      FOCUS: A Guide to AIDS Research and Counseling
      Volume 9, Number 12 - November 1994
      -----------------------------------------------

      Editorial: Conference Culture
      Robert Marks, Editor

      This year marks the Tenth International Conference on AIDS
and inaugurates the conference's every-other-year schedule. Some
would say this hiatus is a long time coming and that the money
spent on this extravaganza is better put towards program costs
and smaller discipline- specific and regional conferences. 

      I have expressed my frustrations about the international
conference before: its failure to provide an effective and
flexible forum for information exchange and, most importantly,
intellectual synthesis. Attending a conference on this scale,
despite innovative summary sessions, is always a process of
describing the elephant after having handled only its trunk--or
toenail. It's exhausting, expensive, and--despite the best
intentions--often dominated by mediocre research, especially in
the area of the social sciences. 

      But as Thomas Coates points out in this issue of FOCUS, it
is the only forum that brings together a truly international
convocation of professionals from a variety of disciplines,
laypeople, and activists. While the AIDS effort will not be
harmed by a two-year wait until the next conference in
Vancouver, this year's conferences--both in Yokohama and in
Brighton--testify to the value of sharing across national
boundaries. 

      Two examples demonstrate this point. Coates observed
several Yokohama presentations where researchers from the
developing world offered lessons to those of us working in the
industrialized world. It is heartening and exciting to confirm
that cross-cultural pollination can yield hybrid approaches like
the Ugandan Post-Test Club. 

      The other example came from the Brighton conference. While
conference organizers were hugely successful at insuring that
this small conference included substantial developing world
attendance, the international aspect of the meeting became
apparent to me in a more subtle way. At the two sessions on
substance use and unsafe sex, which I document in my report, the
most vigorous debate occurred among White researchers from
English-speaking, industrialized countries, debaters who--from
the perspective of someone in the developing world--might appear
culturally identical. It was fascinating to note how alcohol use
held such culturally different meanings among people who by
international standards might be confused with each other. 

      Culture can become a buzzword that obscures differences
among apparently similar peoples even as it magnifies
distinctions among patently different groups. Both conferences
emphasized, as has been the case over the past few years, the
importance of prevention, and the importance of collaboration:
across culture and, as importantly, between researchers and
practitioners. As Jeffrey Kelly asserted at Brighton, such
collaborations are the route to creative solutions to the huge
prevention challenges we face. 

      ***********
      Report from the AIDS Conference
      Care and Prevention: Hand in Hand
      Thomas Coates, PhD

      Some came away from Yokohama, Japan disappointed that the
Tenth International Conference on AIDS did not produce more
breakthroughs. But it is clear that scientists will not, and
should not, wait for the annual international meeting to reveal
important results. Rather, such results should be presented to
the community as soon as they are available. 

      What, then, does the international conference accomplish?
The conference offers an important venue for professionals from
different disciplines and people in the HIV-affected communities
to share ideas, findings, and practical solutions to difficult
problems. These are not the issues that make the headlines, but
they are the ones that will prevent HIV from spreading. This
article describes the range of psychosocial findings presented
at the conference and focuses on research about counseling and
support, school-based prevention, and prevention strategies for
women. 

      Counseling and Support

      The vast majority of cases of HIV infection are in
developing countries, those least able to afford the expensive
medications and medical care needed to arrest disease
progression and to prevent and treat HIV-related opportunistic
infections. As a result, families, friends, and communities must
perform the hard work of caring for people with HIV disease. 

      In Yokohama, there were more presentations on counseling
and support in developing countries than there have been at past
conferences. These presentations defined the issues people with
HIV disease face in resource-poor nations, where counseling and
support--a route to prevention--may be all that a society can
afford. Care and prevention go hand in hand: when people feel
that they will be cared for, that they can turn to their
families and communities for help, they may be more likely to
tell others that they have HIV infection and to avail themselves
of prevention services. It is important to note that these
findings are applicable to industrialized nations as well,
particularly those where the epidemic is hitting "resource-poor"
communities, for example, inner-city neighborhoods. 

      Stefano Bertozzi of the World Health Organization's Global
Programme on AIDS reminded a plenary session of the conference
that the burden of caring, particularly in the developing world,
typically falls to households and not to professionals
(PS30).[1]  Psychosocial interventions should focus on easing
this burden, confronting issues such as caring for self and the
people for which one has responsibility, planning for the death
of a loved one--and the lives of his or her survivors,
particularly children--dealing with HIV-related cognitive
impairment, and providing basic support such as food, shelter,
and medical care. In another plenary session, Thai educator Jon
Ungphakorn reframed a familiar theme: the AIDS challenge is as
much about responding to attitudes as it is about rebuffing the
virus (PS8). As in the industrialized world, many of the
psychological issues raised by infection in the developing world
are related to social reactions to the epidemic and to infected
people. 

      Several presentations offered innovative responses to
these challenges. Elizabeth Marum of the Centers for Disease
Control and Prevention (CDC), in collaboration with the Ugandan
AIDS Information Centre, reported on the Post-Test Club, an
approach to stemming the divisions between seropositive and
seronegative people and to facilitating HIV serostatus
disclosure (240C). Disclosure is still difficult for many
HIV-infected people. It is important to find ways for them to
obtain support and avoid stigmatization. The Post-Test Club was
established for recently tested people, and, like many U.S.
programs, offers a forum to talk about HIV disease and
HIV-related problems. Unlike U.S. support groups, however, which
are usually segregated by serostatus, the Post-Test Club is open
to anyone who has been tested. It is particularly effective
because it encourages interactions among people who identify as
seropositive and seronegative, and people who choose not to
reveal antibody status. 

      A survey of 1,246 Post-Test Club members found that 60
percent participated in safer sex and 68 percent reported safer
sex three months later. In addition, over time, perceptions of
safer sex social norms increased and more participants became
involved in safer sex programs, including condom distribution in
the community. 

      Michael David Thurnherr of The Test Positive Aware Network
(TPAN) of Chicago presented data on peer-led interventions for
newly tested seropositive people and for seropositive people
having problems with maintaining safer sex (277D). Thurnherr
found that recently tested people were confused about safer sex
practices. Those who relapsed felt shame about their slips, and
this shame--and the belief that their friends would not
understand or be willing to discuss instances of relapse--led to
a sense of isolation. In response to these findings, TPAN
developed a peer prevention case management system, pairing
"veteran" people with HIV disease with neophytes. After
training, veterans guide their clients through six discussions
on safer sex alternatives, correct condom use, personal
responsibility, early intervention choices, HIV basics, and STD
education. 

      Knowledge of HIV infection is, of course, the first step
to dealing with the range of HIV-related psychosocial
challenges. Rapid, on-site antibody testing is one way to
facilitate access to this knowledge. But there remain concerns
about the counseling implications for such a testing delivery
system. In response, CDC researcher William Kassler conducted a
study of counselors and clients to examine counseling technique
and client and counselor acceptance (518B/D). Counseling
modifications for the rapid test venue included: changing
consent language, allowing for deferral by those who were not
ready to receive results, and conducting a risk assessment
before drawing blood. 

      Clients who tested positive were told that they were
"likely to be infected." Counseling emphasized the importance of
returning for results of the confirmatory Western Blot test,
further counseling, partner notification, and referral. Although
initially reluctant, counselors found these protocols
acceptable. Kassler found that 90 percent of clients liked
getting their results on the same day and 86 percent of those
who had had a previous antibody test preferred the rapid test. 

      Rapid antibody tests are becoming more and more available.
Some test kits may allow individuals (or physicians or
employers) to test people on the spot. But providers have raised
significant concerns about telephone counseling and "instant"
testing, including the unproven specificity of the tests, the
lack of confirmatory tests, and the lack of adequate pretest
counseling, informed consent, and post-test counseling. The
question is not whether rapid or home-based testing will come,
but when. There is plenty of potential for abuse here in the
United States, but more so in developing nations. There needs to
be research to identify the positive and negative consequences
of rapid or home testing, and legal and ethical safeguards to
maximize the benefits of such tests. 

      School-Based Prevention

      HIV infection is increasing most rapidly among young
people. According to a recent letter in the New England Journal
of Medicine, the median age of infection is now 25 years,
compared to 35 years a decade ago, and one in four new
infections in the United States occurs in people younger than
20.[2] 

      Conference presentations affirmed the value of
school-based prevention programs at the same time as they
questioned the need and efficacy of these interventions for all
students. Deborah Rugg of the CDC assessed the effectiveness of
the range of school-based interventions reported in the
literature and found that well-designed programs do not hasten
the onset or increase the frequency of sexual intercourse; can
delay the onset of intercourse; and can increase condom use
among sexually active youth (371D). Effective programs share
several characteristics: a basis in social learning theory; a
narrow focus on a specific behavior; experiential activities;
instruction on resisting negative influences; reinforcement of
positive peer norms and values; and activities that increase
skills and confidence. 

      Alan King of Queens University in Ontario developed a
program that seems to meet Rugg's criteria (372D). He
administered a 20-hour educational program to 2,000 Canadian
ninth grade students, basing it "on a behavioral change model
emphasizing skill development, responsible attitudes, and
motivational supports through peer modeling and parental
involvement." Its focus was relatively broad, covering
HIV-related knowledge, attitudes toward healthy sexuality,
homosexuality, people with HIV disease, and condoms,
assertiveness, sexual behavior, and condom use. While the
intervention achieved positive results in terms of
assertiveness, comfort in talking about condoms, HIV-related
knowledge, and behavioral intent, it had little practical effect
on delaying vaginal intercourse. In addition, condom use
decreased over time, so that by year three, there was no
significant difference between the demonstration group and the
control group. 

      If we were really interested in HIV prevention, would we
target all youth, or would we would target gay youth,
adolescents in high prevalence poor communities, and teens who
for a variety of reasons may be likely to become injection drug
users? The programs presented at the conference target the
general population of adolescents, and none talked about sexual
diversity and the acceptance of sexual diversity. Part of the
problem is that people who are interested in adolescent
sexuality issues have appropriated HIV prevention as a way of
promoting condom use and other sexual decision-making
strategies. While adolescents may be at risk for other sexually
transmitted diseases and pregnancy, many are not at risk of HIV
disease. We should be doing a more effective job with those
youth who are at highest risk for HIV infection, especially
adolescents who are gay or bisexual. 

      Prevention Strategies for Women

      Among presentations that focused on women with HIV
disease, there continues to be an emphasis on power dynamics and
coercion. Two presentations, which reported on data from a
University of California San Francisco, Center for AIDS
Prevention Studies investigation of 1,600 Latino men and women
throughout the United States, examined these issues. 

      Barbara Marin analyzed the effects of cultural values on
condom use among the 749 respondents 18 to 24 years old (034D).
She found that women were less comfortable with sex than were
men, that is, less comfortable having sex with the lights on or
being naked in front of their partners. Sexual comfort was
related to condom use: of those who were comfortable being
naked, 64 percent of men and 74 percent of women could use a
condom without spoiling the mood. Of those who were
uncomfortable, however, 41 percent of men and only 35 percent of
women could use a condom without spoiling the mood. Marin states
that while the origins of this discomfort are unclear, about
half the respondents had never talked to their parents about
sex. She concluded that this sexual silence is a likely source
of discomfort with sex and is a major impediment to safer sex. 

      Cynthia Gmez investigated the incidence of sexual
coercion among unmarried Latino women in the United States
(064D). Of the study's 846 women, 20 percent reported a history
of sexual abuse or rape in their lifetimes. Of women who had sex
with men in the prior year, 73 percent said that partners
insisted on sex when the women were not interested, 23 percent
said that partners yelled at them, 3 percent said that partners
hit them, and 14 percent said partners harmed them in some other
way during sex. Responses by men confirmed this coercion data.
Men who reported being coercive and women who reported being
coerced were more likely to agree with the following statements:
women like dominant men; a woman has to pay the consequences
when she flirts with a man; it's harmful for a man to get
excited without ejaculating; and it's dangerous for a woman to
know as much about sex as a man. 

      A smaller study of Zambian women focused on safer sex
strategies and, without documenting coercion, described similar
attitudes among male partners (063D). Caroline Chandra of the
Kara Counseling and Training Trust in Lusaka surveyed 152 women
receiving antibody testing and counseling. At three- to
six-month follow-up interviews, some women in "non-steady"
relationships chose to abstain from sex in response to partner
resistance to condom use, and this led to the breakup of the
relationship. Women with steady partners also had difficulty
with resistance to condom use. 

      Conclusion

      While progress in vaccines and therapeutic drugs is slow,
many presentations and conversations at the Yokohama meetings do
support optimism. We have learned much about how to care for and
support those with HIV disease, and about how to prevent HIV
infection. We are more and more commonly talking about topics in
public that 10 years ago were taboo, and these conversations are
leading to progress. 

      References

      1. References to conference abstracts are cited in
parentheses. Plenary Sessions are denoted "PS" followed by a
number. Oral presentations are denoted by a number, followed by
a letter indicating conference track: "A" for Basic Science, "B"
for Clinical Science and Care, "C" for Epidemiology and
Prevention, and "D" for Impact, Societal Response, and
Education. 

      2. Rosenberg PS, Biggar RJ, Goedert JJ. Declining age at
HIV infection in the United States (Letter). New England Journal
of Medicine. 1994; 330 (11): 789-790. 

      Authors

      Thomas Coates, PhD is Director of the Center for AIDS
      Prevention Studies at the University of California San
      Francisco. He is also Professor of Medicine and Director
      of the Behavioral Medicine Unit. 

      ***********
      The Brighton Conference and HIV Prevention 
      Robert Marks

      In response to the emphasis on medical science at the
international AIDS conferences, a group of psychosocial
researchers established the Conference on Biopsychosocial
Aspects of HIV Infection in 1991. The second meeting of this
conference--also known as AIDS' Impact--took place in Brighton,
United Kingdom in July 1994. While it covered aspects of
counseling and support, its strongest presentations were in
terms of prevention strategies for gay men and drug users. 

      Safer Sex among Gay Men

      Faced with continuing relapse from safer sex and new
populations who do not recognize their risk, and armed with
greater sophistication about concepts related to safer sex,
researchers are challenging assumptions about HIV prevention,
particularly for gay men. In a controversial plenary speech, Ron
Gold of Deakin University in Australia questioned the
foundations of HIV prevention among gay men and reported on gay
men's attitudes toward sexual risk (Plenary 3 and IP5.3).[1]

      He cited four studies of gay men who had relapsed to
unsafe sex in the recent past and presented three major
findings: large numbers of gay men have not embraced a "safe sex
culture"; links to the gay community are not effective in
helping all gay men establish and maintain safer sex practices;
and while safe sex campaigns that emphasize information and
exhortation were once successful, they are no longer
particularly useful. 

      Instead, since gay men who participate in unsafe sex use
various arguments to "give themselves permission" to engage in
these practices, Gold found that targeting these
self-justifications directly might lead to risk reduction. He
based his intervention on the premise that self-justifications
represent thinking that occurs only during actual sexual
encounters, thinking that is unique to "the heat of the moment."
Risk reduction occurs when gay men reflect on and evaluate this
thinking in the cold light of day.* 

      Where Gold's talk identified the limits of current
gay-related prevention, Jeffrey Kelly of the Medical College of
Wisconsin focused on successful prevention strategies (Plenary
2). Kelly, a pioneer in HIV prevention, reviewed the 20
published controlled HIV-related risk behavior outcome studies.
He divided prevention into two categories: face-to-face
approaches and community approaches. He concluded that research
strongly supports the effectiveness of face-to-face, ongoing
group interventions that combine risk education and preparation
for change with skills-building, reinforcement, and support.
While community models are not as effective, they are
commensurate with the societal scope of an epidemic and can
change peer reference group norms. 

      Kelly reviewed two studies that exemplify effective
individual and community approaches. In one, researchers worked
with 250 women who received care at an inner-city, primary care
health clinic. The intervention focused on debunking myths,
skills-building, problem-solving, sexual assertiveness, and peer
support. After three months of follow-up, condom use increased
from 26 percent to 56 percent, proving that an intervention of
five sessions could result in increased sexual communication and
negotiation. 

      The second study-which Kelly has reported before-focused
on identifying and harnessing the efforts of "opinion leaders"
in eight small cities. In comparison cities, researchers mounted
a high-quality, but standard, HIV prevention media campaign. In
the study cities, researchers identified local opinion leaders
in the gay community, and taught them about HIV prevention and
how to disseminate non-judgmental messages endorsing behavior
change. Each leader contracted with researchers to talk to a
specified number of friends every week. In the study cities,
there was a steady decline in anal intercourse, particularly for
insertive partners. One-third of the subjects who had been at
high risk before the intervention were at no risk after it.
There was no comparable change in the comparison cities. 

      Two other studies organized by Project SIGMA--a seven-year
investigation of the sociosexual impact of HIV on gay men--also
examined prevention in the gay community. Ford Hickson
documented the flawed process by which gay men assess risk
(W4.2). He surveyed 337 gay men, 38 percent of whom had engaged
in unprotected anal intercourse in the prior year and 5 percent
of whom were seropositive. When asked about casual encounters
that resulted in unsafe sex, Hickson found that both
seropositive and seronegative subjects often assumed that their
partners' serostatus was the same as their own.

      He also found that HIV-infected men, whose major concern
was avoiding transmitting the virus, were better at stopping
transmission than uninfected men, whose major concern was
avoiding contracting the virus. Most notably, untested men who
were in fact seropositive had unsafe sex with seronegative men
and were more concerned about contracting HIV than transmitting
it. Hickson suggested that prevention campaigns focus on the
role of antibody testing in making decisions about sexual risk. 

      In an evaluation of three HIV prevention print media
campaigns in the United Kingdom, Peter Keogh found that gay
men-in this case, predominantly White, single, well-educated,
and out about their sexuality--prefer educational materials that
are sexually explicit, informative, visually well-produced, and
include clear and large text (IP5.4). Keogh asked 300 gay men to 
respond to three examples of printed material: an eight-panel
photo-story, which included explicitly sexual pictures; an
advertisement series called "Sex Tips"; and a glossy poster
series put out by the Health Education Authority.

      Subjects responded negatively to information that was
oversimplified and that included too many messages. They
suggested that materials be more persuasive and less didactic,
and humorous but not silly. In terms of eroticism, subjects
appreciated sexually explicit materials and straightforward
language, but disliked taglines like "ooh," "ah," and "slurp."
They emphasized that forced use of "street language" was not
particularly useful, although avoiding the appearance of
censorship of context-appropriate sexual language was important.
Subjects also responded negatively to models perceived as "too
handsome." 

      Alcohol, Drugs, and Unsafe Sex

      It has become a standard of prevention doctrine that
substance use before sex leads to unsafe behaviors. Two sessions 
scrutinized the relationship between substance use--particularly
alcohol--and unsafe sexual behavior among gay men. Susan Cochran
of California State University, Northridge presented data on
alcohol use and risk among 839 African-American men, 77 percent
of whom were gay and 15 percent of whom were bisexual (W4.1).
She concluded that the current blanket advice to avoid drinking
at the time of sex is not adequate. In particular, while
decreasing drinking might decrease unsafe sex among heavy users,
the behaviors of such users were likely to be influenced by
"chronic patterns of risk-taking." 

      Cochran found that "the association between alcohol use
and HIV risk appears to involve more than just the immediate
affects of alcohol intoxication on sexual behavior choices."
HIV-infected men were significantly more likely than uninfected
or untested men to be classified as "possible alcoholics," to
report using alcohol in conjunction with sex, to use drugs, to
use drugs in conjunction with sex, to be a current or former
cigarette smoker. 

      It should come as no surprise that drinking would have an
effect on risk behavior and at the same time, that it might be
indicative of a psychological predisposition to take risks.
Cochran's findings suggest that prevention that focuses on
alcohol use cannot simply discourage the combination of drinking
and sex. Among heavy drinkers at least--who seem to be more
likely than casual drinkers to be HIV-infected--there appears to
be a psychological component that will function to impel
risk-taking with or without the mediation of alcohol. At this
largely European conference, however, these conclusions evoked
strenuous debate. Drinking in the United States has different
associations and meanings, and research from this U.S. sample
seemed to be less relevant in cultures where alcohol use is
integrated into society in different ways.

      In a session devoted to the relationship between
recreational substance use and high-risk sex among gay and
bisexual men-David Ostrow of the Medical College of Wisconsin,
Michael Ross of the University of Texas, Graham Hart of the
University College and Middlesex School of Medicine in London,
and Peter Weatherburn of Project SIGMA--sparred about similarly
divergent perceptions (IP12). By and large, Ostrow and Ross
presented data to support the notion that substance use is a
cofactor for risk while Hart and Weatherburn questioned this
conclusion. 

      Weatherburn raised eyebrows when he declared that there is
no connection between alcohol use and unsafe sex. He said that
while about half the studies on this topic support the
connection, none of the "event-specific" studies provide
evidence for this conclusion. Weatherburn cited a SIGMA study of
1,625 instances where drinking occurred before sex. There was no
significant difference in the number of anal sex and non-anal
sex instances or in the number of condom use instances that
followed alcohol use. He also cited a study of 2,019 sex
sessions where only one man had anal sex without a condom to
ejaculation and said that this behavior had been affected by
alcohol use. 

      While there was no consensus in the session, the
discussion highlighted two points. First, it is important for
researchers and educators to be precise about the context in
which a behavior--for example, drug and alcohol use--occurs. A
good example of this was raised by Australian researcher Ron
Gold, who detailed a study of men who had sex without condoms
and men who almost had sex without condoms but used them in the
end. Gold found that in Sydney, there was a correlation between
alcohol use and unprotected sex, but that this relationship was
not present in Melbourne. In Sydney, where the gay scene is
geographically concentrated and includes a strip of bars,
neither getting drunk nor having sex requires a great deal of
planning. In Melbourne, however, where the gay scene is much
more dispersed and police are especially vigilant about drunk
driving, gay men who want to drink and find sex must plan their
forays, and it is clear that if a person plans sexual
encounters, he or she is more likely to have safe sex. 

      Second, to the extent that alcohol and drug use occurs and
does affect judgment about sexual activity, it might be useful
to develop state-specific interventions, that is, persuasive
strategies that reach people when they are in the state--
intoxicated or sober--they are in when they usually have sex. 

      Drug Networks

      The conference included fewer presentations on HIV
transmission and injection drug use, but New York researcher Sam
Friedman offered a fascinating analysis of drug user networks
(Plenary 3). Friedman, of the National Development and Research
Institutes, studied 767 injection drug users in Brooklyn and
found that the shape and size of drug use networks were a
crucial factor in determining the extent of HIV infection among
network members. 

      To develop this "community ethnography" of the sample,
researchers asked drug-injecting subjects to nominate up to 10
people with whom they had shared needles, had sex, or otherwise
interacted within the last 30 days. Performing a structural
analysis, they discovered several levels of membership: members
at the "two-core" level are linked to at least two other members
in the core of the network; and members on the "periphery" are
linked either to only one person in the core or to other people
not more than one of whom is in the core. In the Brooklyn
sample, there was one big component with 187 members-some in the
core and some in the periphery-several smaller components with
two to nine members, and 283 individuals unlinked to any
component. 

      Core members were more likely to be homeless, to lack
legal income, and to have been in jail. Almost no core members
were in drug treatment, and many were syringe sellers on the
street. However, bleach and syringe distribution programs were
reaching people in all four structural categories including the
core. While sexual behavior did not vary by membership level,
core members engaged in higher risk drug injection activities.
The result was that people in the core were more likely to be
HIV and Hepatitis B infected. 

      Friedman reported on a methodologically similar study in
Colorado Springs, a low HIV seroprevalence area. Again,
researchers found one big connective component and several
smaller ones. While in New York seroprevalence was high in the
core of the big component, in Colorado Springs, the little HIV
infection that was present was either outside the big component
or on its periphery. Based on this "n" of two, Friedman
suggested the following hypothesis: "HIV transmission may remain
low while the virus is restricted to people in the small
components or the periphery of the big component. If it gets to
core of the large component, it may spread very rapidly." 

      Finally, Friedman discussed the prevention implications of
his data. He cited the SAFE program in Baltimore, where drug
injectors come into counseling with members of their network.
This intervention has led to reduced risk in needle sharing and
injecting in galleries and increased carrying and using of
bleach. He said that prevention programs might: help drug
injectors avoid dangerous network structures like the core; use
network pressure to encourage risk reduction; use larger
networks to influence behavior of smaller networks; shape
movement patterns within networks by reducing turnover,
formation of ties to cores, and size of the large component; and
transform the network into a center for harm reduction--
essentially becoming a "proto-community organization." Finally,
arbitrarily breaking up high seroprevalence networks may spread
HIV, while carefully splitting networks by serostatus thereby
segregating infected users and introducing uninfected users to
low seroprevalence networks may lead to risk reduction. 

      Conclusion

      Despite the fact that there is little published research
on what works in prevention--Allan Hauth reported that of 285 
articles from 11 representative journals, only 5 percent
reported results of interventions on sexual and drug-related
risk behaviors (IP5.1)--the conference demonstrated creative
thinking. In his plenary speech, Kelly called for greater
collaboration between prevention researchers and frontline
providers, collaborations that should foster this creativity.
Such approaches would benefit researchers by ensuring that
studies examine questions of real relevance to the community and
would deliver to community organizations evaluation strategies
that distinguish programs that work from those that do not. 

      *********
      Next Month 

      In the December issue of FOCUS, we continue with a
tradition started last year: devoting an entire issue to book
reviews. This year we have reduced the number of reviews from
seven to five to allow for a more thorough examination of each
book. We have also widened the scope of our exploration to
include books not only about HIV-related counseling, but also
about other HIV-related issues that may affect the counseling
relationship. 

      We have again asked local practitioners to analyze how
these books succeed or fail, and to offer readers insights into
how these books might best be used. Among the books we review
are: The Changing Face of AIDS: Implications for Social Work
Practice; Therapists on the Front Line: Psychotherapy with Gay
Men in the Age of AIDS; AIDS, HIV and Mental Health; Breaking
New Ground: Developing Innovative AIDS Care Residences; and A
Death in the Family: Orphans of the HIV Epidemic. 

      Copyright (c) 1994 - Reproduced with Permission. 
      Reproduction of FOCUS must be cleared through the Editor,
      FOCUS --UCSF AIDS Health Project, Box 0884, San Francisco,
      CA 94143-0884, (415) 476-6430.  Subscription information:
      12 monthly issues- $36 individuals; $90 institutions.