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

12th World AIDS Conference

Abstracts 23516-23519 445

static acid phosphatase and prostatic soluble antigen tests oil the supernatant of
the CVL.
Results: Between April 1994 and November 1995, 421 (39%) of 1078 FSW
were HIV seronegative and a CVL was obtained from 342 women. Of these, 317
CVLs were negative for anti-HIV antibodies (Ab-), 15 were positive for anti-HIV
antibodies and positive for markers of sperm, indicating that the antibodies could
have been in the sperm, and 10 were positive for anti-HIV antibodies and negative for markers of sperm (Ab+Sp-). Of these 10 women two had IgA only, two
IgA+lgG, one IgA+lgM and five IgA+lgG+lgM antibodies. The median duration of
sex work was two years for the 10 Ab+Sp- women and two years for the 317
Ab- women (p = NS). 100% condom use was reported by two of the 10 Ab+Spwomen and by 16% of the Ab- women (p = NS). None of the 10 Ab+Sp- and
20% of the Ab- had a positive TPHA result (p = 0.1).
Conclusion: A small proportion of HIV-seronegative FSW have anti-HIV antibodies in the genital tract. The presence of these antibodies does not seem
related to sexual exposure. Prospective studies are required to determine whether
cervicovaginal anti-HIV antibodies can confer protection against HIV infection.
23516 1Trends in HIV infection rates among New York State
(NYS) prison entrants, 1987-1997
Jaromir Mikl1, A. Dzierbicki2, P.F. Smith3, R. Greifinger4, L. Wright5,
D.L. Morse6. 1NYS Dept of Health Bhae ESP Tower Rm 717 Albany NY 1 2237;
2Suny at Albany-School of Public Health Albany NY; 3Director-Div of EPI-NYS
Dept of Health Albany NY; 4NYS Dept of Corrections Dobbs Ferry NY; 5Chief
Med Dir-NYS Dept of Corrections Albany NY; 6Director-Div of INF Dis-NYS DOH
Albany NY USA
Objectives: To determine and monitor HIV infection rates among NYS prison
entrants.
Methods: Between December '87 and March '97, consecutive prison entrants
were tested for HIV antibody through a series of blinded, point-prevalence serosurveys. Demographic and risk behavior (RB) information, and routine testing
results for tuberculin sensitivity (PPD), syphilis serology, and HBsAg were linked
with HIV test results.
Results: Twelve percent (997 of 8,387) of male and 18% (578 of 3,193) of
female prison entrants were HIV infected. The HIV infection rates decreased significantly among male prisoners, from 18% in '87, to 15% in '90, 13% in '92-'93,
11% in '94-'95, and 10% in '96-'97. This decrease is attributable primarily to the
decreasing proportion of injecting drug users (IDUs) and those sharing injecting
equipment (113) in each successive study. In '87, 28% of male entrants were
IDUs and 11% shared IE. By '96-'97, these proportions decreased to 11% and
5 respectively. We also observed a 20% decrease in HIV infection rates among
male IDUs (from 45% to 36% between '87 and '96-'97). Among female prison
entrants, the HIV infection rates remained high and stable over the years (19% in
'88, 20% in '92-'93, 16% in '94-'95, and 18% in '96-'97). As observed with males,
the proportion of IDUs among entering female prisoners also declined (from 28%
in '88 to 12% in '96-'97). However, corresponding to this decline, we observed
an increase in the proportion of women who engaged in high risk sexual behavior
(prostitution: 9% in '88 and 29% in '96-'97), and having reactive syphilis serology
(14% in '88 and 20% in '96-'97). Adjusted odds ratios (logistic regression) for
men indicated, IDUs and men having sex with men had 6 times, and for women
showed sexual partners of IDUs and inmates with reactive syphilis serology had
over 2 times the risk for HIV infection when compared to their counterparts without
these characteristics.
Conclusions: The observed declining HIV infection rates among males are
primarily due to changing characteristics of entering inmates. However, declining
trends were also observed among IDUs suggesting behavioral changes among
this high risk population. Among females, risky sex behavior displaced IDU as
the most prevalent RB, and may be sustaning the high and non-declining HIV
infection rates observed. The prison setting offers an excellent opportunity for
aggressive HIV prevention messages targeting this high risk population prior to
their release.
23517 Context affects homeless/runaway youths' HIV sexual
risk
Gary Harper, M.S. Miller, C. Butler. De Paul U. Psychology Dept., 2219 N.
Kenmore, Chicago, IL 60614-3504, USA
Issue: Homeless/runaway youths are the subpopulation of adolescents with the
highest rates of HIV infection throughout many parts of the world. Current HIV
prevention efforts for these youths tend to view sexuality as a homogenous construct and fail to address the array of contextual influences that impact sexual risk
behavior.
Project: In order to develop ecologically sensitive HIV prevention interventions,
a more qualitative understanding of the intricate web of contextual factors surrounding the sexual behavior of homeless/runaway youths is needed. To this end,
individual semi-structured qualitative interviews were conducted with 60 youths
(ages 14 to 21) recruited from two different community-based organizations serv
ing homeless/runaway youths. Participants were asked to describe in detail two
sexual scenarios that occurred within the previous year, one in which a condom
was used for penetrative anal or vaginal intercourse, and one in which a condom
was not used for such activity. Thematic analyses of the coded transcripts were
conducted using QSR NUD*IST 4 software.
Results: The following themes emerged from these interviews regarding contextual factors that impact condom use: a) General interpersonal and sexual

communication; b) Cognitive and behavioral impulsivity in the context of sexual
arousal, condom accessibility, and novelty; c) Illusions regarding the nature of
their relationships and their partners' sexual behaviors; d) Beliefs regarding HIV
(e.g., treatability illusions, anticipation of a cure, HIV testing limitations); e) Risk
appraisal based on reputation, appearance, and sexual rituals; and f) Personal
reputation management around the meaning of condom use. These themes varied across gender, sexual orientation, and relationship type (e.g., primary vs.
casual/anonymous sexual partner).
Lessons Learned: To address the complex set of influences on HIV sexual
risk, it is recommended that future interventions with homeless/runaway youths
include program components that: improve affective/interpersonal communication and impulse control; explore the impact of relationship type on personal risk;
dispel myths regarding HIV testing and treatment; encourage non-penetrative
sexual behaviors; increase the ability to accurately and reliably appraise sexual
risk; and buffer against negative peer perceptions of condom users.
23518 HIV prevalence and sexual mixing patterns among ethnic
groups in Amsterdam, The Netherlands
M. Gras, M.W. Langendam, J.F. Weide, S.J. Deul, R.A. Coutinho, J.A.R. Hoek
Van Den. Nieuwe Archtergracht 100, 1018 WT Municipal Health Service,
Amsterdam, The Netherlands
Background: Migration is assumed to play a significant role in the heterosexual
spread of HIV in industrialized countries. To gain more insight in the potential
spread of HIV among and between ethnic groups in Amsterdam, a population
based study is being conducted among people from Surinamese, Antillean and
African origin. Here, we report results on 1) HIV prevalence, 2) the degree of
(unprotected) non-commercial sex in country of origin and in the Netherlands 3)
the degree and determinants of disassortative mixing, i.e. sexual mixing between
different ethnic groups, in the Netherlands.
Methods: The study population consisted of 700, mainly street recruited, heterosexuals (310 Surinamese, 107 Antilleans, 283 Africans), aged between 15-55.
Using logistic regresssion analysis with correction for within person dependency,
we determined predictors for mixing among partnerships in the past year.
Results: 1) HIV prevalence was (4/700) 0.6.% (95%CI 0-1.1). 2) 11% (77/700)
reported sex in country of origin in the past year with 173 local partners in total
(median 2, range 1-20). With 55% of these partners, condoms had been used
consistently. 88% (613/700) reported sex in the Netherlands in the past year
with 1354 partners in total (median 1, range 1-50). Condoms had been used
consistently in 71% of casual and in 14% of steady contacts 3) Information about
the ethnic origin of the partner was available for 1160 of 1354 partnerships; in
40% sexual mixing was disassortative. For men, independent predictors were
casual contact (OR 3.1, 95%CI 2.3-4.2), being Antillean (OR 2.3, 95%CI 1.3-4.0,
ref: Surinamese), short length of stay in the Netherlands (<2 yr: OR 2.4, 95%CI
1.5-4.0; 3-5 yr: OR 1.8, 95%CI 1.1-2.8, ref: >5 yr) and having more than 2
partners in the past 5 years (OR 2.7, 95%CI 1.5-5). For women, no independent
predictors for disassortative mixing were found.
Conclusion: A number of respondents had unprotected sex in country of origin
in the past year. In the Netherlands, mixing was mainly assortative (like-with-like)
and condom use low for steady contacts, while mixing was mainly disassortative
and condom use high for casual contacts. Therefore, HIV transmission seems
more likely to occur within than between ethnic groups. However, as the HIV prevalence is presently low among the study group, the risk for further spread is limited.
23519ý HIV and hepatitis-B viral infections in Jailmates of
Ghaziabad, North India
Sarman DR. Singh1, R. Prasad2, A. Mohanty3. 1E-66, Ansari Nagar, New
Delhi-110029; 2District Jail-Medical Officer Ghaziabad UP; 3All India Institute of
Medical Sciences New Delhi, India
Aim: Determination of prevalence of various infections in inmates of a district jail
in Northern India, near Delhi.
Methods: Two hundred forty male and 9 female jailmates confined to district
jail of Ghaziabad for various crimes were screened for pulmonary tuberculosis,
various skin diseases, and sexually transmitted diseases including HIV, syphilis
and hepatitis B. The inmates aged between 15-55 years were counselled and
informed consent was obtained. Their alleged criminal background, period of stay
insidejail, drug addiction, education, birth place, marital status, sexual activity,
history of contact with commercial sex workers and clinical complaints were
noted. Five milliliter venous blood was withdrawn after general and systemic
examination. The sera were tested for antibodies against HIV (1 + 2), HBV, HCV,
Treponema pallidum and tuberculosis.
Results: Out of 240 males, 184 (76.6%) gave history of indulging in penetrative
sex. 115 were married and 125 unmarried. Of the 184, 53 (28.8%) were homo- or
bisexuals and 131 (71.2%) had sex with women only. Sixty of 131 (45.8%) were
sincere to their partners while 124 gave history of sexual promiscuity and 100
of them (80.6%) had unprotected sex.; 83 of these 100 also visited commercial
sex workers. One hundred twenty six were alcohol addicted, 44 for smack/charas

and 8 used IVDs. 174 were not aware about AIDS, other new only that AIDS is a
dangerous diseases which affects if you have sex with bad women (prostitutes).
On examination 11 of the 240 (4.6%) had ulcer on penis, 25 (10.4%) active
pulmonary TB, 28 (11.6%) active hepatitis or history of jaundice in last two years.
80% teenagers confined to a particular barrack had moderate to severe scabies.
Of the 9 women tested 8 were married and all except one had history of sexual
promiscuity. Three males (1.2%) were found to be western blot confirmed HIV-1