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

Track C: Epidemiology and Public Health
Results: All respondents knew at least one way of getting HIV/AID)S. and thii- roost commonly referred (70%) was sharing of injection equipment; 48% of tfe s-rIl)le mentioned
that they've changed behavior as follow: 36% reported condom use n-,. e, equently; 28%
reduced number of sexual partners; 12% quit using drugs (did not mertiois route). Fifty
two percent did not mention any behavior change: from those, 38% said "they don't care",
36% because it would not happen with me", and 23% reported "laIc of irifiesration".The
HIV- I seroprevalence in the whole sample was 20%. In the two sub sroup,,, it was 35% and
9% for IDU and CS respectively
Conclusions: Although the level of information in the overall transmi ssio oi iIV can be
considered high, behavioral changes do not reflect that knowledge. rs, if c a orough re-eval
uation of prevention efforts ainied at drug users should be carried o' it de u ease of HIV
infection rates in this population is desired.
Renata CS Azevedo,Rua Domingos Casotti 176 - Campinas/SRB az i8 000 Phone 55
192 427599 Fax [phone]
Tu.C.2493
HIV SEROPREVALENCE IN IDUS FROM SANTOS: GENERAL TRENDS AND GENDER
ANALYSIS
Azevedo-Neto, R.S.*+, Bueno, R.C.#+, Mesquita, F.#+, Haiek, R.#.Mo'fstin He.P i\lmeida,
L.N.B.*+. Castrignano, S.B.*+ & Profeto Brasil; *FMUSP; +NUPAIL)S/ iSP, IftPAS/SEHIG,
BRAZIL.
Objectives: To analyse trends in HIV seroprevalence of two cross sect t ral surveys among
IDUs carried out in 1991/92 (WHO Multicity Study) and 1994/95 (Prolelo r asil), both in
the City of Santos, Brazil.
Methods: A serial cross-sectiornal study, using data from the WHC)O nultcit study as the
baseline. 197 IDUs were enrolled in the first cross-section (1991/92) ranid 1t were
enrolled in the second (1994/95), both recruited by snowball sampling. Individuals were
interviewed about their risk behaviour for HIV infection and bled. Blood samples were first
analysed for antibodies anti-HIV using an ELISA commercial kit (EMBRAI3BIO). Positive samples were confirmed by Western Blot technique. Data from interviews will be the issue for
future analysis.
Results: High seroprevalence was observed in both periods with no sigrnificant difference
between the WHO Multicity study (61.42 + 6.82 %) and Projeto Brasil ( 7 18 _ 8.05%),
although there is an indication that the proportion of HIV positivity is increasing among
IDUs in Santos. However, when we compare data relating gender and HIIV positivity, there is
an increasing trend in the risk of acquiring HIV for IDU women, as hown in the table
below.
199 I-1992 1994-1915
male female p* male femiale p*

Tu.C.2493 - Tu.C.2497

HIV positive positive
HIV negative
total

68
50
118

53
26
79

0.2349 54 20 0 0483
27 2
81 22

Methods: Seventy two IDUs from both streets and treatment centers were interviewed in
Rio using three research instruments - a core questionnaire similar to the WHO multicenter collaborative study questionnaire for IDU's, the GHQ-12 (General Health
Questionnaire) designed to identify psychological morbidity, anrid an HIV risk behavior- ques
tionnaire developed at CAPS.We also measured the proportion of participants accepting
each HIV prevention intervention offered.Voluntary HIV testing was performed in the great
majority of the sample (97%).
Results: Needle and syringe sharing (NS), unprotected sex (US) with an occasional partner;
and high frequency of injection (FI >once a week) in the 6 months prior to the interview,
were reported respectively by 58%, 51% and 46% of the sample. High scores on the GHQ
(> 75%), that indicate psychological disturbance, were found in 73% of the sample but were
not associated with the risk behaviors studied (NS, US & FI) or serostatus. HIV seroprevr
lence was 29%. All participants accepted the intervention activities offered (a brief discus
sion on HIV prevention, leaflets, condoms, etc); however, very few asyirptomatic clients
returned for other proposed activities (eg. focus groups, additional information, etc). Only
symptomatic IIV infected patients returned to seek medical referral.The high acceptance of
iterventron actiities at the time of the initial questionnaire may have been that clients
were invited by a trained recruiter and offered a small amount of nioney to cover their
travel ecpenses.
Conclusions: These findings suggest the necessity of an adequate structure (psychological
assistance, more attractive strategies, etc.) in treatment/prevention centers for-IDU's, capable of coping with the high levels of psychological disturbance and low levels of adherence.
More specific psyhological tests should be performed to find reliable predictors of risky
behavior. since gereral levels of psychological disturbance found with the G!-IQ were very
high. Outreach work, reimbursement of travel expenses, and more attractive interventions
(e.g. needle ad yrngeexchange) are armong sor e client suggestions to enaance adherence to inter vention activities.
Arnna Rangel, Av. Rainha Elizabeth 4 I 6/10 I, Rio de Janeiro, RJ. Brazil CEP 2208 1-030
Telephone: [phone] Fax: 011 I 55 21 235 0646 e.mail: [email protected]
Tu.C.2496
EPIDEMIOLOGY OF HIV-I AMONG A SAMPLE OF INJECTING DRUG USERS (IDUS)
AND CRACK SMOKERS (CSS) IN CAMPINAS, BRAZIL
Manfrinatti Marcia B*, Silva Jose Antonio G*, Lima ES**, Azevedo RCS*. *Centro Corsini,
Camnpinas, SR Brazil; **NEPAD/UERJ, Rio de Janeiro, RJ. Brazil;
Objectives: To ascertain HIV seroprevalence and some sociodemrrographic variables in a
sample of IDUs and CSs, in a city which cocaine has a high prevalence of use.
Methods:The sample was mostly recruited in drug treatment centers located in Camrnpinas'
Metropolitan area.A cross-sectional study was performed between March/94 and July/95
using the Questionnaire developed for WHO's Multi City Study on Drug Injecting Behavior
and the Spread of HIV, over which, questions about crack use were added. All subjects vol
unteered and eligibility criteria included injecting behavior or crack cocaine smoking in the
last 12 months. After informed consent 256 drug users (I 10 IDU and 146 CS) were inter
viewed and blood samples were obtained to test for HIV I antibodies. All samples (either
negative or positive) were confirmed through Western blot; 6 I (24%) of the respondents
had, during their life-time, an intersection of injection and cocaine (crack) smoking.
Results:The sample is composed of 98.4% males, age ranging from I15 to 48 years of age
with mid point between 20-29 years (53%); 78% were single; 52% had regular jobs, 9% have
illicit sources of income; 57% have completed at least the first five years of school; 92% have
had legal problems. Use of alcohol was present in 84% of the sample, as well as marijuana
(79%).The HIV I seroprevalence in the whole sample was 20%. In the two sub-groups, it
was 35% and 9% for IDU and CS respectively. Miltivariate analysis of HIV serostatus and
the variables were performed and will be presented upon display.
Conclusions:Though recently introduced crack cocaine has rapidly gained familiarity armong
drug using subjects, in the Campinas-Sao Paulo region.Through oral reports, such drug
users proclaimr that they have changed to crack because it would be a "safer drug" in terms
of HIV infection. However data show that they continue to engage in other risk behavior,
which have kept them as target population for HIV infection.
Project sponsored by National AIDS Office, Ministry of Health, Brazil.
Marcia Manfrinatti, Rua Domingos Casotti,. 176, Campinas/SR Brazil - 13080 -030 Phone 55
192 427599 Fax [phone]
Tu.C.2497
RISKY BEHAVIORS REMAIN HIGH AMONG COCAINE INJECTORS IN RIO DE
JANEIRO, BRAZIL
Telles, Paulo R I., Bastos, F 12, Bastos IJr., Wulmar3, Friedman SR4, Projeto Brasil.I NepadUerj, Rio de Janeiro,Brazil; 2 Dis/Fiocruz,RJ, Brazil; 3 CredeqQ RJ, Brazil4 Ndri, NYC, NY,
USA.
Objective: To make preliminary comparisons between an ongoing Brazilian Iulticentric
study of HIV risk behaviors among IDUs (Projet Brasil -B) and a former sample belonging
to WHO Muiticit Project (W) in order to disclose possible changes in drug scene and risk
behaviors across time.
Methods:W recruited 479 IDUs, from both streets and treatment centers, between 1990 -1993. B recruited 72 IDUs using the sarne methodology and a similar core questionnaire,
between the end of 1994-1995. In B a higher blood test rate (97%) was obtained than had
been in W (27%). In B besides HIV-f/fl tests, [I--BV, HCVI HTLV-/Il and [I-V subtyping were
performed. Despite the still modest sample size, important behavioral differences could be
found even at this point.
Results:[ he two samples shared many similar basic characteristics raean age (32 years B
vs 28 W), predormnance of males (85% B vs 87% W) ald sirmilar raean,re of first injeclion: (13.8 yc'as B vs. 19.3 years V). Mate hoao/a sex actIMty i the last 5 yeas was
reportled 0/ 49%v of thae respordests in B vs. 3(a% mnW. Infected dirigs were: cocaine (90%
B vs. 99% W); opiates (15% B vs. 8%W): amphetamines (22% B vs. I% W); tr anquilizers
(I 0% B vs 0.2% W)a barbiturates (8% B vs. 0% W). MultidWu use appeared mr a huch
greater fieqitency than before, arid crack, tremor nmentioned me W, was used by 28v of thre
sample in B Arother remarkable difference was noticed conmcernng tle errgagement in pre
cc':ve ctisities (.t9% B vs. 9% W) c coirnciden with tte sat i v riin or or of local prevent c'irve!oe t s. IKiiivledge curare:rng AIttS rot iinipiracvd,.m trran (y pit'sti( a si:"

>
aO
u
O
0
U
c
nO
uL
I0
O
O
o
c
350
U
Q)
c
0
C
350

chi- square,Yates corrected
Conclusion: From the results we conclude that the intervention strategies addressed for
IDUs in the City of Santos were not enough to control the spread of I IV in this population.There is an urgent need of implementation of the control strategies such as needle
exchange programmes combined with the expansion of the street outreach programme,
targeting especially women.
Raimnundo Azevedo Neto, Av. Campos Sales no 59, Santos/SP Brasil I I. O I13 I.01, fone/fax
55 013 235-4842
Tu.C.2494
AIDS CASES AMONG IV DRUGS USERS: EPIDEMIOLOGICAL CHARACTERISTICS
AND TRENDS IN RIO DE JANEIRO, BRAZIL.
Valente, Katia R.*, Sanches, K. *Health Secretary of Rio de Janeiro
Objectives: I-To analyse epidemiological characteristics of AIDS cases amnong intravenous
drugs users (IDU) and 2--b make comparisons between IDU and non-IDU AIDS cases.
Methods: It was selected all AIDS cases reported firom 1982 to 1994 to the AIDS
Department of Rio de Janeiro state.The subjects were analysed acchiurg Io educational
level, sex, age, place of residence and year of diagnosis.
Results: From a total of 1703 AIDS cases, 843 (7.2%) were IDU, of which 19 I (23%) had
at least one more transmission mechanism ascertained. Most of IDU (8 1.7%) were aged
between 20 and 39 years. From 1982 to 1989 IDU represented 4.7% of the total, from
1990 to 1992, 6.6% and during 1993-1995 this proportion was 8.8%. Comparisons
between IDU and non-IDU showed significant differences: 1) 57.7% of IDU compared with
48% of non-IDU were illiterate or had elementary educational level (p<0.001); 2) The ratio
Male:Female was 3:1 among IDU and 5:1 amnong non-IDU; 3) 8.38% of nonIDUl) were from
inner cities in contrast with 15.4% of IDU.
Conclusions: In Rio de Janeiro, the proportion of IDU among AIDS..ses has been increasing. IDU are younger; with lower educational level, from inner cities a Ind wIth a higher proportion of womren than non-IDU. Although the results are quite crude, these data points
out the need for strategies target to IDU in order to improve AIDS control and prevention
activities in this specific group.
Katia R.Valente - R. da Cascata 25/503 Rio de Janeiro - RJ CEP 20.5 t 080 Brazil -Tel.:55
021 240 2771 - Fax: [phone]
Tu.C.2495
HIV RISK IN IDU'S IN RIO DE JANEIRO: PSYCHOLOGICAL PREDICTORS &
IMPLICATIONS FOR INTERVENTION
Rangel.A. ***,Telles, Paulo R*., Bastos, Francisco I.**, Guydish, J.*",, mearst, N*"*a*NEPAD/UERJ (State University of Rio de Janeiro), **DIS/FIOCRUZ Rj, Braz i *UERJ, RJ,
Brazil, **Center for AIDS Prevention Studies (CAPS), University Vs Ia for ir. tSan
Francisco, USA.
Objective: To determirne psychological predictors of IDU's high risk tet av, s, r atsir ed by
specific questionraies, anrid to assess the feasibility of interventionrs f's p; cve ii rmtiion.