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

12th World AIDS Conference

Abstracts 23386-23390 419

23386 Women's perception about STDs: Reality and imaginary
Sonia Batista Silva', C.L.F. Araujo2, S.R. Telles2, M.G.B. Dantas2,
M.B. Rodrigues2, A.M. Ferreira2. 1General Glicdrio 74 App 404 Laranjeiras, Rio
de Janeiro; 2Sao Francisco University Hospital-UFRJ, Rio de Janeiro, Brazil
Objective: To analyze women's perception about STDs, from a sample of women
attending an anonymous testing center (ATC) in Rio de Janeiro.
Methods: A qualitative and quantitative survey has been used. Data has been
collected in January and February 1997 by a semi-structured interview conducted
by health professionals in an ATC. Interviews were taken during pre and post
testing counseling sessions, respecting anonymity and willingness to participate
in the study, Data analysis considered category and frequency of answers.
Results: Women were aged 21 to 34 (34.4%) and 41 to 55 (31.2%). The
majority are single (34.4%); 50% have a regular sexual partner, 25% have eventual partners only and 15.62% alternate regular and non regular partners. About
sexual practices, 56.8% have just vaginal intercourse, followed by 29.4% who
have also oral sex. From the sample, 68.7% report STDs and 90.9% had a
regular treatment. Transmission has been from regular partners in 59% of the
cases and 31.8% from non regular partners. STDs have been diagnosed by
noticeable symptoms (68.2%). Reactions to STDs diagnosis varied from fear and
deception (31.8%) to indifference (31.8%). It has been asked about the male
partners' reaction to diagnosis: 18.2% denied their own diagnosis: 13.6% had no
reaction and 18.2% were not informed; one case of physical assault was reported.
About the representation of STDs, 43.7% related to sexual activity, 15.6% had no
idea about did know the meaning and 15.2 could only generally mention syphilis
or gonorrhea. The STDs diagnosis have helped 62.5% of the women to start
preventive action against HIV and STDs, through condom use, partners selection
and regularly attending gynecological checking.
Conclusion: Most of the women can not recognize what is an STD, most of
the information is related to popular knowledge, causing reactions such as fear
and indifference which does not contribute to safer sex practices. Therefore, the
experience of a STD diagnosis followed by counseling contribute to the adoption
of individual preventive practices.
23387 HIV in heterosexuals: 1990-1997 - A Mexican experience
Elia Loo-Mendez1, C. Magis-Rodriguez2, M. Santarriaga-Sandoval2, P.E. Uribe
Zuhga2. 1 Calz Tlalpan 4585 Col. Toriello Guerra C.RP 14050; 2AIDS National
Council Mexico D.F., Mexico
Objective: To analyze HIV seroprevalence, sociodemographic profile, sexual
practices and other risk factors in heterosexual men in Mexico.
Methods: Surveillance Sentinel and seroepidemiological surveys where performed between 1990-1997 in 16 large and medium cities of the country. During
this period we studied 8,815 heterosexual men. They were recruited in HIV detection centers, streets, STD's clinics, public baths and bars. All were done on a
voluntary and confidential basis with pre and post counseling.
Results: Median age was 28 years with 65% between the ages of 20 and 34.
19% with B.A: and postgraduate studies and 20% with less than high school. 49%
were single, 32% married, 46% with children. 249 (3.0%) had positive confirmed
HIV test with Western-Blot.
Principal risk factors:

Roche Amplicor version 1.5 optimized to HIV-1 subtype E (lower detection limit
= 50 copies/ml). Only men with CD4+ > 300 cells/ul were studied to avoid late
stage increases in viral load. Univariate and multivariate analysis were done using
logistic regression.
Results: A total of 184 men were studied, 115 had HIV negative and 73 had
HIV positive wives. Median RNA levels were 33,494 copies/ml in men with HIV
negative wives and 59,625 copies/ml in men with HIV positive wives (Kruskal -
Wallis, p = 0.03). Median In RNA are 10.4 and 11.0 respectively (t-test, p = 0.02).
Median CD4+ was 475 cells/ul in men with HIV negative wives and 446 cells/ul
in men with positive wives (Kruskal - Wallis, p = 0.057). Positive STD history in
the male, O.R. was 3.17 (95% Cl = 1.6, 6.3); positive STD history in female, O.R.
was 1.63 (95% CI = 0.82, 3.25). Multivariate analysis detected only two significant
variables: In HIV RNA (O.R. = 1.27, p = 0.04) and history of STD in male index
case (O.R. = 3.28, p = 0.0008).
Conclusion: Plasma viral load was significantly associated with male to female
transmission in this population. Strategies to reduce viral load and prevent incidence of STD's in HIV infected men could reduce the high rate of heterosexual
transmision from men to women in Northern Thailand.
23389 Perceptions, attitudes, and sexual risk among
HIV-positive men with undetectable plasma viral loads
Robert H. Remien', P.N. Halkitis2, A. O'Leary3, R. Hays4. 1HIV Center PI Unit
74 722 West 168th Street, HIV Center NYS Psych Inst Columbia Univ, New York
NY; 2CTR for HIV Studies Jersey City St Coill, Jersey City NJ; 3Rutgers The
State University, New Brunswick NJ; 4CTR For AIDS Prevention Studies, San
Francisco CA, USA
Background: There are concerns about increased sexual risk behavior among
gay men who are on highly active antiretroviral therapy (HAART) because of
changing attitudes about risk of HIV transmission when plasma viral loads are
undetectable.
Methods: In a cross-sectional descriptive study (Centers for Disease Controlfunded Seropositive Urban Men's Study), we examined the relationship between
attitudes about risk and reported sexual risk behavior in a cohort of sexually
active, culturally diverse (Latino, African-American, European-American, NativeAmerican, Asian-Pacific Islander) seropositive men who have sex with men. The
men were part of a multi-site study in New York City and San Francisco (N = 255)
aimed at developing prevention strategies for this population and were recruited
through mainstream gay venues and in public sex environments (e.g., outdoor
areas, bathhouses, sex clubs). We looked at unprotected insertive anal sex with
an HIV-negative partner or partner of unknown status and its association with
perception of level of risk for HIV transmission on a 5-point Likert scale (1 = "no
risk" and 5 = "very great risk") with specific behaviors, e.g., having undetectable
viral load and engaging in unprotected insertive anal sex with ejaculation inside
partner.
Results. There were 94 men who were on antiretroviral therapy and reported
undetectable viral loads; 17% reported engaging in unprotected insertive anal sex
with an HIV-negative or unknown status partner within the past 3 months. The
perception of HIV transmission risk when engaging in very high risk behaviors
while on HAART was significantly lower (p <.000) for the men who engaged in
unprotected insertive anal sex with an HIV-negative or unknown status partner
than it was for the men who did not engage in this behavior. Related findings and
exploratory analyses will be presented.
Conclusions. Seropositive men who are on HAART, who have undetectable
viral loads and are also engaging in high risk sex with HIV-negative men tend
to believe that their acts carry minimal risk for HIV transmission. Prevention
strategies need to address these beliefs and keep pace with advances both in
treatment and in our understanding of viral load in genital secretions associated
with HAART.
23390 HIV-1 viral load in blood and semen of subtype E infected
Thai men
Bruce Gilliam', K. Wongworadat2, V. Robison2, A. Duerr3, V. Suriyanon2,
M. Robb4, K. Nelson5. 113 Taft Court, Suite 200, Rockville, MD 20850; 3Centers
for Disease Control, Atlanta GA; 4 Walter Reed Army Institute of Research,
Rockville MD; 5Johns Hopkins University Baltimore MD, USA; 2Research
Institute for Health Sciences, Chiang Mai, Thailand
Background: The natural history of HIV-1 in the semen of non subtype B populations is not well defined. We studied the characteristics of HIV-1 in the semen
of a population of predominantly subtype E infected Thai men.
Methods: Thai men found to be infected with HIV-1 through screening of
donated blood were enrolled in a couples study of HIV transmission in northern
Thailand. In a subset of 30 men, blood and semen specimens were obtained and
an extensive behavioral questionaire was administered. The serostatus of the
volunteers' primary partners was also evaluated. Blood and seminal plasma RNA
levels were extracted using the Boom isolation procedure (Organon Teknika) and
measured with the Roche HIV-1- Monitor Version 1.5 assay.

Results: Participants in the couples study were predominantly infected with
subtype E (92.5%) and 46% of the study volunteers' partners were HIV seropositive. 23% (7/30) of the partners of the semen donors were seropositive. All semen
donors (n = 30) were asymptomatic and had CD4 counts ranging from 6 to 965
and CD4% ranging from 1 to 33%. HIV-1 RNA levels ranged from 3.89 log to 6.34
log in blood plasma (BP) and from <2.6 log to 5.37 log in seminal plasma (SP).
HIV-1 RNA was detectable in 100% of the BP and 74% of the SP specimens.

Practice
To have Hepatitis type "B"
Have had a couple recipient of blood transfusion
Have had receive transfusion
Have had Syphilis
Drugs IV user
Have had sexual intercourse with sex worker
Have had STD's

~

OR Cl 95%
9.39 2.07-57.1
4.74 2.76-8.13
4.48 3.00-6.61
2.52 1.18-5.26
2.29 1.35-3.87
2.08 1.52-2.84
1.65 1.25-2.18

Significant
P= 0.001
P = 0.0000
P = 0.0000
P =0.01
P= 0.001
P = 0.0000
P = 0.0002

Conclusions: The higher than general population seroprevalence 3.0% (compared with 0.04% in pregnant women) is due to the name linked strategy.
Nonetheless the prevalence is low compared with men that have sex with men
(15%). Aside from the risk of having had a blood transfusion or a partner with a
blood transfusion that is explained by the blood related HIV epidemic that was
interrupted in 1986, is important to show that there seems to be a group with high
risk related sexual practices.
23388 Viral load and male to female sexual transmission of HIV
in northern Thailand
Sodsaz Tovanabutral, J. Wongtrakul2, V. Suriyanon2, V. Robison3,
S. Kuntolbutra3, A. Duerr4, K. Nelson3. IResearch Institute For Health Sciences
PO. Box 80 CMU Chiang MAI, 50202; 2Chiangmai University, Chiangmai,
Thailand; 3John Hopkins University, Baltimore, MD; 4Centers for Disease Control
Atlanta, GA, USA
Objective: To evaluate the association between the levels of serum HIV-1 RNA
in males infected with subtype E viruses in Northern Thailand and sexual transmission to their female partners
Methods: HIV-1 infected male blood donors and their wives were studied to
evaluate the male-female transmission of HIV-1. Men had been infected from
a commercial sex worker and their wives had no other risks for HIV-1 infection
other than sex with their husband. Data on sexual behavior and other risk factors
were obtained by interview. HIV-1 RNA was quantitated in index males using