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Issue Contents
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AIDS action Issue 21 Page
1 2 
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Issue 21 June-August 1993 |
Sex, drugs and HIV control
At this year's international AIDS conference, great emphasis was placed on the need to take a broader approach if we are to succeed in fighting AIDS. Speakers stressed that individual behaviour is much more than a matter of individual choice - it is affected by social, political and economic forces. Mary Bassett, from the University of Zimbabwe, described how economic pressures have compelled the government to introduce school fees. Enrolment figures for girls now show signs of falling, because families are also short of money, and social attitudes still favour the education of boys. Yet education is key to women's economic independence and ability to negotiate safer sex. Confronting contradictions such as these needs commitment from policy makers at all levels.
Changing policy is essentialPeople who are promoting safer behaviours have a vital role to play in influencing both policy makers and public opinion, and in ensuring that those who lack access to health care and education are reached. Lessons learnt from a wide range of projects provide guidelines (on pages 2 and 3 of this issue) for planning and implementing outreach programmes.
This may be a difficult task - especially for people whose activities are disapproved of or illegal, such as injecting drug users or sex workers. But many organisations, including those that have contributed to this issue, find that, while it may not be easy, it is possible, and are convinced that changing policy is essential for the success of their work.
Prevention is also essential, because there is no cure for HIV. But a few drugs, like AZT, are helping some people with AIDS to live longer. These drugs are not generally available or affordable in developing countries. In principle, this situation is unjust. It is another example of how the unequal distribution of the world's resources limits most people's access to health care. Yet are these particular drugs worth having? AIDS Action reports on AZT and other anti-HIV drugs on pages 6 and 7.
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Another AIDS treatment has been in the press recently. 'Kemron', developed by the Kenyan Medical Research Institute, consists of low oral doses of human interferon (an anti-viral chemical produced by cells in the immune system). In 1990 the institute reported positive results from a small treatment trial without a control group. In June 1993, the results of a larger, longer, controlled trial sponsored by WHO in Uganda were published, showing that people with AIDS symptoms experienced no detectable benefits from treatment. These results should help to resolve the debates about Kemron. |
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New eye-catching design |
AIDS action Issue
21
1 Page 2
3
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Outreach Guideline |
Take prevention to the people
Experience from different outreach projects offers useful lessons for reaching those without access to health care or education.
Outreach aims to reduce the risk of HIV for people who are not reached by existing health or information services. HIV prevention activities are taken directly to people where they are, instead of through a school, clinic or workplace. Through face-to-face, relationships developed over a period of time - usually at least a year - outreach workers learn about people's needs and priorities. They can then find the best ways to develop appropriate information and materials, to improve skills and self-esteem, and to increase access to services. Successful projects have been developed by both non-government organisations and local government health and social services. A successful outreach programme:
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is an effective way to reach people who lack access to services, including sex workers and clients, injecting drug users, young women, men who have sex with men, and street children |
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is inexpensive and appropriate for poorly resourced settings |
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can strengthen the effectiveness of other activities (see diagram on page 3) |
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takes time - a few meetings or one-off events will achieve very little |
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does not involve putting pressure on people to change behaviour (to stop drug use or sex work, for example) |
Assess the situation
A project needs to have an overall picture of the situation before planning outreach activities. Assessment can be
carried out by staff, although it may be useful to contact sympathetic
researchers
for advice. Methods such as observation, group discussions and open-ended interviews help to find out:
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where people live, work and socialise |
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how people view themselves, their health (including HIV and STDs), and their needs |
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sexual behaviours and understanding of risks taken by themselves and partners |
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what people do to obtain money, food and shelter, as well as companionship or relaxation |
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relationships with others who may have influence: police, religious leaders, sex work clients or managers, drug dealers and sex partners |
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what people think of existing services, if and how they use them. |
Assessment should enable staff to
make links with existing organisations,
health workers, police and social workers,
and individuals who have a leadership
role in the community. It will help
in planning: how to promote safer behaviours;
when and where to meet
people; skills training courses; and
whether to set up new services and/or
to focus on existing ones.
Find the right workers
The effectiveness of outreach work depends
very much on who the workers
are, and on how their work is managed.
Issues like these are important:
Age, gender and sexuality Female
sex workers may, or may not, find it
easier to talk with male outreach
workers, rather than with other women.
Men who have occasional sex with
men may, or may not, relate well with
men who identify as gay. Young people
may feel more comfortable talking to
someone who is nearer their own age.
Social background, class and
ethnic origin The best workers are often recruited from the target group
itself, as this can help to generate
trust. However, sometimes these
workers may set themselves apart
from the community they come from.
Education and training Communication skills, life experience and approach can be more valuable than
formal education or qualifications.
How to do the work Depending on
the circumstances, it may be better to
do the work on foot or from a vehicle
(such as a mobile clinic); on the street
or in bars; in pairs or alone.
Start small
Making contacts and developing relationships with people takes time. In
one project two workers spent about
four months getting to know people
on the streets. After eight months,
they had trained 15 'peer communicators'
to distribute condoms and talk
with people about reducing risk.
Another project, in Morocco, developed
a good relationship with a sex
worker who visited the project clinic
several times. She invited other
women along to discuss AIDS, and
through 'friends of friends', information and condoms were distributed.
Involve people
Outreach projects need to be flexible
to adjust to changes in people's situations,
to take into account their
priorities, and to provide appropriate
services. Members of the group a project
is trying to reach are the only
people who can provide information
about these issues.
Women working in brothels in one
Indian city said that, while they already
knew about STDs and HIV, most felt
unable to insist on condom use. They
wanted the project to target safer sex
information at clients, but not in the
red light district itself. In response, the
project reached men by arranging
drama shows on the streets leading
into the district.
Increase self-esteem and skills
People whose behaviour is disapproved
of by wider society often have
low opinions of themselves and little
self-confidence about their ability
to change their situation. This is reinforced by the fact that often they
have had little or no education or training.
A project in Ghana provided
literacy classes at the request of street
youth. Some of the boys who were in
contact with the project worked as
porters, and they were helped to
become a formal organisation.
As well as supporting new types of
organisation, projects can link people
with existing social or political groups.
For example, gay organisations can provide
a supportive environment for
some men in same sex relationships
which can help them to sustain safer
sexual practices.
AIDS action Issue
21
2 Page 3 4
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Outreach Guideline |
Respond to wants and needs
People's immediate needs for food, shelter and medical treatment are often more important to them than preventing HIV. The things they do to survive, such as selling sex, may increase vulnerability to HIV. Project workers have to find ways to help people to meet their needs and overcome the problems that may prevent them from practising safer behaviours. Outreach work with boys who had dropped out of school in Zambia included setting up group discussions to learn about their priorities. As a result, the project designed a five-day 'crash course in survival skills', which included discussions on drug use, how to stay within the law, running a business, obtaining health care, and self-esteem exercises, as well as information about HIV and STDs.
Avoid making assumptions
Outreach workers need to have a non-judgemental approach - it is important that they do not have prejudices or make assumptions about people's ways of living and behaving. How people define themselves (their identities) may be different from what they actually do (behaviours). And prejudice stops people being open about behaviours which may be putting them at risk but which are stigmatised, such as anal sex, same sex activity, injecting drug use and exchanging sex for money or food. For example, street youth workers in a Tanzanian city found that sex between boys was common, although most people denied its existence. Confidentiality is very important too, to avoid increasing people's vulnerability to violence or repression, especially where their activities, such as prostitution, may be illegal.
Advocate for people's rights Outreach projects can influence attitudes of police or health workers and lobby for improvements in laws or policy that help people to change their behaviour. For example, an outreach project in one Indian city persuaded local police not to arrest sex workers who distribute condoms.
Based on a report by John Daly and Meurig Horton of a WHO workshop with participants from 17 outreach projects. Other outreach workers also shared their valuable experience with AIDS Action. Contact addresses are available from AHRTAG.Face-to-face outreach work increases impact
Outreach activities can include and strengthen the effectiveness of:
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providing materials to reduce risk, such as condoms or new needles and syringes |
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strategies that encourage people to change behaviour, such as leaflets and posters, counselling, group discussions and special events (e. g. drama or beauty contests) |
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improving access to health services, including STD clinics and antenatal care |
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setting up local support services, such as laundry facilities, credit unions and child care |
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follow-up with referrals to health and social services, or legal advice centres |
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promoting the development of self-help or advocacy organisations |
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liaising with local police and authorities,
for example, to improve
people's legal rights or housing. |
Activities that outreach can include and reinforce. They range from those that
reach many people, but have less influence on behaviour (e. g. mass media) to those that reach fewer people, but have more influence (e. g. counselling).
AIDS action Issue
21 3 Page 4
5
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HIV and injecting drug use |
Clean needles save lives
Injecting drug use is on the increase worldwide. In some places up to 80 per cent of people who inject are HIV-positive. AIDS Action reports on strategies to prevent HIV transmission.
Injection is one of the most stigmatised methods of taking drugs - injected drugs include cocaine, amphetamines, tranquilisers and opiates. Many of these drugs can also be taken orally (chewed or swallowed) or inhaled (smoked or snorted through the nostrils). Until recently it was thought that injecting drug use was limited to North America, Australia, New Zealand and Europe. Research shows that this is not true. Drug injecting is now reported in over eighty countries in Latin America, eastern Europe, the Middle East, western, central and southern Africa, south-west Asia (the Golden Crescent), and south-east Asia (the Golden Triangle). Numbers of injectors are rising to tens of thousands in cities on drug shipment routes and in drug producing areas. People who inject drugs are often very vulnerable to HIV through sharing needles and syringes. Unprotected sex with sexual partners also poses a high risk of transmission of the virus. For both these reasons it is essential to reach injecting drug users with programmes to prevent HIV transmission. While taking any kind of drug involves a risk to health, it is possible to inject drugs safely, stay relatively healthy and cause minimal harm to self and others. But many users are trapped in a vicious circle of poverty, violence, ill-health and drug dependence, with little access to social and medical services.
Crime and punishment?
Injecting drug use is common in poor urban areas with high unemployment, particularly among young people with low self-esteem and few opportunities for education or paid work. Given these factors, and the high cost of illegal drugs, drug use is often linked with crime and the exchange of sex for drugs by both women and men. Possessing using and selling injected drugs is against the law in most places. In many countries it is also illegal to buy, sell or possess needles and syringes without a prescription. Despite these restrictions, there is little or no evidence that penalising drug distribution or possession prevents injecting. In fact, these policies force prices up, and this may be a factor influencing people to shift from traditional forms of taking drugs, like opium smoking, to injecting which requires less drug for the same effect.
Unsafe drug use
Sharing needles and syringes (or the contents of syringes) which have traces of infected blood can transmit HIV. All three ways of injecting (into a muscle, vein or just beneath the skin) can be unsafe. Studies show that, although HIV cannot normally survive outside the body, it can survive for more than a week inside a closed syringe or a needle that has not been cleaned. Unclean equipment can also transmit hepatitis B and septicaemia (bacterial infection in the blood), and cause skin infections at the place of injection.
Many factors lead to sharing injecting equipment. New needles and syringes are usually very difficult to obtain. In Manipur, a state in northern India, there are over 30,000 people who inject drugs. A survey carried out by the Voluntary Health Association of India among 500 users found that over 70 per cent shared equipment(1). Most knew the risks, and said they would stop sharing if they had access to sterile equipment
Materials to clean equipment are also often in short supply, or people may not know how to sterilise it. There is sometimes pressure to share equipment with a sexual partner, friend or relative because sharing is seen as part of a close relationship.
Women are particularly vulnerable as they are often dependent on their male partners for supplies of drugs and injecting equipment, and therefore may have less choice about adopting safer behaviours. In prisons, where people continue to obtain drugs despite strict security, sharing is very common.
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Sterile equipment reduces risk of HIV
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AIDS action Issue
21
4 Page 5 6
| HIV and injecting drug use |
Effective prevention strategies
Effective prevention stresses 'harm reduction' or 'harm minimisation'. Harm reduction means strategies to encourage and enable people to adopt safer forms of drug use. Strategies include:
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face-to-face outreach programmes involving users or ex-users |
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access to sterile equipment, cleaning materials and information about safer drug use (and safer sex) |
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counselling, support groups, health care, and methadone (heroin substitute) treatment and maintenance programmes |
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care and support for users, partners and children living with HIV/AIDS |
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advocating policy changes, such as legalising provision and possession of needles and syringes |
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supporting users' self-help organisations and involving them in policy development and programme design. |
Research suggests that harm reduction
programmes and policies do not increase
drug use, and in fact may help
some people to stop using drugs altogether.
Programmes are effective in
slowing down the transmission of HIV.
In cities such as Glasgow in Scotland
and Sydney in Australia, the number of
HIV-positive drug users has remained
below 5 per cent. Key factors in these
success stories include developing out-reach
programmes that involve users
themselves and providing new injecting
equipment and cleaning materials(2).
People who use drugs are showing
that, given the means to prevent HIV
infection, and access to education and
health care, they have the ability to
change unsafe injecting practices. Policy
makers and politicians need to aim
to remove obstacles that contribute to
a worsening HIV epidemic among
people using drugs, their sexual partners
and children.
Barbara James, Institute for the
Study of Drug Dependence, I
Hatton Place, London EC1 8ND, UK.
1. KABP study related to AIDS in Manipur
State and intervention strategies, VHAI/MVHA, 1992.
2. Characteristics of prevented HIV epidemics.
Paper WS-C1 5-6, Des Jarlais et al,
International AIDS Conference 1993.
Source: HIV prevention charter for
injecting drug users, Third international
conference on the reduction of
drug-related harm, 1992.
Contact: International Drug Users
Network, do Deutsch AIDS Hilfe,
Diffenbachstrasse 33, W-1000 Berlin 61,
Germany.
Stopping injecting - using other methods
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Increasing access to voluntary treatment programmes and support services |
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Suggesting alternatives to injecting, such as smoking, swallowing or inhaling |
Using new needles and syringes, and disposing of them safely
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Advising people not to share, borrow or lend needles and syringes, or other materials used to prepare drugs |
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Setting up needle exchange services (where used equipment can be exchanged for new) run by outreach projects, pharmacists or doctors |
Cleaning used needles and syringes
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If equipment has to be used again, it can be cleaned to make re-use safer. |
How to clean used equipment
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If bleach is available |
1 a Immediately after being used, the needle and syringe should be washed thoroughly with cold water to remove all visible blood before it clots.
1 b Empty the syringe into a sink, drain or different container. Repeat the process.
2 a Fill the syringe with undiluted household bleach drawn up through the needle from a cup or other container. Leave for at least half a minute.
2 b Empty the syringe as above. Repeat the process.
3 a To rinse, fill the syringe with cold water.
3 b Empty the syringe as above. Do this at least twice.
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If bleach is not available, use cold soapy water or water mixed with some detergent, and rinse at least twice with clean water. If bleach, detergent or soap is not available, flush out with clean water three or four times, shaking vigorously. |
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If the syringe is glass, sterilise it and the needle by placing it in cold water, bringing the water to the boil and boiling for 15 minutes. Most plastic syringes will not withstand boiling. |
AIDS action Issue
21
5 Page 6 7
| Clinical update |
Anti-HIV drugs: no magic bullets
AIDS Action describes the benefits and limitations of anti-HIV drugs and explains why AZT may not be worth the cost
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The most prescribed drug for people with AIDS-related illnesses in industrialised countries is AZT (zidovudine), although other anti-HIV drugs are becoming more widely used. AZT was the first drug approved for treating people with AIDS, in the USA in 1987. It is manufactured by Burroughs Wellcome, under the brand name of Retrovir, and is now licensed for use in 150 countries worldwide. |
How do anti HIV drugs work?
AZT and other anti-HIV drugs (such as
ddl and ddC) do not cure HIV infection,
but only slow the worsening of
disease in most people with AIDS-related
illnesses. The drugs are called
'nucleoside analogues', because they
have a similar (or analogous) structure
to chemicals called 'nucleosides', which
are part of DNA.
DNA is the genetic building block
material found in all human cells, and is
essential for cell growth and reproduction.
During the process of reproducing itself, HIV forces human DNA to
produce more virus. Nucleoside analogue drugs interfere with, and slow
down, this process.
Value for people with AIDS
AZT can benefit people with AIDS.
The first AZT trial in 1986 involved
282 people with AIDS symptoms.
After 24 weeks the trial was stopped
for ethical reasons, because the results
showed that AZT was helping people
to live longer. One person had died in
the group receiving AZT, compared
with 19 people in the control group
who were taking a placebo (a harmless
inactive substitute for AZT).
Although this has been the only controlled
study, other types of trials in
the USA and Europe found that AZT
improves survival in people with AIDS,
and that new infections are less likely
to develop in the first year of treatment.
Increases in CD4 cell levels* and
weight gains have been reported. AZT
is also considered to be an effective
treatment for dementia caused by HIV.
Very few women with AIDS have
been involved in the trials, so there is
little data on the drug's specific effects
for them. One small study explored
the effect of AZT when taken by
women with AIDS during pregnancy.
AZT appears to have no influence on
pregnancy outcome, nor to affect the infant.
However it is not known whether
AZT can improve the health of pregnant
women with AIDS. A trial to test
whether AZT affects mother-to-child
transmission is underway in the USA.
After studies showing that most
children with AIDS can tolerate the
drug, the USA government approved
the use of low doses of AZT for children
aged over three months.
Problems with AZT
Despite its widespread prescription
for people with AIDS in industrialised
countries, AZT is not a miracle drug.
Some people choose not to take it, or
combine it with other types of treatment
such as herbal medicine, and a
healthier lifestyle.
Limited benefits AZT does not significantly
reduce the amount of HIV in
the body. While patients taking AZT
may show improvements at first, benefits
often cease after a few months or
years of treatment. CD4 cell counts
often return to pre-treatment levels. It
is thought that development of viral resistance
may be a reason for decreasing
effectiveness of AZT.
Side effects While most people can
take AZT without any serious side effects,
the drug can cause headaches,
muscle aches and nausea. For most,
these problems cease after a few weeks.
AZT can inhibit human cell reproduction.
For example, production of red
blood cells can be reduced, resulting in anaemia. Muscle damage with pain,
wasting and weakness can occur after
some months or years of taking AZT.
The current dosage is usually 500-600mg per day. Higher dosages tend
to produce more side effects. People
who are very ill are also more likely to
experience more serious side effects.
No symptoms, no proven benefits
It is not clear that AZT benefits asymptomatic people (those who are HIV-positive
but have no opportunistic
infections). In the late 1980s, a controlled
study involving people with
no symptoms reported that AZT
appeared to prevent the development
of serious opportunistic infections.
However, this trial was stopped after a
year, and provided no information
about longer term effects.
The results of the Concorde study,
the largest and longest trial involving symptom-free people, were published
in mid-1993. After three years, survival
rates in both the group taking AZT,
and in the control group (who did not
take AZT unless they developed AIDS
symptoms), were very similar. Equivalent
numbers also developed serious
opportunistic infections or died.
The results of this study showed
that in healthy HIV-positive people,
AZT does not increase the time before
AIDS-related symptoms develop.
In addition, HIV-positive people who
take AZT while still healthy do not live
for any longer than those who start taking
AZT after they develop AIDS symptoms.
Of the people taking AZT from
the beginning of the trial, 9 per cent
developed anaemia.
* HIV attacks and destroys a certain type of
white blood cell in the human immune system
called a T4 or T-helper cell. HIV targets these
cells because it is able to attach itself to a
particular molecule called CD4 on the cell
surface. The impact of HIV infection on the
immune system can be measured by recording
the level of these cells using a blood test called
a CD4 cell or T cell count A low count can
indicate that a person has symptomatic HIV
infection or AIDS. CD4 cell counts are used to
monitor the effects of anti-HIV drugs.
AIDS action Issue
21
6 Page 7 8
| Clinical update |
Barriers to wider use for people with AIDS
Cost AZT is very expensive. A world-wide survey in 1991 found that the estimated annual cost of AZT ranges from US$2,000 to US$4,000 per patient. Current prices still exclude people unable to afford health care in richer countries, as well as most people in developing countries. However, AZT is becoming a little more widely available. Until very recently, Wellcome was the only company producing AZT. Now a leading pharmaceutical company in India has started manufacturing zidovudine under the brand name Zidovir-100, which is sold for about a third of the cost of Wellcome's Retrovir(2). There are reports that companies in Brazil and Thailand will also be making zidovudine.
Technology Although AZT can be prescribed on the basis of AIDS symptoms alone, the effect of the drug should be monitored using CD4 cell counts. Few health workers in developing countries have access to the laboratory facilities required for these tests. Where available, the test costs from US$20 in Thailand to US$150 in the USA. Blood tests are also needed to find out whether AZT is causing side effects such as anaemia.
Training AZT should only be taken when prescribed by a health worker who has the necessary training. In many countries where AZT is used, doctors must attend a special training course before they are permitted to prescribe it.
New drugs on trial
Two other nucleoside analogues are being more widely prescribed for people with AIDS in some industrialised countries. Their cost is similar to that of AZT. The drug ddl (didanosine), manufactured by Bristol Meyers-Squibb, is now approved in over twenty countries, including Argentina, Brazil, Chile, Colombia, Mexico, Peru, South Africa and Thailand. The drug works in a similar way to AZT, but has been found to be less effective as a first-line treatment. Neuropathy (nerve damage in the hands and feet) and diarrhoea are common. More seriously, ddl can sometimes cause inflammation of the pancreas which can be fatal. Another drug, ddC (zalcitabine) is made by Hoffman-LaRoche and has been approved in several countries. It is not as effective as AZT. Side effects include neuropathy, nausea and mouth sores. Prescribing combinations of AZT, with either ddC or ddl, could benefit people with AIDS. Trials evaluating the relative safety and effectiveness of combination therapies are still continuing. Other new drugs are also in development.
Summary
AZT has limited value for people with AIDS. It should be recommended and used with caution. The Concorde study suggests that AZT does not seem to benefit healthy HIV-positive people.* It is also not yet clear whether other drugs being developed will be any more effective.
While increased availability could benefit some people with AIDS, there remain the problems of quality control, and limited access to required technologies and health worker training. Anecdotal reports indicate that more people in developing countries are obtaining and taking AZT. Many are not aware that taking the drug without proper medical supervision can do more harm than good.
Appropriate prophylaxis, early diagnosis and treatment for opportunistic infections, with supportive health care and 'positive living', are still the most important ways to improve quality of life for people with HIV or AIDS.
Nancy Solomon, AIDS Treatment News International, PO Box 411256, San Francisco, CA 94141, USA.
1. Letters, Lancet, vol 341: April 3, 1993.
2. Bhupesh Mangla, Lancet, vol 341, Feb 20, 1993.
* Further references available from AHRTAG. Results of another study have just been published in the New England Journal of Medicine. AIDS Action will report on this and other drug trials in future issues.
AZT: limited usefulness
For people with AIDS symptoms
AZT can increase survival time
it can mean fewer infections in the first few months or year of treatment
but
improvements often cease in the longer term
there are possible side effects
For HIV-positive people without symptoms
no clear benefits have been proved
Best strategies (plus or minus anti-HIV drugs)
prevent symptoms developing/prophylaxis
treat opportunistic illnesses: TB, diarrhoea, skin infections
provide supportive care
promote positive living and healthy lifestyle
AIDS action Issue
21
7 Page 8
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Letters / Resources |
Letter
'Positive and Living' in Zambia
In issue 20, we were encouraged to read about people living with HIV or AIDS taking control over their own lives. We belong to a support group in Lusaka called The PALS (Positive and Living Squad).
At first we met to discuss our hopes and fears, and strengthen each other emotionally. But we realised that this was not enough. Members wanted to do something about their human rights, and about AIDS. We set up an education programme - training HIV-positive members to run AIDS workshops, particularly in workplaces. PALS also liaises closely with AIDS support organisations, helping with their outreach programmes, and meeting their clients.
Some members are also involved in income-generating activities - usually the ones who decide not be trained as educators. But we find that many members find it difficult to set up their own businesses, even with loans and training. They are used to being paid employees, and find it hard to work without a boss!
The biggest difficulty for a self-help group like The PALS is this. Of the seven people who were very active in 1992, three have died and two are very ill. As a result it is hard to keep on working - morale drops and anxiety levels increase.
Despite these issues, The PALS is demonstrating every day what the power of positive living can achieve. You cannot talk about AIDS prevention and care, and empowering people with HIV/AIDS without promoting self-help groups. Yes, we have problems, but these are not all because of our HIV status. Most of them are just due to human nature. So, to everyone trying to set up or support the work of self-help groups, we wish you luck and strength - and 'more grease to your elbow'!
In solidarity, Winstone Zulu, The PALS, PO Box 37559, Lusaka, Zambia.
Resources
Praise for 'Women and HIV/AIDS'!
Women and HIV/AIDS: an international resource book, by Marge Berer with Sunanda Ray. Pandora Press/HarperCollins, pp383, ISBN 0-04-440-876-5.
This new book from AHRTAG and Pandora Press covers practical issues concerning women, their reproductive health, HIV/STDs and sexual relationships, as well as including detailed resource and contact lists.
'The authors have put together a powerful mix of global statistics, biological fact and hypothesis, sexual politics and personal testimony.' The Lancet, June 5, 1993
Readers in developing countries:
£7.50 per copy (surface mail) or £9.00 per copy (airmail), payment by international money order to TALC. PO Box 49, St Albans, Herts AL1 4AX, UK. Contact TALC to order multiple copies.
Other readers: £14.99 per copy from bookshops, HarperCollins Mail Order, Westerhill Rd, Bishopbriggs, Glasgow G64 2QT, UK, or HarperCollins distributors elsewhere.
For information about French and Spanish editions, please contact AHRTAG.
Resource Pack on Sexual Health and AIDS Prevention for Socially Apart Youth
From SOS Crianca and AHRTAG, this 64-page publication provides resources and contacts for networking, planning activities and materials.
Groups working with youth in developing countries: One copy free from SOS Crianca, CP 4884, Ag. Central, CEP 20 100, RJ, Brazil, or from AHRTAG.
Other groups: To order, send £5/$10.00 to AHRTAG.
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Managing editor Kathy Attawell |
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