Number Of AIDS Deaths Research Articles

Corruption and averting AIDS deaths

Abstract This paper looks at the impact of corruption on the effectiveness of antiretroviral drugs in preventing AIDS deaths and the potential channels that generate this relationship. This is based on a unique panel dataset of countries in sub-Saharan Africa, which combines information on all imported antiretroviral drugs (ARVs) from the World Health Organization’s Global Price Reporting Mechanism, with measures of corruption, estimates of the HIV prevalence, and the number of AIDS deaths in each year and in each country. Countries with higher levels of corruption experience a significantly smaller drop in AIDS deaths as a result of the same quantity of ARVs imported. This is robust to different measures of corruption and to a measure of overall death rates as well as HIV-specific death rates as the outcome. A case-study analysis of the Kenyan experience illustrates one potential mechanism for the observed effect, demonstrating that disproportionately more clinics begin distributing ARVs in areas that are predominantly represented by the new leader’s ethnic group.

Rotimi Fani-Kayode's Ecstatic Antibodies

In December of 1989, after a mere six-year artistic career, Rotimi Fani-Kayode died from complications due to AIDS in a Brixton, London hospital. In that brief span, the gay Nigerian-British photographer produced one of the most moving portraits of human sexuality and spiritual transcendence. Doubly marginalized—rejected by his family and society—Fani-Kayode’s photographic vision lifted him out of painful abjection and loss and left behind a profound message of hope and self-love. Fani-Kayode first came to London in 1966 after fleeing civil war in his home country of Nigeria. His father, a prominent revolutionary and politician known as “Fani-Power,” had been a chieftain of Ife, the ancestral Yoruba capitol, before being deposed in a military coup. Fani-Kayode was eleven at the time, just becoming aware that he was different from other boys. A growing attraction to his own sex made Fani-Kayode a pariah in socially conservative Nigeria, but in London his very skin marked him as Other. In 1976, he moved to the United States to study at Georgetown University. By the time he received his MFA from New York’s Pratt Institute in 1983, the AIDS epidemic was in full swing. Not much was known about the virus then, except that it disproportionately affected gay men. Cases had been reported in thirty-three countries, and in the U.S., of 2,807 cases, 2,118 had died. No federal funds had been directed to finding a cure for AIDS or preventing its spread. Ronald Reagan was poised for reelection, and Margaret Thatcher had just retained leadership of Parliament by the largest electoral margin since the Second World War. Wall Street was booming; Gorbachev’s Soviet Union was in steep decline. Ruthless capitalism, it seemed, had won the day. The New Right willfully ignored the growing number of AIDS deaths because the disease seemed to affect only the margins of society—homosexuals

Impact of interventions targeting unhealthy alcohol use in Kenya on HIV transmission and AIDS-related deaths.

BackgroundHIV remains a major cause of preventable morbidity and mortality in Kenya. The effects of behaviors that accompany unhealthy alcohol consumption are a pervasive risk factor for HIV transmission and progression. Our objective was to estimate the portion of HIV infections attributable to unhealthy alcohol use and to evaluate the impact of hypothetical interventions directed at unhealthy alcohol use on HIV infections and deaths.MethodsWe estimated outcomes over a time horizon of 20 years using a computer simulation of the Kenyan population. This computer simulation integrates a compartmental model of HIV transmission with a mechanistic model of HIV progression that was previously validated in sub-Saharan Africa. Integration of the transmission and progression models allows simultaneous consideration of alcohol's effects on HIV transmission and progression (e.g., lowering antiretroviral adherence may increase transmission risk by elevating viral load, and may simultaneously increase progression by increasing the likelihood of AIDS). The simulation considers important aspects of heterogeneous sexual mixing patterns, including assortativeness of partners by age and activity level, age-discordant relationships, and high activity subgroups. Outcomes included number of new HIV infections, number of AIDS deaths, and infectivity (number of new infections per infected person per year).ResultsOur model estimated that the effects of behaviors accompanying unhealthy alcohol consumption are responsible for 13.0% of new HIV infections in Kenya. An alcohol intervention with effectiveness similar to that observed in a published randomized controlled trial of a cognitive-behavioral therapy-based intervention in Kenya (45% reduction in unhealthy alcohol consumption) could prevent nearly half of these infections, reducing their number by 69,858 and reducing AIDS deaths by 17,824 over 20 years. Estimates were sensitive to assumptions with respect to the magnitude of alcohol's underlying effects on condom use, antiretroviral therapy adherence, and sexually transmitted infection prevalence.ConclusionsA substantial number of new HIV infections in Kenya are attributable to unhealthy alcohol use. An alcohol intervention with the effectiveness observed in a published randomized controlled trial has the potential to reduce infections over 20 years by nearly 5% and avert nearly 18,000 deaths related to HIV.

Spectrum: a model platform for linking maternal and child survival interventions with AIDS, family planning and demographic projections

Background LiST is implemented in Spectrum, a modular computer program designed to examine the impact of interventions on health outcomes. A typical LiST application uses three other modules in Spectrum addressing demography, family planning and HIV/AIDS.Methods The demographic module projects the population by single age and sex over time and uses LiST calculations of the mortality rates by age group to calculate the number of deaths. The family planning module uses the proximate determinants of fertility framework to calculate the effects of increasing contraceptive use on the total fertility rate and, thus, the number of births. The HIV/AIDS module calculates the consequences of HIV epidemic trends on child mortality and the effects of programs to prevent mother-to-child transmission of HIV, cotrimoxazole prophylaxis and anti-retroviral treatment on the number of AIDS deaths.Results These modules provide LiST with estimates of the number of children and number of deaths by single age as they are affected by changes in fertility through family planning and interventions to prevent the transmission of HIV or delay AIDS death.Conclusions Integrating LiST within the existing Spectrum system of planning models expands the scope of LiST to include the effects of demographic change, family planning and HIV interventions.

HIV model incorporating differential progression for treatment-naive and treatment-experienced infectives

We formulate an HIV/AIDS deterministic model which incorporates differential infectivity and disease progression for treatment-naive and treatment-experienced HIV/AIDS infectives. To illustrate our model, we have applied it to estimate adult HIV prevalence, the HIV population, the number of new infectives and the number of AIDS deaths for Botswana for the period 1984 to 2012. It is found that the prevalence peaked in the year 2000 and the HIV population is now decreasing. We have also found that under the current conditions, the reproduction number is Rc approximately 13, which is less than the 2004 estimate of Rc approximately equal 4 by [11] and [13]. The results in this study suggest that the HAART program has yielded positive results for Botswana.

Estimates of eligibility for antiretroviral treatment (ART) and projected ART impact on AIDS mortality among South African educators

The study assessed the proportion of HIV-infected educators that need antiretroviral treatment (ART) according to current criteria, and estimated the impact of ART on AIDS mortality by modelling scenarios with and without access to ART. Specimens for HIV testing were obtained from 17 088 educators and a sub-sample of 444 venous blood specimens from HIV-positive educators was selected for a CD4 cell count analysis. The Spectrum model package was used for estimating AIDS-associated mortality and projecting the impact of ART scenarios. The results of the CD4 cell count analysis in the HIV-positive educator study population showed that 8% had fewer than 100, 22% fewer than 200, 52% fewer than 350, and 72% fewer than 500 CD4 cells/mm3. Based on the proportion of HIV-positive educators with a CD4 cell count < 200 cells/mm3 we estimated that in 2005 approximately 10 700 educators would need ART according to current SA government guidelines. For the baseline scenario without ART the number of AIDS deaths among HIV-infected educators was projected to increase from 1 992 deaths in 2000 to 5 260 in 2010. The number of projected AIDS deaths in the educator study population was estimated to be 4 414 in 2005, with almost 50% of the AIDS deaths occurring in the 35 – 44 age group.The estimates suggest that in 2005 9.1% of the HIV-infected educators, or 1.2% of the total educator population, will be dying of AIDS. By 2010, a reduction of almost 50% in AIDS deaths was estimated for the treatment scenario with 90% ART coverage, compared with the baseline scenario without treatment. The ART impact scenarios illustrate that a relatively high ART coverage would be needed to ensure a substantial impact of ART on HIV/AIDS-associated mortality.

Trends and characteristics of AIDS mortality in the Rio de Janeiro city after the introduction of highly active antiretroviral therapy

We examined the characteristics of AIDS mortality in Rio de Janeiro city from 1995 to 2003. During this period, highly active antiretroviral therapy with protease inhibitors was made available, and it changed the pattern of the epidemics. There was a 47.5% reduction in the number of AIDS deaths within the period, with an increase in the proportion of women among the deceased; their schooling was lower than that of the men, similar to the trends of the national-level epidemics. The main place of death changed from university hospitals to emergency rooms. The proportion of cases reported to the National Diseases Surveillance System (SINAN) reported only through the death certificate remained high. Although there is free distribution of antiretrovirals by the public health system, many patients still lack access to diagnosis and treatment. We need to give priority to access to anti-HIV testing and treatment, to increase the quality of care and to look into the issue of adherence in order to further reduce AIDS mortality.

Integrating HIV Prevention and Treatment: From Slogans to Impact

Background Through major efforts to reduce costs and expand access to antiretroviral therapy worldwide, widespread delivery of effective treatment to people living with HIV/AIDS is now conceivable even in severely resource-constrained settings. However, the potential epidemiologic impact of treatment in the context of a broader strategy for HIV/AIDS control has not yet been examined. In this paper, we quantify the opportunities and potential risks of large-scale treatment roll-out. Methods and Findings We used an epidemiologic model of HIV/AIDS, calibrated to sub-Saharan Africa, to investigate a range of possible positive and negative health outcomes under alternative scenarios that reflect varying implementation of prevention and treatment. In baseline projections, reflecting “business as usual,” the numbers of new infections and AIDS deaths are expected to continue rising. In two scenarios representing treatment-centered strategies, with different assumptions about the impact of treatment on transmissibility and behavior, the change in the total number of new infections through 2020 ranges from a 10% increase to a 6% reduction, while the number of AIDS deaths through 2020 declines by 9% to 13%. A prevention-centered strategy provides greater reductions in incidence (36%) and mortality reductions similar to those of the treatment-centered scenarios by 2020, but more modest mortality benefits over the next 5 to 10 years. If treatment enhances prevention in a combined response, the expected benefits are substantial—29 million averted infections (55%) and 10 million averted deaths (27%) through the year 2020. However, if a narrow focus on treatment scale-up leads to reduced effectiveness of prevention efforts, the benefits of a combined response are considerably smaller—9 million averted infections (17%) and 6 million averted deaths (16%). Combining treatment with effective prevention efforts could reduce the resource needs for treatment dramatically in the long term. In the various scenarios the numbers of people being treated in 2020 ranges from 9.2 million in a treatment-only scenario with mixed effects, to 4.2 million in a combined response scenario with positive treatment–prevention synergies. Conclusions These analyses demonstrate the importance of integrating expanded care activities with prevention activities if there are to be long-term reductions in the number of new HIV infections and significant declines in AIDS mortality. Treatment can enable more effective prevention, and prevention makes treatment affordable. Sustained progress in the global fight against HIV/AIDS will be attained only through a comprehensive response.

Projecting the demographic consequences of adult HIV prevalence trends: the Spectrum Projection Package

This paper describes the software package Spectrum, which is a modular program that is used to examine the consequences of current trends and future program interventions in reproductive health. It...

Trends in AIDS incidence and mortality in Brazil, 1985 to 1998

AIDS mortality is decreasing in Brazil, especially after the introduction of anti-retroviral therapy. A study was conducted to evaluate AIDS incidence and mortality in a certain area of Brazil. The number of AIDS deaths according to sex in the study period, obtained from registry sources, were used as the numerator of mortality rates. From 1985 to 1995, deaths with underlying cause classified as code 279/1 in the 9th International Classification of Diseases (ICD) and, from 1996 onwards, B20 to B24 codes in the 10th Review were considered AIDS cases. SINAN/MS disease compulsory notification data were used as the numerator of incidence rates. Percentage of variation of the incidence and mortality rates were calculated using a Poisson regression model. In the study period, there were 1,211 AIDS cases and 501 deaths. AIDS incidence increased 21.6% during this period (p<0.05) in both sexes, though higher among women. The mortality rates increased exponentially (122.5%) from 1985 to 1991. From 1991 to 1998, mortality remained steady among men but continued to rise among women. Stabilization of AIDS mortality in men may be a reflection of large utilization of anti-retroviral therapy. Increasing mortality rate among women could be due to different epidemic dynamics according to sex. This trend is different from the observed in the rest of Brazil, where there has been a fall in AIDS mortality for both sexes since 1991.

Estimativa do número de órfãos decorrentes da AIDS materna, Brasil, 1987-1999

This study proposes a procedure to estimate the number of orphans due to maternal AIDS. The procedure estimates the number of orphans by calendar year, multiplying the cumulative fertility rate by the number of AIDS deaths among women aged 15-49 years. Because the procedure refers to the number of children that are alive, the estimate is adjusted by contemplating the proportion of pediatric AIDS cases due to vertical transmission and the probability of survival in the 5-9-year age group. To estimate the number of AIDS orphans in Brazil from 1987 to 1999, the procedure was applied by stratifying according to geographical region, taking into account the differences in regional fertility rates, completeness of death reporting, and misclassification of AIDS-related deaths as due to other causes. The total number of cumulative AIDS orphans for 1987-99 was estimated at approximately 30,000.

Health Locus of Control and HIV/AIDS Knowledge among Mexican American Young Adolescents

The number of AIDS deaths within the United States disproportionally affects Hispanics, indicating the need for HIV/AIDS prevention strategies that specifically target minority populations. Intervention development should take into account Mexican American cultural beliefs about health maintenance and illness causation. The purpose of this study was to investigate, among young Mexican American adolescents, perceived control over health and health behaviors in relation to HIV/AIDS knowledge. Subjects were 2 72 Mexican American adolescents ranging in age from 12 to 14 years, and data were gathered through a self-report instrument consisting of an HIV/AIDS knowledge inventory, health locus of control scale, and selected demographic variables. Analysis indicated that while those who had received HIV/AIDS instruction in school had greater HIV/AIDS knowledge than those who did not, belief in powerful others controlling one's health emerged as the most dominant factor for both groups. Additionally, as knowledge increased, belief that one's health was the result of chance or fate decreased while internal control appeared to be unaffected by HIV/AIDS knowledge. Findings suggest that HIV/AIDS interventions emphasize family, role models, and community leaders as a means of fostering positive powerful other locus of control influence in the Mexican American learner.

No Plateau for HIV/AIDS Epidemic in US Women

TWO MAJOR messages emerged from the third National Conference on Women and HIV, held last month in Pasadena, Calif: Women have become the fastest-increasing new group of AIDS patients in the United States, and they as a group are being overlooked. The acquired immunodeficiency syndrome has become the third leading cause of death among women in the 25- to 44-year-old age group, and the disease ranks first as cause of death among African-American women in that group. See also p 1752. According to the Centers for Disease Control and Prevention (CDC), Atlanta, Ga, in the first 2 quarters of 1996, the estimated number of AIDS deaths was 13% lower than the estimated number of AIDS deaths in 1995. Deaths declined in men by 15% but increased among women by 3%. Earlier in the US epidemic, in 1985, women accounted for only 7% of cases; while in 1996, the percentage of

Mathematical Models and the Design of Public Health Policy: Hiv and Antiviral Therapy

Antiviral therapy acting to increase the incubation period of HIV-1, without significantly reducing infectiousness, will necessarily increase the prevalence of infection, unless accompanied by appropriate levels of behaviour change. However, the number of AIDS-related deaths may decline despite a large increase in numbers of seropositives, if the latter is balanced by an increase in the average life-span of an infected individual. In a homogeneous population, treatment will be of benefit to both the individual and the community if the basic reproductive rate of the disease is high, provided that the coverage and efficacy are also high. However, therapy may be of detriment to the community (i.e., produce an increase in the number of AIDS deaths) under a combination of low drug efficacy and high coverage or vice versa, if the basic reproductive rate is low. In a behaviourally heterogeneous population with proportionate mixing, the outcome of treatment is extremely sensitive to the rate of cessation of sexual activity. Within certain parameter combinations, the sensitivity of the system to the rate of cessation of sexual activity can cause a larger decrease in population size at higher basic reproductive rates. This is in direct contrast to the homogeneous case, where the outcome of therapy is less likely to be perverse at higher values of the basic reproductive rate. The conclusions of this paper are not in conflict with the moral imperative of providing treatment for individuals infected with HIV.

A stochastic model for the aids epidemic

A stochastic model describing the dynamics of the HIV-seropositive and AIDS population is derived under fairly general conditions. A special case is applied to AIDS data for Alberta and used to predict cumulative AIDS cases, the size of the HIVpopulation, the number of living AIDS cases, cumulative AIDS deaths and number of AIDS deaths by year.

AIDS summit declaration calls for global co-operation.

Governments and health workers worldwide must co-operate in the face of rapidly escalating numbers of AIDS deaths and HIV infection. This was the message from last week's world AIDS Summit in London.