Current situation and regional perspective on HIV/AIDS surveillance in europe

AIDS reporting has been the principal means of monitoring the HIV/AIDS situation in Europe since 1984 [corrected]. HIV reporting was set up at the European level in 1999, although it has existed in most European countries since the 1980s. Anonymous individual data on AIDS and, if available, new HIV diagnoses, and data on HIV prevalence in various populations are reported from the 51 countries of the WHO European Region to EuroHIV, and aggregate data on HIV prevalence in various populations [corrected]. Data are presented after grouping the 51 countries into three geographic areas: the West, Center, and East. At end of 2000, in the West, AIDS incidence continued to decline except among those infected heterosexually; numbers of newly diagnosed HIV infections are relatively stable, but rising among heterosexually infected persons, many of whom originate from countries with generalized HIV epidemics. In the East, numbers of newly diagnosed HIV cases (mostly injection drug users) continue to rise steeply, particularly in the Russian Federation, Latvia, and Estonia. In the Center, levels of HIV and AIDS remain low. HIV reporting is becoming a central element of HIV/AIDS surveillance in Europe. Heterogeneity between countries in health care systems, HIV testing patterns and surveillance systems remain challenging for data standardization at the European level. Efforts should be made to use surveillance data for evaluating the effectiveness of HIV/AIDS prevention interventions.     

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.     

Crossing borders: HIV / AIDS and migrant communities

The annual National Council for International Health Private Volunteer Organization (PVO)/AIDS workshop took place June 30, 1994, in Arlington, Virginia. About 90 representatives of PVOs, domestic and international nongovernmental organizations (NGO), universities, and research organizations were in attendance. Speakers presented both domestic and international perspectives upon the relationship between migration trends and HIV transmission. The keynote address spelled out the UN High Commission on Refugees' policy on HIV/AIDS: refugees are not a risk group per se, and they should benefit from the same control measures as the general host population; there will be no mandatory HIV screening in any population; and the rights of HIV-positive refugees against being deported and for asylum and eventual repatriation need to be protected. The following issues were presented at the workshop: an overview of HIV/AIDS and migration issues; STD/HIV control and prevention; HIV/AIDS among highly mobile populations along the Thailand/Myanmar border; migration trends in Phnom Penh, Cambodia; migrant farmworkers working in the US; changes in sexual practices among Mexican migrants to the US and their impact on the risk of HIV transmission; the importance of understanding the epidemiology, health-care seeking behaviors, and health beliefs of immigrants; the ability of PVOs and NGOs to provide effective HIV/AIDS prevention for refugees and migrants; the impact of political instability and civil strife on population movements and the prevalence of high-risk behaviors; and the important considerations needed for work with special target populations such as adolescents, women, mobile seasonal migrants, and urban residents.     

Health Literacy: Impact on the Health of HIV-Infected Individuals

Health literacy is known to affect vulnerable communities such as persons living with HIV/AIDS. The purpose of this review was to provide a current summary of research on the impact of health literacy on the health of persons living with HIV/AIDS and to address future areas of need. Contemporary studies focused on expanding the reach of health literacy in HIV/AIDS to retention in HIV care, use of technology for assessing and intervening to improve health literacy, and health literacy across the globe, for example. A number of studies did not find health literacy to explain health behaviors whereas other studies supported such a relationship. Future issues relevant to health literacy in HIV/AIDS include the aging of the HIV population and associated comorbidities, studies to understand the role of health literacy in specific populations affected by HIV/AIDS, and the continued need to refine the definition and measurement of health literacy.     

Border restrictions and HIV / AIDS: a public health policy disaster

Some governments restrict people with HIV/AIDS from entering their countries, claiming that doing so reduced HIV transmission. Yet, this claim does not stand to reason in the US which has the world's highest number of AIDS cases or in countries with no reported AIDS cases since some people may already be HIV infected. Some countries require HIV testing for people crossing borders. Yet, some people cross borders illegally. Further, HIV tests only detect HIV antibodies, but they are not present for a period after HIV infection. Some countries claim that people with HIV/AIDS burden the pubic health system. Yet, the countries do not apply this economic standard to travelers with other life-threatening diseases, thus, it is discriminatory. Besides, it is immaterial for short-term visitors and visitors with health insurance. HIV-related border restrictions violate the human right of freedom of movement. Some countries require HIV testing of just certain travelers, often based on country of origin or sexual orientation another form of discrimination. These practices set a bad precedent and encourage local governments to adopt like measures, leading to discrimination of HIV seropositive citizens. These national policies may keep tourists from traveling to some countries, perhaps affecting national revenues. Compulsory testing is very costly and takes money away from needed HIV prevention programs. People in countries with low HIV prevalence often think they are not at risk because HIV-infected foreigners are kept out of their country, so those who partake in risky behavior do not examine this behavior. Further, citizens from such countries will not consider AIDS information necessary. In those cases where HIV/AIDS information is presented in combination with mandatory testing, people will tend not to be interested in the messages. In conclusion, border restrictions based on HIV testing are counter productive and impede efforts to contain the pandemic.     

HIV/AIDS surveillance systems in Australia

We review the HIV/AIDS reporting protocols in Australia, and describe the technical components of surveillance and its guiding principles, including a strict adherence to confidentiality at all levels. The majority of AIDS diagnoses in Australia have occurred in men who acquired HIV infection through male-to-male sex. The annual incidence of AIDS peaked in 1994, and then declined sharply over the subsequent 4 years. Advances in treatment effectiveness have focused attention on ensuring that people with HIV infection have access to optimal therapy, and emphasized the role of AIDS case reports as indicators of treatment failure. Analyses of the date of HIV diagnosis in people with AIDS have been used as indicators and predictors of undiagnosed HIV infection in the population. Australia's linkage of program funding to AIDS case counts provides an incentive for both health departments and community-based organizations to actively support AIDS surveillance activities. The challenge for surveillance is to maintain vigilance for shifts in HIV infection rates, or in behavior patterns that may be related to transmission.     

Unfocused response to AIDS in Indonesia

Indonesia has a population of more than 200 million among which less than 500 official cases of HIV/AIDS have been recorded. The number of estimated cases is far greater. High rates of male migration, widespread prostitution, high rates of sexually transmitted disease infection, the absence of sex education for youth, women's low status, and the absence of a national AIDS awareness campaign were cited in 1993 as reasons why HIV would spread quickly throughout Indonesia. Access to basic information about AIDS remains a problem for both urban and rural populations in Indonesia. A national AIDS strategy was made public in 1993 by President Suharto. Supported by the Australians, the plan comprehensively covers almost every key aspect in managing HIV/AIDS. The plan since its release, however, has been largely ignored and the government has done little aside from a handful of television public service announcements, a few pamphlets distributed by the Department of Health, a few small HIV surveillance projects which have yielded little useful information, and the training of government officials to provide AIDS education. Approximately 15 nongovernmental organizations have been actively and successfully conducting AIDS prevention work.     

Laboratory Innovation Towards Quality Program Sustainability

Laboratory innovation significantly affects program sustainability of HIV programs in low and middle income countries (LMICs) far beyond its immediate sphere of impact. Innovation in rapid development of diagnostic technologies, improved quality management systems, strengthened laboratory management, affordable external quality assurance and accreditation schemes, and building local capacity have reduced costs, brought quality improvement to point-of-care testing, increased access to testing services, reduced treatment and prevention costs and opened the door to the real possibility of ending the AIDS epidemic. However, for effectively implemented laboratory innovation to contribute to HIV quality program sustainability, it must be implemented within the overall context of the national strategic plan and HIV treatment programs. The high quality of HIV rapid diagnostic test was a breakthrough that made it possible for more persons to learn their HIV status, receive counseling, and if infected to receive treatment. Likewise, the use of dried blood spots made the shipment of samples easier for the assessment of different variables of HIV infection—molecular diagnosis, CD4+ cell counts, HIV antibodies, drug resistance surveillance, and even antiretroviral drug level measurements. Such advancement is critical for to reaching the UNAIDS target of 90-90-90 and for bringing the AIDS epidemic to an end, especially in LMICs.     

HIV testing from a community perspective

The communities of people impacted by AIDS in the United States are diverse and have divergent opinions about HIV antibody testing. Concerns over social issues like stigma, confidentiality, and disclosure, combined with a legacy of advocacy, have shaped testing policies and praxis since the introduction of HIV antibody testing in 1985. The continued impact of the HIV epidemic on the underserved and socially marginalized focuses these concerns and highlights the importance of linkages between testing and care and treatment. The development of new testing technologies challenges HIV communities to develop a new rhetoric promoting early detection of the disease.     

Combining data sources to monitor the HIV epidemic in Canada

This article describes the methods, results and future perspectives of four information sources used to monitor the HIV epidemic in Canada: AIDS case surveillance, HIV case surveillance, HIV sentinel serosurveillance, and behavioral surveillance. Synthesizing data from these multiple sources provides a more comprehensive picture of the HIV epidemic than any one source alone could provide. In Canada, there has been a shift over time from an epidemic dominated by men who have sex with men to one where more than half of new infections are attributed to other groups, such as injection drug users and non-injecting heterosexuals. The available evidence also suggests increasing HIV infections among Aboriginal persons and among women. Surveillance data have been used in Canada to guide prevention and care programs and to formulate policy. In particular, these data have been used to support the development of an HIV testing program in pregnancy, to re-direct community work toward injection drug users and the young, and to demonstrate the effectiveness of new treatments for HIV. The main challenge now is to continue to improve the monitoring of the shifting HIV epidemic with more accurate data and to use the resulting information to inform appropriate prevention and care responses.     

HIV/AIDS surveillance in Japan, 1984-2000

The HIV/AIDS surveillance system in Japan, which began collecting data on the number of AIDS patients in 1984 and the number of HIV-infected persons in 1987, has played an important role in monitoring the trend and magnitude of Japan's HIV/AIDS epidemic and its distribution across various population subgroups. However, the system lacks any personal identifiers, making it impossible to eliminate duplication or to track cases for disease progression. It also does not permit the identification of the residence of HIV-infected persons because the residence of only the reporting physician is documented under the New Infectious Diseases Control Law, effective since April 1, 1999. The number of people with HIV/AIDS in Japan continues to grow. Among youth, sexually transmitted diseases, induced abortion, and sexual activities have shown a marked increase since the mid-1990s. Behavioral risk of infection for both injection drug users (IDUs) and men who have sex with men (MSM) remains alarmingly high. Accurate monitoring of infection rates is critical to the planning and evaluation of treatment, care and prevention programs. Japan should restructure its HIV/AIDS surveillance system to more accurately monitor the HIV/AIDS epidemic and related risk behaviors.     

Relative rates of AIDS among racial/ethnic groups by exposure categories

The relative rates of acquired immunodeficiency syndrome (AIDS) were calculated among racial/ethnic populations using Centers for Disease Control and Prevention HIV (human immunodeficiency virus)/Surveillance reports assuming that racial/ethnic distributions reflect that of the US Census Data from 1990. For comparison, a rate of 1 was assigned to whites in each calculation. The overall relative rates were whites--1, African Americans--4.7, Hispanics--3, Asian/Pacific Islanders--0.4, and Native Americans--0.5. Acquired immunodeficiency syndrome surveillance data show higher rates of AIDS for African Americans and Hispanics compared with whites, Asians/Pacific Islanders, and Native Americans. The relative rates for African Americans and Hispanics compared with whites were highest for injecting drug users, heterosexual contact, and pediatric patients. These results led us to explore possible explanations for increased AIDS reporting in African Americans and Hispanics. We then explored available national datasets regarding those variables. The analyses indicate that variables such as access and receptivity to HIV prevention and treatment efforts, race/ethnicity, sexual behaviors, sexually transmitted diseases, socioeconomic status, and substance abuse interact in a complex fashion to influence HIV transmission and progression to AIDS in affected communities.     

Current situation of HIV/AIDS in the world

The pandemic of HIV and AIDS has existed for almost 30 years in the clinical setting. Although there was a surprising reaction during the early years in global public health, for the last 14 years, mainly due to the creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS), a systematic epidemiological surveillance of this disease has refined the available data and has allowed the evolution of the epidemic to be monitored more or less in detail. In Mexico, something similar has occurred. In addition to programs of assistance for persons with HIV/AIDS, epidemiological surveillance systems now have robust software platforms that provide data to define the incidence and prevalence of this epidemic reliably. This article presents the most current official information, and a review of the behavior and current situation of HIV/AIDS in the world and in Mexico.     

PEPFAR's evolving HIV prevention approaches for key populations--people who inject drugs, men who have sex with men, and sex workers: progress, challenges, and opportunities

In most countries, the burden of HIV among people who inject drugs, men who have sex with men, and sex workers is disproportionately high compared with that in the general population. Meanwhile, coverage rates of effective interventions among those key populations (KPs) are extremely low, despite a strong evidence base about the effectiveness of currently available interventions. In its first decade, President's Emergency Plan for AIDS Relief (PEPFAR) is making progress in responding to HIV/AIDS, its risk factors, and the needs of KPs. Recent surveillance, surveys, and size estimation activities are helping PEPFAR country programs better estimate the HIV disease burden, understand risk behavior trends, and determine coverage and resources required for appropriate scale-up of services for KPs. To expand country planning of programs to further reduce HIV burden and increase coverage among KPs, PEPFAR has developed a strategy consisting of technical documents on the prevention of HIV among people who inject drugs (July 2010) and prevention of HIV among men who have sex with men (May 2011), linked with regional meetings and assistance visits to guide the adoption and scale-up of comprehensive packages of evidence-based prevention services for KPs. The implementation and scaling up of available and targeted interventions adapted for KPs are important steps in gaining better control over the spread and impact of HIV/AIDS among these populations.     

The United States President's Emergency Plan for AIDS Relief: a story of partnerships and smart investments to turn the tide of the global AIDS pandemic

The United States President's Emergency Plan for AIDS Relief (PEPFAR) has played a key leadership role in the global response to the HIV/AIDS pandemic. PEPFAR was inspired by the principles of the historic Monterrey Consensus (United Nations. Monterrey Consensus on Financing for Development, Monterrey, Mexico, March 18-22, 2002. New York: United Nations; 2002. Available at: http://www.un.org/esa/ffd/monterrey/MonterreyConsensus.pdf. Accessed April 21, 2012), which changed the underlying conceptual framework for international development, and therefore global health--a shift from paternalism to partnership that begins with country ownership and requires good governance, a results-based approach, and engagement of all sectors of society. PEPFAR began with a focus on the growing emergency of the HIV/AIDS pandemic by rapidly expanding HIV services, building clinical capacity, implementing strategic information systems, and building a coalition of partners to lead the response. Within the first years of implementation, there was a shift to sustainability, including the advent of Partnership Frameworks. The PEPFAR reauthorization in 2008 codified into law, the evolution in policies and programs for the next phase of implementation. In 2011 alone, PEPFAR supported nearly 4 million people on treatment, supported programs that provided more than 1.5 million HIV-positive pregnant women with antiretroviral drugs to prevent HIV transmission to their children, and supported HIV testing for more than 40 million people. This article provides an overview of how smart investments and partnerships across sectors and US agencies have helped achieve unprecedented results in increasing HIV/AIDS services and engaging partner countries and organizations in sharing the responsibility for an AIDS-free generation.     

Incarceration of People Living with HIV/AIDS: Implications for Treatment-as-Prevention

Contact with the criminal justice system, including incarceration, is a common experience for many people living with HIV/AIDS. Optimism has recently been expressed that correctional facilities could be important locations for treatment-as-prevention (TasP)-based initiatives. We review recent findings regarding the effect of incarceration on patterns of HIV transmission, testing, treatment initiation and retention. We found that the prevalence of HIV infection among incarcerated individuals remains higher than analogous non-incarcerated populations. Recent studies have shown that voluntary HIV/AIDS testing is feasible in many correctional facilities, although the number of previously undiagnosed individuals identified has been modest. Studies have implied enhanced linkage to HIV/AIDS treatment and care in jails in the United States was associated with improvements in the HIV cascade of care. However, for many individuals living with HIV/AIDS, exposure to the correctional system remains an important barrier to retention in HIV/AIDS treatment and care. Future research should evaluate structural interventions to address these barriers and facilitate the scale-up of TasP-based efforts among individuals living in correctional settings.     

Accurate monitoring of the HIV epidemic in the United States: case duplication in the national HIV/AIDS surveillance system

OBJECTIVE: To assess the degree of duplicate reporting in the US HIV/AIDS surveillance system as compared with a performance standard of <5%, and to assess the effect of duplicate removal on epidemiologic trends. METHODS: Multistate evaluation of HIV/AIDS case surveillance. Potential duplicate HIV or AIDS case reports in the national surveillance system matched on Soundex, birth date, and sex were assessed for duplication by state and territorial health departments. RESULTS: Of the 990,175 cases of HIV infection and AIDS in the surveillance system on December 31, 2001, 44,945 (4.5%) were identified as duplicate reports. The duplication rate was higher for HIV cases (8.2%) than for AIDS cases (3.8%). The median of 322 duplicate AIDS reports per area (range: 1 to 3947) represented a median of 5% of all AIDS reports per area (range: 1% to 11%). The median of 369 duplicate HIV reports per area (range: 1 to 1247) represented a median of 11% of all HIV reports per area (range: 1% to 30%). DISCUSSION: The overall duplication rate was within acceptable limits in the national HIV/AIDS surveillance system but did not meet the standard for HIV cases. Ongoing centrally coordinated efforts are necessary to minimize duplicate reporting in the future.     

Surveillance, social risk, and symbolism: framing the analysis for research and policy

Name-based surveillance for HIV, considered alone, is a useful public health measure; its benefits outweigh its direct costs. There is little evidence that name-based surveillance directly deters individuals at risk of HIV from being tested, or exposes them to significant social risks. Yet such surveillance is chronically controversial. Understood in a broader context of the social risks and symbolic politics of HIV, as subjectively experienced by people at risk, this opposition is both rational and instructive. Although often discussed, the social risks of HIV infection are poorly understood. To the extent these risks have been addressed by privacy and antidiscrimination laws, the solution has been less complete than many public health professionals appear to believe: developments in law and policy, including the increasing prevalence of criminal HIV transmission laws and proposed changes in HIV testing and counseling standards, are contextual factors that help explain the opposition to name-based surveillance. Rather than focusing piecemeal on specific "barriers" to testing and care, an appreciation of the surveillance debate in context suggests a positive undertaking in public health policy to provide the conditions of opportunity, information, motivation and confidence that people with HIV need to accept an effective program of early intervention.     

许昌市2002-2010年吸毒哨点艾滋病性病监测情况

目的了解许昌市吸毒人员的高危行为和艾滋病及性病的感染状况,为制定艾滋病性病的预防控制措施提供依据。方法按照国家艾滋病哨点监测实施方案的要求,对监测期间新入所的吸毒人员进行行为学调查和艾滋病、梅毒、丙肝血清抗体检测。结果口吸毒者及注射吸毒者分别占吸毒人员总数的93.2%和6.80%;该吸毒人群中HIV抗体阳性率为0.41%,梅毒感染率为1.04%。结论许昌市吸毒人员艾滋病、性病感染危险因素广泛存在,应加强针对该人群的高危行为干预。     

Trauma-Informed HIV Prevention and Treatment

The high prevalence of trauma and its negative impact on health and health-promoting behaviors underscore the need for multi-level interventions to address trauma and its associated sequelae to improve physical and mental well-being in both HIV-infected and HIV-uninfected populations. Growing global awareness of the intersection of trauma and HIV has resulted in development and testing of interventions to address trauma in the context of HIV treatment and HIV prevention in the USA and globally. Despite increasing recognition of the widespread nature of trauma and the importance of trauma to HIV transmission around the globe, several gaps remain. Through a survey of the literature, we identified eight studies (published in the past 5 years) describing interventions to address the effects of trauma on HIV-related outcomes. In particular, this study focused on the levels of intervention, populations the interventions were designed to benefit, and types of trauma addressed in the interventions in the context of both HIV prevention and treatment. Remarkably absent from the HIV prevention, interventions reviewed were interventions designed to address violence experienced by men or transgender individuals, in the USA or globally. Given the pervasive nature of trauma experienced generally, but especially among individuals at heightened risk for HIV, future HIV prevention interventions universally should consider becoming trauma-informed. Widespread acknowledgement of the pervasive impact of gender-based violence on HIV outcomes among women has led to multiple calls for trauma-informed care (TIC) approaches to improve the effectiveness of HIV services for HIV-infected women. TIC approaches may be relevant for and should also be tested among men and all groups with high co-occurring epidemics of HIV and trauma (e.g., men who have sex with men (MSM), transgendered populations, injection drug users, sex workers), regardless of type of trauma experience.