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

12th World AIDS Conference

Abstracts 23476-23479 437

Results: The proportion of women with depressive symptomatology was: 66%
and 58% for the years: 92-94 and 95-97 respectively (p < 0.05). This contrasts
with 33% reported for a large sample of women from the general population (p
-_ 0.05). A subgroup of 48 women were also randomly selected for a structured
diagnostic interview. Of those, 48% had depression by both instruments for a
sensitivity of.65 and a specifity of.68.
Conclusions: Puerto Rican Women with HIV infection have higher rates of
depressive symptomatology than the general population. This difference was
statistically significant (p < 0.05). A decreasing pattern for depressive symptons
was observed for the past five years.
23476 Risk and HIV/AIDS for women toward the year 2000
Sonia Lawless. AIDS Council of NSW, PO Box 350, Darlinghurst, NSW, 2010,
Australia
Issue: Research and anecdotal evidence indicates that strategies such as social
marketing are not always appropriate in meeting the needs of women who are "at
risk" of HIV/AIDS. Many women who are currently living with HIV/AIDS had little
or no perception that they were in fact at risk of infection despite being exposed
to prevention campaigns and education.
Project: This paper is based on data gathered as part of an ongoing research
project which aims to document the lives and experiences of women living with
HIV/AIDS and information which is gathered as a service provider. Many of
the women interviewed and those accessing HIV/AIDS services had little or no
perception that they were "at risk" of HIV/AIDS infection. This situation is more
complex than the women being irresponsible, careless, involved in risk taking
behaviours or being promiscuous. Data gathered indicates that while most of
the women had knowledge of HIV/AIDS education and prevention they felt the
messages were not relevant to their lives and were unrealistic as the emphasis
was placed on the women to negotiate "safe sex" and no recognition was given
to issues such as power differences between partners..
Results: The paper uses in depth interview material provided by HIV positive
women to illustrate some of the short falling's and assumptions made in the education and prevention campaigns that they were exposed to. It highlights that the
terms such as "safe" and "risk" have different meanings for different populations
and that personal safety is more complex than some education and prevention
messages acknowledge.
Lesson Learned: It is worth taking into consideration and listening to the experiences and opinions of women living with HIV/AIDS when targeting education
and prevention messages at women, particularly women "at risk". Rather than
positioning HIV positive women as a potential source of infection to the general
population it may be more productive to consider how women are positioned in
relation to notions of risk and risk behaviours.
S23477 HIV viral load in cervical, vaginal and menstrual fluids as
compared to peripheral blood levels in women with
HIV/AIDS
P. Clay Stephens1, R. Heimer2. 1PO Box 2320 Albany, New York; 2Yale
University Dept. Epi & Public Health New Haven, USA
Background: In a small (N = 11), diverse group of women with HIV infection and
AIDS, efforts were initiated (1) to discern the level of viable HIV-1 in cervical,
vaginal, and menstrual fluids, as compared to peripheral blood levels, (2) to
explore the effect of typical conditions such as vaginitis and cervicitis on viral
load in the genital tract, (3) to inquire as to the effect of individual differences in
antiretroviral medication and disease status on viral load in genital fluids, and (4)
to evaluate ease of use and sample quality of direct specimen collection.
Methods: Vaginal samples were collected via direct visualization during speculum examination. Peripheral samples were drawn during the same clinic visit. A
quantitative microculture assay, previously developed to accept <10 \il input and
standardized to existing PBMC cell culture, was utilized. Viral load was calculated
by end-point dilution of supernatant p24 antigen (Abbott Labs HIV-1 p24 Kits).
Clinical findings and medical history were obtained from visit clinical notes.
Results: Across the group, mean genital levels exceeded mean peripheral
levels (p < 0.05). In 9/10 women, individual genital tract levels exceeded peripheral levels. Load in menstrual fluid equaled or exceeded that in respective paired
vaginal samples. Load in those with intact cervices exceeded load in those without cervices (p < 0.05). The presence of vulvar lesions, vaginitis, and cervicitis
predicted the greatest difference between peripheral and genital levels. There
were no differences between genital and peripheral levels by disease status,
medication use, race/ethnicity, or age.
Conclusions: Higher genital load (1) further illuminates heterosexual, female-to-female and vertical transmission; (2) has implications for vaccine development/application; and (3) among women with GUD supports potential for
increased rates of transmission. (4) Lack of impact of HIV status and medication
use confirms genital compartmentalization. (5) Direct collection is convenient,
simple, allows collection of specific fluid types, and avoids potential dangers and
lack of specificity of lavage.

23478 Transmission ways of human immunodeficiency virus in
Chilean women
Luis Martin Noriega Ricaldi1, Martin Lasso Barreto1, N. Saez2, C. Perret3,
P. Vial4, C. Gajardo1, E. Ahumada1, P. Gonzalez. 1 Concay Y Toro, Santiago;
2Hospital Sotero Del Rio, Santiago; 3Escueela De Medicina Univer. Catolica,
Santiago; 4Hospital Clinico Univesidas Catolico, Chile
Objective: To determinate the ways of infection acquirement among infected
chilean women.
Design: Descriptive study.
Methods: An epidemiological survey was applied to HIV infected women (previous agreement), with questions related to risk behavior and exposures ways to
the virus to establish a mechanism and a source of transmission.
Results: In a cohort study of 170 patients HIV under permanent control, 40
cases (25%) corresponded to women. It was included in the study women who
attend to medical control between July and September of 1997, the average age
of the group was 36 years old (age rank 23-66) and a diagnosis date between
1989 and 1997. The sexual transmission way was presented on 33 cases (97%)
and iv. drug users on 1 case (3%), 94% of the infected women kept a monogamic
relationship with a stable partner at the moment of the contagion and 30 cases
(88%) didn't present any infectious risk behavior. Only four of them presented,
risky activities like prostitution (2 cases) iv. drug addiction (1 case) and multiple
casual sex partners. The diagnosis of 19 cases was based on contact with an
HIV(+) sexual partner or a child with recent HIV(+) diagnosis. In a 21% of the
study, the diagnosis was done through a laboratory finding as a blood doner,
pregnancy medical control, a medical evaluation previous to a surgery or a simply
health check, only two of them were studied because of the presence of personal
risk behavior and three cases for having clinical manifestation of HIV. The infected
women who attributed the infection spread from their couples, mentioned only as
a impression as a cause of the infection the heterosexual promiscuous habits on
a 47%, bisexual behavior on a 20%, while the iv. drug users on a 6%. This habits
were unknown by the infected women on a 66% of the cases, while 97% of them
didn't even know that their sex partners were HIV (+).
Conclusions: HIV infection is acquired among chilean women mostly through
sexual contact with their habitual partner in the context of a monogamic relationship. To promote this kind of relationship as a prevention strategy will not be
enough while their partners won't adapt a similar habit. The ignorance to the risk
these women are beeing exposed, makes them unable to assume a prevention
behavior. The absence of risk factors among the female infected population;
makes mandatory to do a deeper screening to the captive women population
such as the pregnants women.
23479 Pregnant women with HIV disease in Ho Chi Minh City
(HCMC), Vietnam - A report from two maternity hospitals
Patricia Kloser12, T.S. Nguyen3, T.L.T. Le3, B.N. Nguyen4, N.T. Le5,
P.K. Correll2. 1695 Cardinal Hill lane Powell, Ohio 43065; 2UMDNJ New Jersey
Medical School, Newark NJ, USA; 3AIDS Committee of Hochiminh City
Hochiminh City; 4 Tudu OB./Gyn. Hospital, Hochiminh City; 5Hung Vuong
Hospital, Hochiminh, Vietnam
Issues: HIV infection has become a major issue in caring for clients in Vietnam
since the first case was diagnosed in 1990. The HIV epidemic in Vietnam was
originally limited to intravenous drug users, however, there has been an increase
in the HIV infection rates of women in their childbearing years, including commercial sex workers. The problems of testing and treating pregnant women, including
the reduction of vertical transmission, must now be addressed by a health care
system with limited resources.
Project: This descriptive report is compiled from information provided by the two
largest maternity hospitals in southern Vietnam. National surveillance data has
been included to identify factors related to HIV infection in pregnant women, including vertical transmission. Additional information regarding pregnant women and
infants includes the availability of health care, the diagnosis and treatment of HIV,
factors involved in morbidity and mortality and recommendations for the future.
Results: The majority of deliveries are performed by trained, layperson midwives (75%). Deliveries with complications, such as hypertension and dystocia,
are performed by physicians (25%). The rate of HIV in pregnant women is
increasing (1995-0.01%; 1996-0.05%; 1997-0.13%). Vertical transmission went
from 56% in 1996 to 100% in 1997, possibly due to a lack of HIV treatment
during pregnancy and the practice of breastfeeding. Postpartum hemorrhage is
the number one factor in maternal mortality.
Lessons Learned: An increase in heterosexual transmission of HIV will cause
more women of childbearing age to seek treatment. The diagnosis of HIV infection
during pregnancy and the reduction of vertical transmission are important public
health concerns. Global assistance for Vietnam is needed to prevent the problem
of pediatric AIDS in the near future.
23480 Sexual behaviour and reproductive decisions among
HIV+ women in Sao Paulo, Brazil

Naila J.S. Santos1, V.S.F. Paival, R. Plank2, C. Gomez2, E.M. Ventura-Filipe3,
L.E. Bugamella3, L.G. Tunala1. 'Health Department of Sao Paulo State, Rua
Antonio Carlos 122, Sao Paulo-01309-010; 3Health Department of Sao Paulo,
Sao Paulo, Brazil; 2UCSF San Francisco, CA, USA
Objectives: Rates of HIV infection are rising rapidly among Brazilian women,