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

982 Abstracts 44231-44235

12th World AIDS Conference

to donors and the people served; Strategy 5: Social Marketing packages the
HIV/AIDS program to promote the cause to generate community support.
Results: The Resource Mobilization Scheme guided the organization to operationalize strategies to develop, generate and manage resources. It increased
management and technical competence to generate resources to support administration and operation of HIV/AIDS program.
Lessons Learned: The operationalization of a well-studied Resource Mobilization Scheme develops the competence of organizations. The development,
generation and management of resources promotes the program implementation
and sustainability of the HIV/AIDS program.
44231 Resource mobilisation for prevention of HIV/AIDS
epidemic in Ukraine
Yuri Kobyshcha1, L.I. Andrushchak2, L.N. Khodakevich3. 16 Bakinski
Kommissarov Str. AP12, Kiev 253090; 2Programme Coordinator UNICEF Office,
Kiev, Ukraine; 3Team Leader PDO UNAIDS HQ, Geneva, Switzerland
Issues: HIV epidemic in Ukraine recently emerged among vulnerable groups,
first of all IDUs. Before 1996 preventive measures focused mainly on general
population and were of a limited scope due to lack of resources, specialists and
denial by the authorities of the emerging HIV epidemic.
Project: Active mobilisation of potential internal and external resources was
initiated by National AIDS Committee in a close cooperation with UNAIDS and UN
system in 1995. It was focused on raising additional funds, training of specialists,
implementation of new approaches and involving various state institutions and
NGO's in preventive interventions.
Results: Priority areas and population were identified and special projects
for HIV prevention in injecting drug users (UDUs) based on the harm reduction
strategy were developed. With participation of several international consultants
the team of workers were formed and trained at the series of workshops and study
tours were organised on the methods of planning, implementation, monitoring
and evaluation of the preventive activities. Over 20 workshops were held and
some 250 persons from social and medical services, other government sectors,
NGOs, volunteers, were trained as planners for the community work and peer
educators. The projects on HIV/STD prevention among IDUs, female sex workers
(FSW) and prisons inmates were implemented in 4 cities and 3 prisons of Ukraine
with technical and financial support of UNAIDS, UNICEF, UNDP, World AIDS
Foundation, British Council, Open Society Institute and Government of Germany.
The contributions from these agencies and institutions built up to more than
US$680,000. As a result numerous state institutions and NGO's operating in
various areas were involved in the preventive interventions.
Lessons Learned: Intensive resource mobilisation is offering a very good opportunity for further expanding the national response to HIV/AIDS epidemics that
is particularly important in the situation of the deteriorating social and economic
conditions that make the Ukrainian society highly vulnerable to HIV and other
sexually transmitted diseases.
647*/44232 Amounts, patterns and trends of national and
international financing of the response to HIV/AIDS
in developing countries, 1996-1997
Daniel Tarantola1, G. Ernberg2. 'Harvard School of Public Health, FXB Center
651 Huntington Avenue, Boston, MA 02115, USA; 2UNAIDS, Geneva,
Switzerland
Objectives: (1) To estimate the amount of national and international resources
allocated and disbursed in support of HIV/AIDS prevention, care, support and
research in a fiscal year circa 1996 in developing countries' and (2) To track
these resources from their sources (including Official Development Assistance
agencies (ODAs), United Nations and other intergovernmental agencies (IGOs),
developing countries' governments, and others) to their destination (Government
National AIDS Programs (GNAPs), national institutions, NGOs, and others).
Method: The Frangois-Xavier Bagnoud Center for Health and Human Rights
at the Harvard School of Public Health and UNAIDS are conducting a large-scale
study of national and international financing of HIV/AIDS programs in 1996 and
1997. The survey includes 80 developing countries, 12 ODA agencies and 8
United Nations and other agencies. This survey follows and expands on two
similar studies published in AIDS in the World in 1992 and AIDS in the World II in
1996. The 1996 study (covering a year circa 1994) showed strong trends among
donors towards channeling their aid to GNAPs through bilateral (government
to government) channels, and an overall stagnation in the amount of international resources supporting the national response to AIDS (NRA) in developing
countries.
Results: Preliminary information shows that in the mid-1990s, national resources allocated by developing countries to their own NRA increased considerably; bilateral (ODA to NRA) support increased significantly in several countries
in Africa and Asia; multilateral (IGOs to NRA) stagnated or, in some countries,
declined; and increasing resources were allocated to HIV/AIDS care. The ongoing
data collection is expected to support these assertions through a quantified anal
ysis which will attempt to answer the question "How much is spent on HIV/AIDS,
by whom and for what purpose?"
Conclusion: A synthesis of the results of this large-scale survey, which are
due in April 1998, will be presented.

144233 Deadly public policy
Michael V. O'Shaughnessy, J.S.G. Montaner, S. Strathdee, M.T. Schechter. BC
Centre for Excellence in HIV/AIDS, 608-1081 Burrard St., Vancouver, BC,
Canada
Objective: An explosive outbreak of HIV in injection drug users was documented
in Vancouver British Columbia in 1996/97.
Methods: Beginning May/96, 1009 IDUs who injected > once in the previous
month were recruited into the Vancouver IDU Study (VIDUS). At each visit, IDU's
underwent HIV tests and questionnaires on demographics, drug use, sexual behaviours, and service use. HIV incidence was 9.52 (7.0-12.0) per 100 pyrs and
prevalence was 23.2% at baseline.
Results: Our investigation of the environmental context indicated that the
following factors contributed to the HIV epidemic in Vancouver. As federal government support for social housing disappeared, low income housing vanished
and more than 6500 individuals were forced to use single room occupancy (SRO)
accommodations. Addicted individuals were refused access to social housing
facilities. This concentrated IDUs in a 10 square block area. Occupants were
charged ($5-10) exit fees at night and this practice further concentrated the IDUs.
More than 85% of the places dedicated for individuals with mental health illness
were closed yet 30% of the VIDUS seroconverters reported a diagnoses of mental
illness. Detoxes were eliminated as budget reductions were imposed. 25% of the
VIDUS participants were women yet there are no detoxes designated for women.
Social assistance was denied to individuals with outstanding police warrants. The
Canadian prison system did provide needle exchange yet, 76% of the VIDUS
participants have been in jail. Funding for needle exchanges was variable and at
one time vans had to be removed due to budgetary short fall. Monthly welfare
payments were synchronized and may influence sharing behaviour.
Conclusion: Our results indicate the HIV epidemic in injection drug users in
Vancouver is primarily caused by needle sharing. However, government policies
contributed to the dangerous environment of the downtown eastside. We postulate this lack of critical services and the negative effects of deadly public policies
facilitated an epidemic of HIV in IDUs.
|44234 1 Consensus on strategy to control sexual transmission
of HIV
Rajeev Sadanandan. Additional Secretary Department of Health Government of
Kerala, India, India
Issue: Consultation with major stakeholders before implementing interventions
for prevention of sexual transmission of HIV may delay implementation of the
program but is essential in a multi - religious, disparate community.
Project: Kerala state has 3 major religions 2 of which have stated objection to
condom promotion. Media, trade unions, women's' and students' organizations
can modify agenda set by government. Open discussion of sexuality is not welcome. Homosexuality and sex work, while widely prevalent, are illegal and not
socially accepted. Political leadership shies away from any major controversy.
More than 94% of the documented cases of HIV had been sexually transmitted.
The government drew up an intervention plan with media campaign for safe sex,
condom promotion, peer educators for sex workers and street children. Before
implementation the state level leaders of religious groups, women's' organizations, media chiefs and labor unions were consulted. Response ranged form
active co-operation to promise not to oppose. But most of the leaders wanted
their lower level functionaries to be consulted before the implementation started.
They refused to do the advocacy themselves. While the process has delayed
implementation by 8 months, failure to do this would have led to some of the
groups taking a stand, which would have jeopardized the entire program.
Major social and religious groups did not want to associate with interventions
for sexual health even when convinced of its need. Failure'to consult them, while
saving time, could have jeopardized the entire intervention. This phenomenon
may prevail only in the early part of the epidemic when awareness level in the
community is low and stigma is high.
|44235 | Politics and practice: Overcoming barriers to
community-based research
Rick Marchand1, T.A. Trussler1, B. Allan2, P. Perchal1. 1AIDS Vancouvers
304-1918 York Ave Vancouver British Columbia V6J1E3, Canada; 2AIDS
Council of New South Wales Sydney, Australia
Issue: Community-based research is an emerging area of interest for community
AIDS groups pursuing effective prevention and support strategies in a shifting epidemic, however, political, methodological and structural barriers confound these
efforts.
Project: Our National Health Promotion Project undertook three-years of community-based action research to answer a question of practice: what is health
promotion for frontline AIDS groups? Although documents like the Ottawa Charter
for Health Promotion outline principles, little common ground has existed to inform
practice for frontline AIDS workers coming from diverse areas of experience. We

developed a model and published a book on community HIV health promotion.
Results: During the project we realized that no consensus exists about the
place or efficacy of research for community AIDS groups. We experienced a
variety of structural barriers even though we found great interest nationally and
globally. This raises a number of questions: a) What is community-based "action"
research? b) When is it most appropriate to use research as a prevention or
support intervention? c) How does a community AIDS group develop the capacity