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S Berkley

Publications and source records attributed to S Berkley.

14 recordsLinked to original sources
PubMed1995

International aspects of the AIDS/HIV epidemic.

This review provides the reader with pertinent information on the epidemiology, prevention, and new technologies of the ongoing HIV pandemic. These aspects are key to international policy discussions surrounding the public health response to the international spread of HIV. Our understanding of the impact of AIDS on other diseases is evolving, as is our insight into the demographic and economic effects of the epidemic on the global community. Observations on the success of certain prevention strategies allow rational allocation of resources in newly affected epidemic areas. Information on the origin and nature of HIV transmission exemplifies the phenomenon of global emerging infections. As world populations are brought closer together through transportation, communication, trade, and commerce, insight into emerging infections of epidemic potential becomes increasingly important to the practitioner of public health. Although important, legal and social aspects of the epidemic will not be emphasized here. The epidemics of HIV/AIDS in the United States and Europe are not reviewed here. The global pandemic has recently been described in an overview in this publication to which the reader is also referred.

AIDS Vaccines↗
PubMed1994

Incidence of HIV-1 infection in a rural region of Uganda.

OBJECTIVE: To determine the incidence of infection with HIV-1 and the risk factors associated with seroconversion in three geographical strata of a rural Ugandan district. DESIGN: Serological, sociodemographic, and behavioural surveys of everyone aged 13 or more in 21 randomly selected communities at baseline and one year later. SETTING: Rural population of Rakai district, southwestern Uganda, residing in main road trading centres, secondary trading villages, and agricultural villages. SUBJECTS: In 1989, 1292 adults provided a blood sample and interview data; one year later, 778 survivors (77%) who had been seronegative at baseline provided follow up data. MAIN OUTCOME MEASURES: Incidence of HIV infection in relation to individual characteristics and risk factors, including place of residence. RESULTS: Incidence of HIV infection in all adults was 2.1/100 person years of observation (SE 0.5 (95% confidence interval 1.1 to 3.1)); in people aged 15-39 the incidence was 3.2/100 person years. Incidence was highest in men and women aged 20-24 (9.2/100 person years (3.9) and 6.8/100 person years (2.9) respectively). Risk factors significantly associated with seroconversion were age 24 and under and two or more sexual partners. Between the surveys the proportion of all respondents reporting high risk behaviour (two or more partners) significantly increased from 8.9% to 12.3%. CONCLUSIONS: Despite preventive programmes and substantial knowledge about AIDS the incidence of HIV infection remains high in this rural population. Prevention aimed at vulnerable rural communities is urgently needed to contain the HIV epidemic.

Adolescent↗
PubMed1990

AIDS and HIV infection in Uganda--are more women infected than men?

In countries in sub-Saharan Africa, HIV is transmitted primarily heterosexually. HIV infection and AIDS in women not only affects women's health but also has implications for the other members of society. Maternal infection is the source of most childhood HIV infection in Africa and maternal health is a strong predictor of child survival. In Uganda, a review of passive AIDS surveillance has shown almost equal numbers of clinical cases reported in men and women. However, in three population-based HIV serosurveys, women were consistently found to have a higher infection rate (approximately 1.4 times) than men. In addition, both AIDS case surveillance and seroprevalence studies demonstrate an earlier age of presentation and mean age of infection in women. The higher rate of HIV infection in women suggests either differential rates of transmission between women and men, higher rates of female sexual exposure to infected men, or longer survival among HIV-infected women compared with men. Although further studies are required to illuminate both the biology and the epidemiology of heterosexual HIV transmission in Africa, these findings of earlier and higher infection rates in women have important implications for women's health and child survival in Uganda and indicate the need for specially targeted interventions to reduce transmission in this group.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The association of genital ulcer disease and HIV infection at a dermatology-STD clinic in Uganda.

At Mulago Hospital in Kampala, Uganda, 270 consecutive patients at the dermatology and sexually transmitted disease (STD) clinic were enrolled in a study to evaluate the association of clinical STD syndromes and human immunodeficiency virus (HIV) infection. Female patients became sexually active earlier than male patients and were younger at marriage. Persons with a history of an STD during the preceding 5 years were more likely to be HIV infected (43%) than those without such a history (26%; OR 2.08, 95% C.I. 1.17, 3.73). Examination at the time of the visit demonstrated an association between genital ulcers and HIV infection in male and female patients (OR 2.21, 95% C.I. 1.08, 4.53, and OR 8.54, 95% C.I. 1.45, 87.55, respectively) but no association between HIV and urethritis or vaginal discharge. The etiologic fraction for HIV infection of genital ulcers was 0.218. Men with a history of contact with prostitutes were more likely to be HIV infected than those without contact (50% versus 28%, p less than 0.05), but once controlled for STDs, this relationship was no longer significant. This study confirms other studies from East Africa that have shown a relationship between genital ulcers and HIV infection. This finding, in the presence of no association between other STD syndromes and HIV infection, suggests that genital ulcers may be truly associated with HIV infection rather than a marker of high-risk activities.

Adolescent↗
PubMed1989

Surveillance for AIDS in Uganda.

In the developed world, surveillance for AIDS has provided up-to-date information for researchers, clinicians, public health workers and policy makers. In Africa, however, there is no standardized format or methodology for AIDS surveillance. In August 1987, Uganda developed a clinical case definition for AIDS reporting, based upon the World Health Organization (WHO) clinical case definition for AIDS in Africa and began formal surveillance. Surveillance is passive and primarily hospital-based. At the end of July 1988, 5142 cases of AIDS had been reported to the Ministry of Health; 4583 (89%) had confirmatory HIV-antibody testing. Of the 4938 (96%) cases that had their sex recorded, 2358 (48%) were male and 2580 (52%) were female. The mean age of 28.4 years for male patients is higher than that of 24.4 years for female patients (P less than 0.0001). Only 18 (less than 1%) cases have been reported in children between 5 and 12 years of age. Case reports are returned via the District Medical Officers to the Ministry of Health where they are entered into a microcomputer from which a monthly report is generated for feedback to the reporting stations. Here we describe a simple national reporting system to follow the progression of the AIDS epidemic which could be established in Africa using limited resources.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Evaluation of the WHO clinical case definition for AIDS in Uganda.

Infections with human immunodeficiency virus are common in areas of the world where laboratory testing and sophisticated diagnostic facilities are unavailable. A World Health Organization clinical case definition for acquired immunodeficiency syndrome was developed in 1985 for use in such areas. In 1987, we tested this definition on 1328 inpatients and outpatients in 15 hospitals throughout Uganda. Five hundred sixty-two patients (42%) were positive by enzyme-linked immunosorbent assay for human immunodeficiency virus antibody. The World Health Organization definition had a sensitivity of 55%, a specificity of 85%, and a positive predictive value of 73%. Modification of the case definition by excluding a known cough from tuberculosis as a minor criteria decreased sensitivity slightly to 52%, but specificity and positive predictive value increased to 92% and 83%, respectively. Amenorrhea, although not specifically asked about, was a symptom noted by many female patients (26% of females who were positive by enzyme-linked immunosorbent assay); as a symptom indicative of human immunodeficiency virus infection, amenorrhea had a specificity of 99%, with a positive predictive value of 89%. These findings support the generalizability of the World Health Organization clinical acquired immunodeficiency syndrome definition and its use (especially the modified version) in areas of Uganda without sophisticated facilities.

AIDS Serodiagnosis↗