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

Track C: Epidemiology and Public Health
increased 28.0%, bar type sites (bars, pubs, night clubs, etc.) expanded 32.9%, and disguised
sites increased 5.5% duning the same period.
Conclusions: Despite AIDS and political pressure, the total number of sites was roughly
constant. However, brothel based sites were declining in Bangkok with a concurrent shift to
more indirect site types This makes prevention more challenging because these sites are
more difficult to identify, outreach is harder since many sex workers deny commercial sex
involvement, and commercial relationships in these sites can mimic private relationships, discouraging consistent condom use. Cooperative efforts with establishments' owners at these
indirect sites are essential to maintaining HIV/STD prevention success.
Werasit Sittitrai, Program on AIDS,Thai Red Cross Society, 187 I Rama IV Road, Bangkok
10330,1hailand.Tel: [phone], Fax: [phone].
Tu.C.2643
SEXUAL AND OCCUPATIONAL RISKS OF HIV INFECTION AMONG DUTCH
EXPATRIATES WORKING IN AIDS-ENDEMIC AREAS
De Graaf, Ron*,Van Zessen G*, Houweling H**. *The Netherlands Institute of Mental
Health (NcGv), Utrecht,The Netherlands; **National Institute of Public Health and the
Environment (RIVM), Bilthoven,The Netherlands
Objective: lo assess the prevalence of HIV infection and related risk factors among Dutch
expatriates returning from assignment in sub-Saharan Africa, Latin America, and South and
South east Asia.
Methods: Between July 1994-January 1996, a questionnaire on risks of occupational (medical personnel) and sexual exposure was completed by 845 respondents, and a vial of
blood was taken. In addition, 60 people who had sex abroad were interviewed in-depth to
get more insight in factors and considerations that contribute to unprotected sex.
Results: Of the men, 21% reported steady and 28% casual local partners in the previous
three years; of the women 19% and 16%, respectively Among both men and women, having
a local partner was associated with a younger age, having the explicit intention to have sex
abroad, being single at departure, and, only among men: working for a commercial organization, having feelings of loneliness or boredom. Consistent condom use with casual partners
was 69% among men and 64% among women (with steady partners much lower: 20% and
2 1%, respectively). Consistent condom use with casual partners was more often seen
among men and women who took along condoms, and among those women who had a
positive intention before departure to engage in sex abroad. Of participants with healthcare professions (I 3%) 62% reported needlestick accidents (mean number 3.6 during an
average stay of 2 I months). No antibodies against HIV- I,-2 were found among the participants.The qualitative data gathered among 60 sexual active expatriates showed that residence in a different socio-sexual situation might influence protective behaviour. People
appear less prepared to use condoms if sexual contact was not expected and one was
taken by surprise by the sexual opportunities, or if one was ambiguous whether to have
sexual contact.
Conclusions: Although 22% of the expatriates had unprotected sex with partners from
endemic areas, and more than half of the medical personnel reported occupational acci
dents, rio HIV infections were found. Consistent condom use was much higher than in previous research (I 987-1990) among Dutch expatriates (with casual partners only 21%), in
which 5 of 1968 were positive. Still, health education should emphasize sociocultural differences in sexual practices.
R. de Graaf, NcGv, Da Costakade 45, 3521 VS Utrecht,The Netherlands Telephone [phone] Fax [phone] II I
Tu.C.2644
DETECTION OF HEPATITIS C AMONG BRITISH PRISONERS WHO SEEK HIV TEST
AFTER INTRAVENOUS DRUG USE
Mohanty K C, Biswas S. St Luke's Hospital, Bradford BD5 ONA West Yorkshire, UK
Objective: To find out the prevalence of Hepatitis C infection among prisoners who seek
HIV test after intravenous drug use.
Methods: 250 prisoners who shared injecting equipment to use intravenous drugs were
included in the study. After appropriate pre HIV test counselling blood tests were carried
out for HIV I and 2 antibodies, Hepatitis C antibodies and Hepatitis surface antigen
(HBsAg) and Hepatitis B antibodies. All 250 patients were screened for syphilis and other
sexually transmitted diseases.
Results: The mean age of the prisoners was 23 SD ~ 4.5 (range 2 I - 35). 43 prisoners had
antibodies to Hepatitis C (17.2%) HBsAg was detected among I 6 patients (6.4%). Only 5
of them (2%) were HIV positive (HIV I). Syphilis was not detected. However among various STDs non-specific urethritis was found in 2 I prisoners (8.4%), genital warts in I I prisoners (4.4%) and candidiasis among 9 prisoners (3.6%)
Conclusion: We confirm that prevalence of HIV in British prisoners is significantly less than
Hepatitis C or B. It is now more likely to contract Hepatitis C through sharing injecting
equipment than Hepatitis B or HIV
Dr K C Mohanty Department of Genito Urinary Medicine St Luke's HospitalTel: 01274
365425 Bradford BD5 NA West Yorkshire, United Kingdom
Tu.C.2645
SEXUAL BEHAVIOUR AND PREVALENCE OF ANTIBODIES TO HIV AND HEPATITIS
B IN SEAFARERS VISITING LIVERPOOL
Weld AR*, Bellis, MA*, Syed, Q*, Beeching, NJ**. *Dept. of Epidemiology Liverpool PHL &
**Infectious Diseases Unit; Fazakerley Hospital, Liverpool, UK.
Objectives: Investigation of visiting sailors' knowledge of AIDS, their anti-HIV and anti-HBc
serostatus, and their sexual behaviour whilst in Liverpool and at their last international port
of call.
Methods: Anonymised structured interviewing and saliva testing was conducted with seafarers arriving from abroad who had spent at least one night in Liverpool Maritime Port.
Results: I 600 commercial ships still visit Liverpool Maritime port each year resulting in
89,000 overnight stays by sailors. Analyses based on interviews with 398 sailors indicate that

their continent of origin effects their level of knowledge regarding HIV transmission and
treatment (P<0.000 I). Anonymised saliva testing revealed a 0.33% prevalence of anti-HIV
(n=304) and 12% prevalence of anti-HBc (n=29I) with anti-HBc prevalence being related
to continent of origin (P<0.05). I 2.2% of sailors had sex in their last port of call while

Tu.C.2643 -Tu.C.2649
fewer (5%) sailors claimed to have had sex in Liverpool.These latter individuals were char
acterised by a higher probability of also having had sex in their last port of call (P<0.0001)
and by a lower level of condom use (P<0.0 1).
Conclusions: The data from this survey suggest that a core of sailors pay for unprotected
sex in international ports.These sailors are at higher risk of contracting both HIV and
hepatitis B infection and of spreading these infections into other communities, primarily a
sex trade workers. Public health strategies for the control of HIV and HBV infection must
incorporate measures to reduce the potential for their transmission via international ports.
ARWeild, Epidemiology Dept., Liverpool PHL, Fazakerley Hospital, Liverpool, L9 7AL, UK.
Tel: [phone], Fax: [phone], E-mail: INTERNET:
[email protected]
Tu.C.2646
ABUSE-RELATED TRAUMAS ASSOCIATED WITH SEX WORK AMONG WOMEN ON
METHADONE MAINTENANCE
Gilbert Louisa*, EI-Bassel N*, Schilling R*,Wada T*. *Columbia University School of Social
Work
Objective: To examine associations between sex work and childhood abuse and partner
abuse among a sample of predominantly African-American and Latina women attending
inner-city methadone clinics.
Methods: Face-to-face structured interviews covering demographics, drug use, trauma history and sexual risk behavior were conducted with 148 sexually active femrale methadone
patients.The associations between childhood abuse and sex work and between partner
abuse and sex work were assessed by multiple logistic regression.
Results: One-third (33. I%, n=49) of the sample reported having exchanged sex for money
or drugs during the thirty days prior to interview.Three-quarters (75.2%) reported having
been abused by a spouse or boyfriend, 44.4% reported having been physically abused as
children by a parent or guardian, and 32.6% reported experiencing childhood sexual abuse.
After potential confounds of demographic and drug use variables were controlled, childhood sexual abuse, childhood physical abuse, and partner abuse were significantly associated
with exchanging sex for money or drugs.

childhood sexual abuse
childhood physical abuse
abuse by spouse or partner

Unadjusted
OR= 1.83 (C-1.26, 2.65)
OR= 1.48 (CI- 1.04, 2. i)
OR=- I.54 (CI--=.982, 2.45)

Adjusted
OR=1.9 I(CI= 1.28, 2.86)
OR= 1.55 (CI= 1.04, 2.29)
OR= 1.79 (C1==.09, 2,94)

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Conclusions: The high rate of exchanging sex for money or drugs and the associations
between abuse-related traumas and sex work suggest areas for HIV related risk reduction
among this population.
Louisa Gilbert, Columbia Univers ty School of Social Wor k 622 W 13th Street, New York,
NY 10025, USATelephone: 212-854-7812 Fax [phone]
Tu.C.2648
SOME CLASSIFICATIONS OF THE FEMALE COMMERCIAL SEX WORKERS AND THE
BROTHEL MANAGERS IN KRAMATTUNGGAK,JAKARTA:A QUALITATIVE
APPROACH IN DESIGNING STD/AIDS-RELATED EDUCATIONAL PROGRAMS
Sedyaningsih, Endang R. Harvard School of Public Health/Indonesia Ministry of Health
Objective: To study the personal, professional, and socio-economical determinants of the
female commercial sex workers (FCSWs) in Kramat Tunggak, an 'official' brothel complex in
Jakarta, in order to be able to design more appropriate STD/AIDS-related educational programs for similar communities.
Methods: Using qualitative methods, i.e., participatory observation, semi-structured interviews, in-depth interviews, case studies, and focus group discussions (FGDs).
Results: In about 10 months, interviews to 12 brothel managers, 26 FCSWs, 46 clients, 4
vocational training teachers, and 2 government officers have been completed, as well as 3
FGDs and 2 case studies.The preliminary analyses of the findings yield 4 classifications of
the FCSWs based on their motivations to work as sex workers, and 4 other classifications
of the brothel managers based on their relationship with their employees (the FCSWs).
Results also offer some key elements which enable us to roughly and rapidly diagnose each
class.
Conclusions: Until to date, the government and some NGOs in Indonesia have been running both mass and in-groups STD/AIDS related educational programs for the FCSWs. AI
of those endeavors saw the FCSWs as a homogeneous community hence results were not
favorable.To be effective, the approaches should recognize the different classifications since
each class will need different approach. Based on the findings, some alternative approaches
are suggested.
E.R.Sedyaningsih, 706 Huntington Ave. #509, Boston, MA 02115, USA Tel.: [phone]
Fax: [phone] email: esedyani@ahsph. harvard.edu
Tu.C.2649
HIV INFECTION IN DETAINEES AT A CITY JAIL
Barry M. Anita*,**, Manning, AM***, Gunn, JE*, Rufo, R***. Boston Department of Health
& Hospitals*, Boston University**, Suffolk County Sheriffs Department***, Boston, MA,
USA
Objective: Characteristics of HIV infected inmates in post-sentence corrections fiacilities
(CF) have been well described; however, few data are available on HIV infected detainees in
a pre-sentence CF.We evaluated demographics, risk behaviour, & clinical features of HIV
infected persons detained >24 hours in 1995 at the city jail.
Methods: Of 257 persons documented to be HIV infected, I 31 were randomly selected
for chart review. Information on demographics, medical & substance abuse history, skin testing, & laboratory results was collected.
Results: The study cohort was 80% male, 60% black, & 79% United States-born; mean age
was 35 years. Of 131, 28 tested HIV positive prior to 1990. During 1995, the 31 subjects
were detained 233 times (range 1-6), with most arrests drug related. Of 233 detainments,
only 38 resulted in sentences to a CE HIV risk factors were 73% injection drug use (IDU),
34% heterosexual contact, & 7% gay/bisexual. By self report, drug of choice among 94 current users was heroin (76%), cocaine (65%), & alcohol (45%); 64% iniected. Only 34/ I 3 I