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

680 Abstracts ThPeG8389-ThPeG8394

XIV International AIDS Conference

ceptance of harm reduction has had catastrophic health, social and economic
consequences. The need for improved advocacy for harm reduction has been
identified in many regions where HIV infection among injecting drug users threatens or has already occurred.
This paper charts the course and current status of advocacy efforts to introduce
widespread harm reduction strategies and programs in two countries with high
and increasing concentrated HIV epidemics among IDUs: Russian Federation
(RF) and Indonesia. It draws on the author's and others' advocacy work to determine key advocacy activities and to begin to develop indicators of successful
advocacy.
Presenting author: Dave Burrows, 22 Francis St, Marrickville NSW, 2204, Australia, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeG8389 HIV vaccine efficacy trials: what we have learned
about women's perception of risk behavior change
and experiences of risk reduction counseling
T. Rogers1, E. McLellan2, P. Graham3, J. Nedig4, C. Ahrens4, R. Pickard1,
D. McKirnan3, M. Ackers5, V. Vaxgen Study Team6. 1Fenway Community
Health, 7 Haviland St, Boston, MA, 02215, United States; 2Centers fo Disease
Control and Prevention, Atlanta, GA, United States; 3University of Illinois at
Chicago, Chicago, IL, United States; 4Ohio State University, Columbus OH,
United States; 5Centers for Disease Control and Prevention, Atlanta, GA, United
States; 6 Vaxgen, Inc, Brisbane, CA, United States
Issues: Women at heterosexual risk (WAHR) have had a minor role in US HIV
vaccine trials. However, as their inclusion will likely increase in future HIV vaccine
efficacy trials, it is imperative that we understand how vaccine trial participation
and risk reduction counseling influences women's knowledge, attitudes, and behaviors.
Description: The first US HIV vaccine efficacy trial, AIDSVAX B/B, provides a
unique opportunity to examine women's perceptions of risk reduction counseling
and risk behavior change within the trial and to assist in developing counseling
strategies and materials for future efficacy trials involving women at heterosexual
risk.
Lessons learned: Trial participation increases awareness about HIV and supports continued reflection on one's sexual behavior. Risk reduction counseling
sessions assist in increasing condom use, reducing the number of sexual partners, reinforcing safe sex practices, and increasing awareness of the association
between drug use and sexual risk-taking among WAHR.
Recommendations: WAHR will be participants in future HIV vaccine efficacy trials. Counseling sessions should focus on educating women on their HIV risks, offering specific risk-reduction strategies, supporting them in their decision-making
process, and address women's multiple risk factors.
Presenting author: Tracey Rogers, 7 Haviland St., Boston, MA, 2215, United
States, Tel.: [phone], Fax: [phone], E-mail: trogers@fenwayhealth.
org
ThPeG8391 The rejection to Harm Reduction from health's
professionals in Sao Paulo, Brazil
H.L. Lima. Health's Municipal Secretary, Bartolomeo Bandinelli, #45 ZIP
05524-130, Jardim Oriente, Sdo Paulo - SP Brazil
Harm reduction is one policy of public health in HIV-Aids implemented in Brazil
since 1989, and only in 2002 in the capital of Sao Paulo, where it has 15 million inhabitants. There are 19 municipal centers of reference for DST/Aids in the
city, where it has 44.802 notified cases of Aids (until 30/06/2001). In the country, 234.109 are infected, 18,5% for use of injectable drugs. The professionals of
health of the city ignored the politics of Harm Reduction and had started to be
enabled in August of 2001. One program of qualification continued for deepening
of contents and reflections on Harm Reduction in the Center of Formation of the
Worker of Health (CEFOR), duration of 16 hours. In 6 months, 240 professionals
enabled in 96 hour-lesson. Methodologies: expositives lessons, thematic workshops, dramatizations, quarrels and distribution of informative material. Main subjects: concepts on drugs, legislation, prejudice, citizenship, knowledge on Harm
Reduction. The training team was surprised at the high index of rejection to the
program and the difficulties of the health professionals to approach the subject
drugs. The resistance was justified by: politics sequels of the previous management (professionals that had been assigned to work with aids without choosing),
fear of the police, of the dealers, doubts on effectiveness of the program and
budget, children, deficit of other urgent necessities for other illnesses. Judgment
and moral disqualification of the dependent intervening with the attendance. The
professionals of health of the city of Sao Paulo present great resistance to the
implementation of the Politics of Harm Reduction. The reject reaches to all the
escolarization levels and the continued qualification is indispensable tool for the
formation of this professional who takes care of HIV/Aids patients and has difficulty in identifying and taking care of users of injectable drugs and insert they in

the Heath's Public Services. The knowledge is essential.
Presenting author: Helena Lima, Bartolomeo Bandinelli, #45 ZIP 05524-130,
Jardim Oriente, S.o Paulo - SP, Brazil, Tel.: [phone], Fax: [phone].
8157, E-mail: [email protected]

ThPeG8392I The harm reduction project is adopted by the
comunity
A.R.M. Maqosso, E.FEC. Cintra, R.C.S. Sillos, M.R.S. Silva, A.A.S. Silva.
LAR Association, Am&ncio M. Bianco, 21 - Osasco - S&o Paulo - 06030-100,
Brazil
Issues: Osasco, Carapicuiba, Jandira, Itapevi and Barueri are metropolitan areas of Sao Paulo City where there are a large number of poor comunities and the
income of illegal drug users.
Description: These are the communities we have been working with since 1999.
The first activity on this project is to be in touch with the drug dealer and with
his authorization and support start working with the heroin and crack addicted in
activities that includes, a One day on the community, events, weekly meeting and
weekly deliver and colections, always in the comunity".
Lessons learned: The team work has been showing some good answers to the
drug situation around Osasco's communities. After all the projects for reducing
harm, The Lar Osasco, NGO, identified the importance to have the same language that target public who The NGO is going to work with and for.
Recommendations: the community's prejudice about the syringe and condoms
free distribution and collection was decreasing since they understood what is all
about: to support and care the health of our addicted, monitoring the usage of
drugs in the area and helping who want to be out of the addictive to reach hospitals and medical centers. Get money donation and investments are our major
difficulty.
Presenting author: Rogerio Magosso, Amincio M. Bianco, 21 - Osasco - S.o
Paulo - 06030-100, Brazil, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeG8393 ]Improving standards for confidentiality in
recruiting people living with HIV/AIDS (PLHA) for
research
R. Jakharia Mudoi1, V. Sharma Mahendra2, B. George1, A. Kaushik Panda1,
S. Bajaj1, S. Jadavl, L. Gilborn3. 1SHARAN, Population Council/Horizons
Program, 53 Lodi Estate, New Delhi, 110 003, India; 2Population
Council/Horizons Program, New Delhi, India; 3 Population Council/Horizons
Program, Washington DC, United States
Issues: The AIDS epidemic has posed an extraordinary array of ethical challenges for both practitioners and researchers, including protecting the confidentiality of PLHA patients and research participants. The operations research study
"Improving Hospital Environment for HIV-Positive Clients in India" aims to identify
institutional factors and practices that lead to sound infection control practices and
improved services for PLHA. This paper describes an approach to recruit PLHA
that protects both their confidentiality and their right to refuse participation.
Description: To ensure confidentiality, team members used a two-phase recruitment process. They first contacted a designated doctor, nurse or counselor in
each hospital department. This practitioner oriented participants to the study,
explained the pros and cons of participation-including the need to reveal HIV
status-and assured potential participants that access to medical care wasn't contingent on participation. The researcher met only those PLHA who had agreed
to participate, thus protecting the confidentiality of PLHA who opted out of the
study. In the second phase, the researcher again explained the study's purpose
and, recognizing that patients may not feel free to refuse participation in a study
presented to them by their health care provider, repeated the refusal clause. Researchers asked participants to sign a consent form in English and local vernacular language and read the form to any who could not read.
Lessons learned: The first phase protected the confidentiality of all eligible participants. The next phase gave willing participants a second opportunity to refuse
participation. This recruitment system successfully maintained confidentiality and
was appreciated by both PLHA and caregivers.
Recommendations: Safeguards to maintain confidentiality and the rights of
PLHA, such as this two-phase process, can be easily incorporated into research
protocols and should be adopted widely.
Presenting author: Rupa Jakharia Mudoi, Population Council/Horizons Program,
53 Lodi Estate, New Delhi, 110003, India, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeG8394 Can the law always be used to protect the right to
confidentiality for people living with HIV/AIDS
T.L. Motebele. AIDS Law Project, c/o CALS, Private Bag 3, Wits, 2050, South
Africa
Issues: South African law recognises certain circumstances where legal recourse
exists if confidentiality is breached. A health professional has an ethical and legal duty to keep information regarding a patient's health confidential. A patient's

right to confidentiality is legally protected. The question is whether this protection
should be extended to other circumstances. For example, could legal action be
brought against a friend of a person living with HIV/AIDS to whom the latter revealed his HIV positive status in confidence and who then went on to tell others.
Clearly confidentiality implies trust. Should the PWA be protected against bad
judgment? More often than not, the AIDS Law Project (ALP) has been faced with
clients who find themselves in this unfortunate position. More often than not we
are forced to inform them that there is very little we can do to assist.