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

12th World AIDS Conference

Abstracts 43301-43305 907

43301 Inducing pivotal decision makers in effecting behaviour
change through infotainment
Shilpa F. Merchant1, Lalita Shankar2. 149/151 Cursondas Natha Bldg Raja Ram
Mohan Roy Rd, Bombay, India
Issue: An important sphere of power that wields its influence over female sex
workers (FSW) is the male client within the socioeconomic milieu of Bombay's
Red Light District. From the FSWs point of view, it is still a question of economics
and not AIDS, especially when pivotal decision making powers (to use or not to
use a condom, choice in basic reproductive and sexual health care) are under
the male dominion of the brothel owners, their Mafia-related pimps who resort to
strong arm tactics if FSWs refuse to cater to clients who refuse to use condoms
and most influential, the clients themselves. Hence, reaching out to the FSW
through her male influence has been the objective of this Project.
Method: The challenges in making this project operational have been two fold.
One, the target of reaching the male client, leave alone inducing a change in his
behaviour. Hence, activities are based on a model that has identified the need
to implement innovative infotainment strategies (information interspersed within
entertainment) that overcome the limitations of information fatigue. Two, a range
of services that were needed to be provided like easy availability of condoms
and primary health care access to make the objective of the project holistic and
relevant to the FSW, the eventual beneficiary.
Project: The main elements in the communication of information regarding
STD, HIV & AIDS has been through:
(a) Interpersonal Communication with the client: focus on improving condom
usage by promoting it through film shows, flip charts, flannel board, slide viewers.
(b) Street Theatre: By portraying real life situations to depict high risk behaviour,
these shows in two local languages have developed into a popular mass media
exercise.
(c) Social marketing of condoms: This has been achieved by sales through unconventional outlets like teastalls, local barber and pan/beedi kiosks and through
strategically placed condom vending machines that assure both, accessibility and
confidentiality.
Conclusion: Impact: Percent of awareness on HIV/AIDS rose from a mere 6%
to 100% after filmshows. More than half (56%) of the influences (clients) reported
use of condoms after seeing the multimedia show. Evidence of increased health
care awareness and social impact in supplementing the existing preventive efforts
needed to alleviate the AIDS epidemic amongst the target group
43302 Reduction of addictive and risk taking behaviour during
participation in a medically controlled heroin prescription
program
Thomas Steffen1, A. Uchtenhagen1, F. Gutzwiller2, A. Dobler-Mikola1.
'Addiction Research Institute, Konradstrasse 32, 8005 Zuerich; 2Institute of
Social and Preventive Med., Zurich, Switzerland
Objectives: To document and analyze changes in addictive behaviour and risk
factors regarding transmission of a HIV-infection.
Design: Prospective cohort study
Methods: The medically controlled prescription of narcotics program PROVE
followed a uniform research protocol from 1.1.94 until 31.12.96. The program
included 800 slots for heroin prescription, 200 slots for the prescription of intravenous methadon and the same for intravenous morphine. Entry criteria were
minimal age of 20, minimal duration of daily heroin consumption 2 years, negative
outcome of at least 2 previous treatments (residential or substitution with oral
methadon), documented social and/or health deficits as a consequence of their
heroin dependence. Concomitant cocain consumption was documented through
self report and urin analysis.
Results: In the cohort of 873 patients who received heroin, the HIV prevalence
at entry was, according to screening-tests, 15.3%. Patients with daily cocain
consumption had a higher prevalence (21.5%) in comparison to those with occasional use (12.7%) and patients without cocain use (13.0%). Differencies are
highly significant (p = 0.001). After 18 months of continued participation in the
program, 74% of patients reported no illegal heroin consumption, and the rate of
cocain abstinence increased from 15% at entry to 41%.
Conclusion: Intravenous heroin consumption and cocain consumption are
well documented risk factors for the transmission of a HIV infection. Within the
framework of the medically controlled heroin prescription, a significant reduction
of this risk was obtained in a target population of heroin dependent persons who
failed in all previous treatments.
43303 Seafarers' intervention in Navotas, Metro Manila,
Philippines
Dominga Gomez. Phil. Gen. Hosp. (C/O Off. of the Asst. Dir. for Nursing), Univ.
of the Phils. MIa, Taft Ave, Manila, Philippines
Issues: Reaching out to a risk group like seafarers who have low educational

attainment short attention plan, language barrier, irregular work-schedule is a
challenge to HIV/AIDS prevention workers.
Project: This project was an offshoot of a formative research project where
deep sea fishermen and crew of inter-island boats were found to be indulging
in risky and casual sex with female sex workers and who manifested the lowest
level in a knowledge, attitude, and perception survey conducted. An intervention
project targeted the seafarers was implemented using small and large discussion
groups following a defined curriculum.

Results: More than 1,000 seafarers were reached by the project. Also, about
1,000 IEC materials on the infection were distributed. The approaches/strategies
applied were (a) actual immersion work the best way to tap natural leaders,
establish network/linkages and make the target group interested; (b) be there
where they are - if structured room type lecture is not possible, use of other
approaches like boat hopping, informal discussions/presentations in communities
and offices; (c) use of more flexible visual aids like flip charts, clear book, actual demonstration, testimonies and other come-ons to make the session more
interesting and understandable; (d) be one of them - speak their language, avoid
"expert mentality" and use of technical terms; and, (e) team approach.
Lessons Learned: (a) Networking at all levels - from top management, but
more importantly at the grass root level; (b) Patience, perseverance, flexibility and
resourcefulness are important qualities/traits one must possess when conducting
intervention work; and, (c) Audio-visual materials should be culturally appropriate
and easily understood by the target groups.
43304 A comparison of the Unmet service needs of HIV+ and
HIV- injection drug users (IDUs)
Kim Blankenship, K. Khooshnood, C.T. Roan, F.L. Altice. Yale University AIDS
Program 135 College Street #323 New Haven CT 06510, USA
Objective: To compare unmet needs for health and drug treatment services for
HIV+ and HIV- IDUs.
Methods: A cohort of active IDUs (injection within past 6 months) was recruited
using a modified snowball methodology.
Results: Demographic, drug use, and health utilization data for the first 216
(recruited 4/97-9/97) of 357 subjects were entered and analyzed. Of these, 31%
are women, 37% whites, 47% blacks, and 12% latino/as. Daily injection was
reported by 62%; 72% were not enrolled in drug treatment and 36% self-reported
being HIV+. A comparison of met and unmet needs for medical (MS), mental
health (MHS), dental (DS), prescriptive medication (PS), and drug treatment
(DTS) services for HIV+ and HIV respondents revealed that 84% had an unmet
need for at least one service type: 28% for MS, 26% for MHS, 43% for DS, 28%
for PS, and 29% for DTS. One-fourth of HIV+ respondents had an unmet need
for HIV-related care. Overall, HIV respondents were more likely than HIV+s to
have unmet service needs; and in particular, for MHS (32% vs 17%, p. 0.02) and
DTS (31% vs 21%). HIV individuals were also more likely to have unmet needs
in multiple (-3) service categories (33% vs 11%, p - 0.05). HIV respondents
were more likely than HIV+s to cite inability to pay (43% vs 24%, p - 0.01) as
a reason for not receiving services. This is consistent with the finding that 30%
of all HIV-, but only 6% of HIV+, respondents had no medical insurance. Other
top barriers to receiving needed services included "not liking to see providers",
preoccupation with drug use, and stigma due to drug use. Respondents most
often dealt with unmet needs by "waiting out" the problem or by using illicit drugs
to relieve symptoms, but HIV-respondents were more likely to do so (66% vs 56%
and 41% vs 31%, respectively).
Conclusion: The extent of unmet service needs among IDUs is high, but HIV+
IDUs have fewer unmet needs than HIV- IDUs, particularly for mental health
and drug treatment. Greater access to services among HIV+ IDUs may result
from their higher rates of medical insurance coverage. IDUs should not have to
wait to become HIV+ before gaining access to medical coverage and services.
Given the association between mental health problems, drug use and HIV risk,
HIV prevention for IDUs should include improving access to services.
1 43305 A community-based HIV intervention program to MtF
transgenders in Hollywood, California
Cathy Reback1, E.L. Lombardi2. Van Ness Recovery Hopuse/Prevention,
11361/2 North La Brea West Holywood, CA; 2UCLA Drug Abuse Research
Center, Los Angeles, LA, USA
Issue: Los Angeles County is home to a large and heterogenous male-to-female
transgender population, many of whom are at high risk of HIV infection from both
drug use and sex work.
Project: A community-based intervention program targeting MtF transgenders,
and designed with input from MtF transgenders, was implemented to reduce HIV
risks within this population. Services include outreach in identified high-risk areas,
four thematic community skills building workshops, a weekly mentoring support
group, peer counseling, referrals for needed services, prevention packages, and
hygiene and cosmetic kits.
Results: During the first 18 months of the program (January 1996 through
June 1997), 861 MtF transgender persons were contacted and informed of the
HIV intervention/prevention program. Of those, 209 participated in at least one
community workshop and/or support group. 46% were Latin, 28% white, 22%
African American, 6% Asian/Pacific Islander, and 3% Native American. Ages
ranged from 16 to 55 years, with the mean age 31 years. 25% were either
homeless or in marginal living situations. At baseline intervention, 35% reported
exchanging sex for money and/or drugs, 43% reported active drug use and 19%
reported unprotected sex with a male partner in the last 30 days.

Lessons Learned: A HIV intervention/prevention program specifically designed
by and for MtF transgenders at risk of HIV transmission can be an effective way
to lower high-risk behavior(s), increase self-esteem and provide social support
within this population.