HTLV-I and HTLV-II infections among HIV-1 seropositive patients in Sao Paulo, Brazil

To estimate the presence of, and the risk factors for HTLV-I and HTLV-II infections among HIV-1 infected subjects in Sao Paulo, Brazil, a serosurvey was performed in 471 HIV-1 infected patients, including 216 intravenous drug addicts (IVDA), 229 homosexual/bisexual men, and 26 with other risk factors. Serum samples were screened for HTLV seroreactivity by ELISA; reactive samples were analyzed by Western Blot (WB), using whole HTLV-I lysate as antigen. To confirm and discriminate HTLV-I and HTLV-II infections, sera presenting any bands on WB were further analyzed by a WB containing recombinant HTLV-I and HTLV-II proteins (WB 2.3), and by enzyme immunoassays using synthetic peptides specific for envelope proteins (Synth-EIA). In 22 cases, cell samples were available for polymerase chain reaction (PCR) studies. On WB, 114 sera were reactive and, of these, 37 and 25 were concordantly positive on both WB 2.3 and Synth-EIA procedures for HTLV-I and HTLV-II specific antibodies, respectively; 37 specimens were negative on both assays, and 15 gave discordant or indeterminate results. PCR findings confirmed concordant results obtained in the discriminatory serological assays. The prevalence rates of HTLV-I and HTLV-II infections were 15.3% and 11.1% in IVDA, and 0.9% and 0.4% in homosexual/bisexual men, respectively. No case of HTLV-I/HTLV-II co-infection was found.

Was the 1988 HIV epidemic among Bangkok's injecting drug users a common source outbreak?

OBJECTIVE

To describe and understand the genesis of the explosive 1988 HIV epidemic among Thai injecting drug users (IDU) in Bangkok.

DESIGN

Two cross-sectional HIV seroprevalence sample surveys (SP-1 and SP-2) of drug users, including IDU at various stages of treatment. SP-1, a 10-week estimate of prevalence, was conducted by the Bangkok Metropolitan Administration (BMA) in their detoxification clinics from 5 January to 7 March 1988. SP-2 estimated prevalence in 1 week, 12-15 September 1988, in the same 18 BMA clinics. Both surveys included an administered questionnaire that gathered demographic and behavioral information.

METHODS

Analysis of HIV prevalence by clinic in both SP-1 and SP-2, and the relationships between demographic data, behavioral variables, arrest history and HIV positivity in SP-1.

RESULTS

Data from individual clinics in SP-1 show significant increases in HIV prevalence among IDU sampled from early February 1988. Of IDU sampled in five 'early' clinics before 9 February, 2% were positive; in the 13 'late' clinics sampled from 9 February until 7 March, 27% were positive. By September 1988, however, the early and late clinics were no longer heterogeneous for HIV prevalence. For current IDU, HIV-positivity was associated with the sharing of injection equipment in SP-1 [odds ratio (OR), 1.82; 95% confidence limits (CL), 1.31-2.53] and recent jail or prison stay (OR, 2.15; 95% CL, 1.18-3.98).

CONCLUSIONS

The behavioral factors associated with the HIV epidemic among Bangkok's IDU are similar to those described elsewhere. The monthly incidence of 5% from February to September 1988 suggests extensive needle or injection equipment sharing networks among IDU in Bangkok. Additionally, the pattern of HIV-positivity by detoxification clinic over time in early 1988, and then in September 1988 is consistent with a relationship to the prison amnesty of early December 1987. Shortly after that date, an undisclosed number of former IDU, a substantial number of whom were still injecting, and may have become HIV-positive while in custody, returned to resume injecting within existing drug-using networks throughout Bangkok and elsewhere in Thailand.

Epidemic of herpes zoster following HIV epidemic in Manipur, India

Since 1989, injecting drug use (IDU) related HIV infection has affected thousands of young adults in Manipur, a north eastern state of India bordering Myanmar following a similar kind of epidemic in adjoining countries like Thailand and Myanmar. During a clinical surveillance of a group of HIV positive IDUs for a natural history study at Manipur, herpes zoster (HZ) emerged as the most specific early HIV related illness (positive predictive value of 100%) in patients belonging to the age group of 12-45 years. Data collected from the dermatology departments of the two main hospitals of the state revealed that there had been an epidemic of HZ since 1990 (rate of 1990 being 11.3/1000 compared to 6.5/1000 in 1989, P value < 0.0001) among males of 12-45 years. The epidemic of HZ has been attributed to the preceding epidemic of IDU related HIV in the same age and gender group occurring 1 year earlier. HZ should be recognised as a marker condition similar to tuberculosis indicating the necessity of screening for HIV in regions where the dual problem of IDU and HIV exist in young adults.

Cohort study of HIV infection among drug users in Ruili, Longchuan and Luxi of Yunnan Province, China

In March 1992, KAP investigation and HIV blood test were carried out for 860 drug users and 82 spouses in Ruili, Luxi, Longchuan of Yunnan Province, China. The results showed that there were 285 injecting drug users (IDUs) (33.1%) among 860 drug users. Among 282 blood samples of IDUs, the HIV infection rate was 49.0%, highest in Ruili (81.8%, 63/77), then Longchuan (44.6%, 74/166), lowest in Luxi county (5.1%, 2/39). Twelve new HIV(+) were found from 75 persons, who had been tested as HIV(-) in recent two years. Sixty-two blood samples were collected among 82 spouses of IDUs with HIV(+), and 6 were HIV(+) (9.8%), with an increase of 6.7% compared with results of the investigation two years ago (3.1%, 2/64).

AIDS in Nicaragua: epidemiological, political, and sociocultural perspectives

The AIDS epidemic in Nicaragua is several years behind that in the United States and neighboring countries of Central and South America. A combination of events, including the isolation caused by the war of the U.S.-backed Contra army against the Sandinista government, the complete economic embargo imposed on Nicaragua by the United States in 1985, self-sufficiency for blood products, and a low rate of recreational injectable-drug use, have contributed to this situation. Since the Sandinistas were defeated in the general election of 1990, people have returned to Nicaragua from areas where HIV is more prevalent, such as Honduras and the United States. It is probable that many HIV-infected persons have now entered the country. Because of the high rates of sexually transmitted diseases and cultural factors such as "machismo," HIV is likely to spread rapidly by heterosexual transmission, unless effective, culturally appropriate education and sexually transmitted disease prevention programs are implemented now.

Sexual issues and condom use among injecting drug users

Recent surveys of injecting drug users reveal that their injecting behaviours have changed in the light of HIV, but their sexual behaviours have not and, in particular, they remain reluctant to use condoms to reduce the risks of sexual transmission. In an attempt to explore this issue further the present study assessed the behaviours and attitudes of injecting drug users to sexual issues, including condom use. Condom use was low. Obstacles to their use included for some a desire to conceive, for many a belief in their infertility, a perceived invulnerability to HIV infection through their sexual behaviour patterns, a dislike of condoms and difficulty in negotiating condom use with partners. The lifestyle of drug users may also have an influence on condom use. Many drug users funded their habit through illegal activities including prostitution, theft and fraud. The association between these and other factors and condom use are explored.

Prostitution and risk of HIV: male partners of female prostitutes

OBJECTIVE

To describe risk behaviours for infection with HIV in male sexual partners of female prostitutes.

DESIGN

A cross sectional study.

SETTING

Genitourinary medicine clinic, St Mary's Hospital, London.

SUBJECTS

112 self identified male sexual partners of female prostitutes: 101 who reported commercial sexual relationships only, five who reported non-commercial relationships only, and six who reported both commercial and non-commercial relationships.

MAIN OUTCOME MEASURES

Reported risk behaviours for infection with HIV.

RESULTS

Of the 40 men who had had previous HIV tests or were tested during the study, two (5%) were infected with HIV. Of the men who would answer the questions, 34/94 reported having sex with other men, 2/105 reported using injected drugs, 8/105 had a history of blood transfusion, 14/108 reported a past history of gonorrhoea, 44/102 reported paying for sex abroad, and 8/92 said that they had also been paid for sex. Of the 55 men who reported paying for vaginal intercourse in the past year, 45 (82%) said that they had always used a condom. In contrast, of the 11 non-paying partners of prostitutes, only two (18%) reported ever using a condom with their partners.

CONCLUSIONS

Men who have sex with female prostitutes cannot be assumed to be at risk of infection with HIV only by this route: homosexual contact may place them at greater risk. Despite the heterogeneity among male sexual partners of prostitutes, patterns of use of condoms were uniform when they were considered as a reflection of the type of relationship a man had with a female prostitute rather than a consequence of an individual's level of risk.

Prostitution and risk of HIV: female prostitutes in London

OBJECTIVE

To measure the prevalence of HIV and to describe established risk factors in female prostitutes.

DESIGN

A cross sectional survey.

SETTING

A genitourinary medicine clinic, streets, and magistrates' courts in London.

SUBJECTS

280 female prostitutes recruited between April 1989 and August 1991.

MAIN OUTCOME MEASURES

Infection with HIV-1, reported risk behaviours, and prevalence of sexually transmitted infections.

RESULTS

228 of the women had HIV tests, and two (0.9% (95% confidence interval 0% to 2.1%)) were infected with HIV-1. Reported use of condoms was high for commercial clients and low for non-paying partners: 98% (251/255) of women used condoms with all clients and 12% (25/207) with non-paying partners for vaginal intercourse. Twenty two women were current or past injecting drug users. Of the 193 women examined for sexually transmitted infections, 27 had an acute infection (gonorrhoea, chlamydia, trichomonas, or primary genital herpes) at the time of interview. Infection was associated with younger age and increasing numbers of non-paying sexual partners, but not with duration of prostitution, numbers of clients, or reports of condom failures. When age and numbers of non-paying partners were analysed by logistic regression they remained significantly associated with sexually transmitted infections.

CONCLUSIONS

A large and diverse sample of prostitutes had a low prevalence of infection with HIV and high levels of use of condoms in commercial sex. There was a significant risk of other sexually transmitted infections associated with prostitutes' non-commercial sexual relationships, in which unprotected sex is common. Interventions to reduce the risk of sexually transmitted infections in prostitutes should address both commercial and non-commercial sexual partnerships.

HIV infection among injecting drug users in north-east Malaysia, 1992

Human immunodeficiency virus (HIV) has spread widely among injecting drug users (IDUs) in countries to the north and west of the 'Golden Triangle' region of South-East Asia; it is likely to have spread southwards to Malaysia as well. In order to assess HIV seroprevalence among IDUs in north-east Malaysia and describe risk factors for HIV infection in this population, we performed a cross-sectional seroepidemiological study among 210 IDUs recruited at the detoxification ward of the General Hospital in the capital city of the north-eastern Malaysian state, Kelantan. Subjects were sequential entrants to the detoxification ward, interviewed about HIV risk behaviour, and tested for antibody to HIV and to syphilis. Nearly a third (62/210, 30%) of these IDUs were HIV seropositive. Three-quarters (159/210) had travelled to Thailand in the preceding 5 years, of whom 32% (51/159) were HIV seropositive; this was associated with injecting in Thailand, but not with sexual contact there. Of those who had not left Malaysia in the preceding 5 years, 26% (11/43) were HIV seropositive, a rate not significantly different from those who had travelled. Travel within Malaysia was common (144/210, 69%) among IDUs interviewed, as was unsafe injecting and unsafe sexual behaviour (20% had shared injecting equipment and 21% had had unprotected intercourse) in other states. In every locale, rates of unsafe injecting behaviour were high (55% sharing in last month), even among those who knew they were HIV infected, and rates of condom usage were low (93% of 160 sexually active IDUs had never used a condom). Syphilis was not associated with HIV infection, but with contact with Thai prostitutes.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV infection among injecting drug users in Asia: an evolving public health crisis

Injecting drug use is being reported from an increasing number of Asian and other Third World countries. HIV continues to spread globally among and from populations of injecting drug users (IDUs), although the rate of spread appears to have slowed down recently in some industrialized countries. Asia produces two-thirds of the world's supply of opium. In recent years the rapid development of new illicit drug trade routes in efforts to evade detection by law enforcement authorities has exposed new populations in Asia to drug injecting and, thus, the risk of HIV infection. Epidemic spread of HIV has recently commenced in some Asian countries among injecting drug users, and others are at substantial risk of an HIV epidemic among their IDU populations. The speed of spread and the consequences of HIV infection among IDUs in Asian and other Third World countries are even more profound than in western countries. Asian countries attempting to control this component of the epidemic often have greater difficulty than industrialized countries because of their proximity to drug producing areas, scarcity of resources and a greater likelihood of pragmatic policies conflicting with traditional values. Vigorous efforts are urgently required at both a national and international level to raise awareness of the consequences of an uncontrolled epidemic of HIV among IDUs in Asian and other countries, and to support the implementation of policies which are likely to reduce the spread of HIV.

Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States

OBJECTIVE

To determine factors associated with likelihood or failure to use condoms with primary sexual partners among injecting drug users (IDU) in two cities.

DESIGN AND METHODS

Interviews were conducted with 601 IDU in Bangkok in 1989 and with 957 IDU in New York City in 1990-1991. Subjects were recruited from drug-use treatment programs and a research storefront. Informed consent was obtained and a World Health Organization standardized questionnaire about AIDS risk behaviors administered by a trained interviewer.

RESULTS

A substantial minority (37%) of IDU in Bangkok and a majority (55%) of IDU in New York City reported penetrative intercourse (vaginal, anal or oral) with a primary partner in the 6 months before the interview. Of those reporting penetrative intercourse with a primary partner, only 12% in Bangkok and 20% in New York reported that they always used condoms. Parallel bivariate and multiple logistic regression analyses were conducted to distinguish between subjects who reported always using condoms and subjects who reported unsafe sexual activity with primary partners. The same two factor--knowing that one is HIV-seropositive and talking about AIDS with sexual partners--were most strongly associated with always using condoms with primary partners in both cities.

CONCLUSIONS

Programs to prevent sexual transmission of HIV among IDU should provide voluntary and confidential/anonymous HIV counseling and testing, and should facilitate discussions of AIDS and sexual transmission of HIV between IDU and their sexual partners. That the same two factors were associated with always using condoms with primary partners among IDU in these two cities suggests that these factors may also be important in other groups at high risk for HIV.

Risk behaviour associated with HIV infection among drug abusers seen at the general Hospital, Kota Bharu, Kelantan

Sixty-one serologically positive HIV infected drug abusers admitted to the Drug Ward, General Hospital, Kota Bharu, were interviewed for possible risk behaviour and AIDS awareness. Fifty-eight subjects were IV abusers while the other 3 were non-IV abusers. All the IV abusers had shared injecting equipment with no regard for sterility. There was non-usage of condoms among those sexually active. Though AIDS awareness was high, there was a lack of risk behaviour change. The drug abusers appear to be a problem group in HIV control measures. Educating the drug abusers and commitment by them to alter risk behaviour is needed.

Role of drug injection in the spread of HIV in Argentina and Brazil

Drug injectors' have become the second largest HIV transmission category in Argentina and Brazil, as is the case in many pattern I countries, making up more than one-quarter of all AIDS cases reported by 1991. HIV seroprevalence data suggest that the expanding proportion of AIDS cases attributable to drug injection stems from an absolute increase in the number of AIDS cases among drug injectors, and is not merely reflective of a decline in the proportion of cases reported in other transmission categories. Results of a review of studies in Argentina and Brazil indicate that HIV seroprevalence is increasing rapidly, contrary to the situation in some pattern I countries in which HIV seroprevalence among drug injectors is either stably high or increasing only slightly. Also contrary to most pattern I countries, cocaine rather than heroin is the injected drug of choice in Argentina and Brazil. Given that injectors of cocaine are more likely to be HIV infected than are heroin injectors, differences in the type of drug injected between countries may have distinct epidemiological consequences on the spread of HIV.

Determinants of condom use among intravenous drug users

OBJECTIVE

To examine the factors associated with condom use among a cohort of sexually active intravenous drug users (IVDU).

DESIGN

Data were collected via personal interview at the fourth-month assessment point of a longitudinal study monitoring HIV infection and risk behaviors among IVDU.

SETTING

A community-based methadone clinic.

PARTICIPANTS

A total of 158 sexually active heterosexual male and female IVDU, including both methadone patients and out-of-treatment individuals with a history of opiate abuse.

MAIN OUTCOME MEASURES

We describe a new approach to identify the determinants of condom use. Previous studies have described subjects as either 'condom users' or 'condom non-users', using an individual's overall behavior as the unit of analysis. By analyzing condom use during the most recent sexual encounter, we avoided the problem of interpreting inconsistent condom use. Data were analyzed using forward stepwise logistic regression.

RESULTS

Thirty-four per cent of the heterosexual subjects (n = 160) reported using a condom during their last sexual encounter. Being HIV-positive and having either a causal or commercial partner were each associated with increased probability of using a condom (odds ratio, 10.6, 4.4 and 12.1, respectively). No interactions with sex were found.

CONCLUSIONS

Our results suggest that knowing that one is HIV-positive is an important determinant of condom use; HIV testing may therefore increase the use of condoms. In addition, interventions to change sexual behaviors may need to focus on the type of sexual partner.

Highly specific V3 peptide enzyme immunoassay for serotyping HIV-1 specimens from Thailand

OBJECTIVE

To develop and evaluate a simple V3 peptide-based enzyme immunoassay (EIA) for large-scale serotyping of HIV-1 specimens from Thailand.

DESIGN

Serologic reactivities with synthetic peptides derived from the V3 loop of gp120 were used for typing HIV-1 specimens.

METHODS

Synthetic peptides PND-A and PND-B, derived from the consensus amino-acid sequences of the V3 loop of gp120 from two major genomic variants of HIV-1 in Thailand (A and B), were evaluated in an EIA on 61 Thai HIV-1 sera for which genotypes had been determined by polymerase chain reaction. The peptide EIA was then applied to sera from 188 HIV-1-infected patients, selected in non-random, convenience samples of known risk groups from four geographic regions of Thailand.

RESULTS

The sensitivities and specificities of PND-A and PND-B were 86% (30 out of 35) and 96% (25 out of 26) and 92% (24 out of 26) and 94% (33 out of 35), respectively, with 100% predictive values of a monoreactive positive test for both peptides. The assay classified 101 specimens as serotype A, 39 as serotype B, eight as serotype AB (dually reactive), and 40 as untypable (non-reactive). Excluding dual reactors and non-reactors, 92% (77 out of 84) of specimens from patients probably infected by sexual contact were serotype A; conversely, 76% (28 out of 37) of injecting drug users were serotype B.

CONCLUSION

The serologic results corroborated previous findings, in a smaller subset of samples, of an apparent segregation of viral subtypes by mode of transmission, suggesting two separate HIV-1 epidemics in Thailand. This peptide EIA could be a valuable epidemiologic tool in determining the dynamics of the rapid spread of HIV-1 in Thailand.

Safe sex? Misconceptions, gender differences and barriers among injection drug users: a focus group approach

Heterosexual transmission is one factor involved in the spread of the human immunodeficiency virus (HIV) within the injection drug use (IDU) population and between IDU and non-IDU individuals. Insufficient information is currently available to reduce this heterosexual transmission. As a basis for designing a questionnaire aimed at the IDU population, we conducted 5 focus groups to collect information on knowledge of and attitudes toward safe sex as held by male and female IDUs in methadone treatment. We identified misconceptions related to HIV infection, condoms, and sexual behavior. We also found gender-based differences in knowledge and learning style. Also, while individuals felt a responsibility to prevent HIV transmission, they lacked sufficient control to do so. The wide range of responses on questions concerning sexually transmitted diseases (STDs), condoms, reproductive decisions, and methods of promoting safe sex provides a basis for developing a questionnaire designed to identify and target specific subgroups for educational intervention.

Psychosocial factors associated with condom use among African-American drug abusers in treatment

Although strategies for decreasing injection drug use have met with moderate success, efforts to decrease high-risk sexual behaviors have been less successful. Because condom use reduces HIV transmission, it is critically important to identify the attitudinal, emotional, and behavioral factors associated with using condoms. This study evaluated the relationship between condom use and various psychological and behavioral variables among heterosexual, African-American, cocaine-dependent men within the context of the AIDS Risk Reduction Model (ARRM). Subjects who used condoms (n = 52) reported significantly higher levels of self-efficacy, condom use skills, and sexual communication with partners than non-users (n = 84). However, the groups did not differ in perceived susceptibility, anxiety concerning HIV transmission, response efficacy, or knowledge regarding HIV. These findings suggest that future interventions focus on enhancing self-efficacy and condom use skills, as well as eroticizing condom use.

Selling sex: female street prostitution and HIV risk behaviour in Glasgow

Female prostitutes have often been seen as a major source of HIV infection. In this paper we report on a study of HIV-related risk behaviour among street prostitutes in Glasgow. This paper is based on street interviews using a standardized schedule with 68 women. We focus on the extent of HIV testing amongst the women, travel, the sexual services provided, the use of condoms with clients and private partners, and the extent of drug injecting and equipment sharing by the women. It is shown that female street prostitution within Glasgow is, at present, unlikely to be associated with significant heterosexual spread of HIV as most commercial sex is with a condom. However, some risk activities are continuing. Additionally, prostitutes report worrying rates of condom failure with clients. It is suggested that attention should switch away from an exclusive focus on women selling sexual services to target the men who purchase sex. These data indicate that much of the pressure for these women to provide unprotected sex comes from their clients.

[Risk factors for the heterosexual transmission of HIV from man to woman: a Spanish multicenter study]

BACKGROUND

The aims of this study were to estimate the rate of heterosexual transmission of HIV in a population of intravenous drug users (IVDU), as to well as to identify the possible risk factors associated.

METHODS

One hundred thirty heterosexual couples were analyzed in which the male was seropositive for the human immunodeficiency virus (HIV) with the only possible risk factor for the companion being the sexual intercourse with the case index.

RESULTS

The rate of global transmission estimated was 16% (confidence interval of 95% = 10-22.4%). The risk factors significantly associated to HIV transmission were: case index of over 30 years of age (OR = 3.1), clinical status IV (OR = 4.1), less than 0.8 x 10(8) lymphocytes/I (OR = 7), antecedents of sexually transmitted disease (STD) in the woman (OR = 4), and the practice of anal intercourse (OR = 3.1). In the multivariate analysis only the clinical status of the case index and the STC antecedents of the woman were statistically significant (p less than 0.05).

CONCLUSIONS

In this study some of the classical risk factors for the heterosexual transmission of HIV have been confirmed, and the importance of decreasing the prevalence of STD in the IVDU collective in Spain has been corroborated to lower heterosexual transmission and, indirectly the vertical transmission of AIDS.

HIV-2 infection in Denmark

A collection of 3019 selected serum samples (ss), comprising 329 ss from intravenous drug abusers, 558 ss from homosexual men, 682 samples from persons attending a STD clinic, 100 ss from individuals of African origin, 300 ss from sexual contacts to Africans, 650 ss from Danish blood donors who resided in Africa greater than 2 years prior to donating the ss, and 400 ss with equivocal antibody reactions in an HIV-1 Western blot was tested for antibodies against HIV-2 by in-house HIV-2 ELISA and Western blot. Four ss were positive for antibodies against HIV-2. Three of the ss originated from West African men, the fourth belonged to the spouse of one of these men. Three of the samples presented with an uncharacteristic reaction in a HIV-1 Western blot. The study indicates that HIV-2 infection is not yet widespread in Denmark and that it remains closely related to West Africa.

Risk factors and HIV seropositivity among injecting drug users in Bangkok

Bangkok experienced an extremely rapid spread of HIV infection among drug injectors in 1987 and 1988. This study examines risk factors for HIV infection and deliberate risk-reduction efforts by drug injectors. Two subsamples of injecting drug users were recruited in November 1989, a group in drug-use treatment (n = 342) and a group new to the treatment system (n = 259). Subjects were interviewed about AIDS risk behavior, and a blood sample was collected for HIV testing. Seroprevalence was 39 and 27% in the in-treatment sample and the new-to-treatment sample, respectively. The in-treatment sample seroprevalence rate is similar to rates observed 6 and 12 months earlier. Three factors were independently associated with HIV infection: subsample, having been in prison, and sharing injection equipment with two or more individuals in the previous 6 months. Deliberate risk reduction was reported by 92% of individuals, with 59% reporting that they had stopped sharing injection equipment. It appears that large-scale risk reduction has greatly slowed HIV transmission among drug injectors in Bangkok.