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

12th World AIDS Conference

Abstracts 33302-33306 653

lutely ignorant of HIV/AIDS, that there is an AIDS phobia among the people, that
prostitution and prevalence of STDs are in the ascendant, that most people who
had been engaged in risky sex bahaviours didn't use condom, that discrimination
against marginalized populations and people with HIV/AIDS do exist, and that
there is a gap in AIDS education. After counselling, many callers changed their
bahaviours. Saliva tests helped many people dispel stress.
Lessons Learned: Because of confidentiality and convenience, AIDS hotline
is one of effective approaches to prevent the AIDS pandemic. An AIDS hotline
network throughpout the conutry is necessary. Saliva test is received by the risk
populations.
33302 Career development among youth living with HIV
Mary-Jane Rotherram-Borus1, Marguerita Lightfoot2, M.J. Rotheram-Borus2.
110920 Wilshire Blvd., Suite 350, UCLA Los Angeles, CA; 2University of
California, Los Angeles, CA, USA
Background: Career development and its association with coping and emotional
distress was examined among youth living with HIV (YLH).
Methods: YLH from Los Angeles, San Francisco, New York City, and Miami (aged 14-23) participated in the study. The Career Development Inventory
(Thompson et al., 1984) and Career Decision Scale (Osipow, 1987) yielded indices of degree of career certainty and career planning. Career development
scores of the YLH were compared to normative samples in order to gauge the
career development of the participants. Positive action coping, depressed coping,
self-destructive/escape coping and emotional distress were also assessed.
Results: YLH (N = 152) were 57.9% male, 37.5% African American, 32.2%
Latino, and 30.3% Anglo/other. Overall, YLH were comparably certain of their
career goals and were planning for a career in comparison to the normative
samples. Yet, older YLH were significantly more indecisive regarding their career
than would have been expected at their age. YLH who engaged in career planning
were more likely to use positive action coping, F (1,151) = 7.58, p <.01, and
less likely to use escape coping, F (1,150) = 7.05, p <.01. Career certainty was
significantly negatively related to depressed coping, F (1,148) = 5.91, p <.05.
YLH with higher indecision scores were also significantly more likely to engage
in depressed coping, F (1,149) = 7.03, p <.01. Emotional distress was unrelated
to career development.
Conclusion: These findings suggest that, like their peers, YLH plan careers
for the long term. Positive action coping responses will be enhanced when YLH
receive interventions to increase career development.
33303 1 Client-centered counseling and the continuing problem
of unprotected anal intercourse (UAI) among men who
have sex with men (MSM): Critical issues
William Darrow1, R.D. Webster2, K.I. Patel2, A.K. Buckley2, S.P. Kurtz3,
R.R. Stempel2, R.A. Roark2. 1Florida Intenational University, 3000 N.E. 151
Street, ACI-394F North Miami, Florida; 2Department of Public Health, Florida
International University, North Miami; 3Department of Sociology and
Anthopology Florida International Univerisity, North Miami, FL, USA
Objective: To improve client-centered counseling by explaining why MSM continue to report UAI.
Design: Cross-sectional survey with a multistage sampling scheme to identify
a representative sample of 205 MSM living in households in a four census-tract
area of Miami Beach, Florida.
Methods: After providing informed consent, participants were interviewed
face-to-face and asked to complete a self-administered questionnaire. Items
included relationship status with primary and other sex partners (PRIMPART),
engagement in anal intercourse while under the influence of alcohol or drugs
(HIGHSEX), and other variables hypothesized to be related to UAI. Stepwise
logistic regression models were constructed and analyzed to assess reasons for
reports of UAI.
Results: Two variables predicted UAI: PRIMPART and HIGHSEX. Men with
primary partners (63.4%) were twice as likely to report having engaged in UAI
in the past year as men without primary partners (32.0%). UAI was associated
with anal intercourse while under the influence of alcohol or drugs, even when
the effects of relationship status were statistically controlled (Table).

S33304 Analysis of 5 098 demandes for testing HIV in a social
center (1988-1996)
Eric Marsaudon, J.P. Rogez, M.F. Anstett-Barrault, D. Touchard. Dept. of Internal
Medicine and Infectious Deisease, Chateauroux, France
Objective: To analyse demands for testing HIV in a rural district in France.
Method: CIDAG is a gratuitous and anonymous Center for AIDS prevention
and education where anybody can have HIV tests. We have done a restrospective
analysis of 5 098 questionnaires answered by people who came in the CIDAG
from 1988 to 1996.
Results: Patients' characteristics: age: the majority of demands concern subjects between 16 to 25 years.; sex: men represent 65% tested excepted the range
of 16 to 20 years constituted by 57% women. Annual characteristics: the majority
tests were done in November/December and in April/March. In August the rate
was the weakest. Positive test: 47 HIV-positive patients have been discovered
(0.9%). Aims of consultations: the main consultation cause is non protected penetration but since 1994 this motive decreases from 57% to 34%. Tables on the
opposite detailed all these characteristics (age, sex, annual variation, motivation).
Discussion: The strongest rate of tests, during November and December, is
probably the consequence of the development of the world's day for AIDS on 1st
December which focus interest during this period. The decrease of tests for non
protected relation and the increase of tests for new partner's control, condom's
bursting or control before condom's stop in case of regular partner translate a
sexual behavior maturity. The weak number of HIV-positive patients discovered
confirms the informative role of the CIDAG.
Conclusion: These results show the importance of counselling in such center.
The decrease of the case of non protected penetration observed since 3 years,
is encouraging for all health's actors working to prevent AIDS.
S33305 Improving attitudes and comunication aspects during
STD consultations at public health services in Morocco
Hamida Khattabi1, Jrondi2, Balafreti2, Mouniri2, Serkat3, Dialmy4. 1ST Oukba
Rye Alkalsadi No. 14 Agdal Rabat; 2Ministry of Public Health, Rabat; 3 University
of Nohammed V Rabat; 4Department of Sociology University Fes, Morocco
Issue: STD services throughout the Public Health system are often described by
patients as far from any satisfactory standard, and attitudes of service providers
in particular are perceived as part of the problem.
Project: As a component of a joint program between the Ministry of public
Health and the european Commission aiming at an improvement in the quality of
STD services by introducing the syndromic management of cases, a qualitative
research study was carried out among public health professionals in order to
identify constraints in their practice and set training priorites for enhnacing their
IEC skills during consultation.
Following a preparatory workshop held in Rabat in May 1997, visiting teams
of 4 health educators were sent to the 3 cities, Tanger, Khenifra and Essaouira
selected for the study for their different sociocultural backgrounds as well as
reported high rates of STD. Four focus group sessions lasting 1 to 2 hours
were conducted in each study site; 60 medical doctors and 60 nurses working
at PHC and MCH/FP clinics were wnrolled in the study. Nine questions referring
to different aspects of STD case management, and including attitude and behaviour of service providers during consultations, were addressed to the groups
for discussion.
Results: The outcome of this study is providing valuable information to the
IEC comitte responsible of designing the curriculum for the IEC training activities
previewed by the programm. It is also assisting in the development of IEC sections
of the training manual for the management of STD cases.
S33306 Critical realities of HIV/AIDS counselling in a developing
country with high prevalence levels
Chilimbas L. Hamavawa, A. Haworth. University of Zambia Dept. of Psychiatry,
Counselling Unit, Ministry of Health, PO. Box 30043 Lusaka, Zambia
Issues: The often propagated form of counselling in Africa conforms to Western
theory and techniques. For instance should counselling be person-centred according to current emphasis or should it involve families and significant others
right from the beginning? This raises issues of confidentiality but these have to be
seen in the context of a country where there is widespread denial of HIV infection
and where physicians rarely make the diagnosis of AIDS as such.
Project: One to one interviews were conducted involving Home Based Care
givers, counsellors, and clients in three demographically varying cities. The findings were qualitatively analysed.
Results: Most counsellors in Zambia approached counselling from a Eurocentric person - centred perspective. However, clients' perspectives were contextual
to their family or extended family concerns. Counsellors had to make ad-hoc
changes and improviatsions to suit clients' needs. The nature of clients' needs
were essentiallypractical and socio-economic and related to the future care of
children and welfare of other family members..

Lessons Learnt: HIV/AIDS counselling requires due sensitivity but within
clients contexts. Counsellors need to concentrate more upon practical issues,
including prevention of transmission, than on process. However firmly theorygrounded techniqeues are required for overcoming e.g. resistance to acceptance
of the diagnosis and its consequences.

UAI Has Primary Partner
(n = 82)
Not high Sex while high
No 63.3% 36.7%
Yes 36.5 63.5
Total 46.3% 53.7%

No Primary Partner Total
(n = 122) (N = 204)
Not high Sex while high Not high Sex while high
57.8% 42.2% 59.3% 40.7%
33.3 66.7 35.2 64.8
50.0% 50.0% 48.5% 51.5%

Total
55.4%
44.6
100.0%

Age group, perceived HIV status, HIV-test result, bar and club attendance, use
of club drugs, and other variables were not significantly associated with UAI in
logistic regression models (P - 0.05).
Conclusion: Counseling in the USA has been closely linked to HIV status. Our
research indicates two other issues must be addressed with MSM. Counselors
must discuss sexual risk taking within and outside of primary partnerships and
while men are under the influence of alcohol or drugs.