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

430 Abstracts 23441-23444

12th World AIDS Conference

Results: The seropositivity rate for this sample was 1.4% (n = 532).
Risk Factors/Variables OR 95% CI Risk Factors/Variables OR 95% CI
Aged 30 to 39 years 1.75 1.42-2.16 Known HIV+ Partner 4.95 3.75-6.54
Aged 40 to 49 years 2.02 1.58-2.57 Injection Drug Use 2.51 1.93-3.25
Aged 50 to 59 years 2.27 1.49-3.45 Non-injection Drug 1.65 1.19-2.27
Blood Products 1.76 1.12-2.78 Exchanging Money for 1.45 1.10-1.90
Conclusion: Some risk factors for African-American women are analogous
to those found among California women in general; however, unique behavioral
factors related to HIV seropositivity in this sample include both transmission and
exposure risks through blood products and non-injection drug use. Understanding
of the unique HIV issues of African American women is crucial to the design of
effective HIV prevention interventions.
234411 High incidence and prevalence of HIV infection among
female partners of male factory workers in Zimbabwe
Catherine Laye', C. Maposhere4, W. McFarland2, M. Mbizvo4, D. Katzenstein3,
J. Parsonnet3. ' HRP Redwood Bldg T221 Stanford CA 94305-5405; 2AIDS
Office San Francisco DPH, San Francisco CA; 3Stanford University Stanford CA,
USA; 4 Univeristy of Zimbabwe Harare, Zimbabwe
Background: In sub-Saharan Africa, HIV prevention programs to decrease the
number of sexual partners and encourage condom use may have little impact on
women, who are primarily monogamous and have difficulty demanding condom
use. To determine what factors identify women at risk for HIV, we interviewed and
performed HIV testing on partners of workers enrolled in a HIV education study
(ZAPP).
Methods: Wives and/or girlfriends of ZAPP study subjects were invited to
receive HIV counseling and testing and STD treatment. Subjects completed a
face-to-face interview and were tested for HIV antibodies. Women were included
in the current analysis if they were the sole partner brought in by the index subject.
Results: Of 2,860 male factory workers, 95% had girlfriends or wives; 344
women participated. 24% were seropositive for HIV. Of 81 women initially seronegative who had subsequent tests, 4 seroconverted (incidence = 4.7 per 100 person
years). Positive women were more likely to be recently married (median years:
3 vs 6, p =.005), know their partner had other partners (51% vs 20%, p =.001)
and have had a STD in the prior year (51% vs. 18%, p =.001). They were also
more likely to use condoms (52% vs. 37%, p =.03), although use was sporadic.
Few women had more than one sex partner in the past year (4%); this did not
differ by serostatus (p = 1.0). Few women (11%) had no risk factor. Of women
with no prior HIV test, 84% considered themselves at low risk of infection; positive
women were more likely to view themselves as at high or medium risk (32% vs.
12%, p =.002) due primarily to lack of trust in their partner.
Conclusions: These data highlight the high level of HIV risk among monogamous, married women. Despite having at least one risk factor for infection, most
infected women perceived themselves to be at low risk for HIV. Programs are
needed to address this low perception of risk and to provide tools for women to
protect themselves and their families.
23442 Active production of HIV-1 in the female genital tract
Tedd Ellerbrock', J.L. Lennox2, R.F. Schinazi3, K.A. Clancy1, M. Pratt-Palmore2,
C. Schnell2, C.E. Hart3. 'Centers for Disease Control (CDC) 1600 Clifton Road
E45 Atlanta GA 30333; 2Emory University Atlanta GA; 3Emory University/VA
Medical Center Atlanta GA, USA
Objectives: To determine if HIV is produced in the female genital tract, we
compared HIV genotypes, RNA quasispecies, drug resistance mutations, and the
quantity of HIV and HCV in plasma and vaginal secretions.
Methods: Plasma and vaginal lavage samples were obtained from women
enrolled in a prospective study, a subset of whom were receiving antiretroviral
therapy. The C2-V3 region of gp120 was examined using direct cycle sequencing of HIV-1 DNA that had been amplified from reverse-transcribed RNA. Drug
resistance mutations in the reverse transcriptase region of pol were detected,
using sequencing and a Line Probe Assay. For quasispecies analysis, amplified
DNA was cloned and sequenced. HCV and HIV RNA were quantified in plasma
and vaginal secretions, using the respective Roche RT-PCR assays.
Results: The major C2-V3 genotypes expressed in plasma and vaginal lavage
were determined for 7 women. The predicted amino acid differences between
plasma and vaginal virus for 5 of the 7 women were 0%, 0.9%, 3.5%, 7.0%, and
9.6%. For the 2 other women, the major vaginal species had an insertion or deletion, not found in the major plasma species, that would result in a truncated gp120
protein. In one woman, phylogenetic analysis showed a distinct segregation of
most vaginal and plasma quasispecies with only 3 minor plasma clones grouping
with the 10 vaginal clones. Of 3 women tested repeatedly, 2 developed drug
resistance mutations in plasma, but neither developed a simultaneous resistance
mutation in the vagina. For each of 4 women, the HCV viral load was greater than
the HIV viral load in plasma, but in vaginal lavages of 2 of the women, HIV viral
loads were 3,000 and 33,000 copies/lavage, while HCV RNA was undetectable.

Conclusion: The differences in gp120 genotypes, RNA quasispecies, drug
resistance mutations, and comparative amounts of HIV and HCV suggest that
selected HIV-1 variants are actively produced in the female genital tract.

23443_ The non-existent gender: The need for women-specific
approaches within the context of HIV/AIDS in Europe
Elfriede Steffan', S. Reiter2, M. Seibert3, U. Sonneberg-Schwan4. 'SPI
Stresemann Str. 30 D-10963, Berlin; 2Robert-Koch-lnstitut Berlin; 3Departement
"Women & AIDS" DAH Berlin; 4Kiss (Curatorium For Immundeficiency) Munich,
Germany
Issues: Although there has been a substantial decline in the number of reported
AIDS cases in most European countries in the last years the percentage of women
has risen constantly. Due to improved therapeutic measures, the time between
HIV infection and AIDS as well as the survival time after AIDS diagnosis are still
growing. About 20% of all those infected with HIV in Western Europe are women,
with a slight tendency for their share to rise. In Central and Eastern Europe, it is
primarily male i.v. drug-misusers who are affected. But in many regions such as
Kaliningrad in Russia and Tallinn in Estonia the indications of (hetero) sexual risk
behaviour (e.g. STD's) are rising to alarming proportions.
National approaches addressing the specific needs of primary prevention for
women have only managed to establish themselves in very few Western European
countries (e.g. in Switzerland). General prevention messages frequently address
women as "objects" to be protected, thus completely ignoring the lived reality
of many women. With very few exceptions (e.g. the German pilot programme
"Women and AIDS") there have not been, and still do not exist, any national
programmes within Europe tailored to the needs of women. Whilst new therapeutic measures are consequently raising questions as people thus rediscover
a perspective in their lives (e.g. with respect to education and training, work,
sexuality, partnerships, the desire to have children), it is becoming apparent that
the women affected are still being left to their own devices.
Project: The authors will present an up-to-date overview of the epidemiological development, prevention approaches specifically addressing women's needs
and corresponding support measures in Europe. Proceeding from their own (research) experience (the "Women and AIDS" pilot scheme in the Federal Republic
of Germany, the European UMBRELLA-NETWORK, the German "Woman and
AIDS" network, the Deutsche AIDS-Hilfe, the evaluation of social scientific AIDS
research at the Robert Koch Institute, KISS the Curatorium for Immun Deficiency)
and study of European literature, they will also prepare a critical appraisal of
measures taken so far as well as the corresponding shortcomings.
Lessons Learned: The fact that there is a sad lack of structural, national measures addressing the specific needs of women in relation to HIV/AIDS reflects
the basic social position of women in most European countries. The experiences
showed the need to design HIV/AIDS prevention counselling and care concepts
both for women in general, but especially for women affected and threatened by
HIV/AIDS considering gender-specific aspects of socialisation, society-standards
and biology.
123444 Women's AIDS know how
Anna Beltrano, L. Briziarelli, A.A. Stella. Experimental Center of Health,
Education, Via Del Giochetto Univ. di Perugia, Italy
Issue: The most recent epidemiological data concerning the spread of HIV in
Europe shows an increase in the number of cases in the heterosexual population
and in particular in the women. For this reason, it is important to develop and
extend the preventive strategies specifically aimed at young, adolescent and
middle aged women (1545 year age group) belonging to the so called "general
population ".
Project: To identify the specific preventive strategies, the following working
phases have been considered:
Phase I: Collection of European data and information related to structures
and organisations working in this specific field, who have realised research and
intervention projects.
Phase II: Construction of data-base to computerise the collected data, following
a suitable classification criteria and to complete a draft of a "Guide line manual"
about preventive strategies for HIV infection.
Phase ///: Establish a common definition, among EU countries, of "guide lines"
concerning information and prevention activities. At this respect, two actions will
be realised: (1) European Seminar to identify intervention and preventive strategies that require further development and advocacy actions and to review the
draft of the "guide lines manual"; (2) Publication of the "guide lines manual" to
support research and intervention activities.
Results: At present, the data-base with data from the different European
countries was constructed and the draft of the "guide lines manual" has been
writing out. It is evident from the data analysis the small number of research
and intervention projects for this specific target and the lack of homogeneous
prevention strategies for HIV infection in women. The Europen seminar will be
organised in May, therefore a definitive review of the draft will be ready to present
it at the 12th World AIDS Conference.
Lessons learned: The activation of computerised information exchange EU
Countries and the "Reference Manual" represent very important instruments to
support research's and interventions and to construct an European Network to
exchange information in the field of HIV prevention aimed at the female popu
lation. In the other hand, the network will ensure the activation of a Permanent
Observatory as a reference point for Institutions working in this field.