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

Track C: Epidemiology and Public Health
exchange programme, (x2 (I, N=78) 4.46), p_< 0.035), stability of living arrangements (x2
(I, N = 46) 4.08, p< 0.04) and disagreement with a statement that lack of resources
determines hanng (x (, N 32) = 19.36, p< 0.0004) are predictive of not sharing nee -
dies. Seroprevalence rate: A seroprevalence rate of 6.94% (95%C:I.0 12.8) was found for
these women, of whoe 45.6% reported that their chances of becoming infected with HIV
were much lower than other IDUs.
Conclusion: Improvring accessibility of needle exchanges to womern and extending their services to womens' shelters and welfare residences together with the development of associated street out reach services could lower the injection associated risk of women who
inject drugs. Such initiatives need to include tailored interventions to lower high risk sexual
behaviour:
L.E Leonard, Unirversity of Ottawa, 451 Smyth Road, Ottawa, Ontario, K I H 8M5 Canada.
Tel: [phone] ext. 8286; Fax: [phone]; email:leonardo zeus.med.uottawa.ca
Tu.C.2504
HIGH-RISK BEHAVIOURS OF INJECTION DRUG USERS IN TWO LARGE
CANADIAN CITIES
Ofner; MarNianna*, Archibald CP*, Strathdee SA"*, Patrick DM***, Millson P+, Myers T+,
Palmer RWH+, Eades G*", Sutherland D*, O'Shaughnessy MV*. *Bureau of HIV/AIDS &
STD, Health Canada; "*BC Centre for Excellence in HIV/AIDS.Vancouver; *SBC Centre
for Disease Control,Vancouver; +HIV Studies Unit, University of Toronto.
Objective: To compare the high risk behaviours of study subjects from an HIV outbreak
investigation among IDUs in Vancouver to a cohort of IDUs in Toronto, Canada.
Methods: One to-one interviews for both the Vancouver case control and the Toronto
cohort studies were conducted. Similar time frames and information on demographics, drug
use, incarceration, sexual behaviour s, health status and psycho-social factors were collected.
Vancouver's study interviewed 281 IDU's (89 HIV+and 192 HIV-) whileTorontos interviewed 499 (37 HIV+, 447 HIV, 15 with unknown status). Univariate analysis, using MantelHaenszel Chi square to adjust for HIV serostatus and gender, was used to compare the two
cities.
Results: Preliminary reisults show that Vancouver and Torontos IDU populations were simi
lar with respect to age (p=0.73), age at first injection (p=0.83), injecting while in prison
(p:=0.76), sharing needles in prison (p=0.86), cleaning used needles (p=0.24), anrd reporting
cocaine as the drug chosen most often for injection. Compared toToronto,Vancouver's
IDUs were more likely to be female (p<O.001 ), share needles (p=0.05), be incarcerated
(p<0.00I), and attend the needle exchange (p<0.00 I).Vancouver males were more likely
to report injecting heroin (p=0.04) and report accidental overdose (p<0.001I), while the
females were more likely to inject cocaine (p=0.001).
Conclusions: Vancouver's IDU community reports significantly more sharing of needles and
use of heroin (males) and cocaine (females). Factors such as incarceration and accidental
overdose may indicate lifestyles that contribute to riskier behaviours. Programs to further
reduce sharing of needles and improve lifestyles, including access to drug treatment programs, may be necessary to help prevent further outbreaks of HIV in IDUs.
Marianna Ofner, #4019 McMurrich Bldg., University ofToronto,Toronto, Canada M5S I A8
Tel: [phone] Fax: [phone] E-mail: [email protected]
Tu.C.2505
FACTORS ASSOCIATED WITH ANTI-HIV AND ANTI-HBC POSITIVITY AMONG
LONDON IDUS: INTERVENTIONS NEED TO TARGET YOUNGER INJECTORS
Gillian M. Hunter, Tim Rhodes, Gerry V Stimson, Martin C. Donoghoe, Colin P Chalmers,
John Parry. The Centre for Research on Drugs and Health Behaviour, University of
London; I. Public Health Laboratory Service.
Objectives: To examine associations between injecting career, risk behaviour and positivity
to anti HIV and anti-HBc amrong IDUs, and to make comparisons between those found
anti HIV and HBc positive.
Methods: Using a standardized WHO interview schedule, two surveys were undertaken
among 1,012 community recruited London IDUs in 1992 (N-505) and 1993 (N=507).This
sought data on injecting risk behaviour in a six month period. Anonymous salivary specimens were tested, with informed consent, for the presence of anti HIV I and IgG anti-HBc.
Statistical comparisonrs, including the use of logistic regression, were made within and across
years, and between those confirmed anti-HIV and -HBc positive.
Results: Th e majority of IDUs in 1992 and 1993 were male (68%; 70%) and injectors of
heroin (87%: 84%) with a mean age of 30.9 and 31.6 years. Mean length of injecting career
was 10.8 years in 1992 and I 19 in 1993. Prevalence of ani -HIV-I was 7.0% in 1992 and
6.9% in 1993. In contrast, anti-HBc prevalence was 51.5% in 1992 and 47.9% in 1993.
Logistic regress ion showed anti-HBc positivty to be associated with age (p<0.0001), length
of injecting career (p 0.000 1) and a histo ry of having shared syringes/needles (p<0.0005)
but not with recess shasrng tin. sn Ias 5ix isonihs). Is centrist, anti-HIV positiviry was assocsled with ts hitory of haiving sh aced (p 0.05) iv well as with recent sharing (p<0.05), and
there were sic marked differences avociated with age or length of enjecting cireer
Comparisons show youngerI DLUs (p 0.0001) and those with shorter injecting careers
(p<0.05) te be nest lkely to sepert recerat srng.
Conclusions: 1ehern remains she potential for centiued transmission of HIV I and HBV,
partic lasly awog younger IDIs and thse nwith shortes-injxctisg careers. Data suggests
that trsrnarsison of HBV saoeg 6Lridoa IDUs occurred nasty on is the HIV epidemi
curve.While Ides IDUs with longer injectin g saeers may hive vine stopped sharing, raterventrons need to prevent the creation of new traissne networks among younger less
experienced injectors.
Gilian Huntei, CRDHB, 200 Seagrave Road, London, SW6 I RQ, England Tel: 44 I8 I 846 -6565 Fax: [phone]
Tu.C.2506
CROSS-NATIONAL DIFFERENCES IN SEXUAL RISK BEHAVIOUR AMONG
COCAINE AND OPIOID IDUs IN SANTOS, LONDON AND TORONTO:
PREVENTION IMPLICATIONS

Tim Rhodes', Regina Bueno2,Ted Myers3, Gillian M. Hunter', GerryV Stimson. I.The
Centre for Research on Drugs and Health Behaviour, University of London; 2. Institute de
Estudos e Pesquisa em AIDS de Santos; 3. HIV Social, Behavioural and Epidemiological
Studies Unit, University ofToronto.

Tu.C.2504 -Tu.C.2508
Objectives: to examine cross national differences between cocaine and opioid IDUs in
London,Toronto and Santos on measures of sexual behaviour and sexual safety.
Methods: Using a standardized WHO Multi-city Study interview, s ix months risk behaviour
data were collected in 1992 aniong.204 con munity recruited drug injector s in London
(UK),Toronto (Canada) and Santos (Brazil).
Results: Statistically significant behavioural differences in patterns of drug inecting and sexuat behaviour were found between the cties. Results show heroin injection to be most likely
in London and cocaine injection to be most likely in Santos. Anonymous salva samples
show HIV I prevalence among IDUs to be significantly higher in Santos (60%) than in
London (7.0%) orToronto (4.5%). Srntos IDUs were also statistically more likely than
London or Toronto IDUs to report higher frequencies of penetrative sex with same sex
partners, anal sex with opposite sex partners, sex with both primary and casua l partners
sex with casual partners, sex in exchange for drugs or money, and lower levels of condom
use in primary and casual encounters. Santos IDUs' also reported a higher averare number
of sexual partners (17.2) than IDUs in London (1 8) orToronto (3.7) in the last six months.
Conclusions: Possible explanations for the observed behavioural differences include the
impact of particular injected drugs on sexual activity/safety, and the impact of social and
economic factors on risk behaviour: There is an absence of social epidemiology and context
mapping in contemporary cross-national HIV research and this hinders the development of
culturally appropriate interventions. Moves towards a social epidemriology of sexual risk
behaviour are considered. Sexual behaviour change among IDUs is needed mosturge ly in
Santos, where rates of HIV I prevalence and casual partner change were highest and con
dom use lowest. Appropriate intervention responses, whether in developed or developirng
countries, require changes in individual, community as well as political behaviour:
Tim Rhodes, CRDHB, 200 Seagrave Road, London SW6 I RQ.f England Tel: [phone] Fax: [phone]
Tu.C.2507
HIV INFECTION AMONG INJECTING DRUG USERS ENTERING RESIDENTIAL
REHABILITATION CENTRES IN FRANCE, 1993-95
Six C,*, Hamers F,*, Ancelle Park R,*, Brunet Jean-Baptiste,,*. and correspondents i t
Rehabilitation Centres. CEuropean Centre for the Epidemiological Monitoring of AIDS, Sairt
Maurice, France, **Ministry of Health, France
Objectives: To assess trends in HIV infection and to evaluate health care needs related to
HIV among injecting drug users (IDU) enternng residential rehabilitation centres (RRC) fter
detoxification, in France.
Methods: A survey among all IDU residing in government-funded RRC in France began r
July 1993. Six-monthly questionnaires were used to collect anonymous information whch
was updated over time and based on administrative data, medical files and self reported
HIV test results. Data on IDU enternng RRC during July 1993 June 1995 (4 semesters: 11/93,
1/94, 11/94, 1/95) were analysed.
Results: A total of 2892 IDU (women: 28% entered 71 RRC dunrng July 1993 -June 1995.
The median age was 28 years; 50% started to inject after 1985. For 2645 (92%), I itt
HIV test result was available; of these, 352 (17%) were HIV(+). Less than 2% said tiey had
never been tested. Among those who reported a negative test, 75% were tested Icss than
I year earlier. Older IDU were more likely to be HIV(+) than those -<25 years (27% v,
4%).Among those who started to inject in 1992 or later: 2% were HIV(+). From semesteur
11/93 to 1/95, HIV prevalence decreased steadily from 20% to I 3%. However the de ne was
observed only in age groups >25 years (25-34 years: from 24% to 16%; > 35 years: fro
50% to 18%). Mean duration of stay was 110 days for HIV(+) compared with 83 days for
HIV(-). During their stay 47% of HIV(+) received medical treatment for their infection, 39
reported HIV related symptoms and 27% had known CD4 count <200. Estimated morta l
ty rate per 100 person-years was 14.0 for HIV(+) and 2.7 for HIV(-). Most HIV(+) deaths
were due to AIDS: most non AIDS deaths were caused by overdose.
Conclusions: Monitoring RRC activities is criticai for tailoring RRC progra'mmes to the
health care needs of HIV-infected IDU.The declining HIV prevalence in the study population
is probably due largely to increasing numbers of deaths from AIDS among a large cohort of
IDU infected early in the epidemic.The prevalence among recent injectors suggests continuing HIV transmission among IDU in France.
Jean-Baptiste Brunet, European Centre for the Epidemiological Monitoring of AIDS H6pital
National de Saint-Maurice, 14 rue du Val d'Osne, 94410 Saint Maur cedex, France Tel:
(33-1) 43 96 65 45; Fax: (33-I) 43 96 50 8IP; Email: cdlcesesdib3e.jussinu.f
Tu.C.2508
HIGH RISK OF HIV AND STD TRANSMISSION AMONG HIV+ INJECTION DRUG
USERS (IDUS) IN SOUTHERN FRANCE
MaeT--, Sarino N. 3, Dujardin, Moreau, Moatti JP. INSERM U 379, Insttut P
Caimettes, Mar eile, France; 2Oenter lam AIDS Prevenation Studies (CAPS), DC San
Francisce, USA: 3outh Pastern French 0 entre fuar 0iseise Control, Mrseitle,; Depamit. of
Internal Medicine, f6jpitvi Cumuez, Nicc, Francm, 5Depamrt. of infectious sti _ease, H6pitl
Boigny Marseille
Objective: To examine rates of 5TDs and sexual risk behaviors among IDUs wth HIV infection in Southern Franmee
Methods: Thus wax a consecutve convernence simple of tfe isst 100 HIV~ priments moth
IOU ax origin of infection seeking senrsies as outpitixent clinics me spec hosputals me
Marseie, Nice, red Avigeon between Jly med ODecenaber, I1995. We issessed denrogr aphic
variables via meter view specifhc sexuaml practices and dirug use dun mg the preyi0us 6 months
via self report questionnaire; and current STDs through physical examination (conducted by
a physician) and serologic assays.
Results: Demographics-The sample was 67% male, mean age-34 (SD-4.5). Average year
of irst IDU was 1980 (SD-4): 37% were currently active users; I% had stopped using less
than I hyear;andu h5id been abstinent an average of 6 year (SD -.).Vrtuly looms of
the simple fad used herein. Mean CDI cell resins at hirs xinter view was 435 (50- 179).
STDs - 62% of the sample had I or more genital STDs: 37% HSV II; 19% chlamydiae; C4%
syphilis; 5% genital warts. 84% of subiects were hepatitis C antibody positive, and 73 % were

hepatitis B antibody positive (only I I% reported having received a hepatitis B vaccine)
Sexual behavior - 49% of subjects reported receptive analingus in the previous 6 months.
38% of subjects reported being sexually active and Never or Occasionally using condoms:

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