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

666 Abstracts 33380-33384

12th World AIDS Conference

that associations between NEP attendance and HIV infection are explained by
confounding. We suggest the notion that NEPs promote HIV transmission, at
least in our setting, should be abandoned.
33380 Church based harm reduction programs
Edwin Sanders. 2128 1 th Avenue North Nashville Tennessee 37208, USA
Issues: Curbing the spread of HIV/AIDS among injecting drug users needs a
broad based support that includes faith communities.
Project: The Davidson County Harm Reduction Program is an outreach program of Metropolitan Interdenominational Church. It provides clean, sterile equipment to injecting drug users at four sites in economically deprived neighborhoods
where the population is largely African American. It also provides case management services and prevention education designed to improve the injecting drug
user's quality of life.
Results: As the only church-based harm reduction program in the country,
we are developing a model working with Intravenous Drug users that we are
striving to implement in other faith communities.. In six months, outreach workers
made 1600 contacts for eighty clients, providing clean paraphernalia, condoms,
prevention education and access to services. As this work is duplicated in other
churches, the impact will have major effects in halting the spread of the virus
Lessons Learned: The passion in faith communities for enhancing the quality
of life can be directed to respond to the needs of persons who might have been
traditionally excluded from these communities.
33381 Scoring clean works after a needle exchange is shut
down
Yael Van Hulst, R.S. Broadhead, D.D. Heckathorn, R. Mills, M. Carbone. Dept.
of Sociology, Univ. of Connecticut, Storrs, CT 06269, USA
Background: In March 1997, the first well-established and effective needle exchange in the world abruptly shut down in Windham, Connecticut. The closure
was the result of a public outcry over a child pricked by a syringe she had found
while playing in her backyard. The outcry also significantly reduced the willingness
of local pharmacies to sell nonprescription syringes (all 7 pharmacies sold before
the outcry, subsequently 5 do not sell and 2 sell selectively).
Objectives: To examine IDUs' abilities to obtain sterile syringes before and
after the needle exchange's closure.
Methods: Prior to the closure, 546 IDUs were interviewed about where they
normally obtained syringes in two towns in Eastern Connecticut - Windham (N
= 229) and Middletown (N = 317). After the closure, 144 former Windham subjects were re-interviewed, and 67 new subjects were interviewed in Middletown.
Changes in IDUs' abilities to obtain syringes from "reliable sources" (pharmacy,
hospital/clinic, needle exchange) versus "unreliable sources" (family/friends, diabetic non-IDU, street source/other) were compared for the two towns prior to the
exchange's closure and the first 9 months after the closure.
Results: Following the closure, Windham subjects' use of "unreliable sources"
to obtain syringes increased 21% (Chi-sq. = 16.157, p <.000) although subjects
reported a desire to use "reliable sources." Windham IDUs' also reported a significant decrease (42.7% to 27.8%) in their willingness to carry, syringes in the
community (Chi-sq. = 6.952, p <.008), due primarily from fear of the police. In
contrast, Middletown subjects' use of "unreliable sources" decreased (20.7% to
16.4%) rather than increased (Chi-sq. =.619, p <.431), and their willingness to
carry works in the community did not significantly decrease (Chi-sq. = 1.202, p <.273). These results support the hypothesis that the changes in Windham were
not merely historical.
Conclusions: The closing of the needle exchange has significantly reduced
Windham IDUs' abilities to obtain sterile syringes from "reliable sources." Further,
far fewer IDUs report that they carry their works in the community, which increases
the likelihood that they are placed in situations where they share works. IDUs'
access to "reliable sources" of clean syringes is clearly dependent on both the
needle exchange and/or pharmacies.
Supported by the National Institute on Drug Abuse RO1 08014.
238*/33382 Reducing harm: The effects of childhood abuse on
negotiating HIV risk reduction
Claire E. Sterk1, Janna Cordeirol, K. Springer1, K.E. Elifson2. 1Rollins School of
Public Health Emory Univ. 1518 Clifton Rd NE Atlanta, GA 30322; 2Georgia
State University, USA
Objectives: (1) to investigate childhood abuse and its consequences among
low-income, African-American female drug users; (2) to examine the impact
of childhood abuse on HIV risk negotiation in order to ensure effective harm
reduction prevention interventions.
Methods: Structured interviews were conducted with 150 women in Atlanta,
Georgia, USA. Measurements included exposure to violence and abuse, sexual
history, drug use history, self-esteem, and other personality characteristics. SPSS

was used to evaluate statistical relationships. All women survived childhood
emotional, physical, or sexual abuse. Complementary in-depth interviews were
conducted with 30 women. Grounded theory guided the data analysis and QSR
NUD*IST was used to manage the textual data.
Results: Women identified severe psycho-social consequences of the abuse,
including low self-esteem, lack of assertiveness, and difficulty establishing intimate
relationships. In addition, they tended to disassociate during sexual activity. Drug

use was indirectly related to the childhood abuse and seemed not to mediate the
women's sexual HIV risk-taking. The qualitative data provided an important context for the interpretation of the quantitative findings. Overall, the consequences
facilitated situations which were not conducive to HIV risk reduction efforts.
Conclusions: HIV prevention interventions for women often focus on communication and negotiation skills regarding safer sex and drug use. Data from the
current study show that the consequences of childhood abuse warrant a more
holistic approach to HIV risk-taking and harm reduction, including an emphasis
on the women's sense of self.
S33383 A controlled trial of condom provision and health
education in a high risk setting
Matthias Egger1, J. Pauw2, F. Paccaud3, D. Medrano2, G. Davey Smith1.
'Department of Social Medicine, University of Bristol, Bristol BS8 2PR, UK;
2Associacion Tesis Managua, Nicaragua; 3University of Lausanne, Lausanne,
Switzerland
Objectives: To test the effect of different modes of condom provision and of
health education on condom use.
Setting: Motels which provide rooms 'por rato' (for a short while) for sexual
encounters in Managua, Nicaragua. 20 motels participated, 8 catered mainly for
commercial sex, 12 for non commercial sex.
Methods: Factorial design testing the effect of health education material and
condom provision. Motels were randomised to provide/not provide health education (posters, leaflets) and either to provide condoms in rooms, to give condoms
directly to clients or to provide condoms on request only. Rooms were searched
after each couple. The retrieval of a condom containing semen from the room
was the outcome measure in this study.
Results: There were 6547 sexual encounters. 3118 used condoms were retrieved. Rates of condom use (%) by type of motel are shown in the table.

Condoms
Health educat. yes
no

Commercial sex
on request in room handed out
55.6 59.2 62.2
56.1 62.9 65.2

Non-commercial sex
on request in room handed out
18.5 28.7 17.8
10.8 210 22.7

In the commercial setting multivariate analysis adjusted for motel characteristics confirmed the effect of direct or in-room condom provision (p < 0.001). Health
education had a non significant adverse effect on condom use (p = 0.13). In the
non commercial setting, health education had a positive effect if condoms were
provided on request or available in the room, but not if directly handed to clients.
In the presence of health education, handing out condoms decreased condom
use (p = 0.004 by test of interaction).
Conclusions: Establishments that rent rooms by the hour are a key location
for HIV/AIDS prevention. This trial provides unbiased data on a unique endpoint,
the used condom retrieved from the room. Directly handing condoms to the sex
worker and her client increased condom use whereas leaflets and posters had
little effect. In motels catering for non commercial sex, health education material
and providing condoms discreetly in the room almost tripled rates of condom use.
33384 Lower risk of HIV infection with continued regular
participation in needle exchange program
David Vlahov, C. Flynn, R. Brookmeyer, B. Junge, M. Safaeian, P. Beilenson,
K.E. Nelson. Johns Hopkins University, 615 N. Wolfe St., Baltimore, MD, USA
Objective: To examine HIV incidence by recent use of the NEP among injection
drug users longitudinally followed in a community-based cohort study.
Methods: Participants were HIV negative injection drug users (IDUs) recruited
and followed in a community-based longitudinal study that involved semiannual
serological testing and risk behavior interviews since 1988. In 1994, an NEP
opened in Baltimore with NEP registration and usage linked longitudinal to the
cohort study. A nested case control design was used to estimate risk of SC by
use of NEP. To estimate the broader community impact of NEP, HIV incidence
was compared before and after opening of NEP in Baltimore City and County.
Only the City offers access to NEP and special legal immunity to NEP users.
Result: For 35 SCs since NEP opened, 198 HIV negative controls were selected; in the 6 mos. before SC, 21 cases and 115 controls were active injectors.
Among active injectors who had ever used NEP (12 cases/61 controls), 5 cases
and 28 controls reported NEP use in the prior 6 mos. [odds ratio (OR) for SC
by frequency of NEP use in past 6 mos. was 1.00 for non-use, 0.85 for single
visit, and 0.36 for multiple visits. All 95% confidence intervals included unity. The
incidence for HIV in the City and County before and after opening NEP was as
follows:

Year:
Where
# Seroconverters (SC)
Person years (PY)
Rate/ 00 PY

1988-94
City
127
2854.0
4.5

1994-97
City
31
966.4
3.2

1988-94
County
5
166.5
3.0

1994-97
County
2
50.0
3.9

The HIV rate in the City significantly declined 20% whereas the county increased by 30%; however, these city-county time trends were not statistically
significant.
Conclusion: These preliminary data suggest that continued regular participation within a needle exchange program could lower risk of HIV infection among
active IDUs.