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

12th World AIDS Conference

Abstracts 23543-23547 451

123543 The psychosocial and biomedical factors contributing to
the vulnerability of women prisoners to HIV/AIDS at the
state penitentiary in Metro Manila
Nymia Pimentel Simbulan1 2, A.S.A. Aguilar1, T.P.F. Flanigan3, S.C.U. Uvin3.
'College of Arts & Sciences UP Manila, Padre Faura St. Ermita, Manila 1000;
2CEMSHAD & UP Manila, Manila, Philippines; 3Brown University, Providence,
RI, USA
Objectives: To identify the high risk behaviors of women prisoners; to determine
the prevalence of STDs among them; and to determine the factors that influence
their high risk behaviors.
Design: Cross-sectional study
Methods: A total of 100 women prisoners randomly selected and 45 years of
age or younger were interviewed and made to undergo gynecological examination
and STD testing including HIV-antibody test. A structured interview schedule was
used covering the women's socio-demographic background, sexual behaviors,
history of drug use and STDs, and level of knowledge about HIV/AIDS. The
STDs included in the study were trichomoniasis, gonorrhea, chlamydia, syphilis,
Hepatitis B and HIV.
Results: Most (36%) of the women were between the 38-43 age bracket with
36 years as the mean age. Close to half (46%) reached college. Most of them
(41%) are separated and more than a third (36%) are married. Majority (60%) of
the inmates have 1-4 children. Prior to imprisonment, 37% of the women were
self-employed or had their own small business. All the women were sexually
active with majority (56%) experiencing their first sex when they were between
15-19 years. Most of them (41%) said they had 2-3 sex partners while 4% stated
they had so many they can no longer recall the number. More than half (51%)
last had sex at least 3 years ago. Majority (76%) have never used a condom.
Many (34%) admitted having experienced and observed signs and symptoms
of infections like itching, painful urination and vaginal discharges and 34% also
indicated having traveled abroad. More than one-third do not know whether a
person with HIV can look healthy or not, do not know that condoms can reduce
the risk of HIV infection and believed AIDS can be acquired by using dirty toilets.
Finally, the STD screening results revealed 29% of the women were positive
for at least 1 STD with chlamydia (13%), hepatitis B (12%) and gonorrhea (8%)
as the most common among them. Among those with STD, 72.4% were also
found positive for other lower genital infections like ureaplasma, mycoplasma, &
gardnerella.
Conclusion: The high risk behaviors of women prisoners like unprotected
sex with multiple sex partners, sex with drugs and/or alcohol may transmit STD
within prison setting due to the presence of index cases an shown in the high
prevalence (29%) of STD among the study participants. Despite the high level of
educational attainment, there is a need to improve AIDS awareness and correct
misconceptions about the disease. It is likewise urgent to address the health
needs of the women prisoners at the state penitentiary.
S23544 | Prevalence of HIV risk behavior among adults living with
a severe and persistent mental illness
Michael P. Carey K. arey2, S.A. Maisto2, C.M. Gordon2, J.R. Gleason2,
K.K. Brewer2. 14671 Bloomsbury Drive Syracuse NY 13215; 2Syracuse
University NY, USA
Objective: To conduct a census to determine the prevalence and correlates of
HIV-related risk behavior among adult outpatients at a large state psychiatric
hospital.
Design: Population census.
Methods: Collaborating with clinical leaders and patient advocates, we developed an institutional policy that requires that all outpatients be screened for
their risk of HIV infection. Our team of trained research assistants interviewed
new admissions and ongoing patients regarding their sexual and substance use
behavior. After one year, 792 adults were screened (43% female; 75% EuropeanAmerican, 22% African-American), representing 85% of the target population.
Nearly half (49%) of the patients reported being sexually active in the past year,
52% used alcohol, and 18% used street drugs. Seven percent reported having 3
or more sexual partners, 4% had been infected with a STD other than HIV, 3%
had exchanged sex for money or drugs, and 1% had shared injection equipment.
More than one-third acknowledged that alcohol or drugs was a problem. Patients
who reported both sexual behavior and substance use during the past year (n =
107; 13.5% of the screened sample) participated in a more detailed assessment
that revealed a high level of misinformation about HIV, modest levels of risk
perception, and considerable risk behavior. Patients were worried about HIV and
AIDS, but had few formal resources to reduce their risk or allay their concerns.
Conclusion: Behavior associated with enhanced HIV transmission risk occurs
in a significant minority of outpatients living with a severe mental illness. Although
the prevalence is not as high as has been reported previously, this level of
risk behavior - coupled with the elevated seroprevalence rates reported in this
population - indicates the need for a progressive approach to the prevention of
HIV infection among adults living with a severe mental illness.

23545 HIV vulnerability of Bangladeshi migrant workers in
Malaysia
Sharuna Verghis1, Irene I.F. Fernandez1, Aegile A.F. Fernandez1, Ivan
I.W. Wolfers2, Walter W.D. De Ville2. 1 Tenaganita, 11th Floor, Wisma Yakin,
Jalan Masjid India, 50100 Kuala Lumpur, Malaysia; 2Vrije Universiteit,
Amsterdam, Holland
Objectives: To examine the factors contributing to the HIV vulnerability of
Bangladeshi migrant workers in Malaysia within the context of migration as a
co-factor for the spread of HIV in South & S.E. Asia.
Design: Participative research focusing on health, sexuality, knowledge, attitudes and behavior with regards HIV/AIDS.
Methods: Outreach was done to establish a relationship with migrants. Migrant interviewers were identified simultaneously to participate in the research. A
survey with 147 male Bangladeshi migrants was strengthened by 1 focus group
discussion, 2 HIV/AIDS sessions, 10 group discussions, observations, informal
interviews and secondary data analysis. Training of interviewers and monitoring
of research was done by the Kuala Lumpur based NGO, tenaganita.
Results: Single males were an independent risk group (OR = 4.3; p = 0.0017)
when standardized for other associated factors. They were younger and more
educated than married men. 126 had a medical exam before and after arrival in
Malaysia. Only a small percentage knew they were tested for HIV. Only 3 and 5
received counseling for HIV test before & after arrival in Malaysia.
Migrants are a mobile and marginalized group with unique social and sexual
networks and coping mechanisms to deal with lonliness. Creative methodologies
have to be developed to understand and initiate appropriate interventions to
reduce their HIV vulnerability. This research developed some such methods and
interventions which may be tested elsewhere.
S23546 1 Communities at risk - Estimating the impact of the HIV
epidemic upon adolescents and young adults at the local
level
Paul Denning, P.L. Fleming. US Centers for Disease Control, 1600 Clifton Rd,
Mail Stop E-47 Atlanta, GA 30333, USA
Background: Since HIV-infected persons who develop AIDS by age 25 tend
to have been recently infected, trends in AIDS incidence among these young
persons will closely parallel trends in HIV incidence. AIDS incidence data for
persons aged 18-25 years can thus provide a population-based means of estimating recent patterns of HIV infection among adolescents and young adults.
Moreover, communities with the greatest need for HIV preventive interventions
can be identified by examining these data at the local level.
Methods: We analyzed AIDS surveillance and census data from all metropolitan statistical areas (MSAs) in the US to calculate MSA-specific AIDS incidence
rates for the 1-year periods July 1990-June 1991 and July 1995-June 1996. Our
analysis included persons aged 18-25 years who were exposed to HIV through
male-male sex, injecting drug use, or heterosexual contact. We excluded MSAs
with <10 AIDS cases in both evaluation periods. Data were adjusted for reporting
delays, unreported HIV risks, and the 1993 change in the AIDS case definition.
Results: For the 58 MSAs included in our analysis, the median AIDS incidence
rate in 1995/96 was 9.8 cases per 100,000 persons aged 18-25 years (range =
0.8-61.2). Some of the highest rates were in MSAs with populations <500,000,
such as Fort Pierce, FL (61.2), Jackson, MS (21.3), and Columbia, SC (18.9).
Rates in these small MSAs were substantially higher than in nearly all MSAs with
populations >1 million, including Washington, DC (13.8), Los Angeles, CA (8.6),
and Chicago, IL (7.7). Between 1990/91 and 1995/96, AIDS incidence rates for
young persons increased by >25% in 15 (26%) of the 58 MSAs and decreased
by >25% in 21 (36%). MSAs in which rates increased by >25% were significantly
more likely than MSAs with decreases >25% to have populations <1 million
persons (odds ratio [OR] = 3.6, 95% confidence interval [Cl] = 2.0-6.6), and
significantly more likely to have young persons with AIDS who were female (OR
= 1.8, 95% CI = 1.3-2.6), black (OR = 4.4, 95% Cl = 3.1-6.2), or exposed to HIV
through heterosexual contact (OR = 2.1, 95% Cl = 1.5-2.9).
Conclusions: The high AIDS incidence rates in most of the MSAs reflect
persistently high levels of HIV infection among adolescents and young adults. Of
particular concern, trends in AIDS rates during the 1990s indicate that the HIV
epidemic continues to spread, most notably in small MSAs and among women,
blacks, and heterosexual contacts. To halt this continued growth in the epidemic,
HIV prevention activities must be expanded in all communities - those currently
affected, those becoming affected, and those not yet affected.
S23547 Female sex workers in Mexico: Sentinel surveillance
1990-1997
Martha Santarriaga Sandoval1, R.E. Loo Mendez2, C. Magis Rodriguez2,
P.E. Uribe Zuniga2. 1Tlalpan 4585 2Do. Piso Col. Toriello Guerra C.P 14050
Mexico, D.F; 2AIDS National Council Mexico, D.F, Mexico
Objective: To analyze the behavior of the HIV infection in female sex workers in

Mexico.
Method: The information for sentinel prevalence was obtained of the Sentinel
Surveillance Registry of the National AIDS Council (CONASIDA), during the
period from 1990 to 1997.
Results: The sentinel studies include results of 18 states of Mexico. A total
of 28,973 Female sex workers were studied, with a prevalence of 0.4% (C.I.
0.33-0.47) during the Period with some increment in time: