New Cases Of HIV Infection Research Articles

The value of certification in HIV/AIDS nursing revisited.

Relf, Berger, Crespo-Fierro, Mallinson, and MillerHardwick (2004) published the initial work on certification in HIV/AIDS nursing. Their work provided a comprehensive summary of the scope of HIV/AIDS nursing practice, distinguished certification from licensure, detailed the need for nursing certification, described the benefits of certification, and discussed methods for championing certification among nurses in HIV care. Since that initial article 10 years ago, much has changed within the HIV pandemic, nursing profession, and context in which HIV nursing care occurs. Care for clients living with HIV has advanced as these changes evolved. Survival has increased relative to advances in medical care and treatment. Improved care and treatment options mean that clients with HIV disease are now aging. In fact, life expectancy of clients living with HIV infection is nearly equal to those who are not infected (May et al., 2006). Currently, 24% of clients living with HIV in the United States are ages 50 years or older (Centers for Disease Control and Prevention [CDC], 2008). However, aging clients with HIV infection have a host of physical and psychosocial care needs that need to be addressed (Davis & Zanjani, 2012). Unfortunately, some aspects of HIVinfection have not changed over the past 10 years. In the United States alone, nearly 50,000 new cases of HIV infection occur annually. Groups most affected by HIV include Black men and women, and men who have sex with men (CDC, 2011). Unfortunately, the advances in HIV care and treatment are overshadowed by the fact that HIV prevention strategies have not been largely successful in decreasing new cases of HIV infection among these vulnerable populations (Johnson et al., 2008). The complex care needs of persons with HIV infection combined with the lack of HIV prevention interventions indicate that nurses with specialized knowledge, skills, and competencies are needed to provide care to people at risk for HIV, as well as those already infected. The Association of Nurses in AIDS Care in conjunction with the HIV/AIDS Nursing Certification Board (HANCB) recommends certification in HIV/AIDS Nursing for nurses who provide primary, secondary, or tertiary HIV care. As of August 2013, 655 nurses have earned AIDS Certified Registered Nurse (ACRN) certification, and 56 advanced practices nurses have earned Advanced AIDS Certified Registered Nurse (AACRN) certification. However, despite encouragement from both of these organizations, many nurses chose not to seek certification in HIV/AIDS nursing. The purpose of this manuscript is to revisit the value of nursing certification in HIV care. By revisiting this issue and using available evidence to demonstrate that certification

Use of rapid HIV testing in a low threshold centre in Antwerp, Belgium, 2007–2012

The Antwerp Helpcenter is a low threshold screening centre for HIV and STI testing focused on high-risk groups. The aim of this work is to describe our experience with the use of rapid HIV tests including the analysis of the characteristics of new cases of HIV infection. We performed a retrospective analysis of all rapid tests routinely performed at the Helpcenter in the period June 2007 to December 2012. The Determine(®)HIV-1/2 (3rd generation) was used until May 2009 and thereafter the Determine Combo(®)HIV-1/2 Ag/Ab (Alere) test (4th generation) on venous blood. All reactive tests were confirmed using a standard confirmation algorithm with ELISAs and a confirmation test (INNO-LIA HIVI/II Score(®)). In all, 5025 rapid tests were performed on blood specimens of 3881 clients including 1173 men having sex with men and 454 migrants from sub-Sahara Africa. The overall prevalence of HIV infection was 1.5% and higher among the risk groups: 4.0% of men having sex with men and 2.2% of migrants from sub-Sahara Africa. The availability of a rapid test was an important reason to present at the Helpcenter. The rapid test was successfully introduced into an outpatient testing centre. Client satisfaction with RT was high and most clients were successfully linked to care.

“No One’s at Home and They Won’t Pick up the Phone”

The Internet and mobile devices are increasingly used by men who have sex with men to find potential partners. Lack of partner information, besides e-mail addresses or user profiles, limits the ability to adequately perform partner notification by traditional means and test those at high risk. To streamline North Carolina Internet Partner Notification (IPN) services, University of North Carolina at Chapel Hill collaborated with the North Carolina Division of Public Health beginning in July 2011 to formalize state IPN and text messaging for partner notification (txtPN) policies and centralize notification practices by designating a single IPN/txtPN field coordinator within the University of North Carolina at Chapel Hill. We compared the number of IPN and txtPN contacts initiated and their outcomes in July 1, 2011, to June 30, 2012, and compared with outcomes in January 1, 2010, to December 31, 2010, the year before the collaboration. Overall, 362 IPN contacts were initiated compared with 133 initiated in 2010. More than half (59.1%) were black; mean age was 28.8 years. Almost all were men who have sex with men (83.7%). Approximately two-thirds (n = 230; 63.5%) of contacts were successfully notified using centralized IPN. Seven new cases of HIV infection, 11 new cases of syphilis, and 19 known previous HIV-positive persons were identified. Text messaging for partner notification was used for 29 contacts who did not initially respond to traditional notification or IPN; 14 (48%) responded to txtPN in a median time of 57.5 minutes (interquartile range, 9-2708). Centralization of IPN services augmented partner detection of new HIV and syphilis diagnoses. Text messaging for partner notification represents a potentially effective method for augmenting traditional partner services. In addition, IPN and txtPN allow identification of HIV-infected persons in need of linkage to care.

"Can I Be at Risk of Getting AIDS?" A Linguistic Analysis of Two Internet Columns on Sexual Health

Recent global statistics highlight that, out of all new cases of HIV infection, 45% are diagnosed in young people (UNAIDS 2008). Despite a range of new initiatives aimed at increasing young people's knowledge of HIV at the beginning of the first decade of the twenty-first century (UNAIDS 2001), latest figures highlight that such initiatives have not been wholly successful in preventing new infection in young people (UNAIDS 2011). In light of this, the language patterns that young people use when seeking information about HIV/AIDS are investigated. Our focus in particular is on computer-mediated-communication, a relatively under-researched area in the sphere of health communication. Building on previous research (Locher 2006, 2010; Harvey et al. 2008; Harvey 2013), we examine one UK and one US Internet-based, professional, health advice column as sources of advice-information for young people. Despite numerous established health campaigns, young advice-seekers' questions reflect misinformed conceptions, such as the conflation of HIV and AIDS and confusion as to the way in which the virus can be contracted. Our linguistic research gives access to young people's lay beliefs about sexual health and highlights the need to redress such beliefs, with the aim of improving the effectiveness of health education initiatives. We suggest that computer-mediated communication can be one effective medium through which to assess young people's knowledge about HIV/AIDS, as well as effectively disseminating sexual health advice and information by health care bodies.

BCN Checkpoint, a community‐based centre for men who have sex with men in Barcelona, Catalonia, Spain, shows high efficiency in HIV detection and linkage to care

We assessed the efficiency of BCN Checkpoint in detecting new cases of HIV infection and efficiently linking newly diagnosed individuals to care. This study analysed during 2007-2012 the number of tests performed and the number of persons tested in BCN Checkpoint, the HIV prevalence, global and in first visits, the capacity of HIV detection compared to the reported cases in MSM in Catalonia, and the linkage to care rate. During the six years a total of 17.319 tests were performed and 618 HIV-positive cases were detected. Median prevalence of clients who visited the centre for the first time was 5.4% (4.1-5.8). BCN Checkpoint detected 36.3% (35.0-40.4) of all reported cases in MSM during 2009-2011. Linkage to care was achieved directly in 90.5% of the cases and only 2.4% of cases were lost to follow-up. A community-based centre, addressed to a key population at risk, can be less effort consuming (time and funding) and show high efficiency in HIV detection and linkage to care.

Diagnosis of HIV Delay: Lost Opportunities

The diagnosis delay in new cases of HIV infection is a frequent fact. Our objective was to detect and analyse the lost opportunities and describe the characteristics of these patients. Method: The search was done by a revision of personal histories of new diagnosis of HIV infection from 1st January to 31st December 2011 in the database of VACH. We selected those that had consulted a doctor in the previous year in the Emergency area, Primary Care and Specialised Consultations in the database of the histories of the Public Health Service. We called low attendance if they came 1 - 3 times and high if over 3. We grouped patients into those that fulfilled criteria of diagnosis delay by count of CD4s. We called no diagnosis delay to those that had count of CD4 over 350, diagnosis delay under 350 and advanced disease under 200. Results: There were 107 new cases. The global percentage of DD was 61.7% of cases. From these, 45.38% fulfilled criteria of AD. It was possible to find information about the existence of previous sanitary attendance in 59 patients. From these 58% were diagnosed with delay, fulfilling criteria of AD in 27%. The predominant means of infection was sexual. 35 patients attended a healthcare level, 19 two and 5 three. 47.5% consulted over 3 times. They requested a total of 274 consultations. Discussion: The diagnosis delay is a reality. It took our attention that from 59 patients having requested previous medical assistance 58% were diagnosed with delay and 27% fulfilled criteria of AD. We found that almost half of them had been attended in 4 and up to 14 times, in some occasions with suggestive symptoms of HIV infection. Facing this discovery we think that some interventions should be undertaken to get an early diagnosis and the control of the outbreak.

Periodontal disease in HIV/AIDS

Since the early 1990's, the death rate from AIDS among adults has declined in most developed countries, largely because of newer antiretroviral therapies and improved access to these therapies. In addition, from 2006 to 2011, the total number of new cases of HIV infection worldwide has declined somewhat and has remained relatively constant. Nevertheless, because of the large numbers of existing and new cases of HIV infection, the dental practitioner and other healthcare practitioners will still be required to treat oral and periodontal conditions unique to HIV/AIDS as well as conventional periodontal diseases in HIV-infected adults and children. The oral and periodontal conditions most closely associated with HIV infection include oral candidiasis, oral hairy leukoplakia, Kaposi's sarcoma, salivary gland diseases, oral warts, other oral viral infections, linear gingival erythema and necrotizing gingival and periodontal diseases. While the incidence and prevalence of these oral lesions and conditions appear to be declining, in part because of antiretroviral therapy, dental and healthcare practitioners will need to continue to diagnose and treat the more conventional periodontal diseases in these HIV-infected populations. Finding low-cost and easily accessible and acceptable diagnostic and treatment approaches for both the microbiological and the inflammatory aspects of periodontal diseases in these populations are of particular importance, as the systemic spread of the local microbiota and inflammatory products of periodontal diseases may have adverse effects on both the progression of HIV infection and the effectiveness of antiretroviral therapy approaches. Developing and assessing low-cost and accessible diagnostic and treatment approaches to periodontal diseases, particularly in developing countries, will require an internationally coordinated effort to design and conduct standardized clinical trials.

Preexposure Prophylaxis to Prevent HIV in Men Who Have Sex with Men: At What Cost?

Of the 50,000 new cases of HIV infection annually in the U.S., more than half occur in men who have sex with men (MSM). In a study among HIV-negative

“HIV testing is so gay”: The role of masculine gender role conformity in HIV testing among men who have sex with men.

Men who have sex with men (MSM) account for more than half of all new cases of HIV infection in the United States. Yet, many MSM are unaware of their HIV serostatus. Consistent with research indicating that gender role conformity impacts health behaviors, this study examined how masculine norms may influence HIV testing among MSM in the United States. Data from 170 self-identified MSM (age M = 46.45, SD = 12.18) of self-reported negative or unknown HIV serostatus living in the United States were used in this study. About half (52%) of participants reported that they had been tested for HIV within the past 12 months; 48% reported that they had not. Logistic regression was used to examine the association between domains of masculine gender role conformity and HIV testing within the past 12 months, controlling for number of sexual partners in the last 12 months. The masculine norm of heterosexual self-presentation (i.e., desire to be perceived by others as heterosexual) was negatively associated with HIV testing (B = -0.74, SE B = 0.36, O.R. = 0.48, 95% CI [0.24, 0.96]), after controlling for the effect of number of sexual partners. Psychologists and other health professionals may remain mindful of potential implications of HIV testing among MSM, including potential for MSM to view HIV testing as an "outing" procedure.

Missed Opportunities for Universal HIV Screening in Primary Care Clinics.

BackgroundThe Centers for Disease Control and Prevention (CDC) has reported that the number of new cases of HIV infection has been underreported annually by at least 40,000 cases. In 2006, the CDC recommended that voluntary HIV counseling and testing (VCT) was given to all patients aged 13 to 64 years in ambulatory care settings. The purpose of this qualitative study was to explore primary care providers’ (PCP) perspectives on and experiences of facilitators and barriers to offering VCT as part of annual screening.MethodsThis was a descriptive, exploratory study where fifteen primary care providers were individually interviewed. Only community-based primary care providers were interviewed, and no obstetrician/gynecologists were enrolled, as VCT is standard of care in that specialty.ResultsBarriers included doubts about the CDC recommendation, time constraints, fear, and assumptions about age and marital status. Facilitators included normalizing HIV testing and the availability of resources and training. PCPs’ role as an advocate and their professional style had the paradoxical potential of being both a barrier and a facilitator to VCT. Providers’ ability to connect patients to community resources was linked to their persistence and experience.ConclusionsFindings suggest more effort is needed by PCPs to facilitate HIV counseling and testing more frequently to their ambulatory care patients.

Manejo clínico de la infección aguda y crónica por el virus de la inmunodeficiencia humana antes del inicio del tratamiento antirretroviral

The evaluation of new cases of HIV infection is relatively common in Spain, where several thousands of patients with new infections are diagnosed each year. Eighty per cent of them have a chronic HIV infection at the first clinical evaluation, which is symptomatic (late presenters) in up to 30% of patients. The initial evaluation of HIV infection is not only directed at determining the clinical, virological (plasma HIV RNA viral load, resistance test and viral tropism) and immunological (CD4+ T-cell cell count) situation of the patients, but must also address the study of their co-infections (hepatitis, tuberculosis) and comorbidities (cardiovascular, hepatic, renal and bone) and the risk of HIV transmission. This is needed in order to decide, whether or not to start antiretroviral treatment, and with which combined antiretroviral treatment to start with, the prophylaxis of opportunistic infections, and the treatment of coinfections and comorbidities. The past and current medical history, the physical examination and laboratory tests will help us decide if the patient is to receive therapeutic intervention. The level of CD4+ T-cell lymphocytes is the best marker to suggest when to start combined antiretroviral treatment, indicating whether or not to start prophylaxis against opportunistic infections (if patients have a CD4+ T-cell count below 200 cells/mm(3)), and in advanced patients should make us suspect the presence of active opportunistic diseases in symptomatic cases. The management of patients with HIV infection must also include appropriate health education on the modes of transmission and prevention of HIV infection, and also to explain its natural history and how it can be modified with proper antiretroviral treatment, as well as to promote a healthy life. No less important is the psychological support, as these patients must learn to live with a chronic infection, which managed properly can ensure a very good long-term prognosis and quality of life.

HIV-1 group N: travelling beyond Cameroon

On Jan 21, 2011, a 57-year-old man living in France attended our emergency unit with fever, rash, lymphadenopathy, and genital ulceration, 8 days after returning from Togo. He reported sexual contact with a Togolese partner, and HIV primary infection was suspected. Fourth-generation ELISA (ARCHITECT HIV Ag/Ab Combo, Abbott, Chicago, IL) was weakly positive, and HIV-1 western blot (New Lav Blot I, Biorad, Paris, France) showed weak reactivity with the p55 and p24 antigens. On Feb 1, 2011, his HIV-1 RNA load was 4∙2 log10 copies per mL (Cobas TaqMan HIV-1 v2.0 assay, Roche Molecular Systems, Branchburg, NJ, USA). On Feb 9, 2011, he developed facial paralysis. At this time his CD4 cell count was 219 per μL and his plasma and CSF HIV-1 RNA concentrations were 4∙4 log10 and 4∙5 log10 copies per mL, respectively. In keeping with French guidelines on new cases of HIV infection, we undertook resistance genotyping before starting treatment. We were surprised that we could not amplify the reverse transcriptase and protease genes with the ViroSeq HIV-1 genotyping assay (Abbott, Chicago, IL, USA) and the French National Agency for AIDS Research consensus primers, despite the high viral load. This fi nding prompted us to serotype the samples. Clear reactivity against group-N-specifi c antigens was obtained and we therefore did full-length genome sequencing. Phylogenetic analysis confi rmed that the new sequence clustered strictly within available group-N sequences (sequence designated N1.FR.2011, GenBank accession number JN572926). When last seen for followup after 4 weeks of antiretroviral combination therapy with tenofovir, emtricitabine, darunavir/ritonavir, raltegravir, and maraviroc, our patient’s plasma HIV-1 RNA load was below 20 copies per mL and his CD4 cell count was 483 per μL. HIV-1 group N (non-M, non-O) was fi rst identifi ed in 1998 in a Cameroonian woman with AIDS. This highly divergent HIV variant is more closely related to SIV isolated from wild chimpanzees than to HIV-1 groups M (major), O (outlier), and P. Group-N infection has previously been reported only in HIV-infected patients living in Cameroon. More than 12 000 HIVinfected patients living in Cameroon have been tested for group-N infection, but only 12 cases, including two couples infected by the same strains, have been identifi ed. Although our patient was diagnosed in Paris, the infection was probably acquired in Togo, which suggests that group-N viruses are now circulating outside Cameroon. This case of primary HIV-N infection is particularly important because of the severe clinical manifestations and early decline in the CD4 cell count. A fi ve-drug antiretroviral com bination showed good initial effi cacy, but longer-term immunological and virological follow-up is needed. The viral load of this HIV-N infected patient was positive during the primary infection as assessed by the Cobas TaqMan HIV-1 v2.0 assay, but the validity of the quantitative result is uncertain. The viral load was also assessed using the Abbott RealTime HIV-1 assay (Chicago, IL, USA), but was under-quantifi ed by about 1 log10. Whether other commercial assays can quantify these variants remains to be shown. Standard resistance genotyping methods used for group M failed to amplify the group-N virus, as happened with the fi rst case of group-P virus detected in 2009. Discrepancies between the results of HIV viral load assays and molecular tests should alert clinicians and virologists to the possibility of infection by a variant virus, which has important implications for management of the patient. This case of HIV-1 group-N primary infection indicates that this rare group is now circulating outside Cameroon, which emphasises the need for rigorous HIV epidemiological monitoring.

Barriers to Prevention of HIV Type 1 Mother-to-Child-Transmission in Bahia, Brazil

Editor: In Brazil, the AIDS epidemic has recently spread to small towns and the peripheral areas of large cities, involving mostly people younger than 21 or older than 50 years.1 In addition, the number of infected women (through the sexual route) is also increasing, mostly in the poorest areas of the country (the North and Northeast regions), but also in some well-developed areas, such as the South region.1 Brazil provides universal access to antiretroviral drugs, as well as to viral load, CD4+ cell count, and resistance tests. However, most of the patients are still being diagnosed late in the course of the disease, which increases hospitalization rates and morbidity/mortality.1 This is especially important for pregnant women, since a delay in diagnosis may increase the likelihood of mother-to-child transmission (MTCT).2 In Brazil, around 3 million deliveries occur every year. Since the estimated prevalence rate of HIV-1 infection in pregnant women is 0.42%, we should expect at least 12,000 new cases of HIV infection per year in this specific population. However, only 4980 cases were reported in 2008, 125 of them in Bahia, a Northeast state of Brazil.3 This suggests that only half of the cases are diagnosed and/or reported. The incidence rate of HIV infection for children younger than 5 years is 3.0 cases per 100,000 inhabitants, in Bahia (over 90% due to MTCT).1,3 As part of a study conducted to identify the prevalence and risk factors for acquiring HIV-1 infection, we interviewed 3300 parturient women who attended the main public maternity hospital of Bahia state from May 2008 to April 2009.4 The maternity hospital is used by about 40% of all parturient women in Salvador and the surrounding area, and is the referral hospital for complex cases, which includes parturient women with AIDS. As part of the routine care, all parturient women are tested for HIV-1 (two different rapid tests) when they are admitted to the maternity unit. Positive samples are retested by enzyme immunoassay. We found an HIV-1 seroprevalence rate of 0.84% (28/3300, 95% CI: 0.57–1.24). Of note, 8 out of 28 (28.6%) women were already diagnosed as HIV positive before pregnancy and were receiving regular care in a public HIV referral center. The remaining 20 (71.4%) were diagnosed during pregnancy: 10/28 (35.7%) during prenatal care, 9/28 (32.1%) by rapid testing during admission for labor and delivery, and 1/28 (3.5%) immediately after delivery. Ten (35.7%) cases of HIV infection were detected only on admission to the maternity hospital. Of concern, among those with a late diagnosis, only one (10%) received proper HIV-1 prophylaxis during labor. As a referral hospital for complex cases, antiretroviral drugs are readily available, and the staff was previously trained, as part of a national program for the prevention of HIV-1 MTCT. Moreover, after discharge from the hospital, 7/28 (25%) of the diagnosed women (and their newborns) were lost to follow-up. They never returned for scheduled medical visits, the home addresses and telephone numbers they provided when admitted to the hospital were not valid, and they could not be traced. As far as we could determine, they had not been reported to the Public Health authorities, and no effort to locate them was done by hospital/health authorities. All 21 newborns tested for HIV-1 by b-DNA, and proviral DNA, were negative at 4 and 12 weeks of age. Among the seven lost mother–newborn pairs, six mothers (86%) were diagnosed only upon hospital admission. These data reveal that regardless of the great effort made by Brazilian health authorities to control the AIDS epidemic, several problems are still occurring, and many opportunities are lost. Our report clearly identifies some serious failures in the process: most of the parturient women were diagnosed only at the hospital, and even among those already known to be HIV positive, antiretroviral drugs were prescribed in only 72% of the cases. Most importantly, barely 10% of late-diagnosed women received any type of prophylaxis for MTCT, and 86% of them were lost to follow-up, resulting in a likely increase in the chance of MTCT through breastfeeding, as well as the probability of transmission to their sexual partners. Better surveillance of HIV-1 infections in pregnancy and careful follow-up of positive mothers and their infants are mandatory.

The Urgency Of Providing Comprehensive And Integrated Treatment For Substance Abusers With HIV

Substance abuse is linked to many new cases of HIV infection. Barriers such as the myth that drug users cannot adhere to HIV/AIDS treatment block progress in curbing the spread of HIV in that population. In this article we explain the need to aggressively seek out high-risk, hard-to-reach substance abusers and to offer them HIV testing, access to treatment, and the necessary support to remain in treatment--both for HIV and for substance abuse. We summarize evidence showing that injection drug users can successfully undergo HIV treatment; that many substance abusers adhere to antiretroviral therapy as well as do people who don't inject drugs; and that injection drug users who undergo substance abuse treatment are more likely to obtain and stay in treatment for their HIV infection. This evidence makes a strong case for integrating substance abuse treatment with HIV treatment programs and providing substance abusers with universal access to HIV treatment. But an integrated strategy will require changes in the health care system to overcome lingering obstacles that inhibit the merging of substance abuse treatment with HIV programs.

A New Unique Recombinant HIV Type 1 Isolated from a Child Born to an HIV-Infected Mother

The new HIV-1 recombinant, with a B(gag) A(pol)A(env) structure, is described. This recombinant virus differs from the classical "Kaliningrad" (AF193276.1) virus with an A(gag) B(pol)B(env) structure. The number of new HIV cases in Belarus has been increasing in the past few years. Within the 12 months of 2010, 1069 new cases of HIV infection were registered. Molecular epidemiological investigations have shown that though HIV-1 subtype A (84.5%) still dominates in HIV/AIDS patients, the quantity of CRFs has also increased to 7.1%. Although cases with the CRF03_AB virus were previously described in patients from Belarus, CRF06_cpx and CRF02_AG are described in Belarus for the first time.

Thirty Years of HIV and AIDS: Future Challenges and Opportunities

As the third decade since AIDS was first recognized comes to an end, extraordinary advances have occurred in the understanding, treatment, and prevention of HIV infection and AIDS. As a result of these successes, it is now time to focus on future challenges. Paramount among these is reaching the goal of truly controlling and ultimately ending the HIV and AIDS pandemic. To that end, AIDS researchers and public health personnel worldwide are aggressively pursuing 3 key areas of scientific research. Given the availability of highly effective therapeutic regimens for HIV infection, the first challenge is efficiently identifying a maximum number of HIV-infected persons through voluntary HIV testing and initiating antiretroviral therapy (ART). Second, scientists are trying to develop a cure for HIV infection, which would alleviate the need for lifelong ART. Finally, preventing new cases of HIV infection, which currently number approximately 2.6 million per year globally, is critical to any attempt to end this pandemic. This article addresses each of these challenges and provides directions for the future.

Trend analysis and short-term forecast of incident HIV infection in Ghana

The study uses time-series modelling to determine and predict trends in incident HIV infection in Ghana among specific age groups. The HIV data for Ghana were grouped according to northern and southern spatial sectors as they exhibited slightly different data collection formats. The trend of the epidemic is modelled using moving-average smoothing techniques, and the Box-Jenkins ARIMA model is used to forecast cases of newly acquired (incident) HIV infection. Trend analysis of past growth patterns reveals an increase in new cases of HIV infection in the northern sector, with the greatest increase occurring among persons aged 30 years and over. The epidemic in the southern sector appears to have levelled off. However, incident HIV infection in the 20–39-year-old age group of females in the sector is estimated to increase in the next three years. Moreover, the estimates suggest a higher increase in incident cases than that predicted by the National AIDS Control Programme. Nevertheless, incident HIV infection among persons aged 19 and below is found to be relatively stable. Thus, if efforts are made to reduce or prevent an increase in the number of new infections in the northern sector, and for the 20–39 years age group in the southern sector, Ghana will have a brighter future with regard to its response to the HIV epidemic. These findings can assist with developing strategic-intervention policy planning for Ghana and other countries in sub-Saharan Africa.

Analysis of fatal outcomes in HIV infection

The Russian Federation holds the lead in the highest growth rates for the number of new cases of HIV infection and its prognosis remains poor for the years immediate ahead with the rapidly increased rates in the scope of its epidemic being borne in mind. In the Far Eastern Federal District, the Primorye Territory rates first in the number of cases of HIV infection. The aim of this study was to determine the incidence and clinical characteristics of secondary and opportunistic diseases that were a cause of death in HIV-infected patients in the Territorial Clinical Center for Prevention and Control of AIDS and Infectious Diseases, Vladivostok, in 2007. In this year, the mortality rate was 13.6%, which was 1.6 times higher than that in 2006. Tuberculosis the incidence of which was 48.5% occupied the first place in the structure of secondary diseases resulting in a fatal outcome in HIV-infected patients. The proportion of hepatic cirrhosis was 22.9% in the structure of fatal outcomes.

Should microbicides be controlled by women or by physicians?

In 2007, nearly 7000 new cases of HIV infection occurred each day. There is a constant increase in the proportion of women newly infected with HIV in the global population; this increase is particularly high in some areas of the world such as sub-Saharan Africa. Microbicides are products that are being developed to empower women against HIV. First- and second-generation microbicides are broad-spectrum products that include surface active agents, vaginal defense enhancers, and blocking agents. Third-generation microbicides are HIV-specific and include replication and entry inhibitors formulated as gels or as vaginal rings. However, there is a concern that antiretroviral-based microbicides could lead to drug resistance if they are used by HIV-positive women who are unaware of their HIV status. To reach the highest number of women possible, microbicides should be available over-the-counter, which might not be the case with antiretroviral-based formulations. In contrast, non-antiretroviral-based microbicides will have the advantage of being initiated and controlled by women themselves and they will not jeopardize the use of life-saving drugs.

Rapid HIV Testing in an Urban Emergency Department: Using Social Workers to Affect Risk Behaviors and Overcome Barriers

In the 27 years since HIV was first reported in the United States, an estimated 1.6 million people have been diagnosed with HIV, and more than 525,000 have died as a result of AIDS (Centers for Disease Control and Prevention [CDC], 2005). Currently, approximately 250,000 individuals in the United States are unknowingly infected with HIV, and approximately 40,000 new infections occur each year (CDC, 2006). As the HIV epidemic continues, the populations most deeply affected are racial and ethnic minorities and those who are socially and economically marginalized. These populations currently represent almost 70 percent of new cases of HIV infection (CDC, 2007). In addition to the disproportionate spread of HIV among these populations, access to primary and ongoing medical or preventive care is often a financial or logistical impossibility. Emergency departments (EDs) serve as an important part of this country's medical safety net, and those without access to primary medical care commonly use EDs as their sole source of care. The ED, therefore, is often the only medical venue available to target patients at increased risk of harboring unrecognized HIV infection, to identify those who are infected, and to link them into ongoing care. Successful performance of these services may ultimately affect this epidemic (Rothman, 2004). CDC RECOMMENDATIONS FOR HIV TESTING The CDC first released recommendations for performing HIV testing in health care settings in 1986, and in that document it encouraged voluntary HIV counseling and testing (CDC, 1986). Revised in 1993, the CDC recommendations focused further on the importance of prevention counseling--the process of engaging a patient in a discussion regarding HIV transmission and risk behaviors--and considered counseling a critical integrated component of testing (CDC, 1993). As the recommendations evolved, they continued to specifically advise that counseling be provided by a professional trained in HIV-specific counseling (CDC, 2001) and, until 2006, strongly endorsed the provision of counseling as part of HIV testing. To increase the absolute number of individuals tested for HIV infection and to minimize barriers associated with HIV testing, the CDC again revised its recommendations in September 2006. The most recent guidelines call for the following: incorporating nontargeted opt-out rapid HIV screening (that is, performing rapid HIV testing on all patients unless they specifically decline) into routine medical practice, integrating informed consent for HIV testing into the general medical consent (previously, separate informed consent had been standard), and uncoupling prevention counseling from HIV testing (that is, instead of providing prevention counseling in all cases, prevention counseling is now only recommended for all patients who test positive for HIV infection) (CDC, 2006). STRATEGIES FOR PERFORMING HIV TESTING IN EDS Several distinct methods of performing HIV testing in EDs have been described and evaluated and include the following three: (1) identifying patients at increased risk of HIV infection and referring them from the ED for outpatient HIV counseling and testing; (2) performing conventional (nonrapid) HIV testing in the ED and referring the patients to obtain test results and counseling at an outpatient clinic; and (3) performing rapid HIV testing, in which patients are tested and receive test results during the same ED visit. Adherence rates with the former two methods are low, and therefore, various models of ED-based rapid HIV testing have been developed to determine how to most effectively test patients at risk of HIV infection. Current rapid HIV testing strategies in EDs have been described and include the following: diagnostic testing (that is, performing rapid HIV testing on the basis of a patient's clinical signs or symptoms), targeted screening (that is, performing rapid HIV testing on all patients with specific HIV-related risk characteristics), and nontargeted screening (that is, performing rapid HIV testing on all patients regardless of their risk characteristics) (Rothman, Lyons, & Haukoos, 2007). …