1996 World AIDS Conference

CAPS Abstracts
from the 11th International Conference on AIDS
Vancouver, BC July 6-11, 1996

Abstracts are listed in alphabetical order, by author.


Abstract No.: Th.D.4927



Author(s): Accioly, R*, Antunes MC*, Peres CA*, Teles L*, Campos, MRNM*, Stall R**. NEPAIDS, University of Sao Paulo*, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco**.
Objective: To conduct a series of workshops with low-income night school students (age 14-25) who live in the Sao Paulo inner city. To foster community support for a broader program of teacher training, peer support programs and public events which would multiply and extend the effects of the workshops. Methods: We developed a workshop model with 4 sessions of 3 hours each. Males and females were separated in different groups to preserve confidentiality and encourage open discussion of issues such as gender norms and social roles. The participants discussed the symbolism of AIDS, explored the impact AIDS has in their lives and their perception of risk. Using “play-dough sculpting” we discussed information about the reproductive and erotic body, pleasure and AIDS prevention, and how gender norms shape knowledge. We used the play dough models they made to show how reproduction, contraception, sexual pleasure and HIV transmission occur. The groups discussed safer sex in man-woman, man-man and woman-woman relationships. We used role-playing techniques and Freirean group dynamics to foster respect for sexual minorities and sexual negotiation. Results: The workshop was enthusiastically accepted by the school community, such as street theater, music events, and parties, and collected food to give to AIDS patients. Related issues such as pregnancy, abortion, virginity, dating, violence, and drug use were addressed as they arose. All new activities were linked to AIDS prevention. Conclusions: It is both possible and essential that AIDS education be a community effort. Interventions should be tailored to the interests and needs of the specific group. It is important to create safe spaces where people can share their experiences, feelings, doubts, beliefs, and difficulties with AIDS prevention. AIDS prevention efforts must stimulate debate about cultural norms and encourage a supportive climate in which continuous AIDS prevention initiatives are possible.

Address: Renato Accioly, Av. Prof. Mello Moraes, 1721 Sao Paulo, SP,Brazil 05508-900 Telephone: 011 55 11 818 4184 Fax: 011 55 11 818 4460 e.mail: renato.accioly@mandic.com.br

Abstract No.: Mo.D.1863



Author(s): Alonso, Luiza Klein*. *NEPAIDS, University of Sao Paulo
Objective: The number of HIV-infected Brazilian women reporting a single sex partner has been rapidly increasing. While in 1985 there were 36 male AIDS cases for every woman, by 1994, this ratio had fallen to four to one. This shift indicates that bisexual and heterosexual men play an important role in the transmission of HIV. Our purpose was to obtain information about the sexual behavior and HIV risk perception of Brazilian men.Methods: A self-administered questionnaire was applied to 216 men who work in the central business area. All men were recruited through letters of invitation. The sample included men from 18 to 57 years old, with varying educational levels, and partner status. Questions regarding beliefs about risk of STDs and HIV, knowledge about HIV and AIDS, and prevention attitudes and practices were included in the questionnaire. They also answered questions on sexual activities, including masturbation, male-to-male sex, sex under the effect of drugs or alcohol, the use of prostitution, and lifestyle.Results: Knowledge of preventive practices varied from 67% up to 100%, but the levels of misconceptions about “safe sex” and “casual sex” indicate that few men in fact practice safe sex, which increases their risk of becoming infected with HIV. The prevalence of sex with non-regular partners in the last year varied from 15% to 47%. Only 29% reported condom use in their previous sexual intercourse considered to be at risk. The gap between sex and love is important in prevention campaigns. When heterosexual men have sex with ordinary women they rely basically on visual perception, seeking women who “look healthy”. Thirty-five percent of the respondents say that ordinary women will not accept condoms expecting to be the “special one” in the man’s life.Conclusions: Peer pressure, macho culture, and a strong concern about individual sexual performance put Brazilian men at risk. They are unwilling to change their sexual behavior even though they knew they are at risk.

Abstract No.: Th.D.4921



Author(s): Carver, Lisa J., MPH*, Harper, Gary W., PhD. MPH**. * Tri-City Health Center, Fremont, California ** UCSF Center for AIDS Prevention Studies and De Paul University
Issue: Frequent visits by homeless, runaway and chronically truant youth to a suburban family planning clinic revealed that a large number engaged in high HIV risk behavior. Suburban street youth are not as easily reached as those in urban settings. Project: Youth Action Project (YAP) was designed to provide HIV prevention education to suburban street youth through collaboration with youth educators recruited from the target population. Initially, YAP included street outreach, HIV education materials designed by the target population, and HIV education workshops. In response to youth feedback, a drop-in center providing further HIV education and supplies and help with issues such as school dropout, joblessness, substance abuse, abusive relationships and living with HIV were added. With these services YAP became a safe space for an unserved group of youth who previously had no place to seek help with problems leading to HIV risk behavior. Through the drop-in center, the youth receive clothing, tutoring, peer counseling, links to HIV-testing and reinforcement of HIV prevention skills. Most services are provided by youth educators. Results: YAP has been successful at providing HIV education for a high risk population. In a 9 month period, 1600 youth received services, including 227 who attended a 2 hour HIV education workshop. An average of 64 youth per month came to drop-in hours, held once a week. Intake surveys revealed high rates of substance abuse, arrest, suspension, homelessness, exchanging sex for drugs or shelter, and unprotected sex. Incorporating feedback from the target population resulted in a trusted program which is able to address sensitive issues that may contribute to HIV risk. Lessons Learned: High risk youth in suburban areas have many needs interfering with HIV risk reduction. Effective programs should involve youth in program startup, reach youth in their own environment, and provide a safe space for youth to seek services. Looking beyond basic HIV education toward the greater psychosocial picture is crucial to building and reinforcing HIV risk reduction skills.

Address: Lisa J. Carver, 633 Alma Ave. #1 Oakland, CA 94610 U.S.A Telephone:            510-713-6690       or             510-839-8311       Fax: 510-713-6679

Abstract No.: We.D.373



Author(s): Chesney, Margaret A., Folkman, S., Chambers, D. Center for AIDS Prevention Studies, University of California, San Francisco
Objective: To determine if training in coping effectiveness increases coping efficacy and decreases psychological distress among men with HIV and AIDS. Methods: 149 HIV-positive gay men were randomized to one of three conditions: (1) Coping Effectiveness Training (CET), a 10-session coping-skills group intervention based on stress and coping theory, (2) HIV-Information (HIV-Info), a 10-session condition designed to control for the social support of group participation, and (3) a Waiting List Control (WLC) group to control for the effects of assessment. Inclusion criteria were CD4 levels between 200 and 600, and a score of 10 or higher on the Center for Epidemiologic Studies Depression Scale. Participants were excluded if they were experiencing psychotic disorders, had a history of alcohol or substance abuse, or were in psychotherapy or taking psychoactive medications. Of the 149 participants, 86% were retained during the 4 months of treatment. Mean age of these 128 participants was 39, 82% were white, 62% were college-educated, 66% were working full-time, and the median income was $30,000. The average number of HIV symptoms was 3.4, mean CD4 count was 405, and 5% had been diagnosed with AIDS. Results: CET participants showed significantly greater increases in coping efficacy (p=.01) and greater reductions in perceived stress (p=.01) and “burnout” (p=.003) than HIV-Info participants. CET participants also showed greater increases in efficacy (p=.09) and greater decreases in burnout (p=.06) than WLC participants. Increases in coping efficacy were significantly related to the decreases in psychological distress (Pearson r’s-.43 to -.53, p’s<.001). Conclusions: Coping Effectiveness Training should be routinely offered to HIV-positive individuals. We showed that stress and coping theory can be usefully translated into a skill-building intervention that is helpful for persons living with HIV/AIDS. We demonstrated that HIV-positive men receiving CET showed significant reductions in psychological distress compared to HIV-positive men receiving information only or no treatment. Providing information to HIV-positive men, in the absence of coping support, is not helpful.

Address: MA Chesney, 74 New Mongomery, Ste 600, San Francisco, CA 94105 USA Tel:             415-597-9163       Fax: 415-597-9213 email: Margaret_Chesney@quickmail.ucsf.edu

Abstract No.: Mo.D.492



Author(s): Coates, Thomas J, Acree M, Stall R, Hoff C, Kegeles S, Ekstrand M, Paul J, Jinich S. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco USA
Objective: To determine whether or not men who have sex with men who meet sexual partners in gay saunas or in public sex environments (PSEs) are more likely to engage in unprotected anal intercourse (UPI) with non-monogamous partners. Methods: We recruited a cohort of gay men in 1992 in Portland OR and Tucson AZ using two sampling methods: (1) a randomized time period technique to recruit gay male bar patrons; and (2) a list frame telephone sample of households. These data are from the first cross-sectional survey of gay male bar patrons (N=1897). Subjects were asked to report frequency of a variety of sexual behaviors with primary and secondary partners, and whether nor not they had any sexual activity in gay bathhouses (saunas), sex clubs, or other PSEs. Results: A total of 23% (9% at clubs and bathhouses and 19% at cruising settings) of men in Portland and 16% (3% at clubs or bathhouses and 14% at cruising settings) of men in Tucson met sexual partners at PSEs in the month prior to the survey. Men meeting sexual partners at PSEs were more likely to be older, white, to not have a primary partner, and to use alcohol or drugs before having sex. 27.8% of men reporting meeting sexual partners at PSEs reported UPI with a non-monogamous partner compared to 7.1% of men not reporting sex at PSEs (p<.0001). HIV+ and HIV- men were equally likely to report sex at PSEs. Both HIV infected and HIV uninfected men meeting partners at PSEs were more likely to report UPI with non-monogamous partners in the past month, as shown in the table. (table: see text) Conclusions: Men who met sexual partners at PSEs were 2 to 4 times more likely to engage in UPI with non-monogamous partners than men not meeting partners at PSEs. This study could not determine where UPI took place. Nonetheless, these data suggest that targeting interventions to PSEs may reach men at high risk of UPI with non-monogamous partners. They also reinforce the importance of monitoring sexual activity in PSEs to prevent UPI with non-monogamous partners and to reinforce social norms for reducing HIV transmission.

Address: Thomas J. Coates, Ph.D., 74 New Montgomery #600, SF, CA 94105 USA

Abstract No.: Mo.D.1734



Author(s): Crosby, G. Michael, Stall, R.D., Barrett, D., Paul, J.P. Center for AIDS Prevention Services (CAPS), University of California, San Francisco, USA
Objectives: Gay men who enter substance abuse treatment report much higher rates of unprotected anal sex than gay men in general. These rates decline for men who remain in treatment. This analysis was undertaken to identify (a) the level of HIV risk behaviors of men who dropout of treatment and (b) baseline variables associated with treatment dropout. The latter might help programs identify men at risk of not completing treatment.Methods: A cross-sectional sample of 455 gay/bisexual men were recruited from an outpatient substance abuse treatment facility in San Francisco. At intake, respondents completed self-administered questionnaires assessing demographic characteristics, substance use, sexual behaviors and psychosocial variables. We compared the 49% of subjects who completed less than 15 visits, with the 25% who completed the full program. A forward, stepwise logistic regression was used to predict substance abuse treatment dropout at baseline.Results:(Table: See text) Dropouts are more likely to engage in unprotected anal sex and use needles than men who complete treatment. In addition, they have less education, are less likely to use sex for tension relief, less likely to attend AA/NA meetings, report more social problems, more self-blame for problems, and more likely to have used substances prior to intake. (see table)Conclusions: Gay/bisexual men who drop out of substance abuse treatment are an identifiable group at very high risk of HIV infection for whom specialized interventions can be designed. With the development of a screening device that identifies this high risk group at intake, more intensive treatment could be provided during the first 15 visits before dropout occurs.

Abstract No.: Th.C.4669



Author(s): DeCarlo, Pamela H*, Canchola, Jesse*, Bleecker, Tom*. *Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA
Issue: Research is traditionally disseminated by publishing in professional journals. Those who need to put prevention science into practice are not likely to read scientific journals. A CAPS survey of a random sample of 284 Non-governmental Organizations (NGOs) in the US found that only 10% rated scientific journals as one of their top three sources of AIDS prevention information. The Internet is a new and growing method for publishing information that has the potential to attract a wide audience internationally. Our survey showed that fully 95% owned computers, and of those, 70% owned modems, suggesting that access to the Internet is widespread and should be used. Project: In June of 1995, a search of the Internet showed over 6,000 AIDS-related sites, but only one sponsored by an institution specifically devoted to prevention. To fill this gap, the Center for AIDS Prevention Studies (CAPS) opened a home page (http://caps.ucsf.edu/uploads/capsweb). The home page provides full text fact sheets on prevention among specific populations, descriptions of effective prevention programs (including surveys, activities, hand-outs, and curricula that can be replicated and used by other programs), news releases, prevention bibliography, links to other AIDS-related Internet sites, and researcher e-mail addresses. Some information is also available in Spanish. Results: The CAPS home page was accessed over 6,000 times in the first four months by a variety of readers both in the US (87% of readers) and internationally (13%). Internationally, readers from 59 countries have accessed the CAPS home page, from Europe (20 countries), South America (13), Asia (12), Eastern Europe (8) and Africa (5). Largest readership is from Canada (22%) Australia (13%) and the United Kingdom (10%). While most of the resources on the home page have been read across the board, the top three most accessed resources were: 1) Listing of other AIDS Internet sites, 2) “Does HIV Prevention Work?” fact sheet, and 3) “Does Sex Education Work?” fact sheet. Lessons Learned: Researchers should use the Internet to reach a greater diversity of people and more countries than traditional methods of dissemination such as journals or newsletters. NGOs should make use of their access to the Internet to both find and publish information.

Address: P.H. DeCarlo, CAPS, 74 New Montgomery, Suite 600, San Francisco, CA 94105 USA Telephone:             415-597-9360       Fax 415-597-9213 email: pamela_decarlo@quickmail.ucsf.edu

Abstract No.: Tu.C.330



Author(s): Ekstrand Maria L, Siegel D, Nido V, Faigeles B, Cummings G, Battle R, Krasnovsky F, Chiment E, Coates T. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA
Objective: To evaluate the effects of a peer-led HIV prevention program on the initiation of sexual activity among 199 7th grade urban African-American, Latino, and White junior high school students. Methods: Thirty-seven 9th grade peer educators were enrolled in a one semester class in peer helping. Students in the intervention school received a 5 session basic sex and drug education curriculum in 7th grade taught by health educators. This was followed by 8 interactive sessions taught by the 9th grade peers, focusing primarily on peer norms, skills building, and motivating students to remain abstinent, or have only protected sex. Control school students received a standard, brief AIDS and sex education curriculum. Students in these 3 comparable schools were surveyed regarding sexual behavior prior to the intervention and again in the fall of 8th grade. Only students who had not practiced each sexual behavior at baseline are included in these analyses. Results: Initiation of sexual behaviors between baseline and follow up among inexperienced students (table: see text) Control students were thus more than 3 times as likely to initiate vaginal intercourse compared to intervention students. Between 7th and 8th grade, intervention school students also developed safer sexual norms, while control students’ norms became riskier. A longitudinal multiple logistic regression analysis, adjusting for baseline variables, showed that control students were significantly more likely to initiate vaginal sex by follow up (O.R. =8.6) than were intervention students. Conclusions: These results suggest that a school-based peer-led AIDS prevention program can reduce the likelihood of sexual initiation and influence perceived peer norms among young, multi-ethnic urban adolescents. Future research is needed to study the effects of similar interventions on the behaviors of sexually experienced teens.
M.L. Ekstrand, S-600, 74 New Montgomery, San Francisco, CA 94105, USA Telephone:             415-597-9160       Fax 415-597-9213 email: Maria_Ekstrand@quickmail.ucsf.edu

Abstract No.: Tu.B.170



Author(s): MD Feldman, J Zhang, H. Tabor, SR Cummings, T. Coates. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA and the State Science and Technology Commission, Beijing, Peoples Republic of China.
Objective: There has been speculation, but little data, about cross-cultural differences in approaches to clinical ethical dilemmas such as truth telling, the role of family’s wishes, and assisted suicide, that arise in the care of HIV infected persons. In particular, there have been no direct comparisons of bioethical practices between the US and China in the care of persons with HIV/AIDS. Our objective was to test the hypothesis that Chinese and US internists have different ethical standards with HIV/AIDS patients about informing them of terminal diagnoses (truth telling), the role of family versus patients wishes, and assisted suicide, as compared with patients with other medical problems. Methods: We developed 15 clinical vignettes followed by a series of multiple choice questions. The vignettes and questions were translated and back translated into Chinese and English and pre-tested in each country. We surveyed 40 randomly selected internists on staff at both university and community hospitals in San Francisco and Beijing. Results: 95% of the US internists but none of the Chinese internists surveyed would inform a patient with cancer of her diagnosis (p<.001). However, when the terminally ill patient had AIDS instead of cancer, 100% of US and 90% of Chinese internists would tell the patient the diagnosis. Similarly, while only 15% of Chinese internists, but 30% of the Americans, were willing to assist a terminally ill cancer patient obtain enough narcotics to end her life (p<.05), 45% of the Chinese internists were willing to withhold life sustaining treatment from a terminally ill patient with AIDS. Both Chinese and American internists were in strong agreement that physicians should inform patients of the results of their HIV tests, and both agreed that partners have an obligation to inform each other of a positive test. When family members wishes conflicted with patient’s preferences regarding treatment of life threatening conditions, Chinese internists were more likely to follow the family’s instead of the patient’s preferences (65%) than were US internists (5%; P<.001), irregardless of the patient’ diagnosis. Conclusions: Clinical ethical practices between US and Chinese internists were more similar with patients with HIV/AIDS than with patients with other serious medical problems. US internists virtually always and Chinese doctors almost never tell cancer patient’s their diagnosis, but both groups would generally inform patients of an AIDS diagnosis. US physicians are much more willing to assist in ending the life of terminally ill patients with cancer, but only somewhat more willing to withhold life sustaining treatment from a terminally ill person with AIDS. However, Chinese physicians give greater weight to family than to patient preferences irregardless of the underlying illness. We conclude that differences in clinical ethical practices between internists in the US and China are less extreme in the care of persons with HIV/AIDS.

Address: M. Feldman, 74 New Montgomery St., Ste 600, San Francisco, CA 94105 Telephone:             415-476-8587       Fax: 415-597-9213 email:Mitchell_Feldman@ucsfdgim.ucsf.edu

Abstract No.: Th.C.4779



Author(s): Goldstein, Ellen*, Wrubel, Judith*, Faigeles, Bonnie*, DeCarlo, Pamela*. *Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA
Objective: To determine to what extent HIV prevention research is being used by US Non-Governmental Organizations (NGOs) to guide program planning. Methods: We conducted a telephone survey of prevention program managers in the United States. The sample consisted of NGOs that were randomly selected from a national list provided by the Centers for Disease Control and Prevention (CDC). The randomized sample included 284 program managers (response rate 83%) from 42 US states, with 50% from urban areas, 22% rural, 20% mixed and 8% suburban. The one hour survey consisted of 71 open and close-ended questions. Descriptive statistics were calculated for all variables. Results: Of all respondents, 56% indicated they were “satisfied” with the information they had access to for prevention program planning. 52% had collaborated with a researcher, and about half of those rated this as being “very important” in program planning. Most frequently mentioned in the “top three sources” of AIDS prevention information were colleagues/other NGOs (53%), Departments of Public Health (DPH) (44%) and the CDC (40%). 25% cited research and 10% specifically cited peer-reviewed journals. Colleagues in one’s own agency (84%), collaborations (81%) and colleagues in other agencies (80%) were most frequently described as “very important” for prevention program planning. Sources least frequently rated as “very important” were scientific publications (42%), government/non-academic reports (38%), community newspapers (21%) and mainstream newspapers (15%). Conclusions: Survey results are encouraging: over half of NGOs have collaborated with researchers. Less encouraging is that only half of those found the collaboration to be “very important” for planning prevention programs. Program planners rarely use scientific literature, and are most likely to turn to colleagues for help in program planning. Overall, survey results pointed to face-to-face interactions and proximity as some of the most important components of information sharing and use. To more closely link the efforts of researchers and service providers, we suggest: 1) NGOs be more aggressive and proactive in using information that exists outside of their agencies. 2) Researchers share findings in meetings with local NGOs, as well as with CDC and state and federal DPHs. 3) Funding agencies provide adequate money so that NGOs can have access to a broader range of information resources. 4) State DPHs and federal Health Agencies recognize and act upon their role as translators of science.

Address: E. Goldstein, CAPS, 74 New Montgomery, Suite 600, San Francisco, CA 94105 USA Telephone:             415-597-9396       Fax 415-597-9213 email: ellen_goldstein@quickmail.ucsf.edu

Abstract No.: We.C.3520



Author(s): Gomez, Cynthia A, Marin B, Gregorich S. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, CA, USA
Objective: To assess cultural factors in the use of condoms with male partners by unmarried Latina women living in the U.S. Methods: A population-based, random digit dial telephone survey was conducted with 1600 unmarried Latino adults from 10 U.S. states, aged 18 to 49. They represented 87% of Latinos living in the U.S. Response rate was 74%. Self-efficacy to negotiate condom use, peer norms regarding condom use, sexual comfort, and sexual disempowerment were assessed with measures developed specifically for this population. Sexual disempowerment included the acceptance of traditional sexual gender norms and having partners who insisted on sex even when women did not want it. Structural equation modeling was used to predict use of condoms among the 536 unmarried women who reported at least one male sexual partner in the 12 months prior to the interview. Results: Women who reported higher levels of sexual disempowerment reported significantly lower levels of sexual comfort (beta = -.64, p<01) and lower peer norms (beta = -.20, p <.01). Sexual comfort (beta =.38, p <01) and peer norms (beta =.19, p <.01) were strongly related to condom negotiation self-efficacy. Final paths in the model indicated that condom negotiation self-efficacy (beta = .54, p <.01), peer norms (beta = .13, p <.01), age (beta = -.09, p <.05), and sexual comfort (beta =-.11, p <.05) were independently associated with reported condom use (CFI = .98). Conclusions: Latinas who maintain traditional gender norms, and Latino men who insist on sex from their partners must be targeted by HIV prevention providers. Sexual disempowerment, although not directly related to condom use, was a strong mediator. Socio-cultural influences must be considered when targeting specific risk-reducing behaviors. Addressing only one component such as sexual comfort without increasing negotiation skills could lead to riskier behaviors.

Address: C.A. Gomez, 74 New Montgomery St., Ste. 600, San Francisco, CA 94105 USA Telephone:             415-597-9267       Fax 415-597-9213 email: cynthia_gomez@quickmail.ucsf.edu

Abstarct No.: Mo.C.1609



Author(s): Harper, Gary W*, **, Carver L***, Robinson L*, Goldstein E**. *DePaul University, Chicago, IL, USA; **UCSF Center for AIDS Prevention Studies, San Francisco, CA, USA; ***Tri-City Health Center, Fremont, CA, USA.
Issue: Increasing numbers of collaborative relationships between university-based HIV prevention researchers and community-based organizations (CBOs) are being formed. Unfortunately, members of the targeted research populations are typically not included in such collaborations, especially when they are high-risk youth.Project: Ten collaborative research partnerships between CBOs, university researchers, and a private funding consortium were formed, three of which are evaluating community-based HIV prevention programs for high-risk youth. Target population youth were invited to join these three collaborations in order to incorporate the youths’ perspectives. These youth assisted in the design of the research by assessing the feasibility and acceptability of the proposed research components, improved the accuracy of assessment measures by translating items into “street youth” language, assisted in the creation of new measures, recruited participants, and assisted in the collection of data. These youth also created youth-specific educational materials and workshop activities, and were involved in all phases of program implementation. The youth also will be actively involved in the interpretation of the findings.Results: Including high-risk youth in the collaborations has resulted in modifications of the research methods (e.g., sampling techniques), greater access to populations that are typically suspicious of adults (e.g., gang youth), development of new assessment measures, and greater ease in tracking participants. Qualitative feedback from program participants indicates that including youth in research teams has increased the acceptability and credibility of the research. Program participants have reported comfort in interacting with peer research staff, have appreciated youth-specific language on questionnaires, and have felt empowered to offer feedback regarding the research.Lessons Learned: Giving high-risk youth a voice in HIV prevention research through collaborative partnerships improves both science and service. Including youth in all phases of the research process has made the participants feel that their perspective is truly valued, resulting in more active and perhaps more honest research participation.

Abstract No.: Tu.D.362



Author(s): Hays, Robert B, Paul J, Ekstrand M, Kegeles S, Stall R, Coates T. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA
Objective: 1) To compare HIV risk-taking of young gay men who perceive themselves to be HIV-, perceive themselves to be HIV+, or do not know their status; 2) To assess the degree to which perceived HIV status matches actual HIV status; and 3) To examine whether factors related to engaging in unprotected anal intercourse (UAI) vary according to one’s perceived HIV status. Methods: The San Francisco Young Men’s Health Study is a survey of single men age 18-29 recruited by multistage probability sampling from the 21 census tracks in San Francisco with the highest cumulative AIDS prevalence in 1992. 408 gay and bisexual men were interviewed. Blood samples were also obtained from 364 (89%) of the men and tested for HIV antibodies. Results: 84% (n=342) of the men reported knowing their HIV status. 70% (n=285) perceived themselves to be HIV-. 14% (n=57) perceived themselves as HIV+ and 16% (n=66) reported not knowing their status. 37% of the total sample reported engaging in UAI during the past year, but this varied with one’s perceived HIV status: 56% of the men who perceived themselves to be HIV+ reported engaging in UAI, compared to 35% of three men who perceived themselves to be HIV- and 28% of the men who did not know their status. 4% (n=11) of the men who perceived themselves to be HIV- and 9% (n=5) of the untested men were in fact HIV+. 50% (n=8) of these men who did not know they were HIV+ reported engaging in UAI. Bivariate logistic regressions indicated that significant predictors of UAI for both HIV+ and HIV- men were: being more “turned on” during sex, less enjoyment of safe sex, more substance use, and poorer sexual communication skills (ORs ranged from 2.96 to 1.25). For HIV+ men only, higher income predicted UAI (OR=1.37), while the degree to which friends encouraged him to have safe sex was inversely related to UAI (OR=.55). For HIV- men, having a boyfriend (OR=1.97), having more gay friends (OR=1.36), beginning sex at an earlier age (OR=.89) and not having sex with women (OR=.42) predicted UAI. For untested men, (who were more likely to be bisexual [41%] than HIV- [16%] and HIV+ men [4%]), having sex with women predicted safe sex (OR=.11), whereas degree of gay involvement (being less closeted, going to gay bars and having a boyfriend [ORs=3.87 to 1.49]) was associated with UAI. Conclusions: Many predictors of UAI are similar for HIV-, HIV+ and untested men, but differences found do suggest the value of incorporating HIV status-specific components in prevention programs. Importantly, a significant number of self-perceptions are wrong. Understanding the motivations and situational context for engaging in UAI for each status group is essential in designing interventions for young gay men. In particular, the high rate of UAI among HIV+ young gay men must be addressed.

Address: Robert B. Hays, 74 New Montgomery #600, SF, CA 94105 USA. Tel.:            415-597-9206       Fax 415-597-9213 email: robert_hays@quickmail.ucsf.edu

Abstract No.: Th.C.4431



Author(s): Heft, Lisa*, Faigeles B**, Hall, TL**. *San Francisco AIDS Foundation and New Conservatory Theatre Center, San Francisco, USA; **Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA.
Issues: Good parent-child communication on sensitive topics such as sex and HIV could greatly enhance the value of prevention messages to youth; yet teens have substantial difficulty talking with adults about such issues. Project: To test the use of an HIV-awareness drama presented to both parents and students as a method for encouraging parent-child communication about sexual risk-taking. A collaborative community-university study was carried out in the agricultural, university town of Chico, California (USA), population 40,000+. All parents of 1,643 students in grades 9 through 12 enrolled at a Chico high school were invited to preview a 45-minute AIDS awareness drama before it was to be shown to the entire student body. A baseline survey with 1 open-ended and 43 structured questions was satisfactorily completed by 999 students (61% of the eligible total), and similar questionnaires were administered six weeks and three months after the dramatic presentation. The questionnaire sought information on student communication with parents and peers about HIV and sexual risk-taking, HIV-related knowledge, and student suggestions for improving HIV education programs. Results: The prospective experiment was both a success and a failure providing important insights into what must be done. It `failed’ in the sense that we did not attract enough parents to see the play (fewer than 20 of perhaps 3,000 who were invited to the dramatization) to test the effects of this intervention on parent-child communication based on both parties receiving this intervention. It `succeeded,’ however, in demonstrating the effect of the intervention on communications with only student attendance at the play. Overall, 53% of all students who saw the play talked with their parents about the performance, and of the 28% of the respondents who said it was difficult or impossible to talk to their parents at baseline, 50% initiated discussion with parents. Lessons Learned: Adolescents want to talk with their parents about sexual risk-taking and HIV but many find it difficult to do so. However, using the drama as a catalyst for discussion, even teens who felt this difficulty took the initiative to talk to their parents. Teens want parents to initiate more discussion and other studies show this discussion helps to delay sexual experience. Innovative ways to outreach, educate and support parents – ways that do not depend on their attending special activities – are needed to encourage parental involvement in HIV education.

Address: L. Heft, SF AIDS Foundation, P.O. Box 426182, San Francisco, CA, USA 94142-6182. Telephone:             415 487-8088       Fax 415 487-8089 email: lily@slip.net

DocID: Tu.D.360



Author(s): Hoff, Colleen C, Kegeles, S., Acree, M., Stall, R., Paul, J., Ekstrand, M., Coates, T.J. Center for AIDS Prevention Studies, University of California, San Francisco, USA
Objective: To determine which programs within a community-level AIDS prevention intervention reached what types of gay men. Methods: An 18-month community-level HIV/AIDS prevention intervention was conducted in Portland, Oregon offering a variety of prevention activities, each ranging in intensity. The intervention included: Outreach (at bars and community events), a Home meeting (small gatherings to discuss HIV and community issues), a Safer Sex Workshop, and HIV Counseling and Testing (drop-in testing for gay men only). The intervention was evaluated by annual surveys of a cohort of gay men recruited in 1992. We used two sampling methodologies, (1) a randomized time period technique to recruit gay male bar patrons, (2) a list-frame telephone sample of households. Responses to the survey measuring 12 months of the intervention were collected (N=1001). Chi square analyses were used to describe differences in participation based on age, sexual risk and HIV status. Results: More men participated in Outreach prevention efforts than the other approaches offered. Outreach was also more likely to reach younger men and those likely to report unprotected anal intercourse with a non-monogamous partner. Few men, regardless of age, HIV status or sexual behavior, were likely to attend a safer sex workshop. (table: see text) Conclusions: Community-level interventions need to include innovative, minimally structured programs that take place in venues where gay men are known to socialize. Outreach was most successful at reaching men who engage in risk-taking behaviors and younger men suggesting that these groups are amenable to intervention but not structured programs that may challenge anonymity.

Address: C.C. Hoff, 74 New Montgomery St. Suite 600, San Francisco, CA USA Telephone:             415-597-9158       Fax: 415-597-9213 email:colleen_hoff@quickmail.ucsf.edu

Abstract No.: Th.B.4140



Author(s): *Hughes, Veronica, *Uip D, **Reingold A, ***Hearst N. *H.C.F.M. University of Sao Paulo; **University of California, Berkeley; ***Center for AIDS Prevention Studies (CAPS); University of California, San Francisco.
Objective: As the male: female ratio of AIDS cases in Brazil (now 4:1) decreases, we can expect a parallel increase in cases of cervical neoplasia (CIN) among HIV-infected women. Cervical cancer is already the number one cause of cancer death among Brazilian women. Methods: This study included women referred to the outpatient clinic of an infectious diseases hospital because they had a husband, boyfriend, or were widows of AIDS patients. 40 HIV-positive women and 26 HIV-negative women received a physical examination, a behavioral questionnaire, CD4 cell counts, and referral to a private lab for pap smears. No women refused participation, but four HIV-positives were excluded because they did not present for pap smears (one died, two were hospitalized with multiple infections, and 1 disappeared). HIV infection was transmitted sexually in all cases but one (an IVDU). In the HIV-positive group, 50% were married to AIDS patients and 25% were widows of AIDS patients. The age range in the HIV-positive group was 17-60 (median, 31). Results: 1-Vaginal candidiasis is associated with HIV infection, being present in 6 of 40 HIV-positives as compared with one of 26 controls. Only one HIV-positive woman with candidiasis had a CD4 count <200. These data suggest that vaginal candidiasis may be an early manifestation of HIV infection. 2-Bacterial vaginosis and trichomoniasis occurred at similar rates in both groups. 3-Two of four with severe immunocompromise (CD4<50) had CIN compared with none of the immunocompetent and HIV-negative women. Conclusions: We found a lower prevalence of CIN among HIV-positive women than has been reported elsewhere. This may be explained by the low prevalence of severe immuno-compromise among our sample and the low prevalence of other risk factors for CIN in our sample, such as a multiple lifetime sexual partners, early age of first intercourse, and cigarette smoking. CIN among HIV-positive women is likely to become a growing problem in Brazil.

Address: Veronica Hughes, Ave. Highlenopolis 148, Apt. # 63, Sao Paulo, Brazil Telephone/Fax: 011 55 11 256 8146

Abstract No.: Mo.D.1718



Author(s): Jinich, Samuel, Stall R, Acree M, Paul J, Kegeles S, Hoff C, Coates T. J. Center For AIDS Prevention Studies (CAPS), University of California, San Francisco; USA
Objective: 1) To explore the prevalence of childhood sexual abuse with significantly older partners among adult gay and bisexual men in two western cities in the United States. 2) To compare the current sexual behaviors and HIV status of adult gay and bisexual men who experienced sexual abuse as children to the sexual behaviors among men who did not experience childhood sexual abuse.Methods: Adult gay and bisexual men (n=1933) from two household-based and two bar-based samples were interviewed by telephone or by mail. Two methods were used to sample adult gay/bisexual men in Portland and Tucson in 1992: (1) a randomized time period technique to recruit male patrons of gay bars; (2) a list-frame telephone sample of households to screen for households with resident gay/bisexual men.Results: 32% of the men (n=626) reported childhood sexual abuse prior to age 16 with someone at least 5 years older than them. Those who experienced sexual abuse during childhood were more likely to report riskier sexual behaviors as adults than those who were not abused: 30% (vs. 20%, p<.0001) reported unprotected anal intercourse in the last 30 days and 13% (vs. 8%, p<.01) reported unprotected oral sex to ejaculation with a nonprimary receptive partner. Among those abused, 34% reported they had not been coerced, while 31% were mildly coerced and 34% strongly coerced or physically forced. Whereas 21% of nonabused men and 25% of abused/not coerced men engaged in unprotected anal intercourse with a nonprimary partner in the past 12 months, a significantly higher proportion of men who experienced mild coercion (32%) and strong coercion or physical force (36%) engaged in this practice, X2 (3, 1368) = 21.4, p<.0001. Men who were sexually abused were more likely to be HIV + than those not abused (24% vs. 19%, p<.05).Conclusions: The prevalence of sexual abuse in this population was considerably higher than studies have reported for the general male population. Childhood sexual abuse contributes to the continued high-risk sexual behavior of gay and bisexual men particularly among men who recall their experience as coercive. The next generation of HIV preventive interventions requires that we develop interventions which identify, target, and support young sexually abused gay and bisexual adolescents in order to focus on the psychosocial impact of the childhood sexual experience and to provide psychoeducational experiences to focus on underlying processes which, if not addressed, could lead to higher risk for HIV.

Abstract No.: Mo.D.581



Author(s): Kegeles Susan M, Hays R, Pollack L, Coates T. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA.
Objective: To evaluate an 8-month peer-led community-level HIV prevention program for young gay/bisexual men that we developed and implemented in 2 mid-sized U.S. communities. Methods: The intervention, based on diffusion of innovations theory, used 5 elements designed to increase support for safer sex and to change community norms: 1) a young gay men’s community center we created, 2) a core group of young men who ran the project, 3) informal outreach conducted among friends, 4) formal outreach conducted at gay venues and social events we produced, 5) small groups which focused on safer sex and informal outreach in the context of more salient issues to young gay/bi men. Independent of the intervention, we recruited a longitudinal cohort of gay/bi men aged 18-27 in the communities and resurveyed them annually, twice prior to the intervention, and twice post-intervention (Baseline 1 N = 242 combined from the communities). Data from the communities were combined to increase statistical power since we found no significant differences between the communities on risk behavior, demographics, and psychosexual variables. Results: Boyfriend analyses include only men with boyfriends. (table: see text) There were no significant differences between levels of unprotected anal sex at the 2 baselines, indicating no naturally occurring trends towards risk reduction. We found a 32% relative reduction in unsafe sex with casual partners and a 26% relative reduction in unsafe sex with boyfriends from Baseline 2 levels at the 2-month post-intervention assessment. The reduction in unsafe sex with casual partners was sustained one year post-intervention, but there was a return to unsafe sex with boyfriends (many of which were new relationships). Attrition does not appear to bias the results. Conclusions: Mobilizing young gay men to encourage each other about the need for safer sex and creating a center at which support can be expressed is an effective approach to HIV prevention with young gay/bisexual men, but programs need to be sustained over time. Additional efforts particularly need to focus on risk reduction among boyfriends.

Address: SM Kegeles, 74 New Montgomery, #600, San Francisco, CA 94105 USA Tel:             415-597-9159      ; Fax: 415-597-9213; email: Susan_Kegeles@quickmail.ucsf.edu

Abstract No.: Mo.C.1441



Author(s): Lacerda. R*, Gravato N*, Melo A*, Tellini R*, Stall R**, Hearst N.**. *NEPAIDS, University of Sao Paulo,** Center for AIDS Prevention Studies (CAPS), University of California, San Francisco.
Objective: The city of Santos has the highest cumulative incidence of AIDS in Brazil. We are following a cohort of male port workers in Santos to measure their prevalence and incidence of HIV infection and to examine changes in their patterns of risk behavior over time. Methods: In early 1994, we began recruiting a random sample of 395 male employees of CODESP (the Santos Port Authority). These men are being followed over a three-year period, during which they complete a KAPB questionnaire and undergo serologic testing for HIV antibodies every 12 months. 313 (79%) of the men who participated in Wave 1 have so far returned for follow-up in Wave 2. Sera collected in Wave 2 were also tested for syphilis. Results: Four of 395 men (1.1%) were HIV-positive in Wave 1; three of these gave a history of sex with men. Thirty-eight percent of all men reported a lifetime history of at least one STD. No new HIV-positives have been found so far in Wave 2, though six men were positive for syphilis (VDRL and FTA). Questionnaires from Wave 1 showed high levels of knowledge but low levels of condom use. The qualitative impression of interviewers is that men were much more open to talk about their risk activities and barriers to behavior change in Wave 2, but that levels of risk behavior have changed little. Conclusion: Despite good levels of information, adoption of safe sex practices does not seem to be a high priority for these men. They generally do not consider themselves at risk for HIV, despite high rates of other STD’s. Perhaps the most important lesson so far from this study is that longitudinal cohort studies of this type are feasible in the developing world. In this case, the results of this research are forming the basis for a major new AIDS prevention campaign directed at over 20,000 port workers in Santos.

Address: Regina Lacerda, Nucleo de Educacao e Prevencao DST/AIDS, Santos, Brazil CEP11.020-130 Telephone: 011 55 13 233 3634 Fax: 011 55 13 235 2436

Abstract No.: We.D.483



Author(s): Liao Su-su*, Choi K,§ Zhang K, Mandel J,§ Qi B, Deng Y,# Fang J, Liu W, Yang Y,# Wang A, Qin Z,# Shen H. # *Peking Union Medical College, Beijing, China; Kunming Medical College, Yunnan, China; # Yunnan University, Yunnan, China; §Center for AIDS Prevention Studies, University of California, San Francisco, USA
Objective: To assess awareness of AIDS, STD’s, condoms, and sources of health information among Dai ethnic minority villagers in China’s Yunnan Province bordering Laos near Thailand. Methods: In 1994, we conducted face-to-face interviews with a convenience sample of 177 villagers aged 15-49 of Dai origin in Mengla County using a standard survey questionnaire. Focus groups were also used to gather in-depth information on awareness and preventive health behavior. Results: The mean age of respondents was 29; 42% were male; 78% were married; and 76% had less than 6 years of schooling. Only 18% had heard of “AIDS”; among those who had, the level of knowledge was extremely low and many did not know about sexual (39%), injection drug-related (42%), and/or perinatal transmission of HIV (45%). Many believed that AIDS could be transmitted by sharing food utensils (55%) and mosquito bites (16%). Approximately one quarter of respondents had heard of “STD’s”; of those who had, only 36% gave three or more correct answers to four simple questions on STD transmission. Most thought AIDS and STD’s were a problem of foreign countries such as Laos, Thailand, and the U.S. Only 28% had any familiarity with condoms; of those who had, only 40% knew that condoms can prevent unwanted pregnancy and 12% knew condoms could protect people from “diseases.” When condoms were shown to focus group participants, most said they had never seen one before. Among survey respondents, traveling to neighboring countries was common. A majority (77%) reported travel to Laos, 50% in the past 6 months. Nine percent had traveled to Thailand as well. The most important sources of information among survey respondents were TV and video shows but these media are not currently being used to educate about AIDS. Conclusions: Our data revealed that Dai villagers had extremely low awareness and knowledge of AIDS, STD’s, and condoms. Given the escalating HIV epidemic in South Asia, there is an urgent need to examine health education strategies to reach highly mobile ethnic minority groups in China.

Address: Liao Su-su, Peking Union Medical College, 5 Dong Dan San Tiao, Beijing 100005, China Telephone: 8610-512-7733; Fax 8610-512-4876; email: dengxx@sun.ihep.ac.cn

Abstract No.: Tu.C.324



Author(s): Lurie, Peter1, Drucker, E2. 1Center for AIDS Prevention Studies, University of California, San Francisco; 2Department of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
Objectives: 1. To estimate the number of HIV infections among injection drug users (IDUs), their sex partners and their offspring that would have been prevented had the U.S. implemented needle exchange programs (NEPs) at the same rate as Australia. 2. To estimate the cost to the U.S. health care system of treating these preventable HIV infections. Methods: Preventable HIV infections were estimated according to the formula: (annual number of incident IDU infections)*(proportionate reduction in HIV incidence among participants in NEPs)*(proportion of IDUs using NEPs annually)*(1-proportion of HIV transmission among IDUs due to sexual behavior)*(1+proportion of IDU infections transmitted to sex partners and offspring). Data for the model were obtained from epidemiological studies, mathematical models of NEP effectiveness, government reports and consultations with IDU and NEP experts. The U.S. government estimates that the discounted lifetime cost of treating an HIV infection is US$55,640. Results: The effect of the U.S. failure to implement NEPs on a scale comparable to Australia is illustrated in the graph. The number of HIV infections that could have been prevented between 1987, when the first Australian NEP opened, and 1995, when approximately 75% of IDUs were using NEPs at least once annually, ranges from 8,361 (17% reduction in HIV incidence among NEP participants) to 19,673 (40% reduction). Of these infections, 86% would occur among IDUs, with the remainder among their sex partners and offspring. The cost of these infections to the U.S. health care system is estimated at between $0.47 billion and $1.09 billion. With current policies, an additional 9,690 to 22,800 preventable HIV infections will occur by the year 2000. Conclusions: The failure to implement NEPs, despite six government-funded reports supporting the programs, has led to the preventable HIV infection of thousands of IDUs, their sex partners and their offspring and excess costs in the hundreds of millions of dollars. Removing the U.S. government ban on NEP funding is an urgent public health priority.

Address: Peter Lurie, MD, MPH, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105 Phone:             (415)597-9138       Fax: (415)597-9213 Email: peter_lurie@quickmail.ucsf.edu

Abstract No.: We.C.3519



Author(s): Marin, Barbara V, Gomez C, Tschann J, Gregorich S. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, CA, USA
Objective: To assess how traditional gender role beliefs and coercive behaviors affect condom use in Latino heterosexual men in the United States. Methods: A random digit dial telephone survey of 1600 unmarried Latino adults in 10 states with large Latino populations was conducted. Those 10 states represent 87% of Latinos in the U.S. Response rate was 74%. Measures of sexual coercion, traditional gender role beliefs, sexual comfort and self-efficacy to use condoms were developed specifically for this population. A structural equation model analysis was conducted using the responses of 594 men who reported one or more than one heterosexual partner in the 12 months prior to interview. Results: Men who reported more sexual entitlement (comprised of traditional gender role beliefs and coercive sexual behavior) reported significantly lower levels of sexual comfort (beta = -.41, p<.001) and lower self-efficacy to use condoms (beta = -.13, p<.07). Greater sexual comfort was related to increased condom self-efficacy (beta = .26, p<.001). Increased condom self-efficacy (beta=.42, p<.001) and greater condom social norms (beta =.19, p<.001) predicted more condom use. Fit of the a priori model was good (CFI=.96). The men with multiple partners reported higher levels of sexual entitlement and stronger condom social norms than the men with a single partner. Conclusions: Traditional gender role beliefs impede condom use among Latino men by encouraging sexual coercion, lowering sexual comfort and interfering with self-efficacy to use condoms. Programs to increase condom use must include consciousness raising designed to address gender role beliefs and coercive behaviors in men, in addition to skills building to increase sexual impulse control and self-efficacy to use condoms.

Address: B.V. Marin, 74 New Montgomery St., Ste. 600, San Francisco, CA 94105 USA Telephone:             415-597-9162       Fax 415-597-9213 email: barbara_marin@quickmail.ucsf.edu

Abstract No.: Tu.C.2508



Author(s): Mayne T. 1,2, Sannino N. 3, Dujardin 4, Moreau 5, Moatti JP. 1. 1INSERM U 379, Institut P. Calmettes, Marseille, France; 2Center for AIDS Prevention Studies (CAPS), UC San Francisco, USA; 3South-Eastem French Centre for Disease Control, Marseille.; 4Depart. of Internal Medicine, Hopital Cimiez, Nice, France; 5Depart. of Infectious disease, Hopital Boigny, Marseille
Objective: To examine rates of STDs and sexual risk behaviors among IDUs with HIV infection in Southern France. Methods: This was a consecutive convenience sample of the first 100 HIV+ patients with IDU as origin of infection seeking services at outpatient clinics in specific hospitals in Marseille, Nice, and Avignon between July and December, 1995. We assessed demographic variables via interview; specific sexual practices and drug use during the previous 6 months via self-report questionnaire; and current STDs through physical examination (conducted by a physician) and serologic assays. Results: Demographics- The sample was 67% male, mean age=34 (SD=4.5). Average year of first IDU was 1980 (SD=4): 37% were currently active users; 11% had stopped using less than 1 year; and 52% had been abstinent an average of 6 years (SD=4.4). Virtually 100% of the sample had used heroin. Mean CD4 cell count at first interview was 435 (SD=179). STDs – 62% of the sample had 1 or more genital STDs: 37% HSV-II; 19% chlamydiae; 14% syphilis; 5% genital warts. 84% of subjects were hepatitis C antibody positive, and 73% were hepatitis B antibody positive (only 11% reported having received a hepatitis B vaccine). Sexual behavior – 49% of subjects reported receptive analingus in the previous 6 months. 38% of subjects reported being sexually active and Never or Occasionally using condoms: 27% with their primary partner, 8% with other partners, and 3% with both. Of the subjects having unprotected sex with their partners, only 1 reported that their partner was HIV+. Of the remainder, 56% reported that their partner was HIV-, and 44% reported not knowing their partner’s serostatus. Of the subjects having unprotected intercourse, 58% had a genital STD. Conclusions: The rates of unprotected intercourse, coupled with the high rates of genital STDs (which increase risk of HIV transmission), represent an important vector of new HIV infections among the sexual partners of HIV+ IDUs in southern France. In addition, the high rate of receptive analingus among a population that is 84% positive for hepatitis C represents a high risk of transmission for this as well. Intervention is clearly called for in this population.

Address: Tracy J. Mayne, INSERM Unite 379, Institut Paoli-Calmettes, 232 bd Sainte Marguerite, 13273 Marseille, France. Telephone: 91 22 35 02 / Fax: 91 22 35 04 /email: mayne@lovelace.infobiogen.fr

Abstract No.: Th.C.4411



Author(s): Merati. T*, Wardhana M*, Ekstrand M***, Widjaya M**, Pindha S*, Biran S I*, Suarmiartha E**, Yuliana F**, Mandel J***. *Udayana University AIDS Working Group, ** Citra Usadha Indonesia Foundation, *** Center for AIDS Prevention Studies (CAPS), University of California, San Francisco.
Objective: To examine HIV-related risk taking behaviors, alcohol and drug use, and communication patterns among members of traditional Balinese youth groups participating in peer-led AIDS education programs. Methods: As part of a peer-led randomized AIDS prevention trial using the pre-existing structure of traditional Balinese youth clubs, 250 youth completed pre and post-intervention questionnaires. Four demographically comparable, highly touristed, communities were selected as study sites. Participants were unmarried males (n=148) and females (n=102) between 16 and 25 years of age. The questionnaire focused on HIV-related knowledge, perceptions, communication patterns, sexual behaviors, and alcohol and drug consumption. The present analyses include pretest data from all four cities. Results: At baseline, 24% of male and 1% of female participants reported previous sexual intercourse; of these, only 14% reported any condom use. Fifty-eight percent reported having consumed alcohol. Although the majority (89%) of the youth still lived at home, only 33% reported feeling comfortable discussing sex, pregnancy, or STDs/AIDS with their parents. In contrast, 75% reported feeling comfortable discussing these topics with their peers. As a part of this study, a peer-led AIDS education program has been launched in traditional youth clubs for the first time in Bali; the program has been well received and attended by targeted youth club members. Conclusions: Given increasing HIV seroprevalence, reported rates of sexual activity among Balinese youth, and the contest of an extensive tourist and sex industry, the risk of HIV transmission to Balinese youth is clear. There is an urgent need to intervene with these youth, learn about the perceived obstacles to condom use, and determine the effectiveness of prevention programs. Further examination of whether the gender discrepancies in self-reported sexual behaviors are due to reporting bias or the context of sexual activity (with sex workers or between men) is needed to determine the specific risk reduction skills needed. Participants’ reported comfort in discussing sexuality with peers, and lack of comfort with adults, validates the use of peer educators in this population.

Address: Tuti Parwati Merati, Jalan Suli 56, Denpasar 80233,Bali,Indonesia Telephone: 011 62 361 222602 Fax: 011 62 361 235982

Abstract No.: Th.C.4722



Author(s): Mungherera Margaret*, Fowler G*, Mandel J**, Hearst N.**, Mbidde E.***. *Butabika Hospital, Kampala, Uganda; **Center for AIDS Prevention Studies, University of California, San Francisco, USA; ***Uganda Cancer Institute, Mulago Hospital Kampala, Uganda.
Objective: To study the perceptions of hospital-based doctors and nurses regarding AIDS patients, HIV testing, HIV counselling and AIDS prevention education of their inpatients. Methods: On the 3 medical admission wards of Mulago national referral hospital 30 doctors and 26 nurses completed a self-administered questionnaire. Results: All the doctors and 92% of the nurses felt that HIV testing should always be done in patients clinically suspected of HIV infection. A significant number of respondents (19.6%) reported that they are frightened of taking care of HIV infected patients while 19.6% of the doctors and 19.2% of nurses admitted that they would rather not treat HIV infected patients. A considerable proportion of the doctors (40%) and nurses (24%) never talk to inpatients about HIV and prevention of its spread. However, all the doctors and 96% of the nurses felt that the responsibility of HIV counselling should be that of either the doctors or the nurses and not anybody else. Conclusion: There is need for hospitals in Uganda to have HIV testing facilities for inpatients. In addition, hospital-based doctors and nurses should be equipped with HIV counselling skills. There is however, need for larger indepth studies to identify the basis of their feears, their reluctance in such a high HIV prevalence area. to treat HIV infected patients and their not involving themselves in AIDS education of patients on their wards.

Address: Dr. Mungherera M., Butabika Hospital, P.O. Box 7017, Kampala, Uganda Telephone:011-256-41-221376, Fax:011-256-41-241519.

Abstract No.: Mo.C.1487



Author(s): Nzyuko. S*, Nyamwaya D*, Lurie P**, Mandel J**, Hearst N**. *African Medical & Research Foundation, Nairobi, Kenya; **; Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, U.S.A.
Objective: To identify the prevalence of adolescent high risk sexual behavior at truck stops along the Trans-Africa Highway and the characteristics of those who engage in these behaviors. Methods: We conducted a cross-sectional study of 200 adolescents (104 girls and 96 boys) aged 15-19 years (mean 17 years for both girls and boys) at the Malaba, Mashinari, and Sachangwan truck stops in Kenya. The questionnaires were administered by trained interviewers, and included questions about demographics, HIV/AIDS knowledge and attitudes, and high risk sexual practices. Subjects were recruited consecutively with a participation rate of almost 100%. Results: Ninety percent of adolescents surveyed reported prior sexual encounters. Girls reported a median of 15 lifetime sexual partners, including sex with truck drivers, while boys reported a median of 12 lifetime sexual partners, including sex with sex workers in the truck stops. Fifty percent of girls reported at least one sexually transmitted disease (STD) (mean age 17.8 years, compared with 16.9 years for those without a history of STDs), while 30% of boys reported at least one STD (mean age 17.7 years, compared with 17.0 years for those without a history of STDs). Fifty-four percent of girls and 38% of boys reported having ever used a condom. Reasons offered for not using condoms included not liking condoms (29%), condoms not readily available (4.5%), condoms are too large (1.1%), and the condom could burst (0.5%). Sixty percent of the adolescents (76% of girls and 43% of boys) came from broken homes. Thirty-seven percent thought that only ill-appearing persons could transmit HIV, and 43% thought HIV could be transmitted by insect bites. Conclusions: This study documents alarmingly high levels of risk behavior and STDs among adolescents at truck stops in Kenya, and suggests that HIV transmission from truck drivers and sex workers to the adolescents is likely. In the next phase of this project, a multifaceted intervention for these adolescents will be implemented and evaluated.

Address: S. Nzyu ko, African Medical & Research Foundation, PO Box 30125, Nairobi, Kenya Telephone: 254-2-501301 Fax 254-2-506112 Email: 62057276@eln.attmail.com

Abstract No.: Th.D.441



Author(s): Paiva, V*, Skinner S**. *NEPAIDS, University of Sao Paulo,** Center for Latin American Studies, Stanford University.
Objective: To understand the obstacles to consistent safer sex practices among youth who had previously participated in a night school-based “AIDS, Reproductive Health and Safer Sex Workshop” in Sao Paulo, Brazil. Methods: In the year following a series of AIDS prevention workshops, we conducted group evaluation sessions and a community organizing initiative. The evaluation sessions emphasized consciousness-raising through “sexual scenes,” true stories shared and then re-enacted by the students. The “main character” was asked to reinvent the scene, acting as a “sexual subject” or agent. Elements represented in the scenes included the characters/actors, their gendered sexual scripts, their speech, the rhythm (rushed/unhurried), condom use (or not), contraceptives and HIV tests, meanings and feelings which accompany the scene, and normative ghosts (peers, parents). Each of these elements was personified or concretized as part of the sexual scene. We continued the project with student collaboration, investigating the community health system, condom availability, and conducted 30 interviews and ethnographic observation to clarify sexual networks and peer norms. Results: Unsafe sex “sexual scenes” confirmed previous studies showing how gender and power imbalances are key obstacles for sexual negotiation, and emphasized how the standard of living in a low-income community defines the conditions in which sex takes place – rushed in public places, unhurried after paying US$1 for a condom, etc. AIDS is seen as just “another risk” and safer sex as a “burden” among many troubles. Students described the public health services as sexist, classist, unprepared to serve adolescents and not able to help them to have successful experiences with condom use or reproductive health care. The quality of support services, sexual networks in the neighborhood, and the perceived priority of HIV prevention were defined not by race, but by class and by participation/exclusion from the productive system. Conclusion: The “sexual scene”, as the communities own generative word, can be used as a “code” for consciousness-raising in the Brazilian tradition begun by Paulo Freire with the Pedagogy of the Oppressed and is an important new concept in AIDS education. This strategy aims to collaborate with low-income communities to face and challenge personal and structural barriers to AIDS prevention, and to foster the “sexual subject” by organizing for citizenship. Innovative community organization should be a goal of any prevention effort in poor neighborhoods.

Address: Prof.Vera Paiva. IPUSP-Av Prof. Mello Moraes, 1721. Cidade Universitaria. CEP 05508-900. Sao Paulo. Brazil. Fax: 011 55 11 818 4460

Abstract No.: We.D.3752



Author(s): Perez, Camila*/**, Munhoz, R, * Antunes, M.C., ** Paiva, V.,** Stall, R.,*** Fernandes, M.E.L.**** *Sao Paulo State Department of Health; **University of Sao Paulo, *** University of San Francisco – California (CAPS), **** Family Health International – AIDSCAP/Brazil
Issue: To report on a comprehensive, integrated, and collaborative HIV/AIDS/STDs prevention program for adolescents and young adults in Brazil. The Project: Phase I: From 1990 to 1992 a qualitative and quantitative research project with adolescents (14-22 years) attending public night schools was implemented. Based upon results a specific intervention for this target group was designed. This phase was funded by the McArthur Foundation. Phase II: From 1993 to 1995 a cohort study for young adults (18-25 years) linked to an intervention is being implemented as part of the AIDSCAP project in Brazil. The design of the intervention component of this controlled intervention trial took into account the lessons learned in Phase I. This phase is funded by USAID. Phase III: Based on the results of the experience developed Phase I and Phase II, the State Health Department of Sao Paulo State conducted 12 training programs 300 professionals which included the Education and Health Departments and NGOs. In addition, six training programs for 200 adolescents who will act as multipliers were conducted. This phase is funded under the World Bank loan to the Government of Brazil (Ministry of Health AIDS/STDs program). Results:#1. The interaction between research and intervention as well as with all project phases allowed an ongoing refinement of the intervention and provided important feedback for research activities. 2. A macro activity was implemented in the State of Sao Paulo based on two previous Phases (I and II). 3. A model intervention was established Phase I and II. This model was expanded to a macro activity involving the State of Sao Paulo (a region with 33 million people). Lessons learned: Collaboration between individuals, NGOs, Universities, Governments and donors was a key strategy for the development of a prevention program that works.

Address: Camila Perez NEPAIDS-USP Av. Prof. Mello Moraes, 1721 – 05508-900 Sao Paulo, SP Tele:55 11 818 4184 / 55 11 818 4460

Abstract No.: Tu.D.2940



Author(s): Skinner. S*, Serrano O**, Ruiz J**, Stempliuk V**. *Center of Latin American Studies, Stanford University; **NEPAIDS, University of Sao Paulo, Brazil.
Objective: To evaluate, in collaboration with students from the Sao Paulo inner city (an area with a high prevalence of HIV/AIDS), the potential for a community-based HIV prevention and reproductive health program. Methods: Building upon a two-year experimental AIDS education program in the Baixada do Glicerio neighborhood school, a group of students and researchers decided to develop an HIV/reproductive health peer education and outreach program for Glicerio youth. Weekly focus groups with students from the school and participant observation were conducted during periods of 6 months. Semi-open interviews were conducted with 30 young residents (age 13-23) using snowball sampling with reseeds for age, gender, and social group diversity. Interview questions investigated self and group identity, relationships between groups, and significance of the neighborhood to the individual. Results: Glicerio young people did not categorize themselves by race, origin or sexual orientation, but by conduct. Two culturally constructed, opposing behavioral “types” were most significant in defining identity and the divisions between groups: “the person who works and studies” and the “person who uses drugs and steals.” Young people associated the Glicerio primarily with violence (83%) and social networks (50%). Violence and its result, the “law of silence”, prohibited open discussion of community issues such as drugs, HIV, reproductive health services, and access to condoms. Social networks and common recreational activities occasionally allowed young people to overcome their fear of violence and bridge the differences between groups. Relationships within these social networks depended upon a shared past and mutual respect. Conclusions: Previous studies have shown the effectiveness of community-based programs in slowing the spread of HIV. In order to overcome the divisions caused by violence and stereotyping, and HIV prevention project in the Glicerio should build upon commonalties that have positive value for all groups. For example, the program leaders should promote HIV prevention with recreational activities, emphasize respect among program participants, and encourage peer educators to both draw upon their existing social networks and identify shared problems and experiences, thus building the solidarity necessary for a truly community-based program. The Glicerio project is a model of how community organizers and HIV educators can investigate community members’ feelings about themselves, each other, and the community to increase the effectiveness of HIV prevention efforts.

Address: Sara Skinner, 1153 Kimberly Lane, Boise, ID 83712, USA Telephone:            208 343 6766       Fax: 208 345 1897

Abstract No.: We.C.3490



Author(s): Stall. Ron, Paul, J., Barrett, D., Crosby, M. Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA
Objective: To evaluate the effectiveness of a safe sex intervention offered in conjunction with substance abuse treatment at an HIV-sophisticated agency serving gay/bisexual men. Methods: A cohort was formed by sequential recruitment of 455 gay/bisexual men (78% of all eligibles) as they entered substance abuse treatment between 1990-92. The cohort was followed for 5 waves of data collection, each wave measuring the previous three months of behavior. Men were assigned to either an enhanced treatment (substance abuse treatment groups with extensive sexual risk reduction exercises) or standard treatment (conventional substance abuse treatment) at about the second wave of data collection. Treatment drop-outs were also followed. Results: Rates over time for unprotected anal intercourse with a non-monogamous partner were: (table: see text). Both treatment groups showed significant reductions over time in rates of sexual risk from Wave 1 (Wave 2-5 compared to Wave , all p’s<.05), but no differences were detected between enhanced and standard treatments. Men who later dropped out of treatment tended to have higher rates of sexual risk than men who were assigned to groups (trend Waves 1-3, p’s ~ .10; p<.01 at Wave 4), although these differences were not significant at Wave 5. Conclusions: We documented profound (~50%) reductions in high risk sexual activity among gay/bisexual men who remained in substance abuse treatment. Substantial HIV risk reductions among gay male substance abusers can be achieved through available treatment at gay-identified substance abuse treatment agencies whose staffs have considerable experience with HIV issues. We recommend that resources for treatment be a high priority for HIV risk reduction among gay male substance abusers.

Address: R. Stall, 74 New Montgomery, Suite 600, San Francisco CA 94105 USA Telephone:             415-597-9155       Fax 415-597-9125 email: ron_stall@quickmail.ucsf.edu

Abstract No.: Tu.C.2495



Author(s): Rangel, A. ***, Telles, Paulo R*., Bastos, Francisco I.**, Guydish, J.****, Hearst, N****. *NEPAD/UERJ-(State University of Rio de Janeiro), **DIS/FIOCRUZ, RJ, Brazil, ***UERJ, RJ, Brazil, ****Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA.
Objective: To determine psychological predictors of IDU’s high risk behaviors, measured by specific questionnaires, and to assess the feasibility of interventions to prevent infection. Methods: Seventy-two IDU’s from both streets and treatment centers were interviewed in Rio using three research instruments – a core questionnaire similar to the WHO multicenter collaborative study questionnaire for IDU’s, the GHQ-12 (General Health Questionnaire) designed to identify psychological morbidity, and an HIV risk behavior questionnaire developed at CAPS. We also measured the proportion of participants accepting each HIV prevention intervention offered. Voluntary HIV testing was performed in the great majority of the sample (97%). Results: Needle and syringe sharing (NS), unprotected sex (US) with an occasional partner, and high frequency of injection (FI >once a week) in the 6 months prior to the interview, were reported respectively by 58%, 51% and 46% of the sample. High scores on the GHQ (greater than or equal 75%), that indicate psychological disturbance, were found in 73% of the sample but were not associated with the risk behaviors studied (NS, US & FI) or serostatus. HIV seroprevalence was 29%. All participants accepted the intervention activities offered (a brief discussion on HIV prevention, leaflets, condoms, etc); however, very few asymptomatic clients returned for other proposed activities (eg. focus groups, additional information, etc). Only symptomatic HIV-infected patients returned to seek medical referral. The high acceptance of intervention activities at the time of the initial questionnaire may have been that clients were invited by a trained recruiter and offered a small amount of money to cover their travel expenses. Conclusions: These findings suggest the necessity of an adequate structure (psychological assistance, more attractive strategies, etc.) in treatment/prevention centers for IDU’s, capable of coping with the high levels of psychological disturbance and low levels of adherence. More specific psychological tests should be performed to find reliable predictors of risky behavior, since general levels of psychological disturbance found with the GHQ were very high. Outreach work, reimbursement of travel expenses, and more attractive interventions (e.g., needle and syringe exchange) are among some client suggestions to enhance adherence to intervention activities.

Address: Anna Rangel, Av. Rainha Elizabeth 416/101, Rio de Janeiro, RJ, Brazil CEP 22081-030 Telephone: 011 55 21 589 3269 Fax: 011 55 21 235 0646 e.mail: ptelles@vmesa.uerj.br

Abstract No.: Mo.C.455



Author(s): Lieu, Trong Thi Xuan,1 Giang LT,1 Lap VD,2 Thuc NC,2 Thinh T, 2 Mandel J,3 Lindan C.3 1Ho Chi Minh City AIDS Committee; 2DV Hospital, Ho Chi Minh City; 3Center for AIDS Prevention Studies (CAPS) – University of California, San Francisco
Objective: To describe the epidemiology of HIV and STD’s in Vietnam’s largest city and current HIV epicenter, Ho Chi Minh City (HCMC), using current surveillance data. Methods: Surveillance data in HCMC has been collected since the mid-1980′s from multiple sources including D.V. Hospital (HCMC’s main STD hospital) and 18 district health centers; Centers for the treatment of IDU’s, TB and HIV; Centers for the rehabilitation of CSWs; blood bands and others. Results: By the end of 1995, the cumulative number of HIV+ cases from HCMC was 1,669 (almost all cases were reported since 1993); 91% were men; 93% were IDU’s; 1.3% were STD patients; 0.7% were CSW’s; 0.5% were blood donors; 0.4% were pregnant women. The prevalence of HIV+ cases among risk groups screened is shown: (table: see text). From 15-20,000 STD patients are seen yearly in HCMC’s public health clinics; however, this represents only a small proportion of the total as most STD patients seek treatment in private offices. High rates of STD’s are reported among both IDU’s and CSW’s. Conclusion: The HIV/AIDS epidemic in Vietnam shows similarities to the early stages of the epidemic in Thailand with rapidly rising HIV rates among IDU’s, and with HIV infection already present in the large population of CSWs in HCMC (estimated @ 80,000 women). Urgent prevention efforts, including treatment and control of other STD’s are needed to prevent HIV spread to the general population and a repeat of the Thailand experience.

Address: T Thinh, 187/7 Bis Binh Thoi Street, District 11, Ho Chi Minh City, Vietnam Tel: 011-848-653-837 Fax: 011-848-299-810

Abstract No.: Tu.C.2433



Author(s): van der Straten A*, Vittinghoff E**, Glass S**, Quan J**, Padian N**. *Center for AIDS Prevention Studies (CAPS) & ** Department of OBGYN, University of California, San Francisco, CA, USA.
Objective: To compare safe sex behavior with primary and non-primary partners among HIV-discordant heterosexual couples and to explore correlates of these behaviors in each partnership context. Methods: In a prospective couple study of heterosexual HIV-discordant primary partnerships in California (N=242), 48 subjects who also reported non-primary opposite sex partners completed a questionnaire on HIV-risk behavior with non-primary partners. Safe sex behavior was defined as 100% condom use for any vaginal or anal sex. Sexual behavior with non-primary partners was compared to concurrent sexual behavior with the primary partner. We also explored other correlates of safe sex behavior, including demographic and behavioral characteristics of the respondent and the primary and non-primary partnerships. Repeated measures logistic models were used to identify independent correlates of safe sex behavior. For non-primary partners, the partnership was the unit of analysis, while for primary partners we modeled safe sex behavior at each visit. Results: Of the 48 respondents with non-primary partners, 83% were less than 40, 52% female, 58% white, 65% HIV-positive and the median number of non-primary partners per subject was 2. A total of 115 non-primary partnerships were examined. Safe sex behavior was reported with 62% of the 115 non-primary partners, and at 81% of 170 visits with the primary partner. Safe sex behavior with non-primary partners was not associated with safe sex behavior with the primary partner, nor with the HIV status of either the respondent or the non-primary partner. Statistically significant correlates of safe sex behavior with non-primary partners included HIV disclosure of infection (if the respondent was HIV-positive) or having an infected partner (if the respondent was HIV-negative; p<.001), and less frequent oral sex (p<.05). Avoiding substance use while having sex predicted safe sex behavior with both non-primary partners (p<.05) and the primary partner (p<.001). In contrast, age (p<.01) and frequency of vaginal sex (p<.01) predicted safe sex behavior with the primary partner, but not with the non-primary partners. Conclusions: Sexual risk behavior occurred with a substantial number of non-primary partners, and was not associated with the respondent’s serostatus or knowledge of the non-primary partner’s serostatus. HIV disclosure was the strongest correlate of safe sex behavior with the non-primary partners. No association was found between safe sex behavior with primary and non-primary partners, suggesting that this practice depends on characteristics of the relationship. Interventions for individuals in HIV-discordant couples should specifically address prevention both in primary and non-primary partnerships. Encouraging open communication about HIV and disclosure with all sexual partners may facilitate safer sex practice.

Address: A. van der Straten, CAPS, 74 New Montgomery Street, ste 600, University of California, San Francisco, CA 94105, USA. Phone:            415-597-9220       Fax 415-597-9213 email: ariane_van_der_straten@quickmail.ucsf.edu

Abstract No.: Tu.D.2713



Author(s): Woods, William J*, Mayne T**, Kegeles SM*. *Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, USA. **INSERM, Marseilles, France, and CAPS, UCSF, USA.
Objective: To determine how much of sexual risk takes place among men who have sex with men in public sex environments (PSEs), such as sex clubs and cruising areas. Methods: We systematically conducted observations of men having sex with men in 3 sex clubs (monitored spaces) and 1 park cruising area in San Francisco. Observers circulated the PSEs, unobtrusively counting sexual activities (i.e., one act of sex was counted when one man’s penis made contact with another man’s anus or mouth, or a man’s anus was stimulated by another man’s finger, fist or mouth; other sexual activities, such as mutual masturbation, were not counted). At the time of the observations, men entering and exiting the PSEs completed self-administered questionnaires. The entry survey asked men to describe their last high risk sexual behavior, their current mood state, the use of alcohol or drugs prior to arriving, and previous attendance at various PSEs. The exit survey asked about the kind of sex men had while they were at the PSE. Results: Observers spent 32 hours at PSEs, observing sexual activity. Anal sex was observed at all PSEs, and occurred at a rate of 1.06 per hour. Observers noted condom use for 47% (.5/hr) of the anal sex acts, could not tell for 47% (.5/hr), and saw no condom use for 6% (.06/hr) of the acts. 299 men participated in the exit survey; 13% reported having anal sex and 41% had oral sex while at a PSE; 75% of those reporting anal sex used condoms; participants averaged between 1 and 2 partners. 332 men participated in the entry survey and, of those who had previously had unprotected anal intercourse (62%), 69% reported that their last such event was at home; of the men who reported having been tested for HIV (88%), 15% were HIV+. Conclusions: The observers noted few acts of anal intercourse (7%), and, of those, 47% were with condoms. Most participants in the exit survey reported no unprotected anal intercourse. Other studies have suggested that men who go to PSEs are more likely to engage in high risk sex; we found that men entering do report more high risk sex at home than they reported engaging in at PSEs. This study reinforces the success of monitoring behavior at PSEs to create environments that support a social norm for lower risk sexual activities. (table: see text)

Address: William J. Woods, Ph.D. UCSF-CAPS, 74 New Montgomery Ste 600, San Francisco, CA 94105, USA Phone:             415/597-9309      ; Fax: 415-597-9125; e-mail: bill_woods@quickmail.ucsf.edu

Last modified: November 2, 2012