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

12th World AIDS Conference

Abstracts 44171-44175 971

44171 The National AIDS Trust employers' initiative (NAT El)
Julian Hussey. NAT New City Cloisters, 188-196 Old Street, London EC1V 9FR,
UK
Encouraging good employer responses to HIV/AIDS in the UK: HIV prevention;
discrimination; publicity.
Project: The NAT El offers information, advice and guidance to public and
private sector employers on HIV/AIDS in an effort to reduce discrimination and
promote workplace HIV education. Since February 1997 the NAT has to provided
this service in different ways: short newsletters emphasising the social context;
briefing papers on specific issues (eg managing sickness absence, confidentiality); reports on existing good practice; examples of real employer policies; leaflets
and videos for employees; training sessions for managers. These different methods are used to deliver the same message: that good practice (as embodied by
the NAT's Statement of Employment Principles for HIV/AIDS) avoids discrimination, respects confidentiality, embraces education and awareness, and manages
HIV/AIDS illness in line with other serious but less stigmatised conditions.
Results: The project acts as a national focus for employment and HIV/AIDS
issues. It has attracted support and interest from a broad range of employers.
The support for the project has included funding, free advertising (a page in the
Financial Times for World AIDS Day in '96 and '97), resources (Glaxo Wellcome's
Positive Action in the Workplace pack, available for sale to other employers
through NAT El), help with research (focus groups from leading food retailer, J
Sainsbury plc, helped develop posters), legal advice, and endorsement of the
Statement of Principles (over 50 employers to date). The interest has been from
employers that either: face an immediate challenge relating to the HIV status
or illness of an employee; or want to check their own policy or procedure in
preparation for such a challenge. They are offered detailed advice including a
review of any proposed HIV/AIDS policy, and regular updates thereafter.
Lessons Learned: Most employers still want to avoid any public association
with HIV/AIDS. First hand experiences of HIV at work, legal obligations and
concerns about ethics are the primary incentives for action. Employer enquiries
are usually satisfied by written advice on legal and best practice responses.
Even some AIDS-aware Human Resources/Occupational Health specialists require well presented 'expert' advice to convince their management to adopt good
practice, especially in relation to confidentiality.
S44172 I People with AIDS: Vulnerable survey research subjects
Ron Gagne, Mark Mischan1, E. Bisarra2, P. Patch3, N.J. Williams4. 2228 Landis,
San Diego, CA; 1Chair, 2Outreach, 3Secretary - HIV/AIDS Consumer Council,
San Diego; 4County Office of AIDS Coordination, San Diego, CA, USA
Issue: HIV/AIDS programs may unknowingly place their clients in danger when
they ask them to participate in surveys about their attitudes or needs.
Project: Because people with HIV/AIDS are often discriminated against in
housing, employment, and medical care as well as by their families and communities, it is especially important to protect them from possible harm when
they participate in survey research. Unfortunately, the area of human subjects
protection is not well developed related to surveys conducted by government
or non-government agencies providing HIV/AIDS care. A review of extensive
training materials for providers of services funded by the Ryan White C.A.R.E.
Act in the US contains no information regarding protection of clients when they
participate in surveys or focus groups. To correct this problem, agencies in San
Diego, California developed human subjects protection guidelines and protection
methods which are suitable to use when community agencies conduct needs
assessments, behavioral risk surveys, and program evaluation surveys.
Results: Human subjects protection has become an important topic for training
of community volunteers and community health providers in San Diego. A formal
Human Subjects Protection Plan was developed before the last two HIV/AIDS
Consumer Needs Assessments were conducted involving over 2,000 participants.
Lessons Learned: Though health providers take measures to protect their
clients against harm in the clinical area, little has been done to promote human
subjects protection in the area of survey research. This dangerous problem occurs
frequently among service providers who are not formally affiliated with universities
and do not consider their surveys as "research", but simply tools for gathering
information.
1416*/44173 AIDS stigma and HIV-related beliefs in the United
States: Results from a national telephone survey
Gregory Herek, J.P. Capitanio. Psychology Dept., UC Davis Davis, CA
95616-8775, USA
Background: AIDS-related stigma interferes with effective societal response to
the epidemic and imposes hardships on people living with HIV, their loved ones,
caregivers, and communities. This study assessed the prevalence of AIDS stigma
in the USA, and compared current levels with those assessed in a 1990-91 survey.
Method: In telephone interviews with a national probability sample of US
English-speaking adults (N = 1712), questions were asked about affective reac
tions to PWAs, beliefs about PWAs, levels of comfort with PWAs, intentions to
avoid PWAs, attitudes toward AIDS policies, and other AIDS-related attitudes and
beliefs. A substitution experiment permitted comparison of reactions to various
hypothetical PWAs who differed in their source of infection, race, and gender and
sexual orientation.
Results: Only a minority of the US public (< 20%) now supports policies such
as quarantine and public identification of PWAs. However, substantial majorities

(>75%) support mandatory testing of immigrants, pregnant women, and people
from "high-risk" groups. Compared to 1991, fewer people would avoid a PWA in
various hypothetical situations, but approximately one-fourth express discomfort
about such contact. The proportion of the public believing that HIV can be transmitted through casual contact has increased since the early 1990s; more than
40% now overestimate the likelihood of HIV transmission through sharing food
utensils, coughing or sneezing, or similar routes. Despite demographic changes
in the PWA population during the past decade, the public still generally associates
AIDS with gay and bisexual men. Antipathy is strongest toward PWAs who are
gay or bisexual men, and those infected through multiple sexual partners or
injecting drug use.
Conclusions: Although its manifestations have changed in some respects
during the 1990s, AIDS stigma persists in the United States. Support for blatantly
stigmatizing policies has decreased, but support remains high for mandatory testing of specific groups. A significant minority of the public expresses discomfort
about personal contact with PWAs. Belief that HIV can be transmitted through
casual contact is more widespread than at the beginning of the decade. The
public continues to strongly associate AIDS with gay/bisexual men.
144174 The prevention of HIV-STD with transvestites sex workers
in Bahia, Brazil
Marcelo Ferreira. Rua Teodoro Sampaio, 87- Barns, 40070-150 - Salvador.
Bahia, Brazil
Issue: HIV-STD prevention campaigns among transvestite sex workers need to
take advantage of the cultural aspects of the marginal life of this target population.
Project: Brazilian transvestite sex workers occupy a prominent place In Italy,
France and Portugal. Research indicates that transvestites Represent a population of 8000 in Brazil, each one attending an average of 4 clients a night. Research
also suggests seropositivity levels of between 12% and 75% in different towns in
Brazil among this population. This project had as its objective the mobilization of
the transvestite community in Salvador, Bahia, to organize itself into associations
to defend their rights as citizens and to adopt safer sex practices in their work.
Results: After 4 years of direct peer intervention by a group of multipliers of
Grupo Gay da Bahia, the Association of Transvestites of Salvador (ATRAS) was
founded. The organization holds weekly meetings with the participation of 20-30
sex workers. Among its victories are the to protect transvestites against police
violence and the realization of safe sex workshops that induce the correct use
of condom by transvestites, with an increase in the systematic uses of condoms
from 30% at the begining of the project, to 76% at the present time.
Lessons Learned: With a marginalized population, it is crucial to improve
mechanism of self esteem and basic mechanism of citizenship as the first step in
campaigns directed to behavior changes related to health.
|44175 Patients and providers: Myths and misconceptions about
Puerto Rican populations at risk and its potential impact
on health care decisions and case management
Serafin Mendez-Mendez1, A. Hernandez2, M. Bok3, D. Belliveau4, B. Pickett5,
E. Velazquez6, L. Skylla7. 1Central Connecticut State University Communication
Dept New Britain CT; 2Latinos Contra Sida, Hartford; 3University of Connecticut
Hartford; 4Department of Health City of Hartford, Hartford; 5Department of
Public Health Connecticut Hartford; 6American Red Cross San Juan; 7HIV
Initiative Hartford, USA
Background: Puerto Rican populations have been seriously affected by the
HIV/AIDS epidemic. There is a common belief among health care providers in the
United States that Puerto Ricans, infected or at risk for the disease, are difficult
to serve because they are a transient or highly mobile population. A study was
conducted to explore: 1) socio-demographic characteristics; 2) mobility patterns;
3) barriers to health care; and 4) risk behaviors of Puerto Rican populations
living in Connecticut and in Puerto Rico. At the same time, a group of providers
was interviewed to assess how they perceived Puerto Rican patients in the four
dimensions listed before.
Design: Survey/Focus Groups.
Methods: A survey of 250 Puerto Ricans (134 HIV+ and 116 non-HIV+) was
conducted in Hartford and in Puerto Rico. Six focus groups were conducted with
health care providers in Connecticut and in Puerto Rico. The data was analyzed
to generate profiles of Puerto Rican patients and to compare those profiles with
the perceptions commonly held by the medical providers.
Results: Although extremely poor and disenfranchised from the economic
fabric of society, Puerto Ricans who responded to the survey are far more stable regarding their mobility patterns than what was previously thought. Their
educational level should be high enough to conduct successful public health
interventions. Providers in the USA, however, perceive these populations to be
uneducated and mobile. Moreover, they perceive that these patients lack the
capacity to understand and process basic medical information. Thus, they could
be making medical decisions and interventions which can be misguided by their
stereotypes and which may negatively affect their patients.

Conclusions: It is imperative to generate educational strategies to educate
health care providers about the true needs of Puerto Rican populations with
HIV/AIDS or at risk for the disease as many of them do not seem to understand
the true nature of the social realities that contextualize the lives of their patients.