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

12th World AIDS Conference

Abstracts 14104-14108 203

14104 Sexual behaviour patterns and profiles of male STD
patients attending a model community health/STD clinic
Ronaldo Quintana', G.P. Paraiso1, E.L. Latosa1, J.B. Fleras1, R.E. Carandang2.
'Reachout Foundation, 78-80 Jupiter St. Bel-Air 2 Makati City 1200;
2Department of Health, Manila, Philippines
Objective: To determine the sexual behaviour patterns and demographic profiles
of male STD patients attending the model community health / STD clinic in Pasay
City, Philippines.
Methodology: An interpersonal data sheet and a clinic patient record were
designed to document counseling and record medical history and data of patients,
respectively. The data sheet was used by trained staff who provide counseling to
patients and the clinic patient record was filled out by the clinic physician for the
patients who sought consultation in the STD clinic which used STD syndromic
approach in managing cases. Data obtained from 300 interpersonal data sheets
and clinic patient records gathered from April, 1997 to December, 1997 were
collated and analyzed.
Results: Majority (65%) were between the ages of 19-25 years old; most
of the patients (68%) were unmarried; majority (89%) were heterosexual; most
(49%) were blue collar workers; 43% had multiple partners; 89% had sex with
female sex workers; 12% had previous history of STD which was mostly urethral
discharge; 40% had 3-5 sexual partners during the past 6 months; 95% engaged
in vaginal sex; 67% used condom on irregular basis; 43% tried self-medication
prior to consult; 26% had taken alcohol before engaging in sexual activity.
Conclusion: Policies on intervention programs in STD control should be made
addressing also male clients of sex workers. Interventions such as counseling
and education on STD, alcohol and drug use should be strengthened among
male clients of sex workers. Condom usage must be encouraged and enforced
in all hotels, motels and massage parlors.
4105 Level of agreement for last sexual encounter among male
homosexual couples: Methodological issues
George R. Seage III1, B. Cai2, K. Mayer3, R. Hingson'. 'Boston Univ. School of
Public Health 715 Albany Street, Boston, MA 02118; 2Genetics Institute
Cambridge MA; 3Brown University Providence RI, USA
Background: There have been over 100 studies published evaluating the relationship between alcohol use and unsafe sex, with mixed results. "Event analysis",
which are a variant on the case-crossover design, has been suggested as an
important methodological improvement for obtaining information about transient
exposures prior to or during sexual encounters. We evaluated the level of agreement about the most recent sexual encounter among 95 homosexual couples in
the Boston Partner's Study.
Methods: Each member of the couple was independently interviewed on the
same day regarding the person with whom he had sex, when and where the
sexual encounter took place, and what specific sexual and substance using behaviors occurred. Percent agreement and Kappa statistics were used to assess
level of agreement. McNemar's paired Odds Ratios were calculated to estimate
the relationship between unsafe sex and alcohol use.
Results: Among the 65 (68%) couples who agreed that their last sexual encounter was with each other, there was a high level of agreement regarding
specific sexual behaviors (percent agreement >85%, Kappa 0.56 to 0.84), and
location of the last encounter (97%), but less agreement on the date of the last
encounter (49%). Among the 24 couples in which one or both individuals drank
and/or used substance during sex, level of agreement regarding the specific sexual behaviors (83% to 100%) and kappa values (-0.05 to 0.75) dropped. There
was clearly low agreement on the volume of alcohol used. Agreement did not
vary by the couples' ability to recall the date of their last sexual encounter. When
evaluating the relationship between drinking and anal sex at last encounter, the
relative risk increased from 1.0 to 2.0 as more validated information was used.
Conclusion: These data indicate that the last sexual encounter can be accurately recalled and suggest that the relationship between alcohol use and unsafe
sex is influenced by the quality of the obtained information.
14106 Sexual behaviour and perception of vulnerability to HIV
infection in men who have sex with men (MSM) enrolled
in a cohort study on HIV incidence in Rio de Janeiro,
Brazil
Catherine M. Lowndes', Vieira de Souza2, F.I. Bastos2, F. Sutmoller2.
1Cha-Pavillon St-Sacrement, 1050 Chemin Ste-Foy, Quebec, QC GIS 4L8,
Canada; 20swaldo cruz Foundation Rio de Janeiro RJ, Brazil
Objectives: To analyse the relationship between socio-demographic and behavioural characteristics, and perception of vulnerability to HIV infection, in MSM
enrolled in the first cohort study on HIV incidence in Rio de Janeiro (RJ).
Methods: 295 HIV-negative homosexual and bisexual men, between 18 and
50 years of age (excluding transvestites/transexuals and MSM engaged in regular
commercial sex), were recruited through a combined strategy involving outreach

activities, media contacts and referrals from health care facilities, and interviewed
at time of enrollment in the cohort. Chi-square and Fisher's exact tests were used
for statistical analysis.
Results: Levels of knowledge regarding HIV transmission and prevention were
high in the sample of MSM interviewed. Behavioural changes as a result of the
AIDS epidemic, including condom use, reduction in numbers of sexual partners
and lower frequencies of penetrative anal intercouse, were reported by 76% of

MSM. Significant proportions of the cohort nevertheless continued to practice
unprotected sex: of those who had principal partners in the 6 months preceding
interview (PP - 57% of the cohort), 33% reported unprotected receptive anal sex
(URAS) and 40% reported unprotected insertive anal sex (UIAS); while of those
who had casual partners (CP - 61% of the cohort), 27% reported URAS and 36%
reported UIAS. Seventy-two percent of the cohort perceived themselves as being
at risk for HIV infection. Perception of vulnerability to HIV infection (dichotomous
variable from question: "do you think you are at risk of HIV infection?") was
associated with risky sexual practices during the 6 months prior to interview,
including unprotected anal sex with both CP (Prevalence Odds Ratio [POR] =
2.4; p =.03) and PP (POR = 2.6; p =.02); as well as unprotected oral sex with
CP (POR = 1.9; p =.05). In addition, MSM with higher levels of formal education
more frequently perceived themselves as being vulnerable to HIV infection (POR
= 2.5; p =.002).
Conclusions: The association found in MSM in RJ between recent practice
of risky sexual behaviours and perception of vulnerability to HIV infection may
represent a first step towards behaviour change. However, the high levels of
unprotected sex reported here (in sharp contrast to figures from North America,
where for example URAS has been reported by 9% of MSM with CP, in contrast
to 27% in RJ) suggest that knowledge and awareness of HIV infection risk may
not always be acted out as consistently safer sexual behaviour.
I141071 Validation of self-reported sexual risk behavior with STD
incident rates: Results from the voluntary HIV counseling
and testing study
Thomas Coates', Colin Furlonge2, D. Mwakagile3, C. Kamenga4, J. Schacter1,
S. Gregorich'. 1 UCSF Center for AIDS Prevention Studies, 74 New Montgomery
San Francisco, CA; 4FHI/AIDSCAP Arlington, VA, USA; 2Voluntary Counseling
& Testing Centre, Curepe, Trinidad WI; 3Muhimbili University College Dar Es
Salaam, Tanzania
Objective: To assess the validity of self-reported sexual risk behavior by measuring STD incidence as a biological marker of unprotected sexual intercourse.
Method: A multicenter randomized controlled study was conducted in Nairobi,
Kenya, Dar es Salaam, Tanzania, and Port of Spain, Trinidad. Study participants
were randomized to receive voluntary HIV counseling and testing (VCT, N = 2152)
or a standardized health information (HI) intervention (and to return for VCT in 6
months, N = 2141). Diagnosis and treatment of STDs was offered at 6-months, not
at baseline. Urine specimens were collected at baseline and 6-months. All urine
samples were stored and tested by Ligase Chain Reaction for gonorrhea (GC)
and chlamydia (CT). Standardized interviews assessing sexual risk behaviors
were administered at baseline and at 6 months. Here we report on results from
the Kenyan site (N = 1515).
Results: Incidence rates for GC; 1.6% for men and 4.0% for women; for CT:
2.2% for men and 3.8% for women. Participants assigned to VCT were less
likely to report having unprotected sexual intercourse with a non-primary partner
(UI-NP: OR =.69, p <.025). Respondents who reported UI-NP at 6-months
were 2.5 times more likely to have an incident STD at 6-months compared to
those reporting no UI-NP (p <.01). After controlling for UI-NP at 6 months, those
who reported UI-NP at baseline were nearly twice as likely than their less risky
counterparts to have an incident STD (OR = 1.9, p <.025).
Self-reported risk behavior at baseline and at 6 months were associated with
incident STDs. These findings support self-reports as valid measures of sexual
risk behavior.
S14108 1HIV epidemics and behaviours: Evidence of favourable
change in Zambia
Knut Fylkesnes', M. Carael2. 'Institute of Community Medicine, University of
Tromso, Tromso, Norway; 2UNAIDS, Geneva, Switzerland
Objectives: To examine trends in sexual behaviour and factors associated with
"high risk" behaviour.
Design: Cross-sectional population-based surveys.
Methods: The data stem from two population-based surveys from Zambia, one
conducted in 1990 in Lusaka (KABP, GPA/WHO, n = 1992), and the second in
1995 in a residential area in Lusaka (n = 2521). Both surveys employed stratified
random cluster sampling and similar questions on sexual behaviour and condom
use.
Results: Comparison of the two surveys revealed a consistent change in both
sexes and within all age-groups towards more prevalent use of condoms and
less multiple sexual partners during the 5-year period. The most marked changes
seemed to have occurred among higher educational groups. The indication of a
steep rise in condom use is in accordance with the records on condom distribution.
Moreover, self-reporting of change in sexual behaviour, as measured in 1995,
supported the cross-sectional trends: 80% of male respondents stated not to have
used condoms some years ago, while a proportion of 48% reported to actually
have used condoms in most recent casual sex encounter. The same applied
to casual sex: 70% reported less sexual partners than some years ago. Being

male and single increased the probability of casual sex and, in contrast to 1990,
tended to decline by educational level. Condom use in casual encounters was
strongly associated with being single, male and educational level (high vs. low
education: 45% vs. 77% in males; 21% vs. 41% for females). While the majority
of the population believed that condoms are "safe preventing HIV", factors found
to hamper condom use were "religious belief" and the feeling of embarrassment
providing condoms.