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

12th World AIDS Conference

Abstracts 33417-33421 673

provides the rationale for discrimination which is a drug related important harm to
be attended.
Project: AIDS Prevention Program for drug users is being developed in Buenos
Aires since 1992. One of its projects is directed to governmental and non governmental organizations providing services to IDUs and offers HIV/AIDS educational
workshops in which issues as discrimination and rights of drug users and people
living with HIV/AIDS are analyzed. Specific dramatic techniques are applied to
allow participants play different roles in order to experience their feelings in different situations. Social and legal information and resources are also provided to
encourage action against discrimination.
Results: 50 workshops were performed in 6 organizations (3 governmental
and 3 non governmental organizations) involving 110 IDUs. The establishment of
a space for reflection, debate and action has allowed the participants to change
their subjective position as they recognize themselves as discriminated people.
Lessons learned: Standing abstentionist policies which consider drug users
just as offenders and/or patients are being scarcely successful to control HIV/AIDS
epidemic. Actions as described represent a harm reduction intevention in an adverse context and make possible drug users' empowerment involving them in
prevention and against discrimination.
33417 Cambodian housemaids trained for overseas work
Chivariak Khus', M. Tep', S. Soth', S. Verghis2, I. Wolffers3. 1Care Int.
Cambodia PO Box 537 Phom Penh, Cambodia; 2Caram Malaysia/Regional
Partner Kuala Lumpur, Malaysia; 3Utye Universite/Caram Technical Resouce &
Advisor Amsterdam, The Netherlands
Issues: Export of relatively inexpensive Cambodian labour to neighbouring countries is a recent phenomenon. Cambodia intends to send 10,000 housemaids to
Malaysia. Since migration has proven to be an important co-factor for HIV-infection
and STDs, it is important to develop specific interventions to educate Cambodian
housemaids about health, sexuality, and STDs and HIV/AIDS. CARAM Cambodia
started a pre-departure program to educate women, while CARAM Malaysia will
function as a drop-in and/or resource centre for the housemaids when they arrive
in Malaysia and face problems.
Project: CARAM contacted local authorities and labour agents in Cambodia. In
a pre-departure orientation program, the women had the opportunity to learn about
their reproductive health, sexuality, and STDs/HIV/AIDS. The women ranged in
age from 18 to 45 years, and none of the women have ever been outside the
country. One of the women even admitted to having a STD. At the end of the
training, the women were given the address of Tenaganita/CARAM Malaysia.
Results: Through this regional initiative, we have been able to link interventions at the level of a migrants-sending country with follow-up interventions in the
migrants-receiving country. By knowing the situation, the pre-departure program
for the housemaids can be as useful as possible, while in Malaysia, educational
materials can be developed with support from CARAM Cambodia.
Lessons Learned: For regional issues like mobility and migration, regional
networking is of highest importance. This should be done at different levels,
and especially at the grass roots level, where educational interventions and
appropriate STD facilities have to be effective.
33418 The harm reduction cards system: A new way to provide
information to injecting drug users (IDUs)
David Koch', D. Zeegers Paget', R.B. Linder2, P.G. Bauer3. 1Swiss Federal
Office of Public Health, CH-3003 Bern; 2Bureau for Communication, Switzerland;
3Superintenddncia de Salde-Desipes-Seoint, Rio de Janeiro, RJ, Brasil
Issue: IDUs need specific information in order to adopt good practices of safer
behaviour. This information should not be limited to HIV prevention, but should
include the broader optic of 'healthy living'. The information should be presented
in an attractive, short and understandable way, with regard to contents, form and
language. Switzerland has set up a pilot project to provide such information, i.e.
the harm reduction cards system.
Project: In 1996, a pilot project was launched by the Swiss Federal Office of
Public Health (SFOPH) introducing a new approach to providing information to
IDUs. Instead of publishing a brochure containing all information, 8 theme-specific credit-size cards were issued. Each card contained information on a specific
theme (e.g. hygiene, hepatitis, safer sex, overdose and first aid) in a language
understandable to the drug user in the streets. The cards (lay-out and text)
were elaborated by a multidisciplinary group, which included potential distributors
(streetworkers, police, pharmacists, etc.) and potential receivers (drug users).
This collaboration led to a product which was acceptable to both distributors and
receivers.
Results: The evaluation workshop after the pilot phase showed a large acceptance both on distributor' and receiver' side. Especially pharmacists were
pleased with this new information channel, as the cards also helped to engage
in discussions on harm reduction. These positive outcomes have resulted in a
continuation of the project. It is also planned that one to two new themes will be
included each year and the cards are translated in other languages. The card

system has also been adapted to prison settings in Brazil.
Lessons Learned: Specific and adapted information is necessary for IDUs.
Elaborating such information in a multidisciplinary group, including both distributors and receivers, and a creative and flexible approach concerning lay-out and
language are essential for the success and acceptance of such information.

S33419 Intravenous drug using related diseases and
tuberculosis among HIV positive patient receiving or not
methadone substitution
Agnieszka Bernarska, Ewa Kopicz-Kamihska, K. Pulawska, M. Piekarska,
G. Majkowska, G. Cholewihska, A. Horban. 37 Wolska St, 01-201 Warszawa,
AIDS Diagnosis & Theraphy Center, Poland
Objective: To compare the frequency of intravenous drug using related diseases (IVDU-RD) and tuberculosis among HIV positive intravenous drug users
hospitalized in AIDS Diagnosis & Therapy Center in Warsaw, Poland.
Design: Retrospective study
Methods: 49 HIV infected intravenous drug users who were hospitalized
between 1993-1997 and died between 1994-1997 in AIDS D&T Center were included in the study. Patients were divided into two groups. Nineteen persons were
receiving Methadone in Methadone Maintenance Treatment Programs (MMTPs)
in Warsaw, 26 persons were still actively using intravenous drugs. The number
of cases of IVDU-RD (endocarditis, skin abscesses, toxic liver damage) and
tuberculosis were estimated.
Results: IVDU-RD were observed in 17 patients, but only in 2 of 19 (10.5%) who
were attending MMTPs comparing with 15 of 26 (57.7%) using intravenous drugs.
Endocarditis was diagnosed in 6 persons, all in the group without Methadone
substitution. In four of these six cases, endocarditis was considered as a cause
of death. Tuberculosis was diagnosed in three (15.7%) patients treated with
Methadone and 6 (23.1%) in the group without it. Disseminated tuberculosis was
diagnosed in four cases, only among actively drug using patients and in all of
these cases was the cause of death.
Conclusions: Intravenous drug using related diseases were observed less
frequently in the group of patients who were attending MMTPs, and endocarditis
was diagnosed only in the group without Methadon treatment. Disseminated
tuberculosis was found only among patients who were actively using intravenous
drugs, and in all of these cases was considered as the cause of death.
S33420 The total preventive network program in restricting
HIV-epidemics among intravenous drug users in
Rostov-on-Don, South Russia
Sergey Saukhat', D.V. Vorontsov2, V.V. Pokrovsky3. 11I9, Gazetny Pereulok,
Rostov-na-Donu; 2North-Caucasus AIDS Centre Rostov-on-Don, 2Russia AIDS
Research Centre, Moscow, Russia
Issue: To organize HIV prophylaxis among intravenous drug users (IVDUs) by
means of a total preventive network, based on a system of psychosocial counseling, using the active revealing the persons of high exposure to HIV approach.
Project: Given the rapid increase in the number of HIV positive IVDUs in
Rostov-on-Don, a prophylactic intervention, using the approach for the active
revealing the target group, was developed. This approach supposes to help a
drug-addict in being provided with the necessary information, counseling and
learning the safer practices, and HIV testing based on the informed consent as
well as confidentiality (including anonimousness). The AIDS Center establishes
a number of HIV counseling and testing rooms. These rooms are linked with both
the primary identification points in out-patient rooms, schools, and with the mobile
counseling groups working in the public areas and dope dens. Every doctor and
teacher is inclined to be able to discern drug-addiction symptoms for offering
such a person to visit the specialized counseling room, and for providing him
educational matters. The mobile counseling groups may be formed of students,
volunteers and other staffs on irregular basis.
Results: The active revealing the persons of high risk (IVDUs), organized into
the total preventive network, has allowed us to include 150 people, attending 63
dope dens, in the counseling and testing activity within a year. 120 of them are
IVDUs (80%) and 30 are their sexual partners. 63 turned to be HIV positive (42%).
Also, all these people are subjected to a longitudinal survey to control the effectiveness of the preventive influences. According the survey, 74% of the persons
changed their risky behaviour onto the safer practices after the intervention.
Lessons Learned: We were able to reach the described results by the six employees of the North Caucasus AIDS Center. Widening the supposed programme
of total preventive network may help us to be more successful in restricting the
epidemics. For, every IVDUs, according to the survey, may has, average, 15
needle sharing partners and 6 sexual ones. And we should relay upon the "snow
ball"; mechanism in preventive measures.
33421 Outreach workers: An important key to a harm reduction
project in a developing country
Paula Jayme Araujo, I.M.T. Haddad, F.C. Mesquita, E. Palmieri. 'Secretaria da
Saade Programa DST/AIDS, Av. Antonio Emerck 94/98, 11390-000, Sao
Vicente, SPR Brazil
Issue: Sao Vicente (Brazil) is a very poor city located in Sao Paulo state. From
the total AIDS cases 34.2% are related to IDUs. Among men (.13 years old)
this percentage goes to 50%. It also affects the number of women and children

infected as they are usually IDU's sexual partners or kids.
Project: A Harm Reduction Project to prevent HIV Infection among IDU's has
being developed in Sao Vicente since out/95. Outreach Workers were trained and
developed prevention activities such as prevention information (safer injecting,
safer sex) and distribution of prevention material (condoms, sterile needles and
syringes, distilled water, pad, etc...).