIV in the group was much greater than expected.
Results: Participants reporting daily use of alcohol were more likely than others
in the sample to report daily crack use. Participants reporting alcohol-impaired
sex were more likely to report daily use of alcohol and daily use of both alcohol
and crack. Participants reporting crack-impaired sex were more likely to report
daily use of crack, daily use of alcohol, and daily use of both crack and alcohol.

Respondents reporting daily use of alcohol, crack, or both were more likely to
report two or more sexual partners in the last 30 days and 50-100% sex acts
without condoms.
Lessons Learned: For some crack users, alcohol use and impairment may be
a significant factor in their HIV risk behavior. A focus on alcohol treatment along
with interventions for HIV risk reduction may be an important factor in reducing
HIV risk behavior in crack abusers who abuse alcohol.
23422 Child sexual abuse and HIV positive and negative
women's sexual risk taking
Gail E. Wyatt. 760 Westwood Plaza, Los Angeles, USA
Objectives: To compare the prevalence and efforts of histories of child sexual
abuse (CSA) on age, ethnicity, education, income and relationship status
Methods: This research capitalizes on 20 years of research on HIV negative
women's sexual abuse and sexual risk taking using structured interviews including
the Wyatt Sex History Questionnaire. We interviewed 228 HIV positive African
American, White, and Latina women recruited from health and social service
agencies in Southern California, and a random community sample of 98 HIV
negative women with comparable demographic characteristics every six months
to assess medical and psychosocial aspects of risk taking and coping with stress.
Results: One in two HIV positive women reported at least one incident of CSA
compared to one in 3 of the HIV negative cohort (p. <.02). Fifty one percent
of HIV positive versus 36 percent of HIV negative women reported two or more
before the age 18. Further, 42 percent of HIV infected women reported at least
one incident of vaginal rape compared to one in three of the HIV negative cohort
with CSA histories. HIV positive women with CSA histories were also more likely
to engage in current sexual risk taking (unprotected sex, multiple partners, sex
for money or drugs) at baseline (p. <.01) and after six months of the study (p. <.02).
Conclusions: The findings highlights the need to better understand factors
affecting different levels of risks for reinfection and transmission among HIV positive women and to develop interventions that address their victimization and it's
lasting effects in future adherence and sexual and drug reduction programs.
23423 Rehabilitation of Mathammas, Joginis, Bagiselis and
Devadasis
Ramola Sangamalla1, Ramesh Baburayapu2, R. Vaanthakomari3.
1 Project-co-ordinator, Boss-HIV/AIDS Programme for women-Pakala-517112,
Chittoor Dist-A.P; 2'Boss & Cipca' Organisation, PB No: 112, Tirupati-517502,
Chittoor Dist. A.P; 3Miss R. Vasanthakomari, Boss-Pakala, 517112-Chitoordist,
India
Issue: Mathammas, Joginis, Bagiselis and Devadasis are the women dedicated
to God Krishna who are traditionally destined to go with anybody wanting them.
They won't marry anybody but have sex with multiple partners. They are like
licensed professional sex workers. This is an ancient tradition in India followed in
some parts of our State.
Project: Identified 490 Mathammas, Joginis, Bagiselis and Devadasis in the
area. They have been educated and encouraged to give up this profession and
provided rehabilitation by our organization. We motivate the district authorities and
bank officials in our district to provide them bank loans to undertake small scale
industries under self-employment schemes. All the 490 persons were screened
for sexually transmitted diseases. Among them, 84 were STD positives and 22
were HIV positives. All of them are being taken care of by the organisation. Regular medical and health check-ups are being conducted by our trained doctors,
social health workers and counsellors. We are also providing rehabilitation to their
children in our orphanage.
Results: 73% of the Mathammas, Joginis, Bagiselis and Devadasis left their
profession and are going for self-employment, doing other kinds of work for their
livelihood. The community around them is also giving them cooperation and
encouragement. The project received very good response and support from the
society and government officials. Their rehabilitation has been progressing well.
The remaining 27% are still continuing their profession. For them we recommend
condoms and safer sexual practices.
Lessons learned: For these people marriage is the main problem. Nobody is
willing to marry them. Some of them are searching for male partners. They expect
more moral and financial support from the society. Hence, the Government and
the CBOs sector should take adequate steps to eradicate this social evil and
provide them rehabilitation and opportunities to get married. It has been very
difficult to convince a man to marry a Devadasi, Jogini, Bagiseli or Mathamma.
23424 HIV/AIDS risk related behaviours among substance
abusing youth in Shitta community
Adeyemi Adekoya. 14 Adebola Street Off Adeniran Ogunsany A Surulere Lagos,
Nigeria

Issue: The vulnerability of female drug users to HIV/AIDS due to their involvement
in unprotected sex (commercial sex work) as a means of sustainng their drug
habit.
Project: The project identified some of the major social dysfunctions of the
Community to include substance abuse by some youth. Given the sensitive nature
of this investigation, the project resorted to observations and interviews with some
members of the locations where drug are sold (joints). Overtime these joints grew