Newsletter No. 136

2 No. 136 4th December 1998 CUHK Newsletter I n t e r p r e t a t i ons of a Disease: Three Approaches to Understanding AIDS To date over 300 people in Hong Kong have died from AIDS and over a thousand are infected with HIV, not to mention the many cases whichave gone unreported. Withthe advent of the cocktail treatment in the 90s, patients' lives have been prolonged and improved. Yet HIV/AIDS prevention and the psycho-social needsof persons with HIV/AIDS are issues deserving asmuch attention as medical treatments and cures. Here at the University three research projects dealing precisely with theseaspects have attracted funding support from the AIDS Trust Fund. A Pilot Study to Assess the Effectiveness of Group Cognitive-Behavioural and Peer Support/Counselling in Symptomatic HIV Patients (HK$304,200) 'As far as I know, this is the first organized research study in Hong Kong testing psycho-social intervention that involves symptomatic HIV patients,' said Prof. Alexander Molassiotis o f the Department of Nursing, who has been working with HIV/AIDS patients in Hong Kong, the UK, and Greece for the last nine years. The year-long study, which began in May, compares the effectiveness of two different psycho-social treatments on HIV patients: the cognitive-behavioural approach and counselling based on peer support. The subjects for the study are H I V patients who have moved from the initial stage of infection and developed some opportunistic infections but not yet fullblown AIDS. The patients, some 60 of them, are recruited from Queen Elizabeth Hospital and divided into three groups: two receiving the different treatments and a control group receiving, when necessary, the standard psychological treatment usually given to such patients at Queen Elizabeth hospital. Both treatment groups get together with a therapist once a week for about two hours for 12 weeks. For the cognitive-behavioural group, each session deals with a particular topic of interest to the patients, such as how to break the news of HIV infection to friends and family, sexual practices post-HIV, and n u t r i t i o n al considerations. Group members are assigned to find information about the topic and bring it back for discussion during the session. The aim is to alter cognitions, empower patients, and offer skills training to combat stress. The peer counselling/support group operates on the principles of counselling. Yet unlike one-to-one counselling, the subjects w i l l wo r k out so l u t i ons themselves through the support and experiences of their peers w i t h the t he r ap i st i n t e r v e n i ng o n ly wh en discussion reaches an impasse. For ethical reasons, members of the control group receive crisis intervention in the form of counselling on a one-to- one basis, which is given at the member's request. Also to safeguard their rights, all patients from the three groups continue to receive the treatment and support they have all along been receiving from other sources. The primary aim of the study is to find out which treatment is more effective as regards the quality of life and psychosocial status of the patients. Aspects taken to be indicators of quality of life include physical symptoms, psycho l og i cal distress, and social and job-related adjustments, whereas measurements of psycho-social status include anxiety, depression, and other mood states. The treatments' effects on the patients' health behaviours, e.g. sexual practices, are also examined and comparison is made between the effectiveness of sporadic intervention and formal, organized intervention. Baseline data is collected before the patients are assigned to the groups through questionnaires and psychometric scales. These are regiven at the end of therapy and at three months after the end of therapy. The rest of the research time is spent on data compilation and analysis. Prof. Molassiotis said one of the reasons that sparked his interest in doing the study is that existing psycho-social services for persons with HIV/AIDS are patchy and it is hard to know which psycho-social treatment may be more beneficial for the individual needs of HIV/ A I DS patients in Hong Kong. The recommendations of the study will go to the a p p r o p r i a te agencies in the government. Qualitative Study of HIV/ AIDS Risk Behaviour Among Hong Kong Teenage 'Street Roamers' and Approaches for Harm Reduction ( HK$93 , 556) A portion of Hong Kong's teenage population are nocturnal creatures, their day habitually beginning at sundown and ending after breakfast. Against the backdrop of the slumbering city, they hang out in basketball courts, game alleys, and other public areas with others who live by night, or simply loiter about the streets. Given their lifestyle and their age, these 'night youth' are susceptible to many dangers and that include that of H I V/ AIDS. Yet these youth who may have dropped out of school, or in any case are not going to school on a regular basis, or who may be unemployed, are hard to contact for research purposes. 'There is a dire lack of data on youth sexual behaviour/HIV risk in Hong Kong, especially that of fringe youth,' said Dr. Joyce Tang o f the Department o f Commun i ty and Fami ly Med i c i ne. 'Research on sexual behaviour of different groups of people has been conducted but so far nothing has been done on street youth. Hence we don't know the HIV risk among them and how to go about H I V prevention education.' The study, which began in May, is now Hearing completion. Dr. Tang has done field observations with the outreach teams of two social work organizations targeting fringe youth. On one night, Dr. Tang went with an outreach team to the Yaumatei, Tsimshatsui, Mongkok, and Shamshuipo districts. In a 24-hour fastfood store, she saw how the social workers tried to approach the many teenagers who were lying on the tables and chairs. On another night, Dr. Tang was taken to youth hangouts in the Northern New Territories. 'We went to a basketball court where many young people were just walking and standing around. We joined them. A l l of a sudden three policemen came over. They probably assumed we were up to no good. The social worker identified herself and they left us alone. But I could see the boys were very scared. We then followed them to another court where they really played basketball. By then it was past 10. We watched for half an hour and left. ’ Apart from field observations, Dr. Tang and her team have successfully conducted formal interviews of 30 to 45 minutes each with 11 informants and done focus groups of seven informants each. She hopes to interview some a few times more to get more in-depth information about their social and sexual behaviour and has begun weaving in sex and HIV/ A I DS prevention education into her meetings with them. Some of Dr. Tang's informants have clarified 'fringeness' for her. There are different degrees o f 'fringeness' and these include 'every- night-Tsimshatsui-East-fringe', 'every- night-estate-fringe', and 'part-time- fringe'. A l l the informants interviewed so far are sexually active. Only a minority are involved in a steady relationship. The majority have sex with someone they know and some with prostitutes. 'They use condoms part of the time. That's the problem. They have heard of AIDS and know it's sexually transmitted. But how to translate that knowledge into a change ill sexual behaviour is another thing. Sex education has to be conducted through a medium that speaks to them such as peer education, comics or video,' said Dr. Tang, who intends to conduct some more i n t e r v i e ws to c o n f i r m c e r t a i n observations. Development of Indicators to Track Awareness, Attitudes and Behaviours (HK$1,095,000) The project, which began in January, is conducted by the Community Research Programme on AIDS of the University's Ce n t re f o r C l i n i c a l T r i a l s and E p i d e m i o l o g i c a l R e s e a r ch i n collaboration w i th the Department of Family and Community Medicine. The programme was established three years ago and is funded by the Hong Kong Council of AIDS Trust Fund. 'One way to monitor HIV/AIDS and to make predictions about the future scenario is through sero-surveillance of HIV prevalence. However the projection is far from accurate because of much underreporting. As suggested by the W Health Organization, another way is through surveillance on risk behaviours. The project also provides indicators to evaluate HIV/AIDS programmes in Hong Kong,' explained Dr. Joseph Lau, director of the Centre for Clinical Trials and Ep i d em i o l o g i c al Research. ' R i sk behaviours', according to Dr. Lau, refers specifically to such activities as 'the use of commercial sex, intravenous drugs, and homosexual sex'. The current project comprises four studies: (1) monitoring of AIDS-related attitudes and awareness of the general public, (2) surveillance of the risk behaviours of the general public in Hong Kong, (3 ) surveillance of the risk behaviours of travellers returning to Hong Kong via the Lo Wu checkpoint, and (4) validation of a quality of life instrument specific to persons with HIV/AIDS and to study their pattern of service utilization. The four studies w i ll be repeated two or three times over the course of three years to monitor changes over time. To mitigate the social desirability bias —as questionnaires on sexual behaviour are sensitive 一 the clients in the different