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

XIV International AIDS Conference

Abstracts WePeC6078-WePeC6082 103

WePeC6078 Late Diagnosis of HIV infection amongst
individuals with low, unrecognised or
unacknowledged risks in England, Wales and
Northern Ireland (E, W & NI)
V.L. Gilbart, K. Sinka, B.G. Evans. PHLS HIV Reporting Centre at CDSC,
London, United Kingdom
Background: Late diagnosis in E, W & NI is mainly seen in black African heterosexuals. There are, however, a small group of mainly UK nationals who have a
very low risk, are not aware of partners' risks, or do not acknowledge their risk
for HIV who are also diagnosed late and so deprived of early treatment. HIV diagnosis is usually made after frequent attendances with a range of symptoms to
primary care doctors.
Methods: Newly diagnosed and reported HIV infections are followed-up if their
exposure requires clarification. In-depth confidential interviews are conducted if
the clinician and individual agree.
Results: By the end of 2001, 266 individuals had been interviewed. Of these,
146 (55%, 104 men, 42 women) were diagnosed because of symptoms related
to advanced HIV infection. They had repeatedly sought medical attention in the
preceeding year for their deteriorating medical condition. The majority were white
(90%) and British born (88%), the remainder had lived in the UK for a mean of 22
years. Two thirds (65%) were married, cohabiting or had a regular partner at the
time of their diagnosis. For lifetime sexual partners, men reported a median of 12
and women, 5. The majority (70%) reported an HIV related illness at some time
prior to their diagnosis. Over two thirds (71%) had never attended a STI clinic and
88% did not perceive themselves to be at risk from HIV. Data available for 49 of
the 146 individuals shows that no partners had contacted them to inform them of
their HIV status. In response to their own diagnosis, 29% chose not to inform any
partners of their HIV status.
Conclusion: Late diagnoses of HIV infection continue to occur. Primary care
clinicians should be encouraged to consider HIV as a possibility when patients
present with chronic symptoms not responding to established treatments. Sensitive partner notification practices that enable a greater number of individuals to
inform partners should be explored.
Presenting author: Victoria Gilbart, PHLS HIV Reporting Centre at CDSC, 61
Colindale Avenue, London, NW9 5EQ, United Kingdom, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WePeC6079 HIV incidence and characterization of STD clinic
patients with recent HIV infection
S. Schwarcz1, T.A. Kellogg1, W.C. McFarland', B. Louie', J. Klausner1,
D.G. Withum2, M.H. Katz1. 1San Francisco Department of Public Health, 25 Van
Ness Avenue, Suite 500, San Francisco, CA 94102, United States; 2Centers for
Disease Control and Prevention, Atlanta, United States
Background: For prevention programs to be effective, localities must have adequate information on where new HIV infections are occurring. The serologic testing algorithm for recent HIV seroconversion (STARHS) characterizes HIV-infected
persons as having recent (< six months) or longstanding infection and can be
used to estimate HIV incidence.
Methods: STARHS was offered to persons receiving voluntary HIV testing at the
San Francisco municipal sexually transmitted disease (STD) clinic from October
1998 through December 1999 to determine HIV incidence and behavioral and
demographic correlates of recent HIV infection.
Results: Of the 5227 patients tested, 111 (2.1%) were HIV infected, and 28 had
recent infection. HIV incidence was highest among African Americans (2.7%/year,
95% confidence limits [CL] 0.9, 6.8), men who reported sex with a man (MSM)
(5.3%/year, 95% CL 2.6, 10.0), those whose sex partners have HIV-infection
(8.6%/year, 95% CL 2.9, 21.1) or who inject drugs (5.7%/year 95% CL 1.0, 19.1),
patients reporting unprotected anal intercourse (5.3%/year 95% CL 2.3, 10.8) and
those with gonorrhea (6.7%/year, 95% CL 1.5, 20.3) at the time of HIV testing.
Among MSM, African American race (odds ratio [OR] 3.61, 95% [CL] 1.13, 11.55)
Latino ethnicity (OR 3.08, 95% CL 1.11, 8.55), unprotected anal intercourse (OR
2.98, 95% CL 1.20, 7.45), and gonorrhea (OR 3.03, 95% CL 1.07, 8.63) were
independently predictive of being a recent seroconverter.
Conclusions: STARHS permits characterization of persons with recent HIV seroconversion in sentinel surveillance settings. New HIV infections in San Francisco
may be shifting from white MSM to MSM of color.
Presenting author: Sandra Schwarcz, 25 Van Ness Avenue, Suite 500, San
Francisco, CA 94102, United States, Tel.: [phone], Fax: [phone],
E-mail: sandy.schwarcz @ sfdph.org
I WePeC6O8O iComparison of prevalence of STIs/HIV and their
behavioral correlates among long distance
inter-city truck drivers and helpers from three
regions of India

K.K. Bhuyan', S.J. Mills2, D. Dharmaraj3, B. Panda4, I.PS. Kalra5. 1 Family
Health International, New Delhi, India; 2Family Health International, Bangkok,
Thailand; 3PREPARE, Chennai, India; 4BPWT Kolkata, India; 5VOICE,
Bahadurgarh, India
Backgrounds: To compare the prevalence of STIs/HIV and their behavioral correlates in long distance truck drivers (male truckers) from three regions of India.

Methods: STI/HIV prevalence surveys were implemented among male truckers
in West Bengal, East India (N=335); Andhra Pradesh, South India (N=375), and
Haryana, North India (N=410) in 2000-2001. STIs screened for included syphilis
(RPR and TPHA tests), N. gonorrhea (NG) and C. trachomatis (CT) (Roche Amplicor NG CT PCR assay), T. vaginalis (TV) (microscopy and culture), HIV (double
ELISA test). Behavioral information was collected using a structured questionnaire.
Results: In East India, prevalence of STIs/HIV was syphilis 6.3% NG: 1.8%, CT:
1.2%, HIV: 2.99%. In North India, the prevalence among association-based truckers was syphilis 7.2%, NG: 4.8%, CT: 1.4% and HIV:1.9% and among truckers
from halt points was syphilis: 8.4%, NG: 2.5%, CT: 0.5%, TV: 1%, HIV: 6.9% In
South India the prevalence was syphilis: 9.6%, NG: 7.5%, CT: 5.3%, TV: 9.9%
and HIV: 10.9%.
Truckers mostly belonged to the states of the region. About 27% of truckers from
East India, 49.4% from South India, 29% of association-based and 45.3% of
truckers from halt points from North India reported having sex with female sex
workers (FSWs) or non-regular partners (NRP) in the preceding year. Reported
condom use during last sex with FSWs/NRP was: 30.4% in East, 57.2% in South,
and 16.6% among association-based and 12% among halt point based truckers
in North.
Conclusion: Wide variation in the prevalence of STIs, HIV and sexual behavior exists in truckers in India despite high mobility. The HIV prevalence in truckers follow the pattern of local HIV prevalence as shown by HIV sentinel serosurveillance. Review of the data on HIV and risk behavior among truckers during
the last decade suggests that there have been gradual decline in high-risk behavior and stabilization of HIV prevalence among them.
Presenting author: Khanindra Kumar Bhuyan, Family Health international, Opposite Convention Hall, Hotel Ashok, Chanakyapuri, New Delhi 110021, India,
Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeC6081 WHO drug injecting study in S-Petersburg. Phase
two
D.V. Ostrovski. NGO "Vozvrastcheniye (Return)", 9-a, ul. B. Monetnaya, St.
Petersburg, 197101, Russian Federation
The main risk factor of getting of HIV-infection in St.Petersburg is injecting drugs:
96,8% among all cases. In 1999 and in 2000 NGO Vozvrastcheniye in collaboration with Northwest district AIDS Center of Russian Ministry of Health conducted
HIV prevalence study among IDUs using method of the anonymous untied testing of blood remains in used syringes (Method of sentinel surveillance by the
WHO recommendations). The results demonstrate the rapid increasing in HIV
prevalence: in November 1999 - 12% of the sample were infected, in May 2000 -
19,3%.
The secondary data analysis, observations, mapping, focus groups, interviews
with key informants and interviews with IDUs were used.
The study's findings confirm the previous data about the dramatic current situation in St. Petersburg with increasing the drug abuse, reducing the average age
of IDU, epidemics of HIV and viral hepatitis in IDU.
Despite of such visible needs for medical care the main problem is the lack of
effective medical interventions. IDU in Russia and in St.Petersburg in particular
are not offered the long-term medical care, including drug treatment.
The access of medical specialists to IDUs, especially the new IDUs, those who
are not realizing their health problems, is very limited. The same time these
groups of IDUs are characterized with the most dangerous and risky lifestyle and
vulnerability.
From our point of view the easy access would be possible to organize at the
General Clinics where drug users are transported by Emergency Care services
(in cases of an acute Hepatitis, the sepsis, drug overdoses) And the prevention
work of the specialists of these clinics (additionally to emergency help) would be
extremely important in reducing the risks of getting different infections and motivating patients to seek drug treatment care. In case of HIV positive test results
activity of specialists should be directed to the secondary prevention.
Presenting author: Dmitri Ostrovski, 9-a, ul. B. Monetnaya, St. Petersburg,
197101, Russian Federation, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
WePeC6082 Mode of delivery and postpartum HIV-1 disease
progression: The Women and Infants
Transmission Study (WITS).
E.L. Navas-Nacher1, R. Leighty2, J.S. Read3, R. Tuomala4, C. Zorrilla5,
H. Rosenblatt6, S. Landesman7, G. Brown8, E. Matzen9, R.C. Hershow'.
1 Division of Epidemiology and Biostatistics, School of Public Health, University of
Illinois at Chicago, Chicago,; 2Clinical Trials and Surveys Corporation, Baltimore,
United States; 3Pediatric, Adolescent, and Maternal AIDS Branch, NICHD,
National Institutes of Health, Bethesda, United States; 4Brigham and Womens

Hospital, Boston, United States; 5University of Puerto Rico, San Juan, United
States; 6Baylor College of Medicine, Houston, United States; 7State University of
New York at Brooklyn, New York, United States; 8Columbia University College of
Physicians and Surgeons, New York, United States; 9National Institute of Child
Health and Human Development, Bethesda, United States
Background: Scheduled cesarean section (SCS) before labor and ruptured
membranes is associated with a decreased risk of mother-to-child transmission of