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

432 Abstracts 23450-23454

12th World AIDS Conference

Results: HIV-1 prevalence was 29% at the STDC and 12% at the FPC (odds
ratio OR 3.0, 95% CI 2.2-4.2). Women at the FPC were older (29.9 vs 22.6 yrs, p
<.01); and more likely married (46% vs 29%, p <.01); educated (77% vs 44%,
primary school, p <.01); employed (76% vs 55%, p <.01), and had fewer lifetime
sex partners (2.8 vs. 6.3, p <.01). A multivariate analysis, including social and
behavioral variables, was conducted within each group. At the FPC, predictors
of HIV included being single (OR 3.1, 1.6-5.9); number of lifetime sex partners
(1 vs. 4+, OR 3.0, 1.0-8.5); lower education (OR 2.0, 1.1-3.6), informal sector
employment (OR 2.3, 1.0-5.2), and low monthly income (OR 3.9, 1.7-8.9). At the
STDC, the only independenat association was with multiple sex partners (1 vs.
4+, OR 5.7, 2.5-12.7).
Conclusions: Risk factors for HIV infection differed markedly in these two
populations and have implications for interventions. For women at the FPC, who
have attained a certain socio-economic status, vulnerability to HIV may be reduced by improvements in education, income, and employment. For the severely
disadvantaged women at the STCD, reducing HIV vulnerability will require more
radical societal change which breaks the cycle of powerlessness and poverty.
S23450 HIV DNA and RNA detection in cervicovaginal (CV)
secretions of asymptomatic (ASX) HIV + women with and
without genital tract inflammation (GTI)
Kenneth Mayer1, S. Cu-Uvin', J. Hogan1, I. Rodriguez', L. Tucker2,
J. Allsworth', D. Anderson3. Brown University AIDS Program, Providence,
Rhode Island; 2Fearing Lab., Brigham & Women's Hospital, Boston, MA;
3Fearing Lab., Brigham & Women's Hospital, Providence, RI, USA
Objectives: To describe clinical factors associated with genital tract HIV DNA, or
RNA detection among ASX US women, with and without GTI.
Design: 89 ASX HIV + women enrolled in a prospective HIV natural history
study (the HERS cohort) underwent a CV lavage which was analyzed for HIV
DNA, cell-free (CF) and cell-associated (CA) HIV RNA, as well as genital tract
WBC, and screened for syphilis, GC, chlamydia, trichomonas, and CV CMV
culture..
Methods: CV lavage utilized 10 ml PBS instilled during a speculum exam. CV
WBC and STD studies were done on site; frozen CV and blood specimens were
analyzed in batch using HIV RNA and DNA PCR probes.
Results: The women's blood CD4 counts ranged from 4 to 1,911 cells/mm3
(median: 310); CVL WBC counts ranged from 0 to 5,800,000 cells/mm3 (median:
215,000) with less than 1,000 RBC/CVL. Although HIV DNA was detected in 89%
of blood samples (median copies/ml: 450; maximum: 6,000), HIV DNA or RNA
was detected in only 51% of CV samples (maximum copies/ml: CV DNA: 20K;
CF RNA: 240K; CA RNA 140K). Women who were HIV DNA (+) in blood more
often had CV HIV DNA detected (p < 0.05). 2 women who had no blood HIV
DNA detected, had CV CF RNA detected. Women with >100,000 CV WBC/ml
were (-) for other STD screening (including CMV culture) except for 1 (+) for
trichomonas; but 57% had CV HIV DNA or RNA detected. Women with CV WBC
counts >100,000 cells/mm3 more often had CV CF RNA detected than those
who did not (OR = 2.18, 95% C.I. 0.73, 7.06). Women with detectable CV HIV
DNA or RNA had lower median CD4 counts (p = 0.03).
Conclusions: Asymptomatic HIV + women with lower CD4 counts or GTI more
often had CV HIV DNA or RNA detected. GTI in HIV + women was common and
independent of other STDs. HIV may be detected in CV secretions as cell-free
RNA, or cell-associated DNA or RNA, and women with undetectable HIV plasma
viremia may have genital HIV detected.
234*/23451 Women's health promotion - STD/AIDS prevention
and control: Integration of activities
Ligia Rivero Pupo', Ana M.A. Pluciennik', W. Villela2, N.J.S. Santos',
L.H. Matida', C. Megide2. 1STD AIDS Sao Paulo State Program, R Frei Canecca
1140, 01307-002 Sao Paulo; 2Health State Secretary, S&o Paulo, SP, Brazil
Issues: In Brazil, the number of reported AIDS cases in women has grown from
255 in 1987 to 5,667 in 1997. In the State of So Paulo, since 1992 AIDS is the
main cause of death among women 20 to 34 years old. The number of reported
cases of congenital syphilis is also growing in Sao Paulo: 69 cases in 1991 vs.
474 in 1996.
Project: Regional health teams responsible for the care of women and those
responsible for STD/AIDS prevention and control were encouraged to develop
a joint work plan for STD/HIV prevention among low income women. Six workshops were accomplished at 19 of 24 state regions. Four problems related to
women's health and STD/AIDS prevention and control were discussed, as well
as their causes and possible solutions: 1-High incidence of SDT/AIDS in women;
2-Family planning information given separately from SDT/AIDS prevention information; 3-Inadequate prenatal care for HIV/AIDS pregnant women; 4-Inadequate
delivery care for HIV/AIDS pregnant women. In each region, teams defined a set
of activities to be developed in common, specifying who was responsible for it,
timing and needed resources.
Results: As a result, two training courses for maternity teams of all the 19

regions were accomplished as well as the production of learning materials for
the prevention of HIV/syphilis vertical transmission. The distribution of learning
materials, condoms and drugs for STD/AIDS treatment and prevention was implemented at the public health system, considering the specific characteristics of
the regions.
Lessons Learned: It is important to integrate actions directed to promote
women's health to those developed to prevent and control STD/AIDS. To attain

this common goal, the identification of problems and the discussion of their
solutions should be held in each region, in a decentralized process.
23452 HIV transmission/prevention programs target women
over age fifty
Jane Fowler', N.L. Linsk2, K.M. Nokes3, M. Nazon3, J.K. Weinberg4. 12525
Main Street Apt 502, Kansas City MO 64108-2627; 2Natl. Assoc. on HIV over
Fifty (Co-Chair), Chicago, IL; 3NY Assoc. on HIV over Fifty (Co-Chair), New
York, NY; 4Natl. Assoc. on HIV over Fifty, San Francisco, CA, USA
Issue: With the number of heterosexually-transmitted HIV infections on the increase in older American women, and their diagnosed AIDS cases having doubled
between 1991 and 1996, females in the over-50 population in the United States,
and worldwide, must be made aware that HIV is not just a disease of the young.
They must be taught that they, too, can be at risk; that, in fact, they may be even
more vulnerable due to lack of knowledge and advancing age.
Project: Leaders of America' s National Association on HIV Over Fifty (NAHOF), with assistance from Good Samaritan Project, an AIDS service organization in Kansas City, Mo., began a campaign two years ago to offer transmission/prevention trainings for mid-life and older women throughout the United
States. Calling attention to the fact that a combination of ageism and sexism has
resulted in older women being invisible in the HIV/AIDS community, volunteers
have traveled from coast to coast with a warning message: "This disease does
not discriminate. It's not who you are-certainly not how old you are-but what you
do or don't do that leads to infection."
Results: By addressing conferences, meetings and small gatherings in about
20 states, and Washington, D.C., NAHOF representatives have educated hundreds of women, their service providers and caregivers, on HIV infection in
older females. Also, this previously neglected and ignored issue has attracted
the American media, which has brought HIV/AIDS in the elderly to the public's
attention through printed and televised reports.
Lessons Learned: Grass-roots work by individuals can set in motion efforts
to educate women over age 50 to the reality that they are as at-risk as their
younger counterparts for HIV infection, depending on their behaviors. Transmission/prevention programs directed at older females, including the sharing of
personal stories which can generate publicity in the media, will ultimately result in
a more informed population, one that then can better protect itself from disease.
23453 Effect of intrauterine device use on cervical shedding of
HIV-1 DNA
Charles S. Morrison', B.A. Richardson2, C. Sekad De-Kigondu3, S.K. Sinie3,
D. Devange2, J. Overbaugh2, J.K. Kreiss2. 'Researchtriang Lepark NC.;
2University of Washington, Seattle, USA; 3University of Nairobi, Nairobi, Kenya
Background: HIV cervical shedding may be an important marker of the infectivity of an HIV-infected woman. Hormonal contraception has been associated
with increased prevalence of HIV cervical shedding in several studies. However,
little is known about the effects of intrauterine device (IUD) insertion on cervical
shedding of HIV-1 provirus.
Methods: We conducted a prospective study among HIV-infected women attending two family planning clinics in Nairobi, Kenya to evaluate the effect of IUDs
on detection of HIV-1 DNA in cervical secretions. Cervical swab samples were
collected prior to IUD insertion and approximately 4 months thereafter for HIV-1
DNA detection using polymerase chain reaction assays.
Results: Among 98 women enrolled and followed for 4 months after IUD insertion, the prevalence of HIV-1 cervical shedding was 50% (49/98) at baseline,
and 43% (42/98) at follow-up (OR = 0.70; 95% CI 0.37-1.32). No statistically
significant differences in cervical shedding over time were found in any substrata
defined by baseline hormonal contraceptive use, friable cervix, cervical ectopy,
baseline condom use, or CD4 lymphocyte levels.
Conclusion: Insertion of an IUD did not significantly alter the risk of cervical
shedding of HIV-1 DNA. The use of IUDs, in conjunction with condoms, may
be an appropriate method of contraception for HIV-1 infected women from the
standpoint of infectivity to the male partner.
|23454 HIV risk reduction among a national sample of drug using
women: The need for women-centered interventions
Sally Stevens', W.M.W. Wechsberg2. 13912 S. 6 th Ave., Tucson, AZ;
2Research Triange Institute, Research Triangel Park, NC, USA
Objectives: To determine the level of HIV risk reduction among drug using women
after participation in a two session intervention.
Design: Randomized controlled study.
Methods: Women who were active injection drug users and crack cocaine
users (confirmed by urinalysis and evidence of needle track marks) were enrolled
in a 21 city study in the USA. Baseline data on 1,403 women who were randomly
assigned to a two session standardized intervention indicated high levels of both

sex and drug risk behaviors. Six month follow-up data demonstrated significant
reductions in many of the sex and drug risk variables examined. While significant
reductions were also demonstrated for various subgroups of women enrolled in
the study (i.e. injection drug users, women with multiple sexual partners), women
who used crack cocaine were unable to significantly reduce their number of
sexual partners and the number of times they traded sex for money or drugs; two
variables particularly important in heterosexual transmission of HIV.