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

12th World AIDS Conference

Abstracts 23367-23371 415

a social and economic environment which may increase the rate of epidemic
progression. For example the move to private production lead to unemployment,
and a rapid expansion of the informal economy. This, together with widespread
injecting drug use, an association of sex and criminality with some market transactions, and increased rate in STIs, create conditions that increase susceptibility
to HIV spread.
Current levels of HIV were used to project the trends and the likely demand
for health care and social welfare. The increased burden will place a strain on
increasingly streched government resources. The existing population structure,
with adverse dependency ratios, means (a) more difficulty in caring for the ageing population (b) increased numbers of orphans and (c) additional burdens on
women.
Lessons Learnt: Transition as experienced in Ukraine and other former Soviet
states creates a climate for HIV spread. The authoritarian Soviet state controlled
the epidemic. Change makes Ukraine susceptible and vulnerable. This analysis
identifies key areas for intervention.
23367 Prevalence and incidence of hepatitis B among men who
have sex with men (MSM) in Sao Paulo, Brazil: The Bela
Vista Cohort Study
Gerusa M. Figueiredo', E.J.A. Luna2, M.A.M. Veras3, M.O. Fonseca4,
M.T.L. Pierre4, R.C. Moreira5. Instituto de Saude-Ses, Rua Frei Caneca N~
1140-3~ Andar, 01307-002, Sao Paulo, SP; 2Faculdade de Medicina, Sao Paulo,
SP; 3Projeto Bela Vista, Sao Paulo, SP; 4 nstituto de Saude, Sao Paulo, SP;
S5 nstituto Adolfo Lutz, Sao Paulo, SP, Brazil
Objective: To determine the prevalence and incidence of hepatitis B through their
serologic markers in a cohort of MSM in S&o Paulo, Brazil.
Methods: The Bela Vista Cohort Study is a 3 year follow up of MSM. Eiegibility
criteria are: 1) age between 18 and 59 years; 2) negative HIV serology; 3) non
users of intravenous drugs at least 6 months before the first interview. Clinical
and serologic evaluation are undertaken every six months. Data concerning life
history on STDs, transfusions, use of blood products and hemophilia are collected
during first clinical evaluation. Serologic markers on hepatitis B include HBsAg.
anti-HBc and anti-HBsAg.
Results: During the first three years of study 662 volunteers were enrolled.
The prevalence of HBV serologic markers in their first screening was 27.5%
(182/662). There were 23 seroconversions for HBV with an incidence rate of 4.44
per 100 person-year; 52% of them occurring during the first year of follow-up.
Their median age was 25 years. No one reported blood transfusions; use of blood
products, intravenous drug use or tattoos. 21 (91%) of them referred more ocasional sexual partners than regular ones, with a median of 10 ocasional partners
ill the previous six months before seroconversion. Although a low frequency of
unprotective passive anal intercourse has been found, unprotective oral sex was
detected in 65%.
Conclusions: Seroprevalence of hepatitis B was high as in other populations
with high risk sexual practices. The high incidence rate found requires revaluation
of our educational interventions in safe sexual practices and as an imediate
procedure to start the HBV immunization.
(Supported by WHO, MS/BR, SES-SP and FAPESP)
S23368 HIV infection is associated with travel back to Haiti in
Montrealers of Haitian origin
Alix Adrien', V. Leaunel, R.S. Remis2, J.F. Boivin3, E. Rud4, R. Duperval5,
G. Noel6. 'Direction de la Sante Publique de Montreal-Centre 1616, boul.
Rene-Levesque Ouest, Bureau 300, Montreal (Quebec) H3H 1P8; 2Department
of Public Health Sciences, University of Toronto, Toronto, Ont; 3Centre for
Clinical Epidemiology and Community Studies, Jewish General Hospital,
Montreal Qc; 4National Laboratory of HIV Reference Services, Health Canada,
Ottawa, Ont; 5Departmnet of Infectious Disease, Centre Universitaire de Sante
de I'Estrie, Sherbrooke, Qc; 6 Department of Microbiology and Infectious
Disease, C.H. Universite de Montreal, Montreal, Qc, Canada
Background: - AIDS incidence differs substantially by race and ethnicity; patterns of HIV transmission may therefore be different and such variations must
be taken into account in planning prevention programs. Our objective was to
document the possible association between HIV and the frequent travel of many
Montrealers of Haitian origin to Haiti and to the United States.
Methods: We carried out a voluntary, anonymous study using a questionnaire
and saliva specimens and a participatory approach in seven primary care medical
clinics in Montreal. Included in the study were 5,039 persons aged 15-49 years
born in Haiti or with at least one parent born in Haiti.
Results: - The participation rate was 94.3%. HIV prevalence was 1.3% (1.6%
in men and 1.1% in women). Among participants who had travelled to Haiti during
the previous five years, 12.6% of women and 22.5% of men reported unprotected
sex in Haiti, and HIV prevalence was 2.0% (twice the rate of those who had not
travelled to Haiti). In a logistic regression analysis of the determinants of having
unprotected sex in Haiti, we observed a significant association with female gender

(OR = 3.9; 95% CI: 2.1-7.4), lower education level (OR = 3.1; 95% Cl: 1.2-8.2),
being married or in common-law partnership (OR = 2.6; 95% Cl: 1.5-4.3), and a
duration of residency in Canada of 5 years or less (OR = 1.8; 95% Cl: 1.0-3.3).
The adjusted population attributable fraction of HIV infections associated with
having had unprotected sex in Haiti was 10.2%.
Conclusions: - We observed a high HIV prevalence among Montrealers of
Haitian origin. We identified unprotected sex during travel back to Haiti as a

risk factor for HIV infection. Measures such as the provision of information and
condoms at travel agencies, airports and hotels targeted to persons at risk of
such exposure may help to prevent HIV transmission in this community.
526*/23369 Estimating the effect of treating sexually
transmitted diseases (STDs) on HIV transmission
Richard Rothenberg', J. Wasserheit2, M. St. Louis2. National HIV/STD
Interaction Study Group; 'Emory University, 69 Butler Street, S.E. Atlanta,
Georgia 30303; 2Centers for Disease Control, Atlanta, GA, USA
Objective: To assess the potential impact on HIV transmission of treating STDs
in the group of STD-clinic attendees who are coinfected with HIV.
Design: Retrospective chart review of data from 4,455 HIV-positive persons
who attended eight STD clinics in the United States (Birmingham AL, Chicago IL,
Colorado Springs CO, Denver CO, Los Angeles CA, Miami FL, New Orleans LA,
New York NY).
Methods: Clinic records provided estimates of the range of coinfection with
STDs and HIV. Based on published estimates, a relative risk of 3.0 for HIV
transmission in the presence of STDs (using their absence as referrent) was
combined with prevalence data from the clinics. The attributable risk statistic was
used to assess the maximum potential decrease in HIV transmission (assuming
no other behavior change) associated with treatment of Genital Ulcer Disease
(GUD), Nonulcerative STD (NUD), and any STD.
Results: In the group of 4,455 HIV-positive persons studied, the prevalence of
GUD varied by clinic from 4.9% to 45.0%; of NUD, from 8.0% to 61.0%; and of any
STD, from 13.9% to 65.9%. Depending on STD prevalence among HIV+ persons
in these clinic settings, the maximum potential decrease in HIV transmission
ranged from 9.2% to 53.7% (GUD), from 15.8% to 51.1% (NUD), and from 20.4%
to 64.2% (any STD). Using transmission probabilities of 0.001 (9 to co), 0.002
(ct to Q) and 0.01 (cd to d), if each HIV+ person in this group of 4,450 had a
single new uninfected sexual contact, there would be 27 new cases of HIV in the
absence of STD treatment, and 15 new cases if STD treatment were given, a
reduction of 44%.
Conclusions: In this special group of HIV+ persons who seek STD care, treatment of their STD may have an important impact on transmission of HIV to their
uninfected partners. Further assessment is required to determine the impact of
intensive STD case finding and treatment among HIV+ persons, some proportion
of whom continue to practice risky behaviors.
23370 1 HIV sentinel surveillance in Ho Chi Minh City (HCMC),
Vietnam
Hoang Son Le'3, P.C. Kloser', D.T. Nguyen4, M.D. Sarrel', P.K. Correll1.
UMDNJ/New Jersey Medical School, Newark, NJ; 2695 Cardinal Hill Lane,
Powell, Ohio, USA; 3AIDS Committee of Hochiminh City, Hochiminh City;
4Preventive Medicine Center, Hochiminh City, Vietnam (USA)
Issues: Ho Chi Minh City, Vietnam is believed to have the majority of HIV cases in
Vietnam. The need to describe the epidemiology of HIV in HCMC is necessary in
order to prevent the spread of this disease throughout Vietnam. Most practitioners
in HCMC believe that STD and tuberculosis infection rates have a similar trend
with HIV infection rates and several studies have supported this premise.
Project: An HIV sentinel surveillance project for HCMC was established in
1993. The project was conducted by the Preventive Medicine Center of HCMC.
The data was collected from the Sexually Transmitted Disease Hospital, the Pham
Ngoc Thach Tuberculosis and Lung Disease Center, the rehabilitation centers for
drug users and commercial sex workers, as well as prenatal clinics and blood
banks. These centers service clients in HCMC, as well as the 21 provinces located
in Southern Vietnam.
Results: Drug users are the group with the highest number of HIV infected
(82%), followed by commercial sex workers (4.4%) and STD clients (2.7%). Between 1996 and 1997, the tuberculosis infection rate in clients with HIV increased
5,930%, possibly attributed to better diagnostics and reporting, however, this may
also indicate a rapid rise in cases. The HIV epidemic in Vietnam shows similarities
to the epidemic in Thailand, with rapidly rising numbers among commercial sex
workers and drug users. Accurate reporting is essential to describing the HIV
epidemic in Vietnam, and a uniform, centralized reporting mechanism is currently
being developed.
Lessons Learned: While prevention programs should focus on all members of
the population, immediate attention should be given to those members of groups
with rapidly increasing numbers (persons at risk for tuberculosis, commercial
sex workers and drug users) and HIV testing should be offered. Tuberculosis is
currently a better indicator of HIV infection than STD diagnosis or transmission
risk factor.
I 23371 Does intravaginal preparation use increase STD and HIV
transmission in Zimbabwe?
Janneke Van de Wijgert1, M. Mbizvo3, Z.M. Chirenje2, V. II Iff2, P.R. Mason2,

L. Gwanzura2, N.S. Padian4. UZ-UCSF Collaborative Research Program, 114
Nelson Mandela Ave., Harare; 2University of Zimbabwe, Harare, Zimbabwe;
3WHO, Geneva, Switzerland; 4UCSF, San Francisco, CA, USA
Methods: A group of women who douche or wipe at least 12 times, and/or insert
herbs inside the vagina at least 4 times per month (group A), and a control
group (group B) were recruited. At baseline, all women received a physical exam