Should we be tracking AIDS virus transmission in India?

In India HIV infection was 1st found among prostitutes in Madras city in February, 1986. The government and the Indian Council of Medical Research set up 40 surveillance centers equipped with enzyme-linked immunosorbent assay readers and HIV antibody test kits. In 1987, a rural middle-aged breadwinner received a blood transfusion for ulcers and contracted AIDS. The donor was traced and found to be infected with HIV, as were also his wife and child. He had had sexual intercourse with prostitutes in 1984. In 1988, a 3rd man was found to have AIDS; he had had homosexual contacts with many partners. The country's rapid mobilization against AIDS has been criticized on grounds that India has more pressing problems. However, the public health efforts against AIDS have not been diverted from any other program, and if a similar campaign had been mounted against hepatitis B virus infection, many lives would have been saved. 1% to 3% of patients in venereal disease clinics in Vellore have been found to be HIV-positive, and the rate of HIV infection in blood banks is 1.6/1000 donors, which indicates that there are probably 500,000 people already infected with AIDS in India. The Indian government's response to the impending AIDS epidemic should serve as a model in the fight against other communicable diseases.     

Towards effective policies and strategies for control of HIV / AIDS

As of July 31, 1996, 2639 AIDS cases had been reported to India's National AIDS Control Organization, more than 75% of which are thought to be the result of HIV transmission through unprotected heterosexual intercourse. The screening of blood samples from almost 3 million individuals found an HIV-seropositivity rate of 15.97/1000 population. The level of HIV prevalence varies across the country. An estimated 5 million people will have been infected with HIV in India by 2000 if the rate of infection remains at the current level. The National AIDS Control Program launched in India in 1987 has been strengthened and consolidated for 1992-97. However, with HIV infection and AIDS continuing to spread in India, a new and better approach to prevention and control is needed. The HIV pandemic is most severe in places and among people facing obstacles to learning and effecting behavioral change. Belonging to a discriminated, marginalized, or stigmatized groups reduces personal capacity to learn and respond. Interventions are therefore needed to reduce the societal risk factor of discrimination in order to strengthen the personal capacity of people who are most vulnerable to HIV/AIDS. Policies and strategies to address various HIV/AIDS-related concerns are offered.     

HIV / AIDS in South-East Asia: an update

As of July 1, 1996, 1,393,649 cumulative AIDS cases in adults and children had been reported to the World Health Organization (WHO) from 193 countries since the beginning of the pandemic. HIV infection is a serious public health and developmental problem in southeast Asia, with the WHO estimating more than 3.7 million people to be infected with HIV in the region. This infection extends into the general population and is not confined among people who practice high risk behaviors. As of July 1, 1996, Thailand, India, and Myanmar had reported the largest number of AIDS cases: 41,230, 2940, and 1093, respectively. However, WHO estimates that 2.5 million people are actually infected in India, 800,000 in Thailand, 350,000 in Myanmar, and 95,000 in Indonesia. While Bhutan and North Korea have not yet reported AIDS cases, people in Bhutan have been diagnosed with HIV infection. The health and socioeconomic impact of HIV/AIDS, national plans and programs, the 100% condom use program in Thailand, peer education among sex workers in Calcutta, WHO support for country responses, advocacy and support, promoting appropriate HIV prevention strategies and interventions, HIV/AIDS care as part of primary health care, HIV/AIDS and STD surveillance, and the future role of WHO are discussed.     

TB and AIDS

The Indian National Tuberculosis Survey has indicated that 10 million persons above 5 years of age have pulmonary tuberculosis (TB), of whom 2.5 million are infectious. The annual infection rate amounts to 1.5%. In an average district with a population of 1.5 million, there are about 500 active, infectious TB cases and about 20,000 radiologically active cases. The World Health Organization has declared TB a global health emergency. The pandemic of AIDS had infected 13 million people worldwide by early 1993, and by the year 2000 over 40 million will be infected. In May 1986 only 1 AIDS case was reported, but by May 31, 1994, 728 cases of AIDS and 15,325 cases of HIV infections were reported. At the present rate of infection, there will be 5 million people infected with HIV by 2000 in India. HIV infection is the greatest risk factor for developing TB because of the multiplication of tubercle bacilli in quiescent foci, the progression of dormant infection to disease, and superinfection. The incidence of TB has doubled in the course of 5 years in some countries where HIV is epidemic. 30-70% of TB patients in these countries are estimated to be HIV-positive, imposing significant burden on national health services. On the other hand, efficient health services can still cure TB in HIV-positive patients and forestall the spread of the diseases. One-third of the world's population is infected with TB, and the lives of these people are shortened if they contract HIV. Worse still, for HIV-infected people exposure to TB means death, often within weeks. The only protection against the airborne TB germ is the complete cure of TB patients. At a 1993 conference in London several TB control measures were suggested: national TB control programs offering affordable treatment; faster diagnosis; education and incentives to increase patient compliance; proper drug supplies and quality control; education of influential people; and fight against poverty.     

Progress in efforts to prevent the spread of HIV infection among youth.

The Human Immunodeficiency Virus (HIV) that causes AIDS will continue to threaten public health for years to come. Despite some popular misperceptions, adolescents are at risk of infection. Twenty percent of persons reported with AIDS have been ages 20 through 29. Given the long incubation period between HIV infection and AIDS, some of these young adults probably were infected while they were teenagers. Young people must develop the skills they will need to avoid HIV infection and other related health problems. In 1987, the Centers for Disease Control (CDC) launched a national program to help schools and other agencies that serve youth across the nation provide effective health education to prevent the spread of HIV. CDC supports and works closely with national health and education organizations, State and local education agencies, colleges and universities, and local health departments to establish HIV prevention policies and programs, training and demonstration centers, information development and dissemination activities. The impact of these efforts are assessed through applied surveillance and evaluation research. Through this system, CDC is attempting to institutionalize the means for continuously providing educational programs that will be effective in preventing HIV infection and other important health problems.     

宜春市高危人群HIV感染调查

目的：了解全市高危人群艾滋病病毒感染状况，为采取干预措施，控制艾滋病流行提供依据。方法：2001年～2003年对全市4种高危人群1565例进行了血清HIV—Ab检测和调查。结果：共检出HIV感染者6例，均为HIV—Ⅰ型，HIV感染率为0．38％。感染者为血源传播4人，其中静脉吸毒人员3人；普通人群(输白蛋白)1人；性传播2人。感染者5例为本市人，1例来自外市(吸毒者)。结论：我市HIV感染已由高危人群向普通人群转移，要控制艾滋病在我市蔓延，向全民进行HIV／AIDS宣传教育，控制传染源，切断HIV经血源和性接触传播显得尤为重要。     

Knowledge of HIV / AIDS among migrants in Delhi slums

Over the past decade, there has been a sharp increase in the reported and estimated numbers of HIV/AIDS cases in India. The UNAIDS estimates that up to 3 million people in India may be infected with HIV, of which 70-80% were infected through unprotected heterosexual activity. Findings are presented from an assessment of HIV/AIDS-related knowledge and awareness among slum dwellers in Delhi, India, and which factors affect that knowledge. To explore the links between socioeconomic, health, and migrant status generally, a survey was conducted in 1996 among 150 slum households from different parts of the city. The slum dwellers were all migrants from other states, living for at most 15 years in Delhi. All 361 adults in the selected households were interviewed. Despite significant investment in IEC activities by the State AIDS Cell over the past decade, respondents were found to be poorly informed about HIV/AIDS and how it is spread. The probability of having better knowledge about HIV/AIDS was higher among younger, more educated individuals, as well as among those who owned televisions and lived in certain zones.     

AIDS: the plateau?

Noting the difficulty in changing sexually promiscuous behavior, the author examines the available treatments and preventive agents for AIDS. AIDS poses a serious health and economic threat to the world, considering that by the turn of the century, some 40-50 million people will be infected. Infection through sexual contact continues to increase at an alarming rate. 30% of all prostitutes in India are infected with the virus, and in Bombay, some 6000 men get infected through sexual contact with prostitutes every month. In some ways, the AIDS epidemic parallels the outbreak of syphilis in the later part of the 19th century. Despite the lack of cure for syphilis at this time, sexual behavior went unchanged. AIDS differs, however, in that the carriers of the disease can remain symptom free for up to 2-15 years or more. During this period, the HIV virus integrates itself into the host's genetic constitution, targeting the cells of the lymphoid cell system and cells situated in the mouth and genital linings, eventually destroying the immune system. The fields of immunology, virology, chemotherapy, and genetic engineering have made great strides in AIDS research. And despite of a high cost, the drug aziodothymidine (AZT) has succeeded in extending the lives of many patients. But a cure does not appear to be in the near future. Fortunately, condoms and spermicidal agents have been shown to protect against infection. The spermicidal agents Nonoxynol-9 and cycloheximide possess anti-HIV properties. Furthermore, another spermicide, cholorhexidine, can be used as a mouth wash to protect from infection after oral sex. Since history has shown the difficulty of changing sexual behavior, efforts should focus on preventing viral spread.     

HIV and AIDS: where is the epidemic going?

Routine surveillance of HIV (human immunodeficiency virus) infection and AIDS has been established over the past decade in many countries around the world. HIV estimates derived from empirical data are essential to the assessment of the HIV situation in different parts of the world and trends are used in tracking the development of regional epidemics, thereby keeping intervention activities focused on realities. As of the end of 1995, and following an extensive country-by-country review of HIV/AIDS data, a cumulative total of 6 million AIDS cases were estimated to have occurred in adults and children worldwide and currently 20.1 million adults are estimated to be alive and infected with HIV or have AIDS. Of the total prevalent HIV infections, the majority remain concentrated in eastern, central and southern Africa, but the epidemic is evolving with spread of infection from urban to rural areas, as well as to West and South Africa, India and South-east Asia, and to a lesser extent--with proportional shifts to heterosexual infections--in North America, western Europe and Latin America. While the longer-term dimensions of the HIV epidemic at global level cannot be forecast with confidence, WHO currently projects a cumulative total of close to 40 million HIV infections in men, women and children by the year 2000. By that time, the male:female ratio of new infections will be close to 1:1. Recent trends indicate that HIV prevalence levels may be stabilizing or even decreasing among pregnant women in southern Zaire and parts of Uganda, among military recruits aged 21 in Thailand, and in some populations of northern Europe and the USA. While these changes may take place as part of the intrinsic dynamic of the epidemic, there is some evidence that declines in HIV prevalence are related to declines in HIV incidence which are, at least partly, due to prevention efforts. The challenge of surveillance and evaluation methods is now to identify the ingredients of success which may reveal a glimmer of hope.     

Sexual risk behavior among people living with HIV/AIDS in Togo

Since HIV in Africa is spread primarily through unprotected sex, safe sex practices such as condom use can reduce HIV spread significantly. Nevertheless, because sexual behavior involves complex dynamics, condom use is not an easy option for many people in Africa despite years of condom distribution intervention. In fact, the complex nature of sexuality complicates efforts to combat HIV spread and limits the effectiveness of many prevention efforts. This paper uses theoretical explanations--social representation theory, situated rationality theory, and social action theory--to examine the patterns of sexual risk behavior and the underlying reasons and rationalization among people living with HIV/AIDS in Lomé, Togo. Qualitative interviews were conducted with 151 people living with HIV/AIDS, recruited from 3 HIV/AIDS centers. The results of this in-depth study suggest that although people living with HIV/AIDS may be aware of the risk of infecting their sexual partners, they deliberately ignore the risk because other considerations, such as wanting a baby, take precedence. Consequently, condom access is inadequate to change risky sexual behavior that spreads HIV. It must be supplemented with adequate empowerment.     

从回国人员HIV感染的配偶中检出2例HIV感染者的报告

本文报道了汕头卫生检疫局通过对出国探亲回归人员艾滋病病毒感染者的配偶进行艾滋病监测，发现2例女性感染者，流行病学调查结果证实这2例感染者受感染的可能性最大的原因．均是由其在泰国探亲期间感染了艾滋疯病毒的丈夫回归经性接触而感染的．作者认为；为预防和控制艾滋病传播，必须加强预防艾滋病的宣传教育；要加强艾滋病检疫、监测；要采取综合治理的措施，并从法制建设上加强对感染者的监测管理。     

Leveraging the power of the media to combat HIV/AIDS

Improving HIV/AIDS prevention efforts, especially those focused on young people, is a key challenge in the fight against the pandemic. Since the mid-1990s the Henry J. Kaiser Family Foundation has partnered with U.S.-based media companies on comprehensive HIV/AIDS campaigns. This paper outlines the unique public education model that it is using, and how Kaiser is expanding this work globally by working with some of the largest media companies in the world to undertake new initiatives in Russia and India.     

We are all people living with AIDS: myths and realities of AIDS in Brazil

Although AIDS was expected in Brazil, no serious efforts were undertaken to prevent AIDS from taking root. Irresponsible press and media coverage highlighted the spread of AIDS within the gay community of the United States, creating an aura of immunity in Brazil to what was characterized as a "foreign" disorder. When AIDS did surface in 1983, the official response was to adopt an abstract, inappropriate, and ideological "Western" model, in which only stigmatized "others" and "minorities" were at risk of HIV infection. Brazilian health authorities subsequently downplayed the significance of the sale of contaminated blood in HIV transmission, and likewise ignored the rising rates of AIDS among Brazil's one unarguable majority group: the poor. An analysis of efforts to force the "facts" of AIDS to fit a false model's predictions leads to a clearer definition of the broader context of the Brazilian epidemic: we all are people living with AIDS, precisely because we live in this age of AIDS; it is sheer folly to discriminate against persons infected by HIV and to obstruct their participation in efforts to curtail the epidemic's spread; and the necessary response to AIDS is solidarity, not because it is poetic, but because no other response will suffice.     

扬中市2011年-2015年51例HIV抗体检测结果分析

目的:探讨扬州市HIV患者(人类免疫缺陷病毒)感染情况.方法:选取2011年1月~2015年7月在扬州市进行专题调查,术前检查和性病门诊等41960例受检人员,所有人员均接受HIV抗体检测,对检测结果进行回顾性总结、分析.结果:41960例受检人员经实验室确证为HIV感染有51例,HIV感染率为0.12%.近五年的HIV感染率呈现一定的上升趋势.HIV感染者中,41~50岁年龄段HIV感染者所占比例显著高于其他年龄段(P<0.05).51例HIV感染者均为性接触感染,同性传播26例,异性传播25例.HIV感染者来源主要包括专题调查(25.49%),术前检测(15.69%),性病门诊(11.76%),羁押人员(9.80%).结论:HIV感染的年龄跨度较大,男多女少,且HIV感染率近年来有一定的上升趋势,应加大艾滋病知识的宣教力度,提高检测能力,同时对重点和高危人群加强监测,有效抑制艾滋病的传播和蔓延.     

Epidemiologische Entwicklung bei ausgewählten sexuell übertragbaren Infektionen (STI) in Deutschland

The number of people living with HIV infection has been increasing since the mid 1990s and is expected to rise further in the coming years. The HIV epidemic in Germany is still most affected by developments in the group of men who have sex with men (MSM). In this group, the number of newly diagnosed HIV infections has increased in recent years especially in large cities. Despite increased efforts to motivate HIV-infected people, who were not previously diagnosed, to be tested as early as possible and to seek medical treatment, the number of undiagnosed HIV-infected persons has increased. There are more people infected with HIV than those who have been tested positive for HIV and subsequently receive antiretroviral treatment. However, early testing and treatment alone are not sufficient to effectively contain the infection. Increased efforts are required to more effectively prevent new HIV infections by combining all the available options. In Germany as in all other developed countries, a stronger increase in the number of syphilis infections among MSM is reported, which is primarily due to a higher willingness to risk unprotected contacts, whereby the risk of HIV infection is also increased. The public prevention messages available for HIV are only partially effective against syphilis. More frequent examinations and optimized therapy management are necessary in addition to the use of condoms to prevent the spread of syphilis, gonorrhea, and Chlamydia trachomatis. Sustainable containment of new HIV infections must, therefore, be accompanied by both containment of sexually transmitted infections (STI) and use of public prevention messages for HIV/STI.     

Surveillance for the HIV infected

This article describes the efforts at early surveillance of HIV infection in India and calls for continued sentinel surveillance. The fact that Asia was the last continent to be affected by the AIDS has granted India an opportunity to contain the epidemic at an early stage. Seizing this opportunity, the Indian Council of Medical Research (ICMR) began an national serosurveillance program for the detection of HIV infection. This surveillance program has given health officials an idea as to the magnitude and major mode to transmission of HIV while the epidemic is still at an early stage. The 1st phase of the program began on October 1985 with the screening of 3027 people from high risk groups; 10 prostitutes were found to be infected with HIV. The 1st AIDS case was detected in May 1986. That same year, ICMR moved on to phase II, a national serosurveillance and clinical surveillance designed to gather information concerning the prevalence and major mode of transmission. The 2nd phase, which ended on October 1987, screened a total of 53,907 persons. 135 HIV and 14 AIDS cases were reported, indicating a low rate of infection even among high risk groups. The 3rd phase began in November 1987 and ended on October 1988. 109,632 individuals were screened, and 387 seropositive and 11 AIDS cases were detected. In 1990, a screening drug users in the state of Manipur showed an extremely high rate of infection. Drug users now compose the 2nd largest high- risk group after promiscuous heterosexuals. The surveillance findings have resulted in intervention measures, but sustained sentinel surveillance will be needed to provide midcourse corrections for ongoing intervention programs.     

中国老年人群HIV感染现况及行为学特征研究进展

在艾滋病研究领域,一般把≥50岁人群归于老年人,近年来国内多个地区报告新发现的老年HIV/AIDS病例有逐年上升趋势,老年病例晚发现比例较高。老年人艾滋病防治知识知晓率较低,艾滋病防护意识差,老年男性普遍仍存在性行为,相当比例存在非婚性行为,多通过婚外性行为感染HIV,老年女性多为婚内感染。老年人感染HIV后生理、心理均受到较大影响,治疗难度大,需要从多个维度进行医疗护理。目前国内针对性研究较少,值得开展相关研究。     

孕妇艾滋病知识认知现状调查与分析

目的：了解本区内孕产妇对艾滋病预防相关知识的知晓程度,为更好的对孕产妇开展艾滋病健康教育工作提供依据。方法随机抽取2013年11月在新疆乌鲁木齐市妇幼保健医院建卡或围产期保健的孕妇300例进行调查。结果被调查人群对艾滋病知识的总知晓率较低为77．00％（231/300）,调查对象对于目前可以通过干预措施阻止艾滋病母婴垂直传播不清楚,对与艾滋病感染者深接吻会传染艾滋病知晓率只有33．67％,与艾滋病感染者共用牙具剃须刀会传染艾滋病知晓率69．67％,蚊虫叮咬不会传播HIV知晓率43．67％。结论由于少数民族地区的特殊性,语言沟通能力的局限性,孕产妇获得预防艾滋病知识的渠道比较局限,少数民族地区孕产妇艾滋病健康教育有待进一步加强。     

Current CDC efforts to prevent and control human immunodeficiency virus infection and AIDS in the United States through information and education.

The human immunodeficiency virus (HIV) is estimated to have infected more than a million people in the United States and millions more in other countries. Even though there is no vaccine or effective treatment, HIV infection can be prevented through behavioral change. As the lead Public Health Service Agency for disease prevention, the Centers for Disease Control (CDC) has designed and implemented information and education activities with the ultimate goal of preventing HIV infection and AIDS in the United States. The target populations include the general public, school- and college-aged populations, persons infected or at increased risk of infection, minorities, and health workers. Because AIDS will be with us for a long time, CDC views educating the public as a long-term undertaking. The agency has initiated an intensive continuing national public information campaign, an informational brochure to be distributed to every U.S. household, a national AIDS information toll-free hotline, and a clearinghouse system that will maintain a comprehensive inventory of AIDS information resources and services. CDC also supports public information and education efforts by State and local health agencies. To reach school- and college-age youth, CDC, in consultation with governmental and national private sector organizations, developed guidelines for effective school health education to assist school health personnel in determining the scope and content of AIDS education. CDC also works with State and local education agencies to help carry out and evaluate educational efforts to prevent the spread of HIV among school- and college-age youth.(ABSTRACT TRUNCATED AT 250 WORDS)     

AIDS in New York City: the role of intravenous drug users.

The key to the future of the HIV epidemic is the intravenous drug user. In New York City the future has arrived--intravenous drug use is now the predominant risk factor among new cases of AIDS. Our limited knowledge of most facets of drug abuse prevention and treatment and the emotional polarity and politicalization of the issues surrounding AIDS have made control of its spread among intravenous drug users very difficult. Clearly new research efforts are needed better to decide how to reduce the further spread of HIV infection among this group. But efforts to stop the spread cannot await these results. Intense and immediate efforts should focus on five areas for potential control of the spread of HIV infection among drug users: education, treatment on demand, expanding support services, providing sterile equipment, and readjustment of some of society''s moral judgments that currently block action. Let us hope that in 10 years we do not look back and realize that we did too little too late while it was still possible to make a difference.