AIDS INFORMATION NEWSLETTER Michael Howe, MSLS, Editor AIDS Information Center VA Medical Center, San Francisco (415) 221-4810 ext 3305 December 30, 1994 Women and HIV Infection (Part XVI) Abstracts from the XTH International Conference of AIDS - 1994 AU - Alonso L TI - Women, AIDS and social representation. AB - OBJECTIVE: Brazilian women are consistently found to engage in high rates of unsafe sex. Of all women contaminated by HIV, 65% got it from sexual partners. An educational prevention prog. target specifically to the needs of women from 25 to 35 years old was designed, implemented and evaluated. METHOD: The program was offered to 117 women. Six groups of 9 women was formed: 2 as a control group (N = 18) for the interv. (N = 36). It aimed to promote a guide for safer sex through a variety of strategies (role play, lectures, dialogue). Topics of instruction came from a quantitative study and focus group. RESULTS: Myths such as sensitivity, female and male machismo love and sex were clarified and seen as barriers to AIDS prev among 68% of the women in the intervention group against 31% in the control group. CONCLUSIONS: Learning besides a cognitive activity is also an emotional practice. AIDS knowledge associated with discussions about sex-role perception and female machismo were the most significant variables. SO - Int Conf AIDS. 1994 Aug 7-12;10(1):22 (abstract no. 061D). AU - Braggiotti L ; el Amri M ; Cantero A ; Boutet N TI - An European observatory for sanitary and social researches on sex workers. AB - OBJECTIVES: Adapt to five European countries (Spain, Netherlands, Belgium, Germany, Italy) the Bus des Femmes research and action field methods, as evaluated in Paris since 1990. METHODS: By carrying out exchanges with institutional organizations, field workers and health and social care professionals, allow in each country the: a) Breaking barriers between sex workers and researchers, between the field and institutions. b) Training preventive teams (Both sex workers and researchers collect, analyse and use sanitary and social information to update epidemiological studies and public health activities). e) Exploitation of information to optimize the use of sanitary and social networks. RESULTS: The creation and support of 25 preventive sex workers in Europe. Awarcness compaigns (Spain, Netherlands, Belgium, Germany, Italy) and training sessions (Spain, Belgium) between professionals and sex workers. Participation of two sex workers supported by the Bus des Femmes in an injection equipment exchange program in Madrid and Anvers. CONCLUSION: The implication of sex workers, their exchanges with researchers and sanitary and social professionals, created a dynamic current that brought a rapid strengthening of the sex workers preventive behavior towards HIV. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):39 (abstract no. 449D). AU - Chan R ; Soon T TI - User acceptability of female condom among female sex workers in Singapore. AB - OBJECTIVE: To assess the user acceptability of Femidom among female sex workers in Singapore. METHODS: The study was conducted in the STD clinic in October and November 1993. Twenty-nine sex workers were recruited into the study. They attended a workshop comprising of a talk, video and demonstration to introduce the condom. Personal and demographic data were collected. Each was given 8 or 9 condoms to try over a period of one week, after which they returned for a second interview. RESULTS: Out of the 29 sex workers, only 21 managed to use the condoms in the study period. Of these 52% liked the product, 76% thought that it was acceptable as a protection against infections, 43% found the product easy to use, 62% found greater ease with subsequent use. Two-thirds took under 30 seconds to insert the condom. The majority either never or only rarely experienced any discomfort during or after intercourse. Tearing of the condom was experienced by one sex worker, the majority did not notice the condom slipping out or wrong entry of the condom. The major complaints by sex workers was that the condom was complicated to use, clients objected, that the condom was too large, and that it looked ugly. Most did not report any loss of sensation by their clients. However, the majority had problems persuading their clients to accept the female condom,their main reasons were that they preferred male condoms, female condoms looked ugly, and that female condoms reduced sensation. One quarter of the sex workers said they would use the female condom exclusively as protection against infection. DISCUSSION: The female condom is a useful and timely addition to the methods to prevent transmission of STD/AIDS. We found that it was readily acceptable by sex workers. Difficulties encountered were mainly with their clients and to a lesser extent with the construction of the product. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):50 (abstract no. 475C). AU - Fernandes J ; Pereira M ; Vallinoto T ; Fonseca A TI - KAPB survey related to HIV/AIDS in 4 slum populations of Rio de Janeiro. AB - OBJECTIVE: The present survey is part of the Regionalized AIDS Control Programme (RACP), that was created to deliver clinical assistance, counseling and testing to interested persons, as well as education and peer condom distribution in the slum communities of Rio de Janeiro. It was developed in the two target communities, and in two other control communities, at the beginning of the project, to access the knowledges, beliefs and attitudes of these populations, and to build a baseline profile of these items, before the intervention of the RACP. METHODS: Cross-sectional survey, with a stratified one stage random sample of 300 persons in each slum (total sample size = 1200). RESULTS: The level of knowledge about HIV transmission was very high, but there were also high levels of inaccurate information about transmission due to blood donation, lack of hygiene, garbage and mosquito bites. There were no statistical differences between the 4 slums in terms of condom use: nearby 23% of the sample used condoms, although only 10% used them regularly. The women were significantly less inclined to use condoms than men, even if only single sexually active persons were studied. CONCLUSIONS: This study showed that more efforts in demystifying HIV infection are needed, as misunderstanding about transmission means of the HIV may lead to justifications of unsafe practices. Special attention must be developed concerning women, among whom the infection is spreadingquickly. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):398 (abstract no. PD0774). AU - Fichtner RR ; Warner DL ; Rochat RW ; Conlon RT TI - Compliance with prevention guidelines: congenital syphilis outcomes among urban women in Atlanta, GA, 1990-1993. AB - OBJECTIVES: To evaluate compliance by prenatal service providers with congenital syphilis (CS) prevention guidelines by assessing CS outcomes among women who received prenatal care and were delivered of infants in Atlanta, Georgia, during 1990-1993, a period in which Atlanta had the highest incidence rates of infectious syphilis among women of any major U.S. city. METHODS: In order to maximize the likelihood of identifying the totality of 1990-1993 incident cases of CS among infants who were delivered in an inner-city, publicly-funded hospital which reported approximately 40% of all Georgia cases and 95% of all Atlanta cases, we consolidated data from three sources. State report forms were matched against surveillance records at the Centers for Disease Control and Prevention (CDC), and computer linkages were made to Georgia's infant vital statistics system to ensure inclusion of stillbirths. Levels of provider compliance with CDC prevention guidelines were quantified. RESULTS: Of the 179 hospital cases of CS identified to have occurred during the three-year period. 94 (53%) received prenatal care with a median of four prenatal visits. Mothers of CS cases were black (93%), not married (84%), and 20-30 years of age (57%). Adverse outcomes among all cases of CS delivered included perinatal mortality (13%), low birth weight (84%), and prematurity (36%). Among CS cases who were live births, those born to mothers with prenatal care were of greater gestational age (37.8 mos. vs. 35.6 mos., chi 2 = 10.5, p < 0.01) and had greater birth weight (2796 g vs. 2372 g, chi 2 = 9.8, p < 0.01). Among mothers of CS cases who received prenatal care. 71% were not treated during pregnancy. But, among those treated, 81% received treatment inconsistent (i.e., late or non-penicillin) with CDC guidelines; 19% were reinfected after initial treatment during pregnancy. CONCLUSIONS: These findings suggest that compliance with CS prevention guidelines is inconsistent. Although continuity of prenatal care for many urban women cannot be always assured because of factors unrelated to care, more uniform adherence to guidelines, in addition to timely and aggressive outreach to women who have initiated care, are indicated. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):64 (abstract no. 533A). AU - Fuentes L ; el-Sadr W ; Capps L TI - An effective system for tracking challenging populations in community based HIV research. AB - OBJECTIVES: To describe the various components and analyze the outcomes of a system developed to collect follow-up data on minority patients participating in studies conducted in New York City by the Harlem AIDS Treatment Group. METHODS: A plan for tracking patients was developed by project staff, clinicians, an advisory committee and people living with HIV. The plan included the collection of locator information, building a strong bond between patient and provider, provision of incentives, anticipating missed visits, a contact strategy, networking with city and local resources, and the use of staff that is representative of the community being served. RESULTS: The lost to follow-up rate among 362 patients participating in an Observational Data Base Study decreased from over 70% to 24%. Ongoing efforts continue to improve the collection of data. CONCLUSIONS: The methods employed have facilitated the collection of important HIV data and helped to fortify the bond between patient and provider, a bond which is essential for providing high quality patient care and collecting data in community based research. Challenging populations, minorities and women from lower economic groups, can effectively participate in HIV longitudinal studies. However, specific measures are needed to eliminate or reduce barriers, including patient incentives, the use of personnel representative of the community, and the promotion of strong patient-provider bond. Appropriate resources are needed to conduct such an approach. SO - Int Conf AIDS. 1994 Aug 7-12;10(1):412 (abstract no. PD0256). AU - Greet B TI - The role of self-help groups and peer support networks for women with HIV/AIDS. AB - Women with HIV/AIDS are faced with greater social problems than men with the same disease. Women with HIV/AIDS face isolation from society generally and also from other women with HIV. The issues that confront us are not addressed as we do not speak with a common voice and the services available have been constructed to meet the needs of the perceived male population of infected people. The establishment of Positive Women Vic in 1988 provided some answers to these problems. Closed meetings allowed the women to meet in a secure environment and the interactions that occurred have led to an increased awareness of the need of women with HIV/AIDS amongst health care providers and the larger community. Without this increased awareness change could not occur. We have achieved media recognition representation on Government boards and committees concerning both policy and treatment issues. By remaining independent we have forged a clear identity for infected women for the first time. I propose to outline the steps that we took to achieve these goals and the need for the cooperation of health care providers to enable it to develop. SO - Int Conf AIDS. 1994 Aug 7-12;10(1):23 (abstract no. 065D). AU - Guimaraes MD ; Castilho E ; Boschi C ; Berbara V ; Weinssenbacher M TI - Behavior change after knowledge of HIV serostatus. AB - OBJECTIVES: To assess changes in sexual behavior among female partners of HIV infected men in Brazil. METHODS: Male index cases (ICs) were recruited from participant centers in Rio de Janeiro thru Dec 1993. Couples were interviewed for risk factors and had blood collected for exams. Sexual practices before and after knowledge of HIV serostatus of the IC were assessed using McNemar's test. The Odds Ratio (OR) conditional on the number of discordant pairs was also estimated, stratified by IC risk group and age. RESULTS: TABULAR DATA, SEE ABSTRACT VOLUME. CONCLUSIONS: 1. There was a significant decrease in all sexual practices after learning the ICs serostatus; 2. The rate of condom use increased for all practices, although unprotected sex is still practiced after learning the ICs serostatus; 3. Changes occurred independently of IC risk group, IC age or FP age. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):381 (abstract no. PD0707). AU - Karinchai N ; Intarajit O TI - The House of Tomorrow--Chiang Mai. AB - The House of Tomorrow (HOT) is a project by Hotline Center Foundation. HOT is both shelter and training center where will be the first place runned by local Thai NGO in Northern Thailand. HOT had planned to serve distressed women and children in Northern Thailand. But, when AIDS hit Chiang Mai community, HOT is the only place that integrated place where AIDS and non-AIDS women can stay together appropriately and properly. At HOT, the women and children have choices for life since they first came in. After the process of interview and counselling, a baby is allowed to stay in HOT with an accompany only. The institution where referring each case have obligate to follow up their cases in HOT. HOT is the place where is harmonized to other Hotline psychological services. Each day, everybody has activity according to her skills. After, they finish their personal affairs, they get life education and psychotherapy, take care their babies, prepare themselves, go to work outside or start alternative occupational training. HOT staff and members learn to live positively and happily. We believe that any one who is HIV positive or not can live together in any community, if they have chance to choose for their lives. HOT is the model for GOs and NGOs who work for PWHIV/AIDS support in Northern Thaialnd. SO - Int Conf AIDS. 1994 Aug 7-12;10(1):410 (abstract no. PD0246). AU - Kiruhi M ; Ngugi EN ; Kamau P ; Nyambola L ; Ronald A TI - The impact of social economic and sexual empowerment: commercial sex workers. AB - OBJECTIVE: To mobilize women in sex industry willing to exit prostitution, educate and support them in management of small business, and monitor their modification in sexual habits. METHOD: Fifty four women, 10 from Machakos Town and 44 from Nairobi who had earlier indicated that they are seeking alternative means of income were recruited. Indepth interview with trained interviewers and also participatory observations were used to complement qualitative data. The women were then trained in management of small business as well as costing. Reinforcement of STD/AIDS, safe/safer sex and fertility education as part of capability building. Finally, between Ksh. 2,500/= and 25,000/= was disbursed according to their needs. RESULT: The age of these women was 15 1/2 to 45 years from several parts of the country and practising prostitution in homes, hostels, streets and bars. They have 1-8 children with an average of 4. A quarter of them have HIV infection and 5% have AIDS. 2% are child prostitutes and of them is already a mother at 15 and a half. They have started a variety of business in the markets e.g. vegetable, fruits, miraa, grain and are making handcrafts. Two are in training for weaving and tailoring respectively. 6.2% got married, 4% have no sexual partners at all and others have reduced sexual partners from 25 per week to 15. 45% are keeping a regular sexual partner or lover. Those who still have 2 are insisting on condom use to 60% now from 40% before. Group therapy takes place once a week and all of them are experiencing a sense of well being and pride that they do not have to sell sex and expose themselves to the deadly AIDS to survive. When they do, they insist on condom use. They have increased sense of accomplishment. CONCLUSION: This is a sure way of empowering women in core groups to remain free of STD/HIV as well as project other sexual partners; thus breaking the chain of HIV transmission. SO - Int Conf AIDS. 1994 Aug 7-12;10(2):39 (abstract no. 447D).