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

926 Abstracts 43408-43413

12th World AIDS Conference

discussion. Seropositive inmates became aware and self-confident to reveal their
serostatus to their partner. The relationship of the couples improved.
43408 Intervening among the invisible population: CDC's
experience in correctional health care
John Miles', K.M. Krane2. 11600 Clifton Rd NE (MS E - 07) Atlanta, GA 30333;
2Centers for Disease Control Atlanta, GA, USA
Issues: Correctional facilities are critical settings for monitoring the HIV/AIDS,
tuberculosis (TB), sexually transmitted diseases (STDs), hepatitis, and other infectious diseases. The inmate population represents a large concentration of
persons infected with, or at high risk for, HIV due to drug use and sexual risk
factors. Moreover, recidivism rates in the United States are high; many of these
individuals will return repeatedly to jail from their community. This leads to a
substantial population of high-risk individuals circulating between correctional
facilities and communities already beset by poverty, drug use, violence, and
disease.
Project: To improve community health through improved access to health care
and prevention services for incarcerated populations in three areas: surveillance,
prevention programs, and behavioral interventions.
Results: To enhance surveillance activities, CDC has begun several projects.
One CDC-funded project supports nine jail sites with seed money to implement
a STD screening and treatment program, of which five have continued without
further federal funding. Other surveillance projects involve collaborations with
the US National Institute of Justice to evaluate disease burden among persons
entering a drug testing program offered in jails throughout America. CDC has also
begun to develop partnerships with several national organizations, both governmental and non-governmental. One notable effort is CDC's provision of technical
assistance to the Office of Justice Program on their Corrections Programs Office's
Tuberculosis Initiative for five states. Finally CDC has funded four adult facilities
and two juvenile facilities to develop, implement, and evaluate HIV prevention
programs.
Conclusion: Public health agencies offer scientific expertise in disease prevention and control while correctional systems have the population in need of
these services and, commonly, a desire to save scarce resources. By encouraging partnerships between corrections and public health, CDC can assist in
the provision of disease interventions and health care services for those in our
community that are involved in the criminal justice system.
43409 Knowledge and attitudes towards treatment for
Pneumocystitis carinii pneumonia of the HIV+
incarcerated population
Scott Cozza. 73 Mission Dr. Petaluma California 94952, USA
Issue: The HIV incarcerated prisoner in a state prison experienced a higher
mortality and morbidity rate for PCP infection compared to the AIDS population
in the community at large.
Project: Investigated what factors could have contributed to the higher morbidity and mortality rate among the incarceration population and why were many of
the AIDS prisoners not taking their PCP medications. The research investigation
was qualitative anecdotal data from personal observation, several focus groups
and from the participant observation and personal experiences of several of my
HIV peer educators who were prisoners living with HIV/AIDS.
Results: Research data revealed 4 very important influential factors: 1. HIV
population had misinformation about PCP the disease and treatment side effects.
2. The HIV prisoners were reinforcing their misinformation about PCP RX and
medication side effects amongst themselves. 3. There was a lack of trust from the
prisoners towards the medical staff. 4. Prisoners were receiving mixed messages
from the medical team. Some medical technicians were advising prisoners not to
take certain medications.
Lessons Learned: HIV/STD Education for the incarcerated should be peer
driven, promote trust, diverse curriculum to include 01 RX, staff training on 01 and
cultural diversity, HIV peer educators/physician partnership and training for both
physician and prisoner on ways to enhance the physician/patient relationship.
43410 HIV prevention programs in Brazilian prisons
Paulo Junqueira-Aguiar, C. Pimenta. Brazilian AIDS Program, SON 402 E 306
70834 - 050 Brasilia, DF, Brazil
Issue: Studies show HIV seropositivity rates ranged from less than 10% to more
than 20% in inmates of correctional systems of the Southern and South Eastern
states of Brazil.
Project: Given the high prevalence rates of HIV infection and the difficulty of
the Public Health services to reach prison inmates, the Brazilian Program on
AIDS implemented, in 1996/97, a set of prevention programs in 10 states (2/3 of
the 150,000 prison inmates of the country). Regional workshops trained social
and health professionals of correctional systems, to implement instructor-led and

peer-led actions aiming at informing and promoting the use of condoms during
conjugal visits and same-sex relations. In order to support the program, a national guide, educational videos, and a diversity of locally written materials were
produced.
Results: One tenth of the prison population directly participated in these activities. Educational programs were frequently interrupted by riots or by the high
turnover rate in correctional systems. However, reports from the "National Sem
inar AIDS in Prison", (dec. 97) show that 8 of the 10 programs, which were
developed in collaboration with NGO and universities, led to an increase in the
use of condoms.
Lesson Learned: Educational programs in prisons have a great probability to
succeed when led by appropriately trained and supported by especially designed
materials, in collaborative linkage with other institutions.
43411 Behavioural risk factors for hepatitis B (HBV), hepatitis C
(HCV) and HIV infections in a prison in the French part of
Switzerland: A pilot study
Anne Iten', N.V. Niklas2, F.P. Francioli2, G.B. Gravier3, V.O.Y. Von Overbeck1.
1Policlinique Medicale, Inselspital 3010, Berne; 2Div. Maladies Infectieuses,
Lausanne; 3Serv. De Medecine Et De Pshychiatrie Pen, Lausanne, Switzerland
Objectives: To document the existence of risks behaviour for HBV, HCV and HIV
infections in persons living in a prison in the French part of Switzerland and to
test the feasibility of such a study.
Methods: In a pilot study, interviews, self-administered questionnaires and
blood samples (serological tests for HBV, HCV, HIV) were applied to prisoners
selected randomly in a prison for people awaiting trial. Anonymity was preserved
at each stage of the study.
Results: All interviewed persons (30 men) accepted to participate in the study
and answered the questionnaire. Most of them (23) were in prison because of
drug problems, 5 consumed drugs during this period, 1 intravenously. Of the interviewed prisoners, 23 had been imprisoned before: 13% of them have sold drugs
and 61% had consumed them during previous incarcerations. In the investigated
prison, sexual contacts were not possible, but the prisoners described sexual
contacts in other prisons. Inside and outside the prison, condom use with regular
partners, casual partners and sex clients is unpredictable.
All participants agreed to a venous puncture, but it was unsuccessful in 6
injecting drug users despite several attempts. Among the 24 tested persons, 9
were positive for HBV (2 with a chronic active hepatitis B), 8 for HCV and 1 for
HIV. This last result was already known. Two of these persons had consumed
drugs during the investigated period: one had a chronic active hepatitis B and
was HCV positive, the other had a chronic active hepatitis B, was HCV positive
and HIV positive. This last one described equipment sharing: a colleague gave
him the injection material. No prisoner was immunised against HBV.
Conclusion: After evaluation with the participants (prisoners, penitentiary personnel, research staff), such a study is feasible and confirms behaviour risk factors
among our small group of participants. In order to organise adequate information
campaigns and to implement the necessary prevention measures (condom use,
HBV immunisation, effective disinfectants, etc.), we need more data and this
study should be extended to the other prisons of our area. An important task for
the future is to avoid HBV, HCV and HIV transmission in prisons.
43412 AIDS education by peers in the African prison system:
The example of the Cote d'lvoire
Godji Alfred Gougou', A.M.L. Aguirre Marc2, T.Y.T. Togbe Toussaint3,
D.L.N. Doumatey Nicole3. 106 BP 1021 Cidex 1 Abidjan 06; 2Hope Worldwide
Abidjan; 3Centre D'Assistance Socio Medicare Abidjan, Cote D'lvoire
Issue: Overcrowding, poor medical and social conditions, and inaccessibility to
condoms makes African prisons, a favorable environment for high-risk behaviors
and hence for the rapid spread of HIV/AIDS. In the past, all formal attempts to
develop AIDS prevention programs in the Prison system, had been done using
professional educators, who often, were not fully oriented in the workings of the
prison system. Since January 1998, peer educators have been trained to develop
and promote a more effective prevention strategy, within this high-risk population.
Project: In collaboration with penitential and government authorities, 12 peer
educators were selected and trained on HIV/AIDS, and on technical aspects of
preparing and leading a prevention workshop. These workshops will be conducted
at the main state prison in Abidjan.
Results: The 12 peer educators will conduct AIDS education programs for
almost 1000 prisoners. 20 workshop have been planned, each educating 50 prisoners. These workshops will be held from February to May and the final results
will be presented at the 12th World AIDS conference in Geneva.
|43413 Changes in knowledge and attitudes about HIV and AIDS
among recent Central and South American immigrants in
the Washington DC area
Carlos J. Crespol, J. Gutierrez2, P. Moses3, W. Kirsten', C. Loria4, G. Torres5,
S. Mora6. 'Dpt. of Health & Fitness, American University, 4400 Massachussetts
Ave., NW Washington, DC; 2Casa of Maryland, Washington DC; 3Casa of
Maryland, Silver Spring MD; 4Center for Disease Control & Prevention, Takoma
Park MD; 5Casa of Maryland, Takoma Park MD; 6Montgomery County Health
Department, Silver Spring MD, USA

Issue: The HIV infection rate among Hispanics in the United States is much
higher than among non-Hispanic whites. The largest Hispanic subgroups in the
US in descending order are: Mexican Americans, Puerto Ricans, Cuban Americans, Central and South Americans. Very little data, if any, is available regarding
HIV/AIDS knowledge and attitudes of recent immigrants from Central and South
America. These recent immigrants experience lower access to the health care
system, worse employment conditions and uncertain legal status.