Acquired Immunodeficiency Syndrome Policy Research Articles

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023.

In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15-17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine-tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.

Nurses' engagement in AIDS policy development

A multidisciplinary team of 20 researchers and research users from six countries - Canada, Jamaica, Barbados, Kenya, Uganda and South Africa - are collaborating on a 5-year (2007-12) program of research and capacity building project. This program of research situates nurses as leaders in building capacity and promotes collaborative action with other health professionals and decision-makers to improve health systems for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) nursing care. One of the projects within this program of research focused on the influence of workplace policies on nursing care for individuals and families living with HIV. Nurses are at the forefront of HIV prevention and AIDS care in these countries but have limited involvement in related policy decisions and development. In this paper, we present findings related to the barriers and facilitators for nurses' engagement in policymaking. A participatory action research design guided the program of research. Purposive sampling was used to recruit 51 nurses (unit managers, clinic and healthcare managers, and senior nurse officers) for interviews. Participants expressed the urgent need to develop policies related to AIDS care. The need to raise awareness and to 'protect' not only the workers but also the patients were critical reason to develop policies. Nurses in all of the participating countries commented on their lack of involvement in policy development. Lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy development. Resources were often not available to implement the policy requirement. Strong support from the management team is necessary to facilitate nurses involvement in policy development. The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses' involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level.

HUMAN IMMUNODEFICIENCY VIRUS AND OBSTETRIC ANESTHESIA

Acquired immunodeficiency syndrome (AIDS) is a worldwide epidemic with an estimated 23 million persons infected with the human immunodeficiency virus (HIV).24 The Global AIDS Policy Coalition predicts that, if current trends continue, between 60 to 70 million adults will be infected with HIV by the end of the year 2000. Of the current HIV-infected persons, approximately 42% are women and an estimated 1 million are children less than 15 years old, with 90% of the infected children in the developing world.9 One in every three children orphaned by HIV disease is under age five. Since the beginning of the global epidemic, over 9 million children under age 15 have lost their mother to HIV. In the United States, it is estimated that 1.5 million Americans are infected with HIV and that through June 1997, 612,078 persons were diagnosed as having AIDS with a case-fatality rate of approximately 62%.11 Thus, at least 380,000 persons have died from AIDS with the death toll total still rising, despite some recent encouraging drug intervention (Fig. 1). Sadly, approximately 21% of the new cases in the United States are women who are mostly in the reproductive age group (25–44 years old). Thus, while the geographic differences are dramatic (Fig. 2), the labor and delivery suites of most hospitals in the United States will see HIV-infected women and, in some large urban centers, it will be a common occurrence.37 The anesthesiologist is now faced with a disease that “didn't exist” until 1981. At that time, an obscure report noted four homosexual men with Pneumocystis carinii. It seemed to be only a medical curiosity at the time.30 By the early part of 1995, AIDS death rates had surpassed all causes of death among persons aged 25 to 44 years in the United States (Fig. 3).63 The death rate from AIDS has recently declined yet on occasion we are involved in caring for HIV-positive patients in the operating suite. To care properly for this group of patients, the clinician needs to understand the disease itself, unique concerns in pregnancy, therapeutic intervention, opportunistic and associated infections, and infection control techniques. With this information at hand, anesthetic intervention and pain control can be planned appropriately. The management of the HIV-positive patient is now, essentially, a medical specialty. Consultation with the patient's primary care physician is particularly important. Pharmacologic intervention is an ever-changing aspect of the care of these patients with implications for the anesthesiologist. Opportunistic infections can put the patient at significant risk. The clear overlap with tuberculosis and hepatitis C epidemics must be taken into consideration. This chapter will focus on these and related concerns since the operating room and obstetric suite are now a common interface with the HIV-positive patient. While this discussion will focus on the parturient and her child, much of this information is equally pertinent to the general operating theater as well as labor and delivery.

Attitudes, concerns, and fear of acquired immunodeficiency syndrome among registered nurses in the United States.

The article reports a study describing nurses' attitudes, concerns, and fear of acquired immunodeficiency syndrome (AIDS). A convenience sample consisting of 376 nurses in a mid-Atlantic state was drawn. An 84-item questionnaire was used to collect the data. Seven factors were derived from the subjects' responses using the Fear of AIDS Scale II: opinion and AIDS policy, blood and physical closeness to patients with AIDS, punishing the homosexual, ethics of care. "Who would care for me?" financial burden, and self-worth. Fear of AIDS Scale II scores ranked the highest whenever "self" was involved with AIDS issues or blood and physical closeness to a person with AIDS. There was a parallel increasing relationship between concern about contracting AIDS from patients and the fear of AIDS. A number of other significant correlations emerged from the study.

The HIV/AIDS grants economy in New York City, 1983-1992.

The HIV/AIDS grants economy in New York City, 1983-1992.

AIDS Policy

THE NATIONAL Commission on AIDS (the acquired immunodeficiency syndrome) was created by federal statute in 1989. Its major legislative mandate was to provide ongoing oversight of the nation's involvement in the human immunodeficiency virus (HIV) epidemic and to report on the response to the President, the Congress, and the American people. The Commission recently released its final report,¹and we have issued public statements when particular AIDS policy issues have taken on national importance. The time to speak out has come again. Recently, two issues have arisen that once more threaten to divide us as we move into the 13th year of the HIV epidemic. They are deceptively simple: Should HIV prevention programs be narrowly targeted toward certain "at risk" groups, or should prevention programs focus more broadly on the universality of risk among all people? Since drug use is now linked to more than one third of all

AIDS policy. Two divisive issues

THE NATIONAL Commission on AIDS (the acquired immunodeficiency syndrome) was created by federal statute in 1989. Its major legislative mandate was to provide ongoing oversight of the nation's involvement in the human immunodeficiency virus (HIV) epidemic and to report on the response to the President, the Congress, and the American people. The Commission recently released its final report,¹and we have issued public statements when particular AIDS policy issues have taken on national importance. The time to speak out has come again. Recently, two issues have arisen that once more threaten to divide us as we move into the 13th year of the HIV epidemic. They are deceptively simple: Should HIV prevention programs be narrowly targeted toward certain "at risk" groups, or should prevention programs focus more broadly on the universality of risk among all people? Since drug use is now linked to more than one third of all

AIDS: The Making of a Chronic Disease

The sudden appearance of the acquired immunodeficiency syndrome (AIDS) in the early 1980s, its rapid spread, and its devastating consequences gave experts many reasons to make historical analogies to the plagues of the distant past. The infectious disease model was the basis for much of the AIDS policy made during the 1980s, with the emphasis on disease surveillance and containment. It was against this backdrop that Elizabeth Fee and Daniel M. Fox published their first compilation of essays, AIDS: The Burdens of History , in 1988. As AIDS moves into its second decade, however, its predominant features, from both a health policy and clinical perspective, no longer resemble those of an infectious disease, but rather those of a chronic disease. Owing mainly to advances in medical therapies, the most pressing issues to be dealt with now are medical management and health care availability. This shift in historical perception from AIDS as

AIDS in the Netherlands: The Effects of Several Years of Campaigning

One of the primary aims of acquired immunodeficiency syndrome (AIDS) prevention campaigns in the Netherlands has been to inform the public of the facts about AIDS, thereby stimulating informed, but voluntary action to prevent transmission of the human immunodeficiency virus (HIV). By conducting successive population surveys from April 1987 until October 1989, the effects of this approach were assessed. Twice a year, approximately 1000 respondents, a random sample from the general population, were interviewed about AIDS and safe sex. Additionally, condom sales figures and STD incidences were evaluated. It appears that knowledge about the prevention of HIV transmission with condoms has reached 98% of the sample. During the study, there was an increase in the number of people who expressed an intention to use condoms or who already used them. Behaviour, however, appeared to fall short of intention. The observations were confirmed by condom sales figures and STD incidences. We conclude that the AIDS policy in the Netherlands has had beneficial effects, reflected by several indices.

AIDS Policy Into the 1990s

A grim metaphor heard at the First International AIDS Conference in Atlanta in 1985 was that the acquired immunodeficiency syndrome (AIDS) was "a nightmare from which one can never awaken." It was actually two nightmares, in parallel: the syndromes of human immunodeficiency virus (HIV) disease and their attendant suffering and mortality, and a second epidemic of fear and discrimination. The power of those fears to disrupt lives was most vividly demonstrated by the experience of a family with three hemophiliac children. When the parents voluntarily disclosed the HIV antibody status of their sons, they were barred from the local public school and their church, socially ostracized, and finally driven from town when their home was burned (<i>New York Times</i>. August 31, 1987:1). Similar instances of violence and hatred perpetuated by irrational fears have been experienced by homosexual men, drug users, and others affected or perceived to be at risk. For

Methadone Treatment and Acquired Immunodeficiency Syndrome

To the Editor.— The use of the term innocent victims to refer to some of those who have contracted human immunodeficiency virus 1 is inappropriate to a major medical journal and should not be tolerated. Since early in the epidemic, those infected have commonly been divided into innocent victims and—who are the others? Guilty victims? I have worked in acquired immunodeficiency syndrome policy, prevention, and education at the epicenter for several years and have yet to meet anyone who either deserved or wanted to contract human immunodeficiency virus. Health professionals must reject this discriminatory terminology once and for all, for it is neither descriptive nor scientific and reveals only the author's prejudice.

AIDS research and policy decisions

The pressures on policy makers to do something about AIDS (Acquired Immunodeficiency Syndrome) is powerful. The problem is that the scientific information available may not be sufficient or of sufficiently good quality to justify any particular action, and the risk of doing something that might in the long run be harmful is not trivial. Scientists need to develop criteria for assessing the quality and sufficiency of the information available and that they might provide.

Two Hundred Years Of Public Health In The United States

Two Hundred Years Of Public Health In The United States

Aids: The Urban Policymaking Challenge

: The development and spread of Acquired Immunodeficiency Syndrome (AIDS) in American urban areas is challenging established policy making structures and patterns in a variety of ways. AIDS is forcing urban policymakers to engage in unusual efforts at large and nonincremental change while possessing relatively little understanding of the ultimate nature and course of the disease. A variety of uncertainties exist, involving the future scope and development of AIDS, current and future treatment costs, legal and administrative responsibilities, workplace concerns, education efforts, financing methods, and political effects. As a consequence, those making AIDS policy must rely upon what Jones (1984) terms ambitious decisionmaking styles. Successful control of AIDS will require decentralized policymaking centered on experimental efforts in each urban area confronted with the disease. Given the wide range of uncertainties regarding the nature of AIDS and effective policy measures, it is unlikely that a truly national AIDS policy will be established in the immediate future.

Grants and Outcomes

Grants and Outcomes