INTERNATIONAL AIDS CONFERENCE 2010  SHARING SESSION Enriching Minds. Enhancing Strategies. Time Presentation 12.30pm – 1.4...
PREVENTION TARGETING AT COUPLES Sharing from International AIDS Conference  2010 Prepared by Donovan Lo, Snr Programme Man...
<ul><li>Source:  </li></ul><ul><li>Session:  Modeling HIV Epidemics </li></ul><ul><li>Part: WEAC0102 - The Impact of Inter...
<ul><li>Posters: </li></ul><ul><li>TUPE0569 – Determinants of three stigma domains in Thailand: fear of HIV infection, sha...
<ul><li>INTRODUCTION </li></ul><ul><ul><li>High rates of sero conversion among gay male couples. </li></ul></ul><ul><ul><l...
<ul><li>SERO SORTING </li></ul><ul><ul><li>England and Wales conducted a research that examine perceptions of risk reducti...
<ul><li>SERO SORTING </li></ul><ul><ul><ul><li>Risk-reduction strategies were described they were  a post-hoc rationalizat...
<ul><li>DISCORDANT </li></ul><ul><ul><li>Sero discordant couples do exists. </li></ul></ul><ul><ul><li>Results of a study ...
<ul><li>DISCORDANT </li></ul><ul><ul><li>Interventions: </li></ul></ul><ul><ul><li>Challenges: </li></ul></ul><ul><ul><ul>...
<ul><li>STIGMA </li></ul><ul><ul><li>HIV prevention to some extent must capitalise on the desire of seronegative men who h...
<ul><li>STIGMA </li></ul><ul><ul><li>Study on HIV-related stigma was conducted in Australia. </li></ul></ul><ul><ul><ul><l...
<ul><li>STIGMA </li></ul><ul><ul><li>There is strong association between  </li></ul></ul><ul><ul><ul><li>the value placed ...
<ul><li>ASSUMPTION </li></ul><ul><ul><li>Due to stigma,  </li></ul></ul><ul><ul><ul><li>Couples do not talk about their HI...
<ul><li>FINDINGS FROM AN EVALUATION SURVEY OF POSITIVE PARTNERSHIP PROGRAMME </li></ul><ul><ul><li>In Thailand, there is P...
<ul><li>RECOMMENDATION </li></ul><ul><ul><li>Couples  view: Condom is a barrier to intimacy , trust and spontaneity </li><...
<ul><li>SUPPORT </li></ul><ul><ul><li>Sero discordant couples have faced a number of challenges:  </li></ul></ul><ul><ul><...
<ul><li>SUPPORT </li></ul><ul><ul><li>Psychological support </li></ul></ul><ul><ul><li>Counselling </li></ul></ul><ul><ul>...
<ul><li>NORMALIZING HEALTH RELATIONSHIPS </li></ul>The End.
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Presentation by Donovan Lo, Action for AIDS

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Modeling HIV Epidemics,Advancing Prevention for People Living with HIV

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Presentation by Donovan Lo, Action for AIDS

  1. 1. INTERNATIONAL AIDS CONFERENCE 2010 SHARING SESSION Enriching Minds. Enhancing Strategies. Time Presentation 12.30pm – 1.45pm Lunch 1.45pm – 2.00pm HPB Welcome 2.00pm – 2.15pm HPB Youth Health Department 2.15pm – 2.30pm HPB New Media Department 2.30pm – 3.00pm Action for AIDS 3.00pm – 3.30pm Oogachaga 3.30pm – 4.00pm Tea Break 4.00pm – 4.30pm Trevvy 4.30pm – 5.00pm HPB Communicable Diseases Education 5.00pm – 5.30pm Discussion & Next Steps
  2. 2. PREVENTION TARGETING AT COUPLES Sharing from International AIDS Conference 2010 Prepared by Donovan Lo, Snr Programme Manager Action for AIDS Singapore
  3. 3. <ul><li>Source: </li></ul><ul><li>Session: Modeling HIV Epidemics </li></ul><ul><li>Part: WEAC0102 - The Impact of Interventions on HIV transmission at the level of discordant partnership </li></ul><ul><li>Session: Advancing Prevention for People Living with HIV </li></ul><ul><li>Part: Perceptions of risk reduction strategies by gay men with diagnosed HIV engaging in unprotected anal intercourse (UAI) </li></ul>
  4. 4. <ul><li>Posters: </li></ul><ul><li>TUPE0569 – Determinants of three stigma domains in Thailand: fear of HIV infection, shame associated with having HIV, and blame towards people living with HIV </li></ul><ul><li>TUPE0573 – Pride and prejudice: serostatus identity and HIV related stigma among men who have sex with men in a national online study in Australia. </li></ul><ul><li>TUPE0751 – Should HIV prevention Interventions target the couple or the individual? Predictors of sexual risk behavior over time among gay male couples </li></ul><ul><li>WEPE0598 – Serodiscordant couples workshops: psychological support, counselling and capacity building. </li></ul>
  5. 5. <ul><li>INTRODUCTION </li></ul><ul><ul><li>High rates of sero conversion among gay male couples. </li></ul></ul><ul><ul><li>Primary partners are an important and unrecognized source of new infections. </li></ul></ul>
  6. 6. <ul><li>SERO SORTING </li></ul><ul><ul><li>England and Wales conducted a research that examine perceptions of risk reduction strategies by PLHIV engaging in UAI. </li></ul></ul><ul><ul><ul><li>Results shows that PLHIV rejected strategies that could only reduce the risk of HIV transmission, preferring to eliminate risk, which they felt condom use could achieve. </li></ul></ul></ul><ul><ul><ul><li>However, their desire to always use condoms with men of discordant status was influenced by a variety of situational factors. </li></ul></ul></ul>
  7. 7. <ul><li>SERO SORTING </li></ul><ul><ul><ul><li>Risk-reduction strategies were described they were a post-hoc rationalization for risk-taking that was regretted, rather than as a planned course of action. </li></ul></ul></ul><ul><ul><ul><li>Sero-sorting was rejected for reasons of HIV related stigma and a reluctance to limit ones pool of sexual partners </li></ul></ul></ul>
  8. 8. <ul><li>DISCORDANT </li></ul><ul><ul><li>Sero discordant couples do exists. </li></ul></ul><ul><ul><li>Results of a study in USA shows that half of stable partnership affected by HIV are discordant. </li></ul></ul><ul><ul><li>Formulation of an effective package of interventions to reduce HIV incidence among discordant partnership is the key to HIV prevention efforts. </li></ul></ul>
  9. 9. <ul><li>DISCORDANT </li></ul><ul><ul><li>Interventions: </li></ul></ul><ul><ul><li>Challenges: </li></ul></ul><ul><ul><ul><li>Stigma </li></ul></ul></ul>
  10. 10. <ul><li>STIGMA </li></ul><ul><ul><li>HIV prevention to some extent must capitalise on the desire of seronegative men who have sex with men (MSM) to remain uninfected. </li></ul></ul><ul><ul><li>However, what consequences does this valuing of seronegative status have for these men’s attitude towards people living with HIV (PLHIV)? </li></ul></ul>
  11. 11. <ul><li>STIGMA </li></ul><ul><ul><li>Study on HIV-related stigma was conducted in Australia. </li></ul></ul><ul><ul><ul><li>Importance of serostatus was significantly higher for HIV negative men than seropositive or status unknown men. </li></ul></ul></ul><ul><ul><ul><li>Among seronegative men, those who placed greater importance on their own serostatus identity were more likely to exhibit stigmatising attitudes toward PLHIV in all domains, i.e. </li></ul></ul></ul><ul><ul><ul><ul><li>stigma-related attributions e.g. blame, </li></ul></ul></ul></ul><ul><ul><ul><ul><li>negative feelings e.g. disgust, </li></ul></ul></ul></ul><ul><ul><ul><ul><li>social distancing e.g. avoidance and </li></ul></ul></ul></ul><ul><ul><ul><ul><li>sexual exclusion, e.g. will not have sex). </li></ul></ul></ul></ul>
  12. 12. <ul><li>STIGMA </li></ul><ul><ul><li>There is strong association between </li></ul></ul><ul><ul><ul><li>the value placed on one’s own seronegative status and </li></ul></ul></ul><ul><ul><ul><li>avoiding seropositive MSM as potential sexual or romantic partners. </li></ul></ul></ul><ul><ul><li>HIV prevention that seeks to enhance such an identity may have detrimental effects, not only affect </li></ul></ul><ul><ul><ul><li>seropositive MSM directly through feelings of shame and blame, </li></ul></ul></ul><ul><ul><ul><li>but also indirectly through social distancing and sexual exclusion by seronegative MSM. </li></ul></ul></ul>
  13. 13. <ul><li>ASSUMPTION </li></ul><ul><ul><li>Due to stigma, </li></ul></ul><ul><ul><ul><li>Couples do not talk about their HIV status </li></ul></ul></ul><ul><ul><ul><li>Singles may choose not to commit to relationship </li></ul></ul></ul><ul><ul><li>increase unsafe casual sex between couples with unknown status. </li></ul></ul><ul><ul><ul><li>In regular relationship, factor of trust may hinder suggestions of using condoms. </li></ul></ul></ul><ul><ul><ul><li>In casual relationship, partners assume that the party who does not talk about using condom will have the same sero status as theirs </li></ul></ul></ul>
  14. 14. <ul><li>FINDINGS FROM AN EVALUATION SURVEY OF POSITIVE PARTNERSHIP PROGRAMME </li></ul><ul><ul><li>In Thailand, there is Positive Partnership Program which pairs HIV positive to HIV negative individuals and provides the pair loans for income generation business. </li></ul></ul><ul><ul><li>Data was collected as part of an evaluation survey shows respondents with higher HIV knowledge were less likely to exhibit stigma along the dimension of fear and shame. Contrary to expectation, fear of HIV infection was significantly associated with higher feel of shame and blame. </li></ul></ul><ul><ul><li>Result suggest that interventions focused on increasing knowledge and decreasing fear of infection might also decrease stigma associated with shame and blame. </li></ul></ul><ul><ul><li>Stigma is the leading barrier to use of prevention & treatment services, and harms people living with HIV and their families. </li></ul></ul><ul><ul><li>Stigma drives the topics of HIV underground and may increase unsafe casual sex between couples with unknown status. </li></ul></ul>
  15. 15. <ul><li>RECOMMENDATION </li></ul><ul><ul><li>Couples view: Condom is a barrier to intimacy , trust and spontaneity </li></ul></ul><ul><ul><li>Future HIV prevention efforts for male couples must address the complex interplay between couple level, individual level, and situational factors that influence risk behavior. </li></ul></ul><ul><ul><li>Support couples to sustain healthy and satisfying relationship given that positive relationship attributes are strong predictors of lower odds of sexual risk over time. </li></ul></ul><ul><ul><li>Address mental health issues that negatively impact relationship and sexual health </li></ul></ul>
  16. 16. <ul><li>SUPPORT </li></ul><ul><ul><li>Sero discordant couples have faced a number of challenges: </li></ul></ul><ul><ul><ul><li>safe sex measures, </li></ul></ul></ul><ul><ul><ul><li>medical treatments, </li></ul></ul></ul><ul><ul><ul><li>therapies, </li></ul></ul></ul><ul><ul><ul><li>mutual support </li></ul></ul></ul><ul><ul><ul><li>Hope </li></ul></ul></ul><ul><ul><ul><li>intimacy and </li></ul></ul></ul><ul><ul><ul><li>family planning. </li></ul></ul></ul><ul><ul><li>Although members of the groups referred to know and use always condoms, practical difficulties are not often recognized in the medical consultation. </li></ul></ul>
  17. 17. <ul><li>SUPPORT </li></ul><ul><ul><li>Psychological support </li></ul></ul><ul><ul><li>Counselling </li></ul></ul><ul><ul><li>Capacity building </li></ul></ul><ul><ul><li>Peer Support Group </li></ul></ul><ul><li>Peer Support Group </li></ul><ul><ul><li>Peer group allows a secure and prejudice free environment where members of the couples are able to express practical difficulties and errors in the implementation of prevention methods. </li></ul></ul><ul><ul><li>Couples can see others in the same situation and change their believe about being the only ones who share this problem. </li></ul></ul><ul><ul><li>Hearing experiences with peers facilitates dialogues within the couple as well as disclosure of HIV status to other people. </li></ul></ul>
  18. 18. <ul><li>NORMALIZING HEALTH RELATIONSHIPS </li></ul>The End.

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