HIV-INFECTION AND HIGH-RISK BEHAVIOR AMONG PATIENTS ATTENDING AN STD REFERRAL CLINIC IN PRAGUE, CZECH-REPUBLIC

Objective: This survey was conducted to determine the prevalence of HI V infection and associated risk behaviour in a high risk population of clients attending an STD clinic in Prague, Czech Republic. Methods: B etween September 1994 and January 1995 clients entering the Apolinar S TD clinic in Prague, Czech Republic, were enrolled in a blinded, unlin ked HIV antibody seroprevalence study. Non-identifying demographic cha racteristics, STD diagnoses, HIV risk exposures, and voluntary HIV tes ting experience were extracted from medical charts. Results: Of 1394 p atients for whom serum was available for testing, one was positive for HIV (HIV prevalence 0.07%, 95% confidence interval (CI) 0.01, 0.41%). This person was one of 28 men having sex with men (MSWM) (HIV prevale nce among MSWM 3.6%, 95% CI 0.6, 17.7%). Among the 775 male clients, 7 5.5% had heterosexual unprotected sex, 11.1% had sex with high risk pa rtners or prostitutes, 3.6% were MSWM, 1.0% were injecting drug users (IDUs), 0.7% were both MSWM and IDUs, and 6.8% and 1.8% had other or n o recognised risk for HIV/STDs, respectively. Among the 619 female cli ents, 74.5% had heterosexual unprotected sex, 11.6% were prostitutes, 7.8% had sex with high risk partners, 1.1% were IDUs, and 3.9% and 2.3 % had other or no recognised risk, respectively. The 304 adolescent pa tients (age 11-19 years) differed significantly (p<0.05) in risk behav iour and STD diagnoses from the 1090 patients mho were 20 years and ol der. Adolescents were significantly more likely to be female (58.6% a 40.5%, OR=2.1), IDUs (3.6% a 0.4%, OR=10.2), prostitutes (8.9% a 4.7%, OR=2.0), and have sex partners with STDs (7.6% a 4.4%, OR=1.8). The a dolescent patients were also significantly more likely to be diagnosed with gonorrhoea (21.1% v 12.3%, OR=1.9) and non-gonococcal urethritis (27.6% a 17.2%, OR=1.8), and significantly less likely to have been t ested previously for HIV (19.1% a 31.9%, OR=0.5). Conclusions: HIV inf ection is currently uncommon in this population. However, the high rat es of unprotected sex, prostitution, injecting drug use, and STDs, esp ecially among adolescents, provide the basis for an epidemic in this p opulation, Aggressive prevention education should be started before ad olescence.