HIV / AIDS in China: migrant population,drug injection responsible for increased transmission

By 2000, China will have 1.2 million people infected with HIV and 33,000 people with AIDS. While HIV infection has been reported from almost all provinces and occupational groups in the country, HIV prevalence is highest among IV drug users in Yunnan province. The major source of infection elsewhere in China is through the receipt of tainted blood products and heterosexual intercourse. A National AIDS Committee was formed in October 1986 to advise the government on AIDS policy, and since 1990 to coordinate all AIDS prevention activities. The National Strategies Plan for AIDS/STD Prevention in China during 1996-2000 was prepared in 1995. China's in-country migrant labor population may become the most vulnerable to HIV infection. There are currently about 120 million migrant workers in China, of whom about half are registered, nonpermanent residents working in the fastest developing regions. The open nature of China's economy relative to recent past decades has made it difficult to monitor and control internal migration. Floating populations are the most difficult to reach with preventive health education and they tend to be deprived of access of health care. 61.4% of the migrant population is male and 40% are aged 20-24 years. China's traditional trade routes may be a factor in HIV infection. HIV/AIDS epidemiology, the synergy of STDs and AIDS in China, the international partnership in HIV/AIDS prevention in China, the role of international nongovernmental organizations in China, Hong Kong's contribution to AIDS prevention in China, awareness of the problems associated with HIV infection in China, and the challenges for AIDS-related work in China are discussed.     

某地吸毒人群与HIV感染相关的高危行为调查

目的了解深圳市某地吸毒人群与HIV感染相关的高危行为。方法采用整群抽样的方法对一定时间内全体强制戒毒人员进行血清HIV抗体检测,并对其中76例HIV阳性者进行问卷调查。结果HIV抗体检出率为5．01％,戒毒人群中15～35岁占93．67％;HIV感染者中,15—35岁占96．05％,静脉注射吸毒者高达98．68％,共用注射器者占静脉吸毒者的80．26％。结论某地吸毒人群中存在引起HIV流行的高危行为．需尽快开展有效的干预措施。建议在流动人口中开展艾滋病预防教育活动,同时还应对在校学生开展预防吸毒的教育。     

Global update: Morocco

In Morocco, the Ministry of Heath (MOH) has received reports of just 140 AIDS-seropositive cases and 270 HIV-seropositive cases (including the 140 AIDS cases). The numbers are probably low because the only two locations for a public sector-supported HIV serodiagnostic test are Rabat and Casablanca, and the test is very expensive if paid for with private funds. MOH and other groups have tried to inform the medical community about HIV/AIDS, yet it remains relatively ignorant about HIV/AIDS. In those cases where physicians do recognize AIDS, they do not necessarily know that notification should be anonymous. In the late 1980s, men who had lived in Europe represented most AIDS patients in Morocco. They tended to be homosexuals, bisexuals, or IV drug users. Heterosexuality is the chief means to HIV transmission today. Women make up 25% of all HIV-infected cases to date. They are partners of bisexuals and IV drug users and prostitutes. Moroccans consider AIDS to be a shameful disease. AIDS cases tend not to tell their families, friends, or anyone of their condition. Yet, Moroccan families are more likely to accept members with AIDS Western families. Different types of prostitution exist in the country. Homosexual Western men travel to Morocco, especially Marrakech and Agadir, to find homosexual partners. Morocco is close to Europe and Sub-Saharan Africa, both of which have high rates of AIDS cases. So it is surprising that AIDS arrived in Morocco relatively late in the epidemic (1986). IV drug use is somewhat rare in Morocco, but authorities must not neglect this area since some Moroccan ports are transit points for drugs. A medical professor at the University of Casablanca believes that nongovernmental organizations are better at AIDS prevention than governments. In February 1988, he started the first AIDS-centered association in the Maghreb, maybe the first in the Arab world.     

The Four Cs of HIV Prevention with African Americans: Crisis,Condoms, Culture,and Community

HIV/AIDS continues to be a devastating epidemic with African American communities carrying the brunt of the impact. Despite extensive biobehavioral research, current strategies have not resulted in significantly decreasing HIV/AIDS cases among African Americans. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability. Successful interventions targeting African Americans must optimize strategies that integrate socio-cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors. Community-based participatory research to decrease the HIV/AIDS disparity by building community capacity and infrastructure and advocating for and distributing equitably, power and resources, must be promoted. Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent interventions may be tested and implemented at the community level.     

Prevention of HIV infection in street-recruited injection drug users. The Collaborative Injection Drug User Study (CIDUS)

BACKGROUND: Injection drug users (IDUs) and their sex partners account for an increasing proportion of new AIDS and HIV cases in the United States, but public debate and policy regarding the effectiveness of various HIV prevention programs for them must cite data from other countries, from non-street-recruited IDUs already in treatment, or other programs, and from infection rates for pathogens other than HIV. METHODS: Participants were recruited from the street at six sites (Baltimore [Maryland], New York [two sites], Chicago [Illinois], San Jose [California], Los Angeles [California], and at a state women's correctional facility [Connecticut]), interviewed with a standard questionnaire, and located and reinterviewed at one or more follow-up visits (mean, 7.8 months later). HIV serostatus and participation in various programs and behaviors that could reduce HIV infection risk were determined at each visit. RESULTS: In all, 3773 participants were recruited from the street, and 2306 (61%) were located and interviewed subsequently. Of 3562 initial serum specimens, 520 (14.6%) were HIV-seropositive; at subsequent assessment, 19 people, all from the East Coast and Chicago, had acquired HIV. Not using previously used needles was substantially protective against HIV acquisition (relative risk [RR], 0.29; 95% confidence interval [CI], 0.11-0.80 ) and, in a multivariate model, was significantly associated with use of needle and syringe exchange programs (adjusted odds ratio [ORadj], 2.08; 95% CI, 1.15-3.85). Similarly, reduction of injection frequency was very protective against seroconversion (RR, 0.33; 95% CI, 0.14-0.80), and this behavior was strongly associated with participation in drug treatment programs (ORadj, 3.54; 95% CI, 2.50-5.00). In a separate analysis, only 37.5% of study-participants had sufficient new needles to meet their monthly demand. CONCLUSIONS: In this large multicity study of IDUs in the United States, several HIV prevention strategies appeared to be individually and partially effective; these results indicate the continued need for, and substantial gaps in, effective approaches to preventing HIV infection in drug users.     

Drug Treatment as HIV Prevention: Expanding Treatment Options

Research conducted during the first 20 years of the AIDS epidemic provided a solid foundation of data supporting methadone treatment as HIV prevention. Drug users in methadone treatment were consistently found to reduce the frequency of drug use, risk behaviors, and infections. These data have been consistent over time and across cultural settings and have been used to promote the expansion of drug treatment as a prevention intervention. More recently, data have emerged suggesting the prevention potential of medication-assisted treatments other than methadone (buprenorphine/naloxone and naltrexone). Still, with a few notable exceptions, global drug treatment coverage for opiate injectors remains remarkably low and only a few treatment interventions for stimulant use have shown efficacy in reducing HIV risk. Importantly, more recent data provide support for the role of drug treatment programs in improving access and adherence to antiretroviral treatment and that injection drug users in substance abuse treatment are more likely to achieve sustained viral suppression. While important challenges remain in maximizing its impact, the scientific literature provides strong evidence of the efficacy of drug treatment as an HIV prevention strategy.     

Willingness to volunteer in future preventive HIV vaccine trials: issues and perspectives from three U.S. communities

This study examined perceived risks, benefits, and desired information related to willingness to volunteer in preventive HIV vaccine trials. SAMPLE: Purposive sampling was used to select 90 participants among injecting drug users (Philadelphia, PA, U.S.A.); gay men (San Francisco, CA, U.S.A.); and black Americans (Durham, NC, U.S.A.). METHODS: A qualitative interview guide elicited perceived benefits, risks, and desired information relating to trial participation. Themes were developed from the transcribed texts and from freelists. RESULTS: Stated willingness to volunteer in a preventive HIV vaccine trial was similar across the three communities. Eight perceived benefits were reported, including self-benefits, altruism, and stopping the spread of AIDS. Seven perceived risks were reported, including negative side effects and vaccine safety issues, contracting HIV from the vaccine, and social stigmatization. Participants voiced the desire for eight types of information about issues relating to trust and confidentiality in the research process, health complications and later assistance, and vaccine trial methodology. CONCLUSIONS: In this study, many benefits as well as risks of preventive HIV vaccine trial participation were cited. Scientists conducting preventive HIV vaccine trials need to address community perceptions of risks and provide information about the research if trial enrollment is to be diverse and successful.     

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。     

Correlates of African American college students' condom use to prevent pregnancy,STDs, or both outcomes

BACKGROUND: The purpose of the current study was to compare African American college students who reported condom use for pregnancy prevention only, disease prevention only, and both pregnancy and STD prevention (i.e., dual prevention) in terms of their AIDS-related health beliefs, conventional sexual behavior, and unconventional sexual behavior. It was hypothesized that dual-prevention adolescents would express more health protective attitudes and behaviors than single-prevention individuals. METHOD: The sample consisted of 171 African American, undergraduate, single, heterosexual, and sexually active students with at least one partner in the past six months and who used condoms. A self-report questionnaire was administered-including items related to demographic and background information, sexual activity, condom use behavior, and knowledge, attitudes, and beliefs about HIV/AIDS, to participants in groups of 10-30 students in university classroom settings. RESULTS: The main between-group differences were in comparisons of pregnancy-prevention-only condom users and dual-prevention condom users. Participants who used condoms to prevent pregnancy only were less likely to be female, perceived themselves to be less susceptible to HIV/AIDS, perceived fewer barriers to condom use, and reported fewer vaginal sex partners. CONCLUSIONS: Intervention programs must address the relation between African American adolescents' beliefs about susceptibility to HIV/AIDS and unintended pregnancy, as well as their views of involvement in monogamous relationships. Integrated prevention services may allow for discussions of similarities and differences in the issues relevant to condom use for pregnancy prevention versus disease prevention.     

Progress in HIV reduction and prevention among injection and noninjection drug users

Substantial progress has been made in reducing HIV among injection drug users (IDUs) in the United States, despite political and social resistance that reduced resources and restricted access to services. The record for HIV prevention among noninjecting drug users is less developed, although they are more numerous than IDUs. Newer treatments for opiate and alcohol abuse can now be integrated into primary HIV care; treatment for stimulant abuse is less developed. All drug users present challenges for newer HIV prevention strategies (eg, "test and treat," nonoccupational postexposure prophylaxis and preexposure prophylaxis, contingency management, and conditional cash transfer). A comprehensive HIV prevention program that includes multicomponent multilevel approaches (ie, individual, network, structural) has been effective in HIV prevention among IDUs. Expanding these approaches to noninjecting drug users, especially those at highest risk (eg, minority men who have sex with men) and incorporating these newer approaches is a public health priority.     

Social psychological dynamics of enhanced HIV risk reduction among peer interventionists

The authors present a model of interactive social psychological and relational feedback processes leading to human immunodeficiency virus (HIV) risk reduction behavior change among active drug users trained as Peer Health Advocates (PHAs). The model is supported by data from qualitative interviews with PHAs and members of their drug‐using networks in the Risk Avoidance Partnership (RAP) project. Results suggest three mutually reinforcing social psychological processes that motivate PHAs to provide HIV prevention intervention to their peers and to reduce their own risk behaviors: development of a prosocial identity, positive social reinforcement from drug users and community members, and cognitive dissonance associated with continued risk behavior while engaging in health advocacy. These processes directly influence peer interventionists' motivation and efficacy to continue giving intervention to their peers, and to reduce their HIV risk behaviors. The authors discuss implications of the model for continued research on effective HIV prevention in high‐risk groups. © 2011 Wiley Periodicals, Inc.     

Psychological interventions with AIDS and HIV: prevention and treatment.

In the decade since acquired immune deficiency syndrome (AIDS) was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with human immunodeficiency virus (HIV) conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and injection drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "second wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection.     

Willingness of injection drug users to participate in an HIV vaccine efficacy trial in Bangkok, Thailand.

We assessed willingness to participate in an HIV recombinant gp120 bivalent subtypes B/E candidate vaccine efficacy trial among 193 injection drug users (IDUs) attending drug treatment clinics in Bangkok, Thailand. IDUs previously enrolled in a prospective cohort study were invited to group sessions describing a potential trial, then completed questionnaires assessing comprehension and willingness to participate. A week later, they completed a follow-up questionnaire that again assessed comprehension and willingness to participate, as well as barriers to and positive motives for participation, with whom (if anyone) they talked about the information, and whether others thought participation was a good, bad, or neutral idea. At baseline, 51% were definitely willing to participate, and at follow-up 54%; only 3% were not willing to participate at either time. Comprehension was high at baseline and improved at follow-up. Participants who viewed altruism, regular HIV tests, and family support for participation as important were more willing to volunteer. Frequency of incarceration and concerns about the length of the trial, possible vaccine-induced accelerated disease progression, and lack of family support were negatively associated with willingness. Overall, IDUs comprehended the information needed to make a fully informed decision about participating in an rgp120 vaccine efficacy trial and expressed a high level of willingness to participate in such a trial.     

AIDSCAP. Saving a generation: Ethiopian youth rally to prevent AIDS

Afraid that they were infected with HIV and would die in several years, several young adults formed the Save Your Generation Association (SYGA) to warn other young people about the threat of HIV/AIDS. SYGA has since become a registered Ethiopian nongovernmental organization (NGO) with a paid staff of 14 and more than 6000 dues-paying members. It is one of seven NGOs which received support from the AIDS Control and Prevention (AIDSCAP) project over 3 years to bring HIV/AIDS prevention education to out-of-school youth in six urban areas of Ethiopia. The projects recruited young volunteers and enlisted the aid of community organizations to inform and motivate the tens of thousands of school dropouts and other unemployed young people. Bored and hopeless, these youths often turn to dangerous escape mechanisms involving drugs, alcohol, and sex with multiple partners. The local government helped the NGOs find their target population and provided meeting space for HIV/AIDS prevention activities.     

清远市高危人群HIV感染状况及艾滋病相关知识知晓情况调查

目的了解清远市高危人群HIV感染流行趋势和艾滋病相关知识知晓情况,为采取有针对性的行为干预措施和开展宣传教育工作提供准确的信息。方法于2005-2008年采用横断面调查的方法对强制戒毒者、暗娼和性病门诊就诊者等高危人群进行监测,并调查吸毒者和暗娼的艾滋病相关知识知晓情况。结果吸毒人群HIV抗体阳性率介于2.58%～4.15%之间;吸毒者中注射吸毒的比例为82.05%,其中共用注射器吸毒的比例为57.26%;吸毒者中42.39%有商业性行为,而且从未使用安全套的比例为52.53%。在227名暗娼中未发现HIV抗体阳性者,暗娼中最近1个月与客人发生性行为时坚持每次使用安全套的比例为39.43%。性病门诊就诊者HIV抗体阳性率介于0.20%～0.42%之间;34.56%的性病门诊就诊者最近3个月有非婚性伴,而且从未使用安全套的比例为16.25%。调查人群的艾滋病相关知识总体知晓率为57.17%,其中吸毒者和暗娼艾滋病相关知识总知晓率分别为53.05%、61.73%。结论清远市高危人群中以吸毒者HIV抗体阳性率较高,注射吸毒及共用注射器的比例较高,性乱人群中HIV流行水平较低,但存在不安全性行为;高危人群中艾滋病相关知识知晓率低,需采取有效的行为干预措施,加大宣传力度和覆盖面。     

HIV prevention for injecting drug users: the first 25 years and counting

During the last three decades, both the injection of illicit psychoactive drugs and HIV infection among injecting drug users (IDUs) have spread throughout industrialized and developing countries. Extremely rapid transmission of HIV has occurred in IDU populations with incidence rates of 10 to 50/100 person-years. In sharp contrast, there are many examples of very effective HIV risk reduction for IDUs, both in preventing initial epidemics and in bringing existing epidemics under control. IDUs are capable of learning basic information about HIV/AIDS and modifying their behavior to protect both themselves and their peers. Effective HIV prevention for IDUs requires programs that treat IDUs with dignity and respect, provide accurate information and the means for behavior change-access to sterile injection equipment, condoms, and drug abuse treatment. Programs that provide these services need to be implemented on a public health scale for IDU populations at risk for HIV infection.     

Infectious disease comorbidities adversely affecting substance users with HIV: hepatitis C and tuberculosis

The linkage between drug use, particularly injection drug use, and HIV/AIDS, hepatitis C (HCV), and tuberculosis (TB) has been recognized since the beginning of the HIV pandemic. These comorbid conditions affect drug users worldwide and act synergistically, with resultant adverse biologic, epidemiologic, and clinical consequences. Prevention, care, and treatment of TB and HCV can be successful, and both diseases can be cured. Special clinical challenges among drug users, however, can result in increased morbidity, mortality, and decreased therapeutic success. Among these are limited disease screening, inadequate and insensitive diagnostics, difficult treatment regimens with varying toxicities, and complicated pharmacokinetic and pharmacodynamic drug interactions. These may result in delayed diagnosis, deferred treatment initiation, and low completion rates, with the potential for generation and transmission of drug resistant organisms. Strategies to address these challenges include outreach programs to engage substance abusers in nonmedical settings, such as prisons and the streets, active screening programs for HIV, HCV, and TB, increased and broadened clinician expertise, knowledge and avoidance of drug interactions, attention to infection control, use of isoniazid preventive therapy, and creative strategies to insure medication adherence. All of these require structural changes directed at comprehensive prevention and treatment programs and increased collaboration and integration of needed services for substance abusers.     

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.     

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.     

INVESTIGATING COMMUNITY PERSPECTIVES ON FALLS PREVENTION INFORMATION SEEKING AND DELIVERY: OLDER PERSON PERCEPTIONS REGARDING PREFERENCES FOR FALLS PREVENTION EDUCATION USING A WORLD CAFE APPROACH

Falls among older people are a significant global socioeconomic problem, and older adults have low levels of self‐perceived risk and a lack of willingness to take up existing falls prevention strategies. We believe that given the challenges of delivering falls prevention information, meaningful engagement of community members would create solutions based on an understanding of what would work best for that community. A World Cafe community forum sought the opinions of 70 community‐dwelling older people about their preferences on how they would best receive and seek falls prevention information that could prevent falls within their age group. Participants evaluated the café as a highly positive experience and felt that learning occurred by way of interaction and “sharing of ideas.” Local communities could develop this participatory approach to engage older people in leading the translation of falls prevention evidence into practice.