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

12th World AIDS Conference

Abstracts 23506-23509 443

possible, due to the developing country social-economical status, wich implies
certain difficult in disposing the medicine and the professionals awareness about
its importance in preventing vertical transmission.
23506 Risk factors for heterosexual transmission of HIV-1
infection among women in Honduras
Ramon J. Soto1 2, W. Klaskala3, J. Zelaya4, M. Baum3. 1Ministerio de Salud
Dpto. ETS/SIDA Apdo. Postal 3966 Tegucig A/pa; 2Ministry of Health, National
AIDS Program Tegucigalpa; 4Ministry of Health, General Health Directorate
Tegucigalpa, Honduras; 3University of Miami, Fogarty International Program
Miami, FL, USA
Objectives: To determine risk factors associated with the heterosexual transmission of HIV-1 among Honduran women.
Design: Cross-sectional study, which included two groups of HIV positive and
HIV negative women attending public health care clinics
Methods: Between March-November of 1996, 346 women (155 HIV positive
and 191 HIV negative) were enrolled in the study. Those with history of blood
transfusion and intravenous drug use were excluded.
Results: Most of the subjects (median age 29 yr.) were unmarried (74%), of
low socio-economic status, with less than 6 yr. of formal education. A total of 116
(34%) were commercial sex workers (CSW). Univariate analysis revealed that:
not having stable sex partner (OR = 4.2), practicing anal sex (OR = 2.6), rape
history (OR = 4.8), previous STD episodes (OR = 4.2), and abnormal Pap smear
result (OR = 4.2), appeared to be factors associated with the presence of HIV
among non-CSW; while rape history (OR = 2.8), anal coitus (OR = 2.4), cervical
ectopy (OR = 2.9), STD history (OR = 2.7), and inconsistent condom use (OR =
8.48) were associated with HIV infection among CSW. All variables associated
with HIV seropositivity were entered into a logistic regression model to determine
independent associations. Having previous history of STD (OR = 4.2, 95% Cl
2.3-10.8); inconsistent use of condom (OR = 4.6, 95% Cl 1.9-11.5); practicing
anal sex (OR = 4.2, 95% Cl 1.7-10.8); and severe cervical ectopy (OR = 4.2,
95% Cl 1.2-13.9) were independently associated with HIV infection.
Conclusion: History of STD, practices of anal sex, failure to use condom
consistently, and presence of cervical pathology were identified as risk factors
strongly associated with heterosexual HIV infection among women in Honduras.
519*/23507 Risk for HIV-1 seroconversion in the Ugandan
people's defense forces
Kathleen George1, D. Hom2, J. McGrath2, J.L. Johnson2, P. Mugyenyi3,
R. Mugerwa4, J. Ellner2. 1PO Box 10005 Joint Clinical Research Centre
Kampala, Uganda; 2Case Western Reserve University Cleveland OH, USA;
3Joint Clinical Research Centre Kampala; 4Makerere University Medical School
Kampala, Uganda
Objectives: To measure the HIV-1 seroprevalence, seroincidence and identify risk
factors for seroconversion among young Ugandan military males seen between
1995 to 1997.
Design: Prospective cohort design for the measurement of seroincidence
and a nested case-control study design for measurements of risk factors for
seroconversion.
Methods: HIV-1 screening of male military recruits aged 19-30 yrs. of age
was conducted at Ugandan military barracks stationed in a 200 kilometer radius
of Kampala from September 1995 to April 1997. Eligible males were enrolled
into longitudinal follow-up over 24 months to measure seroconversion and vaccine trial acceptability. Routine follow-up was done by trained civilian field team
members at participant barracks in a confidential fashion with pre- and post-test
counseling, medical exam, blood collection and education provided. Seroconversion was based on EIA (Cambridge Bioscience) and western blot (Biorad
Novapath) confirmation on 2 independent specimens. Confirmed seroconverters
were compared to a 20% random sample of seronegatives to identify univariate
predictors of conversion measured at baseline.
Results: Overall prevalence of HIV-1 at screening was 27%, 95% Cl:
24.9-29.1%). HIV-1 seroconverters (n = 50) were identified during study follow-up of 1221 enrolled soldiers, producing a seroincidence rate of 3.44 (95%
Cl: 2.50-4.38) per 100 person-years after 1452 pyrs of follow-up observed. Univariate risk factors for seroconversion were: 1) more than one different sexual
partner reported in the last 6 months (OR = 1.8); 2) more than 1 new partner in
the last 12 months (OR = 2.1); and 3) a positive syphilis serology (OR = 3.6), p
<.05. Other demographic factors (age, education, marital status, condom use)
were not predictive of seroconversion.
Conclusion: Risk for HIV-1 seroconversion remains high in this group of recruits in the Ugandan military. Typical high risk profile of STDs, multiple partners
and recent new partners was observed. Lack of heterogenity in the other usual
risk factors suggests continued difficulties in targeting individuals at high risk in the
Ugandan military and/or the ability to sustain appropriate prevention measures
for long periods.

183*/23508 Peer education/awareness among commercial sex
worker in Pokhara, Nepal
Krishna P. Bista1, R. Adhikari2, P. Arjyal3, A. Erpelding4. 1Ncasccecuoh STDHIV
Project, Teku Kathmandu, PO Box 6331; 2Executive Director, Seda, Pokhara;
3Director, Ncasc, Kathmandu, Nepal; 4Department of Tropical Hygiene Uoh,
Heidelberg, Germany
Issue: Commercial Sex Workers (CSWs), particularly in urban centres are vulnerable to STD/HIV/AIDS through unsafe sexual practices and require appropriate
intervention strategies.
Project: Relising that the number of CSWs in one of Nepal's major tourist
areas was increasing and that the majority of them were practising unsafe sex,
a local NGO, the Society for Education and Development Activities (SEDA),
together with the CEC supported STD/HIV Project developed a peer education
and awareness intervention. The intervention, which considered the perspectives
of the CSWs, consists of a peer education programme to increase the knowledge
on STD/HIV/AIDS and to enable them to negotiate safer sex with their clients.
Free condoms are available at the SEDA office. A link with STD services (private
and public) was established to ensure treatment of STDs. In addition, SEDA is
assisting CSWs to establish a network in order to increase their self esteem and
focuses on non-formal education. The peer educators are monitored by 2 SEDA
supervisors and 3 outreach workers.
Result: Since the beginning of the intervention 18 months ago, 40 peer educators have been trained in 2 batches. The number of CSWs in contact with SEDA
rose from 65 after the first training to presently 380. Each month, on average 65
new CSWs are contacted by the peer educators. In the 4 month period following the second training 250 CSWs were checked by a medical practitioner and
150 received treatment for STDs. Condom distribution through peer educators
increased fourfold from 2000 to 8000 in 4 months. The programme has been well
received by the CSWs and one of its immediate results has been the formation
of a cooperative saving scheme for CSWs.
Lessons Learned: Peer education programme are potentially suceessful if
they are monitored properly and consider other basic needs expressed by the
CSWs such as treatment of STDs, access to free condoms and non formal
education.
S23509 1STD testing and treatment acceptance and factors
associated with syphilis seropositivity among female sex
workers in Bangkok, Thailand
Ryuichi Komatsu1, W. Sittitrai2, T. Brown3, G. Carl2, C. Phadungphon2
W. Sirimahchaiyakul2, D. Jittangkul2. 11601 East-West Road, Honolulu;
3East-West Center, Honolulu, USA; 2Program on AIDS, Thai Red Cross Society
Bangkok, Thailand
Objective: To examine factors influencing female sex workers' acceptance of
voluntary and free syphilis screening and treatment during a research survey and
their risk factors for positive serologies.
Methods: The Multisite Intervention Research Project on Sex Workers and HIV
Prevention (MIRP), funded by AmFAR and the Rockefeller Foundation, employed
a geographic mapping methodology to stratify and randomly sample sex workers
within four types of sites. A detailed face-to-face interview was administered on
sex workers' lives, economic and social situations, risk behaviors and determinants of risk, and HIV/STD knowledge and prevention. Respondents were then
offered free, voluntary testing for syphilis and treatment if positive. Samples were
tested at the Thai Red Cross Society Program on AIDS laboratory.
Results: Of 1231 women interviewed, 899 accepted free and voluntary syphilis
testing/treatment.

Setting Brothel
Massage
Bar
Restaurant
Say can identify STD client
Know Untreated STD consequences
Sex off-site
Consistent condom use

% Accept test p % Testing positive p
67.5 (0.000) 10.3 (0.152)
86.1 5.3
92.3 5.6
91.3 6.1

80.5Y/86.2N
83.9Y/82.0N
89.5Y/78.1 N
82.7Y/90.5N

(0.011)
(0.616)
(0.000)
(0.002)

6.6Y/6.6N
7.5Y/11.8N
5.7Y/7.9N
7.6Y/3.1N

(0.997)
(0.52)
(0.195)
(0.025)

Less likely to accept testing were women with savings, those perceiving health
status as very good/good, better knowledge on key STDs, and lower perceived
risk of transient clients with HIV.
Conclusions: Willingness to test was positively influenced by risk factors (e.g.,
inconsistent condom use or off-site sex), however brothel workers were less willing
to accept testing despite higher rates among those tested. No significant variation
in seropositivity was seen among other types of indirect sites. The association
of positive serology with consistent condom use shows a complex interaction
among perceived risks, risk behaviors, and treatment seeking for curable STDs
requiring close attention in prevention program design.