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PubMed1997

Tuberculosis in England and Wales in 1993: results of a national survey. Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group.

BACKGROUND: A national survey of tuberculosis notifications in England and Wales was carried out in 1993 to determine the notification rate of tuberculosis and the trends in the occurrence of disease by ethnic group in comparison with the findings of similar surveys in 1978/79, 1983, and 1988. The prevalence of HIV infection in adults notified with tuberculosis in the survey period was also estimated. METHODS: Clinical, bacteriological, and sociodemographic information was obtained on all newly notified cases of tuberculosis in England and Wales during the six months from 2 January to 2 July 1993. The prevalence of HIV infection in 16-54 year old patients with tuberculosis notified throughout 1993 was assessed using "unlinked anonymous" testing supplemented by matching of the register of patients with tuberculosis with that of patients with AIDS reported to the PHLS AIDS centre. Annual notification rates were calculated using population estimates from the 1993 Labour Force Survey. RESULTS: A total of 2706 newly notified patients was eligible for inclusion in the survey of whom 2458 were previously untreated the comparable figures for 1988 were 2408 and 2163. The number of patients of white ethnic origin decreased from 1142 (53%) in 1988 to 1088 (44%) in 1993 whereas those of patients of Indian, Pakistani, or Bangladeshi (Indian subcontinent (ISC)) ethnic origin increased from 843 (39%) in 1988 to 1014 (41%) and those of "other" (non-white, non-ISC) ethnic origins increased from 178 (8%) to 356 (14%). The largest increase was seen in the black African ethnic group from 37 in 1988 to 171 in 1993. Forty nine per cent of patients had been born abroad and the highest rates were seen in those who had recently arrived in this country. The overall annual notification rate for previously untreated tuberculosis in England and Wales increased between 1988 and 1993 from 8.4 to 9.2 per 100,000 population. The rate declined in the white, Indian, and black Caribbean ethnic groups and increased in all other groups. In the white group the rate of decline has slowed since the last survey: in several age groups the rates were higher in 1993 than 1988 but the numbers in these groups were small. Thirty six (4.1%) of the 882 previously untreated respiratory cases were resistant to isoniazid and three (0.3%) to isoniazid and rifampicin. Sixty two (2.3%) adults aged 16-54 years were estimated to be HIV-infected. Evidence of under-reporting of HIV positive tuberculosis patients was found. CONCLUSIONS: The number of cases and annual notification rate for previously untreated tuberculosis increased between 1988 and 1993. Although the decline in rates in the white population has continued, the rate of decline has slowed. The high rates in the ISC ethnic group population have continued to decline since 1988 whereas rates in the black African group have increased. An increased proportion of cases were found among people born abroad, particularly those recently arrived in this country. In previously untreated cases the level of drug resistance remains low and multi-drug resistance is rare. A small proportion of adults with tuberculosis were infected with HIV but there may be selective undernotification of tuberculosis in these patients.

Adolescent↗
PubMed1991

HIV seroprevalence among patients admitted to two psychiatric hospitals.

OBJECTIVE: The authors determined the seroprevalence of HIV-1 among patients admitted to two psychiatric hospitals in New York City. METHOD: Patients consecutively admitted to an acute psychiatric unit in Manhattan and a large state hospital in Queens were anonymously tested for HIV-1 antibodies from December 1989 through July 1990. Test results were linked to age, gender, ethnicity, and two risk behaviors: male homosexual activity and injection drug use. RESULTS: Blood was obtained from 83.0% of the eligible patients. The prevalence of HIV was 5.5% (25 of 451). Black patients accounted for 38.0% of the patients tested and 76.0% of positive results (N = 19), a rate of 11.1% for this group. The rate of seropositivity was comparable in women and men. Clinicians had charted risk behavior for nine (36.0%) of the 25 HIV-positive patients. Infection control records suggested that clinicians were aware of seven (28.0%) of the positive cases. CONCLUSIONS: One in every 18 patients admitted to two public psychiatric hospitals in New York City was HIV positive. Clinical staff largely failed to identify HIV-positive patients. Ethnicity and a history of homosexual activity among men or use of injected drugs were strongly associated with seropositivity. This pattern of infection may be linked to needle sharing and/or sexual activity with partners who have shared needles. Future research should clarify how psychiatric illness affects risk-taking behavior, focus on improving detection by clinicians, and identify effective prevention strategies in this population.

Adolescent↗
PubMed1995

Spread of maternal HIV infection in Scotland from 1990 to 1992.

In Scotland since January 1990, unlinked anonymous testing of Guthrie cards has documented maternal HIV-1 antibody in neonatal blood. District postcode and quarter year of birth determined prevalence and spread of infection. The Fujirebio particle agglutination assay screened for HIV-1 antibody, with confirmation by ELISA and full western blotting. Births to known HIV infected women were reported to the Royal College of Obstetricians and Gynaecologists. 0.3/1000 childbearing women were infected with HIV-1 with no significant increase from 1990 to 1992. Spread of infection from 11 to 26 districts has occurred. In 1990, 74%(14/19) of HIV positive deliveries were known to obstetricians falling to 33%(7/21) in 1992. Spread of HIV-1 infection has occurred to mothers who live outside closely defined areas and who do not belong to recognised high risk groups. In Scotland, two thirds of mothers and their infants will not receive early prophylactic care for their HIV disease.

AIDS Serodiagnosis↗
PubMed1995

Respite care for HIV-affected families.

Anonymous testing of all newborn infants in 1988 revealed that one of every 61 babies born in New York City was HIV positive (New York City Department of Health, 1988). With the availability of new treatment, HIV positive children are living longer, often into their school years, and most are able to live at home. The majority of children acquire HIV through maternal transmission. Frequently, multiple family members are HIV positive. Parents, or other caregivers, are overwhelmed by depression, anxiety and grief, and urgently need childcare assistance. Finding childcare is difficult since families are often reluctant to disclose the AIDS diagnosis to potential childcare workers. This article describes an innovative in-home respite care program for parents and caretakers of children who are HIV positive. The service is coordinated through a hospital's social work and volunteer departments. This article describes strategies to recruit, train and supervise volunteers to provide respite care for families with HIV positive children.

Child↗
PubMed1997

A citizens' AIDS Task Force: overcoming obstacles.

This article analyzes the experience of a state-wide Task Force on AIDS using grassroots techniques to construct policy responsive to the needs of people living with HIV. The four primary obstacles to effective policy making were the need (1) to include disenfranchised groups; (2) to avoid the domination of governmental bureaucracy so that community-based organizations could offer solutions, as well as services; (3) to overcome resistance to anonymous testing; and (4) to reach "hard to reach" populations. Task Force members' perspectives colored what were deemed appropriate policies. Members tended to polarize into two groups: those community-based groups and individuals who focused on the needs of people with HIV on one side, and on the other side, more institutional players who wanted to identify and isolate "HIV carriers." The article closes by analyzing the resulting HIV Omnibus Bill. Those who focused on the needs of people with HIV seized the opportunity to draft and successfully pass an omnibus bill through the Arizona Legislature. This success demonstrates that highly organized communities can affect policy making, even to the extent that it offsets more institutionalized power.

AIDS Serodiagnosis↗
PubMed1992

A cohort study of the impact of perinatal drug use on prematurity in an inner-city population.

Perinatal illicit drug use was determined by anonymously testing the urine of 1111 inner-city parturients. Fourteen percent tested positive, 11.5% for cocaine. As determined by self-report or by positive test results, 17% used drugs. Twenty-eight percent of low birthweights and 20% of premature births in this group were attributable to drug use. Risk of prematurity was reduced by a factor of 2 to 3 with adequate prenatal care. These data suggest an enormous potential for improving perinatal health.

Adult↗
PubMed1997

Perinatal drug use among immigrant and native-born Latinas.

Perinatal drug exposures pose a significant health hazard for women and imperil normal fetal and neonatal development. Little is known about patterns of drug exposure among pregnant immigrant and native-born Latinas in the United States. We present multivariate risk factor analyses for alcohol and illicit drug use from the California Perinatal Substance Exposure Study using a statistical probability sample (N = 11,002) of Latinas who were tested anonymously using urine toxicology screening techniques. Alcohol use during pregnancy was pervasive among both immigrant and United States-born Latinas (7%) with little variation on risk factors. Illicit drug use was found primarily in a high risk group of United States-born Latinas between 25 and 34 years of age who received no prenatal care (prevalence 50%, odds ratio of 185). Increased general awareness of perinatal alcohol risk by medical providers and public health practitioners serving this population is needed. The potential isolation of United States-born Latinas who are at risk using illicit drugs during pregnancy requires effective communication and outreach.

Adolescent↗
PubMed1997

HIV seroprevalence in women of childbearing age in Benin City, Nigeria.

HIV seroprevalence was still low in some parts of Nigeria from 1989 to 1991, and only limited reports were available on seroprevalence in childbearing women. In order to assess HIV seroprevalence in pregnant women in Benin City and Bendel State, two sampling methods, unlinked anonymous testing and voluntary testing, were employed. Data obtained from testing 358 sera from pregnant women attending antenatal clinics and cord blood from labour wards in Benin City were compared with data obtained from testing 833 pregnant women at four sentinel surveillance sites in Bendel State. The samples were all analysed by ELISA technique at the University Teaching Hospital, Benin City. Repeatedly reactive samples were confirmed by Western blot. The seroprevalence of HIV-1 in Benin City and in Bendel State was 0.28 percent and 0.36 percent, respectively. At this point in time, intensive health education campaigns targeted at the general population are necessary.

Adolescent↗
PubMed1999

[Evaluation of counseling activities: analysis of a person-centered prevention perspective].

This paper evaluates STD/HIV/AIDS counseling activities provided by the Brazilian National Health Care System (SUS). The following institutional health services were assessed: four anonymous testing and counseling centers, one clinic specializing in treatment for people with HIV, and five STD clinics. All the above are recognized as training centers by the Brazilian Ministry of Health (National STD/AIDS Control Program). The data were collected from March to September 1997. The counseling activities from these health services was compared with guidelines developed by the National STD/AIDS Control Program using a qualitative evaluation methodology. The main categories analyzed were: a) approaching the patient; b) active listening; c) effective communication; d) risk assessment and discussion of alternatives for risk reduction; and e) orientation concerning clinical aspects and treatment (treatment compliance and improved quality of life). The paper concludes by suggesting changes to improve counseling.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[A socio-culturological model of the motivational structure of the initial period of sexual relations in men].

A social and culturological simulation study was made into motivation structure of young male patients during the initial period of their heterosexual intercourse in the series of 957 anonymously tested patients. It can be stated with sufficient certainty that in the initial period of sex intercourse, in major proportion of youths under the influence of more experienced young women there are quickly formed basic psychological motivational stereotypes of sex behaviour. This appeared to directly influence both their married life and nonmarital sex relations including those in which they come to be infected with a venereal disease.

Adolescent↗
PubMed2000

Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. HCSUS Consortium. HIV Cost and Services Utilization Study.

OBJECTIVE: To employ the behavioral model of health services use in examining the extent to which predisposing, enabling, and need factors explain the treatment of the HIV-positive population in the United States with highly active antiretroviral therapy (HAART). DATA SOURCE: A national probability sample of 2,776 adults under treatment for human immunodeficiency virus (HIV) infection. STUDY DESIGN: The article uses data from the baseline and six-month follow-up surveys. The key independent variables describe vulnerable population groups including women, drug users, ethnic minorities, and the less educated. The dependent variable is whether or not a respondent received HAART by December 1996. DATA COLLECTION: All interviews were conducted using computer-assisted personal interview instruments designed for this study. Ninety-two percent of the baseline interviews were conducted in person and the remainder over the telephone. PRINCIPAL FINDINGS: A multistage logit regression shows that the predisposing factors that have previously described vulnerable groups in the general population with limited access to medical care also define HIV-positive groups who are less likely to gain early access to HAART including women, injection drug users, African Americans, and the least educated (odds ratios, controlling for need, ranged from 0.35 to 0.59). CONCLUSIONS: Those HIV-positive persons with the greatest need (defined by a low CD4 count) are most likely to have early access to HAART, which suggests equitable access. However, some predisposing and enabling variables continue to be important as well, suggesting inequitable access, especially for African Americans and lower-income groups. Policymakers and clinicians need to be sensitized to the continued problems of African Americans and other vulnerable populations in gaining access to such potentially beneficial therapies. Higher income, anonymous test sites, and same-day appointments are important enabling resources.

Adult↗
PubMed2000

Prevalence of HIV, hepatitis B, and hepatitis C antibodies in prisoners in England and Wales: a national survey.

Prisoners in eight of the 135 prisons in England and Wales were surveyed in 1997 and 1998 to study the prevalence of and risk factors for transmission of bloodborne viruses in prison. Subjects voluntarily completed a risk factor questionnaire and provided oral fluid specimens for unlinked anonymous testing for the presence of antibodies to HIV, hepatitis C virus (HCV), and the core antigen of hepatitis B virus (HBc). Almost 8% (4778) of the total of 60,561 prisoners were eligible and four fifths (3942) of those eligible took part. Among all those tested (3930) 0.4% (14) were positive for anti-HIV, 8% (308) for anti-HBc, and 7% (293) for anti-HCV (the anti-HBc and anti-HCV prevalences were not adjusted for assay sensitivities of 82% and 80%, respectively). Twenty-four per cent (777/3176) of adult prisoners reported ever having injected drugs, 30% of whom (224/747) reported having injected in prison. Three quarters of those who injected in prison (167/224) shared needles or syringes. Among adult injecting drug users, 0.5% (4/775) had anti-HIV, 31% (240/775) anti-HCV, and 20% (158/775) anti-HBc. The presence of anti-HCV and anti-HBc was associated with injecting inside prison and number of previous times in prison. The results suggest that hepatitis viruses are probably being transmitted in prisons through sharing non-sterile injecting equipment and that a risk of HIV transmission exists. Harm minimisation measures for the 6% of prisoners who continue to inject while in prison should be strengthened.

Adult↗
PubMedDate not supplied

Interface between drug use and sex work in Manipur.

BACKGROUND: In India, drug use is seen predominantly as a problem among men. This study attempts to address the interface between drug use and sex work among women drug users in Manipur and the prevalence of HIV, hepatitis B and other sexually transmitted infections in them. METHODS: This cross-sectional survey was conducted between April and October 1997 at the time of an ethnic clash in imphal, the capital of Manipur. Sixty-nine women drug users were interviewed through street-based outreach workers; 38 women (55%) were injecting drug users. Data were generated with the help of a semi-structured questionnaire on sociodemography, drug use practice and health issues after obtaining informed consent from the participants. Subsequently, consent was also obtained from 60 respondents for collecting blood for unlinked anonymous tests for HIV and hepatitis B surface antigen. Clinical examination for reproductive tract infections, offered to all the study participants, generated data on sexually transmitted diseases. RESULTS: The prevalence of HIV infection in injecting drug users was 57% (20/35) compared to 20% (5/25) among non-injecting drug users (p = 0.001), although the prevalence of hepatitis B surface antigen was similar in the two groups, 48% v. 56%, respectively. Eighty per cent of the respondents, many of whom migrated following the ethnic clash, reported having sex with non-regular partners, two-thirds reported sex in exchange for money or drugs. Eighty-one per cent (29/36) of women who agreed to have a clinical examination had abnormal vaginal discharge, of which 10 had endocervical discharge. The presence of infection was confirmed in only 24% of those with vaginal discharge--4 had bacterial vaginosis and 3 trichomoniasis. CONCLUSION: Environmental interventions to reduce civil unrest and forced migration have an important role to play in HIV containment. The high rate of HIV infection, and the probability of a high rate of sexually transmitted infections in women drug users suggests that a targeted intervention in this population group is a public health need. An innovative outreach strategy should be designed for effective implementation of interventions among women injecting drug users and non-injecting drug users who operate from the streets as sex workers to support their drug habit as well as livelihood.

Adolescent↗
PubMed1997

South Africa says 2.4 million people infected with HIV.

South Africa's Health Ministry said the HIV infection rate had risen to 6% of the population from about 4.6% a year ago. Rose Smuts, Health Ministry AIDS expert, said that the estimated number of people infected with HIV was up to 2.4 million at the end of 1996 from 1.8 million a year earlier. "In 1997, about 90,000 people will progress to [advanced], of whom about 20,000 will be children," she said. Health Minister Nkosazana Zuma released results at the same news conference of the 1996 antenatal HIV survey, which showed that the infection rate among pregnant women attending state clinics rose nearly 35%. Anonymous testing of more than 15,000 pregnant women showed the infection rate up from 10.44% at the end of 1995 to 14.07% in 1996. Infections have almost doubled from 7.5% in 1994. "The sharp increase of 34.8% over the previous year confirms that South Africa is still experiencing a fast growing HIV epidemic," the Health Ministry said in a report. The highest infection rate and a threefold increase were recorded in Northwest Province, near Johannesburg, where positive tests jumped from 8.3% in 1995 to 25.13% in 1996. KwaZulu-Natal, South Africa's most populous province and previously the worst affected, showed a modest increase from 18.23% to 19.9% in 1996. The Western Cape, which includes Cape Town, showed the lowest infection rate of 1.65%, which was unchanged from the previous year. Zuma said that the doubling rate of HIV infection had slowed from 12 months to about 24 months, but she said that the emphasis should remain on the spread of the epidemic, which hits the working population hardest. Smuts said results of the antenatal survey could be extrapolated to a national infection rate of 6%, an 11% infection rate among all adults, and a 10% infection level among men aged 15-45 years.

Africa↗
PubMed2002

HIV-1 seroprevalence and subtypes in police recruits from Afar regional state, Ethiopia.

Surveillance for HIV-1 prevalence and subtypes in Afar Region, Ethiopia was performed among police recruits in the year 2000, by unlinked anonymous testing. Of 408 samples tested, 26 (6.4%) appeared positive for HIV-1 antibodies. There was a trend for higher HIV-1 seroprevalence in women (9.5%, 9/95) than men (5.4%, 17/313), which was significant in one of the 5 administrative areas: Zone 4 (p = 0.01). Around the principal transportation route connecting Addis Ababa to the harbor of Djibouti there was a significantly (p = 0.03) higher HIV-1 seroprevalence of 12.7% (14/110) than elsewhere in Afar Region. In addition, 13 (34%) of the 29 administrative sub-areas (woredas) of Afar Region delivered HIV-1 positive police recruits. Prevalence of syphilis antibodies was 7.4% (30/408), increasing by age, correlating with HIV-1 positive serology (p = 0.001) and with 23.3% (7/30) active cases. Of 22 specimens sequenced, 12 had gp120 V3 regions from Ethiopian subtype C, 9 subtype C' and 1 subtype A. In conclusion, even in very remote areas in Ethiopia, such as Afar Region, the HIV-1 epidemic is established, being primarily of subtype C. Regular HIV-1 surveillances will be necessary to guide action to prevent further spread in this vulnerable area.

Adult↗
PubMedDate not supplied

Tobacco use among medical students in Orissa.

BACKGROUND: Tobacco use is the most important cause of preventable morbidity, disability and premature mortality. There is a lack of adequate and reliable data on tobacco use among medical students and their perceived role as future doctors in tobacco control. We aimed to find out factors associated with tobacco use among medical students and their perceived role in tobacco control as future doctors. METHODS: A cross-sectional study was conducted among 1189 undergraduate medical students (68.5% men, median age: 21 years, age range: 17-27 years) in all 3 medical colleges of Orissa. Information on tobacco use, associated factors and their perceived role in tobacco control as future doctors was collected using a pre-tested anonymous questionnaire. Bivariate and multivariate analyses were done among the men respondents to find out associations between current tobacco use and predictor variables. RESULTS: The prevalence of current tobacco use was 8.7% (95% CI: 7.1-10.3); men: 12.4%, women: 0.8%. Among 286 ever users, 34% started using tobacco after joining medical college. Students with a higher personal monthly expenditure and with a family history of tobacco use were more likely to be current users. Third-year students were 3.2-times more likely to be currenttobacco users (OR: 3.21; CI: 1.43-7.19) compared to first-year students. Students who reported own tobacco use as not very harmful were 4.7-times more likely to be current users compared with those who reported otherwise (OR: 4.7; CI: 2.64-8.37). Compared to non-users, current tobacco users were less likely (p = 0.026) to assess tobacco use in their patients and were less likely (p = 0.012) to advise patients against tobacco use. CONCLUSION: Steps should be initiated early in medical colleges to prevent tobacco use, particularly among men students and those with a family history of tobacco use.

Adolescent↗
PubMedDate not supplied

[Prospective study of the incidence of HIV infection in the 1st trimester of pregnancy].

The article deals with the results of an anonymous testing of HIV infections in Yugoslavia. The presence of anti-HIV-antibodies was examined in the blood of pregnant patients, randomly selected, in a Ward where about 3000 artificial abortions were carried out in the first trimester of pregnancy in a six-month period. On the basis of the obtained results one patient of 177 tested women was infected by HIV virus. At the same time, it can be presumed that among 3000 pregnancies there were many anti-HIV positive persons. It should be emphasized that the staff was not aware of HIV infection in one patient, and that in Yugoslav epidemiological conditions a HIV infected person could unexpectedly be detected without preliminary findings and data.

Female↗
PubMed1989

[A high fraction of drug-dependent patients among anonymously detected HIV-infected patients in Stuttgart].

A high percentage of intravenous drug addicts was found among HIV-infected individuals who had been detected by anonymous testing from May, 1985, to October, 1988, at the AIDS Counselling Service of the Municipal Health Department in Stuttgart. Among the subjects being seropositive for HIV-1 antibodies, 36.6% were drug abusers, while until October, 1988, only 10.3% of the reported AIDS cases in the Federal Republic of Germany were members of this risk group. On the other hand, only 1.9% of 1.001 individuals who came to the AIDS Counselling Service of the Municipal Health Department in Stuttgart for HIV antibody testing were drug addicts. Our observations show that special information campaigns for young people about the risk of HIV infection by intravenous drug abuse should be intensified.

AIDS Serodiagnosis↗