Describing the HIV/AIDS epidemic: using HIV case data in addition to AIDS case reporting

PURPOSE: We examined the demographic and risk characteristics of persons with HIV using traditional AIDS case reporting and the more recent system that includes HIV diagnoses without AIDS. METHODS: Using data from 25 states with HIV reporting of HIV/AIDS cases diagnosed from 1994 through 2001, we calculated percentage distributions, annual diagnosis rates, and estimated annual percent change (EAPC) for persons with HIV (all HIV diagnoses with or without AIDS) and persons with AIDS. RESULTS: The age at diagnosis of persons with all stages of HIV tended to be younger than that of the subset of persons with AIDS. Annual diagnosis rates decreased more among AIDS cases (men: EAPC, - 9.76; 95% CI, - 12.00, - 7.45; women: EAPC, - 3.40; 95% CI - 5.72, - 1.02) than for persons with HIV (men: EAPC, - 6.14; 95% CI, - 7.66, - 4.60; women: EAPC, - 2.99; 95% CI, - 4.15, - 1.82), except among women and black non-Hispanics, for whom the difference in the decreases in rates for both disease groups were small. Injection drug use was a more common mode of exposure for women with AIDS than for women with HIV. CONCLUSIONS: The epidemiology of HIV differs for certain key population groups from that of AIDS.     

Health and economic impact of HIV/AIDS on South African households: a cohort study

Background  

South African households are severely affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) but health and economic impacts have not been quantified in controlled cohort studies.     

Asia--the new epidemic zone for HIV/AIDS

Two articles that appear in this journal present unique ethnographic assessments of the commercial sex industry in Thailand. They discuss how culture, society, and organizations interact with respect to communication approaches, information dissemination, and organizational-behavior change in preventing the spread of HIV/AIDS. Each of these articles provides important insights into the many factors that have intensified the epidemic as well as those identified opportunities for concerted community organization, behavioral reinforcement, and social structural approaches for HIV/AIDS prevention and control.     

元江县历年艾滋病疫情监测结果分析

[目的]分析元江县1997年～2008年12年间的艾滋病疫情,针对疫情提出建议,为政府和相关部门全面开展艾滋病防治工作,有效遏制艾滋病的传播和蔓延提供决策依据。[方法]收集和整理元江县1997年～2008年HIV／AIDS人员的相关信息,分别从历年检出人数、人群构成、传播途径、性别构成、年龄构成、职业构成、地区分布、疾病状态等方面进行分析。[结果]元江县艾滋病疫情已进入中度流行期,呈逐年发展蔓延趋势,传播途径由之前的吸毒传播为主发展到现在的性传播为主,感染人群由以高危人群为主发展到以一般人群为主,感染者以20岁～39岁为主,感染者的身份以农民为主,感染者主要集中在县城所在地澧江镇,全县14个乡镇农场中除洼垤乡外均发现感染者。[结论]元江县艾滋病疫情呈发展蔓延趋势,必须进一步加大人力、物力投入,积极采取有效措施,落实各级各部门职责,加大宣传、培训、监测及行为干预工作力度。     

The global HIV and AIDS epidemic, 2001

Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are pandemic and pose one of the greatest challenges to global public health. As a bloodborne and sexually transmitted infection, HIV has variable patterns of transmission and impact among world regions and has disproportionately affected disadvantaged or marginalized persons such as commercial sex workers, injection drug users, men who have sex with men (MSM), and persons living in poverty. HIV infection has caused approximately 20 million deaths; an estimated 36 million persons are infected (Figure 1). On the basis of data from the Joint United Nations Program on AIDS (UNAIDS) and other sources, this report summarizes epidemiologic trends, highlights several HIV and AIDS prevention milestones, and describes some prevention activities for the coming decade.     

The shape of the HIV/AIDS epidemic in Puerto Rico.

This study presents information on AIDS patients in Puerto Rico, including their general sociodemographic profile, some risk-related parameters, characteristics of vulnerable groups, and elements of the clinical spectrum of the disease. Data were analyzed from the Puerto Rico AIDS Surveillance Program and available studies about the HIV/AIDS epidemic in Puerto Rico. A total of 23,089 AIDS cases was reported to the Puerto Rico AIDS Surveillance Program from January 1981 through February 1999. The HIV/AIDS epidemic has affected mostly males and females between the ages of 30 and 49, though cases have also been reported for other age groups. The cumulative proportion of persons with AIDS who are women has increased tremendously, from 11.4% for the 1981-1986 period to 21.6% for the entire 1981-1999 period. In Puerto Rico the category of injecting drug users (IDUs) accounts for the majority of the AIDS cases (52%), followed by heterosexual contact (22%), and men who have sex with men (17%). The three main diagnoses for AIDS on the island are wasting syndrome (30.7%); esophageal, bronchial, and lung candidiasis (29.4%); and Pneumocystis carinii pneumonia (26.8%). According to 1994 vital statistics for Puerto Rico, AIDS was the fourth-leading cause of death. The overall reported AIDS mortality rate was 42.0 per 100,000 persons, with the rate for males, 67.8, much higher than it was for females, 17.4. AIDS is the first cause of death among persons between 30 and 39 years old. Intense efforts are needed to better understand the epidemic in Puerto Rico and its biology, social and family impacts, and financial costs.     

对823例艾滋病感染者／病人的疫情分析

[目的]对宣威823例HIV感染者进行分析，提出建议，为政府和相关部门全面开展艾滋病防治工作，有效遏制艾滋病的传播和蔓延提供决策依据。[方法]收集和整理宣威自开展艾滋病防治工作以来至2007年12月底前累计发现的823例HIV感染者的相关信息，分别从性别、年龄、民族、职业、婚姻状况、文化程度、地区分布和传播途径等方面进行分析。[结果]宣威的艾滋病感染以注射吸毒传播为主，大多是20岁～49岁的青壮年人群，学历层次普遍较低，农民所占比例较大，未婚男性人数较多，主要集中在城区和城区附近乡（镇、街道）。[结论]必须进一步加大工作力度，积极采取过硬措施，真正做到市、乡、村一体，多部门联动、全社会参与，以确保宣传教育、咨询检测、告知随访及治疗关怀救助等工作措施落到实处。     

HIV infectiousness and the AIDS epidemic

The paper outlines a theory of the AIDS epidemic based on assumptions regarding the changes in infectiousness over the life cycle of the disease. It proposes a short initial period of infectiousness, followed by a long dormant period, which is in turn succeeded by another period of infectiousness, longer than the first period. Each of the two periods of infectiousness can generate an associated epidemic. It is suggested that the Western homosexual epidemic is based on initial stage infectiousness, while the African heterosexual epidemic is mainly the result of end stage infectiousness.     

HIV/AIDS in Vancouver, British Columbia: a growing epidemic

The prevalence of HIV in Vancouver, British Columbia was subject to two distinct periods of rapid increase. The first occurred in the 1980s due to high incidence among men who have sex with men (MSM), and the second occurred in the 1990s due to high incidence among injection drug users (IDU). The purpose of this study was to estimate and model the trends in HIV prevalence in Vancouver from 1980 to 2006. HIV prevalence data were entered into the UNAIDS/WHO Estimation and Projection Package (EPP) where prevalence trends were estimated by fitting an epidemiological model to the data. Epidemic curves were fit for IDU, MSM, street-based female sex trade workers (FSW), and the general population. Using EPP, these curves were then aggregated to produce a model of Vancouver's overall HIV prevalence. Of the 505 000 people over the age of 15 that reside in Vancouver, 6108 (ranging from 4979 to 7237) were living with HIV in the year 2006, giving an overall prevalence of 1.21 percent (ranging from 0.99 to 1.43 percent). The subgroups of IDU and MSM account for the greatest proportion of HIV infections. Our model estimates that the prevalence of HIV in Vancouver is greater than one percent, roughly 6 times higher than Canada's national prevalence. These results suggest that HIV infection is having a relatively large impact in Vancouver and that evidence-based prevention and harm reduction strategies should be expanded.     

HIV/AIDS in Vancouver, British Columbia: a growing epidemic

Manipur and Nagaland in northeast India report an antenatal HIV prevalence of > 1% and the current HIV prevalence among injecting drug users is 24% and 4.5% respectively. Through support from DFID's Challenge Fund, Emmanuel Hospital Association (EHA) established thirteen drop-in-centres across the two states to deliver opioid substitution treatment with sublingual buprenorphine for 1200 injecting drug users. Within a short span of time the treatment has been found to be attractive to the clients and currently 1248 injecting opioid users are receiving opioid substitution treatment. The project is acceptable to the drug users, the families, the communities, religious as well as the militant groups. The treatment centres operate all days of the week, have trained staff members, utilize standardized protocols and ensure a strict supervised delivery system to prevent illicit diversion of buprenorphine. The drug users receiving the substitution treatment are referred to HIV voluntary counselling and testing. As this treatment has the potential to change HIV related risk behaviours, what has been established in the two states needs to be continued and expanded with the support from the Government of India.     

河南省艾滋病流行特征分析

目的分析河南省艾滋病（acquired immunodeficiency syndrome,AIDS）流行特征。方法下载历年全省各种途径发现并报告的艾滋病病毒感染者和患者（people living with HIV／AIDS,）个案资料及随访信息,建立数据库并进行统计分析。结果截至2008年底全省累计报告PLWHA 42879人,其中69．05％是经既往有偿供血感染,病例分布呈明显的聚集性。2008年报告病例中异性性传播占26．64％,通过检测咨询发现病例1802例,占49．59％。结论河南省艾滋病病毒（human immunodeficiency virus,HIV）感染主要集中在既往有偿供血人群,但经采供血传播已被阻断。性传播的比例增加,提示应加强高危人群的行为干预。检测咨询成为发现PLWHA的主要途径。     

HIV/AIDS疫情估计与预测方法

（HIV／AIDS）易感高危人群的特殊性、感染人群的隐匿性、社会歧视以及感染人群的健康意识普遍淡薄导致艾滋病病毒（HIV）抗体检测率较低，使得HIV／AIDS病例报告数不能真实反映HIV／AIDS疫情状况。因此在病例报告数与实际感染情况差异较大的地区HIV／AIDS疫情估计成为了解人群实际感染情况的重要手段。HIV／AIDS估计预测是掌握艾滋病流行现状及趋势、政策开发、项目设计和评价以及资源配置的基础。自20世纪80年代以来，国内外在相关方法上进行了大量的研究和实践，取得了明显的进展。从1997年以来，为了解HIV／AIDS的流行程度和速度及其对当地社会的影响，联合国艾滋病规划署（UNAIDS）以及世界卫生组织（WHO）每半年对各国的HIV／AIDS流行情况做出评估。并根据估计结果，决定抗HIV／AIDS的国际资源如何分配到各个国家。     

中国艾滋病流行的一些新动向

2010年9月22日,温家宝总理在联合国千年发展目标与艾滋病讨论会上宣布:目前,中国艾滋病快速蔓延的势头基本得到遏制,病死率显著降低,感染者和病人的生活质量明显改善.我们有信心在2015年实现艾滋病防治领域的千年发展目标.     

乌鲁木齐市1995～2011年艾滋病疫情分析

目的 分析乌鲁木齐市艾滋病流行特征,为制定有效可行的防治对策提供科学依据.方法 对10 536例艾滋病病毒感染者/艾滋病病人(HIV/AIDS)个案报告资料进行统计学分析.结果 截止2011年底,累计发现HIV/AIDS10 536例,其中AIDS 1 665例,死亡报告997例.男性占69.98％,女性占30.02％; 20～39岁组病例占80.17％;累计报告以经注射吸毒感染为主,占62.03％,但2011年新发病例中性传播构成比已超过经注射感染途径,占52.90％.结论 乌鲁木齐市艾滋病疫情总体呈持续增长态势,经性传播引起的HIV/AIDS越来越多,需采取有效措施以遏制艾滋病疫情的蔓延.     

Modeling the HIV/AIDS epidemic via survivor functions

An original approach to simulation modeling of the HIV/AIDS epidemic is proposed. This approach uses survivor functions estimated from cohort studies conducted with seropositive and AIDS-diagnosed individuals. The model can be considered an alternative to the usual Markov models and accounts for time-dependent HIV progression to AIDS, and AIDS progression to death. By using various forms of survivor functions, it can also easily be extended to accommodate natural history events, as well as long-term survivors and cofactor effects, when appropriate data are available.