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

Tuesday, July 9, 1996

Tu.C.225 -Tu.C.323

Tu.C.225
HIV-I SUBTYPE D NEXT TO SUBTYPE C IS HIGHLY PREVALENT AMONG
ETHIOPIAN RISK GROUPS
Abebe, Almaz*, Rinke de Wit T*, Messele T*, Sahlu T*,Yeneneh H*, Fontanet A*, Goudsmit
J*, De Wolf F**. * Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia;
**Department of Human Retrovirology Academic Medical Center, University of
Amsterdam, the Netherlands
Objective: To determine the predominant HIV I subtypes circulating in high risk populations
of Addis Ababa, Ethiopia.
Materials and Methods: 288 serum samples collected in Addis Ababa, Ethiopia, between
1989-1995 from HIV Iinfected Ethiopians were analyzed by peptide ELISA. Samples were
obtained from three different risk groups: female commercial sex workers (n- 178, collected in 1989, 1990, 1992 and 1995), pregnant women (n=28. collected in I1995), and blood
donors (n=82, collected in 1995). Specificity of these sera to a panel of nine gp120 V3
synthetic peptides representing diffeernt HIV- subtypes was analyzed at 10ng and
100 ng/well coating.
Results: 248/288 (86%) of the tested samples showed peak-reactivity (OD>0.7) to one or
more of the V3 synthetic peptides:
A ii (-_ Others Multiple-reichves Non- eacives
(1,) 5 (? <, 1 56 (5 2 2 ( I, (2 "17 6 %) t0 (I )
The prevalence of subtype C amon female commercial sex workers declined from 70% in
1989 to 55% in 1995, whereas subtype D prevalences increased from 10% in 1989 to
13,2% in 1995. Furthermore, a rise in the number of non-reactive samples was seen over
the same time periocd.
Discussion: The AIDS epidemic is a rapidly growing problem in Addis Ababa where the
seroprevalence is estimated to be 15% in pregnant women, 70% in commercial females sex
workers in 1995, and 7% among blood donors in 1994.As expected, subtype C was predominant among the study groups. Subtype D prevalence is rising, indicating a more recent
introduction and subsequent spread in Ethiopia of this subtype.
Almaz Abebe, Ethiopian Health and Nutrition Research Institute, Box 1242, Addis Ababa,
Ethiopiattel 251-I-130642; fax 251 I--752533
Tu.C.320
NEEDLE EXCHANGE PROGRAM ATTRACTS HIGH-RISK INJECTION DRUG USERS
Archibald Chris Pt. Ofner I, Patrick DM**, Strathdee SA***, Eades G***, Sutherland D",
Rekart ML**, Schechter MT>*", O'Shaughnessy MV***. *Bureau of HIV/AIDS and STD,
Health Canada; *BC Centre for Disease ControlVancouver; **BC Centre for Excellence
in HIV/AIDS and University of BC,Vancouver
Objective: To identify factors associated with frequent needle exchange program (NEP)
attendance by injection drug users (IDUs) in Vancouver, Canada.
Methods: Data were derived from a case-control study of risk factors for HIV infection.
Cases (n-89) were IDUs with a documented new HIV+ test after I/1/94 and a documented HIV- test within the prior 18 months. Controls (n- 192) were IDUs with two documented HIV tests in this same time period. Participants were asked about drug injection behavour; sexual practices and social factors during the time interval between the two qualifying
HIV tests (inter test interval). NEP attendance was categorized as frequent (> IX/week) or
not frequent (<I X/week). Logistic regression was used to examine the effect of mrasultiple
variables on NEP attendance while adjusting for HIV status.
Results: 159/281 participants (57%) reported frequent NEP attendance in the inter test
interval. Frequent versus non-frequent NEP attenders did not differ with respect to gender,
age, ethnicity; education, or HIV serostatus (all p-values>0. I1). Among men, frequent users
were more likely to inject >4X/day (52% vs 24%, p<.001), inject cocaine >4X/day (43% vs
15%, p<.001), inject with used needles (62% vs 49%, p=.08), and to have spent time in jail
(48% vs 35%, p=.08). In addition to these associations, female frequent attenders were
more likely to have a source of non-legal income (34% vs 14%, p=.03), attend shooting galleries (36% vs 8%, p=.003), live in unstable housing (76% vs 36%, p<.00 I), and to not have
a regular sex partner (55% vs 31 %, p=.02). Multivariate analysis showed that for men, fi-eqcluent cocaine injection was the only variable significantly related to NEP attendance
(AOR=4. I, 95%CI= 2.0 8.6). For women, variables independently associated with NEP attendance were frequency of drug inlection (AOR= 1.8, CI 1.0 3.3), having a non-legal source
of income (AOR=2.0, CI1=.0 3.9), shooting gallery attendance (AOR-=8.3, CI - I.8-38.0), and
unstable housing (AOR=2.8, CI-0.95-8.6).
Conclusions: Factors associated with an unstable lifestyle predicted frequency of NEP
attendance in our sample of IDUs.The NEP in Vancouver attracts iDUs at particularly high
risk for HIV infection, a finding which reinforces the role of the NEP as a focal point for
intervention in this hard-to-reach population. Such a finding could also explain the apparently paradoxical association between NEP attendance and HIV infection seen in some cities.
Chris Archibald, Postal Locator 0202A, Tunney s Pasture, Ottawa, Canada K IA 0L2
Tel: 61. 3941 I3 55 Fax: [phone] E-mail: carchibaohpb.hwc. ca
Tu.C.32 I
INCIDENCE AND PREVALENCE OF HIV AND RISK BEHAVIOURS AMONG IDU
ATTENDING NEEDLE EXCHANGE PROGRAMS IN QUEBEC
Parent, Rt, Alary Michel, Hankins Ca, Nod1 I*, Claessens C'*, Guimont C*,Tran T"t
aCentre do Sante Pufalque, Quebec, Qubec, CaradIs. *Direction do Is Sante PubmInu,
Mlontr el-cents e, Quebec Carnad a aboatosse do Sae Publique du Quebec, Ste-Annse
do Bellesue, Quebec, Canada.
Objectives:We h ase inaplesented a srellarce netwosr f DIV inhecton n 7 aneedle
eachasnye proyrans (NEP) ar the paovirce chQQrobec to chasracteaize DIV rheeison s monsy
scalethors dreg useat (IDD)
Methods: IDU, who had injected n the last 6 months, completed a questionnaire on soclo
demographic information and risk behaviours and provided oral fluid for HIV testing with
EIA and RIPA confrmation.
Results: As of October Ist 1995, 1076 questionaires and oral uid sanples had been collected among 934 IDU (277 women, 653 men, and 4 of unknown sex). Cocaine and heroin

were used respectively by 708 (75.8%) and 151 (I 6.2%) individuals. 382 out of 927 (4 1.2%)
injected with used needles in the preceding six months.The main source for those needles
were close friends and regular sexual partners for 240 of the 305 IDU (78.7%) who
answered this question. 5 I out of 196 men (26.0%) reported obtaining used needles from
strangers while only 14 out of 108 women (I 3.0%) did so. 98.2 % (272/277) of the women
and 90.2% (589/653) of the men had been sexually active in the preceding six months.
Consistent condom use with regular casual and paying sexual partners was reported by
10.5%, 17.5% and 28. I1% of the women and by I10.6%, 10.0% and 2.7% of the men respectively HIV prevalence was I 1.1% (Cl95% - 9.2; 13.3). It was 9.3% (CI95% - 7.0; 12.0) in
Quebec city and 14.7% (CI95% = I1.2; 18.9) in Montreal. No positive samples (out of only
20 specimens) have yet been collected from rural areas. Infection was significantly associated (p<0.05) with older age, duration of IV drug use, male and female prostitution, male
homosexuality and injecting with used needles obtained from strangers. Preliminary computations, based on 12 seroconversions among 219 repeaters (total follow-up of 266.6 person-years (PY)), indicate an incidence rate of 4.5 per 100 PY (4.7 and 4.4 per 100 PY
among women and men respectively).
Conclusion: Attenders of NEP are at high risk for HIV infection and are seroconverting at
an alarming rate.They should be targeted by more prevention efforts
Michel Alary, Groupe de recherche en epidemiologie, Hopital du St-Sacrement,
1050 chemin Ste-Foy, Quebec, QC, G IS 4L8, Canada.Tel: [phone] x 218;
Fax: [phone]
Tu.C.322
HIV INCIDENCE AMONG SYRINGE EXCHANGE PARTICIPANTS:THE
INTERNATIONAL DATA
Des Jarlais, Don C.*, Hagan, H.**, Paone, D.*, Fredman, S.R. -. *Beth Israel Medical Center,
NewYork, NY USA; *Seattle/King County Heath Dept., Seattle,WA, USA; +NDRI, New
York, NY, USA
Objective: HIV incidence among participants has typically been considered the "gold stan
dard" for evaluating HIV prevention programs.
Methods:We analyzed data from 15 different geographic areas in which HIV incidence was
either directly measured among syringe exchange (SE) participants or could be estimated
from trends in HIV seroprevalence.The studies included SE programs in Europe
(Amsterdam, Lund, London, Glasgow, England anrd Wales), North AmAerica (Toronto,Tacoma,
Portland, Montreal, New York New Haven, Baltimore,Vancouver), Australia (Sydney) and
Asia (Kathmandu).
Results: Fourteen of the sixteen studies showed low rates of transmission of blood borne
viruses among SE participants. With two exceptions, HIV incidence was low among SE
participants (0-2/100 PYAR in low prevalence areas, 2-4/00 PYAR in moderate to high
prevalence areas). In the two studies with apparent high rates of HIV incidence, potential
causes include: multiple risk factors among IDUs (high injection fequencies, high sexual
risk behaviorn mu tiple soc al disadvantages) arnd SE policies that limit secondary distribution of syringes.
Conclusions: Participation in SE programs is generally associated with a low risk for incidence HIV infection. Additional research is needed to clarify the circumstances under which
SE participation is not sufficient to prevent HIV infection. Issues related to implementing SEs
in developing countries also need be addressed
D.C. Des Jarlais, First Av. & 16th St., New York, NY, 10003, USA Telephone: [phone]
Fax [phone] email: [email protected]
Tu.C.323
INCREASED HIV SEROPREVALENCE AND SEROINCIDENCE ASSOCIATED WITH
PARTICIPATION IN NEEDLE EXCHANGE PROGRAM: UNEXPECTED FINDINGS
FROM THE SAINT-LUC COHORT STUDY IN MONTREAL.
Bruneau, Julie*, Franco Ear, Lamothe F*, Lachance N*, Desy M***, Soto Jt**,Vincelette J.
*CRC Andre-Viallet, H6pital Saint Luc, Universite de Montreal, **Department of Oncology
McGill University, **Unite d'epidemiologie et de biostatistique, Institut Armand-Frappier,
**** Sante publique, Laval. Quebec, Canada.
Objective: To study the association between Needle Exchange Program (NEP) attendance
and risk of HIV infection.
Methods: Recent intravenous drug users (IDUs) were recruited in a prospective cohort, to
evaluate prevalence and incidence of serologically assessed HIV infection and change in risk
behaviours over time.The cohort design afforded three risk assessment scenarios using intensive covariate adjustments for empirical confounders, including drug injection behaviours.
Results: From September 1988 to January 1995, 1599 subjects had been enrolled in the
cohort with a baseline seroprevalence of 10.7% The mean follow-up period was 15.4
months. Using the seroprevalence data, the adjusted odds ratio (OR) of HIV positivity associated with recent NEP use was 2.3 (95% confidence interval [CI]:.6-3.4).There were 89
incident cases of HIV infection with a cumulative probability of HIV seroconversion of 33%
for NEP users and 1 3% for non-users (p<0.0000 I). In a nested case-control analysis of NEP
participation during follow-up as a predictor of seroconversion, we investigated exclusivity
and consistency of NEP attendance, by categorizing users depending on whether subjects
obtained or not their IV equipment from other sources (exclusive), and whether they
reported NEP use at all visits, using baseline and follow-up questionnaires (consistent).
ThEre wre se ubstantial risk elevstirns for er lusie (OR 4.2, Cl: I.5-I I.5) and nonmexuae
NEP osrs (OR: 5.a, ci. 1.6-6.7). relative to notoc usens o NEP, ev'en after adjustment uor
an extensve list of empirical confounders. Cons stent NEP use was strongly predictive of
DIV seoconverstrot duriny hollow-up (OR:lI0.5, I: 2.74 1.0).
Conclusion: Pamadomiaa Is elewrions hor DIV inhection associed mith NEP attendarnce
wero subatsati and cocarstent as all three aisIn assmeni scenarios ass our cohort of lOUt,
dospate orionshe adjusim nor confounder s.Thoe results are in nk disagreeement wih
tho erpeciod puhli health impac on NEPa.Wo have developed qualitative studoe to spochf
cally address thos ofhndinys and thea io xtaral idity.
June Bruneau, Hipital Saint Luc 058 Saint-Den s, Montreal PQ. Canada H2X 3J4
Telephone: [phone], Fax: [phone], email: bruneauj(oere.umontreal.ca

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