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

Tu.C.2425 - Tu.C.2429

Tuesday July 9, 1996

Conclusions: Women who engage in both anal and vaginal intercourse were at double risk
of HIV infection. Male-to female transmission showed high efficiency in Rio de JaneroBrazil.
The lack of female-to-male transmission may express a relatively early phase of epidemic
among heterosexuals or lesser risk of insertive partner compared to receptive ones. Some
of alleged heterosexual rle s may lacked frankness about same gender sexual contacts and
IVDU
Fer nado Samuel Sion. University of Rio de Janeiro. Gaffiree and Guinle Hospital Rui Mariz
e Barros, 775/1 ijuca/Rio de Janeiro.Tels. 55 2 i 264 1620 FAX [phone]
Tu.C.2425
MALE SEXUAL BEHAVIOR AND WOMEN RISK FOR HIV INFECTION IN RIO DE
JANEIRO, BRAZIL.
Morai de Sn C.A., Son, F. S., Moura, E. M., Oliveira, E. R., Meira-de-Vasconcellos;, Borges, M.
R. Gaffree and Guinle University Hospital University of Rio de Janeiro, Rio de Janeiro,
Brazil.
Objective: To study male sexual behavior which could be responsible for male HIV infection
and male- to female transmission in Brazil.
Methods: 365 men (ages from 14 to 60 yrs) have been studied from 1990 to 1995 at the
Anon/mous Counseling and Testing Site, Gaffree and Guinle University Hospital, National
AIDS Referral Center in Rio de Janeiro, Brazil, concerning their sexual behavior, practices
and safer sex. A questionnaire was administered by personal interview. Questions explored
the history of risk fiactors, the number of sexual partners, regular sexual practices and use
of condoms.
Results: The sexual orientation in 365 men interviewed revealed 202 (55.3 %) heterosexual, 92 (25.2 %) bisexual and 71I (I 9.5 %) homosexual. Male heterosexual behavior comprises: one female partner 62(30.6%), multiple female partners 61(30. I%), multiple female partners and seixual ontact wit h prostitutes 50(24.7%), collrective sexual practices 16(7.9%),
sexual contacrs t with prostit cutes 13(6.4%). Male bisexual behavior comprises: with only one
female and male partner 42(45.6%), multiple female partners 21(22.8%), sexual contact
with femalen prostitutes 14(1 5.2%),multiple female partners + sexual contact with male and
fesmale prostitute + collective sexual practi ces 5(5.4 %), sexual contact with female and
male arostitutes 3(3.2%), with collective sexual practices 3(3.2%), multiple female partners
+ collective sexual praictices 2(2. %), sexual contact with female prostitutes + collective
sexual practices 2(2. I%). Male homosexual behavior comprises: multiple partners
44(61.9%), prostitutes and collective sexual practices 11(15.4%), one stable partner
9(I 2.6%), collective sexual practices 7(9.8%). Most of the individuals studied (n-204) rarely
(I 6,2 ) or never (39,7%) used condoms.
Conclusions: Male multiple high risk practices may explain male HIV infection and male-tofemale transmsson in Rio de Janeiro, Brazil. Diversity of sexual practices among sexual
partners in Latin America culture seems to be more widespread then generally appreciated.
To acknowledge real human sexuality as major component in HIV epidemic is essential to
design adequate educational program to reduce the spread of HIV in Brazil and other Latin
America Countries.
Carlos Alberto Morals de Si, University of Rio de Janeiro. Gaffree and Guinle Hospital Rua
Mariz e Barros, 775/Fijuca/Rio de Janen-o.Tels. 55 2 1-264 I 620 FAX [phone]
Tu.C.2426
EFFICIENT TRANSMISSION OF HIV- I SUBTYPE B AMONG WOMEN THROUGH
HETEROSEXUAL CONTACT IN NEWFOUNDLAND, CANADA
Montpetit Michael (, Ratnam 5*, Campbell C*, Gleeson T, Frenette St, Donovan C*,
Tollefson J(J. ( Health Canada, Ottawa, ON, Canada; Newfoundland Department of Health,
St. John 's. NF, Canada
Objective: To determine the HIV I subtypes in a cluster of HIV positive women who
acquired the infection through brief heterosexual contact.This study was carried out as part
of a cluster investigation.
Methods: Thirty two HIV+ volunteer(s (i9 male; 1 3 female), including at least 5 thought to
be infected from a common source, were studied. Fourteen of the 32 represented a cluster
of HIV infection in a community and the rest were sporadic cases.The volunteers were
interviewed to ascertain risk activity and gather relevant data. Proviral DNA from the blinded samples was amplified by the polymerse chain reaction before cloning and automated
and manual DNA sequencing. Sequence alignment and phylogenetic analysis was performed
with the CLUSTALW and VESPA computer programs.
Results: All 32 volunteers, representing approximately 23% of all known HIV persons in
Newfoundland, at that time were determined to carry HIV I subtype B virus. A single phylogenetic branch was composed of I 2 women and 2 men representing the cluster involving
14 personaris. For the 12 women, the only identifiable risk factor was heterosexual sex and a
brief exposure to suspected source(s).They listed only a few (2-4, mean 3) unprotected
sexual contacts with the suspected common source(s) of infection. None of the women
reported anal or traumatic sex as possible infectivity-increasing factors.
Conclusions: Recent reports have suggested that HIV I subtype E is inherently better suited to heterosexual transmission than HIV I subtype B. We report that subtype B may be
tr-ansmitted with equal efficiency heterosexually and that fiactors other than genetic subtype
are required to explain the relative efficiency of HIV transmission by different routes.
M. Montpetit, HIV Genetics, 1000D I Virus Building, Ottawa, Ontario, K IA O2 Canada.
Tel.: [phone]; Fax: [phone] emal: [email protected]
Tu.C.2427
IDENTIFICATION OF A SITE FOR A LONG-TERM COHORT STUDY ON THE
NATURAL HISTORY OF HIV INFECTION AND AIDS IN ETHIOPIA
Sahlu T*, Rinke de Wit TF*, Messele T*,Yeneneh H.**, Bindels PJE.#, Coutinho RA.#,
Fontanet A.#. *Ethiopian-Netherlands AIDS Research ProjectAddis Ababa, Ethiopia,
**Ethiopin Health and Nutrition Research Institute, Addis Ababa, Ethiopia, #Municipal
Health Service Amsterdam, the Netherlands.
Objective: To evaluate the feasibility and acceptabilty of a long term cohort study (8-10
years) on the natural history of HIV nfection and AIDS in Ethiopia.
Methods: 1I204 indivduals aged 15 54 living in the Wonj Sugar Estate (semi-rural area
100kms south of Add s Ababa) were randomly selected to be part of a pilot survey from
November I995 on.

Results: To date, 256 (87%) of the first 294 selected individuals agreed to be enrolled.
Eighty-two (77%) of the 106 males aged I 8-44 intend to stay for the next ten years in the
sugar estate.When told about a long-term research project on HIV/AIDS and other parasitic infections, 251/256 (98%) of the study subjects are willing to participate. Five out of
256 (2%) individuals (all males) were found HIV-positive despite the proximity (I 0kms) of a
town known for high HIV-prevalence and some acknowledged risky behaviours: 22/251
(9%) participants have had a casual par tner in the past twelve months, 28/255 (I %) have
had a history of sexually transmitted diseases in the past five years, 29/254 (I 2%) have had
more than five sexual partners in their lifetime, 242/25 I (96%) never used male condoms,
and 19/I 54 (I 2%) of males have had sexual contacts with sex workers in the past five
years. In a multivariate analysis, being 20-29 or 40-49 years, having been absent from the
sugar estate for more than four months since living there, and having a history of genital
ulcer disease were found independent and significant (p<0.05) predictors of HIV I seropos-.tiviiy
Conclusion: In this stable semi-rural population, 98% of the individuals would be interested
in participating in a longterm research project on HIV/AIDS. However, the relatively low
HIV prevalence makes a study on the natural history of HIV infection difficult in this populatior.
T Sahlu, ENARR Ethiopian Health and Nutrition Research Institute, P0. Box I 242, Addis
Ababa, Ethiopia. Phone 25 I - I - 130642, fax 25 I - 1-752533.
Tu.C.2428
HETEROSEXUALS AT HIGH RISK OF HIV-INFECTION IN ITALY.
Grossi Patrizia,Verdecchia A. Istituto Superiore di Sanita, Roma, Italy
Objective:To determine the HIV estimates and projections for the future and to evaluate
the real risk for people infected through heterosexual contacts.
Methods: A back-calculation procedure (a generalization of standard methods) has been
used to reconstruct the epidemic of HIV infection in three main risk categories and also to
make projections for AIDS in Italy in an endemic situation with infection rate remaiing
constant and equal to the one estimated in 1992.
Results:The increase in AIDS cases in the IDUs category Rs giving less cause for concern
due to a raised awareness of the risk of HIV transmission; on the other hand, the increase
in AIDS cases in the heterosexual category is causing greater concern. Since 199I heterosexual contacts represent the second major risk category after IDUs with regard to the
number of cases for people of both sexes in the age between 14-74 years.The annual rates
for heterosexuals category have shown an alarming increase in 1993 in the region of 35%
with respect to 19% among homosexuals and to 7% among IDUs.

Tabe I Number of AIDS cases 5nd pro ened number of new AIDS

icases by thre e r risk cteones

82-86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000
ii 421s ss 706 25 1692 2 12 252 s 3044 3057 2997 2922 289 2700 2570 2439
1 tO 5-1 5s, ~ UA[ 161 171 28 37 161 37 i m,!, '10 75 696 716 is, '52 780
111 i 51 5C>5 3ALS 35 77 I 259 389 5,6 16 7 ii as400 i441 s 15,-} 167i 71 sr1843
Incidence of HIV infections estimated by gender and age class in the heterosexual group
reveals a higher risk of HIV infection for females and for people of both sexes in the 25 to
35 year age-group.
Conclusions: A new epidemic round of HIV infections is going on in Italy, indicating that
people infected by heterosexual contact are even more at high risk.These results suggest
the necessity of implementing a preventive program to prevent heterosexual transmission
of HIV in addition to conventional programs on high risk categories.
P CGrossi,Viale Regina Elena, 299, 00161 Roma, ItalyTel: [phone] Fax: [phone], Email: [email protected]
Tu.C.2429
TRADITIONAL PRACTICES AND HIV TRANSMISSION IN SENEGAL:THE EXAMPLE
OF LEVIRAT AND SORORAT.
Sow Papa Salif, Gueye B, Sylla, Coil-Sock A.M. Department of Infectious Diseases Fann
Hospital Dakar University BP 5035, Senegal.
Issue:Traditional practices regarding sexual behaviour remain very common in Senegal
Despite the HIV epidemic these practices still uptodate with a risk of HIV transmission.
Methods: In Afriica, marriage constitutes an essential step in the life of nearly everyone. It
consacrates the union of two partners of the opposite sex.The practice of levIrat or wife
inheritance, is a traditional form of alliance consisting of the remarriage of a widow to one
of the brothers of her deceased husband, usually to his next youngest sibling. Sorort is an
arranged marriage which aims to redefine a matrimonial alliance by marrying the younger
sister of a deceased woman to her surviving husband.This study carried out at the
Department of Infectious Diseases at the Dakar University Hospital poses the specific
problem of HIV transmission in the family due to traditional socio-cultural marriage practices in Senegal such as levirt and sormort.
Results: 7 cases of levirat with an HIV I seropositive widow were collected from January
1991 to December 1995. Of the 7 cases, the 4 new husbands were tested after the collaboration of the wive and their informed consent. Despite the counseling, the 3 remaining
HI\/ positive wives didn t give their consent for announcing the HIV seropositivity to their
husband.Three of the tested new husbands were HIV positive, contamined by their wives
throught the levirat practice. All these new husbands didn't have any HIV risk factors before
their wifes inheriting
Conclusions: Aside from these practices, the very real problem which surfaces is that of the
remarriage of a widow who is HIV positive.These issues highlight the difficulties of HIV prevention and counseling in Africa and the complexities of legal and ethical questions posed
by the spread of HIV
Papa Salif Sow Department of Infectious Diseases, Fann Hospiral BP 5035, Dakan Senegal.
Tel [phone] Fax: [phone]

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