Final Program and Oral Abstracts [International Conference on AIDS (8th: 1992: Amsterdam, Netherlands)]

THURSDAY, 23 JULY 1992

ThC 1556-ThC 1561

ThC 1556 STDs among HIV seropositive
C 1 6 patients of a referral hospital in India and their role
in transmission of HIV.
Jacob Mary Dept. of Dermatologyt Christian Medical
lege & spital, Vellore, IR A.
AIM: To study the pattern and incidence of STDs in HIV seropositive
individuals and their role as risk factors in the transmission of HIV.
METDIDS: All new patients attending the STD clinic during the period
OCT '86 to JAN '92 were included. Demographic data and sexual history
were recorded. The diagnosis of various STDs was made by clinical and
relevant lab tests. All patients were screened for HIV antibody by
nISA using a commercial kit (Wellcozyme). All reactive samples were
confirmed by Western Blot (Dupont). For each HIV positive patient,
two age and sex matched control patients seen during the same period
were randomly selected for comparison. Percentages were computed and
the differences tested for statistical significance using z test and
X test.
RESa TS: 113 HIV positive and 226 HIV negative controls were studied.
All HIV positive males had multiple contacts with prostitutes, 82%
were heterosexual, 18% bisexual. 34 of HIV positive women were
prostitutes, 66% had no extramarital contact. There were significantdifferences between HIV positive and control patients in past STD
(75%, 49%), multiple STD (25% 5%), GUD (72%, 25%), Warts (13%, 2%)
and LGV (12%, 0.4%). Among current STD syphilis was the commonest in
both groups while there was no difference in genital herpes or warts.
The marital concordance rate of HIV was 64%.
CONCLUSIONS; The major risk factor in transmission of HIV was heterosexual promiscuity and prostitution. Past GUD and Warts were additional risk factors. The risk of male to female transmission was high.
Jacob Mary, Dept. of Dermatology, Christian Medical
College & Ebspital, Vellore, India.
Telephone No.22102 Extn 2054 FAX No. 416-25035.
ThC 1558 FACTORS ASSOCIATED WITH ACQUIRING
C 1 8 SEXUALLY TRANSMITTED DISEASES IN THE U.S. ARMY Rundell James R.;
Temoshok, L.**; Blake, S.M.**; Sharp, E.S.**; Ledsky, R.** *Div. of Retrovirology, Walter
Reed Army Institute of Research, Wash DC; **Henry M. Jackson Foundation for the
Advancement of Military Medicine, Rockville, MD, USA
Objective. To identify factors associated with occurrence of STDs in an ethnically and geographically diverse sexually active
population, as part of a large-scale survey of HIV risk-relevant behaviors.
Methods. The U.S. Army-Wide HIV/AIDS Survey was administered anonymously in a two-stage random probability design
to active duty Army personnel at 17 installations in the U.S. and Europe. Surveys collected (N = 18,125) represented
74.2% of the assigned unit strength, and 95% of those present for duty at the time of administration. Analyses reported here
were conducted on the 2,549 respondents who reported at least one STD during the past 2 years (14.5%) and the 15,171
who did not.
Results. Preliminary analyses on unweighted data indicated the likelihood of having a STD was greater (p<.0001) in
younger, black, female, unmarried, and enlisted (vs. officer) respondents. Factors significantly associated (p<.0001) with
presence vs. absence of STD were mean number (past year) of: "total" sexual partners (6.7/3.6), "regular" sexual partners
(2.2/1.0), "one-night stands' (2.2/1.4), prostitutes (0.9/0.3), "anonymous" partners (0.7/0.3), new sexual partners (3.7/1.6),
sexual partners in U.S. cities or countries with high AIDS prevalence (respectively, 2.44/1.0 and 0.73/0.29), numbers of
drugs used (0.9/0.4), and condoms purchased or received (23.9/17.6). Mean number of lifetime sexual partners was also
higher in the STD group (38.6/26.2). While respondents reporting a STD used condoms slightly more often with steady
sexual partners (potentially to prevent pregnancy rather than HIV or STD transmission), the frequency of condom usewith
non-steady sexual partners did not differ between the two groups. The STD group was more likely to endorse being very
afraid of getting HIV/AIDS (41%/29%). Drug use (not intravenous) was more frequent in the STD group during the past
month (12%/4%), past year (23%/11%), and lifetime (72%/57%). Women were more likely than men (p<.0001) to report
each STD asked about except pubic lice and gonorrhea.
Conclusions. Provisional results suggest that intensified STD prevention interventions should focus on women, ethnic
minorities, and the unmarried. Recommending increased condom use is not enough; intervention messages should
emphasize reducing numbers of casual or new sexual partners.
Rundell, J.R., Division of Retrovirology, Walter Reed Army Institute of Research, 1 Taft Court,
Suite 250, Rockville, MD, 20850, USA Tel: [phone]; FAX: [phone].
ThC 1560 HIV-4NFECTED ADOLESCENTS: RISK BEHAVIORS AND CUNICAL STATUS
OF A NEW YORK CITY COHORT Futterman. Donna, Cohn J, Monte D,
Shaffer N*. Montefiore Medical Center, Bronx, New York.
*CDC, Atlanta, Georgia, USA.
OBJECTIVE To determine risk behaviors and clinical status of HIV+ adolescents
followed at a New York City clinic for HIV+ and high risk youth (age 13-21y).
METHODS At intake and during periodic followup, HIV+ adolescents (N-60) assessed
via clinical interview and examination regarding sexual and drug use behavior as
well as HIV clinical status. Adolescents were referred to the program from medical
and community-based agencies, 75% known HIV+ at entry.
RESULTS Mean age at HIV+ for females (N-21) was 17.3y, for males (N-39) was 18.3y.
Of patients, 85% were African American or Hispanic. At entry, 35% lived with family
members, 30% were homeless and 18% were in institutional settings.
Sexual and drug history Among females: mean age at first intercourse was 14.2y
(9-19y), 35% had <10 lifetime sex partners, 45% >50. Among males, age first
intercourse was 13.6y (10-18y), 20% reported <10 sex partners and 36% >50. Sexual
abuse reported by 52% of females and 26% of males. Male-male sex reported by 79%,
13% of males denied M-M sex but had clinical evidence of anal intercourse. By
contrast, sexual orientation reported by males was: gay 49%, bisexual 28% and
straight 23%. Among females, 86% reported M-F sex as only route of exposure, but
only 33% knew the specific risk behavior of sex partners. Crack/cocaine use reported
by 66% of females of whom 86% engaged in survival sex (sex for money, drugs, food,
shelter) and crack use by 51% of males of whom 80% had survival sex. Ten percent of
patients were IDU. After knowing HIV+ status, only 10% of females and 26% of males
notified all sex partners and only 23% males and no females always used condoms.
Clinical status Patients followed for median of 11.5 months (1-46). Almost half,
46% had immune dysfunction at presentation (CD, <500/mm3) and were eligible for AZT.
After testing HIV+, 38% of females and 28% of males developed a new STD.
CONCLUSIONS With rates of HIV infection among adolescents continuing to increase
in the US, comprehensive clinical, risk reduction and outreach programs are needed
to identify and treat HIV-infected youth and to develop effective strategies to
reduce ongoing risk behaviors and transmission.
Donna Futterman, MD Montefiore Medical Center,
111 East 210 Street, NW674 Bronx, NY 10467 USA
[phone] Fax [phone]

Th 1 7 SEXUAL BERAVIOUR AND SEXUALLY
ThC 1557 TRANSMITTED DISEASE IN KEMYA: OPPORTUNITIES FOR INTERVENTION
Bradlev. Janet El, Muia, E2, Ngugi, EN2, Njeru, EK2, Eldridge, G3,
Olenja, j2, Wotton, K3, Ronald, AR', Plummer, FA23, Moses, S2,3
'International Projects Assistance Services and 2University of
Nairobi, Nairobi, Kenya; 3University of Manitoba, Winnipeg, Canada
OBJECTIVEs To identify appropriate entry points for intervening to reduce the
transmission of STDs in Kenya, including HIV infection, by examining behaviour which
puts individuals at risk.
METHODSB Questionnaires were administered by trained interviewers to 382 patients
with STDs attending 3 municipal health centres in the city of Nairobi and 4 health
centres and a Special Treatment Clinic in the town of Nakuru, as well as 380
controls attending the same clinics with non-STD related complaints, primarily
injuries. Patients were interviewed after being examined by a clinical officer.
RESULTS: 79.1% of married male STD patients and 16.3% of married male controls
reported having had extramarital sex at least once in the previous 3 months, versus
7.1% of married female STD patients and 3.9% of married female controls (P < 0.001).
61.4% of unmarried male STD patients and 23.7% of unmarried male controls reported
having had 2 or more sex partners in the previous 3 months, versus 43.0% of
unmarried female STD patients and 18.4% of unmarried female controls (P - NS). 36.0%
of male STD patients and 11.1% of male controls reported having paid for sex at
least once in the previous 3 months, and there was no significant difference between
married and unmarried men. 77.8% of married women versus 7.5% of married men felt
that they had acquired their STD from their spouse (P < 0.001). 21.2 % of men felt
that they had acquired their STD from a prostitute and 30.2% from a casual "pickup". Only 13.7% of men and 11.5% of women overall reported having used a condom
during their most recent sex contact with somebody other than their spouse.
CONCLUSIONS Extramarital sex occurs commonly among men, and multiple sex partners
are common among men and unmarried women. Condom use is rare. Most men with STDs
have acquired them from prostitutes or casual sex partners, while most married women
with STDs have acquired them from their husbands. If the demand for, or supply of
prostitution could be reduced, or if condom use among men during casual or
commercial sexual contacts could be increased, then a large proportion of STD
transmission to men could be reduced, with likely a corresponding reduction in
subsequent transmission to their wives and other sexual contacts.
Janet E. Bradley, International Projects Assistance Services
P.O. Box 39814, Nairobi, Kenya
Telephone and fax: [phone]
ThC 1559 OTHER SEXALLY TRANSIT DESASS A SEX
ThC 155 WORKERS AND TECHNICAL STUDENTS IN NORHEAST THAILAND.
Unqichusak. Kurnuant; Rehle,T -Ill iesukwat, C 8 aaol, PItt; Tharaphornpilas,PI;
Erinksan, -PIT traprapasiriTI. Iivision of Epdeioloy, HOPH Thailand; II t TZ, lermany;
Itt Department of CDC P, OP, Thailand; tt1t Harvard School of Public Health, USA.
Objectives: To study the epidemiology and social behavior of female commercial sex
workers (CSWs) and male technical school students in a major Northeastern city,
in order to better plan HIV intervention programs.
Methods: As a result of cooperation and trust between brothel owners and pulbic
health officials, about 220 CSWs in all 24 brothels in the city were persuaded to
make weekly visits to the public STD clinic between November 1990 and September
1991. Male students of average age 18 years in a technical school (n=113B)
completed self-administered anonymous questionaires, and underwent anonymous
testing for HIV and syphilis.
Results: Although the population of CSWs remained steady between 20( and 230,
turnover was 25%-35. every 3 months. HIV testing in 3/91, 6/91, and 9/91 found
rates increasing form 7/., to 13%,to 15%, with corresponding quartery seroincidence
of 1.5%(2/131),2.4%(3/125), and 2.9.(4/138), respectively. Median gonorrhea
incidence was 9 per person-weeks of followup (range 6-12). Among the men,
42%(482/1138) reported ever having sex with CSWs, half of whom began only after
entering the school. Sex with women not CSWs was reported, too. HIV infection was
found in O.e/.(9/1138) of the men, and VDRL reactivity with TPHA confirmation was
0.2% (2/1138). Eighty percentages of students who went to the brothel drank
alcohol and only 60% used condom all the time.
Conclusions: The high HIV incidence and prevalence measured in CSWs stimulated
local and national authorities to speed up targeted control programs for this
particularly high-risk group, such as"l0C% Condom Only " programs to enforce
condom usage by customers. The 40% of male technical school students who do not
use condoms when patronizing CSWs should be a prime target for research and
prevention programs to modify this high-risk behavior.
Dr. Kbunuan Ungchusak, Division of Epidemiology,
Ministry of Ftblic Health, Bangkok 10200, Thailand.
Tel: [phone] FAX [phone]
ThC 1561 HETEROSEXUALLY TRANSMITTED HIV AMONG YOUNG THAI MALES. Theetranont
C.*; Suprasert, S.*; Romyen S.**; Tulvatana, S.**; Nelson, K.***; Celentano, D.***;
Wright, N.****, *Chiang Mai University, Chiang Mai, Thaland; **Royal Thai Army & Air
Force; ***Johns Hopkins University, Baltimore, MD,; ****RWJ Medical School, NJ, USA.
Objective: The spread of HIV Infection in Thailand is reaching epidemic proportions, most notably among
residents of northern provinces. Serosurveys have shown prostitutes and drug users to have high rates,
although few studies have empirically documented risk factors. We assessed the risk factors for prevalent
HIV among a cohort of Thai men, focusing on sexual behavior, drug use, sociodemographic background,
and history of sexually transmitted diseases.
Methods: The baseline assessment (n=1236) of a longitudinal cohort study of young (mean age = 21
years) males in the northern provinces (Chiang Mal) in May, 1991 included an interview on HIV risks
conducted by trained medical students and serology for HIV and syphilis. Risk factors for prevalent HIV
were assessed using multiple logistic regression analysis.
Results: Serological results showed that 10.9% of recruits had antibody to HIV. Behavioral risk factors for
prevalent HIV identified as independent risks included: education limited to primary school (OR=1.8, 95%
CI=1.1,2.8), 20+ lifetime sexual partners (OR=2.35, 95% CI=1.1,5.05), lifetime STD history (OR=2.1, 95%
CI=1.35,3.00), monthly or more frequent prostitute use (OR=2.33, 95% CI=1.2,4.5), and most recent
prostitute in Chiang Mai. Drug injection was rare (< 10%) and not related to HIV status. Condom use with
prostitutes did not afford significant protection from HIV in the manner used by these young men despite
their use 60% of the time with last prostitute contact.
Conclusions: Sex with female prostitutes appears to be the principal risk factor for the heterosexual
transmission of HIV among youth in Thailand. Rates of HIV are rapidly Increasing, and public health
countermeasures are urgently required to decrease this epidemic. Consistent condom use would appear to
offer the greatest (and perhaps sole) protection for the acquisition of HIV in this high risk setting.
Choti Theetranont, MD, Office of the President, Chiang Mai
University, Chiang Mai 50002, Thailand
Phone [phone] Fax [phone]

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