High HIV Infection Research Articles

Decreased Invasive Pneumococcal Disease in Adults after PCV 7

Source: Flannery B, Heffernan RT, Harrison LH, et al. Changes in invasive pneumococcal disease among HIV-infected adults living in the era of childhood pneumococcal immunization. Ann Intern Med. 2006;144:1–10.This observational study employing historic controls examined rates of invasive pneumococcal disease in HIV- and non-HIV-infected adults in 7 metropolitan areas in the US before and after the introduction of conjugate pneumococcal immunization (PCV 7) in children. The surveillance was conducted through the Emerging Infections Program network of the Centers for Disease Control and Prevention for cases diagnosed between January 1, 1998 and December 31, 2003. The 7 sites included San Francisco County, Calif; the state of Connecticut; metropolitan Atlanta, Ga; metropolitan Baltimore, Md; metropolitan Minneapolis-St. Paul, Minn; metropolitan Portland, Ore; and a collection of Tennessee counties. Cases were included if pneumococcus was isolated from any normally sterile site. The investigators compared rates before and after routine PCV 7 vaccination in infants in 2000.A total of 8582 cases of invasive pneumococcal disease occurred in adults aged 18 to 64 years, and 2013 (24%) of these were among patients with HIV infection. The authors found a decrease in incidence in non-HIV-infected adults from 13 (in 1998–1999) to 9 (in 2003) cases per 100,000 (P<.001), driven by declines in the serotypes present in PCV 7. Because the authors could not determine the total number of HIV-infected individuals living in the surveillance areas, they could not provide exact incidence rates for this population. However, they did determine the ratios of invasive pneumococcal disease in HIV-infected adults to the number of adults living with AIDS in the area as a proxy measurement. By this yardstick, ratios decreased from 1127 to 919 cases of invasive pneumococcal disease per 100,000 AIDS population over the study period, a 19% reduction (P=.002). Among HIV-infected adults, there was a 62% decrease (P<.001) in the serotypes present in conjugate vaccine, but a 44% increase in all other serotypes (P<.001), including those in the polysaccharide vaccine.Dr. Robbins has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.For pediatricians to see the benefits of their preventive health efforts is heartening, and indirect benefits in other population groups is a bonus. Since the introduction of PCV 7 for infants in the US, the incidence of invasive pneumococcal disease in adults due to vaccine serotypes has decreased. What is a bit surprising is that although HIV-infected adults had an overall decline in pneumococcal disease, there was a significant increase in disease caused by non-vaccine strains of pneumococcus, and that the “serotype replacement phenomenon” was seen only among the HIV-infected adults. So, it would seem that a marked benefit of childhood PCV 7 is seen in non-HIV-infected adults, but to a lesser extent among HIV-infected adults. The serotype replacement phenomenon has important implications for developing countries with higher HIV infection rates.The authors acknowledge that their method of determining the ratio of invasive pneumococcal disease cases to the number of adults living with AIDS is only a proxy of the true incidence rates, which they could not determine. Also, they lacked information about degree of immunosuppression and use of antiretroviral therapy in these patients, factors that would be expected to have a large bearing on susceptibility to pneumococcal disease. While the introduction of infant PCV 7 would seem to be the most likely explanation for this disease decline, these data can show only an association and do not prove cause and effect.

I Can Use a Condom, I Just Don’t: The Importance of Motivation to Prevent HIV in Adolescent Seeking Psychiatric Care

Youth continue to show high HIV infection rates, and adolescents with mental health problems are especially at risk. We used longitudinal data to test a cognitive-behavioral model of risky sexual behavior among 175, ethnically diverse urban adolescents seeking mental health services. Path analyses of the cross-sectional data revealed that Motivation was a strong predictor of Behavioral Skills and Sexual Risk Taking. The model explained 42% of the variance in Sexual Risk Taking with age included-29% without age. In the longitudinal path analyses, Motivation had a significant negative effect on levels of Sexual Risk Taking 6 months later, controlling for Information, Behavioral Skills, age, and baseline levels of Sexual Risk Taking. These longitudinal effects explained 60% of the variance in Sexual Risk Taking. These results underscore the need to address motivational factors in HIV prevention programs designed for adolescents with mental health problems.

The contribution of two Brazilian multi-center studies to the assessment of HIV and HCV infection and prevention strategies among injecting drug users: the AjUDE-Brasil I and II Projects

This study assessed 1,144 Brazilian injecting drug users (IDUs) recruited on the street through outreach syringe exchange programs by two multi-center cross-sectional studies: 287 IDUs were recruited during the AjUDE-Brasil I Project and 857 during the AjUDE-Brasil II Project. IDU characteristics related to drug use and sexual behavior, and legal and health conditions for the two studies were compared, using decision tree and logistic regression for each individual study, with HIV infection as the outcome. Fifty-two percent of IDUs were HIV-infected in AjUDE I versus 36.5% in AjUDE II. In both studies, HIV infection was independently associated with: mean background HIV prevalence for each site (OR = 2.17; 10.66), HCV seropositive status (OR = 19.79; 15.48), and men who reported ever having sex with other men (OR = 2.10; 2.09). Incarceration (OR = 1.41) and 8 or more years of injecting drug (OR = 2.13) were also associated with HIV in AjUDE II. The high HIV infection rates and high prevalence of both parenteral and sexual risk behaviors in the context of syringe-exchange programs are of great concern and demand thorough surveillance and renewed prevention strategies.

Evolution of Tuberculosis Control and Prospects for Reducing Tuberculosis Incidence, Prevalence, and Deaths Globally

The United Nations Millennium Development Goals (MDGs) are stimulating more rigorous evaluations of the impact of DOTS (the WHO-recommended approach to tuberculosis control based on 5 essential elements) and other possible strategies for tuberculosis (TB) control. To evaluate the prospects for detecting 70% of new sputum smear-positive cases and successfully treating 85% of these by the end of 2005, for reducing TB incidence, and for halving TB prevalence and deaths globally between 1990 and 2015, as specified by the MDGs. TB case notifications (1980-2003) from DOTS and non-DOTS programs and cohort treatment outcomes (1994-2002) reported annually to the World Health Organization (WHO) by up to 200 countries, TB death registrations, and prevalence surveys of infection and disease. Case notification series that reflect trends in incidence, treatment outcomes from DOTS cohorts, death statistics from countries with WHO-validated vital registration systems, and national prevalence surveys of infection and disease. Case reports, treatment outcomes, prevalence surveys, and death registrations from WHO's global TB database covering 1990-2003 to estimate TB incidence, prevalence, and death rates through 2015 for 9 epidemiologically different world regions. TB incidence increased globally in 2003, but incidence, prevalence, and death rates were approximately stable or decreased in 7 of 9 regions. The exceptions were regions of Africa with low (<4% in adults 15-49 years) and high rates (> or =4%) of HIV infection. The global detection rate of new smear-positive cases by DOTS programs increased from 11% in 1995 to 45% in 2003 (with the lowest case-detection rates in Eastern Europe and the highest rates in the Western Pacific) and could reach 60% by 2005. More than 17 million patients were treated in DOTS programs between 1994 and 2003, with overall treatment success rates more than 80% since 1998. In 2003, overall reported treatment success was 82%, with much variation among regions. The highest rates were reported in the Western Pacific region (89%) and lowest rates in African countries with high and low HIV infection rates (71% and 74%, respectively), in established market economies (77%), and in Eastern Europe (75%). To halve the prevalence rate by 2015, TB control programs must reach global targets for detection (70%) and treatment success (85%) and also reduce the incidence rate by at least 2% annually. To halve the death rate, incidence must decrease more steeply, by at least 5% to 6% annually. Reduction of TB incidence, prevalence, and deaths by 2015 could be achieved in most of the world, but the challenge will be greatest in Africa and Eastern Europe.

Clinical and radiological features of pulmonary disease due to culture-positiveM. tuberculosisor nontuberculous mycobacteria in South African gold miners

Distinguishing whether pulmonary mycobacterial disease is due to Mycobacterium tuberculosis or nontuberculous mycobacteria (NTM) has important clinical and public health implications. There are limited data comparing these groups of patients, particularly from developing countries in the era of HIV infection South African mlneworkers have high ratesoftubercLsis(TB), NTM diseL and HIV infection. The study took place in a hospital serving four gold mines. All men with a positive sputum mycobacterial culture in 1995 were enrolled. Patients were interviewed, sputum and blood samples obtained and a chest radiograph taken. We compared clinical, laboratory and radiological features in those with TB with those with NTM disease(mainly Mycobacterinmnsii).Treatment outcomes are reported for those with pulmonary disease due to M. kansasii. The 425 patients with TB and 51with NTM disease showed no significant difference in HIV status. Of patients with a positive smear, 91.3% (314/344) cultured M. tuberculosis. Patients with TB weighed less (p=0.03) and had lower haemoglobin levels (p<0.001). Those with NTM were less likely to have extensive radiographic changes (OR 0.27) than those with TB. Those with NTM were morelikely to haves Mcosis(OR97).Fourteen of the 36 patients with M.kansasii pulmonary disease had a positive culture at sic months and a further 11 had a positive culture in the follow-up period. Patients with TB had features of more aggressive disease. The current practice of treating smear-positive patients as TB seems reasonable. Treatment failure and relapse were common in thosewith disease due to M. Kansasii.

Once Upon a Virus: AIDS Legends and Vernacular Risk Perception (review)

Reviewed by: Once Upon a Virus: AIDS Legends and Vernacular Risk Perception Jennifer Orme Once Upon a Virus: AIDS Legends and Vernacular Risk Perception. By Diane E. Goldstein . Logan: Utah State UP, 2004. 210 pp. In Once Upon a Virus, Diane Goldstein, professor of Folkloristics at Memorial University in St. John's Newfoundland, examines the intersections between HIV and AIDS narratives, medical and public health discourse, and actual behaviors related to HIV risk perception. Goldstein aims to show the ways in which these popular narratives work with and against official narratives about HIV, AIDS, and the risks of infection, as well as the roles that contemporary legends play in the success or failure of public health messages about risk behaviors and practices. The four narrative case studies in the middle chapters make up the heart of the text and deserve close attention. Each chapter takes a contemporary legend or group of legends as they appeared in Newfoundland at specific times and discusses them at length. Taken together, they reveal the interrelationships [End Page 327] among narrative, public discourse, social practice, and private behavior. These studies underscore the need to look at contemporary legends within their localized contexts and the ways in which narratives are taken up and modified by the people of a community so that they maintain relevance to that community. Goldstein's analysis in these chapters demonstrates the influence that legends have on the behavior of a specific population at a particular moment in history. The first two chapters, "Tag, You've Got AIDS" and "Bad People and Body Fluids," locate AIDS legends within the much older tradition of folk narratives about disease, infection, susceptibility, and blame. Goldstein provides substantial contextualization for Newfoundland as the site of the ethnographic data used throughout the text. She also lays the groundwork for the case studies in later chapters by establishing the history of AIDS in Newfoundland and introduces Conception Bay North as an area stigmatized by the statistics of high HIV infection recorded there in the early 1990s. Early in chapter 2 the features of contemporary legends and the major concerns of legend scholars are introduced and outlined briefly but succinctly. And the latter part of this chapter delineates the types of motifs of disease narratives that reappear in HIV and AIDS legends. "Making Sense" is the title and aim of chapter 3. Here Goldstein addresses the intersections among contemporary legends, public health services, the medical establishment, and the media. She argues convincingly for the importance of public health initiatives to acknowledge the ways in which disease narratives reflect concerns about the trustworthiness of the medical establishment. Further, narratives provide clues to understanding the causes of continued risky behavior even though most people seem to understand the messages public health is trying to project. Goldstein stresses the importance of taking popular narratives into account when designing health education projects. She concludes by identifying a significant hole in medical and public health studies and argues that they need to begin looking at shared social narratives rather than individual personal experience narratives alone. Chapter 4, "What Exactly Did They Do with That Monkey, Anyway?," is the first of the four case studies in the book and looks at HIV/AIDS origin narratives in medical, media, and popular traditions. The chapter is broken into sections based upon the three categories of AIDS origin narratives: "Animal Theories," "Isolated Case Theories," and the most revealing and interesting section, "Laboratory-Virus Theory." In this last section, Goldstein argues that conspiracy theories may demonstrate resistance to government, medical, and military organizations as well as work as "counter-blame" narratives for the communities that feel targeted by the other two origin categories. In the strongest chapter, "Welcome to the Innocent World of AIDS" (an earlier version of which was published in Contemporary Legend 2 [1992]: 23–40), Goldstein looks at two popular "Welcome to the World of AIDS" legends. [End Page 328] Her discussion of the second legend in particular and the reasons for its popularity in Newfoundland is brilliantly argued. This study clearly illustrates the efficacy and importance of understanding local social factors in determining not only how and why certain legend variants are told in specific...

SOCIOECONOMIC STATUS AS A RISK FACTOR FOR HIV INFECTION IN WOMEN IN EAST, CENTRAL AND SOUTHERN AFRICA: A SYSTEMATIC REVIEW

This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner's SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.

Estimation of HIV Incidence among Repeat Anonymous Testers in Catalonia, Spain

A retrospective cohort study of 2124 repeat HIV testers attending at anonymous testing sites (ATS) of Catalonia between 1995 and 2001 registered 3273 person-years (PY) of follow-up and 76 seroconversions (incidence density of 2.32 per 100 PY; 95% CI: 1.83, 2.90). The highest HIV infection incidence was observed among heterosexual injection drug users (IDU) (9.25 per 100 PY; 95% CI: 6.77, 12.25) and the lowest was among heterosexual non-IDU (0.69 per 100 PY; 95% CI: 0.35, 1.24). In multivariate Cox regression, factors independently associated with seroconversion were men having sex with men, IDU, and having sex with a known HIV-infected person. In spite of some limitations, such results suggest that prevention interventions targeting specific groups attending at ATS in Catalonia should be prioritized.

Complications following caesarean delivery at King Edward VIII hospital, Durban, South Africa: original article

Aim: This study was designed to determine the prevalence of complications associated with caesarean section in a setting of high caesarean section and HIV rates. Setting: A tertiary teaching hospital in Durban, South Africa. Design: A retrospective analysis. Methods: A detailed review of the records of 737 caesarean sections performed over a three month period. Results: The overall complication rate was 14.2%. Major complications included bladder injury, endometritis, wound sepsis and post-partum haemorrhage. HIV infection may have a negative impact on morbidity rates. Disimpacting the fetal head vaginally had a significant association with endometritis (p=0.021). The use of a corrugated drain did not prevent wound sepsis (p Conclusion: Complications associated with caesarean section are common is a setting of high caesarean section rates and HIV infection. O & B Forum Vol.14(2) 2004: 21-26

Perception of Risk and Action Taken to Avoid HIV/AIDS Infection among Students in a High-Risk State

The paper presents the findings of an investigation into adolescents' sexual behaviour and action taken to avoid infection among JSS students of Otukpo Local Government Area of Benue State-the state with the highest HIV infection rate in Nigeria. Several types of questionnaire were deployed to collect the data. The questions have a high reliability because they have been used in studies on school children in Uganda. Responses to the survey questions were coded for computer analysis frequencies. Two-way table methods including chi-square test for independence were used to determine if there was a significant difference between those who reported that they have not had sex and those who reported that they had sex. The difference was significant (p IFE Psychologia (2003) 11(2), 19-33

Does name-based HIV reporting deter high-risk persons from HIV testing? Results from San Francisco.

Name-based HIV reporting has been recommended as a method to track the HIV epidemic but may deter or delay at-risk persons from HIV testing. Previous studies of a deterrent effect of HIV reporting were not conducted in areas with high HIV infection rates and politically active populations. In a cross-sectional survey, men who have sex with men (MSM) recruited from gay bars, heterosexuals recruited from the sexually transmitted disease clinic, and injection drug users (IDUs) recruited from street venues were administered a face-to-face anonymous questionnaire. Ninety-four percent of the 118 MSM, 76% of the 99 heterosexuals, and 97% of 105 IDUs surveyed were tested. Six percent of MSM, 9% of heterosexuals, and none of the IDUs correctly identified California's HIV reporting regulations. Of the 75 (25%) participants who thought California had a name-based HIV reporting system, 2 were never tested and 23 had not been tested in the past 12 months. None of those who had never been tested and 2 of those who had not been tested in the past 12 months cited fear of being reported as a reason for not testing recently. Fear of reporting is an infrequently cited reason for deterring or delaying testing.

Concern Regarding the HIV/AIDS epidemic and Individual Childbearing

I examine if and how rural Malawians alter their childbearing as a consequence of concern regarding the HIV/AIDS epidemic. The paper is motivated by the debate which opposes two ideas regarding the childbearing effect of high HIV infection rates and heightened AIDS mortality: one the acceleration of childbearing as individuals find themselves under time pressure to meet their reproductive goals and two the decrease in childbearing as parents opt to avoid the risk of transmitting the virus. I find some evidence to support the hypothesis of reduced childbearing in the presence of high levels of worry regarding HIV/AIDS. However this finding does not seem to apply to younger women who are perhaps subject to relatively stronger childbearing promoting norms. (authors)

Mother-to-child transmission of HIV: a simulation-based approach for the evaluation of intervention strategies

Mother-to-child transmission (MTCT) of HIV is the most significant source of HIV infection in children below the age of 15 years. In 2000 alone, about 600 000 new infections occurred, the vast majority from mothers living in developing countries who were not aware of their HIV-positive status. To date, at least 4.3 million children have died from AIDS. In this paper, we discuss the development of an operational model that can be used to evaluate intervention options for the prevention of MTCT of HIV. The problem was approached by defining suitable pregnancy risk groups, prevention options and the required model outputs to evaluate different intervention strategies. The method chosen to approach the problem was a discrete-event, three-phase simulation, built in Visual Basic, with a stochastic semi-Markov structure. The developed model takes individual pregnant women through each stage of their pregnancy, labour and birth. Different intervention strategies may be modelled at any time, including short-course antiretroviral drugs and cessation of breastfeeding. The model is demonstrated with data from Botswana, which has one of the highest HIV-infection rates in the world.

Silence, sexuality and HIV/AIDS in South African schools

In South Africa where there is a very high HIV infection rate among teenagers and young adults, it is surprising to find that students and teachers are very unwilling to talk about the possibility of being or becoming HIV positive. While AIDS messages dominate public discourse, there is a silence in schools about the personal in relation to AIDS. This article seeks to explain the reluctance of learners to test, talk about and disclose their HIV status, by examining silence within a broader context. It draws on gender theories to show the connections between the silence of AIDS and broader, society-wide gender inequalities. A focus on ‘silence’ adds a neglected gendered phenomenon to the understanding of the AIDS pandemic. Silence is a feature of gender relations that prevents the negotiation of safe sex, the exploration of the self and the expression of vulnerability and hence the building of trust and respect. Conversely, silence contributes to intolerance and fuels prejudice. When interventions consciously attempt to break the silence, they make a major contribution to reducing the likelihood of HIV transmission and to promoting gender equality.

Transplacental transmission of HIV: a potential role for HIV binding lectins

Although the majority of vertical transmission of HIV occurs around the time of birth, 1.5–2% of pregnancies in HIV-positive women appear to result in the vertical transmission of HIV across the placenta. HIV infection of a number of placental cell types has been demonstrated, but the exact mechanisms of intrauterine vertical transmission remain obscure. The recent discovery of the HIV binding lectins dendritic cell-specific ICAM-grabbing non-integrin (DC-SIGN) and DC-SIGN-related molecule (DC-SIGNR) provides one possible explanation. Cells expressing these lectins are able to adsorb the virus and mediate high efficiency HIV infection of other cell types. Both lectins are expressed by the placenta, with DC-SIGN expression also being present on maternal cells intimately associated with the placenta. This review focuses on possible mechanisms by which these lectins may potentiate the intrauterine vertical transmission of HIV.

Substance use and HIV disentagling the nexus of risk. Introduction.

Persons who use drugs are a high-risk subpopulation for HIV infection because more than one drug user often take drugs together, which increases the risk of HIV transmission. For the PWUDs who had tested for HIV, we extracted data on demographic characteristics, drug types, injection drug use behavior, encrypted IDs of co-users, and drug use location from the National Dynamic Management and Control Database for Persons Who Use Drugs between January 2008 and July 2016. We mapped and classified Co-UDs’ networks and estimated the risk of HIV infection. Drug co-use networks were formulated on the basis of connections between PWUDs at the same time and location. Latent profile analysis (LPA) and logistic regression models were used to cluster the classes and to estimate the HIV infection risk among them, respectively. A total of 470 967 PWUDs were included, among whom 69 529 Co-UDs formed 7 001 networks, which were categorized into three classes: Class A (n = 211, 3.0%) had large networks, with more members (median 10.0 (IQR: 8.0-14.5)), and comprised depressant and stimulant users located in central and eastern China; Class B (n = 3 770, 53.8%) was dominated by depressant users (median 3.0 (IQR: 3.0-4.0)) across the country; Class C (n = 3 020, 43.1%) was dominated by stimulant users (median 3.0 (IQR: 3.0-4.0)) located in central and eastern China. The HIV infection rates were 9.71%, 3.33%, and 0.33% in Classes A, B, and C, respectively. Compared with Class A, Classes B and C were associated with decreased odds of HIV infection. Our findings suggest that more attention should be paid to larger networks, with a relatively high HIV infection risk, to enhance prevention and intervention strategies.

Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa.

To estimate parameters of concurrent sexual partnerships in five urban populations in sub-Saharan Africa and to assess their association with levels of HIV infection and other sexually transmitted infections (STI). Data were obtained from a multicentre study of factors which determine the differences in rate of spread of HIV in five African cities. Consenting participants were interviewed on sexual behaviour and at four of the five sites also provided a blood and a urine sample for testing for HIV and other STI. Data on sexual behaviour included the number of partnerships in the 12 months preceding the interview as well as the dates of the start and end of each partnership. Summary indices of concurrent sexual partnerships -- some of which were taken from the literature, while others were newly developed -- were computed for each city and compared to HIV and STI prevalence rates. A total of 1819 adults aged 15--49 years were interviewed in Dakar (Senegal), 2116 in Cotonou (Benin), 2089 in Yaoundé (Cameroon), 1889 in Kisumu (Kenya) and 1730 in Ndola (Zambia). Prevalence rates of HIV infection were 3.4% for Cotonou, 5.9% for Yaoundé, 25.9% for Kisumu and 28.4% for Ndola, and around 1% for Dakar. The estimated fraction of sexual partnerships that were concurrent at the time of interview (index k) was relatively high in Yaoundé (0.98), intermediate in Kisumu (0.44) and Cotonou (0.33) and low in Ndola (0.26) and in Dakar (0.18). An individual indicator of concurrency (iic) was developed which depends neither on the number of partners nor on the length of the partnerships and estimates the individual propensity to keep (positive values) or to dissolve (negative values) on-going partnership before engaging in another one. This measure iic did not discriminate between cities with high HIV infection levels and cities with low HIV infection levels. In addition, iic did not differ significantly between HIV-infected and uninfected people in the four cities where data on HIV status were collected. We could not find evidence that concurrent sexual partnerships were a major determinant of the rate of spread of HIV in five cities in sub-Saharan Africa. HIV epidemics are the result of many factors, behavioural as well as biological, of which concurrent sexual partnerships are only one.

HIV prevention with young men who have sex with men: What young men themselves say is needed

Young men who have sex with men (YMSM), and particularly ethnic minority YMSM, experience high incidence HIV infection due to continued patterns of high-risk sexual behaviour. The intent of this research was to systematically solicit input and recommendations from YMSM themselves concerning the kinds of HIV prevention programmes that would best meet their needs and would address risk issues they believed are critical. In-depth qualitative interviews were conducted with a sample of 72 purposively selected YMSM to identify necessary components of HIV prevention targeting YMSM. Respondents noted a need for comprehensive HIV prevention programmes that addressed issues related to dating and intimacy, sexuality and arousal, drugs and alcohol, self-esteem and self-worth, abuse and coercion, and sexual identity. Respondents emphasized the importance of keeping programmes confidential, fun, comfortable, accepting and open to all YMSM regardless of sexual identity. Identified community resource needs included safe havens for youth, more peer educators and older MSM mentors, increased school-based sexuality education, and greater support from the society at large as well as from churches, the gay community and communities of Color. Implications of these findings for HIV prevention are discussed.

艾滋病防治中的倫理和政策問題

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文討論了艾滋病在中國大陸傳播引起的倫理和政策問題。作者首先指出在預防控制艾滋病問題上中國正處在十字路口。挨著作者分析了中國會不會成為艾滋病和艾滋病病毒感染的高發國，討論了制訂有效而合乎倫理的艾滋病防治政策的理論預設和價值以及評價政策的倫理學框架，討論了艾滋病治療和預防中的倫理和政策問題。The AIDS/HIV prevention and control in China is at crossroad. At present, there are insufficient grounds for us to say that China will definitely become a country with a high HIV infection rate in the future. However, we have much less sufficient grounds for saying that China will never reach that stage. On the contrary, we have much more reason to say that it is very probable for China to become a country with high HIV infection rate if we leave the current policy unchanged. The reasons are: economic reforms associated with large scale population movements in unprecedented way; proliferation of all sorts of high risk behavior, presence of other STDs which facilitate the spread of HIV; the risk of iatrogenic spread through untested blood transfusion; the "sex revolution" with changes in patterns of sex behaviour and increased casual sex, multiple sex partners among the younger generation; most Chinese still do not know how to protect themselves; and the ethical and legal atmosphere necessary for effectively preventing the HIV epidemic has not been formed.The conventional public health approach is not sufficient to prevent or control an HIV epidemic. When the cases of HIV infection were detected one by one in China, health professionals and programmers believed that they could take a conventional public health approach to cope with HIV epidemic. But they are wrong. HIV infection is an epidemic so special that the conventional public health measures such as testing, reporting, contact tracing, isolation are inadequate or ineffective to control the epidemic. HIV is often spread among those groups who are usually marginalized or stigmatized by society through behaviours both confidential or private.An effective policy of preventing HIV cannot be insensitive to ethical issues. However, many of health professionals and programmers bypassed ethical issues emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that "AIDS is the punishment by God" or "AIDS is the punishment for promiscuity". For them suffering AIDS is not morally irrelevant, and thus the ancient conception of disease was revived. But this conception of disease has already proved wrong and harmful to the treatment and prevention of any disease, especially to HIV. The consequence entailed by this conception is that the IIIV positive and AIDS patients were discriminated against and stigmatized. When their positive serological status was disclosed, they were faced with the risk of being expelled from school or fired from working unit, even rejected for admission into hospital, and their tights to confidentiality and privacy were often infringed upon. If all these ethical issues cannot be properly treated, how can those persons in danger or risk get access to information, services, education, counselling and techniques necessary to prevent HIV infection? One Chinese adage says that "You cannot have fish and bear palm both". In the prevention of HIV epidemic we have to have the protection of public health and the safeguarding of individual rights.For controlling HIV epidemic what we need is not a repressive law, but a supportive law to build a supportive environment in treatment and prevention of AIDS/HIV. So the policy and law involving AIDS/ HIV should be reformed.DOWNLOAD HISTORY | This article has been downloaded 19 times in Digital Commons before migrating into this platform.

HIV risk behaviors become survival techniques for aboriginal women.

In northern Alberta, the Aboriginal (native) female population appears to be overrepresented in the HIV statistics. A qualitative research study was designed to explore the cultural factors that relate to the high HIV infection rate in these women. Eight HIV-positive women were interviewed for the study, representing about one third of the population. A model was developed to explain the relationships that exist between the women's formative years, their self-esteem, and the survival techniques they used prior to becoming HIV-positive. These survival techniques may have placed them in situations that increased their risk of infection with the HIV virus.