Challenges of a hidden epidemic: HIV prevention among women in the United States

HIV/AIDS trends in the United States depict a concentrated epidemic with hot spots that vary by location, poverty, race/ethnicity, and transmission mode. HIV/AIDS is a leading cause of death among US women of color; two-thirds of new infections among women occur in black women, despite the fact that black women account for just 14% of the US female population. The gravity of the HIV epidemic among US women is often not appreciated by those at risk and by the broader scientific community. We summarize the current epidemiology of HIV/AIDS among US women and discuss clinical, research, and public health intervention components that must be brought together in a cohesive plan to reduce new HIV infections in US women. Only by accelerating research and programmatic efforts will the hidden epidemic of HIV among US women emerge into the light and come under control.     

A way forward: the National HIV/AIDS Strategy and reducing HIV incidence in the United States

In July 2010, the Obama Administration released a National HIV/AIDS Strategy for the United States to refocus national attention on responding to the domestic HIV epidemic. The goals of the strategy are to reduce HIV incidence; to increase access to care and optimize health outcomes among people living with HIV; and to reduce HIV-related disparities. The strategy identifies a small number of action steps that will align efforts across federal, state, local, and tribal levels of government, and maximally impact the domestic HIV epidemic. In this article, we outline key programmatic and research issues that must be addressed to accomplish the prevention goals of the National HIV/AIDS Strategy.     

An Upsurge in early childhood mortality in Kenya: A search for explanations

This study seeks to document recent trends in early childhood mortality in the country and to offer some plausible explanations for the upsurge in the trends. Data and information from various sources are used in this paper to achieve this purpose. The results obtained show that infant, child and under-five mortality rates had declined in the 1960s and 1970s but were taking an upward trend since early 1990s. This situation is attributable to a combination of factors, including increased poverty, adverse effects of economic hardships and cost recovery programs associated with structural adjustment programs, increased childhood malnutrition, decreased use of certain maternity care services, decline in the coverage of child immunisations, inability of the public health system to provide services, and the HIV / AIDS epidemic and the recent ethnic clashes that rocked some parts of the Rift Valley, Coast, Nyanza and Western province. In order to reverse the upward trend in mortality, there is an urgent need to intensify efforts to reduce poverty, to enable most people to have adequate food supply, improve the public health sector so that it can deliver health care to all people; to make greater efforts to raise the living standards of rural populations and improve the quality of housing, sanitary and sewerage conditions in urban slums. In addition, concerted efforts must continue to be made to contain the spread of HIV/AIDS, to assist Aids orphans and to eliminate completely and to avoid recurrence of ethnic clashes and cattle rustling.     

Laos: rural economy threatened by AIDS

Laos is a rural country in which more than 70% of the work force depends upon the agricultural sector for its livelihood. Crop production in Laos is a low-productivity, labor-intensive affair which is highly vulnerable to disruption by natural disasters and outbreaks of disease. Laos is also a crossroads for trade from Cambodia, China, Thailand, and Vietnam. While such trade has some positive effect upon the domestic economy, it also facilitates the spread of sexually transmitted diseases into Laos from neighboring countries with high rates of HIV infection. The northwestern trading corridor bordering Thailand, Myanmar, and China is of particular concern with regard to the spread of HIV. The Lao government identified eleven individuals infected with HIV and had officially reported only one case of AIDS to the World Health Organization (WHO) as of April 1992. Although WHO has not yet confirmed or projected the number of HIV-seropositive and AIDS cases in Laos, scant available data suggest that AIDS is concentrated in urban areas. Poverty and isolation will not, however, protect rural villages from HIV. The implications of a growing HIV/AIDS epidemic for rural social structures are considered. It is clear that such a situation could lead to agroeconomic dislocation and jeopardize national food security. The following measures are recommended to confront HIV/AIDS in the agricultural sector: change cropping systems, provide AIDS prevention education and technical assistance, and recruit village cadres to increase AIDS awareness among young Lao and care for the very ill.     

A prevention response that fits America's epidemic: community perspectives on the status of HIV prevention in the United States

HIV prevention services have succeeded in limiting HIV incidence in the United States but have not prevented HIV from becoming a devastating epidemic in the communities most affected. The National HIV/AIDS Strategy represents an important opportunity to improve domestic HIV prevention efforts and to begin to reduce HIV incidence over time. Elements that are essential to improving HIV incidence outcomes include greater transparency and accountability in use of HIV prevention funds; scaling up programming for those most at risk; fostering and evaluating community-based HIV prevention efforts; and looking beyond individual behavior change programming by putting a greater emphasis on structural, network, and policy interventions. To overcome years of stagnation on HIV prevention outcomes, we need a response characterized by accountability, appropriate targeting, and sufficient scale.     

The tragedy of AIDS in Black America

Statistics reveal that while African Americans comprise only 13 percent of the population, they account for 56 percent of reported HIV cases nationwide. The nation's near disregard for health issues related to African Americans coupled with their communities being left poor, politically weak, and ignored has contributed to allowing diseases, some of which are curable, to reach epidemic proportions. African Americans most at risk for HIV are mired in poverty. African American leaders have called for a national "State of Emergency" on HIV/AIDS to provide quick emergency financial intervention to follow the AIDS epidemic and meet the needs of impacted African American communities. In 1998, $171 million was appropriated to be disbursed through grants from the Centers for Disease Control and Prevention (CDC) to community-based service organizations (CBOs). These CBOs will develop and implement HIV prevention programs. Funding for HIV/AIDS through other government agencies will also be distributed to African American communities.     

The main tasks concerning the organization of surveillance and prophylaxis of HIV-infection in Russian Federation

The main task concerning striving against HIV/AIDS epidemic is effective use of present political, financial, organizational, and informative possibilities. However, despite efforts, the epidemic situation with HIV/AIDS is constantly worsening. Approaches to and stereotypes of the organization of this work and its fulfillment cannot provide a complete solution to this problem. Among strategic tasks that should be fulfilled at the federal level are the following: strengthening of coordination of actions from the departmental level to interaction with Russian and international organizations and the community of people living with HIV/AIDS; determination of requirements and purchase of necessary diagnostic test systems for HIV-infection detection as well as pharmaceuticals, and providing subjects of Russian Federation with them. Tactical tasks that should be fulfilled at the level of subjects of Russian Federation are the following: medical aid to patients with HIV/AIDS should become more approachable; complete dispensary observation and treatment of these patients should be organized. Civil society and interaction between non-profit organizations and governmental structures play an important role in organization and fulfillment of striving against HIV epidemic.     

Reducing HIV and AIDS in Adolescents: Opportunities and Challenges

Adolescents are critical to efforts to end the AIDS epidemic. Few national AIDS strategies explicitly program for children in their second decade of life. Adolescents (aged 10–19 years) are therefore largely invisible in global, regional, and country HIV and AIDS reports making it difficult to assess progress in this population. We have unprecedented knowledge to guide investment towards greater impact on HIV prevention, treatment, and care in adolescents, but it has not been applied to reach those most vulnerable and optimize efficiency and scale. The cost of this is increasing AIDS-related deaths and largely unchanged levels of new HIV infections in adolescents. An AIDS-free generation will remain out of reach if the global community does not prioritize adolescents. National AIDS responses must be accountable to adolescents, invest in strengthening and monitoring protective and supportive laws and policies and access for adolescents to high impact HIV interventions.     

Equity, empowerment and choice: from theory to practice in public health

The purpose of this article is to illustrate how a framework that links equity and empowerment to improved health outcomes for those who live in poverty can be a useful tool for planning and managing health programmes. Using the work of Amartya Sen, Susan Rifkin has developed a framework described in the acronym CHOICE. The article applies the framework to two case studies from Kenya seeking to reduce the disease burdens of malaria and HIV/AIDS. The article examines how the process of pursuing equity and empowerment either supports the positive health outcomes identified as objectives and/or strengthens these outcomes.     

Food insecurity and HIV/AIDS: Current knowledge, gaps, and research priorities

Food insecurity and HIV/AIDS are intertwined in a vicious cycle that heightens vulnerability to, and worsens the severity of, each condition. We review current knowledge and research priorities regarding the impact of food insecurity on HIV transmission risk and clinical outcomes. Observational studies suggest that food insecurity is associated with increased HIV transmission risk behaviors and decreased access to HIV treatment and care. Among individuals receiving antiretroviral therapy (ART), food insecurity is associated with decreased ART adherence, reduced baseline CD4 cell count, incomplete virologic suppression, and decreased survival. Integration of food security interventions into HIV/AIDS treatment programs is essential to curtail the HIV/AIDS epidemic and improve health and quality of life among those infected. Longitudinal research applying validated measurement tools is needed to better understand the mechanisms through which food insecurity adversely impacts HIV transmission, treatment, and care. Research should compare the effectiveness of various food assistance and livelihood strategies.     

艾滋病流行病学

1　概述艾滋病是严重危害人群健康的疾病之一 ,其病死率极高。自 1981年美国首次报道艾滋病以来 ,艾滋病以传播迅速、病势凶险 ,预后差及危害严重而震惊世界。目前艾滋病已在全球广泛流行 ,严重危害着人类的健康。1 1　全球流行形势联合国艾滋病规划署和世界卫生组织最新报告显示 ,截至 1999年底全球ＨＩＶ感染者总数已超过5310万人 ,死于ＡＩＤＳ的人数已达 1880万人 (其中成人 150 0万、儿童 380万 )。 1999年全球新增加ＨＩＶ/ＡＩＤＳ 540万人 ,因艾滋病死亡 2 80万 ,平均每天新增加ＨＩＶ感染者 1 5万人。而且 95%以上的感染者集中在发…     

Community health workers and home-based care programs for HIV clients

In Nyanza Province, Kenya, estimated HIV prevalence is 22%. Given that more than 80% of the population resides in rural areas, the majority of individuals in Nyanza Province do not have access to medical facilities on a regular basis. In response to the growing demands the HIV epidemic has placed on the people and communities in this region, hundreds of lay individuals have been trained as community health workers to provide home-based care to sick or dying HIV/AIDS clients in rural areas. This paper discusses the role and impact of these community health workers in Nyanza Province, Kenya. It outlines the collaborative relationship between community health workers and the Ministry of Health, examining community health workers' use of extant biomedical structures at the district level to provide services that government-run health facilities lack the monetary resources or personnel to provide. Finally, it explores the role played by community health workers in providing HIV/AIDS education to individuals in an attempt to prevent further infections.     

Knowledge of HIV/AIDS and attitude towards voluntary counseling and testing among adults

BACKGROUND: Nigeria has the third highest population of people living with human immunodeficiency virus (HIV). Despite this, the knowledge of HIV/AIDS and uptake of voluntary counseling and testing (VCT) is still low, especially in the rural areas. This study assessed knowledge of HIV/AIDS and attitude towards VCT among adults in a rural community in northern Nigeria. METHODS: A pretested questionnaire was administered on a cross-section of 210 adults in Danbare village, northern Nigeria. Information about knowledge of HIV/AIDS and attitudes toward VCT was elicited among respondents. RESULTS: The majority of respondents (59%) did not know the causative agent of AIDS; however, knowledge of route of disease transmission was high, with 71% and 64% of study participants mentioning sexual activity and unscreened blood transfusion, respectively, as possible transmission routes. Respondents listed avoidance of premarital sex, outlawing prostitution, condom use and screening of blood before transfusion as protective measures. Overall, 58 (27.6%), 80 (38.1%) and 72 (34.3%) of the respondents had good, fair and poor knowledge of HIV/AIDS, respectively. After adjusting for confounders, female gender and formal education remained significant predictors of HIV/AIDS knowledge. Reasons for rejection of VCT included fear of stigma, marital disharmony, incurable nature of the disease and cost of treatment. Formal education, female gender and HIV knowledge significantly predicted positive attitude toward VCT for HIV/AIDS among the study population. CONCLUSION: More than half of the respondents had adequate knowledge of HIV/AIDS, and the majority were willing to have VCT. However, misconceptions, fear, gaps in knowledge and limited access to VCT remain prevalent. Our findings suggest the need to provide health education and scale up VCT services in northern Nigeria by targeting the efforts of international and local development partners to underserved rural areas.     

Problem issues related to HIV/AIDS in Eastern European and Central Asian countries

HIV has been spreading over the territories of our countries for 18 years, and it is still possible to resist the epidemic in a unique and efficient way. In June 2001, the UNO General Assembly Special Session was devoted to the problem of HIV/AIDS in full. Its Declaration of Commitment on HIV/AIDS (Resolution S-26/2) defines main directions of this work both in world-wide, regional, and international scopes. It should be stressed that first of all the Declaration emphasizes the necessity to improve management and coordination of efforts at the global, regional, and national levels, which is of special importance to Eastern Europe and Central Asia, where a new phase of HIV infection epidemic has begun and the spread of the virus grows and very soon may gain uncontrollable character. As for the countries of our region, here the epidemic process has been developing mostly through sexual way of transmission for 8 years since 1987, when the first case of HIV infection was revealed. More than 350000 HIV-infected people, including more than 15,000 children, have been registered in Russian Federation. More than 9000 people have died. The proportion of childbearing age women constantly grows, and the number of children born to mothers with AIDS has now exceeded 15,000. To realize the component "Prevention of HIV infection, B and C hepatitis, and revealing and treatment of HIV patients" of the priority national health project, 3.1 billion rubles are allocated for the prophylaxis of and fight against HIV and AIDS. The measures that are planned to take will allow for principle changes in the present situation with medical aid providence of contemporary antiretroviral medicines. Russian Orthodox Church with its parishes, monasteries etc. carries out numerous projects of primary HIV prophylaxis among children and young people in different regions; these projects are directed towards forming moral values.     

Toward Beijing: linking HIV / AIDS to other women's issues is imperative

The senior advisor to the AIDSCAP Women's Initiative, Dr. E. Maxine Ankrah, is actively lobbying to secure the inclusion of HIV/AIDS language in the draft platform of the UN Fourth World Conference on Women: Action for Equality, Development and Peace scheduled for September 1995 in Beijing. She organized the only workshop on HIV/AIDS at the preparatory meeting in New York in March 1995. It examined the effects of poverty on the expanding epidemic among females. Workshop presentations included international perspectives on: the effect of structural adjustment programs on women's vulnerability; the relationship between poverty, female prostitution, and AIDS; credit schemes and education to empower rural women; reproductive rights; ethnic issues; and the need for women to help women. Obstacles that obscured the relationships between HIV/AIDS and other women's issues have been: that AIDS was initially defined as a medical problem; that risk groups were narrowly defined; and the emphasis on behavior that blames persons infected with HIV. Despite earlier obstacles, the draft platform has several sections with HIV/AIDS language. Strategic Objective C.3: Undertake Multi-Sectoral Initiatives Sensitive to Women's Life Situations addresses the HIV pandemic and other sexual and reproductive health issues. Some of the actions called for in this objective are involvement of women in decision making, expansion of peer education and outreach, and supporting research of woman-controlled prevention methods. AIDSCAP Women's Initiative and other nongovernmental organizations will work together focus attention on HIV/AIDS in Beijing. AIDSCAP plans to have resource publications available in Beijing as well as to host networking sessions. Unless it is waived, the policy prohibiting HIV-infected persons from entering China will preclude HIV-infected women from taking part in the Conference.     

HIV epidemic in Central African Republic: high prevalence rates in both rural and urban areas

A sentinel serosurveillance study was conducted in Central African Republic to estimate the prevalence of HIV seropositivity in the general adult population in each province so that the public health authorities can target HIV prevention programmes to the priority areas. Blood samples were collected from women attending 48 antenatal clinics in urban and rural areas of the Central African Republic. These samples were tested for HIV antibodies in an anonymous and unlinked manner using strategy II recommended by WHO. The data were extrapolated to all women of reproductive age in Central African Republic by use of a parity-based adjustment involving the application of correction factors to the observed prevalence rates. A total of 9,305 pregnant women were recruited from November 2001 to October 2002. HIV seroprevalence was high in all age groups (12% in the less than 20 year age group to 17% in the 25-29 year age group). The median prevalence of HIV in antenatal clinics was similar for rural areas, for Bangui and for other urban areas (16.5, 15.0, and 12.5% respectively). Adjustment for parity and fertility pattern increased the prevalence of HIV in all antenatal clinics except in Bangui. This first national study of HIV prevalence in Central African Republic revealed that the HIV epidemic is continuing to spread in both urban and rural areas. Thus, efforts to reduce transmission should be made in every part of the country.     

Is HIV/AIDS epidemic outcome of poverty in sub-saharan Africa?

Undisputable fact is that 14000 people in Sub-Saharan Africa are being infected daily with HIV and 11000 are dying every day due to HIV/AIDS related illnesses. In this region more than 60% of the people live below UN poverty line of US$ 1 per day. Some studies have shown that poverty and HIV infection are in correlation, but none has shown whether HIV/AIDS in Sub-Saharan Africa is an outcome of poverty. This article, therefore, shows that HIV is an important outcome of poverty, with sexual trade, migration, polygamy, and teenage marriages as its predictors in the Sub Saharan region. I used the examples of 20 countries with the highest poverty level in the region to demonstrate the gravity of the HIV scourge, using the data from different international databases.     

Global impact of human immunodeficiency virus and AIDS

This review provides information on the epidemiology, economic impact, and intervention strategies for the human immunodeficiency virus (HIV)/AIDS pandemic in developing countries. According to the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) at the end of 1999, an estimated 34.3 million people were living with HIV/AIDS. Most of the people living with HIV, 95% of the global total, live in developing countries. Examples of the impact of HIV/AIDS in Africa, Asia, Latin America, the Caribbean, and the Newly Independent States provide insight into the demographics, modes of exposure, treatment and prevention options, and the economic effect of the epidemic on the global community. The epidemic in each region of the world is influenced by the specific risk factors that are associated with the spread of HIV/AIDS and the responses that have evolved to address it. These influences are important in developing HIV/AIDS policies and programs to effectively address the global pandemic.