Criminalization of HIV transmission: can doctors be liable for the onward transmission of HIV?

The English Court of Appeal has recently confirmed that the reckless transmission of HIV can amount to a criminal offence, following on from a similar development in Scotland in 2001. This development has led to some concern as to whether doctors could, in certain circumstances, themselves be liable for the onward transmission of HIV by a patient. This article reviews the current scope of the criminal law, before considering the law on liability for onward transmission in the UK. It concludes that civil liability (liability in damages) for onward transmission will be imposed only in unusual cases, and probably only where a doctor has failed to discharge his or her duty of care towards one of his or her own patients. Criminal liability is perhaps theoretically possible but exceptionally unlikely.     

Is HIV out of control in the UK? An example of analysing patterns of HIV spreading using incidence-to-prevalence ratios

The incidence of diagnosed HIV in the UK is increasing. We calculated the incidence-to-prevalence ratio, IPR(t), which must exceed an 'epidemic threshold', the reciprocal of the mean infectious period, for sustained transmission to occur. For heterosexuals the IPR(t) is too low for a self-sustained UK epidemic, and incidence is driven by increasing prevalence, mostly from imported cases. For men who have sex with men the IPR(t) is around the epidemic threshold, suggesting that spread is not yet under control.     

The Psychosocial Functioning of HIV+ and HIV− African American Recent Mothers

African American HIV+ and HIV– recent mothers were compared on levels of psychosocial functioning. Participants included 82 HIV+ and 122 HIV– women. HIV risk behaviors, stressors, coping resources, close relationships, coping responses, and psychological distress were examined. There were fewer statistically significant differences than expected, indicating that psychosocial functioning was relatively well preserved for the HIV+ women. There were no statistically significant differences in social support, close relationships or psychological distress. Statistically significant differences indicated that HIV– women perceived greater control over present health and sexual behaviors than HIV+ women, although HIV+ women used more sexual protection than did the HIV– women. HIV+ women also used avoidant as well as support coping more than their HIV– counterparts. These differences were also apparent in a discriminant function analysis, implying that they are independent of each other. Implications of the findings for future efforts to address HIV/AIDS in this community are discussed.     

Perceptions of HIV/AIDS in One’s Community Predict HIV Testing

Using a subsample of respondents to the 2005 Los Angeles County health survey, we examined the relationship between perceptions of the seriousness of HIV/AIDS in one's community and HIV testing. We constructed a propensity score-based matched sample of three groups with differing perceptions of the seriousness of HIV in their community: high perceived seriousness, low perceived seriousness, and uncertain about seriousness. We compared HIV testing behavior in the three groups before and after using propensity score matching to control for selection on observed covariates. The unadjusted comparison showed a testing rate of 30.2?% among those perceiving high seriousness, 11.4 percentage points higher than the 18.8?% testing rate among those perceiving low seriousness. After propensity score matching, the adjusted testing difference was 7.0 percentage points (p?相似文献   

Behavior and health beliefs as predictors of HIV testing among women: a prospective study of observed HIV testing

Much of the research examining predictors of HIV testing has used retrospective self-report to assess HIV testing. Findings. therefore, may be subject to recall bias and to difficulties determining the direction of associations. In this prospective study, we administered surveys to women in community clinics to identify predictors of subsequent observed HIV testing, overcoming these limitations. Eighty-three percent were tested. In the adjusted multivariable model, being born in the U.S., perceived benefits of testing, worries about being infected with HIV, having had more than 15 lifetime sexual partners, and having had one or more casual sexual partners in the previous three months predicted acceptance of testing. Perceived obstacles to testing predicted non-acceptance. Those who had never been tested for HIV and those tested two to five years previously had greater odds of test acceptance than those who had been tested within the last year. The findings from this study with observed testing as the outcome, confirm some of the results from retrospective, self-report studies. Participants made largely rational decisions about testing, reflecting assessments of their risk and their history of HIV testing. Health beliefs are potentially modifiable through behavioral intervention, and such interventions might result in greater acceptance of testing.

Abbreviations: HIV: human immunodeficiency virus; AIDS: acquired immune deficiency syndrome; CDC: Centers for Disease Control and Prevention; ACASI: audio computer-assisted self-interview; TRA: theory of reasoned action; HBM: Health Belief Model; STI: sexually transmitted infection; STD: Sexually Transmitted Disease; AOR: adjusted odds ratio; CI: confidence interval     

Comparison of cognitive performance in HIV or HCV mono-infected and HIV–HCV co-infected patients

Purpose

Our aim was to explore the interplay between human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections in the expression of cognitive disorders.

Methods

We performed a multi-centre cross-sectional study, enrolling three groups of asymptomatic outpatients matched for age and education: (1) HIV mono-infected; (2) HCV mono-infected; (3) HIV–HCV co-infected. All subjects were subjected to the Zung depression scale and a comprehensive neuropsychological battery.

Results

A total of 50 patients for each group were enrolled. Patients in the three groups did not significantly differ in the main common demographic and clinical characteristics, except for a lower proportion of past injecting drug use (IDU) in group 1 (4 %) in comparison to groups 2 (38 %, p < 0.001) and 3 (78 %, p < 0.001), a longer duration of HIV infection in group 3 in comparison to group 1 (p < 0.001) and a longer duration of HCV infection in group 3 in comparison to group 2 (p = 0.028). Overall, 39.3 % of patients showed minor cognitive impairment, with a higher proportion in group 3 (54 %) when compared to groups 1 (28 %, p = 0.015) or 2 (36 %, p = 0.108). Patients in group 3 [odds ratio (OR) 3.35, p = 0.038 when compared to group 1] and those with higher depression scores (OR 1.05, p = 0.017) showed an increased risk of cognitive impairment after adjusting for education and past injection drug use. In particular, group 3 showed worse performance in psychomotor speed tasks when compared to group 1 (p = 0.033).

Conclusions

A worse cognitive performance in HIV–HCV co-infected patients was observed, suggesting an additive role of the two viruses in the pathogenesis of cognitive disorders.     

Implementation of prevention of mother-to-child transmission of HIV programme through private hospitals of Delhi – policy implications

In India, programme for prevention of mother-to-child transmission (PMTCT) of HIV is primarily implemented through public health system. State AIDS Control Societies (SACSs) encourage private hospitals to set up integrated counselling and testing centres (ICTCs). However, private hospitals of Delhi did not set up ICTCs. Consequently, there is no information on PMTCT interventions in private hospitals of Delhi. This study was undertaken by Delhi SACS during March 2013 through September 2013 to assess status of implementation of PMTCT programme in various private hospitals of Delhi to assist programme managers in framing national policy to facilitate uniform implementation of National PMTCT guidelines. Out of total 575 private hospitals registered with Government of Delhi, 336 (58.4%) catering to pregnant women were identified. About 100 private hospitals with facility of antenatal care, vaginal/caesarean delivery and postnatal care and minimum 10 indoor beds were selected for study. Study sample comprised of large corporate hospitals (≥100 beds; n = 29), medium-sized hospitals (25 to <100 beds; n = 42) and small nursing homes (10 to <25 beds; n = 29). A pre-tested questionnaire was designed to obtain basic information about hospital in context to PMTCT programme. Interviews of heads of obstetrics and gynaecology and paediatric departments were conducted by trained interviewers. It was observed that in private hospitals in year 2012, out of 38,186 antenatal women tested, 52 (0.14%) were detected HIV-positive. However, against National Policy, HIV testing was done without pre/post-test counselling/or consent of women, no PMTCT protocol existed, delivery of HIV-positive women was not undertaken and no efforts were made to link HIV-positive women to antiretroviral treatment. Major intervention observed was medical termination of pregnancy, which indicates lack of awareness in private hospitals about available interventions under national programme. The role of private hospitals in management of HIV in pregnant women must be recognized and mainstreamed in HIV control efforts. There is an urgent need for capacity building of private health care providers to improve standards of practice. National AIDS Control Organization may consider establishing linkages or adopting model developed by some countries with generalized epidemic for delivering PMTCT services in private health sector.     

Unexpected low prevalence of HIV among fertile women in Luanda, Angola. Does war prevent the spread of HIV?

We studied HIV prevalence and risk factors for HIV infection among fertile women in Luanda for the purposes of obtaining background data for planning of interventions as well as to look into the association of armed conflicts and HIV prevalence in sub-Saharan Africa. The HIV-1 prevalence was 1.7% in an antenatal care group (n = 517) and 1.9% in a family planning group (n = 518). Socioeconomic and sexual background factors did not significantly differ HIV-positive from HIV-negative women. Data on armed conflict factors were matched with HIV prevalence figures among pregnant women in sub-Saharan Africa. The level of armed conflicts was found to be inversely related to HIV prevalence. The low HIV seroprevalence in Luanda is in sharp contrast to the capitals of neighbouring countries. While the spread of HIV may have been hampered by the long armed conflict in the country, it is feared to increase rapidly with the return of soldiers and refugees in a post-war situation. The challenge for preventive actions is urgent. This example may be relevant to other areas with a recent end-of-war situation.     

Life After HIV: Examination of HIV Serodiscordant Couples’ Desire to Conceive Through Assisted Reproduction

The current study addresses fertility desires and considerations among 143 HIV serodiscordant, opposite-sex couples (in which only the male partner is HIV positive) in the Northeastern U.S. Couples responded to questionnaires during their initial consultation for assisted reproduction, and data were collected over 7 years and analyzed retrospectively. Results indicated that a majority of the male participants had HIV when they met their partner, and a majority also disclosed their HIV status upon meeting. Most couples reported that they had previously discussed or considered a host of fertility-related issues, including the potential risk of HIV infection to the mother and the fetus during the process of fertility treatment. The majority of couples had also discussed the possibility that the male partner could die prematurely due to HIV/AIDS and had considered making arrangements for third-party parenting in the event of the male partner’s death. If their fertility treatment were to be successful in the future, most couples desired additional children, and most believed that their future child should be told of the male partner’s HIV status. Predictors of the desire for additional children after successful fertility treatment included: younger age, shorter relationship duration, being childless currently, and beginning their relationship after the male partner had already been diagnosed as HIV positive. Future research on fertility desires should include perspectives of HIV positive men on fatherhood, as well as concerns and issues specific to HIV serodiscordant couples.     

A Systematic Review of Psychological Functioning of Children Exposed to HIV: Using Evidence to Plan for Tomorrow’s HIV Needs

Prevention of mother to child transmission of HIV can virtually eliminate paediatric HIV infection. Studies are needed to understand child development outcomes for children exposed to HIV in utero but born HIV negative (HIV affected children). This systematic review examined cognitive, developmental and behavioural outcomes for HIV affected children compared to control unexposed and uninfected children. Key word searches of electronic databases generated 1,739 hits and 11 studies with adequate quality design and measures of standardised cognitive, behavioural and developmental indices. Cognitive performance, behaviour and developmental delay were measured with 15 different standardised scales from 650 HIV affected children, 736 control children and 205 HIV positive children. Performance scores for HIV affected children were significantly lower than controls in at least one measure in 7/11 studies. An emerging pattern of delay seems apparent. HIV affected children will grow in number and their development needs to be monitored and provided for.     

Does an HIV clinical trial information booklet improve patient knowledge and understanding of HIV clinical trials?

Objectives To evaluate the impact of an information booklet on HIV clinical trials, Clinical Trials in HIV and AIDS: Information For People Who Are Thinking About Joining a Trial, in addition to the standard trial information (SI) on patients' knowledge; understanding and attitudes about clinical trials; and to investigate patients' motivations and reasons for enrolling or not enrolling in a clinical trial. Methods Fifty HIV‐1 positive patients who attended the HIV clinic at a west London hospital were randomized to receive either SI alone (n = 27) or SI and a 16 page information booklet explaining the principles and procedures of HIV clinical trials (n = 23). A self‐administered questionnaire was used at baseline to assess past experience and attitudes to clinical trials (10 questions), knowledge and understanding of HIV treatments (8 questions) and clinical trials (11 questions). At 2–6 months after randomization, a second interviewer‐administered questionnaire addressed the patient's assessment of the usefulness and comprehensiveness of the information provided by the SI and information booklet, whether or not the patient had enrolled in a clinical trial and reasons for enrolling/not enrolling, knowledge of specific aspects of the trial protocol the patient was eligible to join (13 questions) and general knowledge of clinical trial procedures (repeat of 11 baseline questions). Changes in the attitudes and scores on knowledge and understanding of clinical trials were compared for the two groups. Results In both groups, patient knowledge of clinical trial procedures improved significantly over the study period. The median score increased from 30 at baseline to 35/44 at follow‐up (SI only) vs. 24–31/44 (SI plus booklet), but this did not differ significantly between the two groups. However, knowledge of the specific trial protocol was poor [median score 13/25, interquartile range (IQR) 8–14], and there was no difference in the scores for the two groups. The prime motivations for joining a clinical trial were to benefit personal health and to gain access to new treatments. Potential side‐effects were the main concern of prospective trial participants. Conclusions This small trial shows that, while the patients' general knowledge and understanding of clinical trials improved over time, this was not improved by the information booklet and recollection of the details of the relevant trial protocol remained poor.     

International symposium on natural immunity to HIV: a gathering of the HIV‐exposed seronegative clan

This supplemental issue of the Journal of Infectious Diseases collects summaries of oral presentations on the phenomenon of natural immunity to human immunodeficiency virus type (HIV) infection that were given at the International Symposium on Natural Immunity to HIV in Winnipeg, Manitoba, Canada, in November 2009.