Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

160 Abstracts WePeD6297-WePeD6300

XIV International AIDS Conference

Baalak Trust, an NGO working with street children at the New Delhi railway station
for the past 12 years is looking to scale up the present HIV prevention program
to reach out to more vulnerable street children in various parts of India Description: The initial scale up of the program with street children was the integration of
care & support activities with the existing HIV prevention program. The activities
included training of staff on care & support, improving counselling facilities and
linkages with VCTs and referral directory of support services for infected children.
The second phase of the scale up was to identify the areas from where the children are running away from through analysis of data of street children accessing
services of SBT for the past 2 years. Criteria for selecting CBOs working in the
identified areas were also developed. A short list of CBOs working in the identified
areas in the community development or health sector was also undertaken. The
next phase of the scale up would be to finalize the selection of CBOs, undertake
capacity building including training of staff in programs centered around childrenlife skills education, skills training & HIV prevention & care activities and monitor
progress of programs.
Lessons learnt: Scaling up of programs needs to be in a phased manner. Selection of organizations for capacity building should be carried out carefully. Capacity
building of CBOs should include training in how to address basic vulnerabilities of
children in poor communities. The scale up capacity building program would help
in facilitate the smoother repatriation back to their families of runaway children.
Recommendations: There is a need to scale up existing projects to prevent HIV
infection among vulnerable children and meet the care needs of HIV infected children in India.
Presenting author: Bitra George, Ist Floor, 37/1235, DDA Flats, Madangir, New
Delhi, 110062, India, Tel.: [phone], Fax: [phone], E-mail: bitra george @ hotmail.com
WePeD6297I Condom negotiation skill among women in
prostituion
H.N. Malim. Instituion, 3/88 ab upstairs, opp.sccb marriage hall, new fair/ands,
salem - 636 016, tami/nadu, India
Background: A study at Salem town to succeed half of the time in getting clients
to use condoms. Condom negotiation is a complex communication activity that is
influenced by clients characteristics. Women sex workers self efficacy and negotiation capabilities as well as socio environmental factors.
Method: & objective
A indepth interview and qulitative investigation was conducted for 40 sex workers
to explore their perceived barriers, difficulties & approaches in negotiating condom use with clients.
Results: Five different patterns of condom use negotiation were identified: successful, unsuccessful, misinformed, passive, and uninterested.
The successful negotiators used several practical approaches to secure clients
compliance, unsuccessful negotiators experienced problems such as inability to
resist clients, pressure or response to their queries. The misinformed group did
not negotiate condom use to their perceptions not lack of support from peers and
brothel keepers. The uninterested group was apathetic with fatalistic perceptions.
Conclusion: The indepth interview with successful negotiators provided relevant
specific and practical information which could be disseminated to their peers to
develop their negotiation capabilities. This qulitative study has also contributed
to our understanding of problems of condom use negotiation and highlighted the
need for comprehensive inteaction which should not only aim at developing sex
workers negotiation skills but also gathering support from brothel keepers and
peers to reinforce behavioural change.
Presenting author: nathar sha malim, 3/88 ab upstairs, opp.sccb marriage hall,
new fairlands, salem - 636 016, tamilnadu, India, Tel.: [phone], Fax: +91
427 440423, E-mail: [email protected]
WePeD6298 Results from the pilot evaluation of steppimg
stones
M. Nduna, R.K. Jewkes, RN. Jama, J.B. Levin. Medical Research Council,
Gender and Health, private bagx385, Pretoria, 0001
Background: Stepping Stones, an educational tool for HIV prevention, seeks
to build equitable gender relations, communication and lifeskills. Evaluation of
HIV/AIDS programs is essential to demonstrate what is effective. This paper
presents results of a study conducted to test a questionnaire and explore the
impact of Stepping Stones, with men and women aged 12-42 in Winterveldt, a
peri-urban settlement, in South Africa.
Methods: Data was collected a week before and after the workshops from 109
men and 95 women using an interviewer-administered questionnaire. 102 participants were sexually active.
Results: Knowledge of sexual and reproductive health was measured using a
scale (20 items). Participants improved their knowledge (p<0.003). There was a
significant improvement in women's attitudes towards gender relations, measured

using a Likert scale with 18 items (p<0.001) and some for men (p<0.07). The
equitability of power in the relationship was measured using a Sexual Relationship Power Scale. Women reported significant improvements (p<0.022), but there
was no evidence of change for men (p= 0.34). Attitudes towards condoms, intentions to use a condom and reported use on last intercourse were measured. Attitudes towards condoms showed a highly significant positive change for women
(p<0.000), but not men (p= 0.5), intentions to use condoms improved for both

women (p<0.06) and men (p<0.05). Condom use on last sexual encounter was
high to start with 75% for men and 37% for women and did not change for participants who had sex during the time of the intervention.
Conclusion: Even in this small sample, Stepping Stones was shown to be effective in increasing knowledge, changing attitudes towards gender relations and
condom use. It has also been effective in changing some practices of gender relations for women participants. Change in practices was difficult to measure with
a short follow up and relatively high levels of safer sexual practices reported at
baseline.
Presenting author: Mzikazi Nduna, Gender and Health, private bagx385, Pretoria, 1, South Africa, Tel.: +27+12 3398528, Fax: +27+12 3398582, E-mail: [email protected]
WePeD6299 Best practices in HIV/AIDS training for the South
African public health care service
M. Dankers./APAC, suite 244, Postnet Killarney Private Bag X2600, Houghton
2146, South Africa
Issues: The South African Department of Health contracted IAPAC to train health
care workers (HCWs) on the implementation of the National HIV/AIDS Guidelines
and the proper use of Diflucan in a training program called "Best Practices in
HIV/AIDS". Before this, training for HCW's was sporadic and ineffective.
Descriptions: The objective of Best Practices is to reach all South African HCW's
and to make them aware of National HIV/AIDS Guidelines and training in the use
of Diflucan donated by the Pfizer Corporation for the treatment of HIV related
Cryptococcal Menningitis and Oesophageal Candidiasis within public health facilities. Diflucan Partnership Program training was incorporated into Guideline Training for broader reach and cost savings.
Lessons learned: Systematic training programs can be implemented to support
existing HIV/AIDS training programs in guideline implementation. A drug donation
access training program can be effectively incorporated with government training
programmes to effectively teach large amounts of HCWs. Also key to the success
of such a program is the involvement of the NGO sector and establishing of local
partnerships with health services and local educational institutions.
Recommendations: Coordination and collaboration with provincial, local, district
health departments, NGO's and academic institutions is crucial for the success of
training programs
Presenting author: Maylene Dankers, suite 244, Postnet Killarney, Private Bag
X2600, Houghton 2146, South Africa, Tel.: [phone], Fax: [phone]
5990, E-mail: [email protected]
WePeD6300 Kick-starting district level HIV services: preparing
providers and managers of district health services
in the Eastern Cape, South Africa
E.E. Banda1, A. Mckenzie2, J.F. Littlefield3. 1lntrah/Equity Project, 15 Summit
Rd, Beacon Bay, East London, 5241, South Africa; 2Department of Health, East
London, South Africa; 3MSH/Equity Project, East London, South Africa
Issues: South Africa's slow recognition of the severity of its HIV/AIDS problem,
changing policies on counseling, testing and care, and stuttering progress in
defining public HIV/AIDS services left clinic nurses and managers adrift. In the
Eastern Cape Province, rural clinic nurses were untrained in facts about HIV,
lacked skills to counsel or care for HIV positive clients and many retained judgmental attitudes. Supervisors were ill-equipped to provide technical support or to
protect clients' rights and tutors were not up-to-date.
Description Recognising the relationship between clinic services and managerial
support to ensure quality of care, the EQUITY Project and the Eastern Cape Department of Health forged training programmes in clinical and managerial development for complementary members of district health services teams. The District
Health Management & Leadership Program course on "HAST": HIV/AIDS, Sexually Transmitted Infections (STIs) and Tuberculosis (TB) services management
targets managers of district programs in services design, services assessment,
and practical experience in improving services. Their assessments found clinical
skills and quality to be lacking. To effect and sustain clinical improvements, Clinical Updates in HIV/AIDS, TB, STIs, Family Planning (FP), and Child Health now
target clinic supervisors, in-service trainers and pre-service tutors with related
HIV clinical care approaches, thereby supporting both service delivery and future
training.
Lessons Learned: Providing participants the opportunity to solve problems
greatly enhanced improvements in district HAST services. Both managerial and
clinic training are needed ensure necessary support for clinic services to respond
to constant changes in policies and service packages.
Next, links between policy makers and training should be established to ensure
on-going integration of policy and practice changes into in-service training and
pre-service education.

Presenting author: Eta E Banda, 15 Summit Rd, Beacon Bay, East London,
5241, South Africa, Tel.: [phone], Fax: [phone], E-mail: [email protected]