Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

92 Abstracts WeOrC1268-WeOrC1271

XIV International AIDS Conference

was collected for HIV testing. The over-all response rates to the blood collection
was approximately 90%.
Results: This first nationally representative sero-prevalence study of HIV from
an African country revealed an HIV prevalence of 1.3 per cent for men (15-49
years) and 2 percent for women (15-59). Social and geographic distribution of the
disease in Mali will be presented.
Conclusions: The completion of the Mali Demographic and Health Survey raises
the prospects for inclusion of sero-prevalence in DHS for other countries. The role
of national population-based HIV sero-prevalence studies will be discussed in the
context of the need for "second-generation" HIV/AIDS monitoring and evaluation.
Presenting author: Gregory Pappas, 11785 Beltsville Drive, Calverton, Maryland, 20705, United States, Tel.: [phone], Fax: [phone], E-mail:
gpappas @macroint.com
WeOrC1268 The use of blood donor data for HIV surveillance
purposes. A global perspective
E. Sedyaningsih-Marnahil', S. Lazzari', N. Schinaia2, N. Dhingran3,
G. Vercauteren3, L. Noel3, J. Emmanuel3, S. Lloyd3. 'CDS/WHO, Geneve,
Switzerland; 21stituto Superiore di Sanit, c/o Istituto Superiore di Sanitb,
Laboratorio di Epidemiologia e Biostatistica - Reparto AIDS e MST 00161
ROMA, Italy; 3BTS/WHO, Geneve, Switzerland
Background: The purpose of this study was to update most recent figures and
trends of HIV prevalence among blood donors worldwide, and to assess its impact
on general HIV surveillance activities.
Methods: Source of data were the Global Blood Safety Initiative Database (primarily) and the US Bureau of Census HIV Surveillance Database, June 2000,
country reports on blood transfusion, the UNAIDS/WHO estimation for adults living with HIV/AIDS as of the end of 1999. Our analysis was restricted to the last
three years for which information was available (1997-1999).
Results: We included in our study 50/55 countries in the world with generalised
level of HIV/AIDS epidemics (36 African, 4 Asian and 10 Caribbean and Latin
American countries). The highest prevalence rate was 18% and the lowest 0.01%.
In 19 countries, HIV prevalence rates in blood donors were similar to the estimation of HIV prevalence in the adult population: in most of the remainders they
were lower. When matching these results with the quality of the surveillance system in the countries, almost all countries where blood donor HIV prevalence was
greater than its estimate in the adult population had poor HIV surveillance system. Replacement donors were the majority in almost all the countries where HIV
prevalence was similar in blood donors and in the adult population, while there
was a highly significant association between high proportion of repeat donors
and lowest HIV prevalence rates.
Conclusions: Transfusion-transmitted (TT) HIV infection may still represent a
sizeable problem in many resource-poor areas of the world. The major actions
towards controlling is, through nationally-coordinated blood transfusion services,
to expand the voluntary, non-remunerated blood donor population selected in low
risk groups of the population, to test all donations for anti-HIV antibodies, and to
reduce the unjustified use of blood.
Presenting author: Nicola Schinaia, c/o Istituto Superiore di Sanitb, Laboratorio
di Epidemiologia e Biostatistica - Reparto AIDS e MST, 00161 ROMA, Italy, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WeOrC1269 Trends in HIV prevalence and sexual behaviour
(1990-2000) in Uganda
W.L. Kirungi', J.B. Musinguzil, A. Opio2, E. Madraal. 'STD/AIDS Control
Programme, Ministry of Health, Ministry of Health, RPO. Box 22375, Kampala,
Uganda, Uganda; 2Ministry of Health, Kampala, Uganda
Background:Epidemiological surveillanceof in Uganda has shown consistent decline in HIV prevalence among antenatal and STD clients at sentinel sites. This is
corroborated by parallel changes in sexual behaviour.
Methods: Analysis of annual HIV prevalence data of 250-300 clients from each of
20 sentinel sites (1989-2000) and data on sexual behaviour of about 1500 adults
resident in the catchment areas of the sites based on repeated cross-sectional
behavioural surveys. Chi square test was used to compare differences and Chi
square test for trend was used to test for linear trend in sero prevalence and
sexual behaviour.
Results: In 2000, urban-rural disparities in antenatal HIV prevalence were still
evident, Median 8.3%, range 11.8%-4.2% in major urban areas, relative to 2.7%,
range 10.5%-1.9%, in peri-urban/rural sites. HIV prevalence fell from a highest
recorded of any urban site (30.2%, 1992) to a lowest of 4.2% in 2000, while remaining somewhat stable, median under 5% in peri-urban/rural areas. HIV prevalence among STD patients at a clinic in Kampala fell from 44.6% in 1990 to 20.5%.
In 3 areas where HIV prevalence data is available, along side behavioural data
from the catchment area, HIV prevalence fell from 30.2%, 29.4% and 19.8% in
1992 to 11.8%, 10.0% and 8.3% respectively. Stratified by age-group, there is

a linear trend in sero-prevalence among 15-19 and 20-24 yr age-groups. The
proportion of youths at any age, 15-24 yrs who had had their sexual debut, fell
by 2-5% between 1995-2000. Reported casual sexual relationships was mixed
(14.1% vs 13.7%, 7.8% vs 7.0% and 6.6%Vs 8.7%); however, condom use at last
sex with casual partner increased (57.6% vs 76.0%, 34.3% vs 66.7% and 31.9%
vs 48%). Reported ever use of condoms increased (42% vs 50.7%, 22.0% vs
28.9%, 13.6% vs 14.5%).

Conclusion: These trends in sexual behaviour appear to further support the
trends in HIV prevalence, in this HIV epidemic as previously described.
Presenting author: Wilford Kirungi, Ministry of Health, PRO. Box 22375, Kampala,
Uganda, Uganda, Tel.: [phone], Fax: [phone], E-mail: wkirungi
@starcom.co.ug
WeOrC1270 National survey of STDs and HIV prevalence
among residents in rural growth point villages in
Zimbabwe
G.B. Woelkl, D. Kasprzyk2, D.E. Montaho2, R. Mutsindiri3, N.I.H. NIMH
Collaborative HIV/STD Prevention Trial4. '1 Department of Community Medicine,
Medical School, Universtiy of Zimbabwe, Department of Community Medicine,
University of Zimbabwe Medical School, P 0 Box A 178, Avondale, Harare,
Zimbabwe; 2Battelle, CPHRE, Seattle, United States; 3ZiCHIRe, Harare,
Zimbabwe; 'National Institute of Mental Health, Washington, DC, United States
Background: A comprehensive national survey of risk behaviors and STD/HIV
was conducted in 32 rural Growth Point Villages in Zimbabwe as part of a cooperative international trial in 5 countries. The trial will use the Community Popular
Opinion Leader Intervention to prevent STD/HIV. To establish risk prior to the Trial,
a computer assisted interview (CAI) assessed the magnitude of behavioral risk. In
addition, residents were assessed for gonorrhea (GC), chlamydia (CT), syphilis,
trichomonasis (TV), bacterial vaginosis (BV), herpes simplex 2 (HSV2), and HIV
Methods: A trained team of nurses went to 32 villages and randomly selected 70 households in each, enumerated them for residents aged 16-30; randomly selected a respondent; gave informed consent; and administered a CAl
to 50 respondents. Pre test counselling was conducted; blood, urine and selfadministered vaginal swabs were collected. Biological samples were transported
to the lab for analysis. Nurses assessed STD symptoms and treated syndromically. 3 weeks later nurses gave STD/HIV results to returning individuals, and
treated lab diagnosed STDs.
Results: 1601 individuals were assessed: 57% female, 43% male; 46% had primary educations with 53% secondary, 3% post-secondary. Female mean age
was 23, and males 22. Rates of GC, CT and Syphilis were 2%, 1% and 2% respectively. TV was 15%; BV 20%. HSV2 was 44%, and HIV 26%. Across the 32
villages HIV rates ranged from 10% to 42%. Female rates were 19% to 55%; male
rates 3% to 33%.
Conclusions: CT, GC and Syphilis rates were low, likely a result of access to
treatment in rural villages. This indicates the success of Zimbabwe's national
STD control program, which was implemented in the early '90s to treat STDs
syndromically. Female HIV rates were more than twice male rates: Females had
rates of 1 in 3; males 1 in 7. Interestingly, villages with highest female HIV rates
were not the same as villages with highest male HIV rates.
Presenting author: Godfrey Woelk, Department of Community Medicine, University of Zimbabwe Medical School, P O Box A 178, Avondale, Harare, Zimbabwe,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
WeOrC12711 Success of Cambodian HIV prevention efforts
confirmed by low prevalence of sexually
transmitted infections and declining HIV and risk
behaviors
L.B. Hor', W.S. Seng', T. Saidel2, R. Steen2, S.P. Ly', S. Seng', Y. Htun2,
F. Stuer3, C. Natpratan3, G. Dallabetta4. 'National Center for HIV/AIDS,
Dermatology and STD, #170, Preah Sihanouk Blvd., Phnom Penh, Cambodia;
2Family Health International, Bangkok, Thailand; 3Family Health International,
Phnom Penh, Cambodia; 4Family Health International, Arlington, VA, United
States
Background: To determine the impact of HIV prevention efforts on the prevalence of common sexually transmitted infections (STIs) in key risk populations in
Cambodia.
Methods: A self-weighted cluster sampling design was used to select representative population-based samples of brothel-based sex workers (n=141), police
(n=165) and women attending reproductive health clinics (n=451) for antenatal
or family planning services from 7 provinces. A standardized questionnaire and
examination were administered. Samples were tested for N. gonorrhea, C. trachomatis, syphilis, T pallidum, H. ducreyi, and HSV-2.
Results: Gonorrhea prevalence was 14.2% among sex workers (SW) and 0.0%
for both police (P) and reproductive health clinic women (RHC). Chlamydia
prevalence was 12.1% (SW), 1.8% (P) and 2.8% (RHC). Syphilis seropositivity
(TPHA+/RPR1:8) was 2.8% (SW), 0.0% (P), and 0.7% (RHC). Genital ulcers due
to chancroid were seen in 1.4% (SW) and 0.4% (RHC), and HSV-2 ulcers in 0.7%
(SW) and 0.4% (RHC). No primary syphilitic ulcer was seen in any group, and no
asymptomatic chancroid or syphilis was detected on routine vaginal swabs from
sex workers. 2.4% of sex workers had evidence of asymptomatic HSV-2.
Conclusions: Low rates of both ulcerative and non-ulcerative STIs support re
cent behavioral trends showing increased levels of condom use in commercial
sex and decreases in commercial sex use among men. These findings are also
consistent with recent declining HIV seroprevalence trends showing 21-48% reductions in HIV-1 prevalence for these same groups between 1997 and 2000.
Triangulation of data from STI, behavioral and HIV surveys provides evidence
that Cambodia's targeted policies of STI control and HIV prevention are having a
significant effect on disease transmission.