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

660 Abstracts 33343-33348

12th World AIDS Conference

33343 SHIELD study: Using opinions leaders as outreach
workers for HIV prevention in injection drug using
populations
Carl Latkin. 624 N. Broadway, HPM/SBS, Johns Hopkins U., Baltimore MD
21205, USA
Objectives: Guided by a social influence empowerment framework, peer leaders
among injection drug users in Baltimore, Maryland, USA, were trained to promote
HIV prevention among their sex and drug networks and other contacts.
Design: Pre-test, post-test intervention.
Methods: Ninety-six leaders and 63 controls were interviewed and participated
in the 8-session psychoeducational training. Training emphasized modeling of
HIV preventive behaviors and techniques of interpersonal communication. Evaluation included self-reports of leaders, controls, and their risk network members,
and ethnographic observations. Measures included HIV-related behaviors and
diffusion of information. Data on the first 41 leaders has thus far been analyzed.
Results: Leaders reported a significant increase in condom use (t = 3.38, p
<.01) and in cleaning used needles with bleach (c2 = 14.25, p <.001). In an
assessment of diffusion of information, the majority of network members who were
current injectors reported receiving needle cleaning materials from the leaders
(70%), and the majority of network members (83%) were able to identity HIV
prevention slogans that had been taught to the leaders. The leaders documented
2,165 HIV prevention interactions; 84% of which were with active drug users.
Conclusion: Results of the SHIELD study suggest that training opinion leaders
of injection drug users as HIV outreach educators may promote HIV prevention
among their network members and others at risk of acquiring and transmitting. Furthermore, the intervention may provide injection drug users an effective
pro-social role within their communities
33344 Community outreach and AIDS education through the
post test club of the AIDS information centre, Uganda
Irene Nakku Namagembe1, S. Barugahare1, M.S. Wangalwa1, F. Mahoro1,
M.G. Alwano-Edyegu1, F. Baryarama1, E. Marum2. 1AIDS Information Center
PO Box 10446, Kampala; 2CDC/USAID Kampala, Uganda
Issues: The AIDS Information Centre (AIC) in Uganda has been providing voluntary and anonymous HIV counseling and testing (CT) since 1990 and by the end
of 1997, over 350,000 clients had been served. Within the first year of services,
the need was expressed by clients for a social support club offering long term
mutual support for behavior change.
Project: The Post Test Club (PTC) was established to provide these services.
Clients who have received CT, regardless of serostatus, are eligible to join; to
date, over 10,000 have joined, and about 2,500 are active members. Clubs have
been established in the four urban sites where AIC maintains a full time service
centre. In addition to receiving services, club members have become active
community AIDS educators and aim to raise awareness of HIV/AIDS through
community outreach. Multiple strategies are used to carry out HIV/AIDS awareness and education, including drama (songs, plays and dances); video shows with
HIV/AIDS messages; distribution of IEC materials; condom distribution, personal
testimonies, and peer education.
Results: In 1997, the PTC drama groups performed for over 14,000 persons in
85 communities in 10 districts. An average of 3 club members give their personal
testimonies regarding HIV testing during each outreach. 90 peer educators were
trained and have documented contacts with 4,656 individuals (55% female), an
average of 52 encounters for each peer educator, or about one contact per week.
Lessons learned: Post Test Club members are active partners in educating
the community through drama, personal testimonies, and peer education, which
has increased awareness of HIV CT services, and the testimonies of persons
who have been tested has reduced fear of HIV testing. These efforts have probably contributed to the widespread acceptance of HIV CT in Uganda, and other
countries wishing to make CT more available and acceptable should consider
using former clients as community and peer educators.
33345 An overview of out reach activities for flat based sex
workers (women) in central Calcutta, for preventive
interventions
Indira Roy. 48 Ripon Street Calcutta-16, India
Issue: Absence of organisation and Unity in flat based sex workers called for
different outreach strategies.
Project: Identification of clandestine flats of sex workers by outreach workers.
* Indentifying and befriending 'gate keepers' in order to reach to target groups.
* Entering the flats and befriending sex workers. Rapport Building.
* Assessment of knowledge, attitude, behaviour and practice of gate keepers
and sex workers.
* Information education and communication materials tested and used for
target groups.

* The 'Fragile Area' of negotiating skills which were poor were given immediate
attention.
* High frequency of outreach maintained.
Result: Acceptance of outreach workers in the flats was gained after a year.
Regular outreach brought about sustained improvement in negotiating skills. (for
condoms, Safer Sex practices and monetory issues with both gate keepers and
clients).

* Advocacy with police required as police raids in these flats make outreach
difficult.
* Reluctance to accept outreach workers in the initial stages is normal.
33346 Innovative approaches towards HIV/AIDS prevention
activities aimed at a youth population in Lima, Peru
Carmen Murguia1, F. Perez2. IJose Sabogal 485 La Aurora Lima 18, Peru;
2Medicus Mundi France, Paris
Issue: to establish SERJOVEN, a sexual and reproductive health service aimed
at an adolescent population in an urban - marginal sector of Lima, Peru.
Project: SERJOVEN includes information of youth promotors, secondary
school teachers and health care workers on issues concerning HIV/AIDS prevention with emphasis on the needs of adolescents. Individual, group and community
strategies are being undertaken. The youth center develops and uses alternative
communication techniques so as to introduce risk reduction issues and promote protective behaviors concerning the transmission of sexually transmitted
diseases, including HIV/AIDS. Among the communication strategies used are:
entertaining, education through psychodramas, corporal expression, theatre and
music. Additionally, interactive decision support systems between peers, parents
and the youth population are considered. These activities are complemented with
counselling, psychological, social and health support.
Results: the "SERJOVEN project" has been well received by the youth population and the community as a whole. Within two years of activities being
developed, it has reached 5,400 adolescents. 60 health professionals of 20
health care centers have been trained in counselling skills and monitored to evaluate training impact. 35 trained youth promotors influence health attitudes and
behaviors among their peers through outreach activities, individual consultations
and refering those peers at risk.
Lessons learned: sexual and reproductive youth health services can be
sucessful if they are addressed meeting the needs of the specific population for
whom the program is being addressed to. SERJOVEN is an important systematised model capable of being replicated by the national Peruvian health and
education programs.
33347 Drug injection initiation among street youth
lise Roy, N. Lemire, C. Morissette, N. Haley. Montreal Public Health Unit 1616,
Boul. Rend-Ldvesque 0. Montreal (QC), H3H 1P8, Canada
Background: In 1995, an epidemiological study showed that 36.1% of Montreal
street youth had injected drugs.
Objectives: To describe drug injection initiation among street youth and explore
how initiation occurs within their drug use itinerary.
Methods: In an exploratory qualitative study, in-depth semi-structured interviews were conducted with 25 new injection drug users (IDUs) (initiation <4
years) aged 15-22 years. Participants were recruited among Montreal street
youth through various means including outreach at street youth agencies and
snowballing technique.
Results: Most participants started drug use around 12-13 years of age, experimented with a variety of drugs in the following years (pot, hash, acid, PCP,
mushrooms) and started injecting within five years. Many seemed attracted by
the experience of the injection itself (whatever the drug); a few were particularly
attracted by heroin and believed injecting was the only way of taking that drug.
Some were initiated into injection by friends or acquaintances, others asked to
be injected or tried by themselves. Girls tended to be more pro-active, more
self-reliant and more organized than boys regarding their first injection. Overall,
initiation of injection did not seem to be experienced by street youth as a major
happening in their life. Indeed, their first injection was either idealized because of
the "trip" they had or seen as a casual event since "everybody was doing it" and
"it's just another way of taking a drug".
Conclusion: Initiation of injection among street youth does not seem to be the
result of a dependance toward a specific drug. For these youth who are heavy
users of multiple drugs, drug injection initiation appears to be just another way of
experimenting drug use.
S33348 Disseminating knowledge on AIDS prevention to millions
through grassroots women's groups in Bangladesh
A. Mushtaque R. Chowdhury1, H. Nasreen1, S.M. Ahmed1, J.U. Ahmed1,
A. Bhuiya2. 1BRAC; 21CDDRB, 75 Mohakhali Dhaka 1212, Bangladesh
Issue: HIV/AIDS is not a major public health problem in Bangladesh. Yet, recent
reports on the risky sexual behavior of a segment of the population, large wageearner groups returning from overseas and a high prevalence of the disease
in neighboring countries make the country very vulnerable. The awareness and
knowledge level about AIDS in Bangladesh is still among the lowest in the world.
Project: BRAC, a large NGO, has recently tested a simple, inexpensive and
replicable method of disseminating AIDS knowledge using its own network of

village level women's groups. Using a cascade, field workers of BRAC in a
sub-district were first trained on five key questions: what is AIDS; how is it transmitted; how it is not transmitted; how can it be prevented; and what are the high
risk behaviors. They then trained village health workers who in turn trained the
members of the women's groups through weekly meetings, which covered nearly
5,000 women in 70 villages. Survey of the women, their husbands and neighbors
were conducted before and after the intervention. Based on encouraging results,