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

12th World AIDS Conference

Abstracts 43253-43257 897

counseling activities, peer education trainings, supervision, educational materials
development, and HIV testing triage.
Results: At the end of the first year, over 900 group and individual interventions
have been conducted. 582 Latino gay men have signed up to receive information
on a regular basis. Volunteer participation in the program has steadily increased.
60 men enrolled in the program as volunteers; 22 of these have been trained
and have worked as outreach workers; 4 of these are in the process of becoming
peer counselors. Volunteer participation in program planning has also increased.
HIV testing and Hep B vaccination has been particularly promoted among volunteers. One-fourth of volunteers (15) have tested for HIV while participating in the
program.
Lessons learned: 1) Using socio-cultural norms about community, family and
friendship gets clients and volunteers consciously involved in HIV preventions efforts for others and for themselves. 2) Integrating sexual identity and practices into
discussions around religion, isolation, acculturation, gender, and cultural identity
increases participation. 3) HIV prevention must address the cultural meanings of
specific sexual practices. 4) Changing from "deficiency" models to one of selfregulation provides individuals with cognitive tools to develop reachable goals.
S43253 Social economic empowers commercial sex workers to
reduce reported attack rate of STDs
Elizabeth Ngugi1, Staugard Frants2, Gallachi Alberto2, Mary Njoroge3,
Anne Waweru3. 1University of Nairobi Community Health, Box 19676, Nairobi;
2Health Sector Support Programme Moh/Danida, Nairobi; 3Kenya Voluntary
Women Rehabilitation Centre, Nairobi, Kenya
Introduction: Commercial Sex Workers in Africa have consistently reported social
economic disempowerment as a barrier to safer sex negotiation thus facilitating
transmission of STD/HIV.
Objective: To identify and measure safer sex practices including condom use
and reported status of STDs as a result of improved social economic status.
Method: Closed and open ended questionnaires were administered to a sub set
of 30 commercial sex workers out of 300 that joined the intervention programme
at different times during one year period 1995/1996.
The training packages included educational counselling about proper condom
use, negotiation and provision. Also identification and management of small income generating activity as well as stock taking, customer relations, profit group
and individual saving.
Result: Their income through alternative generating activity of their choice
improved i.e. those earning 4000/ = (US$ 72.8) per month increased from 26.6%
to 33% and Kshs.2000/ = -3200/ = (US $36.4 to US $ 66) per month increased
from 33% to 43%. Significant decrease is in those earning 800/ = 1600/ = (US$
14.4 to US $ 28.8) per month before which has now decreased from 36.6% to
23%.
The sexual partners decreased from 2-10 per day to 0-5 per day. Two of the
30 suspended having sex and are not in decision making process as to what to
do with their sexual life. Two have boyfriends who are HIV negative and do not
use condoms.
Negotiation for safer sex even with the "lover", "husband" which is most difficult
to change increase to 93.3% within about one year.
80% of the women had suffered an STD a year before the study period,
compared to zero STD during the study period.
There was no increase in use of family planning method, namely injectables,
pills and tubal ligation. Drinking of alcohol decreased from 73.3% to 43.5% and
smoking from 16.6% to 0%. None was on any other type of drugs.
Conclusion: Social economic development of CSW is a powerful tool to
increase self-esteem, safer sex negotiation practices and reduction of STDs.
43254 A participatory approach to AIDS prevention for young
gays who haven't come out yet
Roberto Induni. AIDS-Hilfe Schweiz, Postfach CH-8041 Zurich, Switzerland
Issue: Effective communication of safer sex guidelines to young gay and bisexual
males who haven't come out yet requires innovative approaches and tools. This
group often has little or no contact with gay community resources. Furthermore,
AIDS prevention materials typically don't tie into their lives, particularly concerning
struggles they likely experience around coming out.
Project: In Switzerland, members of the target group who were struggling with
coming out were asked to define problems they faced and possible solutions.
Based on their involvement, a booklet was produced which emphasizes relationships of "newcomers" (not yet self-identified as gay or bisexual people) with their
parents and friends. The booklet offers avenues for better self-acceptance, as
well as awareness of safer sex guidelines. It was distributed not only within the
gay scene, but also in schools, centers in which family counselling is held, and
paper stores.
Results: The booklet was well-accepted by the target group. Its use became a
trend in Switzerland.
Limits: The final product, because it was not produced primarily for already-iden
tified gay people, resulted in what appears as a narrow, very "politically correct"
representation of young gay and bisexual males and of gay culture. This contradicts a strong political desire within the gay community to make visible the
richness and wide range of gay culture.
Lessons Learned: a participatory empowerment approach, whereby communication materials are made by and for the target group itself, raised the likelihood
of producing well-accepted and widely-used AIDS prevention tools.

43255 1 Pe no Breque - Prevention of STD/HIV among truck
drivers in the City of Sio Paulo - Brazil
Luiz Henrique Passador1, L. Guirao, Jr.2, T.C. Reis Pinto2, C.A. Barreiros2,
E. Feitosa2. 1R Dr. Veiga Filho 61 AP31 Sao Paulo, SP; 2APTA, Sao Paulo, SP,
Brazil
Issue: A national research among different categories of workers in Brazil revealed that truck drivers have a lack of information about STD/HIV/AIDS and
scarcely use condoms in their sexual intercourses. Truck drivers usually have
sex with sexworkers and are abusive drug users, becoming one of the prioritary
populations for STD/HIV/AIDS prevention works in Brazil.
Project: Four health agents are on duty twice a week in a cargo terminal to
give information, counseling and controlled condom distribution to truck drivers.
While they wait to be attended, the health agents perform workshops to form
peer educators. There are boxes spread in the cargo terminal where truck drivers
can leave written questions about STD/HIV/AIDS and related issues, which are
answered in a free distributed newspaper published by the project staff.
Results: 1) Round 50 truck drivers look for duties each week; 2) round 170
truck drivers have regular searching for condoms; 3) the health agents have
already made seven workshops; 4) the project succeeded to make preventive
work with relatives (wives and sons) who travel together with truck drivers.
Lessons Learned: 1) Truck drivers started looking for information and condoms
when these became disposable in their workplace; 2) trust in stable sexpartners is
the main obstruction to adoption of safe sex among truck drivers; 3) truck drivers
have accepted to play the peer educator role.
237*/ 43256 Working with women whose male partners are
homosexually active
Sara Lubowitz. The AIDS Council of New South Wales 9 Commonwealth Street
Sydney N.S. W 2010, Australia
Issue: 84% of HIV infections in Australia are through male homosexual/bisexual
contact or IDU. Of the recorded Australian infections amongst women attributed to
heterosexual transmission, "Sex with a bisexual male" is 20%. Many women are
unaware of their male partners sex with men and so do not percieve themselves
to be at risk of HIV infection. The need to educate & support these women on
HTV/AIDS is essential to limit infections in women.
Project: The AIDS Council of New South Wales, established peer support
groups for women partners of bisexual/gay men. The aim to support women provide information on HIV prevention strategies & emotional support to empower
them to make informed choices about their health & lives.
Results: As a result of peer support groups attended by 189 women, a
statewide phone-in, one to one peer support & statewide workshops for health
workers the need to produce an information video & manual for health workers
and as a support for women became evident. The project also produces education campaigns, an annual newsletter for health workers, articles in womens
magazines, collaborations with television drama writers, radio interviews & press
advertisments.
Leesons learned: As one of the few publicly funded projects of this type, in a
environment thatsstill reluctant to recognise that many men who identify as gay
have sex with women & many heterosexual men have sex with men, the need for
further education for women is imperative.
43257 Leaving sex work: Work history in a cohort of female sex
workers in northern Thailand
Peter H. Kilmarx', K. Limpakarnjanarat2, S. Saisorn3, J. Kaewkungwal1,
S. Korattana', N.L. Young', M.E. St. Louis', T.D. Mastrol. 1US CDC & HIV/AIDS
Collaboration DMS 6 Bldg. Tivanon Rd; Nonthaburi, 11000; 2HIV/AIDS
Collaboration, Nonthaburi; 3Chiang Rai Provincial Health Office, Chiang Rai,
Thailand
Background: Female sex workers in northern Thailand have a high risk of
acquiring HIV and other sexy, ally transmitted diseases (STDs). Although numerous programs are devoted to helping women stop commercial sex work, little
information is available to guide these efforts.
Methods: Female sex workers in Chiang Rai province were enrolled in a cohort study from 1991 through 1994 and evaluated prospectively with interviews,
physical examination, and laboratory testing.
Results: Of the 500 women enrolled, 422 (84%) had at least one follow-up visit.
Of them, 260 (62%) reported at their latest follow-up visit that they had stopped
sex work. Those women who stopped did so a mean of 15 months (median. 9
months) after study enrollment; and their mean time from first commercial sex to
leaving sex work was 5.7 years (median, 4.3 years). In a proportional hazards
regression model, leaving sex work was significantly associated (P <.05) with
having a husband or steady sex partner (adjusted risk ratio [ARR] 2.8; 95% confidence interval [Cl] 2.0-3.8) and with lower customer charge (<300 baht [-12
US$]; ARR 1.8; 95% Cl 1.2-2.7) but was not associated with HIV-infection status.
At the follow-up visits before and after having left sex work, rates of gonorrhea

were 16% and 10%. respectively, and rates of chlamydial infection were 20%
and 10% respectively. Of 285 women who were HIV-seronegative at enrollment,
32 (11%) seroconverted; of them, 5 (16%) were seronegative when they left sex
work and seroconverted after having stopped.
Conclusion: Leaving sex work was associated with having a steady sex partner and with low customer charge, but not with HIV-infection status. HIV and
STD infection rates decreased after the women left sex work but were still sub