From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference newspaper - Friday 24 July - part 2
Note: non-commercial reproduction.
Archive-Number: 5785
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 26 Jul 92 17:16:20 GMT

Do drinking and sex mix?

Sex sessions among gay men that involve alcohol use are no more 
likely to be unsafe than sex sessions where no alcohol is consumed, 
said Peter Weatherburn, of Project Sigma in the UK, at a session on 
Alcohol, Other Drugs and Sex. 
Much health education material for gay men presents the message 
that using drugs, including alcohol, is linked with having unsafe 
sex, Weatherburn said. But, he said, most research studies find no 
association between alcohol and sex and the few that find an 
association do not separate alcohol from other drugs. 
Project Sigma initiated a study in which gay men kept a diary of 
their alcohol use and, separately, their sexual activity. Subjects 
recorded 1,624 drinking sessions and 841 sex sessions with 
someone else (in contrast to solitary masturbation). The men had 
drunk alcohol one to two hours before the sexual activity in 31% of 
the sessions. But sex sessions following alcohol use were no more 
likely to involve casual sex, to include receptive anal intercourse, 
or, in cases of penetrative sex, to be done without a condom, 
Weatherburn reported.  
Alcohol use may actually promote safe sex, Weatherburn said. Some 
gay men said that alcohol made them more relaxed and better able 
to negotiate condom use during sex. 
*********************************************************
Why Western          governments fail to act:        
After fear, denial?
At the beginning of the second decade of AIDS, there is a growing 
perception that much work on AIDs is marking time in both 
quantity and quality. In some places, AIDS programmes have even 
retreated, due to local resistance.
In some of the most affected Western countries, collective 
prevention efforts appear to be giving way to the idea (stated or 
not) of 'everyone for themselves', perhaps due to increasing 
concern about the costs of the public health system. This includes 
the idea that prevention efforts have no clear economic payback, 
unlike investment in research or treatments.
The privileged classes, educated and not generally part of classic 
risk groups during the first decade of AIDS, support measures more 
for their own protection than for the protection of the disad-
vantaged. The acceleration of AIDS among the poorer classes, as in 
the poor countries, has created the impression of a two-speed 
epidemic. This leads some ordinary citizens (as well as decision-
makers) to think that AIDS carries neither urgency nor collective 
implications for the middle class in developing countries. Policy 
makers accept the human losses among minorities, the 
disadvantaged and in the poor countries. Is this denial of AIDS or 
denial of human reality?
At the beginning of the second decade, the scientific world has 
evolved considerably in rapport and in numbers, but the sense of 
individual and collective responsibility that linked physicians and 
researchers in the first decade has been diluted as AIDS-related 
specialties have multiplied and become frag-mented. 
The problem has been made worse by the self-promoting 
announcements of vaccine and drug researchers seeking funding, 
which has taken public interest away from prevention. The 
complexity of the epidemic, compared to all previous ones, has led 
to a multitude of experiences in prevention, education, social 
treatment, and so on, that generally had no pertinent models. But 
despite the proliferation of international conferences, knowledge is 
rarely transmitted efficiently, and people continue to perform 
experiments that others have shown are doomed to failure.
All of these things contribute to governmental denial, if not of AIDS 
as such, of the urgent need for financial and moral resources. 
Nothing is more useful to a politician faced with AIDS than the 
illusion that the epidemic is simple, distant (destined for others) 
and without large financial implications (not urgent).

Frederic Edelman
ARCAT-SIDA
Paris
*********************************************************
From Amsterdam to Berlin - and beyond

The week of the conference, like other intense experiences, has 
had a dual aspect: each day seemed very long, packed as it was with 
discussions, challenges and stimulation; yet now that it is ending, 
the days seem to have passed so quickly. 
It is quite legitimate to ask ourselves: what have we gained from 
being in Amsterdam, rather than staying at home and "reading all 
about it" - in the press and     from the abstract volumes? As I 
suggested at the opening ceremony, the basic technology of a 
conference is really quite primitive: we travel long distances so that 
we can sit together, see each other, talk and listen. So what 
precisely was the point of "being there"?
These questions bring us back to the objectives of the conference: 
exchange of knowledge, experience and ideas; literacy (our own); 
and solidarity. 
It is impossible to measure the extent of information exchange: the 
sessions (more than 160 of them, not counting the minicourses and 
poster discussions) are only the formal framework for exchange. 
The conference provides the reason for coming together: several 
hundred meetings scheduled just before, during and even after the 
conference, many of which would likely not have happened 
otherwise, and the countless individual and small group informal 
discussions, either with colleagues from home (being away, you 
finally find the time to meet!) or with colleagues from elsewhere, 
add enormously to the exchange capacity of the conference. 
The question of whether there is a new virus is perhaps the most 
dramatic recent example of how information exchange helps 
accelerate progress. Rather than leave the exchange on this 
emerging issue exclusively to chance, we organised a session in 
which new questions were generated and from which a quite 
different sense of what was happening emerged before our eyes. 
What happens next will certainly be influenced by our discussions of 
the matter: the potential for accelerating discoveries in this area 
alone, through the medium of the conference, may be worth the 
cost of the conference all by itself. 
Yet this dramatic, real-time and mediagenic situation is just one 
example: the same phenomenon occurred in sessions on 
prevention and care, in which the presenters' findings were 
reinforced, or challenged, by the experience of others in the same 
field, from different places. The sparking of new ideas, methods 
and insight is a poorly understood phenomenon which flourishes in 
this environment. 
It is now a major challenge to remain literate about AIDS 
(fortunately, this is not defined as having read all of the conference 
abstracts). Literacy requires a general understanding of several 
fields outside one's own, as well as a sense of context and 
proportion. Summary articles can be read at home, but listening to 
a single speaker, or hearing those at a state-of-the-art or 
multidisciplinary session, transmits their hard-won knowledge and 
perspective to us. The minicourses, designed to help deepen and 
consolidate knowledge, the roundtables and the use of discussants 
to provide a context for new information - in oral abstract and 
poster sessions - all seem to have been popular innovations. 
Solidarity takes many forms. To some, the word solidarity may 
seem too abstract, or weighted with unfriendly political associations 
or implications of rigid mass conformity. Yet for most, the feelings 
which come along with being together, even for a week, the sense 
of sharing challenges, emotions and - yes, why not say it? - dreams 
of what could be, are important. Whether in the large opening 
ceremony, the global meetings, or in face-to-face discussions, we 
gain precious strength by not being alone, by connecting. The 
feeling of having a common ground, being a part of a larger whole, 
is concrete, and no one will question that our diversity is 
extraordinary and assured by a healthy spirit of non-conformity 
(scientific and otherwise). 
As we leave Amsterdam, we recognise that together, over eight 
years, we have created something precious: there is no forum in 
health which shares the special qualities and breadth of the 
international AIDS conferences. It is ours - it belongs to all of us - 
and we must help nurture and protect it. It is common ground, a 
place of meeting, which we would threaten if we were to treat it as 
our private preserve. 
I am grateful that we met in 1992. I cannot imagine the year ahead 
without having had this week in Amsterdam. Now we return to our 
homes. Enough plenary speakers, microphones and hotel rooms for 
a while! But we take back with us precious gifts, to share with those 
at home: information, insight, personal contacts and renewed 
confidence - the abstract and concrete ingredients of our 
commitment, the source of hope for our future. 

Jonathan Mann
Conference Chair
VIII International Conference on AIDS/III STD World Congress
*********************************************************
Needle exchanges reduce HIV risk 
By William Check

Syringe-exchange programmes can reduce the incidence of high-
risk behaviour among intravenous drug users (IVDUs) and lower the 
incidence of new HIV infections among them, according to a poster 
discussion session this week. 

Don Des Jarlais, of Beth Israel Medical Center, New York City, and 
the US National AIDS Commission, said: "Failure to provide legal 
access should be considered public health mal-practice."
Kachit Choopanya, of the Bangkok Health Department in Thailand, 
described a programme which provides low-priced syringes 
through pharmacies. Among 263 seronegative IVDUs, only 17 
seroconverted over a mean of 10 months. Those who remained 
seronegative were more likely to have stopped sharing injection 
equipment and to have a regular sexual partner, Choopanya said.   
Des Jarlais said this is the first programme in which people who 
said they had stopped sharing could be shown to have a lower 
incidence of HIV infection. It showed that intervention is effective 
and that people can reliably report on their own behaviour. 
Holly Hagan, of the Tacoma-Pierce County Health Department in 
Tacoma, Washington, said syringe exchange there is associated with 
a decrease in risk behaviours and a lower rate of HIV infection. 
Injectors entering the programme had been those at higher risk: 
they had shared needles more often and had a longer history of use; 
17 years on average. But once involved with the programme, their 
rate of renting or sharing dropped below that of IVDUs who did not 
exchange needles. 
Among the exchangers, 2% are seropositive, compared with 8% of 
the non-exchangers, suggesting that the programme has had an 
impact. To confirm this effect, the researchers are now offering 
serial HIV testing. One problem is that the police can confiscate 
syringes, in which case the drug user must find discarded syringes 
in order to participate in the programme.  
Syringe exchange was made legal in Oregon in 1989 through an 
exemption in the state's law on drug paraphernalia. In November 
1989, an exchange programme was started in Portland. Kathy 
Oliver, its director, said it attracted 1,000 people, about 16% of the 
county's IVDUs, in its first two years. 
The exchange programme managed to reduce its clients' risky 
behaviours more than a neighbouring bleach programme. For 
example, exchangers who never shared increased from 56% to 
65% over six months, while bleach users who never shared 
remained at 57%.  
Des Jarlais said: "AIDS is simply too important a problem for 
policymakers to allow counter-productive laws to continue."
-------------------------------------------------
Sidebar:  Californians hope to change the law 

In July 1991, former rock music photographer Joey Tranchina was 
acquitted on an 11-1 jury vote of violating a California law against 
needle exchange. In an interview with World AIDS News, Tranchina 
said, "The verdict was evidence of the overwhelming power of the 
medical testimony." Dr John Watters, of the University of California, 
San Francisco, as well as the director of the San Mateo (California) 
County Health Department and other experts testified that needle 
exchange does no harm and much good.  
Tranchina believes that the trial helped exchange programmes. He 
said that,  following the verdict, the jury foreman and three other 
jurors walked with him to the site where he had been arrested. 
The jury foreman has since become active in Tranchina's exchange 
project, the National AIDS Brigade. 
Currently a bill legalising needle exchange, written by a coalition 
with the San Francisco AIDS Foundation as the lead agency, has 
passed both houses of the California legislature and awaits approval 
by one committee and the governor. 
Tranchina is asking people to fax him statements about their 
experiences with needle exchange and their attitude toward the US 
government's rejection of exchange at: +1 415 341-6157 after 7 
August.
-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands
Newsgroups: sci.med.aids