Program Supplement [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

multifactorial. Because of this complexity, the development
and implementation of integrated programs is extremely
challenging. While many times compounded with issues of
poverty, gender inequality, lack of education, drug abuse, and
lack of power, the association between women who are victims
of violence and women who are HIV positive is present and
demands immediate attention. The lives and health of women,
their children, and communities are dependent on the
response of advocates, policymakers, and active citizens.
A shift in the cultural acceptance of men and women as equals
is integral to creating positive change for HIV-positive women
and women who are victims of violence.
Recommendations:
- Increase funding for and expanded foci on research
pertaining to the link between HIV and violence against
women
- Heighten involvement of healthcare providers
- Empower women, financially, educationally, and physically
- Improve health education
- Develop cross-training initiatives for service providers
- Improve awareness and decrease stigma associated with the
epidemics
Corresponding author: Namur, Jenny, Danya International, Inc.,
8737 Colesville Road, Suite 1200oo, Silver Spring, MD 20910,
United States, Tel: [phone], Fax: [phone],
Email: [email protected]
LBPEG90591
The next generation: policy responses for children orphaned
by and vulnerable to HIV
Peel Suzi', Powell, Greg2 ('United States; 2Zimbabwe)
Issues: Current and future increases in numbers of children
orphaned by AIDS require policy measures to cost-effectively
and meaningfully reach many children.
Description: Contrasting programming with policy: models of
care, time frame, quality of care, scale and scalability.
Lessons learned: Traditional responses to orphaning (family
care, adoption, institutional care) cannot be adequately scaled
up. Myriad new responses are very beneficial and cost-effective,
such as community initiatives,(1) but are not easily scalable.
Outside assistance to OVC is increasing but not at a scale to
match the problem. In Uganda (1998-2000), 183 organizations
provided assistance to about 4.8% (83,100oo) of orphans out of
about 1.7 million.(2) Education is the most ubiquitous and
readily scalable program available. Support for education may
avert a social disaster.(3) It tops the list of children's requests,
second to nutrition. School is a place of normality where
orphans and their peers can acquire the skills that will help
them overcome the obstacles strewn in their path by AIDS. It is
usually a safe and stable environment where children can be
children and grow progressively into adulthood.
Recommendations: Focus on education as the most costeffective and scalable intervention for children orphaned by
AIDS. AIDS demands drastic modifications in policy:
1. Innovations in teaching methods and formats; flexible access
to enable education for all children, especially access for
orphans who head households(3); and education for all

2. Massive commitment to increase the number of educators
being trained in anticipation of the rising rates of mortality due
to AIDS.
(i) Foster, Getting Resources to the Base Supporting
Community Orphan Initiatives, 2002 (2) Dieninger, Garcia,
Subbarao, AIDS-induced Orphanhood as a Systemic Shock:
Magnitude, Impact & Program Interventions in Africa, 2002 (3)
Powell, Matshalaga Editorial BMJ 2002 (4) Kelly, personal
communication, 2002
Corresponding author: Peel, Suzi, 45 Orchard Street,
Cambridge MA 02140, United States,
Tel: [phone], Email: [email protected]
[ LBPEG90601
If I get AIDS, I go home to my village and die: perception of
individual HIV-risk in urban sex workers in Lagos
Masi Vincent Sommerfeld, Carsten (Nigeria)
Background: The HIV sero prevalence in Nigeria at the end of
2001 was estimated at 5.8% -3.1 million persons. Nigeria has
the second highest number of HIV-positive persons in the
world, behind South Africa. Among the high-risk groups,
female sex workers (FSWs) are of special interest because they
are highly stigmatised and discriminated. Due to the high
incidence of sexually transmitted infections (STIs) among
them, they are vulnerable to HIV infection.
Method: In October 2001 M6decins sans Frontibres (MSF)
began an outreach project with brothel based FSWs. The main
objective was to offer HIV/AIDS/STI education and provide
syndromic management of STIs. To understand their living
conditions, MSF conducted a knowledge, attitude, practice and
behaviour (KAPB) survey. Using questionnaires and focus
group discussions, the individual perception of risks
concerning their work and life were examined. The survey was
conducted in eight brothels in a low-income area in Lagos and
included ioo women.
Results: The majority were between between 12 and 24 years
(79%) and came mainly from two states, Edo and Delta (64%).
They view their work in Lagos as transient and are highly
mobile, with 83% remaining in Lagos for a year in the same
brothel; 40% have children. Although the level of HIV/AIDS
knowledge among the FSWs is incomplete, they are aware of
the risks. One third of them had been tested for HIV antibodies
(34%) and nearly half are willing to be tested (46%). If they
found themselves to have HIV/AIDS, half of them would stop
sex work and return to their villages to die, 14% said they
would commit suicide and only 1% would seek medical care.
Conclusions: There is minimal care and support for people
living with HIV/AIDS in Nigeria. FSWs have few avenues for
receiving care if they are HIV-infected. FSWs are highly
vulnerable to HIV infection and are neglected by the
Nigerian health care system. Modalities of care and support
need to be developed for this vulnerable group.
Corresponding author: Masi, Vincent, M decins Sans Frontires,
20 Alexander Avenue, Ikoyi, Lagos, Lagos State, Nigeria,
Tel: [phone], Fax: [phone],
Email: [email protected]

54 Program Supplement