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

Mo.C.1482 - Mo.C.1486

Monday, July 8, 1996

Mo.C. 1482
THE RISK FACTORS OF HIV INFECTION INTURKEY:THE EXPERIENCE OF
HACETTEPE UNIVERSITY HOSPITAL
Unal S, Kocagoz S, Uzun O, Kansu F, Hayran M, Akova M. Hacettepe University School of
Medicine, Department of Internal Medicine, Ankara,Turkey
The first HIV (+) Turkish patient was diagnosed in 1985. By the end of 1995 there were
497 HIV (+) partients (Table), 187 of them developed AIDS and 57 died.The most irmportant risk factors are heterosexual intercourse (40%), intravenous drug use (12%), homosexual intercourse ( 10%).The unknown category (27%) may be mainly hetero and homosexual
transmission.
As a cross-sectional example of all this group,
34 patients (I I female. 23 male) have been Table
followed in Hacettepe University Hospital, N 10
Department of Internal Medicine, Section of a 0
Infectious Diseases since 1986.Their ages b
were between 22-60 years (Mean age is 40). e 20
The probable risk factors for these patients ' r
were as follows: Heterosexual intercourse 35 6 87 3 9 90 91 92 93 34 36
with HIV infected partner (23 patients), Year
homosexual intercourse (2 patients), transfu
sion (8 patients), iv drug use (I patient). According to CDC/WHO criteria 22 patients were
at category A. 12 were at category C.
In conclusion, although the cases are probably underreported the number of HIV patients is
increasing in Turkey At present heterosexual intercourse is the main transmission route. It is
time to intensify the programs to educate the public about HIV infection.
Serhat Unal, Hacettepe Universitesi,Tip Fakultesi, I1 Hastaliklari Anabilim Dali, Infeksiyon
Hastallklar Unitesi, 06100 Ankara,Turkey.Telephone: [phone] Fax: [phone],
Email: [email protected]
Mo.C. 1483
HIV- I SEROPREVALENCE, INCIDENCE AND RISK BEHAVIOR IN THE UGANDAN
MILITARY.
Mugyenyi, Petert, Hom D*, Loughlin A*, Johnson J*, McGrath J*, George K*, Silar G*,
Mugerwa R, ElIner J*. (Joint Clinical Research Centre (JCRC), Kampala, Uganda; *Case
Western Reserve University Cleveland, OH, USA; Makerere University, Kampala, Uganda.
Objectives: Measure changes in HIV- I seroprevalence, incidence, and risk behavior over
time, and identify issues of vaccine acceptability/knowledge in two longitudinal cohorts of
Ugandan regular military assembled 1994 to present.
Methods: Two large cohorts from the Ugandan military are currently being assembled
(1994 to present) for longterm follow-up. Cohort I is a projected 1 100 HIV seronegative
23-26 year males (6/94 to present). Cohort 2 is a projected 1200 HIV seronegative 18-30
year males (8/95 to present). All enrolled subjects return to the JCRC or are seen at military posts for routine behavioral risk assessment, specimen collection, STD diagnosis and
treatment and pre/post HIV test counseling at 6 month intervals by two project teams. At
baseline all subjects were also queried about vaccine knowledge and attitudes regarding
participating in future efficacy trials. HIV- I seroconversion is based on EIA (Cambridge
Bioscience) and Western Blot (Biorad Novapath) positive confirmation.
Results: To date, 92I (84%) of the 1100 required in cohort I and 506 (42%) of the 1200
required in cohort 2 have been enrolled, with follow-up ranging f-om 0 to 18 mos. (median: 6.7), with screening/enrollment continuing. From the two cohorts a total of 2572 subjects have been screened for eligibility with a stable HIV- I seroprevalence at 25.4% (95% CI:
23.6, 27.2) across 18 mos. of recruitment. General behavioral profile also has remained relatively unchanged (I.6~0.9 new partners in last 12 mos.; 60% ever used condoms). Eleven
confirmed seroconverters have been identified, for a seroincidence rate of 2.5% (I.0, 4.0),
with mean time to seroconversion at 3.8~ 1.6 mos. Data on vaccine acceptability indicate
subject confision on the true action of a vaccine, i.e. prevention (67%) or therapeutic
(17%) purposes, while all recognizing that vaccines help boost the immune system (92%).
Conclusions: These results demonstrate that Ugandan military recruits demonstrate a high
but stable HIV- I seroprevalence and seroconversion iate since 1994. In combination with
data collected earlier in 1992, rates of infection continue to remained high, while little indication of behavioral change is apparent.The data continues to indicate that the Ugandan
military is a suitable population for future interventional research.
Dr Peter Mugyenyi, Joint Clinical Research Cente r, PO Box 10005, Kampala, Uganda,
phn:256-41 -270-622, fax: [phone], E-mail: jcrclmukla.gn.apc.org
Mo.C. 1484
THE PREVALENCE OF HIV AND OTHER SELECTED tD I R STDS IN A RURAL SOUTH
AFRICAN COMMUNITY
Colvin, Marke*, Abdool Karim SS *, Connolly C*, Hoosen A*. *Medical Research Council,
Durban, South Africa **Microbiology University of Natal, Durban, South Africa
Objective: To determine the prevalence of HIV and other STD and associated factrs in a
rural South African community.
Methods: The sample comprised all adults living under the cai-e of a randomly chosen community health worker- in the vicinity of Hlabisa Hospital. i.e. about I120 homesteads.
Consenting subjects provided information on household demographics, migiation patterns
sexual practices ned symptoms of ST~n. In addition, blood and urine samples were collected for- HIV and syphilis serology and LCR (ligase chain reaction) tents for chlamydial and
goiococcal infections.
Results: From a potential 469 sublects, 33.0% were temporarily or permanently away
from home (migrants) and I 7. I % refused no participate.The pi-evalence of HIV among
the 239 studied sublects wan I I%, syphilis 10%, chlamydia 8% and gonorrhoea 4%.There
wan no association between positive HI'V status and positive tests for other STDs. Only
one subject reported symptoms. All cases of HIV occurred among per-sons who spent I10
or less nights per- month with their regular partners (p<O) but this pattern was not
repeated for other- STDs.
Conclusions: Migrancy plays,in important i-ole in HIV tr-ansmission.The high prevalence of
asymptomatic STDs reflects the importance of scieeriing for these infections.
DrPark Colvin, 106 Haven Ave #22. New York, NY 10032, USA Tel: [phone]

Fax: 2 I 2-3059413 (h) msc49lf)columbia.edu

Mo.C. 1485
TRENDS IN HIV-I PREVAI ENCE AND RISK FACTORS IN PREGNANT WOMEN
MEASURED BY CLINIC ON-SITE TESTING AND LABORATORY CONFIRMATION IN
HARARE, ZIMBABWE
Mbizvo M.T Cp,:t,,I ilashu A,* Makura E, * Bopoto R, * Fottrell P*. *Department
of Obstetrics anc Gyrn e-ology University of Zimbabwe, Avondale, Harare ** Department
of Biochemistry Uni,.et- College, Galway Ireland
Objective: To determi re HIV prevalence and risk factors in pregnant women attending
antenatal clinics in Harare area with use of a rapid on-site HIV antibody test operated by
nurses and confirmed in the laboratory by ELISA and Western Blot.
Methods: Women presenting for antenatal care in maternity clinics in Greater Harare
between January 1994 and March 1995 were tested for HIV- I antibody following informed
consent, counselling and administration of a questionnaire.
HIV antibodies were tested on-site by midwives or nurses using a rapid test (Capillus) followed in the laboratory by RTD, ELISA and Western Blot (Cambridge Biotech, Galway).
Quest software was used to analyse the data using bivariate and multivariate models.The
performance of rapid on-site HIV testing by nurses (sensitivity and specificity) combined
with on-site counselling will be the subject of another abstract.
Results: Of the II 69 women, 30.3% tested HIV positive, with prevalence rates ranging from
23.6% at a lower density clinic, 28.4% in a medium density clinic, 30.7% in a higher density
clinic and 33.0% at the referral maternity hospital.The 20 - 29 years age group had the highest prevalence of 35% seropositive status (Odds Ratio (OR) = 2.3. 95%CI = 1.33 - 3.99).
Single pregnant women were more likely to test positive, (OR = 2.06. 95%CI =- I.15 - 3.69).
Thirty five percent of the women reported previous use of condoms and in those where
condom use was reported in casual relationships, there was a higher risk of HIV (OR 6.07,
95%CI = 2.13 - 17.29). Reported use of intravaginal herbs was associated with a significant
HIV risk (OR 1.4, 95%CI = I. I - I.8). Instances where partner frequented the pub everyday every weekend or twice a month were associated with an increased likelihood of being
HIV positive (ORs 2.0; 1.6; 2.3 I.58). History of genital ulcer (OR = 2.3), discharge (OR =
2.4), genital ulcer with PID (OR = 5.79) was significantly associated with HIV infection.
Conclusion: These studies indicate a 30.3% HIV prevalence rate for a sample of II 69 pregnant women in Harare.This rate is higher than that reported for a similar population in
1990 of 18% in a sample of 1008 pregnant women.The findings emphasize the need for
aggressive community based interventions aimed at adoption of behaviour less likely to
continue to put the women at risk. Prevention strategies should include a wide range of
locally defined, socially contextualized initiatives.
Micheal T Mbizvo,Tel: [phone], Fax: [phone]/-724912
e-mail: [email protected]
Mo.C. 1486
EPIDEMIOLOGICAL, BEHAVIOURAL, PSYCHOLOGICAL, AND SOCIAL VARIABLES
THAT COULD HINDER THE EFFICACY OF COUNSELLING FOR SAFE-SEX IN
HETEROSEXUAL STABLE AND HIV DISCORDANT COUPLES AT RISK FOR HIV
TRANSMISSION
Costiliola P, Lazzari C, Fulgaro C, Di Bari MA. Marinacci G. Colangeli V, Borderi M. Chiodo
F. Dpt of Clinical and Experimental Medicine, Division of Infectious Diseases - University of
Bologna - Italy
Objective - The aim of the stuidy was to evaluate t atehe degree of adoption of sexual preventinve measures by heterosexual partners after specific counselling, and the behavioural, psycological, and social variables that could influence the heterosexual stable couples at rk of
HIV sexual contagion in deciding to adopt safe sex measures.
Methods - Background: from 1985 to 1 995, we have examined 327 heterosexuals without
any other previous and current risk factors of acquiring HIV infection exept for a stable
relationship with a subject who lately discovered to be I-IV Ab +ve. All subjects, at the time
of HIV serology received a counselling on safe sex measures, and 1 93 were interwieved on
sexual behaviourThe epidemiological interview inquired about the length of the relationship, frequency of the sexual contacts, contraceptive behaviors, medical history regarding
sexually transmitted diseases, and sexual practices. More in detail, we examined 193 discordant (HIV+/HIV-) couples, including 1 52 couples (Group A; stable partner -SP:F/M 95/57)
which started the relationship before knowing the risk of HIV contagion and receiving the
counselling, and 4 I couples (Group B; SP:F/M 27/14) which were aware of the risk and had
been counselled fiom the beginning of the relationship. From January 1 994, the last 66 new
enrolled couples (Group C) were interviewed using an additional questionnaire containing
items about the educational and professional level ofeal e both SP and index case (IC),. and their
parents, the financial condition of the original family and, for the SR the fright of AIDS, the
recognition of risk, the one (SP or IC) who required to use condoms, the reason for using
condoms, the degree of interaction with the original family the presence of conflicts with
parents, and the degree of depression.
Results An overall condom use before the counselling was reported by 15.8% of interviewed partners of Group A, and condom use increased to 77% of partners after counselling (male partner - MP: 71.9%; female partner- - FP: 80%). However: condoms were used
primarily in vaginal contacts, and a large amount of partners who decided to continue to
have high-risk conctacts practiced them without using condomss (notably anal sex (MR:
62.5% FR: 81I.8%] and fellatio [MRP: 93.2% FR: 90.5%]). A relationship lasting more than 36
months, and age over 24 years were the main variables linked to the use of condoms and
to the cessation of anal sex. of fellatio, of cunnilingus. of vaginal sex during menses.The
Group B showed sexual behaviocir after counselling with a risk globally more reduced thin
Group A, instead of a fiequency of sexual intercourse per- week higher in Group B. In detail,
also if the use of condoms during vaginal contacts resulted quite similar between the two
Groups (A: 79%: B: 87.8%). the Group B referred: i) a lesser frequency of ejaculation and an
sigher frequency csf condoms use duiring vaginal contacts during menses ii) a more frequent
occurrence of fellatio bus with an higher use of condoms: iii) an higher frequency of condor use during anal sex. Preliminary analysis of data from Group C showed that the denisiori to not use condoms was related no: i) a good economical condition of original family
of female an like as of male SR; ii) the repented request hloer exposed SR to have sex without condoms use: iii) a poor and unsatisfactory interaction of the exposed partner with the
original family.
Conclusions - The counselling for the adoption ofi safe sex measures is the min way to
prevent HIV trarnsmissron in stable couples. Mlore effort should be put in the counselling of

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