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

XIV International AIDS Conference

Abstracts ThPeG8384-ThPeG8388 679

ThPeG8384 Migration, sex work, health and HIV risk in London
K. Cooper, S. Day, A. Green, H. Ward. Department of Epidemiology & Public
Health, Department of Epidemiology & Public Health, Imperial College of
Science, Technology & Medicine at St Mary's, Norfolk Place, London W2 1PG,
United Kingdom
Issues: How health and HIV risk differ between and amongst migrant and local
(UK) sex workers in London.
Description: Three aspects of our research into the London sex industry confirm
significant heterogeneity among sex workers and a corresponding wide range of
health and service needs.
(a) Research conducted in our clinic show that new recruits (1997-2000) were
older (median age 27) than new recruits a decade ago (1985-1989) (median age
25). Their median time in sex work had reduced from 31 months (1985-1989) to
12 months (1997-2000). The percentage of women reporting past sexually transmitted infection (STI) had reduced from 63% (1985-1989) to 31% (1997-2000).
Clinic data also showed an increase in the proportion of non-UK women attending our clinic, from 20% (1985-1989) to 72% (1997-2000).
(b) Fieldwork (1998-2000) in 60 flats and 8 saunas confirmed a majority of nonUK women in flats (37/48) and in saunas (40/52). These data revealed serious
health problems and HIV risk including limited sexual health knowledge; lack of
access to services; poor language skills; exploitation.
(c) Women met through fieldwork (1998-2000) on streets in a red light area were
all from the UK. These data revealed severe health problems related to drug
abuse, homelessness, mental health.
Lessons learned: While clinic data show decreased STI and HIV risk among sex
workers from all parts of the world, case studies show that health is contingent
upon migration status, education, knowledge of English, peer networks, access
to or by appropriate services.
Recommendations: (a) For both local and migrant sex workers, good health;
knowledge of STI and prevention measures, including less risk of HIV, go hand
in hand with the appropriate delivery of outreach and other support services.
(b) Legal advice; some English knowledge; peer networks from the same country
are crucial to an improvement in the working and living conditions of migrant sex
workers, as amongst migrants more generally.
Presenting author: Kate Cooper, Department of Epidemiology & Public Health,
Imperial College of Science, Technology & Medicine at St Mary's, Norfolk Place,
London W2 1PG, United Kingdom, Tel.: [phone], Fax: +44 (0)20
7402 2150, E-mail: [email protected]
ThPeG8385 Assessement of the needs and responses of
migrant workers' populations towards integrated
hiv/aids prevention services
M.M. Diepart, B.A. Zerhyun. IOM, Addis Ababa, Ethiopia
Issues: As HIV/AIDS awareness increases among migrant workers it also creates an important demand for services, that are not met or not available.
Description: Through this project, mobile units have been implemented as a
specific response to address the needs of mobile people such as truck drivers,
merchants, gold miners, sex workers and surrounding populations.
The design of these mobile units has been adapted to the settings, along the
major trucking route and in a gold mines area in Ethiopia.
Each mobile unit consists of four staff, two counselors and two nurses. The unit
provides free services and easy access to personal counseling, voluntary and
confidential counseling and testing by dubble rapid tests and sexually transmitted
infections syndromic treatment.
The assessment of needs and demand for these services and the results related
in report documents are analyzed.
Results: This study identifies:
- the profile, prevalence rates and mapping of the population attending the services;
- the demand of attendants: type and number of services mostly required;
- the personal risks, needs for additional or specific information or for services
assessed through counseling sessions;
- the readiness for testing, the referral systems for care and support, the test
results analyzed in voluntary and confidential counseling and testing services;
- the sexually transmitted infections diagnosis and treatments and their correlations with the results drawn from testing and risk assessment reports;
- the cost and sustainability of the different interventions.
Recommendations: The results of the pilot phase of the project have shown the
need to further develop the number of mobile units, their geographical coverage
and extend services to include opportunistic diseases treatment.
Presenting author: micheline diepart, iom uneca 2 building, po box 3005, code
1000, addis ababa, Ethiopia, Tel.: [phone] ext 2281, Fax: [phone]
00, E-mail: [email protected]

ThPeG8386 Gay men in smaller cities: Different experiences of
sexuality, risk and HIV?
G. Brown. Western Australian AIDS Council, WA AIDS Council, PO Box 1510,
West Perth WA 6872, Australia
Issues: HIV/AIDS, in the lives of gay men, has moved from a panic driven crisis to day-to-day management and assimilation. Crisis-driven approaches may

no longer be effective. An under researched area of this picture is the post crisis
responses in gay communities in smaller cities, which have a different experience
of the HIV epidemic compared to larger cities.
Description: This paper will report on a study of gay men in Perth, Australia
about changes in sexual behaviour and risk reduction, and contrast this with the
experiences of larger cities. The study consisted of a survey of approximately
1000 Perth gay men in 1998 and 2000 about sexual behaviour and relationships,
followed by 25 in depth interviews about the meanings given to HIV and HIV status, sexual negotiation, risk and risk reduction, and living and loving in a small
gay community.
Lessons learnt: While there were increases in the level of unprotected anal sex
with regular and casual partners, the context, relationship factors, HIV status and
sexual positioning indicated a diversifying responses to HIV and risk. Some of
these results differed significantly to studies in larger cities, while other results
were consistent. This study indicates that the experiences of smaller cities impacts on assessment of risk and risk reduction strategies and the expectation
of 100% compliance, driven by a crises model, may be unrealistic and counter
productive to effective reduction of HIV transmission.
Recommendations: The study provided a vital and timely insight to the Perth gay
community's experience of risk, HIV and living in the epidemic. A rigid distinction
between 'safe' and 'unsafe', and the 'use a condom' for all practices and for all
partners over simplifies what gay men know to be more complex. The study identified opportunities to inform health promotion strategies within these contexts,
some which appear to be transferable to similar cities in other western countries.
Presenting author: Graham Brown, WA AIDS Council, PO Box 1510, West Perth
WA 6872, Australia, Tel.: [phone], Fax: [phone], E-mail: gbrown
@waaids.asn.au
ThPeG8387 Using a mock safe injection facility, built in a
chapel, to dispel myths and promote public
support: a Vancouver experience
W.W. O'Briain1, R. Barnes1, F Gold2, J. Kavanaugh2. 1AIDS Vancouver,
Vancouver, BC, Canada; 2Harm Reduction Action Society, Vancouver, Canada
Issue: HIV infection rates among injection drug users in Vancouver, Canada are
the highest recorded in a North American city. New harm reduction-based HIV
prevention programming has been proposed, including Safe Injection Facilities
(SIFs). Evidence from abroad points to the need for a SIF pilot in Vancouver.
Two levels of government have discussed piloting SIFs. But public misconception
about a SIF pilot's intended outcomes and proposed staff model has impeded
forward movement.
Project: Members of community groups, user groups, and a local church designed and built a mock SIF in a chapel adjacent to Vancouver's open drug scene,
Canada's largest. Modeled on similar SIFs operating abroad, each portion of the
mock SIF was clearly labeled, with procedures outlined and purpose identified.
A media strategy was developed. Spokespeople able to communicate in English,
Mandarin, Cantonese and Spanish were identified. Key messages were prepared
to ensure consistency in all languages. On Dec. 1, 2002, reporters and decisionmakers were invited to a news conference, and an experiential tour of the mock
SIF with nurses, physicians, clergy, users and community workers.
Lessons learned: Major regional television, radio and print outlets covered the
event, and organizers were guests on national broadcasts. Coverage accurately
reflected the intended outcomes of a SIF pilot. A member of a parliamentary committee on the Non-Medical Use of Drugs spoke supportively of SIFs. Polls show
growing public support.
Recommendations: In a multilingual city, spokespeople must respond to media
questions in the language of each media outlet. Engaging faith communities can
reach new audiences. Creating an audio/visual experience for radio/television is
essential.Targeting sectors perceived as unfamiliar SIFs, the planning group will
reconstruct the model and organize tours for local officials and small business
owners.
Presenting author: Warren O'Briain, 1107 Seymour St., Vancouver, BC, V6B
5S8, Canada, Tel.: [phone], Fax: [phone], E-mail: warreno
@ parc.org
ThPeG8388 Advocacy for harm reduction in Russian
Federation and Indonesia: commonalities,
differences, indicators of success
D. Burrows. 3 Palms Consulting, 22 Francis St, Marrickville NSW 2204, Australia
Harm reduction approaches to the control of HIV infection among and from injecting drug users (IDUs) have been shown convincingly for at least a decade to
be to be both effective and cost effective. These measures are the only proven
effective way to address HIV epidemics in high concentrated epidemics of HIV
among IDUs. Such epidemics have now occurred in many cities throughout the
world and are increasing in many cities and countries, especially in developing or

transitional countries.
Importantly, harm reduction measures are not associated with serious negative
adverse consequences such as increasing illicit drug use. Nevertheless, policy
makers in many countries have demonstrated a profound reluctance to accept
the strong evidence of benefit and safety from harm reduction programs. Consequently, implementation of harm reduction prevention strategies has often been
inadequate, delayed or obstructed. In many countries and regions, the poor ac