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

12th World AIDS Conference

Abstracts 60933-60937 1171

Methods: In 1990, a population of 1,397 men and 1,705 women aged 13
years and older, were enrolled in a stratified sample of 31 randomly selected
communities. Strata were comprised of main road trading centers, secondary
road trading villages and rural villages. Sociodemographic and behavioral data
were obtained by interview and serum for HIV serostatus were obtained. The
analysis examines the association between sex-specific prevalent HIV infection
and educational attainment, categorized as secondary, primary or none. The
odds ratios (OR) and 95% confidence intervals (95% CI) of HIV infection were
estimated, using no education as the referent group, after adjustment by logistic
regression.
Results: Higher levels of education were associated with a higher HIV seroprevalence in bivariate analyses (OR 2.7 for primary and 4.1 for secondary
education, relative to no education). The strength of the association was diminished but remained statistically significant after multivariate adjustment for
sociodemographic and behavioral variables (adjusted OR of HIV infection 1.6
(95% CI: 1.2-2.1) for primary education and 1.5 (95% CI: 1.0-2.2) for secondary
education). Stratified multivariate analyses by place of residence indicated that
the association between education and HIV prevalence was statistically significant in the rural villages, but not in the main road trading centers and intermediate
trading villages.
Conclusions: Educational attainment is a significant predictor of HIV risk in
rural Uganda, in part due to risk behaviors and other characteristics among better
educated individuals. Preventive interventions need to focus on better educated
adults and on school-aged populations.
60933 HIV-related behavioural risk prevalence in Japan:
5-year-transition after the 1992 biggest AIDS campaign
Tsunetsugu Munakata1, F.N. Onuoha2. 1-1-1 Tennoudai Tsukuba; 2University
of Tsukuba, Tsukuba, Japan
Issue: To compare results of Japanese HIV-related behavioural risk prevalence,
five years after the 1992 Biggest media AIDS campaign.
Project: In 1992 the AIDS campaign sensitized public awareness to the impeding AIDS explosion in Japan in the near future, and anti-discrimination against
PWA. The large-scale repeated-measure mail survey conducted in 1991 and
1996 sought to examine Japanese HIV/AIDS knowledge, casual sex behavior
and condom use rates, etc, before and 5 years after the campaign. The target
population were 5 major cities in Japan of 50 districts from which 10 districts were
randomly selected. The random sample were 10,000 respondents, aged 20-9.
Results: (1) HIV/AIDS Knowledge greatly increased; (2) casual sex by male
and female in their 20-24s decreased, but no significant change for those in their
25-49s; (3) every-time condom use in casual sex by male increased 34.9% to
53.5%; by female 35.9% to 64.1% in the last 4 weeks.
Conclusion: Global knowledge related to HIV/AIDS and condom use rate for
male and female were greatly enhanced, but the average casual sex partner rate
did not significantly decrease 5 years after the 1992 Biggest AIDS campaign,
except for the 20-24 aged.
60934 Activity of Taxotere (docetaxel) as therapy for
pretreated HIV-associated kaposi's sarcoma (KS).
An ANRS trial: Pharmacokinetics with protease inhibitors
Francois Boue, G. Zaikas, E. Caumes, C. Lebbe, B. Milpiedmomsi,
J.C. Vergniol, P. Baille. ' Inserm SC4 Saint Antoine, Paris; 2Hopital Pitie
Salpetriere, Paris; 3Hospital Saint Louis, Paris; 4Hotel Dieu Nantes, Nantes;
5Rhone Poulenc Rorer, Antony, France
Objectives: To determine the response rate, toxicity and pharmacokinetics of
Docetaxel as second line therapy or HIV infected patients with KS.
Patients and Methods: Phase II trial (ANRS 066) including patients with
HIV infection and multiple mucocutaneous lesions and/or visceral KS previously
treated with at least one prior course of cytotoxic chemotherapy. Docetaxel is
administered as a one hour IV infusion of 60 mg/m2 every 3 week with G-CSF
(lenograstim) from day 4 to day 10. Fifty evaluable patients are planned. Pharmacokinetic interactions between docetaxel and protease inhibitors are studied.
Quality of life (MOS-HIV-30) of patients is evaluated every 3 month during study.
Results: Interim analysis: Forty-four patients have been included today, 35 are
evaluable for toxicity and 28 are evaluable for response. Median age was 35
years. Median Karnofsky index was 80%. Median number of prior chemotherapy
cycles was 20. Twenty-one patients (78%) have had previous chemotherapy
with anthracycline. Median CD4 count was 60//I. Twenty patients had exclusively cutaneous KS and 8 had associated pulmonary KS. Twenty-three (85%)
patients were previously with protease inhibitors at inclusion. Toxicity, Serious
adverse events: Nine grade IV neutropenia, 5 grade IV thrombocytopenia, 2 CMV
diseases, 1 Stevens-Johnson syndrome. Tumor response: twenty-one (75%)
patients achieved partial response and among them 18 (64%) achieved their
response before the third cycle of Docetaxel, 3 had stable disease, and 4 had
progression of KS.
Pharmacokinetic measures showed that the median of docetaxel clearance

and AUC were similar to previous estimates in other cancer patients and were not
modified by both indinavir and saquinavir treatment given concomitantly. Other
antiretroviral molecules are under study.
Conclusion: These preliminary results suggest that Docetaxel has substantial
and rapid activity in HIV-associated KS for heavily pretreated patients. Metabolism
of Docetaxel does not seem to be substantially modified by the addition of
saquinavir or indinavir.

60935 Out-reach prevention program for high-risk groups in a
suburban region
Elias AI-Aaraj1, W.B. Badran2. 1Youssef Karam 55391 (PO. Box). Sin-El-Fil:
2Head of AIDS Program, Sin-EI-Fil, Lebanon
SIDC Association is an NGO whose area of action covers part of a North-Eastern
suburb of Beirut, known for the low socio-economic standard of its inhabitants in
addition to the prevalence of a low educational level.
From its field work and from its close relationship with the residents of the area,
SIDC could identify several recreational attractions, being used for the practice
of risky behavior vis-a-vis HIV transmission; this practice includes IV-drug use,
homosexuality, child sexual abuse, prostitution,...
According to a study done in by Dr. F. R. Ingold on drug users in Greater Beirut,
whose field coordinator was the SIDC, though IV-drug users rarely share needles,
but most of the time they do not consider using condoms during their sexual relationships. Also, and based on our experience with the residents of the area, we
assume that their knowledge of AIDS prevention methods are minimal. Moreover,
we believe that the prevalence of a low socio-economic class contributes also to
the neglect of prevention measures.
Knowing these facts, SIDC started a prevention action among the clients
of the above mentioned sites, based on a one-to-one or one-to small group
comprehensive AIDS education and prevention.
This mode of action has been chosen to ensure the out-reach for the at-risk
individuals, in a comprehensive and confidential manner aiming at minimizing
the risk of their sexuality and/or their drug abuse behavior, and to get more
information on the attitudes and beliefs of high risk groups. As we believe, the
out-reach approach has not been applied yet in Lebanon, for this reason this
action is subject to continuous assessment of the impact and of the results in
order to decide on further intervention.
Primary feed-back from the street workers could confirm our assumptions regarding their behavior and information, and has shown potential for behavior
change. The targeted subjects have started discussing their life style and suggested alternatives through which they could actively get involved, as a group of
peers, in changing their behavior.
60936 Implication of administrative officials in the fight against
AIDS in rural areas
Paul Mbappe-Mandengue1, L.A.Z. Kaptue2, J.R. Kuate3, J.-M. Talom1.
SSidalerte-Cameroun, BP 4675 Yaounde; 2Faculte de Medecine et Des
Sciences Biomedicales (FMSSE), Yaounde: 3"SGS-PSY" Yaounde. Cameroun
Specific Objectives: Senzitation and Implication of the administrative authorities
in the fight against HIV/AIDS in rural communities.
Strategics: Ever since its creation, SidAlerte Cameroon has trained group of
educators in many schools in town. (Yaounde). it is in this regard that a group of
our educators got engaged in an effective fight against this panddemic. Conscious
of the problem, this group contacted the highest authority of ESSE in the person
of the Sub - Divisional Officer; him being the first Sub - Divisional officer to get
involued in educative discussion. Discussions took place in the presence of other
top officials of Sub-Department as the Principal of government high school ESSE
and the Head medical Officer of this locality. They were enriched by the brilliant
presentations and by the testimony of Paul MBAPPE Jedd who happens to be
the first Cameroonian to have testified openly on Cameroon National Television.
Results: Very touched by this testimony, the Sub Divisional Officer took part
in a support march across the town during which he took the lead-role. In turn,
he in his refreshment hall sensitized other elites, while presenting Paul MBAPPE
whom many people earlier had the opportunity to see when following the "SOS
YOUTH" broadcast of Ist December 1996.
Lessons: It is our hope that subsquently other similar actions shall be initiated
in other localities of the rural areas in order to remove them from this present
spiritual sleep.
60937 Emerging trends of HIV infections in urban slum
population of Mumbai megapolis, review of a decade
Alka Gogate. LTM Medical College, Sion, Mumbai, India
Objective: To assess the incidance of HIV/AIDS in the urban population covered
by HIV surveillance centre at L.T.M. Medical College & Hospital in the decade
1989-1997 end, and gauge it's impact on HIV prevention compaign. This is a
retrospective study.
Material, Observation: Though India had it's first AIDS case as late as 1986,
in just over a decade the HIV/AIDS has spread across the country and already
India is vying with Thailand as one of the worst affected countries. The AIDS
Surveillance Centre at L.T.M.G. Hospital was started in 1989. The centre caters
to Indoor (55000/year) & outdoor (288000/year) patients attending the hospital
which mainly comprises of low-socio economic population staying in urban slum of
Dharavi. The population includes high risk subgroups like C.S.W., IV drug users &
S.T.D. as well as low risk population attending Antenatal OPD, Medical & Surgical

departments. There has been steep increase of seropositivity for HIV/AIDS from
1.09% to 7.05%. The rise is perticularly noticable in general class OPD, Indoor
cases (1.29-14.8%). The increment is also significant in Blood donors & STD
cases. The female to male ratio has also changed significantly.
The city of Mumbai is sitting on AIDS volcano. There is steep increment in HIV
positivity as well as marked quality different as more and more 'low risk behavior'
population is getting affected. In view of migration of ruralpopulation into those