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

530 Abstracts ThOrE1l406-ThOrE1l422

XIV International AIDS Conference

ThOrE1 406 Living on the edge: ethnographic observations on
risk-taking among marginalised township youth in
South Africa
K.M. Wood. Medical Research Council, Medical Research Council, Private Bag
X385, Pretoria 0001, South Africa
Background: Despite the seriousness of the HIV epidemic in their midst and
their witnessing of AIDS-related deaths among peers, South African youth continue to adopt safer sexual practices only erratically. This paper seeks to take
analysis beyond narrow, individualistic explanations which focus on attitudes towards condoms and male 'irresponsibility', to consider the linkages of sexual risk
to broader contexts of risk-taking among male youth in a setting characterised by
daily violence and economic vulnerability
Methods: The findings are based on an anthropological doctorate for which the
author conducted 18 months of ethnographic fieldwork including participant observation, in-depth interviews and focus groups, in a working-class neighbourhood of a township in the former Transkei region of South Africa.
Results: The paper begins by describing the complex intersection of factors
which impacts on individuals' capacity to take up sexual risk-reduction strategies.
It goes on to consider how in a context of deprivation and poverty of opportunity,
the daily lives of male youth are characterised by a survivalistic ethos which jeopardises their ability to confront fully the consequences of their actions. Many are
bound up in criminal practices fraught with danger, as a means to instant income,
camaraderie and 'respect'. Risk-taking is described as pleasurable. Sudden violent death as a result of alcohol-related stabbings and botched criminal 'missions',
is common. In this context, short-termism, fatalism and a sense of being out of
control are evident in young men's thinking about their lives, and mould their responses to HIV- a disease which brings incapacitation 'tomorrow', not today.
Conclusions: These findings suggest the importance for HIV intervention design of understanding the conditions in HIV-afflicted communities giving rise to a
variety of risk-taking practices, which include- and go beyond- the sexual domain.
Presenting author: Katharine Wood, Medical Research Council, Private Bag
X385, Pretoria 0001, South Africa, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThOrE1407 Understanding the relevance of youth culture in the
fight against HIV/AIDS epidemic in South Africa:
Youth in privately owned flats and university
residences in Durban, South Africa
N.G. Zungu. University Room 11, CSTP TB Davis, University of Natal, Durban,
South Africa
Issues: Despite the high level of HIV/ AIDS awareness in South Africa (90%+),
in 2001 the Medical Research Council of South Africa (MRC) reported about 4,
1 million out of 40 million people are living with HIV/ AIDS in the country - and
this translates to give a ratio of 1:10. Besides, the MRC projects that "the cumulative number of HIV/AIDS deaths will exceed 6 million, while the number of AIDS
sick people will be well over 1 million. The population will fall significantly such
that while the population rises to 49 million in 2010, by that time it will be barely
growing" (MRC, 2001: 21). Out of the 4.1 million people living with HIV/AIDS, the
youth constitutes a larger percentage although it is presumed that the youth is
functionally literate. This scenario sends a message that there is more that the
government and other sectors of society need to know about the dynamics that
surround the HIV/AIDS epidemic.
Description: The paper argues that youth subculture contributes to the spread
of the HIV/ AIDS epidemic in South Africa. The following specific points are addressed in this paper.
1. youth culture versus awareness;
2. economics and youth culture (drugs and entertainment activities);
3. reflexive commercial sex engagements by the youth (e.g. 'buy me a pizza I will
have sex with you'); and
4. psychology of the youth culture.
Conclusions: While it is important to for the government to dispense antiretrovirals for those who are already infected by HIV/ AIDS, to prevent mother
to child transmission or related diseases, it is also important for the government,
especially the Department of Education and the Department of Health) to look
beyond awareness campaigns and pay special attention into the youth subculture. Also, if it is the youth that gets more infected and affected by the epidemic,
therefore it is critical read into youth cultural behaviour.
Presenting author: Ntokozo Gabangaye Zungu, Room 11, CSTP TB Davis, University of Natal, Durban, South Africa, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
ThOrE1408 Sexual risks and vulnerability: "Street kids" and
"loose girls" in a Shanty Town in Chiclayo, Peru

X.S. Salazar', M.R.G. Gc.ratel, A.M. Maiorana2, T.C. Coates2, C.C. CAceres1.
1 Universidad Peruana Cayetano Heredia, Perez de Tudela 176 # 602, Lima 27,
Lima, Peru; 2University of California San Francisco, San Francisco, United States
Background: Young people constitute a frequently studied group in sexual
health. In most studies, the rule has been to regard them as a homogeneous
group defined by developmental stages, and to see their problems as inherent to
youth, rather than as a result of structural vulnerability.

Methods: In an ethnographic study for the Peruvian component of the NIMH
HIV/STD Collaborative Intervention Trial, 33 interviews, 4 focus groups, and participant observation in 10 settings, were conducted with young people in Chiclayo, Peru. Self- and peer- images of youths, as well as differences in patterns
of social and sexual behavior were examined on the basis of access to economic
resources, educational opportunities and social support.
Results: Although most youths showed similar STI/HIV knowledge, their attitudes
towards health and HIV/STI, and exposure to sexual risk varied according to their
living conditions (levels of employment, educational opportunities, family characteristics, social support). Two special segments were described to exist in the population: Street kids and loose girls, since they did not study nor work, used drugs,
and frequently practiced various forms of compensated sex. Members of both
segments lacked ideas about preserving long-term health. They differed importantly from two residual population segments: young males who studied/worked,
and the "quiet girls".
Conclusions: This study provided strong evidence for the need, in prevention interventions, to abandon the concept of "young people" as a single group defined
only by age and gender. When incorporating economic/educational resources
and social support into the analysis, specific segments may emerge which show
diverse beliefs, sexual practices and health seeking behaviors. Understanding
this diversity will not only help us design more focused programs, but also consider the role of structural change in HIV prevention.
Presenting author: Ximena Salazar Lostaunau, Perez de Tudela 176 # 602,
Lima 27, Lima, Peru, Tel.: [phone], Fax: [phone], E-mail: 16570
@upch.edu.pe
ThOrE1421 Breaking the excuses: New knowledge about
patents and international aid financing, and why
AIDS treatment isn't happening
A. Attaran. Harvard University, Kennedy School of Government, 79 JFK St,
Cambridge, MA, 02138, United States
Issues: Recent research (Attaran et al, 2001, JAMA 286:1886-1892) has demonstrated that for low income countries, the barrier to antiretroviral treatment is not
often the existence of patents. In a pairwise comparison of 53 African countries
and 15 antiretroviral drugs, patents exist in only 21.6% of cases, such that 1 or
more of the most "strongly recommended" HAART regimens is totally unpatented
in up to 98% of countries. Thus in nearly all African countries (with the important exception of South Africa), there is often unrecognized latitude to use brandname or generic drugs in AIDS treatment. The theory that patents block access to
HAART in Africa, while not without validity, is thus easily overstated, and HAART
is possible in nearly every African country now without patents as an impasse.
However, where patents are not such a problem, finance absolutely is. Even using
the cheapest generics, HAART costs several times the per capita health budget of
even the wealthiest African country. Nor is international aid finance forthcoming:
in 1999, the world's 23 richest countries contributed about $161 million as aid for
AIDS in all low income countries globally (Attaran & Sachs, 2001, Lancet 357:57 -61). This is about what it costs to build 10 kilometers of highway, and represents
just $7 on every $1,000,000 of income in rich countries.
Recommendations: Effective advocacy requires two simultaneous strategies.
The first must be to increase international aid funding for AIDS, by replicating
the lobbying energy that was focussed on patent issues, to compel donor governments to meet their international obligations. The second must be to reach
agreement on equitable access to medicines in the few cases where patents exist, by making use of existing concessions from pharmaceutical firms, and seeking
similar arrangements for other urgent cases, such as for malaria, TB, and other
diseases of the poor. A Global Fund for AIDS, TB and malaria can ease these
steps.
Presenting author: Amir Attaran, 79 JFK St, Cambridge, MA, 2138, United
States, Tel.: [phone], Fax: [phone], E-mail: amir_attaran@harvard.
edu
ThOrE1422 Technology transfer for local production of
HIV/AIDS-related drugs in African countries:
collaboration between Thailand and Africa
K. Kraisintu. Government Pharmaceutical Organization, 75/1 Rama6 road,
Rajthevi, Bangkok 10400, Thailand
Issues: In the Resolution "WHO Medicines Strategy" (WHA54.11), the World
Health Assembly recognizes the efforts of Members States to expand access
to drugs and promote domestic industry, cooperate constructively in strengthening pharmaceutical policies and practices, including those applicable to generic
drugs and intellectual property regimes in order to promote innovation and the
development of domestic industries, consistent with applicable international law.
The UNGASS Declaration of Commitment on HIV/AIDS 25-27 June 2001, with regard to care support and treatment recommends Members to cooperate construc
tively in strengthening pharmaceutical policies and practices (including generic
drugs and IP regimes).
Description: The Technical Cooperation among Developing Countries (TCDC) is
the execution and management of developmental activities and projects by institutions of developing countries in which they share one another's experience and
technical capacities.
The production of generic antiretrovirals is currently done in Thailand and Brazil