AIDS: an update

In sub-Saharan Africa, where the acquired immunodeficiency syndrome (AIDS) epidemic threatens to undermine the social and economic structure of society, there has been insufficient attention to health care demand, supply, and quality issues. Most of those currently infected with human immunodeficiency virus (HIV) will register their demand for increased health services within the next six years. A study of medical insurance claims in Zimbabwe indicated that the claims of HIV-infected persons in the last 7-15 months of their lives were 700% higher than the average claim for the same age group. Absenteeism by HIV-infected health care workers is affecting the quality of care in hospitals, and countries that provide sickness benefits for public sector workers face the double drain of financing these benefits and paying for replacement staff. Emerging evidence suggests that HIV screening and counseling is not an effective intervention in this culture. Pregnant Kenyan women screened for HIV tended not to want the results, failed to inform their partner of a positive result, or were subjected to violence and abandonment when they did inform their husbands. Most effective, in this region, have been programs aimed at improving the diagnosis and treatment of sexually transmitted diseases. Other recommendations include decentralization of care to district health systems where costs are lower, increased support for home-based care, AIDS education for traditional healers, and informational campaigns to counter discrimination against HIV-infected community members.     

Connecticut will test newborns if mother isn't tested first

A new law in Connecticut mandates HIV testing for all newborns whose mothers were not screened for HIV during their prenatal care. Connecticut has the fourth highest rate of perinatal transmission in the country, according to Institute of Medicine figures for 1996. Under the new law, health care workers will inform each woman receiving prenatal care that HIV testing is routine. The woman must be counseled about benefits of the testing and must give informed consent before the testing is performed. If a prenatal HIV test is not documented in the mother's medical record, the baby must be tested within 24 hours of delivery unless a specific objection is made. The law also establishes a registry of all infants who have been exposed to HIV or AIDS medication to enable the study of potential long-term effects of the drugs. A second bill, 1705, expands eligibility requirements for the State's AIDS drug assistance program and makes it easier for clients of needle exchange programs to obtain clean syringes.     

Country watch: Zimbabwe

In 1991, the Matabeleland AIDS Council (MAC) in Bulawayo, Zimbabwe, established a peer education program for industry workers. To date, workers from 45 companies, particularly manufacturing companies, have participated in the program. Program goals include prevention of the spread of HIV and promotion of a supportive response to co-workers known or suspected to have HIV infection or AIDS. MAC first contacts senior management to get company support. It then helps personnel and training management staff develop each company's program. MAC negotiates free time for the 5-day initial training course of peer educators and for the quarterly follow-up meetings. Workers complete questionnaires so MAC can determine training content and materials required. Management and workers choose workers to be trained as informal resource persons. The criteria for the non-paid peer educators are that they be permanent employees, good communicators, literate in English, highly motivated, and persons trusted and respected by their co-workers. The peer educator/worker ratio is 1-2/100. The task of peer educators is dispelling misconceptions and myths and creating on-going discussions about HIV/AIDS both in and outside the workplace. MAC also trains nurses in 16 companies in AIDS counseling and methods of training peer educators. MAC conducted an evaluation of the peer educator program in 1994 in 15 companies. 13 companies either did not have an AIDS policy or did not address AIDS in its general health policy. 91% of workers had received written materials. 74% attended drama or video sessions, 66% received condoms. 30% asked a peer educator personal questions. Between 1992 and 1993, distribution of condoms increased from 25,776 to 49,392. Workers have adopted a positive attitude towards persons with AIDS. Many peer educators have taken up AIDS related-community work. Business leaders acknowledge the benefits of the peer educator program.     

Assessing business responses to HIV / AIDS in Kenya

A consulting firm conducted interviews with managers of 16 businesses in 3 Kenyan cities, representatives of 2 trade unions, focus groups with workers at 13 companies, and an analysis of financial/labor data from 4 companies. It then did a needs assessment. The business types were light industry, manufacturing companies, tourism organizations, transport firms, agro-industrial and plantation businesses, and the service industry. Only one company followed all the workplace policy principles recommended by the World Health Organization and the International Labor Organization. Six businesses required all applicants and/or employees to undergo HIV testing. All their managers claimed that they would not discriminate against HIV-infected workers. Many workers thought that they would be fired if they were--or were suspected to be--HIV positive. Lack of a non-discrimination policy brings about worker mistrust of management. 11 companies had some type of HIV/AIDS education program. All the programs generated positive feedback. The main reasons for not providing HIV/AIDS education for the remaining 5 companies were: no employee requests, fears that it would be taboo, and assumptions that workers could receive adequate information elsewhere. More than 90% of all companies distributed condoms. 60% offered sexually transmitted disease diagnosis and treatment. About 33% offered counseling. Four companies provided volunteer HIV testing. Almost 50% of companies received financial or other external support for their programs. Most managers thought AIDS to be a problem mainly with manual staff and not with professional staff. Almost all businesses offered some medical benefits. The future impact of HIV/AIDS would be $90/employee/year (by 2005, $260) due to health care costs, absenteeism, retraining, and burial benefits. The annual costs of a comprehensive workplace HIV/AIDS prevention program varied from $18 to $54/worker at one company.     

Co-located Substance Use Treatment and HIV Prevention and Primary Care Services,New York State, 1990–2002: A Model for Effective Service Delivery to a High-Risk Population

The New York State Department of Health (NYSDOH) AIDS Institute (AI) began an initiative in 1990 in collaboration with the Office of Alcoholism and Substance Abuse Services (OASAS) to colocate HIV prevention and clinical services at drug treatment clinics. In 1990, the initiative began funding drug treatment programs to provide HIV counseling, testing, and prevention services. HIV primary care was added the following year. Program implementation and development are described. An analysis is included of HIV counseling and testing data for the period 1990–2002 and quality of care data for five standardized quality measures with comparisons to data from other clinical settings. In the first 13 years of the initiative 168,340 HIV-antibody tests were conducted including 52,562 tests of injection drug users (IDUs) identifying 14,612 HIV-infected persons; the seroprevalence was 8.68%. By the end of 2000, the HIV primary care caseload peaked at 3,815 patients. Quality of primary medical care services among participating drug treatment programs has consistently matched or exceeded that provided in more conventional health care settings such as the hospitals and community health centers that were used as a basis for comparison. Colocating HIV primary care within substance use treatment is an effective strategy for providing accessible high-quality HIV prevention and primary care services. Rothman is with the Bureau of HIV Ambulatory Care, AIDS Institute, New York State Department of Health, Albany, New York, USA; Rudnick and Slifer are with the Substance Abuse Unit, AIDS Institute, New York, NY, USA; Agins is with the Office of the Medical Director, AIDS Institute, New York, NY, USA; Heiner is with the Karl Heiner Statistical Consulting, Ltd., Schenectady, New York, USA; Birkhead is with the AIDS Institute, Albany, New York, USA.     

Building adherence-competent communities: factors promoting children's adherence to anti-retroviral HIV/AIDS treatment in rural Zimbabwe

Given relatively high levels of adherence to HIV treatment in Africa, we explore factors facilitating children's adherence, despite poverty, social disruption and limited health infrastructure. Using interviews with 25 nurses and 40 guardians in Zimbabwe, we develop our conceptualisation of an 'adherence competent community', showing how members of five networks (children, guardians, community members, health workers and NGOs) have taken advantage of the gradual public normalisation of HIV/AIDS and improved drug and service availability to construct new norms of solidarity with HIV and AIDS sufferers, recognition of HIV-infected children's social worth, an ethic of care/assistance and a supporting atmosphere of enablement/empowerment.     

Innate Health Threat Among a Visibly Hidden Immigrant Group: A Formative Field Data Analysis for HIV/AIDS Prevention Among Zimbabwean Workers in Botswana

As a result of the collapse of the national economy and political instability, Zimbabwe has experienced a diaspora in recent years. Although Zimbabweans are now the largest immigrant group in most sub-Saharan countries, Zimbabwean immigrants are a mostly illegal and socioeconomically marginalized population. This study explores the lives of Zimbabwean workers in Botswana from a health communication perspective and provides suggestions for accelerating the diffusion of HIV/AIDS prevention information and practices among the target population. In particular, this ethnographic report portrays how the Zimbabwean workers in Botswana make sense of their surroundings and perceive information on HIV/AIDS prevention and other public health risks. Field data analysis highlights several communication features among the immigrants, including reliance on interpersonal communication, high rate of mobile phone adoption, inaccurate public awareness on HIV/AIDS and prevention messages, and stagnated communication with health care services. By connecting Dervin's sensemaking theory to Roger's diffusion of innovations theory, the suggestions from this study can be applied to design HIV/AIDS prevention interventions for the immigrants and socioeconomically marginalized groups.     

Changes in the knowledge and attitude of physicians and health professionals in relation to AIDS during 1988-1990

The authors interviewed in 1988, 570 and in 1990 425 health personnel about their knowledge and attitudes with AIDS. The results of 1990 survey shows: 63-76% of subjects changed their working habits, the increase rate to 1988 data is 30-40% and 11.7-18.0% changed their habits in their private life, the rate of increasing are: 8-9%. The safety gloves was mentioned by 82.1%-20% more than in 1988. 14% of the interviewed doctors and other health workers are refuse the care of an AIDS or a HIV positive patient, this rate is the double than was in 1988. Among the information resources the rate of postgraduate education was by 10% lower and 95% of the interviewed persons nominated the mass media as a main information channel in their knowledges about AIDS.     

Prevention practices of primary health care physicians in Switzerland in the context of the HIV/Aids epidemic: changes between 1990 and 2002

BACKGROUND: Individual preventive counseling offered to the general public by private doctors working in primary health care is an essential component of the Swiss National Aids Prevention strategy. Surveys were conducted to assess to what extent they fulfill this role and how this may have changed over time. METHODS: Three cross-sectional surveys were conducted in 1990, 1995, and 2002 by anonymous mailed questionnaire in a random sample of primary health care physicians. Dimensions of the physicians HIV prevention practices investigated were: practice of HIV risk assessment, content and frequency of HIV pretest counseling, and, in 2002 only, care of patients living with HIV/AIDS. Trends over the 12-year period were calculated; logistic regressions were performed to investigate factors associated with the frequency of counseling given to HIV positive patients. RESULTS: Risk assessment has increased dramatically over the period for certain groups of patients (patients requesting contraception, young people and new patients). In 2002, routine screening is often or always performed by 93% of physicians for intravenous drug patients or patients with a sexually transmitted infection; 77% for homosexuals; 76% for patients requesting contraception; 63% for young people. It is less frequent in other groups (migrants: 40%; separated/divorced patients: 29%). More than half of physicians care for patients with HIV. Around two-thirds of physicians regularly discuss with their HIV positive patients issues related to patients' professional, social and private life. There are few differences among specialties regarding the propensity to discuss these topics. CONCLUSION: Prevention activities by primary care physicians have increased in the last decade. Nonetheless, potential for increased prevention still exists in some areas of risk assessment and counseling.     

Caring for people with AIDS: it can be done

The evolution of care for AIDS patients at the Chikankata Hospital in Southern Zambia, from inpatient to outpatient management, is described. Hospital and community health care of AIDs patients should integrate education, counseling, clinical, nursing, laboratory, pastoral care and administration. Decentralization of primary health car into the wider community is achieved in this way. The ultimate result of community care is re-education of the family and the community so that behavioral change in patterns of sexual intercourse occurs. At Chikankata Hospital the average length of stay of HIV patients has fallen from 32 days in 1987 to 16.2 days in 1988. Numbers of home care patients have increased, as 80% prefer home visits, and most people prefer to die at home. As an example of the powerful effect of community counseling as a result of home care, people are deciding to take action on the issue of ritual cleansing by sexual intercourse, to re-introduce traditional taboos and family authority, and to discuss the effect of alcohol on AIDS. Chikankata Hospital has also started training programs for AIDS health workers from the region, and for local volunteers. Transferable management concepts include the term "normalization" which implies that AIDS is here to stay and future generations must be protected by permanent change in behavior.     

HIV disclosure and discussions about grief with Shona children: a comparison between health care workers and community members in Eastern Zimbabwe

Research in HIV-related counseling for African children has concentrated on urban tertiary hospitals, but most children have their first health care encounter at a rural primary health care center. This study investigated perceptions about the acceptability of disclosing the parents' or child's HIV status to a child and talking about grief with children, as well as the preferred time, type and setting for HIV disclosure. An anonymous survey was taken from 64 primary health care workers and 131 community members from rural Eastern Zimbabwe. The results expressed a high need and desire for such communications and should be interpreted against a background of high perceived confidence to talk about grief with adults and a high degree of familiarity with child bereavement and foster care. The participants preferred that partial disclosure occurs from the age of 10.8 (+/-4.2) years and full disclosure from the age of 14.4 (+/-4.5) years. Compared to community members, health care workers were significantly more open to full disclosure and disclosure at a younger age but were slightly less open to discussing grief. The different preferred combinations of persons to initiate such communications included a health care worker in up to 56% of the responses and a family member in up to 52%. The most commonly preferred family members were father's sister (up to 37%) and grandmother (up to 40%) rather than the partner (up to 15%). Southern African family dynamics may hinder a mother initiating HIV disclosure and discussions about grief, even though she is traditionally present during HIV diagnosis, counseling and health education. A more culturally adapted approach than the standard Western 'couple approach' may thus be required. Consequently, counseling training models may need to be adapted. Further research into empowering mothers to involve significant members from the extended family may be highly beneficial.     

'We are mothers first': localocentric articulation of sex worker identity as a key in HIV/AIDS communication

The connection between identity and health communication has been amply documented in communication research. How an individual frames oneself with respect to and in conjunction with one's interpersonal relationships and material and communicative structures shapes one's identity. This in turn shapes how one enacts the self, given the relationships and available contexts one is embedded in, all of which have a significant influence on how one communicates about and negotiates health and illness. This study reports the results of an ethnographic field study conducted during two periods-June and August 2007 and July and August 2009, which examined, chiefly through interviews of 46 participants, how members of a community of sex workers in Kalighat, in the city of Kolkata in India, communicatively constructed their selves with respect to their prevalent cultural indices and available structures, and how enunciations and enactments of sex worker selves as "mothers first" influenced localized patterns of HIV/AIDS communication and related work practices. Sex worker narratives suggested that mainstream assumptions and identity labels that depict sex workers as incapable mothers and the concurrent HIV/AIDS practices sex workers are asked to adopt need to be questioned and transformed to effect positive changes in health and HIV/AIDS negotiation practices among members of this marginalized community.     

安徽省示范区孕产妇艾滋病病毒抗体咨询与检测数据分析

目的探讨安徽省艾滋病综合防治示范区孕产妇艾滋病病毒抗体咨询与检测服务现状及存在问题。方法分析21个示范区2009～2011年全国预防艾滋病母婴传播信息系统网络直报孕产妇艾滋病病毒抗体咨询与检测报表数据。结果婚检人群的艾滋病病毒抗体检测率21.5%,阳性率8.0/10万;产期检查孕妇检测率为74.3%,阳性率21.3/10万;住院分娩产妇检测率78.5%,阳性率10.0/10万,其中孕期检查时检测率为28.7%,阳性率16.2/10万,仅临产时检测率49.8%,阳性率6.4/10万。结论预防艾滋病母婴传播项目工作深入开展,与妇幼保健常规工作相结合的工作要求到进一步落实。产妇的孕期检测信息可能存在遗漏现象,应进一步加大健康教育力度,加强孕产妇保健手册的管理和规范运转,加强初筛实验室和快速检测点的管理,完善分娩登记。     

HIV / AIDS and STDs control: new policy perspectives

The prevention and control of HIV/AIDS is a social as well as a public health issue. This approach is reflected in new policy initiatives developed by the Government of India's National AIDS Control Organization in 1997. Future strategies will be based on a multisectoral, partnership-oriented approach. Bilateral agencies are encouraged to establish interventions in areas such as sexually transmitted disease (STD) control, condom distribution, counseling, health care, and hospice care. Special campaigns focused on youth and adolescents, including the inclusion of HIV/AIDS in the school curriculum, are planned. New strategies will be developed to address the HIV risk associated with drug abuse. The home- and community-based care of HIV/AIDS patients will be promoted, with emphasis on emotional and social support needs. Other areas to be addressed include the integration of STD control with primary health care, a blood transfusion policy, education for commercial sex workers, an end to discrimination against people with AIDS, and expansion of the national sentinel surveillance system.     

Country watch: Thailand

In response to the needs of people living with HIV/AIDS (PHA) and their families to improve preventive clinical practice, the Department of Mental Health in the Ministry of Public Health in Thailand launched a counseling service in 1993 in every public hospital in the country. The initial goal of the counseling training program was to train 10,000 counselors in 3 years. As more people got trained, a critical mass of counselors helped the health care system understand its essence. However, technical and administrative problems have caused the return of these counselors to their hospitals. Due to this, the Department of Mental Health set up a technical center in 1996 to support counselors in the northern region. Working with different groups, the AIDS Counselling Center for Training and Research (ACCTaR) develops understanding of problems and practical solutions for the counseling service system. One key program of ACCTaR involved people with HIV/AIDS to help themselves. ACCTaR developed a new counseling training program based on practical models developed by and for the PHA. After 7 years of implementation, most health workers and administrators now consider counseling a core activity in HIV/AIDS prevention and care programs, as well as in other health areas.     

Knowledge,attitudes and practices of Greek health professionals,in relation to AIDS

In order to improve educational programmes directed at health care workers we investigated their knowledge, attitudes and practices in relation to HIV/AIDS.An anonymous self-administered questionnaires was distributed to 609 health care workers. Of these, 59.6% agreed to participate (42.4% of the medical doctors, 74.3% of the nurses and 79.6% of the laboratory technicians, health visitors and other health care workers).All studied groups believed that their knowledge of HIV modes of transmission (84.3%) was sufficient. In contrast, a relatively small percentage reported knowledge of the clinical spectrum of HIV infection (48.8%) and the diagnostic assays (57.6%). Nearly all the study participants believe (92.8%) that there is a risk of acquiring HIV infection during the hospitalization of HIV/AIDS patients. Obligatory screening of all patients was reported by nearly all participants (90.6%) as a chance to minimize their occupational risk.Although health care workers reported satisfactory knowledge of safety measures (87.0%), only 56.7% used gloves and 38.8% accept the hospitalization of HIV/AIDS patients.In spite of the educational programmes for AIDS in Greece, this study demonstrates that health professionals' knowledge and precautionary measures are not sufficient. As a result, a small percentage of them treat AIDS patients without discrimination. There is an urgent need to implement specific educational programmes for health professionals so that they will safely provide high quality care to people affected by HIV/AIDS.Corresponding author.     

建水县HIV阳性暗娼综合干预管理模式探索

目的探索建立HIV阳性暗娼综合干预管理模式。方法对建水县辖区的HIV阳性暗娼开展建档管理、规范行为告诫谈话、抗病毒治疗转介、性病检查、随访督导、生活救助及转行指导等综合干预管理。结果通过项目实施,建水县建立了由防艾办协调领导,以县疾控中心为核心,以县卫健局、卫计综合执法局和社区等相关部门为组织保证,集艾滋病防治健康教育、行为干预、心理疏导、随访、抗病毒治疗转介、生活救助及转行指导为一体的HIV阳性暗娼综合干预管理模式。结论建水县HIV阳性暗娼综合干预管理模式的建立,有效加强了阳性暗娼的管理,遏制了以该人群为桥梁的艾滋病二代传播和家庭传播。     

HIV/AIDS in African children: the Bristol-Myers Squibb Foundation and Baylor response

In 2000, 1.4 million children were living with HIV/AIDS in sub-Saharan Africa, according to the Joint United Nations Programme on HIV/AIDS. Few of them were receiving lifesaving antiretroviral therapy because public health systems lacked the clinical infrastructure and trained health care workers to implement and disseminate high-quality care. Research has shown that without treatment, half of HIV-infected infants die by age two. From 2000 to 2011 the Bristol-Myers Squibb Foundation worked with the Baylor International Pediatric AIDS Initiative, governments in sub-Saharan Africa, and other funders to help ensure that children received needed treatment and care. The partnership led to the creation of seven Children's Clinical Centers for Excellence and the Pediatric AIDS Corps of physicians. The mortality rate for the 13,154 children receiving antiretroviral therapy at the centers was 3.35 deaths per 100 patient-years, which compares favorably with results of similar programs in Africa. The experience showed that strategic investments by foundations and others can have a positive impact on health service delivery and the training of health professionals to meet the specific needs of HIV-infected children for the short and long terms.     

The costs of HIV/AIDS care at government hospitals in Zimbabwe

According to official figures, HIV infection in Zimbabwe stood at 700 000-1 000 000 in 1995, representing 7-10% of the population, with even higher expected numbers in 2000. Such high numbers will have far reaching effects on the economy and the health care sector. Information on costs of treatment and care of HIV/AIDS patients in health facilities is necessary in order to have an idea of the likely costs of the increasing number of HIV/AIDS patients. Therefore, the present study estimated the costs per in-patient day as well as per in-patient stay for patients in government health facilities in Zimbabwe with special emphasis on HIV/AIDS patients. Data collection and costing was done in seven hospitals representing various levels of the referral system. The costs per in-patient day and per in-patient stay were estimated through a combination of two methods: bottom-up costing methodology (through an in-patient note review) to identify the direct treatment and diagnostic costs such as medication, laboratory tests and X-rays, and the standard step-down costing methodology to capture all the remaining resources used such as hospital administration, meals, housekeeping, laundry, etc. The findings of the study indicate that hospital care for HIV/AIDS patients was considerably higher than for non-HIV/AIDS patients. In five of the seven hospitals visited, the average costs of an in-patient stay for an HIV/AIDS patient were found to be as much as twice as high as a non-HIV/AIDS patient. This difference could be attributed to higher direct costs per in-patient day (medication, laboratory tests and X-rays) as well as longer average lengths of stay in hospital for HIV/AIDS patients compared with non-infected patients. Therefore, the impact on hospital services of increasing number of HIV/AIDS patients will be enormous.     

宁阳县外出务工人员防治艾滋病健康教育与行为干预效果评价

[目的]做好外出务工人员的艾滋病防治工作,防止艾滋病疫情输入、蔓延。[方法]2008年,宁阳县疾病预防控制中心协调有关部门,实施了＂外出务工人员防治艾滋病多部门参与模式探讨＂项目,对外出务工人员进行艾滋病健康教育、行为干预和监测研究。[结果]活动实施前与实施1年后各调查750人。艾滋病防治知识总体知晓率分别为60.07%、87.77%（P〈0.01）;艾滋病态度、行为正确率,实施前为37.53%,实施后为64.2%（P〈0.01）。外出务工人员自愿咨询检测,实施前的1年为226人;实施期间的1年为502人,检出1例HIV抗体阳性者。实施期间主动检测108人,检出HIV抗体阳性者2例（外地到本地打工人员）。[结论]对外出务工人员实施的艾滋病宣传教育和行为干预工作取得明显效果。