Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

1164 Abstracts 60892-60897

12th World AIDS Conference

60892 The use of sexually transmitted disease (STD) diagnosis
and transmission risk factors for HIV test screening in Ho
Chi Minh City (HCMC), Vietnam
Patricia Correll12, T.S. Nguyen3, L.T. Le Thuy3, P.C. Kloser1. 1UMDNJ/New
Jersey Medical School, Newark, NJ; 2695 Cardinal Hill Lane, Powell, Ohio, USA;
3AIDS Committee of Hochiminh City, Hochiminh City, Vietnam (USA)
Issue: Sexually transmitted diseases have been associated with HIV infection.
Transmission risk and STD infection have been used for HIV screening in resource-poor areas, such as HCMC. Confirming the characteristics of low-risk and
high-risk groups and identifying those STDs associated with HIV infection in this
population may allow for appropriate allocation of limited resources, such as HIV
tests, and the targeting of education efforts.
Project: Clients with a STD diagnosis were examined over the period of 1990
through 1997 at one hospita-based STD clinic in HCMC. Two groups of clients
were identified as low-risk and high-risk (commercial sex workers) for HIV transmission using commonly accepted risk behavior characteristics for assessment
and categorizing.
Results: The percentage of low-risk group members that received HIV testing
ranged from 9 to 28 percent from 1992 through 1997, while 100 percent of the
high-risk group members were tested. The high-risk group had more than twice
the incidence of HIV infection when compared to the low-risk group, 1.06 to 0.47
percent, respectively. The characteristics attributed to low-risk and high-risk of
HIV infection were accurate for this population. The most frequently occurring
STD in the low-risk group was genital warts (21%). Incomplete reporting of STD
diagnoses in the high-risk group did not allow for the identification of the most
frequently occurring STD in this group. STD infections occurred at higher rates
than HIV.
Lessons Learned: STD infection rates and characteristics of transmission risk
are adequate indicators of HIV infection in the population study. STD clinics are
excellent venues for HIV screening, surveillance and risk reduction. This high-risk
group of commercial sex workers may not be representative of all high-risk groups
in HCMC. Governmental, global and private sector support is needed to increase
the availability of HIV testing to all risk groups in Vietnam.
60893 Cervical biopsy analysis in women with HIV infection
Parameswari Srijayanth1, J. Padmini Jayachandran2, D. Raja1, N.M. Samuel1.
1Dem The TN Dr. Mgr. Medical University Guindy, Chennai; 2Govt. Royapettah
Hospital, Chennai, TN, India
Background: Heterosexual intercourse is the major mode of transmission of
HIV world wide and it is particularly important in India. It is not yet clear as to
the cervico-vaginal environment, and the suceptibility of HIV, mechanism of HIV
infection of the female genital tract with HIV and subsequent events leading to
clinical infection. With this background the pilot study is undertaken to observe
the cellular dynamics and other changes occurring in cervical biopsy tissues of
HIV positive women.
Method & Result: 12 women, who tested positive for HIV antibody and were
confirmed by western blot and who were admitted for regular clinical surveillance
were studied. A pelvic examination was performed and under asceptic condition
cervical biopsy was performed. The tissue was divided into two portions, one
was frozen in liquid nitrogen for immunohistochemical analysis and the other
was fixed in buffered formalin for routine histopathological analysis. All the twelve
biopsy analysis reveal Focal mononuclear inflamatory infiltration with features of
mild dysplasia denoting cervical intra-epithelial neoplasia (CIN) Stage I. In one
specimen endocervical glands with metaplastic changes were observed.
In conclusion, cervical abnormalities in HIV positive women is better detected
when cervical biopsies are studied. HIV disease is associated with alternations
in the proportions of immuno competent cells (CD4/CD8) in the cervix. Further
studies are warranted to understand the dynamics of HIV infection of the human
cervix.
S60894 A retrospective chart review of HIV positive clients with
thromboembolic events and alpha erythropoietin use
Abha Bharbava12, P.C. Kloser2, S. Mulaparthi2, P.K. Correll2. 1695 Cardinal Hill
Lane, Powell, OH; 2UMDNJ/New Jersey Medical School, Newark, NJ, USA
Objective: To assess the risk of clients with HIV infection for serious thromboembolic events with prior use of alpha erythropoietin.
Design: Retrospective, case control study
Methods: Adult clients with confirmed HIV disease and a documented thromboembolic event were included in a retrospective chart review of clients evaluated
from 1996 through 1997 for Greenfield filter insertion at the University of Medicine
& Dentistry of New Jersey (UMDNJ)/University Hospital.
Results: One hundred and eighty clients were evaluated for filter insertion
during the two year period studied. Thirty eight of these clients were infected with
HIV. Of the 38 clients, 10 met inclusion criteria, including one or more documented
thromboembolic events.

Conclusion: In this population, there is the suggestion that higher dose erythropoietin (10,000 units, sq, 3x/week), is associated with serious thromboembolic
events in advanced AIDS clients. Conditions associated with advanced AIDS may
place clients at risk for thromboembolic events. Careful monitoring and preventive measures for thromboembolic events in the advanced AIDS client would be
advised.
S60895 A surveillance method for emerging HIV infection in
immigrant and ethnic minority groups in the UK
Susan Jane Cliffe1, E. Boisson2, A. Tuner3, P.A. Tookey4, J.M. Mithal1,
A. Nicoll1. 1PHLS AIDS & STD Centre, CDSC, London; 2London School of
Hygiene & Medicine, London; 3Bristol PHL, London; 4Institute of Child Health
(London), London, UK
Background: Aspects of the changing HIV pandemic, such as the extensive
transmission in Southern Africa and South Asia, have major implications for all
countries with substantial numbers of persons coming from or linked with those
areas. Intense transmission in one country does not necessarily imply an increase
in infections in people originating from that area but resident elsewhere, for example the transmission in West Africa and the West Indies has so far had little
known impact on those countries diaspora in the UK while the complete opposite
is true for East African countries. It is important to devise methods which ensure
timely detection of any emerging infection. One such method has been designed
and used to determine whether South Asians resident in the UK have a higher
rate of HIV infection than the indigenous population.
Methods: Analysis of population data, ethnic grouping and country of infection
recorded on voluntary confidential reports of AIDS cases and HIV infections, ethnic group of HIV positive blood donors, reports of imported gonorrhoea, country
of birth data from the unlinked anonymous (UA) survey of STD clinic attenders
and district of residence data from UA surveys of pregnant women.
Results: No evidence to suggest the South Asian community resident in the UK
were at increased risk of HIV infection. However, there is a vital need to gather ethnic group and country of birth specific data for the UA survey of pregnant women as
that would be the most sensitive surveillance programme for emerging infection.
Conclusion: A method has been devised for the multi-source monitoring of
potential emerging sub-populations at higher risk of acquiring infection related to
the changing global epidemic. Results from such research has already influenced
policy-making decisions for prevention.
60896 AIDS prevention beliefs and practices among urban
workers in Botswana: Implications for prevention
Kathleen Norr1, S.D. Tlou2, J.L. Norr1, B. McElmurry1, P. Humbles1,
J.B. Teasley1. 1 University of Illinois at Chicago 845 S Damen M/C 802, Chicago,
Illinois 60612, USA; 2University of Botswana, Gaborone, Botswana
Background: The HIV/AIDS epidemic has spread rapidly in Botswana, and has
been accompanied by intensive mass media campaigns. However, no recent surveys of individuals' knowledge, attitudes and practices related to AIDS prevention
are available. Such information is essential to refine prevention program content
and approaches in a rapidly changing environment.
Methods: As part of the ongoing Peer Education & AIDS Prevention Project in
Botswana, pre-intervention interviews were conducted with 102 security workers
and clerical staff at the University of Botswana. Face-to-face interviews were
conducted with the help of five Minority International Research Training scholars
from the University of Illinois at Chicago. Half of those interviewed were male,
38% were under 30, 48% had less than a secondary education, 36% were married
and 28% were currently living with a partner.
Results: Only about 60% felt that AIDS was very common or that they were
personally at moderate-to-high risk of getting AIDS. On an 18 item AIDS knowledge scale, over 40% missed at least 4 items, indicating misunderstanding of
basic AIDS facts. About 10% were not sexually active in the last 2 months, but
13% had multiple partners in the last 2 months and 33% in the last year (50%
of men vs. 16% of women). Half said they used condoms always in the last two
months, but their comments indicated that many discontinue condom use after a
few months with the same partner without testing. 25% of men reported physical
abuse, and 41% reported heavy drinking, both barriers to safer sex.
Conclusions: Recent interviews with urban workers indicate that intensive
national campaigns have greatly increased AIDS awareness and condom use.
However, urban workers continue to need more in-depth knowledge of AIDS
facts and remain at risk due to multiple partners, inconsistent condom use, and
patterns of violence in relationships and heavy drinking. These results document
the need for continued intensive prevention such as peer education.
S60897 Chinese women's willingness to be tested for HIV
antibodies in an antenatal clinic in the southern China
Guan Feng Quan, A.S.M. Abdullah, Y.W. Tian. 1Shenzhenzhen Maternal & Child
Health Hospital, Fu Cheng Ke Shen Zhen Du Er Yi Yuan, 41 - Hong Li Road

Shenzhen - 51028; 2The University of Hongkong, Hongkong, Hongkong
Objectives: To assess women's understanding about HIV infection and to examine the acceptability of HIV infection and HIV antibody testing among women
attending an antenatal clinic in the PR of China.
Methods: A cross-sectional study was carried out among 200 pregnant women
attending for obstetric examination in an antenatal clinic in the southern China.

Erythropoietin
<4,000 sq
3x q week
1 (10%)

Erythropoietin No Pulmonary Deep Vein Other
>10,000 sq Erythropoietin Embolism Thrombosis
3x q week
3 (30%) 4 (40%) 1 9 3
- 1(10%) - 1
- 1(10%) - -

CD4<200
CD4>200
CD4 unknown