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

716 Abstracts 34149-34153

12th World AIDS Conference

themselves don't think themselves as being at risk even though their sexual
behaviour has changed.
Project: CARAM (Co-ordination of Action Research on AIDS and Mobility) develops interventions simultaneously with research. The first step in our research is
to organise focus group discussions, which are often used also as data collection
and information sessions. We use that knowledge gained to guide our current and
future work. Our approach is participatory and involves the workers in designing
and building their own interventions. Peers are also recruited to help collect data
and act as educators.
Results: We have learned that the women developed new social norms and
networks when migrating to the city. Sex is more acceptable, and the female
workers are sexually active and rarely use condoms. Many have expressed a
desire to learn more about reproductive health including STDs/HIV/AIDS. They
requested accurate information and training because they are concerned about
STDs/HIV/AIDS and pregnancy.
Lessons Learned: Young female garment workers are sexually active and
without proper information about reproductive health. In a country with high
HIV-infection among pregnant women (3.22% according to the National AIDS
Program), it is important to develop interventions that understands their particular
situation. The most useful tool in achieving this is active community participation, which involves the workers in changing and bettering their knowledge and
behaviours.
[34149 Facilitating strategic planning with NGOs responding to
HIV/AIDS in India
Anne Scott1, M. Bailey2. 1 International HIV/AIDS Alliance, Barratt House 341
Oxford St, London WIR IHB, UK; 2lnternational HIV/AIDS Alliance, Barcelona,
Spain
Issues: This paper will report on the process and outcome of strategic planning
workshops carried out with two NGOs that are providing HIV/AIDS prevention and
care services in India. These NGOs are now seeing more clients, and receiving
more requests to expand their activities. Each organisation must determine what
it can do and cannot do to meet the needs of people living with and affected by
HIV and AIDS. A method of facilitating strategic planning among NGOs will be
presented. It has proven effective in helping NGOs address organisational and
programme management dilemmas that arise as they try to respond to a rapidly
growing epidemic.
Project: During the workshops, the authors developed and applied a facilitation method that effectively links organisational capacity-building and communitybased programming within the strategic planning process. Workshop participants
carry out a needs assessment of communities affected by HIV and an assessment of their organisation's resources, systems and policies. Participants then
use information from the community needs and organisational assessments to
make a revised logical framework and programme of work. A new objective on
organisational maintenance is included in the logical framework, so that programme development and personnel management issues are addressed along
with programme implementation. Relevant concepts of logframe analysis and
performance evaluation are introduced and explained as they arise in the process
of making a strategic plan.
Lessons Learned: In the strategic planning workshops, each organisation
re-evaluated community needs, the purpose and scope of programmes, management procedures and indicators for measuring progress. Participants reported
that this helped them to face current challenges with clearer priorities and more
efficient systems and re-establish the link between programme activities and
community needs.
34150 The economic and social costs from the HIV/AIDS
epidemic in Colombia
Juan Cespedes1, S. Forsythe2, E. Gaillard2, G. Siegel2, J. Castro3, D. Ospina4,
C. Morales4. 1Consultores Internationales En Seguridad Social Calle 72 No.
00-44 E. Apt. 302, Santafe de Bogota, DC; 3Ministerio De Salud, Bogota DC;
4Javeriana University, Bogota, DC, Colombia; 2AIDSCAP/Family Health
International, Arlington, USA
Issues: As health expenditure in Colombia reaches 8.0% of its GNP, public health
policymakers need better evidence on the epidemiologic, social and economic
characteristics of health issues in order to allocate resources more efficiently.
The current controversy over the feasibility of a recent decision to include triple
combination antirretroviral therapy (TCAT) in the package of benefits delivered by
the Health Social Insurance System, illustrates the pitfalls of disregarding such
evidences. This socioeconomic research was therefore carried out in order to
better describe the potential impact of the HIV/AIDS epidemic and to identify
future needs for control.
Project: Data provided by Colombia's national health and planning authorities was analyzed, using internationally-recognized epidemiologic and economic
models, to: 1) project the HIV/AIDS epidemic over a period of 5 years; 2) estimate
the ensuing direct and indirect costs to society; and 3) evaluate the impact on

families and various sectors of the Colombian economy.
Results: Between 1983-1997, a total of 8,500 AIDS cases were reported to
the MOH. But, projections estimated the cumulative number of AIDS cases between 25,180-72,760 and the number of people currently living with HIV between
47,350-138,760. The direct costs of providing health care (including TCAT) to all
individuals with HIV/AIDS could reach US $2.3 billion in 1998, equivalent to 25%
of the total health expenditure. Without TCAT, the indirect costs because of loss

productivity due to AIDS could reach a total of U.S $892 million. Furthermore,
primary data shows that families caring for people with HIV/AIDS are subject to
considerable emotional and economic trauma. Finally, the industry is beginning
to incur economic losses due to HIV/AIDS.
Lessons Learned: While the prevalence of HIV in Colombia is relatively low
(less than 0.5%), the epidemic continues to increase, and remains an issue of
enormous importance because of its social consequences. Thus, the epidemic is
likely to exert a devastating impact on: 1) the demand for health services; 2) the
productivity of individuals and businesses; and 3) the family and the community.
34151 Reduction of negative AIDS impact in the community
Omario Nyantika1, Bridie McGowan1, Elizabeth Kyalo2, Francis Rutere2.
'Medical Co-ordinator Nairobi; 2Nurse Nairobi, Kenya
Issue: AIDS care and prevention activities need to include appropriate advocacy
programs in order to lessen the stigmatization and discrimination that persons
with HIV/AIDS continue to suffer.
Project: To respond to the continued Negative AIDS impact in a rural community
setting, an existing Home based care program developed an advocacy program to
increase AIDS awareness. These education and advocacy out-reaches targeted
health care providers and various community groups. Strategies included skilled
persons with HIV/AIDS who identify with these groups used as volunteer educators sharing experiences. During the sessions participants were encouraged to
ask questions and make comments on AIDS issues regarding their fears.
Results: During the period positive attitudes were noted among health care
providers and care given to people with AIDS improved. Persons with HIV/AIDS
were accepted in their families. Five groups of persons with AIDS were established
as a support network.
Lessons Learned: Persons living with HIV/AIDS as resource persons in AIDS
care and prevention creates a great challenge and promotes a sustaining positive
impact to the community.
34152 "Faces" - The face of HIV/AIDS in South Africa
Stefan Victor. 74 Shannons Green, Sumer Greens Cape Town 7441, South
Africa
The National AIDS Programme of South Africa decided in 1996 to take the GIPA
(Greater Involvement of people living with HIV/AIDS) principle a step further by
implementing a programme called "Faces" the face of HIV/AIDS in South Africa.
The programme employed twelve people openly living with HIV/AIDS to work
within the National Programme at both the national and provincial level. The aim
of the project (as defined by the people employed) was as follows:
(1) To put a face to the epidemic and
(2) To mobilise the South African society to get involved in the new struggle.
The twelve faces came from all walks of life and were representative of the
new South Africa. A training programme was held for the "Faces", which was
facilitated by the Global Network of People living with HIV/AIDS (GNP+). The
"Faces" have had varying successes in their work, as well as a number of difficult
and challenging failures. The programme is very weak at the moment, due to
various reasons, and many of the 'faces' are struggling to maintain a positive
outlook on the work that they are doing.
The author will be looking at these reasons as well as coming up with suggestions as to how to improve/develop such a programme for other National AIDS
Programmes. The GIPA principle will only remain a principle, unless there is
dedicated and committed support to see it succeed. Both financially and goodwill.
34153 Measuring impact and evaluating effectiveness of
community-based programming through analyzing
client-centred program data
Jeffrey A. Van Steenes1, W.W. O'Briain2, D. Graham2, G. Pusher2, R. Leblanc3,
P. Gu2, D. Roberts2. 11107 Seymour St Vancouver B.C.; 2AIDS Vancouver,
Vancouver BC; 3R.J.L. Computer Consulting Vancouver BC, Canada
Issue: A community agency has provided support services to more than 2,900
people living with HIV/AIDS (PHAs) over the past 15 years, but never analyzed
available data pertaining to service usage.
Project: A team of volunteers assisted in consolidating all existing client data
into a single client-centred case management database; this single relational
database currently contains extensive records pertaining to community care and
support services received by more than 2,900 PHAs. An analysis of the data was
conducted. PHA program usage was analyzed by: identified risk factors, gender,
age, sexual orientation, income level, date from initial diagnosis, health status,
date of death, and other available data sets.
Results: Results have provided the agency, community partners, and funders
with a better understanding of patterns of service usage. Understanding different
service usage patterns in different population groups has guided us in focusing
services more effectively for the demographic makeup of the communities we

serve. A report was prepared containing recommendations for planning, research
and evaluation of existing and new programs.
Lessons Learned: This project demonstrates the usefulness of client-centred
and program-based data management systems in evaluating the impact of demographic factors on service usage, providing agencies with valuable program
planning information.