Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Track C: Epidemiology & Public Health

Mo.C.1408 - Mo.C.1413

Mo.C. 1408
HEPATITIS B SEROPREVALENCE AMONG AN INNER-CITY COHORT OF HIVINFECTED AND -UNINFECTED WOMEN
ustman, I.E.-,. Augenbraun. M.2, Kalish, L.3, Burns, D.4, Sha, B.E.5, Brosgart, C.6, Kovacs, A.7.
Bronx-Lebanon Hosp. SUNYBrookyvn2, New England Research Inst.3, NIH4, Rush-Presb.St. Luke's Med. Ct:, Alia Bites Med. Ctr.6. LAC+USC 7.
Objective: To determine the seroprevalence of, and risk factors for hepatitis B virus (HBV)
among innercity HIV infected and -uninfected women.
Methods: From O)ctober I, 1994 to May I, 1995 176 I women were enrolled in the
Women's Interagency HIV study (WIHS), a prospective natural history study of HIV+ and
high-risk HIV- women at six sites in the United States. Hepatitis B surface antigen (HBsAg),
surface antibody (HBsAb) and core antibody (HBcAb) were assayed at baseline. HBV infection was defined as having erione or more positive serologic tests.
Results: At least one HBV serologic test result and a confirmed HIV status were available
for I 629 women, 8 I% of whom were HIV-infected. Prevalence in the HIV+/HIV- cohorts
were: HBsAg 3.4%/I% (n= 1626, p=.02); HBsAb 29%/20% (n=785, p=.03); and HBcAb
46%/27% (n= 1335, p<.00 I). Geographic variation in all three seroprevalence rates exists;
e.g., the HBcAb prevalence ranged from 27% in Los Angeles to 57% in the Bronx.
Data on all three HBV serologic tests were available for the 764 women from the Brooklyn,
Los Angeles and San Francisco sites.This subgroup's prevalence rates for each of the three
tests are almost identical to the whole cohort's. HBV infection was strongly associated with
any injection drug use (IDU) since 1985 (77% vs. 33%, p<.001). Among non-IDU women.
history of crack, cocaine or heroin use (CCHU) was associated with HBV infection (44% vs.
23%). After assessing covanates simultaneously by logistic regression, independent predictors
for HBV infection were: IDU, CCHU, HIV infection, geographic site of enrollment and history of syphilis (p <_.003 for all variables). Age, ethnicity, needle-sharing, condom use, history
of other sexually transmitted diseases and anal intercourse were not predictive of HBV
infection.
Conclusion: In this cohort, intravenous drug use is the strongest predictor for HBV infection. HIV status, CCHU and a history of syphilis were also predictors for HBV infection.
Significant geographic variation in the seroprevalence of HBV exists, even after accounting
for drug use.
J.E.Justman, M.D., Bronx-Lebanon Hospital Center; 8th floor, 1650 Grand Concourse, Bronx
NY 10457 Tel: 7 18-5 I 8-5727; Fax: [phone]; email: [email protected]
Mo.C. 1409
THE EPIDEMIOLOGY OF HIV IN THE RURAL SOUTH
Schable, Barbara, Diaz,T Ward. jW and Supplement to HIV and AIDS Surveillance Rural
Project Group. Centers for Disease Control and Prevention, Atlanta, GA, USA
Background: AIDS cases in non-urban areas of the southern United States have recently
been increasing more rapidly than in other regions; however information on the HIV epidemic in these areas is sparse.
Methods:We interviewed persons reported with HIV/AIDS to health departments in 5
rural areas in 4 southern states. Persons were asked about migration and risk behaviours
practiced between their first negative HIV test (or since 1980 for those without a negative
test) and their first positive HIV test.
Results: As of I 2/31/95, 363 persons were interviewed; 33% were women, 66% were black,
and 40% had < 12 years of education. By residence, 2 13 (59%) had lived outside the rural
area, 137 (38%) had never lived elsewhere, and 13 (4%) had been migrant workers. Men
who had lived outside (n t145) were as likely as men who had never lived elsewhere
(n89) to haive had unprotected sex with men (48% vs. 5 1%) and use crack (32% vs. 28%)
but were more likely (p<0.05) to have injected drugs (14% vs. 7%).Women who had lived
outside (n-68) were more likely than women who had never lived elsewhere (n-48) to
receive money for sex (31 % vs. I I%), inect drugs (25% vs. 4%), and use crack (50% vs.
35%). Among the 2 13 persons who had lived outside, 72% report practicing risky behavours in the rural area, 49% believe they were infected in areas with a population _500,000,
59% were diagnosed in another county or state, and 9 1% receive HIV care locally. Of the
mien and women who never lived elsewhere, 25% and 65%, respectively, were exposed to
HIV through heterosexual contact; 18% and 60%, respectively, of men or women who had
lived outside also reported heterosexual risks.
Conclusion: Persons with HIV in the rural south include many persons who were likely
infected in large metropolitan areas, practice risky behaviours locally, and place a greater
demand on local HIV services than would be expected based on locally diagnosed cases.
Persons who never lived outside the rural area are often infected through heterosexual
contact and their high rate of crack use is likely associated with acquiring HIV.
Barbara Schable, Centers for Disease Control & Prevention, I 600 Clifton Road, MS-E-47,
Atlanta, GA 30333, USA. tel:[phone], Fax: [phone]
Mo.C. 14 10
CLINICAL EPIDEMIOLOGY OF HIV DISEASE IN RURAL ALABAMA
Fawal, H1 *, Beltrami JC, Holmberg S**, DiazT**, DiClemente R, Holmes R***, Cheeks
J***,Vermund SH*. *University ofAL at Birmingham; **CDC Atlanta, GA; -*0AL Dept. of
Public Health, Montgomery AL.
Atabama (AL) is experiencing an HIV epidemic of moderate magnitude (1994 AIDS incidence I 3.7/100,000). However. a rising female-to-male ratio (0.20 in 1994), expansion of
the geographic scope of the epidemic within the state, and substantial migration among
infected persons suggest expanding sexual transmission of HIV
Objectives: I) To chaiacterize the sociodemographic, behavioral, and migratory characteristics of HIV-infected persons in AL: 2) To estimate the relative frequency of in-state versus
out-of-state acquisition of infection; and 3) To begin to identify social networks of HIV transmission sri refine prevention progrims.
Methods: As of( mrenury I I 1996, 84 HIV-infected persons living in rural or small town settings free six AL clinics hive been interviewed in depth as to their behaviors, geographic
roots, mud their ittitudes rewinds high risk practices An additional 00~ intervews are not
yet processed.
Results: Sisty-four (76%) nine med 20 (24%) women were interviewed. An estimated 40%/
(ne-34) of the infections were acquiied out-of-stite, med the highest isk behavior-was
reported while in HIV-ensdenic crban minis such is Atlanta or Houston. At the same time

high risk behavior is also practiced locally and male-to-male sexual transmission is a comrnon source of HIV acquisition in rural AL. Of the 54 men who have sex with men (MSM),
52 (96%) self-identify as gay or bisexual. Of the 20 women, 8 (40%) were aware of their
partners behavioral risks for HIV infection. Nineteen women had a mean of 4 partners
(range I to I I) during the time they were infected: the remaining woman had an estinmated
total of 100 partners. At the time of interview, 8% (6/78) of the sublects who were sexually
active reported the same or higher number of sexual partners in the last month compared
to the time period during which they acquired HIV (6 subjects were excluded from this
analysis because of missing data).
Conclusions: HIV infections in rural Alabama were frequently acquired out-of-state and
in major metropolitan areas. Most HIV-infected persons reduce high risk behaviors after
acquisition.
Hala J. Fawal, 720 So. 20th St.,TH212D, Birmingham. AL 35294-0008 Telephone: [phone] Fax [phone] email: [email protected]
Mo.C.141 I
RELATIVE RATES OF AIDS AMONG RACIAL/ETHNIC GROUPS BY EXPOSURE
CATEGORIES
Haverkos, HarryW National Institute on Drug Abuse, NIH, Rockville, Maryland, USA
Objective: To determine the relative rates (RR) of AIDS among racial/ethnic populations.
Methods: RR are calculated by assuming that racial distributions reflect that of U.S. Census
Data, 1992, i.e., White - 74%; African-American - I I.8%; Hispanic - 9.5%; Asian/Pacific Islander
- 3. 1%; American Indian/Alaskan Native - 0.8%. A rate of I1.0 is assigned to Whites in each
exposure category CDC HIV/AIDS Surveillance Report, 1995, is used to calculate RR.

Selected Results:
Homosexual Male
Male IDU
Female IDU
Female Heterosexual
Male Heterosexual
Ad. Hemophiliac
Mother to Child
Total

White
I.0
1.0
I.0
1.0
I.0
I.0
I.0
I.0

Black
1.8
15.1
16.3
12.8
15.6
0.8
25.5
4.3

Relative Rates
Hispanic Asian
1.4 0.3
11.0 0.2
6.9 0.2
7.8 0.6
7.6 0.5
0.8 0.3
12.5 0.6
2.7 0.3

Total #
Am. Indian Patients
0.3 228,954
0.6 81,491
1.2 27,902
1.0 21,021
0.5 10,64 I
0.8 3,642
1.9 5,541
0.5 441,526

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Conclusions: AIDS surveillance data show higher relative rates of AIDS for AfricanAmericans and Hispanics compared with Whites, Asian/Pacific Islanders, and American
Indians/Alaskan natives for most exposure categories.There are no known biologic reasons
to explain why racial or ethnic factors alone should alter risk for AIDS. Rather, race and ethnicity appear to be risk markers that correlate with other determinants of HIV exposure
and disease such as poverty access and receptivity to HIV prevention efforts, illicit drug use,
commercial sex work, and living in communities with high prevalence of HIV infection.
H.W Haverkos, Room 9A30, 5600 Fishers Lane, Rockville, MD 20857 USA
Tele. 30 I -443-6046 FAX [phone] email:[email protected]
Mo.C.1412
HIV SEROPREVALENCE TRENDS IN 15-24YEAR-OLD PATIENTS ATTENDING
SEXUALLY TRANSMITTED DISEASE CLINICS, NEW YORK CITY, 1990-1995.
Torian LV* Murrill CS, Makki HA, Benson DA, Economou AN, Schween FWVavagiakis R
Weisfuse lB. New York City Department of Health, NY, NY
Objective: To estimate HIV seroprevalence (P) in 15-24 year-olds who presented to NYC
Department of Health sexually transmitted disease (STD) clinics dung 1990-1995
(N=25,040).
Method: Unlinked HIV-I serosurvey using remnant serum originally drawn for routine serologic tests for syphilis (STS). Demographic, risk factor, clinical and laboratory data were
abstracted from clinic charts.
Results: The modal risk exposure was heterosexual contact (97%). 2% (N=302) of the
patients were men who had sex with men (MSM), 2% (N=343) used crack cocaine, and
0.5% (N= 109) used injecting drugs. 75% had a laboratory-confirmed STD: 1070 (7%) had a
genital ulcer (primary or secondary [P&S] syphilis chancroid or genital herpes), 17% had
gonorrhea, and 1483 (10%) multiple STDs. 8% ((1927/25040), 6% of males and 10% of
females) were STS+.The cumulative P was 2.4% (602/25040); 2.4% in both males
(349/14476) and females (250/l10515), 1.2% (98/8323) in 15-19 year-olds, 3.05
(504/I 67 17) in 20-24 year-olds, 23% in MSM, 12% n IDUs, 13% in female crack users, and
8% in STS+ patients. Annual P declined from 4% to I%. Steadily decreasing P was observed
in all demographic and risk exposure categories.
Conclusion: P in I15-24 year-olds is of interest because HIV was probably acquired relatively
recently and therefore after the first decades (1977- I 987 in MSM and I 982- I 992 in others) of seroconversions in NYC. Although P declined steadily over the six-year period, in
1995 it remained high in MSM (19%), IDU (14%) and crack users (I 8%), and in STS+ (5%)
and P&S syphilis patients (7%), reflecting the long-established association between the two
infections. New risk reduction approaches for young patients presenting with biological and
behavioral exposures which place them at risk for HIV infection are needed.
LuciaVTorian, 346 Broadway, Rm. 701, New York, NY 10013 Telephone: [phone]
Fax 2 I 2-442-3482
Mo.C.1413
HIV- I SEROPREVALENCE AMONG INJECTING DRUG USERS PRESENTING TO NYC
SEXUALLY TRANSMITTED DISEASE CLINICS, 1990-1995.
Murrill, Christopher S*,Torian LV*, Makki HA*, Benson DA*, Economou AN*, Schween
FW*,Weisfuse IB. **NYC Department of Health, New York, NY, USA.
Objective: To determine HIV- I seroprevalence in injecting drug users attending NYC
Department of Health STD clinics between 1 990 and 1995.
Methods: Unlinked HIV- I serosurveys using remnant serum originally drawn for routine
syphilis screening. Consecutive enrollment of patients presenting to clinics for routine STD
examinations. Demographic, risk factor, clinical and laboratory information abstracted f-om
patients' clinical charts. No patient interviews conducted.