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

114 Abstracts WePeC6127-WePeC6130

XIV International AIDS Conference

commonly injected both intramuscularly and intravenously; the first injection event
often comprised of multiple injections; injection initiation groups typically ranged
between 5 and 10 injectors; bottles of liquid ketamine were frequently shared;
and the first shot of ketamine was often obtained for free. Most of the youth had
experienced homelessness and had injected ketamine in at least one city outside
of New York.
Conclusion: Ketamine injectors are a hidden population of injection drug users
given the mobility of the user population and since few epidemiological studies of
injection drug users focus on ketamine. This study is the first to offer ethnographic
descriptions of risk practices employed during initiation into injection as a mode
of administrating ketamine.
Presenting author: Stephen E. Lankenau, Columbia University, Mailman School
of Public Health, 722 W. 168th St., Suite 1040, New York, NY 10032, United
States, Tel.: [phone], Fax: [phone], E-mail: s12056@columbia.
edu
WePeC6127 History of incarceration in HIV/AIDS patients
recently reported to state/local health departments
in the United States
A.K. Nakashima, M.L. Campsmith, G.V. Nakamura. Centers for Disease Control
and Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road,
MS D-21, Atlanta, GA 30333, United States
Background: Studies have suggested that the number of persons with HIV/AIDS
who pass through the criminal justice system is high. We estimated the prevalence of incarceration in an HIV-infected population through surveillance activities.
Methods: We analyzed cross-sectional interviews from HIV/AIDS cases (aged
>18 yrs) reported through surveillance to 16 state/local health departments using population-based (9 sites) or facility-based (7 sites) sampling methods. Interviews were conducted during May 2000-October 2001. We calculated proportion
of persons every having been incarcerated for >24 hrs and adjusted odds ratios
(AORs) with 95% confidence intervals (CIs) using multivariate logistic regression
for factors associated incarceration.
Results: Among 2,633 persons interviewed, 1,270 (48%) had ever been incarcerated: 37% of 844 men who have sex with men (MSM), 73% of 494 injecting drug
users (IDU), 76% of 148 MSM/IDU, 41% of 585 persons heterosexually exposed,
and 42% of 562 others, including persons reported without identified risk. Of incarcerated persons, 156 (12%) were initially diagnosed with HIV in a correctional
setting. Ever having been incarcerated was significantly associated with belonging to a risk group other than MSM (for IDU AOR 2.4, CI 1.7-3.4; MSM/IDU AOR
2.6, CI 1.6-4.1; heterosexual AOR 1.9, 1.4-2.6); male sex (AOR 2.8, Cl 2.2-3.5),
black race (AOR 1.9, CI 1.5-2.4), less than high school education (AOR 1.5, Cl
1.2-1.8), problem with alcohol (AOR 1.7, Cl 1.4-2.1), and crack use (AOR 2.6 Cl
2.1-3.3); there were no significant differences in access to medical or current antiretroviral therapy Conclusions: In this large, diverse HIV-infected population,
rates of ever having been incarcerated were high, and many of those who had
been incarcerated were initially diagnosed in this setting. Incarceration settings
may be useful for accessing high risk populations for HIV prevention interventions.
Presenting author: Allyn K. Nakashima, Centers for Disease Control and Prevention, 1600 Clifton Road, MS D-21, Atlanta, GA 30333, United States, Tel.: [phone], Fax: [phone], E-mail: alnl @cdc.gov
WePeC6128 Behavioral patterns of groups at high risk to
human immunodeficiency virus (HIV) transmission
in Davao City
V.T.L. Lupase. Davao Medical School Foundation, davao medical school
foundation, medical drive, bajada, davao city Philippines
Background: To monitor behaviors of high risk groups (HRGs) covered in the
DOH-initiated HIV Serologic Sentinel Surveillance (HSS), a five-year Behavioral
Sentinel Surveillance (BSS) was conducted in Davao City last 1997-2001.
Methods: Repeated yearly surveys were conducted among 480 Registered Female Sex Workers (RFSWs), Freelance Sex Workers (FLSWs), Clients of Female
Sex Workers (CFSWs) and Men Who Have Sex with Men (MSMs). Personal interview was done using a standard interview schedule translated in the local dialect.
Results: Most of the HRGs were in their 20's, single and have had obtained at
least high school education. Median number of sex partners among HRGs has
increased. The FLSWs consistently got the highest number of sex partners of
4 per week. Among MSMs, oral sex was more commonly practiced than anal
sex. Knowledge on HIV/AIDS has increased to almost 70%, however, consisted
condom use remained low (<50%). Lack of satisfaction is the main reason why
around 80% of CFSWs and 50% of MSMs did not use condom. The television,
health workers, friends and peer educators were the most common sources of
information on HIV/AIDS. The FLSWs had the highest proportion (25%) among

those who had signs and symptoms of STDs. The RFSWs and FLSWs continually sought medical help from the Social Hygiene Clinic while private clinics were
popular among CFSWs and MSMs.
Conclusions: Findings indicate a need to intensify campaign on strict condom
use which should focus on male HRGs and also of the introduction of female
condoms. Training of more peer educators and conduct of qualitative studies to
identify barriers to condom use are likewise recommended.

Presenting author: vicky lupase, davao medical school foundation, medical
drive, bajada, davao city, Philippines, Tel.: [phone], Fax: [phone], Email: [email protected]
WePeC6129 Measuring risk behavior among injecting drug
users: lessons from Asian surveillance systems
T.J. Saidel1, E. Pisani2, N.A. Tuan3, T.V. Hoang4, S.M. Tuladhar5, H. Rahman6.
1 Family Health International, Family Health International, Asia Regional Office,
8th floor, 1339 Arwan Building, Bangkok 10800, Thailand; 2Family Health
International, Jakarta, Indonesia; 3National Institute of Hygiene and
Epidemiology, Hanoi, Vietnam; 4National AIDS Standing Bureau, Hanoi,
Vietnam; 5New ERA, Kathmanda, Nepal; 6Family Health
International/Bangladesh, Dhaka, Bangladesh
Background: Surveillance of risk behaviors enables planners of HIV prevention
and care initiatives to quantify service provision needs, and contributes to evaluating the success of those services by tracking changes in risk behavior over
time. The objective of this paper is to review the challenges associated with measuring illegal and stigmatized behaviors in hard-to-reach populations, and give an
overview of state-of-the-art methodologies.
Methods: Repeat cross-sectional surveys of HIV-related risk behavior among injecting drug users have been conducted in Bangladesh, Indonesia and Vietnam,
while Nepal and Yunnan province in China have completed one round. Methods
have been developed to obtain a random sample of injecting drug users, to the
degree possible. A standardized questionnaire is administered to respondents.
Results: Mapping and respondent selection tend to improve over time as research teams establish rapport with IDU populations. Inclusion of NGOs serving
IDUs in mapping teams increases sample representativeness. Injecting cultures
differ widely by location, and IDU understanding of concepts such as sharing
equipment must be explored in formative research and taken into account in questionnaire design. Measures of sexual risk, including buying and selling sex, should
be included in surveillance for IDUs. Flexibility is necessary to ensure that data
are locally relevant, but more effort should be made at an international level to
standardize some components such as time reference periods for risk behavior,
methods of measuring sharing and definitions of current injectors.
Conculsions: Significant strides have been made by several Asian countries in
measuring HIV-related risk in IDU populations. As methodologies and data quality improve, more efforts are needed to ensure the data are used to improve HIV
prevention and care services for drug using populations.
Presenting author: Tobi Saidel, Family Health International, Asia Regional Office, 8th floor, 1339 Arwan Building, Bangkok 10800, Thailand, Tel.:
[phone], Fax: [phone], E-mail: [email protected]
WePeC6130 HIV incidence, prevalence, and related risk
behavior among male and female sex workers
upon arrest, San Francisco 1999-2001
A. Kim1, W. McFarland1, C. Kent2, R. Kohn2, A. Snell2, J. Goldenson3,
K. Bordelon4, K. Sabin4. 1San Francisco Department of Public Health, HIV
Seroepidemiology Unit, #170, Preah Sihanouk Blvd., Boeung Keng Kang 1,
Camkarmorn, Phnom Penh, United States; 2San Francisco Department of Public
Health, STD Prevention And Control Services, San Francisco, United States;
3San Francisco Department of Public Health, Forensic Services, San Francisco,
United States; 4 United States Centers for Disease Control and Prevention,
Atlanta, United States
Background: Monitoring HIV incidence, prevalence, and related risk behavior is
essential for guiding prevention and care programs. However, sex workers (SWs)
are a hard-to-reach population for surveillance and epidemiological studies. One
strategy to assess the HIV epidemic among SWs is to measure HIV infection and
risk behavior among arrestees.
Methods: We conducted blinded sentinel surveillance among persons who
agreed to STD screening upon arrest in San Francisco's central intake jail from
6/99 to 7/01. Data were abstracted from medical and arrest records. Specimens
collected for syphilis screening were tested for HIV after removing identifying information. HIV incidence was estimated using the Serological Testing Algorithm
for Recent HIV Seroconversion (STARHS).
Results: Of 7,348 arrestees, 360 were incarcerated for SW or reported a history
of SW (122 men, 230 women, 8 male to female transgendered persons).
Variable Male Other male P value Female Other female P value
(past 6 months) SWs arrestees SWs arrestees
(n=122) (n=5558) (n=230) (n=1359)
Mean no. male partners 30% 3 <0.01 137 4 <0.01
Sex with HIV+ person 7% 1% <0.01 3% 1% <0.01
Sex with MSM(a) 11% 1% <0.01 4% 0.4% <0.01
Sex with IDU(b) 11% 3% <0.01 8% 3% <0.01
Injecting drugs 23% 6% <0.01 10% 6% 0.05

HIV prevalence 6% 2% <0.01 2% 2% 1.0
HIV incidence (per year) 1.9% 0.6% ns(c) 0% 0.5% ns
a: man who has sex with man; b: injection drug user; c: not significant; ns: not significnant.
Among male SWs, sex with an MSM (6% vs. 20%, p=0.01), injection drug use
(16% vs. 29%, p=0.03), and HIV prevalence (4% vs. 13%, p=0.02) were significantly higher in year 2 (1999/2000) compared to year 1 (2000/2001).