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

12th World AIDS Conference

Abstracts 43382-43386 921

Project: After four years of implementation of a HIV prevention project targeting women, we perceived the need to broaden the discussion emphasizing the
problem of lack of male HIV/AIDS awareness. The project focused on increasing
HIV risk perception among men, stimulating their involvement in making decisions
concerning condom use and all other aspects of reproductive health. Through
outreach interventions, using a clear message and specific educational materials,
the project introduced to the target population the discussion on gender, sexuality
and safer sex negotiation. The men were reached in health care units, and in
their workplaces. This initiative stimulated the discussion inside the NGO about
specific prevention strategies recognizing the importance of differences in gender
power. In this way we were able to integrate two prevention projects and their
specific approaches.
Results: More than 150 men were reached during four months of intervention. Several discussions about these issues were held involving heterosexual
PWAs, increasing our understanding of the situation. This enabled us to plan a
continuation for the project, with deeper interventions, for a two years period,
starting in 1998. The majority of men reached have very little information about
HIV prevention, with stereotypes playing a major role on their perceptions about
AIDS.
Lessons Learned: There is an urgent need for development of innovative
strategies to prevent AIDS among heterosexual men. Men prefer to talk about
sex and AIDS when not in the presence of women. Due to gender issues, prevention projects must consider that most of the time women are not able to
control their male partners sexual behavior, projects should also focus on the
male population.
43382 Evaluation of a cohort study of HIV-1 infection in young
men in the Royal Thai Army
Kalyanee Torugsa1, R.A. Jenkins2, C.J. Mason3, V. Jamroenratana4,
S. Kujareevanich3, C. Lalang5, S. Nitayaphan3, A.E. Brown3. AFRIMS 31 5/6
Rajvithi Rd.; 2HMJF/USAMC-Afrims, 3USAMC-AFRIMS, Bangkok, 4Royal Thai
Army medical Department, Pranburi, 5Ministry of Public Health, Phetburi,
Thailand
Objective:To evaluate the feasibility of establishing a large HIV-1 cohort of young
Thai men for phase III HIV vaccine efficacy trials.
Design:Open, prospective cohort study.
Method:Young Thai men who had been conscripted by lottery to serve two
years in the Royal Thai Army (RTA) at Prachuap Khiri Khan (PKK) Province were
screened for HIV-1, syphilis and hepatitis B, using standard lab tests and completed a self-administered risk assessment questionnaire. They were rescreened
every 6 months for HIV-1 and, each time, completed a risk assessment. The
project also provided preventive HIV intervention and a program for prophylaxis
against HIV-related coinfections.
Results:Of 3842 men at baseline 1.8% were HIV-1 positive, 0.7% positive for
syphilis and 41.7% were positive for HBV markers. Of the HBV naive, 59.3%
agreed to receive the hepatitis B vaccine, and of them, 90.2% vaccinee received
a full 3 dose course. 3011 (78.4%) of the young men seronegative at baseline
were enrolled for incidence follow up. Of this group, 88.7% were available for
follow-up at 24 months. The overall incidence was 0.43%/100 p-y. During the
study period, CSW patronage decreased from 27.7% to 15.5% (p < 0.05), and
condom use with CSWs increased from 58.1% to 76.4% (p < 0.05) Of those
HIV-1 seropositive, 89.1% participated in a program for prophylaxis and treatment
for HIV-related infection.
Conclusions:The HIV-1 seroincidence was probably too low to justify a phase
III vaccine trial in this population, although 24-month follow up rates were relatively high, and participation in the hepatitis B vaccination was very consistent.
Declining CSW patronage and increased condom use over time may reflect the
impact of preventive intervention.
43383 Police concepts on risk, death and HIV/AIDS in Colombia
Maria Margarita Echeverri Buritica. CRA. 7#73-55 Piso 12 Santafe de Bogota,
Colombia
Issues: The police men/women base their concepts of risk, death, HIV/AIDS
on their rank, their uniform and following the rules of the institution. There fore
beconing highly vulnerable to HIV/AIDS.
Project: A qualitative research using ethnography methods was developed
around the relations between risk, death, vulnerability, HIV/AIDS and hierarchy
power on the police department. 8 workshops were done on the topics of sexuality, death, HIV, risk and vulnerability with 35 persons of the National Police
Department of COLOMBIA. 3 in-depth interviews were developed to get more
information and gather elements for the research hypothesis. Several on the field
observations were done. Parties, military parades, daily exercises and choses
were observed and analized.
Results: 1) Colombian police build their identity and concepts of death, risk
and HIV/AIDS after the institutions rules and power is refleated on the uniform,
the rank and the weaponds. 2) Power behind the uniform creates a sense of

invulnerability, allowing them to assume riks that other people avoid. 3) HIV/AIDS
is perceived as a problem that only affects homosexuals, prostitutes, drug addicts
and people that violate institutional norms or rules. 5) HIV/AIDS is denied by the
institution.
Lessons Learned: Military Institutions by the manegement of power, rules and
policies create identities of invulnerability on their personnel making them highly
vulnerable to HIV as a mortal virus. Denial of realities increases the risk.

43384 The armed forces of Latin America confront an
expanding epidemic
Sergio Olmedo-Drouguett. Intenational Co-Chair of the Civil-Military Alliance to
Combat HIV and AIDS Avenida Bernardo O'Higgins No 1170-Piso 10 Santiago,
Chile
Issues: Since 1995, the armed forces of Central and South America have recognized that their personnel, and their families, are population groups at special
risk for HIV transmission. They have also indicated that many of the same factors
have a strong role among seafarers and the maritime industry. There is also a
new realization that the role of women (military personnel and community organizations of military wives, sex workers, women in factories) must be taken into
account because of their special vulnerability and the contribution they make in
the fight against HIV/AIDS.
Project: The Alianza Civico-Militar para Combatir el VIH/SIDA was formed in
1996, held its first Regional Seminar in 1997. It has undertaken an extensive
programme of prevention and training activities in Latin America. Prevention is
the key, and efforts are directed to creative programme expansion and improved
management of resources by means of civil-military collaboration.
Results: There has been a strong advocacy impact due to the high-visibility
Civil-Military Alliance. It has been able to mobilize new commitments at the policy
level in Ministries of Defence and in the development of more comprehensive
military AIDS programming. Military-specific publications have been prepared
as popular briefing brochures, STD prevention and management, and Counseling.
Lessons Learned: In some countries, excellent laboratory facilities are found
in military facilities, and the strengthening of their role in a more complete national
surveillance scheme is emerging as a promising approach. These same linkages
may offer a new dimension to the work of the Civil-Military Alliance to Combat
HIV and AIDS and help to build regional surveillance support networks.
43385 HIV seroincidence and willingness to participate in trials
of military recruits in South Africa
Elna van der Ryst', F. Steyn2, C. Heunis2, G. Joubert3, J. Viljoen', N. van Zyl1,
W. Strydom1. 1Dept of Virology (G23) PO Box 339 UOFS Bloemfontein 9300;
2Dept of Sociology PO Box 339 UOFS Bloemfontein; 3Dept of Biostatistics PO
Box 339 UOFS Bloemfontein, South Africa
Introduction: In order to fully understand the natural history of HIV/AIDS it is necessary to establish cohorts of seroconverters for long-term follow-up. However,
these studies are difficult due to the problems involved in long-term follow-up of
large groups of patients.
Objectives: To determine the suitability of military recruits for inclusion in a
natural history cohort.
Methods: To determine knowledge regarding HIV/AIDS transmission, risktaking behaviour and willingness to participate in trials relating to HIV/AIDS a
questionnaire was administered to 343 recruits from a military base in Bloemfontein, South Africa. Hundred and one of these recruits were also tested for HIV
antibodies using an ELISA.
Results: The recruits had a good level of knowledge regarding HIV/AIDS and
transmission of HIV-1. However, in spite of this, a significant number of them still
practice high-risk behaviour. Six percent of them were found to be HIV positive,
which gives a 6% seroincidence over a 12 month period since they were all tested
negative at intake 12 months earlier. The majority felt that HIV/AIDS research
was important and 77.8% indicated that they would be willing to participate in
studies regarding HIV/AIDS, even if it entails regular testing for HIV antibodies.
Conclusions: These results show that military recruits are a high-risk group
for HIV-infection, and this, together with their willingness to participate in trials,
indicate that they will be good candidates for inclusion in a prospective cohort
study on the natural history of HIV-1 infection from seroconversion onwards.
43386 The evaluation of a AIDSCAP (AIDS Control and
Prevention) project of sexually transmitted diseases
(STD) and AIDS prevention among Cameroonian Armed
Forces
Jean Paul Tchupo12, Mathias Kuepie2, Saidel3, Debuscher4, Boupda5. 1BP
13888 Younde; 21RESCO, Yaounde; 5CHP, Yaounde, Cameroon; 3lmpact,
Washington; 4FHI, Washington, USA
Issue: It is well known that armed forces are a sub-population with high risk
of having STD/AIDS. That's why in 1993 AIDSCAP implemented a three years
project to reduce the risk of contracting AIDS and other STD among cameroonian
armed forces. The aim of this abstract is to value the success of that project
through changes observed on its indicators.
Project: In 1993, giving the high rate of HIV infected among soldiers in
Cameroon (with a seroprevalency of 6.2% against 1% for the hole population),
the Ministry of Public health and that of Armed forces, decided to launch a project
to sensitize Soldiers in adopting safe sexual behaviors. That project was carried

out by AIDSCAP and evaluated by IRESCO (Institut de Recherche et des Etudes
de Comportements). The project activities were based on the peer educators
strategy. The major aims of the project were: increase the rate of condom use
during risked sexual intercourse(by 20%); reduce the ratio of soldiers with more
than two sexual partner during the last three months (by 25%). Surveys were
done at the beginning and at the end of the project (by IRESCO) to measure the
project achievement.