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

12th World AIDS Conference

Abstracts 43262-43266 899

43262 Attitudes of staff at juvenile detention facilities towards
AIDS prevention programs, Sao Paulo, Brazil
Camila A. Peres1, A.S. Amorim2, F. Silveira4, R. Barbosa2, M.C.S. Castro3,
N. Hearst5. 'Rua Frei Caneca 1140 Sao Paulo SP CEP 01307-002; 2AIDS State
Program Health Department, Sao Paulo SP; 3State Foundation for Child
Welfare, Sao Paulo SP; 4 University of Sao Paulo, Sao Paulo SP, Brazil;
5University of California, San Francisco CA, USA
Cases of AIDS are increasing among incarcerated juveniles in Brazil. Despite
this, few prevention activities have been developed, and always carried out
by non-governmental organizations without involving the own workers of the
institution.
Objectives: To determine the psychosocial and institutional barriers to AIDS
prevention programs within the Brazilian government juvenile detention system
(FEBEM).
Methods: Questionnaires and group discussions have held with 75 workers
who deal directly with 900 boys and girls in 15 units. These discussions occurred
during 6 workshops, each lasting 16 hours and including 15-18 workers. The
workshops aimed to prepare them to design and carry out AIDS prevention
programs within their units.
Results: The main obstacles reported by workers were: 1) few workers and
overcrowded units; 2) predominance of the jailer function over that of educators; 3)
previous projects without continuity and little incentive from leadership; 4) inability
to deal with sexuality, drug addiction, marginality and violence in discussions with
youths; 5) ambivalent feelings-pity and impotence in the face of the youngsters'
emotional and social problems; repressed anger concerning the "conspiracies" of
the boys (rebellions and escape attempts); and jealousy due to projects always
being concerned only with the boys, and never with workers; 6) beliefs about the
non-rehabilitation of youngsters; in the effectiveness of the punishment educational method; and in the idea that condom distribution increases rape of weaker
boys by stronger ones.
Conclusions: Based on these data was designed a training program which
the main principles are: 1) systematic supervision; 2) workshops; 3) discussions
of AIDS prevention integrated with themes such as adolescence, marginality,
sexuality, drug addition and violence; 4) involving chief, workers, and youngsters;
5) specific AIDS programs for each unit; 6) periodic visits by an expert educator
to each unit to discuss the difficulties; 7) educational activities with the youngsters
aimed at making decisions and encouraging autonomy.
43263 Victor Vancouver: A multi-media health promotion
campaign for young gay/bi men
Zdenky H.S. Burkhardt1 2. AIDS Vancouver, 1107 Seymour St., Vancouver, BC,
V6B 5S8, Canada
Issues: Vancouver is a major HIV epicentre and has one of the highest sero-incidence rates among 19-30 year old gay and bisexual men in Canada. Designing a
HIV prevention and Health Promotion Campaign for this group must be dynamic,
non-traditional and must reflect this population's social realities.
Project: The Victor Vancouver Project utilized several distinct media elements
targeting the 19-30 gay and bisexual community with the goal of raising community awareness and facilitating community discussion of gay/bi male HIV/AIDS
and health issues. The multi-media elements included: a weekly cartoon strip;
weekly distribution of the cartoon in poster and postcard form; an interactive
internet site; voice-mail with voting on community issues; sidewalk outreach with
street level surveying; discussion groups; and a compilation comic book. The
campaign promoted access to HIV/AIDS and health information and services.
It also utilized a variety of creative survey techniques to better understand the
social contexts and realities of this target population.
Results: The Victor Vancouver campaign received overwhelming support and
participation from the gay community. Many hard to reach young gay and bi
men were engaged in meaningful discussions about HIV/AIDS and other health
concerns. A wealth of information was gathered through several dynamic survey
and evaluation techniques and was used to assist with the development of further
programming for young gay and bi men in Vancouver.
Lessons Learned: Young gay and bisexual men who are tired of the "AIDS"
message, and other traditionally "hard to reach" young gay and bisexual men,
are receptive to health promotion initiatives when those initiatives are creative
and socially relevant.
43264 Motherhood as an opportunity for HIV risk reduction
among crack-using women
Nancy Corby1, M.G. Shedlin2, M.M. Wood1. 'CSULB Center For Behav
Research & SRVCS 1090 Atlantic Avenue, Long Beach, CA; 2Sociomedical
Resources Associates Inc., Westport, USA
Background: Crack cocaine users may not consider themselves at risk for HIV
because they smoke the drug rather than injecting it; furthermore, many female
crack cocaine users who trade sex for drugs or money do not define this activity

as prostitution and deny or avoid HIV prevention efforts targeting commercial
sex workers. The purpose of this study was to identify approaches for motivating
female crack cocaine users to reduce their HIV risk.
Methods: Qualitative data collected included in-depth individual interviews with
13 women who were current crack users. An additional 37 women participated in
one of five focus groups, one of crack users in treatment, two with current crack

users who described themselves as sex workers, and two with current users who
did not.
Results: All of the women, whether or not they identified themselves as sex
workers, reported they frequently traded sex for money. Most used condoms for
vaginal sex and some for oral sex. Many reported oral lesions from smoking
crack. Most of the women had children, but few were currently living with their
children. While some had been removed from the mother's custody by a children's
service agency, more were living with their fathers or grandparents (maternal and
also paternal grandparents) or with siblings of the mother. In all but a few cases,
crack-using mothers without custody expressed great sadness that they did not
live with their children. Their motherhood was a condition of pride, indeed, the
only thing many of the women felt pride over. All the women, however, reported
not wanting their children to know of their drug use or, especially, their sex work.
A substantial minority of the women expressed intentions to become pregnant
again and when they did, to use that as an opportunity to quit their drug use.
Participants expressed cynicism about their own or others' ability to do this.
Conclusions: Motherhood appears to be of major importance to female crack
users' sense of self-worth. The desire to retain or regain custody of their children
or for future pregnancies may serve as a motivator to adopt behaviors to avoid
HIV in order to be able to bear or care for one's children and may furthermore
provide an opportunity for recruitment into drug-treatment programs. This finding
further suggests the value of gender-specific risk-reduction strategies.
143265 An innovative intervention that promotes a healthier sex
life for the HIV+ man who has sex with men
Deborah Cornman1 2. AIDS Project/Hartford 110 Bartholomew Ave. Hartford,
CT; 2AIDS Project/Hartford, USA
AIDS Project/Hartford in collaboration with four other community-based organizations in Connecticut developed an innovative 8-session risk-reduction workshop
for HIV+ men who have sex with men. The focus of the workshop is to reduce
riskier behavior among HIV+ MSMs in order to maximize their health and to
minimize the transfer of the HIV virus to others. The workshop is based on the
Information-Motivation-Behavioral Skills Model of Fisher and Fisher (1992). In
addition, over 50 HIV+ MSMs were interviewed for their input into the design
of this workshop. The resulting workshop is a highly structured, stimulating, and
provocative intervention that does the following: (1) utilizes a group format as a
way of enhancing participants' perception of social support for safer sexual behaviors, (2) provides information about a variety of topics including sexual rights, oral
sex, reinfection, and sexually transmitted diseases, (3) provides behavioral skills
training for negotiating safer sex with partners, for dealing with sexual triggers,
and for telling partners that they are HIV+, and (4) explores creative and varied
ways to have healthy sex. All group workshops are facilitated by HIV+ MSMs.
The workshop is in the process of being evaluated in the form of a randomized
ciontrol trial.
Group workshops which incorporate innovative and provocative ways to increase information, motivation, and behavioral skills can be very effective ways
to impact on the practices of risky behavior in HIV+ MSMs.
43266 Drug substitution treatment for HIV prevention: A WHO
initiative
Sujata Rana, A. Ball, M. Donoghoe, G. Weiler, A. Reynolds. WHO, Geneva,
Switzerland
Issue: Rapid dissemination of HIV infection associated with drug injection has
stimulated the development and expansion of drug substitution programmes as
a means to prevent HIV infection associated with injecting drug use.
Project: Drug substitution programmes are currently being implemented in
many countries with a wide range of socio-cultural, political and economic circumstances. Of the range of substances used in substitution therapies, methadone
is the most widely used and rigorously evaluated of all substitution approaches.
Most research on methadone and other substitution therapies has focused on
developed countries. However, given the dramatic spread of HIV associated with
drug use in many developing country contexts, there have been some innovative
and effective responses. This has included the establishment of drug substitution
programmes using methadone, buprenorphine and tincture of opium. WHO has
initiated a global project which comprises a number of integrated components.
The focus of this phase has been on Asia, where data have been collected from
existing programmes with a view to initiating demonstration drug substitution programmes in six Asian countries as well as a training package on drug substitution
programmes for drug treatment services and community health workers in the
Asian context.
Results: Evaluation of existing drug substitution programmes have provided
invaluable information on the wide range of community based substitution
approaches that exist in Nepal (methadone), India (buprenorphine), Thailand
(methadone, tincture of opium) and Vietnam (methadone) and demonstrated the
feasibility of community based and other substitution approaches.
Lessons Learned: One of the greatest challenges has been trying to maintain

a balance between developed country approaches to clinical practice and safety
versus the reality of clinical settings in the Asian context for drug substitution
programmes.