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

672 Abstracts ThPeG8353-ThPeG8356

XIV International AIDS Conference

Description: NVP halves the risk of HIV transmission mother-to-child at birth,
from -20% to 10%, but transmission may continue thereafter via breastfeeding.
For this reason, many assume that formula should replace breast feeding among
HIV+ women. We argue that the link between NVP and formula should be reexamined; only mixed breastfeeding is a proven HIV hazard, and optimal feeding
practices for HIV transmission and/or infant survival are not well established. As
counterpoint, we address difficulties of preserving confidentiality, immunopotency
of breast milk, and contamination of formula use to the wider community. Costs
of formula, although currently allayed by subsidies or gifts, create dependency,
an undesirable outcome. Both formula and exclusive breastfeeding require accession of counsellors, with or without nursing qualifications, to implement, if the
endpoint to be achieved is healthy infant survival. Preparation and training for
counselling are crucial steps, and should not assume that the link with formula is
unavoidable.
Lessons learned: Wide introduction of formula could spread the practice across
communities reversing breast feeding promotion efforts of the last few decades.
Simplistic decisions on the replacement of breast by formula should be strongly
discouraged. Urgent attention should be paid to training and support of counsellors, not only in VCT and disclosure, but also in conveying feeding options and
giving support to all mothers, especially around exclusive breastfeeding.
Recommendations: Further research and timely communication of findings on
postnatal feeding of infants of HIV+ mothers should be encouraged as urgent and
important. There are enormous contraindications, health-wise and economically,
if declines in breastfeeding in Africa prove to be yet another hazard of the HIV
epidemic.
Presenting author: Louise Kuhn, Sergievsky Center, 630 W 168th Street, New
York, NY, United States, Tel.: [phone], Fax: [phone], E-mail: Ik24
@columbia.edu
ThPeG8353 ]Addressing the vulnerability of and identifying safe
life options for street and working children
E.K. Vinayakan', W.H. Alderfer', K. Romano2, J. Yourkavitch2. 1Project
Concern International/India, Project Concern International/India, C- 38, Defence
Colony, New Delhi - 110024, India; 2Project Concern International, San Diego,
California, United States
Issues: In India, children from rural areas are increasingly migrating to cities, often alone, to escape from poverty and physical abuse by parents/relatives. While
many street and working children (SWC) have run away or been orphaned, many
others live with their parents in slums and are involved in rag picking, begging,
shining shoes, cleaning railway compartments, and working in tea and food stalls.
SWC have little knowledge of safe sex, STDs or HIV/AIDS. Lack of basic health
facilities and treatment of sexual diseases, drug and sexual abuse, and exploitation make them highly vulnerable to HIV/AIDS.
Description: Programs at three sites in Delhi reduce the vulnerability of SWC to
HIV/AIDS. Program components include: HIV/AIDS awareness and prevention,
control of STDs, peer education, community sensitization, condom promotion and
distribution, counseling, literacy, health care, shelter, family reintegration and economic empowerment. Results include substantial increases in the attendance of
SWC and community members (especially females) in STD camps, and in the
knowledge of SWC and the community on STDs and HIV/AIDS. Condom use
among SWC and members of the community has increased. SWC now have access to treatment for STDs. Exposure to sexual abuse has been decreased by
shelter provision and family reintegration.
Lessons learned: High-risk sexual behavior of SWC is linked to high-risk behavior of their communities. A root cause for high-risk sexual activity among SWC
is their quest for income and this should be addressed by providing alternative
vocations and sources of income. The prevalence of STDs and HIV/AIDS among
SWC needs to be tracked and reported to Government surveillance. Tools, like
the Child Development Measurement Tool, to measure the impact of interventions
on SWC need to be developed.
Recommendation: This paper recommends integrated and holistic communitybased interventions to address the vulnerability of SWC to HIV/AIDS.
Presenting author: Ellath kavinkare Vinayakan, Project Concern International/India, C- 38, Defence Colony, New Delhi - 110024, India, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeG8354 The project for promoting the roles of youth
volunteers in facilitating joint learning process
among children and older people
S. Wanarat. Maekowtom, Chiangrai, Thailand
One challenge encountered in working on AIDS in rural communities in northern
Thailand is the problem of the generation gap between children and elderly people affected by AIDS. The children and their grandparents have to live together
alone after the death of the parents. This situation has severe impacts on the

emotional and psychological well-being as well as on everyday life among both
children and the elderly.
Maekowtom community in Chiangrai, Thailand,has a population of about 10,000.
From 1994 to 2001, it has accumulated a total of 250 AIDS deaths among people
in their productive years, 220 children whose parents died of AIDS, 176 elderly
people living in families with AIDS. In response, the project was launched in 1999.
The project has promoted youth volunteers' roles in facilitating joint learning pro
cess among children and older people through various creative activities such as
family camps and learning through folk media and folk wisdom with elderly people serving as resource persons.The project has expanded its activities to include
mobilizing community fund in the form of a savings group and use the profits generated by the savings to establish a welfare fund which provides for medical costs
for elderly people and school fees for children.
Implementation of the project has shown concrete results regarding development
of potentials and capacities of youth volunteers in AIDS work and promoting quality of life for children and older people affected by AIDS.The affected children
shown proper physical, social,emotional, psychological and intellectual development. The affected older people enjoy living a dignified and valued life, with continued promotion of their quality of life.
The next target is to promote education concurrently with promotion of vocational
development and income generation among older people and children.This will
be done through promoting the community as vanu for learning about folk culture
and eco-tourism.
Presenting author: Sumalee Wanarat, 138 Moo 20, T maekowtom, A.Muang,
Chiangrai, Thailand, Tel.: [phone], Fax: [phone], E-mail: s_wanarat
@ hotmail.com
ThPeG8355 Supporting teachers to ensure children with HIV
receive an education
N. Ounjit, M. Ponnet. Medecins sans Frontieres - Belgium, Bangkok
Issues (Problems) Many children with, or suspected of having, HIV face teachers
who are afraid of them and are ill equipped to support them. The more terrify and
ill informed the teacher, the more negative the impact on the child. Classmates
and friends become aware of the child being treated differently and make fun of
it. In my experience seven HIV positive children age between six to eight years
faced problems with teachers and friends which led to four of them dropping out
of school, one having to cope with a suspicious school environment.
Descriptions Discussing with the teachers or school director cannot solve the
problems that affect children with HIV in school, but working together is one possibilty to resolve problems. From our experience of working together with Wat
Bangduan School on a project Supporting teachers to encourage the education
for children with HIV we carried out a number of activities aimed both at teachers
and children including:
Training on basic knowledge and attitudes about AIDS for teachers
Inviting the school director to participate in the Fifth International Conference on
Home and Community Care for Persons living with HIV / AIDS at Chiang Mai
Setting up a project called Thirthy Friends that involved all students in school,
aiming to promote a positive attitude towards AIDS among students.
Holding a monthly meeting between teachers, parents and NGO workers to maintain activities that will create unity among children and develop new activities for
children in grade four to six.
Lessons learned If NGO workers, teachers and parents work together it is possible to solve many problems, keep children with HIV in school and provide additional help for children with HIV in other areas such as health, psychological and
spiritual support. We only need the will to make it happen.
Recommendation Extend this idea to all schools in Thailand.
Presenting author: Nisachol Ounjit, Medecins sans Frontieres-Belgium, 311
Ladprao road, Soi 101, Wangtonglang, Bangkok 10240, Thailand, Tel.: +662
3756491, Fax: [phone], E-mail: [email protected]
ThPeG8356 Hartford (Connecticut/USA) youth HIV linkage to
care (HYHIL)
C.I. Acosta-Glynn, N.L. Fernandez, R. Neil, J.C. Salazar. University of
Connecticut Health Center and Connecticut Children's Medical Center, Pediatric
Infectious Diseases, Hartford, CT United States
Issues: Approximately 20,000 new HIV infections occur in youth between 13 and
24 yr. of age in the United States. Many youth do not know they are infected or
receive adequate medical treatment. Many youth with high-risk behaviors are not
in schools nor structured programs where they can receive preventive education.
Many of these youths confront discrimination, poverty, sexism and homophobia.
Description: To prevent the spread of HIV/AIDS in adolescents, a network of
medical and mental health providers, faith-base agencies, CBOs and youth organizations created a consortium in Hartford, Connecticut. This consortium has
been working with outreach and identification of HIV positive youth, providing HIV
counseling and testing at risk youth in a friendly way; linking HIV positive youth
to health care; reducing the transmission of HIV and STDs trough preventive education; advocating for services tailored to teens; looking for funding and closing
any gap in services that would allow a youth to get lost in the system
Lessons learned: We have learned that to prevent HIV and STDs we needed
to go out of the HIV network and involve any organization that works with youth.
Also, that by collaborating rather than competing, we can use existing resources

and provide a greater amount and more effective services to the youth. We can
empower the community to advocate for youth services that take into account
their needs. In addition, we have learned that by using adolescents as consultants
and as aids to provide the services, it keeps us more competent and relevant.
Recommendations: To create an evaluation tool for the program obtain funding
for a social marketing campaign and share the model with programs interested in
replicating it.