A comparison of high-risk sexual behaviour and HIV testing amongst a bar-going sample of homosexual men in London and Edinburgh.

BACKGROUND: This study compared high-risk sexual and HIV testing behaviour amongst homosexual men recruited from gay bars in London and Edinburgh. METHODS: A cross-sectional survey monitoring high-risk sexual and HIV testing behaviour using a self-completed questionnaire was conducted in November and December 1996. RESULTS: Two thousand, three hundred and ninety-seven questionnaires were returned (1,366 recruited in London and 1,031 in Edinburgh), with a response rate of 77%. A larger proportion of men surveyed in London had had unprotected anal intercourse (UAI) with one or more male partners in the previous year (35%) than in Edinburgh (30%). Men recruited in Edinburgh were less likely to have had an HIV test (54%) than men in London (63%). In both surveys, 25% of men who reported UAI with partners of the same HIV status as themselves also reported never having had an HIV test. CONCLUSIONS: The observed dissimilarities in the HIV epidemic in the two cities may be accounted for by the differences in self-reported high-risk sexual and HIV testing behaviours between the two populations. A large proportion of men in both cities continue to engage in high-risk sexual behaviour suggesting continued transmission of HIV in these populations. Thus, there is a continued need for innovative and relevant health promotion amongst homosexual men in the UK.     

HIV risk behaviour of older persons

BACKGROUND: This study investigated social and psychological determinants of preventive behaviour in HIV-relevant situations. METHODS: Using computer-assisted telephone survey methodology, 2275 male and female were interviewed about their sexual habits. RESULTS: For the first time in Switzerland, data concerning HIV-relevant protection as well as their determinants were systematically collected also from persons older than 45. This age group (n=834) showed an increased risk with regard to HIV-relevant sexual contacts. CONCLUSIONS: The present findings call for more adequate monitoring of sexual behaviour of people older than 40 and suggest the development and implementation of respective age-specific prevention measures.     

Surveillance of measles: A comparison of active and passive methods

Background: The Catalan Health Plan includes the eliminationof indigenous measles as one of its objectives for the year2000. Together with an adequate vaccination policy, epidemiologicalsurveillance is a critical component in this strategy. The objectiveof the study is to compare the utility of active and passivesurveillance methods in detecting and characterising cases ofmeasles. Methods: Active surveillance was carried out by epidemiologistswho revised hospital discharges and questioned the staff inhealth centres about cases and passive surveillance was carriedout by receiving physician's notification of cases. The studywas done throughout the whole territory of Catalonia in 1996.For each case, laboratory results, age, probable site of transmission,size of the region of origin and immunisation status were investigated.Results: One hundred and seventy-one cases were detected, ofwhich 96 (56.1%) were confirmed and 52 (30.4%) laboratory confirmed.The positive predictive values for passive and active surveillancewere 54.6% (95% Cl: 46.4–63.6) and 60.9% (95% Cl: 44.5–75.8)respectively. The proportion of patients under 15 years washigher in cases detected by passive surveillance than in thosedetected by active surveillance (OR=2.9 and 95% Cl; 1.3–7.0).The probable site of transmission was less frequently knownby passive surveillance than by active surveillance (OR=0.2and 95% Cl: 0.07–0.4). No association was found betweenthe method of surveillance and the size of the region or immunisationstatus. Conclusion: A reasonable strategy for measles surveillanceappears to be the individualised notification of the diseaseby physicians followed by surveillance activities directed atconfirming the case and identifying its origin.     

江苏省吸毒人群HIV感染危险行为及影响因素分析

目的:了解江苏省吸毒人群人类免疫缺陷病毒(HIV)感染相关危险行为状况及其影响因素。方法:通过匿名调查,获得吸毒人群的行为学资料,用Logistic回归模型进行危险因素分析。结果:调查的952名吸毒人群中,静脉注射吸毒占59.66%,其中有44.54%的人曾与他人共用过针具,近20%的人曾与我国艾滋病流行率最高的云南和新疆地区的吸毒者一起吸食过毒品。70.38%的人有多性伴史,59.56%的人从未用过安全套。多因素分析注射吸毒的危险因素包括首次吸毒年龄(OR=0.39),吸毒年限(OR=192),吸毒圈中有云南、新疆人(OR=6.79);共用注射器吸毒的危险因素包括注射史>3年(OR=3),吸毒圈中有云南、新疆人(OR=2.1)。结论:江苏省吸毒人群中存在HIV感染流行的危险,应进一步完善目前的行为监测系统,并加大美沙酮社区维持和针具交换项目的覆盖面。     

Homophobia,stigma and HIV in Jamaican prisons

Success in addressing HIV and AIDS among men who have sex with men, a key population in the global epidemic, is impeded by homophobia. Homophobia as a barrier to HIV prevention and AIDS treatment is a particularly acute problem in the prison setting. In this qualitative study, we explore HIV and AIDS, stigma and homosexuality in the largest all male prison in Jamaica by conducting iterative in-depth interviews with 25 inmates. Participant narratives unveil a purposeful manipulation of beliefs related to homosexuality that impedes an effective response to HIV and AIDS both in prison and wider society. Findings indicate that homophobia is both a social construction and a tangible tool used to leverage power and a sense of solidarity in a larger political and economic landscape. This use of homophobia may not be unique to Jamaica and is an important issue to address in other low- and middle-income post-colonialist societies.     

Migration and HIV epidemic in Greece

BACKGROUND: Over the last decade, Greece has experienced a massive influx of migrants from countries in South Eastern/Central Europe, the Middle East, Asia and Africa. This study aimed to estimate the percentage and the specific characteristics of HIV-positive migrants reported in Greece, and to describe the secular trend of migrants' proportion among HIV-infected individuals. METHODS: Secondary analysis of data reported to the Hellenic Centre for Infectious Diseases Control (HCIDC) during the years 1989-2003. RESULTS: From 1989 to 2003, 6292 HIV-positive cases were reported to HCIDC. Data show that 749 people (439 males, 303 females) originated from countries other than Greece. Most HIV-positive migrants come from Sub-Saharan Africa (32.44%) and nearly 20% from Central and Eastern Europe. In the Greek population, men who have sex with men (MSM) constitute 50.47% of cases, while 16.15% are heterosexuals. The epidemic profile follows a different pattern among migrants (P<0.05). Heterosexual transmission accounts for 41.52% of HIV-positive reported migrants, while 19.09% are MSM. An 11% increase for each subsequent year in the rate of HIV-positive migrants reported in Greece has been estimated using a Poisson regression model fitted to the data (IR 1.11; 95% confidence interval 1.08-1.13). CONCLUSIONS: The results suggest an increasing trend of HIV-seropositive migrants in Greece during recent years. Group-based interventions, better access to health care and a comprehensive public approach should be applied to migrants.     

A European risk model for hepatitis among health care workers

Hepatitis B (HBV) is the most important occupational hazardfacing workers in the hearth care and related environments.It is a serious, but underestimated, occupational hazard amongsuch personnel, who are at a 2 to 10 times greater risk of infectionthan the general population. In the light of recent changesin legislation concerning hepatitis B, we have designed a riskmodel for health care workers (HCW) in Western Europe to estimatethe number of cases of HBV infection in this group. An annualattack rate was derived, based on data from the literature andfrom hearth registers. The number of HCW exposed to HBV infectionwas calculated from official registers, taking into accountthe prevalence and incidence of HBV infection and vaccinationcoverage. Even with the present vaccination coverage of 40%among traditional HCW and 25% among allied HCW, we estimatethat 16,500 cases of HBV infection occur in these groups annually(i.e. over 40 per day). Approximately 5,800 workers will developacute symptoms and 990 will become carriers, of whom 240 willdie due to liver cirrhosis and/or primary hepatocellular cancer.If no further vaccinations are made, the number of infectionswill rise to approximately 24,000 each per year. An increasein vaccination coverage would greatly decrease these numbers.The amendments to the Biological Agents at Work EC Directive(EC90/679/EEC) were formally adopted on 12 October 1993. SinceApril 1994, a specific code of practice on vaccination shouldhave been in place in the national legislation of each memberstate. This represents an important step in achieving consensuson a preventive policy In Western Europe. It is equally importantthat the legislation obliges employers to identify and vacdnate(free of charge) those workers at risk of infection from hepatitisB.     

Employment loss following HIV infection in the era of highly active antiretroviral therapies

BACKGROUND: Employment is a major factor in maintaining living conditions of patients with chronic diseases. This study aimed to quantify the frequency and to identify the determinants of employment loss during the first years of HIV disease in the era of highly active antiretroviral therapies (HAART). METHODS: The French PRIMO multicentre prospective cohort of 319 patients enrolled during primary HIV-1 infection between 1996 and 2002. Employment loss was defined as moving from employment to inactivity between two visits. Characteristics associated with employment loss were assessed using generalized estimating equations. RESULTS: During a median follow-up time of 2.5 years, 56 employment losses occurred among 51 patients (18.0%). In multivariate analysis, female gender (adjusted odds ratio 3.1; 95% confidence interval 1.1-8.5), non-permanent job (3.8; 1.5-9.3) and poor accommodation (4.2; 1.6-11.2) constituted independent risk factors for employment loss; subjects with a high occupational position had a decreased risk of job loss. Moreover, an updated HIV viral load above 10 000 copies/ml either persistent (2.4; 1.1-5.0) or incident (3.7; 1.0-13.9) and hospitalization in the preceding 6 months (3.9; 1.6-9.7) constituted independent risk factors for employment loss, as tended to be a baseline CD4 cell count <350/mm(3) (1.9; 0.9-4.3) and chronic comorbidity (1.8; 0.9-3.6). CONCLUSIONS: In the HAART era, employment loss is frequent from the first months of HIV infection. Employment loss occurs especially in women and in patients with adverse socioeconomic conditions, severe HIV infection and/or comorbidity. Social interventions should seek to prevent HIV-infected patients from leaving their job from the earliest times of the disease.     

Temporal trend of HIV infection: an update of the HIV surveillance system in Lazio, Italy, 1985-2000

BACKGROUND: After the introduction of the highly active antiretroviral therapies, data from AIDS surveillance systems are less useful to describe the HIV epidemic, while HIV surveillance could give more detailed information to provide data for HIV prevention and care programmes. We report the results of the HIV surveillance system update in Lazio, Italy, from 1985 through 2000. METHODS: New diagnoses of HIV infection were identified through a linkage procedure on the total reports, and underreporting was estimated through a link between the HIV surveillance system and the Hospital Information System of Lazio. RESULTS: As of December 2000, 20,912 new diagnoses of HIV occurred in Lazio. New diagnoses have decreased steadily since 1992. The male/female ratio decreased during the study period, while the number of foreign-born cases increased. Sexual transmission became the main modality of exposure for men in 1996 and for women in 1992. In 2000 the proportion of men infected by sexual transmission reached 54.0% versus 15.2% of those infected by intravenous drug use, whereas the proportion of women was 58.9% and 8.6% respectively. The sensitivity of the system has slightly decreased. CONCLUSION: HIV infection is increasing in women and immigrants; people are being infected more frequently by sexual transmission than intravenous drug use.     

A five year follow-up study of attitudes to HIV infection among Finns

Changes from 1986 to 1990 in knowledge, attitudes and behaviouramong Finnish people towards HIV infection were studied. In1986, 1 013 Finns aged 15 to 64 years were chosen at randomfrom the entire population, and from 1987 to 1990 about 1 900annually were similarly selected. Interviews took place at homeor by telephone, using a structured questionnaire. Throughout the period knowledge was good about modes of HIVtransmission, as well as diagnostic methods and location oftest facilities. There appeared to be improvements over timein awareness about some aspects of transmission. Support forcompulsory population screening declined during the period,while the proportion in favour of voluntary testing grew. Opinionswere stable over the need for screening certain special groups.Perceptions of the personal threat of HIV also remained constantover the study years. There were no significant alterationsin sexual behaviour due to the risk of HIV infection. The study revealed that perceptions among Finns towards issuesof HIV infection did not change markedly between 1986 and 1990.Finnish opinions and attitudes relating to HIV infection maythus have stabilized.     

HIV epidemiology and risk behavior promoting HIV transmission in Austrian prisons

In 1989, 1990 and 1992, 19%, 15% and 10%, respectively, of all prisoners newly admitted to prisons and penitentiary institutions in Austria underwent HIV antibody tests. Based on the HIV test outcome in prisons in which more than 80% of the newly admitted inmates were tested, annual HIV prevalences among prison inmates in Austria were determined. These were 0.5% (11/2,223), 1.3% (19/1,466) and 0.9% (14/1,509) in 1989, 1990 and 1992, respectively. The prevalence rates among prison inmates in Austria are thus 5 times higher than those in the general Austrian population. About 5% of all inmates belong to the high-risk group of intravenous drug users. Inquiries into HIV risk behavior among prison inmates showed that, in Austrian prisons just like in those of many other countries, intravenous drug use and sexual contacts are common practices. As disposable needles and condoms are not available to prison inmates, these practices carry a particularly high risk of HIV transmission. The data collected can be taken as a basis for developing strategies which are designed to reduce the risk of HIV transmission in prisons and which have a major bearing on the development of the HIV pandemic.     

Measurement and reporting of burden of disease for hepatitis A: results of the EUROHEP.NET feasibility survey

BACKGROUND: European countries use a wide variety of surveillance systems and prevention measures for viral hepatitis. Each system is adapted to the local situation and an overview was never mapped out at European level. The EUROHEP.NET Project is a European Commission-funded feasibility study for a future network on surveillance and prevention of vaccine-preventable hepatitis. We analysed the measurement and reporting of burden of disease for hepatitis A (HA) and B (HB) in the participating countries. METHODS: Twenty-eight countries were invited to participate in this study. An online survey was available from the project's website (www.eurohep.net). The questions concerned the organisation of the surveillance system, case definition, burden of disease, epidemiology, and vaccination strategies. The responses on data sources and the numeric data related to burden of disease for HA for the period 1997-2001 were analysed. RESULTS: Twenty-two countries completed the survey for hepatitis A. Data on total number of hospitalisations and deaths were available from 17 and 18 countries, respectively, although sometimes not complete. Data on hospitalisation days, number of liver transplants and proportion of these due to HAV were often not available. CONCLUSION: Surveillance systems on burden of disease for hepatitis A show a wide diversity among the participating countries. The introduction of a standardised system of data collection at the European Union level according to ICD-10 but respecting the local current practices is a primary need, especially for data that should be collected in all countries, like hospitalisation and mortality. A link to surveillance databases is also strongly recommended.     

Knowledge,attitudes and behaviour after 15 years of HIV/AIDS prevention in schools

BACKGROUND: This paper reports efforts to estimate the results of the prevention policy of HIV/AIDS in young people, 15 years after the first case of AIDS in Greece by investigating the current level of knowledge, attitudes, beliefs, behaviour and practices of high school students towards HIV/AIDS. METHODS: Questionnaires from 702 students of 13 technical high schools in the Athens area were collected and analysed in 1997. RESULTS: 72% of the questions regarding knowledge were answered accurately. 43.15% of the participants believed that their knowledge about HIV/AIDS was sufficient. They considered AIDS to be a big threat to society (89.65%), and would be embarrassed if they were HIV positive (31.75%), however, they would be compassionate to HIV positive persons. One out of three were worried about already being HIV infected, because of their risky behaviour in the past, especially boys. The major change in their behaviour was the use of a condom (80.9% for boys and 56.7% for girls). 64.8% of the girls did not have sexual relations, while 41.9% of the boys had sexual relations with casual partners. CONCLUSION: After 15 years of prevention activities among young people, students have a satisfactory level of knowledge and have adopted relatively safe behaviour. However, boys, younger students, students with a high sense of religiousness and students with both excellent and low school records need more intense and systematic information through suitable interventions.     

On the European Union's new eastern border: health promotion, HIV and Ukraine

HIV control in Ukraine is a pressing public health challenge and national efforts to control the epidemic have been hindered by a lack of capacity and resources. One component of control is the need to raise awareness. Implementing a health promotion strategy through the education system and through multi-sector network with early stakeholder ownership resulted in a limited budget being spent principally on production costs rather than purchasing media time and space with considerable savings. Early involvement of powerful corporate stakeholders in multi-disciplinary teams has the potential to enhance the effectiveness and efficiency of health promotion measures in a post-Soviet transitional economy.     

Prevention of mother-to-child transmission of HIV infection: Ukraine experience to date

BACKGROUND: Despite the availability of effective interventions for the prevention of mother-to-child transmission (PMTCT), questions remain regarding implementation of programmes in settings with limited resources. This article sets out to describe the first 2 years of the implementation of the national PMTCT programme in Ukraine. METHODS: National data sources and data from a cohort of pregnant HIV-infected women delivering in 13 centres in Ukraine since 2000 were analysed. RESULTS: Interventions for prevention of MTCT have been implemented as a national programme within Ukraine's well developed infrastructure for maternal and child health. Implementation of an 'opt-out' model of counselling and HIV testing in antenatal clinics resulted in a 97% uptake of women who agreed to be HIV tested. In 2002, approximately 91% of HIV-positive pregnant women received ARV prophylaxis (mainly single-dose nevirapine or short-course zidovudine) for PMTCT. The MTCT rate has decreased from 30% in 2000 to 10% in 2002. The need to scale-up prevention interventions in pregnant women with risky behaviour and late access to medical services was identified in a review of the national programme in 2003. CONCLUSIONS: Further implementation of a comprehensive approach for the prevention of HIV infection in infants, including more extensive ART regimen, as recommended by WHO, would help Ukraine to achieve the strategic goal of virtual elimination of HIV infection in infants by 2010.     

War and HIV: Sex and gender differences in risk behaviour among young men and women in post-conflict Gulu District,Northern Uganda

Despite growing knowledge of the dynamics of HIV infection during conflict, far less is known about the period that follows cessation of hostilities and its implications for population health. This study sought to fill a lacuna in epidemiological evidence by examining HIV infection and related vulnerabilities of young people living in resource-scarce, post-emergency transit camps that are now home to thousands of displaced people following two decades of war in northern Uganda. In 2010, a cross-sectional demographic and behavioural survey was conducted with 384 transit camp residents aged 15–29 years old in Gulu District. Biological specimens were collected for rapid and confirmatory HIV testing. Separate multivariable logistic regression models by sex identified risk factors for HIV infection. HIV prevalence was 15.6% (95% confidence interval [CI]: 10.8%, 21.6%) among females and 9.9% (95% CI: 6.1%, 15.0%) among males. The strongest correlate of HIV infection among men was a non-consensual sexual debut (adjusted odds ratio [AOR] 3.24; 95% CI: 1.37–7.67), and having practiced dry sex (AOR 7.62; 95% CI: 1.56–16.95) was the strongest correlate among women. Conflict-affected men and women experience vulnerability to HIV infection in different ways than may have originally been understood. Post-conflict programme planners must therefore design and implement contextualised, evidence-based responses to HIV that are sensitive to gender and cultural issues.     

Occupational transmission of HIV in health care workers: A review

Health care workers have a small but real risk of acquiringHIV infection as a result of occupational exposure. In thispaper, we review all reports in the scientific literature from1984 through to December 1993 of confirmed and probable casesof HIV seroconversion after a specific occupational exposure.A total of 64 confirmed cases have been reported, 24 in Europe,36 in the USA and 4 in other countries. Most seroconversionshave resulted from percutaneous exposure (91%) to AIDS patients(62%), usually caused by hollow bore needlestick injuries inflictedduring blood drawing procedures. Almost all seroconversionshave been detected within 6 months of exposure (94%) and haveusually been preceded by an episode of acute illness (73%).Ten seroconversions have occurred in spite of partial or completecourses of zidovudine prophylaxis. An additional 113 probablecases have been reported, 75 in the USA, 35 in Europe and 3in other countries. Aggregating the results of the prospectivestudies carried out, it is calculated that the risk of seroconversionfollowing percutaneous exposure is 0.33% or 3 in 1000 exposures(95% Cl: 0.21–0.52%), while the risk following mucocutaneousexposure is much lower (0.04%, 95% Cl: 0.006–0.31%). Thedocumented failure of zidovudine prophylaxis following occupationalexposure in a number of instances indicate its effect is, atbest, only partial; furthermore, exposure to source patientswho have been receiving the drug may lead to transmission ofzidovudine-resistant strains of HIV. Risk factors for occupationalexposure to HIV and for transmission, given that an exposurehas occurred, are discussed.     

江苏省艾滋病病毒感染流行病学研究

目的：了解江苏省艾滋病病毒（HIV）感染的流行特征、传染来源及危险因素,推断其流行趋势，为制定防制策略提供依据。方法：使用酶联免疫吸附法及免疫印迹试验对高危人群进行HIV抗体检测，采集感染全血分离淋巴细胞用套式聚合酶链反应扩增HIV－1DNA片段进行序列分析，鉴定病毒亚型。结果：从1986年至2001年6月底，全省共监测各类人群954 445人次，发现HIV抗体阳性133例，检出率0．14‰，其中艾滋病病人（AIDS）8例，死亡4例。对19例HIV感染进行了亚型鉴定，HIV－1M群共有4种亚型。A，B′，C，D。献血员中85．71％为B′亚型，吸毒人群均为C亚型，回国劳务人员为A和D亚型。结论：江苏省艾滋病病毒感染的流行已进入快速增长期，以静脉吸毒和性途径传播为主，HIV－1毒株亚型复杂，防治工作形势严峻。应尽快开展性病艾滋病的综合监测和高危人群的行为干预。     

Determinants of current HIV risk behaviour among injecting drug users in Warsaw, Poland

Of the injecting drug users (IDUs), 24% had borrowed, and 37% had passed on syringes in the previous 6 months. In logistic regression analysis, current borrowing of syringes was significantly associated with a shorter duration of injecting drug use, a higher number of drug-injecting sex partners in the previous 6 months, and with current lending of syringes. A majority of the IDUs have modified previous HIV risk behaviour but these modifications are insufficient and not sustained over time. Intensified AIDS prevention measures for IDUs in Poland are needed.     

Diabetes and social conditions in Estonia. A population-based study

BACKGROUND: The aim of this study was to investigate aspects of metabolic control, treatment and complications as well as quality of life in patients with diabetes mellitus from a defined population in Estonia. METHODS: We invited 220 randomly selected diabetes patients recruited to a clinical investigation from a local diabetes register of 1,100 patients in Viljandi, Estonia. The main outcome measures were derived from medical history, physical examination (height, weight and blood pressure), laboratory variables (blood glucose and glycated haemoglobin A1 (HbA1 normal reference range 3.2-5.6%), serum total and HDL cholesterol and creatinine), a questionnaire on disease-related knowledge and quality of life variables. RESULTS: In all, 181 diabetes patients were investigated, of whom 90% were diagnosed with type 2 diabetes. The mean diabetes duration was 8.9 years from clinical diagnosis and mean HbA1 level was 7.3%. The overall proportion of patients treated with insulin was 29.8% and with anti-hypertensive drugs 26.5%. Smoking was present in 14.3%. The proportion of patients with various diabetes complications was high (73.5%), mostly consisting of different manifestations of cardiovascular disease. Foot ulcers or gangrene were observed in 11.6%. A low level of quality of life was registered in many patients, mostly due to difficult living conditions. CONCLUSIONS: Diabetes patients in Viljandi showed an acceptable degree of glucose metabolic control, but reported a high degree of diabetes complications, as well as impaired quality of life. The diabetes complications may therefore be due to detrimental factors other than hyperglycaemia, e.g. the standard of care during previous years as well as current social and living conditions.