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

12th World AIDS Conference

Abstracts 23534-23538 449

edge level was conducted after six months to determine their retention levels.
About 73.56% of the women got correct answers on these questions.
Lessons Learned: Women's vulnerability to HIV/AIDS can be greatly reduced
when provided with a culturally sensitive intervention/education program where
correct information on the infections may be accessed. Also, women are able to
empower themselves to reduce the perils of the infections to themselves, their
children and their loved ones.
570*/23534 HIV infection among transsexual sex workers from
developing countries: A review of six years of
activity of a reference center in Rome
Laura Spizzichino1, P. Gattari1, M. Zaccarelli Mauro2, S. Venezia1, G. Rezza3.
1AIDS Unit ASL RME Rome; 2IRCCS L. Spallanzani, Rome; 31st Superiore di
Sanita Rome, Italy
Objective: To describe the HIV related epidemiological and behavioral characteristics of transsexual (TS) sex workers attending a reference center in Rome, from
January 1992 to December 1997, that is usually attended by foreign individuals
asking HIV testing and treatment.
Design: Cross-sectional and follow-up study.
Methods: All patients attending the center routinely receive HIV counselling
and are interviewed with a standard questionnaire to collect demographic and
behavioral information. The data are input in a computerized data-base together
with the results of the HIV test. The interview is repeated at each follow-2up visit.
Results: Overall, 237 TS sex workers attended the center in the study period.
HIV prevalence at enrolment was 42.6% (101/237) in the whole sample, but
it differed stratifying the participants into subgroups by geographic area. HIV
prevalence was 67.3% (68/101) among subjects from Brazil, 22.5% (27/120)
among subjects from Columbia, 54.6% (6/11) among subjects from other South
American countries. Two of 3 persons 66.7% (2/3) from North Africa and none
of 2 subjects from Bosnia were infected. HIV prevalence was higher among TS
reporting injecting drug use: 66.7% (24/36) versus 38.3% (77/201), p < 0.01; and
increased in those reporting injecting cocaine use: 78.1% (11/14). The prevalence
did not show differences by age, reported number of partners and condom use.
115 TS returned for at least one follow-up visit (up to 8 visits). Among 69 initially
HIV negative TS, 7 seroconverted during a total of 118.4 persons/years (incidence
rate 5.9 per 100 p/y); all seroconverted were from Columbia so that the incidence
rate for 87.6 p/y of observation within this group was 8.0 per 100 p/y. A general
increase in regular condom use with the clients was reported during the follow-up
(from 58.8% to 86.8%).
Conclusions: In recent years our center was attended by an increasing number of transsexual sex workers for HIV testing and treatment. The data collected
suggest that HIV infection is widespread among these individuals, but counselling
is rather effective in reducing their HIV related risk behaviour.
S235351 Environmental factors in injection-related HIV risk in
female commercial sex workers from two US cities
Lloyd A. Goldsamt1, M.C. Clatts1, J.L. Sotheran1, P.A. Luciano1, T.M. Gallo1,
P.Z. Simons2. 1NDRI, 2 World Trade Center, 16th Floor, New York, New York
10048, 2Peers, Denver, CO, USA
Background: As part of a study of injection drug users (IDU) in New York City
and Denver Colorado, USA, 50 female commercial sex workers (CSWs) and 79
women who were not CSWs were interviewed regarding their injection-related
HIV risk behaviors. All subjects were recruited in street-based venues (e.g., parks,
public restrooms) on the Lower East Side of NYC and the East Side of Denver. These cities were selected for their contrasting background seroprevalence,
density of IDUs, drug forms, and associated drug injection practices.
Methods: Subjects were eligible if they reported any injection drug use during
the past 30 days. A structured interview, based upon existing measures and the
results of extensive ethnographic research in each community, was administered
to all subjects. The interview covered 13 different areas, including demographics,
most recent solitary/group injection episodes, HIV-related drug risk behaviors,
knowledge of HIV-related drug risks, and intentions regarding HIV-related drug
behavior. We used general linear modeling to control for the effects of city and
city/CSW interactions, with follow-up t-tests or chi-square analyses for significant
main effects.
Results: CSWs and non-CSWs did not differ on demographic measures (age,
ethnicity, education, marital status). CSWs injected more frequently, were more
likely to inject in public locations, and had less stable housing. CSWs injected
an average of 7.9 times each day, compared to 2.9 injections/day for non-CSWs
(t = 2.65, p =.01); felt that their most recent injection was in a location likely to
be interrupted by another person (x2 = 8.70, p =.013); and were more likely to
have spent a night in a public place during the last 30 days (t = 9.98, p =.002),
although no differences were found in type of primary living situation or perceived
homelessness.
Conclusions: Female commercial sex workers are at greater HIV risk than
non-commercial sex workers due not only to higher injection frequency, but also

to injection in high risk environments, which create the need to inject more
quickly and surreptitiously. Furthermore, unstable living situations limit CSWs
ability to maintain new or clean injection equipment. These results suggest that
environmental factors and their relationship to HIV-related risk behaviors need
to be explored in research and interventions involving CSWs and other high risk
populations.

23536 | Prevalence of HIV infection in transgendered individuals
in San Francisco
Kristen Clements, R. Marx, R. Guzman, S. Ikeda, M. Katz. San Francisco Dept
of Public Health, 25 Van Ness Ave., Ste 500, San Francisco, CA, USA
Objective: Although transgendered individuals are thought to be at high risk for
HIV infection, there are no representative estimates of the level of HIV infection in
this community. This study aims to estimate HIV prevalence in the Male-To-Female
(MTF) and Female-To-Male (FTM) populations in San Francisco.
Methods: Transgendered individuals 18 years of age or older, who lived, worked
or socialized in San Francisco in the past 6 months were eligible. Transgendered
staff recruited individuals from social service agencies, clinics, bars, and street
settings; participants also referred other eligibles. Subjects were interviewed on
demographics, medical history, and risk behaviors, and were tested for HIV with
the OraSure Oral Mucosal Transudate technique. We used EIA screening and
Western blot confirmatory testing on specimens.
Results: Between July 1 and December 31, 1997, we recruited 642 individuals;
583 (91%) were eligible, of whom 519 (89%) completed the study. The mean
age of the sample was 35.6 years (range: 18-67 years) and most participants
were living in San Francisco (85%). Three-fourths of the participants were MTF,
24% were FTM, and 7 individuals were born intersexed. The MTF sample was
racially diverse (28% White, 27% Latina, 27% African-American, 12% Asian/PI,
and 6% Other) while the FTM sample was predominantly White (66% White, 13%
Latino, 9% African-American, 6% Asian/PI, and 4% Other). The prevalence of
HIV infection was significantly higher among MTF individuals (35%) than FTMs
(2%) (p <.001). Among the MTFs, HIV prevalence was higher in those 30
years and older compared to younger individuals (31% vs. 20%; p =.02), and in
African-Americans compared to other racial groups (61% vs. 26%; p =.001).
Conclusion: HIV prevalence in MTFs, particularly among African Americans,
is higher than in San Francisco's gay/bisexual male and injection drug using
populations. Our results suggest an urgent need for effective HIV prevention and
access to health services for the transgendered population.
S23537 Health evaluation of the inmates of the prison system of
Rio de Janeiro
Eugenia M.M. Midlej, E.J. Biondi, L.P. Veiga, J.L. Fialho, O.N. Santos,
S.B. Souza, A.C.A. Peixoto. Superintendancia de Saude, Desipe-Sejint, Rua
Senador Dantas 15, 90 Andar, 20031-201 Centro, Rio de Janeiro, Brasil
Issue: The prisoners which entered the Brazilian prison system or which were
previously referred to other units were not submitted to routine medical evaluation. Therefore, health problems were not identified or treated early. New cases
of infectious are expected to occur in a confined system.
Project: Nowadays, prisoners entering the system are informed about daily
routine, participate on lectures/debates on STD/AIDS and other subjects of interest. A questionnaire is administered by health care professionals for selection
and referral This questionnaire includes psycho-social, legal and health aspects.
HIV and syphilis blood testing are offered with pre- and post-counselling. Further
anonymous questionnaire, deals with drug use.
Results: In 1997, 1103 questionnaires were filled. The analysis of 40% showed
that 46.7% of the inmates referred to a health problem, 35.7% to STDs. Prisoners
with a previous history of STDs revealed, that 76.% initiated a specific therapy,
but only 61.7% completed their treatment. 71.2% informed their partner. 31.4%
mentioned having made an HIV test, with 4.4% seropositives. Regarding use
and importance of condoms the declarations of the prisoners were contradictory:
24.3% knew that condoms protect against STDs, 67.5% did not feel at risk, but
55.8% had risk behavior. 34.1% used no protection at all. 45.1% of the interviewed
prisoners mentioned drug use, 6.6% injecting drug use. Out of the 1103 prisoners
participating in the evaluation 16.7% mentioned actual STD problems and 62.3%
requested a test for HIV.
Lessons Learned: Clinical evaluation at the entrance, early diagnosis and
treatment of infectious diseases are likely to impact on STD/HIV infection. Furthermore, as bio-psychlogical profile are determined, adequate health policies
and prevention may be established, mainly with regard to STD/HIV
S23538 HIV infection and syphilis among female commercial sex
workers in Guyana
Navindra E. Persaud1, W. Klaskala Winslow1, M. Baum1, T. Tiwari2. University
of Miami, FL., 1400 NW 10Th Avenue Suite D21, Miami Florida, USA; 2Ministry
of Health Guyana, Georgetown, Guyana
Objectives: To determine the prevalence of and identify risk factors for HI infection
among female commercial sex workers in Guyana.
Methods: During January-February, 1997, a cross sectional survey was conducted among 124 street-walkers and brothel based female sex workers in
Georgetown, Guyana. Risk factor information was collected by means of a questionnaire. Samples were screened for HI using the ELISA method while the Rapid
Plasma Reagin (RPR) kit was used to test for syphilis.

Results: The mean age of the women was 30.6 years (range = 17-52; sd =
7.24). Sixty-one percent admitted working in the sex industry for 1-4 years while
the remainder had four or more years of experience. Fifty-four women (46%) were
HIV positive and thirty-three (27%) were diagnosed with syphilis. In univariate
analysis factors that were significantly associated with HI seropositivity included
syphilis infection (OR = 7.56; 95% CI = 2.7-21.97; p < 0.01); use of cocaine
(OR = 2.57; 95%CI = 0.95-7.11; p = 0.04); having more than four clients per