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

534 Abstracts ThOrE1502-ThPpE2153

XIV International AIDS Conference

living with HIV/AIDS. Social theories suggest that social- compared to individuallevel intervention may be more powerful for effecting and sustaining behavior
change. The paper summarizes our social contextual research findings for instructive discussion of how research findings and theories of social influence, social norms, and social capital may inform unified intervention for HIV prevention
and care.
Methods: Social network analysis was used to identify structural, functional, and
relational network characteristics associated with behavioral risk (n=503) and
medical service seeking (n=297) among HIV seropositive injection drug users
in Baltimore, U.S.A. Sociodemographics of participants' network members were
also assessed.
Results: Specific forms and sources of social support were associated with sexual and injection risk behaviors, formal medical care seeking, and network provision of informal care. Findings elucidate how the social stigma of drug use affects
the social and economic marginalization of drug users, particularly female drug
users, and its affects on their HIV risk and care seeking behaviors. Findings suggest the influence of female support on health behaviors, and the potential roles
of sex partners and supportive kin and non-kin alike in affecting access to health
resources.
Conclusions: Social network analysis may aid in identifying individuals who influence a population's health behaviors and access to health resources. These individuals may be important targets for intervention approaches that capitalize on
their potential influences on social norms of behavioral risk and service seeking,
and mobilizing community informal HIV care. Findings may aid in understanding social theories and research methodologies relevant for developing unified
approaches to HIV prevention and care.
Presenting author: Amy Knowlton, 624 North Broadway, Johns Hopkins School
of Public Health, Dept. Health Policy & Management, SBS, Baltimore, MD 21205,
United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThOrE1l5021 Health lies and unhealthy truths: Iconic and textual
narratives of awareness capaigns in India
L. Coutinho. University of De/hi, E-24, First Floor, Saket, New Delhi 110 017,
India
Background: This research paper focuses on a question of lies and truths within
the discourse of health and illness as has emerged during my research on
HIV/AIDS prevention campaigns. Health education materials may be read as narratives, which attempt to give particular meaning to state, community and individual experience of HIV/AIDS. The paper attempts to understand the inter-relations
between state, community and individual in relation to the AIDS epidemic through
these iconic and textual narratives that are interwoven with fictions, half-truths
and lies.
Methods: Based in anthropological theory these narratives have been critically
examined as objects which circulate in the public domain and hence constitute
and are constituted by public discourse. The narratives of the state, community
and individual in relation to issues of health and illness are not distinct from each
other, but are enmeshed within the discourse and practices of each other. Hence,
the paper traces the discursive formations that inform and that are informed by
each other.
Results: The fictions and lies of the state as evident in HIV awareness campaigns
are produced through a particular set of practices of health bureaucracies. Social
and cultural processes mediate the transformation of state perception of risk, to
community and finally individually perceived risk. Thus the medico-scientific and
epidemiological category of risk is negotiated by various social factors.
Conclusion: These narratives point towards state polices and its relationship with
the body politic.The state's fictions and lies inform the community and individual
meaning-giving strategies, in as much as their narratives influence those of the
state. Hence, an individual or collective fiction is not only an engagement with
the particular health issue, but with the issue in its dispersion over several sites,
including the practices of the state, community and individual.
Presenting author: Lester Coutinho, E-24, First Floor, Saket, New Delhi 110
017, India, Tel.: [phone], E-mail: [email protected]
pThPpE2151 Ie percepinof access to HIV treatment
Iand barriers to adherence: implications for HIV
treatment teams and systems of care
L. Frank1, R. Day1, J. Pease2, J. Folby3. 1University of Pittsburgh,
Pennsylvania/MidAtlantic AETC, university of pittsburgh, graduate school of
public health, 418 parran hail, pittsburgh, pa 15213, United States;
2pennsylvania Department of Health, Harrisburg, PA, United States;
3 pennsylvania Department of Public Welfare, Harrisburg, PA, United States
Background: The paper examines the results of a study conducted with HIV patients. The study was conducted by the Pennsylvania/MidAtlantic AIDS Education

and Training Center, University of Pittsburgh, Graduate School of Public Health
in collaboration with the Pennsylvania Department of Health and Department of
Public Welfare, AIDS Drug Assistance Program.
Methods: A series of 126 HIV consumers participated in focus groups through
the Ryan White regional planning coalitions in Pennsylvania.
The groups used a standard set of questions, which were recorded and participants were asked to complete a 55-item survey. The primary objective was to

assess differential patient access to HIV health care resources in urban and rural
areas and its impact on treatment adherence.
Results: Subjects included in this study were evenly distributed between those
residing in rural and urban areas. The urban as compared the rural sample had
a significantly greater proportion of minority subjects (p<0.001). Adherence was
similar between the two samples(p=0.13). Subjects reported greatest difficulty accessing gynecologists, dentists, HIV specialists, and physicians in rural areas and
demonstrated a significantly lower mean number of yearly provider visits than the
urban sample (p<0.01). Logistic regression applied to the survey data indicated
that the primary independent predictors of adherence status were age (younger
subjects less adherent, OR=2.7, p=0.012) and minority status (OR=2.4, p=0.057).
Conclusions: Despite levels of adherence similar to those in urban areas, the rural subjects reported significantly more barriers to medical care. This indicates the
need to increase access to HIV specialist for those outside of major metropolitan
areas. Our findings also indicate the necessity of focused adherence improvement programs on younger HIV patients, particularly among minorities residing in
urban areas.
Presenting author: Linda Frank, university of pittsburgh, graduate school of public health, 418 parran hall, pittsburgh, pa 15213, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPpE2152 Effect of stigma on the provision and utilization of
health care
J. Mbwambo1, L. Nyblade2, S. Mathur2, G. Kilonzol, P. Kopoka3
K. MacQuarrie2. 1Muhimbili University College of Health Sciences, 1717
Masschusetts Ave, NW Suite 302, Washington, DC 20036, Tanzania; 2ICRW,
Washington, DC, United States; 3 University of Dar es Salaam, Dar es Salaam,
Tanzania
Background: HIV related stigma and the resulting discrimination is increasingly
recognized as a barrier to care and treatment in sub-Saharan Africa, yet little data
exists to help us address this problem.
Methods: Qualitative methods are being used in two areas in Tanzania to study
the causes, manifestations, and consequences of stigma and resulting discrimination in health care and community settings. Data is being collected from the
community and health care providers. A cohort of PLHA (15 men, 45 women from
VCT and ANC clinic sites) is being followed for a year to document experiences
with stigma and discrimination.
Results: Preliminary results confirm that a complicated mix of factors, especially
stigma, impede provision and utilization of health care. Health care workers may
be reluctant to care for PLHA because they: fear infection (due to lack of knowledge and protective supplies), have judgmental attitudes about PLHA, have to decide who receives treatment in resource poor environments, experience burnout,
feel hopeless, and fear secondary stigma and discrimination. PLHA may also be
reluctant to access health care, for complex reasons. Some fear poor care and
that in seeking health care their positive status will become known, resulting in
stigma and discrimination outside the health care setting. PLHA also fear that
once their families know they are HIV positive, they may be reluctant to expend
scarce resources on health care. PLHA may also self-stigmatize, attributing their
infection to "bad" behavior, making them less likely to access health care and
support.
Conclusions: Service providers need on-going training and support to deal with
providing care in a difficult work environment and opportunity to process their
own issues with HIV/AIDS that may lead to stigma and discrimination within the
health care system. PLHA need support to understand how stigma is affecting
their utilization of health services and how to overcome this
Presenting author: Laura Nyblade, 1717 Masschusetts Ave, NW, Suite 302,
Washington, DC 20036, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPpE2153 Fuelling HIV epidemic in Russia: the stigma of IDU
and HIV and its impact on treatment access and
testing
V. Orekhovsky1, L. Calzavara2, A. Yakovlev3, T. Nikitina4, G. Volkova5,
M. Michalchenko5, V. Saldanha5. CnaaAIDS Russia Project (CARP),
Toronto,; 2HIV Studies Unit, University of Toronto, c/o Casey House, 9 Huntley
Street, Toronto, Ontario, M4Y 2K8,; 3Botkin Hospital, St.Petersburg, Russian
Federation; 4PrOvincial AIDS Centre, Kaliningrad, Russian Federation; 5Canada
AIDS Russia Project (CARP), St.Petersburg, Russian Federation
Background: Russia currently has the highest rates of HIV transmission. Over
90% of the new cases are among the estimated 2 million injection drug users
(IDU). In June 2000, focus group discussions were conducted to obtain a better
understanding of the escalating epidemics among IDUs.
Methods: 69 IDUs and 15 professionals, who work with IDUs, participated in the
study that was carried out in Kaliningrad and St. Petersburg. Individuals com
pleted an anonymous questionnaire and participated in a discussion session that
explored the determinants of IDU, access to services and health care, and society's attitude toward IDUs.
Results: IDUs ranged in age from 16-50 years; 49% were females; 48 % were
HIV-positive, and 56% were infected with Hepatitis C (HCV). Injection drug users
reported experiencing pervasive stigmatization in accessing services and medical care. They recounted that treatment was frequently refused, delayed or in