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

908 Abstracts 43306-43312

12th World AIDS Conference

43306 AIDS education, gender, sexuality, culture and risk
taking: An analysis of infection prevention materials in
Vancouver, Canada
John P. Egan. 408-621 East 6th Avenue, Vancouver, BC V5T 4H3, Canada
Issues: Though almost two decades of AIDS education have dramatically slowed
infection rates, a significant number of young people continue to engage in sexual
activities which are perceived to carry significant risk for HIV infection.
Project: What strategies in printed English-language materials have been employed in AIDS prevention flyers and posters used in Vancouver Canada? How
are issues of sexuality, gender and sexual health represented? In a culturally pluralistic milieu such as Vancouver, what cultural communities are being neglected?
How might these representations havefailed to reach certain risk takers? Are the
categorization of risk themselves problematic?
Results: Printed AIDS education materials are of limited relevance to persons
who are not self-identified gay men. Alternately, the behavourist stance in much
of these materials serves to depersonalize sexual activity, which is not wellaligned with more mainstream Canadian paradigms about sexuality. Gay men
are often subtextually characterized as untrustworthy and irresponsible sexual
partners, from whom gay men must protect themselves. And a broader selection of linguistically and culturally specific printed materials must be made more
readily available. These aspects of otherwise very successful AIDS education
programmes exclude and alienate some, leaving them at risk for HIV infection.
Lessons Learned: While the strategies currently employed by community
based and government entities have been largely successful, HIV infections
continue to occur. Printed materials successfully have helped self-identified gay
and bisexual men to reduce infection risk, but the production of materials which
validate the contextual realities of those at risk (gay/bi men, hetero women, hetero
men, specific cultural communities) has also been successful, and might well fill
the gaps listed above.
S43307 HOPE worldwide Prison Program: Support and
prevention based on KAP assessment
Mokgethi Tshabalala1, M.R. Ottenweller2. 1220 Cornelis St. Fair land
Johannesburg; 2Hope Worlwide Johannesburg, RSA
Issue: Comprehensive care, support, and prevention must be based on KAP
assessment.
Project: The HOPE worldwide prison program at Johannesburg Prison is a
model of comprehensive, integrated AIDS support and prevention. Counsellor
training programs have been instituted at all levels of the prison personnel.
Support groups provide on-going counselling, psycho-social support and open
discussion of social issues. Medical care is provided through weekly medical
clinics and must be integrated with the peer counsellors. PWA's use daily video
presentations and discussions to educate 500 new inmates per week on awareness and prevention. Presently 12 medical providers and 60 warders have been
trained and several support groups meet on a weekly basis.
Results: After extensive questionnaires and focus group discussions it became
apparent that 83% of the inmates considered themselves at little or no risk of the
infection, less than 50% ever used a condom, and sexual behaviour was difficult
to assess due to stigma.
Lessons Learned: All levels of staff must be involved in the program. Care,
support and prevention are best developed and implemented by PWAs. Support
and prevention must be integrated. Despite many challenges, dynamic prison
support and prevention programs can be established.
43308 Strategies for the prevention of HIV infection associated
with injecting drug use: An overview
Andrew Ball1, M. Donoghoe1, S. Rana1, G. Weiler2. 1 World Health Organization
CH-1211 Geneva, 27, Switzerland; 2The Centre for Research on Drugs, London,
UK
Issue: HIV infection associated with injecting drug use has spread rapidly worldwide. Evidence indicates that there are effective interventions which may prevent,
slow and even reverse HIV epidemics associated with injecting drug use, both in
developed and developing countries.
Project: An objective of the WHO Programme on Substance Abuse Drug Injecting Project Phase II is to review the range of interventions available to prevent
HIV (and other blood-borne infections) transmission associated with injecting
drug use, both an individual and population level. The review has covered the
international literature and has focused particularly on grey literature and case
studies from a wide range of developing countries. New data is being collected
from at least 20 cities around the world.
Results: There is a wide range of interventions being implemented in both
developed and developing countries which aim to reduce HIV risk practices
associated with injecting drug use. Such interventions include: Opioid substitution pharmacotherapy, needle syringe exchange and distribution, condom and
bleach distribution, outreach to injecting drug users, peer education programmes,

social network interventions and abstinence-based treatment. Many of these
interventions have been evaluated and found to be effective in preventing HIV
transmission.
Lessons Learned: Situation assessment is essential for the design of a comprehensive and multisectorial response to prevent HIV transmission associated
with injecting drug use. Most interventions developed and tested in developed
countries may be translated to developing and transitional country situations.

43309 1CHAPS: Developing a nationally co-ordinated, research
based HIV prevention project targetting gay men in
England
Colin Dixon. The Terrence Higgins Trust 52-54 Grays Inn Road London WC1X
8JU, England
Issues: This paper addresses the issues involved in establishing a nationally
co-ordinated community based HIV prevention strategy for gay men and bisexual
men. It will examine ways of integrating appropriate research and epidemiology
into prevention programmes and strategy development and will look at experimental ways of developing and distributing specific prevention campaigns and
resources.
Project: For the last two years the Terrence Higgins Trust has taken the lead in
establishing a nationally co-ordinated primary prevention programme for gay men
and bisexual men in England. CHAPS (Community HIV and AIDS Prevention
Strategy) has provided an opportunity for nine community based organisations
to work in partnership with researchers in developing primary prevention programmes targeting gay men and bisexual men in England.
Having prioritised a number of issues specific campaigns which could be implemented at local and national level were developed. Two research organisations
were involved in basic research, pre-testing and evaluation for the campaigns and
in the development of a comprehensive national strategic framework to reduce
the incidence of HIV amongst homosexually active men in England.
Results: Researchers have played a central role in the development and
establishment of CHAPS. A national strategy for gay mens and bisexual mens
HIV prevention work has been developed and agreed by all CHAPS partners.
Consideration is currently being given to ways of broadening the impact of this
strategy with its adoption by a larger selection of prevention agencies in England.
Researchers and prevention specialists can work in partnership effectively if
care is taken in the process of establishing and maintaining national collaborative
working. The national strategy provides a framework for prevention work with gay
men and bisexual men which will be relevant in a variety of settings and could be
adapted for use in other countries and with other target populations.
43311 A randomised controlled trial of a small-group
behavioural intervention with high risk gay men attending
and STD clinic: Baseline data
John C.G. Imrie1, A.P.J. Billington2. 1Sexually Tansmitted Diseases, University
College London Medical School; 2Camden & Islington Health Service Trust,
London, UK
Objective: To determine the effectiveness of a brief small-group behavioural
intervention in reducing sexual risk-taking of high risk gay men attending a central
London STD clinic.
Methods: Ongoing randomised controlled trial with recruitment and intervention
complete. Three hundred sixty-one gay and bisexual men 'at high risk' (presenting
with an acute STD or self-reported unprotected anal intercourse within the last 12
months) were recruited and randomised to either standard management (one-toone with a counsellor and possible onward referral) or standard management
plus a one-day (7 hour) small group behavioural intervention workshop run by
trained facilitators.
Follow-Up: At 6 months = 84% (234/279) (83% Interventions, 85% Controls);
At 12 months = 72% (154/214) (71% Interventions, 73% Controls).
Outcome measures: Self-reported sexual behaviour and incident STDs compared between the trial arms.
Baseline Characteristics: Of 499 men referred to the trial, 361 (72%) agreed
to participate, and 72% (133/185) completed the intervention. Mean age 30.2
years (SD 6.9); 91% white; 86% educated beyond secondary school, which accurately represents gay men attending this clinic. Mean age at first anal intercourse
20.1 years (SD 4.2); 56% reported previous STD treatment; median number of
male sexual partners in last year was 20 (range 0-500), 61% (219/358) reported
at least one episode of non-condom use for anal intercourse in the last year, of
whom 66% (145/219) reported it having occurred with a partner of unknown or
discordant HIV status.
Conclusions: 1) Simple criteria have identified a group of clinic users whose
STD histories and sexual practice places them at higher risk of HIV infection. 2)
Recruitment and follow-up rates indicate that RCTs of behavioural intervention
within an STD clinic are possible and appropriate. 3) With interventions focusing
on individual behaviour change, RCTs provide the best evidence of effectiveness.
143312 Project Lambda: HIV/AIDS prevention and care project for
gay men in Bogota, Colombia
Jeffrey Stanton1, H.A. Ardila1, A.D. Mejia1, A.M. Pehuela2, J.L. Calderon1.
1LCLCS, Av. 32 14-46, Bogota; 2Secretaria Distrital de Salud, Bogota, Columbia
Background: Reduce the sexual transmission of HIV in Gay men and other men
who have sex with men in Bogota, Colombia
Methods: Train 200 "multipliers" on sexuality and HIV/AIDS and provide them

with the tools to multiply the acquired information in their social networks. Each
"multiplier" recieves an 8 hour training not only on HIV/AIDS, but also on communication skills. Each "multiplier" is given a "tool box" with 15 posters (5 on oral sex,
prevalence of HIV and safer sex in stable relationships), 40 leaflets (20 on safer
sex, 20 on oral sex), 1 safer sex video, 20 safer sex guides based on the video,
20 reports on the 1995 KABP study, 100 condoms and lubricant. All materials
are designed by members of Project LAMBDA with the participation of other