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

12th World AIDS Conference

Abstracts 44225-44230 981

571*/44225 1 The HIV hormone bridge: Connecting
impoverished HIV+ transsexual sex workers to HIV
medical care
James Grimaldi1, J. Jacobs2. 1New York Hospital/Center for Special Studies 226
East 68th Street Room f-24 NY; 2New York Hospital Cornell Medical Center,
New York, USA
Issues: Male-to-female pre-operative transsexuals on illicitly obtained hormones
treated at our HIV/AIDS clinic presented with poor records of medical compliance,
health, substance abuse, sharing needles, and unsafe sex.
Project: Our clinic developed a specialized Transgender HIV program: a Transgender support group; staff education; integration of hormone therapy into HIV
treatment, observation of hormones on HIV illness.
Results: We followed transgender patients over 4 years who joined a support group and turned away from exploitative "black market" hormone suppliers
on condition that we prescribe and administer their hormones. HIV doctors received endocrinilogical instruction. Patients signed a treatment contract. Nurses
administered hormone needles. Social work provided psycho-therapeutic & socio-economic counseling and managed HIV & hormone medication compliance.
We placed HIV+ patients on hormones for a total of 18 patient years of follow-up
and observed no side effects. It was not possible to assess the impact of hormone
therapy on viral load or CD4 counts in this retrospective study given confounding
variables. Integrating hormone treatments into HIV care did yield positive psycho-social results. All patients turned away from black market hormones, stopped
sharing hormone needles and self-administering dangerous doses of hormones.
Patients developed trust, became more compliant with HIV medication & condom
use and more receptive to protease inhibitors. Prescribing hormones made them
re-imbursable through medical insurance, thereby decreasing patients' financial
need to sex work, violence from customers and police. Therapists engaged
patients in non-judgmental discussion re sex work and created a resource of
Transgender-friendly employers/educational opportunities for those who sought
alternate employment.
Lessons Learned: Integrating hormone replacement into HIV care for pre-op
transsexuals is successful when it takes into account a unified approach i.e.
an empowered peer driven therapeutic community and an educated/culturally
sensitive health care team. It helped break the socio-economic cycle that had
endangered the Transgender community & yielded positive behavioral changes.
More scientific research on the effects of hormone therapy on HIV+ transsexuals
is needed so that clinics can feel more comfortable prescribing hormones.
44226 HIV/AIDS care programs should include poverty
alleviation interventions
Alan Vos. Management Sciences for Health, PO. Box 214, Bisho, 5605, South
Africa
Background: Many breadwinners are the first to die from AIDS in rural and urban
African Families, leaving no support for families, creating dependency on the
larger community. While we may successfully teach families to care for sick loved
ones. We do not provide for a future of the family.
Approach: The approach was taken at projects in the urban and rural areas
in the Eastern Cape Province, and Kwa Zulu-Natal, in South Africa, where future
breadwinners were identified and appropriate skills developed to enable them to
provide for their families. Many of the new breadwinners were taught "victory" or
trench gardening methods, some became so successful at that they were able to
sell vegetables to neighbours, others were referred to technical training centres
where they learned sewing, knitting, and silk screening, one became chef, able
to provide a new and better home for his family and care for his mother who has
since died of AIDS. HIV/AIDS cannot be seen in isolation, development must be
seen as integral part of HIV/AIDS care programmes. Home carers were trained in
helping families identify new breadwinners, in determining family needs, assessing breadwinner potential and interests, networking with training institutions, and
referral to other support organisations. Development began within these family
units as soon as home care was initiated, which provided stress and mental
relief to the dying family member in knowing the family's future would be secure.
The result has been that families where this development has occurred are less
dependent on social services, remain financially active in communities, and stay
together as family units.
Organizations providing care services have an ethical obligation to assist families to develop long term plans and activities for their survival as a unit. This
approach is key to lessening the social impact of HIV/AIDS and other life threatening diseases on communities. HIV/AIDS is after all a developmental issue as it
mostly affects those on the lower scale of socio economic development.
44227 Financial problems for people with HIV/AIDS
Fred Van De Meer. leHelmerssraat 17 1054 CX Amsterdam, Holland
Objectives: Estimate the frequency at which people with HIV/AIDS face financial
problems. Determine the bottle-necks which create these problems. Derive and

develop solutions that soften or remove these bottle-necks.
Design: Descriptive study.
Methods: In the first phase 25 key-persons in the AIDS relief work were orally
interviewed. In the second phase people with HIV/AIDS were questioned in writing. In the third phase detailed information was gathered from them by means of
depth interviews. In the last phase the information, that was gathered, was used
to define bottle-necks and derive and develop solutions.

(Preliminary) Results: About 10% of people with HIV/AIDS in care in the
Netherlands face financial problems (ranging from 7-0%). These problems occur
particularly in groups with lower degrees of education (women and cultural minorities), whose numbers seem to be increasing. Here, HIV and AIDS appears
to be a bigger taboo, resulting in isolation and less appeal for help at the regular
relief providing institutions. Many of the financial problems appear to be more
related to illness and poverty in general and less to HIV/AIDS specifically. In the
study, HIV-related items are the taboo on HIV/AIDS and the cumulating effect of
all kinds of (non-HIV specific) financial problems.
In general a good safety net is available for these groups of persons. However
a huge communication problem is seen at the the institutions, located both inside
the institution and in the communication with the outside world. The institutes in
the city of Rotterdam for example focused attention to the communication issue:
this resulted almost immediately in a substantial increase in the number people
which were reached by the institutes.
Conclusions Financial problems seem to increase with the change in social
groups, infected by HIV. A major part of the problem seems to be related to
general poverty problems in the Netherlands. A lesser part is HIV- or illness
related. Solutions have to be found in the communicative sphere.
44228 Advocacy for poverty alleviation as an alternative tool to
fight HIV/AIDS in the developing countries and improved
survival
John Kiwalabye1, Josephine Nabanoba2. 1P0. Box X2750 Nsambya Sharing
Ant Community for Youth; 2Social Worker, Kampala, Uganda
Issue: Vicious circle of poverty has made youth in the Dev. Countries Vulnerable
to HIV/AIDS which needs Intervention and awareness.
Project: With this effect a poverty alleviation project was established particularly among the youth with a socio-Economically background in focus. Strategies
and policies had to be laid down and those include:- Establishment of income
generating projects among the youth, Provision of information, working skills and
project support were pre-requisite to self sustainance stratage. To make the public
more aware of the issue, sex education and counselling on HIV/AIDS policy was
followed.
Among the staff are the HIV youth working as peer educators.
Results: The programme has been very well received by over 700 youth all
over the district of Kampala which it is based, within two years. Many youth
some of who were sex workers have used the required skills and come to self
sustainance, leading to HIV/AIDS prevention. A significant achievement to the
community.
Lesson Learned: Poverty alleviation programme is a successful alternative to
fight the pandemic HIV/AIDS in Developing countries if it is specifically addressed
to meet the specific needs and desires of a turgeted group.
44229 Poverty reduction to combat the spread of HIV among
refugees
Johnson Franks Owori, D.M. Nduhura, M. Nakazibwe. Acord East Moyo PO.
Box 280 Kampala, Uganda
Issue: Population in refugee settings are vulnerable to HIV infection due to
economic Insecurity and require appropriate credit & awareness interventions.
Project: Given the increasing levels of exchange of sex for material gains in
the refugee setting, ACORD East Moyo Integrated an HIV/AIDS Component to
its programme activities. By March 1997, the Project had supported the Community to elect loan Management Committee (LMC) members from 5 Settlement
Camps and one Subcounty as Pioneer Sites. The project targets orphan carers,
women and youth. A strong reproductive Health education element, focusing on
HIV/AIDS and Sexually Transmitted Infections forms the Core of the project. A
team of Community Volunteers including counsellors, educators and trainers work
with two full time staff to run the project.
Results: The project was well received by both refugees and the host population. Loans ranging from $60 to $400 were disbursed to 20 women groups and 19
families. Visists to and discussions with the beneficiaries revealed the that their
livelihood had improved as a result of the loan.
Lessons: Credit Schemes in a refugee setting are pottentially successful if
they are initiated in a participatroy way, targeting both refugees and the host
population.
|44230 Resource mobilization for community HIV/AIDS
prevention program
Marilyn De Castro. 33 Assumption Road, Baguio City 2600, Philippines
Issue: Inadequate skills to mobilize community resources for HIV/AIDS support.
Project: The difficulty in generating resources for AIDS prevention program is
due to lack of capability in resource mobilization. The awareness of a Resource
Mobilization Scheme was adapted to increase competence to support the pro
gram. Strategy 1: Analysis and Planning of Resource Requirement to tap internal
and external resources; Strategy 2: Identification of Community Opportunities to
consider detailed processes and innovative activities for an effective matching of
partnership. Strategy 3: Advocacy for HIV/AIDS prevention to generate resources
and policy support from stakeholders, local councils and the government; Strategy 4: Management of Resources guide the disbursement and expenditure of
funds within the bounds of efficiency, effectivity, accountability, and transparency