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

XIV International AIDS Conference

Abstracts ThPeD7626-ThPeD7630 497

ThPeD7626 Effectiveness of harm reduction strategies of
HIV/AIDS prevention in Temirtau (Kazakhstan)
A. Kossukhin1, S. Baimursina2, T. Chacklikov3. 1Joint UN and Government
Coordinated Programme of Healthy Lifestyles Development, UNDP Office, 67
Tole Bi Street, Almaty City, Post Code 480091, Kazakhstan; 2Center of AIDS
Prevention and Control of the Town of Temirtau, Temirtau, Kazakhstan; 3Center
of AIDS Prevention and Control of the Republic of Kazakhstan, Almaty
Kazakhstan
Temirtau is a town in the center of Kazakhstan, which became famous for the
onset of HIV/AIDS epidemic. Nowadays 40 per cent of people living with HIV in
the country are concentrated there. The assessed HIV prevalence in Temirtau in
2001 was 1,5 per 100 adolescents and adults of the age 15-45. Injecting drug
users (IDU) contribute to 90 per cent of the known HIV cases. The assessed
number of IDU in the town came to 8,000 i.e. to about 10 per cent adolescents
and adults of the age 15-45.
Medical-biological approaches based on compulsory testing of IDU for HIV, identifying people with HIV among them with subsequent contact tracing and registration proved to be ineffective for counteracting the epidemic. Since 1997 nontraditional intervention on HIV/AIDS prevention was piloted in Temirtau. The intervention included improvement of access to information, education, counseling
and medical service, inculcation of syringes and needles exchange programmes,
condom and disinfectants supply. Implementation mechanisms were based on
the establishment of Trust Points and friendly cabinets for STI treatment, conducting training of the staff and volunteers, initiating out reach work, providence
permanent peer education and counseling. Direct and indirect coverage of IDU in
the end of 2001 was estimated as 10 and 50 per cent accordingly.
The survey conducted among IDU had proved that the intervention leaded to significant improvement of their awareness in HIV/AIDS issues and their behavior.
In spite of eight-fold growth of HIV cases per 10,000 people tested having been
identified nation-wide in 2001 in comparison with 1997 the intervention in Temirtau stipulated six-fold decrease of the speed of HIV spread. The number of HIV
cases there was going down significantly although the assessed number of IDU
was growing up twice during the same period.
It is ascertained that package of harm reduction strategies could be effectively
used for counteracting the HIV epidemic among IDU.
Presenting author: Alexander Kossukhin, UNDP Office, 67 Tole Bi Street, Almaty City, Post Code 480091, Kazakhstan, Tel.: [phone], Fax: +7 3272
58 26 45, E-mail: [email protected]
ThPeD7627 The impact of interruptions in delivery of HIV
preventive measures amongst intravenous drug
users
P.T. Vickerman, C. Watts. London School of Hygiene and Tropical Medicine,
London School of Hygiene and Tropical Medicine, Keppel street, London, SW2
2JS, United Kingdom
Background: Many needle exchange projects (NEPs) have problems obtaining
long-term funding and have periods of reduced funding and activity (project gaps).
This is likely to reduce needle and syringe distribution and so increase sharing.
We use a mathematical model to study the effect of project gaps on the impact of
a NEP in Svetlogorsk, Belarus that had an 8-month funding gap in 1998, resulting
in 75% fewer syringes being distributed over 15 months.
Methods: A mathematical model was constructed to simulate the impact of a
NEP intervention. The model assumes that during a project gap syringe sharing
increases by a percentage of the reduction in sharing due to the intervention (this
percentage is defined as the 'gap effect'). For different gap durations and for the
gap starting at different times after the start of the intervention, the model is used
to estimate the recovery time for the IDU HIV prevalence to return to its pre gap
level (using data from Svetlogorsk).
Results: With a 15 month gap effect of 75%, the model projections fit the observed trends in IDU HIV prevalence in Svetlogorsk (74%-71% from 1997-2000),
and predict that the project gap increased IDU HIV prevalence to 79% in 1998
(69% without gap), and after funding re-commenced it took 19 months to return
to the pre-gap level. The figure shows the recovery time for project gaps (gap
effect=75%) of different durations and start times.

Presenting author: Peter Vickerman, London School of Hygiene and Tropical
Medicine, Keppel street, London, SW2 2JS, United Kingdom, Tel.: [phone]
7886, Fax: [phone], E-mail: [email protected]
ThPeD7628 Using self-reported concerns about HIV risk
behaviors to design an HIV prevention intervention
for female sex partners of drug users
A.C. Schoffel1, F. Pechansky', R. Boni1, V.K. Genrol, H.L. Surrat2,
J.A. Inciardi2. 'Federal University of Rio Grande do Sul, rua padre chagas,
147/905, porto alegre, rs,;2University of Delaware, Delaware
Issues: to design a sexual risk reduction intervention relevant to the needs and
concerns of female sex partners of drug users.
Description: eight volunteers female partners of drug users, was participate in
focus group. The discussion was focusing on sexual practices with their drugusing partners, domestic violence, drug use by their partners and themselves,
and self-image. Group sessions were transcribed and qualitatively analyzed. This
analysis generated pairs of statements describing factors associated with risky
sexual situations that were discussed with participants to get feedback on the
appropriateness of the language and meaning.
Lessons learned: 47 two-sided intervention cards were generated. Each card
contains a pair of opposing sentences on either side, and each side of the card
has an image to facilitate understanding of the statement. "Queens and Beggars"
(25 cards) covers four topic areas mentioned by participants: using sex as a tool,
self disregard vs. self care, perceptions of reality, and intimacy/trust issues. "Kings
and beggars" (22 cards) covers five areas: violence/safety, family life, money issues, sex/love/intimacy, and drug use.
Recommendations: The intervention cards designed in this research were
based on participant reports of individual, relationship, and contextual issues affecting risky sexual behaviors among female partners of drug users. The "Queens
and beggars" component deals primarily with the participants' feelings about their
own sexuality, as well as their self-image and self-esteem. "Kings and beggars"
focuses on the negotiation of safe sex, by role-playing discussions of risk reduction practices with sexual partners. Although these card components need to be
field tested to confirm their clinical validity, the inclusion of members of the target population in the design of the intervention is an important step in producing
effective, appropriate risk reduction programs.
Presenting author: adriana schoffel, rua padre chagas, 147/905, porto alegre,
rs, Brazil, Tel.: [phone], Fax: [phone], E-mail: schoffel@terra.
com.br
ThPeD7629I The research in Tver (Russia) a injecting drug
users sexual behavior
I. Ivanov. Aids center, Tver AIDS Center, 50 Let Oktyabrya, 2/2, 170040, TVER,
Russian Federation
Since April, 1999 the project of "Harm reduction among injecting drug users
(IDU)" has been operating in the city of Tver. The project is being realized by
the AIDS-center with the support of the Soros foundation and Regional administration. As of 01.07.2001 in Tver region there has been 2 982 cases of HIV
registered, 72,8 % out of which are among IDUs (in 1997 IDUs made up 95 %).
Since July, 1999 until May, 2000 a structured interview (survey) of IDUs - participants of the project was conducted.
The goal of the survey: IDUs risk behavior assessment.
The outcome of sexual behavior assessment of IDUs showed that among 408
IDUs surveyed, 357 has sexual contacts during the last 3 months. 224 of them
had sexual contacts with non-drug users, which makes up 62,7 % of all IDUs who
had sexual contacts during the last 3 months. Among the 405 IDUs surveyed
119 didn't not use condoms when having sexual contacts, 140 used them not
regularly, 146 used them always.
Conclusions: 1. There is a high risk of HIV spread through sex not only in IDUs
environment.
2. It is advisable to conduct preventive work in the groups of IDUs' sexual partners
- non-drug users.
3. In the sphere of sexual contacts IDUs group is not isolated.
Presenting author: Iouri Ivanov, Tver AIDS Center, 50 Let Oktyabrya, 2/2,
170040, TVER, Russian Federation, Tel.: [phone], Fax: +7(0822)
448151, E-mail: [email protected]
ThPeD7630 Cost-effectiveness of Lithuania's AIDS centre's
psychological-social rehabilitation community for
drug addicts
L. Gasiliauskas, K. Dragunevicius. Lithuania's AIDS centre, nugaletoju 3, vilnius,
lithuania, 2016, Lithuania

Background: Evaluation of cost-effectiveness of Lithuania's AIDS centre's
psychological-social rehabilitation community for drug addicts.
Methods: The financial analysis of activity of Lithuania's AIDS centre's
psychological-social rehabilitation community for drug addicts was made. The
harm which untreated addicts cause for society was evaluated. Also costeffectiveness and resources of Lithuania's AIDS centre's psychological-social rehabilitation community for drug addicts was evaluated.

12112

starttime of
gap inyrs
I--,I

-.-.-.----- - --- ----- ----- -- --- -- - -- ----- -- --x
2.- -
0 1 2duration of gap period in years3 4
duration of gap period in years

-s---10

In general, the recovery time for a project gap is greater than its duration, and
increases with the size of the gap effect, the duration of the gap, and the time
when the gap started. The main impact of a gap is in its first year (1-year gap with
75% gap effect has 80% the recovery time of a 4-year gap).
Conclusion: The findings highlight the importance of the sustained funding of
NEP interventions, and illustrate the substantial impact of even short-term gaps
in project funding on both the short and long term impact of NEP interventions.