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

12th World AIDS Conference

Abstracts 22488-23104 361

22488 | Appropriate hospital facilities for the care of HIV/AIDS
patients in Singapore
Doroth Guek Neo Ong', W.S.Y. Won Sin Yew2, Teresa Straugghan2. BIk. 112
Potong Pasir Avenue 1 #07-644 Singapore; 2Communicable Disease Centre,
Singapore, Singapore
Objectives: To provide the quality of life through improved standard of Nursing
Care and extended hospital facilities for the care of HIV and AIDS patients.
Method: Statistic collected from 1994-1997 showed a tremendous increase in
the number of newly diagnosed HIV patients and the number of admissions to
hospitals. This prompted the immediate action of training staff to provide the essential competent and quality care and to look into the varied facilities to improve
the quality of life besides the availability of drugs.
Chart to show the need to provide the appropriate hospital facilities
Facilities 1994 1995 1996 1997
Newly diagnosed positive patients 76 Male 102 Male 123 Male 156 Male
(Singapore Resident) 10 Female 9 Female 16 Female 16 Female
Day treatment centre attendances 256 1080 2521 2882
SOC J attendance 1372 1607 3113 4102
Admissions 177 217 273 299
Patient Care Centre attendances since Oct 97 - - - 6-8 daily
Home Care Programme started in Dec 97 - - - 2 patients
Results: We have a group of trained dedicated doctors, nurses, medical social
workers, programme coordinator assistant, physiotherapist and dietitian for the
provision of care.
We have increased the existing 13 bedded ward with another 12 bedded ward
in October 1996. In 1994 October, we started the day treatment centre to provide
the outpatient drug therapy treatment to save hospitalisation cost.
In April 1997, provision of the Patient Care Centre for patient and families to
congregate together for counselling, education and integration activities.
Patient discharged from the ward but need the continual care are followed up
by our Home Care Team.
With the foresight, we have achieved our aims of providing the improved standard of care and hospital facilities through training of our health care team and
continously planning for better care facilities.
23101 Objective: To characterize risk behaviors associated with
incident HIV infection in San Francisco
Beth A. Dillon1, F.M. Hecht2, J.A. Kahn2, M. Chesney2. 1995 Potrero Avenue,
San Francisco, California, 94110; 2University of California, San Francisco, CA,
USA
Methods: From 6/96 to 10/97 we screened 209 persons suspected of having
recently acquired HIV-1. The criteria to establish recent infection were presence
of HIV RNA while still HIV-1 antibody negative or indetermanent, or documented
seroconversion in the previous 6 months. Specific risk behaviors for the period during which infection occurred were elicited with self-administered and
interviewer administered questionnaire.
Results: 39 of the 209 screened persons were found to have recent HIV
infection. Of these 39, 34 are male and 5 female. All of the males are homosexual
or bisexual. A hierarchy of transmission risk for unprotected sexual exposures
(receptive anal (RA), or receptive vaginal (RV), or insertive anal (IA) or vaginal,
receptive oral (RO), or insertive oral (10)) was used to analyze probable route
of acquisition. Of the recently infected males 27 (79.4%) reported unprotected
RA sex, 3 (8.8%) reported unprotected IA sex. Of the 9 initially reporting only
unprotected oral sex as a risk for HIV exposure, 5 were reclassified after detailed
follow-up interviewing. However, 4 (11.8%) of the incident infections are likely to
represent RO transmission of the virus. Interviews are being performed with the
probable source partners of the persons identified as acquiring HIV through oral
transmission and when possible serum obtained to substantiate source spread
analysis.
Conclusion: A substantial proportion of recent HIV infections in this group of
high-risk men may be a consequence of receptive oral sex exposures; further
investigation of partners when possible is needed to assist in confirming route of
transmission. This finding has substantial implications for prevention messages.
However, most recent infections in men who have sex with men continue to result
from unprotected receptive anal (80%) sexual exposures.
23102 Changing sexual behavior in men who have sex with men
seen at a Seattle HIV testing site, 1988-1997
Robert W. Wood1, G.M. Goldbaum2, K. Okita2. 1400 Yesler Way 3rd floor
Seattle, Washington; 2Seattle-King Country Public Health, Seattle, Washington,
WA, USA
Objectives: To determine if unsafe behaviors were increasing in association with
new HIV treatment developments.
Design: We analyzed initial visit data for 6,497 MSM who sought HIV testing

at the main alternative test site in Seattle, Washington from 1988 through 1997,
who reported any male partners during the preceding 12 months, and who had
not previously tested HIV seropositive.
Results: The proportion of MSM who reported unprotected anal sex in the
prior 6 months declined from 40% (1988-89) to 31% (1996-97), while those who
reported only protected anal sex rose from 20% (1988-89) to 34% (1994-95)
and then fell to 22% (1996-97). Nearly all oral sex was unprotected (96%), and

the proportion reporting unprotected oral sex varied from 78% (1988-89) to 88%
(1994-95) to 65% (1996-97). Of the 9% who reported penile-vaginal intercourse,
only 35% reported only protected sex with women, with no significant trend over
time. Differences in the numbers of partners over time were subtle and without
significant trends.
Conclusions: Among MSM seeking HIV testing at initial visits over ten years,
the prevalence of reported unprotected anal sex fell consistently and significantly
while unprotected oral sex rose for 8 years, then fell during the years after highly
active anti-retroviral treatment arrived. MSM sexual risks remain high.
23103 Risk behaviors for HIV infection among men who have
sex with men
Expedito J.A. Luna1, H.M.D. Novaes1, E.A. Castilho2, J.R. Carvalheiro3.
1Faculdade de Medicine = USFR Sao Paulo, SP; 2CoordenaCao Nacional De
DST/AIDS, Brasilia, DF; 3 nstituto de Sadde, Sao Paulo, SP Brazil
Objectives: To assess the factors associated with unprotected anal intercourse
(UAI) among men who have sex with men (MSM) in S&o Paulo, Brazil
Methods: A case-control study was carried out among the participants of the
Bela Vista Project, an ongoing HIV incidence cohort study. Volunteers, all of
whom HIV negative, recruited from 1994 to 1994 were eligible for participation.
All subjects that reported UAI in the 6 months previous to their first interview were
considered cases. For each case, the next recruited subject, not reporting UAI,
was selected as a control (n = 518; 259 cases and controls). Univariate analysis
of the association between UAI and an extensive list of socio-demographic and
behavioral variables was undertaken (Pearson's X2, t-test). Variables with an
alpha error equal or below 10% were included in a multiple logistic regression
model, to assess their effect in the presence of other relevant variables.
Results: It was observed the association between UAI and socio-demographic
variables (lower occupational status and being a college drop-out); partnership
status (steady partnership and knowledge of HIV status of steady partner); perception of discrimination for the sexual orientation; and to the level of knowledge
on HIV transmission. Seven variables of risk perception and reasons for the use
or non-use of condoms were also associated with UAI. Participation in AIDS or
gay NGOs had a protective effect concerning UAI.
Conclusions: Present data might be useful to redirect preventive interventions
targeting MSM in Brazil. Steady partnership and knowledge of HIV status of
steady partner were important predictors of UAI, evidencing the need to address those negotiations. Despite some degree of knowledge inaccuracy on HIV
transmission, risk perceptions and reasons for use or non use of condoms were
associated with UAI among study participants, showing they were aware of the
risks involved in their behaviors.
[23104 When worlds collide: Sex, needles, and HIV infection
among young injection drug using men who have sex
with men
Greg Rebchook1, W. McFarland2, M. Katz2, V. Guilin2, G. Nieri2, D. MacKellar3,
L. Valleroy3. 1UCSF/Center for AIDS Prevention Studies, 74 New Montgomery,
San Francisco; 2San Francisco Dept. of Public Health, San Francisco, CA;
3Centers for Disease Control & Prevention, Atlanta, GA, USA
Objective: To describe the HIV risks of young injection drug using men who have
sex with men.
Methods: From 1994 to 1995, young men who have sex with men (MSM),
ages 15-22, participated in a venue-based survey in 3 California, USA counties.
719 subjects were sampled from 62 locations known to attract young MSM.
These men received a detailed face-to-face risk assessment interview, HIV/AIDS
prevention counseling (conducted after the interview), referrals for health and
social services, and serologic testing for HIV and hepatitis B.
Results: 8% (n = 58) of the sample reported injecting drugs at least once in
their life.

HIV+
HBV+
White
History STD, ever
Sex with women, ever
>9 male partners, 6 mos.
Sex w/HIV+, 6 mos.
Money/drugs for sex
Self-ID heterosexual
1st anal sex --15 yrs.

IDU Non-IDU
16% 5%
25% 12%
59% 28%
38% 11%
85% 57%

- 0.01
-0.01
0.001
0.001
0.001
S0.01
0.06
0.001
0.001
0.05

34%
22%
48%
17%
33%

9%
11%
7%
2%
19%

The injection drug users (IDUs) were no older than the non-IDUs (p < 0.90),
and the IDUs reported the same frequency of condom use as their non-injecting
peers (p < 0.90), but a much higher proportion of the IDUs tested HIV positive.
Young IDU MSM reported that anal sex and injecting behaviors began, and rapidly
increased, during their pre-teen and teenage years. Among those who reported
unprotected anal intercourse in the past six months (n = 223), the IDUs were
more likely than non-IDUs to report it with exchange partners, and the non-IDUs
were more likely than IDUs to report it with steady partners. 53% of the IDU MSM
reported that they sometimes or always shared needles.
Conclusions: Clearly, this population of youth is vulnerable to HIV infection
from both their sexual and injection behaviors. Without further prevention efforts,