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

XIV International AIDS Conference

Abstracts ThPeF8172-ThPeF8176 627

affecting women, and unfortunately, none of them have been followed up with
any concrete action on how to amend or replaceor supplemewnt these laws so
they provide effective protection from violence for the women at risk. This paper
reveals recommended specific actions to be taken by Ngos, civil society, Governmentsand the women themselves in order to address these conserns. ifthese
recommendations are taken and applied as is, they will andswer the question that
is ever begging in a situation like this, "yes but how?".
Presenting author: maame baffour-awuah, p.o.box 72, gaborone, Botswana,
Tel.: [phone], Fax: [phone], E-mail: mafe [email protected]
ThPeF8172 HIV Prevention Program among Sex Workers in
Cambodia
S. Nith. Family Health International, PO Box 2586, Phnom Penh I//, Post Boeng
Pralit, Cambodia
Issues: HIV prevalence rates in Cambodia remain among the highest in Asia.
The worst affected group is commercial sex workers, registering an HIV prevalence rate of 31% in 2000. Interventions providing sex workers with sexual health
information without addressing the underlying context of lack of power, economic
marginalization, and social exclusion, are unlikely to lead to sustainable HIV prevention. Projects including peer support, motivational and skill building components, involving all stakeholders in a collaborative process, and adddress a variety
of needs, show promise in empowering women to negotiate safer sex.
Descriptions: The Women's Network for Unity, a network of sex workers in Cambodia is a support network of more than 3,000 women who have joined together
in small, local groups. Network representatives are elected from each group and
are involved in the development of activities such as savings and vocational training, HIV/AIDS/STD information and referrals, World AIDS Day and Women's Day,
advocacy to government, brothel owners and local authorities, and workshops
such as condom negotiation skills and techniques to avoid violence. NGOs supporting the women's network actively advocate on their behalf with brothel and
other establishment owners, local police and health care providers.
Lessons learned: The Women's Network for Unity has noticeably raised the selfesteem and confidence of vulnerable women engaged in sex work in Cambodia,
enabling them to discuss and collectively address their problems in a supportive environment, and gain additional support from local authorities and brothel
owners in promoting condom use, their own health and rights.
Recommendations: Bringing sex workers together to address their common
problems helps raise their self-esteem and their concerns to a stage where they
can be adequately addressed. The involvement of all concerned stakeholders
and authorities is crucial in creating a supportive environment.
Presenting author: Sopha nith, PO Box 2586, Phnom Penh III, Post Boeng Pralit,
Cambodia, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeF8173 Sexual assault and AIDS: crisis counseling and
ethical obligations for disclosure
S. Burtner1, N. Meginness2. 1California State University, Fresno, 2213
Shropshire Ave., Fort Collins, CO 80526, United States; 2Larimer Center for
Mental Health SAVA Program, Fort Collins, United States
We consider two issues pertaining to sexual assault survivors who are thereby at
risk of AIDS: 1) whether sexual assault victims have unique concerns that AIDS
workers should be aware of; and 2) whether an AIDS worker has an ethical obligation to disclose the at-risk status of a sexual assault survivor, especially if the
survivor chooses not to do so.
Our paper is based on 20 years' experience as crisis counselors for sexual assault survivors. We draw on statistics, anecdotal evidence and the ethics literature
to discuss the issues in the paper. For issue 1, we outline psychological factors
common to all sexual assaults and explain how these factors are compounded in
special populations. Next, we offer guidelines for crisis counseling in all the above
cases, and how HIV testing should be introduced into the counseling. Next, we
offer guidelines for follow-up services for at-risk sexual assault victims. Finally,
we illustrate our format with a role-play session. For issue 2, we will consider
the argument that confidentiality is an absolute right. We argue that confidentiality is not an absolute right, and that it can sometimes be violated based on the
expected consequences. However, we argue that in the case of at-risk sexual
assault survivors, the consequences of violating confidentiality may be worse in
the long term than the consequences of respecting it. Therefore, AIDS workers
ought to respect confidentiality while urging their clients to disclose their at-risk
status through emotional support and tools for disclosure. (1) In the process of
our research, we will be developing a blueprint for how to provide crisis counseling about AIDS to sexual assault victims; and also concluding that sexual assault
victims do have special concerns to which AIDS workers should be sensitive; and
(2) it is not permissible to violate confidentiality in most cases, and so AIDS workers should develop methods that help at-risk individuals to arrive at that decision
themselves.

Presenting author: Seetha Burtner, 2213 Shropshire Ave., Fort Collins, CO
80526, United States, Tel.: [phone], E-mail: [email protected]

ThPeF8174 Direct services outreach strategies that work
M.J. David-Wilson, B. McGovern. NJCRI, Newark, NJ
Issues: Many persons living with HIV/AIDS; especially those residing in urban
areas with high incidence of HIV/AIDS, are either not yet in care and treatment or
have dropped out due to a variety of personal and social issues, including: fear
of disclosure of their HIV status and HIV related discrimination, personal substance abuse and unstable living environments. Their non-participation in care
and treatment results in further erosion of the immune system, increased illness
and hospitalization, and related costs.
Description: NJCRI has developed a successful model program to seek out and
find HIV+ persons not in HIV care and treatment and actively assist them to enroll and continue their participation in care and treatment using indigenous Peer
Outreach Workers (POWs).
Lessons Learned: 1) Since its inception in October 1999, 748 HIV+ persons either: a) not yet in care and treatment or b) who have dropped out, have responded
to outreach interventions and have successfully enrolled and maintained their participation in care and treatment. 2) People encountered respond well to invitations
of peers. 3) When asked why they had not previously enrolled, 68% stated, "no
one had asked them before". 4) 100% of enrollees noted improved health and
personal stability after 3-6 months of participation in care and treatment.
Recommendations: 1)Urban areas with high incidence of HIV / AIDS should
have such a project in place. 2) AIDS Service Organizations should see hiring HIV
infected and affected persons from their target communities as a key to success.
3) Community based projects are more effective when they formally collaborate
closely with HIV medical centers.
Presenting author: Michael David-Wilson, NJCRI, 393 Central Avenue, Newark,
New Jersey, 07103-2842, United States, Tel.: [phone], Ext. 32, Fax: [phone], E-mail: m.david-wilson @ njcri.org
SThPeF8175 Will VCT be acceptable and an effective tool to
conquer TB in HIV era, if offered to all TB patients
in Mozambique?
A. Macarthur Jr., A. Barreto, A. Noya, A. Vergara, S. Gloyd. Epidemic and
Endemic Department, Ministry of Health of Mozambique, Maputo, Mozambique
Background: VCT in TB patients is still not in place due to some concerning.
Should the doctors offers VCT to all TB patients or just the cases suspect with
HIV? Can this approach be acceptable without reducing the results of anti-TB
treatment, and reactivating the stigmatisation that TB patients suffered in the
past? HIV prevalence in TB is around 32%. In addition, more than 75% of patients in wards of TB referral hospitals are HIV positive.
Methods: A cross sectional study was conducted over nine month period, targeting a population sampled in all three regions of the country. Eligible health
facilities were selected randomly, proportional to population size of new cases of
registered new adult tuberculosis cases. All newly registered tuberculosis cases
from each health facility who gave consent was enrolled in the study and interviews and then HIV testing were conducted after TB diagnosis on all consenting
enrolees regardless of AFB status.
Results: Of a total of 1,036 TB patients enrolled for VCT, 59% were male and no
difference between male and female for consenting; 91,2 vs. 91,0 respectively,
OR= 1.03 (0.66, 1.59). After HIV testing there was no difference for accepting
to receive their results and share it with someone else in the family 58,7 in HIV
positive vs. 57.4, OR 1.05 (0.70, 1.57) regardless HIV results. Either positive or
Negative HIV patients responded well during post-counselling and having their
willing to change their sex behaviour (97% HIV positive vs. 95% HIV negative
OR= 1.78 (0.48, 7.26).
Conclusions: VCT could be a first step and an effective tool to conquer TB in
HIV era. VCT on a broad basis to TB patients would help health care workers
to choose the best TB treatment regimen, help prevent other opportunistic infections, encourage follow-up of tuberculosis patients, as well as prevent the spread
of HIV in the family and community.
Presenting author: alfredo macarthur jr., pobox 264, ministry of health, aven.
eduardo mondlane number 1008, maputo mozambique, Mozambique, Tel.: +258
1 427131 ext 203, Fax: [phone], E-mail: [email protected]
ThPeF8176 Use of "Therapeutic Friends" to improve adherence
to antiretroviral therapy
J.J. Gimenes1, E.E. Freitas1, M.I. Souza1, M.PI. Figueiro1, E.Z. Lopes',
R.M.C. Tellini1, S. Chen2, N. Hearst3. 1Praia Grande STD/AIDS Program,
Secretaria de Saude, S~o Paulo, Brazil; 2johns Hopkins Bloomberg School of
Public Health, Baltimore, United States; 3University of California, San Francisco,
San Francisco, United States
Issues: AIDS patients from Specialized Clinical Services in Praia Grande often
have difficulties adhering to antiretroviral therapy. Illiteracy and lack of under
standing of medical instructions are the main causes of nonadherence.
Description: We developed an adherence strategy based on a system of "Therapeutic Friends". These are qualified volunteers and relatives who received initial
training followed by continued weekly technical and psychological support. Three
of the volunteers were selected as peer leaders to help coordinate the program;
they receive a small stipend. Volunteers became involved in visiting homebound
patients and supporting adherence of mothers to treatment to prevent vertical