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

12th World AIDS Conference

Abstracts 23525-23529 447

HIV-positive. She was HIV-negative before a prolonged operation by the surgeon
in 1992 (placement of a hip prosthesis with bone graft) and had no identified
risk exposure to HIV. The molecular analysis indicated that the viral sequences
obtained from the surgeon and the HIV-infected woman were highly related.
Infection-control precautions were in accordance with recommendations but
blood contacts between the surgeon and his patients occurred commonly during
operations.
Conclusions: This epidemiological investigation confirmed by viral sequencing
provides evidence that an HIV-infected orthopedic surgeon had transmitted HIV
to one of his patients while operating.
23525 Characteristics of male sex trade workers in a
prospective study of HIV incidence and behaviors in
young men having sex with men
Martin Schechter1, Steve Martindale2, M.L. Miller2, S.A. Strathdee2,
P.G.A. Cornelisse2, F.T.K. Tetlock2, J. Tigchelaar2, M.T. Schechter2. 608 - 1081
Burrard Street St. Pauls Hospital, BC Centre for Excellence in HIV/AIDS, Canada
Objective: To compare demographics, sexual and drug using behaviours among
male sex trade workers relative to other young men having sex with men (MSM)
men enrolled in a prospective cohort study.
Methods: MSM aged 18-30 who enrolled in a prospective cohort study in
Vancouver, Canada, beginning May/95, underwent HIV testing and completed
self-administered questionnaires at baseline and on an annual basis. Data were
collected on demographics, sexual and drug-using behaviours, depression (7
item CES-D scale), social support, and whether or not men had provided sex in
exchange for money, goods or drugs, ever or in the previous year. Similarly, men
were asked if they had paid another male for sex. Contingency table analysis was
used to compare men who had been paid for sex in the previous year to those
who had not.
Results: As of Oct/97, 624 men had enrolled. Of these, 146 (24%) had ever
been paid for sex, 81 (13%) in the previous year, and 11% had ever paid another
male for sex, 3% in the previous year. Relative to the remainder of the cohort (n =
543), men who were paid for sex in the last year (n = 81) were significantly more
likely to be: HIV+ at baseline (3.7% vs 1.3%); younger (median 24 yrs vs 26 yrs,
p < 0.001); non-white (43% vs 25%, p < 0.001), less educated, live in unstable
housing, and earn less than $10K/yr. These men were significantly more likely
to: identify as bisexual (52% vs 7%, p < 0.001); report non-consensual sex (51%
vs. 30%, p = 0.001); report first having sex with both men and women at younger
ages (p < 0.001); report use of coke/crack, heroin and poppers. In particular, they
were more likely to have used injection drugs in the previous year (28% vs 4%,
p < 0.001). These men had less social support and higher depression scores (p
< 0.001). They were also more likely to use condoms for oral sex with regular or
casual partners compared to the remainder of the cohort, but they were also more
likely to report unprotected insertive anal sex with casual partners (23% vs. 13%,
p < 0.01), and 21% reported ever being paid more to have sex without condoms.
Conclusions: Male sex trade workers are vulnerable to HIV infection due to
unfavourable living conditions, high rates of recreational drug use, and high-risk
sexual behaviour. As these men often do not self-identify as gay, they may not
be reached through conventional prevention programmes. Since our definition of
sex trade work is fairly broad, however, our results may not be generalizable to
other settings or specific sub-groups of men engaging in the sex trade.
23526 Geriatric AIDS population study (GAPS) of an inner city
population in the United States
Cheryl Smith1, S.S. Shah2, J.P. Mcgowan3, S. Blum3, E.E. Telzak3, A. Malik3,
R.S. Klein2. 'One Gustave Levy Place, Box 1009-New York, N.Y. 10029;
2Montefiore Med. Ctr., Bronx; 3Bronx-Lebanon Hospital Center, Bronx NY USA
Objectives: To describe the demographics, clinical status and primary care of
older HIV infected individuals being treated at three major New York City hospital
HIV clinics.
Design: Retrospective chart review.
Methods: The medical records of 126 patients _55 years were reviewed.
Gender, race/ethnicity, HIV risk factors (RFs), AIDS defining conditions (ADCs),
comorbid conditions (COs) and documentation of preventive care were abstracted.
Results: The gender and race/ethnicity were: 69% male; 53% Black (Non
Hispanic), 45% Hispanic, 2% Caucasian. Median age was 58 (55-80) yrs. 48% of
individuals irrespective of gender, and 44% of males, reported heterosexual contact (HSC) as their RF. Other RFs included: injecting drug use (30%), men having
sex with men (7%), and blood transfusion (3%). 64% had ADC (44% were solely
by CD4 count <200/mm3). Other ADC by frequency were: PCP (29%), wasting
(20%), Candida esophagitis (20%), CMV (11%), HIV encephalopathy (9%), and
others (11%). Median duration of follow up was 26.5 (0-113) months. The patients
had a mean of 2.1 COs which included HTN (37%), COPD/Asthma (32%), DM
(18%), CAD (10%). The proportion of individuals with documented annual preventive care was: mammogram (54% of females), Papanicolaou smear (72% of females), digital rectal examination (35%), serum cholesterol (86%), tuberculin skin

testing (80%) and influenza vaccination (89%). Documentation for pneumococcal
vaccination and minimental status examination was 88% and 4% respectively.
Conclusions: Our findings of heterosexual contact as the major risk factor
demonstrate a greater need for education of inner city geriatric populations with
regard to high risk sexual behavior. As the number of elderly people with HIV
increases, health care providers must emphasize general medical preventive
strategies and neuro-psychiatric evaluation.

23527 HIV risk behaviours and HIV seroprevalence among
European prisoners: A multicenter study of the EC
Network on HIV-Hepatitis Prevention in Prison
Michel Rotily. Inserm U379, ORS PACA, 23 Rue S. Torrents, 13006 Marseille,
France
Objectives: To estimate the prevalence of HIV infection and HIV-Hepatitis related
risk behaviours in European prisons.
Methods: This study was carried out in 25 prisons of eight European countries
between October 1996 and January 1998 (France, Germany, Sweden, Portugal,
Italy, Belgium, Spain and Scotland). Inmates were invited to fill a self-administered
questionnaire and to give a saliva sample in order to test anti-HIV antibodies.
All information was collected anonymously; questionnaires and saliva samples
were related by a bar code. Furthermore inmates participating in the survey were
offered a personal HIV and HCV screening, and counseling.
Results: (on 15 prisons on 15/01/98): Participation rate varied between 65%
and 95%. 1789 inmates participated in the survey, 675/1701 reported having ever
injected drug (40%); 7% reported having started to inject drug in prison and 39%
having ever injected in prison. Ten per cent declared having had anal or vaginal
sex with a women during the current incarceration and 2% having ever had anal
sex with a man in prison. One third of inmates reported having ever been tattooed
in prison (27%); that proportion was higher among IDUs than non-IDUs (44%
vs 15%, p < 0.001 after correction for differential time inside prison). The global
HIV-1 seroprevalence rate was 6% ([4.7-7.2]95%cI) but varied significantly among
countries, up to 13% in the Portuguese prisons; that rate was significantly higher
among IDUs than among non-IDUs (13% vs 1.5%; P < 0.001).
Conclusion: Although the prevalence of HIV-hepatitis related risk behaviours
among incarcerated IDUs tend to vary among European prisons, these behaviours
are reported in each prison system and might contribute to the dynamics of the
HIV epidemic, especially in South European countries. The still high HIV seroprevalence among incarcerated inmates, especially IDUs, should encourage us
to enhance risk reduction and education programmes in prison.
123528 1 A look behind closed doors: Injection and sexual risk
behaviour and HIV, HBV and HCV inside a Canadian
prison
Lee Lior1'2, J. Beal3, J. Portman4, E. Rud2, R. Chaudhary5, J. Scott6,
C.P. Archibald2. 1PL 090 OB1 Tunney's Pasture Ottawa, Ontario KIA OK9;
2Bureau Off HIV/alDS & STD, Health Canada, Ottawa, ON; 3Northern Region
Health Board, Nova Scotia Amherst, NS; 4 Correctional Services Of Canada,
Ottawa, ON; 5Division Of Blood-Borne Pathogens, Health Canada, Ottawa, ON:
6Nova Scotia Department Off Health, Haliffax, NS, Canada
Objectives: To estimate the prevalence of HIV, Hepatitis B (HBV) and C (HCV)
infection and injection and sexual risk behaviours among inmates in a Canadian
prison to help plan additional prevention and care services.
Methods: In response to self-reported high risk behaviours by an HIV+, HBV+
and HCV+ inmate, a voluntary, confidential survey was conducted with 3 principle
components: a face-to-face interview with a detailed risk behaviour questionnaire,
a blood test (for HIV, HBV and HCV) and pre- and post-test counselling. All components were administered by an external public health nurse trusted by inmates.
Inmates were enrolled over a 6 month period in 1997 and had the opportunity to
return for their results.
Results: Over 340 inmates volunteered for the survey, however time constraints, early release and inmate transfer allowed only 194 interviews to be
completed (187 male, 7 female), which represented about half the inmate population. To date, 1% (2/171) had evidence of HIV infection, 1 HBV carrier, and 28%
(53/192) had evidence of HCV infection. The questionnaire included questions
on sexual and injection behaviours both inside and out of the prison system,
during current and past incarcerations. Injection behaviours of interest included
the proportion who report ever having injected drugs, the proportion who had ever
used drugs while incarcerated, and those who report using injection drugs during
their current incarceration. Sexual behaviour questions focussed on condom use
with various partner types, both inside and out of the prison system. Inmates were
also asked to provide input on how specific services might be needed, including
access to needles and condoms inside.
Conclusion: This study has demonstrated that both HIV and HCV are present in
this institution and further analysis will be done. The presence of these pathogens
serves to reinforce the need for appropriate prevention and care services to
prevent transmission in prisons and in the community at large.
S23529 | HIV-infected children becoming adolescents:
A descriptive study of older children in New York City,
Los Angeles County, Massachusetts, and Washington DC
Toni Frederick1, Laurene Mascola2, P. Thomas3, H.W. Hsu4, T. Rakusan5,
J. Bertolli6. y13 N Figueroa St., Rm. 203, Los Angeles, CA 90013; 2Los
Angeles Cnty, Dept of Health Srvcs, Los Angeles, CA; 3New York City Dept of

Health, New York, NY; 4New England Newborn Screening, Jamaica Plains, MA;
5Washington DC, Health Dept, Washington, DC; 6Centers for Disease
Control/Prevention, Atlanta, GA, USA
Background: Survival is increasing among HIV-infected children. We describe
psychosocial characteristics of older adolescent children with HIV acquired perinatally (PA), from blood transfusion (TA), or receipt of blood products for hemophilia
(H).