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PubMed2000

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

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

AIDS Serodiagnosis↗
PubMed1992

Trends of HIV infections using the anonymous mandatory reporting system and other data sources in Switzerland and in the Federal Republic of Germany.

In Switzerland and in the Federal Republic of Germany the reporting of HIV infections is based on an anonymous mandatory reporting system for laboratories. In Switzerland, physicians have to complete a questionnaire on the patient's clinical status and risk behaviour. To make a rough estimate of the prevalence of HIV infections in the general population at low risk, data on blood donations are used in both countries. In Switzerland, additional data with information on positive and negative test results have been obtained since 1985 from anonymous test sites. In both countries, the data do not show evidence of an increasing incidence of HIV infection. The number of positive test results reported by the laboratories and physicians remains stable, and the rates of HIV-positive blood donations are declining. In the Federal Republic of Germany, homo-/bisexual men play the most important role in the epidemic, whilst in Switzerland, injecting drug users contribute most to the burden of HIV infection, and the proportion of persons probably heterosexually infected is increasing steadily. Possible selection biases need to be further discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Revised guidelines for HIV counseling, testing, and referral.

These guidelines replace CDC's 1994 guidelines, HIV Counseling, Testing, and Referral Standards and Guidelines, and contain recommendations for public- and private-sector policy makers and service providers of human immunodeficiency virus (HIV) counseling, testing, and referral (CTR). To develop these guidelines, CDC used an evidence-based approach advocated by the U.S. Preventive Services Task Force and public health practice guidelines. The recommendations are based on evidence from all available scientific sources; where evidence is lacking, opinion of "best practices" by specialists in the field has been used. This revision was prompted by scientific and programmatic advances in HIV CTR, as well as advances in prevention and the treatment and care of HIV-infected persons. These advances include a) demonstrated efficacy of HIV prevention counseling models aimed at behavioral risk reduction; b) effective treatments for HIV infection and opportunistic infections; c) effective treatment regimens for preventing perinatal transmission; and d) new test technologies. Although the new guidelines include many aspects of the previous ones (e.g., encouragement of confidential and anonymous voluntary HIV testing, need for informed consent, and provision of HIV prevention counseling that focuses on the client's own risk), the new guidelines differ in several respects, including: giving guidance to all providers of voluntary HIV CTR in the public and private sectors; using an evidence-based approach to provide specific recommendations for CTR; underscoring the importance of early knowledge of HIV status and making testing more accessible and available; acknowledging providers' need for flexibility in implementing the guidelines, given their particular client base, setting HIV prevalence level, and available resources; recommending that CTR be targeted efficiently through risk screening and other strategies; and addressing ways to improve the quality and provision of HIV CTR.

AIDS Serodiagnosis↗
PubMed2002

[The seroprevalence of HIV in pregnant women in New Caledonia: an assessment of 1 year of surveillance].

OBJECTIVES: To evaluate the HIV prevalence among pregnant women in New-Caledonia and to analyse the uptake of testing among the patients according to their demographic data. METHOD: The study was based on statistical exploitation of anonymously recorded HIV test results during the follow-up of pregnant women. The first 12-month assessment of this monitoring (April 1999--March 2000) is reported. RESULTS: 88.6% of the 3380 patients were tested for HIV, significantly less in Wallisian and Melanesian groups of women. Two results were positive, which corresponds to a prevalence of 0.66 +/- 0.45 per thousand (0.21-1.11 per 1000) within the studied group. Although our study is not representative of this situation, lack of testing for women undergoing an abortion was frequent. CONCLUSION: This study indicates that offering HIV testing in pregnancy follow-up is fairly systematic and most often accepted. Evidently, there is a need for adjusting of pre-test counselling to the cultural and ethnic characteristics of the woman, to the preparedness of medical staff as well as to the problem of HIV screening in abortion management. Our prevalence data also show that New-Caledonia ranks among countries of low endemicity for HIV where pregnant women are concerned.

AIDS Serodiagnosis↗
PubMed1992

Sexually transmitted diseases amongst a sample of people seeking HIV testing.

AIMS: To examine the incidence of sexually transmitted diseases according to gender, age, sexual orientation, sexual behaviour and drug use. METHODS: Data were collected from 814 clients attending anonymously for HIV testing at the Burnett Centre in Auckland. During pretest counselling clients were asked questions designed to assess their risk of HIV infection including a detailed history of sexually transmitted diseases (STDs). RESULTS: Amongst attenders 44% reported at least one lifetime STD including 16% reporting more than one. Multiple STDs were not associated with gender or sexual orientation but they were associated with the practice of anal sex and with a history of multiple sex partners. Alcohol and drug use were also related to multiple STDs. For men the most common STD was NSU with 20% of them reporting it whereas for women genital warts was the most common reported by 18%. Amongst those under 20 years 9% reported genital warts, 7% NSU and 6% chlamydia. CONCLUSIONS: The findings confirm that it is sexual practices which put people at risk of infection from STDs rather than their sexual orientation. They also draw attention to the role that drugs and alcohol play in the practice of unsafe sex and the consequent transmission of STDs. Finally they suggest that screening for STDs as well as HIV in AIDS clinics should be encouraged.

Adult↗
PubMed1995

Prevalence of HIV-1 infection in 18 year old men in Tuscany. The Toscana Collaborative Group.

BACKGROUND: The main route of transmission of the human immunodeficiency virus type 1 (HIV-1) is sexual contact. A high proportion of young adults is exposed to this mode of transmission. Therefore it is important to assess the level of HIV-1 prevalence among 18 year olds in Italy. METHODS: Available blood samples taken at the physical examination of the military draft visit in Tuscany, Italy, have been tested in an anonymous unlinked fashion for HIV-1 infection in 1990 and 1991. RESULTS: In the 2 years, 4478 and 4959 men were tested, respectively, representing 91.7% of all subjects included in the draft lists. Prevalence of HIV-1 infection was 1.12 per 1000 (95%CI: 0.36-2.61 per 1000) in 1990 and 0.20 per 1000 (95% CI: 0.01-1.12) in 1991. CONCLUSIONS: Prevalence of HIV-1 infection in the 18 year old male population in Tuscany is close to or below 1/1000. Evidence of the presence of HIV-1 infection in this population should prompt the implementation of adequate prevention programmes among adolescents.

Adolescent↗
PubMed2000

Effect of national seminar on AIDS and anesthesia upon knowledge, attitude and practice concerning HIV among Thai anesthesia personnel.

In the national seminar of AIDS and Anesthesia which was a short course educational program in all aspects of HIV medicine, 195 questionnaires about knowledge, attitude and practice concerning HIV were distributed among the participants (anesthesiologists and nurse anesthetists) in 3 periods, pretest, post test (at the end of 2 days seminar) and post test 2 (at 4 months after the seminar). There were 177 (90.76%) respondents who completed both pretest and post test 1 questionnaires. About 12 questions of knowledge; mean scores were statistically significantly increased; 7.95 (0.98) vs 9.5 (0.78), P < 0.001. Two thirds (8 out of 12 questions) were answered correctly in post test 1 more than in the pretest by Mc Nemar Chi-square test; P < 0.05. About attitude; 2 out of 5 answers changed significantly by Mc Nemar Chi-square test; P < 0.05. The post test 2 questionnaires were mailed to all 177 participants twice asking to reply only once. All questionnaires were to be completed anonymously. The post test 2 with a response rate of 65.5 per cent revealed that universal precautions were frequently used among Thai anesthesia personnel but not universally followed. At least one-third of the respondents admitted recapping before disposal of used needles. Fifty six per cent of respondents (vs 22.8% in pretest) admitted re-using one syringe for more than one patient. In conclusion, this study showed that a short course educational program may improve knowledge about HIV and partly change attitude, but can not change behaviour. Changing the practice of anesthesia health care workers needs continual education and appropriate training.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Surveillance of HIV and syphilis infections among antenatal clinic attendees in Tanzania-2003/2004.

BACKGROUND: This paper presents the prevalence of human immunodeficiency virus (HIV) and syphilis infections among women attending antenatal clinics (ANC) in Tanzania obtained during the 2003/2004 ANC surveillance. METHODS: Ten geographical regions; six of them were involved in a previous survey, while the remaining four were freshly selected on the basis of having the largest population among the remaining 20 regions. For each region, six ANC were selected, two from each of three strata (urban, peri-urban and rural). Three of the sites did not participate, resulting into 57 surveyed clinics. 17,813 women who were attending the chosen clinics for the first time for any pregnancy between October 2003 and January 2004. Patient particulars were obtained by interview and blood specimens were drawn for HIV and syphilis testing. HIV testing was done anonymously and the results were unlinked. RESULTS: Of the 17,813 women screened for HIV, 1,545 (8.7% (95% CI = 8.3-9.1)) tested positive with the highest prevalence in women aged 25-34 years (11%), being higher among single women (9.7%) than married women (8.6%) (p < 0.07), and increased with level of education from 5.2% among women with no education to 9.3% among those at least primary education (p < 0.001). Prevalence ranged from 4.8% (95% CI = 3.8%-9.8%) in Kagera to 15.3% (95% CI = 13.9%-16.8%) in Mbeya and was; 3.7%, 4.7%, 9.1%, 11.2% and 15.3% for rural, semi-urban, road side, urban and 15.3% border clinics, respectively (p < 0.001). Of the 17,323 women screened for syphilis, 1265 (7.3% (95%CI = 6.9-7.7)) were positive, with highest prevalence in the age group 35-49 yrs (10.4%) (p < 0.001), and being higher among women with no education than those with some education (9.8% versus 6.8%) (p < 0.0001), but marital status had no influence. Prevalence ranged from 2.1% (95% CI = 1.4%-3.0%) in Kigoma to 14.9% (95% CI = 13.3%-16.6%) in Kagera and was 16.0% (95% CI = 13.3-18.9), 10.5% (95% CI = 9.5-11.5) and 5.8% (95% CI = 5.4-6.3) for roadside, rural and urban clinics, respectively. Syphilis and HIV co-infection was seen in 130/17813 (0.7%). CONCLUSION: The high HIV prevalence observed among the ANC clinic attendees in Tanzania call for expansion of current voluntary counselling and testing (VCT) services and access to antiretroviral drugs (ARV) in the clinics. There is also a need for modification of obstetric practices and infant feeding options in HIV infection in order to prevent mother to child transmission of HIV. To increase uptake to HIV testing the opt-out strategy in which all clients are offered HIV testing is recommended in order to meet the needs of as many pregnant women as possible.

Adult↗
PubMed1993

Sentinel surveillance for HIV-2 infection in high-risk US populations.

OBJECTIVES: We conducted sentinel surveillance in persons practicing behaviors known to transmit retroviruses to determine the US presence and extent of human immunodeficiency virus type 2 (HIV-2). METHODS: Sentinel surveillance for HIV-2 was conducted by testing 31,533 anonymous blood specimens from patients at sexually transmitted disease clinics, injecting drug users at treatment centers, and clients at HIV counseling and testing sites in 14 US cities where West African immigrants often settle. Specimens were tested by HIV-1 and HIV-2 whole virus and synthetic peptide enzyme immunoassay and confirmed by HIV-1 and HIV-2 Western blots. RESULTS: Nearly 10% of 31,533 sera were positive for HIV-1. Two heterosexual Black male sexually transmitted disease patients were infected with HIV-2. One of the HIV-2 positive specimens did not cross-react on HIV-1 enzyme immunoassay screening. One client had antibodies consistent with malarial infection in West Africa; the other, who had syphilis, did not have antibodies to malaria or to any of 20 arboviruses present in Africa. CONCLUSIONS: Clinics serving clients from HIV-2 endemic areas should test persons practicing risk behaviors for both HIV-1 and HIV-2. Sentinel surveillance for HIV-2 serves as an early warning system for the possible spread of this virus in the United States.

Adult↗
PubMed1988

[HIV testing in general practice].

In the third quarter of 1987 a questionnaire was sent to 350 consecutive patients of a general practice for the purpose of ascertaining patients' willingness to be tested (if desired, anonymously) without charge for antibodies against human immunodeficiency virus (HIV). They were asked, among other questions, about their reasons for or against wanting the test, previous blood transfusions, drug dependence, homo- or bisexuality, and sexual contact with heroin addicts. Nearly half the questionnaires (162 were completed and returned. Of the responding patients 60% voted for, 40% against the test. The large majority of those for it reported no previous risk factors but wanted to have what they assumed would be a negative test confirmed in writing. In addition to this questionnaire study all clinical and anamnestic indications for HIV testing were documented over a six-month period (16 cases). Two heroin addicts and a homosexual male had a positive anti-HIV test, while all others were negative.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Prevalence of HIV infection among former commercial plasma donors in rural eastern China.

BACKGROUND: Sporadic reports of HIV-1 infection among commercial plasma donors in China between 1994 and 1995. OBJECTIVES: (1) To determine the prevalence of HIV infection among repeat plasma donors; (2) to identify factors associated with HIV infection; and (3) to describe characteristics associated with secondary transmission. METHODS: Plasma/blood donors who had a history of donating plasma/blood before March 1, 1995, their spouses, and their children under 5 years were recruited for a cross-sectional study. A questionnaire and an HIV test were collected anonymously. Information collected included demographic characteristics, sexual behaviour, recreational drug use and history of medical care and blood/plasma donation. HIV antibody was identified by the Hema-Strip rapid test and confirmed by Western blot. The prevalence of HIV infection was calculated and risk factors associated with infection determined by univariate analyses followed by multivariate modelling. RESULTS: A total of 1517 individuals were interviewed and tested, of whom 1043 adults admitted to donating plasma. The prevalence of HIV infection among plasma donors was 12.5% and among their non-donor spouses was 2.1%. Prevalence was inversely related to educational level and was higher in married participants, but was not associated with medical care, drug abuse or multiple sexual partners. A higher frequency of plasma donation was directly associated with a higher risk of HIV infection. Multivariate analyses demonstrated that being HIV-positive was associated with being 30 to 49 years old [odds ratio (OR) = 1.9], donating both plasma and blood (OR = 2.5), and the frequency of plasma donation (OR = 14 for >10 donations per month). CONCLUSION: The study demonstrated that the prevalence of HIV infection in the commercial plasma donor population was alarmingly high. Many married individuals and those getting married in the future will transmit the virus to their spouses and future children. Plasma donors need to be alerted to the risk of being infected with HIV and of transmitting HIV to their families and others. Other countries can benefit from the experience of China in reducing the risk of HIV transmission from plasma donating.

AIDS Serodiagnosis↗
PubMed1997

Age-stratified seroprevalence of measles, mumps and rubella (MMR) virus infections in Switzerland after the introduction of MMR mass vaccination.

We have performed age-stratified seroprevalence studies for MMR to evaluate these vaccinations. Serum samples submitted for diagnostic testing were randomly selected for unlinked anonymous panels. IgG antibodies were tested by ELISA and indirect immunofluorescence. In the vaccination cohort (age 1.5 to 6.5 years), seroprevalence attained 80%. For measles and mumps it continued to increase to 95%, while for rubella it declined transiently to 60% between 7 and 12 years of age. We observed no differences according to gender in any age group in 1991-1992. (Semi)quantitative values of the IgG antibodies against all three viruses increased during adolescence, suggesting wild virus circulation. In 1992, MMR vaccination has reached < 80% of the children during their second year of age. Due to previous monovalent measles and mumps vaccinations in pre-school children and due to endemic and epidemic activity, particularly of mumps virus, a trough of the seroprevalence in adolescents was evident only for rubella. MMR vaccination campaigns performed at school since 1987 have increase seroprevalence in this population segment and have probably over-compensated for the expected shift to the right of the seroprevalence curves. A more compulsive implementation of the recommended childhood vaccination schedule and continued efforts at catchup vaccinations during school age especially for rubella are necessary to avoid the accumulation of susceptible young adults during the forthcoming decades.

Adolescent↗
PubMed1991

Seroprevalence of human immunodeficiency virus in women admitted to the hospital with pelvic inflammatory disease.

To assess the association of the human immunodeficiency virus (HIV) with other sexually transmitted diseases we undertook an anonymous HIV antibody serosurvey of all women admitted to the hospital with pelvic inflammatory disease. All the patients were given HIV risk reduction information and offered voluntary antibody testing. Thirty-one consecutive patients were evaluated; 30 specimens were suitable for anonymous testing. Five of the 30 (16.7%) were seropositive on both an enzyme-linked immunosorbent assay and Western blot test. The majority of the patients expressed concern about their HIV risk; 23 (74%) requested confidential testing. Of those tested, five (21.7%) were seropositive; three had traditional risk factors (intravenous drug abuse and/or sexual contacts at risk), and two denied traditional risk factors but reported nonintravenous cocaine use and multiple sexual partners. Of the seronegative women, 33% reported nonintravenous cocaine use (many with multiple sexual partners). Preventing the heterosexual spread of HIV into this vulnerable population is a formidable public health challenge.

Adult↗
PubMedDate not supplied

Laboratory-based HIV surveillance with information on exposure: importance of discriminating person-based from test-based results.

Within a surveillance programme in a Regional Public Health Laboratory anonymous information on HIV test, requesting physician and tested individual is automatically selected, regardless of test result. Thereby, personal identifiers are transformed into unique but meaningless numeric codes. Besides, requesting physicians receive a questionnaire on indication for testing (response 87%). Between April 1989 and June 1993 12,219 HIV tests were performed in 10,972 individuals. The percentage of positive tests (2.1%) was twice the percentage of positive individuals (1%). No increase in number of new infections was observed over time. Of individuals, 41.6% were tested due to third party requests (mainly insurance): HIV was demonstrated once (0.03%). Among the remainder, with medical indications, seroprevalence was 1.4%. At relatively little expense, we were able to provide valid information about patterns of HIV-testing and HIV seroprevalences among people tested in routine medical practice. Prevention of double counts proved to be important. Extension to other Dutch areas is expected.

AIDS Serodiagnosis↗
PubMed1999

Prevalence of alcohol problems among pediatric residents.

OBJECTIVE: To measure the prevalence of alcohol-related problems among pediatric trainees. METHODS: An alcoholism screening test was administered anonymously to participants at a mandatory substance abuse education and prevention program. SETTING: A large urban pediatric residency training program. SUBJECTS: One hundred fifteen pediatric residents attended the program during 3 consecutive years (1996-1998). Eighty-five (74%) screening tests were returned and 81 (70%) were analyzed MAIN OUTCOME MEASURE: The 25-item Michigan Alcoholism Screening Test (MAST). Differential MAST cutpoints have been established to "suggest" or "indicate" a lifetime diagnosis of alcoholism. RESULTS: Twelve residents (15%) had scores suggestive and 6 (7%) indicative of alcoholism. Twenty-eight (35%) admitted to having alcohol-associated amnesia (blackouts), 13 (16%) to "feeling bad" about their drinking, 9 (11%) to drinking before noon, 6 (7%) to getting into fights when drunk, and 2 (2%) to alcohol-related marital problems. However, only 1 (1%) had gone to anyone for help and none admitted to alcohol-related problems at work. CONCLUSIONS: These screening data suggest that alcohol abuse and related problems exist among pediatric trainees at troubling rates. While more than one third of the trainees had experienced a serious consequence from heavy drinking, only 1 had gone for help and problems were not apparent at work. Greater emphasis should be placed on alcohol prevention and early intervention programs as a routine part of pediatric training.

Adult↗