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

882 Abstracts 43176-43180

12th World AIDS Conference

43176 Educating female sex partners of long distance drivers
(LDDs) on HIV/AIDS/STD
Bernard Nwabuko', P.N. Nwashili1, J. Onyebuenyil, J. Nathaniel2,
A.S. Yakasai'. 'STOPAIDS Organization, Box 5052 MM Intl Airport, Ikeja,
Lagos; 2Community Health Agency, Bauchi, Nigeria
Issue: The knowledge level of female sex partners of LDDs about the risk of
acquiring HIV/AIDS/STD through unprotected sexual contact could be increased
with an appropriate educational strategy thereby fostering personal and community health.
Project: This abstract is based on an on-going five-year project established
among LDDs whose permanent stations are within urban and semi-urban cities.
The women were mobilized using the assistance of their male sex partners who
had been sensitized over time. Sensitization workshops were conducted by both
male and female health professionals. Adult learning principles were employed.
Hours and venues of the workshop were fixed by consensus. Identified women
leaders were involved from planning to implementation. Uninhibited experience
sharing among the sex partners was enhanced through role-plays. They were
empowered to discuss HIV/AIDS and STD risk behaviors with their sex partners.
The women gained support to share IEC and other AIDS information in their
communities.
Results: For both education providers and recipients fear of the unknown
was dispelled. Socio-cultural and traditional quagmire were broken. The women
were motivated to seek ways to change their practices. The existing women's
group was reactivated to create awareness on HIV/AIDS/STD and reproductive
health issues, distribute IEC materials within their neighbourhoods in conjunction with STOPAIDS field staff. Additional responsibility was given to the groups
three-member committee.
Lessons Learned: Sex partners of LDDs have enormous role to play in the
fight against HIV/AIDS/STDs. Continuous exposure to education and training
workshops has opened up their hitherto closed communities to more information.
The change in the sex attitudes of the women has raised the awareness of
leaders to the enormity of community health needs. There is a new resolve to
seek creative means of reaching their with AIDS information.
43177 Planning to change and changing to plan technology
transfer: Applying lessons learned from prevention
planning in the US to inform efforts in Argentina
Debbie Indyk1, Alejandra Gurtman', P. Clay Stevens2, G. Reboredo3,
M. Ballve4, P. Cahn5, I. Cassetti6, M. Szalardi7, R. Bologna8. ' Mount Siani
Medical Center Box 1045 19 E. 98th St. New York, NY 10029; 2Bhae New York
State Dep. of Health, Albany, NY, USA; 3University Hospital, Buenos Aires;
4Proyecto Cambio, Buenos Aires; 5Hospital Fernandez, Buenos Aires;
6Fundacion Helios, Buenos Aires; 7Fundacion Gingko Bilboa, Buenos Aires;
8Garraham Hospital, Buenos Aires, Argentina
Issues: Can lessons learned from the US's evolving CDC HIV Community Planning Groups be transferred to developing countries with differing social, clinical,
public health, and political structures who are also at different stages in their
organizational response to HIV prevention and care? How can Diffusion and
Stages-of-Change Theory be applied to support and accelerate the institutional
and system changes needed to incorporate prevention findings into practice?
Present Situation: Recent medical and behavioral science advances have led
to: 1) a better understanding of viral load and replication through the stages of
HIV disease; 2) increased availability and effectiveness of multiple drug therapies;
3) an increased recognition of the secondary prevention of STD as a primary
prevention of HIV; and 4) an expanding knowledge base regarding effective
behavioral interventions. These advances are being absorbed into the planning
process which is, itself, is maturing and in transition.
Current Results: Researchers, practitioners and educators in New York City,
New York State and Buenos Aires are collaborating to develop infrastructure and
training of a critical mass of individuals and institutions through which to effect
rapid technology transfer and are seeking Fogarty funding to do this. The goal is to
achieve system change via multi-level training of groups within Buenos Aires who
are strategically linked to: private, public and pediatric hospitals, medical schools,
managed care, government, NGOs and the media. Through this collaboration
they are working together and with the New York based group of medical school,
community and government leaders instrumentally involved in advancing HIV
prevention and knowledge and its transfer. A critical mass of trainees will become
trained with system-level assessment and intervention skills and multiple linkages
to medical, community and governmental resources. These trainees become
trainers linked to critical masses at various institutions which will permit them to
interact through a web of linkages they establish and sustain both in New York
and Buenos Aires so that model creates mechanisms for developing a sustained
exchange system for creating and integrating new prevention knowledge within
and across systems.
Lessons Learned: The evolving HIV Community Prevention Planning process
spearheaded by CDC has been successful in fostering top-down sharing of expertise and administrative experience by state and public health staff with the

bottom-up personal, delivery, and application expertise of community members.
A methodology for creating an inclusive and effective structure for combating
the HIV epidemic is emerging. The structure is malleable and, when culturally
adapted, can serve as the core for similar efforts in other countries.

43178 Cultural activism and community mobilization:
Rethinking models of HIV/AIDS prevention for gay and
bisexual men
Vagner Almeida 2, V. Terto, Jr.2, J.C. Concepcion Rexach2, J. Galvao2,
R.G. Parker. HIV Center NY State Psychiatric Institute 'Unit 10, Columbia
University, 722 West 168th Street, New York, NY, USA; 2ABIA, Rio De Janiero,
RJ, Brazil
Issue: Effective and sustainable HIV/AIDS prevention programs for marginalized
and vulnerable populations, such as gay, bisexual and other men who have
sex with men in many developing countries, requires moving beyond standard
models of health promotion and behavior change in order to develop innovative,
community-based approaches to social and community transformation.
Project: From 1993 through 1997, a multidimensional intervention program
was developed for men who have sex with men in Rio de Janeiro and Sao
Paulo, Brazil, and was implemented through a partnership between communitybased AIDS advocacy and gay rights organizations. Project activities focused on
HIV/AIDS prevention as a form of cultural activism and community mobilization,
addressing AIDS-related issues as part of a broader social context in which violence, racism and economic marginalization interact with stigma, discrimination
and sexual oppression.
Results: Health promotion education and outreach work was combined with a
range of cultural activities: an ongoing experimental theater workshop, a regular
series of cultural debates featuring films and videos, the production of a play, a
video (documenting the play), and a book exploring HIV prevention within the
context of Brazilian gay cultures, the production of a video focusing on the life
histories of selected gay men, and the publication of a collection of essays on gay
and bisexual behavior and HIV/AIDS prevention strategies. Project activities were
fully documented and evaluated as part of a broader construction of a community
response to the epidemic.
Lessons Learned: Effective HIV/AIDS prevention strategies depend upon
cultural and political mobilization at the community level. Particularly in marginalized and oppressed communities, such efforts can provide alternative models
for intervention which offer important advantages in comparison to more indivdual/psychological approaches.
43179 Community participation: Bridging the gaps in HIV/AIDS
prevention
Arturo Cristobal, Jr.. PHANSuP Mezzanine, 28 N. Domingo St., New Manila,
Quezon City 1112, Philippines
Issue: HIV/AIDS prevention work must not stop with IEC and awareness raising
alone. It should go further in motivating and sustaining change in behaviour and attitude towards sexual health by facilitating and enhancing community participation
in HIV/AIDS work.
Project: In the Philippines, a more participatory methodology is being adapted
by NGOs and CBOs to respond to the pressing needs of preventing HIV/AIDS
and other sexually-transmitted diseases in the communities. As the pandemic is
not visualized as a threat or problem, NGOs have begun to use old and new tools
to facilitate and enhance community participation in identifying issues, problems,
behaviours and other factors that could put people at risk in contracting the virus.
The use of Participatory Rural Appraisal (PRA) and Stepping Stones by NGOs
have empowered the communities and other marginalized sectors to determine
their own vulnerabilities to HIV and other STDs thereby giving them the sense
that HIV/AIDS is a real threat and a serious problem that affects and may infect
people in the communities.
Results: Community participation has created more impact for the people to
realize their own vulnerabilities that they themselves identify unlike the "imposed"
vulnerabilities in IEC materials. A group of mothers and young adults in Cebu
City where PRA was conducted in December 1997 were convinced that they
were at risk to HIV after using different PRA tools. A group of gay peer educators
on HIV/AIDS in Davao City admitted not using condoms and engaging in other
risky sexual activities during the conduct of Stepping Stones and PRA last year.
With these realizations, the groups thought of changing sexual behaviours and
attitudes to prevent them from HIV and STD transmission.
Lessons Learned: Community participation is very vital in HIV/AIDS work. It
bridges the gaps left by IEC and awareness raising on HIV and STD prevention program. It also facilitated the people to have ownership of the problem of
HIV/AIDS and visualize the effects of the virus in the communities.
S43180 Integration of STD-AIDS services to primary health care:
A community based approach
Ferchito L. Avelino2, Ma. Elena Borromeo', Teodora Wi2, Ramon Mora4,
Marisa Saguinsin4, Babilyn Lanan5, Modesto Capuno3. Department of Health,;
'Metro Manila; 2Regional Health Office No 5, Legazpi City; 3City Health Office,
Legazpi City; Rural Health Unit; 4 Tabaco; 5Daraga, Albay, Philippines
Issue: People seeking medical attention in social hygiene clinics were labeled

with discrimination and stigmatization as having ill reputes (e.g. commercial
sex workers and clients of sex workers). This has resulted to poor to no clinic
attendance, which encouraged self-medication, under to mistreatment.
Project: On December 1996, the Bicol Regional STD-AIDS Prevention and
Control Program developed an approach to address this issue. Its objectives are
to reduce the negative image of social hygiene clinics and to strengthen the STD
surveillance through integration of STD-AIDS services to the Family Planning and