HIV/AIDS and the Black Church: what are the barriers to prevention services?

The HIV/AIDS epidemic continues to have a devastating impact on the black community in the United States. Trusted community institutions within the black community--the Black Church among them--have often been reluctant to respond to the epidemic in a manner commensurate with the scope of the problem. The aim of the current study was to understand the barriers to HIV/AIDS prevention services offered by black churches in a northeastern metropolitan area by surveying the ministers who lead the churches. METHODS: The study team constructed a 25-item questionnaire that asked questions about the ministers' and congregational demographics as well as general health and/or HIV/AIDS prevention services offered by the churches. The overall response rate was 82% (N=18). RESULTS: 83.3% (N=15) of the ministers surveyed reported financial barriers as reason for not providing HIV/AIDS prevention services. A majority of the ministers also perceived HIV/AIDS to be a problem in their communities. DISCUSSION: The resource-related nature of the barriers and the eagerness of the ministers to get more involved suggest that fostering creative partnerships between AIDS service organizations and churches may encourage more churches to offer HIV/AIDS prevention programming in a culturally acceptable manner.     

Reducing HIV/AIDS transmission among African-American females: is the female condom a solution?

Rates of HIV/AIDS have increased at an alarming rate among minority women, especially African-American women. Suggestions that have been presented to decrease HIV/AIDS transmission among African-American women include promoting abstinence and the use of the male condom. Little recognition and support have been given for promoting the female condom as a viable solution to combating the HIV/AIDS epidemic.     

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.     

Comparing the epidemic in U.S. and Britain

Cultural differences between the United States and Britain influence how the AIDS/HIV epidemic is being addressed and why AIDS rates are smaller in the United Kingdom. The author proposes that highly diverse and racist societies, like in the United States, may cause distrust among different groups in the effort to challenge the spread of HIV/AIDS, leaving people to fend for themselves. Because of racism and distrust between ethnic and racial groups, as well as differences in financial resources between groups, the AIDS epidemic in the United States is being fought on too many fronts without the benefit of a uniform response. Ironically, this problem has also spurred a greater ability among US AIDS service providers to work with diverse communities during the course of the epidemic.     

Incarceration, African Americans and HIV: advancing a research agenda

Incarceration is a crisis among African Americans, and the prevalence of HIV/AIDS in incarcerated men and women is 3-5 times that of the general population. We explore the potential implications of the widespread incarceration of African Americans on HIV risk and HIV outcomes in: 1) the current and formerly incarcerated, 2) their sexual partners, and 3) the communities impacted by incarceration. We set forth a research agenda for understanding and ameliorating the negative impacts incarceration and conclude that the African-American population's ability to successfully address the HIV/AIDS epidemic requires a coordinated and evidence-based response to the challenge of effectively preventing, managing and treating HIV in populations affected by incarceration.     

The global HIV epidemic: What the pathologist needs to know

The World Health Organization estimates that at the end of 2015, approximately 36.7 million people were living with HIV worldwide. An estimated 0.8% of adults aged 15–49 years are infected with HIV with women representing a little over half of these infections. The burden of the epidemic varies considerably between regions of the world and within countries. Sub-Saharan Africa is the region of the world with most infections accounting for approximately 70% of people living with HIV. In the United States the number of new infections decreased by 19% between 2005 and 2014 yet, close to 40,000 new infections occurred in 2015 and, as people with HIV live longer and new infections continue, the number of people living with HIV in the US now stands at nearly 1.2 million and continues to rise. Unprecedented funding initiatives for antiretroviral therapy have resulted in coverage of up to 46% of those in need globally. In recent years, studies have demonstrated that HIV-infected persons who are on antiretroviral therapy and suppressed do not transmit HIV thus the United Nations AIDS Program (UNAIDS) initiative of “treatment is prevention”. The UNAIDS goals for 2020 are to have diagnosis of 90% of those infected, 90% of those infected will be on treatment and in 90% there will be viral suppression. Of note, for two of the goals, laboratory system strengthening is paramount.     

重庆市艾滋病流行形势分析与防治策略研究

目的了解重庆市艾滋病流行趋势与特征,为艾滋病防治工作提供建议。方法收集1993—2009年重庆市艾滋病疫情资料与哨点监测数据,描述性分析HIV感染者年龄、性别、婚姻状况、职业、传播途径等的流行趋势,比较分析1999—2009年吸毒人群以及2006—2009年暗娼与男男性行为人群HIV感染率的变化趋势。结果重庆市累计报告HIV感染者7775例,近5年报告的病例数都超过了1000例,2009年经异性和同性性接触传播分别占26.6%和38.5%,50岁及以上年龄组所占的比例由2001年前的1.9%上升至2009年的17.4%。哨点监测发现静脉注射吸毒人群HIV由1999年的0.4%上升至2009年的6.4%,男男性行为人群HIV感染率由2006年的10.4%上升至2009年的19.0%,暗娼人群HIV感染率维持在0.5%以下。结论重庆市男男性行为人群、吸毒人群HIV感染率显著升高,加强针对上述人群的防控工作与HIV感染者的管理工作刻不容缓。     

Trends and determinants of Comprehensive HIV and AIDS knowledge among urban young women in Kenya

Background  

Sub-Saharan Africa remains the region most heavily affected by HIV. In 2008, the region accounted for 67% of HIV infections worldwide, the region also accounted for 72% of the world's AIDS-related deaths in 2008. Young people aged 15-24 years accounted for an estimated 45% of the new HIV infections. In sub-Saharan Africa, Kenya is among countries affected by the HIV and AIDS pandemic which led to the declaration of AIDS as a national disaster in 1999. Given these scenario the study was undertaken to examine trends in HIV and AIDS comprehensive knowledge and identify the main correlates of comprehensive HIV and AIDS knowledge among Kenyan urban young women.     

Operational research to improve HIV prevention in the United States

The HIV/AIDS epidemic in the United States continues despite several recent noteworthy advances in HIV prevention. Contemporary approaches to HIV prevention involve implementing combinations of biomedical, behavioral, and structural interventions in novel ways to achieve high levels of impact on the epidemic. Methods are needed to develop optimal combinations of approaches for improving efficiency, effectiveness, and scalability. This article argues that operational research offers promise as a valuable tool for addressing these issues. We define operational research relative to domestic HIV prevention, identify and illustrate how operational research can improve HIV prevention, and pose a series of questions to guide future operational research. Operational research can help achieve national HIV prevention goals of reducing new infections, improving access to care and optimization of health outcomes of people living with HIV, and reducing HIV-related health disparities.     

Smoking, depression, and gender in low-income African Americans with HIV/AIDS

Individuals with HIV/AIDS have disproportionately high depression and smoking prevalence rates. Smokers with HIV/AIDS are more susceptible to opportunistic infections, smoking-related illnesses, and mortality. African Americans (AAs) comprise nearly half of newly diagnosed HIV+ cases. We examined the relationship among smoking, depression, and gender in un- or under-insured AA patients (N = 289) at an urban community HIV/AIDS clinic in the southeastern US. Approximately 33% met criteria for a depressive disorder and 37% endorsed current smoking status. Men were more likely than women to be current smokers and depressed participants were more likely to smoke than non-depressed participants. Women had significantly higher rates of depression compared to men. Both depression and male gender independently predicted current smoking status. Depression and smoking are likely to co-occur in HIV/AIDS patients; however, standard smoking cessation interventions often exclude smokers with comorbid psychiatric and/or medical illnesses. Interventions addressing these comorbidities are warranted.     

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.     

Ending pediatric AIDS and achieving a generation born HIV-free

In the 30 years of the AIDS pandemic, the devastating effects of HIV on infants and young children have often been overlooked and neglected. However, the ability to prevent mother-to-child transmission of HIV (PMTCT), or vertical transmission, has been one of the most significant prevention success stories in the global AIDS response. New HIV infections in children have been virtually eliminated in high-income countries and programmatic efforts have shifted to low-income and middle-income countries, particularly in sub-Saharan Africa, home to the vast majority of pediatric AIDS cases.Over the past decade, the dramatic scale-up of PMTCT programs has saved millions of lives and has provided a foundation for HIV prevention and care and treatment programs that are integrated within maternal and child health services. Although some countries in sub-Saharan Africa are now approaching universal PMTCT coverage, global access to PMTCT for HIV-positive pregnant women remains at nearly 50%. Recently, a new global plan has focused efforts and resources to keep HIV-positive mothers healthy and to virtually eliminate new pediatric infections by 2015.What programmatic and technical innovations will be necessary to overcome current service gaps and implementation barriers? How can countries continue the current momentum with sustainable locally-led programs that address the epidemic in women and children? And how can the vital perspectives of communities and people living with HIV help drive these efforts? Successfully addressing these and other issues will be key to ending HIV infections in children and creating an AIDS-free generation within the next decade.     

Corporate response to the HIV/AIDS epidemic in Uganda - time for a paradigm shift?

The HIV/AIDS epidemic is likely to remain the pre-eminent global health concern for the foreseeable future. In Uganda, while significant progress has been made by the government over the past decade in bringing down the rate of new infections, the HIV/AIDS burden in the country remains huge and vigilant efforts must be continued if this burden is to further decrease.

Traditionally the government, supported by its international partners as well as local non-government organizations and the community has borne the brunt of the costs of containing the epidemic in Uganda. While the corporate sector in the country has financially contributed towards the costs of some of the interventions that are currently in place to combat the HIV epidemic, there is largely a paucity of sustained and systematic corporate leadership in providing comprehensive HIV/AIDS programmes for their employees.

A survey done by the authors of this paper reveals that most programmes undertaken in the private sector are of limited scope. We argue that there is more the corporate sector can do to more equitably share the HIV/AIDS burden, without necessarily jeopardizing its primary role - namely to maximize returns to shareholders.

This paper proposes a conceptual framework of how companies can approach the issue of HIV/AIDS within their workforce and suggests that providing more comprehensive interventions may in some instances result in substantial cost savings through the prevention or at least delay of HIV/AIDS related consequences such as: frequent absences from work, erosion of company skills and knowledge through key employee deaths, and the costs of hiring and training replacements etc. This ultimately could result in positive financial returns to those companies that choose to pursue work place led HIV/AIDS control and prevention programmes.

     

Together for the future: report on the Tenth International AIDS Conference,Yokohama, Japan

More than 11,000 researchers, activists, and health practitioners from 130 countries assembled in Yokohama, Japan, for the Tenth International Conference on AIDS. Involving 30 plenary sessions, 32 round table sessions, 580 abstract sessions, and 2700 poster sessions, this was the first of the annual international conferences on AIDS to be held in Asia, where the HIV epidemic is expected to explode in the next few years. As host of the conference, Japan demonstrated its commitment to contributing to the global fight against the HIV/AIDS pandemic by sending its highest officials. The features of the epidemic in Asia received considerable attention. Speakers pointed out that AIDS and HIV infection are spreading rapidly throughout Asia. By the year 2000, the majority of new HIV infections will occur in Asia, with 42% of the total in India, Thailand, and Myanmar. Scientific concerns dominated a large portion of the conference, but the socioeconomic impact of the pandemic as well as international collaboration, advocacy, and other topics were also explored. The solid contributions made by nongovernmental organizations against HIV/AIDS was recognized and supported in the conference.     

Death, AIDS morbidity, and HIV seroprevalence in New York City intravenous drug abusers

Drug treatment programs represent a point of access to intravenous drug abusers and, as such, may also be useful in monitoring health status indicators among this population. Such a surveillance project was established in 1985 among drug treatment clinics in New York City to monitor the human immunodeficiency virus (HIV) epidemic. HIV seroprevalence was 54% (255/469) in 1985, 61% (159/262) in 1986, and 60% (133/222) in 1987. Of the 2500 cumulative enrollees in these clinics each year, 4 patients met the Centers for Disease Control acquired immunodeficiency syndrome (AIDS) surveillance definition in 1985, 37 in 1986, and 37 in 1987. There were 25 AIDS-related deaths in 1985, 8 in 1986, and 16 in 1987. These results suggest that by including drug treatment programs in a rational surveillance system, we may be able to monitor the HIV epidemic more closely. The public health significance of such a surveillance program is magnified given the association between intravenous drug abuse-associated AIDS and the prevalence of AIDS among women, children, and ethnic/racial minorities.     

Society for Women and AIDS in Africa (SWAA)

In 1988, a group of African women founded the Society for Women and AIDS in Africa (SWAA) during the Fourth International Conference on AIDS in Stockholm. SWAA founders were concerned that national AIDS programs, professional associations, and donor agencies were not paying enough attention to how HIV/AIDS touches the lives of women in Africa. SWAA provides opportunities for women to be leaders in bringing about positive change. It asserts that if women have appropriate education and problem-solving opportunities, they will use their knowledge to make decisions and to take action, minimizing their risk of HIV infection and the risk behaviors of their partners and family members. SWAA helps women to provide AIDS education appropriate for women and safe, effective home and community-based HIV/AIDS health care and to address the cultural beliefs that foster misinformation about AIDS and the stigmatization of women. SWAA also assists women in changing traditional norms, in reducing prostitution, and in being advocates for persons living with HIV/AIDS, including AIDS orphans, grandparents, and street children. SWAA targets male policy and decision makers at both the national and international level. It cooperates with governmental and nongovernmental organizations to stem the AIDS epidemic in Africa. SWAA News is a permanent link between the SWAA branches in 25 countries and members. It features meetings, conferences, and SWAA activities. SWAA has increased solidarity among African women. It provides a forum for examining the sexual, social, and economic factors affecting the lives of women. It is expanding to include women's support centers and networks, counseling and help for women and HIV/AIDS, and training of media professionals on women and AIDS issues.     

Africa's children and AIDS -- a continent in crisis. The devastation of the HIV / AIDS pandemic

AIDS is having a major impact upon child health. By mid-1996, UNAIDS estimated that worldwide there were 3 million HIV infections in children. Accordingly, infant mortality rates (IMRs) have increased due to AIDS, reversing declines which had been occurring in many countries over the last few decades. The IMR in 1996 would have been 51.7 per 1000 without AIDS; it is instead 72.8 with AIDS, 40% higher than expected. IMR is 30% higher than expected in Zambia and almost 20% higher in Kenya and Uganda. IMRs should grow considerably during the next decade as the epidemic spreads. Two-thirds of AIDS deaths among children occur among those aged 1-4 years, with countries in southern Africa being the most affected. With regard to life expectancy, many years of life will be lost due to the AIDS epidemic. AIDS has already led to widespread and marked reductions in life expectancy, with life expectancy for females being lower than that for males because women are infected with HIV and die at younger ages than men. Lower life expectancy will lead to an increase in the proportion of orphaned children. It is likely that at least 30 million children are living with HIV-positive parents, at risk of being orphaned in the next few years. The implications of the growing proportions of orphans and challenges in child health are considered.     

HIV prevention for teenage girls: relationships are the medium and the message

HIV is a growing problem among young black and Hispanic women. Teenage girls' risk of HIV infection is primarily social in nature because sexual and/or needle-sharing behaviors typically occur in the context of relationships. Without cure or vaccine, the practice of safe or protected personal behaviors is absolutely critical to prevent new HIV infections. To optimize HIV-prevention efforts, clinicians can form caring and developmentally appropriate relationships that address HIV education. Medical HIV prevention for teenage girls is fundamentally about healthy relationships.     

Vaginal microbicides: A novel approach to preventing sexual transmission of HIV

The AIDS epidemic continues its unrelentless expansion. According to the Joint United Nations Programme on HIV/AIDS, there are more than 40 million people living with HIV, and more than 15,000 new infections occur every day. One approach to curbing HIV is the development of topical microbicidal agents or microbicides. These are compounds designed to protect the body’s mucosal surfaces from infection by sexually transmitted diseasecausing pathogens, including HIV. Several candidates are in preclinical stages; however, only a handful have been tested in humans for safety, and even fewer are ready for clinical efficacy trials. In this update, we describe microbicide research and development, including preclinical screening algorithms, ideal properties, compounds in the pipeline, and future prospects. This review is based on a previous work, which has been updated to contain new information, especially regarding microbicide candidates in preclinical and clinical stages of development.     

The epidemiology of clinically apparent HIV infection in Nicaragua

The purpose of this study was to describe the epidemic of clinically apparent human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) infection in Nicaragua and to discuss the reasons why the number of HIV patients presenting to the public health care system is increasing compared with other Central American countries. From 1987 to 2004, 1,614 HIV-positive patients were officially reported to the Nicaraguan STI/HIV/AIDS national program. Urban areas along the west-central and eastern part of Nicaragua showed the highest prevalence of AIDS, with a maximum of 54.2/year per 100,000 inhabitants. Most of the infections (91%) were acquired sexually: 65% by heterosexual contacts and 26% by homosexual contacts. The highest rate of infection was found in men aged between 20 to 39 years, with a peak around 35 to 39 years (annual incidence of 125.6 new cases per 100,000 inhabitants), and in women aged 20 to 34 years old, with a peak around 20 to 24 years (annual incidence 46.6 per 100,000 inhabitants). The male to female ratio of infection was 3:1. The death rate was stable until the beginning of 1999, but increased sharply thereafter up to 2004, the year that highly active antiretroviral therapy (HAART) was introduced in Nicaragua. In 2005, we observed a further increase in the mortality. However, our data do not represent the magnitude of the HIV/AIDS epidemic as a whole, due to a lack of systemic surveillance. HIV/AIDS in Nicaragua is in a nascent stage and is concentrated in high-risk populations, such as utility workers, commercial sex workers, men who have sex with men, prisoners, street children, housewives and police and military forces. Education of the population is an urgent need to increase HIV/AIDS-related knowledge, change attitudes, and increase safer sex practice in the community.