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

12th World AIDS Conference

Abstracts 24162-24166 473

Conclusion: Most sex workers still practice high risk behavior. The use of
condoms depends mainly on the customers. Social characteristics such as age,
education, job, place of residence are closely related to the knowledge of HIV/AIDS
and STDs, and the use of condoms. A special IEC and counselling program for
sex workers are needed to improve their knowledge and change their behavior.
24162 Examining how 'evidence' is used as a tool of control and
resistance in the organisation of HIV/AIDS services
Chris Bonell. Social Science Research Unit Institute of Education, 18 Woburn
Square London WC1H ONS, England
Background: Foucault's theory of governmentality has identified the production
and use of knowledge as key in discourses of control in advanced liberal societies.
In the United Kingdom's National Health Service and elsewhere, practitioners and
managers are increasingly being asked to base their policy and practice on
evidence from research, audit and monitoring. This study explores the political
background and significance of these developments in the area of HIV/AIDS
services, focusing particularly on implications for the distribution of control.
Methods: A retrospective comparative case study approach was used. The activities of two London-based organisations during the period 1996/97 were investigated using document analysis, and semi-structured interviews with participants.
One organisation was a volunteer-led gay men's HIV prevention organisation,
while the other was a hospital providing sexual health and HIV treatment services.
Key themes relating to the production and use of evidence in the management
and provision of services were elucidated.
Results: The production and use of evidence was a key issue in both organisations. Notions of what was meant by 'evidence' varied by sector and
occupational group. Commissioners and managers of services attempted to use
evidence from monitoring, audit and research in order to regulate the actions of
volunteers and practitioners with variable results. Clinical practitioners tended to
be able to produce and use evidence more autonomously than did volunteers
and health promotion practitioners. As well as functioning as a resource of managerial/commissioner control, research evidence was utilized, especially by those
in the voluntary agency, as a resource in campaigns regarding the policy and
funding environment.
Conclusions: What counts as acceptable evidence in a setting is the outcome
of social processes. Evidence can function both as a resource of control and
resistance between different groups of actors involved in HIV/AIDS services.
Certain groups however have more opportunities and constraints regarding this
usage than others. The distribution of these opportunities and constraints is patterned with regards to sector (statutory/voluntary) and occupation (clinical/health
promotion).
124163 Predictors of satisfaction with informal caregivers among
lower class injection drug users affected by HIV
Amy Knowlton, C.A. Latkin, D.D. Celentano, D.R. Hoover. 624 N. Broadway,
John Hopkins SHPH, HPM/SBS, Baltimore MD 21205, USA
Objectives: The SAIL Study (1994-present) examined individual, network, and
caregiver attributes as predictors of satisfaction with informal caregivers of injection drug users (IDUs) affected by HIV.
Design: Prospective study.
Methods: Participants were 503 former and current IDUs recruited for an
HIV natural history study by street outreach. 360 participants remained in the
study at the third semi-annual follow-up (1996). Multiple logistic regression was
used to assess the independent influence on satisfaction with caregivers of the
individual attributes of current drug use, HIV status, education level, physical
functioning (MOS), and depression (CES-D) at baseline. Network attributes entered in the model were proportion of support network at baseline comprised of
current drug users and of those rated as having a close relationship. Informal
caregiver attributes in the model were gender, current drug use, and family or
other relationship. Statistical significance was set at p <.05.
Results: Controlling for other variables in the model, HIV seropositives (OR
= 7.40) were more likely to be highly satisfied with their caregivers compared to
HIV seronegatives. Controlling for all other variables in the model, current drug
use (OR =.34), depression at baseline (OR =.31), and proportion of network
members close to at baseline (OR =.46) were independently negatively associated with satisfaction with caregiver. Proportion of network comprised of females
(OR =.49) and physical functioning (OR =.45) were positively associated with
satisfaction with caregivers. Gender, drug use, and relationship type of caregivers
and participants' education level were not significant in the model.
Conclusion: Results of the SAIL study indicate that satisfaction with caregivers
among lower class IDUs was predicted by individual as well as network attributes,
independent of depression at baseline. The findings suggest that satisfaction with
caregiving is influenced by availability of close female ties, which may be more
highly appraised by HIV seropositives but less so by those with impaired physical
functioning. These findings also suggest the importance of examining caregiving
processes as health declines and within the social context.

24164 The attitudes of patients to treatments
Janine Barbot, N. Dodier. Cermes-182 BD de la Villette 75019 Paris, France
Objective: This work covers the attitudes that people with AIDS have towards
the medicines and information relating to the treatments and to research. The

AIDS epidemic is characterised by the diversity in the sources of information
available on the effectiveness of this or that treatment, or on the promising nature
of any given new molecule. The aim of this work is to study the different ways in
which each patient, during his medical history, deals with the different situations
(doctors, media, AIDS associations, family and friends, etc.) with wich he is
faced.
Methodology and Main Results: Using a qualitative survey carried out in 1996
on 68 patients - a survey which mainly covered patients' relationships with their
doctors, with patient associations, with clinical trials, with media promotion of the
results of research - we analysed the diversity of the different cases encountered
by identifying four attitudes. These attitudes were built at the meeting point of
two axes: the first axis compares situations in which the patient finds himself
in a distant relationship with regard to the diversity of the matters he is faced
with, with situations where, on the contrary, he has a relationship of proximity
with regard to these matters; the second axis compares situations in which the
patient takes his place within a configuration of matters that he immediately feels
to be coherent, and cases where, on the contrary, he is actively involved in a
process of adjustment between matters that he feels to be heterogeneous or
even contradictory. For each of these attitudes, the analysis throws light on how
it is anchored in the patient's living conditions. It also highlights the dynamics that
patients may find themselves involved in when they move from one attitude to
another.
This analysis allows us to report on the condition of people living with HIV, from
the point of view of their attitude to the treatments. Its aim is to combine the study
of patients' social conditions of existence with an understanding of the complex
dynamics of individual case histories.
24165 The impact of HIV infection on families with one/several
infected children
Ovidiu Cristian Anghelina1 2, D. Buzducea2, L. Lazarescu2, A. Nicolae2,
C. Stirb2, D. Serban2, S. Petrea2. 1Dr Grozovici 1, Sector 2 Bucharest;
2Colentina Hospital, Bucharest, Romania
Objective: Identifying the psychosocial effects of HIV/AIDS infection on families
with one/several infected children.
Methods: Semistructured interviews of 60 parents/legal care givers from
Bucharest. Interviews were taken by social workers from the "Sunflower" Day
Center within the Colentina Hospital. Both qualitativ eand quantitative methods
were used. Informations from medical staff and from home visits were also used.
Parents and tutors needs and challenges were identified within a biopsychosocial
framework.
Results: The research identified problems that affected by HIV/AIDS have to
deal with. Emotional reactions of parents were filed, together with the ways they
deal with the possibility of their children's death, their future plans, changes in
their social behaviour, and their approach to revealing their problems to other
people. All these must be linked to the powerful economic pressure determined
by extra-expenses (medicine, food, clothes, transportation, etrc.) and the isolation and secrecy that surround these families. Parents/the family adopt various
methods of surviving as a family.
Conclusions: It is very important that these families are granted material
support - this can be essential for preserving a favorable climate in the family.
Relived from the economical pressure parents are more capable of handelling
the specific problems of the family. As to the decision of sharing the situation of
their family to other people (relatives. friends) it has been noticed that this may
have either negative or positive effects. Sanitary and social workers in charge of
these families must be able to creatively support these family during the entire
period they are facing these problems.
24166 Integrating a sociolinguistic approach to AIDS education:
The challenges of multicultulism
Philip Oduor Otieno1, John Yuri Omondi1, A.W. Macharia2. 1 SCA-Health Action
Programme; PO. Box 74930, University of Nairobi, Nairobi; 2Shelter Women of
Kenya, Nairobi, Kenya
Objective: The main aim of this study is to determine the effects of conservatism
by the community in communicating about sex and sexuality in promoting safe
sex during AIDS education; to investigate how AIDS/peer educators negotiate
sociolinguistic norms and terminologies in discussing matters of sexuality and to
demonstrate the usefulness of a sociolinguistic approach in the promotion of safe
sex among the youth and through them the community in general.
Method: 10 key informants from the AIDS/peer educators Clubs based in
Nairobi University were selected with the assistance of their project co-ordinators. Informal interviews were conducted using an unstructured guideline of lead
questions. The content of the safe sex promotion model used by the educators
within their local grassroot communities was reviewed with special attention to
its language applicability, acceptability and cultural relevance. A review of documentation kept by the educators was also reviewed. Case studies were used to
illustrate the findings.

Results: It came up clearly that the centrality of culture cannot be ignored in
any discussion on HIV/AIDS, behaviour and safe sex. An understanding of the
cultural dynamics at play such as taboos regarding issues surrounding sexuality
is a necessity.
Conclusion: This paper attempts to examine how peer educators within Nairobi
University, Main campus, attempt to address the problem posed by religious and
cultural traditions especially the difficulties in communicating on sensitive topics