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

XIV International AIDS Conference

Abstracts ThOrE1497-ThOrE1501 533

they are circumcised. During the year 2000, 14 out of 46 boys (30%) in Bubulo
county were circumcised from hospital and in 1998, 8 out of 39 boys (21%) were
circumcised from hospital.
Conclusion: HIV/AIDS awareness programmes should continue to improve on
cultural practices that are likely to be a health risk.
Presenting author: Alice Kataami, Joint Clinical Research Centre, Ring Road,
Butikiro House, P. O. Box 10005, Kampala, Uganda, Tel.: [phone], Fax:
[phone], E-mail: [email protected]
ThOrE1497 The scientific construction of the HIV positive
person within studies of anti-viral efficacy: a
systematic and critical review
PR Flowers1, J. Frankis1, M. Rosengarten2, M. Davis3, G. Hart4, J. Imrie2.
Glasgow Caledonian University Dpt. Of Psychology Glasgow Caledonian
University, 70 Cowcaddens Road, Glasgow G9 O0B, United Kingdom;
2University College London, London, United Kingdom; 3Imperial College,
London, United Kingdom; 4MRC Social and Public Health Sciences Unit,
Glasgow, United Kingdom
Background: To explore the 'medical' construction of the HIV positive person in
current literature regarding the efficacy of HIV treatments and theorise the potential impact of such constructions on positive individuals' experiences of treatments
and treatment failure.
Method: Embase, Medline and Web of Science were searched for all papers
which assess the efficacy of anti-HIV drugs, published during the first quarter of
2001 (n=30). Study participants demographics were collated, eg country of residence, treatment history, age, ethnicity, gender, transmission route.
Results: The medical construction of the HIV positive person implicit within the
treatment efficacy literature embodies a person who is male (the median proportion of women per trial is 14%), from North America or central Europe, white
(72% of participants in studies which reported ethnicity), early middle-aged (most
studies having a median age between 37 - 41 years), gay (56% of participants
in studies where transmission route was reported), and had experience of treatments (70% of studies included only treatment-experienced participants).
Conclusions: This systematic literature review suggests an over-representation
of white, gay, middle aged men who participate in clinical trials. This is problematic as this construction of the HIV positive person differs from the majority of HIV
positive people in the world. These constructions and their associated expectations may mitigate against understanding the complex social and cultural issues
involved in treatment failure. The positivist epistemology of empirical science (eg
cumulative knowledge) has delivered effective HIV treatments, yet from a critical perspective, this paradigm may also produce specific understandings of HIV
positive people which are not generalisable.
Presenting author: Paul Flowers, Dpt. Of Psychology, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G9 00B, United Kingdom, Tel.: +44
(0)141 331 8617, Fax: [phone], E-mail: [email protected]
ThOrE1 498 Rising HIV rates in major cities: "AIDS optimism",
semiotic snares, and the bio-medical subject
B.D. Adam. University of Windsor, Dept of Sociology & Anthropology, University
of Windsor, Windsor, Ontario, N9B 3P4, Canada
Issues: the soco-historical context and epistemological premises that ground
contemporary hypotheses trying to explain rising HIV rates in major cities of advanced, industrial societies.
Description: The "AIDS optimism" hypothesis and the search for "barebackers"
reflect a particular cultural construction of HIV disease, consistent with fundamental discourses of western societies. The assignment of individual pathology and
responsibility through the medical model, the predominance of the knowledgeattitudes-behaviour model in psychosocial medicine, and the construction of sexuality in terms of mechanics and technique, construct a subject location that "men
who have sex with men" are then made to embody.
Lessons learned: Attending closely to the narratives of gay and bisexual men
about their own sexuality shows how consistent unsafe sex may be with predominant discourses of romantic and erotic communication, and how safe sex decision
making may be caught up insemiotic snares built into scientific and public health
language, autobiographical narratives, status hierarchies, body images, aging,
and the search for intimacy. HIV is as much an "opportunistic" agent of these
social mechanisms as it is of immune systems.
Recommendations: Alternative paradigms must be supported and employed
which can better address the internal narratives and reasoning processes of gay
men. This is a prerequisite for effective communication strategies that can engage
these internal narratives.
Presenting author: Barry Adam, Dept of Sociology & Anthropology, University
of Windsor, Windsor, Ontario, N9B 3P4, Canada, Tel.: [phone], Fax: +1

519 971 3621, E-mail: [email protected]

ThOrEl1499 The role of social capital in promoting or hindering
HIV prevention: a case study of a South African
mining community
C.M. Campbell1, C. MacPhail2, Z. Mzaidume3, B.G. Williams2. 1London School
of Economics, Social Psychology, London, United Kingdom; 2CSIR Miningtek,
Johannesburg, South Africa; 30Outreach co-ordinator, Mothusimpilo Project,
Johannesburg, South Africa
Background: We explore the role of local community participation in HIV prevention. It has been argued that participation promotes sexual health through building
'social capital' (trust, support, positive identity resulting from local participation) in
target communities, providing the optimal context for the re-negotiation of sexual identities and empowerment processes that facilitate behaviour change. We
report on a process evaluation of the peer education component of a communitybased HIV prevention intervention in a South African mining community exploring
the role of social capital in facilitating or impeding programme success.
Methods: Three year longitudinal case studies of peer education by miners, sex
workers and youth, including 350 depth interviews; analyses of project documentation; interviews with project personnel.
Results: We examine the extent to which the project succeeded in building social
capital, and factors which impeded or promoted this goal. Ironically, while there
was some success in building strong peer education networks in informal settings
(amongst sex workers and youth out of school), a range of institutional obstacles
impeded such network development in the formal settings of mines and schools.
There was some success in building 'bonding social capital' (collaborative networks within homogenous groups, such as sex workers and unemployed youth).
There was less success in building 'bridging social capital' (bringing together local stakeholders as diverse as mine managements, government officials, impoverished local residents, doctors, academics and traditional healers).
Conclusions: While we have no doubt that community participation plays a key
role in creating local contexts which enable and support behaviour change, much
remains to be learned about the complexities of implementing such participation.
The concepts of bonding and bridging social capital provide useful heuristic tools
for research and practice in this area.
Presenting author: Catherine Campbell, Social Psychology, London School of
Economics, Houghton Street, London, WC2A 2AE, United Kingdom, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThOrE1500 HIV positive gay male sex requires new policy and
education environments
M. Hurley, J.W. Grierson, J.M. Willis, K.M. McDonald, M.K. Pitts. Australian
Research Centre in Sex, Health and Society La Trobe University Melbourne,
Victoria 3000, Australia
Issues: Cultures of HIV positive gay male sex in developed epidemics have outpaced policy environments to the extent that policy environments threaten to
undercut safe sex cultures. In Australia, minor variations in HIV incidence and
increases in unprotected sex are being interpreted as breakdowns in safe sex
practice, though there is no concomitant increase in HIV infection nationally
Description: The HIV Futures I and II quantitative (n=924) and qualitative studies
clearly indicate that HIV positive gay men in Australia take good care not to put
their HIV negative sexual partners at risk of HIV.
Lessons: There is a mismatch between policy environments and the lived sexual
cultures of HIV positive gay men. This mismatch has the effect of demonising HIV
positive gay male sex, and casual gay sex generally, as 'barebacking' and sexual excess. Same sex passion is represented as threatening to public health. An
alarmist interpretive framework of imminent risk has two problems. Firstly, it singularly fails to understand why the conceptual difference between 'unprotected'
and 'unsafe' sex matters. Secondly, it encourages policy responses that undercut
the co-operation of lived gay male sexual cultures with partnerships supportive
of dynamic safe sex practices. The cultures and practices that enable the social
enacting of care between HIV positive and negative gay men are unproductively
constrained and public discourse around them overly delimited. The HIV Futures
qualitative study confirms that the field of safe sex constituted by HIV positive gay
men is dynamic and careful but threatened by being burdened with requirements
that it act to protect HIV negative gay men.
Recommendations: Implications for intervention include educational and policy
initiatives integrating understanding of HIV positive sex cultures and HIV negative
unprotected sex into shared practices of harm reduction between HIV positive
and negative gay men.
Presenting author: michael hurley, australian research centre in sex, health and
society, latrobe university, level one, 215 franklin st, melbourne, victoria 3000,
Australia, Tel.: [phone], Fax: [phone], E-mail: michael.hurley
@ latrobe.edu.au

ThOrEl 501 Social network approaches to HIV prevention and
care: Theoretical and methodological
considerations of intervention
A.R. Knowlton. Johns Hopkins School of Public Health, Baltimore, MD, United
States
Background: Theory-based research may help identify potential targets and
strategies of intervention to promote HIV prevention and care among populations