Report from the 3rd AIDS Impact Conference: culture, community, empowerment

Presentations made at the 3rd AIDS Impact Conferences in June 1997 in Melbourne, Australia are summarized. The presentations focused on the importance of local beliefs, practices, and sexual cultures as factors that impact HIV risk. The three dominant themes of this conference were a concern for community, an emphasis on culture, and empowerment for the most vulnerable groups. Speakers illustrated the importance of culture as a factor in the form, context, and meaning of sex among young men and women in Thailand, Australia, Italy, Cambodia, and the United States. Studies conducted in correctional facilities illustrate how the culture of sex and substance use can intensify the HIV risk. Papers examined the sexual revolution in China and the experiences of indigenous people in Brazil, Australia, and New Zealand. The presentations also highlighted drug use cultures among gay men in Australian and German cities and introduced new research methodologies for the analysis of these processes and issues. The closing presentation considered the politics of HIV and their relationship to national and international processes of negative societal responses to HIV diseases.     

Report from the 12th World AIDS Conference: the psychology of treatment. The difficult road from Geneva

The 12th World AIDS Conference confirmed that a gap still exists between the efforts of developed nations to combat AIDS and developing nations who have little or no access to care. For those who have access, the recommendation of combination antiviral therapy was balanced by questions of how long the effects could be maintained and of the new side effects of treatments. Many of the presentations focused on adherence to drug therapy and detailed whether subjects were complying with treatment regimens. Discussions centered on how an individual's behavior impacts his or her success in maintaining therapy, and also on the product's and health care provider's ability to influence adherence. Solutions for promoting adherence, and minimizing blame for those who have difficulty, were tempered by presentations acknowledging disadvantaged people, even within developed countries, who are unable to receive treatment. Other topics covered were: how and when treatment should begin, who should receive it, psychological and social ramifications of being treated, and methods of supporting patients. Papers were also presented about the effect of treatment on risk behavior, and the level of discussion and agreement among sexual partners to avoid this behavior.     

Current advances in the diagnosis and treatment of AIDS: an introduction

Significant progress has been made in the diagnosis and treatment of AIDS. Laboratory tests available for assessment of human immunodeficiency virus (HIV) infection include the detection of antibodies to HIV type 1, the direct detection of the virus, the identification of surrogate markers, and the phenotypic analysis of peripheral blood mononuclear cells. Clinicians have made great strides in the treatment of tumors, opportunistic infections, and complications associated with AIDS as well as in the treatment of the infection itself. In selected patients, treatment with interferon-alpha has been successful against AIDS-related Kaposi's sarcoma. Attempts to treat the leukopenia and anemia of patients with AIDS by the administration of hematopoietic growth factors have resulted in increased white blood cell counts and a decrease in erythrocyte transfusion requirements. In addition to zidovudine, several antiretroviral agents are undergoing testing, including the nucleoside analogues dideoxycytidine and dideoxyinosine, soluble CD4, and the glycosidase inhibitor N-butyldeoxynojirimycin.     

AIDS防治实验研究的新动向

1抗AIDS新药的研究已可采用大鼠模型[1]由于种属的特异性,一般实验大鼠根本不易感染HIV。近年来,科学家们一直在尝试培育出可以感染HIV的啮齿动物。2007年1月10日文章报道:一种经过基因改造的大鼠很容易感染HIV,能为治疗     

Coming to terms with the era of AIDS:

Purpose: To examine factors associated with residents’ willingness to provide care to persons with AIDS. Patients and methods: Survey of all senior residents in internal medicine and family medicine in ten geographically representative states in early 1989. Results: Preferring not to care for persons with AIDS was less common in the western United States and more common among those with more conservative politics, men physicians, Asian physicians, and foreign medical graduates. Multivariate analysis revealed scores on six attitudinal scales (homophobia, dislike of intravenous drug users, professional responsibility, fear of AIDS, futility of providing AIDS care, and clinical difficulty of AIDS care) to be strong independent predictors of willingness to care for persons with AIDS (adjusted R²=0.42). The authors postulated a model in which these six fundamental attitudes functioned as intervening variables between demographic characteristics and expressed willingness to provide AIDS care. Regression results supported the hypothesis that the associations between demographic characteristics and willingness to provide AIDS care were mediated via these attitudes. However, having had ambulatory experience in AIDS care during residency was associated with future intentions to provide such care, independent of negative attitudes. Conclusions: Physician willingness to care for persons with AIDS is inversely related to fear of acquiring AIDS, viewing treatment as futile or difficult, dislike of certain risk groups, and a lower sense of professional responsibility. These results identify concerns and stresses that should be addressed by residency programs, and emphasize the need for attention to the ethics and ideals of the profession in medical education. Presented in part at the National American Federation of Clinical Research Meeting, Washington, DC, May 1990. Supported by a grant from The Robert Wood Johnson Foundation.     

Difficulties facing healthcare workers in the era of AIDS treatment in Lesotho

Sub-Saharan Africa is most affected by the AIDS pandemic and Lesotho is no exception. In many countries, healthcare workers are at the forefront of the fight against AIDS. This study explores the difficulties facing healthcare workers in Lesotho using a combination of qualitative methods – focus group discussions and in-depth interviews. The findings suggest that healthcare workers are afraid of contracting HIV from their patients and this affects their delivery of services. In addition, the results revealed that poor infrastructure and shortage of supplies at the facilities hinder healthcare workers from performing their duties effectively. The other concern was the heavy workload and severe time constraints which puts enormous stress on healthcare workers. Stigma and discrimination emerged as major problems for healthcare workers. Addressing the challenges facing healthcare workers is essential in effectively managing the AIDS pandemic facing the continent.     

Histoplasmosis in AIDS: advances in management

Histoplasmosis is one of the most common opportunistic infections in HIV-infected patients who reside in endemic areas, and "imported infections" also occur elsewhere. A recent decline in the incidence of histoplasmosis appears to correlate with advances in antiretroviral therapy. Histoplasmosis occurs due to either dissemination of newly acquired infection or reactivation of latent foci of infection. Major risk factors include a CD4 count < or = 150/microL, positive complement fixation serology for the Histoplasma capsulatum mycelial antigen, and a history of exposure to chicken coops; in addition, suboptimal antiretroviral therapy seems likely to be a risk factor. Although there are a variety of clinical manifestations, most patients present with a several-week history of fever, chills, weakness, and weight loss. Diagnosis is based on positive cultures of blood, bone marrow, or other sites; detection of antigen in serum or urine; or characteristic histopathologic findings in biopsy specimens. Induction therapy consists of amphotericin B for acutely ill patients or itraconazole for patients with mild to moderately severe disease. Subsequent lifelong maintenance therapy with itraconazole is recommended. In patients with CD4 counts of < or = 150/microL, itraconazole is effective primary prophylaxis.