AIDS INFORMATION NEWSLETTER Michael Howe, MSLS, Editor AIDS Information Center VA Medical Center, San Francisco (415) 221-4810 ext 3305 January 13, 1995 Women and HIV Infection (Part XVII) Abstracts from the XTH International Conference of AIDS - 1994 AU - Marlink R ; Traore I ; Thior I ; Ndoye I ; Essex M ; Mboup S ; Kanki P TI - Natural history of HIV-1 & HIV-2 in cohort of W. African females. AB - OBJECTIVE: A large cohort of female sex workers has been followed since 1985 in Dakar, Senegal, to determine the clinical and immunologic outcome of HIV-1 and HIV-2 disease. METHODS: Women enrolling in an outpatient clinic in Dakar were screened for HIV status after informed consent. Prevalent seropositives and known seroconverters, along with a stratified seronegative group, were asked to enroll in a clinical follow-up study if asymptomatic. RESULTS: Incidence of AIDS according to person-years observed (PYO): TABULAR DATA, SEE ABSTRACT VOLUME. Kaplanmeir analysis shows that the HIV-2 seroprevalent and seroconverters have a significantly longer disease-free time to AIDS or CDCIV disease than the HIV-1 seroprevalent or seroconverters (Wilcoxon-Gehantest, p < .05). DISCUSSION AND CONCLUSIONS: The rate of disease development with HIV-2 is significantly less than that of HIV-1 in the same region and population. This difference in clinical latency has important implications for the individual patient and modeling the epidemic for this area. SO - Int Conf AIDS. 1994 Aug 7-12;10(1):147 (abstract no. PB0015). AU - Perelis L ; Perez P TI - Imprisoned women, a positive change. AB - PRINCIPALS: Since the work of Argentine Networh of Women living with HIV/AIDS, women under detention have being identified as the more affected. Added to this difficulties, prison conditions restrict better way of living for these women. Caractheristics: 1. her own care; 2. as an imprisoned mother living without her children; 3. Care of the positive or negative children; 4. relationship with family outside the prison. OBJECTIVES: 1. Research on the women living with HIV/AIDS in Argentine prisons. 2. Workshops in: a. knowledge and care of concerned women illnesses, b. Therapeutic work with children of imprisoned mothers: (1. if children live inside prison, 2. outside, 3. if they are HIV+, 4. if negatives.), c. Therapeutic work with rest of the family: (1. while deteined, 2. ready to freed, 3. care in freedom), d. selfcare conscience devellopment. METHODS: 1. Programmed work with prison authorities. 2. Count quantity of women HIV+ and identification of those who want to be involved, 3. inclusion of prison staff, 4. workshops supervised by coordination, 5. self work started by trainers, 6. Form multipliers in or outside the prison. RESULTS: 1. Count of large groups inside prison, 2. Objective evaluation of the relationship with children and others after one year of work, 3. better condicion for children of imprisoned women, 4. Publish of a newsletter about experiences, 5. create a solidarity network for freed women living with HIV/AIDS. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):53 (abstract no. 487D). AU - Policek N ; McKenzie M TI - Positive women relating their experiences of service provision within Edinburgh. AB - OBJECTIVE: In Edinburgh 282 women are diagnosed HIV positive (at 31/1/94), approximately 100 are in touch with service providers. This paper, presented by two HIV positive women, looks at the response to the needs of positive women in Edinburgh, Scotland from the service users viewpoint. METHOD: The study used a questionnaire for HIV positive women in touch with hospital based or voluntary services asking what agencies are used and pinpointing gaps in service provision. RESULTS: Women have been affected by HIV and AIDS from the beginning--as carer, mother, partner and friend. Results showed that services are still male dominated and rarely geared towards the needs of women. CONCLUSION: There is a need for continued research into this area to assist more women to access services sooner rather than in times of crisis. SO - Int Conf AIDS. 1994 Aug 7-12;10(1):404 (abstract no. PD0225). AU - Purohit A ; Chakraborty J ; Danner R ; Hein D ; Anderson C; Kiessling A TI - Pre- and post-test counseling to a diverse group of HIV infected population. AB - OBJECTIVE: To develop model protocols for pre- and post-test counseling for diverse groups of population, based on ethnicity, age, gender preference and cultural beliefs. METHODS: In Boston City Hospital, the protocols for pre- and post-test counseling were revised and specific protocols were developed for Haitian, Latino, African American (black women and gay black men), injecting drug users, women, transsexuals and adolescents. After three months of training the counselors were allowed to use this new protocol. RESULTS: With improved skills and modification of the pre- and post-test counseling protocols, the counselors felt more comfortable and confident in the management of their patients. In 1994, an increase of 3% to 7% in seropositivity was recorded as a result of better recruitment of different ethnic groups at high risk infection. As a result of this modified protocol we observed i) an increased rate of patient participation, risk reduction and relapse prevention; ii) about 85% of these patients who tested HIV positive were engaged directly in primary care. This is an increase of 35% over the previous year. CONCLUSION: Design and implementation of culturally specific pre- and post-test counseling protocols is essential when dealing with a diverse group of population. Personal preference and beliefs must be dealt with in order to implement effective counseling. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):394 (abstract no. PD0759). AU - Roitstein F ; Becker J TI - Reaching women in Latin America and the Caribbean: an integrated approach to safer sex. AB - Most HIV/STD prevention programs have focused on populations practicing high risk behaviors such as gay men, injection drug users and commercial sex workers. However, of the estimated 14 million HIV-infected adults worldwide, 6 million are women. In Latin America and the Caribbean (LAC), the incidence of infection among women is increasing at an alarming rate. Since the early 90's, heterosexual intercourse has become the dominant mode of transmission in LAC, and now it accounts for 75% of all new infections. These data suggest a deficiency in such approaches to HIV/STD prevention and highlight the need to reach all sexually active people, especially women. To shift this trend, IPPF/WHR and its affiliated Family Planning Associations (FPAs) have taken advantage of their ability to reach large numbers of sexually active people, especially women, by integrating HIV/STD prevention into existing programs and services through the promotion of safe sex practices. This integration process necessitates rethinking of traditional approaches to family planning requiring a shift from a narrowly defined medical and vertical family planning model to a broader sexual health model. Comparative advantages of the IPPF/WHR affiliates and potential barriers to implementation will be discussed. This presentation will also describe the sexual health model used in these projects, and will illustrate how it is being applied and evaluated through a comprehensive plan. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):397 (abstract no. PD0768). AU - Sanchez S ; Woolcott D ; Mejia A ; Rouillon M ; Blume E ; Mazzotti G ; Sanchez J TI - STD/HIV prevention program for women of low socioeconomic status in Lima, Peru. AB - OBJECTIVE: To develop and evaluate educational material for women of low socioeconomic status (SES) organized in clubs de madres (mothers' clubs), community-based organizations settled in Lima, Peru. METHODS: Eighteen focus groups among women from mothers' clubs, and 7 focus groups and 7 in-deep interviews among men of low SES were performed to obtain information at 2 levels: a) sexuality, machismo, STD/HIV, condom use; b) Information and communication network. A set of educational material (poster, brochure, manuals and flipcharts) was developed and pre-tested using in-deep interviews. Health promoters (120) from the community were trained to use the educational material; changes on knowledge and attitudes among the promoters were measured among the promoters. After pre-test, a sample of 600 women from mothers' clubs not previously interviewed entered into an educational intervention made by the trained promoters. A post-test will be performed after 6 month. RESULTS: Educational materials were develop using messages to improve perception of risk for STD/HIV and health seeking behavior; to give information on STD/HIV prevention and family planning; to change attitudes and beliefs towards sexuality; and to empower women's decision making in health behavior. Among community health promoters, a significant improvement was found between pre and post-test regarding knowledge about STD/HIV and attitudes towards sexuality. In the pre-test evaluation, women from mothers' clubs were found to have low perception of risk for STD/HIV, poor health seeking behavior, low or no power in the family decisions, low or no power in contraceptive use decisions, and poor knowledge regarding STD/HIV prevention. CONCLUSIONS: This program develop educational materials for women of low SES using information from qualitative assessment and perform a successful intervention to encourage STD/HIV prevention. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):68 (abstract no. 548D). AU - Schilling RF ; Ivanoff A ; el-Bassel N ; Borne D ; Kabas F TI - HIV-related risk reduction among women offenders in jail and in the community. AB - OBJECTIVE: Women drug users account for a growing proportion in jails and prisons, and HIV seroprevalence rates of incarcerated women are higher than those of their male counterparts. This study tests the efficacy of a group intervention, combining skills-building and social support, and designed to reduce HIV risk behavior among drug-abusing female offenders. METHOD: Derived from socio-behavioral theories and from developmental work with the target population, the intervention consists of 8 group sessions in prison and 8 individual post-release sessions in the community. Women with recent drug abuse, approaching release from a 3-12 month sentence, are recruited in Rikers Island jail, New York City. RESULT: More than 300 women have thus far been randomly assigned to the skills-building/social support intervention or to a single AIDS information session. Measurement includes baseline, and follow-up at 1, 3, 6, and 12 months. In a logistic regression model controlling for demographic variables and number of sessions attended, preliminary findings (N = 159) favor skill/social support participants on indicators of condom use improvement (OR = 3.92, p < .07) coping skills improvement (OR = 2.14, p < .1), and emotional support improvement (OR = 2.42, p < .05), but not sex trading. CONCLUSION: Early results lend some support to group skills-building interventions to reduce HIV risk behavior among female offenders. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):43 (abstract no. 464C). AU - Ssentongo R ; Sharpe U ; Nanteza C TI - Women as caretakers. AB - OBJECTIVE: To study the achievements/problems as experienced by women caring for AIDS patients/orphans in their homes. According to your experience as a carer, how do you explain care? METHODS: The Mobile program cares for AIDS patients in their homes supports 7500 orphans in school and helps families to cope during this hard period. A number of questions were discussed with women under this program individually and in groups. RESULTS: Women have played a big role in caring for people infected and affected with AIDS. The whole process is stressful. Despite the social, economic and emotional problems women have shown great concern. CONCLUSIONS: Home care for AIDS infected and affected people is necessary and very important in our society. There is a need to offer more support to women. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):238 (abstract no. PB0965). AU - Sushma S ; Mathur R ; Yadav N ; Sarin E ; Sahi R ; Rao B TI - STD prevention in low-risk poor women of Delhi. AB - The study is based on 12 months work: OBJECTIVES--1. To assess the prevalence rate of STDs: 2. To Demonstrate the need for providing STD services: 3. To provide counselling to women with STDs. 4. To make women aware of STDS/HIV infection. METHODS--*Five STD centres established in collaboration with Family Welfare Programmes of the hospitals. *Individual counselling to STD+ive women. *IEC strategies. RESULTS--8276 cases secreened, 521+ive for STDs, (prevalence rate 6.6%), 550 random sample tested for HIV none+ive, 4028 women and men contacted in interactive awareness programmes, 428 individual counsellings. CONCLUSIONS--*STD services should be supported by consistent areness programmes on STDs/HIV and vice-versa, in the corresponding population. *The incidence of STDs/HIV infection is strongly linked with other problems resulting from over population, poverty, disease, illiteracy and gender bias. *Majority of men and many women (housewive and girls) of these communities indulge in very very high risk behaviour. *Religion used as vehicle to spread the message may be more acceptable to these people. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):68 (abstract no. 549D). AU - Vorakitphokatorn S TI - Sexual behavior of young Japanese women tourists in southern Thailand and risk for HIV infection. AB - OBJECTIVE: To study the sexual behavior of young Japanese women tourists in Phuket, Thailand. This group was seen as particularly at high risk for contracting the HIV infection. METHODS: In-depth interviews were conducted in Phuket (southern Thailand) with managers of Japanese tour agencies tour guides, beachboys, Japanese women tourists and tourist policemen. Interviews were transcribed, coded, and entered. RESULTS: Following aggressive promotional activities in Japan for FIT Phuket vacation package, there has been a significant increase in visits of young Japanese women tourists to the island, with estimates of over 30,000 Japanese tourists of which 65-70 percent were women in the past 9 months. These young women tourists are seen as culturally, and socially naive and yet willing to take risks by the local service boys; beachboys, guides, hotel personnel, etc. who quickly develop casual sexual relationship with them. Condom use is sometimes requested by the women but the place and the frequency of sex acts does not lend itself to any effective preventive behavior. DISCUSSION AND CONCLUSIONS: The liberating and exotic environment of a vacation community outside of Japan and certain personality traits involving the risk taking behavior associated with young people of both sexes have created situations where cases of sexual permissiveness, exploitation and unprotected sexual intercourse are common. Young Japanese women tourists are generally unfamiliar with aspects of travelling safely as well as with the risks of various STD's given the very low rate in their own country. The young, especially should be well informed and well rehearsed of proper protective measures to use in situations requiring cautions before embarking on foreign vacation communities. Package tour operators and health authorities should take this on as their responsibility. SO - Int Conf AIDS. 1994 Aug 7-12;10(1):23 (abstract no. 066D). AU - Weiss E ; Rao GG TI - The need for female-controlled HIV prevention. AB - OBJECTIVE: Women currently constitute approximately 40% of the global total of adult HIV infections worldwide. Current HIV/AIDS risk-reduction strategies (sexual partner reduction, mutual monogamy, consistent condom use, and appropriate treatment for STDs) do not address the broader economic and sociocultural factors within which sexual behavior takes place. In order to provide a more comprehensive understanding of how these factors influence women's risk of HIV infection, findings from 17 studies conducted by the Women and AIDS Research Program of the International Center for Research on Women will be presented. METHODS: In order to provide insights into the realities of women's and men's sexual lives, the studies supported through the Women and AIDS Research Program utilized a variety of qualitative methods, including focus group discussions, individual interviews, sexual life histories, and participant observation. RESULTS: Data from the studies show that women in a variety of life circumstances are at risk of HIV infection, and face numerous constraints in adopting HIV risk-reduction behaviors. Cultural norms which encourage men to have multiple partner relationships also expect women to be ignorant and passive in sexual interactions. Economic vulnerability not only contributes to women exchanging sex for goods and services, but also prevents them from leaving high-risk sexual relationships. DISCUSSION AND CONCLUSIONS: Policy and program recommendations which emerged from the studies--including the need to develop female-controlled technologies--will be presented. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):46 (abstract no. SS9).