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

444 Abstracts 23510-23515

12th World AIDS Conference

S23510 The prevalence of HIV and associated risk factors in
prisoners in England and Wales in 1997: Results of a
national survey
Andrew Weild1, L. Curran2, J. Parry1, D. Bennett4, J. Newham1, O.N. Gill3.
1PHLS Virus Reference Division, CPHL, London; 2HM Prison Service
Directorate of Health Care, London; 3PHLS AIDS and STD Centre, London, UK;
4Division of Tuberculosis Elimination, CDC, Atlanta, USA
Background: During 1996 there was an average of 56,500 inmates in the prisons
of England and Wales with an annual turnover in excess of 125,000. There has
been much debate about the prevalence of HIV infection, risk factors and whether
incarceration augments or diminishes HIV transmission. A national unlinked
anonymous survey of HIV, hepatitis B and C prevalence, and risk behaviour was
undertaken during 1997 among a representative sample of the prison population.
Methods: The population eligible for inclusion in the survey were all the inmates
in eight prisons. Following a full briefing, consenting inmates self-completed a
questionnaire detailing, sexual behaviour, injecting drug use and also provided
an oral fluid sample for antibody testing.
Results: A total of 3,942 inmates took part, with a participation rate of 83%.
Injecting drug use was reported by between 5.0% and 30% of the populations
of adult male prisons; by 28% of women prisoners; and by 4.0% of young male
prisoners (21 years old or less). Injecting inside prison was reported by 7.0% of
all men (41% of those with a history of injecting drug use (IDUs)), by 6.8% of
women (25% of IDUs) and by 0.8% of young males (20% of IDUs). High rates of
sexual partner change were reported, with 62% of adult males and 83% of young
males reporting two or more female sexual partners in the 12 months preceding
incarceration; 32% of female inmates reported two or more male partners in the
same period. Anal sex in prison was reported by 4.1% of adult males and 0.4%
of young males. Prevalence of anti-HIV in prisons for adult males was 0.29%
(6/2100; range 0.0% to 0.6%); among young males it was 0.0% (0/713); among
females it was 1.2% (5/410).
Conclusions: This national survey of 3,942 prisoners in eight prisons (83% participation) has shown the prevalence of HIV infection to be very low (0.34% overall). However, the survey revealed continuing risk of transmission of blood-borne
infection; 36% of IDUs and 5.4% of all male prisoners have injected within prison;
3.2% of males have engaged in anal sex with fellow inmates. The results have
further stimulated the development of an active prevention policy for prisoners.
23511 1 Which policy STD/AIDS program in prison in Senegal?
Elisabeth Benga De', I. NDoye1, N. Tounkara2, E. Sidibe3, D. Diop4, Diao4.
I National AIDS Control Programme, BP: 3435, BP: 10045 - Dakar; 2Female
Prison of Rufisque/PA; 3Female Prison Fort B of Dakar/PA; 4Penitentiary
Administration (PA), Senegal
Issue: The Senegalese National AIDS Control Program (NACP) has many activities among them, some interventions over ten years in female prisons at the
request of the medical staff: midwifes and nurses. In addition, inmates are generally people at high risk for STD and HIV infection and it is difficult to reach them
out of prisons. Appropriate education and prevention in prisons might help them
to improve their behavior once the prisonners are free.
Project: According to the fundamental Human Rights, the goal is to ensure to
prisonners the same right of Health as anybody else specially regarding to STD
and HIV infection in a regular and sustainable basis.
Results: * the program did a baseline study to asses training, health promotion,
equipment, supplies needs and performed an environmental health audit.
* Focus group discussions arose misconceptions, beliefs about STDs and
AIDS.
a The medical staff training improved STD care management, also allocated
equipment for consulting room, laboratory and drug supplies in prison.
* Inmates were involved in the design and implementation of the prevention
program. The supervision of peer educators is done by trained prison guard
to promote and sustain AIDS activities. They also received IEC materials like
pamphlets, posters, diapositives, video films.
* It has has been established support and contact point for existing HIV/AIDS
network (Prison, NGO, NACP, Volunteers).
Learning Lessons: It is absolutely necessary to implement a policy dialogue
for an appropriate STD/HIV AIDS program in prison. The department of Health
and Justice through National AIDS Control Program (NACP) and Penitentiary
Administration (PA) must join their effort to reach this endeavor in a sustainable
way. This strategy has created the bridge between the NEEDS and the available
resources (human and material) to achieve STD/AIDS prevention program in
Prison.
S23513 Determinants of HIV infection in a cohort of native
Canadian injection drug users
Martin Schecter, Katharine Heath, S.A Strathdee, A. Palepu,
M.V. O'Shaughnessy. 608-1081 Bubbard Street, St. Paul's Hospital, BC Centre

for Excellence in HIV/AIDS, Vancouver, Canada
Objective: Native Canadians (i.e. Aboriginal, First Nations, Inuit and Metis) are
over-represented among the injection drug user (IDU) population in Vancouver,
Canada. We identified determinants of HIV prevalence at baseline among Native
IDUs enrolled in a prospective cohort study.
Methods: Beginning May/96, 1125 IDUs enrolled in a prospective study and
underwent semi-annual HIV tests and questionnaires detailing current and past

risk behaviors. Contingency table analysis was used to compare risk factors for
HIV infection among Native vs. non-Native IDUs. Logistic regression models were
used to identify determinants of HIV prevalence among Native and non-Native
IDUs.
Results: A total of 300 Native (27%) and 825 (73%) non-Native IDUs were
studied. Relative to non-Native IDUs, Native IDUs were more likely to be female
(51% vs 28%, p <.001), more likely to be HIV positive (30% vs 21%, p = 0.002)
and less likely to currently be enrolled in methadone treatment (5% vs 14%, p <.001). Native IDUs were no more likely to be established IDUs (i.e. first injected
>2 years prior) (94% vs 91%, p =.06), to frequently attend (>1/week) needle
exchanges (NEP) (63% vs 60% p =.271) or to live in unstable housing (79% vs
78%, p =.735). Natives were less likely to have borrowed needles ever (62% vs
71%, p =.002), or in the past six months (33% vs 45%, p <.001).
In multivariate analysis, predictors of HIV infection at baseline among nonNatives were living in unstable housing (AOR = 3.15, 95% CI = 1.74, 5.69), being
an established injector (AOR = 2.40, 95% CI = 1.10, 5.21) and having ever been
paid for sex (AOR = 1.66, 95% Cl = 1.01, 2.71). Among Native participants, ever
borrowing needles (AOR = 1.91, 95% Cl = 1.10, 3.31) and current methadone
treatment (AOR = 4.23, 95% Cl = 1.34, 13.36) were associated with HIV+ status
at baseline.
Conclusion: In the context of the present study, Native Canadians are overrepresented among IDUs and among IDUs, are more likely to test HIV-positive at
study entry. We identified differences in drug using behavior and sexual history
between Native and non-Native IDUs. Clearly, among IDUs, Native Canadians
carry a unique risk profile in comparison to other IDUs and in relation to determinants of prevalent HIV infection within this sub-group. Due to the cross-sectional
nature of this study causal relationship should not be assumed.
23514 HIV among aboriginal people in Canada: Injection drug
use is a main concern
Mai Nguyen12, D. Patrick3, S. Houston4, B. Romanowski4, S. Hudson5,
E. Roy6, CP. Archibald2. 1Brooke Claxton Bldg. Room 0108B Tunney's Pasture,
Health Canada; 2Bureau Of HIV/AIDS & STD, Health Canada Ottawa ON; 3BCC
Centre For Disease Control Society Vancouver BC; 4 University Of Alberta
Hospital Edmonton Al; 5Saskatchewan Health Regina SA; 6MGH Public Health
Unit Montreal QC, Canada
Objective: To examine the contribution of injection drug use (IDU) to HIV infection
among Aboriginal people in Canada.
Methods: AIDS data were derived from the Canadian AIDS Case Reporting and
Surveillance System. HIV testing data were obtained from the British Columbia
(BC) Enhanced HIV Surveillance Study, the Northern Alberta (NA) HIV Clinic, the
HIV testing programs in Saskatchewan. HIV prevalence/risk behaviour data were
obtained from 3 studies with Aboriginal identifiers: Vancouver IDU Cohort Study,
Alberta STD clinic study, and Montreal street youth study.
Results: As of 30/09/97, 249/13 310 AIDS cases were reported among Aboriginal people in Canada. The proportion of adult Aboriginal AIDS cases (> age
15) attributed to IDU were 54.0% in women and 17.8% in men, with an additional
13.9% of adult men attributed to the category MSM/IDU. The proportion of cases
attributed to IDU alone among adult Aboriginal AIDS cases has increased over
time, from 3.2% (<1989) to 10.4% (1989-92) and 35.3% (1993-96). Recent HIV
testing data (1993-97) in BC and Saskatchewan as well as HIV clinical data in
NA all found that the IDU exposure category in combination with other risk factors
(MSM/Lesbian, sex trade, heterosexual contact) accounted for 52-60% of male
HIV+ diagnoses and 40-75% of female HIV+ diagnoses. A history of IDU was
also more common among Montreal street youth aged 13-25 years of Aboriginal
background (43.7%, n = 71). The Vancouver IDU cohort study found a significantly
higher HIV prevalence among Aboriginal than non-Aboriginal persons (30.4% vs
21.1%, p = 0.01). In the Alberta STD clinic study, the 3 HIV+ cases in Aboriginal
women (n = 226) were all associated with IDU while the 2 cases in non-Aboriginal
women (n = 2 677) were both attributed to heterosexual transmission.
Conclusion: Evidence suggests that IDU is increasingly becoming an important risk factor for HIV infection among Aboriginal people in Canada, and appears
to be involved in half or more of new infections. Therefore, targeted programs for
Aboriginal IDU are urgently needed to slow the spread of HIV.
123515 Presence of anti-HIV antibodies in cervicovaginal fluid of
HIV-seronegative female sex workers in Abidjan, C6te
d'lvoire
Peter Ghys1, P. Becquart2, M.O. Diallo3, V. Ettiegne-Traore3, S. Koblavi-Deme3,
C. Maurice3, I.M. Coulibally4, A.E. Greenberg5, M. Laga6, S.Z. Wiktor5,
L. Belec2. 101 BP 1712 Abidjan 01; 3Project Retro-CI Abidjan; 4National
AIDS/STD/TB Control Program Abidjan, Cote d'lvoire; 2Laboratoire de Virologie,
Hopital Broussais Paris, France; 5Center for Disease Control and Prevention
Atlanta, USA; 6Institute of Tropical Medicine Antwerp, Belgium
Objective: To identify the presence of acquired cervicovaginal mucosal HIV
antibodies among HIV-seronegative female sex workers (FSW) in Abidjan.

Methods: As part of a larger intervention study, FSW were interviewed and
screened for HIV and other sexually-transmitted diseases at a confidential clinic
in Abidjan. HIV serostatus was determined using an algorithm including ELISA,
a synthetic peptide line immuno-assay (LIA) and Western blot. Specific syphilitic
antibodies were detected by TPHA. A cervicovaginal lavage (CVL) was collected
in 10 ml PBS. Among HIV-seronegative FSW, anti-HIVgpl60 antibodies were
measured by indirect ELISA and the presence of sperm was assessed by pro