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

XIV International AIDS Conference

Abstracts WePeC6156-WePeC6160 121

WePeC6156 IThe epidemiology of HIV infection among clients
attending Tebelopele voluntary counseling and
testing (VCT) centers in Botswana, 2000-2001
T.A. Kenyon1, V.I. Mwasalla1, R. Molosiwa1, M. Mokomane1, K. Bussell2,
M.G. Alwano. 1The BOTUSA Project/CDC, Gaborone, Botswana; 2Centers for
Disease Control and Prevention, Atlanta, United States
Background: In Botswana, the 2001 sentinel surveillance among pregnant
women gave a HIV prevalence of 36.2%. As prevalence data and information
on risk factors for HIV infection among the general population are missing, data
from other large sub-populations might be useful.
Methods: From April 2000 through November 2001, the BOTUSA Project in collaboration with the Botswana Government, opened seven Tebelopele VCT Centers where free, anonymous HIV testing with same-day test results was provided.
Clients were properly counseled & tested and completed a standard anonymous
questionnaire. HIV prevalence and HIV risk factors were assessed among clients
with an initial visit; repeat visits were excluded.
Results: Among the 17,858 visits, 13,567 were initial visits (6392 men, 7175
women). Mean age was 29.3 years for males and 27.7 years for females (p<0.01).
80% of clients reported to be single. Overall HIV prevalence was 26.5%. HIV
prevalence was higher among females (30.9%) compared to males (21.5%,
P<0.001). The same trend was observed in age groups 15-19 years (9.0% vs
1.4%) and 20-29 years (31.7% vs 13.3%). Clients who had received no formal
education or completed only primary school were more likely to be HIV+ (50.9%)
than those who completed secondary (27.9%) or those with tertiary education
(15.2%) (test for trend, P<0.001). 28.8% of employed clients were HIV infected
compared to 23.1% of unemployed clients (P<0.001). Individuals reporting having "never" used condoms in the past 3 months were more likely to be HIV+
(33.7%) than those who reported "sometimes" (29.0%) or those who reported
"always" (22.7%) (test for trend, P<0.001).
Conclusions: HIV infection amongst a large number of VCT clients in Botswana
is associated with female gender, age, education, disposable income through employment, and lack of condom use. Though VCT clients may not be representative
of the general population, they may still provide valuable information on the HIV
epidemic in a population.
Presenting author: Tom Kenyon, The BOTUSA Project, PO BOX 90, Gaborone,
Botswana, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeC6157 HIV voluntary counseling and testing (VCT) in
Buenos Aires: A study of 11.440 cases
F. Ameal, R. Cahn, G. Melicchio, G. Ben, P. Cahn. Hospital Fernandez, Angel
Peluffo 3932, C1202ABB, Buenos Aires, Argentina
Background: Study of VCT provides important information about the epidemic,
and may serve for developing prevention strategies on a rational basis.
Methods: In a main AIDS reference center, between 01/01/91-31/07/01, 11440
HIV tests have been performed including pre and post test counseling. We studied: gender, age, risk behaviour, job, level of education, knowledge and practices
on safe behaviour, partner's serostatus. Statistical analysis was performed using
non-parametric tests. We compared two periods: 1/91-7/95 (P1) and 8/95-7/01
(P2).
Results: The average monthly request for VCT has increased 138% from P1 to
P2. Heterosexual population grew from 62% to 70%, IVDA's decreased from 7%
to 4%, females increased from 47% to 51%, the population with education limited
to elementary school has increased from 61% to 64%. Unemployed clients grew
from 16% to 25%. Global seroprevalence was 18% and 16% respectively. The
HIV+ population was composed as follows: heterosexuals 46%, homo/bisexuals
32%, IVDA 17%, others 5%. The prevalence rate in these populations was (P1 -P2): heterosexuals 9,2-8,3%; IVDA 53,3-55,6%, homosexuals 38,4-42%; bisexuals 37,6-35,8%. Partners were also HIV+ in 19 and 10% respectively, while children did so in 9% and 1%, probably reflecting apropriate MTCT prevention in the
last period. History of identified rsk behaviours was >4 years in 47% (P1) and
21% (P2). Knowledge of safe behaviour was claimed by 95% and 88%, while safe
practices were informed by 62 and 59% by the same groups.
Conclusions: VCT request is increasing, particullarly among heterosexuals,
women and people with relatively short history of risk behaviour. IVDA's are heavily affected by the epidemic. The high proportion of clients with ongoing risk behaviour should prompt special prevention programs. Two third of consultants with
limited education and increasing rates of unemployment are cofactors are to be
considered when designing those programs.
Presenting author: Pedro Cahn, Angel Peluffo 3932, C1202ABB, Buenos Aires,
Argentina, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeC6158 Determinants of delayed presentation to medical
care after testing HIV positive

E. Girardi1, C. Arici2, M.S. Aloisi1, D. Serrainol, F. Delfanti3, M.C. Moioli4,
M. Ciardi5, M. De Marco6, E. Manzillo 6, G. Ippolito on behalf of ICONA-BehEpi
Study1. 1INMI L. Spallanzani, Dept. of Epidemiology, Roma; 2Ospedali Riuniti,
Bergamo; 31RCCS San Raffaele, Milan; 40spedale Niguarda, Milan; 5Universita
La Sapienza, Rome; 60spedale Cotugno, Naples, Italy
Background: It has been suggested that a significant proportion of persons with

HIV delay seeking medical care after testing HIV positive. Such condition may
limit the possibility to obtain the maximum benefit from available therapies and
the impact of prevention interventions. However, only limited data are available
on prevalence and determinants of delayed presentation to care.
Methods: This analysis was carried out on antiretroviral naive patients enrolled
in the ICONA cohort in 1997-2000 in 57 units of Infectious diseases in Italy. A
self-administered questionnaire was distributed to 645 patients who had their first
clinic visit at the time of enrolment and did not have CD4 cell count and/or HIVRNA determination since testing HIV positive. Patients were defined delayed presenters if more than three months elapsed between the first HIV positive test and
the first clinic visit.
Results: Of the 645 patients, 256 (36.8%) were delayed presenters. Of them 101
(39.8%) had CD4<200/mmc or clinically defined AIDS at their first visit. Among
delayed presenters, median time between first HIV test and first clinic visit was
73 months. In multivariate analysis, factors associated with delayed presentation
were: age (OR 0.76 IC95% 0.65-0.94 per ten years increment) iv drug use (OR
6.3, 95%CI 4.3-9.3) lack of psychosocial support (OR 1.6 95%CI 1.1-2.3), believing that treating HIV is difficult (OR 1.8, 95%CI 1.1-2.8) or very difficult (OR 2.9,
95%CI 1.1-7.6), and first visit in 1997 (OR 1.6, 95%CI 1.1-2.3)
Conclusions: Delayed presentation to medical care is common in Italy and it
is often associated with advanced HIV disease at first clinic visit. Interventions
aimed at favouring linkage to medical care of those testing HIV positive are urgently needed and should be targeted in particular to IVDU and to younger patients and should include counselling on individual benefit of antiretroviral therapy.
Presenting author: Enrico Girardi, INMI L. Spallanzani, Dept. of Epidemiology, Via Portuense 292, 00149 Roma, Italy, Tel.: [phone], Fax:
[phone], E-mail: girardi @ spallanzani.roma.it
WePeC6159 Knowledge of HIV seropositivity before AIDS
diagnosis in the south of Spain, 1992-2000
E. Cafas1, M. Castaio2, R. Jurado3, A. Vergara4, M.D. Merino5, A. Collado6,
M. Torres-Tortosa7, I. Sudrez8, M. Perez9, E. Nuho1o, J. Marfn1, A. Villar12.
1 H.U. Virgen del Rocfo, Avda. Eduardo Dato 50, 1o izquierda, 41005 Sevilla,
Spain; 2H. Carlos Haya, Mlaga, Spain; 3H. Reina Soffa, Cdrdoba, Spain; 4H.U.
Puerto Real, Puerto Real (Cidiz), Spain; 5 H. Juan Ramdn Jimdnez, Huelva,
Spain; 6H. Torrecardenas, Almeria, Spain; 7H.Punta de Europa, Algeciras
(C.diz), Spain; 8H. Infanta Elena, Huelva, Spain; 9H. La Lfnea, La Linea (Cidiz),
Spain; 10H. La Axarqua, V lez-Mdlaga (Mdlaga), Spain; 11H. La Merced, Osuna
(Sevilla), Spain; 12H. San Juan de/Ia Cruz, Ubeda (Jadn), Spain
Background: To assesss the degree of knowledge of HIV seropositvity before
AIDS diagnosis in the Andalusia (south of Spain) during 1992-2000.
Methods: AIDS patients with known dates of HIV and AIDS diagnoses were selected from 12 cross-sectional surveys of adults with HIV infection attended in 23
public hospitals in 1992-2000. A descriptive analysis of the time interval between
HIV and AIDS diagnoses was performed using the Epi-Info program.
Results: 2708 AIDS patients were included.The median age at AIDS diagnosis was 33,6 years and 81% were males. 69% were intravenous drugs users
(IDU), 17% were infected by heterosexual intercourse (HET) and 10% were
homo/bisexual men (HBM). 21% had secondary or high studies, 42% had been in
prision and 24% of women were sex-workers. Overall, the median time between
the first positive HIV test and AIDS diagnosis was 33 months (2,7 years). The
proportion of persons with undiagnosed HIV infection prior to AIDS was 27% (simultaneous diagnoses), and for the rest (deferred diagnoses), the median interval
was 56 months (4,6 years). The overall median interval between both diagnoses,
the proportion of simultaneous diagnoses and the median interval for deferred diagnoses were: IDU men (48 months, 19%, 61 months), IDU women (53 months,
16,7%, 63 months), HBM (1 months, 46,2%, 29 months), HET men (0 months,
55,4%, 20 months), HET women (11,5 months,36,8%, 36 months). In the period
1992-2000, the overall median time between HIV and AIDS diagnoses increased
(22 months in 1992 vs 62,5 moths in 2000), although the proportion of simultaneous diagnoses remained unchanged (29,9% in 1992 vs 31,3% in 2000).
Conclusions: A large proportion of HIV infections remain undiagnosed before
AIDS onset, particularly in non-IDU populations. This is a serious handicap for
early interventions and reductions in risk behaviours to limit HIV transmission.
Presenting author: Elias Caas, Avda. Eduardo Dato 50, 1~ izquierda, 41005
Sevilla, Spain, Tel.: [phone], Fax: [phone], E-mail: med025748
@ nacom.es
WePeC6160 Factors associated with lack of awareness of HIV
infection before AIDS diagnosis - France
1994-2001
R Gouezel, A. Laporte, F. Lot, J. Pillonel. Institut de Veille Sanitaire,
Saint-Maurice, France
Background: Since the availability of HAART (1996) AIDS cases not aware of

their HIV status are the majority of diagnosed cases. The objective of our study
was to identify characteristics those people in order to better target screening
programmes and access to care.
Methods: We analysed 22 042 AIDS cases reported to the French national centre for surveillance and diagnosed from January 1994 to December 2000. Lack
of awareness of HIV infection was defined as an interval of 3 months or less
between first HIV(+) result and diagnosis of AIDS. Logistic regression analysis