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

Mo.C.1436 - Mo.C.1440

Monday, July 8, 1996

Methods: A total of 183 paired blood and urine samples were collected from I 0 heterosexual individuals (7 female / 103 male) and 73 commercial sex workers-CSW-(68 female
CSW / 5 male homosexuals) from Tequila City Jalisco.The sera were tested for HBsAg by
ELISA and syphilis by RPR/MHATPThe urine samples were tested by Chemilumninescence
Enzyme Immunoassay (CLEIA) for HIV- I antibodies and the positive samples were confirmed by Western blot.
Results: Of I183 samples tested we found one anti-HIV- I positive (0.55%); 6 HBsAg
(3.27%); and 5 reactive for syphilis (2.73%). One male heterosexual and I male homosexual
were coinfected with HBV and syphilis.
Conclusions: This study shows that syphilis and HBV infections were more common than
HIV- I infections and that there is still a low prevalence of HIV- I infection in rural Mexican
population.
H.E.Vicente, 1320 Freeport Blvd. Unit I1 I, Sparks, NV 89431 USA.Tel: [phone]; Fax:
702-331 1716
Mo.C.1436
PREVALENCE OF STD AMONG WOMEN ON THE SUGAR CANE PLANTATIONS
(BATAYES) OF THE DOMINICAN REPUBLIC (D.R.)
BrewerT*, Hasbun J*, Sanchez J*, Ryan C*, Butler de Lister M**, Hawes S*, Constanzo
J***,Lopez J**, Holmes K*. University of Washington, SeattleWA, USA;
*AIDSCAP/FH, Santo Domingo, Dominican Republic; ***Central Romana Sugar Estates,
La Romana, Dominican Republic
Objective: To define the prevalence of STD among women on the bateyes of a large private company in the Dominican Republic (D.R.).These camps have unequal sex ratios, with
I.4-1.7 males to I female, depending on the time of the agricultural cycle, and few economic opportunities for women.
Methods: 23 of the 98 bateyes (total adult population estimated at I 8,500 dunring the off
season) were randomly selected and visited by a mobile medical unit. Sexually active volunteers underwent interviews and gynecological exams, including wet mount, gonorrhea cultures, cervical swabs for chlamydial EIA, and urine for N. gonorrhoeae and C. trachomatis
ligase chain reaction (LCR). Serum was collected for HIV and VDRL/FTA-AB testing. Of 5 I 3
women approached, 509 volunteered; 502 with completed questionnaires and lab tests are
included in this analysis.
Results: Subjects ranged in age from I 6 to 72 years. 53% were born in Haiti, 36% in the
bateyes and I12% elsewhere in the D.R. 79% had never had a gynecological examn and 9 1%
had never had a cervical Papanicolou smear:The most common diagnosis bacterial vaginosis (BV) was found in 59% of subjects.Trichomonas was diagnosed in 28% of subjects
and was associated with BV (OR 2.75, p<0.01).VDRL and-FTA-AB were both positive in
18%; this was associated with age >25 (OR=2. I, p=0.02), birth in Haiti (OR 1.69, p=0.04),
greater than I lifetime sex partner (OR 2.4, p=0.0I) and a last partner who is Haitian
(OR=2.06, p=0.03). Chlamydia prevalence was 9.6% by EIA and N. gonorrhnoeae prevalence
was only I1.6% by culture. Univariate analysis of LCR test results are pending. Risk factors for
cervical infections included age <25 (OR 2.3, p=0.02), self-description as a prostitute (OR
4.53, p=-O.03), being head of ones family (OR=3.7, pO=0.01) and suspecting one's partner to
be unfaithful (OR 2.03 p=0.02) Cervical infections were associated with complaints of
dysuria (OR 1.95, p=0.03) and with concurrent BV (OR 1.96. p=0.03).
Conclusion: In this population with an HIV prevalence of 5.7%, the prevalences of vaginal
and cervical infections are high. These are risk factors for HIV infection. Improved access to
routine gynecological care is essential.
Martha Butler de Lister, c/ o Alfred Nimocks, AIDSCARP 210 I Wilson Blvd. #700, Arlington,
VA, USA, 2220 I;Tel. [phone]; Fax. [phone]
Mo.C. 1437
AIDS AS AN INCREASING CAUSE OF DEATH AMONG YOUNG MEN IN THE STATE
OF LARA,VENEZUELA.
Granero Ricardo (I,2),Vargas Jesus (I), Issacura Cesar (I), Klaskala Winslow (2), Baum
Marianna (2). I-Sub-region Estado Lara, Ministerio de Sanidad Venezuela 2- Fogarty
International Training Program, University of Miami, USA.
Objectives: To describe AIDS morbidity and mortality patterns in young men, aged I 8 to
44 in the State of Lara,Venezuela.
Methods: AIDS surveillance data fr-om the Lara's Regional Health System, Department of
Epidemiology were analyzed from I1985 and March I1995. Most recent information on risk
factors including age and sex are fr-om 1994. Standarized rates were calculated.
Results: The State of Lara, located in the north-western region ofVenezuela has a total area
of 21000 square Km and 1.5 million population. About 40 % of the population live under the
poverty line and 80% reside in urbtan areas. Between January 1985 and March 1995, 4200
AIDS cases were reported in Venezuela. During the same period the case fatality rate was
6 1%. In the State of Lara, during the same period, the corresponding figures were 246 cases
and 17.5% case fatality rate. In Lara, AIDS mortality rates (per 100.000 population) experienced a five fold increase from 0.4 in 1993 to 1.9 in 1994. In the same period over 70% of
the deceased cases were below 44 years of age, and 14% of the cases were in young adults
(below 24 years). The majority of cases were males (90.5%) and their risk distribution was:
40% men who had sex with men, 31% heterosexual, 27% bisexual and 2% unknown.With
respect to AIDS moridity and mortality the State of Lara ranks in the nation s lowest quartile. However: during the last two years, a significative increment has occurred in both AIDS
morbidity and mortality this trend is even more marked in young men.
Discussion: Lara has experienced a rapid increase in both AIDS mortality and morbidity
rates. AIDS is becoming an increasing cause of death among young men.
Ricardo Granero, U of Miami, Dept. Epidemiology (R669) RO. Box 0 I 6069, Miami, FL 3310 1
[phone] email: [email protected]

Mo.C.1438
AN EPIDEMIOLOGICAL APPROACH TO HIV- I/2 INFECTION AMONG FEMALE SEX
WORKERS AND GAY MEN OF MARGARITA ISLAND
Castro de BatanrJ(sErikC, f theverria de Perez Gs*, Coura J.R*. *Oswaldo Cruz Institute,
Brazil; **Central Universv c, Venezuela
Objectives: To establish the prevalence of HIV- 1/2 infection in both clusters: to evaluate
correlations between sexual practices among gay men and HIV infection; and to evaluate
the existence of female sex workers subgroups.
Methods: The study was done in the main tourist county of the island (02- I 2/94).
Censorships of female street sex workers and gay men were required.Two questionnaires
were applied: one to evaluate characteristics of female sex workers and other to evaluate
sexual practices among gay men.We collected sera of I 15 female sex workers (Z= 1.96
~=0.0 I12) who were registe-red in the local hospital (RSVW), 26 female street sex workers
(SSW) (Z= 1.96 ~=0.0 I 2) and 40 gay men (Z= I1.645 ~=0.056). Sera samples were
screened for HIV- I and HIV- I/2 by ELISA (ABBOTT). Repeatedly reactive sera were tested
by Western blot (Cambridge Biotech Corporation). Results showed that 3.6% of SSW and
25% of the gay men were HIV- I positive. In the RSW no serum was confirmed by Western
blot nor Liatek. RSW and SSW were different according to: "t" Student test for
age(p-0.028017 0-0.05),Wilcoxon-Mann-Whitney test for sexual intercourse/price
(p=0.000000 ~=0.05) and for condom use (p=0.00008 L=0.05).We also found in the gay
sample a correlation between bisexual intercourses and HIV- I positive result using Yates X2
(p-0.02 16372 ~=0.05). We suggest for Margarita's AIDS control program better attention
to street sex workers and non-safe sex among men, in order to reduce future chances of
HIV infection to women and children of this area.
Erika Castro de Batanjer Apdo Postal 738, Porlamar, Margarita. Venezuela.
Telephone:[phone] Fax: [phone]
Mo.C. 1439
FIFTEEN YEARS OF AIDS EPIDEMIC IN BRAZIL:TRENDS OVER TIME AND
PERSPECTIVES
Chequer, Pedro, Castilho E, Gomes MRO, Rodrigues LGM, von-Borries FG, Lima GAP
Ministry of Health, Brasilia-Brazil
Objective: To describe the Brazilian AIDS epidemic in terms of temporal trends and to outline perspectives.
Methods: All AIDS cases reported to the Ministry of Health as of December I1995 were
analysed in terms of descriptive statistics such as rates, ratios and proportions.
Results: Between Jan. 1980 and Dec. 1995, 76,396 AIDS cases were reported.The annual
incidence rate increased from 0.05 in 1982 to 5. I in 1990 and reached 8.6 in 1994
(/100000 pop).The male/female ratio changed from 46:1 in 1984 to 3:1 in 1995.The first
pediatric case occurred in 1983 and they accounted for 4% of the total reported cases in
1995. Among pediatric cases, while in 1985 7% were due to perinatal transmission, this proportion is 91% in 1995.The relative frequency of homo/bisexual AIDS cases decreased
from 80% in 1985 to 4 1% in 1990 and 26% in 1995. The proportion of IVDUs, which was
1% in the period I1982-1985, increased to 22% in 1995. As far as heterosexual transmission
is concerned,it was. also observed important changes over time: In the period of 1980 -1988, this exposure category which represented only 3% of all reported cases, in 1990
ranked 5%, and 28% in 1995. In terms of education, until 1984, more than 80% of all cases
were individuals who attended university or high school, while in 1995, 70% were illiterate
or those who attended at most elementary school.
Conclusions: Presently the profile of the epidemic in the country is almost inverse to that
observed in the very beginning: From a disease restricted to homo/bisexual males, hemophiliacs, blood recipients, it converted to a disease mainly of both male and female, who
acquired the HIV infection through syringes sharing (IVDU) or heterosexual contacts.The
results also indicate that the epidemic is spreading through all social strata of the Brazilian
population, mainly in those of low level of education.This setting points out the coming
years for a predominance of IVDU and heterosexual individuals among AIDS cases as well
as an increased participation of women in the epidemic.
Pedro Chequer Ministerio da Saude, Bloco G. Sobreloja, Sala 11 5. 70.058-900 Brasilia, Brazil.
Tel: 55-6 I -315.2520 Fax: 55-6 I -315.2519 email: [email protected]
Mo.C.1440
CHANGING FREQUENCIES OF AIDS DEFINING DISEASE IN BRAZIL: IMPROVED
CARE OR SURVEILLANCE ARTIFACT?
Ramos-Filho, Celso F*, Comes MRO**, Chequer P**, Castilho E**, Rodrigues LGM**,
Loures LAM**. *Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;** Ministry of
Health, Brasilia, Brazil
Objective: To determine whether the frequencies of presenting diagnoses of AIDS in Brazil
suffered any change over time (I 980 - 1995).
Methods: National registry of AIDS cases in Brazil. Since September 92, cases are notified
according to both the CDC 87 and the Rio de Janeiro-Caracas case definitions. Four time
periods were defined: early (before 1985), established epidemic (85-87), PCP prophylactics
recommended (87-90) and free, state-sponsored distribution of AZT and other drugs (91 -95).The proportion of cases with PCP, Kaposi sarcoma (Ks), cerebral toxoplasmosis (Ctx)
and disseminated tuberculosis (Dtb) in four transmission categories (homosexual - Hm,
bisexual - Bs, heterosexual - Ht, intravenous drug use Iv) were analyzed and compared
among the four periods. Results were tested by the chi-square method.
Results: Overall, there was a trend towards the reduction in diagnoses of Ks, along the four
periods, and in all four categories. For PCP, frequencies increased during the first three periods, with a sharp reduction in the last one, and in all transmission categories. With regard to
Dtb, although no consistent pattern was discernible in the first three periods, or mn any category, a marked reduction was observed in 9 I -95. Ctx somehow mirrors Dtb, with a less
pronounced fall in the last period, except for Iv. Chi-square results were significant at the
0.05 level.
Conclusion: Results observed are similar to what has been verified in Canada and the US,
this being usually attributed to the use of PCP prophylactics and of antiretrovirals, or to
improved, more precise diagnosis and reporting, while this may be the case in Brazil, one
other factor may be operative, explaining the shift observed in the last period: since the Rio
de Janeiro-Caracas case-definition has a better sensitivity than the CDC 87 one, cases are

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