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PubMed1999

Specialist services: the need for multi-agency partnership.

In the UK the broad trend noted in prevalence surveys is towards increased availability, exposure, and use of illicit drugs across all social strata. There is a developing consensus regarding those groups of young people who are at particular risk. They may be homeless, pregnant, leaving local authority or foster care, engaged in prostitution or involved with the criminal justice system. These young people are likely to require intervention from a variety of agencies and professionals to respond to their multiple needs, yet they are faced with a dearth of specialist substance misuse services. Consequently there is a need to develop a range of partnership approaches amongst both providers and commissioners of services. The importance of partnership has been stressed in a succession of professional guidance documents, but there remain considerable bureaucratic, organisational, and historical barriers that must be overcome. Effective service models that exist in the UK and elsewhere are a source of ideas to stimulate appropriate, child-centred developments. Overall the need for a fresh impetus is emphasised, in which new partnerships are formed, and collaborative services are developed and evaluated. In this way future initiatives can be based upon evidence of clinical and cost effectiveness.

Adolescent↗
PubMed1998

Incorporating health and behavioral consequences of child abuse in prevention programs targeting female adolescents.

A study examining the health and behavioral consequences of child abuse was conducted among 263 parenting and 257 never-pregnant teens attending a reproductive health clinic. Both groups of teens identified the following major consequences: suicide, prostitution, school drop-out, crime and substance abuse. However, only parenting teens expressed interest in prevention programs that would address these consequences. Traditional child abuse prevention programs are focused on parenting issues and rarely address health and behavioral consequences of abuse. These health and behavioral consequences of abuse may make adolescents vulnerable to abuse their own children as well as interfere with their psychosocial development. Therefore, the authors recommend integrating health and behavioral issues into child abuse prevention programs.

Adolescent↗
PubMed1998

Factors associated with serum HCV RNA positivity in anti-HCV antibody positive intravenous drug users.

Serum hepatitis C virus (HCV) RNA, HCV genotypes and liver function tests were evaluated in a series of 189 unselected, consecutive anti-HCV positive intravenous drug users (IVDUs). Serum HCV RNA was detected in 106/189 patients. Abnormal liver function tests were associated with alcohol abuse, but not with the presence of serum HCV RNA. Among 109 patients retested after a mean follow-up of 21 months, 41 were intermittently serum HCV RNA positive. Patients persistently negative had more commonly a past history of acute hepatitis. A history of prostitution and/or a pattern of abuse involving >30 injections per week were related to infection by genotype 3a. In conclusion, serum HCV RNA is either transiently or persistently detectable in most anti-HCV positive IVDUs, but bears no association with abnormal liver biochemistry. Infection by HCV-3a is more common in IVDUs with more deviant life styles. In those cases where serum HCV RNA is found repeatedly negative, HCV infection may have been cleared, possibly through an episode of acute hepatitis.

Adult↗
PubMed2003

Travel epidemiology--a global perspective.

In order to have a rational approach to necessary preventive measures it is essential to know the health risks. The 80 million travellers each year with destinations in Africa, Asia, Latin America, Pacific Islands and remote areas in Eastern Europe are exposed to a broad range of pathogens that are rarely encountered at home. The risk depends on the degree of endemicity in the area visited, the duration of stay, the individual behaviour and the preventive measures taken. Travellers' diarrhoea (TD) is the most frequent ailment of visitors to countries with poor hygiene. The incidence rate is 25-90% in the first 2 weeks abroad. The risk of TD is far less in travellers originating in a high risk country, as some immunity develops. Malaria is an important risk for travellers going to endemic areas. Without chemoprophylaxis, the monthly incidence is high in some destinations, among them frequently visited tropical Africa where 80-95% of the infections are due to Plasmodium falciparum. The incidence rates are lower in most endemic areas of Asia and Latin America where Plasmodium vivax predominates. The risk is nil in all capital cities of South America and SE Asia, as well as in many frequently visited tourist destinations. The diseases preventable by immunization will be discussed in a separate paper (Vaccination priorities; page 175). Sexually transmitted diseases occur frequently, as some travellers (5% of Europeans) engage in casual sex, approximately half of them without being protected by a condom. The prevalence for HIV-infection, syphilis, gonorrhoea, etc. often exceeds 50% in prostitutes. In some European countries, a major proportion of heterosexuals with newly acquired HIV-infection have acquired it while abroad.

Accidents↗
PubMed1997

[Management of drug addict pregnant women and their children].

Children of substance abuse mothers have an increased risk of severe pathological disorders such as perinatal diseases (prematurity, intrauterine growth retardation, infections) with their neurological and respiratory complications and sequelae, and transmission of drug addiction related infections, ie human immunodeficiency virus, hepatitis B and C virus, syphilis. Many of these children present a drug withdrawal syndrome characterized by restlessness and jetteriness during the neonatal period. This is frequently followed by a post withdrawal period of several weeks duration with crying, excitement, sleep and feeding difficulties. Although these drug withdrawal manifestations have no incidence on the vital prognosis, it severely impairs the mother-infant interaction. Despite these disorders it appears that the outcome of these children is mainly related to their familial environment which is exposed to many risk factors: mother-child separation, violence, delinquency, precariousness, unhealthy housing, prostitution, drug dependency, parental death or imprisonment... Early medico-psycho-social intervention starting during pregnancy and a prolonged support for several years are the only way to improve their spontaneously poor outcome.

Female↗
PubMed1994

High proportion of HIV-2 and HIV-1/2 double-reactive sera in two Indian states, Maharashtra and Goa: first appearance of an HIV-2 epidemic along with an HIV-1 epidemic outside of Africa.

The seroprevalence of HIV-1 and HIV-2 infections was determined in selected groups of patients from an STD clinic and in female prostitutes from two different states of India. A total of 809 sera from Maharashtra and of 61 sera from Goa were analyzed. Of the unscreened sera from Bombay, 39% were positive as were 15% of the sera from Goa. Among the HIV-positive sera from Bombay, 79% were positive for HIV-1, 4% were positive for HIV-2 and 17% were positive for HIV-1 and 2. In the Goa group, 67% of the infected sera were HIV-1-positive and 33% were HIV-2 positive. Due to the nearly even distribution of infections between men and women, a mainly heterosexual mode of transmission is evident. HIV-2 infections were first detected in India in 1990 (Rübsamen et al., Lancet, 1991). Before that time, Asia was believed to be free HIV-2. The present study represents the first documentation of a large proportion of these infections, alone and in combination with HIV-1, in the Asian continent. An HIV-2 epidemic running parallel to an HIV-1 epidemic so far has never been observed outside of Africa. This would indicate that a further spread of HIV-2 worldwide is to be expected and that HIV-2 should be included in programs of vaccine development for humans.

Blotting, Western↗
PubMed1995

Seroprevalence of HCV, HAV, HBV, HDV, HCMV and HIV in high risk groups/Frankfurt a.M., Germany.

During the period from August 1991 to April 1993, serum samples originating from different risk groups were tested for antibodies against hepatitis C virus (HCV), using a second-generation ELISA. The highest HCV seroprevalence levels were observed in haemophiliacs (87.0%) and intravenous drug abusers (IVDA) (78.9%). The HCV-seropositivity rates of polytransfused and organ transplant recipients were nearly identical (18.4% vs. 16.8%). Significantly lower HCV-seroprevalence rates were determined in chronic haemodialysis patients (8.1%) and homo/bisexuals (10.0%). The lowest HCV seroprevalence levels were found in the groups of female prostitutes (1.4%) and health care staff (0.8%). A strong correlation between HCV seropositivity and the presence of antibodies against HIV-1, HBc and HCMV was observed. There was also an association between HCV seropositivity and HAV. The seroprevalence of HDV and the proportion of HBsAg and HBeAg carriers was not significantly influenced by HCV serostatus. The incidence of HCV infection in renal transplant recipients was 3.9%. In 10 (6.5%) patients, anti-HCV seroconversion was observed in the immediate post-transplantation period followed by a decrease of the index value and finally, disappearance of antibodies at the end of the study. Antibodies passively acquired through intravenous immunoglobulin (IVIG) donation may account for overestimation of HCV seroprevalence in retrospective seroepidemiological surveys as established by our findings.

Adolescent↗
PubMed1992

Human retroviruses.

It was only in 1980 that the first human retrovirus, HTLV-1, was isolated. Since then, HTLV-2, HIV-1 and HIV-2 have been identified. All four viruses are transmitted with varying efficiency sexually, vertically from mother to infant, and through blood by transfusion or contamination. HTLV-1 is endemic in populations in south-west Japan, Taiwan, sub-Saharan Africa, the Caribbean, southern USA, central and south America, Australia, Papua New Guinea, Solomon Islands and western Asia. There is now epidemic spread amongst IVDUs in north and south America and southern Europe. HTLV-1 is the aetiological agent of adult T-cell leukaemia/lymphoma (ATL) and tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM). Other associations which may be causative are with polymyositis, infective dermatitis, gastrointestinal malignant lymphoma and chronic lymphatic leukaemia. ATL appears to be due to malignant transformation of HTLV-1 infected cells, and TSP/HAM to chronic activation of these cells. The epidemiology of HTLV-2 is being separated only recently from HTLV-1 through the application of PCR. It has a low level of endemicity in populations of central Africa, and central and south America. It is being spread epidemically amongst IVDUs in north America and southern Europe. Its association with any pathology in man remains uncertain. HIV-1 is epidemic and spreading rapidly throughout the world. In areas where homosexual contact was the predominant mode of transmission, heterosexual spread is becoming increasingly important. The areas where heterosexual contact is the predominant mode of transmission include the worst affected populations in the world, for example sub-Saharan Africa and some of the Caribbean. There have been recent and explosive increases of HIV-1 seroprevalence in IVDUs and female prostitutes in Asia, especially Thailand and India. Of the diverse pathology following infection, only the haematological consequences are reviewed in detail: these include anaemia, leucopenia, thrombocytopenia, disorders of coagulation and lymphomas. HIV-2, compared to HIV-1, is less infectious and causes less immunosuppression with more slowly progressive disease. It is prevalent in west Africa, but is spreading, albeit slowly, far beyond.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The situation in Africa.

More than three million women world-wide are infected with HIV, and women will constitute 40% of the new AIDS cases in 1990-1991. Unlike in the industrialized world, HIV in Africa is heterosexually transmitted and thus affects at least as many women as men. Already the leading cause of death in a major African city, HIV may be spreading to rural areas. In spite of improvement in surveillance, under-reporting makes it difficult to project trends, document differences within and between urban and rural areas, and identify at-risk groups. Increasing evidence shows that STDs play a major role in spreading the HIV epidemic. Male-to-female transmission is more efficient owing to factors related to the pathogen and the host. Ulcerative STDs such as chancroid, syphilis and herpes facilitate HIV entry through mucosal discontinuation and recruitment of HIV target cells. The role of non-ulcerative STDs such as gonorrhoeal, chlamydial and trichomonal infections needs further elucidation. Lack of circumcision, traditional healing practices and oral contraceptives may affect the risk of viral transmission, but may not be major or modifiable risk factors. Pregnancy and pregnancy-associated immune alterations do not seem to affect the clinical course of HIV/AIDS in African women or impair immunocompetence. Maternal HIV can adversely affect pregnancy outcome in Africa, causing low birth-weight, prematurity, intrauterine and intrapartum fetal death. The risk for these outcomes is likely to depend on the degree of immunological and clinical deterioration. Breast-feeding does not appreciably increase the risk of HIV transmission to the infant and should be actively promoted in Africa. Control of HIV/AIDS in Africa, in the absence of an effective vaccine, will focus on behavioural changes through health education and condom use. High frequency STD transmitter core groups, mainly prostitutes and their clients, are currently the target of prevention campaigns which are proving to be successful and affordable.

Africa↗
PubMedDate not supplied

In quest of the perfect analogy for using in vitro fertilization patients as oocyte donors.

Whether painted in totalitarian terror, like the organ farm story and The Handmaid's Tale, the science-fiction reality of Make Room! Make Room!, the cinema noir urban tragedy of prostitution, or the portrayals of slavery (Afro-American, Nazi-European, and Russian), this series of resemblances, I hope, illustrates the power of analogy to surface sensitivity to ethical issues in the efficient, and possibly entertaining, texture demanded by medical personnel. Although my quest was quixotic from the start, I hope that this exercise will encourage your consideration of using analogy as an educational tool to heighten the awareness in medical personnel to many issues, to allow our better service of patients and society.

Commodification↗
PubMed1998

Are there risk factors for hepatitis B infection in inner-city adolescents that justify prevaccination screening?

PURPOSE: This study was undertaken to determine if homelessness could serve as a marker for previous hepatitis B infection (HBI), and thus justify prevaccination screening. METHODS: One hundred sexually active 13-21-year-olds (mean = 17 years), 74% female, attending an inner-city hospital-based adolescent clinic (HOSP), and 48 sexually active 13-21-year-olds (mean = 19 years), 40% female, attending a clinic based at an urban drop-in center (UDC) for street youth were consecutively enrolled, screened for HBI serum markers and administered a structured interview about sexual practices, sexual abuse, prior sexually transmitted diseases (STDs), and injection drug use. RESULTS: For the HOSP group, 7% were homeless and 4% were HBI positive. In the UDC group, 96% were homeless and 23% were HBI positive. Homelessness was significantly associated with HBI (p < 0.001), and this was corroborated by logistic regression analysis (p < 0.01). Other factors significantly associated with HBI in adolescents included a history of anal sex (p < or = 0.002), anal-receptive sex (p < or = 0.01), genital Chlamydia (p < or = 0.03), prostitution (p < or = 0.03), and sexual abuse (p < or = 0.002). For both populations, gender, sexual orientation, intravenous drug use, and genital sex were not related to HBI. CONCLUSION: These data indicate that homelessness and associated high-risk sexual practices may be indications for prevaccination screening for HBI in adolescents.

Adolescent↗
PubMed1998

Variations in HIV risk behaviors of incarcerated juveniles during a four-year period: 1989-1992.

OBJECTIVE: To retrospectively monitor over several years change in incarcerated juveniles' human immunodeficiency virus (HIV) risk behaviors. METHODS: From 1989 to 1992, detainees who volunteered after an HIV class or were referred by a health care provider were counseled individually and privately by health educators using a standardized questionnaire and counseling form developed from an instrument used to counsel prostitutes in Los Angeles, California. RESULTS: The number counseled each year was 1045, 1745, 2354 and 1428 from 1989 to 1992, respectively. Those agreeing to HIV testing rose from 72% of total participants in 1989 to 84% of total participants in 1992. Eight of those youth tested as HIV positive. Four blind seroprevalence studies during the same time yielded one case in 1000 for 1988, one case in 1005 for 1989, two cases in 751 in late 1989 (2.7/1000), and one case in 1214 for 1990 (1.25/1000). The number worrying about AIDS and considering themselves vulnerable to AIDS increased, but protective behaviors did not. Sexual partners per year were 2.1 regardless of the age of first sexual activity. Alcohol was associated with an increased number of sexual partners (2.6/year) and higher rates of sexually transmissible infections (STIs) and pregnancy. Although 96% of boys and girls were sexually active, only 4% used a condom consistently during the first 3 years, and only 7% in 1992. Those reporting having used condoms with the intention to prevent both STIs and pregnancy had a higher rate of use. Those carrying condoms all the time used condoms more often. Males having sex with both males and females rarely used condoms, and 45% had one or more STIs. CONCLUSIONS: Although the rate of HIV infection remains low in juveniles detained by the County of Los Angeles, their rates of risky behaviors place them at high risk for HIV acquisition.

Adolescent↗
PubMedDate not supplied

The lives of incarcerated women: violence, substance abuse, and at risk for HIV.

High rates of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) are seen in women prisoners. These high rates may be related to the nature of their lives, which may include violence, substance abuse, promiscuity, prostitution, and exchange of sex for drugs--all of which increase their risk for acquiring HIV. The purpose of this study was to examine the HIV-related risk behaviors and protective practices of women prisoners in a rural southern state and factors related to these behaviors. The sample included 57 women incarcerated in a medium-to-maximum security prison. Key findings included high rates of substance abuse, extensive past and current violent experiences including sexual abuse, high percentage of multiple partners, and low use of condoms. Additionally, women in this sample did not perceive themselves to be at risk for HIV infection. Practical suggestions for reducing the HIV risks of incarcerated women are offered.

Adolescent↗
PubMed2000

Epidemiology of human immunodeficiency virus and acquired immunodeficiency syndrome in Lebanon from 1984 through 1998.

OBJECTIVE: To identify the epidemiologic characteristics of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in Lebanon during the period between January 1, 1984, and December 31, 1998. MATERIALS AND METHODS: This report presents a descriptive analysis of HIV and AIDS surveillance data. The subjects of this study were all notified HIV and AIDS cases in Lebanon reported to the Epidemiological Surveillance Unit of the Department of Preventive Medicine at the Ministry of Public Health in Lebanon. RESULTS: The HIV epidemic started in Lebanon in 1984 with the first diagnosed AIDS cases. The number of cases slowly but steadily increased, to reach, by 1998, 529 cases, of which 147 were AIDS cases. The average age of infected persons was 31 years, with a ratio of men to women close to 3.6:1. The most frequent mode of transmission is sexual (71.9% of all cases; heterosexual, 53.9% of all cases), which consequently increases the perinatal transmission of the disease (4.3% of all declared cases). Data on high-risk groups (intravenous drug users, homosexuals, prostitutes, and prisoners) are incomplete, although the problem does exist. The safety of blood products is relatively well controlled in the country. No new cases of HIV infections through blood transfused in Lebanon have been reported since 1993 (8.5% of all cases). CONCLUSION: The continuously increasing number of HIV and AIDS cases shows an urgent need for targeted interventions in the general population to stop any further spread of HIV infections in the years to come.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The incidence of superfecundation and of double paternity in the general population.

It is estimated that at least one dizygotic (DZ) twin maternity in twelve is preceded by superfecundation (the fertilization of two ova by sperm from different coitions). Presumably this parameter varies from population to population eg. with coital rates and rates of double ovulation. Sometimes superfecundation occurs by two different men. The frequency with which this occurs must depend on rates of infidelity (promiscuity). It is suggested that among DZ twins born to married white women in the U.S., about one pair in 400 is bipaternal. The incidence may be substantially higher in small selected groups of dizygotic twin maternities, eg. those of women engaged in prostitution.

Female↗
PubMed1998

Sexual networks and the transmission of HIV in London.

This paper discusses ways in which empirical research investigating sexual networks can further understanding of the transmission of HIV in London, using information from a 24-month period of participant observation and 53 open-ended, in-depth interviews with eighteen men and one woman who have direct and indirect sexual links with each other. These interviews enabled the identification of a wider sexual network between 154 participants and contacts during the year August 1994-July 1995. The linked network data help to identify pathways of transmission between individuals who are HIV+ and those who are HIV-, as well as sexual links between 'older' and 'younger' men, and with male prostitutes. There appears to be considerable on-going transmission of HIV in London. The majority of participants reported having had unprotected anal and/or vaginal sex within a variety of relationships. The implications of these findings for policies designed to prevent the transmission of HIV are discussed.

Adult↗
PubMed1999

HIV-risk behaviour and knowledge about HIV/AIDS among patients with schizophrenia.

BACKGROUND: Recent literature has demonstrated that psychiatric patients, particularly those with a diagnosis of schizophrenia, may be at high risk for HIV infection. In fact, HIV-risk behaviour, such as intravenous drug with sharing needles, promiscuity associated with unprotected sex and high-risk sexual activity after using drugs has been reported by a substantial proportion of mentally ill patients. METHODS: In order to examine this problem in Italy, HIV-risk taking behaviour and knowledge about HIV/AIDS was investigated among 91 schizophrenic patients by using two self-report questionnaires (HIV-Risk Behaviour Questionnaire; AIDS-Risk Behaviour Knowledge Test). RESULTS: One-third of the patients reported having been tested for HIV infection and one tested seropositive (prevalence 3.4%). A high proportion of patients reported HIV-risk behaviour, such as injected drugs use (22.4%) and engaging in high risk sexual activity (e.g. multiple partners, 58%; prostitutes, 45%; occasional partners, 37%). Condoms were 'never used' by 41% of the patients and 'almost never used' by another 25%. In spite of these behaviours, 65% reported no concern of HIV infection. Knowledge about AIDS was lower among psychiatric patients than a healthy control group. Patients with long-lasting illness and numerous psychiatric admissions were less acknowledgeable about HIV infection. Certain misconceptions on HIV transmission were related to HIV risk behaviour. CONCLUSIONS: These results indicate the urgent need for HIV educational programmes within mental health community-care settings.

Acquired Immunodeficiency Syndrome↗