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

12th World AIDS Conference

Abstracts 24172-24177 475

prediction of condom use for vaginal, anal and oral sex with regular partners, and
oral sex with casual partners. Facilitating conditions provided best prediction of
condom use for vaginal and anal sex with both types of partners, while perceived
control obtained best predicti on of condom use for anal sex with both partner
types. Alternative strategies was not a significant determinant of either intentions
or behaviors.
Conclusions: Cross-sectional analyses to explain intention suggest that all
four model components should be targeted to change each behavior. However,
prospective analyses to predict actual behavior indicate intervention strategies
should be different for each behavior. The findings indicate that attitude should
be targeted by interventions to change all six behaviors. However, social norm,
facilitating conditions, and perceived control should be targeted differently to
impact different behaviors.
S24172 A method for taking a household-based probability
sample of men who have sex with men (MSMs) in major
American cities
Thomas Mills1, J. Paul, R. Stall, J. Catania. CAPS/Univ of California, San
Francisco, 1PO Box 460520, San Francisco, CA, USA
Objectives: 1) To describe the method used for designing a household-based
probability sample of MSMs. 2) To compare demographic and HIV-related risktaking data on MSMs who reside in "gay ghettos" and MSMs who live elsewhere.
Design: Large-scale cross-sectional survey (n = 2,530 complete interviews for
all four cities: San Francisco, New York, Los Angeles, and Chicago).
Method: Through use of existing data sources on MSM residence patterns
(MSM AIDS case data, census data on male couples, and marketing lists), geographical areas within each of the cities were stratified for density of MSMs and
telephone surveyed using random digit dialing. Men reporting sex with men in the
last five years were surveyed on a broad range of health issues. Responses of
MSMs who live in the densest MSM areas ("ghettos") were compared with MSMs
who reside in other areas.
Results: In the four cities, 3,453 MSMs were identified using this method.
There is a prevalence of MSMs of 13.4% in the "ghettos", and 7.4% outside the
"ghettos" (p <.001). In San Francisco (n = 872), for example, MSMs outside the
"ghetto" were significantly more likely to be non-white and were less likely to be
HIV-positive. In addition, MSMs outside the "ghetto" were significantly more likely
to identify as bisexual or heterosexual.

San Francisco
Non-white
HIV-Positive
Bi/Straight Identified
Interview Completion

"Ghetto"
12.1%
27.6%
6.8%
83.4%

other
20.6%
18.0%
13.9%
79.4%

S0.01
0.01
-0.01
NS

S24175 Parents' needs and feelings about disclosure of HIV
infection diagnosis to their children
Clara Gabiano1, S. Bertotti2, G. Ferro3, L. Grosso4, M.T. Scasselatti5, P. Altini6.
1 Dipartimento Scienze ped. Eadolescenza P ZZA Apolonia 94 10126 Torino;
2Associazione Gianni Wendye e Michele Torino, 3Azienda Ospedaliera O.I.R.M.:
4Grupo Abele Torino; 5Anlaids Piemonte Torino; 6Associazione Arcobaleno
AIDS Torino, Italy
Issues: Medical understanding of the natural history and survival of perinatally
acquired HIV infection has significantly evolved since the first description of the
disease in childhood. The number of HIV infected older children and adolescents
is increasing and disclosure of diagnosis to them remains a controversial and
emotionally laden issue.
Project: In our centre we are, at present, taking care of 32 HIV infected children
(11 of them with full-blown AIDS), median age 76.08 months (range 1.09-175.1).
Five of them are younger than 2 years, 10 are 2-5 years old, 13 are 6-10 years
old, 3 are 11-13 and 1 is older than 14 years. Most parents are reluctant to
disclose the HIV diagnosis to their child. We are convinced that an open dialogue
with children can have positive effects, such as reduction of anxiety and improved
family functioning. To understand the factors that affect the process of disclosure
and its consequence and to plan the best way to set out the discussion with the
families and their children, we interviewed parents, through an open questionnaire, about their decision to disclose or not disclose HIV related information, the
reasons of their decision and the way adopted to answer the child's questions,
their needs, the feelings of their children about this issue, sharing information
with relatives, friends and school environment. The questionnaire also contains
information about the family (natural or foster and composition), parents' serostatus and stage of disease, level of education, socioeconomic position and child's
disease and treatment.
Results: The findings of the questionnaire will be analyzed according to different social situations and they will be compared with other similar experiences in
Italy and throughout the world.
Lesson learned: Data derived from the questionnaire are used to a) discuss
with parents issues related to the disclosure of HIV diagnosis with particular
attention to psychological impact on the family; b) detect parents' difficulties and
weaknesses as concerns this issue; c) identify adequate strategies to prepare
the most suitable conditions for disclosure.
24176 The future of randomised control trials in the field of
STDs: Or... what after Mwanza, Masaka and Rakai?
Cliff Lenton, L. Fransen. Willis Farm Cadeleigh Tiverton; European Commission,
Brussels, Belgium
Randomised Control Trials (RCTs) are the "Gold Standard" of health intervention
research, they measure the impact of health interventions on health outcomes
and a rigorously-designed RCT need not be repeated to validate its results -
it can immediately be "scaled up". Three RCTs have been completed, or are
on-going, in East Africa, testing whether sexually transmitted disease (STD)
treatment is an effective and affordable public health HIV-prevention strategy in
high prevalence, low resource communities. The results of these trials have important consequences for investments in HIV/AIDS prevention - it would appear
that good public health research can now be scaled up into good public health
programmes. But early evidence suggests that this is going to be more difficult
than envisaged. Public health systems do not have the capacity to replicate the
intervention proven to be effective in the trials. Whilst STD/HIV control is cost
effective, costs remain well beyond the health expenditures of people in the communities where the trials are conducted. Finally, where should public investment
be focused - on further tests of efficacy or replications of trials? Whilst private
investment may be interested in the former, it has failed so far to respond to the
latter. Where does this leave international finance agencies funding HIV/AIDS
control?
STD RCTs have important implications for HIV/AIDS control. But if RCTs are
to be quickly scaled up, the ability of the public health system to replicate the
intervention must be taken into account in their design. The affordability of scaling
up RCTs, and the comparative advantages of public and private investment, also
need to be carefully considered in decisions to fund them.
[24177 Imaginative research for HIV prevention in public sex
environments
Robert Power', R. French2, S. Mitchell3, M. Dockrell3. iDept of STDs Mortimer
Market Centre UCLMS London; 2 University College Hosp Medical School,
London; 3Gay Men Fighting AIDS, London, UK
Issue: The use of opportunistic and imaginative research techniques to collect
relevant qualitative data from public sex environments (PSE) to inform process
evaluation and project development.
Project: Gay Men Fighting AIDS' (GMFA) Hampstead Heath Project aims to
provide condoms and health promotion material to men using Hampstead Heath,

London, as a PSE during nighttime hours. A multi-indicator process evaluation
provided quantitative and qualitative data. To complement this, researchers participated in one of the regular litter collections at the site of the PSE. This led to
an unanticipated and unplanned opportunity to collect data. The contents of one
of ten random litter bags were collated and analysed and used as data to help
describe patterns of sexual activity taking place at the PSE.

Conclusion: It is possible to design a household-based probability sampling
frame of MSMs and thereby avoid the inevitable biases of convenience samples. MSMs, including those of ethnic minorities and those who reside outside
"ghettos", as well as MSMs who identify as bisexual/heterosexual, are willing to
discuss many private aspects of their lives.
S24174 Targeted vs. network sampling for accessing injection
drug users
Heather Madray, R.S. Broadhead, D.D. Heckathorn, R.J. Mills. Univ of
Connecticut, Dept of Sociology, U-68 Storrs, CT 06269-2068, USA
Issue: We compare the effectiveness of targeted sampling, using a traditional
outreach intervention, with network sampling, using a peer-driven intervention, in
recruiting active injection drug users (IDUs) into an HIV risk reduction program.
Project: A project utilizing targeted sampling, relying on professional outreach workers to access active IDUs, operated in Windham, Connecticut from
1994-1997. By the end of its third operating year, the targeted sampling process
had reached a saturation point in accessing IDUs. For example, in the first two
years an average of 10 new IDUs per month were recruited, but recruitment
dwindled during the last six months of operation to an average of only 5 new
users per month. To determine whether a sizable number of IDUs had been
missed by targeted sampling, network sampling was implemented, which relied
on active IDUs to recruit and educate their peers, for which they were paid modest
monetary rewards for their success.
Results: For the first six months of operation, network sampling increased
recruitment to an average of 14 new recruits per month, representing an increase
of almost 300% over targeted sampling. The network sample also contained
specific sub-sets of subjects who were under-recruited in the targeted sample.
For example, there was a 9% increase in the recruitment of IDUs aged 25 or
younger over the targeted sample - an at-risk population that represents the
leading edge of the AIDS epidemic. In addition, there was a 17% increase in
the recruitment of women, a group under-served by traditional outreach interventions. More users with lower educational attainment were also accessed using
the network sampling.
Lessons Learned: Network sampling, that relies on active drug users to recruit
their peers, is a more effective method than targeted sampling in accessing hidden populations at high risk for HIV. Turning to network sampling may rejuvenate
outreach projects having difficulty reaching under-served groups of IDUs.
Supported by the National Institute on Drug Abuse R01 08014.