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Nurturing for careers in drug use and crime: conduct norms for children and juveniles in crack-using households.

A very sizable proportion of juvenile delinquents and adult criminals come from backgrounds and family kin systems having deviant parents or kin. This paper provides a focus upon the child-rearing practices directly observed by trained ethnographer during a case study of one highly criminal, drug-using household/kin network. The concrete expectations (and actual practices--called conduct norms--with which the household adults respond to (or "nurture") children and juveniles are delineated. While children are taught to "pay attention" to what adults do, adults typically model various deviant activities and rarely engage in conventional behaviors. Drug-using, and especially crack-using, men and women are expected not to raise (or financially support) children born to them; other kin expect to raise children of such unions. Children are not expected, nor able, to develop strong affective bonds with any household adults, and receive little or no psychological parenting. Adults do not take strong measures to protect children/juveniles from harm, and often adults are a major source of harm. In many ways the conduct norms in such crack-using households are well designed to "nurture" those persons who will be antisocial as children, delinquents as juveniles, and become criminals, drug misusers, and prostitutes in adulthood--and who have very few chances to become conventional adults.

Adolescent↗

Crack cocaine use in rural migrant populations: living arrangements and social support.

Correlates of crack cocaine use were studied among a targeted sample of migrant workers and their sexual partners (n = 571) in rural Southern Florida. Employment among men and recent drug-user treatment among men and women are positively related to crack use, as is involvement in crime and prostitution. Among women but not men, living with children is negatively related to crack use. Drug use and HIV prevention programs should intervene with individuals and their families and social groups. Migrant workers and their sexual partners also need effective drug-user treatment with long-term relapse prevention services.

Adult↗

Pathology of suspected acquired immune deficiency syndrome in children: a study of eight cases.

Biopsy and/or autopsy material from lymphoreticular and other organs was studied in 8 children with suspected acquired immune deficiency syndrome (AIDS). One or both parents of each of these children had one or more of the recognized risk factors for AIDS, such as intravenous drug abuse, prostitution, Haitian origin. The following histologic patterns were noted in the lymph nodes: (1) follicular hyperplasia with normocellular paracortex, (2) follicular hyperplasia with depletion of paracortex, and (3) atrophy of follicles with depletion of paracortex. Lymphoid interstitial pneumonitis (LIP), a previously unreported lesion in AIDS, was present in 4 cases. It is suggested that the pulmonary lymphoid lesion may be part of a more generalized lymphoid hyperplasia involving B cells. The gross and microscopic features of the thymus, available in 2 of the 8 cases, indicated that the immunologic defect in these children was not of congenital type. Pathologic findings can be helpful in the diagnosis of the syndrome when correlated with clinical and immunologic features of suspected cases and of the pulmonary lesion. The latter is of importance in deciding the type of therapy to be given for the pulmonary disease process.

Acquired Immunodeficiency Syndrome↗

Bad habits and bad genes: early 20th-century eugenic attempts to eliminate syphilis and associated "defects" from the United States.

American eugenists in the early 20th century distinguished "degenerates," including syphilitics, prostitutes, alcoholics and criminals, from the "normal" population by their particular bad habits. From eugenists' viewpoint, these bad habits were derived from bad character, a flaw that stemmed from an individual's bad genes. This essay explores how eugenists during this period characterized syphilitics and those with associated character "defects" in terms of heredity. Additionally, it examines the methods eugenists most frequently advocated to rectify these bad habits. These methods included marriage restriction, immigration control and reproductive sterilization. Overall, eugenists directed their efforts not so much at the "degenerate" as at his or her germ line.

Disease Management↗

Causes of sudden death related to sexual activity: results of a medicolegal postmortem study from 2001 to 2005.

Sexual activity (SA), combined with organic heart disease, may cause sudden death (SD). However, the causes of SD related to SA are not known well. The aim of this study was to assess the causes of SD related to SA. From August 2001 to November 2005, all autopsies (n=1,379) performed at Kyungpook National University were prospectively searched for SD cases related to SA. Fourteen cases (46+/-11 yr old, 9 males) of SD related to SA were found. All were heterosexual. The toxicologic study was negative in all. Ten cases were witnessed; during SA in 4 cases, just after SA in another 4 cases, 2 and 5 hr after in 1 each case. In 4 unwitnessed cases the victims were found dead less than 12 hr from the end of their SA. The partners were steady extramarital partners (n=8), prostitutes (n=2), marital partner (n=1) and unknown (n=3). The causes of the SD were as follows; coronary artery disease in 6, subarachnoid hemorrhage with ruptured berry aneurysm in 4, fibromuscular dysplasia of the atrioventricular nodal artery in 2, and unknown in 2. Coronary artery disease and subarachnoid hemorrhage with ruptured berry aneurysm were important as causes of SD related to SA.

Adult↗

Emerging antimicrobial resistance, plasmid profile and pulsed-field gel electrophoresis pattern of the endonuclease-digested genomic DNA of Neisseria gonorrhoeae.

Resistant gonococci are very prevalent in many countries, particularly in Asia. This study was conducted to determine the trend of resistance, the effect of decreasing the ciprofloxacin susceptibilities of gonococci on the prevalence of penicillinase-producing N. gonorrhoeae (PPNG), and to compare the epidemiology of strains with the previous studies. A total of 602 strains of gonococci were isolated from prostitutes in 1997-1999. Antimicrobial susceptibility was tested by NCCLS disk diffusion and agar dilution methods. For epidemiologic analysis, plasmid analysis and pulsed-field gel electrophoresis (PFGE) were performed. The proportion of PPNG remained high (79%), and the strains with decreased susceptibility to ciprofloxacin increased significantly from 67% in 1997 to 84% in 1999. Compared to our previous study, the PFGE patterns were similar, while the proportion of strain with the 3.2-MDa plasmid markedly decreased. In conclusion, a rapid increase in ciprofloxacin-nonsusceptible strains may suggest difficulties in the treatment of gonococcal infections in the near future with the drug. The recent decrease of PPNG with the 3.2-MDa plasmid may suggest that there is an epidemiological change in gonococcal infections, and the prevalence of related PFGE patterns suggests the dissemination of a few clones among the high risk populations.

DNA↗

Human immunodeficiency virus infection in the Republic of Panama.

Thirty-one documented acquired immune deficiency syndrome (AIDS) cases occurred in Panama during 1984-1987. Twenty-three (74%) patients were homosexual males and all but 2 patients recognized prior to June 1987 have died. To identify risk factors for human immunodeficiency virus infection, 287 male homosexual residents of Panama City were enrolled in a cross-sectional study. Nine had human immunodeficiency virus (HIV) antibody. Travel to the United States, homosexual relations with United States nationals in Panama, and sexual contacts in Panamanian clubs and bars were associated with human immunodeficiency virus infection by logistic regression analysis. Number of different male sex partners per year was identified but did not enter the logistic model at a significant level. To estimate seroprevalence in other high risk populations, 183 Panama City female prostitutes and 55 homosexual males from the rural Azuero peninsula were screened; none were seropositive. Eighty-four percent of Panamanian hemophiliacs had antibody; infection was related to factor VIII transfusions. Two of 182 sickle cell anemia patients and 15 of 7,720 volunteer blood donors were positive.

Acquired Immunodeficiency Syndrome↗

Epidemiology of acute hepatitis in the Stann Creek District of Belize, Central America.

Hepatitis is common in the Stann Creek District of southern Belize. To determine the etiologies, incidence, and potential risk factors for acute jaundice, we conducted active surveillance for cases. Cases of jaundice diagnosed by a physician within the previous 6 weeks were enrolled. Evaluation included a questionnaire and laboratory tests for hepatitis A, B, C, D, and E, a blood film for malaria, and a serologic test for syphilis. Etiologies of jaundice among 62 evaluable patients included acute hepatitis A, 6 (9.7%), acute hepatitis B, 49 (79.0%), hepatitis non-A-E, 2 (3.2%), and malaria, 5 (8.1%). There were no cases of acute hepatitis E. One patient each with antibody to hepatitis C and D were detected. The annualized incidence of hepatitis A was 0.26 per 1,000. All cases of hepatitis A were in children 4-16 years of age. The annualized incidence of hepatitis B, 2.17 per 1,000, was highest in adults aged 15-44 years (4.4 per 1,000) and was higher in men (36 cases; 3.09 per 1,000) than women (13 cases; 1.19 per 1,000). Four (31%) of the women with hepatitis B were pregnant. The annualized incidence was significantly higher in Mestizo (6.18 per 1000) and Maya (6.79 per 1,000) than Garifuna (0.38 per 1,000) or Creole (0.36 per 1,000). Persons with hepatitis B were significantly more likely to be born outside of Belize (82%), had been in Belize < 5 years (73%), and lived and worked in rural areas (96%) than was the general population. Of those > or = 14 years of age with hepatitis B, only 36% were married. Few persons admitted to transfusions, tattoos, IV drug use, multiple sexual partners, visiting prostitutes, or sexually transmitted diseases. Only 1 of 49 had a reactive test for syphilis. Six patients were hospitalized (including 3 with acute hepatitis B and one with hepatitis A), and none to our knowledge died. Acute hepatitis B is the most common cause of viral hepatitis in the Stann Creek District, but the modes of transmission remain obscure. Infants, women attending prenatal clinics, and new workers are potential targets for immunization with hepatitis B vaccine.

Acute Disease↗

Impact of a longitudinal community HIV intervention targeting injecting drug users' stage of change for condom and bleach use.

PURPOSE: To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation. DESIGN: Repeated cross-sectional sampling with matched intervention and comparison communities. SETTING: Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution. SUBJECTS: 3081 injecting drug users who were sexually active and/or shared injection equipment. INTERVENTION: Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms. MEASURES: Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners. RESULTS: Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p < .001), and there was an increase from 2.32 to 3.11 in mean stage of change for using condoms with other partners, while stage of change decreased in the comparison area (p < .01). Mean stage of change for using condoms with a main partner also increased in the intervention area, but the difference was not significant after controlling for change in the comparison area. Subjects with recent project exposure had higher stage-of-change scores for using condoms with a main partner (p < .05) and other partners (p < .01) and for cleaning injection equipment with bleach (p < .05). CONCLUSIONS: The results demonstrate the effectiveness of the AIDS Community Demonstration Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.

Adult↗

Hepatitis B surface antigen and antibody to hepatitis C virus among accident and emergency patients.

OBJECTIVE: To determine the sero-prevalence and epidemiology of antibody to hepatitis C virus (anti-HCV) and hepatitis B surface antigen in accident and emergency patients. DESIGN: A descriptive study was performed on 150 accident and emergency patients. Sera was screened for anti-HCV and HbsAg, using enzyme linked immunosorbent assay. Personal information and risk factors involved were obtained using a questionnaire. SETTING: Haematology laboratory of the University of Benin Teaching Hospital, Nigeria. SUBJECTS: One hundred and fifty adults consisting of 122 males and 28 females who were above the age of 21 years. Patients were randomly selected from all adults including dental patients attending the emergency department for both surgical, dental and medical emergencies. The age range was between 21-58 years. In order to ascertain the epidemiology of both viruses a questionnaire was used detailing the possible risk factors for transmission. These included history of previous blood transfusion; history of life time occurrence of multiple sexually transmitted diseases; history of heterosexual exposure to partners at risk (for example prostitutes); history involving the use of unsterilized blades; presence of scarification marks and tattooing; low socio-economic status (low annual income or unemployed): history of intravenous drug use and heterosexual activity. Anti-HCV and HBsAg were both assayed using different assay kits, based on the enzyme linked immuno absorbent assay (ELISA) tests from different manufacturers. RESULTS: The sero-prevalence of anti-HCV was 14% and 29.3% for HBsAg. Anti-HCV positivity was significantly associated with a past history of blood transfusion and heterosexual exposure to partners at risk. The study also revealed a significant association between HBsAg positivity and all the risk factors. CONCLUSION: The high prevalence rate for anti-HCV and HbsAg in accident and emergency patients increases the likelihood of further spread from patients to health care providers especially if adequate precautions are not observed.

Adult↗

Childcare practices of commercial sex workers.

OBJECTIVE: To determine the childcare practices of commercial sex workers (CSWs). DESIGN: A descriptive cross-sectional survey was conducted between July and December 2000 during which a structured questionnaire was administered. SETTING: Kibera slum, Nairobi, Kenya. SUBJECTS: Three hundred eighty five CSWs and four focus group discussions (FGDs) held. Health cards from 126 under five years old children belonging to the respondents were reviewed for immunization status and regularity of growth monitoring. RESULTS: The mean age of the 385 CSWs surveyed was 32 +/- 7 years and mean duration of sex work was 6 +/- 4 years. The mean number of living children was 3.4 +/- 2 and 81.2% of the mothers lived with their children. Three quarters of the CSWs practised prostitution at home. The most common daily childcare activities by the mothers were food preparation (96.2%) and washing children's clothes (91.3%). Overall 96.8% of their under-five years old children were fully immunized and 80% of their under one year old children had their growth monitored monthly. About three quarters of the mothers with adolescent children educated them on HIV/STDs. Health seeking behaviour for the children was hampered by health care cost (71.4%) and consumption of alcohol by the mothers. Like other mothers, the CSWs encouraged their adolescent children to take up some adult roles such as maintaining a clean house (93.3%). However only 2.0% took time to converse or counsel the children. Focus group discussions (FGDs) with the CSWs showed that children were left unattended at night while the mothers went out in search of clients. Efforts to provide better education for the children were undermined by lack of funds (52.2%) and truancy (46.6%). One third of the study population had invested for the future maintenance of their children. CONCLUSION: There was more emphasis on physical, rather than psychological aspect of childcare. The practice of living with the children ensured that earnings from the sex trade were used for the immediate needs of the children such as food. However this practice had a negative influence on the children as the majority of the respondents conducted their sexual business at home with little or no privacy. Health seeking behaviour for the children was hampered by lack of funds and to some extent alcohol consumption by the mothers. Efforts to invest in the education of their children were undermined by lack of funds and truancy.

Adolescent↗

Complementary factors contributing to the rapid spread of HIV-I in sub-Saharan Africa: a review.

OBJECTIVE: To examine and establish complementary factors that contribute to the alarmingly high prevalence of HIV-1 in sub-Saharan Africa (SSA) in order to create awareness and suggest possible measures to avert the spread of the pandemic. DATA SOURCES: Review of literature via Medline, the Internet, articles in refereed journals, and un-refereed features from the East Africa media houses and personal communications. DATA SELECTION: Most published data from 1981 to September 2004 found to have revealed an impact on the spread of HIV-1 in SSA were included in the review. Therefore, all selected articles were read and critically evaluated. Where possible the number of citations articles which had been received were sought to established the degree of impact. DATA EXTRACTION: Abstracts of all articles identified were accessed, read and analysed to determined possible relevance to the spread of HIV-1. When relevance was established from the abstract the entire paper was read and important points were included in the review. DATA SYNTHESIS: A matrix was drawn to include all subtitles (e.g. polygamy, circumcision, poverty, etc). Below each subtitle all published works were included and prioritised. Published works that were found to have impact were included in the review. Finally a percent composite picture of all factors was drawn in an attempt to prioritise the factors, not withstanding the fact that most factors are interrelated and complementary. CONCLUSIONS: There are many reasons why the spread of HIV-1 in SSA has not been declining over the years. Main risk factors for HIV-1 infection and AIDS disease in SSA were found to include poverty, famine, low status of women in society, corruption, naive risk taking perception, resistance to sexual behaviour change, high prevalence of sexually transmitted infections (STI), internal conflicts and refugee status, antiquated beliefs, lack of recreational facilities, ignorance of individual's HIV status, child and adult prostitution, uncertainty of safety of blood intended for transfusion, widow inheritance, circumcision, illiteracy and female genital cutting and polygamy. It is suggested that control programmes both local and donor-driven seeking to mitigate the spread of HIV-1 in SSA should take into account the apparent multiplicity of sub-Saharan African cultures and beliefs, some of which augment the spread of HIV-1.

Africa South of the Sahara↗

HIV-related risk-taking behaviour, knowledge and serostatus of intravenous drug users in Sydney.

This study was carried out in 1987 to investigate the relationships between human immunodeficiency virus (HIV)-related risk-taking behaviour, demographic characteristics and serostatus of 181 intravenous drug users in Sydney. Subjects were predominantly heterosexual men in their late twenties with limited secondary education. The majority (77%) had been injecting drugs for more than two years and were daily (91%) injectors of heroin (87%). Eighty per cent had shared injection equipment. Condom use was uncommon (15%) except during prostitution (72%). Sixty-nine per cent of all subjects were at risk of HIV infection due to either unsafe sexual practices or sharing of injection equipment. Thirty per cent of the sample had been in prison at some time since 1981 and half of these (15%) had used intravenous drugs and shared injection equipment while in custody. Thirteen per cent of men who had been imprisoned reported anal intercourse with other male prisoners. HIV antibody test results were available from 132 subjects of whom 12 (9%) (95% confidence intervals [CI], 4%-14%) were seropositive. The majority (67%) of seropositive subjects were homosexual/bisexual men but no other behavioural or demographic factor differentiated seropositive from seronegative subjects. The HIV seroprevalence (9%) found in this study of intravenous drug users in Sydney is significantly higher than a 1985 estimate of 0.5% (P less than 0.001). This finding and the level of risk-taking behaviour by this sample indicates that strategies introduced at the time may have been inadequate to prevent HIV infection among intravenous drug users in Sydney. Widespread HIV infection in Australian intravenous drug users may be imminent unless major changes in HIV-related risk-taking behaviour occur in the near future.

Adult↗

Epidemiology and hepatitis C virus in Victoria.

Parenterally transmitted non-A, non-B (NANB) hepatitis virus or hepatitis C virus is a common cause of both acute and chronic hepatitis. Using a recently developed enzyme-linked immunosorbent assay we looked at the prevalence of antibodies to hepatis C virus (anti-HCV) in a number of groups. People with haemophilia (75.6%) and intravenous drug users (61.9%) had the highest prevalence, while homosexual men attending a sauna (34.1%) and prisoners (30.8%) had a moderately high prevalence of anti-HCV. A lower prevalence of antibody was detected in female prostitutes (10.4%), institutionalised mentally retarded subjects (9.5%), homosexual men requesting human immunodeficiency virus (HIV) testing through their local doctor (8.8%), dialysis patients (5.9%), renal transplant patients (6.9%), and patients referred from a sexually transmitted diseases clinic (6.2%). The lowest prevalence of anti-HCV was recorded in women attending a provincial hospital for antenatal care (0.4%). The predominance of anti-HCV in groups of people exposed to blood-borne and sexually transmitted infections suggests that these routes may be primarily involved in the spread of hepatitis C virus infection.

Adult↗

Immunologic thrombocytopenic purpura after heterosexual transmission of human immunodeficiency virus (HIV).

We report four cases of immunologic thrombocytopenic purpura related to human immunodeficiency virus (HIV) transmitted through heterosexual contact in persons who were not homosexual, addicted to intravenous narcotic drugs, or hemophilic. Each transmission occurred in a different setting. A 23-year-old white woman had immunologic thrombocytopenic purpura in July 1985, with a platelet count of 11 X 10(9)/L. In January 1987, she had prominent submandibular and posterior cervical adenopathy. A careful social-sexual history revealed several sexual contacts with a male narcotic addict before July 1985. A 27-year-old heterosexual white man had a platelet count of 8 X 10(9)/L in December 1986. A social-sexual history revealed that his fiancée had been an intravenous narcotic addict 6 years ago. A 64-year-old white woman had a platelet count of 75 X 10(9)/L in May 1986, approximately 2 years after she had resumed having sexual intercourse with her husband who had had a triple coronary bypass in October 1983. The husband had received HIV-seropositive blood. A 42-year-old white man had a platelet count of 45 X 10(9)/L, which was associated with a cutaneous eruption refractory to antibiotics and antifungal agents. He had had sexual contacts with several women, who, to the best of his knowledge, were neither prostitutes nor intravenous narcotic addicts. He denied homosexuality or drug abuse. All four patients were HIV-seropositive and had circulating immune complexes and platelet-associated IgG, C3C4, and IgM values that were considerably higher than those usually measured in patients with classic autoimmune thrombocytopenia, averaging 2.4-, 2.2-, 6.5- and 5.2-fold higher, respectively. Thus, HIV-related immunologic thrombocytopenic purpura can be heterosexually spread and should become part of the differential diagnosis of unexplained thrombocytopenia. Obtaining a careful social-sexual history is mandatory in such patients.

Adult↗

Effect of the U.S. embargo and economic decline on health in Cuba.

This article describes the ways in which economic crisis and the U.S. embargo have affected Cuba's health care system during the past 15 years. With the demise of subsidized trade, the absence of aid from the former Soviet Union, and the progressive tightening of U.S. sanctions, Cuba's model health care system has become threatened by serious shortages of medical supplies. Several public health catastrophes have occurred, including an epidemic of blindness that was partially attributed to a dramatic decrease in access to nutrients; an outbreak of the Guillain-Barré syndrome caused by lack of chlorination chemicals; and an epidemic of lye ingestion in toddlers due to severe shortages of soap. The policy of mandatory quarantine for HIV-infected Cubans has evolved into a less rigid system. Although the prevalence of HIV infection in Cuba is low compared with that in the United States and other Caribbean nations, it is threatened by prostitution, which has increased along with tourism. In general, economic sanctions may have an unintended but profound effect on the health and nutrition of vulnerable populations.

Cuba↗

A serological survey for human immunodeficiency virus types 1 and 2 of individuals who visited health centers in Tokyo.

The serum antibodies to human immunodeficiency virus types 1 (HIV-1) and 2 (HIV-2) were examined for among individuals who visited health centers in Tokyo. Of 8,198 sera screened, one was true-positive and 37 false-positive for HIV-1 antibodies. These 37 false-positives and 305 sera from the population groups at risk for HIV-2 (42 sojourners in Africa, 251 homo- and bisexuals, and 19 prostitutes) were further examined for HIV-2 antibodies by indirect immunofluorescence and Western blotting. No antibodies reactive with HIV-2 were detected in the sera examined. Serological cross-reactivity between HIV-1 and HIV-2 was examined by use of rabbit antisera.

Animals↗

Gonorrhoea caused by a mixture of penicillinase-positive and -negative gonococci: a case report.

A 23-year-old unmarried man was infected with gonorrhoea from a prostitute in Fukuoka City and was treated with ampicillin which resulted in failure. By a rapid iodometric test it was found that the isolates before the treatment were penicillinase-negative. After the ampicillin treatment, however, the isolates turned to penicillinase-positive but were, in fact, a mixture of penicillinase-positive and penicillinase-negative gonococcal strains. Treatment by spectinomycin and doxycycline resulted in failure but the gonorrhoea was cured by ribostamycin.

Adult↗

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