A "Youth Multi-function Centre" in the Free State: an alternative to clinic-based HIV/AIDS prevention and care

The youth are especially vulnerable to the HIV/AIDS epidemic in South Africa. In the Free State (second highest incidence of HIV/AIDS among the provinces), the Welkom-Goldfields area may for various reasons be singled out as a high risk area for HIV/AIDS which should receive priority attention in attempts to combat the disease. It is suggested that a Youth Multi-function Centre would place youth reproductive health care in the broader development and life skills arena--where it could be thought to rightfully belong. The objectives of the paper are to depict the rationale for a Youth Multi-function Centre, to broadly conceptualise a Youth Multi-function Centre, and to report on the process and methodology followed in an attempt to actually establish such a centre in Thabong/Welkom.     

Trends in the European HIV/AIDS epidemic: a perspective from Italy

The HIV/AIDS epidemic represents one of the major public-health challenges in present days. Despite the relevant improvement in the prognosis of HIV disease following the introduction of highly active antiretroviral therapy (HAART), numerous new challenges are progressively emerging as patient characteristics evolve. In this article, we give an insight into more actual topics in the HIV/AIDS epidemic in Italy and Europe, including recent epidemiological trends, emerging drug resistance and non-B-subtype circulation, the lights and shadows of HAART and the potential of HARRT to reduce sexual transmission of HIV.     

新型冠状病毒肺炎疫情对浙江省宁波市艾滋病防制工作的影响评估

目的了解新型冠状病毒肺炎（COVID-19）流行对浙江省宁波市艾滋病防制工作的影响,为政府和艾滋病防制部门制定应对措施提供参考依据。方法收集2020年1 — 3月宁波市COVID-19疫情数据、近10年同期艾滋病感染者/患者（HIV/AIDS）报告数、HIV抗体检测、高危干预、艾滋病抗反转录病毒治疗（ART）、健康教育云平台和其他相关专题调查等信息,通过相关性分析、线性回归及空间聚集性分析艾滋病防制工作变化情况。结果2020年1 — 3月新报告HIV/AIDS数较2019年同期下降36.36%,自愿咨询检测、全人群HIV检测量及高危干预覆盖人数较2019年同期均出现较大幅度下降,累积解决本地管理患者在外省领药244人,ART覆盖率较2019年同期上升6.03%。结论COVID-19流行对本地艾滋病检测发现、高危干预等防制工作均有较大影响,2020年1 — 3月新报告HIV/AIDS数下降明显,全市虽已解决滞留病例领药难问题,需进一步加强艾滋病咨询检测和重点人群高危干预力度。     

Primary and preferred sources for HIV/AIDS and sexual risk behavior information among adolescents in Swaziland, Southern Africa

The HIV/AIDS epidemic in Sub-Saharan Africa poses a massive diffusion and persuasion challenge for health professionals. Individuals working with adolescents to prevent the spread of HIV/AIDS must gain an understanding of adolescent's preference in obtaining information about HIV/AIDS and sexual behaviors. This study describes the primary and preferred sources of information regarding HIV/AIDS and sexual risk behavior in relation to several socio-demographic variables (n=941) in Swaziland, Southern Africa. Although print/broadcast media was the primary source for HIV/AIDS and sexual risk behavior information for the students, most participants preferred information from the healthcare workers. This study suggests a greater role for healthcare providers in providing HIV/AIDS and sexual risk information.     

1996-2009年山西省大同市艾滋病疫情分析

目的 了解山西省大同市艾滋病疫情流行特点。 方法 以国家艾滋病综合防治管理信息系统为主导,从HIV/AIDS病例报告和现住址统计两个方面,对大同市1996 - 2009年艾滋病疫情数据进行统计、汇总和分析。 结果 1996 - 2009年,全市累计报告HIV/AIDS病例143例,其中HIV感染者116例,AIDS患者27例,报告死亡病例22例。按现住址统计:外省市77例,本市66例。辖区66例HIV/AIDS病例中,死亡15例、失访2例、查无此人14例,在访35例。调查显示,目前大同市常住人口320万,HIV感染者29例,HIV感染率为0.91/10万;AIDS发病数23例, AIDS发病率为0.72/10万。艾滋病疫情波及到10个县(区)、27个乡(镇)、42个自然村(或城镇街道)。病例出现较高的地区是城区、矿区、南郊区。 结论 大同市艾滋病疫情处于低流行期,进入第一个发病高峰。主要传播途径为性传播。艾滋病疫情地区分布不均。     

An overview of the human immunodeficiency virus featuring laboratory testing for drug resistance.

The human immunodeficiency virus (HIV) pandemic is unique in human history in its rapid spread, its persistence, and the depth of its impact. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that approximately 65 million people have been infected with HIV since the beginning of the epidemic. During this time, approximately 25 million people have died from acquired immune deficiency syndrome AIDS. HIV-associated morbidity and mortality was substantially reduced during the last decade following the introduction of highly active antiretroviral therapy (HAART). In spite of the striking success of HAART in treating HIV infection, many patients experience treatment failure as genetic changes emerge in the virus leading to drug resistance. Laboratory testing for drug resistance in HIV strains is now used in combination with other methods to guide antiretroviral therapy. The purpose of this report is to review the background information on HIV with the focus on the problem of drug resistance and to describe the laboratory methods of testing for drug resistance in HIV strains.     

HIV/AIDS care in KwaZulu-Natal, South Africa: an interview with Dr. Leana Uys. Interviewed by Ellen Giarelli and Linda A. Jacobs.

Human suffering from the HIV/AIDS epidemic in Africa has reached unprecedented proportions. In 1998, an estimated 50% of all new infections in sub-Saharan Africa occurred in South Africa; and it is predicted that by the year 2003, South Africa will be experiencing a negative population growth. Besides the toll in human lives, the estimated cost for basic care and prevention services in Africa is 10 times the current expenditure. Three unique factors are critical in the South African HIV/AIDS epidemic: HIV transmission patterns, the effect of this disease on women and children, and the role that traditional healers play in the treatment of HIV/AIDS. In a recent interview, Dr. Leana Uys, an educational leader in the School of Nursing at the University of Natal in Durban, Republic of South Africa, provided an insightful perspective on HIV/AIDS policies and related sociocultural issues that have a direct effect on the HIV/AIDS epidemic. She communicated her personal experiences as well as the experiences of South African nurses working as caregivers, educators, and policy makers with AIDS patients and their families in KwaZulu-Natal.     

Recent advances in natural anti-HIV triterpenoids and analogs

The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic is one of the world's most serious health challenges. Although combination antiretroviral therapy provides effective viral suppression, current medicines used against HIV cannot completely eradicate the infectious disease and often have associated toxicities and severe side effects in addition to causing drug resistance. Therefore, the continued development of new antiviral agents with diverse structures and novel mechanisms of action remains a vital need for the management of HIV/AIDS. Natural products are an important source of drug discovery, and certain triterpenes and their analogs have demonstrated potential as pharmaceutical precursors for the treatment of HIV. Over the past decade, natural triterpenoids and analogs have been extensively studied to find new anti-HIV drugs. This review discusses the anti-HIV triterpenoids and analogs reported during the period of 2009–2019. The article includes not only a comprehensive review of the recent anti-HIV agent development from the perspective of medicinal chemistry, but also discusses structure–activity relationship analyses of the described triterpenoids.     

Considerations relating to the epidemiology of human immunodeficiency virus infection: the impact of bacterial antigens and consequences for treatment

OBJECTIVE: A treatment for patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is presented, which is based on an isopathic method that appears to be effective in eliminating bacterial antigens from the body. The concept is based on a new hypothesis concerning the outbreak and spread of AIDS in Africa and worldwide. SUBJECTS AND DESIGN: Laboratory data are presented from five European and seven African patients with HIV. RESULTS: Oral administration of ultra-low doses of a lysate of Staphylococcus aureus Cowan I (12c potency) resulted in a significant increase of CD4 T-cell subsets and CD4/CD8 ratios in patients with HIV infection as well as in advanced stages of HIV disease, concomitant with the improvement of clinical HIV-related symptoms. CONCLUSIONS: Based on epidemiologic data, the beginning of the African AIDS epidemic is related-to time, place, and circumstances-to the initial large-scale introduction of antibiotics in areas of Central Africa that would later comprise the AIDS belt. It is concluded that certain antimicrobial agents can enhance the formation of persistent bacterial superantigens, which may indicate a link between asymptomatic HIV carriers and the development of AIDS. According to this view, superantigens and bacterial cell wall components remaining in the body after antibiotic treatment cause a permanent activation of the immune system and would thus favor T-cell infection and viral replication in HIV-infected individuals.     

Effectiveness of an HIV/AIDS educational programme for Chinese nurses

AIM: This paper reports a study examining the effect of a multifaceted HIV/AIDS educational intervention on the knowledge, attitudes and willingness of Chinese nurses in caring for patients with human immunodeficiency virus. BACKGROUND: The expanding HIV/AIDS epidemic challenges nurses to increase their knowledge about this devastating illness to provide effective HIV/AIDS prevention and care to their patients. HIV/AIDS educational interventions, which were developed for North American and European nurses, have not been studied among nurses in other societies. METHODS: The study employed a pretest, post-test experimental design with 208 nurses from seven Chinese provinces. The intervention consisted of a 5-day workshop comprising didactic lectures interspersed with activities designed to elicit discussion of participants' values and personal feelings about HIV/AIDS. Bloom's Taxonomy and principles of good HIV/AIDS educational practice guided the educational intervention. Outcome variables were HIV/AIDS knowledge, attitude toward patients with HIV/AIDS (including empathy for and desire to avoid these patients) and willingness to provide nursing care to these patients. The data were collected in 2003. FINDINGS: At baseline, HIV/AIDS knowledge was not high and attitudes and willingness to care were neutral. Knowledge, attitudes toward patients with HIV/AIDS and willingness to provide nursing care to these patients were each improved at the conclusion of the workshop (P<0.001). CONCLUSIONS: As the HIV/AIDS epidemic expands, nurses will be called upon to deliver competent, compassionate and comprehensive care to patients and their significant others. Intensive, interactive HIV/AIDS professional workshops can contribute to the national effort by increasing knowledge and improving attitudes towards and willingness to provide nursing care for patients with HIV/AIDS.     

Antiretroviral-based HIV prevention strategies for women

Almost three decades have elapsed since researchers identified HIV as the cause of AIDS, with current estimates from UNAIDS that 33.4 million adults were living with HIV/AIDS in 2008. Two-thirds of this burden of disease is in Sub-Saharan Africa, and 60% of those infected are women. The disease still remains incurable and current prevention strategies including abstinence, male/female condom use and male circumcision are only partially effective. New strategies to curb the epidemic are urgently needed. Scientists are diligently exploring HIV prevention methods that are safe, effective and affordable. These new biological interventions include oral pre-exposure prophylaxis using oral antiretroviral (ARV) drugs, ARV treatment in HIV-infected persons to reduce transmission and topical ARV-based microbicide formulations.     

AANA journal course: update for nurse anesthetists--managing human immunodeficiency virus and acquired immune deficiency syndrome during anesthesia care.

The human immunodeficiency virus (HIV) and its advanced progression to acquired immune deficiency syndrome (AIDS) has had a greater impact on our society than any other disease entity during this century. Throughout the past decade the prevalence of HIV disease has grown to pandemic proportions throughout many regions of the world. The infectious and often fatal nature of HIV has made AIDS the most threatening epidemic currently facing modern medicine. A myriad of fears concerns, challenges, and frustration face all healthcare providers whose awareness and impact on practice is continuously challenged. Every nurse anesthetist is responsible for maintaining the ability to both prevent HIV disease transmission and appropriately care for HIV-infected patients during anesthesia care. Experience throughout the past decade of a continuously increasing prevalence of both HIV and AIDS has provided a wealth of information and knowledge that continues to enhance patient care. The following AANA Journal Course will present a current overview of HIV disease and considerations for providing quality anesthesia care while preventing disease transmission.     

Antiretroviral-based HIV prevention strategies for women

Almost three decades have elapsed since researchers identified HIV as the cause of AIDS, with current estimates from UNAIDS that 33.4 million adults were living with HIV/AIDS in 2008. Two-thirds of this burden of disease is in Sub-Saharan Africa, and 60% of those infected are women. The disease still remains incurable and current prevention strategies including abstinence, male/female condom use and male circumcision are only partially effective. New strategies to curb the epidemic are urgently needed. Scientists are diligently exploring HIV prevention methods that are safe, effective and affordable. These new biological interventions include oral pre-exposure prophylaxis using oral antiretroviral (ARV) drugs, ARV treatment in HIV-infected persons to reduce transmission and topical ARV-based microbicide formulations.     

Paediatric HIV encephalopathy in sub-Saharan Africa

Abstract

Background: HIV/AIDS continues to be one of the greatest health challenges which sub-Saharan Africa faces. HIV is known to invade the central nervous system at the time of infection, and causes widespread damage. In children, this leads to a well-researched condition known as HIV encephalopathy, which affects all areas of neurodevelopment.

Objectives: To discuss HIV encephalopathy in sub-Saharan Africa, and highlight the importance of early detection and intervention.

Major findings: The effects of timely initiation of antiretroviral therapy on alleviating the impact of encephalopathy have been well described. Neurodevelopmental delay is a stage four disease indicator according to the World Health Organization (WHO), and therefore is a criterion for initiation of highly active antiretroviral therapy (HAART). HAART is often only administered according to the virologic and immunologic status of a child, as standardized neurodevelopmental assessment tools are not widely available in clinics in developing countries. When HAART initiation is dependent on immunologic status, it is often too late to prevent encephalopathy. To date, the only means of prevention of this condition is early initiation of HAART. Stringent guidelines for the commencement of this therapy have had to be followed due to a shortage of and lack of access to antiretrovirals, leading to late initiation of HAART, and widespread central nervous system encephalopathy.

Conclusion: Early detection of encephalopathy is vital, so that children may commence treatment, and be referred for assessments in all facets of development in order to initiate intervention.     

Reducing the rate of mother-to-child HIV transmission in Africa.

Currently there are about twenty four million HIV/AIDS (human immunodeficiency virus and acquired immunodeficiency syndrome) cases on the continent of Africa. Over the past two years, many health care professionals have been in a stage of denial concerning this problem. According to researchers attending the XIII International AIDS Conference held in Durban, South Africa, the world became aware that cost-effective strategies are needed desperately to stop the rapid spread of HIV/AIDS in Africa. Recent studies suggest that modest antiretroviral drug therapies for HIV-positive pregnant women can reduce one-half of the risk of HIV transmission to the unborn child. Challenges to the governments of Africa such as the high cost of drugs, lack of health care infrastructure and cultural barriers, priority to treat only pregnant women has been a difficult decision, while other infected persons with HIV are not treated.     

Knowledge of, and attitudes to, acquired immune deficiency syndrome (AIDS) among traditional birth attendants (TBAs) in rural communities in Cross River State, Nigeria

AIM: To survey knowledge of, and attitudes to, HIV/AIDS held by traditional birth attendants (TBAs) in rural communities in Cross River State, Nigeria. BACKGROUND: As the HIV/AIDS epidemic continues to spread, undermining development, reversing health gains and exacerbating poverty, TBAs in rural communities in Cross River State, Nigeria are still less informed about this dreadful disease. METHODS: A survey consisting of structured questionnaires was used with 140 randomly selected TBAs to assess their knowledge of HIV/AIDS, source of information on HIV and protective practices. FINDINGS: Results revealed that 62 (44.3%) of the TBAs had no formal education. Forty-four (31.4%) had primary education, while 19 (13.6%) had secondary education. On knowledge of HIV and sources of information, 49 (35.0%) of respondents reported knowing what HIV means. While 26.4% indicated that they received information about HIV from the government health centres, 23.6% had no information about the disease. There was a great disparity between male (73.7%) and female (28.9%) respondents on knowledge about HIV. On the use of protective safety procedures during delivery, 61 (43.6%) used sterilized blades, while 10.7% admitted wearing protective clothes and gloves. Only three (2.1%) of the respondents said that they were aware of the HIV status of their clients prior to delivery. CONCLUSIONS: This survey has demonstrated that few TBAs in the communities studied in Cross River State are informed about HIV/AIDS, and this has revealed the urgency of starting a programme specifically designed for TBAs in rural communities towards a massive educational campaign on HIV/AIDS.     

Report on the Fifth Conference on Retroviruses and Opportunistic Infections

Presentations made at the Fifth Conference on Retroviruses and Opportunistic Infections are summarized. Hundreds of papers confirmed and analyzed the impact of highly active antiretroviral therapy (HAART) in clinical trials and routine clinical care. Papers on HAART therapy and research on the underlying dynamics of HIV infection are highlighted in the areas of epidemiology, prevention, HIV pathophysiology, primary HIV infection, combination antiretroviral therapy, salvage therapy, antiretroviral toxicities, adherence issues, and opportunistic infections. The papers show that the theoretical and therapeutic advances made in 1996 and 1997 are tempered by challenges that remain: the emergence of viral resistance, extensive cross resistance affecting antiretrovirals still in the development pipeline, the failure to extend the benefits of antiretroviral therapy to the vast majority of AIDS patients, the continuing problem of HIV transmission, and the need and frustrating search for a vaccine.