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

12th World AIDS Conference

Abstracts 43235-43238 893

and improve their activities. One of these, the AMMOR Clinic (AC), has been
offering direct medical attention, HIV counselling, testing and treatment for those
youth and their babies, supplies condoms and other contraceptive since 1989.
Its slogan is "Education for Life through Health". AC assumed responsability to
expand its preventive activities, especially among the other members of the pool.
Eight pool members have a religious profile, 4 are fundamentalists. In spite of
providing quality education, professionalization and rescue from marginalization,
there is resistance to "safe sex" and "harm reduction" approachs. Only 3 have
systematic sexual education. Recognising ideologic differences between intitutions, educators were invited to discuss consensus approaches to drug abuse
and sexuality prior to initiating the preventive program.
Consensus: a) dealing with drug users should be guided by tolerance without
complicity, in a damage reduction policy; b) causes of drug use identified to be
subject of interventions were: group pressure; self affirmation; existencial anguish
and search for pleasure, c) drugs effects description is not important; d) the proportion of IDU among street kids is low (-2%) but responsible for 71% of the 21
diagnosed AIDS cases among them: needle exchange is justified; e) adolescent
size and female condoms are unknown to most of the educators and not available at AC. Distribution should be iniciated and the acceptance evaluated; f) the
preferred contraceptive for girls >15 y is trimestral injection of medhroxyprogesterone plus condoms; g) preventive program and direct attendance must promot
self-care and coping skills, self esteem, knowledge of civil rights and construction
of quality of life; h) after 18y of age, these boys and girls will leave the projects,
lose "Street Kids" status and be at risk for relapse. For this reason, their time
in programs must be highly effective in developing coping skills, educating for
life.
Lessons learned: In spite of their differences, the institutions are able to cooperate in a common project. Some disagreement persists about the approach to
sexuality and drugs abuse. The consensus which emerged represents progress
as long as it is accepted by the hierarchy of the institutions. In fact, only three
have done so at present. Legal matters with regard to needles exchange must
be solved. The greatest merit of the project is uniting these intitutions to discuss
their methods, increasing their tolerance and critical sense, and recognition of a
commom goal: welfare for these boys and girls.
43235 The challenge is to change prevailing attitudes: A lesson
from the field
Nhu Trang Nguyen1, M. Raab2. 191/35 Su Van Hanh Noi DAI, Districtio Ho Chi
Minh City; Care Vietnam, Ho Chi Minh City Vietnam; 2NOVIB, The Hague, The
Netherlands
Issue: Commercial sex workers in Vietnam often have little choice because of lack
of education coupled with dire poverty. Women are incarcerated for membership
of the sex industry and often return to it on exit.
Project: CARE developed a skills training programme (funded by NOVIB) for
women in the Re-education Centre of HCMC. It covered computer skills, business
planning, professional development and health issues. It's aim was to give skills
for other work, a framework of social analysis, self esteem, health information
community contacts, and loans on exit. Women who agreed were followed up for
six months.
Results: The project was a huge success from the 80 individual women's points
of view - particularly in the areas of self esteem and their understanding of their
situation. Also, the women had increased knowledge of their bodies, nutrition,
sexuality and safety. They easily learned the skills of computer, professional development and developed business plans and applied for loans - Very successful?
On the individual level yes, on a community level no. On exit from the centre the
women came across resentment at them having had such opportunities, refusal
of basic help, no real choice to legitimately work, attend school or heath clinics.
They owed money and no government approved groups (until recently) would
assist with the distribution and monitoring of loans.
Why? Societal attitudes did not change in line with the changes in the potential
opportunities for the women. The women are still viewed as part of the society's
"social evils".
Lessons Learned: Attitude changes necessary must come from within a society. Effort should go into attitudinal change, prior to innovative programming for
fringe groups.
182* / 43236 Decline in prevalence of HIV infection and sexually
transmitted diseases and increase in condom use
among female sex workers in Abidjan, C6te
d'lvoire, 1992-1997
Mamadou Otto Diallo1, P.D. Ghys2, V. Ettiegne-Traore3, C. Anoma3,
M. N'Krumah3, Y. Hoyi3, J.C. Kadjo3, A. Tiemele4, I.M. Coulibaly4,
A.E. Greenberg5, M. Laga2, S.Z. Wiktor5. 101 BP 1712, Abidjan 01; 3Projet
Retro-CI, Abidjan; 4National AIDS/STD/TB Control Program, Abidjan, Cote
d'lvoire; 2Institute of Tropical Medicine, Antwerp, Belgium; 5Centers for Disease
Control and Prevention, Atlanta, USA

Objectives: To monitor trends in demographic and behavioral characteristics,
sexually transmitted diseases (STD) and HIV prevalence among female sex
workers (FSW) attending a confidential clinic in Abidjan.
Methods: Since 1991, the Ivorian Ministry of Health has conducted an HIV/STD
prevention campaign targeted at FSW. Since 1992, a confidential clinic provides
free HIV counseling and testing, and STD diagnosis and treatment for FSW. Data

are presented for the 4,365 first-time clinic attenders seen between 1992 and
1997.
Results: In 1992 and 1997 the percent of FSW from the following countries
was: C6te d'lvoire 9% and 45%; Ghana 82% and 20%: Nigeria 2% and 24% and
Liberian 0% in 1992, 15% in 1995 and 4% in 1997.

Year
No. FSW
Mean age (yrs)
Ivorian%
Some formal education %
Sex work in months (median)
100% condom use last day %
Genital ulcers %
TPHA %
N. gonorrhoeae %
HIV-positive %

1992
356
30.4
9
51
36
20
21
40
33
89.4

1993
778
29.2
13
54
36
23
17
38
29
79.3

1994
607
29.0
42
56
36
35
12
37
26
69.4

1995
832
27.5
45
60
24
40
8
27
22
53.0

1996
916
27.4
42
60
24
44
4
18
15
51.8

1997
876
26.3
45
67
18
59
5
12
13
51.9

p-value.0001.0001.0001.0001.0001.0001.0001.0001.0001

Conclusion: Since 1992, there have been important changes in the characteristics of FSW attending the clinic. They are younger, more educated, more likely to
be Ivorian, and have been practicing sex work for a shorter period. These factors,
coupled with intensive educational effort targeted at this population, may have
contributed to a significant increase in condom use, which in turn may be related
to the significant decline observed in STD and HIV among FSW in Abidjan.
530*/43237 Mekong movements: Border areas HIV/AIDS
prevention project
Gioi Tran Minh1, L.A. Esposito Catherine2, O. Souksavanh3. 130A Thuy Khue
Hanoi; 2Care International in Vietnam Hanoi, Vietnam; 3Care International in
Laos, Vientienne, Laos
Objectives: To develop and implement HIV/AIDS prevention projects that are
suitable for border areas where there is a high level of risk behaviour of HIV
infection between Cambodia, Laos and Vietnam.
Methods: Participatory Rapid Assessments were conducted to collect information about communities on either side of international borders between Cambodia/Vietnam and Vietnam/Laos. From this and further focused research, a contextual analysis and subsequent risk profile of HIV infection was developed. From the
research results pictures of how the disease is spread both externally and internally emerged and risky behaviours and vulnerable groups within host and mobile
populations were identified. Strategies and interventions for HIV/STD prevention
projects were then developed around the concept of a "twin city". Other components adopted included a community approach in tandem with more targeted ones,
demonstration of links between twin sites, action that was guided by and endorsed
by local community members that strengthened the capacity of local organisations
and complimented national efforts for HIV/AIDS prevention programmes.
Results: Trialing researched interventions on both sides of borders that combined and accommodated the common and unique needs of different communities
enabled viable, cheap and relevant projects to be piloted. Tackling the problem
from both made interventions stronger, more cost effective and sustainable,
helped erode the projection of blame to other nationalities, and put the whole
epidemic in a much wider and regional economic, political and socio-cultural
framework.
Conclusion: Targeting twin border sites is one preventative approach that
highlights and demonstrates the benefits of initiating a more macro approach and
programme for HIV/AIDS prevention within the region and increases the options
available to curb the spread of the disease throughout South East Asia.
S43238 Improving adjustment among parents with AIDS and their
adolescents
Mary-Jane Rotherram-Borus1, M. Gwadz2, S. Grosser2. 110920 Wilshire Blvd.
Suite 350, UCLA, Los Angeles, CA; 2University of California, Los Angeles, Los
Angeles, CA, USA
Background: Social, behavioral, and mental health symptoms are expected
among adolescents of parents with AIDS (PWAs). The efficacy of a 3-module
intervention to enhance adjustment of parents and their teens was evaluated over
2 years.
Methods: A series of 307 PWAs and their 498 teens were randomly assigned
to either: 1) standard care, or 2) an intensive intervention over 3 modules (Taking
Care of Myself, Parenting while III, and Grieving) of 8 sessions each. Module 1
was attended only by parents; youth and PWAs attended Module 2, and youth
and their new custodial guardians attended Module 3. More than 93% of PWAs
assigned to the intervention attended the groups; more than 90% were followed
over 24 months; 75% were reassessed 5 or more times.
Results: Most PWAs were mothers (83%); 43% were Latino and 34% AfricanAmerican. Youth were better adjusted than anticipated based on normative data
of same-ethnic, same-age peers. There were initially low levels of problem behaviors: substance use, sexual behaviors, emotional distress, school problems,
and contact with the criminal justice system. Over time, those receiving standard
care reported significant increases in these same problem behaviors. In contrast,
the intervention group appeared to maintain lower rates of problem behaviors
and emotional distress. Three patterns of youth's adjustment over 2 years were
found: those whose adjustment was consistently positive, those with increased
problems over time, and those with severe and persistent problems.