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

446 Abstracts 23520-23524

12th World AIDS Conference

positive while 33 (13.7%) men & 3 (33%) women were positive for HBsAg. One
of the three HIV positives was a IVDU, second was a drug addict and frequent
CSW visitor while third was a homosexual.
Conclusion: This pilot study gives an indication that sexually transmitted and
blood borne infections are highly prevalent in jail premises and pose a threat of
rapid spread of these infections through IVD use and homosexuality.
[23520 Gay men's strategic use of bathhouse communication
rules for unprotected anal sex
William Elwood1, M.L. Williams2. 1402 Tuam Avenue #1, Houston, Texas;
2Behavioral Research Group, Houston, TX, USA
Objective: Mainstream and gay news media in the US have reported spectacular
increases in the number of unprotected sexual encounters in bathhouses. To
determine the veracity of such reports, we conducted structured, in-depth topical
interviews with men who frequent bathhouses in Houston, Texas.
Methods: 41 men reporting recent sex with a man in a bathhouse were
interviewed. Data on sociodemographics, life history, and sexual practices in
bathhouses and other settings were collected using a semi-structured interview
guide. Interviews were audiotaped and transcribed into text files, which were
content coded using a subjective-objective analytical strategy. Objective analytical criteria codes were derived from the Theory of Reasoned Action; subjective
codes were based on the principles of grounded theory. Data were analyzed
and re-analyzed as the subjective coding scheme developed. Coded data were
assessed for patterns that emerged as data were analyzed.
Results: All participants demonstrated proficiency in HIV prevention knowledge
and practice. Silence as a communication rule emerged as primary descriptor
of bathhouses. Reasons for silence included efficiency within sexual encounter,
lack of desire for intimacy, and maintenance of confidentiality. An unexpected
finding was that men who practiced insertive anal sex relied on the silence rule
to obtain unprotected anal sex. Both insertive and receptive participants stated
that initiating condom use was an insertive partner's responsibility. Insertive men
reported using condoms if asked, but that few partners did so. Receptive men
reported reluctance to break the silence rule, and frequently were penetrated
without a condom.
Conclusion: Additional descriptive research on men who attend bathhouses
and their behaviors is needed to describe the kinds of sex men have in bathhouses and the psychological characteristics of insertive and receptive men, by
protected and unprotected practices. Any intervention must take into account the
rule for silence in bathhouses. Changing the rule of silence must avoid compromising patron identities, while normalizing negotiation of sexual practices and risk
reduction activities.
23521 1 Perception of the risk of transmitting HIV among people
living with HIV/AIDS presently cared for in the Italian
health system
Maria Stella Aloisi1, E. Girardi1, M. Carballo2, A. D'Arminio Monforte3, C. Arici4,
G. Ippolito1. 'Centro Rifer AIDS-lrccs OSP L.Spallanzani via Portuense 292
-00149 Roma; 3Clinica Malattie INF. Ospedali Riuniti Bergamo; 4Divisione
Malattie Inf Ospedali-Riuniti, Bergamo, Italy; 2 nternational centre for Migration
health Geneva, Switzerland
Issue/problem: To evaluate perception of the risk of transmitting HIV in seropositive people presently cared for in the Italian health system and to correlate these
data with clinical and biological course of the infection.
Project: We designed a national multicentre study to assess the behavioural
characteristics of people living with HIV, to analyse of behaviour changes in these
persons nested within a cohort study on the natural history of HIV infection. A selfadministered anonymous questionnaire was distributed to patients antiretrovirals
therapies naives consecutively admitted to participating centres.
Results: Between June 30 and November 30, 1997 a total of 948 persons
completed the first questionnaire in 36 clinical centres (30% females - 70%
males). Of these 70% had no HIV related symptoms and the median time from
first HIV positive test was 57 months. The risk of transmitting HIV to others was
described as non existent by 36% and low by around 40%. Self perception of the
risk of transmitting HIV was not correlated with several other variables such as
gender, sexual orientation, patterns of drug use, main source of information on
HIV infection, or clinical stage. However, it appeared to be correlated with sexual
promiscuity. The proportion of those considering their risk of transmitting HIV to
others non existent was 45% among those reporting no sexual partners in the last
month and it dropped to 35% percents and to 25% respectively, among persons
reporting one or two or more partners in the last month.
Lessons Learned: The strong relationships between perception of the risk of
transmitting HIV and sexual behaviour seem to be a factor to be considered in
the development of future AIDS/HIV-related health interventions.

23522 An HIV and sexual health needs assessment of female
commercial sex workers (CSWs) in a suburban London
low HIV prevalence area: A pilot study
Lizzi Pickton', Tomas Campbell2. 'Bodytime, 81 High St., Uxbridge, Middx;
2Tudor Wing Sexual Health Centre, The Hillingdon Hospital, Uxbridge, Middx, UK
Issue: CSWs are not visible in this suburban area as street work is unusual.
Secrecy about their work and fear of being identified as a CSW are primary

concerns. Accessing sexual health services (SHSs) seems to be affected by the
fear of being identified as a CSW. This study was conducted by a community
based project offering information/out-reach to CSWs and explored what are the
sexual health needs (SHNs) of these CSWs, concerns about, and precautions
taken against, sexually transmitted diseases and HIV, how appropriate services
identified as important by the CSWs might be delivered and what information was
needed by CSWs entering the sex industry.
Project: A 43 point self-administered questionnaire was developed covering the
following areas; demographic details, sex work undertaken, STD/HIV prevention,
SHNs and opinions about current and prospective SHSs. 230 questionnaires
were distributed to CSWs working from escort agencies and/or private apartments. 69 responses were received (x = 27.1 yrs; range 17-64 yrs; 85% were
aged 18-35yrs; response rate = 33%).
Results: 98.6% (68) did not engage in street work. This is a secretive group;
33% (23) had told no-one about their work. 33% (22) did not know about services
(information, support, SHSs) for local CSWs. 97% (67) always used condoms for
HIV/STD prevention and relied on them for contraception as 45% (30) never used
the contraceptive pill. 45% (31) did not always use condoms with non-paying
partners. Women expressed a preference for non-hospital based clinic provision.
94% (65) said they had regular check-ups but only 43% (29) told the clinic about
their work. This explains why only 38% (26) have a HepB vaccination. 72% (48)
said they worried more about HIV than other STD's and 70% (48) had had an
HIV test. No-one said they were HIV+.
Lessons Learned: The SHN of this hidden group differ to CSWs working in
urban areas. While they access clinic services they are not getting consistently
appropriate treatment as they do not always divulge their profession. HIV remains
a concern to CSWs but they seem to take appropriate prevention. Clear gaps in
the provision of services emerged. There needs to be a variety of service options
available (formal & informal) to ensure comprehensive and accessible care.
123523 AIDS/STD knowledge, preventive practices, condom use
and STD prevalence among female sex workers in Bali,
Indonesia
Kathleen Ford1, D.N. Wirawan2, B. Reed', P. Muliawan2, M. Sutarga2. 1Dept. of
Epidemiology School of Public Health University of Michigan Ann Arbor, M/,
USA; 2Kerti Praja Foundation Bail, Indonesia
Objective: The objective of this study was to describe the levels of AIDS/STD
knowledge, perceived susceptibility to AIDS/STDs, preventive practices, STD
prevalence, and condom use among female sex workers in Bali, Indonesia
Methods: Survey interviews with 600 female sex workers were conducted in
October-December, 1997. All women who worked in several low price brothels
were interviewed and screened for STDs. STD diagnoses included gonorrhea
(culture), syphilis (TPHA/RPR), trichomonas(culture) and BV(clinical diagnosis).
Results: Almost all women in the study (95%) had heard of sexually transmitted diseases, including AIDS. Although most were aware of transmission through
sexual intercourse, many reported that transmission could also occur through
casual contact. More than half of the women reported that AIDS could be prevented by taking antibiotics or traditional medicines. Indeed, about 55% reported
taking antibiotics themselves to prevent AIDS and 22% reported taking traditional
medicines to prevent AIDS. About 89% report that they ask their clients to use
condoms. The perceived attitudes of clients toward condom use were not always
positive. Reported condom use was high (75% for the day before the interview).
Sexually transmitted diseases were also common in these women (gonorrhea
16%, trichomonas 7%, syphilis 17%, and BV 41%).
Conclusion: Compared to earlier studies in this area, awareness of AIDS/STDs
and condom use has increased substantially among these women. However,
further education is needed to develop a better understanding of modes of transmission and effective preventive practices. Given the high levels of STD infection,
frequent diagnosis and treatment of sexually transmitted infections should also
be a priority.
S23524 HIV transmission from an orthopedic surgeon to a patient
in France
Florence Lot', J.C. Seguier2, S. Fegueux2, P. Astagneau3, M. Ruch4,
J.C. Desenclos5. RNSP 14 Rue du val D'Osne, 94415 Saint-Maurice Cedex;
2Hopital de Saint-Germain-en-Laye, St Germain-en-Laye; 3C-Clin Paris-Nord,
Paris; 4DDass Des y Elines, Versailles; 5RNSR St-Maurice, France
Background: Transmission of HIV to patients by infected health care workers
has been documented in only one cluster involving 6 patients of a dentist in
Florida. In July 1995, the French press reported that an orthopedic surgeon of a
public hospital, recently diagnosed with AIDS, was requesting HIV screening of
all his former patients. In October 1995, the Ministry of health offered HIV-testing
to patients who had been operated on by the surgeon. to determine whether the
surgeon transmitted HIV to his patients
Methods: An epidemiologic investigation was conducted and consisted of 1) a
review of the medical history of the surgeon, 2) the assessment of infection control

precautions and surgeon's practices and 3) the identification and HIV testing of
patients.
Results: Of 3 004 former patients on whom the surgeon performed invasive
procedures between May 1983 (presumed date of infection) and October 1993
(stop of activity), 983 patients were ascertained for their serological status (33%).
None of the untested patients was identified in the national AIDS case registry.
Among the tested patients, 982 patients were HIV-negative and one woman was