Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

who either received treatment for 6 months during acute infection (group A
n=12), or remained off therapy over the entire 12 months study period (group
B n=8). CD4+ T cell count, HIV-1 plasma RNA levels and HIV-1-specific T cell
responses by Elispot and ICS were assessed over the study period.
Results: The two groups did not differ with respect to host genetic factors
CD4+ count (p=0.91) or viral load (p=0.86) at baseline. At the 24 wks time
point there was a significant difference in the median VL of the treated group
(<50 cop/ml) compared to the untreated group (131,000cop/ml) (p=0.006)
and CD4+ T cell numbers were significantly elevated in the treated subjects
than in the untreated arm(p=0.007). Short-term treatment in acute infection
resulted in significantly higher HIV-1-specific IFN-y+ and CD107a+ CD8+ T
cells at week 48 compared to the untreated group (p=0.06 and p<0.05), and
in a better differentiation of these virus-specific T cells from effector memory
to effector cells (28% (untreated) vs. 49% (treated)). However, despite these
changes in HIV-1-specific immune responses, no differences in the treated and
untreated group was observed 6 months following therapy discontinuation at
week 48 with respect to VL (32,300 cop/ml vs 38,300 cop/ml; p=0.41) or
CD4+ (596/pl vs. 456.1/pl, p=0.15)
Conclusions: Our data suggest that despite a boosting of immunological
functions and T cell maturation following 6 months of therapy in acute HIV-1
infection, this intervention had no impact on immunological control of HIV-1
replication.
MOAX0105
Comprehensive analysis of HIV-specific IL-2 and
IFN- y immune responses in treatment-naive
individuals in acute infection early disease (AIED)
versus long term non progressors (LTNP) and
individuals with progressive disease
N. Lubaki', Y. Peretz', M.P. Boisvert2, R. Boulassel', C. Tremblay3, R. LeBlanc4,
D. Rouleaus, C. Tsoukas', J.P. Routy', N. Bernard'. 'McGill University,
Montreal, Canada, 2Montreal General Hospital Research Institute, Montreal,
Canada, 3Centre Hospitalier de l'Universite de Montreal, Montreal, Canada,
4Clinique Medicale G.L.R, Montreal, Canada, 5Hopital Notre Dame, Universite
de Montreal, Montreal, Canada
Background: The initial host response to HIV is associated with viral load
(VL) control during acute infection and is an important determinant in the
subsequent disease course. HIV-specific IL-2 secretion is associated with VL
control and better clinical outcome. Objective: To screen and compare the
breadth, magnitude and hierarchy of HIV-specific IL-2 and IFN-y responses in
subjects in AIED, LTNP and progressors.
Methods: The study population included 18 individuals in AIED within 6
months of infection. We compared responses in these individuals to those in
10 untreated LTNPs infected >7 yrs with CD4 counts >500cells/mm3 and low
VL and 6 untreated progressors infected for >1 yr with a median CD4 count of
301 (range 16-540). Peripheral blood mononuclear cells (PBMC) were tested for
IL-2 and IFN-y secretion using the ELISPOT assay. PBMC were stimulated with
peptide pool matrices corresponding to all expressed clade B HIV genes. The
stimulatory capacity of peptides was verified individually in a second ELISPOT
assay.
Results: Individuals in AIED were recruited and evaluated for IL-2 and IFN-y
responses 78 (range 46-160) days following date of infection. The hierarchy
of the breadth and magnitude of IL-2 responses was LTNP > subjects in AIED
> progressors (p<0.05 for all comparisons). The breadth and magnitude of
IFN-y responses were higher in LTNP versus individuals in AIED (p<0.05). Only
the magnitude (p<0.05) and not the breadth of IFN-y responses were higher
in LTNP versus progressors. An inverse correlation was found between HIV VL
and magnitude (p=0.032) and breadth (p=0.0018) of IL-2 responses. Nef was
recognized most frequently during AIED and Gag during chronic infection.
Conclusions: The specificity and hierarchy of HIV recognition in AIED differs
from that of subjects with chronic infection. Both LTNP and subjects in AIED
have HIV-specific IL-2 responses and these are associated with VL control.
MOAX0201
Intersecting sexuality, gender, race and citizenship:
mental health issues faced by immigrants and
refugees living with HIV/AIDS in Toronto
J.P. Wong', A. Li2, Y.B. Chen', P. Kanagaratnam', S. Yee3, K. Fung4, A. Roy
Sen'. 'Toronto Public Health, Planning & Policy, Toronto, Canada, 'Regent Park
Community Health Centre, Toronto, Canada, 'Committee for Accessible AIDS
Treatment, Toronto, Canada, 'University Health Network, Toronto, Canada
Issues: Advances in medical knowledge and access to HIV treatments have
changed the nature how people living with HIV/AIDS (PHA) experience this
illness in Canada and other developed countries. While a substantial number
of research have been conducted to examine the impact of HIV/AIDS as a
chronic illness on the mental health of PHAs, these studies mostly focus on
gay white males or MSM or address PHA mental health issues in unidisciplinary
silos. Research on mental health issues faced by immigrants and refugees living

with HIV/AIDS (I&R-PHAs) and multiple marginalities in developed countries is
almost non-existent.
Description: A preliminary study that explored the mental health needs of
I&R-PHAs living in the Greater Toronto Area was conducted in order to identify
the research priority for this population. It included a detailed literature review,
a scan of existing programs and two separate focus groups attended by 7 I&RPHAs and 10 service providers.
Lessons learned: The mental health of I&R-PHAs is affected by intertwining

biophysical, psychosocial, socioeconomic and sociopolitical determinants. In
addition to coping with HIV/AIDS stigma, many I&R-PHAs reported experiences
of racism, inadequate housing, unemployment, poverty and social isolation.
Immigration procedures and citizenship status were named as key stressors for
refugee and non-status PHAs. Female I&R-PHAs expressed a fear of becoming
ill and having nobody to take care of their children. When I&R-PHAs seeked
help to deal with these stressors, many of them were re-traumatized by
uncoordinated health care services as they were asked to retell their histories
repeatedly to different service providers while they navigated the system.
Recommendations: Service coordination, research on the mental health needs
of I&R-PHAs, and policy analysis of HIV/AIDS in the contexts of migration,
employment, health care access and systemic discrimination are critical to
promoting health and reducing health disparity in this PHA subpopulation.
MOAX0202
The silent bullet, the unfought war: HIV/AIDS
amongst young people in conflict situation
W. Ochan', E. Mugumya2, R. Nambooze2. 1IPPFAR, Programmes, Nairobi,
Kenya, 2FPAU, Office of Executive Director, Kampala, Uganda
Background: In war situations, young girls and boys get caught between
the fire of bullets and risk of HIV infection. Physical survival takes precedence
despite the risks involved, while HIV continues to spread silently showing its
devastating impact on host & displaced population later in the post conflict
period.
Methods: We conducted a descriptive cross-sectional study amongst 345
young people (10 - 24 years), randomly sampled in Awer and Palenga camps
In Gulu District, Northern Uganda. We used both quantitative and qualitative
research methods to determine knowledge, attitude and practices of young
people relating to HIV/AIDS. Factors that make young people vulnerable in
conflict settings were also explored.
Results: The study respondents mean age was 17.4 years. 45% were in
sexual relationships and 25% married, and age of sexual debut is 13.8 years
(national 17 years). Level of awareness on HIV/AIDS & its mode of transmission
were high. However, only 6.4% knew of VCT as confirmatory HIV test. First
sexual intercourse was involuntary amongst 36% of the girls; perpetrators
being: soldiers, rebels, neighbours and camp leaders. Condom use was 43.4%,
because of lack of condoms and negative attitude and limited skills in its use.
HIV/AIDS services are lacking in the camps. Factors that make girls vulnerable
to HIV/AIDS infections were sex with soldiers or camp leaders for material/
monetary reward, insecurity, lack of condoms, lack of VCT & STDs services,
substance use, multiple sex partners, being orphaned, etc. Spots for rapes
included: water points, night clubs, and nearby bushes
Conclusions: Despite high level of awareness on HIV/AIDS, young people in
conflict situations are constrained in practicing safer sex methods. Material and
security needs, coupled with lack of HIV/AIDS services mak
MOAX0203
International migration and HIV risk among Mexican
gay men
H. Carrillo, J. Fontdevila, J. Brown. University of California, San Francisco,
Center for AIDS Prevention Studies, San Diego, United States
Background: Previous survey research has found that recent Latino gay male
immigrants in the U.S. have lower levels of HIV risk than U.S.-born Latino gay
men, but also that HIV risk among longer-term immigrants resembles that of
U.S.-born men. The goal of this study is to describe and analyze how HIV risk is
produced among recent Mexican gay immigrants in U.S. cities.
Methods: We conducted in-depth, semi-structured interviews with 80 men in
San Diego who self-identified as gay, bisexual, or transgender, and who were
raised in Mexico. We utilized a rigorous qualitative analytical method that
combines reading and summarizing of individual cases with coding of transcript
material and thematic searches using QSR N6.0. Additionally, we analyzed field
notes from 62 participant observation sessions in venues where Mexican gay
immigrant men socialize.
Results: Participants' HIV safety or risk in the U.S. is related to processes that
begin in Mexico and that influence their paths of migration and incorporation
into U.S. gay life. The degree or urbanization of participants' place of origin in
Mexico; their personal characteristics in terms of social class, education, and
ethnic features; their language skills; their degree of participation in genderbased versus object-choice Mexican homosexualities; their expressed sexual
attractions towards different types of men; their imaginaries of U.S. gay life;
and the mix of expressed motivations for migration (sexual, family, or economic)
all influence their experiences of incorporation into U.S. gay communities and,
in turn, the contexts of HIV safety or risk to which they gain access.
Conclusions: To fully understand HIV risk and safety among gay immigrant
populations (particularly among those individuals whose motivations for
migration are primarily sexual) and design appropriate interventions, we must
pay close attention to their situations and sexual histories before relocation,
their paths of international migration, and their processes of incorporation into

gay life in host countries.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1