Human immunodeficiency virus infection in the Republic of Panama

Thirty-one documented acquired immune deficiency syndrome (AIDS) cases occurred in Panama during 1984-1987. Twenty-three (74%) patients were homosexual males and all but 2 patients recognized prior to June 1987 have died. To identify risk factors for human immunodeficiency virus infection, 287 male homosexual residents of Panama City were enrolled in a cross-sectional study. Nine had human immunodeficiency virus (HIV) antibody. Travel to the United States, homosexual relations with United States nationals in Panama, and sexual contacts in Panamanian clubs and bars were associated with human immunodeficiency virus infection by logistic regression analysis. Number of different male sex partners per year was identified but did not enter the logistic model at a significant level. To estimate seroprevalence in other high risk populations, 183 Panama City female prostitutes and 55 homosexual males from the rural Azuero peninsula were screened; none were seropositive. Eighty-four percent of Panamanian hemophiliacs had antibody; infection was related to factor VIII transfusions. Two of 182 sickle cell anemia patients and 15 of 7,720 volunteer blood donors were positive.     

烟台市2009-2011年艾滋病自愿咨询检测人群现况

目的了解烟台市艾滋病自愿咨询检测（VCT）人群的现况,为有针对性地加强VCT工作提供科学依据。方法对2009-2011年烟台市各VCT门诊的主动求询者进行匿名问卷调查。结果共调查29 935人,男性18 209人（占60.83%）,女性11 726人（占39.17%）;以青壮年为主,21～40岁的23 891人（占79.81%）;已婚者和未婚者所占比例相当,分别为50.31%（15 060人）、45.21%（13 535人）。求询原因中,非婚异性性行为史的23 427人（占78.26%）。27 979人进行了HIV抗体检测,其中初次检测的25 329人（占90.53%）,HIV抗体阳性检出率为0.22%（61/27 979）。有注射毒品史者（IDU）检出率最高,为15.38%（4/26）,有男男性行为史者次之,为2.22%（44/1 984）。2010-2011年,梅毒血清抗体检测率为94.54%（21 293/22 523）,检测阳性率为1.37%（291/21 293）。结论 VCT是及时发现感染者的有效手段,有非婚异性性行为者、男男性行为者是VCT的重点人群。     

Experience of hepatitis C testing among injecting drug users in Sydney, Australia

Testing injecting drug users (IDUs) for HIV and hepatitis C virus (HCV) provides a useful opportunity for health promotion, risk-reduction assessment and counselling, and increases opportunities for treatment assessment, yet little is known about IDUs' experience of testing. This study aimed to examine the experiences of testing among IDUs recruited through primary healthcare and drug treatment services. Almost all the 229 participants recruited had been previously tested for HIV (96%) and HCV (97%), a median of five and four times respectively. Reasons for seeking testing were similar for both HIV and HCV, the most common being to protect others (72 and 74%, respectively), blood/needle exposure (66 and 70%, respectively) and to receive early treatment (66%, both). The most common locations for testing were general medical practices (GPs) (53%), specialised clinics (45%) and methadone clinics (43%). Preferred locations were similar for HIV and HCV testing: methadone clinics (47 and 48%, respectively), GPs (42%, both), specialised clinics (32%, both). The most common reasons for delaying testing were being anxious about waiting for results (66%), scared or afraid of finding out results (65%) and having trouble keeping appointments (64%). The majority of participants (HIV 62%; HCV 59%) reported that they would prefer pre-test counselling to be delivered in person rather than receiving written information and would prefer test results to be delivered face-to-face (HIV 83%; HCV 80%). High prevalence of testing suggests good uptake and high acceptability among this population in Australia. Specialised services for drug users such as methadone clinics and primary healthcare are suitable locations to provide access to testing.     

Dealing with a positive result: routine HIV testing of pregnant women in Vietnam

HIV testing is an essential component of PMTCT. It can be offered to pregnant women through different testing models, ranging from voluntary counseling and testing (VCT) to routine and mandatory testing. This study was conducted in Hanoi, Vietnam, where HIV-prevalence is low among the general population, but high among young, urban, sexually active, male intravenous drug users. Women who want to deliver in a state hospital are routinely tested for HIV in the absence of well-defined opt-out procedures. In-depth interviews with a convenience sample of 38 seropositive pregnant women and mothers and 53 health workers explored the acceptability of routine testing. Patients and healthcare workers appeared to accept routine 'blood' tests (including HIV tests) because they feel uncomfortable discussing issues specific to HIV/AIDS. To avoid having to inform women directly about their HIV status, health workers at routine testing sites rely on the official notification system, shifting the responsibility from the hospitals to district and commune health staff. The notification system in Hanoi informs these local officials about the HIV status of people living in their catchment area without patients' consent. Our study shows that this non-confidential process can have serious social, economic and health consequences for the HIV-positive women and their children.     

广东省1997年艾滋病哨点监测报告

1997年广东省艾滋病(AIDS)哨点监测结果表明吸毒人群中艾滋病病毒(HIV)感染率比1996年增加60%;在性病门诊就诊者中检出HIV感染者,确诊性病患者占就诊人数的60.8%;暗娼人群的避孕套使用率比1996年高.值得注意的是有9.2%的暗娼承认与境外人员发生性关系,提示HIV已在该人群中加速流行.     

Knowledge, attitudes and beliefs regarding tuberculosis preventive therapy for HIV-infected persons, Botswana, 1999.

SETTING: Botswana, 1999. OBJECTIVE: To measure knowledge, attitudes and beliefs about tuberculosis (TB) preventive therapy (PT) for persons infected with the human immunodeficiency virus (HIV). DESIGN: A systematic sample of adult clinic attendees, using a standardised questionnaire. RESULTS: A total of 275 patients at 38 clinics in five districts were interviewed. The majority were female (65%) and unmarried (84%). Knowing someone with TB or AIDS was common (78% and 53%, respectively). Respondents perceived a relationship between TB and HIV (80%), and the majority were willing to undergo tuberculin skin testing (92%). Of those, most were willing to undergo evaluation for active TB (98%), and to take PT, although willingness to take PT declined with proposed duration (97% 6 months, 90% 1 year, 81% lifetime, P < 0.01). Previous HIV testing was reported by 13%; those who had not undergone testing reported that they would if doctors could improve the quality (95%) or duration (93%) of life of persons with AIDS. The majority favoured receiving HIV test results on the day they were tested (60%). CONCLUSIONS: Most clinic attendees in Botswana were willing to undergo HIV testing if it were beneficial to do so, such as by receiving PT. Pilot PT projects should be initiated. Voluntary HIV counselling and testing services should consider rapid HIV testing methods.     

Cost-effectiveness of counseling and testing and partner notification: a decision analysis.

OBJECTIVE: Counseling and testing and partner notification are effective HIV prevention strategies, but they can be resource intensive. This paper evaluates the cost-effectiveness of partner notification and counseling and testing offered in HIV and sexually transmitted disease (STD) clinics in preventing future HIV infections in the United States of America. METHODS: Decision trees were developed from both societal and provider perspectives. The counseling and testing and partner notification models incorporate estimates of HIV prevalence, return rates for counseling, risk of HIV transmission within 1 year, and the effectiveness of counseling. Cost estimates for counseling and testing and partner notification programs and lifetime treatment cost of HIV for the United States of America were obtained from published literature. Extensive sensitivity analyses of model parameters were conducted. RESULTS: For a cohort of 10,000 individuals at a clinic with an HIV seroprevalence of 1.5%, we estimate that counseling and testing prevents eight HIV infections and saves society almost $1,000,000. We estimate that partner notification for the 113 infected persons identified by counseling and testing, prevents another 1.2 HIV infections and saves an additional $181,000. To the provider (HIV and STD clinics), this translates to a cost of $32,000 per case prevented by counseling and testing and an additional $28,000 for partner notification. Model results are most sensitive to assumptions of HIV prevalence, risk of transmission, and treatment cost of HIV. CONCLUSIONS: Counseling and testing and partner notification are cost effective in preventing HIV transmission in this setting. This model can be adapted to assess the cost-effectiveness of counseling and testing and partner notification in other settings.     

HIV testing in antenatal clinics: the impact on women

One hundred and fifty-five women attending antenatal clinics in an inner city area where the rate of AIDS reporting is high were interviewed to examine the acceptability of different modes and purposes of antenatal HIV testing. Eighty-two per cent of women felt the test should be available in antenatal clinics, but only 48% reported that they themselves would take the test. Seventy-four per cent would accept anonymous testing. Potential anxiety levels surrounding the HIV test were significantly higher than for other (currently routine) tests in antenatal clinics. The implications of these findings for policy are discussed.     

A national study of AIDS and residency training: experiences, concerns, and consequences

OBJECTIVE: To examine residents' experiences in the care of patients with the acquired immunodeficiency syndrome (AIDS), and to examine factors that may influence their attitudes about such care. DESIGN: Cross-sectional, self-administered questionnaire survey conducted in 1989. PARTICIPANTS: All senior internal medicine and family medicine residents in ten geographically representative states who were identified through the 1986 National Residency Matching Program. MEASUREMENTS AND MAIN RESULTS: Seventy-four percent of residents reported that patients with AIDS accounted for 5% or more of general medicine admissions, and 50% of residents reported that they were currently following one or more human immunodeficiency virus (HIV)-infected patients in their continuity clinics. Among residents who had provided ambulatory care to patients with AIDS, 77% felt that it was an excellent educational experience, and among those who planned to do general primary care in their future practices, 74% planned on providing primary care to patients with AIDS. However, 61% expressed concerns about the adequacy of their training in AIDS ambulatory care. A greater amount of contact with outpatients who had AIDS, but not with inpatients who had AIDS, was associated with residents' intending to provide AIDS primary care in their future practices. Among all residents, 23% reported that, if given a choice, they would not provide care to any patients with AIDS, and 23% reported that they would not work in an area with a high prevalence of AIDS because of concern about contracting the syndrome. Nine percent of residents reported that they had been exposed to a blood-contaminated needlestick from an HIV-seropositive patient. CONCLUSIONS: Although most residents have substantial contact with inpatients and outpatients with AIDS, most still find their education in AIDS ambulatory care to be deficient. A minority of residents would prefer not to care for patients with AIDS. Residency curricula should include training and experience in ambulatory AIDS care, explicitly address negative attitudes toward caring for patients with AIDS, and include programs to reduce needlestick exposures.     

The role of sympathy on avoidance intention toward persons living with HIV/AIDS in Jamaica

As the number of persons living with HIV/AIDS (PLWHA) continues to increase in Jamaica, concerns of attitudes become more important. As such, the objective of the present study is to examine the attitudes of university students in Jamaica toward PLWHA including sympathy and avoidance intentions. A large sample of university students (N=1,252) was surveyed between June 2001 and February 2002 using a 193-item questionnaire that measured HIV-related knowledge, attitudes and behaviors. Results revealed that less than half of the students reported sympathetic attitudes toward homosexual males or female prostitutes living with HIV/AIDS (41% and 44%, respectively) while the majority reported sympathetic attitudes toward heterosexual males and non-prostitute females living with the disease (67% and 81%, respectively). Most students (80%) reported no avoidance intentions toward family members or friends living with the disease. Sympathy, HIV knowledge, education and awareness were associated with no avoidance intention of HIV-positive family members and friends. These findings suggest that sympathy could be important in improving prosocial intentions toward PLWHA and warrants further research.     

123例HIV抗体阳性尖锐湿疣患者的临床特征及其与细胞免疫功能低下的关系

目的了解艾滋病病毒(HIV)抗体阳性的尖锐湿疣(CA)患者的流行病学特征和临床特征,以及不同细胞免疫状态下尖锐湿疣的复发情况。方法回顾性分析近4年来在地坛医院就诊的HIV/艾滋病(AIDS)病人中,合并尖锐湿疣者的人口学特征、CA发病部位、复发情况及其与免疫低下的关系,以及合并性病感染的情况等。结果在894例HIV/AIDS病人中,发现合并尖锐湿疣者123例,发病率为13.76%。其中男性116例,女性7例;平均年龄27.9岁(20～57岁),发病率最高的年龄段为20～30岁(占59.35%),合并感染者中未婚率高达79.67%。经同性性行为感染HIV率为74.80%(92/123),经同性性行为感染尖锐湿疣率为81.30%(100/123)。CD4+为0～50个/μL时,CA复发率最高(66.66%),平均复发次数也最多(4.8次),随CD4+升高,CA复发率和复发次数均呈下降趋势。同时合并第三种性病者中,合并梅毒占29.27%(36/123),合并淋病占7.32%(9/123)。结论 HIV/AIDS病人中合并尖锐湿疣者以性活跃的男性为主,主要感染方式均是同性性行为,CD4+越低CA的复发率和复发次数越高,提示全身细胞免疫状态对CA的转归有明显影响,在CA的治疗中要考虑增强免疫治疗。     

A new approach to prevent HIV transmission: Project Protect intervention for recently infected individuals

Past research suggests that as many as 50% of onward human immunodeficiency virus (HIV) transmissions occur during acute and recent HIV infection. It is clearly important to develop interventions which focus on this highly infectious stage of HIV infection to prevent further transmission in the risk networks of acutely and recently infected individuals. Project Protect tries to find recently and acutely infected individuals and prevents HIV transmission in their risk networks. Participants are recruited by community health outreach workers at community-based HIV testing sites and drug users' community venues, by coupon referrals and through referrals from AIDS clinics. When a network with acute/recent infection is identified, network members are interviewed about their risky behaviors, network information is collected, and blood is drawn for HIV testing. Participants are also educated and given prevention materials (condoms, syringes, educational materials); HIV-infected participants are referred to AIDS clinics and are assisted with access to care. Community alerts about elevated risk of HIV transmission are distributed within the risk networks of recently infected. Overall, 342 people were recruited to the project and screened for acute/recent HIV infection. Only six index cases of recent infection (2.3% of all people screened) were found through primary screening at voluntary counseling and testing (VCT) sites, but six cases of recent infection were found through contact tracing of these recently infected participants (7% of network members who came to the interview). Combining screening at VCT sites and contact tracing the number of recently infected people we located as compared to VCT screening alone. No adverse events were encountered. These first results provide evidence for the theory behind the intervention, i.e., in the risk networks of recently infected people there are other people with recent HIV infection and they can be successfully located without increasing stigma for project participants.     

The link between sexually transmitted disease clinics and HIV counseling and testing centers: who is not getting referred?

A total of 236 clients attending human immunodeficiency virus (HIV) counseling and testing (C&T) centers and sexually transmitted disease (STD) clinics were interviewed to evaluate who is being reached by C&T services and if STD clients are being referred to HIV C&T centers. Respondents receiving HIV C&T reported significantly more sexual risk based on characteristics of their partners, whereas STD clinics respondents more frequently reported previous STD diagnoses and sex with prostitutes. Over 50% of the high-risk individuals attending STD clinics were not referred to HIV C&T centers. The differences in perceived risk of current and future infection between STD and HIV C&T centers and the low referral rates of high-risk individuals for HIV C&T indicate a need for increased education efforts, more effective risk-assessment policies in STD clinics, and a tightening of the link between STD clinics and HIV C&T centers.     

1997～1998年深圳市艾滋病哨点监测情况分析

1997和1998年在深圳市分别对1029名暗娼和1570名STD门诊就诊者进行HIV哨点监测。发现STD门诊就诊者主要为男性和未婚的省外流动人员,两个监测年度STD的罹患率分别为71.5％和70.0％,以梅毒、尖锐湿疣和NGU等溃疡性性病为主,未检出HIV抗体阳性者,在两个监测年度中,分别有31.8％和30.2％的暗娼有境外性伴,安全套使用率分别为45.9％和49.8％,暗娼人群呈明显年轻化趋势,平均性伴数显著增多(户<0.001),且在1998年第二轮250名暗娼中检出1例HW抗体阳性者,感染率为0.4％。监测结果表明HIV已开始在深圳市卖淫嫖娼等性乱人群中流行,HIV传播的多种危险性因素在不断增加。     

Screening for seroprevalence of HTLV-III/HIV infection in high risk groups in Delhi

Serum samples from a total of 1505 (826 males and 679 females) individuals belonging to various categories of Delhi based high-risk groups, such as those attending clinics which treat sexually transmitted diseases (n=700), prostitutes (n=348), jail inmates (n=325), drug addicts (n=26), blood donors (n=11), those clinically suspected AIDS cases (n=89), and those who underwent coronary bypass surgery abroad during the past 3-4 years (n=6) were screened for the presence of antibodies to HTLV-III/LAV/HIV virus. The commercial Wellcozyme AIDS ELISA kit was used and none of the serum samples tested positive for the HTLV-III virus.     

The acquired immunodeficiency syndrome. A report on the Second International Conference on AIDS

Although there have been significant gains in knowledge about acquired immunodeficiency syndrome (AIDS) since the 1st International Conference on AIDS in 1985 and some reason for hope that the epidemic can be controlled in developed countries, reports presented to the 2nd Conference (1986) indicated that AIDS will be a more formidable challenge than was originally recognized. There remains disagreement about the name and taxonomy responsible for the AIDS virus. Specifically, Montagnier and Levy have classified the AIDS virus in the lentivirus subfamily of retroviruses, while Gallo maintains it has more in common with other lymphotropic viruses and should be placed with ten in a separate category. Both the heterogeneity of the AIDS virus and its evolution within individual hosts complicate efforts to develop a vaccine that is effective against all strains. Even the clinical manifestations of AIDS vary among risks groups and may be changing within risk groups (e.g., the decline in Kaposi's sarcoma in homosexual men with AIDS). There are further differences in terms of risk groups. In developed countries, HIV infection has been limited to bisexual and homosexual men, intravenous drug abusers, prostitutes, recipients of blood and blood products, and their sexual contacts and children. In developing countries, especially in Africa, HIV infection is concentrated primarily among non-drug-using, non-homosexual men and women. In the US and Western Europe, HIV transmission has been slowed by blood screening, the purification of blood products, and health education aimed at reducing high-risk behaviors. In the Third World, however, risk groups remain unidentified, many governments are resistant to acknowledging AIDS, and resources for preventive activities are not available.     

Low perception of sexual behaviours at risk for human immunodeficiency virus infection among blood donors who call the AIDS/STI Help Line in Italy

Background

In Italy, the circulation of human immunodeficiency virus (HIV) has expanded to include population groups that do not perceive themselves to be “at risk” of HIV infection and who do not even consider undergoing HIV testing. The aim of this study was to describe the socio-demographic and behavioural characteristics, and perceived risk of HIV infection in a sample of blood donors who reported never having been tested for HIV.

Materials and methods

A questionnaire was administered to a sample of donors who called the Italian National AIDS/STI Help Line and reported never having been tested for HIV.

Results

The study sample consisted of 164 blood donors: 29.3% had given blood in the preceding 2 years. With regards to at-risk behaviours, 39.6% of the donors interviewed were heterosexuals who had sexual contacts with multiple partners, and 5.5% were men who had sex with multiple male partners. Sexual contacts with female sex workers were reported by 11.6% of first-time donors and 25.7% of repeat donors. Of the 164 donors interviewed, 125 (76.2%) said that the main reason that they had never been tested for HIV was that they did not consider themselves at risk. Among these, 56 (44.8%) reported that they would have sexual contacts with a sex worker, 52 (41.6%) reported that they would have sexual contacts with someone having more than one sexual partner, and 36 (28.8%) reported that they would have sexual contacts without using a condom.

Discussion

All the donors interviewed reported that they had never been tested for HIV despite the fact that they had been certainly been tested upon blood donation. These results show that some sexual behaviours may not be perceived as behaviours at risk for acquiring HIV infection. These findings suggest that not all blood donors are knowledgeable about HIV risk behaviours and that an explicit pre-donation questionnaire and effective counselling continue to be important for the selection of candidate donors.     

Using tuberculosis suspects to identify patients eligible for antiretroviral treatment.

SETTING: A district in rural sub-Saharan Africa with a recently introduced antiretroviral (ARV) programme. The population has high human immunodeficiency virus (HIV) prevalence and high tuberculosis (TB) incidence. OBJECTIVE: To determine the prevalence of HIV and acquired immune-deficiency syndrome (AIDS) related symptoms in people presenting with chronic cough who are not diagnosed with TB. DESIGN: A cross-sectional survey of TB suspects. METHODS: Patients with chronic cough were recruited from out-patient facilities. After standard diagnostic procedures and providing informed consent, they received counselling and testing for HIV, and were interviewed and examined with respect to staging criteria for HIV/AIDS. Suspects were followed up for 3 months after the end of the recruitment period to allow for delayed diagnosis of TB. RESULTS: Of 145 suspects, 79% had not been diagnosed with TB by the end of the follow-up period. Of these, 108 (95%) agreed to HIV testing and 61 (56%) were HIV-positive. More than half of these were eligible for ARV treatment (Stage III or IV disease) under national programme criteria. CONCLUSION: Established chronic cough clinics are a useful setting for recruitment of patients to ARV clinics. Attendees should be offered HIV testing and simple clinical screening to identify those who should be referred for ARV treatment.     

北京市朝阳区艾滋病自愿咨询检测情况分析

目的调查北京市朝阳区艾滋病自愿咨询检测（VCT）人群的社会人口学特征和艾滋病病毒（HIV）感染状况,有针对性地制定朝阳区艾滋病健康教育和高危干预措施。方法对2007年6月-2008年9月,朝阳区疾病预防控制中心艾滋病VCT门诊求询者的调查结果进行分析。结果868名求询者接受咨询和血清HIV抗体检测,以20～40岁男性青壮年为主,占89.9%;男女比例7.19∶1;未婚占68.9%。求询原因以发生危险性行为为主,占86.3%。HIV抗体阳性41例,感染率为4.7%,以性途径感染为主（75.6%）,22人通过同性性行为感染。结论朝阳区艾滋病的传播以性途径为主,求询者以年轻、未婚和高学历男性为主,HIV感染在男男性行为人群（MSM）中检出率较高。因此,应对男性青壮年、MSM人群进行广泛的艾滋病健康教育,加强针对MSM人群的行为干预措施。     

北京市护理人员关于HIV/AIDS的认识和接受程度调查分析

目的 为了解北京市护理人员对HIV/AIDS的认识和接受态度,以便对护理人员有针对性地实施继续教育.方法于2000年1月上旬分层随机抽取北京市6所医院内当日上岗的护士中发放调查问卷1300份,进行流行病学现况研究.结果 有84.2%以上的护士对HIV/AIDS的基本知识掌握较好.对HIV/AIDS接受态度调查结果表明,只有31.8%的护士能对病人做全护理,知识掌握与接受态度不呈正比(P<0.05),特别是对自己患病态度,有50.8%的人答能正常生活,11%的人采取自杀行为,值得关注,说明护士对HIV/AIDS的恐惧心理严重.结论 尽管绝大多数护士对HIV/AIDS知识掌握得较好,但调查显示还有死角,还需加强对护理人员关于HIV/AIDS知识的继续教育;同时本文分析了护士恐惧心理的原因,并提出相应对策及建议,为研究护理人员的心理状况、职业保护措施和心理支持提供了客观依据.