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J S Lehman

Publications and source records attributed to J S Lehman.

At least 19 recordsLinked to original sources
PubMed2002

What happened to home HIV test collection kits? Intent to use kits, actual use, and barriers to use among persons at risk for HIV infection.

Through sequential cross-sectional surveys, we examined intent to use home HIV test collection kits, actual use and barriers to use among persons at high risk for HIV infection. Interest in kits was assessed in the 1995-96 HIV Testing Survey (HITS, n=1683). Kit use, knowledge of kits and barriers to use were assessed in the 1998-99 HITS (n=1788), after kits had become widely available. When asked to choose among future testing options, 19% of 1995-96 participants intended to use kits. Untested participants were more likely than previously tested HIV-negative participants to choose kits for their next HIV test (p < 0.001). Among 1998-99 participants, only 24 (1%) had used kits; 46% had never heard of kits. Predictors of not knowing about kits included never having been HIV tested and black or Latino race. Common reasons for not using kits among participants aware of home test kits were concerns about accuracy, lack of in-person counselling and cost. Despite high rates of anticipated use, kits have had minimal impact on the testing behaviour of persons at high risk for HIV infection. Increasing awareness of kits, reducing price and addressing concerns about kit testing procedures may increase kit use, leading to more HIV testing by at-risk individuals.

Cross-Sectional Studies↗
PubMed2000

Does HIV reporting by name deter testing? MESH Study Group.

OBJECTIVE: Name-based HIV reporting is controversial in the United States because of concerns that it may deter high-risk persons from being tested. We sought to determine whether persons at risk of HIV infection knew their state's HIV reporting policy and whether they had delayed or avoided testing because of it. DESIGN: A cross-sectional anonymous survey. METHODS: We interviewed 2404 participants in one of three high-risk groups: men who have sex with men (MSM), heterosexuals attending a sexually transmitted disease (STD) clinic, and street-recruited injection drug users (IDU). Participants were asked standardized questions about their knowledge of reporting policies and reasons for having delayed or avoided testing. We recruited in eight US states: four with name-based reporting and four without; all offered anonymous testing at certain sites. RESULTS: Fewer than 25% correctly identified their state's HIV reporting policy. Over 50% stated they did not know whether their state used name-based reporting. Of the total, 480 participants (20%) had never been tested. Of these, 17% from states with name-based reporting selected concern about reporting as a reason for not testing compared with 14% from states without name-based reporting (P = 0.5). Comparing previously tested participants from states with name-based reporting to those from states without, concern about HIV reporting was given as a reason for delaying testing by 26% compared with 13% of IDU (P < 0.001), and for 26% compared with 19% of MSM (P = 0.06). CONCLUSION: Most participants did not know their state's HIV reporting policy. Name-based reporting policies were not associated with avoiding HIV testing because of worry about reporting, although they may have contributed to delays in testing among some IDU.

AIDS Serodiagnosis↗
PubMed1999

Name-based surveillance and public health interventions for persons with HIV infection. Multistate Evaluation of Surveillance for HIV Study Group.

Name-based surveillance of HIV infection is the law in 31 U.S. states but remains controversial. This policy can be advocated solely to support surveillance of the epidemic, but a frequent argument is that it also provides a public health benefit by allowing follow-up of HIV-infected persons. These persons can then receive timely medical care and can be assisted with notifying sex and needle-sharing partners. Few comparative data are available to evaluate the outcomes of these interventions. In five states with name-based surveillance of HIV infection, the Multistate Evaluation of Surveillance for HIV Study Group surveyed a cross-sectional probability sample of persons with AIDS who tested positive for HIV before the date of their AIDS diagnosis. Health department follow-up of a reported HIV infection was not associated with more timely receipt of medical care after a positive HIV test result. Only 8.6% of persons who delayed medical care after their first positive HIV test result gave concern about being reported by name as a reason; no person gave it as the main reason. Persons who were tested anonymously and those who were tested confidentially did not differ in the mean number of sex and needle-sharing partners notified: Those tested anonymously reported personally notifying 3.85 sex and needle-sharing partners, and those tested confidentially reported notifying-personally and through the health department-3.80 partners. Many researchers and policymakers believe that name-based surveillance of HIV infection will have positive or negative effects on partner notification and access to health care. These results suggest that the potential for such effects has been exaggerated.

Anonymous Testing↗
PubMed1998

Multistate evaluation of anonymous HIV testing and access to medical care. Multistate Evaluation of Surveillance of HIV (MESH) Study Group.

CONTEXT: Infection with the human immunodeficiency virus (HIV) is the only infectious disease for which anonymous testing is publicly funded, an exception that has been controversial. OBJECTIVE: To assess whether anonymous HIV testing was associated with earlier HIV testing and HIV-related medical care than confidential HIV testing. DESIGN: Retrospective cohort. SETTING: Arizona, Colorado, Missouri, New Mexico, North Carolina, Oregon, and Texas. PARTICIPANTS: Probability sample of 835 new acquired immunodeficiency syndrome (AIDS) cases reported to the state health department's HIV/AIDS Reporting System from May 1995 through December 1996. All had responded to the AIDS Patient Survey; 643 had been tested confidentially for HIV, and 192 had been tested anonymously. MAIN OUTCOME MEASURES: First CD4+ cell count; number of days from HIV-positive test result to first HIV-related medical care, from first HIV-related medical care to AIDS, and from first HIV-positive test result to AIDS. RESULTS: Persons tested anonymously sought testing and medical care earlier in the course of HIV disease than did persons tested confidentially. Mean first CD4+ cell count was 0.427x 10(9)/L in persons tested anonymously vs 0.267x 10(9)/L in persons tested confidentially. Persons tested anonymously experienced an average of 918 days in HIV-related medical care before an AIDS diagnosis vs 531 days for persons tested confidentially. The mean time from learning they were HIV positive to the diagnosis of AIDS was 1246 days for persons tested anonymously vs 718 days for persons tested confidentially. After adjustment for the subject's age, sex, race/ethnicity, education, income, insurance status, HIV exposure group, whether the respondent had a regular source of care or symptoms at the time of the HIV test, and state residence, anonymous testing remained significantly associated with earlier entry into medical care (P<.001). CONCLUSION: Anonymous testing contributes to early HIV testing and medical care.

AIDS Serodiagnosis↗
PubMed1996

Trends in human immunodeficiency virus seroprevalence among injection drug users entering drug treatment centers, United States, 1988-1993.

National unlinked sentinel surveillance data were used to describe trends in prevalent human immunodeficiency virus infection among injection drug users entering drug treatment programs in the United States from 1988 through 1993. During this 6-year period, unlinked testing was performed on 70,882 specimens from injection drug users at 60 sentinel sites. The annual change in seroprevalence was estimated for each site by odds ratios obtained from logistic regression models fit within site-specific age and race/ethnicity subgroups. Overall trends for age and race/ethnicity subgroups across sites were described by summary odds ratios calculated using the inverse variance method. A decrease was observed among younger (age less than 30 years) whites both in areas with high (10% or higher) and low (less than 10%) prevalence, although this decrease was significant only in high-prevalence areas (odds ratio = 0.90, 95% confidence interval 0.81-0.99). Seroprevalence also decreased among older whites in high-prevalence areas, although this decrease was not significant (odds ratio = 0.95, 95% confidence interval 0.89-1.00). Seroprevalence remained stable among all other age and race/ethnicity subgroups. Stable seroprevalence among the dynamic population of injection drug users entering treatment suggests continued transmission among these individuals in both high- and low-prevalence areas of the United States.

Adult↗
PubMed1994

HIV infection among non-injecting drug users entering drug treatment, United States, 1989-1992. Field Services Branch.

OBJECTIVE: To describe HIV seroprevalence among non-injecting drug users (non-IDU) entering sentinel drug treatment centers in the United States. DESIGN: Anonymous, blinded (unlinked) HIV seroprevalence surveys. SETTING: Sixty-eight sentinel drug treatment centers in 37 United States metropolitan areas. PARTICIPANTS: Consecutive sample of clients admitted to sentinel drug treatment centers from January 1989 through December 1992. Of 84,617 clients, 37,633 (44.5%) had used illicit drugs but reported no injecting drug use since 1978. MAIN OUTCOME MEASURES: Center-specific, metropolitan area-specific, and national median HIV seroprevalence rates. RESULTS: National median center-specific HIV seroprevalence among non-IDU was 3.2% (range, 0-15.2%). Rates varied widely by geographic area. Median rates were highest in the northeast (5.6%; range, 0-15.2%), intermediate in the south (3.4%; range, 0.6-8.0%), and generally lower throughout the rest of the country: midwest (1.3%; range, 0-3.1%) and west (1.8%; range, 0-14.5%). When stratified by treatment center, there were few statistically significant differences in seroprevalence among African Americans, Hispanics and whites. The median rate was 3.4% among men and 2.7% among women. Rates among non-IDU were lower than among IDU attending the same drug treatment centers, but consistently higher than among heterosexual patients attending sexually transmitted disease clinics in the same metropolitan areas. CONCLUSIONS: HIV seroprevalence among non-IDU entering drug treatment is high in many metropolitan areas. HIV prevention and education efforts in drug treatment centers should target sexual as well as drug-use risk reduction for all clients.

Adolescent↗
PubMed1994

HIV infection among homeless adults and runaway youth, United States, 1989-1992. Field Services Branch.

OBJECTIVES: Homeless persons have an increased risk of HIV infection because of a high prevalence of HIV-related risk behaviors. These include drug use, sexual contact with persons at risk for HIV infection, and the exchange of sex for drugs. The objectives of this investigation were to describe HIV seroprevalence rates in homeless adults and runaway youth. METHODS: In 1989, the Centers for Disease Control and Prevention began collaboration with state and local health departments to conduct HIV seroprevalence surveys in homeless populations. Unlinked HIV seroprevalence surveys were conducted in 16 sites; 11 provided medical services primarily to homeless adults, and five to runaway youth aged < 25 years. RESULTS: From January 1989 through December 1992, annual surveys were conducted in 16 sites in 14 cities. Site-specific seroprevalence rates ranged from 0-21.1% (median, 3.3%). Among homeless adults in three sites, rates were higher among men who had sex with other men and those who injected drugs than among persons with other risk exposures (28.9 versus 5.3%). In general, rates were higher for heterosexual men than for women and higher among African Americans than whites. In sites providing services to homeless youth, HIV seroprevalence rates ranged from 0-7.3% (median, 2.3%). CONCLUSIONS: These data indicate that HIV infection among homeless adults and runaway youth is an important public health problem. HIV prevention and treatment should be integrated into comprehensive health and medical programs serving homeless populations.

Adolescent↗
PubMed1991

HIV infection among women entering the New York State correctional system.

Human immunodeficiency virus infection is the leading medical problem among prison inmates in several states. In 1988 a blinded seroprevalence study was conducted on 480 New York female prison entrants to determine the prevalence of and risk factors for HIV infection in this population. Ninety (18.8 percent) women were HIV-seropositive. Seroprevalence was highest among women ages 30-39 (25.0 percent) and varied by ethnicity (Hispanics, 29.4 percent; Blacks, 14.4 percent; Whites, 7.1 percent) and residence (New York City, 23.8 percent; Upstate, 5.1 percent). Nearly half (44.9 percent) of the 136 acknowledged intravenous drug users and one-third (33.8 percent) of the 71 women with a positive syphilis serology were HIV-seropositive. There was no difference in fertility histories between seropositive and seronegative women, and two of 21 pregnant women were seropositive. This study led to increased clinical and prevention services for this high-risk population.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Idiopathic hypertrophic subaortic stenosis. By Irwin M. Freundlich, J. Thomas McMurray, J. Stauffer Lehman, 1967.

In patients with a systolic ejection murmur and without a history of rheumatic fever, a probable diagnosis of idiopathic hypertrophic subaortic stenosis (IHSS) can be made from the roentgenologic findings. Left ventricular enlargement, associated at times with minimal left atrial enlargement, without intracardiac calcification and with a normal ascending aorta are the most frequent roentgen findings. For a positive diagnosis, a pressure gradient within the left ventricle and hypertrophic muscular obstruction should be demonstrated by angiocardiography.

Cardiomyopathy, Hypertrophic↗
PubMed1983

Relationship of electrocardiographic abnormalities and seropositivity to Trypanosoma cruzi within a rural community in northeast Brazil.

The relationship of infection with Trypanosoma cruzi to ECG abnormalities was studied in a defined population in rural Bahia, Brazil. Of 644 individuals 10 years of age or older who had complement fixation tests for antibodies to T. cruzi and ECGs, 53.7% were seropositive. ECG abnormalities were more common in seropositive individuals than in seronegative individuals, and more common in men than in women. The peak prevalence rate of abnormal ECGs occurred among seropositive individuals between 25 and 44 years of age; in this age group ECG abnormalities occurred 9.6 times more frequently among seropositive individuals than among seronegative individuals. The most common abnormalities were ventricular conduction defects, and right bundle branch block with or without fascicular block occurred in 10.7% of the infected population. PR intervals were longer in seropositive individuals than in seronegative individuals. Ventricular extrasystoles were slightly more common in seropositive individuals. A declining prevalence rate of abnormal ECGs among older seropositive individuals suggested selective mortality due to Chagas' heart disease.

Adolescent↗
PubMed1981

A three year follow-up of chemotherapy with oxamniquine in a Brazilian community with endemic schistosomiasis mansoni.

Oral oxamniquine was tested as a control strategy for endemic schistosomiasis in a rural area of Bahia, Brazil. Adults were treated with a single dose (12.5 to 15 mg per kg) and children (less than 12 years old) with a total of 20 mg per kg in two doses. The 191 (infected) persons treated represented 69% of the infected population in the study area. Follow-up stool examinations (Kato-Katz method) at one, 3, 6, 13, 25 and 33 months showed the cure rate declining from 80% at three months to 46% at 33 months. Over one half of those not cured showed a decrease in egg counts throughout the follow-up which, after 33 months, remained 66% below the pre-treatment levels. Stool examinations conducted on all study area residents during three years before chemotherapy showed the prevalence and intensity of Schistosoma mansoni infection to be high and stable. 33 months after the chemotherapy the prevalence was 41% and for infected individuals the geometric mean egg count was 121 epg, a decline of respectively 35% and 40% from pre-treatment levels for each index. Chemotherapy of infected persons with oxamniquine protected the community as a whole from high worm burdens for almost three years, although at this point the prevalence began to rise towards pretreatment levels.

Adult↗
PubMed1979

Control of schistosomiasis: report of a workshop.

Nineteen scientists, field workers, and representatives of funding agencies active in schistosomiasis research and control met in Bellagio, Italy in October 1977 to attempt to evaluate the effectiveness of current control methods and what might be accomplished with available technology. The deliberations included summaries of knowledge on the biology, transmission, and control of schistosomiasis and assessment of major control programs and methodologies. The groups concluded that in the major endemic areas considerable gains in control of schistosomiasis could be made with current technology. However, maintenance of control in most countries, and establishment of serious control programs in countries in which schistosomiasis is a less severe public health problem, would require development of less expensive modalities which would need little monitoring and possibly have benefits extending beyond schistosomiasis control.

Agriculture↗
PubMed1978

Stability of faecal egg excretion in Schistosoma mansoni infection.

Stability of Schistosoma mansoni egg excretion was studied in 23 residents of a rural endemic area in North-east Brazil where the over-all prevalence rate was 87% and the peak geometric mean egg excretion was 308 eggs/ml (Bell method) in the 10 to 14-year-old age group. Stool examinations by the Kato method were performed for three to four consecutive days each month for three consecutive months. Both raw and transformed data showed significant stability of S. mansoni egg excretion from day to day and month to month in this population. A single Kato examination detected 68% of individuals who were excreting more than 400 eggs per gramme. Although S. mansoni egg excretion is stable over time, identifying individuals with high egg excretion in endemic populations requires sensitive quantitative methods.

Adolescent↗
PubMed1978

House construction, triatomine distribution, and household distribution of seroreactivity to Trypanosoma cruzi in a rural community in northeast Brazil.

Household distribution of seroreactivity to Trypanosoma cruzi in inhabitants was analyzed in relation to house construction and the distribution of Panstrongylus megistus, the principal domestic vector of Chagas' disease in a rural area in northeast Brazil. No children residing in mud-brick houses were seroreactive to T. cruzi. The highest rates of seroreactivity occurred in residents of unplastered mud-stick houses, and were twice as high as those found in persons living in mud-brick houses or plastered mud-stick houses. Two-thirds of seroreactive children in this area resided in unplastered mud-stick houses. Over 90% of the P. megistus infestations were found in mud-stick houses. Mud-brick houses had the lowest infestation rates of P. megistus and the lowest household rates of seroreactivity to T. cruzi.

Adult↗