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

12th World AIDS Conference

Abstracts 33137-33141 619

or more occasions - 77.5%. In addition, many women also preferred the female
condom over the male condom in terms of overall satisfaction.
Lessons Learned: Given that the female condom is a relatively new device and
that it was unfamiliar to these women prior to this study, these favorable reactions
are remarkable. The adoption of a new technology can be a long-term process,
particularly when it involves very personal reproductive health decisions, but
these data suggest that there is a viable role for this device in the HIV prevention
field.
S33137 Promoting dual protection: Integrating HIV, STI and
family planning services
Joanne E. Mantell1,2, Eugene Weiss3, Elma Scheepers4. 1832 Broadway, 10th
Floor, New York, New York 10003; 2HIV Ctr for Clin & Behav Studies/Col U, New
York, NY; 31ndependent Consultant, Harrington Park, NJ, USA; 4Independent
Consultant, Pretoria, South Africa
Issues: Successful integration of family planning (FP), HIV and STI prevention
services requires consideration of four issues: (1) concurrent protection from
pregnancy and HIV/STIs; (2) the social forces and gender relations affecting
sexual negotiations between women and men; (3) the need for reorganization
of FP programmes; and (4) improvement in STI diagnosis and treatment among
asymptomatic clients. To date, operations research which simultaneously documents the problems of effective service integration, tests the field-effectiveness
of FP provider training, client education and counselling, and other inputs, and
also measures program outcomes is lacking.
Project: Our conceptual approach entails a revision of the basic format of
education and counselling to include the: (1) provision of dual protection (contraception and HIV/STI prevention); (2) accessibility to methods that woman
can initiate; (3) a client-centred counselling, informed choice approach based
on lifestyle and risk, social context and personal contraceptive and HIV/STI
prevention objectives; (4) skills-building; (5) recognition of the need to balance
contraceptive efficacy and HIV/STI prevention; and (6) integration of FP/HIV/STI
prevention/treatment services. Other key intervention components are: the training, supervision and monitoring of clinic service providers; supply and distribution
of barrier method contraceptives; and modifications in clinic procedures, providers'
roles, and program management. This model is applicable to both FP and STI
settings.
Results: Although no hard data are available yet, this conceptual approach
will be evaluated in a community-based project in Zimbabwe. Published case
study data and our field work in several Sub-Saharan African countries indicate
that even with training, providers frequently fail to discuss HIV/STI issues with
clients or assess clients' risk; level of condom or dual method use is not routinely
documented; and the male condom has been the only barrier method available
for dual protection (DP).
Lessons Learned: Promoting DP norms and behaviours requires a multimethod, community-based approach: (1) expansion of the array of barrier methods in clinics and through social marketing; (2) intensive focus on the HIV/STI
prevention; and (3) concrete changes in the way services are provided (program
objectives, provider training, management information systems).
S33138 | Evaluation of local tolerance of a vaginal film (VF) of
nonoxynol-9 (N-9) in women at low risk of sexually
transmitted diseases for HIV prevention
Nzilambi Nzila1, M.D. Tuliza2, M.D. Malele2, M.D. Kiruru2. 1B.P. 8502 Kinshasa
I; 2Project SIDA, Kinshasa, Democratic Republic of Congo
Objectives: To determine the type of genital lesions colposcopically detectable
and symptoms reported by participants in the study.
Design: Randomized, double-blinded, controlled clinical trials.
Methods: Participants were volunteers, healthy women 18-45 years old, not
engaged in prostitution, with a normal colposcopy at the entry of the study. Endpoints were evaluated through clinical and colposcopic examinations at day 7
and 14. Thirty cases were instructed to insert a VF containing 72 mg of N-9 three
times per day for 14 days while the 30 controls inserted nothing. In the second
study, the 30 cases inserted a VF with N-9 three times per day, while controls
inserted a placebo VF 3 times per day; in addition, participants were instructed to
apply vaginal douche with 10 ml of physiological solution after the insertion. Free
condoms were provided.
Results: of the first study

33139 Acceptability of the female condom among women who
exchange sex for drugs or money
Nabila EI-Bassel1, S.S. White2, L. Gilbert2, R.F. Schilling2, J. Wallace2. 1CUSSW
622 West 113th Street, New York, NY; 2Columbia University New York, NY USA
Objective: The study examines knowledge of, experience with, and attitudes
towards the female condom among women who exchange sex for money or
drugs.
Design: Survey
Methods: A purposive sample of 113 sex workers approached while receiving
HIV prevention and other services from a mobile van. Subjects were baselined,
given a demonstration on proper use of the female condom, provided with 10
female condoms and asked to return in 2 weeks for a follow up interview. A total
of 101 completed the follow-up.
Results: Mean age was 36; 66.3% were African-American; 27.7% Latina; 69%
never married. All women reported current substance abuse, 72.3% used crack,
19.8% injected drugs, and 49.5% abused alcohol. The majority has heard of the
female condom, but only six had used it prior to baseline. Seventy-one women
tried at least one of the 10 female condoms provided, most often with customers.
Comfort level, and attitudes towards the female condom were positive, but decreased after they had used it. The sex workers indicated that they were more
likely to use it with customers than with regular partners. Half of the women plan
to use it with regular partners and almost two thirds planned to use the device
with future customers.
Conclusion: Findings suggest that for sex workers, the female condom may
be a feasible and acceptable barrier method for use with customers and regular
sex partners.
33140 Non-traditional partnership to distribute female condoms
to people at risk for STD, HIV and unintended pregnancy
Carol Rogers. Health Center 1, 500 S. Broad St., Philadelphia, PA, USA
Issue: The female condom, approved by the US FDA in 1993 "to help prevent
pregnancy and STD including [HIV]" offers a unique method of protection because
it is controlled by the woman. High morbidity in Philadelphia called for innovative
and non-traditional methods to get female condoms and information about how
to use them into the hands of Philadelphians at risk.
Project: In July 1995 the Philadelphia Department of Public Health undertook a
campaign to educate health care workers and the general pubic about the female
condom as a risk reduction tool. We integrated female condoms into all program
areas where male condoms are distributed. Hundreds of individuals (non health
care workers) provide community leadership by promoting life-saving health information. Our goal was to identify these non-traditional health educators and
enlist their support to spread the word about this prevention option. We offered
free female condoms and education materials to all who expressed a desire to
spread the word about this important prevention tool.
Conclusion: As of 1/98 we have distributed nearly 500,000 female condoms
and educational materials free of charge. We have enlisted the active support of
mentoring programs, girl scout troops, sports teams, recreation centers, church
groups, women's service groups, police community relations officers, block captains, mental health, drug treatment and mental retardation programs, recovery
communities, night clubs, school counselors/nurses, college health centers, day
care centers, homeless shelters as well as more traditional health care providers
and educators.
When materials are made available, many people will spread the word about
the female condom, a new method of protection for STD/HIV and unintended
pregnancy. The female condom is a method of protection that is easy for women
to learn to use, and information can be disseminated through clinical health
providers as well as non-traditional community based leaders.
33141 Men's attitudes toward a potential vaginal microbicide in
Mexico, the US, and Zimbabwe
Kelly Blanchard, C. Coggins. Population Council, New York NY USA
Issues: Men's attitudes toward use of a potential vaginal microbicide could have
a significant impact on product use. Though some women may choose to conceal product use from their partner, others may choose to include their partners
in the decision to use a microbicide. Ensuring that such a product meets the
needs of men may therefore increase usage, and enable more women to protect
themselves from HIV infection.
Project: To capture both urban and rural perspectives, focus groups were held
with male taxi drivers and farmers in Mexico, the US and Zimbabwe. The men discussed their concerns about a potential microbicide, whether they would be likely
to use one, and debated the relative merits of various physical characteristics of
vaginal products.
Results: In general, men were supportive the idea of using a potential microbicide. Men in all three sites voiced concerns about possible side effects they might
experience due to their partner's use of such a product, and whether it could

have an impact on future fertility. Men in each site felt that the product would
need to conform to local perceptions about pleasurable sex, and suggested that a
microbicide should be inexpensive and freely available through the same distribution channels as condoms. Statements by some men that such a product would
be a welcome substitute for condoms (which some men perceive as inhibiting
sexual pleasure) are cause for concern, and appropriate messages will need to

Day 7
Cases Controls
(n = 30) (n = 30)

Genithal erythema
Epithelial disruption
Vaginal itch

OR Cases
(n = 30)
2.158 3
4
3.22 6

Day 14
Controls
(n = 30)
3.27
0
2

In the 2nd study, genital epithelial disruptions have been found in only 2 cases at day 14. We
observed that the VF was not soluble instantaneously, in vivo.
Conclusions: Genital lesions are often located at the point of the contact of
the film with the mucosa and are associated with the slow dissolution of the film.
Vaginal douche seems to decrease side effects due to N-9. Those results are
encouraging. Further studies are needed with other formulations of N-9 and with
other virucides.