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

12th World AIDS Conference

Abstracts 13159-13163 117

media for the initial CD4 count was 477cel/mm3. During the follow up 21% of the
women presented AIDS defining events: 28% PCP, 14% extrapulmonary TB and
7% cerebral Toxoplasmosis. The median time free of disease progression was
12 months and the median time of survival was 15 months.
Conclusions: 1- Most of the women belong to second decade of life, have a
good level of instruction and have adecuate jobs; 2- 3/4 of the patients acquired
the infection through a heterosexual contact; 3- The most frequent co-infections
were Toxoplasmosis, CMV and HCV; 4- 21% of the women progressed to Stage
4.
13159 Knowledge about the HIV transmission among male
individuals aged 17, in Brazil
Ermenegyldo Munhoz, Junior1, D.L. Sczwarcwald2, M.R.O. Gomes1,
E.A. Castilho'1, G. Von Borries3, A. Barbosa, Junior1. 1Brazilian AIDS Program
ESPL. Ministerios BL. G Brasilia DF,; 2Fundacao Oswaldo Cruz, Rio De Janeiro
RJ,; 3Universidade De Brasilia, Brasilia DF, Brazil 70058-900
Background: In 1996, the Brazilian AIDS Programme/Ministry of Health and the
Brazilian Army conducted a study to evaluate the level of knowledge of young
men aged 17 on the transmission of HIV.
Methods: A questionnaire was applied to approximately 23,000 conscripts of
the Army, young men aged 17, a sample of the 750,000 conscripts of that year.
Ten questions addressing the most important issues of HIV transmission were
used to create an index, called "level of knowledge" (LK), ranging from zero to
tem. Sources of information and their reliability were also assessed.
Results: Only 3% of the subjects had LK equal zero, and 5% all the answers
correct (LK = 10). The mean was 5.2, the median 5.0 and the centiles were 4.0
(25%) and 7.0 (75%). In rural areas, the mean was less than 4.0. If the place
of residence was in the North, Northeast or Midwest, the poorest regions of the
country, the mean was 3.5. The most frequently referred source of information
was television (49%). The most reliable source of information referred was health
professionals.
Conclusion: This was the first study to evaluate, in national level, the knowledge of male individuals aged 17, about HIV transmission. The level of knowledge
was low, especially for the low-educated young men living in rural areas, in the
less developed regions of the country. Prevention efforts should be directed especially to youngsters living in those areas, oriented by health professionals, with
the use of the electronic media, especially in the school setting.
S13160 The HIV/AIDS epidemic in Honduras is getting worse:
A priority for intervention
Winslow Klaskala', R.J. Soto2, R. Garcia-Bernal1, J.E. Zelaya2, C.J. Palmer1,
M.K. Baum1. University of Miami School Of Medicine 1400 N. W. 10th Avenue,
10th floor (D21) Miami, FL, USA; 2Ministry of Health, Tegucigalpa, Honduras
Objective: To describe the severity of the HIV/AIDS epidemic in Honduras including the HIV prevalence trends among population groups at different level of
risk.
Methods: National AIDS surveillance data from 1985 to 1997 were reviewed
and analyzed. Statistics were also compiled from HIV serosurveys conducted
during the last decade among various population groups.
Results: As of Nov. 1997, a cumulative number of 8,167 cases (58% men,
42% women), have been reported. This represents 57% of the total number of
AIDS cases documented in Central America, with a cumulative incidence of 138
cases/100,000 people. Annual incidence rates have increased from 3.1 in 1988
to 15.7 in 1996, with 82% of the cases occurring among heterosexual individuals.
Of the cases reported among women, 15% occurred among teenagers 15-19
years old and 20% in the 20-24 age group; while among AIDS cases in men the
proportions were significantly lower, 3% and 14% respectively. Nearly one-third
of AIDS diagnosed individuals were female commercial sex workers. The HIV
prevalence rates have been increasing sharply reaching 46% among men who
have sex wih men, 21% in female commercial sex workers, and 4.1% among
pregnant women.
Summary of the HIV seroprevalence rates from various convenience samples
are presented below.

131611 Recent trends of the AIDS epidemic in the Dominican
Republic
Manuel Silva Saavedra1, L. Wille1, A. Kraemer1, L. Martinez2. 1University of
Bielefeld, School of Public Health, P.O.B. 1000131, 33501 Bielefeld; 2Secretary
of Health & Social Assistance, Germany
Objective: To study recent epidemiologic trends of the AIDS epidemic in the
Dominican Republic as a prerequisite for future prevention and intervention
programs.
Methods: AIDS cases were reported by the surveillance system of the national
AIDS/STDs program (PROCETS) from the year 1980 until January 10, 1997. The
data set includes information about age, gender, HIV-test results, various clinical
symptoms and AIDS manifestations, exposure groups and sexual contacts.
Results: Until the beginning of 1997 3634 AIDS cases (56.8% males) were
reported of which 404 individuals had already died. Children under 14 years of
age were excluded for further investigations (95 cases). Between 1990 and 1995
the annual incidence rate of AIDS (per million persons) increased from 33.2 to
54.3, but revealing a similar age distribution over time. The male:female ratio of
AIDS cases decreased from 2.2:1 to 1.6:1 (p = 0.08). The major transmission
mode was through heterosexual contacts (70.0%), followed by blood transfusion
(5.5%), and homosexual contacts (4.3%). Weight loss of more than 10% (90.3%),
continuous fever of at least one month (77.0%) and persistent diarrhea (69.9%)
were reported as the most prevalent symptoms of the AIDS cases. These data
must be corrected for underreporting of AIDS cases in this region, estimated at
rates of 50% to 75% of total cases.
Conclusions: There is a rapidly increasing incidence of AIDS cases in the Dominican Republic. Wasting syndrome represents a predominant clinical feature.
During recent years the male:female ratio has declined pointing to a growing role
of the heterosexual component of the epidemic. Therefore effective prevention
programs are strongly needed that take these recent trends into account.
434*/13162 1HIV-1 subtypes circulating in Sco Paulo, Brazil
Luis F.M. Brigido1, M. Rossini2, I. Santos2, Santana2, C. Oliviera2. SP HIV/AIDS
Vac. Committee; 1Rua Dr. Arnaldo 355 Virologia IAL, Sao Paulo; 2 Instituto
Adolfo Lutz, Sao Paulo, SP, Brazil
Objective: To determine the proportions of circulating Subtypes in distinct stages
of infection in the state of Sao Paulo and monitor introduction of new Subtypes
Design: Retrospective, uncontrolled study
A convenient sampling of the biological material of consent HIV+ volunteers
from different sites in the State of Sao Paulo, Brazil, received and stored at
our Institute repository since 1992 were analyzed HMA (Heteroduplex mobility
assay). HIV-1 from 243 out of 267 individuals tested have been subtyped by with
methodology and prototypes from UNAIDS. Time from infection was defined with
the seroconvertion dates within the last 4 years or suggested by clinical staging.
Results: 219 B (82%), 5 C (1.9%) and 19 F (7.1%) Subtypes have been
detected in 243 HIV infected patients typed. 24 (9%) were not amplified (n.a.)
In patients with AIDS or Arc at entry or that died or developed Arc/AIDS during
follow up, 114 B (78.6%), 3 C (2.1%), 12 F (8.3%), 16 n.a. (11%) was observed.
In patients that remained asymptomatic though out the observation period (mean
follow up 3 years) 43 (86%) were typed as B subtype, 1 C (2%), 3 F (6%), 3 n.a.
(6%). In patients with documented seroconvertion (mean 3/95, 2/93 to 1/97), 21
B (87.5%), 1 C (4.2%) and 2 F (8.3%) were detected. In patients with CD4 above
500 at collection35 (83.3%) had B subtype, 1 (2.4%) C, 2 F (4.8%) and 4 n.a.
(9.5%). In those with CD4 200-500, 77 (85.6%).
2 C (2.2%), 7 F (7.8%) and 4 n.a (4.4%) In patients with CD4 lower then 200,
107 B (79.3%), 2 C (1.5%), 10 F (7.4%) and 16 n.a. (11.9%) clades were found.
Conclusion: No evidence for major changes in the proportion of HIV clades
was observed in this study. Although there is no change in the proportion of C
and F subtypes in this area, in spite the fact that both seems to be present in
this Sao Paulo since last decade. The global evolution of the C subtype and the
possibility of new introductions poses the need for close monitoring.
113163 Prevalence of HIV among women and children evaluated
in a emergency room of an inner city hospital in Rio de
Janeiro

Population Group
Men Who Have Sex With Men
Female Commercial Sex Workers
STD Clinic Attendees
Antenatal Clinic Attendees
Hospital Emergency Room Patients
Blood Donors

1988-1990 1991-1993 1994-1996 Maria Cristina Serral, Susie Nogueira2, M.A. Lima3, C. Ramalho4, G.C. Herdy5,
35% (38/109) 46% (38/83) J.S. Lambert6, A. Molinaro3. 1Rua Padre Aschotegui 25 Apt 604 Leblon, Rio De
20% (40/241) 15% (24/161) 21% (56/268) Janeiro Cep 22430-090; 2Universidade Federal Do Rio De Janeiro Rio De
10% (21/208) 10% (15/150) Janeiro RJ; 3Hospital Souza Aguiar Rio De Janeiro RJ; 4Pam Henrique
% 10/495) % (16/416 Valadares Rio De Janeiro RJ; 5Universidade Federal Fluminense Niteroi RJ,
0.7% (232/33179) 0.5% (261/52,223) 0.7% (448/64,112) sil; titute f Human Virology USA
0.7% (232/33.179) 0.50 (261/52,223) 0.7-% (448/64.1121 Brasil; 6lnstitute of Human Virology, USA

Conclusions: Tracking HIV infection is necessary to measure the scope and
severity of the explosive AIDS epidemic in Honduras. Interim approaches may
be needed for estimating its magnitude and the socioeconomic impact. In addition, effective disease intervention and education efforts focusing on behavioral
and socio-cultural factors affecting women's empowerment to negotiate safe sex
practices, are urgently needed.

Objective: To assess the prevalence of HIV-1 infection in children and women
evaluated in the emergency room of an inner city hospital of Rio de Janeiro,
Brazil.
Design: Cross sectional study.
Methods: Between May and October of 1997, 282 women (15-45 years old)
and 268 children, evaluated in the emergency room of Hospital Souza Aguiar,
Rio de Janeiro, who had their blood drawn for other exams and consented to be
tested for HIV antibodies were studied. HIV infection was defined as the presence
of two positive ELISA tests, confirmed by Western blot.
Results: 44 women were HIV positive (15.6%, CI: 11.7-20.5), 51% were
housewives and 49% worked in low paying related jobs. Respiratory diseases
were significantly more common at emergency room evaluation in HIV infected