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

Track C: Epidemiology & Public Health

Mo.C.1550 - Mo.C.1554

interactions, stage classification,..). Research projects based on collected data are in progress.
Conclusions: The software is well accepted by the medical staff thanks to the strategy chosen for its implementation, its simple use and its multiple functions. Reliability of collected
data provides the opportunity to use the information for research, and to evaluate medical
practices with regard to recommendations concerning HIV patients management. Extension
of the system to other units catering for HIV patients and use of this tool in other pathologies are contemplated,.
P Pugliese, Service de Maladies Infectieuses, H6pital I' Archet BP79, 06202 Nice cedex 03,
France Telephone: [phone]Fax: [phone]
Mo.C.1550
THE HIV SENTINEL SURVEILLANCE SYSTEM IN KENYA: METHODOLOGY, RESULTS
AND USES
Baltazar, Godfrey, Okeyo,TM. National AIDS and STDs Control Programme, Nairobi, Kenya
Objective: To determine the extent and pattern of HIV infection in Kenya in order to monitor the epidemic, design effective control programmes and evalu ate program impac t.
Methods: Sentinel surveillance is conducted for STD patients and ante-natal clinic (ANC)
attendees.The system has been operational since I1990. Urban surveillance is conducted in
13 sites around the country In I 994 s x peri-urban and rural ites were added. For ANC
sites, blood is drawn and tested from 200-300 women attending the clinic for their first
ante-natal visit during the last quarter of each year:
Results: HIV prevalence among pregnant women in urban areas has been high and roughly
stable since 1990 in the southem port city of Mombasa (I 5%) and areas of Western Kenya
around Lake Victoria and the border with Uganda (20%).The highest rates recorded have
been about 30%. Prevalence has been increasing rapidly in areas immediately north and south
of Lake Victoria in Western Kenya and along the road from the Ugandan border to Mombasa,
including Nairobi. In these areas prevalence has increased from 2 -10% in 1990 and 9 30% in
1994. Prevalence has remained lower (I-8%) in areas to the north and east of Nairobi. Periurban sites in the areas of high urban prevalence show levels as high as the urban areas. The
two rural sites in Central and Eastern Kenya had prevalence of only 2% in 1994.
Conclusions: The Kenya National AIDS and STDs Control Programme has developed an
efficient sentinel surveillance system for monitoring HIV levels and trends.The results have
been used to target prevention services appropriate for each region.The five year trends
suggest that prevalence may have reached a plateau level in areas with the highest prevalence. Surrounding areas in Central and Western Kenya are still experiencing explosive
growth in prevalence.There is no clear evidence yet that prevention efforts have led to a
decrease in prevalence anywhere in the country
G.Baltazai1 Kenya National AIDS & STDs Control Programme, Mnistry of Health,
P.O. Box 19361, Nairobi, KenyaTel: 254-2-729-502 Fax: [phone]
email: knacpdlken.healthnet.org
Mo.C.1551I
COMPARISON OF CD4 POSITIVE T-CELL COUNTS IN MEN AND WOMEN
RECENTLY DIAGNOSED WITH HIV INFECTION IN MEXICO CITY, MEXICO.
Guarner Lans jeanette.**, Uribe P*, Hernandez G*,Teran X., del Rio C.**. National
Cancer Institute, Mexico. *CONASIDA, Mexico.
Objective: To compare the CD4 cell counts between HIV positive men and women that
are diagnosed with HIV infection at the AIDS testing Centers (CONASIDA) in Mexico City
for the first time.
Method: Prospective study of all patients that were referred for CD4 cell counts for the
first time in 1994 and 1995. CD4 counts were performed using flow cytometry Total lymphocytes, CD4% and absolute CD4 cell counts were compared by gender Statistical analy
sis was done using Epi-Info 6.0.
Results: A total of 747 patients were seen, 76 (10.2%) women and 6/71 (89.8%) men.
There was no significant difference in counts between men and women. The following
table shows the results:

tine testing, compulsory contact and partner tracing and subsequent testing.
Methods: HIV is a notifiable disease in Sweden, and according to the Communicable
Diseases Law, 1989, an individual infected with HIV can be detained i n hospital if he or she
poses a threat of spreading the infection to others.The patient 's physician is obliged to
report a case of HIV to the County Council medical health officer in charge of the otrol
of communicable diseases.The report includes a coded (anonymous) case -number ind provides information on sex, year, and country of birth; risk category and, if possible, the t me
and place of tran smission. The consulting physician is responsible for givn the patient land
ing regulations to prevent further spread of infection. If the patients do not adhere to these
rules, the physician has to report the r identity to the medical officer who then cantais the
patient and additional councelling is given, wh ch s usually sufficient to alter a high -nrsk
behavior.An administrative court decides about detainment.
Results: In Sweden there have been almost 4000 HIV-in ected individuals reported. (
these, about 3000 live in Stockholm county S rince 1985 the medical oficers have had on
tact with about 800 persons in the Stockholm county who have been reported for not
adhering to the rules During the same period a total of 47 persons with HIV in Sweden
have been detained by the administrative court, 37 of whomre irefrom the Stockholm re.
Thus, about 25% of HIV-infected persons have been sublect to councellinr efforts and I%
have been subject to isolation.
Conclusion: The widespread testing could be part of the fourable HIV situatsicini
Sweden together with the cenfidence of the public health strategy and a benevolent health
care system.
P-A Parment, Dept of Communicable Diseases, Karolinska Hospital, S-1 7 I /6 Sweden,
Telephone: [phone], Fax: + 46 8 31 57 67
Mo.C.1553
FIVEYEARS OF HIV SURVEILLANCE AMONG PATIENTS ATTENDING SIX STD CLINICS IN SWITZERLAND USING VOLUNTARY TESTING:ANALYSIS OF TEST REFUSERS
AND HIV TRENDS OVERTIME
Paget Wohn*, Zwahlen M*, Eichmann A"*. and the Swiss Network of
Dermatovenereology Policlincs * Swiss Federal Office of Public Health. Bern, Switzerland
Stadtspital Triemli, Zurich, Switzerland.
Objective: To monitor the prevalence of HIV infection among STD patients by exposure
category
Methods: A voluntary HIV test was offered to all persons diagnosed with an S7 D ait the six
policlinics of dermatovenereology which exist in Switzerland. Anonymous socio-demograiph
ic and behavioural information was collected for each patient regardless of whether s/he
accepted or refused the test.
Results: The table provides refusal rate s and HIV prevalences among est cceptors for rr
drug-injecting heterosexuals and homo-bisexual men between 1990 and 1994 tother exposure categories were excluded from the analysis).
%: 1990 1991 1992 1993 1994 N:1990 1991 1992 199- i~1

Heterosexuals: refusers 25.2 16.2 16.8 14.2 16.1
HIV prevalence 2.2 1.7 0.4 1.3 1.5
Homo bisexuals: refusers 21.5 13.7 14.0 25.4 12.7
HIV prevalence 28.8 19.5 22.5 16.0 21.8

611
457
66
5,?

754 559
632 465
95 93
82 80

52 323
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150

Number tested
total lympochytes (cells/pL)
mean
range
median
CD4% (cells/pL)
mean
range
median
absolute CD4 (cells/pL)
mean
range
median

WOMEN
76
1683
(304 to 3,619)
1558
14.9
(0 to 86)
14
256.9
(0 to 1093)
207

MEN
671
1746
126 to 4,977)
1666
12.1
(0 to 62)
9
228,7
(0 to 1228)
X17

To assess the potential impact of refusers on the HIV prevalences, we analysed test rec uer
using a logistic regression analysis.Among heterosexuals, refusal rates were significantly high
er among persons with relatively low risk behaviours (eg: I-2 partners in the previous six
months) whilst among homo-bisexuals men they were significantly higher among those with
high risk behaviours (eg: 5+ partners). No significant trend in HIV prevalences was found
when controlling for potential confounders by logistic regression. Among HIV positive persons, the proportion who knew they were HIV infected before acquinng their STD was
39% (I 2/31) among heterosexuals and 59% (41/69) among homo-bisexual men.
Conclusions: In a European Concerted Acton to monitor HIV among ST D patients, only
three out of 17 national networks used unlinked anonymous testing which eliminates the
bias of non-participation (persons refusing an HIV test). In the Swiss network, voluntary HIV
testing might have led to an overestimate in HIV prevalences among heterosexuals rid un
underestimate among homo-bisexual rmen. The high and stable HIV prevalences and at
that many of the STD patients already knew they were HIV positive indicate that preven
tion efforts targeted at this population need to be improved, particularly among homobisexual men.
WJ. Paget, Hess Strasse 27E, 3097 Liebefeld Bern, Switzerland
Telephone: ++4 1-31 -970.87.47, Fax: ++41 3 1-970.8795, email: john.paget(bag.adrn ch
Mo.C. 1554
YEARLY CHANGES IN SOURCES OF HIV REPORTING: IMPLICATIONS FOR HIV
SURVEILLANCE IN TAIWAN
Lin Yvonne G, Hou Sl*, Stone T*,Twu SJ*), Chuang CY. *Nation alTlwan Universty
Hospital, Dept. of Internal Medicine,Taipei,Taiwan Nationa Taiwan University College of
Public Health,Taipei,Taiwan
Objective:This report examines changes in the source of HIV reporting in liwan.
Methods:Annual HIV seroprevalence data from 1991 to 1995 were obtained from the
Taiwan Department of Health. Information on related risk factors and demographic were
gathered from all patients testing positive for HIV. In addition, the facility at which HIV infec
tion was reported was also recorded. The types of sites from which new HIV cases were
reported were analyzed to determine whether or not a change in the use of testing fac
ties has changed over-tise.
Results: Accountin for 58% of all 1995 HIV infection reports, hospital -based FHIV surveil
ance programs remained the primary source of reporting. In 1991 and 1992, blood donor
cetes had the second highest nu mber of ncident HIV reports, accountng for 13 and
I I% of case reports, respectively. However, beginning in 1993 and continung to the pre
sent, sites other than the traditional hospitals, blood donor centers, prisons and the military
became the second most common source for HIV r eporting. Amon the pr edesignated
testing facility types, only the sites designated as"other'' revealed an annual incease in HIV

Conclusions: In our patient population both men and women present for initial HIV testing
late in the course of the disease as shown by a median CD4 cell count of 243 cells/pL
(median percent count of 12.4%). Contrary to other reports in the literature, womrnen in
Mexico City diagnosed at CONASIDA are not diagnosed further along in their -illness than
men.There is a need to increase risk perception about HIV in Mexico to encourage both
men and women to be tested earlier in the course of the infection.
Jeanette Guarner Lans, Calz. deTlalpan 4585 2do Piso. Col.Toriello Guerra, Deleg.Tlalpan
Mexico City Mexico (5 25) 528.4086/528.4848 FAX [phone]
Mo.C.1552
ESTIMATED EFFECTS RELATED TO COMPULSORY EFFORTS IN COMBATING HIV
Christenson B*, Parment P A*, Lundbergh P*. *Dept of Comrunicable Diseases, Karolinsk
Hospital, Stockholm, Sweden
Objective: To describe and evaluate the Swedish model to combat the spread of HIV.
Sweden has incorporated the classical public health tradition which has been voluntary rou