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

970 Abstracts 44166-44170

12th World AIDS Conference

the option. Among the latter, one-half were HIV infected. QSR NUD*IST was used
for data management and analysis was guided by grounded theory.
Results: Major themes among those women who lacked direct experiences
with HIV clinical trials were their distrust of the biomedical community and vice
versa and a misunderstanding of such trials. The women who were denied participation in a trial mentioned the stigma of being drug users as the main perceived
reason. Those who were enrolled in trials identified confusion regarding enrollment procedures, including unclear informed consent protocols, and difficulties
with adherence.
Conclusions: HIV clinical trials as prevention interventions may have limited
impact on the situation of women, including those who use drugs, unless their
unique circumstances are addressed. Specific attention should be given to enrollment procedures and adherence issues. Unless educational efforts target both
the health care providers as well as high-risk women, the success of such trials
is likely to remain limited.
44166 Racial inequalities in the receipt of HIV/AIDS-related
treatment and enrollment in clinical trials for persons
living with HIV
Gina Wingood', E. Funkhouser2, R.J. Diclemente2, H. Fawal2, S. Vermund2.
11665 University Blvd, Ryals Bldg. Rm 215 Birmingham, Alabama 35294-0022;
2UAB School Of Public Health, Birmingham, AL, USA
Objectives: To determine whether racial inequalities exist in the receipt of
HIV/AIDS-related treatment and enrollment in clinical trials for persons living with
HIV.
Design: A cross-sectional study.
Methods: Persons living with HIV, 13 years of age and older, attending one of
six public clinics that treat persons with HIV and reside in non-urban communities
were recruited during routine clinic visits. Interviews were sought from all persons
attending the clinics. Interviews were conducted in a private area and took approximately one hour. Information was elicited on demographics, the treatment,
medication and social services received by persons living with HIV.
Results: Of the 501 persons living with HIV, 44.5% were African-American
and 55.%% were White. There were no significant differences in insurance status
or age between African-Americans and Whites. However, significant differences
were reported in gender, income and education. After controlling for these potential confounding factors, African-Americans were 70% more likely to have never
been prescribed AZT (OR = 1.7; 90%CI = 1.1-2.6), were 80% more likely to have
not been enrolled in an AIDS clinical trials for new therapeutic treatments (OR =
1.8; 90% CI = 1.0-3.0) and were 70% more likely to have not been treated with
protease inhibitors (OR = 1.7; 90%CI = 1.1-2.6).
Conclusions: This study suggests that African-Americans are less likely to
receive HIV/AIDS-related medical treatment or be involved in experimental drug
trials compared to Whites. These differences may partially explain the poor
survival of African-Americans living with HIV/AIDS relative to Whites. This disparity suggests a need for interventions tailored to African-Americans living with
HIV/AIDS to ensure uniform receipt of HIV/AIDS-related drug therapy.
44167 Legal issues relating to Aboriginal people and HIV/AIDS:
Discrimination, jurisdictional divisions, testing and
confidentiality
Stefan Matiation', R.E.F. J0rgensz. Canadian HIV/AIDS Legal Network,
Montreal, QC; 1Suite 101, 1151 Barton Street, Thunder Bay, Ontario, Canada
Issue: The HIV epidemic among Aboriginal people in Canada shows no signs of
abating and HIV/AIDS could have devastating impact on First Nations, Metis
and Inuit communities. Efforts to deal with the epidemic are hampered by
HIV/AIDS-related discrimination; systemic and direct discrimination experienced
by Aboriginal people; jurisdictional divisions between federal, provincial, and
aboriginal governments; and limited access to appropriate HIV testing facilities.
Project: Vast consultations were conducted, draft discussion papers were distributed for input and comments, three final papers were produced, and follow-up
work undertaken to ensure that their recommendations will be implemented.
Results: Three topics have been analyzed in detail, and recommendations
made regarding them: (1) Aboriginal people, HIV/AIDS and discrimination; (2)
problems of jurisdiction and funding; and (3) testing and confidentiality issues for
Aboriginal people. This has stimulated discussion about legal issues relating to
HIV/AIDS and Aboriginal communities.
Lessons Learned: The HIV epidemic among Aboriginal peoples is exacerbated
by a history of oppression, racism and colonization. Discrimination and jurisdictional divisions further contribute to the disproportionate impact of HIV/AIDS.
Approaches to dealing with the epidemic must include: reducing the impact of
jurisdictional divisions; engaging the leadership in discussion and awareness
about AIDS; Aboriginal control of and participation in the development of AIDS
initiatives for Aboriginals.

44168 Discrimination and stigmatization, PLWHA response
Richard Sserunkuuma, E.O.T. Otorok Tanga, M.B. Mwogeza. 1Taso Mulago, PO.
Box 11485 Kampala; 2 The AIDS Support Organization, Kampala, Uganda
Issue: HIV 6 AIDS is more of a social problem than a medical one, people living
with HIV & AIDS too have a role to play if the social - ills associated with HIV
infection and disease are to be minimised or eradicated.

Project: The AIDS support organisation (TASO), has got music, dance and
drama groups in each of its 8 centres in Uganda. These groups are composed
of PLWHA/TASO clients. They go to places like schools, local communities,
churches, e.t.c. The main objective is to educate the public about HIV/AIDS to influence behaviour change and to fight stigmatization of PLWHA through personal
life experiences.
Results: Families, communities and entire public have come out to support
rather than stigmatise and discriminate PLWHA. They have even identified themeselves with the problem of AIDS, TASO service Evaluation indicated 76% of the
community and 79% of family members had accepted PLWHA.
Lessons Learnt: People identify/relate themeselves with the problem better
when the problem is realistically personalized.
When healthy PLWHA come in the open the public then discribes HIV & AIDS
as "It is our problem" not "their problem".
144169 Creating positive attitudes towards persons living with
HIV/AIDS among young people in hostile environments
Lois Hue', Carole Kauffman2. 'Jamaica Red Cross, Kingston, Jamaica;
2American Red Cross, Falls Church, VA, USA
Issue: Despite widespread knowledge about how HIV is transmitted, stigma is
still associated with the disease and continues to lead to discrimination and unwarranted attacks on individuals. Effective educational approaches are needed to
change these destructive attitudes. Reaching youth is critical if we are to change
societal norms related to stigma.
Project: In the Jamaican society, as in many others, there exists considerable fear of PLWAs, leading to negative reactions including violence, neglect and
scorning, The Jamaica Red Cross' "Together We Can" peer education programme
for youth recognised the need to highlight and reinforce the workshop component
"Living With HIV Infection". To counter the effects of the societal norm of rejection
and mockery, a multi-pronged approach was used to encourage compassion and
acceptance of PLWAs.
Techniques include pre-workshop assignments, street interviews to examine
teens' own fears and prejudices as well as the publics', one on one dialogues
with PLWAs, community concerts, and training of adults to replicate the training
workshops. Pre/post intervention questionnaires, focus group discussions and
direct observations are used to evaluate the impact.
Results: There were significant increases (p <.001) in favourable attitudes
towards persons living with HIV/AIDS as measured by willingness to sit next
to someone (67% pre-/90% post-workshop); eat with someone (54% pre, 88%
post-workshop); visit someone (54% pre, 88% post): and reduced prejudices in
terms of feeling that PWAs should be made to live away from the rest of the world
(29% pre, 13% post-workshop). Direct observation demonstrated that most youth
participating in the workshops hugged the PLWA following their interaction with
the person. (n = 320)
Lessons Learned: It is possible to change negative attitudes towards
PLWHIV/AIDS found among young people and measure the degree to which
this occurs, using a structured programme of activities involving examination of
personal attitudes and dyadic intercourse.
44170 HIV/AIDS discrimination in an industrialised country, the
case of Switzerland
Mary Haour-Knipe, F. Dubois-Arber. Inst Univ de Medecine Sociale et
Preventive 17, Rue du Bugnon, CH-1005, Lausanne; 2UEPP IUMSP Luasanne,
Switzerland
Background: The fight against HIV/AIDS discrimination forms a basic pillar of the
Swiss AIDS prevention strategy. This study, part of the overall evaluation of the
strategy, funded by the Federal Office of Public Health, applies a research protocol
developed by UNAIDS to examine possible institutional discrimination at 3 levels
(legislative texts, internal regulations, and practices) and in 9 domains: health,
employment, justice/legal procedures, public administration, social welfare, housing, education, family life, insurance. Strict legal definitions of discrimination were
used.
Methods: After extensive calls for testimonials of HIV or AIDS discrimination,
field work was carried out in two French-speaking cantons by a group of representatives of AIDS and PWA associations, physicians, lawyers, civil servants and
experts in each of the domains, under supervision of the evaluators. Analysis was
performed of: documents, key informant interviews (over 200) and testimonials
(n = 31). Cross-checks were made. Decisions as to presence of discrimination
were made after group review and consensus.
Results: Legislative texts and internal regulations were not found to be discriminatory. As for practices, strictly defined institutionalised discrimination was found
in a few cases, regarding HIV testing. However, the study revealed instances of
undesirable practices (e.g. firing during sick leave, restricted access to some insurance) related to employment, health care and insurance, although not specific
to HIV/AIDS. Similarly several cases of individual (as opposed to institutional)
discrimination and stigmatisation were revealed. Some positive discrimination

was also encountered, among employers and in health care particularly.
Conclusions: A policy encouraging solidarity with people affected by HIV and
AIDS seems to have been largely successful, at least as far as institutional
discrimination is concerned. However illness (as opposed to HIV/AIDS) discrimination is encountered, and individual discrimination and stigmatisation exist.
These more subtle forms of discrimination are much more difficult to detect and
to combat.