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

XIV International AIDS Conference

Abstracts ThPeC7418-ThPeC7421 443

were HIV+; there were 5 HIV-2 infections. 11% had syphilis, 6% HBsAg, 42%
HSV2, 8% HD, 4% CT and 15% GC. HIV was significantly associated (p<.05)
with age 31-40, exposure to CSW, urethral discharge, HSV2 and syphilis. 20%
were circumcised (21% v 11% HIV+, NS). Visiting CSW in the last 3 months was
associated (p<.05) with HSV2, active genital ulcer and urethral discharge. Recent
MSM activity was not associated with increased HIV or STD risk.
Conclusions Men attending public STD clinics in Mumbai have a high prevalence
of HIV, associated with HSV2 infection and visiting a female CSW. Many married
men visit CSW and have risky male-male sex, placing wives at risk. Although
MSM were not at higher risk for HIV/STDs in this study, other surveys reveal high
rates of HIV in MSM in Mumbai. Prevention programs must ask about MSM activity and find means to access wives for STD treatment and HIV C&T. Treatment
of active HSV2 infection needs to be considered.
Presenting author: Christina P Lindan, 74 New Montgomery Street, Suite 600,
San Francisco, CA, 94105, United States, Tel.: [phone], Fax: +1 (415)
597-9213, E-mail: klindan @ psg.ucsf.edu
ThPeC7418 Concurrency as an indicator of HIV/STI risk:
Empirical evidence from the British National
Survey of Sexual Attitudes and Lifestyles (Natsal)
2000
C.H. Mercer1, A.M. Johnson1, K.A. Fenton', K. Wellings2, B. Erens3. 'Royal
Free and University College Medical School, Dept of Sexually Transmitted
Diseases, UCL, 3rd Floor Mortimer Market Centre, off Capper Street, London,
WC1E 6AU, United Kingdom; 2London School of Hygiene and Tropical Medicine,
London, United Kingdom; 3National Centre for Social Research, London, United
Kingdom
Background: Models of HIV/STI transmission dynamics indicate that concurrent
partnerships as well as partner change rates influence incident infections. This
hypothesis is examined using empirical data from the British Natsal 2000 survey
Methods: Probability sample survey of 11,161 respondents aged 16-44 resident
in Britain. Partnership histories were deduced from dates of first and last intercourse for 3 most recent partnerships in last 5 years and serial monogamous and
concurrent partnerships identified. Prevalence of HIV/STI risk behaviours in last
5 years derived including same sex partner(s); paying for sex; STI history. Associations between partnership history, number of partners, age, marital status, and
HIV/STI risk are explored.
Results: 42.6% of men and 39.0% of women with 2+ partners in last 5 years had
concurrent partnerships. Prevalence varied significantly by number of partners,
age and marital status (p=.000). Preliminary analyses indicate that concurrency
relative to serial monogamy is significantly associated with several HIV/STI risks
e.g. for men, 2+ partners in last year with inconsistent condom use in last 4 weeks
(OR 2.32, 95% Cl 1.83-2.95). However, concurrency was not significantly associated with STI diagnosis in last 5 years. Controlling for number of partners, age
and marital status, tends to reduce OR magnitude.
Conclusions: Multivariate analysis of concurrency compared with serial
monogamy remained significantly associated with some HIV/STI risk behaviours,
but not STI diagnosis in last 5 years. This may in part result from empirical problems of accurately recording concurrency and STI history but may also reflect
dominant effects of numbers of partners.
Presenting author: Catherine Mercer, Dept of Sexually Transmitted Diseases,
UCL, 3rd Floor Mortimer Market Centre, off Capper Street, London, WC1E 6AU,
United Kingdom, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7419 Cervicovaginal HIV-1 RNA shedding is not related
to the presence of white blood cells in the genital
tract
J.I. Harwell1, A. Caliendo2, J. Kurpewski1, S. Donahue', J. Ingersoll2,
K.H. Mayer1. 1 The Miriam Hospital, 164 Summit Avenue, Fain 385, Providence,
RI 02906, United States; 2Emory University Atlanta, GA, United States
Background: Cervicitis is associated with genital tract shedding of HIV-1, but
there are no studies relating genital tract HIV-1 shedding to the number of white
blood cells (WBC), in the absence of other genital infections.
Methods: Using hemocytometry, we assessed cervicovaginal lavage (CVL) WBC
count from HIV-infected women without genital infection. CVL cell counts were assessed among women with CVL HIV-1 RNA levels <400 copies/mL, compared
to women with CVL HIV-1 RNA >400 copies/mL. Several longitudinal collections
made from each subject. Women were tested annually for gonorrhea, chlamydia,
and syphilis, and at each collection for bacterial vaginosis, candida, trichomoniasis, the presence of semen, and pregnancy. Specimens were excluded if any of
these tests were positive. Women were asked not to douche, insert vaginal products, or have intercourse at least 48 hours prior to collection. No specimens were
collected during menses.

Results: A total of 71 specimens were collected from 27 women with CVL HIV-1
RNA <400 copies/mL. The average CVL WBC count from this group was 822.
A total of 23 collections were made from 17 women with CVL HIV-1 RNA >400
copies/mL. The average CVL WBC count from these women was 1,453. When
stratified by CVL HIV-1 RNA, there was no relationship between CVL cell counts
and CVL HIV-1 RNA levels (see table).
Conclusion: There is no difference in CVL WBC counts between women with

CVL HIV-1 RNA Level (Copies/mL) N (specimens) Average WBC Count
<10,000 13 798
10,000-100,000 7 3188
> 100,000 3 247
CVL HIV-1 RNA <400 copies/mL vs. those with CVL HIV-1 RNA >400 copies/mL,
in the absence of genital infections. It appears that the presence of CVL WBC is
not associated with CVL HIV-1 RNA shedding. Further analysis is needed to determine the effect of other genital infections, such as CMV, mycoplasmas, and
asymptomatic HSV on the relationship between CVL WBC and CVL HIV-1 RNA
levels.
Presenting author: Jospeh Harwell, 164 Summit Avenue, Fain 385, Providence,
RI 02906, United States, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
ThPeC7420 Role of male circumcision in HIV transmission
insignificant in Conjugal relationship
S.M. Changedia, I.S. Gilada. Unison Medicare & Research Centre, Unison
Medicare & Research Centre, Maharukh Mansion, Alibhai Premji Marg, Grant
Road (East), Mumbai-400007, India
Background: Some anthropological studies and review of dozens of epidemiologic studies suggests that the relative risk of heterosexual HIV infection, the
predominant route HIV is spread throughout Africa and Asia, is two to eight times
higher for uncircumcised men. While this may be true for efficiency of HIV transmission rate per sexual act, the effect of circumcision on HIV transmission in
conjugal relationship has been an important area of study. The suggestion that
the public health promotion of male circumcision could potentially save millions
of men and their partners from becoming infected with HIV has generated some
debate.
Methods: A retrospective study of among index cases attending a comprehensive HIV Care Clinic was conducted. We analysed their marital status, whether
they were circumcised and HIV concordance in conjugal relationship to establish
the effect of circumcision on protection offered to their spouses or vice versa from
HIV infection. This was compared to equal number of non-circumcised men from
the same study group.
Results: Of the total 3223 live HIV patients, 210 belonged to Muslim community
that follows male-circumcision as a cultural practice, of which 168 were married.
Of the 40 discordant patients, men:women ratio was 35:5; while in control group
of the 47 discordant patients this ratio was 37:10. The table reveals the findings
with respect to HIV status and circumcision. The HIV discordance rate among
couples did not differ according to the status of circumcision.
Patients: N Concordant Discordant Unknown
Circumcised 168 47 40 81
Uncircumcised 168 58 47 63
Conclusion: Though circumcision offers protection in acquisition of HIV infection, our findings reveal that it does not reduce transmission of HIV in conjugal
settings. This is important in formulating IEC messages since many believe that
circumsized men don't acquire nor likely to transmit HIV infection as a protection
derived by circumcision and may continue the risk behaviour.
Presenting author: Sachin Changedia, Unison Medicare & Research Centre,
Maharukh Mansion, Alibhai Premji Marg, Grant Road (East), Mumbai-400007,
India, Tel.: [phone], Fax: [phone], E-mail: [email protected]
ThPeC7421 The sensitivity of heterosexual characteristics
definition in an AIDS registry
A. Romaguera Lliso, R.G. Lugo, J. Casabona. CEESCAT CEESCAT HUGTIP,
Ctra Canyet, s/n, 08916 Badalona, Barcelona, Spain
Background: In Catalonia (Spain) from the beginning of the AIDS epidemic,
IDUs has been the driving force. Nevertheless, during the last 5 years heterosexual(HTS) transmission, as well as cases without a known route of transmission
has been increasing. In European AIDS registries, criteria for HTS acquisition
have been traditionally more restricted than for homosexual. The objective of this
presentation is to assess the sensibility of new classification criteria for HIV HTS
acquisition in our registry.
Methods: Adults cases reported to the Catalonia AIDS Registry between 1994 -2000 were analyzed. HTS HIV-exposure was defined (A) as a documented HTS
behavior, with no evidence of other HIV-related risk and HTS relations with a
documented HIV+ infected person, or with a person with known HIV risk. We proposed a second, less restrictive, definition (B) as a documented HTS behavior
and no evidence of other HIV-related risk behavior. Both definitions were applied

to the AIDS cases diagnosed during 1994-2000.
Results: Out of the 7095 AIDS cases, 19.1% were classified as being HTS HIVexposed and 6.6% were classified as Other-No classified. The percentages of
cases with No-classified HIV-exposure were higher during the last two years, 15%
(1999), and 12% (2000). Once applied the proposed HTS definition criteria, 23%
of the 7095 cases were then classified as having HTS HIV-exposure, decreasing
the proportion of those with Other-No classified (2.6%). Significant differences