Program Supplement [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

high risk sexual behaviour and the potential for the expansion
of HIV. At least one STI was observed in 86% female sex
workers (SW) in Yunnan China (n= 505), in 41% SW of both
sexes in Kuala Lumpur Malaysia (n=2o8), 18 % male truck
drivers in Anhui China (n=55o), and in one third of women
attending hospital-based antenatal clinics (ANC) in Port Vila
Vanuatu (n=547) and Apia Samoa (n=472). The most prevalent
STI is Chlamydia, with rates in SWs of 35% in Vientiane Laos
and Angeles Philippines and 59% in Yunnan. Syphilis
seropositivity varied among SW populations: from 0.4% in
Vientiane to 9.5 % in Yunnan among female SWs, to 16%
among freelance SWs in Angeles, and to 31% in SWs of both
sexes in Kuala Lumpur. Young age is significantly associated
with STI in ANC women and SWs. A four-fold increase of
reported STI cases was observed in China (1990-2000). In
Cambodia, a decrease in chlamydia prevalence in SWs from
22.5 % in 1996 to 12 % in 2001 was consistent with a decrease
in HIV prevalence (in 1999 and 2000) and an increase in
condom usage.
Conclusions: STI data from WPC was helpful as an indicator of
vulnerability for H IV infection, information for targeting
interventions, and a tool to evaluate effectiveness of STI/HIV
control programs. Surveillance of STIs should be strengthened
in line with STI/HIV program.
Corresponding author: Nguyen thi thanh, Thuy, World Health
Organisation, Western Pacific Regional Office, PO Box 2932
United Nations Avenue, looo Manila, Philippines,
Tel: [phone], Fax: [phone],
Email: [email protected]
Track D
[ LBPED9038]
A five-year review of medical encounters prior to the
diagnosis of HIV (the HEDS UP study): implications
for early detection strategies
Klein, Daniel, Hurley, Leo, Merrill, Deanna, Quesenberry,
Charles, Allerton, Michael (United States)
Background: HIV infection is now a treatable chronic condition.
Early detection can improve prognosis and reduce
transmission, but 30-40% of cases are diagnosed with
advanced immunodeficiency. This study was designed to
evaluate whether medical encounters in the five years prior to
a diagnosis of HIV infection represent an opportunity to raise
mean CD4 at diagnosis, and explore what other factors might
be employed in early detection strategies.
Methods: We conducted a retrospective review of patient
medical records to examine medical encounters in the five years
prior to diagnosis among all members of a large, multi-site closed
system, managed care organization, diagnosed with HIV in 1998.
Main outcome measures were CD4 cell count at diagnosis,
documentation of HIV risk factors and HIV-related clinical events
prior to diagnosis, and circumstances of diagnosis.
Results: Among 440 patients, 43% had immunologic AIDS at
diagnosis (mean 310, 18% (so). 61% of patients had clinical
indicators of HIV prior to diagnosis; but only 22% had them
over one year prior. 86% of patients had high risk, but only
26% had risks noted over one year prior. In multiple logistic
regression, patients with undocumented risks (OR 2.0; Cl 1.1,
3.5), or clinical indicators >1 year prior to diagnosis (OR 2.6; Cl
1.3, 4.9), or <=1 year prior (OR 3.6; Cl 2.0, 6.4) had increased
odds of having a CD4 < 200 at diagnosis. Conversely, younger

(OR 1.05; Cl 1.02, 1.08; per year), and female (OR 0.3; CI 0.1,
0.7) patients, those previously testing HIV-negative (OR 0.4; Cl
0.2, 0.7), and those who requested testing (OR 0.5; Cl 0.3, 0.8)
had lower odds.
Conclusions: Even with good access to care, early detection of
HIV remains a challenge. In this setting, increased risk
assessment and more widespread patient-readiness to test
appear more likely to improve early detection than does
increased attention to clinical indicators.
Corresponding author: Allerton, Michael, Kaiser Permanente,
1950 Franklin, 19th Fl, Oakland, CA 94612, United States,
Tel: [phone], Fax: [phone],
Email: [email protected]
[ LBPED90391
Risk and prevention behaviors relating to sexual
transmission of HIV among teenagers (aged 14-21) living
under residential care in 3 autonomous regions of Spain.
Garcfa Ruiz, Mercedes, Amalia, Franco Vidal, Ricardo,
de Dios del Valle, Oscar, Suarez Alvarez, Jorge, Ferndndez del
Valle (Spain)
Background: Describe risk and prevention behaviors regarding
to sexual transmision of HIV among teenagers(aged 14-21)
living under residential care to propose a prevention
programme.
Methods: A cross-sectional descriptive study in 3 autonomous
regions with different prevalence levels of HIV. 329 youngsters
completed a self administrated questionnaire, validated by the
EASP, 1997. Variables (PRECEDE model): a)sociodemographics
b)dependant: condom use in the last 12 months c)intermediary:
1)Predisposing: attitudes, knowledge, locus of control,
2)Facilitators: type of partner; 3)Reinforcements: guilty feelings.
Results: the average age was 15,9. 55% were males and 61.2
% were just studying. 47,7% had risky sexual relations, 31,8%
of this group didn't use condom last time: 34% because of the
sort of partner, 14% because of non disponibility and 12%
because they used another anticonceptive method. No
difference in use of condom was found related to county,
nationality, gender, age or study level. The rate among people
that had sexual intercourses no using protection was bigger
among those who had an external locus of control than those
with an internal. The part of young people considering condom
as a low security method to avoid H IV transmission was bigger
among those who were having sexual risk intercourses without
condom, furthermore, use of condom among those considering
coitus interruptus as a valid method to avoid HIV transmission
was lower.69% of young people having risky sexual behaviors
haven't had any guilty feelings.
Conclusions: Percentage of institutionalized teenagers using
condoms is similar to the non institutionalised. There is
confusion about the ways of transmission and the efficiency of
condom as a prevention method.This leads to a low awareness
of the risk and maintainment of risky sexual behaviors. Locus
of control and guilty feelings are related with the use of
condom so PRECEDE is a good model for the design of
prevention programmes.
Corresponding author: Garcia Ruiz, Mercedes, Fuertes
Acevedo, 1o, bajo, C.P:33oo6 Oviedo, Asturias, Spain,
Tel: [phone], Fax: [phone],
Email: [email protected]

XIV International AIDS Conference BARCELONA - JULY 7-12

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