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

XIV International AIDS Conference

Abstracts WeOrD1319-WeOrD1352 151

Conclusions: There appears to be a potential market for microbicides in California, particularly among younger women and Hispanic women. Given the growing population of young Hispanics in California, an interest in using microbicides
could translate into a viable market for these products.
Presenting author: Maya Tholandi, 2515 H Street #10, Sacramento, CA 95816,
United States, Tel.: [phone], Fax: [phone], E-mail: mtholand
@dhs.ca.gov
WeOrD1319 Will shifts from condom to microbicide use
increase HIV risk? Model projections
A.M. Foss1, P. Vickerman1, L. Heise2, C. Watts1. 1London School of Hygiene &
Tropical Medicine, London School of Hygiene & Tropical Medicine, Keppel Street,
London, WC1E 7HT United Kingdom; 2Path-DC, Washington, United States
Background: Currently there are six microbicide candidates nearing phase III
trials. There are concerns, however, that the introduction of microbicides might
lead to women using condoms less consistently (condom migration). This study
estimates the level of condom migration that could occur following microbicide introduction without increasing an individual's risk of HIV infection (migration threshold).
Methods: A static mathematical model was developed to compare the relative
levels of protection from HIV provided by different combinations of condom and
microbicide use and to obtain the migration threshold.
Results: Microbicides will always provide more protection than condoms if the
initial consistency of condom use is less than the product of the consistency that
microbicides will be used and the relative efficacy of microbicides to condoms.
Maximum threshold level of condom migration that can occur after microbicide
introduction:
Consistency of Percentage of non-condom- Minimum consistency Migration threshold
of condom use protected sex acts in which of condom use (absolute reduction in
pre-introduction a microbicide is used post-introduction condom-consistency)
25% 50% 0% 25%
50% 50% 32.2% 17.8%
75% 50% 66.1% 8.9%
Assuming microbicide is of 50% HIV and STD efficacy, and condoms are 95%
efficacious.
For a microbicide that is efficacious against both HIV and other STDs, the migration threshold is:
* greater for higher microbicide efficacies and consistencies;
* greater for lower pre-introduction condom-consistencies;
* independent of the number of sexual partners and acts, and HIV and STD
prevalence.
For further illustration, suppose the condom-consistency pre-introduction is less
than 50%, then any amount of migration can be tolerated if microbicides are used
whenever condoms are not.
Conclusions: The findings provide a quantitative estimate of the degree of migration that can be tolerated in different settings. The analysis highlights the importance of microbicides for HIV prevention. Further research will explore the
dynamic impact of microbicide use and condom migration.
Presenting author: Anna Foss, London School of Hygiene & Tropical Medicine,
Keppel Street, London, WC1E 7HT, United Kingdom, Tel.: [phone],
Fax: [phone], E-mail: [email protected]
WeOrD1350 Systematic review of HIV prevention interventions
in African-American heterosexuals in the U.S
L.A. Darbes', G.E. Kennedy2, G. Peersman3, L. Zohrabyan3, G.W. Rutherford4.
1 Univeristy of California, AIDS Research Institute, 74 New Montgomery St.,
Suite 508, San Francisco, CA, 94105, United States; 2Univeristy of California,
San Francisco, United States; 3BIRB, Centers for Disease Control and
Prevention, Atlanta, United States; 4University of California, AIDS Research
Institute, San Francisco, United States
Background: Recent studies have shown a substantial increase in HIV infections
among racial/ethnic minorities in the U.S. We conducted a systematic review of
HIV prevention interventions in U.S. minority populations and a meta-analysis of
a subset of trials that addressed the issue of heterosexual risk among African
Americans.
Methods: We conducted comprehensive and systematic searches for both published and unpublished studies. For the meta-analysis our inclusion criteria required that studies were randomized clinical trials, and that the sample population be comprised of 100% African-American participants. We examined sexual
behavior outcomes including condom use, number of sexual partners, and frequency of condom-protected intercourse. We calculated a standardized effect

size (g) for each study. (When studies presented more than one outcome, the
effect sizes for each outcome were averaged to obtain one score per study).
Results: We identified 36 potentially relevant studies (100% African-American
participants). Of those, 15 were excluded for not meeting our inclusion or methodological criteria. Of the remaining 21, 14 trials examined adult heterosexual risk
and 7 examined adolescents. Of these 21 studies, only 7 presented sufficient
data to conduct meta-analysis. Overall, interventions had a positive and signifi
cant impact on reducing HIV risk behavior. Across studies, the most successful
interventions provided skills training and were sensitive to issues of gender and
ethnicity. Peer education was also found to be a useful component.
Comparison # of studies Average effect size p value
All adult heterosexual studies 5.22.01
Heterosexual adult men 2.24.25
Heterosexual adult women 3.22.10
Heterosexual adolescents 2.41.09
Conclusions: Overall, the effect sizes were in the medium range, from 0.22 - 0.41
standard deviations, and demonstrated that behavioral interventions can positively impact HIV risk behavior in heterosexual African Americans.
Presenting author: Lynae Darbes, 74 New Montgomery St., Suite 508, San
Francisco, CA, 94105, United States, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
WeOrD1351 1Descriptive mapping of evaluation research in HIV
prevention in Africa and Asia
G. Peersman, K. Reed, D. Rugg. Centers for Disease Control and Prevention /
Global AIDS Program, Centers for Disease Control and Prevention, 1600 Clifton
Road, MS E-41, Atlanta, GA, 30333, United States
Background: Several literature reviews of evaluation research have been conducted, but few have focused on the effectiveness of HIV prevention in lowincome countries. The CDC/Global AIDS Program is undertaking a systematic
effort to identify and integrate the findings from evaluation studies conducted in
low-income countries.
Methods: Systematic searches were undertaken to identify outcome evaluation
studies of HIV/AIDS behavioral interventions in Africa and Asia. Full reports were
obtained and classified according to key characteristics of the study population,
the intervention, and the evaluation.
Results: Searches identified 2041 citations relevant to HIV prevention in lowincome countries of which only 145 (7%) were outcome evaluations. These evaluations focused mostly on commercial sex work (28%), HIV-testing and counseling (20%), and school-based interventions (16%). Interventions typically included
provision of information (73%) and risk reduction supplies (49%), counseling
(29%), provision of services (21%), and skills practicing (16%). Few studies were
conducted in rural settings (21%); or included information on cost (6%). The vast
majority of studies were one-group designs (70%); 18% were non-randomized
trials; and 12% were randomized trials. The rigor of these studies was low as
rated by 4 basic methodological quality criteria. Age and gender was not specified in 21% and 6% of studies, respectively; 24% of studies failed to mention the
intervention provider, and 9% did not provide any information on the intervention
setting.
Conclusions: (1) Critical analysis of the evaluation research literature shows that
the evidence for HIV prevention is not as solid as anticipated; (2) More funding
is needed for well-planned evaluations; (3) The public health impact of scaling-up
programs without solid evidence of their effectiveness may ultimately compromise
our ability to control the epidemic in Africa and Asia.
Presenting author: Greet Peersman, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-41, Atlanta, GA, 30333, United States, Tel.: +1 404
639 0997, Fax: [phone], E-mail: [email protected]
WeOrD13521 Rapid Assessment does act as a catalyst for
change and HIV prevention development among
substance users: findings from the WHO Phase II
drug injecting study (retrospective evaluation
component)
C.D. Fitch1, G.V. Stimson1, V. Poznyak2, T.J. Rhodes1. 'Ilmperial College,
Imperial College, Reynolds Building (3rd floor), Charing Cross Campus, St
Dunstans Road, London, United Kingdom; 2WHO, Geneva, Switzerland
Background: 'Rapid assessment' (RA) methods have the potential to generate
important public health data. This potential is the subject of debate within the substance use and HIV prevention field, with the approach attracting attention as a
means of profiling drug-related problems, mobilising HIV prevention efforts, initiating policy change, and as a potential component of 'second generation' HIV
surveillance. However, much is still not known about the use and outcomes of RA
in the substance use field.
Methods: The WHO study aimed to retrospectively evaluate the application and
outcomes of RA in the substance use field through: (i) a review of published and
grey literature on RA (n=300 documents); (ii) survey of individuals and organizations conducting or sponsoring RAs (n=1200 contacts); (iii) in-depth expert interviews (n=10).

Results: Origins and diffusion: the earliest identified RAs in the substance use
field were conducted in 1993, with 83 identified studies conducted by 2001 in
at least 70 countries, and with approximately 7 out of 10 RAs conducted between 1998-2001. Models of assessment: assessments are taking 9-486 days
(69 weeks). Outcomes: important outcomes can follow RA - 1 in 2 studies were
followed by medical or non-medical interventions, workshops, training, policy
change, community participation, network building, or other outcomes (45/83;