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

12th World AIDS Conference

Abstracts 34208-34212 727

affected are the youth between 20-35 years, the youth girl being the worst hit
with the ratio of one boy to six girls.
Subject: At the age of 19, a wealthy man who took advantage of poverty in my
family promised to pay my school fees, if I could love him. He used my relatives
to persuade me. Because of my ignorance of HIV/AIDS, I didn't know that the
man was infected.
Constraints: In most African cultures, a wife doesn't say no to sex once suggested by the husband. The legal and ethical framework is quite inadequate, thus
if the man died, his relatives can deny the widow her late husband's property.
Results: Most young girls married to rich men in Africa are sacrificed to give
care to the already infected old men. After the man dies, the young woman is left
in total desolation and isolation, driving her into fatalistic tendencies for survival.
Lessons learnt: Unless a practical legal and ethical frame work is put in place
to protect young girls, Africa is heading for total disaster. The young girls in Africa
should be given skills for survival and avoid resorting to sex as a means of
survival. This will reduce the spread of HIV.
34208 Socio-economic factors influencing the spread of
HIV/AIDS of women in the Gambia
Lawrence Kweku Yamuah. Medical Research Council Laboratories Banjul, The
Gambia
Introduction: The health of women continues to be depressing particularly in
Africa. The recent epidemics of HIV/AIDS is worsening the situation. The prevalence of HIV in The Gambia is increasing. A high prevalence of STD's in the
country supports the potential fear for an epidemic of HIV taking off if something
is not done. The prevention of HIV in The Gambia is made more difficult by low
rates of enrolment of girls in schools, and low status of women. Women form
an indispensable group in the community. They provide the labour domestically
and in the farms. They are involved in looking after children. Incidentally they are
traumatized by a lot of factors which ranges from diseases associated with child
bearing and societal norms to poverty.
Objective: The objective of this paper is to discuss the social and economic
factors influencing HIV/AIDS of women in the Gambia and suggesting recommendations that may help in reducing the impact.
Method: Information was gathered from reports produced by UNICEF, UNDP,
UNAIDS, National AIDS Control Project and Maternal and Child Health Unit.
Results/Observations: Total AIDS cases between may 1986 and March 1997
stood as 485 which comprises of 292 male and 193 female. The hardest hit age
group was 20-49 years. Out of the 485 cases 254 were infected with the HIV-1
virus, 196 with the HIV-2 and 33 were dually infected. There is a well developed Primary Health Care System however health is significantly influenced by
traditional medicine, socio-economic status and cultural habits. Factors influencing the HIV/AIDS included behavior of members in polygamous marriage, early
marriages, inheritance of brother's wives, poverty, cultural habits and illiteracy
rates.
Conclusion/Recommendation: Prioritise maternal education to help fight ignorance, improve socio-economic status of women, government to support the
community and women's groups towards behavioral change and reduction of
stigmatization through community development programs.
34209 A trans-border case management and client follow-up
model to link HIV and primary health and supportive care
services on the US-Mexico border
Rebeca Ramos. Lopez Mateos 848, CD Juarez Chihuahua, Mexico
Issue: The transborder initiative is formalize a trans-border model to link HIV and
primary health and supportive care services for low income HIV+ individuals.
Project: The model seeks a creative integration and utilization of traditional
and non-traditional health and social service. This model focuses on populations
who move back and forth through the permeable membrane that is the US-Mexico border. These low-income, vulnerable populations have a high incidence and
prevalence of acute and chronic illness. They impact the health care system in the
border area and within the migration corridors leading into the interior of the United
States and Mexico. The case management utilizes a plan developed between
provider, client/family, significant others, and community liaisons or promotores.
Results: Trans-border case management has resulted an a mechanism for
discovering and describing gaps in services which may be filled through community based organizations linked in a trans-border network, and facilitation of
access to, and coordination of, health and social services which are usually not
available through a single agency located on either one side of the border.
In binational or multinational settings alternative funding should be put in place
to allow the development of integrated services for migrating populations.
186*/34210 Scaling up of interventions through community
based organisations

Rekha Chowdhury1, S. Jana2, S. Chowdhury2, L. Mali1, P. Singh1, M. Mitra2.
1USHA Multipurpose Cooperative Soc. Ltd. 8/2 Bhawani Dutta Lane, Calcutta
700073; 2STD/HIV Intervention Programme, Calcutta, India
Issue: A peer based STD/HIV Intervention Programme among the female sex
workers in Calcutta showed sign of success in the year of 1992 calls for a
statewide intervention.

Project: To make the impact of the felt programme effective expansion throughout the state covering all red light districts deemed necessary. Different donors
showed interest to support this scaling up of programmes based on the policy
guidelines of the successful project run by A.I.I.H & P.H (Research Institute).
Though intense effort was made to replicate both from the Government and from
the Non government Organisations to expand this programme in all other red light
districts in the State could not succeed in doing so due to various socio economic
& technical reasons.
Result: But by that time sex workers in the state come close 6 developed their
own organisation & by 6 months time Durbar Mahila Samanwaya Committee the
organisation of sex workers could replicate prevention programme in 30 other red
light districts with their own resources covering a sex workers population of about
25000.
Community mobilisation is a critical element in scaling up of any community
based prevention programme.
34211 Attitude change through soap opera for AIDS prevention
in Vietnam - Produced by CARE International in Vietnam:
Funded by the Commission of European Communities'
AIDS Task Force
Khanh Ngo Thi. 130A-Thuy Khue Street-Ha Noi, Vietnam
Issue: The increasing spread of the HIV/AIDS has influenced the lives of thousands of families in Vietnam. HIV/AIDS is strongly associated with "Social evils"
and at risk "groups". "It won't happen to me" is a common cry. CARE aimed
to educate a mass number of people in Vietnam about HIV/AIDS through an
entertaining, captivating television drama series which subtly portrays HIV/AIDS
as "everyone's disease".
Project: "Wind Blows Through Dark and Light" is a story of four generations.
Many of the situations facing ordinary people throughout Vietnam are reflected
as the triumphs and tragedies of the characters unfold. This television series
encourages appropriate and safe sexual behaviour whilst promoting healthy supportive family relationships incorporating traditional values. The process of story
development with AIDS messages is as follows:
(1) Audience research
(2) HIV/AIDS messages development
(3) Story line/character designing with HIV/AIDS messages.
(4) Script writing
(5) Script pretesting with target audience and making of appropriate changes
(6) Continuous checking after Script goes to production to make sure that the
production is following the scripts
(7) Launching and publicity for Soap on TV, newspapers and poster distribution
before the broadcast.
(8) Audience follow up and response analysis based on the Soap objectives
(9) Audience attitude changes measured by comparing results of pre and post
broadcast surveys.
Result: The production of a television Soap Opera is a unique, innovative and
entertaining approach to inform, communicate and educate a mass audience
about the realities of HIV/AIDS and subtly promote desired changes in attitudes
and behaviours.
Lessons Learned: Soap Opera is a strong, effective tool to reach a large
target audience if we have a good script carrying strong education messages in
an interesting & entertaining way.
638*/34212 Do people fail drugs, or do drugs fail people:
The discourse of "adherence"
Agnes Harley1, J.D. Davids1, J.M. Maskovsky2, J.S. Shull1. Philadelphia Fight
1233 Locust Street Philadelphia, PA 19107, USA
Issue: Since the advent of highly active anti-retroviral therapy (HAART), an unprecedented emphasis has been placed on patient adherence to drug regimens
that are complicated, likely to produce side effects and often of limited efficacy in
combating HIV. Yet, patient education adherence methods often overemphasize
the ability that individual patients have in maintaining his/her health, and may go
as far as virtually promising good results if one is "adherent."
Project: A discourse analysis of various texts discussing adherence, including
pharmaceutical industry give-aways, mainstream articles, consumer education
reports, and presentations targeting health care professionals were analyzed to
determine the assumtions about patient agency that underly these materials.
Results: Anaylsis revealed three overlapping ways in which patient agency
is described in relation to adherence: 1) that responsibility for adherence is exclusively that of the patients; 2) that adherence is the responsibility of patients
and health care providers; 3) that adherence is the responsibilty of the drug
companies that need to develop drugs that are easier to take and more widely
effective for years at a time. A large number of texts emphasize the importance
of the first and the second points, effectively inflating the importance of patient
conduct while deflecting attention away from the limitations of the current roster
of antiviral drug regimens

Lessons Learned: A balanced discussion of adherence that fully discusses
the limitations of drugs and the need to develop new regimens places less blame
on patients if their HAART therapy fails, and more accurately reflects the lived
challenges of adherence for people on currently available combination therapy.