An effective Australian-Chinese peer education program on HIV/AIDS/STDs for university students in China

<正> IntroductionCurrently,there are at least 850,000 peo-ple living with human immuno-deficiency virus(HIV) and acquired immuno-deficiency syn-drome (AIDS) in China.Among them 16-29years old account for about 65%.Accordingto the Chinese health authorities,if the pre-ventive measures are not effective,the figurecould reach as many as 10 million by the year2010.Since there are currently no cure or     

Developing a surveillance system for HIV/AIDS in Pakistan

Apart from other interventions, surveillance remains a major focus of the national response to HIV/AIDS. However, with a shift in the epidemic pattern, the existing surveillance strategies are barely insufficient and long-term structural changes are desirable. This article provides a conceptual framework for developing a scientific system for HIV surveillance in Pakistan. Second generation surveillance system including repeated cross-sectional surveys in high risk population groups are suggested to collect behavioral and serological data at regular intervals on an annual basis to monitor the epidemic trend as well as the associated behaviors. In addition, multiple data resources have been highlighted, which could be coordinated to describe the epidemic pattern in the country. This information should form the basis for national prevention planning and ought to be used for making sensible choices through which prevention efforts are most likely to reduce new infections.     

The problems in France created by the HIV/AIDS epidemic at the onset of the third millenium

UNANSWERED QUESTIONS: The HIV/AIDS epidemic represented a medical, social and political challenge to our society. It raises numerous questions, to which some replies have been partially proposed. In the context of less attention paid to AIDS, the epidemic continues to create problems in France and has led to the debates on medical and sanitary questions and other political, social and economical issues. FROM A THERAPEUTIC POINT OF VIEW: Among the issues concerning health management, those related to treatment are first-line: progress in therapeutic indications, choice of antiretroviral molecules and their combinations, particular aspects of treatments delivered in certain circumstances (pregnant women or primary-infection), difficulties in the assessment of the benefit/risk progress. The problems of compliance that occasionally induce severe side effects, provoke therapeutic failure in some patients and for whom rapid access to new antiretroviral molecules and new therapeutic strategies is mandated. THE CROSS-LINK WITH POLITICAL, SOCIAL AND ECONOMIC PROBLEMS: The resulting debates partly depend on the progress made in therapeutics. The latter have led to expectations of HIV-infected patients, who would like to benefit fully from the promise of a return to normal life (access to insurance and medically-assisted procreation). HIV/AIDS has led to new ethical debates on the rights of patients, such as those related to screening, clinical research or confidential access of under-aged patients to treatment. Some of these aspects involve political decisions: prevention measures to be taken against the possibility of a new epidemic, the risks and damages related to the use of drugs and the guarantee of access to treatment of patients living in under-developed countries.     

Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS

Introduction

The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women''s specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care.

Methods

A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines.

Results and discussion

The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research.

Conclusions

This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV-positive women''s health outcomes.     

我国HIV/AIDS患者抗病毒治疗存在的问题与对策

截至2009年底,我国HIV/AIDS人数已达326 000例,其中AIDS患者107 000例,累计死亡54 000例.高效抗反转录病毒疗法（HAART）是目前治疗AIDS最有效的方法,可显著降低HIV/AIDS的病死率.我国自2003年实施免费抗病毒治疗以来,接受免费治疗的人数累计达8万人,病死率已从22.6%降至4%～5%[1],但其间仍面临诸多挑战.     

Evaluation of an HIV/AIDS peer education programme in a South African workplace.

OBJECTIVES: To evaluate a South African workplace HIV/AIDS peer-education programme running since 1997. METHODS: In 2001 a cross-sectional study was done of 900 retail-section employees in three geographical areas. The study measured HIV/AIDS knowledge, attitudes towards people living with HIV/AIDS, belief about self-risk of infection, and condom use as a practice indicator. The impact of an HIV/AIDS peer-education programme on these outcomes was examined. RESULTS: Training by peer educators had no significant impact on any outcome. Fifty-nine per cent of subjects had a good knowledge score, 62% had a positive attitude towards people with HIV/AIDS, 34% used condoms frequently, and the majority of participants (73%) believed they were at low risk of infection. Logistical regression showed that a very small proportion of the variance in the four outcomes was explained by potential determinants of interest (8% for knowledge, 6% for attitude, 7% for risk and 17% for condom use). CONCLUSIONS: The HIV peer-education programme was found to be ineffective and may have involved an opportunity cost. The programme contrasts with more costly comprehensive care that includes antiretrovirals. The private sector appears to have been as tardy as the public sector in addressing the epidemic effectively.     

HIV/AIDS and lipodystrophy: Implications for clinical management in resource-limited settings

Introduction

Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings.

Methods

We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review.

Results and Discussion

Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden.

Conclusions

Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.     

Psychopathology and coping in recently diagnosed HIV/AIDS patients--the role of gender.

BACKGROUND: Although there is growing literature on the psychological responses to and the psychopathology associated with HIV/AIDS, few investigations have focused on the role of gender. This study compared psychiatric morbidity, coping responses, and disability in male and female outpatients recently diagnosed with HIV/AIDS. METHOD: One hundred and forty-nine patients (44 male, 105 female) with HIV/AIDS (mean +/- standard deviation (SD) months since diagnosis 5.8 +/- 4.1) attending an infectious diseases clinic at Tygerberg Hospital, Cape Town, were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE, and the Sheehan Disability Scale. In addition, negative life events and risk behaviours were evaluated. RESULTS: Fifty-six per cent of patients were diagnosed with a psychiatric disorder, most commonly major depression (34.9%), dysthymic disorder (21.5%), post-traumatic stress disorder (14.8%), and alcohol dependence (10.1%). There were no significant gender differences in the prevalence of mood disorders in the sample. Men, however, were more likely than women to meet diagnostic criteria for alcohol abuse or dependence, and to engage in certain risky sexual behaviours. Women were more likely to suffer from post-traumatic stress disorder, and to use coping strategies of planning and religion to deal with the illness. There were no significant gender differences in disability. CONCLUSION: Psychiatric disorders are common in recently diagnosed HIV/AIDS patients in South Africa. Clinicians should be aware of the high prevalence of mood disorders in both men and women, and of gender-different responses such as increased alcohol and substance use and more risky sexual behaviour in men.     

美国HIV/AIDS专科护士的资格认证及启示

阐述了美国HIV/AIDS认证注册护士及高级认证注册护士的资格认证准入要求、考试形式、考核内容、认证机构及继续认证等方面的内容。提出美国HIV/AIDS护士资格认证对我国HIV/AIDS专业护士在认证准入资格、考核内容、认证机构等方面具有重要的借鉴、指导作用,并有利于促进我国HIV/AIDS护理事业专业化、护理人才专科化的发展进程。     

Social policy, imperiled communities and HIV/AIDS transmission in prisons: a call for zero tolerance

HIV/AIDS and African-American male imprisonment contribute to the destruction of African-American communities. African-American men and HIV/AIDS are disproportionately represented throughout all sectors of the criminal justice industry, including the juvenile justice system. The criminal justice system contributes to unacceptably high African-American male imprisonment rates and HIV prevalence directly via the ‘war on drugs’ and lax enforcement of institutional policy among other things, and indirectly through perpetuation of economic hardship which further exacerbates imprisonment rates, thus closing the loop of a vicious cycle of revolving prison doors and HIV contraction. This article briefly introduces surrounding socio-political issues that contextualizes the ensuing discussion. It then considers the State of Georgia to explore issues of incidence and how HIV transmission occurs in prisons, uses Prison Rape Elimination Act data to shed light on accountability issues and the degree to which the nature of sex in prisons is romantic or violent, and concludes by offering overarching solutions and encouraging action in response to the myriad associated problems.     

Driving a decade of change: HIV/AIDS,patents and access to medicines for all

Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, a result of global political mobilization that cleared the way for competitive production of generic versions of widely patented medicines. Global trade rules agreed upon in 1994 required many developing countries to begin offering patents on medicines for the first time. Government and civil society reaction to expected increases in drug prices precipitated a series of events challenging these rules, culminating in the 2001 World Trade Organization's Doha Declaration on the Agreement on Trade‐Related Aspects of Intellectual Property Rights and Public Health. The Declaration affirmed that patent rules should be interpreted and implemented to protect public health and to promote access to medicines for all. Since Doha, more than 60 low‐ and middle‐income countries have procured generic versions of patented medicines on a large scale. Despite these changes, however, a “treatment timebomb” awaits. First, increasing numbers of people need access to newer antiretrovirals, but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required. One promising new mechanism is the UNITAID‐supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. Such innovative approaches are possible today due to the previous decade of AIDS activism. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource‐poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health.