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

XIV International AIDS Conference

Abstracts ThOrG1420-ThOrG1l470 641

ThOrG1420 Serenading to the tunes of violence - the tip of the ThOrG 1468 Prevent AIDS network for cost-effectiveness
iceberg of the sexual violence faced by the Kothis analysis (PANCEA) study on the cost and efficiency
during Lagan of HIV prevention in developing countries

P.K. Banerjee. New Alipore Praajak Development Society, P-777, Block 'P, New
Alipore, Kolkata, West Bengal, India
Issue: The Kothis (MSM with a female gender construct) of Kolkata set off to villages and towns in Bihar and Uttar Pradesh to dance during Lagan- the wedding
season. This paper delves into the atrocities and sexual violence they undergo
during Lagan.Description: The Kothis owing to their effeminate mannerism are
stigmatized in the patriarchal society. The Lagan comes as a draft of fresh air to
escape from the claustrophobic phallic society. The Kothis, dressed up as women
dance continuously for five six hours, are often subjected to violence. Alcohol
proves to be panache for coping violence. The squalor of their living condition
and absence of privacy makes them entertain their clients in the fields rather than
their quarters. This leads to them having hurried sex, leaving no room for negotiation and heeding to safer sex practices. Cases of gang rape and purported
violence leading to death are common.
Lesson learned: 1) They undertake the anticipated enormous risk to break free
from the shackles of the oppressive society that challenges their masculinity and
gender construction that depletes their self-esteem. 2) Engage in risky sexual behaviour where negotiation is unheard of. 3) Predominance of Male Rape. 4) To
supplement their depraved economic condition from which they are often cheated
by middle-men.
Recommendation: 1)Providing a support system to empower them strike against
violence, raise their self esteem & negotiation skills 2)Intensive Sexual Health
Trainings emphasizing on condom & lube usage. 3) Introduction of Gender Sensitive Income Generation Program. 4)Establishing strong network with NGO's in
Bihar & U.P for addressing issues on Sexual Health Matters to the general populace in a culture specific manner.5) Establishing referral services for treatment
and medicines with the NGO's & Go's operating in Bihar & U.P.6) Advocacy with
the law enforcement agencis.
Presenting author: protik kumar banerjee, P-777, Block 'P', New Alipore,
Kolkata, West Bengal, India, Tel.: [phone], Fax: [phone], Email: [email protected]
ThOrG1467 What to consider before attempting to expand the
impact of NGO action on HIV/AIDS
J. DeJong', C. Castle2, B. Goumbala3, S. Lucas4. 1University of Manchester,
Horizons/Population Council, 4301 Connecticut Ave NW Suite 280, Washington
DC, United Kingdom; 2Horizons/International HIV/AIDS Alliance, Washington
DC, United States; 3ANCS, Dakar, Senegal; 4International HIV/AIDS Alliance,
Brighton, United Kingdom
Issues: There is widespread concern that organisations addressing HIV/AIDS
are not operating at sufficient scale or with enough impact to stem its progress.
Only a very small proportion of the world's population at risk of HIV infection
is currently being reached (UNAIDS June 2000 Report). NGOs ranging from
community-based to the national level have been influential and innovative actors in HIV/AIDS. Yet they often experience particular difficulties in increasing the
scale of their activities to reach more people and have greater impact. They now
face pressure to expand their scale both because of the escalating epidemic and
funding trends favouring NGOs.
Description: A study was commissioned by the Horizons Program and the International HIV/AIDS Alliance to address the lack of documentation about which
types of NGOs or aspects of their work are amenable to scaling up, the different
programmatic approaches that have been used and their organisational implications. It is based on a literature review of scaling up in development and on
case studies of fourteen NGOs internationally that have scaled up their activities in either prevention, care or impact mitigation. It discusses the relative merits
of scaling up, the challenges NGOs face and the implications for their internal
processes and structures.
Lessons Learned: Scaling up does not necessarily jeopardise the quality, responsiveness and participatory approach of NGOs said to be their comparative
advantage. However, scaling up does entail many risks programmatically and has
profound internal organisational implications for NGOs.
Recommendations: Donors and organisations supporting NGOs need to understand the complexities of the scaling up process. Careful consideration of NGOs'
relationships with government, communities and other NGOs needs to be made
prior to scaling up. NGOs need to be more systematic in evaluating the impact of
their activities before scaling them up.
Presenting author: Christopher Castle, Horizons/Population Council, 4301 Connecticut Ave NW, Suite 280, Washington DC, United States, Tel.: [phone]
9412, Fax: [phone], E-mail: [email protected]

J.G. Kahn1, E. Marseille', M. Over2, M. Lundberg2, G. Garnett3, J. Saba4,
A. Reeler4, S. Bertozzi5. 'University of California, Institute for Health Policy
Studies, University of California, San Francisco, Box 0936, San Francisco CA
94143, United States; I World Bank, Washington, D.C., United States; 31mperial
College of Science, Technology and Medicine, Department of Infectious Disease
Epidemiology, London, United Kingdom; 4Axios International, Dublin, Ireland;
5National Institute of Public Health, Mexico, Cuernavaca, Mexico
Issues. With growing international funds for AIDS, there is an urgent need for
data to guide the efficient scaling up of HIV prevention spending in developing
countries. We report on the initial phase of an NIH-funded multi-center study
on the economics of HIV prevention in developing countries. The goal is to provide policy-relevant cost-effectiveness analyses on 8 major HIV prevention types
(CSW outreach, MTCT, STD control, VCT, school-based curricula, condom promotion, needle exchange, mass media) in five countries.
Description. We will collect cost and output data from prevention programs. A facility survey will be used to gather basic data from 200 programs, and econometric
regressions will be used with these data to assess the determinants of program
efficiency. A second, accounting-based, method will collect more detailed cost
and output data from a subset of 40 programs to describe the cost function that
relates costs and outputs over time and the associated mix of program inputs.
Case studies will characterize program history and context. The most important
expected result of these analyses is identification of factors that predict efficiency
for each intervention type. In conjunction with an epidemiologic model, we will
then predict how the mix of prevention spending affects on program outputs, risk
and behavior change, and ultimately HIV incidence and cost-effectiveness.
Lessons learned. We will report initial findings pertaining to the relationship between program expenditures and outputs from Mexico, South Africa, and Russia
for two HIV prevention types.
Recommendations. Cost functions are vital to estimates of the cost and impact
of 'scaling-up' HIV prevention programs. More generally, they are needed to refine
resource allocation decisions. These findings will have significant implications for
making best use of scarce HIV prevention resources.
Presenting author: James G. Kahn, Institute for Health Policy Studies, University
of California, San Francisco, Box 0936, San Francisco CA 94143, United States,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThOrG1469 Building health system capacity to provide
Voluntary Counseling and Testing (VCT) services
in Central Mozambique
S.O. Gimbel-Sherr', K.H. Sherr', J. Coutinho', M.A. Mercer2, S. Gloyd2.
'Health Alliance International, H.A.I., PO. Box 1227, Mutare, Mozambique;
2Health Alliance International, Seattle, United States
Issues: Voluntary counseling and testing (VCT) for HIV is typically a first step
taken by national governments to move beyond prevention strategies and address HIV/AIDS care and support. Collaboration between NGOs and the formal
health sector to conduct VCT may determine the extent to which the official health
system will take the lead in later interventions, including the improvement of clinical services (including opportunistic infections), Prevention of Mother to Child
Transmission (PMTCT) and finally anteretroviral introduction.
Description: VCT services were recently introduced on a national level in
Mozambique. In the final trimester of 2001, two VCT sites were opened in the second largest city of Beira. These two sites represent two different strategies used in
establishing VCT services-one is run by an international non-governmental organization (NGO) independent of the health system, the other is operated within the
national health system with technical and financial support from a consortium of
international NGOs. This presentation compares implementation strategies of the
two VCT sites, assessing how the two approaches affect utilization rates, referral
patterns, client demographics and client satisfaction.
Lessons Learned: In this resource poor setting, building capacity within the
health system resulted in dramatically higher utilization rates, more diverse referral patterns, and VCT services that are likely to be more sustainable.
Recommendations: Further operations research is needed to identify effective
collaboration strategies between NGOs and the formal health sector in offering
clinical and preventive services for HIV/AIDS.
Presenting author: Sarah Gimbel-Sherr, H.A.I., P.O. Box 1227, Mutare, Zimbabwe, Tel.: [phone], Fax: [phone], E-mail: hai.chimoio@teledata.
mz
ThOrG1470 A programmatic model for scaling up the response
to HIV/AIDS in highly affected countries in Africa
M.E. St. Louis', O. Mugurungi2, M. Fussell', R. Mayes', D. Dhlakama2,
E. McCray3. 1CDC-Zimbabwe, PO. Box 3340, U.S. Embassy Harare, Zimbabwe;
2Ministry of Health & Child Welfare, Harare, Zimbabwe; 3CDC Atlanta, Atlanta,
Zimbabwe

Issues: In most highly-affected countries, the penetration of effective new interventions for HIV/AIDS prevention and care (such as VCT, PMTCT, and cotrimoxazole prophylaxis) remains disappointing. Eroding public health infrastructure and