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

902 Abstracts 43278-43281

12th World AIDS Conference

privileging the expression of emotions, attitudes and beliefs in front of participants, to their sexuality and to the HIV/AIDS reality. A space of analysis on their
sexuality, style of life and information and prevention of STD and HIV/AIDS, in
social networks. The topics were approached through 9 activities that included:
attitudes towards their sex; perception of risk; family communication; the couple;
assertively in the decisions; self-acceptation of the sexual orientation; human
rights.
Results: 172 activities were implemented between 1995-1997 with the participation of 1.576 people in 7 Chilean cities. The evaluation process of each session
revealed the necessity of promoting public spaces of communication among
themselves, as well as the necessity of information on STD and HIV/AIDS. 1.902
condoms were distributed. Also information of access to Public STD Centers
where the ELISA exam is given.
Lessons Learned: the STD and HIV/AIDS prevention in vulnerable populations is effective by means of an integral boarding (dissemination of information,
creation of a social favourable environment and the provision of basic services) as
well as the community participation (education of pairs), overcoming the traditional
outlines of individual information.
43278 HIV prevention among men with severe mental illness
Alan Berkman1, E. Susser2, E. Valencia3, N. Sohler4, S. Conover2, J. Torres3.
178 Bank Street Apt 6 New York NY 10014; 2HIV Center for Clinical & Behav.
Studies New York NY; 3Presbyterian Hospital Psych. Services New York NY;
4Columbia University Dept of Psychiatry New York NY, USA
Background: The spread of HIV to impaired populations has intensified the challenge for HIV prevention; control of the epidemic now requires behavioral change
among individuals with limited ability to attend and learn. This randomized clinical
trial tested an intervention to reduce sexual risk behaviors in a high risk impaired
population: homeless men with severe mental illness.
Methods: Men were recruited from a psychiatric program in a homeless shelter.
Among 116 eligible men, 97 (84%) participated. The majority were African-American, had a chronic psychotic disorder and a comorbid substance use disorder.
Participants were assigned to a 15 session experimental group intervention or to
a 2 session control intervention, and followed for 18 months. The 59 participants
sexually active prior to the trial were the main target of the intervention. Sexual
risk behavior was the primary outcome.
Results: Among the 59 sexually active men, complete follow-up data were
obtained on 59 (100%) for the initial six-month follow-up, and on 56 (95%) for the
remainder of the 18-month follow-up. The mean score on a sexual risk index for
the experimental group was three times lower than for the control group (1.0 versus 3.1, p =.01) during the initial six-month follow-up, and two times lower during
the remainder of the 18-month follow-up. The proportion of encounters protected
by condoms in the experimental group was two times higher than in controls. No
adverse reactions to the sexually explicit intervention were documented.
Conclusions: This intervention successfully and safely reduced sexual risk
behaviors of homeless mentally ill men. The effect diminished over 18 months
but did not disappear. Similar approaches may be effective in other impaired high
risk populations.
43279 Lessons learned from the CDC African-American
initiative: Keeping pace with an unrelenting epidemic
P. Imani Thompson, Dawn Smith, Kim Miller, Mari Brown, Lumbe Davis. Centers
for Disease Control and Prevention (CDC), 1600 Clifton Road, Mailstop E-58,
Atlanta, GA 30333, USA
Issues: African-Americans remain disproportionately affected by the HIV epidemic in the United States. In 29 states where newly identified HIV infections
are reported to CDC, African-Americans were 54% of reported cases compared
to whites at 36%. Due to the long interval between HIV infection and the development of AIDS, HIV infections may more accurately represent the current
demographic epidemiology of the epidemic than newly reported AIDS cases.
Project: CDC is assessing its HIV prevention efforts in African-American communities. To date, critical analysis of epidemiological and research program data
was conducted, and eight focus groups of specific sub-populations (e.g., injection
drug users, women, gay/bisexual men, adolescents, etc.) were held. Governmental and non-governmental consultants have participated in a multi-phased
process including defining the problems, assessing programs, and designing
and implementing strategies. The implementation strategies will include developing evidence-based approaches and strengthening, supporting, and redesigning
existing HIV prevention strategies.
Results: Examination of existing epidemiological data revealed that in 1996, for
the first time, the number and proportion of annual AIDS cases reported among
African-Americans (28,346; 41%) exceeded that among whites (26,229; 38%).
This "parity" is occurring despite the fact that African-Americans are 13% of the
US population and whites constitute 73%.
Focus group participants described a variety of emotions in reaction to HIV
and AIDS including: fear, denial, and compassion for those infected and affected.

HIV/AIDS is also associated with the stigmas of homosexuality, promiscuity, and
substance abuse. Racism and discrimination, gender role socialization, hopelessness, and lack of knowledge were social and cultural factors repeatedly identified
as facilitating the spread of HIV through African-American communities.
Denial of the existence of HIV/AIDS in the community was an especially strong
theme in all focus group sessions. Faith communities were seen as playing a
key role in HIV prevention by shaping attitudes towards those who are infected.

Programs with a holistic approach (dealing with the whole person- not just HIV
infection) were viewed as most effective. Finally, inadequate funding has reportedly prevented many programs from reaching large segments of their intended
audiences.
Lessons Learned: The African-American initiative can serve as a model for
the development of similar assessments in other people of color communities.
In-depth needs assessments such as that conducted by the African-American Initiative help to elucidate the strengths and weakness of current program strategies
and identify gaps in services. Specific behavioral and community interventions
must be designed, implemented, and evaluated with culturally appropriate leadership and participation from affected communities.
S43280 HIV/AIDS among males who have sex with males (MSMs)
in Pakistan
Omar Khan1, A.A. Hyder2. 1Johns Hopkins Sch. Public Health/Ctr. for Comm.
Programs, 111 Market Place, Ste 310, Baltimore, Maryland 21202-4024; 2Johns
Hopkins Sch. of Public Health, Baltimore, MD, USA
The presence of HIV was first discovered in Pakistan in 1988, and subsequently
has been reported from all parts of the country. Data from the national AIDS control program indicates that HIV/AIDS cases have been increasing over the past
decade. Among other risk factors, males having sex with males (MSM) has also
been identified. The issue of MSMs in South Asia, especially in Islamic countries,
is not adequately discussed even among those charged with the prevention and
control of AIDS. Pakistan is a country in both categories, making such a dialogue
both innovative and urgent. The objective of this paper is to demonstrate the role
of MSMs in the transmission of HIV in Pakistan and to extrapolate that information
to study the occurrence of this behavior in the country. The intent is to focus attention on MSMs and the accompanying high health risks as currently practiced,
and to explore the social and cultural context within which this behavior occurs.
Data on HIV/AIDS in Pakistan, an extensive review of literature and field visits
have been used to collect information on MSMs. Discussions with public health
and HIV/AIDS professionals have also been conducted and the work of other
foundations has also been reviewed. This paper presents a profile of HIV/AIDS
in Pakistan using epidemiological estimates. Then it specifically identifies those
reported cases acquired by males having sex with males. The socio-cultural
context of HIV/AIDS transmission is then analyzed with special reference to the
MSM population. Finally, potential interventions that would increase awareness
of AIDS among this marginalized group have been described.
Attitudes towards HIV/AIDS in the country range from denial to grudging acceptance to notions of retribution for sinful acts. This work attempts to bring a
discussion of such issues to the forefront. The aim is to promote a more constructive dialogue on sexuality and health with special reference to HIV/AIDS
transmission among MSMs in countries such as Pakistan.
[43281 Intervention/awareness among long-distance lorry
drivers and inn girls working along highways connecting
China and Vietnam
Kong-Lai Zhang1, H. Li1, J. Chen2, W. Liu2, S.L. Liang2, Q.Y. Wang1, X. Liang2.
15 Dong Dan Santiao, Peking Union Medical College, Beijing; 2Guang Xi
Epidemic Prevention Center, Nanning, China
Objectives: To understand the awareness of HIV, practice of sex business and to
develop of intervention programs among long distance lorry drivers and inn-girls
working along highways connecting southern part of China and Vietnam.
Design: Cross-sectional, prospective.
Methods: A total number of 364 drivers (184 and 180 in the intervention and
control groups) and 410 inn-girls (220,190 in intervention and in control groups)
were selected in KAB studies (pre- and post-intervention) along the border areas
in Guangxi which connecting Vietnam and China. HIV/STDs awareness and sex
practice, using self-administered questionnaires in addition to focus-group discussion and in-depth interview, peer-education approach was studied, followed by
intervention program emphasizing condom use through distribution of condoms
and other specifically designed comics, music tapes pamphlets, video-tapes,
group discussion and peer education. A similar number of drivers and inn-girls
served as control groups.
Results: Prevalence rates of Gonorrhea, syphilis and HIV were: 10.96%,
0.66%, 0%; 17.51%, 1.87%, 0% among drivers and inn-girls respectively. Data
from the second survey, three months after the intervention program, showed: 1)
rates of awareness on condom use increased from 45.6% to 89.8% and 23.2%
to 86.7% in the intervention group for both drivers and inn-girls; while 27.4%
to 30.1% and 47.3% to 49.6% in control groups. 2) rates of condom use when
having casual sex increased from 38.0% to 68.0% and 26.2% to 42.3% in the
intervention group, comparing to 30.2% to 30.6% and 26.7% to 22.7% in the
control group, for both drivers and inn-girls; 3) average numbers of self-reported
casual sex partners were 2.3 versus 1.3, and 2.9 versus 2.3 in the intervention
group, comparing to 2.3 versus 2.0 and 2.9 versus 2.6 in the control group for
both drivers and inn-girls.

Conclusion: Intervention program seemed to be acceptable and effective for
the lorry-drivers and inn-girls to increase awareness and practice of condom use
while the number of sex partners remained almost the same. Condom promotion
needs to be further strenthened along with a better understanding of sex business
in the area.