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

204 Abstracts 14109-14113

12th World AIDS Conference

Conclusion: Despite many methodological constraints involved in assessing sexual behaviour, the findings provide convincing evidence that widespread
changes have occurred in sexual behaviour in Lusaka since 1990. These changes
may be linked to the HIV surveillance findings from the residential Lusaka area
surveyed in 1995 of a decline in HIV prevalence (antenatal care attendees aged
15-19 years) from 29% in 1993 to 17% in 1996.

141091

Early sexual activity is common among teenagers in the
Democratic Republic of Congo (DRC), while perception of
risk of AIDS is low

Patrick Kayembe Kalambayi1, Lina Piripiri1, Karl Nawej2, Peter Remes2.
School of Public Health, BP 11850, Kinshasa I; 2MSF/Belgique, Kinshasa,
Dem. Rep. of Congo
Objective: To describe sexual lifestyle, to measure knowledge of AIDS, and
perception of risk of getting AIDS and STDs among teenagers in DRC.
Method: In 1997, a random sample of 900 teenagers attending first grade of
high school in 4 administrative areas of DRC (Kinshasa, Equateur, Bas-Congo,
Katanga) were surveyed by the mean of an anonymous self-administered questionnaire. Team members assisted selected respondents with the questionnaire.
Standard demographic data, information on sexual behavior, knowledge of AIDS
and perception of risk of AIDS were collected. Chi-square, t-test and logistic
regression analyses were performed where appropriate.
Results: Of 900 questionnaires distributed 845 (93%) were completed. Half of
respondents were males and half females. The mean age of respondents was
14.47 (SD: 1.52) and there was no statistical difference in age between boys
and girls. One third of girls (30%) and 57% of boys were already sexually active
and these proportions were similar across regions. Fifty percent of respondents
became sexually active before age 13. Girls have had older partners and boys
younger one. Forty percent of respondents have discontinued sexual activity
because of fear of AIDS (13%), dislike of sex or lack of intimate friend (25%).
The reasons for continuing sexual activity were pleasure (42%), to be in good
health (46.8%), being forced by partners (31%), to satisfy partner who gives
gifts (36.5%). More than 25% of sexually active respondents have had 2 or more
partners the previous 3 months. Less than 10% reported using condoms on a regular basis. Two third of respondents reported having received information about
sexual matters from friends. Knowledge of AIDS (transmission and prevention
means) and perception of risk of getting AIDS were low.
Conclusion: The findings that teenagers become sexually active very early,
that they are experiencing behavior that puts them at high risk of getting AIDS,
and that they are getting information about sexual matters mostly from friends,
underscore the needs for starting sexual education at an early age, the need for
using peer educators, and the need for parents in DRC to go beyond culture by
talking openly with their children about sex in order to delay the age at first sexual
activity or use proper protection.
S14110| Eight-year trends in HIV risk behaviors among US youth
Laura Kann1, R. Lowry2, S. Kinchen2, J. Collins2. 1Centers for Disease Control
& Prevention, Atlanta, GA; 2CDC, Atlanta, USA
Background: The HIV epidemic in the US continues to escalate among adolescents and young adults. Sexual behaviors provide important markers of HIV risk.
The objective of this study was to examine trends in sexual risk behaviors among
US high school students during the 1990s.
Methods: Data from the 1990, 1991, 1993, 1995, and 1997 national Youth Risk
Behavior Surveys (YRBS) were used to examine whether significant changes
have occurred in HIV-related risk behaviors among in-school youth. The YRBS is
the only ongoing surveillance system in the US providing sexual risk behavior data
on high school students. The YRBS provides self-report data from comparable,
independent samples of approximately 12,000 youth ages 14-18 (grades 9-12)
each year it is conducted.
Results: From 1990 through 1997, no significant change was detected in the
percent of high school students ever having had sexual intercourse (54.2% to
48.4%), having had sexual intercourse with four or more partners (18.7% to
16.0%), or having had sexual intercourse during the three months preceding the
survey (37.5% to 34.8%). In contrast, overall condom use at last sexual intercourse increased significantly from 1991 to 1997 (46.2% to 56.8%). Subgroup
analyses by gender, grade, and race/ethnicity indicated a significant increase in
condom use among female and black students.
Conclusion: After more than 10 years of HIV prevention education through
schools, families, and communities, sexual intercourse rates are level and condom use is increasing. While these findings are encouraging, many high school
students are establishing patterns of behavior that put them at risk of HIV infection. More must be done to help young people delay initiation of sexual activity
and increase condom use among those who choose to be sexually active.
14111 Attitudes towards childbearing and adherence to safer
sex rules in a cohort of HIV infected women
Christoph Rudin1, B. Laubereau1, U. Lauper2. And the Swiss HIVand Pregnancy
Collaborative Study Group; 1University Children's Hospital, Roemergasse 8
CH-4058, Basel; 2Dept. of Gynecology, University Hospital, Zuerich, Switzerland
Background: The introduction of zidovudine prophylaxis according to
PACTG-076 into clinical practice resulted in a marked reduction of vertical HIV

transmission in the industrialized world. With increasing use of HAART (highly
active antiretroviral therapy) during pregnancy and/or primary cesarean section
a further decline in vertical transmission rates may be anticipated. However this
progress could encourage pregnancy and risky behaviour in HIV-infected couples.
Methods: The 'Swiss HIV and Pregnancy Study' is an ongoing nationwide
prospective study, funded by the Swiss Federal Office of Health. This study has
been collecting data in HIV infected pregnant women on a voluntary basis since
1989. An extensive questionnaire covering state of health, risk behaviour, sexual
partners, counselling and pregnancy has to be completed at enrolment. Selected
information from these questionnaires is presented.
Results: Since 1989 253 questionnaires on women (mean age 27.8 ~ 4.2,
range 16-41 years) who decided to continue their pregnancy to full-term have
been collected. Of those who answered the respective questions, 43% (89/208)
had actively planned to become pregnant and 47% (89/191) refrained from contraception. The wish to have their own child was stated as the main reason
not to terminate pregnancy (66% (121/182)). Nine out of ten women (188/210
(90%)) claimed to have informed their sexual partners about their HIV infection.
Nevertheless 54% (99/185) admitted no or low adherence to safer sex rules. In
contrast to our apprehension contraceptive use increased from 48% (1989-1994;
68/140) before to 67% (34/51) after the introduction of zidovudine prophylaxis into
clinical practice (1995-1997) (p < 0.05), while the other proportions remained
stable.
Conclusions: In Switzerland many HIV infected pregnant women wish to have
children and actively seek pregnancy despite potential risks for their partners
and offspring. This desire has to be respected and provisions to reduce the
respective risks have to be offered. Although adherence to safer sex rules and
contraception is low, optional HIV transmission prophylaxis does not seem to
adversely influence the attitudes of couples stricken with HIV infection.
14112 Temporal trends in the prevalence of needle-sharing and
condom use among injecting drug users
Marco Villa1, A. Lucchini2, R. Mangili3, R. Mollica4, G. De Micco5, E. Cozzolino6,
A. Cinquegrana7. 1Dept. Epidemiology ITBA-CNR Via FLLI Cervi 93 - 20090
Segrate (MI); 2ASL Provincia Di Milano 2 - Sert Gorgonzola (MI); 3ASL Provincia
Di Bergamo - Sert Ponte S. Peitro (BG); 4ASL Citta' Di Milano - Sert Milano;
5ASL Provincia Di Varese - Sert Somma Lombardo (VA); 6ASL Provincia Di
Bergamo - Sert Trezzo D'Adda (BG); 7ASL Provincia Di Brescia - Sert Gardone
Valtrompia (BS), Italy
Objective: To evaluate the trend in the prevalence of risk behaviors for HIV
infection among injecting drug users.
Methods: A questionnaire about behaviors related to drug use and sex was
administered to all subjects entering one of 14 drug treatment centers in Northern
Italy in May 1996, as well as to a sample of patients under treatment.
Results: Of 228 drug users (173 males and 55 females) of age 17-47 (mean
29.4 ~ 5.9) years, 59 were HIV-positive. 136 subjects (62%) reported injecting
drugs in the last month and, among them, 23 (17% of the respondents) used
the injecting equipment previously used by someone else. HIV-positives shared
needles more often than HIV-negatives (22% vs. 18%). Among drug users who
shared needles, 38% shared it only with the sexual partner whereas the remaining
62% shared also with other people.
Regarding sexual behaviors, seropositives reported to use condom during
sexual intercourses more often than seronegatives, both with their partner and
occasional partners: 12 out of 36 (33%) HIV-positives reported to have always
used condom with the partner during the last month (as opposed to 6% among
seronegatives) and 7 out of 14 (50%) HIV-positives reported to have always used
it in occasional encounters during the last six months (36% among seronegatives).
The frequency of condom use reported by males was higher than that reported by
females. A comparison with analogous surveys (1986-1990) previously carried
out on the same population showed a big change in the frequency of needle
sharing, from almost 70% in 1986-1990 to about 20% in 1996. There also was
an increase in the frequency of condom use, even though the change is of less
extent than needle sharing.
Conclusions: The population of injecting drug users of Northern Italy appears
to have markedly decreased the frequency of needle-sharing, habit which is
now confined to a minority of drug users. More efforts have to be undertaken to
improve the frequency of safe sexual behaviors.
S14113 How valid are self-reported measures of drug use and
condom practices for the study of HIV risk behaviors
among street sex workers?
Mildred Vera, M. Alegria, M. Santos, R. Perez, A. Irizarry, J. Rodriguez,
J. Calderon. School of Public Health PO. Box 365067 San Juan PR 00936-5067,
Puerto Rico
Background: Concerns arise about the validity of self-reported measures of drug
use and condom practices in the study of HIV risk behaviors. In this presentation we examine the concordance between self-reported drug use and condom

practices with objective measures.
Methods: We collected information on 311 street sex workers. Outreach activities were conducted at eleven street locations throughout the island. After
extensive information had been provided, the women voluntarily agreed to participate. A small number of participants were enrolled at each site to generate
a sample that would reflect the diversity of the sex worker population. Data
about risk behaviors were collected via a structured interview. Respondents who