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

12th World AIDS Conference

Abstracts 24112-24115 463

to tell a story describing how they feel about AIDS, other sexually transmitted
diseases (STDs) and sexuality and love in general.
Methodology: Krippendorff's (1992) content analysis methodology was used,
from the definition of sample units to data reduction. Six hundred and thirty-five
texts were selected from among those entered in contest. Of this number, 434
fell under the category of a narrative and qualified for analysis. Most of these
narratives came from within the school system (89.5%) and were written by girls
(85%) in the 14-17 age group (77%). From this group, a sample was selected in
order to reflect (1) sociogeographic diversity (according to region, age, genre and
origin, either from within or outside the school system) and (2) "literal" diversity.
The final selection is comprised of 54 narratives which attained the first saturation
level.
Results: Several of the narratives are haunted by themes relating to suicide,
death, STDs and a sense of fatality. The supportive friend, confidante and accomplice is the theme of several other narratives. Gender roles seldom depart
from the traditional roles with regard to sexuality.
Conclusion: The voice of young Quebecers reflects past prevention efforts.
However, death, which is so frequently mentioned, is pictured as reversible and
the theme of survival comes up regularly. Several of the authors are "condom
missionaries."
24112 Imaginary protections and imaginary risks the case of the
french homosexual milieu
Rommel Mendes-Leite. 47 Rue Michelet 93100 Montrevil-Sous-Bois;
Las-lnserm U158 Paris, France
Main target: within the scope of a larger project we will specifically analyze what
type of risk management of HIV sexual transmission is implemented by some
French men who have sex with men.
Methodology: The approach refers to anthropology and qualitative sociology: ethnographic observation on certain Parisian gay places and semi-directive
interviews (n = 160) conducted with men who have sex with men (homosexuals, bisexuals, heterosexuals) in three diferent French regions and from various
research projects during the last five years.
Main findings: We noted the existence of a phenomenon which we called
imaginary protections. Our work reveals that most individuals acknowledge the
necessity of using various prevention techniques to avoid HIV-infection. Yet people sometimes apply the official prevention guidelines by giving them a different
meaning. This process of reassigning meaning involves a kind of symbolic "manipulation" of preventive techniques, which allows these practices to be drawn
closer to the person's own cognitive framework. The person is then able to
perform particular sexual behaviors while assuming he is taking no risk.
In other side, as far as risk representations are concerned, the analysis of interviewed mens' discourses sometimes referred also to admitting unlikely (from an
epidemiological point of view) actual risk-taking. These declarations are related to
social imagery associating some styles of sexuality or some sexual practices with
perversion, filth, sexual deviance and, consequently, infection and propagation of
these imaginary dangers. For example, in some interviews imaginary risk-taking is
declared vis-a-vis group sex and so-called hard-core sex. We will attempt to apply
relativism to the notion of debauchery, which systematically refers to high-risk
places; sexual practices that are conceived as non-deviant are not necessarily
safer in terms of HIV infection.
Our approach makes possible to understand not only what representations are
implemented in HIV risk management, but also what types of sexual imagery
are operative, and how personal prevention strategies interract with ideological
constructs. The rationale underlying a symbolic framework may prevent both
the rationalization process and efficient management of actual risk-taking for
epidemiological purposes.
24113 A multi-disciplinary approach to demographic research
on HIV/AIDS in Africa
O.D. Chimere-Dan. Population Research Programme University of the
Witwatersrand, South Africa
Issue: Policies for AIDS prevention and care are made in environment that are
far more complex that are taken into consideration in many studies that consider
the demography or demographic impacts of HIV/AIDS in Africa. Unfortunately,
despite the large amount of clinical and allied research on HIV/AIDS in Africa,
studies with complex multi-disciplinary designs to capture the demography of
AIDS and the implications for intervention programmes are rare.
The project: In 1996, the Union for African Population Studies constituted a
regional (African) research network to develop among other projects, an integrated approach to demographic research on HIV/AIDS in Africa. The aim was to
strengthen collaboration and networking among a team of specialists in demography and other population sciences who will pool their knowledge of the local environments in different African countries to produce research that is more responsive
policy and programmatic needs in AIDS in Africa. Local researchers in different
countries volunteered to share their insights and findings with an aim to contribute

to the development of multi-pronged government and NGO intervention policies,
programmes and advocacy in AIDS and other reproductive health problems.
Results: Membership of the network has grown to include active AIDS and
reproductive health researchers in twelve African countries including, South
Africa, Swaziland, Botswana, Kenya, Uganda, Zambia, Zimbabwe, Ghana, Central African Republic, Cameroon, Benin, Nigeria, Congo and Democratic Republic
of Congo. Network members have successfully completed projects that have

influenced policy and advocacy at the local and national levels. A good number of
the network members are directly involved with their national government either
as full-time government staff or in other capacities. This ensured that results
of collaborative research on AIDS were immediately diffused into policy and
programme planning.
Lesson Learned: A multi-disciplinary network of permanently localized AIDS
researchers produce results that are more policy relevant than those working
within a single narrow specialisation. A problem that this project encountered is
mainly logistic. There is unevenness in the availability of communication facilities in the various countries where the researchers are based and this posed a
major problem for networking, timely distribution and utilization of information for
research.
S241141 Changing demographics of HIV infection at a university
medical center hospital in a small city
Michael Wong, J. Settle, C. Burnham, R. Higginson, V. Watson, E. Fisher.
Medical College of Virginia Hospitals PO. Box 980019 Richmond VA 23298, USA
Issue: The demographics of the HIV epidemic have evolved significantly over the
past 15 years particularly in urban centers. Small cities (200,000-500,000) were
perceived to be relatively immune from the high proportion of at-risk populations.
However, this misconception may actually place smaller cities at great disadvantage in resource allocation and education to deal with the emerging populations,
treatment, and prevention.
Setting: Richmond, Virginia, is a small metropolitan center (population 203,507)
with a median per capita income of $13,993 in the Central Virginia region. The
total number of AIDS cases in 1982-84 were 1534 with a rate of 29.8/100,000 for
the region. Richmond receives only Ryan White Title II dollars; it does not qualify
for Title 1 and has not been granted Title 3 funding. In 1997, the total cases were
2310, with a rate of 32.4 with the majority of HIV care (>54% for the region)
provided by the Medical College of Virginia Hospitals and Physicians Infectious
Disease Clinic. The IDC serves Richmond City and the surrounding suburban
and rural areas (total population, -1 million) and the state and federal corrections
populations.
Results: Over the past 6 years, the case mix has increased from 831 (20%
AIDS) to 1194 (54.4% AIDS). Women now make up over 1/3 of the patients seen.
A shift in the age distribution is occurring with a greater proportion of persons
>40 yrs old being identified with HIV for the first time. The racial/ethnic proportions have changed as well with African Americans increasing from 67% to 76%.
Although men who have sex with men remain the largest single exposure group
(32%), heterosexual acquisition has increased from <20% to 42%; injecting drug
use has remained constant. Finally, a shift in payor source has also occurred with
-45% reimbursement occurring from federal government programs.
Conclusions: Significant shifts have occurred in the demographics of persons
with HIV. In spite of intensive education programs, a University based medical
center clinic in a small US city reflects the changes described elsewhere. However, the drain on clinical provider and social resources is felt more significantly
in smaller cities.
24115 1 Risk behaviour, use of condoms and HIV/AIDS awareness
among long distance truck drivers in India
Santosh Jatrana. Demography Program RSSS Australian, National University
Canberra Act 0200, Australia
Background: A cross-sectional survey was carried out to determine the levels
of knowledge of AIDS, condom use, patterns of sexual behaviour among long
distance truck drivers in India.
Methods: A total of one hundred and twenty seven randomly selected long
distance truck drivers and their assistants (Khalsis) were interviewed at the DelhiHaryana border check-post on the Delhi-Jaipur highway between April 1996-June
1996. Out of 1000 contacted, only 127 agreed to participate. A structured questionnaire was administered to each of them to obtain demographic information,
knowledge of AIDS, the frequency of condom use and visits to prostitutes.
Results: Nearly 71% (90) of the truck drivers had heard of AIDS. Of the 71%
who had heard of AIDS, 46% (41) of them attributed their first knowledge to
friends, relations, fellow workmen through gossip sittings at roadside dhabas
(simple & inexpensive eating places along highways). While only 17% (12) first
heard of AIDS during 1986-90, 37% (26) heard during 1991-94 and 46% (33)
heard during 1995-96. Although AIDS awareness improved over time, the awareness level among them was so poor that around 70% (50) believed that the
disease was curable with the use of drugs, although they could not identify which
it. 29% (20) of them described AIDS as a sexually transmitted disease (STD).
Approximately 44% (32) believed that AIDS could be transmitted through kissing,
handshake, sharing of food etc. Only 40% (28) of them knew that use of condoms
could prevent STD and only 2% (2) knew that it could also prevent AIDS. Of the
total truck drivers surveyed, 91% (115) of them had heard of condoms, but only
35% (44) had ever used them. Only 13% (17) of them always used condoms in
commercial sex and another 20% (25) used them occasionally. This was in spite

of the fact that 91% (115) admitted to visiting female sex workers. On whether
there has been any change in their behaviour since hearing of AIDS, only 7%
said that they insist on the use of condoms.
Conclusion: A sizeable proportion of truck drivers are not only ignorant about
HIV modes of transmission and means of prevention, but they also carry a lot
of misconceptions about the disease. HIV/AIDS awareness has not resulted in
increased use of condoms.