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

414 Abstracts 23362-23366

12th World AIDS Conference

and bisexual men's sexual practices and their beliefs regarding their personal
responsibility to protect others from being exposed to HIV.
Methods: Men who identified themselves as HIV-seropositive (N = 250) were
recruited from AIDS service organizations, gay bars, and public sex environments
in New York City and San Francisco. Most considered themselves to be either
White (30%), African American (28%) or Latino (24%). Participants completed
a self-administered questionnaire regarding their sexual and drug-use practices,
beliefs regarding condom use, serostatus disclosure, and physical and mental
health status. A four-item scale was used to measure participants' beliefs about
their responsibility for preventing HIV transmission (alpha =.69). The individual
items were measured using a 5-point Likert-type scale ranging from I (strongly
disagree) to 5 (strongly agree), and were summed to create an overall score
(Range = 4-20).
Results: Participants typically agreed that HIV-seropositive individuals have a
special responsibility to protect others from HIV infection (M = 15.8, SD = 3.3).
Perceived responsibility was negatively associated with risky sexual practices
in the past year. For example, men who reported having unprotected insertive
anal intercourse with a male partner who was HIV-seronegative or of unknown
serostatus (53/244) had lower perceived responsibility scores (M = 13.3) than
did those who did not report this behavior (M = 16.5, p <.001). Men who had
graduated from college and those who were over 35 years of age had higher
perceived responsibility scores than did younger men (p <.05) and those who
had not graduated from college (p <.05).
Conclusions: Self-perceived responsibility may be an important factor influencing HIV-seropositive men's safer sex decisions and should be explicitly addressed
in counseling and intervention programs for people living with HIV.
S23362 A family study among relatives of HIV-1 persistently
seronegative prostitutes in Nairobi, Kenya
Joshua Kimani. PO. Box 19676 Nairobi Kenya, Medical Microbiology Nairobi
University, Kenya
Introduction: In a cohort of HIV-1 resistant prostitutes from Pumwani, Nairobi,
30% have been noted to be first degree relatives, suggesting that inherited genetic
factors may influence HIV-1 susceptibility. We are therefore conducting a family
study to determine whether there is a hereditary basis for HIV-1 resistance.
Method: The study is designed using the approach of King et al. For every one
index HIV-1 resistant prostitute, four index HIV-1 susceptible prostitutes, matched
for tribe and prostitution duration, are recruited. These women then ask their
first degree relatives to participate. A standard questionnaire is administered to
all participating relatives. Blood is then drawn for ABO grouping, RPR, HIV-1
serology, serologic HLA typing and genetic analysis.
Results: We have recruited 48 HIV-1 resistant and 89 HIV-1 susceptible prostitutes from the Pumwani cohort, and a total of 508 relatives. Among the relatives,
102 women are also prostitutes enrolled in the Pumwani cohort. Relatives of
resistant and susceptible prostitutes are similar in terms of demographic, social
and sexual parameters. However, relatives of resistant prostitutes are significantly
less likely to be infected by HIV-1. This applies both to high-risk relatives who are
enrolled in the prostitute cohort (OR = 0.03, 95% CI; 0.006-0.1); and to lower-risk
relatives from outside the cohort (OR = 0.46, 95% CI; 0.26-0.8).
Conclusion: Relatives of HIV-1 resistant prostitutes are less likely to be infected by HIV-1 than relatives of HIV-1 susceptible prostitutes, despite similar
risk-taking behaviours. This suggests that resistance to HIV-1 may be mediated
by inherited factor (s).
S23363 Acquisition of herpes simplex type 2 (HSV-2) infection in
a cohort of Zimbabwean men with high prevalence and
incidence of HIV
William McFarland1, M.T. Bassett4, L. Gwanzura4, A. Latif4, R. Machekano4,
R.L. Burke2, D.A. Katzenstein3. 1AIDS Office 25 Van Ness Avenue Suite 500
San Francisco California 94102; 2Chiron Corporation Emeryville CA;
3Stanford University, Stanford, CA, USA; 4University of Zimbabwe Harare,
Zimbabwe
Background: Evidence suggests a causal association between the transmission
of HIV and other STD, particularly genital ulcer syndromes. HSV-2 is one of the
most common causes of genital ulcers; however, little is known about its epidemiology in African populations with high prevalence and incidence of HIV. We tested
sera from a longitudinal study of HIV infection for HSV-2 antibodies in order to
measure the incidence and associated risk factors of HSV-2 seroconversion.
Methods: Subjects were male factory workers in Harare, Zimbabwe participating in a longitudinal study that entailed six-monthly follow-up of HIV serostatus
and risk behaviors. Prevalence of HIV was 20%; incidence of HIV was 2.5%/yr.
Stored sera were tested for HSV with a strip immunoblot assay (Chiron RIBA,
Emeryville, USA) that differentiates between HSV-1 antibodies to gG1 and gB1
and HSV-2 antibodies to gG2 and gD2.
Results: At baseline, 40% (953/2397) of men were positive for HSV-2 antibodies. Among 1,444 men HSV-2 negative at baseline, 204 seroconverted during

3,316 person-years of follow-up (incidence: 6.2%/yr). During the follow-up period, gential ulcers were reported by 31 (15%) of the 204 HSV-2 seroconverters
compared to 23 (1.9%) of the 1,236 non-seroconverters. HSV-2 incidence was
significantly (p < 0.05) higher among men with history of other STD (17.4%/yr),
multiple sex partners (10.1%/yr), pre-existing HIV seropositivity (23.0%/yr), and
HIV seroconversion during the study period (49.7%/yr). HIV incidence was somewhat increased among men with pre-existing HSV-2 seropositivity (3.2 vs 2.2%/yr,

p = 0.04). Of men with both infections, 57 acquired HIV first, 61 acquired HSV-2
first, 317 were positive at the same visit.
Conclusions: HSV-2 seroconversion was a strong marker of sexual risk and
appeared to be the leading cause of genital ulcers among male factory workers in
Harare. High HSV-2 incidence among HIV-positive men is evidence of continued
high risk behavior likely to fuel both epidemics. Supression of HIV transmission associated with HSV-2 will be an important but challenging component of
prevention interventions in Africa.
23364 1 Use of crack cocaine after HIV diagnosis and impact on
condom use
Michael Campsmith, A.K. Nakashima, J.L. Jones, J.W. Ward. SHAS Project
Group; Center for Disease Control and Prevention, Mailstop E-47 1600 Clifton
Road NE, Atlanta, Georgia 30333, USA
Objective: To characterize the level of crack cocaine use after HIV diagnosis,
and the level of condom use among HIV+ persons who continue to use crack.
Methods: Analysis of personal interviews with subjects >18 years of age reported with HIV or AIDS to 12 state and local health departments from June 1990
through October 1997.
Results: Of 18,095 persons interviewed, 5,214 (29%) had ever used crack.
Among crack users, 3,306 (65%) had used crack since being diagnosed with HIV.
Women were more likely than men (69% vs. 63%, p =.001) and Black persons
were more likely than persons of other races (69% vs. 58%, p =.001) to have
used crack since HIV was diagnosed. Logistic regression analysis of crack users
who had been sexually active since HIV was diagnosed (n = 1,778) showed that
those who continued to use crack were more likely than those who did not to
have unprotected sex (sex without a condom) with steady partners (47% vs. 40%;
adjusted odds ratio [AOR] 1.4, 95% confidence interval [CI] 1.1-1.8) and casual
partners (46% vs. 36%; AOR 1.6, 95% CI 1.2-2.1), after controlling for age, race,
gender, education, disease status (HIV vs. AIDS) and history of injected drug use.
Conclusions: Crack use can affect high-risk sexual behavior. Because many
HIV-infected crack users continue both to use crack and have unprotected sex,
sexual transmission of HIV by this group is likely. Prevention efforts should be
focused on expanding drug treatment options for HIV infected crack users and
increasing the use of condoms by this group to reduce sexual transmission of
HIV.
23365 1AIDS awareness among migrant workers at borderpoint
and situational pattern or STD, HIV/AIDS
G.Raj Shakya. Rapti Path, Old Cinema Road, Nepalgan-4, Nepal
Issue: Wage-dependent migratory population vulnerable to STD, HIV/AIDS require appropriate awareness and counselling.
Project: Keeping in view of the rapid increase in HIV/AIDS cases in Nepal since
1988, an intervention using direct client approach through a planned program was
developed. The program includes peer and social educators, border-point awareness cell, STD Clinics, the appropriate IEC package, training and counselling,
out-reach and the referral services etc. The migrant workers were individually
interviewed and counselled by social/peer educators using a format questionaire,
IEC package and condoms. High-risk clients and the clients suffering from STD
were referred to STD Clinics with facilities of free consultation with professionally
qualified STD Specialist, free investigations and medicines package, alongwith
lateral counselling to each patient with emphasis to both-partners treatment.
Training program and out-reach health camps were conducted in certain high risk
communities to access an effective participatory approach.
Results: The program was very well appreciated by the migrant workers.
5000 migrant workers were interviewed. 346 STD cases were registered within 6
months with increased demand of IEC materials and condoms.
Lessons Learned: AIDS-education program at cross-border points of Nepal
and India was practically very successful to know the real situation of wagedependent mobile ethnic populations and the existing STD/HIV risks among
them.
|23366 The HIV epidemic in Ukraine: Assessing susceptibility
and vulnerability
Alan Whiteside1, L. Khodakevich2, Y. Kruglov3, V. Steshenko4, A.S. Barnett5.
1Health Economics and HIV/AIDS Div., ERU, University of Natal - 4041 Durban,
South Africa; 2UNAIDS Programme Adviser, Geneva, Switzerland; 3lnstitute of
Epidemiology, Min. of Health, Kiev; 4National Academy of Science of Ukraine,
Kiev, Ukraine; 5Sch of Dev Studies, UEA, Norwich, England
Issues: Ukraine is currently experiencing an HIV epidemic in IVDUs. Questions
are: 1. Will HIV spread further, what is the susceptibility to this spread? 2. How
vulnerable is Ukraine to the impact? 3. What can be done to address the issues
of susceptibility and vulnerability?
Project: A UNAIDS and British Council team looked at the epidemic and as
sessed its likely development. Projections were prepared to indicate trends and
case loads. The problem was considered in the context of a society in transition.
Results: Extensive testing between 1987 and 1994 recorded few HIV+ results
(398 of 39 226 986 tests). Since 1995 there has been a significant increase,
25 000 HIV+ tests. There is an HIV epidemic in IVDUs. The research assessed
the prospects of the epidemic spreading more widely. It concluded many preconditions are in place. The political, economic and social transition has created