AIDS and pediatric HIV infection: the problem of the infected mother and her newborn

The number or pediatric AIDS cases in the US was around 2000 in 1990, and children under 13 accounted for about 2% of reported cases. Pediatric cases are increasing as the number of infected women increases. Such cases are concentrated in poor urban populations, aggravating the lack of resources of already overtaxed health services. Ethnic minorities are overrepresented among AIDS cases. In the US, 52% of AIDS cases in adult women are in blacks, 27% in non-Hispanic whites, and 20% in women of Hispanic origin. Among children under 13, 53% are in blacks, 25% in Hispanics, and 22% in whites. The majority of children with AIDS were 5 and were probably infected by vertical transmission. Over 80% were born to mothers with AIDS or at risk of HIV infection, 11% received transfusions of contaminated blood, and 5% received contaminated blood products. Through December 1989, 53% of white, 91% of black, and 85% of Hispanic children with AIDS were infected vertically by their mothers. In the US, over 1/2 of cases of vertical AIDS transmission are due to maternal IV drug abuse and 1/5 to mothers who have sexual relations with IV drug abusers. The rate of infection in children born to seropositive mothers has not been established. Estimates of rates of transmission range from 20% to 50%. The factors causing HIV transmission in 1/3 of infants and protecting the other 2/3 have not been identified. Transmission to the infant may occur during pregnancy or delivery or through breast feeding. There is no evidence that cesarean delivery can protect against infection. The risk of intrauterine infection is probably much greater than that of infection during delivery. Diagnosis of HIV infection in young infants is difficult. There are no physical characteristics distinguishing infected newborns, and laboratory diagnosis is unhelpful because maternal HIV antibodies cross the placental barrier to the fetus. There is as yet no vaccine or curative treatment for HIV infection. Prevention of pediatric HIV infection requires prevention of the infection and the disease in pregnant women. Primary prevention in women depends on their being adequately informed about risks and able to change risk behaviors. Secondary prevention is achieved through use of AZT, which slows the progression of the disease, and prevention or treatment of complications. There is no conclusive evidence as yet that pregnancy hastens the progression of maternal HIV infection. Seropositive mothers should avoid breast feeding if adequate substitute foods are available. The average age at appearance of symptoms in infected children is 8 months. Mortality is higher among children manifesting the disease in the 1st year, with a median survival of 38 months. Full information about HIV infection and voluntary and confidential screening should be available to all women contemplating pregnancy.     

Knowledge and attitudes of Pakistani medical students towards HIV-positive and/or AIDS patients

As the incidence of HIV increases, one of the major steps in preventing a widespread epidemic is to make certain that medical students are prepared to recognize and treat HIV infections and their related conditions, and to counsel patients about avoiding risks that might lead to infections. This cross-sectional study assessed the knowledge level of 357 medical students and their attitudes about AIDS and HIV enrolled in a Medical College in Karachi, Pakistan. Only 6% of the students had complete knowledge on symptoms of HIV/AIDS and 7% of the students had complete knowledge on the modes of transmission of HIV. Statistical analysis of demographic factors affecting knowledge was done. Linear regression and Maentel-Haenszel tests showed that older and clinical students were more knowledgeable of symptoms and modes of transmission of HIV/AIDS. Ten attitudes were correlated with knowledge and none of these showed an association. These results on knowledge indicate that education about HIV/AIDS should be incorporated in the curriculum and interventions must be taken by public health professionals to avoid poor treatment outcomes.     

AIDS: behavioral contributions to its prevention

AIDS is caused by the human T cell leukemia virus (HTLV) or lymphadenopathy associated virus (LAV) or human immunodeficiency virus (HIV). The latter name has been widely accepted. According to the WHO in 1988 there were 5 million infected persons. In Argentina, there were 300 AIDS patients and 30,000 infected people in 1989 and 60,000 in 1990. Obstacles to prevention of the spread of AIDS are: fear which causes some to conceal its existence; prolonged latency; complacency about future negative outcome; the lack of value of life among drug addicts; adolescent behavior of defiance and confrontation; militant denial by many of the possibility of contracting AIDS; and a criminally low level of measures to combat AIDS in the Third World. Primary prevention includes avoidance of contact with body fluids of an infected person submitting to a serological test if infection is suspected massive educational campaigns, study of subcultures such as drug addicts and adolescents, use of disposable needles and sterilization of all medical instruments use of condoms, and analysis of the blood of donated organs and blood for transfusion. Secondary prevention means making sure that seropositive patients undergo periodic medical checkups and receive medical attention when suspicious symptoms are detected and follow various steps to strengthen their immune systems. Tertiary prevention comprises psychological and psychopharmacological treatment of emotional distress to facilitate a less painful progress of the disease and to avert possible complications and relapses.     

An Investigation of the Determinants of Stigmatization and Prejudice Toward People Living With HIV/AIDS

The components and determinants of HIV/AIDS stigma and prejudice were investigated in an online‐questionnaire study. The results show that the components of the attitude toward people with HIV/AIDS consist of social distance, demands for political measures, negative stereotypes, and attribution of responsibility to people living with HIV/AIDS. Besides antigay attitudes and false beliefs about ways of infection, the HIV/AIDS attitude is connected to and depends on social dominance orientation (SDO) and right‐wing authoritarianism (RWA). Structural equation modeling indicated that antigay attitudes and false beliefs function as mediator variables for SDO and RWA. Implications of the results are discussed.     

Using the Spiritual Perspective in Counseling Persons with HIV/AIDS: An Integrative Approach

The authors explore counseling persons infected with HIV and AIDS, within the specific themes of rejection, powerlessness, and death. These themes have been chosen because they are common concerns of people with HIV and AIDS. Selected quotations from 14 interviews with persons diagnosed with HIV/AIDS are used to clarify these concerns. Specific counseling recommendations are provided to make counseling an effective, compassionate endeavor with this population. Counselors are encouraged to struggle with these themes to enhance the counseling they provide to people with HIV and AIDS.     

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.     

盘锦市2005年～2013年艾滋病流行特征分析

分析盘锦市艾滋病瘦情流行特征,为预防控制提供依据.对盘锦市2005年～2013年艾滋病瘦情数及流行病学调查资料进行统计分析.结果盘锦市2005年～2013年累计报告HIV/AIDS 127例,病例逐年上升,男性显著高于女性,发病年龄以20岁～44岁的青壮年,未婚占54.88％,感染途径以性途径为主,占95.28％,男男同性占61.42％,病例主要发现途径为医疗机构的检测及疾控机构的检测咨询.因此,盘锦市的艾滋病瘦情呈上升趋势,以性传播途径为主,尤其是男男同性增加明显.     

A problem-posing educational methodology for the prevention of HIV / AIDS

The problem-posing methodology of Brazilian educator Paulo Freire, using the reading circle approach previously deployed in successful literacy campaigns in developing countries, is introduced for application in AIDS information programs. The basis of this educational process is the dialogue where those to be educated resolve their problems by evaluating information critically, capturing concepts by codification and decodification, and transmitting information by creating relevant educational materials. Health circles are organized with women as educators to impart knowledge about AIDS and HIV: definitions, epidemiological components (sex, age, and risk behavior), means of transmission, stages of the progression of AIDS, prevention of HIV infection, and tests for detecting HIV antibodies. The dialogue explores knowledge and feelings about AIDS and how it affects life in the community reveals personal experiences and accounts of knowing someone who was HIV-positive, and develops action plans to minimize AIDS cases in the community. The Latin population of California, mainly of Mexican origin, with low levels of education, income, and acculturation and a high incidence of AIDS, is an appropriate target of such intervention. In 1980, there were 12.3 million people of Hispanic origin in the US. In August 1990, there were 143,280 persons diagnoses with AIDS according to the Centers for Disease Control. 78,878 of these (55%) were Anglos, and 21,752 (15%) were Hispanics. Among the Anglos, the incidence was 300/million inhabitants, while among Hispanics, it was 1059/million, a 3-field higher rate.     

A Preliminary Examination of Sexual Orientation as a Social Vulnerability for Experiencing HIV/AIDS-related Stigma

This investigation is a preliminary examination of sexual orientation as a social vulnerability for experiencing HIV/AIDS-related stigma, specifically concerns about disclosure and public attitudes. Participants were 36 heterosexual men and 82 gay men with HIV/AIDS. Consistent with prediction, a heterosexual sexual orientation was significantly associated with HIV/AIDS disclosure concerns. This effect was evident after controlling for various demographic variables, CD4 T-cell count, time since HIV diagnosis, self-esteem, and coping styles. Also, as predicted, similar levels of enacted stigma were evident regardless of sexual orientation. Further work is needed to understand the process of HIV/AIDS disclosure for heterosexual men with this illness and to differentiate the experience of HIV/AIDS-related stigma among gay and straight men with HIV/AIDS.     

The National Commission on AIDS

A decade after the first cases were recognized in the United States, AIDS continues to vex policymakers and fascinate the public. It has been said that AIDS acts as a prism, refracting a spectrum of controversial topics. For bioethicists, these topics include: equity in the allocation of resources for treatment and research; forgoing life-sustaining care and proxy decision making; informed consent in the context of HIV testing and screening; the ethical duties of health care workers to provide care for persons with HIV disease; and competing obligations of health care professionals to patients and to third parties who may be put at risk.     

Women and AIDS

While the origin of the AIDS virus remains controversial, it is indisputable that AIDS is spreading worldwide. By June 1987, the World Health Organization estimated that 50 million Africans were infected with HIV and that the disease was epidemic in many parts of the continent. However, African governments chose to deny the threat of the disease. The AIDS crisis has diverted resources from other vital areas of disease prevention, health promotion, and research. Whereas AIDS is spread in developed nations by sexual promiscuity, by drug addicts sharing unclean hypodermic needles, and by homosexual behavior, in Africa cultural factors contribute to the transmission of AIDS. Female genital mutilation leads to extensive laceration of the female genitals upon initiation of sexual intercourse and/or to substitution of anal sex during the weeks and months before vaginal penetration can be achieved. In addition, the reuse of the same knives during the mutilation can spread HIV infection. Other factors that contribute to the spread of HIV in Africa include the patriarchal practice of polygamy, the subordinate position of women that makes them unable to insist on protection during intercourse, and a failure to screen blood used in transfusions. With all of these risk factors at play, women at the grassroots level must be equipped with the health education that is the only available tool to fight AIDS. Women's organizations can provide information and education to people at risk of acquiring HIV, counsel infected persons, ensure the safety of the blood supply, and work to overcome harmful traditional practices.     

Community-Based Collaboration in Support of Older Persons

This study describes the processes for community-based collaboration in support of the older person living in the world of HIV/AIDS in South Africa. Secondary data from study from 333 older persons (> 60 years) and 28 leaders of community agencies of and for health and wellbeing were thematically analyzed. Findings suggest that older persons are resources in community partnership for ameliorating the impact of HIV and AIDS. This would be the case even as the older people may be living with HIV or AIDS.     

Social Support Provision to HIV-Infected Gay Men1

The study examined associations between attitudes toward homosexuality, fear of AIDS, blame of persons infected with the HIV-virus, and social support provision to these individuals. A sample of HIV-infected gay men reported on the support they receive from specific members of their social networks. These network members then completed questionnaires assessing the predictor variables. Homophobia, homosexual preference, and the interaction of these two variables were positively associated with blame. Blame, together with fear of AIDS and low levels of psychological well-being, were negatively associated with provision of emotional support. Fear of AIDS was also related to negative changes in the quality of recipients' and providers' relationships. Finally, emotional support was strongly related to adjustment to illness among support recipients. Results suggest important points for intervention to promote adjustment to HIV infection among gay men.     

Repeat HIV Testing and HIV Transmission Risk Behaviors Among Sexually Transmitted Infection Clinic Patients

HIV testing and counseling expends considerable HIV prevention resources and offers great opportunities for HIV risk reduction. Individuals who are at risk for HIV and have not been HIV tested are the focus of current targeted testing campaigns and yet persons who are repeatedly tested for HIV often continue engaging in high-risk practices. This study examined HIV testing, risk behaviors, and other medical diagnostic testing practices of men (N = 231) and women (N = 86) attending an inner-city sexually transmitted infections (STI) clinic. Results showed that 75 (23%) participants had not yet been tested for HIV, 45 (14%) had been tested once, and 197 (63%) had been tested two or more times. Patients that had not been tested and those who were repeatedly tested were similar in their risk behaviors; both demonstrated significantly greater risks for HIV than persons tested just once, although repeat testers were more likely to have had a past STI. HIV testing history was minimally associated with other medical testing and health protective practices, such as testicular self-examination, mammography, and having had PAP tests. Results support targeting high-risk untested persons for HIV testing and suggest an urgent need for interventions to reduce risk behaviors among STI clinic patients who repeatedly test for HIV.     

论艾滋病人及艾滋病毒感染者权利与义务的平衡

《艾滋病防治条例》,对于艾滋病病毒感染者和艾滋病人的权利和义务进行了精巧的设计。本着保护人权和预防疾病的需要,对艾滋病病毒感染者和艾滋病人在医疗活动、人身权益和社会经济各方面的权利与义务都进行了很好的平衡。     

“Whenever Jack sees a condom,he falls asleep”: experiences of condom use and erectile disorder among HIV positive men in a Zimbabwean rural setting

In this qualitative inquiry, we set out to explore the experience of condom use and erectile disorder (ED) among men living with HIV in a rural district of Zimbabwe. Data on condom use related erectile disorder with antiretroviral (ART) medication were collected from a purposive sample of 18 men living with HIV and AIDS (age range 23–54 years). These data were supplemented with those from a convenience sample of 23 women living with HIV who self-identified as partners of men living with HIV and AIDS (age range 26–37 years). The data were thematically analyzed. Results suggest that men attributed their experiencing of erectile problems to two main explanations: use of condoms and ART medication. These men reported inconsistent use of condoms and/or adherance to ART therapy due to a belief that these cause their ED. The women informants reported similar observations, including the shared gendered perspective that the men perceived a loss of sense of manhood from ED. Beliefs that influence health promotion with men living with HIV and AIDS are important to public health interventions with them.     

Attitudes Toward People Living With HIV/AIDS: A Model of Attitudes to Illness1

This study examined attitudes toward people living with HIV/AIDS within a sample of 220 young men and women. As predicted, a multiple regression analysis revealed that the fear of contracting HIV/AIDS through casual contact was a significant predictor of both men's and women's willingness to interact with people living with HIV/AIDS. Attitudes toward homosexuality were also a significant predictor of attitudes toward people living with HIV/AIDS among women, who generally have a low risk of contracting the disease in Western societies. These results indicate that attitudes toward people with a serious illness may be strongly related to the perceived risk of contracting the disease.     

Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997-2005.

OBJECTIVE: Beliefs about HIV treatment effectiveness and the impact of HIV treatments on HIV transmission risks were initially related to sexual risk-taking in the late 1990s when multidrug HIV treatments first became available. This study examined changes in beliefs about the effects of HIV treatment for preventing HIV transmission and their association to sexual risk behaviors between the years 1997 and 2005. DESIGN: Anonymous surveys were administered to a convenience sample of gay and bisexual men attending a large community event in Atlanta, Georgia in 1997 (N = 498) and again at the same community event in 2005 (N = 448). Analyses were performed for men living with HIV/AIDS and for men who have not been diagnosed with HIV/AIDS. MAIN OUTCOME MEASURES: Rates of unprotected anal intercourse in the previous 3 months. RESULTS: There were significant increases in high-risk sexual practices that coincided with increased beliefs that HIV treatments can reduce the chance of transmitting HIV. However, optimistic beliefs about the health benefits of HIV treatments decreased over the 8 years and were not related to risk behaviors. CONCLUSIONS: Beliefs about how HIV treatments impact HIV infectiousness remain associated with HIV transmission risk behavior and interventions targeting at-risk as well as HIV-positive men who have sex with men must directly address these beliefs and perceptions.     

People with AIDS (PWA) Since Highly Active Antiretroviral Therapy, 1996

Although clarity about HIV transmission biology and effective therapy should mean that an AIDS diagnosis is more socially acceptable today, for some groups the cultural stigma of HIV infection has changed little in the last 30 years. This paper will examine why representations of HIV-positive gay men suggest they pose a special civic risk and how these conceptualizations have harnessed cultural anxieties about racial and sexual minorities to shape public policy and behavior since the advent of Highly Active Antiretroviral Therapy (HAART) in 1996.