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

12th World AIDS Conference

Abstracts 43243-43247 895

S43243 Cultural mediator outreach program increases medical
follow-up and decreases non-use of condom and
pregnancy rates among HIV infected immigrants in Israel
Varda Soskolne12, R.A. Shtarkshall3, E.H. Kaplan4, B. Adler2, A. Leventhal5.
'Center AIDS Prevention Studies, UCSF 74 New Montgomery St. 600 SF CA
94105 4 Yale University New Haven, CT USA; 2Hadassah Medical Center,
Jerusalem 91120; 3School of Public Health. Hebrew University, Jerusalem;
5lsrael Ministry of Health Jerusalem, Israel
Background: In response to concerns about low HIV follow-up rate, difficulties
in doctor-patient communication and resistance to condom use among HIV+
immigrants from Ethiopia to Israel, Ethiopian community members were trained
as case managers and cultural mediators. They reach out and provide culturally
sensitive counseling to Ethiopian PWHIV in their language, facilitating their access
to HIV information and care.
Objectives: To evaluate the cultural mediator program in terms of 1) regular
follow-up visits at HIV clinics, 2) condom use, 3) pregnancy rates.
Methods: The program has been gradually implemented in all regions since
1/95. Data for this interim evaluation were retrieved from the mediators' semistructured reports (178 men and 149 women enrolled over 2 years). Data on
clinic follow-up and condom use are reported for those who were enrolled for 9
months (76 men and 89 women). Pregnancy data are presented as rates per 100
women per year, pre-program vs. during the program.
Results: The program proved to be feasible and acceptable to these immigrants: only 1.5% refused any contact with the mediator, 95% were still enrolled
after 9 months. The rates of regular HIV follow-up visit increased, non-condom
use and pregnancy rates decreased.

often get involved in sexual activities under the influence of drug and alcohol.
Children on the streets are also exposed to various types of sexual activities at an
early age. Local toughs, family members and other adults exploit and force these
children into sexual activities. Rape, commercial sex work and promiscuity make
them vulnerable to HIV/AIDS. A study was conducted among 2416 street children
in the city of Calcutta to explore their vulnerability by analysing the needs and
problems related to their sexual health and their knowledge attitude, behaviour
and practice. Focus group discussion, direct observation, depth interview and
case study were used as techniques to elicit detailed information on various
issues related to sexually transmitted diseases, HIV/AIDS. In addition, quantitative data was also collected through questionnaire. Secondary information was
collected through desk research of the available data on the subject.
Results: Out of the total sample, 39.3% were substance abusers among whom
54.2% females were addicted to depressants and 42% males were addicted
to cannabis. 17.3% males and 46% females reported sexual abuse as a major
impediment of living on the streets. 27.7% suffered from genital infections. 56% females and 50% males responded that they are engaged in various types of sexual
activities. 49.3% males and 65.6% females had no knowledge on HIV/AIDS.
Lessons Learned: The high risk behaviour of children on the streets make
them extremely vulnerable towards HIV/AIDS however, the vulnerability can be
reduced to a great extent through awareness generation programmes, training of peer educators, distribution of information, education and communication
materials in local language and establishment of sexual health clinics.
43246 Promoting sexual health in women at risk of HIV:
The role of social capital
Pamela Gillies', N.J. James2, R. Slack2, R.J. Madeley2, S. Johnson3,
M. McDonald3. 1 Public Health Medicine, University of Nottingham, Nottingham
NG7 2UH; 2University of Nottingham Nottingham; 3Prostitute Outreach Workers
Nottingham, UK

Men

\

Women
9 month

Entry 9 month Entry

HIV follow-up: % regular
Non-use of condoms: % never
E
Pregnancy ratel
1 Men = rate for partners; * p 0.05;
Conclusion: Mediators with th
sexual behavior modification, (val
to greater adherence to medical c
ture intervention should consider t
by men, and decrease barriers to
43244 Substance use an
vulnerable young
Andrew Ball1, John Howard2, M. I
D. Widdust. 1 World Health Organ
2Mac Quairie University, Sydney,
Issue: Street children, and othe
which HIV and substance use ris
substance use preventive interver
Project: Since 1992 the WHC
refining a methodology to deliver
ventions specifically targeted to str
countries. The WHO Street Childr
gies, the development of site-spe(
methods for monitoring and evalut
and a manual on programme mor
information and skill developmer
methodologies and resources, qu
risk behaviours were collected. E'
the delivery of HIV/AIDS preventic
the Project has been expanded to
Results: The draft training pack
educators and others in 19 cities
participated in focus groups. Eval
focus groups has informed the rE
ogy, which has now incorporated
disseminated and adapted for use
poor, Indigenous youth.
Lessons Learned: A general tr;
can be effective in particular sit(
local adaptations based on rapic
involvement and informal strategic
43245 Assessment of sex
children in the City
Tapas Karmakar, T. Bandyopadhy
25/1A Diamond Harbour Road, C;
Issue: Does the lifestyle of stree
HIV/AIDS?
Project: Life on the street is ver
to overcome their loneliness and

47 53 44 63
58 22 56 47

ring Issue: Can local community development to promote sexual health, its impact
ntry During Entry During upon health outcomes, behaviour and the social context in which these occur be
12 4 20 10 evaluated and sustained?
p 0.06Project: Launched in 1990 as a research project, prostitute volunteers working
in partnership with University colleagues assessed local womens health needs.
ie same cultural background can contribute to Using these data, they designed an evolving community outreach project, creating
idated by the decrease in pregnancy rates) and networks for dissemination of information about harm reduction and condoms,;are in hard-to-reach immigrant population. Fu- with advocacy, advice and referral to a range of appropriate services. By building:he gender differences to improve HIV follow-up a solid infrastructure for change including a safe space for men and women at risk;
condom use among partners of HIV+ women. partnerships across professional and lay boundaries and social support in the
form of child care, housing, probation and other legal advice, welfare, educational
opportunities and small loans, the project has contributed to the social capital of
d HIV prevention among especially the locality it serves.
people (EVYP) Results: Data linking initial and repeat contact with the project has been
1 Rana, L Ri, G. Wee available since 1995. This has demonstrated a statistically significant increase in
Donoghoe-, S. Rana, L. iley,. Weler, reported condom use with non-paying partners. This finding is particularly imporzationH-1211 Geneva, 27, Switzerland; tant given evidence that the risk of morbidity associated with sexually transmitted
ustralainfections among prostitutes is largely due to the behaviour of non-paying partners.
r EVYP, are a difficult to reach population in [Condom use with partners (n = 79): First Contact: 'Always' 13.16%, 'Sometimes';k practices are prevalent. Innovative HIV and 9.11%; 'Never' 57.72%; Repeat Contact: 'Always' 22.28%, 'Sometimes' 13.16%,
ntions are necessary. 'Never' 44.56%, Stuart Maxwell test x2 = 6.88, p < 0.05].
) Programme on Substance Abuse has been Evidence of increased levels of civic engagement, reciprocity, use of networks
substance use prevention and treatment inter- indicates the extent to which the project has built social capital.
eet children in differing circumstances in over 25 Lessons Learned: Local community development involving marginalised
en Project comprises rapid assessment strate- groups has gained institutional support, is sustainable, creates an infrastruccific interventions for prevention and care, and ture for accessing sexual health and welfare services, builds social capital for
ation. A package for training of street educators health and has a demonstrable impact upon health and health related behaviours.
nitoring and evaluation provide comprehensive
it activities. During the development of these
jalitative data on HIV/STD and substance use 43247 Young women in the sex trade: Peer-led
valuation has indicated that it is well suited for HIV strategies
3n. Consequently, in association with UNAIDS, Shaleena Theophilust, Patricia Baptie2, S.C. Theophilus2. 1203-319 West
Sstrengthen HIV prevention interventions. Pender Street, Vancouver, BC V6B 1 T4; 2 Youth CO AIDS Society Vancouver,
<age has been used for training over 700 street Canada;. Over 2,500 street children from those cities
uation from the training and feedback from the Issue: How to teach young women in the sex trade safer sex strategies while
evision of the training package and methodol- they are working in an accepting way which relies on the knowledge and abilities
HIV/AIDS material. The package will now be that are already present in this community.
Sto target other EVYP, such as refugees, urban Project: Traditionally, education and outreach to young women working in the
sex trade has been degrading and mainly focused on getting them off of the
aining package aimed at street and other EVYP streets. There are many organizations working to accomplish these tasks, but
es if it is not too proscriptive, but allows for none support them or address their issues or concerns while they are working.
I assessment, youth participation, community This therefore puts them at great risk for HIV transmission. As a result, this project
Splanning activities, was developed to fill this gap in a peer-for-peer, harm reduction approach. It uses
street workers as peer educators, and advocates for other young women who are
working but are not in a position to do so themselves. Strategies for education
(ual health status among the street include one-to-one street outreach, condom distribution, information disseminaSof Calcutta tion on condom use and alternatives to intercourse while working, referral to
ay, A. Seal. 1Vivekananda Education Society, agencies.
ay, A Vivtio ci Results: This project has been very well received by the young women worklc na ing. They are now actively soliciting information from our outreach worker, and
Dt children increase their vulnerability towards passing on our name to other workers. Our outreach worker has been approached
by pimps, and has done workshops for their girls. There is now an interest in
y stressful. Street children usually abuse drugs this community to develop their own resource brochure that can be circulated to
escape the harsh realities of their lives. They young women, especially new workers.