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[HIV infection in intravenous drug dependent patients--Vienna 1988 results].

The rapid spread of HIV infection among intravenous drug abusers plays an increasing role in the AIDS epidemic. In this context the Austrian government changed politics and introduced a methadone maintenance program 1987, to reach more intravenous drug addicts and to stop intravenous drug abuse of this clients. 119 intravenous drug users were anonymously tested for HIV antibodies between April 18 and May 17, 1988 at the out-patient clinic of the Psychiatric University clinic of Vienna and were examined by means of a standardized questionnaire. The data are discussed in respect of the benefits of a methadone maintenance program to decrease HIV-infection among intravenous drug abusers in Vienna.

Acquired Immunodeficiency Syndrome↗

[Epidemiology and means of transmission of HIV infection].

Epidemiological features of HIV infection and the AIDS pandemic are described in this review. The number of AIDS cases will continue to rise for several years, despite enormous efforts to slow the spread of HIV via sexual and parenteral exposure, since virtually all adult patients who will develop AIDS within the next 3-5 years are already infected. Careful examination of AIDS patients without identified risk factors and results obtained from anonymous testing sites for HIV infection have failed to disclose any new forms of HIV transmission. The risk for health care workers to become infected through occupational exposure appears to be very small (0.1-0.4% per documented parenteral HIV-positive blood exposure). Universal precautions against mucocutaneous blood exposure are likely to reduce this risk even further.

Acquired Immunodeficiency Syndrome↗

Survey of human immunodeficiency virus infection among pregnant women in England and Wales: 1990-93.

We report on the first four years (1990-93) of a survey within the national HIV prevalence monitoring programme. The survey's objective is to monitor the prevalence of infection with the human immunodeficiency virus (HIV) in pregnant women in London and elsewhere in England. The survey--based in forty centres that offer antenatal care in London, Greater Manchester, West Yorkshire, and adjacent non-metropolitan areas--uses repeated cross sectional serosurveillance for anti-HIV-1 and 2 and the unlinked anonymous test method on blood left over from specimens collected for antenatal screening for immunity to rubella. The seroprevalence of HIV-1 ranged from 0.007% (1 in 14,530) in non-metropolitan areas, to 0.011% (1 in 8790) in metropolitan areas outside London, and 0.23% (1 in 440) in London. Evidence of HIV-2 infection was found in only four specimens, in London (1 in 50,300). The seroprevalence of HIV-1 in London varied more than tenfold between centres, from 0.03% (1 in 3190) to 0.51% (1 in 200). The highest prevalence of infection was in London in women aged between 20 and 30 (0.30%; 1 in 335). The seroprevalence in London centres rose from 0.18% in 1990 (1 in 560) to 0.26% in 1993 (1 in 390) and the rise was significant in all age groups. If voluntary confidential HIV testing (with counselling) among pregnant women in England were to be promoted, its cost effectiveness would be greater if focused on particular centres that provide antenatal care in London.

Adult↗

Human immunodeficiency virus infection in Taiwan, 1984 to 1994.

From 1984 to September 1994, a total of 9,099,734 serum samples from six population groups were tested for the antibody to human immunodeficiency virus type 1 (HIV). Mandatory testing was carried out for blood donors, military recruits, immigrants and prisoners; other population groups were tested anonymously with consent. A total of 695 samples were seropositive and, of these HIV carriers, 142 developed acquired immunodeficiency syndrome (AIDS). Although the prevalence of HIV infection and AIDS has remained low, there has been a rapid increase since 1991. Of the 142 AIDS cases, 68 were in homosexuals/bisexuals, 6 were in hemophiliacs, 7 were in prisoners/intravenous drug users, 49 were in heterosexuals and for 12 cases, the risk factors were unknown. Before 1987, 69 (90.8%) of the 76 HIV-infected persons were homosexuals or hemophiliacs. Thereafter, the risk groups diversified, with the main group shifting from hemophiliacs to intravenous drug users, and the number of heterosexuals surpassing that of homosexuals. Among the 142 cases of AIDS, 135 were males and only 7 were females. Despite the short period of follow-up, 114 have died (including 3 suicides).

Adolescent↗

Viral hepatitis in health care personnel at The Johns Hopkins Hospital. The seroprevalence of and risk factors for hepatitis B virus and hepatitis C virus infection.

BACKGROUND: Health care personnel are at increased risk of occupational acquisition of hepatitis B virus (HBV) infection. While effective vaccination for HBV is widely available, the prevalence of HBV and vaccine acceptance in hospital personnel have not been recently assessed. In addition, hepatitis C virus (HCV) is a newly recognized cause of parenterally acquired hepatitis, and the risk of HCV transmission to health care personnel remains unclear. METHODS: From April to December 1991, health care personnel at The Johns Hopkins Hospital, Baltimore, Md, were offered anonymous testing for HBV and HCV and were asked to complete a confidential questionnaire. Serum samples were tested for HBV surface antigen and antibodies to HBV core antigen, HBV surface antigen, and HCV. Seroprevalence rates were compared with those detected in local blood donors during the same year. RESULTS: Antibodies to HBV core antigen were found in 59 (6.2%) of 943 health care workers compared with 1879 (1.8%) of 104,239 local blood donors (P < .001). In contrast, antibodies to HCV were found in seven (0.7%) of 943 health care workers and 0.4% of local blood donors (P = .10). Infection with HBV was associated with age (> or = 33 years) (P < .001), black race (P < .001), type of health care worker (nurse) (P = .02), 10 ore more years of clinical employment (P = .003), and lack of HBV vaccination (P < .001). After logistic regression, only absence of HBV vaccination was independently associated with HBV infection (P < .001). CONCLUSION: These data suggest that the prevalence of HCV infection in health care personnel at The Johns Hopkins Hospital is similar to that observed in local blood donors, and that HBV may be more efficiently transmitted than HCV in the health care setting. Efforts to vaccinate health care personnel against HBV should be vigorously pursued since 23% remain unvaccinated after 9 years of HBV vaccine availability.

Adult↗

Unlinked anonymous monitoring of HIV prevalence at sexually transmitted disease clinics.

AIM: To determine the prevalence of HIV infection among patients attending the four sexually transmitted disease (STD) clinics in two metropolitan areas of New Zealand. METHODS: The population studied comprised everyone who attended between August 1991 and August 1992 because of concern about a possible new episode of an STD and who had a blood specimen taken for hepatitis B (or syphilis) serology. The study involved unlinked anonymous testing of left-over blood specimens, following ethical guidelines that have been proposed internationally. RESULTS: Among 8478 specimens tested, 23 (2.7 per 1000) were found to be HIV positive. The seroprevalence rates per 1000 among women, heterosexual men, and homosexual or bisexual men were 1.1, 1.3, and 44, respectively. All but five of the infected people were either known to be HIV positive or had an identifiable test during their clinic attendance. CONCLUSIONS: The seroprevalence rates are similar to those reported from STD clinics in England, and suggest that heterosexual transmission of HIV infection has not yet been extensive in New Zealand.

Adolescent↗

Prevalence of human immunodeficiency virus-1 infection in a Baltimore acute care hospital.

In conjunction with the Centers for Disease Control and Prevention's (CDC's) national Sentinel Hospital Surveillance System for HIV (human immunodeficiency virus) Infection, we conducted unlinked (anonymous) testing of a systematically selected sample of blood specimens for HIV-1 antibodies to assess the HIV-1 infection level in an urban hospital's catchment population. We excluded specimens from patients with admitting diagnoses often associated with HIV infection. Of the 5,350 specimens tested between April 1988 and October 1989, 106 (2%) were HIV-1 seropositive. HIV-1 seroprevalence in female patients was 1%, and in male patients, 3%. Those 25-44 years of age showed the highest seroprevalence (3.7% in all patients: 6.6% in male patients, 1.1% in female patients). These results demonstrate a high HIV-1 infection level in this patient population and suggest Baltimore hospitals should evaluate the impact and costs of developing routine HIV counseling and testing programs for their patients.

AIDS Serodiagnosis↗

[Gdansk HIV-AIDS project, yesterday, today and future].

Medical care project for HIV positive and AIDS patients in Gdańsk voivodship was established in 1988 in the Clinic for Infectious Diseases of Gdańsk Medical University. The aim of this modern and multidirectional program was to provide full medical care for HIV/AIDS patients and introduce effective prophylaxis against spread of HIV infection. According to the project-clinical ward, outpatient clinic for HIV positive and AIDS patients, diagnostic and laboratory units, were established. Close cooperation including specialistic and general medical care, was set with detoxication ward, rehabilitation centers for drug addicts, prison medical services and the Korczak Orphanage. Education of medical staff and some social groups was provided (teachers, teenagers of secondary schools, journalists, police employees). Clinical ward for HIV positive patients who are in need of inpatient medical care is localized in the Clinic for Infectious Diseases of Gdańsk Medical University. The ward has 16 double - bed Melcer's boxes which are used for other HIV/AIDS patients according to present needs. Free beds are used for HIV negative patients. HIV/AIDS Outpatient Clinic is localized in Venerologic Outpatient Unit. This was because of some psychological, social, professional and organization aspects. Outpatient Clinic staff is responsible for first patients' examination. Serological diagnostics of HIV infection is follow up for everyone (anonymous testing is possible); testing for STD is available also. Diagnostic laboratory base for clinical ward and other units are the laboratories of Gdańsk Voivodship Hospital for Infectious Diseases. Clinic for Infectious Diseases supervises all co-operating units. These are the following: 10-beds detoxication ward for drug addicts in Psychiatric - Neurological Hospital "Srebrzysko", 70-80 places in rehabilitation centers for drug addicts in Zapowiednik and Smazyno, remand prison ward for HIV positive patients (this is the first ward established in Poland, thanks to our initiative, in 1990). One of very important units of our Center is the Korczak Orphanage for children aged 0-7 years, which is subjected to Voivodship Health Department. This orphanage is the place for children with positive HIV serology from the whole Poland. Children who need inpatient medical care, among them AIDS children, are admitted to the Clinic for Infectious Diseases and can be diagnosed and consulted in all units of Gdańsk Medical University. In 1992 the co-operation with Gdańsk homosexual society represented by the Gdańsk Initiative (a submit of Lambda organization), was established. Education program is the next very important part of the Clinical and Diagnostic HIV/AIDS Center work. Until now medical staff and Education Department staff were mainly concerned. It is planned to establish Voivodship Social Needs Outpatient Clinic which would continue all hitherto activities, which would be extended by social law counseling. Such outpatient clinic would facilitate education activity. It would be the base for medical research on social pathology and HIV/AIDS related problems.

AIDS Serodiagnosis↗

Intentions to use violence among young adolescents.

OBJECTIVE: Frequent violent behavior among adolescents has been found to be associated with previous exposure to violence, personal victimization, depression, hopelessness, and older age. Although young adolescents engage in less severe violent behavior than older adolescents, their perceived normative expectations to use violence to resolve conflicts may already be established by early adolescence. This study examined the influence of exposure to violence, depression, church attendance, multiple drug use, and demographic variables on young adolescents' intentions to use violence to resolve conflict. METHODS: Young adolescents (N = 225, males = 49.4%, black = 88.7%, mean age = 12.9 +/- 1 years) in two middle schools serving low-income and working-class communities were administered a previously tested anonymous questionnaire. They were also asked how they would resolve conflict in 15 different hypothetical situations. Each situation had 10 possible responses ranging from humor or avoidance to severe violence (eg, use of a gun). The Intentions to Use Violence in Hypothetical Situations Scale had a high internal reliability (alpha = .88) and was correlated (r = .46) at the expected level for this age group with a standardized use of violence and weapon-carrying scale. RESULTS: The Intentions to Use Violence in Hypothetical Situations Scale was significantly correlated with age (r = .17), school grade (r = .14), lower church attendance (r = -.23), frequency of smoking (r = .24), alcohol use (r = .37), marijuana use (r = .36), crack cocaine use (r = .14), smokeless tobacco use (r = .20), injecting drug use (r = .16), depression (r = .12), and exposure to violence (r = .48). Based on multiple regression analysis, exposure to violence, marijuana use, frequency of church attendance, alcohol use, cocaine use, and tobacco use accounted for 36.6% of the variation in the Intentions to Use Violence in Hypothetical Situations Scale. CONCLUSION: Although the intention to use violence was associated with previous exposure to violence and current drug use, adolescents who attended religious services more often were less likely to report that they would use violence to resolve interpersonal conflict.

Adolescent↗

[Sex behavior of patients attending a free, anonymous HIV screening center in Paris].

People's sexual behavior changes as they acquire knowledge od HIV infection. During a 10-week period (September-November 1994), we analysed the results of interviews conducted prior to free, anonymous tests in the Figuier HIV screening center (CDAG, Paris). Men accounted for 61% of the 1275 attendees, and 62% were aged between 20 and 29 years (both sexes). Consultants were homo/bisexuals in 26% cases and 23% had an HIV-infected partner. Male and female hetero-sexual represented respectively 35 and 38% of attendees, and 1.7% had an HIV-infected partner. Most of the subjects (76%) had had more than one sexual partner in the last 12 months. 72% of the homo/bisexuals of all ages stated that they used condoms systematically during sexual penetration, compared to 35% of the heterosexuals. In contrast, only 3.9% of homo/bisexual used condoms during oral intercourse. 12% of the subjects (21% of homo/bisexuals, and 8.5% of heterosexuals) stated that they had been treated for an STD during the previous year, and most were aged between 25 and 34 years. The most frequent stated STDs were anogenital papillomavirus and herpes virus infections, and chlamydial infections. 80% of the homo/bisexual considered they "too a risk" (oral intercourse), compared to 47% of heterosexuals. 10% of the subjects did not collect their result. In this study the seroprevalence of HIV was 1%, with the highest values in the 25-34 year age group and among homo/bisexuals (3%), and the lowest values among male and female heterosexuals (0.4% and 0.2%, respectively). Most of the subjects, on the basis of their stated sexual behavior, were aware of the risk of HIV infection, but the high frequency of STDs shows that prevention campaigns must be reinforced. Practician must offer advice on prevention and screening in order to reduce the frequency of infective and tumoral diseases due to sexually transmitted pathogens.

Adolescent↗

[Patient education: what does the patient know, what does he want to know? Thrombosis and wound infection].

UNLABELLED: The manners of which preoperative informations are given to a patient depend on several different points. So not only the patient's education, his knowledge of medical items and his intelligence are important, but also the juridical situation and the doctor's ability to explain the situation in a way the patient is able to understand. The aim of this study was to evaluate the patient's previous knowledge about two major complications in surgery--thrombosis and wound infection. Beside this it was looked for the importance of confidence in the doctor and previous information about the operation. PATIENTS AND METHOD: 117 patients aged 16 to 87 years were tested anonymous by a standardised questionnaire. RESULTS: There is only little knowledge about the time a thrombosis develops, embolism, a wound infection and their consequences. On the other side, more than 50% of the patients were able to explain correctly the symptoms of thrombosis and the time a wound infection occurs. There was a correlation between the statement of knowledge about thrombosis (p < 0.01) and wound infection (p < 0.01) and the ability of correct explanation. Almost 90% of the patients thought that information about the operation is as important as the confidence in their surgeon. More than two third of the patients wanted to be informed about "everything" that possibly could happen. The main sources of information were neighbours, friends, the press, books and at last the doctor. CONCLUSION: There wasn't any influence of former surgeries, the awareness of complications or education on the active knowledge of the patients. Therefore we think that the way of giving explanation to a patient should help reducing fear of an uncomfortable situation and take account to the patients need for information. Thus, the patient will be able to make a real decision.

Adolescent↗

Rising HIV infection rates in Ho Chi Minh City herald emerging AIDS epidemic in Vietnam.

OBJECTIVE: To describe the epidemiology of HIV in Ho Chi Minh City in the context of current surveillance data from Vietnam. METHODS: Since the late 1980s, HIV surveillance data have been collected in Ho Chi Minh City from centers for the treatment of venereal disease and tuberculosis, centers for the rehabilitation of injecting drug users and sex workers, prenatal clinics, blood banks and other sites. RESULTS: The first case of HIV infection in Vietnam was identified in 1990 in Ho Chi Minh City. The cumulative number of reported HIV infections in this city at the end of 1996 was 2774, about half of the number of cases in the country; 86% of infections were among men, 86% among injecting drug users, 2.5% among patients with sexually transmitted diseases and 2.5% among sex workers. The first HIV infection among antenatal women was detected in 1994. The prevalence of HIV among injecting drug users rose dramatically from 1% in 1992 to 39% in 1996, compared with 1.2% among sex workers, 0.3% among blood donors and 1.3% among tuberculosis patients in 1996. The populations of injecting drug users and sex workers in Ho Chi Minh City are estimated to be 30000 and 80000, respectively, and rates of sexually transmitted diseases are 2-3 per 1000 persons per year. By the end of December 1996, 42 out of 53 provinces had reported HIV infections, and border areas near China and Cambodia began identifying large numbers of HIV-seropositive people. CONCLUSIONS: Ho Chi Minh City is at the forefront of a new HIV epidemic in Vietnam. This epidemic shows similarities to that in Thailand nearly a decade ago, with rapidly rising HIV rates among injecting drug users and infection already established among sex workers. Prevention efforts should include the targeting of injecting drug users and sex workers outside rehabilitation centers, the availability of sterile needles and condoms, the establishment of anonymous testing sites, the control of sexually transmitted diseases and the coordination of programs within southeast Asia.

Acquired Immunodeficiency Syndrome↗

Sexually transmitted diseases among teenagers in England and Wales.

A profile of sexually transmitted diseases (STDs) and HIV infections among teenagers in England and Wales was obtained from reports of newly diagnosed STDs among teenagers attending genitourinary medicine (GUM) clinics in 1995, laboratory reports of newly diagnosed HIV infections between 1985 when reporting began and the end of 1995, and the prevalence of HIV (unlinked anonymous programme) among teenagers attending genitourinary medicine clinics and antenatal clinics in 1994 and 1995. STD reports were analysed by sex, age group, and place of residence of patients--whether in the NHS Thames regions or elsewhere in England and Wales. High rates of STDs were reported in teenagers, particularly in girls. The incidences of gonorrhoea, chlamydia infection, and first attack genital wart infections were higher in teenage girls than in any other age group. Boys under 16 years of age had substantially higher rates of infection with all STDs in the Thames regions than elsewhere. Rates of gonorrhoea in teenagers of both sexes in the Thames regions were more than twice those in the rest of the country. Infection rates for genital herpes, and chlamydia in girls, were also higher in the Thames regions, although the geographical differences were less marked. The seroprevalence of HIV among heterosexual teenagers was very low. In contrast, 226 HIV infections among teenage boys had probably been acquired through sexual intercourse with other males. Unlinked anonymous testing revealed HIV antibody in 7.5% of routinely collected serology specimens taken from teenage homosexual or bisexual males attending GUM clinics in London. The high rates of STDs among teenage girls and all teenagers in the Thames regions make these groups a high priority for sexual health promotion, with special consideration given to homo/bisexual male teenagers. Detailed surveillance of risk factors for STDs, and further studies of teenage sexual behaviour will help to effectively target resources to improve the sexual health of teenagers in England and Wales.

Adolescent↗

Radioimmunoassay for monitoring zidovudine in dried blood spot specimens.

We modified and evaluated a RIA for serum and used the modified RIA to measure zidovudine in dried blood spot specimens (DBSs) routinely collected for newborn screening and tested anonymously for maternally acquired HIV antibodies in the national HIV Seroprevalence Survey Among Childbearing Women. DBS calibration and quality-control materials were used to adapt the serum assay to the DBS matrix. The assay had a limit of detection of 24 micrograms/L serum and was used to measure zidovudine from both whole DBSs and the eluate remaining after HIV antibody screening. We initiated a pilot study to investigate the assay's performance and assess its potential to determine the implementation of the US Public Health Service recommendations that HIV-infected pregnant women and newborns receive zidovudine treatment to reduce the risk of perinatal HIV transmission.

Adult↗

Prevalence and epidemiological characteristics of hepatitis B and C infections among doctors and dentists in Nigeria.

A random sample of seventy five doctors and dentists at the University College Hospital, Ibadan, Nigeria, was surveyed. They were offered anonymous testing for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), antibodies to hepatitis B core antigen (anti-HBc) and to hepatitis C virus (anti-HCV) by enzyme immunoassay. The results suggest a high prevalence of hepatitis B virus (HBV) with a high potential of transmissibility, as well as a high prevalence of HCV infection. Most of the doctors and dentists use universal precaution for protection against viral hepatitis less than 50% of the occasions when they carry out procedures on their patients. Infection with HBV was associated with type of specialty (surgeons and dentists) and lack of HBV vaccination (p < 0.05). After logistic regression, these factors were independently associated with HBV infection (p < 0.05). Sixty (80%) of these health care workers had not received prior HBV vaccination. The unvaccinated personnel were more likely to be surgeons, dentists, less than 37 years of age and have fewer years of professional activity (p < 0.05). After logistic regression, only the fewer years of professional activity remained independently associated with lack of vaccination (p < 0.05). We conclude that to reduce the occupational exposure of HBV, universal precautions must be rigorously adhered to when doctors and dentists carry out procedures on their patients. It is necessary that these health care workers are vaccinated with HBV vaccine and the currently anticipated HCV vaccination, if not immune. No recent study exists that exclusively addresses this problem in health care workers in tropical Africa.

Adult↗

Differences between anonymous and confidential registrants for HIV testing--Seattle, 1986-1992.

Human immunodeficiency virus (HIV) counseling and testing is a major component of the public health effort to contain the HIV/acquired immunodeficiency syndrome (AIDS) epidemic. However, persons may avoid HIV testing in part because they fear discrimination and legal sanctions if their drug use, sexual behavior, or test results became public (1,2). Anonymous testing has been offered to address these fears, but it is not clear whether anonymous testing, compared with confidential testing, actually results in testing more persons at risk for or infected with HIV. This report, using registration data from a freestanding HIV-testing clinic in Seattle, compares demographic, behavioral, and serologic characteristics of anonymous and confidential registrants during 1986-1992.

Adult↗

Many people who seek anonymous HIV-antibody testing would avoid it under other circumstances.

Decreases in high-risk behavior have been observed when people have sought anonymous or confidential HIV-antibody testing accompanied by counseling. HIV-antibody testing also benefits those who are tested, since people who find that they are seropositive can receive closer medical follow-up, and, in certain cases, medical treatment. However, debates continue about appropriate testing policy. This study concerns the conditions under which people who are currently seeking anonymous testing at an alternative test site would be willing to obtain testing. On self-administered questionnaires all sexual orientation/gender groups expressed reluctance to obtain testing if anonymity were not assured. Bisexual men were especially concerned about seeking testing if there was mandatory reporting. Believing that one was infected with HIV was slightly associated with a decreased inclination to obtain testing under non-anonymous circumstances.

Acquired Immunodeficiency Syndrome↗

[Incidence of HIV infection in consultants reviewed after a first negative test in an anonymous and free screening center at the Institut Pasteur of Cambodia, 1996-1999].

A retrospective study was performed to determine the incidence of HIV seroconversion among repeat consultants attending the voluntary testing and counselling centre of the Institut Pasteur of Cambodia as well as factors associated with HIV seroconversion. From 1996 to 1999, 5541 repeat consultants were selected for the study. Exclusion criteria included being aged under 15 years, having initially tested positive or inconclusive and a time span of fewer than 30 days since the last test. In all, 276 persons had seroconverted to HIV, giving an incidence rate of 5.56 per 100 person-years. The seroconversion rate declined from 8.46% in 1996, to 3.06% in 1999 (chi 2 test for trend, p = 10(-5)). Among the risk factors analysed, 3 were significantly associated with lack of seroconversion: being a student (RR = 0.53, p = 0.032) or a civil servant (RR = 0.63, p = 0.012) and systematic condom use with causal partners (RR = 0.37, p = 10(-5)). The decline of HIV seroconversion among repeat consultants attending the VCT centre over the study period may reflect changes in risk behaviour and the beneficial impact of counselling.

Adult↗