Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

Two interactions between a health professional and potential trial participants
were recorded during the pre-screening informed consent process of an HIV/
AIDS vaccine trial. Data was qualitatively analyzed using Conversation Analysis
techniques and quantitatively examined according to essential components of
informed consent protocols. Post-interaction interviews with trial participants
were conducted to determine understanding of crucial information.
Results: A general lack of understanding and recall of information by trial
participants was noted, indicating that consent was not truly informed.
Interactions were dominated by the health professional and trial participants
contributed minimally. Participants' understanding of content was not completely
assessed by the health professional. Some blatant errors in explanations and
terminology were made by the health professional. Interactions were conducted
in English, which was not the first language of the participants. A linguistically
and culturally inappropriate protocol form was used in the trial.
Conclusions: The study highlights the need for monitoring and review
of informed consent protocols currently utilized in clinical trials, and
implementation of measures to ensure thorough understanding of information
by patients and trial participants. Such protocols need to be culturally and
linguistically modified for the target population, and health professionals need
to receive communication skills training in obtaining informed consent from trial
participants and patients.
MOAD0203
Web-based community research on sexual venues in
Mexico city
O. Feliciano', V. Montiel2, M. Lopez2'. 'La Manta de Mexico, Targeted
Interventions, Mexico city, Mexico, 2La manta de mexico, Mexico city, Mexico
Background: Mexico City has a connectivity level similar to some European
cities (50% of the population); therefore the internet has become an important
resource for MSM to cruise and to gather information about sexual venues.
Methods: We performed a community research based in a web-based data
base and in a email listing. We applied speech analysis creating a table were
we split what the users wrote about the venue, interaction, sexual scripts,
description of the users, kind of sexual act performed and other observations.
We create another table where we compared the venues by source to remove
those which had only incidental cruising, to be included the venue must be in
both sources.
Results: We identified 147 sexual venues described in 252 messages by 10
categories: 68 public toilets (89 messages), 25 saunas (55 messages), 17
public transport (32 messages), 13 parks (16 messages), 9 movie theatres (14
messages), 8 sex clubs (21 messages), 7 bars (8 messages), 4 private parties
(5 messages), 4 hotels (6 messages), 4 sex shops (7 messages). In the sexual
narratives we profiled 3 kinds of users: calculated risk takers, no risk takers and
no calculated risk takers. We identified five interactions (group sex, private sex,
limited oral sex, limited anal sex & voyeur) and three kinds of safe practices (no
anal sex, condoms 100% and negotiated safety); these shaped by the level of
intimacy of the place and sexual script.
Conclusions: The recognition of the principal trends in the cruising scene allows
to design site-specific interventions or to address specific users. The cruising
scene is a network woven by the sexual scripts, interactions and homophobia.
The more risky activities happened in the limited anal sex and in the private sex
interactions among no calculated risk takers. Anal sex in the subway and the
sex-shops cabins are an example.
MOADO2O4
Perspectives of minors and caregivers on the rights
of minors to be involved in decision making about
research participation: findings from formative
research on assent and disclosure for HIV-positive
children in Kinshasa, Democratic Republic of the
Congo
A. Corneli', S. Rennie2, L. Vaz', J. Dulyx', S. Omba3, J. Kayumba Baye4,
T. Badinga4, N. Kutumbakana4, O. Daiku4, M. Ilaka4, J.-S. Kalengi Kukemfuka4,
S. Callens', A. Van Rie', F. Behets'. 'University of North Carolina, Department
of Epidemiology, Chapel Hill, United States, 'University of North Carolina,
Department of Dentistry, Chapel Hill, United States, 'UNC-CDC/GAP-DRC
Project, Kinshasa, Congo, the Democratic Republic of the, 'Independent
Contractor, Kinshasa, Congo, the Democratic Republic of the
Background: Operational research is being conducted in Kinshasa, DRC, to
develop a context-appropriate, reproducible model of comprehensive HIV care,
including antiretroviral treatment, for children and their family members. Little
is known about the cultural appropriateness of obtaining assent for health care
or research in this setting, and there are no known local guidelines on assent in
biomedical research or clinical care.
Methods: As part of a larger formative study, semi-structured interviews
were conducted with 19 minors aged 8 years old who had been previously
told their HIV status and 15 caregivers of HIV-positive children aged 8 years

old. Questions explored minors' rights related to decision making on research
participation and contextual factors surrounding assent. Participants were
purposively selected from three HIV care centers. Content analysis was used to
identify themes and patterns related to research questions.
Results: Most minors indicated that minors have the right to be told what will
happen if they join a research study and believed they could sign an assent
form to indicate they agree to take part in the research. Only a few minors
believed that minors' opinions need not be considered when decisions are made
about their participation in research. Many minors believed that minors cannot

refuse research participation if their caregivers want them to participate.
Caregivers agreed that minors should be provided information about the
research and several said it was permissible for minors to sign an assent form.
Most caregivers, however, believed that research participation among minors
was the caregivers' decision alone.
Conclusions: Involving minors in discussions about research participation
and obtaining their assent is considered acceptable; however, in this context,
caregiver decisions are regarded as final. Understanding minors' and caregivers'
perspectives can inform the development of guidelines on assent in this
setting.
MOAD0205
Increasing access to voluntary counselling and
testing (VCT) through mobile VCT services; case
study of 6 communities in Oyo state
U.R. Okeke', T. Ogungbenro2, A. Faloye2. 1Centre for Reproductive Health,
Aromatherapy and Development, Non-Governmental Organisation, Ibadan,
Nigeria, 2Society for Family Health, Ibadan, Nigeria
Issues: Challenges experienced from using designated centres for VCT services
and community perception and response to mobile VCT services. The impact on
HIV screening response from the community.
Description: The Mobile VCT service was initiated as a vital and effective
approach in combating HIV infection rate in the poor resource community
settings where designated centres are seriously stigmatized. The awareness
being created by the Promoting Sexual Reproductive Health and HIV Reduction
(PSRHH) nationwide programme on HIV, have created more response to HIV
screening and in time past, indulged in giving referrals to designated centres
across the state, of which recorded only 2% response in designated centres.
The process, involved monitoring of designated centres to collect referral
stubs of which out of 140 referrals given in 2nd and 3rd Quarter of 2004 only
9 persons accessed VCT due to clinical complications. In the 4th quarter of
2004 and through 2005, a total number of 1,245 persons were tested at the
community level by the Mobile VCT team of implementing CSO partners of the
PSRHH programme in Oyo state. Community perception survey was carried out
and it was discovered that people in poor communities refuse to associate with
designated centres because of stigma and fear of being ostracize, even though
they understand the benefits of VCT services.
Achievements and successes were evident in this process that incorporated
both community perception and financial constraints.
Lessons learned:
- Records show high turn out in accessing services of both sex.
- VCT could be accessed without spousal consent especially in high stigmatized
communities.
- Clients seeking VCT are self motivated and in desperate need of it.
Recommendations: Mobile VCT services should be encourage in reducing
access barriers and stigmatization. Community Based Initiatives should be
encouraged and funded to create linkages for service providers.
MOADO301
Gender discriminatory beliefs are associated with
vulnerability to HIV among women and men in
Botswana
K.S. Leiter', S. Weiser2, M. Heisler', F. Percy-de Kortel, S. DeMonner',
S. TIou4, N. Phaladze4, M. Dandu3, V. Iacopino'. 'Physicians for Human Rights,
Cambridge, Massachusetts, United States, 2University of California, San
Francisco, Epidemiology and Prevention Interventions Center, San Francisco,
California, United States, 3University of Michigan, Division of General
Medicine, Department of Internal Medicine, Ann Arbor, Michigan, United
States, 4University of Botswana, Department of Nursing Education, Gaborone,
Botswana
Background: In southern Africa, inequitable and discriminatory economic and
social conditions drive the epidemic and disproportionately affect women. This
study sought to assess the prevalence and correlates of gender discriminatory
beliefs and to quantify the association of such attitudes with risk-taking sexual
practices or circumstances.
Methods: We conducted a cross-sectional, population-based study of 1,268
individuals in five districts in Botswana, using a two-stage probability design.
Descriptive statistics characterized the study populations and distribution
of responses and multivariate logistic regression analyses examined factors
associated with holding gender discriminatory beliefs and with sexual risk.
Results: Ninety-five percent of women and 90% of men in Botswana held
one or more gender discriminatory attitudes. The most commonly held beliefs
among participants were that it is more important for a woman to respect
her partner than for a man (19%) and that a man may beat his partner if he
believes her to be having sex with other men (17%). Behavioral factors (refusal
to use condoms (29%), multiple sexual partnerships (25%) and alcohol abuse
(37%)) were identified as the most important reasons men were at risk for HIV.
Risk factors for women were related to lack of power in their relationships with

men, e.g., economic dependence (8%), lack of control in sexual relations (9%)
and domestic violence/rape (11%). Holding gender discriminatory attitudes
also predicted sexual risk. For example, participants having three or more
discriminatory attitudes were 2.7 times as likely to have unprotected sex with
a non-primary partner in the past year (95% CI=1.01-7.01).
Conclusions: For women in Botswana, risk-taking sexual behavior is often
not chosen but compelled by social and economic inequality. In order for HIV/
AIDS interventions to be effective for women, not only individual behaviors but

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1