Epidemiologic Notes and Reports Positive HTLV-III/LAV Antibody Results for Sexually Active Female Members of Social/Sexual Clubs -- Minnesota

In June 1986, two sexually active women in Minnesota were found to have antibody to human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV).* Both belonged to social/sexual clubs whose stated purpose was to provide their members (primarily couples) with opportunities for social and sexual contacts.** Each of the two seropositive women reported having sexual contact with a number of other persons from these clubs, including two men who were bisexual.

Infection was detected in these two women during a serologic screening program conducted by the St. Paul Division of Public Health, in consultation with the Minnesota Department of Health. This screening was undertaken because members of these clubs were known to have been involved in outbreaks of other sexually transmitted diseases (including syphilis and gonorrhea). From a total of 285 members (143 women and 142 men) of two of these social/sexual clubs in the Minneapolis-St. Paul area, 134 volunteers were tested with an enzyme-linked immunosorbent assay (ELISA) for antibody to HTLV-III/LAV in June and July 1986. Any ELISA-positive specimens were also tested with the Western blot assay. All 75 men tested had negative ELISA results for antibody to HTLV-III/LAV. Two of 59 women tested had positive antibody test results for HTLV-III/LAV with both ELISA and Western blot. Antibody results for these women were again positive with ELISA and Western blot when repeated 6 weeks later. The seroprevalence rate of 3% among female club members tested is significantly higher than the seroprevalence rate of zero (none of 56,000) among female blood donors in Minnesota.

The two seropositive women had belonged to two different social/sexual clubs for approximately 2 years. Both denied intravenous drug use, a history of blood transfusions, or receipt of clotting factor concentrates. One woman was 31 years old, married, and had sexual relations only with other club members; her husband (also a member) had negative test results for HTLV-III/LAV antibody. The other woman was 25 years old, unmarried, and occasionally had sexual relations with men outside the club.

Each of these two women reported having had sexual contact with more than 25 other club members, including five men with whom they had both had sexual intercourse. Two of these five men could be located for testing and had negative results for HTLV-III/LAV antibody. Two of the other three men whose serologic status could not be determined were reported to be bisexual men with whom both women had had repeated vaginal and anal intercourse.

An additional bisexual man who was a former member of one of these clubs is known to have developed acquired immunodeficiency syndrome (AIDS). He had no history of sexual contact with either of the seropositive women or with either of the two bisexual men who had sexual contact with these women.

To date, 55 of the 134 club members tested for antibody to HTLV-III/LAV (including the two seropositive women) have participated in follow-up interviews and have received counselling about their sexual practices and attitudes. Four (15%) of 27 men reported homosexual contact with other club members as well as with men who were not members of either of the two clubs. When asked whether they perceived themselves as being at increased risk of having AIDS, 40 members (73%) replied that they did not. One man reported that he "usually" used condoms while having sexual intercourse. When asked whether they would continue to participate in the activities promoted by social/sexual clubs if they knew such activities were associated with a high risk of having AIDS, 54/55 (98%) answered that they would not.

When it was known that one member of each of the two clubs was positive for HTLV-III/LAV antibody, both clubs disbanded. In an effort to minimize the transmission of HTLV-III/LAV, educational programs for sexually active adults (including former club members) are currently being implemented in the Minneapolis-St. Paul area. Follow-up studies of former club members are planned to assess whether other changes in sexual behavior are occurring. Reported by K Henry, MD, St. Paul Div of Public Health, St. Paul Ramsey Medical Center and the University of Minnesota School of Medicine; KL MacDonald, MD, MT Osterholm, PhD, MPH, State Epidemiologist, Minnesota Dept of Health; AIDS Program, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The risk of having HTLV-III/LAV infection and other sexually transmitted diseases is increased for persons who have multiple sexual partners as well as for persons who have sexual encounters with high-risk individuals (2-5). However, most members of two social/sexual clubs in Minnesota who were interviewed did not consider themselves at increased risk of having AIDS and did not take precautions to protect themselves against AIDS or other sexually transmitted diseases.

Both seropositive women discussed above had a history of multiple sexual encounters--including vaginal and anal intercourse--with high-risk individuals. Although receptive anal intercourse is associated with increased risk of HTLV-III/LAV infection for homosexual men, most women infected with HTLV-III/LAV through sexual contact have denied having had anal intercourse (6-11).

To reduce the risk of HTLV-III/LAV infection, the Public Health Service recommends avoiding sexual contact with multiple partners or with persons who have been sexually active with multiple partners (2,4,5). Persons who do not follow this recommendation and who a) initiate a sexual relationship with another person who is at increased risk of having HTLV-III/LAV infection or b) maintain multiple sexual partnerships should at least avoid sexual practices that permit the exchange of blood, semen, urine, feces, saliva, or vaginal/cervical secretions. Consistent use of condoms may reduce transmission of HTLV-III/LAV (12). Other efforts to reduce HTLV-III/LAV transmission include making available voluntary serologic testing and health education and counselling for all persons believed to be at increased risk of having HTLV-III/LAV infection (4).

References

1. North American Swing Club Association. International directory swing clubs and publications. Buena Park, California: NASCA, 1986.

2. CDC. 1985 STD Treatment Guidelines. MMWR 1985;34:75S-109S.

3. CDC. Heterosexual transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus. MMWR 1985;34:561-3.

4. CDC. Additional recommendations to reduce sexual and drug abuse-related transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus. MMWR 1986;35:152-5.

5. Office of the Assistant Secretary for Health. Surgeon General's report on acquired immune deficiency syndrome. Washington, DC: Public Health Service, 1986:15-6.

6. Goedert JJ, Sarngadharan MG, Biggar RJ, et al. Determinants of retrovirus (HTLV-III) antibody and immunodeficiency conditions in homosexual men. Lancet 1984;2:711-6.

7. Groopman JE, Mayer KH, Sarngadharan MG, et al. Seroepidemiology of human T-lymphotropic virus type III among homosexual men with the acquired immunodeficiency syndrome or generalized lymphadenopathy and among asymptomatic controls in Boston. Ann Intern Med 1985;102:334-7.

8. Nicholson JK, McDougal JS, Jaffe HW, et al. Exposure to human T-lymphotropic virus type III/lymphadenopathy-associated virus and immunologic abnormalities in asymptomatic homosexual men. Ann Intern Med 1985;103:37-42.

9. Kreiss JK, Kitchen LW, Prince HE, Kasper CK, Essex M. Antibody to human T-lymphotropic virus type III in wives of hemophiliacs. Evidence for heterosexual transmission. Ann Intern Med 1985;102:623-6.

10. Peterman TA, Stoneburner RL, Allen JR. Risk of HTLV-III/LAV transmission to household contacts of persons with transfusion-associated HTLV-III/LAV infection. Presented at the International Conference on the Acquired Immunodeficiency Syndrome (AIDS), Paris, France, June 1986.

11. Saltzman BR, Harris CA, Klein RS, et al. HTLV-III/LAV infection and immunodeficiency in heterosexual partners (HP) of AIDS patients. Presented at the International Conference on the Acquired Immunodeficiency Syndrome (AIDS), Paris, France, June 1986.

12. Mann JM, Quinn T, Francis H, et al. Sexual practices associated with LAV/HTLV-III seropositivity among female prostitutes in Kinshasa, Zaire. Presented at the International Conference on the Acquired Immunodeficiency Syndrome, Paris, France, June 1986.

*The AIDS virus has been variously termed human T-lymphotropic virus type III (HTLV-III/LAV), lymphadenopathy-associated virus (LAV), AIDS-associated retrovirus (ARV), or human immunodeficiency virus (HIV). The designation "human immunodeficiency virus" (HIV) has been accepted by a subcommittee of the International Committee for the Taxonomy of Viruses as the appropriate name for the retrovirus that has been implicated as the causative agent of AIDS (Science 1986;232:697). **These clubs are popularly known as "swing clubs". A national organization lists more than 100 such clubs (1).

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