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

372 Abstracts 23155-23158

12th World AIDS Conference

Relatively high numbers of subjects reported no sexual partners in the 6 months
prior to the interviews: 47% in 1989, 53% in 1993, and 47% in 1997 (n.s. trend).
Consistent condom use was reported by a minority of subjects in relationships
with primary partners, 12% of those with primary partners in 1989, 13% in 1993,
and 10% in 1997 (n.s. trend). Relatively few subjects reported sexual relationships
with causal partners, 14% in 1989, 10% in 1993, and 12% in 1997. Consistent
condom use increased in relationships with casual partners, from 35% in 1989,
to 47% in 1993 to 63% in 1997 (p =.008 for trend).
Conclusions: The high percentage of subjects reporting no sexual partners,
the small number of subjects with casual partners, and the increasing consistent
condom use with casual partners all indicate that IDUs in Bangkok are not likely
to become infected through sexual activities. The relatively low rates of condom
use with primary partners, however, indicate a relatively high risk for transmitting
HIV to primary partners if they should become infected through needle-borne
transmission.
123155 Fatherhood in seropositive men - medical and
psychosocial aspects of assisted reproduction with
processed sperm
Ulrike Sonnenberg-Schwan', M. Weigel2, H. Jaeger', A.E. Semprini3, S. Fiore3,
S. Savasi3, M. Oneta3, T. Persico3. 'KIS - Curatoriom For Immunedeficiency,
Mozartstr:3 80336 Munich; 2 Municipal Hospital, Gynaecolical Clinic, Manheim,
Germany; 3Univ. of Milan Med. School, San Paolo Biomed. Institute, Milan, Italy
Objectives: The project "Assisted Reproduction in HIV-Discordant Couples" is
aiming at offering medical, psychosocial and psychotherapeutical support to heterosexual couples where the male partner is seropositive, having a strong wish
for parenthood. Up to now treatment is available only in Italy and Germany. The
German study investigates the impact of treatment, pregnancy and parenthood
on the couples' psychological and psychosocial situation and their perspectives
on life.
Methods: Reproductive options for these couples are: either the use of semen
from a seronegative donor to exclude any risk of infection for the woman completely, or reduction of HIV-RNA in the partner's semen by seminal processing in
order to limit the infective risk to a minimum. After testing the processed semen for
HIV-RNA by PCR it can be used for assisted reproductive technologies (intrauterine transfer, in-vitro fertilization, intra-cytoplasmatic sperm injection) according to
semen quality and the presence of infertility factors. The psychosocial aspects of
reproduction of the couples enrolled in the study are investigated by means of
semi-standardized and standardized questionnaires as well as structured interviews.
Results: From Oct. 91 to Jan. 98 72 couples out of 121 who contacted us for
counselling decided for treatment, 40 of them enrolled in the study. The figure
shows the clinical outcome of treatment in German and Italy:
Couples treated Inseminations Pregnancies Livebirths Seroconversion
mother
Germany 30 86 13 10 0
Italy 455 1427 215 157 0
Data show a slight decrease in psychological strain and distress, an increase
in social contacts and disclosure and a pronouncedly more optimistic perspective
on life during treatment, pregnancy and parenthood.
Conclusions: Assisted reproduction with processed sperm can reduce the risk
of infection for a seronegative woman willing to have a child from her seropositive
partner. The possibility to fulfill the wish for parenthood enhances the perceived
life quality of HIV-discordant couples. The preventive impact of the project is high,
as couples refrain from unprotected intercourse. Reproductive counselling and
assistance should be part of the medical care of patients infected with HIV.
1231561 Prevalence of HIV amongst commercial sex workers in
Kathmandu
Vijaya Lall Gurubacharya, R.L. Gurubacharya, J. Shrestha. SACTS, P B. No.
7314. GPO. Kathmandu, Nepal
Objective: To asses and monitor HIV amongst commercial sex workers operating
in streets of Kathmandu.
Method: For a period of three years from 1994-97 each year three hundred
commercial sex workers were interviewed for safer sex practice and blood samples were collected for unlinked annonymous HIV testing. The sex workers were
also counselled on risk of HIV infection through unprotected sex and information
was given on use of condom. The sex workers come from very poor families of
villages and were forced to prostitution either due to poverty or by a middle man.
As sex workers do not have their own room to operate, clients take them to public
place or small local hotel. Most of the clients are from low or middle class income
group migrant workers, labourers and students. Age of sex workers range from
14 to 40 and operates in different street in Kathmandy valley.
Result: Out of three hundred sex workers studied 2 (0.66%), in year one, 8

(2.66%), in year two and 26 (8.66%) in year three tested HIV positive. In three
year period HIV prevalence in sex workers increased from 0.66% to 8.66%. In
spite of public awareness programm for promotion of safer sex no significant rise
in use of condom by sex workers and their clients was observed. Condom use by
sex worker is insignificant.
Conclusion: HIV infection which was until recently limited to a few sex workers
has now reached to significant number of this hard to reach group in Nepal. This

suggest that more sex workers are now being infected by their infected partners.
And this in turn can pass the infection to many more uninfected partners and who
may take home HIV to their spouse. Continued monitoring and follw up this study
can provide confidential identification of group in need of urgent intervention and
plan for preventive measures.
23157 Synthesis of HIV prevention intervention research for
heterosexual populations
Mary Neumann', W.D. Johnson', S.V. Semaan', E.D. Sogolow', G. Ramirez2,
D. Strouse3, L. Hedges4. 1CDC, 1600 Clifton Rd., NE Mailstop, Atlanta, GA;
2University of N. Texas, Health Sciences Center, Forth Worth, TX; 3ASPEN
Systems Corporation, Rockville, MD; 4 Univ. of Chicago, Dept. of Education,
Chicago, IL, USA
Background: This study examines the effects of behavioral and social interventions on the sexual behaviors of persons at risk for HIV through heterosexual
transmission, using data from studies identified by the new database of HIV prevention studies developed by the US Centers for Disease Control and Prevention.
Methods: The CDC Prevention Research Synthesis database includes 82
studies, from 1988 to the present and around the world, that meet pre-established criteria for relevance (e.g., behavioral or HIV/STD outcomes) and methods
(e.g., inclusion of control or comparison groups). Of the 82, 26 (32%) address
heterosexual populations and are the focus of this presentation. We synthesized
results descriptively and meta-analytically; calculating weighted average effect
sizes (WA), and 95% confidence intervals (CI) for studies with safer sex outcomes.
Results: Synthesis of the 26 studies reveals their most common characteristics.
Intervention designs include: clinic settings (62%); single short sessions (46%);
and delivery by counselors (50%). Study populations were youth (46%), women
(23%), clinic patients (19%), general public (4%), persons who are mentally ill
(4%), and HIV-infected persons (4%). The median sample size was 150. Metaanalysis was performed on the 10 studies, to date, which report sufficient data
on safer sex outcomes. The analysis showed positive (indicating effectiveness)
and significant (CI did not include zero) protective effects of the interventions [n
= 10, WA = 0.37, CI = (0.26 to 0.47)]. Similar positive and significant effects were
obtained when analyses were done by sub-groups of youth and adult subjects;
clinic and non-clinic settings; and no treatment and minimal care comparison
groups.
Conclusions: Synthesis of HIV prevention studies for heterosexuals reveals
diversity among intervention features, six study populations, reliance on health
care settings for intervention delivery, but no intervention studies specifically for
heterosexual men. The 0.37 weighted average effect size found by meta-analysis
is equivalent to an 18% reduction in sexual risk behavior. This indicates that
science-based prevention programs may be helpful in reducing HIV incidence
among populations at risk through heterosexual transmission.
S23158 HIV/STD status and risks for frequent visits to female sex
workers (FSWs) among male sexually transmitted
disease (STD) clinic attendees in southern Vietnam
Thanh Thuy Nguyen Thi', T.H. Phong2, L.N. An3, T.V. Dat2, V.T. Nhung',
H.B. Khiem'. 2Pasteur Institute Hochiminh City, Hochiminh City; 'Center for
Preventive Medicine, SOC Trang; 3Center For Dermato-Venerology, So Trang,
Vietnam
Background: FSWs were identified as a core group in the heterosexual HIV
transmission in Southern Vietnam. This study aims to determine the HIV/STD
status and identify sociodemographic and behavioral risks for frequent visits to
FSWs among male STD clinic attendees who frequently visit FSWs.
Methods: From March 1996 to March 1997, 804 male STD clinic attendees
were consecutively enrolled in STD clinics in two provinces of the Mekong delta,
where heterosexual transmission was found to be predominant. Information was
based on confidential interviews, physical examinations and laboratory testing.
Results: The HIV seroprevalence was 0.5% (W. Blot). Gonorrheal infection
was detected in 9% (Gram Stain), treponemal seroprevalence in 2% (RPR), and
HBsAg prevalence in 7.5% (ELISA). The frequency of FSW visits was categorized into 3 groups: no visit in the past three years, infrequent (less than one visit
per month), frequent (more than one visit per month). The multivariate analysis
showed that frequent visits to FSWs were associated with a low educational level
(OR = 9.1), unmarried men (OR = 4.4), first intercourse at <17 yr. (OR = 4.3) and
drug use (OR = 16.7). Risk factors for infrequent visitors compared with those who
had never visited a FSW were: young age (OR = 2.1), unmarried status (OR =
2.3), no sexually active girlfriend (OR = 2.1), had sex for the first time with a FSW
(OR = 2.1), drug use (OR = 5.2) and alcohol consumption (OR = 2.9). Frequent
visits to FSWs were independently related to STD status such as past history
of urethritis (OR = 17.5), signs of gonorrheal infection (OR = 6.5) or of genital
ulceration (OR = 6.4). HIV seroprevalence in infrequent and frequent visitors was
0.7% (4 out of 585) while no sepositive case was found in 217 subjects of the no
visit group. Consistent condom use rate was low (7.5% out of 791 responses).
Conclusions: In formulating HIV/STD prevention measures in Vietnam, there

is a need to consider reduction of frequency of FSW visits, drug and alcohol
consumption, and condom use among the general male population, particularly
young or single men with a low educational level.