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

900 Abstracts 43267-43271

12th World AIDS Conference

573*/ 43267 The Portuguese transgender community:
An unknown reality
J6 Bernardo1, Maria Jose Campos2, G. Machado2, G. Tavares2, K. Wandolly2,
G. Salce, Jr.2, G. Diniz3. 1Trav. do Noronha 5, 39 Dto., 1200 Lisboa; 2AbraCo
Lisbon; 311ga Portugal, Lisbon, Portugal
Issue: Characterise the Transgender Community in Portugal
Project: Two questionnaires, one directed towards transgenders working as
sex workers, the other towards transgenders working on other professions, were
designed to describe and evaluate social and economic characteristics of community, together with aspects connected to healthcare, the amount of information
on HIV infection and risk behaviour. Questionnaires were filled in by personal
interview realised by members of the community.
Results: In the community as a all, 57% are sex workers, 64% live in an
apartment, 43.5% live alone, 54% do not benefit from any kind of social security,
72% come from rural areas, and 28% moved from their birthplaces due to their
sexual orientation. 62% have done HIV test and 30% are HIV positive. 25% of the
ones submitted to HIV tests did not have any kind of counselling. 70% consume
alcohol, tranquillisers and/or heroin on a regular basis. 61% said they always use
a condom.
Of those working as sexual workers, they started working between ages 11 and
38. 86% work in the streets and 54.5% said they always use a condom.
The most important needs identified by this community are leaflets with information on HIV prevention and counselling mobile unit at their workplaces during
the night.
Lessons Learned: The Transgender community in Portugal is an unknown
reality, ignored by the public health system. A large majority of its members having
a profession that is considered illegal, they do not benefit from any kind of social
and medical assistance. The fact that 25% did not have any kind of counselling
when they were tested for HIV stresses the need of information among the
community.
43268 100% condom policy in brothel complexes in Indonesia:
Lesson learned from the Kramat Tunggak study
Endang Sedyan Ingsih-Mamahit. JI. Pen Didikan Raya III, Blok J55, Duren
Sawit, Jakarta, Indonesia
Issues: The female commercial sex workers (FCSWs) and their clients in Indonesia constitute communities at high risk to get and to spread the HIV infection.
Since a public safe-sex campaign is still difficult to do, considerable efforts have
been targeted at brothel communities. The 100% condom policy for the FCSWs'
clients is one strategy recently launched by the Indonesia Ministry of Health. Its
implementation is, however, still a big challenge for public health practitioners in
this country.
Project: Interweaving qualitative methods with behavioral survey, this crosssectional study in Kramat Tunggak brothels investigates the determinants of the
FCSWs' Sexually Transmitted Diseases (STD)- and AIDS-related risk behaviors.
Results: The women's continuous condom use was significantly predicted by
their previous experiences in using and negotiating condoms; ORs (odd ratios)
= 9 (p = 0.007), and 5 (for the highest experience) (p = 0.0001), respectively.
Experience in negotiating condoms was, in turn, significantly predicted by knowledge on STD/AIDS, positive beliefs about condoms, and self-efficacy in using
condoms. Continuous condom use was negatively associated with clients' and
brothel managers' rejection on condoms; OR = 0.12 (for the highest rejection) with
p = 0.0001. Qualitative approaches revealed the characteristics of the FCSWs
and brothel management style which influenced the condom-use practice in this
brothel complex.
Lessons Learned: To be successful, 100% condom policy in brothel complexes should not stand alone, but should be implemented together with other
strategies, such as appropriate and friendly health services and well-tailored
STD/AIDS training programs.
43269 HIV infection and risk behavior among urban female sex
workers: Missed opportunities for intervention
Jennifer Von Bargen1, K.S. Miller1, S. Faruque1, C. Word2, C.B. McCoy3,
B.R. Edlin1. 1Centers for Disease Control 1600 Clifton RD MS-E-45 Atlanta
GA30333; 2Bayview-Hunters Point Foundation San Francisco CA; 3CDRC
University of Miami Miami, USA
Background: To examine factors associated with condom use and opportunities
for intervention among young inner-city female sex workers.
Methods: We categorized women recruited from the street for the Multicenter
Study of Crack Cocaine and HIV Infection who reported using crack cocaine
and engaging in sex work (n = 306) into 3 groups: Those who used condoms
always with both paying and nonpaying partners (n = 35), always with paying
partners only (n = 67), and inconsistently with both types of partners (n = 204). We
also examined intervention opportunities in three convenience settings: medical
facilities, jails and prisons, and drug treatment centers.

Results: Women who did not use condoms consistently were more likely to
be homeless (9%, 18%, 26%, p =.02), use sex work as their principle source
of income (37%, 33%, 50%, p =.02), report more paying sex partners in the
previous 30 days (mean, 2, 3, 7, p < 0.001), report sex with an injecting drug
user (35%, 36%, 52%, p =.02), engage in sex work in a public place (40%, 37%,
55%, p =.01), smoke crack in a public place and (49%, 48%, 67%, p <.01), and
be HIV positive (11%, 16%, 34%, p <.01), and were less likely to have been

previously tested for HIV (77%, 73%, 58%, p =.01). There were no differences in
the amount or duration of crack use (mean, 16 hits/day, 5.3 years), or duration of
sex work (mean, 6.4 years). Of those who spent time in a medical facility, in jail,
or in a drug treatment center, only 22%, 19%, and 29%, respectively, received
AIDS information in these settings. The vast majority received AIDS information
from television or newspapers.
Conclusion: Life circumstances such as adequate housing and the social
and economic context of sex work were more predictive of condom use than
receipt of AIDS information as currently delivered. Medical facilities, jails, and
drug treatment centers are underutilized in educating, counseling, and supporting
this reportedly hard-to-reach population.
S43270 HIV risk behavior intervention trial in foreign female
prostitutes (FFPs) in Japan
Timothy Sankary1, R. Frerichs1, M. Kihara2, M. Miyao3, K. Nakajima4,
K. Tadokoro4. 1Dept. of Epidemology, UCLA School of Public Health, Los
Angeles, CA, USA; 2Kanagawa Cancer Center, Yokohama; 3Nagoya University,
Nagoya; 4Japanese Red Cross Blood Center, Tokyo, Japan
Objectives: 1. To determine the prevalence of HIV infection and risk factors in
street FFPs in Japan. 2. To recruit FFPs into an ongoing STD care/HIV prevention
program providing them with stronger condoms and proper lubricant, providing
education and care in their native languages. 3. To determine the effect of this
first ever program on condom usage and breakage rates.
Design: Cross-sectional study, followed by a prospective, controlled intervention trial.
Methods: Street-based interviews to assess risk factors were conducted on
146 FFPs (Latin Americans in Japan) in summer 1997. Saliva specimens were
collected (Orasure) after informed consent and tested using HIV-1/HIV-2 EIA Plus
(Abbott) with confirmation by Western Blot. Trial subjects in defined areas were
recruited into a 2-month prevention program offering culturally-sensitive HIV testing/counseling, stronger condoms (0.10 mm) and proper water-based lubricants.
Similar control subjects from a comparable but distant area were randomly surveyed and tested but not offered the intervention program. Controls used the free
condoms (0.02-0.03 mm) provided by the hotels and little or no lube. Daily diaries
of condom/lube use and breakage were collected every 2 weeks as allowed from
both groups.
Results: Control and trial groups were comparable at baseline and condom
use was nearly 100%. During the 4 month study, police raids caused great subject
attrition and doubled the work. In the trial group, 63/81 (77.8%) FFPs returned
diaries, similar to 38/65 (58.5%) of controls (p = 0.28). Only 2/4850 (0.041%)
strong condoms broke in the trial group, vs. 24/3821 (0.628%) hotel condoms
in the control group (including 18/239 hotel condoms used by the trial group
when they ran out of strong condoms) RiskRatio = 0.07 (95% CI = 0.02, 0.28).
Prevented Fraction 93.4% (72.2, 98.4)
Conclusion: HIV risk in commercial sex workers that always use condoms but
the condoms frequently break, can be reduced through a community intervention
providing stronger condoms, lubricant and risk reduction education. AIDS prevention is difficult in a hostile environment. Japan needs to place priority on AIDS
prevention in their high risk groups.
43271 Interventions in public sex venues: An example of
developing an HIV prevention strategy in England
Will Nutland. 52/54 Grays Inn Road London, England
Issues: The illegality of public sex has hampered interventions to increase easy
access to strong condoms and water-based lubricant in public sex venues in
London and other metropolitan areas in England. Debates about interventions in
PSVs have focused on the responsibility of the state, 'community', venue owner
or individual venue users rather than regarding a strategic approach.
Project: During 1997, The Terrence Higgins Trust co-ordinated CHAPS initiative researched and developed a strategy to reduce the incidence of HIV infection
through sex between men in England. The strategy provides theoretical and
strategic planning frameworks for HIV health promotion with homosexually active
men in England. By systematically examining factors influencing HIV incidence,
the strategy identifies twelve health promotion aims. The strategy provides a
framework to determine the health promotion methods which make achieving the
aim of 'increasing easy access to strong condoms and water-based lubricant' in
this particular setting (public sex venues) more likely.
Results: A combination of four areas of health promotion methods (strategic planning and facilitation; direct contact health promotion; community health
promotion and organisational and institutional health promotion) are identified
that increase the likelihood of achieving the stated aim. Addressing one method
without regarding a combination of the others will not be effective in achieving the
aim.
Lessons learnt: Interventions to increase access to strong condoms and lubricant in PSVs need to be built into a strategic planning framework that involves
more than just the marketing of condoms. Educating venue owners and staff,

local authorities and key policy makers are also essential activities.