Young AIDS migrants in Southern Africa: policy implications for empowering children

Many AIDS-affected children in southern Africa engage in migration when household members fall sick or die from AIDS, or because they are sent to assist relatives. Despite this, little attention has been paid to the consequences of these movements for children's lives. Multi-method research, conducted in Lesotho and Malawi, revealed that children sent to live with kin commonly move over long distances and between urban and rural areas. They are generally not consulted or informed about these migrations and face a range of associated difficulties, particularly with integrating into new families and communities. Severed family ties exacerbate the difficulties faced by children who end up in institutions or on the streets. This paper advocates that policy approaches for those affected by AIDS should be children-centred and take into account the implications of migration at three levels. First, many of the difficulties children face could be overcome if they were familiar with the place and people they were moving to Second, children would be better able to cope with new situations if they were included in family discussions with decision-makers regarding their migration preferences. Third, maintaining ties with kin would ensure that children do not become distanced from their family and cultural heritage, which is essential for post-institutional support.     

Characteristics of homeless HIV-positive outreach responders in urban US and their success in primary care treatment

Homeless HIV+ persons with persistent mental illness and substance use disorders need services, but are hard to reach and enrol into treatment. Connecting them to services is a major challenge of the AIDS epidemic. This report describes characteristics of homeless HIV+ substance abusers who responded to outreach and enrolled in integrated treatment services. The target population was urban, homeless, HIV+ individuals with substance dependence and/or mental illness diagnoses. Health and physical functioning were measured using a refinement of the Medical Outcomes Study Health Survey. Questions based on the PRIME-MD measured subjects' mental health status. Outreach occurred at shelters, soup kitchens, and on the streets. The outreach team consisted of a nurse, substance abuse counsellor, and a formerly homeless person. Outreach contacted 3,059 individuals; 1,446 entered the clinic, 110 of 206 eligible candidates enrolled in the study, and 82.7% of study participants completed 12-month follow-up interviews. Enrollees exhibited 5th percentile composite health scores. They reported heavy street drug use and unmet service needs particularly for housing and financial assistance. Outreach successfully recruited targeted individuals into treatment. They stayed in treatment and demonstrated improvements on measures of physical and mental health 12-months later.     

Self-reports of HIV risk behavior by injecting drug users: are they reliable"

While most studies of AIDS risk behavior rely on self-reports, few studies have assessed the reliability of these reports. The present study examines self-reports of drug-related and sexual risk behavior among pairs of injecting drug users (IDUs) recruited from the streets in New York City. Since both members of the pair were interviewed, it was possible to compare their responses in order to assess reliability. Subjects reported on their contacts' demographic data (age, gender, race/ethnicity) and on shared risk behaviors, including syringe sharing. Despite the private and/or illegal nature of AIDS risk behaviors, IDU subjects were generally reliable in their reports of both demographic and AIDS risk behaviors.     

Gay men, social support and HIV disease: a study of social integration in the gay community

As part of a large study of the effects of HIV and AIDS on gay male sexual behaviour, we investigated the extent to which gay men in the UK have access to social support and informal care at times of illness. The study sample (n = 502) demonstrated high levels of willingness to disclose sexuality to others, sociability and social integration. Over 90% reported that they had access to people whom they could turn for practical help at times of temporary incapacity. Between 42% and 46% have known a person, or persons, with HIV symptomatic disease, AIDS or someone who has died of AIDS, although men recruited in larger towns and cities were more likely to know people at every stage of HIV infection and AIDS than those from smaller towns. Twenty-five per cent had provided practical help and support to at least one person with AIDS; men in this situation were more likely to have had a close friend, lover or former lover who had died of AIDS. It is argued that it is not possible to expect the gay community to provide fully for the non-medical care of its members and, whilst some needs can be fulfilled on an informal care basis, the demands of long-term serious illness are such that adequate support services should be available in the community.     

柳州市HIV感染者/AIDS病人中“查无此人”情况分析

目的分析柳州市艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人中"查无此人"情况,了解导致出现"查无此人"的原因及探索解决办法。方法分析材料来源于《全国艾滋病综合防治信息系统》,截至2010年底,所有随访状态为"查无此人"病例的数据资料。采用SPSS 13.0对数据进行统计分析。结果柳州市累计报告的病例中,2 500例随访状态为"查无此人",其中HIV感染者2 322例,AIDS病人178例。多为姓名、身份证号码、联系方式、职业、民族、文化程度等多项记录不准确或缺失。主要报告来源是疾病预防控制中心,占70.08%;感染途径以不详为主,占41.40%;其次是注射毒品和异性传播,分别占37.08%和18.88%。结论 "查无此人"由多种原因造成,应采取针对性措施,逐步摸清这些病例的真实情况。     

The effect of antiretroviral therapy provision on all‐cause,AIDS and non‐AIDS mortality at the population level – a comparative analysis of data from four settings in Southern and East Africa

Objective To provide a broad and up‐to‐date picture of the effect of antiretroviral therapy (ART) provision on population‐level mortality in Southern and East Africa. Methods Data on all‐cause, AIDS and non‐AIDS mortality among 15–59 year olds were analysed from demographic surveillance sites (DSS) in Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and the Africa Centre (South Africa), using Poisson regression. Trends over time from up to 5 years prior to ART roll‐out, to 4–6 years afterwards, are presented, overall and by age and sex. For Masaka and Kisesa, trends are analysed separately for HIV‐negative and HIV‐positive individuals. For Karonga and the Africa Centre, trends in AIDS and non‐AIDS mortality are analysed using verbal autopsy data. Results For all‐cause mortality, overall rate ratios (RRs) comparing the period 2–6 years following ART roll‐out with the pre‐ART period were 0.58 (5.9 vs. 10.2 deaths per 1000 person‐years) in Karonga, 0.79 (7.2 vs. 9.1 deaths per 1000 person‐years) in Kisesa, 0.61 (6.7 compared with 11.0 deaths per 1000 person‐years) in Masaka and 0.79 (14.8 compared with 18.6 deaths per 1000 person‐years) in the Africa Centre DSS. The mortality decline was seen only in HIV‐positive individuals/AIDS mortality, with no decline in HIV‐negative individuals/non‐AIDS mortality. Less difference was seen in Kisesa where ART uptake was lower. Conclusions Falls in all‐cause mortality are consistent with ART uptake. The largest falls occurred where ART provision has been decentralised or available locally, suggesting that this is important.     

Knowledge about HIV/AIDS, the perceived risks of infection and sources of information of Asian-Indian adolescents born in the USA

This study examined the extent and specificity of knowledge about HIV/AIDS, the most used sources of information and the usefulness of these sources among Asian-Indian adolescents who were born in the USA and whose parents emigrated from India. Although 86% knew that having unsafe sex with a person infected with HIV could transmit HIV, 47% did not know that sharing a razor with an HIV-positive person could do so, and a significant proportion believed that donating blood (27%) and taking blood tests (14%) could transmit HIV. Television was the most used source of information, but school programmes on HIV/AIDS were considered the most useful source. The results indicated that to be effective, HIV/AIDS prevention programmes must assess the gap in scientific knowledge and beliefs, and clarify misconceptions, reinforce school programmes to present clear messages about the transmission of HIV/AIDS and utilize television to reach adolescents.     

Beyond negative attitudes: Examining HIV/AIDS stigma behaviors in clinical encounters

HIV/AIDS related stigma remains a major global health issue with detrimental consequences for the treatment and health of people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has successfully documented negative attitudes towards PWHA among health professionals. However, fewer studies have examined how stigma is manifested behaviorally by health professionals during clinical interactions. Therefore, this study aimed to: (1) examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during clinical interactions, and (2) document the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient (SP) simulations, observational techniques, and quantitative questionnaires. The sample consisted of 66 physicians in training in Puerto Rico who engaged in SP encounters with two scenarios: (1) PWHA infected via illegal drug use (experimental condition), and (2) a person with a common cold (control condition). Results evidenced statistically significant differences between both simulations (p = .047), with a higher number of stigma behaviors manifested in the experimental condition. HIV/AIDS stigma attitudes were not correlated with stigma behaviors. Negative emotions associated with drug use were positively associated with drug-related stigmatizing behaviors.     

Analysis of lymphocytes, monocytes, and neutrophils from human immunodeficiency virus (HIV)-infected persons for HIV DNA

The human immunodeficiency virus (HIV) infects and depletes or alters the function of cells involved in immune responsiveness. While both T helper lymphocytes and monocyte/macrophages can be infected via cell-surface CD4 in vitro, previous studies showed that few blood cells express HIV RNA in vivo. This study used DNA amplification to determine the levels of HIV DNA in purified lymphocytes, monocytes, and neutrophils from HIV-infected asymptomatic individuals and persons with AIDS. The average numbers of HIV DNA copies in lymphocytes from AIDS patients and asymptomatic individuals were similar (approximately 100-140 copies/150,000 cells). However, when expressed on the basis of numbers of CD4+ T cells, AIDS patients' cells contained approximately 2.5 times more HIV DNA. While HIV DNA was present in lymphocytes from all 27 subjects, little or no HIV DNA was observed in monocytes or neutrophils. Only 1 asymptomatic person contained levels of HIV DNA in monocytes (125 proviral copies/150,000 cells) that were comparable to levels expressed in lymphocytes (160/150,000). While expression of monocyte HIV DNA in this person was persistent over at least 8 months, it was not observed in neutrophils, suggesting that monocyte HIV DNA did not originate in myeloid precursors. This study shows that in AIDS or asymptomatic HIV infection, lymphocytes are the predominant infected cell found in blood.     

Calculation and use of an HIV-1 disease progression score

OBJECTIVE: The pathogenesis of human disease is often multifactorial. For fatal diseases, it is common to combine survival information in relation to different aspects of pathogenesis. Here we explored a scoring system for HIV disease markers that combines measures of immunodeficiency (CD4 cell count), plasma viral burden, and immune activation (CD38 expression on CD8 T cells) DESIGN: Observational data from 252 HIV-infected individuals from the Multicenter AIDS Cohort Study (MACS) was used for model development. METHODS: A statistical model was used to develop a system that related marker values to the outcomes of clinical AIDS or death. RESULTS: Mathematical formulae were derived to calculate AIDS and death progression scores. These scores give the number of days at which there is a 50% probability that a person may develop AIDS or die. Graphs were constructed that can be used to determine the probability that a person will be AIDS-free or alive for times between 6 months and 4 years. The model was valid when tested on data from 240 additional people from the MACS cohort. CONCLUSIONS: These formulae and graphs are a convenient way for individuals and their physicians to apply existing MACS cohort data to HIV disease markers in order to estimate probabilities of progression to AIDS or death. Further investigation is needed to determine whether modifications of the formulae are required to predict outcome accurately in those patients on highly active antiretroviral therapy or in other demographic groups.     

HIV/AIDS: impact on healing

Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) are leading chronic illnesses in many major cities worldwide. Frequently, people with HIV infection require surgery or develop chronic wounds. This paper summarizes the impact of HIV infection on body organs and systems and the effect of antiretroviral therapy as a basis for potential complications with wound care and healing. The authors also present research on wound healing in HIV-positive people undergoing operative procedures. Besides the physical effect of HIV infection on the person, clinicians must also realize psychosocial and economic effects of the disease when considering wound care. This paper also addresses care considerations for patients with HIV/AIDS in the inpatient, outpatient, and home care settings.     

Stigmatization of AIDS Patients: Disentangling Thai Nursing Students’ Attitudes Towards HIV/AIDS, Drug Use, and Commercial Sex

This paper analyzes the interrelationships between the stigma of HIV/AIDS stigma and the co-stigmas of commercial sex (CS) and injecting drug use (IDU). Students of a Bangkok nursing college (N = 144) were presented with vignettes describing a person varying in the disease diagnoses (AIDS, leukemia, no disease) and co-characteristics (IDU, CS, blood transfusion, no co-characteristic). For each vignette, participants completed a social distance measure assessing their attitudes towards the hypothetical person portrayed. Multivariate analyses showed strong interactions between the stigmas of AIDS and IDU but not between AIDS and CS. Although AIDS was shown to be stigmatizing in and of itself, it was significantly less stigmatizing than IDU. The findings highlight the need to consider the non-disease-related stigmas associated with HIV as well as the actual stigma of HIV/AIDS in treatment and care settings. Methodological strengths and limitations were evaluated and implications for future research discussed. The scales used in this study can be made available to the reader upon request.     

Primary care of the patient with HIV/AIDS

Primary care of the person with HIV/AIDS is a complex endeavor with many components. The primary care provider's goal is to combine preventive health care interventions that are known to be effective, with ongoing surveillance and treatment of HIV-related and non-HIV-related medical problems, and effective antiretroviral therapy when indicated. The provider needs to have an approach that enhances trust, involves the patient in important health care decisions, and meets the patient's own expectations for health care.     

中国抗AIDS药物费用现状分析

目的通过对中国目前免费供应的抗艾滋病（AIDS）药品的价格,与国际上相关药品现状做对比分析,发现中国药品价格存在问题,为今后药品的生产及采购的管理决策提供依据。方法将仿制药品2008年国家招标采购价格,按照当年中国银行基准价牌价折合成美金价格,进口专利药品按到岸价格,根据不同治疗方案计算每人每年的药品费用,与世界卫生组织公布的同期价格进行比较分析。结果为了落实国家“四免一关怀”政策,对AIDs病人实施全面关怀救助,中国先后批准5种国产仿制药品、5种进口专利药品,用于一、二线AIDs病人治疗方案。中国含进口专利药品的一线治疗方案及二线治疗方案,每人每年的抗病毒治疗药品费用显著高于其他发展中国家。由于病人人数增加,特别是对进口专利药品的需求增加,尽管国家投入艾滋病专项经费逐年增加,每年用于采购药品的预算占总预算的比例连续增加,从2004年的19％增加到2008年的38％。结论采购经费的增加,除需要治疗的病人增加外,一个最主要的原因是进口专利药品价格过高。中国含EFV的一线治疗方案,每人每年抗AIDS治疗费用,远远高于中高收入国家的相应方案费用,进口专利药品价格是AIDS防治工作亟待解决的问题。     

State-level spending on health care and social services for people living with HIV/AIDS in the USA: a systematic review

Every year for the past decade, approximately 50,000 people have been diagnosed with HIV or AIDS in the USA, and the incidence of HIV/AIDS varies considerably from state to state. Studies have shown that health care services, most notably treatment with combination antiretroviral therapy, can help people living with HIV/AIDS (PLWHA) live healthier, longer lives, and prevent the spread of HIV from person to person. In addition, social services, such as housing support and provision of meals, have also shown to be important for helping PLWHA adhere to antiretroviral treatment and maintain contact with health care providers for improved health outcomes. Although spending on health care and social services for PLWHA varies across the USA, the relationship between state-level spending on these services and HIV/AIDS-related outcomes is not clear. We therefore conducted a systematic review of peer-reviewed literature to identify studies that explore state-level spending on health care services and/or social services for PLWHA and HIV/AIDS-related health outcomes in the USA.     

Court ruling may change Medicaid disability policy

The U.S. Supreme Court has upheld a lower court's ruling confirming that refusing any type of medical treatment to an asymptomatic HIV-positive person is discrimination and therefore is covered under the Americans with Disabilities Act. This ruling has implications for Medicaid guidelines which currently deny coverage for HIV-related treatments until a patient is diagnosed with AIDS. It is argued that covering asymptomatic HIV-positive people under Medicaid will save money, because intervening before AIDS develops has been shown to offset the exorbitant medical costs associated with AIDS treatment.     

The relationship between stress and clinical outcomes for persons living with HIV/AIDS: a systematic review of the global literature

For persons living with HIV/AIDS, the relationship between stress and clinical outcomes has received little attention in current research, yet represents an important area for future research and intervention. Chronic illness has been theorized to place additional demands on a person that may exceed their ability to cope with daily life, leading to long-term stress, which then increases the risk for negative health outcomes in persons already at risk. This paper reviews the existing global literature to answer two main questions: (1) how is stress conceptualized in research with persons living with HIV/AIDS? and (2) what are the current findings linking stress to clinical outcomes? Twenty-three articles are included in the final review. Findings reveal that researchers conceptualize stress in multiple ways for persons living with HIV/AIDS, including depressive symptomology, post-traumatic stress, life events, emotions linked to stress, and biological markers (such as cortisol levels and autonomic nervous system activity). Further, findings related to the link between stress and clinical outcomes are mixed; however, stress was shown to be related to lower CD4 cell counts, higher viral load, and disease progression. Several studies also showed a link between stress and poorer treatment adherence. Implications and directions for future research are discussed, including further thought into how we conceptualize stress for persons living with HIV, future research that is necessary to elucidate current mixed findings on the link between stress and clinical outcomes, and preliminary suggestions for intervention to prevent and alleviate stress in this population.     

Perceived social support and the psychological well-being of AIDS orphans in urban Kenya

Parental deaths due to AIDS seriously affect the psychological well-being of children. Social support may provide an effective resource in the care of vulnerable children in resource-limited settings. However, few studies have examined the relationships between social support and psychological well-being among AIDS orphans. This cross-sectional study was conducted to explore associations between perceived social support (PSS) and the psychological well-being of AIDS orphans, and to identify socio-demographic factors that are associated with PSS. Data were collected from 398 pairs of AIDS orphans (aged 10-18 years) and their caregivers in Nairobi, Kenya. The participants provided information on their socio-demographic characteristics, the children's PSS, and the children's psychological status (based on measures of depressive symptoms and self-esteem). Of the 398 pairs, 327 were included in the analysis. PSS scores of AIDS orphans showed significant correlations with depressive symptoms (ρ =-0.31, p<0.001) and self-esteem (ρ=0.32, p<0.001). Socio-demographic factors, such as HIV-positive status of children (β=3.714, p=0.014) and cohabitation with siblings (β=3.044, p=0.016), were also associated with higher PSS scores. In particular, HIV-infected children (n=37) had higher scores of PSS from a special person (β=2.208, p=0.004), and children living with biological siblings (n=269) also had higher scores of PSS from both a special person (β=1.411, p=0.029) and friends (β=1.276, p=0.039). In conclusion, this study showed that PSS is positively associated with the psychological well-being of AIDS orphans. Siblings and special persons can be effective sources of social support for AIDS orphans, which help to promote their psychological well-being.     

Clinical and immunological follow-up of previously hospitalized HIV-2 seropositive patients in Bissau, Guinea-Bissau.

A follow-up study was done in Bissau on 113 HIV-2 seropositive patients and 97 HIV-2 seronegative patients 3-15 months after hospitalization. Follow-up totalled 63.5 person years for seropositive patients and 62 for seronegative patients. The mortality during the follow-up period was 43.3% among the seropositive patients (rate 72/100 person years; p.y.) and 25.8% among the seronegative patients (40/100 p. y.). Among 25 HIV-2 associated AIDS cases the mortality was 80% (rate 117/100 p. y.). The median survival time for the AIDS patients was 8 months. Among 48 HIV-2 seropositive patients who lacked signs or symptoms included in the WHO case definition for AIDS at the time of hospitalization 6 patients (12.5%) developed AIDS related symptoms (ARS) during altogether 31.5 person years of follow-up (rate 19/100 p. y.). Tuberculin anergy was demonstrated in 83.3% (15/18) of HIV-2 seropositive patients with AIDS or ARS, in 14.3% (6/42) of seropositive patients without HIV-related symptoms and in 6.9% (5/72) of seronegative patients. A low CD4 T-lymphocyte count in combination with a low CD4/CD8 T-cell ratio was found significantly more often in HIV-2 seropositive patients with AIDS or ARS (62.5%, 10/16) than in HIV-2 seropositive patients without HIV associated symptoms (6.9%, 2/29) or in seronegative patients (2.7%, 1/37). Thus the mortality among recently hospitalized HIV-2 seropositive patients was high and a high proportion of seropositive patients with HIV-related symptoms had evidence of immunodeficiency.     

广西大型艾滋病预防展览短期效果评价

目的 通过评价艾滋病预防展览效果,说明健康教育行为干预在预防HIV中的作用。方法 1998年5月16～23日在南宁调查参观展览的市民和大学生322名,各分参观前后两组。采用定性和定量研究分析展览会对观众知识、态度、行为的影响。结果 参观后市民预防知识总分增加17.0％,学生8.6％,非传播途径正确回答率明显高于参观前,观众防范意识增强,96％的市民和99％的学生认识到AIDS离我们并不遥远。市民组拟采取预防行为由参观前的每人3种上升为参观后的5种,学生组采用不吸毒,正确使用避孕套比例高于参观前。结论 展览会能起到普及艾滋病预防知识、促进行为改变的效果,建议在全国巡回展出。