Africa begins to face up to AIDS.

Grants and Outcomes

As of March 21 1988 136 countries or territories worldwide had reported a total of 84256 cases of acquired immunodeficiency syndrome (AIDS) to WHOs Global Program on AIDS. 37 countries or territories reported no cases. Because of reporting lags the global total of AIDS cases reported for 1987 is not yet complete but as of March 21 1988 34913 cases had been reported for 1987 representing a 72% increase. 42 countries in the Americas have reported 73% of the world total of AIDS cases: US 54233; Brazil 2325; Canada 1517. In Europe 28 countries have reported 13% of the worlds total: France 3073; Federal Republic of Germany 1669; Italy 1411; UK 1227; and Spain 789. Countries in Europe with the highest rates per population size are France Switzerland and Denmark; the lowest rates were reported from eastern European countries. 38 countries in Africa have reported 13% of the worlds total cases with central eastern and southern Africa reporting the largest number of cases. Oceania has reported 834 cases; Asia 231; and eastern Mediterranean countries 100. Most AIDS cases in these areas were reported in Australia New Zealand Japan Qatar and Turkey. Epidemiologic studies indicate 3 broad distinct patterns of transmission. In pattern I typical of industrialized countries with large numbers of AIDS patients most cases occur among homosexual or bisexual males and urban iv drug users. In pattern II seen in central eastern and southern Africa and some Caribbean countries AIDS occurs among heterosexuals; the male/female ratio is approximately 1/1. Pattern III with small numbers of cases is found in eastern Europe the Middle East Asia and the Pacific. Generally cases occur among travelers to endemic areas or through sexual contact with persons from those areas. Although the number of AIDS cases is expected to increase significantly over the next few years there is growing confidence that the spread of AIDS can be stopped through education and modification of risk factors.

World AIDS Day 2021: highlighting the pulmonary complications of HIV/AIDS.

AIDS risk among black male adolescents: Implications for nursing interventions

The counselling experience at Chikankata hospital for the first year of the AIDS care and prevention programme is described. People in the counselling team are selected according to specific criteria. Counselling is conducted in integrated AIDS management context, at the individual family and community levels. Counselling emphases differ according to the clinical expression of the disease. Some cultural issues require specific counselling approaches, such as ritual cleansing, and dealing with seropositive women of childbearing age. Counselling is integral to comprehensive AIDS management which is inclusive of the disciplines of clinical care, education, counselling, pastoral care and administration.

Black and Latino community organizations can play a major role in acquired immunodeficiency syndrome (AIDS) prevention. Their ongoing relationships with their constituents, knowledge of relevant cultural values and channels of communication, and commitment to safeguard the well-being of their neighborhoods are an important resource for AIDS prevention campaigns. In order to better understand the process by which community groups have taken on the issue of AIDS, investigators conducted in-depth interviews with a convenience sample of 47 neighborhood organizations in two primarily Latino communities in New York City. Researchers also attended community meetings, interviewed AIDS educators, and conducted focus groups with respondents. More than half the groups had already sponsored some AIDS prevention activities prior to the first interview. More active groups were more likely to have multiple missions, previous experience with the target population, and prior experience working with people with AIDS. Respondents reported a variety of obstacles to more active involvement in AIDS prevention at the community, organizational, and individual levels. To strengthen the role of community organizations in AIDS prevention, more resources should be provided to grass roots groups, AIDS should be linked to other urgent social problems facing black and Latino communities, and funders and AIDS organizations should respond more flexibly to the needs of neighborhood organizations.

Grants and Outcomes

The Abuja Declaration, which was endorsed in 2001, was a hallmark of African leadership’s decision to prevent and control human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in Africa. Since this declaration, there have been several achievements recorded in the fight against HIV and AIDS. This includes increased domestic and international financing, ground-breaking innovations and discoveries for effective screening, diagnosis, and treatment of HIV and AIDS, targeted interventions to address mother-to-child transmission, and tailored and innovative approaches to prevent new HIV infections, particularly among the key and vulnerable populations. However, unaddressed challenges still require urgent and accelerated interventions to attain and sustain the set 95-95-95 Joint United Nations Programme on HIV and AIDS (UNAIDS) target. As we are near the 2030 landmark, revitalisation of the commitments made in the Abuja Declaration is essential. African countries must increase their domestic resources to address the inequities and improve access to essential HIV and AIDS prevention and response interventions, particularly for adolescent girls and young women, children, and vulnerable populations. Revitalisation of sex education, social protection, and revisiting in-country laws that negatively impact the HIV prevention and response efforts are more essential than ever before. There is a clear need for rededication of political and leadership will and commitment as we envision epidemic control of HIV and AIDS by 2030. Countries need to develop an action-oriented, targeted, and all-inclusive roadmap for HIV and AIDS epidemic control by 2030.

The impact of AIDS on an urban population of high-risk female minority adolescents: Implications for intervention

Since July 1986 the serologic diagnosis laboratory at Brazzavilles General Hospital has been equipped to identify serum samples positive for infection with human immunodeficiency virus (HIV). This study analyzed the results of serologic testing of 563 samples obtained from hospitalized patients in 4 principal centers in Brazzaville and 1215 samples from blood donors obtained during the same period (July 1986-February 1987). Of the 82 hospitalized children under 15 years of age screened for antibodies to HIV infection 43% of those 3 months-4 years of age were positive for infection 72% of those 5-9 years were seropositive and 30% of children 10-14 years old were seropositive. 55% of the seropositive children had received blood transfusions and 26% had mothers with HIV infection. Major signs observed in pediatric cases included weight loss greater than 10% of body weight (45%) and fever of more than 1 months duration (38%); the most frequent minor sign was generalized lymphadenopathy (28%). Overall the prevalence of HIV infection was 52% in the hospitalized patients (50% in females and 55% in males). The highest seroprevalence rate (60%) is found in the 30-34-year age group. Major signs of acquired immunodeficiency syndrome (AIDS) observed in the hospitalized adults included weight loss (83%) prolonged fever (69%) and chronic diarrhea (53%). The most common minor signs were herpes zoster (89%) and generalized pruritus (25%). The HIV seropositivity rate was strikingly lower among the blood donors screened--7% (7% among males and 6% among females). A further analysis of serum samples with hepatitis B surface antigen revealed that 6% were also seropositive for HIV infection suggesting that hepatitis B is not a major cofactor in the development of AIDS. To prevent the further spread of AIDS in the Congo (561 AIDS cases were reported by April 1987) rational use of blood transfusions and education in sexually transmitted diseases are recommended.

The epidemic of Acquired Immunodeficiency Syndrome (AIDS) and suggestions for its control in drug abusers

Acquired immune deficiency syndrome (AIDS) is worldwide, but the clinical and epidemiological pattern of the disease in Africa is different from that in developed areas. "Type 1 AIDS" occurs in industrialized North America and Europe; it has a distinctive sex ratio (16:1) and risk pattern of IV drug use and sexual practices. "Type 2 AIDS" occurs in Third World countries, particularly in eastern, southern, and central Africa. It is characterized by an entirely different sex ratio (1:1) and by distinctively different risk patterns. Both epidemics are caused by the HIV-1 virus. The key concept for understanding the origins of the differences between Type 1 and Type 2 AIDS is the migratory labor system in eastern, central, and southern Africa. This system causes long absences, increased family breakdown, and increased numbers of sexual partners. Historically the organization of this labor market has created a population which suffers from epidemics of sexually transmitted diseases. These historical patterns are presented as evidence for the contemporary transmission of AIDS. When contemporary AIDS and HIV-1 seropositivity prevalence data are examined, a systematic temporal and geographic pattern emerges for the AIDS epidemic in Africa. Despite a paucity of good data, the prevalence data from eastern, central, and southern Africa support the thesis of migrant labor's role in the transmission of AIDS.

In the mid-1980s, when AIDS (acquired immune deficiency syndrome) was well established in North America and Africa, it was little known in Asia. Now the World Health Organization (WHO) estimates that before 2000 most new cases of HIV (human immunodeficiency virus) infection, which causes AIDS, will occur in Asia (Mann 1992, 4; World Bank 1993, 33). Worldwide the number of HIV-infected persons will increase from nine million in 1990 to twenty-six million by 2000 (World Bank 1993, 99). During that period the number of infected people in south, east, and southeastern Asia will rise from fewer than half a million to nine million, which means that an additional 8.6 million cases will be recorded for Asia by the end of the twentieth century. The corresponding tally for Africa is 6.2 million (World Bank 1993, 33). The Global AIDS Policy Coalition asserts that by 2000 Asia will overtake Africa as the most Aids-afflicted continent (Mann 1992). HIV is transmitted primarily by three methods: sexual intercourse; intravenous exposure to HIV-infected blood through transmission, donated organs, and drug use; and vertical transmission from mother to child (Over and Piot 1993, 460). The patterns and prevalence of these three modes of transmitting HIV vary geographically. On the bases of data from the period when the virus began to spread significantly, the prevalence of each mode, and its specific mechanisms, WHO distinguishes three epidemiological patterns of HIV infection (Mosley and Cowley 1991, 20). Pattern I is typical of western Europe, North America, Australia, and New Zealand, where the most common form of transmission is male homosexual or bisexual intercourse and the second most is intravenous drug use. Pattern II, in which heterosexuals are the main group affected, is found in sub-Saharan Africa, the Caribbean, and parts of South America. Pattern III is typical of countries where HIV has recently been introduced. Much of Asia and eastern Europe fit this pattern. Prostitutes, their clients, and intravenous drug users account for most cases. The first AIDS case in Asia was reported in Israel in 1980, post diagnosis (Dossier 1988, 154). No AIDS case was detected in any other Asian country for the next three years. The Philippines, Thailand, and Turkey reported AIDS cases in 1984; first-time reports of cases came from China, Hong Kong, Japan, and Qatar in 1985. By 1 January 1992, as many as twenty-eight Asian countries, outside the former Soviet Union, had officially reported cases (Fig. 1). A relatively large number of countries reported cases for the first time in the mid-1980s, in contrast with the early and late years of that decade. Thirty new cases were reported in 1985 (Fig. 2). The number rose steadily to 1990, when 403 were officially reported. The tally dropped in 1991 but sharply increased in 1992 and soared to more than three thousand in 1993. One source (Economist 1994b, 128) used WHO data to assert that a total of 10,387 AIDS cases had been officially recorded in Asia as of February 1994. That tally is less than for the Americas in 1984 or for Europe by 1987. But if the current trend persists, Asia will have the largest number of AIDS cases in the world in a decade. Without proper intervention programs to slow the spread of AIDS in Asia, the epidemic will bring catastrophe to many countries. The main objective of this article is to examine the spatial patterns of AIDS distribution in Asia. Data were available from twenty-eight countries, all outside the former Soviet Union. Three variables are usually used to study distribution patterns of AIDS: HIV-infected cases, AIDS cases, and deaths attributed to AIDS. Data on the first and third variables are available only for a few Asian countries. Therefore, the AIDS cases alone are used to show the spatial distribution of the disease in Asia. Additionally, I examine the status of AIDS in Thailand and India in detail as case studies. …

Condoms offer considerable protection against sexual transmission of AIDS. Yet many Africans who are at risk of infection reject condoms as "unnatural." Data from Zaire have been used to examine this culturally constructed category in relation to sexuality, procreation, gender roles, class formation and international health and development policy. Much more than a simple transfer of biomedical technology is involved. Condom use with regular partners raises issues of cultural politics at many levels. "Traditional" African healers represent important social networks with considerable authority in poor urban communities. They are able to reinterpret cultural categories and endow behavior with new meanings. Action-research in Kinshasa was used to explore roles that healers might play in promoting change to safer sex practices.

Data on incidence of AIDS between 1981 and 1986 from the U.S. Centers for Disease Control are analyzed geographically. Nationwide and regional patterns by source groups, gender, race, age cohorts, and survival rates in the United States are emphasized. Some elements like association of AIDS incidence by source display distinct regional variations, while others like incidence by age cohort have uniform patterns. A CQUIRED immune deficiency syndrome (AIDS) is the bubonic plague of the twentieth century. Both diseases were initially incurable, and, as was the case with the plague, almost everyone who contracts AIDS eventually dies of it. Contrastingly the cause of AIDS was discovered and isolated shortly after the disease was identified.1 In this article we offer a spatial analysis of the disease in the United States by region, by patient, gender, and age groups of the victims, and by country of birth and death. This analysis is both tentative and speculative. Because of the current status of data collection and reporting for AIDS, definitive conclusions are virtually impossible. However, the problem has such contemporary enormity and future implications that it cannot be ignored or withheld from geographical analysis. The deadliness of AIDS is unquestioned. According to the World Health Organization, more than 500,000 AIDS cases had been reported globally by mid-1987, and five to ten million persons in all parts of the world had been infected by the virus.2 By the end of 1986, 32,560 cases had been reported in the Western Hemisphere, and 90 percent of them were in the United States. From the initial four diagnoses in 1978, the number of new cases in the United States increased to nine in 1979 and to forty-four in 1980.3 In 1986 alone, 9,877 new cases were reported by the U.S. Centers for Disease Control (CDC). The origin of the AIDS virus has several possible explanations. Most researchers believe that the retrovirus responsible for AIDS originated in * Margaret Geib, cartographer for the Department of Geography, University of Akron, prepared the graphics. Bani Bose, librarian at Akron City Hospital, Swati Sinha, and Karen Schauri are thanked for their help in the research for this article. I Colin Norman, AIDS Priority Fight Goes to Court, Science 231 (3 Jan. 1986): 11-13; Colin Norman, AIDS Virology: A Battle on Many Fronts, Science 230 (29 Nov. 1985): 518-521. 2 Jean L. Marx, Probing the AIDS Virus and Its Relatives, Science 230 (19 June 1987): 1523. 3A. M. Hardy, James R. Allen, W. Meade Morgan, and James W. Curran, The Incidence Rate of Acquired Immune Deficiency Syndrome in Selected Populations, Journal of American Medical Association 253, No. 2 (1985): 215-220. * DR. DUTT and DR. MONROE are members of the geography faculty at the University of Akron, Akron, Ohio 44325, where MRS. PRINCE is a graduate student in urban studies. DR. DUTTA is an associate professor of biological sciences at Kent State University, Kent, Ohio 44242. This content downloaded from 157.55.39.135 on Sun, 03 Jul 2016 04:14:23 UTC All use subject to http://about.jstor.org/terms AIDS IN THE UNITED STATES 457 Africa.4 The disease has been recognized in central Africa at least since 1972, six years before its identification in the United States. The large number of cases recognized in central Africa earlier than in other regions of the world suggests an African origin and the spread of the AIDS virus from there. This explanation of the origin of AIDS emanates from the isolation of a retrovirus, similar to the AIDS virus, from West African wild green monkeys. The virus may recently have crossed the species barrier and infected humans, although the green monkeys with the virus remained devoid of AIDS. Thus the monkey virus may be mutated in humans and may have acquired some destructive properties.5 Two other explanations have been postulated.6 The AIDS virus may have been present in a small number of humans for a long time, but only recently did the number become large enough for the disease to be identified. The recent increase in cases may result from various factors such as changing migration patterns and rises in intravenous drug abuse and homosexuality. Another possibility is that the AIDS virus is a variant of a retrovirus that has always infected humans. The data for this study come from AIDS-case reports received by the U.S. Centers for Disease Control as of January 1987. These data are reported voluntarily by state and local health departments and are compiled on a Public Information Data Tape by the CDC. Information for each victim includes age at and date of first diagnosis; race; large SMA region (Northeast, Central, West, South, Mid-Atlantic) or small SMA; country of birth and, if patient is deceased, of death; and gender (male, subdivided into homosexual, bisexual, or heterosexual, and female). Information is also available for relevant patient groups: homosexual/bisexual male, intravenous drug user, a combination of these two, hemophiliac, heterosexual contact with an AIDS victim, or transfusion recipient. Through January 1987, the total sample included 29,137 AIDS patients. These data were cross-tabulated to examine relationships among the characteristics of each AIDS victim. The annual incidence rates of AIDS victims per 100,000 persons for the years 1981 to 1985, 1986, and 1987 appear on figures 1 and 2. Because statewide data were not available for individual years from 1981 to 1985, the five-year total for each state was divided by five to obtain an average for the period. Although the disease was primarily concentrated in large cities, only statelevel data were available nationwide. Hence choropleth maps were based on states. Incidence in the District of Columbia was also included on these figures. The initial appearance of AIDS in the United States had three foci-the metropolitan areas of New York City, San Francisco, and Los Angeles. Prior to 1983, 67 percent of the AIDS victims in the country were confined to these 4 Colin Norman, Africa and Origins of AIDS, Science 230 (6 Dec. 1985): 1141. 5 Ronald C. Desrosiers, Origins of the Human AIDS Virus, Nature 319 (27 Feb. 1986): 728. 6 Desrosiers, footnote 5 above. This content downloaded from 157.55.39.135 on Sun, 03 Jul 2016 04:14:23 UTC All use subject to http://about.jstor.org/terms 458 THE GEOGRAPHICAL REVIEW