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

Track C: Epidemiology and Public Health
condoms because they didn't believe that they could be contaminated by their partners.
This also shows that the concept of"Risk Group" is still present in the general population
From these results we concluded that specific campaigns must be done to advise and stimulate the women's participation in specific health programs and if possible with their part
ners.
A. E. B. Miranda; AvVitoria, 1227 -Vitoria - ES - Brasil. CEP 29,040 331 Tel.: [phone]
Fax: [phone]
Tu.C.2445
FACTORS ASSOCIATED WITH HIV INFECTION AMONG WOMEN IN SAO PAULO,
BRAZIL
Luppi, Carla G*, ElufNeto J., Lapschick, M.**. Faculdade de Medicina, USR Sao Paulo, SR
Brasil; COA-DST-AIDS-Henfil, PMSR Sao Paulo, SR Brasil
Objective:To determine factors associated with HIV infection among women seeking a
public health service that offers anonymous testing in Sao Paulo, Brazil.
Methods:The study was carried out in a public health service that offers anonymous testing
for HIV. In this service, situated in the center of Sao Paulo city attenders are interviewed
when returning for HIV result. Information obtained include sociodemographic characteristics, sexual behavior; sexual partner behavior, condom use, history of injection drug use
(IDU) and history of sexually transmitted diseases.The 3,995 records from all women who
returned for HIV result between January 93 and June 95 were abstracted.
Results:The prevalence of HIV infection was 6,0%.The following factors were found significantly associated with HIV infection: history of IDU (odds ratio (OR - 10.3, 95% confidence interval (CI) 5.8- I 8. I); sexual partner with history of IDU (OR - 5.5, 95% CI 4.0 -7.5); history of syphilis (OR - 2.9, 95% Cl 1.8 4.7); heterosexual partner with multiple partners (OR - I1.5, 95% Cl I. I-2. I); educational level less than complete high school (OR =
2.7, 95% CI 2.0-3.6); marital status - single vs. married (OR = 0.5, 95% CI 0.4-0.7); condom
use - (OR - 0.6, 95% Cl 0.5 0.8). Number of sexual partners in the previous year, type of
sexual intercourse and having had a bisexual partner were not found associated with HIV
infection.
Conclusions: History of IDU and having had a sexual partner with history of IDU were
strongly related to HIV infection among women seeking a service for anonymous testing in
Sao Paulo city Condom use was significantly associated with a decreased risk. Infected and
non-infected women were very similar according to number of sexual partners in the previous year.
C. G. Luppi, AV. Dr. Arnaldo, 455-Sao Paulo-SP Brasil, CEP 0 I 246-903.Tel.: (55 I 1)8526822;
Fax: (55 I 1)280789 I
Tu.C.2446
WOMEN AND HIV INFECTION IN RIO DE JANEIRO - BRAZIL
Grinsztejn, B,Veloso,VG., Gonzales, D., Galhardo, M.C.G., Azambuja, Rodrigo, DoValleF.,
Guimaraes,M.R. Evandro Chagas Hospital/loc/Fiocruz
The epidemiology of HIV in Brazil has changed dramatically in the past decade, primarily as
a function of an increase in heterosexual HIV transmission. Given this shift in epidemiology,
it is critical to study the presentation of HIV in our female population.
Objective:To describe the characteristics of HIV infected women followed at the Evandro
Chagas Hospital(HEC) from 1990-1995.
Methods: Retrospective study reviewing charts of all women followed at the HEC from
1990 to 1995. Cdc-87 was used to classify the patients' HIV status.
Results: A total of 142 women were followed during this period.The majority of them were
registered at the HEC after 1992 I 15(8 I%). Mean age was 3 1, risk factors associated with
HIV infection were an HIV positive partner in I 9(83.8%), HIV positive iv drug user partner
17(I 2%), blood transfusion in 6 (4.2%).The majority of them were from outlying poor areas
of Rio De Janeiro I 27 (90.7%). Forty six (32.8%) have 3 or more children. At the initial visit
103(72.6%) were classified as group ii/giii, 28(19%) as iv, and 10 (7%) as AIDS.To date
19(14.7%) have died, and 13 (9%) have been lost to follow-up.The most frequent 0.1 were
candidiasis 55 (38.7%), bacterial respiratory infection 20(14%), tuberculosis 19 (I 3.4%), PC.P
I I (7.7%), CMV 8(5%), and toxoplasmosis 5(3%),. Only 34 (24%) received gynecological
examinations. Six (I 8.8%) had abnormal pap smears, with HPV being found in 2(33%) of
those that were abnormal. AZT use was reported in 78(55.3%) and PC.P prophylaxis in 74
(52%).
Conclusion: According to Brazilian AIDS program data, we could observe an increase in HIV
infected women was observed over the last 4 years. In our cohort the most frequent risk
factor was an HIV partner. After candidiasis, bacterial respiratory infection was the most
common manifestation associated.The small number of gynecological exams performed in
this group indicates the need for improvement in the quality of overall care of HIV infected
female patients and the need to address the HIV related issues specific to women.
Rodrigo Azambuja Fax: 55 2 I 246 0493 Rua: Alzira Cortes, 5/308, Rio De Janes o Br-azil.
Cep 22260-050
Tu.C.2447
THE B.C. POSITIVE WOMEN'S SURVEY: SOCIODEMOGRAPHIC CHARACTERISTICS,
HEALTH STATUS AND ATTITUDES TOWARDS MEDICAL CARE
Kirkham, Colleen M, Lobb, D. University of British ColumbiaVancouve, BC, Canada
Objective: To obtain a sociodemographic profile and to determine risk factors, health status
and level of satisfiction with medical care of HIV positive women in British Columbia,
Canada.
Methods: Self administered questionnaires were distributed to HIV positive women
through community organizationsVancouver HIV clinics, physicians' and dentists' offices and
the street nurse clinic. Information was requested on demographics, issues relating to HIV
testing, frequency of specific psychosocial stressors. HIV related illnesses, health care utilization and level of satisfaction with medical care.
Results: A preliminary analysis of 85 respondents revealed that 69% of the women were
between the ages of 25 39, 98% were from developed countries and 86% were Caucasian.

Many (39%) did not complete high school and 5 1% reported a household income
<$20,000 per year. Fifty-three per cent of respondents were mothers and I 2% of those
had HIV positive children. Forty-five per cent reported being sexually abused as a child.The
majority (54%) reported sex with a man as their only risk factor for HIV infection, 20%

Tu.C.2445 - Tu.C.2450
reported both intravenous drug use (IDU) anrid sex with a man, and 12% reported IDU
only Over one half of the women felt that they had received inadequate pre and post test
counselling and 10% were not aware that they were being tested for HIV The most Ire
quent medical problems were recurrent vaginal infections (61%) and cervical dysplasia
(33%). Sixty nine per cent experienced changes in their menstrual cycle. Most recent CD4
counts had a mean of 387 (range 2-1400), and 43% of women with CD4 counts less than
500 were taking antiretrovirals. Only 45% of the women were satisfied with the caire they
received from their doctor. Psychosocial concerns identified to be of greatest importance
were not having enough money lack of intimacy or satisfying sexual relationship, and fear of
rejection/discrimination.
Conclusions: Our findings provide a profile of HIV positive women living in British
Columbia, Canada. Some HIV related problems are unique to women.The high incidence of
previous sexual abuse and menstrual cycle changes may warrant further study. Improved
education about HIV/AIDS in women for health care professionals may be of benefit.
C.M. Kirkham and D.J. Lobb, 218-2760 West Broadway, Vancouver B.C.,V6K 2G4 Canada
Telephone: [phone], email: [email protected]
Tu.C.2448
WOMEN HAVE PARTICULAR ISSUES THAT ARE NOT WELL SERVED BY MAINSTREAM AIDS SERVICE ORGANIZATIONS
Taylor Darien. AIDS Committee of TorontoVoices of Positive Women
Issue: Mainstream AIDS Service Organizations tend to emphasize HIV education and prevention and do not provide services geared to the particular needs of wonmen.
Project: Darien Taylor and Andrea Rudd received funding from the AIDS Community
Action Project (ACAP) for funding to start an agency for women living with HIV/AIDS in
Ontario.The goal of Voices of Positive Women was to develop and begin irmplementing a
strategy designed to mobilize HIV/AIDS infected women to work together to establish a
"consumer controlled" organization in Ontario dedicated to improving the length and quali
ty of life of HIV positive women.
Results: Voices of Positive Women is only one of 2 agencies in Canada that provides services exclusively to women living with HIV/AIDS.We presently have a memrbership of 175
women with an average growth of 3 new members per week. Among the many services
we provide, ourTreatment Access Fund is the most popular because it allows our members
to access alternative treatments and vitamin supplements not covered under the provincial
plan.
Lessons: Voices of Positive Women was one of the first agencies to pick up on the shift in
demographics in the AIDS epidemic. Our organization provides services identified as most
needed by women living with HIV/AIDS, we are member driven and our Board of
Directors is the only one of its kind in Canada, comprised only of HIV positive women.
Darien Taylor, 399 Church Street,Toronto, Ontario, M5B 2J6 Canada Telephone: [phone] Ext 261 Fax: [phone]
Tu.C.2449
WOMEN AND HIVTESTING IN ONTARIO
Maor Carol*, Galli R*, Fearon M*, Palmer R" Brown D*, Calzavara L"*, Ofner M****.
*HIV Laboratory Ontario Ministry of Health,Taronto, Canada; H**IV Project Centre,
Sunnybrook Health Sciences Centre; "*HIV Studies Unit,. University of Toronto;
****Laboratory Centre for Disease Control
Objective: To determine HIV testing patterns, prevalence and incidence of women in
Ontario, a province with a population of I I million and 40% of the AIDS cases in Canada.
Methods: An HIV database which contains demographic information on all diagnostic testing carried out in Ontario (1985-1995), was retrospectively analysed. In addition, 1994 and
1995 data was enhanced through a physician questionnaire to ensure completeness with
respect to exposure category and other demographic information.
Results: Women represent 52% of all testers (n 1.6 million tests). 86% of women test
once only while 14% test at least twice.The mnost common reason for testing is history of
blood transfusion (54%) followed by heterosexual exposure (8.6%) and IDU (6.2%). Overall
prevalence rates have remained stable since 1992 at 1.6 per 1000 tests, but are highest
amongst women originating from endemic areas(13.5/1000 tests) and IDU ( 1.5/1000
tests).Women represented <3% of HIV positive cases prior to 1988, but in 1994 corn
prised 17% of HIV positive cases. A total of 1,189 women have been diagnosed with HIV
infection. Enhanced data indicates that 26.2% are IDUs, 23.3% originate from an endemic
area, 24.7% acquired HIV through heterosexual transmission (and do riot orginate flrom an
endemic area), 15.6% were infected through blood transfusion and 10% have no identified
exposure category Mean CD4 count at time of first positive test is 477 which is higher
than males (377) (p=0-.08). Seroconversion rates amongst repeat negative testers have
remained stable since 1992 at 0.07 per 100 person years (95% CL 004,0 12) cominpared to
males at 0.44 py (CL 0.3 I, 0.60). Increasing incidence density was observed amongst female
IDUs, from 0.5 per 100 person years(CL 0.05,1.99) in 1993 to 1.43 per i00 py in 1994 (CL
0.4.3.3).
Conclusions: Women in Ontario are aware of HIV and seek testing freely Higher CD4
counts suggest women are being identifled earlier in the course of HIV infection than men.
Women represent an increasing proportion of the HIV epidemic and seroconversion rates
are highest among IDUs.
Carol J. Major HIV Laboratory Ontario IMinistry of Health, 8 I Resources Road, Etobicoke,
Ontario, Canada, M9P-3T I. Phone: (4 I 6) 235-6096. Fax: (4 I 6) 235 6194.
Tu.C.2450
AIDS PREVENTION IN HETEROSEXUAL WOMEN WITH STABLE PARTNERS
Bascunan. Ana Cecilia. Instituto de Ia Muier Santiago, Chile.
The purpose of the project is to design and apply an AIDS prevention strategy on heterosexual women with stable partners fl-om a gender perspective, through the identification of
elements that will allow us to understand, question and reelaborate the barriers (psycological, social, cultural, economical and legal) that limit women's capacity to choose and make

decisions about their sexuality and about the access and handling information.
At the beginning the project presents the conclusions of a diagnosis done on focal groups,
women's attitudes and creeds in relation to AIDS. and about the identification of people
who can work on changing their own conducts From that diagnosis the project takes the,,o
ON
0
U
u
>
C
0
U
Q)
Q)
C
c
0)
c
L)
c
x
C
CO
a
(0)
342