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

472 Abstracts 24157-24161

12th World AIDS Conference

tratensive direction, the image VI and IV are disliked, a distress index superior to
the meaningful threshold (12%), a distress linked to corporal sensations, frequent
anatomic answers and observations made upon the image.
24157 The questions not asked: The pitfalls of methodological
individualism in HIV epidemiology
Samuel R. Friedman1, R. Young2, M.C. Clatts1, A. Hollibaugh3, M. Asensio2,
M.J. Plumb4, P. Case1. 1NDRI, 2 World Trade Center 16th Floor, New York, NY;
2Columbia University, New York, NY; 3Lesbian AIDS Project, GNHC, New York,
NY; 4Gay and Lesbian Medical Association, San Francisco, CA, USA
Objective: To consider ways in which social understandings of "risk" can uncover
important forces that affect HIV epidemiology which individualistic approaches
may ignore.
Design: "Methodological individualism" is an approach that analyses and classifies HIV infection in terms of the contributions of individuals' risk behaviors. We
present a case study of one issue where (a) the paradigm of methodological individualism, faithfully applied, led an important question not to be considered-the
HIV risk of drug-injecting women who have sex with women (WSWs); and (b) subsequent evidence strongly suggests that drug-injecting WSWs are nonetheless
at enhanced HIV risk.
Methods: Several major international studies of HIV and risk behavior among
drug injectors which were based on individual-behavioral conceptions of risk,
correctly seeing woman-with-woman sex as a very low risk behavior, decided
not to ask women drug injectors about WSW. We review 14 USA and Australian
studies which did ask women drug injectors about WSW or sexual orientation.
Results: Seven of nine studies (in Sydney, Houston, San Francisco, Seattle,
New York [2] and Los Angeles) found HIV seroprevalence greater among WSW
IDUs than among other IDUs. One found no relationship. A study at an STD
clinic in New York found a negative relationship. WSW IDUs had much higher
(Adjusted Hazard Rate = 4.3) seroconversion rates than other IDUs in 10 low
prevalence cities. Data from six studies found WSW IDUs to be more likely to
engage in high-risk injection behaviors and/or unprotected sex with men. Some
find evidence of higher-risk networks. An estimated 20% to 30% of women drug
injectors are WSWs, so these differences are important for epidemiology and for
prevention.
Discussion: Social analysis identifies variables downplayed by methodological individualism that may help to explain differences in HIV risk behaviors and
transmission. Such variables include social networks, roles, identities, and social statuses and social class (considered as relationships rather than individual
attributes).
Conclusions: Data on behavior, risk networks, and HIV prevalence and incidence indicate that WSW IDUs are at high HIV risk. Failure to consider "WSW"
as a social category led major investigations not to study HIV risk among WSW
IDU-which has hampered research and prevention. This case study suggests
that sociological paradigms can usefully augment methodological individualism in
epidemiology and other prevention science.
24158 Adjustment strategies and time management among
long-term AIDS non-progressors
Janine Pierret. Cermes - CNRS/INSERM/EHESS, Paris, France
Objectives: To study the strategies that persons who have been living with HIVinfection for a long time work out to build up the hope necessary for living and
making adjustments over time to changes in their lives.
Methodology: The population was selected from a cohort (in B. Autran's 1994
project) of long-term asymptomatic nonprogressors on the basis of the following
criteria: proof of having been infected at least eight years earlier; the absence
of any treatment; and a T4 count above 600 without any decrease over the
past five years. Out of the 54 persons contacted between October 1996 and
October 1997, 30 accepted to participate in a research project consisting of a
recorded semidirective interview and a questionnaire. The interview focused on
the changes made in different fields of life during the years following the moment
when the interviewee learned he/she was HIV-positive.
Population: 24 men and 6 women: 12 of them <35 years old, 13 between
36 and 45; and 5 > 46. 1/3 lived in Paris, 1/3 in this city's suburbs, 1/3 in
the provinces. Half the respondents were living in couples. Nineteen had been
infected through sexual relations (16 through homosexual relations); 6, through
blood products; and 5, through intravenous drug-use.
Major results: Infected for more than 10 years, these persons have built
up hope by working out diversified strategies around the following parameters:
whether they keep their infection secret or disclose it, whether they go on attending to everyday activities as usual or effect changes in their relations and
occupations. This research aimed at identifying significant life events over the
years (deaths, mourning, moving, changing jobs, forming a couple, depression,
etc.) and the kind of resources tapped so as to implement the diverse strategies.
Since the spring of 1996, progress in treatment will swell the ranks of long-time
nonprogressors. Hence, it necessary to understand how long-term nonprogres
sors have lived for a long time with their infection and how they organize everyday
life around their chronic condition.

24159 1 Illness, deaths, and social obligations: Peasant food
security in the context of AIDS in Malawi
Mike Mtika. PO Box 2521 CS Pullman WA 99165, USA
Objectives: To examine the effect of illness, deaths, and social obligations, made
worse by the worsening AIDS epidemic, on peasant food security in Malawi.
Methods: Weekly interviews of guardians in 123 peasant households assessing
how household labor taken up by illness, deaths, and social obligations influences
peasant food security. Done interviews during December to February, the peak
period in agricultural labor demand and a period during which food shortage is
most acute. Documented illness and deaths (both AIDS-related and non-AIDS
type) in households, how households took care of the ill, funeral proceedings
in the villages, how households dealt with food shortages, and how households
assisted each other. Developed case histories on households' experiences with
illness, deaths, and social obligations. Computed household food security from
households' cash income and maize (staple food) production.
Results: The research provides a reminder and evidence that food security,
an important economic aim in the peasantry, is embedded in a web of social
and cultural obligations characterized by reciprocity and redistribution activities
through which resources are shared and household food security is collectively
insured. AIDS increases the magnitude of illness, deaths, and social obligations to
a threshold at which reciprocity and redistribution activities in the peasantry along
with the collective food security insurance among peasants are undermined.
Because AIDS compromises reciprocity and redistribution processes in the
peasantry, the ability of communities to deal with the epidemic is fractured. It is
therefore unrealistic to expect peasant households and communities to contain
the consequences of AIDS by themselves. External intervention is necessary but
must aim at regenerating reciprocity and redistribution activities in the peasantry.
S24160 | A needs assessment of transgendered people and
HIV/AIDS in Quebec, Canada: Sociological explanations
of marginalization and risk
Ki Namaste. 4564 Rue Boyer #4, MonTreal Quebec, Canada
Objectives: To conduct a needs assessment of transgendered people in the
province of Quebec (Canada) with respect to HIV and AIDS.
Methods: The needs assessment was conducted using qualitative research
methods, interviewing both male-to-female and female-to-male transsexual and
transgendered people. Government officials in health, etat civil (civil status), and
Gender Identity Clinics were also interviewed. Using the framework of institutional ethnography developed by Canadian sociologist Dorothy Smith, the needs
assessment sought to understand how transgendered people's everyday world
was shaped by adminstrative practices in health care, Gender Identity Clinics,
and etat civil (civil status).
Results: Interviewees report that, within the context of Quebec, difficulties in
changing one's name and sex on identification papers prevent social integration
- notably accessing health care and finding employment. These difficulties create
a situation in which many transgendered people live in an underground world of
prostitution and street culture, where they may be at increased risk for HIV/AIDS.
The need for policy change with respect to the application of the law regarding
change of name and sex for transgendered people is clear.
Conclusion: Epidemiological studies of HIV and transgendered prostitute communities indicate a seroprevalence rate which is exceedingly high, surpassing
65% (Atlanta) of a sample population. The present study explains some of
the social and administrative reasons why transgendered people are at high
risk for HIV/AIDS: difficulties integrating socially given an inability to change
the names and sexes on their legal documents in a francophone context. The
needs assessment further demonstrates the relevance of a sociological inquiry
for understanding how and why different populations are at risk for HIV/AIDS.
1 24161 Commercial sex workers in the northern provinces of
Vietnam: Social background and risk behaviour related to
HIV/AIDS and STD
Khuat Thu Hong. Institute of Sociology 27 Tran Xuan Soan, Hanoi, Vietnam
Objectives: To explore the social background of sex workers and to define the
behavioural aspects which put them at risk for HIV/AIDS and STD.
Methodology: The quantitative method (questionnaires) was used to identify
social background of sex workers and define the risk behaviorrelated to HIV/AIDS
and STDs. In-depth interviews have been conducted in order to collect more
detailed information to answer the questions why and how do they practice a risk
behaviour.
Results: A total of 261 female sex workers were interviewed. They are from
different social groups. Economic difficulties, unemployment and disappointment
about their family or lover are the main reasons for entering prostitution. More
than 80% of the women have heard about AIDS, nearly 60% knew about STDs
but many of them have insufficient knowledge regarding how to avoid infection.
Most young girls do not know anything about STDs and HIV/AIDS at all. Over

80% of them always used condoms with new customers. However, with familiar
customers, only 60% of them always used condoms and 12.9% never used a
condom. About 60% never used condoms with their husbands, and 85% never
used condoms with their boyfriends. Street sex workers are less likely to use
condoms as compared to those who work at brothels or hotels. Only 30% of
customers bring condoms when they visit prostitutes. Many of men believe that
pregnant women and women from countryside have no diseases.