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When the epidemic first started it affected mainly homosexual men and a majority seemed to be professional well educated people accustomed to planning their lives and dealing effectively with bureaucracies. Later, small numbers of heterosexual men and women had become infected, but the majority were native to the country in which they lived. In more recent years, the experts became conscious of a major shift in the HIV/Aids population towards socially and economically disadvantaged groups who were less well educated and poor. Some were drug users, some were prostitutes and an increasing number were not native to the country in which they lived and did not speak its language adequately. Many were illegal immigrants.
The experience that had grown up in dealing with the earlier clients and the structures designed to help them, such as Buddies and self-help groups were not always thought to be appropriate or suitable to dealing with these culturally highly differentiated new need groups which lack priority on the political agenda.
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There is a need for more systematic knowledge about the different under-represented groups, their needs and their cultural distinctiveness. For instance it is necessary to learn about and be patient with characteristics that jar with the local culture, such as attitudes to time, punctuality and reliability in carrying out instructions.
Cultural differences lead to different sex practices. Young people in one group which requires virginity in girls, will practice anal sex but lack the information about special anal condoms
Community based organizations have been found useful in dealing with linguistic needs and culturally sensitive issues. Such an approach requires a re-allocation of existing resources
In general, our experts felt that there was much to be gained in finding ways of empowering under-represented groups to discuss and chose ways and means of prevention and amelioration of the effects of the disease. Such empowerment can lead to the establishment of a special interest group like the International Organization of Turkish Homosexuals (IPOTH). It can also lead to adaptations of the Buddy system and Self-help groups that adjust to specific local customs and practices.
The use of ‘facilitators’ has been successful in work with special need groups like prostitutes and transsexual workers. Facilitators have to be carefully selected and trained and usually come from the group in which they are expected to facilitate new ideas and practices. For instance, prostitutes have been trained to influence their colleagues to practice safe sex.
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