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

12th World AIDS Conference

Abstracts 43334-43339 913

S43334 Helping gay men in a provincial Vietnamese town to
protect themselves from AIDS
David W. Wilson, P. Cawthorne. 311 Ladprao - SOI 101, Bangkapi Bangkok,
Medecins Sans Frontieres (Belgium), Bangkok, Thailand
Issues: A thriving underground gay culture exists in Vietnamese towns. Appropriate AIDS prevention information for gay men is not available. The importance
of homosexual transmission of HIV in Vietnam is unknown.
Project: A young Vietnamese gay man worked as a Peer Educator with gay
men in Nha Trang, a small town. Over 6 months (August 1996 to February 1997)
he made contact with more than 70 men. He made regular contact with 12 men
who went to a beach for sex most evenings. All of them had heard of AIDS. None
of them knew that HIV was an infection, but thought people could develop AIDS
if they came into contact with "body fluids". They thought anal sex was safer
than oral sex because the anus is dry and the mouth is wet. In spite of this, their
commonest sexual activities were oral sex and mutual masturbation, but all 12
men had anal sex at least occasionally. Only one man had ever used a condom.
Results: The men learned to use a condom more quickly if the Peer Educator
demonstrated on someone's penis rather than on his fingers. He distributed a
total of 200 condoms. For the men with whom he made regular contact, forming
a relationship was as important as having sex. The Peer Educator spent much of
his time discussing honesty in sexual relationships with his target group.
Lessons Learned: Vaguely worded AIDS prevention campaigns may contain
misleading hidden messages. Condoms need to be presented in an interesting
way. To access gay men in Vietnam, we need to give correct information but also
make friendly contact and share their feelings.
43335 Implementation of inter-institutional teams to decrease
STD/AIDS vulnerability among the Indian population of
the State of Sao Paulo
Luciene Bosco Oliveira1, E.A.P. Ortil, R. Barboza2, J.C.B. Pacca2. 'Fundagao
Nacional de Saude, R Frei Canecca 1140, 01307-002, Sao Paulo; 2STD AIDS
Sao Paulo State Program, Sao Paulo, SP Brazil
Issue: The State of Sao Paulo has a population of 2194 indian people, with
4 ethnic groups (Guarani, Kaikang, Krenak, Terena), divided in 17 settlements
with specific social and cultural characteristics. They are very much vulnerable to
STD/AIDS, due to high mobility among settlements, frequent contact with white
people, and little access to health services.
Project: By december 1996, the Ministry of Health decided to implement a
STD/AIDS prevention project for indian population. The Indian Foundation and
STD/AIDS Program of the State of Sao Paulo-were called to participate. The
training of those institutions teams was planned, including professionals from
the municipalities where the indian settlements are located. A coordination team
supervise all actions monthly, besides being responsible for planning, carrying
out and evaluating preventive actions.
Results: 28 hours training for 40 professionals, using participatory interactive training methods and discussing meanings, values and attitudes related to
STD/AIDS and the indian community. After the training, 94.9% were sensitized;
81.6% understood the need for an action that considers social and cultural characteristics of the indians; 45% understood the need for preventive education. Nine
working plans were elaborated and 90% think that a team work at the settlements
is the best way to STD/AIDS prevention.
Lessons Learned: The inter institutional work with common responsabilities
for the preventive actions is very important to achieve a decreased vulnerability
to STD/AIDS among indian population.
43336 Phoenix - Sex worker education and support project
Darren I. McEwen. PO. Box 276 Northbridge, WA. 6865, Australia
Issue: A government funded community-based project to raise awareness of
safe sex practices within the sex industry of Western Australia, thus reducing the
transmission of HIV/AIDS.
Project: Given Western Australia's punitive and strict laws regarding sex work,
it is vital to have a community-based project such as Phoenix that provides
confidential, non-judgemental support, safe sex supplies and counselling, and
retraining for HIV-positive sex workers wanting to exit the sex industry. Phoenix is
staffed by a social worker and three outreach officers. Some staff are ex-sex workers, thus inluding peer-based interventions to the target populations of women,
men, transgender, and non-English speaking. One to one counselling is available
on HIV/AIDS, safe sex and sex education; the office doubles as a drop in centre,
providing more informal support and counselling, and a store of condoms and
safe sex supplies.
Results: Phoenix proves to be extremely beneficial to the West Australian
sex industry. Client numbers have doubled in the past six months with approximately 500 workers accessed. STD & HIV/AIDS workshops have been conducted
throughout the state (which is geographically about half the size of Australia in
total) in various brothels and parlours, and individually to sex- and street-workers.

Phoenix has been approached by the West Australian Health Minister for input
into the current sex industry law reforms. This demonstrates the credibility that
Phoenix has developed not only within the industry but also amongst government
and health bodies. By targetting specific populations of workers (gay, transgender,
non-English speaking, male, female), Phoenix is able to build trust and empower
specific workers and communities to sustain primary and secondary preventative
health practices in specifically relevant ways.

I43337 Social and individual constraints underlying the
emergence of "gay" identity and "gay" support groups in
India
Ananya Banerjee1, S. Sengupta2, S. Bhattacharya3. 15 Dr TN Majumdar Street
Calcutta; 2Project Officer WB. Sexual Health Proj., Calcutta; 3Social Dev. Officer
W.B.S.H.P, Calcutta, India
Issue: In India, majority of Males who have Sex With Males (MSM) do not
consider their sexual identity as a political or social issue because of the given
climate of denial, mis-recognition and homophobia. Invisibility of sex between
males is due to sanctions against same sex relationships, which hampers the
development of social identity and organised community amongst MSMs.
Project: Extensive review of MSM literature and focused group discussions
and interviews with MSMs over the last one year have given insights into the
problems associated with formation of support groups amongst MSMs.
Results: Sex between males is largely invisible due to various social sanctions. Overt homosexual expression is absent because majority of MSMs either
get married or remain single without cohabiting with a fixed male partner. Sex
between males being illegal under the Indian Penal Code, MSMs are targeted for
persecution. Same sex relationships are considered as 'unnatural', 'perverted',
'dirty', 'immoral' etc. Penalties for being exposed as a "homosexual" are severe,
which may include stigma, ridicule, isolation, ostracisation and even domestic and
social violence. This results in guilt, low self esteem and a dual existence at the
individual level. Sex between MSMs occur secretly, mainly in public parks, public
toilets etc. where there is a constant threat of exposure and harassment. These
factors do not provide social opportunities for strong relationships and social
networks. Lack of space for socialisation and social relationships, lead to multiple
partners and high partner turnover. Group bonding though present, is extremely
weak to promote group action. Anonymous sex between male strangers is purely
a physical act and not an issue of solidarity. Hence it does not promote affiliation
and association.
Lessons Learnt: The approach for support group formation amongst MSMs
may include 1. Behavioural change-addressing the individual and promoting self
esteem and 2. Community mobilisation and social negotiations, addressing MSM
groups and broader social contexts. The aim would be to create a supportive
social environment focusing on individual identity, group identity and collective
response to HIV through awareness, advocacy and activism, coterminous with a
safer sex culture amongst MSMs.
S43338 HIV/AIDS risk reduction strategies for gay youth of color
in the "house" community
Linda Podhurst1, J. Credle2. 1NJAETC At UMDNJ 30 Bergen St ADMC 710
Newark New Jersey 07107-3000; 2Rutgers Univ Multicultural Affairs Newark NJ,
USA
Background: The "House" culture serves as a source of familial and community
support to gay and transgendered youth of color. This study seeks to understand
the HIV prevention function filled by the houses and aspects of this role that may
be adopted for community-based HIV prevention programs.
Methods: This exploratory study of two "Houses" in Newark, New Jersey employed qualitative research methods including participant observation and indepth
interviewing to discern the role of the "mother" and "father" of the "Houses" in developing and implementing HIV prevention strategies for gay and transgendered
youth of color.
Results: Sociological analysis of the functions of norms established within the
"House" culture regarding appropriate and safe sexual encounters suggest that
this alternative family structure is highly influential in limiting high-risk encounters.
Conclusions: Strategies employed by "House Parents" have had an impact on
the choices made by children of the Houses regarding HIV risk behaviors. These
strategies can be adapted for use by well-established community-based HIV prevention programs when they are comprised of staff who mirror the characteristics
of "House Parents" and engage in relationships that parallel this alternative family
structure.
43339 AIDS prevention knowledge and practice among
Sudanese refugees in Adjumani District, northern
Uganda
John Dralobu1, D. Moluma2, A. Arkangel2, J.W. Idro2, J. Homsy2, R. King3.
1Moyo AIDS Control Initiative (MACI), Adjaumani; 2MACI, Adjumani;
3MSF-Switzerland, Kampala, Uganda
Objectives: To assess the impact of AIDS information dissemination among
Sudanese Refugees in northern Uganda after a 3-year IEC program.
Method: The IEC program emphasized since 1994 classical AIDS prevention
messages including condom use, faithfulness, and abstinence, among others.
In 1997, 166 respondents aged 15 to 55 were randomly interviewed regarding
their knowledge and practice of AIDS prevention methods using a structured

questionnaire and open-ended questions.
Results (see table): While many more males than females were likely to know
and practice condom use (both p < 0.0001), substantially more females than
males reported practising faithfulness for HIV/AIDS prevention (p = 0.002).
Conclusion: Sudanese refugee women's lesser knowledge and practices regarding condom use and higher reliance on faithfulness reflect their increased
vulnerability and dependence as compared to men in their situation which may