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

932 Abstracts 43439-43442

12th World AIDS Conference

Conclusions: Although most HT cases were in persons whose partners had
a primary risk, 16% of men and 24% of women were potentially infected through
secondary HT. Women were more likely than men to report secondary HT. Better
characterization of these persons is needed to design appropriate prevention
messages.
43439 HIV prevention indicators provide evidence of successes
and failures of HIV prevention in San Francisco,
California
Kimberly Page Shafer1, W. McFarland2, K. Scheer2, D. Wohlfeiler3, R. Kohn4,
A. Abramowitz5, M.H. Katz6. 1AIDS Office 25 Van Ness Ave. Ste 500, San
Francisco, CA 94102-6033; 2AIDS Office San Francisco DPH, San Francsico,
CA; 3Stop AIDS, San Francisco, CA; 4STD Control San Francisco DPH, San
Francisco, CA; 5Community Substance Abuse Services DPH San Francisco CA;
6San Francisco Dept Public Health San Francisco, USA
Objective: To examine the effectiveness of HIV prevention efforts by identifying
and evaluating key indicators of HIV prevention using local data from various
realms including: biological, behavioral, social and service areas.
Methods: Biological, behavioral, service, and socio-political level indicators are
selected based on considerations of how prevention efforts have been targeted,
specific objectives, data availability, reliability, validity and ease of assessment.
Data were collected from local sources including: the San Francisco Department
of Public Health (SFDPH) Division of STD Control, Division of Community Substance Abuse Services (CSAS), ongoing studies of at risk populations, outreach
groups, and service providers.
Results: The table presents selected prevention indicators (PI) from four
realms: biological (Bio), behavioral (Beh), service (Ser), and socio-political (S-P)
among men, women, men who have sex with men (MSM), injection drug users
(ISU).

Realm
Bio
Bio
Bio
Bio
Beh
Beh
Ser
Ser
S-P
S-P
S-P
S-P

Indicator Population 1994 1996 % change
Syphilis (early) cases Men age 15-24 8 2 75%,
Chlamydia cases Women age 15-24 1091 893 18%
Syphilis (early) cases Women age 15-24 7 2 71%,
Rectal gonorrhea (GC) cases Men age 15 73 134 84%
Unprotected anal sex w/ >2 partners MSM (% reporting) 48% 60% 25% 1
Condom use always (anal sex) MSM (% reporting) 70% 66% 6%
No. needles disbursed at NEP/month IDU 125,027 157,138 6%
Persons receiving drug treatment IDU 13,969 13,134 6%
Clean needle distribution IDU Public Health exemption: 1988
Sodomy laws MSM Repealed in 1976
Anti-discrimination based on sexual orientation Legislation enacted 1991
Domestic partnership recognition for same-sex couples Legislation enacted 1990

intercourse between men, many resulted through migration from hyper-endemic
foci elsewhere, and a few were due to drug injection. A reasonable approximation
of recent HIV incidence may be obtained in a country where HIV transmission has
stabilised through combining data from a range of surveillance systems which
includes either regular or annual HIV case reporting.
S43441 Low and stable HIV epidemics in general population in
Senegal: What do we know about HIV differentials?
Alpha Wade1, Dialla Abdoul Aziz2, Jiaw Papa Ousmane2, Hanne
Almany Abdouaye3, Diakhate Lamine3, Ndoye Ibra4, Mboup Souleymane3
SPO. Box 6506 Dakar Etoile Dakar Senegal University Cad Dakar; 2Bacteriology
Virology Laboratory Hald, Dakar; 3University Cad Dakar, Dakar; 4 Instit Dhygiene
Sociale, Dakar, Senegal
Objective: - To evaluate trends of HIV 1 and HIV2 infections in a HIV2 endemic
area. - To use data to monitor, understand and explain the low level of HIV
seroprevalence among general population.
Methodology: From 1989 to now, a regular HIV surveillance of pregnant
women, registred female sex workers, men with STD's, TB patients and hospitalized patients in infectious disease clinics is conducted by a national sentinel
surveillance network to the level of 20 sites of 4 main regions of Senegal.
Results: The infection of HIV2 is relatively stable in all sites and all groups. No
significant tendency of the propagation of the HIV1 infection is observed among
low risk groups (Chi2 tendency). Rates of HIV seroprevalence of the pregnant
women stabilize at around 0.3% and at around 4.5 to 6.1% for the men with
STD's.
HIV1 seroprevalence in Sn6egal
2 o....I Prelnnt women
i -s - Men a gwith S oT f h'
ditioalscia olrn, o wnornwloe
16
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42 P0 at e 2 b3 e 4 9c on
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Conclusions: A decade of supervision allows today to place Senegal in countries with low HIV seroprevalence. We performed a meta-analysis which identified
several factors which compete to explain the control of the epidemic in Senegal:
a solid system of blood transfusion banks, a regulation of the prostitution, a
traditional social control on the sexuality (especially on women), an intense policy
dialogue, an early national response to HIV pandemic, a level of very high level
of knowledge of measures of prevention (more than 95% of persons of 15-49
years), a rate of utilization of the condom satisfactory enough, a very good media
coverage of HIV/AIDS issues,...
43442 1i Partner based surveillance to direct control toward
populations where undetected infections are spreading
James Koopmani, S.E. Chick2, M.P. Beckere, M.L. Wilsony. 1 Univ. of Michigan
Sch of Public Health, 109 Observatory Ann Arbor MI 48109; 2Univ. of Michigan
College of Engineering, Ann Arbor, MI, USA
Issue: New potential of HIV treatment to stop transmission and new methods to
diagnose infection in the field have created a need for surveillance procedures
that can identify small populations where undiagnosed infections are actively
transmitting. Traditional surveillance paints risk groups too broadly for this purpose and can only direct control efforts to areas with diagnosed rather than
undiagnosed infections. Using information on the contacts of infected individuals
could overcome these deficiencies.
Project: Individual based computer simulations are being constructed and field
work is being conducted to design partner based surveillance systems. Operations engineering methods are being used to design systems with the following
characteristics: Infected individuals are not asked to identify partners. They are
asked about partnership timing, place of meeting and having sex with short
term partners, and residence of long term partners. Both geographic and social
dimensions are used to map the data. Different algorithms are being evaluated
to focus field diagnosis and contact tracing efforts.
Results: Efficient and flexible contact process formulations have been developed for the simulations. Fieldwork indicates the geographic and social data
collection is feasible.
Lessons learned: Using data on partners of HIV infected individuals in this
new surveillance framework can direct focused screening and partner notification efforts to populations and individuals where transmission is currently go

undetected. There is value in using operations engineering methods to design
surveillance systems

Conclusions: Indicators in San Francisco show decreases in STD in the general population yet disturbing increases in risk behaviors and rectal GC among
MSM. Socio-political PI attest to a positive environment for marginalized populations at risk for HIV, which may facilitate prevention efforts. Service PI are more
difficult to evaluate. Biological, behavioral, socio-political, and service level PI
help build a more comprehensive view of the results of prevention, allowing more
timely responses to trends than afforded by HIV or AIDS surveillance.
43440 Combining sequential HIV prevalence with mortality
estimates to measure recent HIV incidence in England
and Wales
Owen Noel Gill1, A. Nicoll2, A.M. Molesworth2, P.A. Rogers, A.M. Johnson2,
B.G. Evans1. 1 PHLS AIDS & STD Centre, CDSC, London; 2Academic Dept.
Genitourinary Medicine, University College London medical School, London, UK
Background: AIDS case reports and AIDS deaths cannot answer key public
health questions concerning the level and trend of recent HIV transmission. Other
surveillance systems have been established including HIV case reporting via laboratories (1985-), an annual survey of prevalent HIV infected persons receiving
care (1995-), and a programme of unlinked anonymous (UA) HIV serosurveys
(1990-). To deduce the number of new infections which occurred in 1995-96, data
from each surveillance system and from the national survey of sexual attitudes
and lifestyles (NAT-SSAL) was used to estimate the prevalence of infection at
two points in time and the number of HIV-related deaths inbetween.
Methods: Prevalence at end of 1994 and 1996 of clinically diagnosed HIV infections was estimated from cumulative infection reports minus deaths and from
the annual survey of persons in care. Undiagnosed HIV infections were estimated
indirectly using both the "HIV to AIDS diagnosis-interval" and the "HIV test-history"
methods, and directly by combining UA serosurvey results with NAT-SSAL data.
Recent deaths were derived by applying survival curves to AIDS incidence data
after adjustment for reporting delay.
Results: The prevalence of HIV infection differed according to the technique
used: 27,000 infections by the indirect method using cumulative HIV case reports,
22,000 by the indirect method using the annual survey of persons in care, and
25,000 by the direct method. Between the end of 1994 and 1996, by whatever
method used, the HIV prevalence did not change. As there had been 1,500
deaths from AIDS in 1995 and 1996, over 1000 new infections probably arose in
each of these years. Three-quarters of the deaths were in homo-bisexual men so
that most new infections would have been in this group.
Conclusions: Probably between 1000 and 1500 new HIV infections arose
annually in 1995-96. Most of these infections were due to unprotected sexual