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

Tu.C.2650 - Tu.C.2654

Tuesday July 9, 1996

(26%) met AIDS surveillance criteria of these, 9 had a history of an opportunistic infection.
Median CD4 count (available for 88 persons) was 375/mm3 (range 0-1520) with
22%>500. In 25 detainees with CD4 count <200, 16 reported current antiretroviral therapy & 2 I current Preumiocys tis crrrir pneumonia prophylaxis.Thirty detainees (including 4
wth AIDS) were unable to identify any health care provider A significant response to
purifed protein derivative (PPD) testing was documented in 28 (2 1%), including 4 with
prior active tuberculosis, 1 6 who had completed preventive therapy (PT), 5 receiving current PT & 3 released before P[ evaluallon.
Conclusions: Ear ltIV infection is common in a c ty ja il rand many detainees lack medical
care in the community. Pre sentence F can be a point of access for this HIV infected
group but inkage of d etainees into con r munty bsed programstoprovide continuous HIV
care postre skyt ress the needs of this disenfranchisedpopulation.
M. Anita Barry, 1010 Massachusetts Ave, Boston, MA 02118 USATel: 617 534 561 I Fax:
617-534 -5905
Tu.C.2650
CHARACTERISTICS OF PERSONS WITH AIDS WITH NO IDENTIFIED RISK FOR HIV
INFECTION-UNITED STATES
Hammett, Teresa A, Fleming P Bush T Centers for Disease Control and Prevention, Atlanta,
CA, USA
Objective: To describe persons reported with AIDS (PWAs) who remain, after investigation,
without one of the specific HIV risk exposures collected for surveillance purposes.
Methods: Adults/adolescents initially reported with AIDS with no identified risk (NIR) for
HIV were investigated to deterrrine possible exposures. Follow -up included medical record
reviews, discussion with health care providers, and interviews with PWAs when possible.
Two different versions of the interview form were used: a pre- 1994 and 1994 version.
Interviews included questions regarding occupational, drug, sexual, and prison histories.
Results: As of December 31, 1995, only 7% (33,371) of 506,538 adult/adolescent AIDS
cases reported nationally remained with NIR. Of NIR cases, 68% (22,743) were still being
nvestigated, and 32% (10,628) were investigated with no specific risk being identifed. Of
these cases, most had incomplete investigations due to death (4 I%), initial report of Pattern
II-associated risk (30%), refusal to participate in interview (I I%), or loss to follow-up (9%);
8% had complete investigations, most (75%) of which included interviews. Of the 650 interviewed PWAs, 80% were men and 20% women. Interviewed PWAs were more likely than
those not interviewed to be white, reported before 1989, US -born, and residents of the
midwest or west. Of interviewed PWAs, 40% of men and 24% of women reported at least
one STD, 23% of men and 1 8% of women reported using at least one noninjected drug,
17% of men and 5% of wormen reported a hepatitis infection, and 38% of men reported
sexualcontact with a prostitute Overal, 60% of inter viewed PWAs reported at least I of
these behacours. PWAs who reported these behaviours were more likely to be male, black
or Hispanic, and ounger. In addition, 13% of men and 3% of women reported serving time
in prison. Of persons interviewed with the 1994 form (N- 158), 7% of men and none of
the women reported visitin a crck house;58% ofmen reported more than 2 sex part
ners snce 1978, and 30% reported 10 ora more partner s; 60% or women reported more
than 2 partners since 1978, and 13% reported 10 or more partners.
Conclusion: Ninety three percent of AIDS case reports included at least one specific risk
factor for- HIVThose PWAs who remain with NIR after complete investigation can largely
be divided nto 3 groups: those tht report behaviours that increase an individual's risk for
HIV, those who appear unaware of Pany behaviours on their Opart or on the part of their sex
partners which would inc crerasether risk IV and those who are ounwllng todiscuss cert ita rk behaviours. However, 60% of NIR PWAs interviewed did report behaviours that
put them at increased risk for acquireing HIV. hese data psuggest that persons who re main
NIPr most kely were infected through s exual or drug inlect ing be haviours ra other than
through an unrecogni zed route of transmission.
Tere sa oammett, CD C, 1600 Clifton Road, S-E 47,Atlanta, GA 30333, USA.Tel:[phone], Fax: [phone]
Tu.C.265 I
HIV PREVALENCE, RISK FACTORSAND PREDICTORS OF UNPROTECTED SEX
AMONG HOMELESS AND RUNAWAY YOUTH IN FOUR U.S. COMMUNITIES
MacKellar Duncan A>,Valleroy l*, anssen R J cobsT. tand the Homeless and oRunaway
Youth Survey Tearm 'Centers fo r Disease Cntrol and PreventionAt lanta, Georga, United
States
Objectives: determine H IV prevalence, risk factors, and predictors of unprotected sexual
intercourse a mong homeless and runaway youth (HY) sampled in 4 U.S. commun ities.
Methods: Both linked adnink uIed seroprelence surveys sampled HY at 3 shelters (New
York, NY; Houston,TX; Ft. Lauderdale, FL t) and 2 clini cs (San Francisco, CA) in 994/95. In
linked surveys, HY 12t 2 years of rge who a reed to participlate were interviewed, cou nseled, and tested for HIV In unlinked surveys, consecutive serum samples collected for routine medical purposes were tested for HIV after personal identifiers were removed.
Demograpfic and risk data were oftrtoactel too edica records for tfese samples.
Results: d n085 DY samp ed rn r icfed vey, 2 were HIlV nfectdmed antan ste 1.5%
9rpe 3.5 5.4) ) these, 6 80 rep ted pr ctdop mo ato-moe sex Df 3,46e1 DY
mpoedin onlrnked s %rey t09 sore DIV nrfe ted odan site., ange 0.6 12. I>)v
of tfese, 66 (63% reported pr0cticingp mole-to orale sex. ftV preyvalence n linked surveps
wa s simlar 0to that >n ulned,ur a m > nd s h 0bretially 0ower.00t 3 oses. O 000
hY sompled or linked orv eps 90 reported ecer irlectinp doups (medrn site 4>, onpe I%52> ), rod of these, 54 reported ofharoop needles (medror sote 36,r ropge 0%-74> ); 899
reported havonp ornteroourse (vagnpor na ern tfe last 6 moontfs (roedoior sine 86, >.ianpe
76 >90%), rod of these, 626 reported ot earot Iepisode of cunprotected intercourse (DI)
(omedion ste 70,o ropge 65% 76%) Dl d d rot coop srprrfcantpy bp site, ape, or race: however, 'women were nmore lkely to report ClItthan mer (78> vc 61 I, p <.001). Controllinp for
sex, lopostoc repression identifed farcrp > 3 sex prtrees, fhavnp >:-I steady partner being
high rn drops or oateho doriop sex. ord haciro a previoos STD rs predoctors of Dl.
Conclusion: DIV porecoler e o mc6 fipfer aonp DY thoar n mopg other populatiers of
D.S. pyott. Despite' enrollrnpyott wth lower- precalerce. linked oar veys show very tiph

rates of HIV risk behaviours among HY Intervention programs are needed to reduce the
prevalence of UI and substance use among diverse populations of HY
D.A. MacKellar, CDC, 1600 Clifton Rd MS E46, Atlanta, GA 30333 USA.Tel: [phone]
Fax [phone] Email: DYM4@cCIDHIV I.EM.CDC.GOV
Tu.C.2652
TRENDS AMONG FOREIGN-BORN PERSONS WITH AIDS, UNITED STATES,
1993-1995:A SPECIAL CHALLENGE FOR HIV PREVENTION
Dean-Gaiter Hazel D., Fleming PL, Li J, Diaz T Ward JW Centers for Disease Contro and
Prevention (CDC),.Atlanta, CA. USA.
Objective:To characterize fore gn-born persons with AIDS in the USA who may represent
a high-risk population with unique prevention needs.
Methods: We compared characteristics of US born (USB) and foreign -born (FB) adults > 13
years of age with AIDS reported from January 1993 through November 1995 and analyzed
data from interviews of FB persons with AIDS from the Supplement to HIV and AIDS
Surveillance Project conducted in 12 states.
Results: Of the 25 I, 109 adults with AIDS reported in this period, 7,573 (7%) were FB;
20% of FB were from Mexico, 19% from Central/South America, and 15% from Haiti.
Compared with USB, FB were significantly more likely (p<.0 ) to be Hispanic (53% vs 8%),
reported with heterosexual transmission (14% vs 10%), reported without a risk (24% vs
8%), and reported with tuberculosis (I 0% vs 5%).The median age at AIDS diagnosis was 36
years for USB and FB persons. In 1993, rates per 100,000 population were 43 for FB and
40 for USB.Three states (California, Florida and New York) reported 7 % of all FB persons
with AIDS but only 44% of all AIDS cases; FB persons represented 12%, 17%, and 7% of
AIDS cases reported from these states, respectively Of a representative sample of 656 FB
persons interviewed, 57% primarily sought HIV testing because of illness, for 39% the pri
mary language spoken was Spanish.These 656 FB persons had resided in the USA a median of 14 years and in their current state a median of II years
Conclusion: FB persons with AIDS have unique demographic and clinical characteristics and
reside in US states with high HIV/AIDS prevalence.The median age of AIDS diagnosis of FB
was similar to USB and the median number of years residing in the USA suggests many FB
may have acquired HIV infection in the USA.The high proportions that speak Spanish and
that seek testing because of illness support the need to enhance access to testing and care
in states with large FB populations.
Hazel D. Dean Gaito CDC, 1600 Clifton Road, MS-E -47, Atlanta, GA, 30333, USA.Tel:
[phone], Fax: [phone] e mail: hddocidhiv I.em.cdc.gov
Tu.C.2653
DETERMINANTS OF HIV SEROPREVALENCE AND SEROINCIDENCE OF NEW
ENTRANTS TO A WOMEN'S PRISON
Altce Frederick L, Khoshnood K, Blankenship K,Thompsor AS, Balacos K, F ennie KP
Monter roseo E, Selwyn PA. AIDS ProgeramYale Uni over sity, New Haven, CT Centers for
Disease Control and Prevent ion, Atl anta. GA
Objectives: I)To determine the communi ty-derived HIV seroprevalence(SP) seroincidence(SI), particularly among IDUs, at CT's sole female correctional facility (CF). 2) To
describe a new methodology for estimato ing HIV SI a mong high risk populations.
Methods: All women entering the CF undergo routine medical/behavioral intake, phleboto
my and exam. Inmate number (ID-I) is receded to a unique study numnber ID-2); hID- s
then removed, and intake datao labelled only with ID 2 are merged and sent with sera to
CDC where a new code onumber is assigned (ID-3). Sera is tested for HdIV and results are
linked to intake data using ID- 3 only: no linkage with inmate identifier is possible b etwoeen
HIV results and inmate oidentifiers. Assignment of seri al study number rs and separation of
clincal/serologic testing sites allow repeat sampling while preservin ubects' anonym ity.
Results: Over I I months, there were 2668 unique indvd ouaad 340 Iadmssonrs to the
CF; discard sera was available for 1759 (66%). No demographic or risk behavwor differences
noted between those with/withouet sera. For those with sera, the mean age was 30 prs; 43%
were Black, 38% White and 18% Hispanic. 2 I% were IDUs, 33% had an STD, and 26%
reported commercial sex work (CSW). On seroleogic testing, 8.% (n 46 of the sample
were HIV+ with mean age=32.5 (p<.0 for HIV+ vs. HIV). Of the 373 IDUs, 25% were
HIV+, as were 15% of CSWs. Multivariate logistic predictors of HIV include IDU, having an
STE, CSW, and age (all p<.05).To date, 175 initially HIV- women (60 p yrs of observation)
have been readmitted to the CF; repeat HIV serologic tests are peOnding.
Conclusions: The HIV SP among female entrants to a CF is 8.3%, predominantly among
women of color. Unlike previous HIV SP studies of femalce prisoners, IDU, CS And STD
were all independently associated with HIV infection. Addit ionally the high rate s of high risk
HIV- IDUs, CSW, and those with STDs make prisons important sites for risk reduction
nterventio ns, as well as has important implications for provision o f cinical care in CFs. Our
data suggest feasibility of novel m ethodology to conduct community-derived anonymous
HIV SI studies of diffi cult to reach populations. HIV SI for the fint 1.5 yrs wil be presented
for this population.
Foedlerick L.A Atoce, M1DYale AIDS Proram, 135 Coleye Street, New Dryer. CT 0650
Pfcre: [phone]. Fax. [phone], emaml:fo~eder rk itt coedeedo
Tu.C.2654
COMMERCIAL SEX WORK AND RISK FOR HIV INFECTION AMONG
INCARCERATED WOMEN
Blankenshiop Rim M1,Thompson AS. Rhoshnood K, Balacos PA Atoce FL. Selwyn PA. Yrc,
Dorwerscity AIDS Program. New Haoven, CT, DSA.
Objectives: To determine DIV seroprevalence and is oPcthrt0s asscited wotf H V ontectio
amoong commercial sex workers incarcerated on CT
Method: Dnipue entrants (n-2668) admotted into CT' seler oe0cr1a city tor women
son e 1194 were erolled on 000 anonymous DIV seropoeculencc/soro ncden e studyT
pre-erve anonymity, entr-ants were usigned anipoe rodes 00 the CCC serum bare where
serroleoic testngo was performed arc linked to acm ssmens' eeocuaions Thi oralroes s hosed
en tho 661 inmates for whona complete serooi and sex woPk data re asailrhoe

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