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

180 Abstracts WePeD6385-WePeD6389

XIV International AIDS Conference

WePeD6385 Evidence of distinctive communication channels
related to population level behaviour changes and
HIV prevalence declines in Uganda
D. Low-Beer1, R. Stoneburner', T Low-Beer2. 'Cambridge University, sidney
sussex college, sidney street, cambridge, cb23hu, United Kingdom; 2Selly Oak
Hospital, Cambridge, United Kingdom
Background: There is considerable speculation on the communication and behavioural elements related to HIV prevalence declines in Uganda, but limited success in evaluating empirically their importance and interactions. This study provides evidence of the distinctive communication elements related to behaviour
changes in Uganda compared to 5 other sub-Saharan African countries
Methods: We analysed population based demographic and health survey (DHS)
and knowledge, attitude and behaviour surveys (KAPB) for Uganda in 1989
and 1995, Kenya(1998), Zambia(1996), Malawi(1996), Tanzania(1996) and Zimbabwe(1994). Channels (personal, mass, institutional) for communicating about
AIDS and people with AIDS were classified in the data, and compared by country
and by age, sex and geographical region. Risk ratios for behaviour changes related to communication channels were analysed and stratified by age, sex, sexual
partners and region
Results: Despite similar knowledge levels of HIV, there were considerable differences when comparing channels for communicating about AIDS and people with
AIDS. By 1995 in Uganda, personal channels of friends and family became dominant for communicating about AIDS, in contrast to Uganda in 1989 and to the
5 comparison countries. Personal channels were dominant in Uganda in 1995
among women (82%), men (70%), in urban and rural areas. Personal knowledge
of someone with AIDS was also higher in Uganda (91.5% of men and 86.4% of
women). These communication elements were related to behaviour changes in
Uganda, with risk ratios for reducing partners (1.65), condom use with last intercourse (2.19), and starting condom use (4.6)
Conclusions: The results suggest there are unique communication elements
which affected behaviour changes and enhanced HIV prevention in Uganda. The
behavioural and communication process we have identified needs to be better
understood and incorporated into prevention activities, as they are scaled to the
population level
Presenting author: daniel low-beer, sidney sussex college, sidney street, cambridge, cb23hu, United Kingdom, Tel.: [phone], Fax: [phone],
E-mail: daniel @ low-beer.com
WePeD6386 Type of sexual relationships and condom use in
inner-city adolescents
L.J. Bauman, R. Berman. Albert Einstein College of Medicine, Bronx, NY, United
States
Background: Research indicates that a "regular" sexual relationship can be a
barrier to condom use because participants believe condoms are not needed.
Measures of sexual partnerships use terms such as regular, casual, primary,
exclusive, close, and new. These terms from adult studies may not apply to
teenagers. Objective: To identify types of adolescent sexual relationships and examine their relationship to condom use.
Methods: In-depth qualitative interviews were audiotaped with 11 sexually active
minority Bronx youth aged 15-18. Authors read and coded transcripts independently.
Results: We identified three relationships: messing, for sex only; boyfriendgirlfriend, a more serious relationship; and hubby-wifey, which mimics marriage.
Adolescents never referred to "regular" or "casual" partners, terms typically used
in measures. Moreover, messing could be a one-night stand or with a "regular"
partner. Relationships were given meaning by four factors: (1) future commitment (messing none; boy/girlfriend some; hubby-wifey definite); (2) love (messing none; boy/girlfriend some; hubby-wifey strong); (3) secrecy (messing always;
boy/girlfriend rarely; hubby-wifey never); and (4) expectation of monogamy (messing rarely; boy/girlfriend often; hubby-wifey usually). Condom use was related to
type of relationship. When messing, condoms were typically used. Boy/girlfriends
tended to use condoms until intimacy/trust emerged. Condom use was rare
among hubby-wifeys.
Conclusions: Condom use is much less likely in loving, trusting relationships.
However, measures that define relationships temporally will miss this important
dimension. Moreover, measurement error is likely when the term "regular" partner
is used, as among teenagers a "regular" partner could be an ongoing or episodic
messing relationship, a girl/boyfriend, or a hubby-wifey. Our data suggest that
condom use would be typical when messing, episodic with boy/girlfriend, and
rare with a hubby-wifey.
Presenting author: Laurie Bauman, Albert Einstein College of Medicine, PIRC
NR 7South, 1300 Morris Park Avenue, Bronx, NY 10461, United States, Tel.:
[phone], Fax: [phone], E-mail: [email protected]

WePeD6387I At-risk teens and HIV+ adults survey internal
co-factors in HIV prevention of peers
E. Bay. Special Audiences, Inc., 40 ferry street, newark, new jersey 07105,
United States
Background: Many HIV prevention programs recognize that self-esteem plays a
crucial role in a person's reducing risk behaviors, yet no models have been devel
oped to respond to specific populations' web of atitudes and beliefs about their
ability to control their own lives.
Method: At-risk adolescents and HIV+ adults in Newark, NJ (USA) designed and
conducted a 10-item, multiple choice self-rating survey of their peers who chose
to enroll in a two-session workshop on assertiveness and conflict resolution. The
survey focused on five markers of self-esteem: self-confidence, self-efficacy, flexibility, self-reliance, and locus of control. The 337 respondents were at-risk adolescents 13 to 22 years old (53% of the sample), at-risk adults 25 to 50 years old
(25% of the sample, one-third of whom are HIV+), and HIV+ adults 25-55 years
old (22% of the sample). Data collection was facilitated by the fact that participants were peers of the survey sample and built trust relationships.
Results: All 10 suvey items correlated over six subpopulations, demonstrating consistency as markers of self-esteem. Generally, at-risk and HIV+ women
rated themselves lowest in self-confidence; all adults except HIV+ women had a
stronger sense of self-efficacy than adolescents; HIV+ women reported the most
self-reliance, and teens were the most likely to ask for help. Overall, 46% of the
males and 20% of the females felt generally "in total control" of their lives; yet
3% of the HIV+ males and 21% of the HIV+ females felt they were not in control
(analysis of variance,R-square, and Pearson chi-square used).
Conclusion: Primary and secondary HIV prevention programs trageting at-risk
adolescents and adults need to recognize and respond to the continuing role of
markers of self-esteem, such as locus of control, as they relate to women's atitudes and beliefs about their ability to change risk behaviors.
Presenting author: ellen bay, 40 ferry street, newark, new jersey 07105, United
States, Tel.: [phone], Fax: [phone], E-mail: specialaudiences
@earthlink.net
WePeD6388 HIV risk characteristics of homeless men and
women
W.D. Klinkenberg1, G.A. Morse2, R.J. Calsyn3, S. McCudden 1. University of
Missouri, MIMH, 5400 Arsenal St., St. Louis, MO, 63139, United States;
2 Community Alternatives, St. Louis, MO, United States; 3University of
Missouri-St. Louis, St. Louis, MO, United States
Background: We examined the HIV risk-related characteristics of homeless men
and women, with a particular emphasis on mental health and substance use disorders and gender differences in risk.
Methods: This project interviewed 396 people, representing 80% of the available
pool of residents of fourteen local shelters.
Results: The sample was predominantly African-American (88%) and male
(72%); the average age of participants was 39. We estimate that 55% of the
participants had experienced a major depressive episode in the past year and
that 27% of participants had a psychotic disorder. Women were more likely than
men to screen positive for depressive and psychotic disorders. We also estimate
that about 77% of participants would meet criteria for a lifetime substance use
disorder, with men being more likely to have a substance use disorder. Fifty-two
percent of participants reported having had at least one sexually transmitted disease in their life, twice the general population rate. Thirteen participants (3.3%)
were HIV-positive. Seventy-two percent of the participants were sexually active in
the past six months with an average of three partners, and 56% had intercourse
without using a condom. Twenty-five percent reported exchanging sex for money
or drugs at least once in the past six months. Men were more likely to pay someone for sex and women were more likely to have been paid for sex. More frequent
acts of unprotected intercourse for homeless men were associated with being in
a steady relationship, exchanging sex for money/drugs, and low self-efficacy for
sexual risk reduction. For women, predictors of the frequency of unprotected intercourse were being in a steady relationship and higher perceived vulnerability
to HIV infection.
Conclusions: Our data demonstrate that homeless men and women experience
high rates of depression, substance use, and sexual risk behaviors. Women are
particularly vulnerable to HIV through relationship and partner risk factors.
Presenting author: Dean Klinkenberg, MIMH, 5400 Arsenal St., St. Louis, MO,
63139, United States, Tel.: [phone], Fax: [phone], E-mail:
klinkd @ mimh.edu
WePeD6389 Self perception of risk: a study of knowledge,
attitudes and practices among women between
ages 15-49 in Central Mozambique
K.H. Sherr1, F. Jaqueta, S.O. Gimbel-Sherr1, A. Soares1, S. Gloyd2,
M.A. Mercer2. 1Health Alliance International, H.A.I., PO. Box 1227, Mutare,
Mozambique; 2Health Alliance International, Seattle, United States
Background: In Central Mozambique the HIV/AIDS epidemic has reached catastrophic proportions. Year 2000 sentinel surveillance found rates as high as 31%
in urban areas in the region. Interventions to date have focused on prevention
via mass media and social marketing of condoms, resulting in high knowledge of

HIV transmission and prevention. However, as the increase in incidence attests,
these widespread education campaigns have not increased preventive sexual behaviors. Though increasing and tracking knowledge is important in combating
HIV/AIDS, assessing risk perception levels may be more indicative of an individual's likelihood to adopt safer behaviors.
Methods: Using an adapted EPI cluster methodology, 2681 women between the
ages of 15-49 were surveyed from four districts of Manica province. Questions