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

12th World AIDS Conference

Abstracts 33338-33342 659

lated to altruism rather than to secondary personal benefits. (Grant support FHI
01-35173-15)
33338 Behavioural modification through outreach among IDUs
of Calcutta, India
Samiran Panda1, A. Chatterjee1, S. Bhattacharjee2, S. Bhattacharya3,
D. Mahalanabis'. 'RIICE (Society for Applied Studies), 108 Manicktala, Main
Road Flat 3/21, Cal 54; 2Society for Community Intervention & Research,
Calcutta, WB; 3Indian Council of Medical Research (NICED), Calcutta, WB, India
Issue: Outreach programme to injection drug users (IDUs) need to have in-built
sensors that could sense the changes in direct or indirect influencers of the
programme well ahead.
Project: Given the spread of injection drug use in India since early '90s, outreach activity to IDUs emerged as an important tool for reducing the harms related
to injecting practices. Calcutta has recorded injection equipment sharing, mixing
of different drugs before shooting and non-protective sexual practices among
IDUs who had mostly switched from smoking heroin to injecting buprenorphine.
To keep the HIV prevalence at its present low (1%) among IDUs of the city, outreach activity has been launched where ex- or current drugs users and non-drug
using outreach workers (ORWs) exchange syringe and needle, promote safer
injecting as well as safer sexual behaviour.
Results: Recent drive for cleaning the city to attract funds for development
forced the IDUs to go far off for rag picking, a means to survive. Roadside makeshift shelters or unused hollow iron pipes also vanished that posed a difficulty
for them to keep in touch with the exchange programme. Some youth-clubs
perceived the outreach workers as promoters of drug use and caused difficulty
that had to be addressed separately. Drug use by some of the ORWs, however,
did not always allow them to stick to the rules of the game. One big sealed
multi-dose vial of antihistaminic was used by many injectors for mixing drugs
(cocktail) through centrally uncovered rubber cap. This vial was never perceived
as a container that could spread infections and behaviour modification message
had to take this into account.
Lessons learned: Outreach programmes need to respond to the constantly
changing situations surrounding and within the injection drug use community. A
long term commitment for funding support is also an essential need of the time.
33339 Mobilization of hair-dressers to educate sex workers on
safe sex practices
Yok Uah Yin. All Women's Action Society (AWAM) Kuala Lumpur, Malaysia
Issue: Sex workers are a marginalized group and are vulnerable to HIV/AIDS.
They are not unionized and not empowered to deal with difficult clients.
Project: As sex workers are difficult to reach due to the nature of their work,
a pilot outreach project was launched to reach them through their hairdressers.
Strategies used were disseminating information to them on HIV/AIDS through
conversation, pamphlets and condom distribution. They were then encouraged
to talk to the sex workers. Hair-dressers were chosen because sex workers are
their target audiance and hair-dressers also serve as their confidant.
Results: A total of 50 hair-dressing saloons in Kuala Lumpur were covered.
The project was well received by the hair-dressers who could see that there
is a risk of losing their clientele to HIV/AIDS. Sex workers had also gained an
insight on the issue and have asked their clients to use condoms. Only three
hair-dressers were uncooperative and were fearful of associating with the issue.
Lessons Learnt: A bigger number of sex workers can be reached in minimum
time and effort. There is also direct human contact which is satisfying for both
hair-dressers and their clients and it is empowering. This project will be extended
to other to other areas in future.

participants was observed, but there was no change in proportion of girls who
realized STD risk of themselves. Men's negative attitudes towards condoms,
poor cooperation of some owners of the restaurants as well as high turnover
of girls and restaurant owners created major difficulties in implementation and
accomplishment of intervention in the context of the sex trade in this small rural
town.
Lessons Learned: Without an enabling environment, an intervention to reduce
sex related risks targeting only women is likely to have limited effect. A sustainable intervention involving the women and their male partners may be a way to
build such an environment. Mobilization of local resources such as integrating
reproductive health, STD and HIV/AIDS education in existing health services, is
likely to be a strategy to sustain the intervention.
33341 Teens talking to teens about safer sex
Brenda Seals', M.G. Kennedy', Y. Mizuno2. 1CDC, 1600 Clifton Rd., NE
Mailstop, Atlanta; 2Conwal Inc., Atlanta, GA, USA
Background: Peer education and peer outreach are popular approaches in HIV
prevention programs for teens. This study explored ordinary, unprompted teen
discussions about safer sex. The frequency and themes of such conversations
were analyzed by looking at differences between those who had already initiated
sexual activity and those who remained abstinent.
Methods: Anonymous telephone interviews were conducted at 3 US sites
(Phoenix, Sacramento and northern Virginia) with a random sample of 663 adolescents (65% participation rate) from target zip codes with high rates of teen
STDs. Youth aged 15-19 were asked whether they had spoken with a peer
about safer sex in the past 30 days and about the content of their conversations.
Chi-square values were calculated for reported data.
Results: Fifty-eight percent (383) of teens reported talking with another teen
about safer sex in the past 30 days. Teens who talked with teens about safer
sex discussed topics such as the need to use condoms for protection (46%), the
risk of pregnancy (16%) and abstainance from sex (8%). Teens who had talked
with other teens about safer sex were more likely to have spoken with friends
and parents about HIV and STDs, to know about AIDS prevention programs in
the community and to have obtained free or purchased condoms in the past 30
days (all p <.00). Fifty-three percent (348) of teens reported having had sexual
intercourse. Sexually active teens were more likely than nonactive teens to have
talked with peers about safer sex (p <.00). Among sexually active teens, those
who had talked with peers about safer sex were more likely than those who had
not had such discussions to report using condoms the last time they had sex (p.01).
Conclusion: Conversations among teens about safer sex occur frequently,
reach many teens who have initiated sexual activity and promote HIV risk-reduction messages. In HIV prevention programs for teens, mass communication, peer
education and outreach should encourage conversations among teens about HIV
risk-reduction including carrying condoms for sexually active teens. Researchers
should conduct longitudinal studies to explore the causal relationships between
teen safer sex conversations and sexual risk taking.
33342 Perceptions of sexually transmitted diseases (STDs) and
treatment seeking behaviors among rural men in Gujarat,
India
Archana Joshi, M. Dhapola. ORG House Operations Research Group,
Rameshwar Estate Subhanpura, Baroda Gujarat, India
Issue: Interventions for sexual health in rural India should be planned on the
basis of people's understanding of these problems, their patterns of treatment
seeking and availability of services.
Project: Ethnographic study was conducted to understand perceived sexual
and reproductive health problems of men and their treatment seeking behaviors
in rural Gujarat. Data were primarily gathered using repeat in-depth interviews
with married men (25-60 years) and unmarried youth (14-24 years) from 8
villages near Vadodara city. Besides interviews with local health care providers,
focus group discussions and key informant interviews were also conducted with
community members.
Results: Despite the recognition that sores, ulcers and other symptoms that
manifests on and around the penis are the results of sexual contact with sex
workers, men do not use condoms. AIDS is not perceived as a problem that could
affect rural population and is seen as an "urban" or a "western" phenomenon by
the community members. Men's understanding and explanations of the symptoms
of STDs focus on "garmi" (heat) and this concept of heat governs their treatment
seeking behaviors. Local practitioners (mainly unqualified) are the first resort for
treatment of such symptoms. If symptoms persists, private facilities in the city are
approached and government primary health care (PHC) services of STD clinics
are scarcely utilized.
Lessons Learned: With the threat of HIV/AIDS round the corner, government's
current effort of combating the problem by integrating STD treatment services
with PHC services is not enough. There is an urgent need to warn the rural

communities of the impending dangers of STDs/HIV/AIDS. Appropriate prevention interventions for sexual health will require careful designing of educational
campaigns and involvment of private practitioners in delivery of STD treatment
services.

S33340|

Evaluation of a pilot STD/HIV prevention program with
girl-attendants of roadside restaurants in Hainan
Province, China

Susu Liao', M. Liu2, Q.Y. He3, J.F. Liao4, L. Meng4, N. Wang3, X.C. Wang4.
Department of Epidemiology, PUMC, 5 Dong Dan San Tiao, Beijing; 2Peking
Union Medical College, Beijing; 3Provincial Anti-Epidemic Station, Haikou,
Hainan; 4Anti-epidemic Station of Chengmai County, Chengmai, Hainan, China
Issue: Many girls working as attendants at road-side restaurants in towns in
Hainan province, China, are exposing themselves to sex related health hazards
by providing sexual services to male clients.
Project: To reduce sex-related risks of these women, a pilot prevention program was designed, which included reproductive health and STD/HIV education,
condom distribution through outreach, distribution of information pamphlets and
drop-in activities based in a women health club set up by the project. The program
was conducted between April and July, 1997, in F town located near provincial
capital, where more than 200 girl-attendants worked. In-depth interviews, baseline
and evaluation surveys were performed.
Results: Several thousands of pamphlets and condoms were distributed in
the project. The evaluation survey showed that 74% of the girls reported receiving educational materials through the project, 61% reported reading them,
and 46% reported obtaining condoms from the project. When baseline and evaluation survey participants were compared, approximately 67% of respondents
were different. Comparing results of two surveys, STD/HIV awareness improved
somewhat and an increase in frequency of condom use in longer-term project's