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

Track C: Epidemiology and Public Health
Results: For the first year of follow-up, 436 women entering the facility (26%) reported a
history of sex work (SW), i.e. ever having exchanged sex for money, drugs, protection or
rent. SWs were 42 % Black, 42% White and I 6% Latina. SWs were more likely to be IDUs
than were non-SWs (p<.0001) and to report having sex with an IDU (p<.000I).The seroprevalence among SWs was 15% compared to 6% among non-SWs (p<.0001).The relationship between HIV and SW is not a reflection of increased IDU among SWs:While
IDU-SW's had higher seroprevalence than non-IDU-SW's (28% vs. 8%), non-IDU-SW's still
had higher rates of HIV than non-IDUs-non-SW history (8% vs. 3%, p=.00 I). Among all
IDUs, SW's were more likely than non-SW's to be HIV infected (28% vs. 20%, p=.07).
When stratifying by race/ethnicity IDU-SW's had between a 2-and 5-fold greater risk of
HIV compared to non-IDU-SW's in all race/ethnic groups (highest seroprevalence among
Black-IDU-SW's, 39%). An elevated HIV risk in non-IDU-SW's was seen only for White
women (p=.07) and Latinas (p=.005). Among IDUs, the elevated HIV risk in SW's appeared
only for White women (25% vs. 14%, p=.05). Finally, although SW's were more likely than
non-SW's to report having sex with an IDU (SIDU), even among SIDUs, SW's are at
increased risk for HIV infection (24% vs. I 2%, p=.005).
Conclusions: We confirm that commercial sex work represents a risk factor for HIV that is
not entirely explained by the increased likelihood that SWs are IDUs or the sex partners of
IDUs.This, as well as the race/ethnic differences in the effects of SW on seroprevalence
need to be further explored.
Kim M. Blankenship,Yale AIDS Program, 135 College Street, New Haven, CT 06510 Phone:
[phone]; Fax: [phone] I; email: [email protected]
Tu.C.2655
HEPATITIS C PREVALENCE AND INCIDENCE IN A COHORT OF HIV+ AND HIVFEMALE PRISONERS
Fennie Kristopher P. Selwyn PA, Stephens PC, Balacos K, Altice FL. Yale University AIDS
Program, New Haven, CT USA.
Objective: To examine the prevalence, incidence and risk factors for Hepatitis C (HCV) and
its relationship to HIV infection in female prisoners, at Connecticut's sole intake facility for
women.
Methods: Anonymous HCV seroprevalence (P)/Incidence (I) study using discard sera
obtained on admission, and linked anonymously to medical, clinical, and behavioral data
obtained from routine intake. Assignment of serial study numbers and separation of clinical/serologic testing sites, allowed repeat sampling and linkage of clinical/serologic data while
preserving anonymity of data. Subjects included: I) random sample; 2) IDUs; and 3) nonIDUs who reported sex with IDU (SxHx). HCV incidence calculated on readmission of
those initially HCV-.
HIV (P) HCV (P) HCV (I
Random N= 174 8% 32% 0
IDU N=162 24% 76% 52
SxHx N= 154 12% 46% 0
Results: In the random sample, IDU was the only significant risk factor for HCV (p<.05);
HIV, sexual behavio, and race were not significant. In the IDU/SxHx populations, HIV was a
risk factor for HCV (OR I I.3, 95%CI 3.7-37.9) During a I yr followup, 3/1I 3 HCV- IDUs
became HCV+: 1=52/100 person years.
Conclusions: This study demonstrates a high prevalence of HIV and HCV in female prisoners (HCV>HIV), both in IDUs and sex partners of IDUs. Preliminary data suggest high HCV
incidence in at risk IDUs, thus emphasizing the importance for clinical care and risk reduction interventions for high risk women entering a correctional setting.
Kristopher P Fennie,Yale AIDS Program, 135 College Street, New Haven, CT 06510 Phone:
[phone]; Fax: [phone] I; email: [email protected]
Tu.C.2656
WHERE HAVE ALLTHE PRISONERS GONE? A PROFILE OF INMATE DEATHS 1990
AND 1994
Blash, Ruth*, Sharp,V*, Steinbock, C*, Perez, G*. *The Spellman Center for HIV Related
Diseases, St. Clare's Hospital, New York City, NY USA
Objective: To compare the causes of death among the HIV+ inmate population admitted
to an inner city inpatient unit in 1990 to the causes of death in 1994.
Methods: ICD-9-CM codes and chart review were used to determine cause of death. All
HIV+ inmate deaths occurring in 1990 and 1994 were reviewed. Causes of death were
classified into four categories: a) AIDS defining illnesses. b) AIDS related illnesses, c) Other.
d) Unknown. Fifty two patients died in 1990 out of 315 admissions whereas 62 patients
died in 1994 out of 262 admissions.
Results: Seventy one percent (71%) of patients who died in 1990 died of AIDS defining illnesses rompared to 58% in 1994. AIDS related illness was present in I5.4% of patients in
1990 as compared to 4 1% in 1994. Other rauses of death including GI bleed, other tancers
(exreptions KS and Lymphoma), end stage liver disease, pancreatitis, AAA rupture, and
CVA romprised I17.3% of the 1990 group vs. 25% of the 1994 group. AIDS defining illnesses inrluded PCP (About the same number died in eath group 10/52 (1 9%), 9/62 (14%)),
CMV, Toxo, crypto, lymphoma, KS and Mycobacterial infections, 5 people died of mycobacterial infections in I 990 as ompared to I6 in 1994. In 1990, ten people died of mycobacterial infertions; 7 of MAC and 3 of MTB. Of the people who died of TB in I1994, the
majority (I 13/I 6) died of MAC while only 3 had MTB. Only I patient had MDRTB (1/3).
Conclusions: Fewer- inmates died of AIDS defining illnesses in 1994 than 1990. Of those
dying of AIDS defining illness, more are dying of MAI and about the same are dying of PCP
AIDS related illnesses including sepsis and bacterial pneumonias comprise more than double the deaths in I1994 than 1990. About 20% of patients still die of other rauses like CI
bleeds.
Ruth Blash, 4 I 5 West 5 I st Street,The Spellman Center for HIV Related Diseases, St. Clare's
Hospital, NewYork City NY, 10022; USA.Tel: [phone] Fax: [phone]
Tu.C.2657

HIGH PREVALENCE OF HIV AND OTHER STDS IN JAMAICAN WOMEN
Dowe G 112, King SD2,Wynter A3, Chout R4, Klaskala W, et al. Fogarty International
Training Program, U of Miami; 2U of the West Indies, Dpt. Microbiology & 3Dpt. OBGYN;
4Microbiology Centre Hospitalier dur Lamentin, Martinique

Tu.C.2655 -Tu.C.2659
Objective:To determine and compare prevalence rates of HIV, HTLV, Hepatitis B and
Chlamydia among women representing high and low risk sexual behaviors in Kingston,
Jamaica.
Methods: 316 Jamaican women from three different risk groups were randomly selected
and screened for infectious diseases such as: HIV, HTLV, Hepatitis B, and Chlamydia. Blood
specimens were collected from 140 (43%) pregnant women visiting antenatal clinics, 100
(33%) from STD clinic attendees and 76 (24%) from commercial street sex workers
(CSSW). All sera were tested for Hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (HBcAb), HTLV and HIV antibodies. Hepatitis B markers were determined by ELISA
test. Retrovirus antibodies for HIV and HTLV I were tested by ELISA and confirmed by
Western blot.The simplified microimmunofluorence (MIF) method was used to detect
Chlamydia trachomatis.
Results: The table represents the seroprevalence results (tested positive/ total tested; %
positive:

RISK GROUP

HIV HTLV- I HEPT. B CHLAMYDIA

CSSW 7/76; (9%)
STD Clients 2/100;(2%)
Pregnant Women I / I 40;(.7%)

13/76; (17%) 31/76; (41%) 74/76; (97%)
8/100;(8%) 23/100;(23%) 82/100;(82%)
4/I 40;(3%) 13/1 40;(9%) 74/1 40:(52%)

Conclusions: Extremely high prevalence rate of Chlamydia, especially in low-risk pregnant
women, can be explained by unprotected sex practices.These findings, and high prevalence
of other STDs, suggest that further spread of HIV infection in the country via heterosexual
transmission may be expected. Specific efforts, including a condom promotion campaign
should be made to intensify STD (including HIV) prevention and treatment services for
Jamaican women.
Gwendolyn Dowe, PhD, U of Miami, Dpt. Epidemiology & Public Health (R669), PO. Box
016069, Miami, FL 3310 I.Tel: [phone]; Fax: [phone]; email: [email protected]
Tu.C.2658
HIGH HIV SEROCONVERSION RATE DESPITE STABLE PREVALENCE AMONG SEX
PARTNERS OF COMMERCIAL SEX WORKERS IN MIAMI, FLORIDA, USA
Klaskala W*, Sosa C**, Shor-Posner G*, Baum MK*. *University of Miami School of
Medicine, Dpt. Epidemiology & Public Health; **Fogarty International Training Program,
University of Miami, Miami, Florida USA
Objective:To determine prevalence, incidence (seroconversion rates) and risks for HIV
among sex partners of female commercial street sex workers (CSSVV) in Miami, Florida.
Methods: Male sex partners of CSSW arrested for exchange of money for sex under a
mandatory legislated program were tested for HIV antibodies. An annual cross-sectional
prevalence and incidence of new infections were examined in those men who were tested
more than once. All collected blood samples were tested for antibodies to HIV using ELISA
and Western blot.
Results: Of 424 men tested for HIV from January I1990 to December I1993, 17 (4%) had
antibodies on their initial test. Over this period a total of 47 men were found to be HIV
positive, which represents a period prevalence rate of I I. I% (p=0.04, chi square). Despite
relatively stable annual prevalence of HIV, (4-5%) cumulative incidence (seroconversion
rate) increased rapidly from 9.3 (100 persons/yrs) at the second HIV testing to 28.4 (100
persons/yrs) at the third HIV testing. Median seroconversion time was 25.7 months.
Seroconverters were more likely to be young (<35 yrs of age) black men with a prior history of sexually transmitted diseases (STDs). A new episode of syphilis during the follow-up
period predicted HIV seroconversion (OR = 3.7, 95%, CI I1.7 - 8. I).
Conclusions: Seroconversion rates increased rapidly while seroprevalence remained relatively stable due to the increasing proportion of subjects who were retested for HIV each
year. Frequent episodes of STDs indicating unprotected sex practices explain high seroconversion rates of HIV infection. Innovative behavior modification strategies are urgently needed in order to reduce the risk of potential spread of HIV in the general population.
Winslow Klaskala, U of Miami, Dpt. Epidemiology & Public Health (R669), PO. Box 0 I 6069,
Miami, Florida 33101 [phone]
Tu.C.2659
A BEHAVIORAL INTERVENTION AMONG MALE CLIENTS OF FEMALE
SEX WORKERS IN KAOLACK SENEGAL
Leonard Lori*, Ndiaye I**, Sail M**, Kanki P*, Mboup S***. *Harvard School of Public
Health, Boston, MA, USA; **Kasnack Clinic, Kaolack, Senegal; ***Laboratoire BacterioVirologie CHU A. LeDantec, Dakar, SENEGAL
Issue: Few AIDS prevention interventions have targeted the male clients of female sex
workers. Clients' knowledge of condoms and their attitudes about using them with their
commercial and other sex partners are key determinants of the safety of these encounters.
Few studies have demonstrated the efficacy of behavioral intervention programs with
changes in the incidence of HIV.
Project: In preparation for a behavioral change intervention among male clients of female
sex workers, we assessed the sexual behavior, as well as knowledge, beliefs, and attitudes
about condom use and HIV and AIDS of men working in transportation parts and among
members of the military in Kaolack, Senegal.These two groups were identified as major
client sources in research with a cohort of 100 registered, commercial sex workers. We
used a stages of change model to inform our interventions via an assessment of men's
readiness to consistently use condoms with different types of sexual partners.The interventions will be evaluated using sex workers' reports of client behavior men's self-reports, and
clinical measures of the incidence of sexually transmitted diseases, including HIV.
Results: We found important inter-group differences in sexual behavior, knowledge of HIV
and AIDS, experience with condom use, and readiness to adopt consistent condom use
with sexual partners. We also documented significant differences in the use of condoms,
and in intentions to use condoms, across partner types. Men were currently over 4 times
more likely to use a condom with casual partners than with steady partners. However,
approximately 50% reported not using condoms the last time they had sex with a commercial sex worker.

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