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

12th World AIDS Conference

Abstracts 23150-23154 371

HIV discordant. Among the discordant couples, the man was HIV+ in 46 couples
(44%) and the woman HIV+ in 59 couples (56%). Among 57 couples where the
man was HIV+, 46 (81%) of the prospective women partners were HIV-; among
the 70 couples where the woman was HIV+, 59 (84%) of the prospective men
partners were HIV-. Thus, among these AIC clients, the probability of a man
with HIV infection intending to have sex with a new partner who is HIV- is 0.81;
among the HIV+ women, the probability is 0.84.
Conclusions: Our data on couples intending to get married or to start a sexual
relationship indicates that there is a high probability that persons who are HIV+ will
develop sexual relationships with HIV- partners and unknowingly transmit HIV.
If HIV CT is not readily available, there would be a high risk of HIV transmission.
AIDS education messages need to emphasize the benefits of couple CT before
marriage and before new sexual relationships, and counsellors need to be trained
in couple counselling.
23150 Cofactors for acquisition of HIV-1 among heterosexual
men: Prospective cohort study of trucking company
workers in Kenya
Joel Rakwar', L. Lavreys2, J.K. Kreiss2, B.J. Jackson3, J.J. Bwayo3,
J. Ndinya-Achola3. 1PO. Box 11340 Nairobi, 3University of Nairobi, Nairobi,
Kenya; 2University of Washington, Seattle, WA, USA
Objective: To determine the prevalence, incidence, and correlates of HIV-1
infection in a cohort of east African trucking company employees.
Design: Prospective cohort study
Methods: Trucking company employees were screened for HIV-1 antibodies. HIV-1 seronegative men were enrolled in a prospective cohort study and
evaluated at 3 monthly intervals for HIV-1 seroconversion, sexually transmitted
diseases, and sexual behavior.
Results: The seroprevalence of HIV-1 among 1500 trucking company employees was 17.8%. Among 752 HIV-1 seronegative men who were followed, the
annual HIV-1 seroincidence was 3.1%. In univariate analysis, HIV-1 acquisition
was associated with age <25 years, <10 years of sexual activity, occupation as
a driver/driver's assistant, occupational travel for >14 days per month, religion,
uncircumcised status, sex with a prostitute, sex with a girlfriend/casual partner, any extramarital sex, and enrollment seropositivity to Treponema pallidum,
Haemophilus ducreyi, and Herpes simplex virus type 2 (all Pvalues <0.05). Using
multivariate analysis, HIV-1 acquisition was independently associated with <10
years of sexual activity (hazard rate ratio [HRR] 2.0, 95% confidence interval [CI]
1.0, 4.7), occupation as driver/driver's assistant (HRR 3.9, 95% CI 1.8, 8.5), religion other than Christian or Muslim (HRR 6.1, 95% Cl 1.6, 23.6), uncircumcised
status (HRR 2.3, 95% Cl 1.0, 5.1), and unprotected sex with a prostitute (HRR
2.8, 95% Cl 1.0, 7.3).
Conclusions: Trucking company employees had a high HIV-1 seroprevalence
rate at enrollment and a high HIV-1 seroincidence during follow-up, despite risk
reduction counselling and free condom availability. Risk factors for HIV-1 seroconversion included unprotected high-risk sexual encounters and uncircumcised
status.
23151 A comparative study of risk behaviour among male
attendees to a STD clinic
Ingeborgl Vik', J.T. Thorvaldsen', M.L. Loeb2, H.M. Moi'. 'Olafiaklinikken,
Groland Postkontor 0133 Oslo; 2Hosp Oslo; The National Institute of Public
Health Oslo, Norway
Objectives: To analyse and compare the results of the systematic collection of
demographic and risk behaviour data among homosexual men (n = 1475 (15%))
and heterosexual men (n = 8284 (85%)) on their first consultation to a STD clinic
in Oslo during 1996 and 1997.
Design: Longitudinal routinely obtained data and cross sectional analysis.
Methods: All patients attending the Oslo Municipal STD Clinic are systematically interviewed by a nurse prior to the medical examination. Information is
obtained regarding age, domicile (city or countryside), level of education, reason
for attending, steady partner, use of condom with steady partner versus casual
partner, number of sex partners, casual partner born outside Norway, buying or
selling sexual services, injecting drug use, number and site of previous HIV-tests
and previous STDs. Diagnosis and treatment are based upon clinical findings and
testing, including serology.
Results: Data from 1475 homosexual and bisexual and 8284 heterosexual
men were analysed. 3.3% of the gay men versus 5.3% of the heterosexual men
had no formal education whereas the proportion attaining university level was
57% versus 50%. 64% of the gay men did not use condom the last time they
had sex whereas non-use among heterosexual men was 80%. 65% of the homosexuals and 85% of the heterosexuals had had sex during the last three months
without using condom. 50% versus 33% had had one or more casual partners
of foreign origin, these results are all statistically significant. The difference regarding buying and selling sex was not significant, however, whereas men who
had sex with men had had significantly more gonorrhoeae, syphilis and hepatitis

B; heterosexually active men had more chlamydia. 85% of the gay men were
previously HIV-tested, only 73% of the heterosexually active men were, also a
significant difference.
Conclusion: Unsafe sex is highly prevalent in both groups. The HIV preventive
measures in Norway have mainly been targeted towards risk groups according
to the "follow the virus" line. Negotiated safety prevails as the salient strategy,
the increasing incidence of sexually transmitted diseases other than HIV gives

however reason for rethinking of strategies in a low HIV prevalence country, at
least on the STD clinic level.
23152 HIV incidence and HIV-associated mortality among male
factory workers and their spouses in northwest Tanzania
Ties Boerma1, K.P. Senkoro2, A.H. Klokke3, M.W. Borgdorff4, L.R. Barongo2,
J.Z.L. Ngweshemi1. 1Tanesa Project, PO Box 434; 2National Institure for Medical
Research; 3Bugando Medical Centre, Mwanza, Tanzania; 4KNCU Tuberculosis,
The Hague, Netherlands
Objectives: To assess HIV incidence and HIV-associated mortality among factory
workers and their spouses, including discordant couples
Design: Observational cohort study
Methods: The study population includes workers and their spouses at a large
urban textile factory in Mwanza, NW Tanzania. Enrollment started in October
1991 and follow-up continued until April 1996. All participants were invited to
make 4-monthly follow-up visits to the study clinic for interview, physical examination and laboratory investigations, including HIV. Free medical treatment was
provided. Home visits were used to obtain survival data up to one year after the
last study clinic visit.
Results: 1594 men and 880 women were enrolled for the study with an average follow-up time of 2.5 years. HIV incidences were 1.0 (95% Cl: 0.7-1.5)
among men and 1.9 per 100 person years (PY) (95% CI: 1.2-2.9) among women
respectively. Among 71 discordant couples HIV incidence was 5.8 per 100 PY
(2.5-11.1), and the risk per 1,000 times sexual intercourse was 0.74 for men
and 1.19 for women. In comparison, HIV incidence among HIV negative couples
was 0.4 per 100 PY (0.2-0.8). Mortality among HIV negatives was 3.1 per 1,000
PY (1.9-4.9), compared to 45.0 (32.7-60.2) among HIV positives, corresponding
with a population-attributable fraction of 64%.
Conclusion: In this population with good access to STD treatment services HIV
incidence was considerably lower than among factory workers elsewhere (e.g.
Harare, Zimbabwe,), but about twice as high as among men in STD intervention
communities in rural Mwanza. Annual mortality rates among HIV positives were
lower than in community studies in East Africa, but HIV was associated with a
more than twofold increase in adult mortality.
23153 Serodiscordance of HIV-1 among pregnancy women in
Nairobi, Kenya
Anthony K. Mwatha', M. Keilly3, R.W. Nduati2, D.A. Mbori-Ngacha2, J. Bwayo2,
J.C. Kreiss3, G.C. John3. 1 PO Box 19676 Nairobi; 2University of Nairobi, Kenya;
3University of Washington Seattle, USA
Objective: To determine the prevalence and correlates of HIV-1 seroconcordance
in HIV-1 infected pregnant women and their sexual partners in Nairobi, Kenya.
Methods: HIV-1 testing was offered to partners of HIV-1 seropositive pregnant
women enrolled in an ongoing vertical transmission study. Baseline demographic
and laboratory evaluation of the female index cases was conducted. Laboratory evaluations included CD4 counts, screening for STDs, genital HIV-1 DNA,
determination of viral subtype, and plasma viral load.
Results: Among 426 women enrolled, HIV-1 results were available for 161
partners. Fifty eight percent (93/161) of couples were HIV-1 seroconcordant.
Concordant and discordant couples were similar with respect to age, marital status, and education level, although the proportion of concordant women who were
primiparous was somewhat higher (64% vs 49%, p = 0.06). Concordant women
were more likely to have trichonomas infection (OR = 2.7, p = 0.03), vaginal discharge (OR = 1.9, p = 0.05), and higher cervical HIV-1 shedding rate (OR = 2.9, p
= 0.02). Of the 98 women for whom subtype information was available, the majority were type A (71%), and the remainder were types D (24%), and C (5%), with
the distribution of viral types being similar for concordant and discordant couples.
Of 101 women, 29% had detectable cervical HIV-1 DNA and 10% vaginal HIV-1
DNA. The mean plasma viral load was 139,776 copies/ml (2,500-1,123,150), and
the mean CD4 count was 618 (99-1258). Clinical disease status, plasma viral
load and immunosuppression were not associated with concordance.
Conclusions: In this group of pregnant HIV-1 infected, a substantial proportion
of partners were uninfected. We observed higher prevalence of trichonomas and
cervical shedding of HIV-1 among women in concordant relationships. These
factors may facilitate heterosexual transmission of HIV-1.
23154 Sexual risk behaviors of injecting drug users in Bangkok,
Thailand
Don C. Des Jarlais', Wonchart Subhachaturas2, S. Vanichseni2, P. Friedmann1,
K. Choopanya2, S. Raktham2. 'Beth Israel Medical Center First Av. at 16th
Street, USA; 2Bangkok Metropolitan Administration Bangkok, Thailand
Objective: Bangkok has experience high rates of both injecting drug use and heterosexual HIV transmission. Compared to IDUs in other cities, IDUs in Bangkok
may be at unusually high risk for becoming infected with HIV through both
needle-borne and heterosexual transmission.

Methods: Cross-sectional surveys of IDUs in drug abuse treatment programs
was conducted in 1989 (n = 600), 1993 (n = 600), and 1997 (n = 300). Questionnaires were administered by trained interviewers, and serum samples were
collected for HIV testing.
Results: 94% to 95% of subjects were male in each of the surveys. HIV
seroprevalence was relatively stable at 34%, 38% and 33% across the 3 surveys.