Subhash K. Hira

Condom and nonoxynol-9 use and the incidence of HIV infection in serodiscordant couples in Zambia

We aimed to measure the effectiveness of latex condoms and of nonoxynol-9 [N-9] spermicides, in preventing HIV transmission in heterosexual serodiscordant couples in Lusaka. Each couple was examined at clinic visits scheduled at 3-month intervals for one year or more per couple, or until seroconversion or discontinuation. Couples were given condoms and their choice of 3 N-9 products and advised to use both at every intercourse. Sexual exposure was ascertained from coital logs that recorded coitus and barrier method use. HIV serological testing was done at each clinic visit (ELISA and Western blot if positive). One hundred and ten discordant couples were followed for a mean of 17.6 months. Seventy-eight per cent of coital episodes were protected by condoms, 85% by spermicides and 6.4% were unprotected. Fourteen seroconversions occurred (8.7 infections per 100 couple-years [c-y]). The rate was higher among seronegative men than seronegative women. Among couples who reported using condoms at every intercourse the infection rate was 2.3/100 c-y, compared with 10.7/100 c-y among couples using condoms less consistently (rate ratio [RR] 0.2; 95% confidence interval [CI] 0-1.6). Among couples who reported using N-9 at every intercourse, the seroconversion rate was 6.9/100 c-y; among couples who reported less than fulltime N-9 use, the rate was 8.9/100 c-y (RR 0.8; 95% CI 0.2-2.8). Among the subset of female seronegatives, the N-9 RR was 0.5 (95% CI 0.1-3.8). But when we calculated HIV rates according to N-9 consistency in coital acts when condoms were not used, there was no evidence of protection with higher N-9 use. Consistent use of latex condoms reduces the incidence of HIV infection, but the association between N-9 spermicides and HIV is less clear. The current study could not provide compelling data on the impact of N-9 spermicide use on risk of HIV infection. The studys small size, as well as the consistency of concurrent condom use, limited our inferences. Available spermicide products must be studied further.

Reintroducing antituberculosis therapy after Stevens-Johnson syndrome in human immunodeficiency virus-infected patients with tuberculosis: role of desensitization.

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the ̄ow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Roberto CorteÂs Franco, MD, Fax: +52 (5) 665 7691. E-mail: cortesmd@prodigy.net.mx

Evidence of AIDS-related mortality in Mumbai, India

From an estimated 85,200 HIV-infected individuals in Mumbai in 1997, at least 4120 excess deaths attributed to AIDS occurred among 15-54-year-olds. To prevent repetition of this excess in other parts of India, priority intervention programmes should be instituted quickly because the window of opportunity is closing quickly.

High occurrence of HBV among STD clinic attenders in Bombay, India.

The pattern of sexually transmitted disease (STD) is the basis for designing surveillance of specific STD, their trends and syndromic management protocols. Two hundred and fifteen consecutive first-time STD clinic attenders at a teaching hospital in Bombay were recruited for the study in October 1995. Thorough clinical examination and the following investigations were done: wet mount, Gram stain, Giemsa stain, modified Thayer-Martin (MTM) medium culture, Fontana stain, Venereal Disease Research Laboratory (VDRL), Treponema pallidium haemagglutination test (TPHA), HBsAg and HIV. Ulcerative STD constituted 73.5% of total STD while 15.8% were discharges and 10.2% were genital growths. Ulcers in decreasing order of frequency were chancroid (51.9%), genital herpes (29.1%) and syphilis (14.5). 76.5% of genital discharges were due to gonococcal infection. The high rate of ulcerative STD is possibly an important co-factor for the high HIV prevalence of 31.2% in Bombay. Of 182 patients tested for HBV, 16 (8.8%) were reactive for HBsAg, revealing a high prevalence among STD attenders. A high co-relation of HBsAg positive with either HIV or VDRL requires urgent attention for HBV intervention strategies in this population.

Long-Term Preservation of Whole Blood Samples for Flow Cytometry Analysis in Normal and HIV-Infected Individuals from Africa:

A whole blood method requiring less than 4 ml of heparinized blood was developed to assess the practicality of preparing whole blood samples that could be easily stored, transported and readily used to determine the lymphocyte phenotypes and proliferation responses of individuals from remote areas who are infected with the human immunodeficiency virus. Minor modifications in standard whole blood procedure for lymphocyte phenotyping have significantly increased the stability of light scatter and fluorescence intensity of the cells for subsequent flow cytometry (FC) analysis. These changes include removal of lysis solution prior to fixation, fixation of monoclonal antibody-stained cells in 1% paraformaldehyde for 30 minutes and storage of fixed samples in medium containing 1% bovine serum albumin. Lymphocyte subsets and their functional subsets could reliably be determined on samples stored for up to 4 weeks. Further, blood samples could be kept at room temperature for up to 96 hours or at ambient temperature during transportation from Africa before staining for FC without affecting their quantitation. While samples could be processed for FC analysis under field-laboratory conditions, proliferation assays could only be performed on samples that were transported within 48 hours of their collection. The whole blood method saves time and expense and decreases the volumes of blood required to perform phenotypic analysis and functional assays on specimens collected in remote areas.

Knowledge and Attitudes Towards HIV/STD Among Indian Adolescents

ABSTRACT This is a secondary data set of a study conducted in 1996 among 1230 Indian students in the 11th and 12th grades in Bombay. The aim of the study is to examine the relationship of knowledge, health beliefs, attitudes, and risk behaviors to HIV/STD risk intentions among Indian adolescents and also to examine predictive utility of the Health Belief Model (HBM). Correlations, multiple regression, and logit regression were applied to predict the variables related to the HBM dimensions. The overall explanatory power of the models for either dimension of the HBM or preventive intention with knowledge about HIV/STD was modest. These results suggest that either the models are lacking some important variables or the measurement of key variables is inadequate. Another limitation is that the data collection tool was a secondary subset, and only some relevant questions were chosen to examine the aim of the study. The HBM is partially, but significantly, related to the likelihood of recommendation of preventive intention changes. Individual perception of a disease is more likely to depend upon the language spoken at home because Indian adolescents may assimilate health messages more completely when those messages are conveyed in the local language. Parent education levels do not influence preventive intention changes. However, it was observed that a low level of maternal education encouraged childrens preventive intention. Girls especially have shown a higher intention to practice safer sex behaviors. Knowledge about HIV/STD appears to influence preventive intention to practice safer sex behaviors. It is very important to teach Indian adolescents the proper use of condoms, and such education should be given in the local language. Indian male adolescents are more likely to report that they engage in risky behavior than female adolescents. Indian adolescents need greater access to relevant health education.

AIDS-Related Social Anxieties, Social Skills and Sexual Activities in Indian College Students

ABSTRACT The objective of this study was to determine the relationships between social skills/anxieties in HIV/STD prevention and actual and anticipated sexual behaviors in year 11 and 12 Indian college students. A quantitative questionnaire examining HIV and STD risk behaviors, knowledge, attitudes and beliefs, and the AIDS Social Asser-tiveness Scale (ASAS) were administered to 1230 year 11 and 12 Indian college students. The 5 scales of the ASAS were scored and compared between three groups: those who had had sexual experience (HS), those who anticipated being unable to refuse sex (AS), and those who did not anticipate problems in refusing sex (DS). Those in the AS group had significantly greater anxieties about refusing sexual or other risk behaviors than the HS and DS groups, and there were also significantly greater anxieties about dealing with condoms in the AS and DS groups compared with the HS group. Confiding sexual or HIV/STD related problems to significant others was considered more anxiety-provoking for the AS group compared with the HS group, and the AS group were more anxious about interactions with people with HIV. Factor analysis produced the same 5 dimensions as those found in previous studies. Condom interactions and confiding in significant others were most anxiety provoking. It is concluded that social skills training in sexual negotiations, condom negotiations, and confiding HIV/STD-related concerns to significant others should reduce the risks of Indian college students having unwanted or unprotected sex.

Designing appropriate intervention strategies for HIV/AIDS in southern Africa

Zambias estimated 190 population was 8.1 million of whom 43% resided in cities. 1000 health care facilities are spread throughout 9 provinces and comprise village and district health clinics as well as provincial hospitals and the University Teaching Hospital (UTH) in Lusaka. A national sexually transmitted disease (STD) control program was launched in 1980 by the Ministry of Health to initially assess the extent of diseases on the basis of sample surveys and ultimately make preventive and curative interventions. The 1987 annual incidence of STDs in the adult population was 18/1000 with the male: female ration of 1.7:1. Genital ulcers due to syphilis or chancroid comprised more than 50% of new STD cases with the remainder resulting from gonorrhea chlamydia or trichomonias vaginalis. HIV seroprevalence surveys among antenatal women delivering on labor wards at the UTH show an increase from 8.6% to 22% over the period 1985-90; the level of male HIV seroprevalence increase is probably the same or greater. Risk factors among sexually active male adults are blood transfusions travel outside of Zambia and positive serological tests for syphilis; while blood transfusion and history of venereal disease are risk factors for female adults. Adults having had more than 50 sex partners are at highest risk for HIV infection; circumcised men have a significantly lower prevalence of HIV compared to uncircumcised men; and the female practice of removing vaginal secretions with a cloth to increase penile-vaginal friction increases the risk of transmission. Studies indicate however that condoms used alone or with spermicides are not effective in preventing the sexual transmission of HIV except in highly motivated couples. The cost and availability of condoms limit their use while the importance of their need is poorly recognized by health agencies. It is estimated from blood tests and interviews that 2.6 million Zambians between ages 15-34 years are at risk of HIV infection. Constrained by the lack of available resources to provide condoms on mass scale Ministry of Health programs reach out to diagnose and treat STD patients and partners and provide them with condoms. Primary and secondary syphilis and chancroid are the 2 most important STDs which may increase the risk of HIV transmission. Both can usually be cured with single doses of antibiotics.