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

12th World AIDS Conference

Abstracts 43224-43229 891

43224 Added value of a regional approach to improve the
respond to the HIV pandemics in sub-Saharan Africa.
Example of the GTZ Regional AIDS Programme for West
and Central Africa (German Technical Corporation)
Roger Salla. GTZ Regional AIDS Programme Box 9698 Kia Accra, Ghana
Project: The programme exists since January 1994, with the following goals:
- Facilitate information exchange and networking of GTZ supported primary
health care projects within the region.
- Build up capacities within the region and develop a core group of professional
for HIV/AIDS advisory services.
- Advocate for the integration of HIV related issues within more health projects.
- Support initiatives transcending boundaries (migration, prostitution)
- Support operational research on regional concerns
Results: Since its creation, the programme has:
- Contributed to develop a south to south collaboration within different bodies
within the region.
- Contributed to build human adapted capacities within the region.
- Contributed to a better understanding of important factors in the spread
of the epidemic (migrations, prostitution, poverty, socio-economic changes) by
contracting regional researchers and facilitating publications.
Lessons Learnt: Considering the regional dimension of the epidemic is necessary. HIV prevalence within migrants and fragilised populations are higher than
in general population every where. A better understanding of human regional dynamics, and a collaboration between the country projects (for example by sharing
adapted IEC materials) can lead to increase the accuracy of the programme.
43225 Solving the problems in finance and logistics: Software
development to answer the NGOs and the public sector
needs on HIV/AIDS prevention, Brazil
Juan Finj1, Maria Eugenia Fernandes2, Luis Antonio Dangelo2, Elizabeth Viera2.
1Heitor Penteado 47 Casa 3, CEP 05437-000 Sao Paulo SP; 2Associacao
Saude Familia, Sao Paulo SP Brazil
Issue: Receiving and managing resources from an international donor or agency
can be a real nightmare in the level of NGO's and the public sector in Brazil.
Project: In order to answer to the management difficulties in the area of finance and logistics of condom and STI drugs the AIDSCAPA/BRAZIL program
developed two friendly users software, one in the area of finance and the other
in the area of logistics. The softwares were pre-tested and adjusted according
to NGO'S and public sector needs. Training on its use was provided to all collaborating NGO's. Finance software was installed in 10 NGO's and the logistics
software was installed in the state of Sao Paulo and Rio de Janeiro. Training
was provided to 10 NGO's and 2 public sector areas responsible for HIV/AIDS
prevention programs.
Results: Currently more than 10 NGO working on HIV/AIDS prevention are
using the finance software to control funds from different donors.
Logistics software is being used in Rio de Janeiro to control STI/HIV/AIDS
drugs and condoms. During an evaluation conducted in 1997 one NGO stated
that the Program Management in one word: "amazing".
Conclusion: 1. The development of finance and logistics software were key
for the proper Control of resources by NGO's and the public sector. 2. It allowed
rational use of time and money.
43226 Impact of political and structural development on
HIV/AIDS programmes
Elizabeth Madraa. STD/ACP/MOH, PO. Box 8 Entebe, Uganda
Issue: Political and structural development facilitated districts mobilisation to plan,
manage and implement HIV/AIDS programmes effectively.
Project: The political structure developed was used by NACP (National
AIDS Control Programme) to decentralise resources, mobilise district health
team, NGOs, CBOs, and religious organisation to plan, implement and manage
HIV/AIDS Programme. This was achieved by providing technical assistance, training, setting of standards, developing of guidelines, policy formation and support
supervision.
Results: District capacity has been built. Work out put increased because
resources were allocated to NGOs, CBOs to plan and implement HIV/AIDS
programmes and programme sustainability was ensured.
Lesson Learnt: HIV/AIDS Programmes should be decentralised, government
support to NGOs, CBOs to build district capacity should be encouraged and
political commitement is needed for HIV/AIDS Programmes.
S406*43227 Needle exchange-based health services as a
comprehensive community prevention program
Frederick Altice, K. Khooshnood, K.M. Blankenship, M.P. Lamberti, P.A. Selwyn.

Yale University AIDS Program 135 College ST #323 New Haven CT 06510, USA
Issues: Despite demonstrations of successful linkages of primary care to drug
treatment programs, few models have been developed to meet the medical needs
for active injection drug users (IDUs). By maintaining contact with out-of-treatment
IDUs through Needle Exchange Programs (NEPs), the project has expanded the
services of a mobile health care program, the Community Health Care Van

(CHCV), to meet the special health needs of active IDUs and other high-risk
community members.
Project: The CHCV provides an array of acute and preventive medical services, HIV testing, drug treatment and case management services, referral to
community-based health care and outreach/education. These services principally
target the needs of drug users with or at high risk for HIV infection. The goal
of the project is to deploy mobile medical services to produce reductions in HIV
and other medical complications of drug use. Services are provided in a nonjudgmental style with an emphasis on retention of high-risk clients. The CHCV
aims to achieve this goal through friendly outreach and advocacy at sites remote
from existing health centers and in areas with high rates of drug use, sexually
transmitted diseases (STDs) and poverty.
Results: From 1/93-6/96, 866 clients made 1824 visits to the CHCV. Of these,
65% were black, 17% were white, 18% were latino, and 15% were homeless.
IDUs comprised 22% of clients, while 38% were non-injecting drug users (NIDUs).
NIDUs were more likely to have had a STD, however were less likely than IDUs
to be HIV+. HIV testing on 495 individuals revealed that 83% returned for results
and 5% were HIV+. Of the 142 who were placed in drug treatment, 57% were
IDUs. HIV+s were more likely to use the CHCV - 2 times, and therefore received
case management services. Linkage to medical care was achieved for 41% of
referred clients.
Lesson Learned: Mobile NEP-based health services can reach populations at
risk for HIV not traditionally reached by NEP itself. Comprehensive programs can
enhance linkage to existing community resources. Such linkages require intensive coordination of services between medical providers, case managers, drug
treatment advocates, and outreach workers. Such programs may be important as
part of innovative programs for health services delivery for out-of-treatment IDUs
and other drug users.
239*/43228 Outcomes of a community-level HIV prevention
intervention for women
Kathleen Sikkema1, J.A. Kelly1, L.J. Solomon2, R.A. Roffman3, V.A. Cargill,
R.A. Winett5, T.L. Mcauliffe1. 1Cair Medical College WI Milwaukee WI; 1201 N
Prospect Avenue Milwaukee W1 53202; 2University of Vermont Burlingto VT.
3University of Washington Seattle WA; 4 University Hospital Case Western
Cleveland OH; 5 Virginia Tech Blackburh VA, USA
Background: Women, especially in impoverished, inner-city neighborhoods, are
at high risk for contracting HIV, and community-level prevention efforts are needed.
Methods: A randomized, multisite community-level trial was undertaken with
women living in 18 low-income housing developments in five US cities. Nine
developments received the intervention and nine developments served as comparisons. Baseline and 12-month follow up population risk characteristics were
assessed by surveying 690 women (75% African American, 20% white) at both
time points. The community intervention included HIV risk reduction workshops
for women and an ongoing series of community events that were planned and
carried out by women in each development identified as popular opinion leaders
by their peers. HIV education materials and free condoms were made available
in both intervention and comparison developments.
Results: A mixed-model generalized linear model approach with housing developments as the unit of analysis was conducted. Relative to women in the
comparison developments who showed little change in risk behavior, the proportion of women in the intervention developments reporting any unprotected
intercourse in the past two months declined from 50% to 37.6% (p =.03) and the
percentage of women's intercourse occasions protected by condoms increased
from 30.2% to 47.2% (p =.007). Among women exposed to the intervention,
there was a trend for mean frequency of unprotected intercourse acts to be
lower at follow up (M = 4.05) than at baseline (M= 6.04). Self-reported behavior
change was corroborated by change in other risk indicators, including condom
redemption.
Conclusions: Women living in low-income housing developments exhibited
reductions in sexual risk behaviors with changes of 25% to 57% from baseline
levels. Community-level interventions that involve and engage women in prevention efforts can be effective in reducing HIV risk behaviors. This type of community
intervention, which relies on conversations and community mobilization, has applicability for HIV prevention in developing countries where condom use norm
changes are needed.
185* / 43229 Criteria for evaluation of education given to clients
of sex workers
Lucie Van Mens1, P. Vangelder2. 1Dutch Foundation for STD Control PO Box
8189 3503 RD Utrecht; 2University of Amsterdam, Amsterdam. The Netherlands
Issue: STD and AIDS information and education given in the sex industry mainly
targets sex workers, in spite of the fact that the pressure to have unsafe sex
mainly comes from the side of the client. In the past decade, prevention activities
targeting customers have been organized in various Dutch cities where street and
window prostitution take place. The objective of the project is to develop criteria

for evaluation of intervention strategies among clients of sex workers.
Project: In 1996, around 1500 clients of sex workers were reached by specially
trained educators who gave face-to-face counselling on safer sex and related
topics. An effect evaluation of the intervention strategies is hard to conduct among
a 'hidden population' like clients. Therefore other evaluation criteria had to be
developed. On the one hand they were based on sociological concepts on be