High HIV Seroprevalence Research Articles

Prevalence of HCV and HIV antibodies and related risk factors among entrants to the main southeastern French prison

Objective To estimate the prevalence of HCV and HIV serologic markers and related factors among entrants to the main southeastern French prison. Methods During the mandatory consultation at the STD clinic of the Marseilles Prison (HIV counseling, and syphilis/HIV screening), physicians also offered HCV serologic testing to each entrant. Inmates were interviewed face to face by a physician with a standardized questionnaire. Results In total, 391 of 411 new inmates (89%) participated in the survey; 79% were male, 75% were aged 18–35 years, and 23% were injecting drug users (IDUs). Twenty per cent of the IDUs admitted that they had shared their injection equipment during the last 12 months. Of the 391 new inmates, 104 (27%) were HCV positive (91% among IDUs) but only 45 of 104 (43%) knew their seropositivity status; 23 of 389 (6%) were HIV positive (21% among IDUs). Conclusions This survey underlines the high HCV and HIV seroprevalence among entrants to French prisons, especially injecting drug users, and the high proportion of inmates at risk for these infections as well. There is an urgent need for education and screening programs in prison and also in the at-risk free-living populations.

HIV seroprevalence and rapid testing in unbooked pregnant African women

A study was conducted to determine the seroprevalence of HIV-I/II infection by rapid testing and its association with syphilis serology in unbooked women in a region of high HIV seroprevalence. 146 women who had not attended the antenatal clinic at King Edward Hospital Durban between April and June 1998 were tested for HIV by a rapid test. Of the 146 women 66 were confirmed HIV positive by ELISA--about 64 of those tested positive by the rapid test; about 39 were positive for syphilis with 19 testing positive for HIV. Between the HIV-infected and uninfected women there were no significant differences with regard to their demographic characteristics. Findings indicate that the high HIV seroprevalence among women with positive syphilis serology shows a strong association between the two sexually transmitted diseases. Syphilis would be a useful marker for HIV testing especially in women without antenatal care.

Understanding AIDS risk behavior among sexually active urban adolescents: an empirical test of the information-motivation-behavioral skills model.

The current research applied the information-motivation-behavioral skills (IMB) model to examine psychological determinants of AIDS risk behavior in a sample of sexually active, primarily minority, urban adolescents (N = 148) drawn from an area of high adolescent HIV seroprevalence. Structural equation modeling demonstrated that the IMB model fit the data and that the constructs of the model accounted for 46–75% of the variance in AIDS risk behavior among sexually active urban male and female adolescents. Structural equation modeling also examined the fit of a restricted special case of the IMB model, focusing on motivation and behavioral skills as determinants of AIDS risk behavior, and showed that this model fit the data as well. Discussion focuses on the generality of the IMB model of AIDS risk behavior across diverse populations at risk, on the comparative value of the full IMB model and the restricted special case of this model, and on the implications of these findings for interventions to reduce AIDS risk behavior among sexually active urban adolescents.

HIV seropositivity rates in outreach-based counseling and testing services: program evaluation.

A common assumption is that outreach-based HIV counseling and testing services reach a clientele with a higher HIV seroprevalence than clinic-based counseling and testing. To examine this assumption, we analyzed Wisconsin's anonymous counseling and testing client records for 62,299 contacts (testing episodes) from 1992 to 1995. Bivariate analysis of counseling and testing service setting (outreach-based or clinic-based) and HIV test results suggested that outreach contacts were 23% (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.0-1.5) more likely to test HIV-seropositive than clinic-based contacts. Relations between HIV test outcome and variables for client age, race, gender, previous testing history, mode of risk exposure, and region, as well as service setting, were examined by logistic regression. An inverted relation between service setting and seropositivity (OR, 0.65; 95% CI, 0.5-0.8) indicated that, within some subpopulations, outreach contacts were significantly less likely to test HIV-positive than clinic-based contacts. Analysis of interactions among the covariates identified race as a critical codeterminant in the relation between service setting and test outcome. These results support retargeting outreach services to enhance their overall effectiveness. Specific recommendations include the need for aggressive strategies to better "market" HIV counseling and testing to nonwhite populations, and to focus resources more selectively on gay/bisexual men of all races.

Local understandings of adult diarrhoeal disease and its treatment in an area of high HIV-seroprevalence in Zambia.

We set out to investigate the extent to which cultural constructs might determine treatment-seeking for diarrhoea in the poorer populations of Lusaka, Zambia. This paper describes these concepts and perceptions and outlines a classification of such illnesses, together with an analysis of its implications for understanding treatment choice. Data were derived from focus group discussions, a household survey, a survey of practitioners of traditional medicine and interviews with local residents attending an urban health centre with persistent diarrhoea. The classification is based on symptoms and perceptions of aetiology. While resulting categories convey imperatives for treatment choice, it is clear that individuals with diarrhoeal illnesses seek treatment from multiple sources. This may be because any single illness may fit more than once category, or because unrelenting ill-health engenders desperate behaviour. The cultural constructs do not fully explain treatment choice and attitudes to prevention, but could be used to improve communication regarding public health and treatment strategies.

Development and testing of an HIV-risk screening instrument for use in health care settings

Objective: To develop and test a brief, reliable, and valid HIV-risk screening instrument for use in primary health care settings. Design: A two-phase study: (1) developing a self-administered HIV-risk screening instrument, and (2) testing it with a primary care population, including testing the effect of confidentiality on disclosure of HIV-risk behaviors. Setting: Phase 1: 3 types of sites (a blood donor center, a methadone clinic, and 2 STD clinics) representing low and high HIV-seroprevalence rates. Phase 2: 4 primary care sites. Participants: Phase 1: 293 consecutively recruited participants. Phase 2: 459 randomly recruited primary care patients. Main Outcome Measure: Phase 1: comparison of the responses of participants from low and high HIV-seroprevalence sites. Phase 2: primary care patients’ rates of disclosure of HIV-risk behaviors and ratings of acceptability. Results: Phase 1: through examining item-confirmation rates, item-total correlations, and comparison of responses from low and high HIV-seroprevalence sites, we developed a final 10-item HIV-risk Screening Instrument (HSI) with an internal consistency coefficient of .73. Phase 2: 76% of primary care patients disclosed at least 1 risky behavior and 52% disclosed 2 or more risky behaviors. Patients were willing to disclose HIV-risk behaviors even knowing that their physician would see this information. Ninety-five percent of our patient participants were comfortable with the questions on the HSI, 78% felt it was important that their doctor know their answers, and 52% wished to discuss their answers with their physician. Conclusion: Our brief, self-administered HSI is a reliable and valid measure. The HSI can be used in health care settings to identify individuals at risk for HIV and to initiate HIV testing, early care, and risk-reduction counseling, necessary goals for effective HIV prevention efforts.

A multicentre study on the causes of death among Italian injecting drug users. AIDS has overtaken overdose as the principal cause of death

The causes of death among injecting drug users (IDUs) are still being discussed worldwide. We analysed the causes of death among IDUs attending 26 centres for drug users in North-Eastern Italy from 1985 to 1994. The study of a total number of 1,022 deaths reveals the following: (1) AIDS has become the primary cause of death among IDUs since 1991 and is rising even in an area with a moderate HIV seroprevalence; (2) the mean age of death in AIDS patients proved higher than among patients who died of other causes (which may be due to the long incubation period of AIDS); (3) our data do not reveal higher HIV seroprevalence among IDUs who died of overdose and suicide as opposed to IDUs who died of other causes; (4) the mortality rate in IDUs is significantly higher when compared to that of the general population in the same age group.

Interactions between HIV and hepatitis B virus in homosexual men: effects on the natural history of infection.

Hepatitis B virus (HBV) and HIV infections share risk-factors; therefore coinfection is common. Interactions have been reported but controlled studies have been limited. Our objective was to study the effect of HIV infection on the natural history of chronic HBV infection and the reverse effect of the HBV carrier state on HIV infection. Prospective observational cohort study. Open-access outpatient HIV/genitourinary medicine clinic at a Central London hospital. Total of 152 untreated homosexual male HBV carriers and 212 HBV surface antigen-negative controls (41.4 and 70.3% HIV-seropositive, respectively). The rate of loss of serum HBV e antigen (HBeAg) and its reappearance in HIV-infected and HIV-uninfected HBV carriers; serum HBV DNA levels measured by dot-blot hybridization assay), HBV DNA polymerase activity and liver transaminase activities, the progression of HIV infection to symptomatic disease or AIDS in HIV-infected compared with HBV-HIV coinfected patients. In HIV-infected HBV carriers, serum HBV DNA polymerase activity was higher, alanine aminotransferase was lower and loss of serum HBeAg (mean follow-up, 2.8 years) occurred at a lower rate when compared with HIV-uninfected HBV carriers (estimated relative hazard, 0.39; 95% confidence interval, 0.161-0.942) Concomitant chronic HBV infection had no detectable effect on the rate of progression of HIV disease after correction for lead-time bias. This study strengthens the evidence for a significant effect of HIV infection on the natural history of chronic HBV infection, which by prolonging the period of infectivity could have an important impact on the epidemiology of HBV infection in regions, or patient groups, with high HIV seroprevalence. There was no evidence of an important effect of HBV carriage on HIV disease progression.

High HIV Seroprevalence Epidemics among Injecting Drug Users; New York City and Bangkok

New York City, U.S.A., and Bangkok, Thailand, experienced two of the most important HIV epidemics among injecting drug users (IDUs) in the world. The epidemic in New York was the first, and by far the largest, HIV epidemic among IDUs. The Bangkok epidemic was notable both for the rapidity of HIV transmission among IDUs and for demonstrating that HIV transmission could occur among IDUs in developing countries. Rapid HIV transmission among IDUs in both cities was followed by large-scale behavior change and stabilization of HIV seroprevalence at high levels. The stabilization of seroprevalence includes unacceptably high rates of continued HIV seroconversions—estimated to be 4 per 100 person-years at risk or greater in both cities. Recent additional HIV prevention efforts in both cities—long-term methadone maintenance treatment in Bangkok and legal access to sterile injection equipment in New York—indicate possibilities for father reducing HIV transmission among IDUs in the two cities.

Injection drug use and risk of HIV transmission among homeless men with mental illness

The high seroprevalence of HIV that has been reported among homeless individuals with mental illness indicates an urgent need to examine HIV risk behavior in this population. Injection drug use and sexual behavior were assessed in comprehensive interviews with 218 homeless mentally ill men in a New York City shelter. First, the proportion of men who had injected drugs was established. Then, among those who had injected drugs, the injection drug use behaviors associated with HIV transmission (i.e., whether they had ever engaged in high-risk behaviors and had ever engaged in risk-reduction behaviors) and their current sexual risk behaviors were examined. Fifty (23%) of the 218 men had injected drugs. Among these 50, the great majority had engaged in high-risk behaviors, including sharing needles (66%) and using shooting galleries (64%). Few had engaged in risk-reduction behaviors, such as cleaning needles with bleach (22%) and using a needle exchange program (2%). In the past 6 months alone, the majority of the injection drug users had had unprotected sex with women (48%) or with men (10%). This study documents a high lifetime prevalence of injection drug use in a group of homeless men with mental illness. The men who had injected drugs reported injection drug use and sexual behaviors with high risk of HIV transmission and gave scant evidence of risk-reduction behaviors. These individuals may fall between service systems and may be difficult to reach but, nonetheless, must be included in efforts to prevent transmission of HIV infection.

High HIV seroprevalence among patients with pyomyositis in Northern Uganda

With the aim of correlating pyomyositis with HIV infection, we have carried out a case-control comparison of HIV seroprevalence among patients affected by pyomyositis and an age and sex-matched control group of healthy subjects. Over a one-year period, 35 patients with pyomyositis, 20 male and 15 female, mean age 28.31 years, were admitted to Dr Ambrosoli Memorial Hospital of Kalongo (Kitgum District, Northern Uganda). Among these patients, II were HIV-antibody-positive, with a seroprevalence of 31.42%. In the age and sex-matched control group of 35 healthy subjects, selected in the same period from volunteers admitted to the surgical ward for orthopaedic trauma, two were HIV-antibody-positive, with a seroprevalence of 5.71%. The matched analysis produced a Mantel-Haenszel matched odds ratio of 5.50 and a maximum likelihood estimate of OR (MLE) of 5.50 (exact 95% confidence limits for MLE = 1.20 < OR < 51.07). Among the II HIV-seropositive patients, 9 (81.8%) fulfilled the World Health Organization (WHO) clinical case definition (CCD) for AIDS, compared with I of twenty-four (4.1%) HIV-negatives. The chi-square test for difference in fulfilling the CCD for AIDS between patients with pyomyositis seropositive and seronegative gave a statistically significant result (P < 0.0001). The authors conclude that pyomyositis is a bacterial infection very significantly associated with HIV infection, to be considered a strong sign of stage III-IV of HIV disease.

Emigration Dynamics in Sub‐Saharan Africa1

The introduction to this description of emigration dynamics in sub-Saharan Africa notes that the region is characterized by intensive migration caused by such factors as population growth, negative economic growth, ethnic conflict, and human rights abuses. The second section of the report discusses the fragmentary and incomplete nature of data on international migration in the region, especially data on conventional migration. Section 3 looks at demographic factors such as high population growth, illiteracy levels, HIV seroprevalence, and urbanization which lead to high unemployment and emigration. The fourth section considers the effects of the rapid expansion of education which is outstripping the absorptive capacity of the economies of many countries. Unemployment is a serious problem which is projected to become worse as increases in employment opportunities continue to lag behind increases in output. Sections five, six, and seven of the report describe relevant economic factors such as per capita income, income distribution, the economic resource base, and economic development; poverty; and the effects of economic adjustment programs, especially on employment opportunities and wages in the public and private sectors. The next section is devoted to sociocultural factors influencing migration both on the micro- and the macro-levels, including the influence of ethnicity and ethnic conflicts as well as the domination of leadership positions by members of minority groups. The political factors discussed in section 9 include women's status, repressive regimes, political instability which leads to underdevelopment, and the policies of the Organization of African Unity which broadened the definition of refugees and set inviolable borders of member states identical to those inherited upon independence. Section 10 outlines ecological factors contributing to migration, including the decline in acreage of arable land, soil deterioration, poor land management, and the effects of draught. The interaction of all of these factors has contributed to refugee flows of acute magnitude and complexity. The next major section of the report describes the migration situation in each subregion (Western Africa, Nigeria and Ghana, the Sahel, Mail, Eastern Africa, Southern Africa, and Lesotho). The report concludes that migration in response to socioeconomic conditions will continue until conditions improve in the countries of origin.

Knowledge, attitudes and behaviour among HIV-positive and HIV-negative clients of a confidential HIV counselling and testing centre in Thailand.

To describe the clients, operation and impact of an Asian public HIV counselling and testing centre. Analysis of samples from clients attending the Thai Red Cross Anonymous Clinic (TRC-AC) in Bangkok, Thailand in 1993. HIV-positive and HIV-negative consecutive clients (250 of each). HIV seroprevalence rates, knowledge, attitudes and behaviour. Overall HIV-1 prevalence was 16%; 13% in men and 24% in women. Reasons for requesting an HIV test were high-risk behaviour (21%), feeling unwell (20%), checking a previous HIV test result (18%), a planned marriage or new relationship (10%), and planning a baby (5%). Heterosexual risk behaviour was reported by 85% of clients, while in each case only 1% reported male homosexual or intravenous drug use risk behaviour. Factors associated with HIV infection on univariate analysis included a history of sexually transmitted disease, not using condoms, a low level of education and salary, and being female. Knowledge about HIV transmission risks and AIDS prevention measures was good, and most clients expressed a caring attitude towards people with HIV and AIDS. A former negative HIV test result was associated with higher levels of condom use, and most clients expressed the intention to reduce their HIV risk behaviour in response to a positive or negative HIV test result (more so if positive). Our study demonstrates the demand for and the feasibility of confidential HIV counseling and testing services in Thailand and illustrates the value of these services in achieving behaviour changes. Such services should be considered as an additional approach for reducing HIV transmission in Asia, especially in areas with high HIV seroprevalence rates.

High HIV seroprevalence and increased HIV-associated mortality among hospitalized patients with deep bacterial infections in Dar es Salaam, Tanzania

To correlate deep bacterial infections with HIV infection and evaluate the influence of HIV on clinical picture and outcome in patients with meningitis, pneumonia or pyomyositis. Case-control comparison of HIV seroprevalence between patients and an age- and sex-matched control group in a prospective cross-sectional study of hospitalized patients. One hundred and sixty-five patients admitted to hospital with either purulent meningitis, pneumonia or pyomyositis and 165 age- and sex-matched controls from orthopaedic/trauma wards. University Hospital, Dar es Salaam, Tanzania. Differences in HIV seroprevalence and mortality. Of 78 patients with purulent meningitis, 19 (24%) were HIV-seropositive, compared with 13 (17%) in the control group (P = 0.345). Of 36 patients with meningitis seen before a meningococcal epidemic affected Dar es Salaam, there was a statistically significant association with HIV infection (P = 0.013). Ten out of 19 (53%) HIV-seropositives died, compared with nine out of 59 (15%) seronegatives (P = 0.028). Of patients with pneumococcal meningitis, five out of six (83%) seropositives died, compared with two out of 12 (17%) seronegatives (P = 0.013). Fifteen out of 45 (33%) patients with pneumonia were HIV-seropositive, compared with four (9%) in the control group (P = 0.001). There was no difference in mortality between seropositive and seronegative patients with pneumonia. HIV seroprevalence was 62% among 42 patients with pyomyositis and 12% among 42 controls (P less than 0.0001). Eighteen out of 25 (72%) seropositive patients with pyomyositis fulfilled the World Health Organization (WHO) clinical case definition for AIDS. Response to recommended antibiotic treatment was satisfactory among patients with pneumonia and pyomyositis. These results show a strong association between pyomyositis, pneumonia and HIV infection. They also indicate an increased mortality associated with HIV infection in patients with pyogenic meningitis, especially pneumococcal meningitis. Pyomyositis should be considered an indicator of stage III HIV disease in the proposed WHO clinical staging system.

HIV prevalence, attitudes and behaviour in clients of a confidential HIV testing and counselling centre in Uganda.

To describe clients, operation and impact of an African public HIV testing and counselling centre. Analysis of samples from clients attending the AIDS Information Centre (AIC) in Kampala, Uganda in early 1991. HIV-1-positive and HIV-negative consecutive clients (250 of each), 86 consecutive couples, and 200 consecutive clients who were HIV-negative in 1990 and were attending for their repeat test. HIV seroprevalence rates, attitudes, behaviour and behaviour change. HIV-1 prevalence was 28% overall, 24% in men and 35% in women. Reasons for taking the HIV test were a planned marriage or a new relationship (27%; 84% in couples), to plan for the future (35%), distrust of sexual partner (14%) and illness or disease/death (not HIV-specific) of partner (20%). The majority of the reported intentions in response to a positive or a negative HIV test result were positive, demonstrating the ability to cope with this information. Of repeat clients, two (1%) had become HIV-1-positive. The majority of repeat clients reported one sexual partner only (67%) or sexual abstinence (25%). Compared with pre-test information from AIC clients attending for the first time, repeat clients reported casual sexual contacts less often (6 versus 25%) and, of those, the majority used condoms. Our study demonstrates the demand for and the feasibility of confidential HIV testing and counseling services in Uganda, and illustrates the value of these services in achieving behaviour changes. Such services should be considered an additional approach for the reduction of HIV transmission in Africa, especially in areas with high HIV seroprevalence rates.

HIV seroprevalence surveys: impetus for preventive activities.

Seroprevalence determinations of human immunodeficiency virus are essential for design and implementation of preventive strategies. By demonstrating the severity of HIV infections within communities, New York State surveys have spurred preventive interventions, including information to the public and health care providers and increased counseling and testing of women of reproductive age. In high-prevalence areas the community health workers have been employed in preventive activities. Specific information has been provided to county health departments on zip code areas with high HIV seroprevalence rates. Serosurveys revealed that the magnitude of HIV infection in adolescents is much larger than indicated by case reports. Various seroprevalence studies confirmed higher rates of infection with increasing age and minority status and a strong association with intravenous drug use. Combining data provided by seroprevalence studies in a given community enables planners to assess the extent of infection in that community and in groups important to transmission of the virus.

Change in HIV‐antibody seroprevalence rates in i.v. drug dependent prisoners

In 1985 a high HIV-seroprevalence (44.2%) was found in a cohort of parenteral drug addicted prisoners in Innsbruck, Austria. In a longitudinal study from March 1985 to March 1989 we investigated the epidemiology of HIV-infection as well as possible changes in the drug taking behaviour of this defined population at risk. During the study HIV-seroprevalence rates in drug dependent prisoners showed a statistical decrease to 30%. A concomitant increase in admission to any kind of therapy programmes as well as an increasing change from 'heavy use' (mainly taking heroin i.v.) to 'non-heavy use' (mainly taking drugs orally) could be noted. The influence of preventive measures, such as comprehensive AIDS-information, special therapy programmes including the methadone substitution programme, and the unrestricted availability of needles and syringes is discussed.

Human immunodeficiency virus seroprevalence in female intravenous drug users: The puzzle of black women's risk

This study of 155 female i.v. drug users found that black women had higher HIV seroprevalence than white women (21% compared to 7%, respectively, odds ratio = 3.59, 95% CI 1.28-9.98). To attempt to explain why black female i.v. drug users were more likely to test HIV antibody positive, the ethnic distribution of a series of risk factors associated with HIV seropositivity, such as needle sharing, high risk sexual behavior and history of sexually transmitted disease, was examined. Either there was no significant difference between the two groups or white i.v. drug users were more likely than blacks to engage in specific risk behaviors. Although this study failed to identify risk factors associated with higher HIV seropositivity in black female i.v. drug users, it did uncover important trends in the data. These trends are analyzed in terms of observed or possible social and cultural differences between black and white women. It is suggested that these underlying social and cultural differences may hold the key to black female i.v. drug users' greater risk of HIV infection.

AIDS prevention

Prospects for vaccines to prevent HIV infection and disease have dimmed appreciably in the past year, and drugs for chemoprophylaxis and/or chemical cure are both unlikely and grossly unrealistic as a means of global HIV control. However, the paucity of transmission routes and their susceptibility to strategies of blood screening and of education for behavior modification point in a clear direction for concerted effort. Where they have been applied, blood screening programs have resulted in a dramatic reduction in transfusion-associated infections, and efforts at enhancing donor- and unit-deferral strategies offer promise of further decrease in risk. There is much encouragement in recent reports of education for prevention. While there has been some unevenness in the extent to which successful risk reeducation has occurred, it is nonetheless dramatic compared with prior health educational efforts, and especially so given the exceptional sensitivity of the sexual and illicit drug using behaviors at issue. Finally, clearly articulated public education and particularly correction of misinformation, can contribute significantly to overall prevention efforts by easing fear and enhancing the climate in which persons at behavioral risk of HIV infection can receive and respond to targeted messages.

AIDS in Africa: a public health priority

AIDS and HIV infection are now endemic in many parts of Africa. The infection is mainly transmitted by heterosexual activity, as illustrated by a 1:1 female to male case ratio and high HIV seroprevalence rates in people at risk for sexually transmitted diseases and female prostitutes. Transmission by blood transfusions, contaminated injections and from mother to child is occurring more frequently than in Europe. AIDS will probably have a profound impact on health care programmes and economic development in the continent, and its control should be a public health priority.