Testing for antibody to HIV: confidentiality vs anonymity.
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Mass casualty triage knowledge of military medical personnel.
During battlefield and mass casualty incidents, triage has been traditionally performed by many different personnel, including medics, nurses, dentists, and physicians. The objective of this study was to determine which military medical providers are most knowledgeable in mass casualty triage. The design was a prospective, written, timed, case-based examination of triage knowledge. Participants were volunteers from the active duty medical (physician), dental, nursing, and enlisted corps of the three military services. Subjects completed a 16-minute written examination consisting of seven cases in each of three simulated mass casualty scenarios: combat; nuclear, biological, and chemical; and humanitarian. Tests were taken anonymously, although demographic data on medical specialty, training, and experience were collected. Participants were instructed to classify the cases using the NATO categories of immediate, delayed, minimal, or expectant. Scores were tabulated according to two grading scales: an absolute scale of number correct, and a weighted scale amplifying gross misclassifications. Median scores between groups were tested pairwise using the Kruskal-Wallis one-way analysis of variance with p < or = 0.05. Statistically significant differences were noted between the highest and lowest scoring groups in each scenario. Our conclusion is that among the subject groups tested, physicians were best at mass casualty triage. Dentists, nurses, and medics scored progressively less well on our examination.
Analysis of Variance↗
AIDS and STD knowledge, condom use and HIV/STD infection among female sex workers in Bali, Indonesia.
The objectives of this paper were to examine changes in AIDS/STD knowledge and behaviour from 1992-1998, current levels of STD infection and psychosocial and demographic determinants of condom use and STD infection among female sex workers. Data for the study were drawn from cross-sectional surveys of female sex workers conducted in 1992, 1994 and 1997-8. For each survey, women participated in a face-to-face interview in the brothel complexes. Survey questions included information on AIDS/STD knowledge, demographics, sexual history and psychosocial factors related to condom use. After the last survey, women were offered a vaginal exam for STD diagnosis and treatment. Sera were tested for HIV infection (anonymous, Elisa/Western blot) and syphilis (TYPHA, RPR). Cervical mucous was tested for chlamydia (LcX), gonorrhea (LCx), herpes (pcr) and HPV (pcr). Knowledge of AIDS and awareness of STDs has increased tremendously in this population since 1992. Reported condom use has also increased substantially (69.9%). Perceived susceptibility toward HIV infection remains low. Ineffective preventive strategies such as medication use continue to be common. HIV infection remains very low in this population (0.2%), although the prevalence of other STDs such as gonorrhea (60.5%), chlamydia (41.3%) and HPV (37.7%) were very high. STD knowledge and self-efficacy were significantly related to condom use as were the sex workers' perceived susceptibility to STD and HIV infection. Women with a larger number of partners were more likely to be infected with gonorrhea, chlamydia and HIV. Women who had come to Bali recently were more likely to be infected with HIV and gonorrhea.
Adult↗
South African national household survey of HIV/AIDS prevalence, behavioural risks and mass media impact--detailed methodology and response rate results.
OBJECTIVES: To describe the methodology used in a recent survey of HIV/AIDS in South Africa and to present the response rates. METHODS: A cross-sectional, national household-based survey was conducted using second-generation surveillance procedures. A complex multistage sampling technique was used to create a master sample of 1,000 census enumerator areas out of a total of 86,000 nationally. Aerial photographs were taken and used to randomly select more than 10,197 households and ultimately 13,518 individuals from a sampling frame of 31,321 people. Phase 1 of the study involved notifying the household residents about the study and collecting key demographic information on respondents aged 2 years and older. This information was used to randomly select up to 3 respondents from each household: 1 adult (25 years and older), 1 youth (15-24 years), and 1 child (2-14 years). In phase 2 nurses interviewed respondents and collected oral fluid specimens for HIV testing. In the case of children aged 2-11 years, parents or guardians were interviewed, but HIV testing was performed on the selected children. Questionnaire data were anonymously linked with HIV test results. RESULTS: A total of 9,963 persons agreed to be interviewed and 8,840 were tested for HIV, yielding a response rate of 73.7% and 65.4% respectively. However, only 8,428 (62.3%) HIV test results were correctly matched with behavioural data. The results showed that those tested for HIV did not differ from those not tested in terms of key determinants. CONCLUSION: It is possible to use community-based surveys to study the prevalence of HIV in the general population.
Adolescent↗
[HIV/AIDS infection. The Brazilian view. AIDS in Brazil].
The Ministry of Health coordinates and orients in Brazil all the activities concerning the acquired immunodeficiency syndrome which is officially designated as AIDS. The first AIDS' case registered in Brazil was, by retrospective diagnosis, in 1981 but it was in 1982 that the first two diagnosis in live patients were made. The incidence is very high in this country that is among the ones where the higher number of cases are being registered. The great majority of the Brazilian cases occurs in the cities and in direct proportion to the population index. The groups of risk are the same universally known and a comparative increase of heterosexual transmission is noted, chiefly due to the use of injectable drugs and bisexuality of the male partners. Another problem that is being increased is pediatric AIDS, with raising importance of perinatal transmission as well as the use of injectable drugs and precocious prostitution in adolescence. The transfusional and haemophilic AIDS have proportionally decreased due to the control of blood products. The control and the orientation activity of the Ministry of Health is directed to varied points such as: compulsory cases notification, cooperation between public and private sectors, preventive and sexual orientation, freely delivered medication and laboratory tests including sigilous tests, lay and technical personnel preparation, diversified informative and educational campaigns. Trial tests with anti-HIV vaccines have begun to be performed. Multiple Reference Centers were officially established by the administration. Among them is to be quoted the Hospital Universitário Gaffrée Guinle of Rio de Janeiro where the authors work. It is credited for its intensive activity and pioneerism. In this Institution special attention was due against discrimination of HIV-infected patients, to diagnosis, to anonymous and sigilous tests, to medical and psychological assistance, to myocardium involvement, to the virologic study of the Brazilian HIV samples, to research on HIV immunogenicity and pathogenicity, to post-mortem diagnosis control through necropsies.
AIDS-Related Opportunistic Infections↗
Use of and exposure to HIV prevention programs and services by persons at high risk for HIV.
Although HIV information is widely available in this country, little is known about how commonly used HIV prevention activities reach persons at highest risk for HIV. In this paper, we describe the extent to which HIV prevention strategies reach a sample of high-risk persons and whether such exposure correlates with having been tested for HIV. Data are from the 2000 HIV Testing Survey, an anonymous interview study of men who have sex with men (MSM), injection drug users (IDU), and high-risk heterosexuals (HRH), recruited from appropriate venues in seven states and New York City. We report the proportion of persons exposed to three types of interventions: information (media messages, brochures), counseling or skills-building (group counseling, role play, calling an AIDS hotline), and prevention supplies (provision of condoms, bleach kits), stratified by HIV testing status (ever, never). Exposure to information interventions was high among 2491 respondents (85%-96%) and did not differ by testing status. Use of counseling or skills-building interventions varied by testing status for IDU (8% untested versus 41% tested, p < 0.01) and HRH (14% versus 20%, p = 0.03) but not MSM (15% versus 23%, p = 0.08). Among tested IDU, those receiving bleach kits were more likely to report consistent bleach use when injecting with nonsterile needles (25% versus 9%, p = 0.003). Exposure to HIV prevention information is high but exposure to counseling or skills-building interventions is less common and more prevalent among those previously tested. Prevention initiatives should focus on counseling and testing, skills-building, and prevention supplies.
Adolescent↗
Comparison of HIV+ and HIV- adolescents: risk factors and psychosocial determinants.
According to the World Health Organization, half of the 14 million people with human immunodeficiency virus (HIV) worldwide were infected between the ages of 15 and 24 years. However, details about HIV-positive (HIV+) youths' risk-related behavior and social context have not been previously reported. OBJECTIVES. To outline detailed sexual and drug use practices, social and psychological status of HIV+ youth compared with a cohort of HIV-negative (HIV-) youth; and to examine the ability of the health belief and risk-taking models to predict sexual and drug use acts of HIV+ youth. METHODS. HIV testing was conducted on and a 207-item structured interview covering HIV risk-related acts, protective factors and background information was administered to 72 HIV+ and 1142 HIV- adolescents aged 13 through 21 years receiving care in an adolescent clinical care unit of a large medical center in New York City. Data were analyzed for adolescents reporting sexual intercourse (71 HIV+ and 722 HIV-) by logistic regression analysis of five domains to identify variables significantly associated with HIV seropositivity. RESULTS. Logistic regressions indicated significant differences in sexual risk acts based on serostatus and gender. Anonymous, blinded seroprevalence testing identified 11% more HIV+ adolescents than would have been identified by current counseling and testing practices. HIV+ adolescents were significantly more likely to be sexually abused (33 vs 21%, P < .05), engage in anal sex and survival sex (32 vs 4%, P < .01), unprotected sex with casual partners (42 vs 23%, P < .05), have had sex under the influence of drugs (52 vs 27%, P < .01), have a sexually transmitted disease (59 vs 28%, P < .01), use multiple drugs (43 vs 9%, P < .01) and engage in multiple problem behaviors (72 vs 30%, P < .01) than HIV- young people. HIV+ females reported more oral (69 vs 45%, P < .01) and/or anal (42 vs 12%, P < .01) intercourse compared to HIV- females. HIV+ males reported significantly higher rates of both insertive (82 vs 46%, P < .05) and receptive (51 vs 4%, P < .01) oral and anal (53 vs 13%, P < .01) intercourse than HIV- males. Protective factors were not significantly different for HIV+ and HIV- young people. CONCLUSIONS. Routine, confidential HIV counseling and testing should be considered for adolescents having unprotected sexual intercourse when age-specific services are available for HIV+ youth. Prevention programs should consider adolescents' history of abuse, homelessness, and other social as well as psychological dimensions in designing comprehensive care strategies to address HIV+ adolescents' multiple problem behaviors and living situations. Current theoretical models of health behaviors should be reconsidered, given the lack of their association to HIV risk acts of HIV+ youth. Age-specific services and interventions for HIV+ youth are urgently needed as HIV is spreading among youth worldwide.
Acquired Immunodeficiency Syndrome↗
[Risk assessment for eating disorders in a high school: a study based on the Eating Attitudes Test 26].
AIM: Disordered eating behaviours can lead to clinically evident and serious eating disorders (ED). Aim of this paper is to determine their extent among adolescents and to evaluate the associated characteristics. METHODS: All students of a high school (age 14-18) have been asked to fill up the Eating Attitudes Test (EAT-26) anonymously. EAT-26 is a self-reported questionnaire identifying subjects at risk for ED. This questionnaire included also an integrative section, aimed at investigating some ED-related variables (family composition, diet among relatives, social relationships, spare time activities, self-esteem). Collected data have been analyzed using EpiInfo6. RESULTS: The study involved all the 902 students of the school; 833 questionnaires have been distributed and 701 were collected (89.4% from girls, 10.3% from boys). The percentage of EAT-26 positive boys (i.e. scoring = or > 20) is 3%, while for girls is 13.7%. A positive test significantly correlates with low self-esteem (OR = 46.67, CI = 13.16-182.04), contentious relationships with the mother (OR = 2.20, CI = 1.12-4.29) and the father (OR=2.45, CI=1.24-4.80). No significant correlation has been found for being an only child, living in a single-parent family having limited/not having social relationships, having unsatisfactory social relationships, spending spare time mostly alone, watching TV more than 2 h per day. CONCLUSION: Our data suggest an increasing diffusion in the risk for ED among adolescents. Personal characteristics and behaviours related to this risk are good start points to program projects focusing on primary and secondary prevention of ED in high schools.
Adolescent↗
Acceptability of voluntary population screening for antibodies against HIV. Aarhus Research Group on AIDS.
In order to assess the acceptability of voluntary population screening for antibodies against human immunodeficiency virus (HIV), a random sample of 300 Danish men, aged 20-49 years, were sent a self-administered questionnaire. Among nonrespondents, recruitment attempts were repeated three times with intervals of 8-10 days. In total, 76.7% responded. Two hundred men (87.0% of the respondents) would accept an offer to be tested in an anti-HIV screening programme. Among respondents, 72.9% agreed to identify themselves to the researchers, 22.1% preferred to be tested under a code number known only by the participant himself, and 5% wanted the test information to be completely anonymous. Among the 30 men refusing HIV testing, 40% reported they were not concerned about AIDS, 16.7% expressed concern with confidentiality problems, and another 16.7% had been tested already and for this reason declined to participate. Previous reports have indicated high seroprevalences among nonrespondents and raised prevalences of behavior at high risk for HIV infection among persons who do themselves take the initiative to be tested or who decline to be tested because they worry about confidentiality. Low respondency and the associated disproportional loss of subjects at high risk of HIV infection may bias HIV seroprevalence estimates based on population probability sampling, especially in areas with low HIV infection prevalence. Because of these biases, voluntary population screening is likely to give only lower bound estimates of HIV seroprevalence. So, this technique should only be used in combination with other surveillance approaches.
Adult↗
Survey of the prevalence of HIV infection in an antenatal population in South Dakota.
Vertical transmission of the Human Immunodeficiency Virus is the major cause of pediatric AIDS cases. It is known that zidovudine therapy will substantially reduce the incidence of perinatal vertical transmission. Some authorities have made recommendations for universal HIV screening based on these findings. However, in an area of low prevalence of HIV, such as South Dakota, the benefits of such testing are questionable. We undertook a survey of one thousand consecutive deliveries in which a sample of cord blood was tested for HIV in an anonymous fashion. In all cases, the ELISA test was negative. Based on this extremely low incidence of HIV in our population, it is reasonable at the present time to undertake a selective screening protocol for testing for HIV during the antepartum period, based on the presence of risk factors, rather than applying universal screening to our population.
Costs and Cost Analysis↗
Study of infection with HIV and related risk factors in young offenders' institution.
OBJECTIVES: To estimate the prevalence of infection with HIV in young offenders in Scotland and to obtain information about related risk factors and previous tests for HIV. DESIGN: Voluntary anonymous study with subjects giving saliva samples for testing for HIV and completing questionnaires about risk factors. SETTING: Polmont Young Offenders' Institution near Falkirk, Scotland. SUBJECTS: 421 of 424 available male prisoners in Polmont. The questionnaires of 17 of the prisoners were excluded because of inaccuracies. MAIN OUTCOME MEASURES: Prevalence of infection with HIV and related risk behaviour. RESULTS: 68 (17%) of prisoners admitted misuse of intravenous drugs, of whom 17 (25%) admitted having injected drugs while in prison. Three subjects admitted having anal intercourse while in prison. Prevalence of misuse of intravenous drugs varied geographically: 28% (33/120) of prisoners from Glasgow compared with 9% (7/81) of those from Edinburgh and Fife. A high level of heterosexual activity was reported, with 36% (142/397) of prisoners claiming to have had six or more female sexual partners in the year before they were imprisoned. Altogether 8% (32/389) of prisoners had previously taken a personal test for HIV: 50% (9/18) of those who had started misusing intravenous drugs before 1989, 18% (9/49) of those who started misuse later, and only 4% (14/322) of those who had not misused intravenous drugs. No saliva sample tested positive for antibodies to HIV, but 96 prisoners requested a confidential personal test for HIV as a result of heightened awareness generated by the study. CONCLUSIONS: Voluntary, anonymous HIV surveys can achieve excellent compliance in prisons, and the interest generated by the study suggests that prisons may be suitable sites for providing education and drug rehabilitation for a young male population at high risk of future infection with HIV.
Adolescent↗
Repeat HIV testing: high-risk behaviour or risk reduction strategy?
OBJECTIVE: To examine the characteristics of repeat and first-time HIV testers and consider their implications for HIV test counselling. METHODS: An anonymous questionnaire was completed by nearly 1500 people seeking an HIV test between September 1997 and July 1998 at a same-day HIV testing clinic in London, United Kingdom. Repeat testers were those people who had previously tested HIV negative and were returning for another test. Information was collected on self-reported unprotected penetrative sex (UPS) in the previous 3 months and reasons for seeking the present test. RESULTS: Overall, 50.6% (721/1446) of all clinic attenders were repeat testers: gay men 71.7% (337/470), heterosexual men 42.1% (208/494) and heterosexual women 38.6% (186/482). No significant differences were found between repeat and first time testers in the frequency of UPS (P > or = 0.06). However, gay men (but not heterosexual men and women) reporting three or more previous HIV tests were significantly more likely to report higher-risk UPS (i.e. with a partner whose HIV status was either positive or unknown) (42.2%) than those who had had one-two or no previous tests (25.3 and 25.4%, respectively; P = 0.002). Over half the heterosexual men and women, and one third of gay men said they were seeking the current HIV test in preparation for a new relationship; these proportions did not differ significantly between repeat and first-time testers (P > 0.1). CONCLUSION: In this London HIV testing clinic, no significant differences were found in the frequency of UPS between repeat and first-time testers with the exception of gay men with a history of three or more previous HIV tests, who reported elevated levels of high-risk sexual behaviour. For many people, repeat HIV testing has become part of a risk reduction strategy to establish seroconcordance with a regular partner. HIV test counselling provides the opportunity both to address high-risk behaviour and to reinforce personal risk-reduction strategies.
Female↗
Update on the seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1994.
To update the estimate of seroprevalence of HIV from the third National Health and Nutrition Examination Survey (NHANES III), data from the second phase of the survey were combined with previously published data to produce a more precise estimate. The testing was performed anonymously on 11,203 individuals 18-59 years of age examined from 1988 to 1994. Fifty-nine individuals were HIV positive, for an overall prevalence of 0.32%. The number of individuals living in households with HIV infection based on this estimate was 461,000, with a 95% confidence interval of 290,000-733,000. Analysis of nonresponse demonstrated that white and black men 40-59 years of age were least likely to participate in the survey. A sensitivity analysis demonstrated that this nonresponse may have biased the NHANES III estimate downward by 190,000 persons. Data from the second phase of the survey were used to analyze the association between drug use and HIV infection. Black women who used cocaine were 12 times more likely to be HIV positive compared with all tested black women (6.5% vs. 0.55%). This survey provides an estimate of HIV prevalence for individuals who reside in households but excludes some persons who are at higher risk for HIV infection, including prisoners and the homeless not residing in shelters.
Adolescent↗
[Medical-psychosocial HIV ambulatory care within the scope of anonymous and free AIDS counseling in HIV antibody testing].
It is essential for HIV-positive outpatients to come to terms with their disease by learning to accept their new situation and to adjust their lives to it. Since 1988 the HIV-outpatient welfare centre at the Düsseldorf Public Health Department has been taking care of HIV-positive outpatients, offering a combination of examination and psychosocial support. This programme begins with the first visit preceding the HIV-AK test. The outpatients find the active psychological support very helpful. The care provided helps them to cope with their disease. In this way, the first consultation will lead to a continual care programme under the same conditions (anonymous and free of charge). The medical programme consists of: outpatient examination; physico-immunological 'staging'; establishing individual plans of diagnosis The medical programme is developed exclusively for patients without signs and symptoms. If immunological or clinical signs or symptoms are present, the patient is referred to a suitable HIV-outpatient care clinic. The psychosocial care continues in every case. Psychosocial care consists of: advice on common and alternative therapy for those suffering from HIV disease measures to help strengthen the immune system (e.g. nutrition); psychotherapy in personal crisis (e.g. depressive reaction); care for dying patients; special advice concerning disability pension, invalidity and general social welfare problems.
AIDS Serodiagnosis↗
Introductory biology of Fusarium moniliforme.
Fusarium moniliforme is a name that has been applied to any of six biological species (or mating populations) that share the teleomorph (sexual stage) Gibberella fujikuroi. Two of these six biological species, termed "A" and "D", are known to produce fumonisin mycotoxins. Strains from the "A" biological species grow as endophytes on maize and often comprise 90+% of the Fusarium isolates recovered from healthy maize seed. It is possible to distinguish all six biological species using sexual fertility and isozymes. Other attributes, such as morphological characters and sequences from the ribosomal DNA internally transcribed spacer (rDNA-ITS) region, can be used to identify some, but not all, of the biological species. Within a biological species, genetic variability and population structure can be assessed with anonymous RFLPs and tests of vegetative compatibility. The "A" biological species is genetically diverse, and the sexual cycle appears to be important in the life cycle of field populations of this organism in the United States.
Food Contamination↗
Risk of human immunodeficiency virus infection for emergency department workers. Italian Study Group on Occupational Risk of HIV Infection.
To evaluate the risk of human immunodeficiency virus (HIV) exposure among emergency department workers (EDWs) and their ability to identify HIV-infected patients, a seroprevalence study was performed in March 1991 in the emergency departments (EDs) of six Italian urban hospitals. At each visit, patients aged 18-65 years were asked to undergo fingerstick blood sampling for anonymous, unlinked HIV testing performed on blood adsorbed filter paper collection cards. Demographic characteristics, known or suspected HIV risk factors, and occupational exposures reported by the EDWs during the patient's visit were recorded. On 9,457 consecutive visits, 9,005 samples (95%) were tested and 65 (0.7%) were HIV positive. ED staff failed to identify 59% of HIV-infected patients. The rate of occupational exposures was 0.13/100 visits. As it is impossible to predict the HIV status of patients attending EDs, adherence to universal precautions and the development of safer devices should be utilized to minimize the risk of blood-borne infections in EDWs.
Adolescent↗
Antituberculosis drug resistance and anonymous HIV surveillance in tuberculosis patients in Botswana, 2002.
Two surveys undertaken in Botswana in the 1990s have recorded low rates of antituberculosis drug resistance, despite a three-fold rise in tuberculosis since 1989. We undertook a third survey to determine both trends since 1995 and HIV prevalence in tuberculosis patients in Botswana. Sputum specimens were obtained from patients nationwide in 2002 who also underwent anonymous, rapid HIV testing by use of Oraquick. Of 2200 sputum smear-positive patients and 219 previously treated patients with suspected recurrent tuberculosis, 1457 (60%) were infected with HIV. Resistance to at least one drug in new patients rose from 16 (3.7%) isolates in 1995 to 123 (10.4%; p<0.0001) in 2002. Interventions for tuberculosis control are urgently needed in Botswana to prevent further emergence of drug resistance.
AIDS Serodiagnosis↗
Factors associated with unrecognized HIV-1 infection in an inner-city emergency department.
STUDY OBJECTIVE: To determine the prevalence of and risk factors associated with unrecognized HIV-1 infection among medical patients presenting to an inner-city emergency department. METHODS: We conducted anonymous HIV-1 testing in subjects interviewed for risk behaviors and knowledge of HIV status at an inner-city ED in the Bronx, New York. Our subjects were consecutive adult medical patients in noncritical condition (N = 1,744) who were evaluated by three physicians providing primary emergency care. Each patient was given a structured interview for demographic characteristics, risk behaviors, and knowledge of HIV status. Excess serum, drawn for clinical purposes, was linked without identifiers to responses and tested for antibodies to HIV-1. In subjects who denied HIV infection, we tested associations with seropositivity using univariate analyses and logistic-regression techniques (multivariate). RESULTS: Of the 1,744 patients interviewed, 656 (37.6%) reported HIV risk behaviors. Of 970 tested for HIV-1 antibodies, 125 (12.9%) were seropositive. The prevalence of HIV-1 infection among those who denied known infection was 4.0% (35 of 875). In the multivariate model, independent predictors of unrecognized HIV-1 infection were age 35 to 44 years, crack cocaine use, history of syphilis, and ED diagnosis of an infection not necessarily related to HIV infection. Unrecognized HIV-1 infection was more likely among patients admitted to the hospital, but 21 of the 35 with unrecognized infection (60%) were not admitted and in 9(25.7%) no risk factors were identified. CONCLUSION: More than one third of patients who visited one inner-city ED acknowledged HIV risk behaviors. One quarter of patients with unrecognized HIV-1 infection reported no identifiable risk factors. Easily accessible HIV counseling and testing should be considered in EDs in areas serving persons at risk for HIV infection.
Adolescent↗