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

12th World AIDS Conference

Abstracts 60909-60913 1167

3 years evaluated at the San Diego Naval Medical Center beginning in March
1997. Study procedures include a detailed self-report questionnaire of behaviors
during the window of seroconversion, medical chart review, and collection of the
standard HIV staging laboratory data. HIV-1 subtype analysis is performed via a
competitive binding V3 peptide ELISA assay with confirmatory genetic sequencing on all non-B ELISA samples. In addition, genetic sequencing for mutations
significant for both reverse transcriptase and protease gene mutations is being
done. Preliminary analysis of the 76 patients of 8 1 eligible enrolled to date shows
12% of the patients to have non-B subtypes (8% E and 4% B/F recombinant). Well
established risk behaviors (i.e. infrequent condom use, anonymous sex) during
the window of seroconversion were reported in all but I of the 76 subjects. All
subjects with non-B subtypes reported only heterosexual contact; all 6 subjects
with subtype E and 2 of the 3 with B/F had a history of sexual contact outside of
the US during their seroconversion window.
In conclusion, this ongoing epidemiologic risk assessment is being used to
develop and implement targeted interventions in military populations.
60909 Factors associated with cervical chlamydial infection in
African women with or without HIV infection
Hortense Faye-Kette. 01 BP 1953 Abinjan 01, Cote d'voire
Objectives: To assess the factors associated with chlamydial infection in HIVinfected and non-infected African women.
Design: Cross-sectional study from three outpatient gynaecology clinics in
Abidjan, C6te d'lvoire.
Methods: Chlamydial culture from cervical specimens was performed on cycloheximide treated Mac Coy cells. A systematic screening was also performed
for HIV infection, and for other genital infections: culture for gonorrhoea, Gram
stain for trichomoniasis, candidiasis and bacterial vaginosis.
Results: Of 1695 women enrolled in this study, 364 (21.5%) were HIV-infected,
32 of them (1.9%) infected with HIV type 2. The prevalence of chlamydial
infection was 11% (186/1695). Chlamydial infection was not related to HIV-1
infection, but tended to be more frequent in HIV-2-infected women (22%) than
in non-infected women (11%, P = 0.06). Chlamydial infection was not linked to
other genital infections, excepted to trichomoniasis in HIV-negative women. For
the entire group, and for the 1331 HIV-negative women, no socio-demographic,
behavioural (including number of sexual partners) or clinical (including vaginal
discharge) factor was associated with chlamydial infection. Regarding the 364
HIV-infected women, two factors were associated with chlamydial infection in
multivariate analysis: non-ivorian nationality (adjusted odds ratio [OR] 2.6; P =
0.01) and having pain during sexual intercourse (OR 2.6; P = 0.007).
Conclusion: Our results suggest that it is possible to detect HIV-infected
women at-risk for chlamydial infection from interview data, whereas such selection seems not feasible in the general population.
60910 Surveillance of HIV/AIDS and other related infectious
diseases in post-complex emergency conditions:
The case of Bosnia and Herzegovina
Manuel Carballo' 4, Zlatko Puvacic2, N. Petrosillo3, R. Stoneburner4. Route Du
Nant-D'Avril, 11, CH-1214 Geneva; 4International Centre for Migration & Health,
Geneva, Switzerland; 2National Committee for AIDS Prevention, Sarajevo,
Bosnia; 31RCCS Spallanzi, Rome, Italy
Issues: The transition from situations of complex emergency to peace and
reconstruction provides an important opportunity for the strengthening of infectious diseases surveillance, and in particular for the monitoring of trends in
HIV/AIDS/STI. In the case of Bosnia and Herzegovina, many surveillance activities were necessarily neglected during the five years of war. Because the fear of
HIV/AIDS/STI remained low during this period, there was little or no monitoring
of its incidence/prevalence and little attention was paid to other potentially useful
surrogate indicators such as STIs. In adddition, the infrastructure and interest
needed to monitor infectious diseases also deteriorated.
Project: If HIV/AIDS/STI surveillance were to be achieved, a new and creative
approach was required. In 1996 a project was started to assess changing trends
in STIs and to identify if and how patterns of HIV infection were changing. The
project used remnants of the pre-war communicable disease surveillance system,
but also took into account the limited infrastructure as well as the few health care
staff able to allocate time to this activity.
Results: The project set out to identify new ways of assessing patterns of
STI and HIV using community based information that could be gathered from
a variety of sources, including from key informants as well as from health care
information records. The system includes a series of cross sectional prevalence
studies super imposed on the strengthened routine health care system reporting.
Lessons learned: It shows that during periods of war and during the transitions to reconstruction steps can be taken to introduce surveillance using a mix
of methods and indicators. In the case of Bosnia and Herzegovina, the project
has pointed to a growing incidence of STIs and to an emerging social situation
that includes significantly heightened risk of an HIV/AIDS outbreak.

S60911 Profile of the AIDS call service demand and profilatic
strategy propositions
Eustazioalves Pereira Filho12, K.H. Santos2, A.D.S. Alvares2. PQ Rui Barbosa
No. 23, 4' Andar Centro Santos, Sao Paulo CEP 11010130; 2Programa
Municipal DST/AIDS, Santos SP Brazil
Problem: Identify through the calls made to the ACS between june and november
of 1997, the profile of the population using this service and the most common
doubts and questions made regarding STD/AIDS.
Project: To identify the level of information absorbed by the population based
on questions made by them on 527 calls made to the ACS, also specifying the
profile of the questions in order to develop prevention and education strategies.
Results: Most of the calls came originally from the city of Santos (77.22%),
being 53.7% from male and 46.29% female. Single individuals totalized 57.68%
being most of them between 20 and 30 years old. 45.35% had a high school
degree, followed by 29.98% having college degree.
Lessons Learned: The profile of the users is formed by single and young
people, sexually active, slight predominance for the male individual who lives
in Santos with high school degree. The question deserving more investment in
terms of educational strategy and profilaxy concerns to the doubts related to the
forms of transmission of the HIV.
60912 Social determinants of behaviour/Indian society has
some of the most unique social constraints
Shivendra Gopal Gurha. B-253, India Naga Lucknow (U.P) -226016, President
Friends India, Lucknow, UP India
Issue: How various social constraints of the India society effect the behaviour of
men who have sex with men in relation to the AIDS?
Project: Men who have sex with men is a unique phenomenon somewhat
peculiar to Indian sub continent. The two most important social factors which
effect the behaviour leading their being men who have sex with men are: non
accessibility of females in general and the compulsion of the marriage. As the
females are not available or difficult to access, the men have sex with men. Even
those men who have no inclination towards females are forced into marriage
thus they also have sex with men. This group is one of the very high risk group
because it has sexual access to males and females both.
Results: The group has been able to identify and help a large number of men
who have sex with men, who are married, in creating awareness about HIV/AIDS.
Lessons Learnt: It is felt that there is a need to enlarge the area of our work
to encompass a larger number of men who sex with men from other parts of the
country also.
S60913 High prevalence of HIV infection in low income pregnant
women in Rio de Janeiro - Brazil
Valdilea Gongalv Veloso', J.H. Pilotto2, R. Azambuja3, F.F. do Valle3, M. Perez3,
B. Grinsztein3, M.I. Nascimento2. 'Rua Alzira Cortes 5/308, Botafogo, Rio de
Janeiro, CEP-22260-050; 2Hospital Geral de Nova Iguagu, Nova Iguagu, RJ;
3FundaCa Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
Objectives: To estimate the HIV-1 infection seroprevalence in postpartum women
attending the Nova Iguaqu General Hospital (HGNI), a public hospital in Rio de
Janeiro Brazil.
Casuistic and Methods: A cross-sectional study was conducted from may/96
to november/97 in a population of postpartum women admitted to HGNI for
delivery or abortion. Informed consent was obtained from all women. Testing
was voluntary and named. A standardized questionnaire was administered by a
interviewer and blood was collected and double tested by ELISA. Positive results
were confirmed by WB in another sample. Syphilis serology (VDRL) results were
obtained from the patient charts.
Results: 966 women were included in the study, 90% had never been tested
for HIV although 655 (67.9%) reported prenatal care. Mean age was 24.9 years
(SD 7.0), 6 (0.7%) were IVDU and 62 (6.4%) reported a IVDU partner. Mean
parity was 2.3 (SD 1.7) and 296 (30.6%) have had at least 01 abortion. Average
family monthly income was U$ 288 (SD 306) and 689 (71.3%) did not finish
elementary school. 78% had less than 2 sexual partners in the last 5 years. Only
55 (10.2%) reported condom use and 566 (58.6%) would like to have avoided
the pregnancy. The majority of the women 713 (73.8%) answered they knew
how to prevent HIV infection, but only 91 (12.8%) of them reported condom use.
In the group reporting lack of knowledge about AIDS prevention, 31.7% did not
complete elementary school and 8.8% had completed at least elementary school
(p < 0.0001). The overall HIV infection prevalence was 2.6% and reactive VDRL
14%. HIV prevalence in VDRL reactive samples was 4.8%.
Conclusions: 1. The overall HIV prevalence was 2.6%; 2. Positive syphilis
serology is associated with a higher HIV prevalence; 3. Low educational level is
associated with increased vulnerability to HIV infection and especially designed
health education programs targeting this population is imperative; 4. Condom
usage is low even in the group who report knowledge about HIV prevention; 5.

The majority of pregnant women deliver without being HIV tested and so without
opportunity to prevent HIV vertical transmission.
Supported by Fogarty JHU International Training Grant.