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

12th World AIDS Conference

Abstracts 33524-33528 693

or negative work environment, opportunities for advancement for peer educators,
opportunities for professional development for peer educators, and levels of job
security for peer educators.
Results: We found that there was a structural tendency in all peer education
programs surveyed to employ low-income people who survive on public assistance. Peer educators were paid small stipends at an hourly wage ranging from
$6.50 to $10 per hour. While wages from peer education provided vital supplemental income for the peer educators, programs often treated peer educators as
the most marginal sector of the organization's staff. No program provided opportunities for flexible, permanent full time or salaried employment with benefits for
peer educators. There was little or no opportunity for advancement, nor support
for the development of "professional" skills; and peer educators were "last hired,
first fired" since they were hired with "soft" grant money, and the first to be let go if
there are funding cuts, whereas greater efforts were employed to find alternative
funding solutions for permanent staff. We also found that many programs may
divide or pathologize peer educators. For instance, some programs hire HIV
positive women to serve as "bad examples" for HIV negative women in their
communities. Peer educators are placed in direct competition with one another
for outreach slots that determine their supplemental income, creating internal
tensions within grassroots initiatives in which they participate. As welfare cuts
occur, increased economic pressure on peer educators from poor communities
will intensify these problems.
Lessons Learned: Peer education is a powerful tool, but it may be undermined
if peer educators are treated as marginal or throw away staff members whose
work conditions and wages slip below unacceptable levels.
33524 Peer education to reduce STI/HIV transmission in Lusaka,
Zambia
R. Kathuria', P. Chirenda2, R. Sabatier3, N. Dube2. University of Zambia,
Lusaka, Zambia; 2University of Zimbabwe, Harare; 3SAT Programme, Harare,
Zimbabwe
Introduction: A community peer education project to reduce STI/HIV transmission in three low-income areas in Lusaka, Zambia's capital city, was established
in 1992. These three sites, George, Matero and Kanyama have an estimated
population of 400,000.
Methods: The project has eight components: formative assessment; mapping;
recruiting and training peer educators; community outreach, particularly "hotspots"
or social contexts conducive to casual sex, including bars, transit places including
bus-stops and sex worker neighbourhoods; condom distribution; improving STD
care seeking, access and acceptance; women's associations; and monitoring and
evaluation.
Results: In Lusaka, from 1993 to 1997, the project held 37,400 meetings,
reached 417,095 men and 384,734 women and distributed 2.74 million condoms.
Service delivery unit costs (excluding donated condoms and opportunity costs)
averaged US$4.2 per meeting, US$0.2 per person reached and US$0.06 per
condom distributed. Syphilis seropositivity fell by 77%, from 32% to 7.3%, in the
first project site, George, by 47%, from 17.4% to 9.2% in the second project
site, Matero and by 58%, from 24% to 10%, in the third project site, Kanyama,
despite a 40% growth in urban population. In addition, a quasi-experimental study
compared syphilis trends in project sites with syphilis trends in comparison sites
without projects. Specifically, syphilis trends in two project sites - George and
Matero, were compared with syphilis trends in two comparison sites - Chipata
and Chilanga. Declines were only observed in project sites, suggesting a secular
trend, attributable to the peer education interventions.
Conclusions: These data demonstrate that peer education may be an economical and effective large-scale strategy to reduce STD, and by implication HIV,
transmission.
33525 1STAND - A teen peer educator course in the rural south:
Direct and diffusion effects (1-year post)
Mike Smith', M.E. Archer2, R.S. Devereuax1, F.C. Dane1, H.P. Katner1. 'Mercer
University School of Medicine, 857 Orange Terrace, Macon, Georgia; 2Elder
Middle School, Sandersville, GA, USA
Objectives: To design, implement, and evaluate Students Together Against Negative Decisions (STAND), a 36-hour, 4-month long, teen peer educator training
course based on the Diffusion of Innovations and Stages of Change (Transtheoretical) theories in a rural high school in the Southeastern United States.
Methods: 21 tenth graders (12 African American; 9 white) selected as opinion
leaders by their peers participated in STAND training, focusing on pregnancy and
STD/HIV prevention. Comparison subjects received either a 22-hour leadership
training (n = 20) or no intervention (n = 45). All these subjects completed written
pretests (Pre), an immediate posttest after training (Post1), and a delayed posttest
12 months after the pretest (Post2). Diffusion of the intervention effects was tested
by Pre and 12-month Post telephone interviews completed by non-STAND 9thand 10th-graders (167 in Intervention County-I; 74 in Comparison County-C). Descriptive (instead of inferential) data analyses were employed because subjects

were neither chosen at random nor randomly assigned to study groups.
Results: No virgin STAND member initiated intercourse by Post1 and only 1
(of 7 virgins) had initiated intercourse at Post2 (vs. 22% of comparison group
virgins). The onset of intercourse was similar at Post2 countywide (1:25%; C:20%).
At Post2 there was a 28% increase in the proportion of STAND members who
reported using condoms every time (comparison subjects: +8%); County I teens
reported a 25% increase in consistent condom use vs. +7% for County C. STAND

members reported an 88% decrease in unprotected intercourse at Post1, which
was still down 69% at Post 2; County I teens reported a 38% decrease in unprotected intercourse at Post 2 compared to a 40% increase in County C. Over the
12-month period all groups made modest gains of similar magnitude on the Risk
Behavior Knowledge Scale. STAND members and comparison subjects showed
modest unfavorable shifts in HIV Prevention Attitude Scale scores (-0.7 vs. -0.9
of 5); county-wide data revealed essentially no attitude changes for either county.
Conclusions: At the 1-year followup, sexually active STAND members reported 8.6 fold greater decreases in unprotected intercourse than did their peers;
non-STAND teens in the intervention county reported a 38% decrease in unprotected sex vs. a 40% increase in the comparison county. STAND virgins also
appear to have delayed first intercourse longer than comparison subjects. STAND
is a promising intervention for both virgin and sexually active teenagers in the
rural South, with substantial direct and diffusion effects.
L33526 Outreach education in sex on premises venues
Bruce Maguire. 103 Fifth Avenue, Mount Lawley, 6050 Western, Australia,
Australia
Issue: Utilising sex on premises venues as sites for implementing intervention/education strategies to non gay identifying men who have sex with men.
Project: Gay community-based information on HIV & AIDS prevention can
be difficult to access for men who frequent sex on premises venues. A range
of strategies was implemented on site, including provision of counselling and
information rooms, monthly information nights, the establishment of a clinic for
anonymous HIV testing and free Hepatitis B vaccination, training of sauna staff,
and the provision of HIV information and promotional materials. A team of workers
were trained to staff the advisory rooms and clinic reception.
Results: Services have been very well utilised by gay men, men from non-Anglo
cultural backgrounds and non gay identifying men who have sex with men. Opportunities for crisis intervention arose. Client uptake of services and especially
access to HIV testing is high.
Lessons Learned: Establishing cooperative relationships with sex on premises
venues provide highly successful intervention opportunities with at-risk men who
have sex with men
S33527 Training ethnic minorities living in northern Thailand to
develop their own indigenous approach to AIDS
prevention and community-based care
Kimberly Brown', Amnuayporn Chirakura2, K. Ponsakunpaisa3, L. Rowe2. 1PO.
Box 29 Chiangmai; 2Manager, Health Project for Tribal People, Changmai;
3Manager, House of Love, Changmai, Thailand
Issues: Indigenous ethnic minorities, often poor and with little access to health
care systems, cannot depend on the ethnic majority to develop care programs
that are culturally accepted.
Project: The Health Project for Tribal People has trained ethnic minorities living
in Northern Thailand and working in their communities of origin to educate their
own ethnic groups about AIDS and AIDS prevention, as well as to educate these
groups about, and to facilitate, home and community-based care. Because the
project is linked to the grassroots, the development of the project has closely
followed the progression of the AIDS epidemic in tribal communities. The project
began with the core idea of peer-to-peer education focused on prevention of HIV
infection. As more and more tribal people developed HIV and full blown AIDS the
project responded by developing an indigenous approach to community-based
care.
Results: Ethnic minorities, using peer-to-peer education, were able to increase
knowledge about AIDS and AIDS prevention to ethnic communities, were able to
lessen the knowledge gap between men and women, were able to increase the
acceptance of PWAs within tribal villages, and were able to support families and
communities in caring for PWAs and orphans within their homes.
Ethic minorities can be trained to develop their own indigenous approach to
AIDS prevention and community-based care which will successfully meet the
needs of the changing nature of the AIDS epidemic.
S33528 TRIBES
Annie Madden, J. Carey. NSW2022 Users and Association (NUAA), 16 Leswell
Street Bondi Junction, Sydney, Australia
Issue: Understanding the role of peer driven interventions in the prevention of
HIV/AIDS amongst Australian Injecting Drug Users (IDU).
Project: IDU Organisations in Australia have developed some of the most successful and innovative peer education and community development approaches
in the history of HIV/AIDS prevention for IDU. One of these approaches is the
"TRIBES" Project which was developed by the NSW Users & AIDS Assiociation
(NUAA) in 1992. "TRIBES" operates on the premise that drug users do not always
primarily identify as "injecting drug users" but rather, often identify with a sub-cul
tural group or "tribe" within the community. NUAA funds these "tribes" to carry out
HIV/AIDS peer education and community development projects which utilise the
specific icons, media and language of the "tribe". Their common experiences and
interests are targetted as the basis for their shared identity rather than the fact
that they may inject drugs.
Results: The "TRIBES" Project was independently evaluated in 1995. This
evaluation showed that the "TRIBES" Project had been highly successful in