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

390 Abstracts 23243-23247

12th World AIDS Conference

23243 Spread of HIV and hepatitis viruses through the use of
injection needles for Kala-azar therapy, in India
Sarman Singh1, J. Kumar2, R. Singh3. 1E-66, Ansari Nagar New Delhi; 2All Indi
Institute of Medical Sciences New Delhi; 3N.I.C.D. Branch Patna, Patna BI, India
Aim: Human Immunodeficiency, hepatitis B and hepatitis C viruses have recently
emerged as major blood borne infections. Possibility of transmitting these viruses
through the use of unsterile injection needles used for the treatment of visceral
leishmaniasis was hypothesized in an endemic state of Bihar (India).
Methods: Five villages with 4050 families of 3 highly endemic districts of
Bihar were included in this study. The sociodemographic data of the affected
families and their annual income was determined as per Government of India
guidelines. All the Leishmania infected patients, their spouses, family members
and villagemates were tested for HBs antigen, anti-Hepatitis C and anti-HIV (1 +
2) antibodies using commercially available kits.
Findings: Of the 4050 families, 61 (1.5%) were found affected with 77 cases
kala-azar or PKDL. Out of these 61 families 57 (93.4%) belonged to low income
group and so-called untouchable castes. Nine patients had no treatment due to
poverty while 64 were treated with sodium antimony gluconate (SAG) with or
without second line drugs-pentamidine and Amphotericin-B. The number of intramuscular injections received by these patients ranged from 3 to 120. Hepatitis B
and C viral infections were significantly more prevalent in those receiving multiple
injections. Females infected with Leishmania donovani and who received injectable medicines were at highest risk of contracting hepatitis B (20% vs. 11.3%)
and hepatitis C virus infection (26.7% vs. 18.9%) than their male counter parts.
Overall HCV infection was more common (20.6%) than HBV infection (13.2%) in
this group of patients. Villagemates with history of injections for other ailments
were also found highly infected with hepatitis viruses. One kala-azar patient was
also found co-infected with Human Immunodeficiency Virus.
Conclusions: This preliminary study indicates that visceral leishmaniasis is
a disease of poor. All the available therapeutic regimens carry a high risk of
transmitting yet more dangerous blood borne infections like HIV, HBV and HCV
through the shared use of unsterile injection needles. Since these injections are
administered by the local medical and paramedical health care workers, there
is an urgent need to upgrade their knowledge about proper disinfection of these
syringes and needles, if at all they are re-used.
23244 A cohort study of HIV infection among IDUs and natural
history of HIV infection in Ruili, China, 1992-1997
Xiwen Zheng1, Jiapeng Zhang Jiaping2, Qu Shuquan1, Cheng Hehe2, Li Daqin1,
Jia Manhong2, Zhang Guiyun1, Duan Song3. 127 Nanwei Road Beijing Center
For AIDS Surveillance Capm China 100050; 2 Yunnan Hygienge & Epidemic
Prevention St Kunming China 100050; 3Dehong HY Gienge & Epidemic
Prvention St, Dehong, China
Objective: To provide the information for policy-making on AIDS prevention and
control and on medical care of AIDS patients.
Design: Cross-sectional study and cohort study
Methods:Since 1992, cohort study of prevalence of HIV infection and incidence rate among drug users has been conducted annually at the study spots
along southwestern border areas of Ruili, Longchuan and Luxi counties, Yunnan
province of China. From 1992 to 1995, 859, 437, 343 and 540 drug users with a
total number of 2179 cases were studied respectively.
Results: The proportion of IDU among drug users was about 30% in 1992, and
went up to about 50% in 1995. HIV sero-prevalence rates were 81.8%, 85.7%,
61.8% and 51.9% respectively in Ruili. Longchuan county was at medium, 44.6%,
40.0%, 42.2% and 43.5% respectively. Luxi county kept at a lower level, which
were 5.1%, 0%, 0% and 3.1%. From 1992 to 1995, the average incidence rates
were 30.1%, from 21.7% to 42.1% in Ruili county, 17.2% in Longchuan and 0.6%
in Luxi. The sero-prevalence rate among the spouses of these HIV infected persons was 3.1% in 1990, but increased to 9.8%, 7.4%, 0% and 10.3% respectively
from 1992 to 1995, and was 12.3% in 1997. CD4 counting was conducted in
107 cases. The result indicated that the earlier of the year being infected, the
proportion of the HIV infected persons for CD count <500/mm3 was higher. The
NASBA was applied to analyse the viral load, 3 out of 29 cases were <1000
copies/mi, while Log mean of viral load in the rest of 26 cases was 4.37.
Conclusion: There is a good coherence between the sero-prevelance and
incidence rate at high, middle and low levels among the three counties.
S23245 Title not indicated
Magdalena Martinez. Isla Espahola 222 y Rio Coca Casilla, Ecuador
Issue: To sensitize and motivate radio broadcasters in Quito so they could assume a responsible and committed attitude in the prevention of the VIH/AIDS
through an informative and educational proposal address to youth within the ages
of 15 to 29 years old.
Project: The population most affected by the HIV/AIDS is the youth group
from 15 to 29 years old. CAFSIDA with the support of the program "Initiatives to

Face AIDS" of Comunidec/International Alliance carried out the project mentioned
above. Eight radios with the best rating in the city were identified. The project
was presented to the radio broadcasters and producers of juvenile programs,
they were open to assume this responsibility and during a year they transmitted
HIV/AIDS prevention messages, opening spaces for the youth to talked about
this topic. To close this project a Rock concert was organized and we were able
to get the participation of the producers and broadcasters were the animators

they count with the participation of different artists and the groups well recognize
in Ecuador.
Results: 18 radio broadcasters and producers from 8 radio stations in the
city were involved in the project assuming the responsibility to transmitted the
informative and educational messages in the prevention of the HIV/AIDS address
to their audience. During the year the project last preventive messages were
permanently broadcast and this open spaces for the youth to give their opinion.
It is important to mention that even after the project was done, they continued
transmitting messages by their own.
Lessons learned: It was very hard to enter into the show business and motivate this group to assume the a responsibility of prevention of the AIDS with their
audience. It was not possible to make a formal training with radio broadcasters,
so we reached them through periodical visits to talk about the topic and started
a friendship. The radios were commercial radios so it was very difficult to have
them transmitted the messages for free.
S23246 1 Prevalence of HIV amongst intravenous drug abusers in
Kathmandu
Rajesh Lall Gurubacharya, V.L. Gurubacharya, J. Shrestha. Bakhundole
Pulchowk, P O. Box No. 7314. GPO. Kathmandu, Nepal
Objectives: To Monitor and Asses risk of HIV infection amongst intravenous
users in Kathmandu Valley.
Methods: HIV infection amongst intravenous drug users is reported very low.
Because of high cost of drugs for oral and smoking use and easy availability of
Parentral drug, dramatic increase of intravenous drug user has been noted in
Kathmandu. As a Part of ongoing monitoring study, 165 blood samples were collected in 1997 from intravenous drug users. All these blood samples were tested
unlinked and anonymous. However those who want to know HIV status were
offered free service after counseling for confidential screening. During interview
126 respondents gave the history of needle sharing on more than one occasion.
The youngest respondent 14 years old and 90% of the respondents fall in the age
group 17-30 years and 20 drug abusers were married. Most respondents come
from low and middle economic social group.
Results: All the blood samples were tested for HIV by two techniques. 82/165
(49.69%) tested Positive for HIV. And this prevalence of 49.69% amongst intravenous drug users is a significant dramatic rise of very low Prevalence rate in reported previous years. Sharing of needle among intravenous drug users is alarmly
high. There is high risk of spread of HIV to many more uninfected drug users.
Conclusion: Sharing of needle among intravenous drug users and rapid spread
of HIV in this group has gone unnoticed. Harm reduction activity do not seem
to have reached this group in a effective way. So this study warrants an urgent
intervention activity to reach drug users to avoid further spread. This study and
further follow-up of this type of study can provide confidential identification of
individual or groups in need of urgent intervention and necessity of refocussing
the intervention and preventive strategies.
23247 1 Alcohol dependence and HIV in slum communities
Thomas Joseph. Snehadaan, Sajapura Road, Carmelarum PO, Bangalore
560035, India
Issue: Individuals in slum communities exhibit high risk behaviours related to the
use and use of alochol.
There is an endemic level of alcohol use/abuse within Bangalore Slums and
many instances of high risk behaviour take place as a result. The pilot project
has 2 aims: to minimize high risk behaviour taking place when alcohol is used
and to educate alcohol users about HIV/AIDS in the targeted area. A counsellor
and 2 people from a specified slum community started work, attempting to build
relationships with the mainly male alcohol users. A room was found which could
be used as a 'meeting point' where groups could meet and exchange information,
and where HIV Education and Risk Reduction could begin. Condoms were displayed and given out free. Preventative strategies included peer education, skill
building workshops, safer sex orientated streetplays and one to one counselling.
The project has been running for 3 months and the achievements have been
variable. At the start only 2 people attended regularly -this has now risen to 10.
The community is still very resistant and threats have been made by alcohol
sellers in the slum. Some of the people attending have been willing to examine
their own behaviour and the safer sex information has been popular. Information
about HIV/AIDS is still poor and condom distribution remains low.
(a) There is a need to make the project more relevant to the lives of the slum
population with less attention made to the alcohol use and more on issues around
HIV/AIDS and safer sex.
(b) More community participation is required. The alcohol sellers need to be
contacted and educated/motivated, to provide information at source.
|23248 Prevalence of HIV-1 subtypes and co-infection with
HTLV-I/II among IDUs in Rio de Janeiro, Brazil

Monick Guimara6s1, F.I. Bastos2, P.R. Telles3, V. Bongertz4, B. Castro-Galvao5,
M.G. Morgado3. 1AV. Visconde de Albuquerque 171-404 Leblon - Rio de Janeiro
CEP: 22450-001; 2CICT - FIOCRUZ, Rio de Janeiro; 3NEPAD - UERJ, Rio de
Janeiro; 410C - FIOCRUZ, Rio de Janeiro; 5LASP - CPQGM - FIOCRUZ,
Salvador, Brazil
Objectives: The aim of this study is to evaluate the prevalence of HIV-1 subtypes,