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

Tuesday, July 9, 1996

Tu.C.334 -Tu.C.342

23% in older adults. Most of these couples report that they are coming for pre-marital testing.
Previous evaluations indicated that persons receiving CT at AIC were highly likely to adopt
and maintain preventive behaviors, including partner reduction, abstinence, and condom use.
Lessons Learned: Young people in Uganda have high awareness of AIDS, are increasingly
requesting HIV CT and apparently many young couples are discussing their sexuality together Demand for pre-marital testing is increasing, and AIC provides this along with intensive
prevention counseling. Provision of voluntary and confidential CT for young people is an
important element in prevention programs targeting youth in developing countries.
Edmund Gumisiriza, AIC, PO. Box 10446, Kampala, Uganda Tel: 256-4 I -231-258
Fax: [phone]
Tu.C.334
CROSS-CULTURAL EXPERIENCES IN PROMOTING EFFECTIVE PREVENTION
AMONG YOUTH IN DEVELOPING COUNTRIES AND AS NEW IMMIGRANTS
Chitt ick, John B., Ed.D. Harvard University School of Public Health, Boston, Massachusetts
Issue: Adolescents who are caught between two cultures are at higher risk for HIV/AIDS
because they do not receive the full information necessary for prevention strategies to work,
due to cultural and bilingual barriers while living in two different societies. How best to
assimilate and interact with culture-specific messages in a foreign environment is the issue.
Project: Youth peer educators were trained to do street outreach in their communities and
barrios.They were taught how to survey other bi-cultural students regarding their perceived
vulnerability to HIV/AIDS in Ho Chi Minh City (Saigon),Vietnam; Santo Domingo, Dominican
Republic;Toronto, Canada; and Boston, Massachusetts, USA. Over one thousand students
from urban schools and city streets were surveyed using revised KAPB questionnaires
regarding problems in understanding AIDS prevention messages when living and/or traveling
between two cultures with their families. In-depth interviews with 75 bi-cultural students
were also conducted (videotaped for showing to peers, researchers, and conferees).
Results: A mrajority ofViet Kieu (Vietnamese in North America) and Latino (Dominicans in
North America) students reported they were frustrated by their inability to fully comprehend societal messages about their vulnerability to HIV/AIDS because of the mixed cultural
messages received at home and school. Students living in developing countries reported
receiving consistent but incomplete instruction on HIV prevention techniques due to cultural and social prohibitions against the public discussion of sex. Students who emigrated to
the United States and Canada reported receiving inconsistent instruction, but acknowledged that school-based information is more complete in countries with medically-sound
education. Students discovered practical ways (role-playing, street drama, peer counseling,
PLWHA outreach, etc.) to help.
Lessons Learned: Students made a number of key recommendations to improve prevention
education for other vulnerable, bi-cultural youth. Because many young people have learned
that AIDS is now a global pandemic, there appears to be a greater feeling of solidarity
among youth educators who are taking the prevention message to other peers at risk.
Dr John B. Chittick, Ed.D., 43 Charles Street, Boston, MA 02114, USATel. 617-742-1325
FAX: [phone] email: [email protected]
Tu.C.335
SEXUAL BEHAVIOUR AND HIV RISK AMONG UNIVERSITY STUDENTS FROM
PORTUGUESE SPEAKING AFRICAN COUNTRIES.
Virella, Daniel, MourLo. Maria Vitria. ISCSP Instituto Superior de Cifncias Sociais e Politicas,
Technical University of Lisbon, Portugal.
Objective: Compare sexual behaviour and risky behaviours for HIV infection between
Portuguese speaking African countries migrant students frequenting portuguese universities,
and Portuguese University students.
Methods: A self administered questionnaire was applied in 1996 to 3000 university students in Lisbon Universities. Data analysis was performed stratifying four cohorts defined
by birthplace (Portugal or Africa) and residence before university admission (Portugal or
Africa). Statistical analysis was performed using Chi square significance, Fisher test and
ANOVA, as appropriate.
Results: Among males: African students (AS) initiated sexually earlier than Portuguese students (PS); more AS are sexually active than PS (98% Vs 85,3%); both groups have stable
sexual partners (60%) but fidelity among AS is lower (77,2%Vs 52,9%); perception of mate
fidelity is lower among AS (50%Vs79,7%); condom use is equally frequent in both groups
(30% always, 20% never); more AS ignore the past sexual life of their partners (46,3% Vs
27,8%): auto-reported prevalence of STD is higher among AS (25,5% Vs 4,3%); HIV testing
is more frequent among AS (34,8% Vs 15,7%); no infection cases are reported but 52,4% of
AS Vs 26,5% of PS do not know the result of performed tests. Among females: AS initiated
sexually earlier than PS (mean I15 Vs 17 years); both groups have stable sexual partners
(70%), fidelity is equal in both groups (90%) but perception of mate fidelity is lower among
AS (33% Vs 80%); condom use is less frequent in AS (7, %Vs 17,3% always; 34% never);
more AS ignore the past sexual life of their partners (40% Vs 9,8%); HIV testing is less frequent among females (6% and 9%); no infection cases are reported.
Conclusions: Gender and cultural differences lead to different patterns of sexual behaviour
among university students. In spite of higher prevalences of infidelity and STD, African students protect themselves as seldom as Portuguese students. Specifically targeted information is needed to reach young population particularly those with African origins.
Maria V. Mouto; Instituto Superior Cifncias Sociais e Politicas Rua da Junqueira n~86, 1399
Lisboa Codex. Portugal;Tel 00351 I 4425190; Fax00351 I 3642081 I
Tu.C.340
MOTHER TO CHILD HIV TRANSMISSION ASSOCIATED WITH DURATION OF THE
SECOND STAGE OF LABOUR
Lapointe Normand*, Samson J), Ag Bazet A*, Boucher M*, Fauvel M**,Tran T*** Hankins
C***. *Centre maternel et infantile sur le sida, Hfpital Sainte Justine, *Laboratoire de
sante publique du Quebec, ***Direction de la sante publique du Montreal-Centre,
Montrdal (Qudbec) Canada
-Objective: To study factors associated with mother to child transmission and in particular the
duration of the second stage of labour (cervical dilatation of 10 cm to expulsion of infant).
Method: This prospective study involved 97 pregnant women and 109 children. Sixteen
women received ZDV during pregnancy Information on sociodemographic, behavioural,

immunologic, virologic factors, clinical and intrapartum events was collected during pregnancy and at delivery Infant HIV infection was confirmed by 2 positive HIV cultures. Statistical
analyses used Wilcoxon, median test, T-test (Satherwaite), Fishers exact test. Multivariate
analysis used logistic regression.
Results: Overall rate of transmission was 25.7% (25 infected, 72 non infected, 12 undeterm.). 7 I women had vaginal delivery; duration of the second stage of labour was strongly
associated with transmission (p-=0.002). After controlling for ZDV use, mean duration of
labor was 66.5 min for I 8 infected vs I 6.7 min for 31 non infected children (p < 0.00 I).
For primiparas duration was 82.4 min for 9 infected vs 20.2 min for 10 non infected
(p-0.14) and multiparas, 50.6 min in 9 infected vs 10.2 min in 21 non infected (p=0.004).
ZDV reduced transmission (29.6% to 6.25%) (p=0.04). Duration of rupture of membranes
was suggestive of transmission (mean -= 5 I 8 vs 340. I min) but did not reach significance
(p=0. I I). CD4 cells lower than 300 (p=0.0 I) anid CD4/CD8 ratio below 0.75 (p=0.08)
were associated with transmission, as was breast feeding in 7 cases (p-0.064). Females
were more likely to be infected than males (35% vs 19%, p 0.067). No relation was fiund
between maternal age, clinical status, STD, chorioamniotitis, spontaneous or induced labor;
internal monitoring, mode of delivery, p24 Ag in serum of nother, prematurity and weight
of newborn. In logistic regression involving 97 subjects, the second stage of labour (OR:
6.35, p < 0.001) and ZDV use (OR: 10.22, p-0.034) remained significant.
Conclusion: In this cohort, the enfant's longer contact with cervical and vaginal secret ons
increases the risk of HIV transmission from mother to child.
Normand Lapointe, Centre maternel et infantile sur le sida / Hfpital Ste-Justine 3175
Chemin de la cote Ste-Catherine, Montreal (Quebec) H3T I C5
Teldphone: [phone], Fax: [phone], Email: cmis@)ERE. UMontreal.CA
Tu.C.34 I
PLACENTAL RISK FACTORS FOR THE VERTICAL TRANSMISSION OF
HIV-I IN UGANDA
Wabwire-Man en F I, Gray RH2, Mmiro FA 1,Wabinga H I, Abramowsky C3, Ndugwa, C,
Saah AJ. Makerere University Kampala Uganda, 2Johns Hopkins University Baltimore
Maryland, 3Emory University Atlanta Georgia.
Objective: To assess whether the presence of placental pathology in HIV seropositive
women increases the risk of vertical transmission of HIV.
Methods: A cohort of 171 HIV seropositive pregnant women enrolled at 28 weeks of ges
tation were followed through delivery and the placenta examined grossly and histopatho
logically Specific pathology including funisitis, chcrioamnionitis. villitis, plasma cell deciduitis
and intervillitis was assessed for its effect on the risk of vertical transmission of HIV I. HIV
transmission was defined as having HIV I antibody at 15 months of age or a positive PCR
at 6 months in those babies who died before 15 months.
Results: Of the 171 HIV seropositive women, 4 I (24%) were transmitters and 130 (76%)
were nontransmitters.The placental membrane inflammation types i.e funisitis and chorioamnionitis were associated with increased risk of HIV transmission. Funisitis significantly
increased the risk of vertical transmission (OR=2.49; 95% CI= I. I 0-5.6 I), while the increased
risk in vertical transmission in women with chorioamnionitis (OR=3.58; 95% CI= 1.4 I-9.10)
was dependent on the stage of HIV infection.There was no significant association between
placental villous inflammation types such as villitis, plasma cell deciduitis and intervillitis or any
of the gross placental factors and vertical transmission. Other non-placental factors independently associated with vertical transmission included maternal skin rash eand wis ulceration
Conclusion: Placental membrane inflammations increase the risk of vertical transmission of
HIV infection but this increase may be dependent on the stage of HIV infection. Public
health interventions targetting the decrease of placental membrane inflammations are
required to decrease the risk of vertical transmission of HIV.
F. Wabwire-Mangen, Institute of Public Health, PO. Box 7072 Kampala, Uganda.
Fax: 256 4 I -54500 I IEmail: [email protected]
Tu.C.342
MATERNAL AND OBSTETRICAL FACTORS IN MOTHER TO CHILD TRANSMISSION
OF HIV IN SOWETO, SOUTH AFRICA.
McIntyre James A*, Gray GE*, Lyons SF*. *Perinatal HIV Research Unit, Baragwanath
Hospital and University of the Witwatersrand, **National Institute of Virology
Johannesburg, South Africa.
Introduction: Maternal condition and obstetrical factors such as the mode of delivery and
length of labour have been implicated in the determination of transmission of HIV frorm
mother to child.
Objectives: To investigate the relationship between maternal factors, progression of HIV disease, mode of delivery and other obstetrical events in the transmission of HIV from mother
to child at Baragwanath Hospital.
Method: Five hundred HIV positive women identified at the prenatal clinic have been
enrolled in a prospective follow up studyThe maternal medical and obstetrical outcomes
were followed and infants followed for eighteen months. Follow up included a full clnical
assessment, CD4 counts in mother and child and PCR analysis in children.
Results: An interim analysis of I 63 mother infant pairs has been undertaken. Over 95% of
the HIV positive women enrolled in this study had no clinical signs of AIDS, although 9.1%
had CD4 counts below 200/mm3.The overall transmission rate was 38.1 %.Where
Caesarean section was performed before the onset of labour transmission was markedly
reduced at 14.3%, [RR 0.37 (0.06-2.32)].This wAs not the case where Caesarean section
was performed after onset of labour (35%).The maternal condition, length of labour assis
ed delivery use of fetal scalp electrodes, episiotomy and duration of ruptured membrrnes
showed no significant association with HIV transmission. In this sample of predominanly
healthy HIV positive women, there was a non significant trend towards higher transmission
rates with CD4 counts less than 200/mm3 (43%).Transmission fl-om breastfeeding mothers
was 18% compared with 46% in those who formulr fed [RR 0.40 (0.21 074)].
Conclusions: HIV transmission appears to be affected more by mode of delivery rnd
choice of feeding than by the maternal condition or duration of labour in this group of
women. Appropriate interventions to provide elective Caesarean section or breast milk
substitutes for identified HIV positive women may be important in reducins mother to child
transmission of HIV in this developing world urban setting.
Dr James McIntyre, Perinatal HIV Research Unit, Baragwanath Hospital, PO Bertsham, 2013,

South Africa.Tel & Fax: +27- I 1-938- I1534, e-mail: mcintyre (@pixie.co.za,,0
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