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

946 Abstracts 43507-43511

12th World AIDS Conference

Laboratory, prevention, and health system research are considered. Proposals
are ranked and granted by score.
Results: A clinical research network was set up in 1996 and had supplied in
1997 double combination for 1,200 cases, triple combination for 40 cases, all in 58
sites. Investigators were trained for Good Clinical Practices (GCP). Psychological
and social support are encouraged through health system research network. Until
15 Jan 98, 46 proposals were submitted (41 ARV, 1 01, 1 herbal medicine, 2
perinatal). A working group consisted of local experts from medical schools, and
Ministry of Public Health institutions ranked proposals. Supply was planned to
allocate in April 1998.
Lessons Learned: Central supply encouraged physicians to treat more cases
but discouraged their hospitals to set up their own budget. The clinical research
network allows team and infrastructure building up which can be adapted for drug
and vaccine trials. More training is needed.
43507 A model programme on HIV prevention in the workplace
Narcella de Luca1, S. Visco Eilardi2. 1109 Old South Lanberth Rd., London SW
81 XU, Great Britain; 2Cooperativa Marcella, Lurago Marinune CO, Italy
Aim: The conceptual, methodological and technical structure at the basis of the
euridice project network in Europe is presented and discussed.
Methods: Criteria and guidelines to implement the project within enterprises
and to identify indicators for the efficacy study are explained. The research plan
within the project is also presented. A case-study is presented and discussed.
Context: The euridice project was established 10 years ago in Italy and currently involves around 100 enterprises. It has a European dimension. It is infact
being implemented in some Member states (e.g. Spain, France, Portugal). It
is supported by the European Commission and by a transnational committee of
co-ordination composed by the World Health Organisation, the Council of Europe,
the International Labour Office, the European Trade Union Confederation.
Results: A programme on HIV prevention in the workplace is effective if workers are protagonists of each phase of its implementation and if it takes into
account the interests, motivations and the levels of proffessional responsibility of
the involved workers.
Conclusion: The authors conclude by suggesting a model type of preventive
intervention in the workplace based on dialogue and co-operation between the
social partners. Key words: model type, HIV, prevention, workplace, social policy
521*/43508 HIV in the Philippines: Analysis of data from the
National HIV Sentinel Surveillance System
Maria Consoria Lim-Quizon1, M.C.R. Roces1, W. Cuenco1, A.E. Ghee1,
G. Poumerol1, S. Omi1. 1FETP, Department of Health, Manila, Philippines
Background: The Philippines National HIV Sentinel Surveillance System
(NHSSS) was established in 1993; analyzing data from the system identifies
a number of trends.
Methods: HIV serosurveillance (HSS) started in two sites and has expanded to
ten sites. HSS was undertaken among six groups: registered female sex workers
(RFSW); freelance female sex workers (FFSW); male sex workers; MSM; males
with STD (MSTD); and IDUs. Sample size was 300 per group per site. Under
this design, if one HIV+ specimen is found in a group, then prevalence in that
group is assumed to exceed 1%. Specimens were tested for syphilis (VDRL), and
behavioural data was also gathered. Behavioural surveillance (BSS) was added
in 1997. BSS was undertaken among RFSW and FFSW groups in all sites, and
among MSM, IDU and clients of FSW in selected sites.
Results: Eight rounds of HSS had been completed by early 1997. Overall
HIV infection rates remain low. Infection rates among RFSWs exceed the 1%
threshold in seven sites. HIV rates also exceed 1% among MSMs in three sites,
among MSTDs in two sites and among IDUs in one site. However, HIV transmission factors exist in all sites, including: high syphilis rates; low condom use rates
(except among RFSWs); multiple sexual partners; and sharing of injecting equipment. BSS shows that 62% of RFSWs had HIV/AIDS knowledge, and 48% report
consistent condom use. This compares to 54% of FFSWs having knowledge, and
28% reporting consistent condom use. Yet 31% of both groups felt that they were
at risk of acquiring HIV/AIDS. 6% of IDUs reported sharing injecting equipment.
Conclusions: HIV transmission continues to be low in the Philippines, but the
potential for increased transmission is evident. Efforts to increase education and
outreach, and to improve STD services are needed. To avoid an "HIV explosion",
national and local government agencies and NGOs need to be engaged in a
collaborative effort to prevent and control HIV/AIDS.
S43509 | Promoting GO-NGO-CBO-PHA Co-operation in HIV/AIDS
work: Lessons learned for international agencies
Usa Duongsaa. AIDS Network Development Foundation, 48/1
Chiangmai-Lampang Rd. Chiagmai 50300, Thailand
Issue: Multi-sectoral co-operation is always a priority on the wish list of in
ternational agencies providing support for bi-lateral and multi-lateral programs.
However, success has often been elusive.
Project: The NAPAC Project actively promoted multi-sectoral co-operation/co-ordination. Its resource centre published regular AIDS bulletins and
newsletters, and provided information/referral/loan services of documents and
materials. Representatives from government agencies (GOs) and non-government organizations (NGOs) were invited to serve on the program management

board to set directions and to allocate funds. Projects proposed by GOs, NGOs,
community-based organizations (CBOs) and people living with HIV/AIDS (PHA)
groups were supported, with conditions that they co-ordinated with each other.
GO, NGO, CBO and PHA representatives were regularly invited to help organize
and participate in seminars, meetings, skills trainings, and workshops.
Results: The Project's technical and financial support provided opportunities
to indigenous people, PHAs, and CBOs to form and strengthen their own groups,
as well as to network and learn from each other. Groups supported by the Project
eventually grew to form the Northern NGO Coalition on AIDS, Northern Network
of PHAs, and the Network of Indigenous NGOs on AIDS. Each network became
capable and worthy of full collaboration with the government sector. Through
frequent and regular interactions co-ordinated and promoted by the Project, GOs,
NGOs, CBOs and PHAs learned to understand, appreciate and respect each
other, and to collaborate with each other. This successful NAPAC model, currently being replicated and expanded by AIDSNet, has been visited and studied by
many different organizations and countries. AIDSNet is funded by the European
Community's Programme on HIV/AIDS in Developing Countries.
Lessons Learned: Different sectorscan collaborate better if they have regular
venues and occasions to meet and work together. Technical support and financial
support need to be provided concurrently by international funding agencies in
order to promote such relationships, as well as to strengthen NGOs, CBOs and
PHAs so that equal partnerships and good governance become possible.
43510 Allocating HIV prevention resources through a
community-level prioritization process: National
experience in USA, 1993-1996
Ronald Valdiserri, C. Robinson, L. Lin, G. West, D.R. Holtgrave. Centers for
Disease Cntrl & Prevention; CDC 1600 Clifton Road, Mailstop E07, Atlanta, GA,
USA
Issue: Since 1994, the Centers for Disease Control and Prevention (CDC) has
required all health departments in the USA to prioritize their use of federal HIV
prevention funds ($191 M in 1994) through an evidence-based, participatory,
process in which authority for identifying fundable HIV prevention interventions is
vested in one or more local/regional planning groups. This process is known as
HIV Prevention Community Planning (HCP). Prior to 1994, intervention allocations
were determined centrally, at the federal level, and nearly 70% of total federal
HIV prevention resources were earmarked, a priori, to support HIV counseling
and testing programs.
Project: Allocation levels for specific HIV prevention interventions in 1993 (the
year prior to HCP) were compared with allocations for these same interventions
in 1996 to assess the impact of this federal funding policy change.
Results: The relative allocation of federal HIV prevention funds, across interventions, changed substantially between 1993 and 1996. Fewer federal dollars
were spent on HIV counseling and testing in 1996 (-22%) and more resources
were spent on health education and risk reduction activities (+123%). Especially
notable was the increase in level of prevention activities carried out by non-governmental organizations in 1996, compared to 1993 (+74%). Other evaluations
of HCP validate that this process has improved the targeting of federal resources
to reach high-risk populations and has increased community support for planned
HIV prevention programs.
Lessons Learned: Comprehensive HIV prevention requires a variety of interventions. Yet, there are no published standards for allocating HIV prevention
resources across interventions for different risk populations. HCP is one model
which addresses this gap. Future evaluations of HCP will move beyond aggregate
analyses to address the targeting of intervention resources at the client level.
435111 Health reform and HIV in Phayao: From crisis to
opportunity
Jean-Louis Lamboray1, Aree Tambanjong2, P. Sirinirund3. 'Health Care Reform
& HIV Office of Health Care Reform Project, Nonthaburi 11000; 2Phayao Health
Office Phayao; 3Provincial Health Office Phayao, Thailand
Issue: what is the secret behind the observed progress on HIV/AIDS in Northern
Thailand?
Project: severely hit by HIV/AIDS, people in Phayao Province (500,000 inh.)
have responded in remarkable fashion. HIV seroprevalence among pregnant
women decreased from 11% in 1992, to 4.9% in 1997 and among military conscripts from 20% in 1992 to 5-7% in 1997. Communities are adapting their culture
to the presence of HIV/AIDS. Quality of the lives of PWHA has improved. Set up
to foster a multisectoral response to HIV/AIDS, the Phayao AIDS Action Center
reflected on its experience to articulate "factors of progress" -key ingredients in
managing support the HIV/AIDS response. The Center could then foster further
progress on HIV/AIDS and influence the design of health care reform in that
Province. The single most important factor of progress identified is the strengthening of the capacity by people and organizations to assess reality, act on it,
and learn from it. Other -related- factors include: the exceptional autonomy given
to the Province to handle the AIDS crisis, the allocation of about 2$ per capita

per year of public money to deal with AIDS, an intense activity by all sectors to
address through more than 80 projects factors of vulnerability and risk, and deep
concern of key Provincial leaders and workers. The challenge is now to foster a
systemic, rather than Project-based response.
Conclusion: to be competent to deal with AIDS, the health care system needs
deep reforms. It should aim not only at reduced morbidity and mortality, but
also at reduced suffering and increased autonomy. Health Centers need to be