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Query: UMLS:C0019693 (HIV)
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An attempt is made to characterize the population of homeless street youth who are living marginally and to describe aspects of this population's dynamics, motivations, values, and aspirations. Street youth, ranging in age from birth to 21, are on the street for one reason or another--dire poverty in the home, which necessitates their working on the street to supplement the family income, because they have been rejected by parents or guardians, because they have left home due to violence in the home, drug or alcohol use by family members, or because of lack of a place where they feel they can be "themselves." These conditions make street youths particularly vulnerable to HIV infection, not to mention malnutrition, stress, and drug use. Their violently accelerated emotional maturation, ignorance, alcohol- and drug-induced confusion, together with the exploitation and sexual abuse of which they are often victims, are additional factors that contribute to sexual practices that may lead to HIV infection.
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PMID:Street youth and AIDS. 138 67

The number of people suffering from conditions associated with HIV infection is growing steadily. These people require care from nurses who should be well trained to undertake all the various aspects of nursing care. Surveys have indicated that health professionals associate AIDS with minority groups such as homosexuals, drug-abusers and prostitutes. Incidents of sub-optimal nursing care of AIDS patients, or suspected AIDS patients belonging to these minority groups, have been well documented. Surveys have revealed much ignorance and confusion among the general public as well as among health professionals with regard to this controversial syndrome. This study aimed to measure nurses' knowledge and attitudes towards homosexuals, drug-abusers and prostitutes, who through their lifestyle are at increased risk for HIV infection. Questionnaires were distributed to a random sample of 800 nurses in Northern Ireland. The sample was stratified by several demographic variables. A response rate of almost 60% was achieved. Nurses appeared to have a moderate knowledge of issues related to HIV infection, but there were large gaps in their knowledge of the terminology used in HIV infection. Nurses were not extremely worried about AIDS itself. However, homosexuals, prostitutes and drug-abusers were seen to be at least partly responsible for their own illness. Implications for nursing care and for nurse education are discussed.
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PMID:Acquired immunodeficiency syndrome: knowledge and attitudes of nurses in Northern Ireland. 140 48

Women now constitute the fastest-growing population of persons with AIDS in the U.S. The psychosocial problems of women with AIDS and HIV infection are underrecognized, and economic, personal, and social resources to meet their needs are often inadequate. The authors describe development of a group for HIV-infected women and discuss issues raised by group members. HIV-infected women often feel isolated and experience stigma and shame. Their roles as caregivers and as wives and mothers are often changed or lost, and they experience anxiety and confusion about options for sexual activity. They sometimes fear transmitting HIV to family members through non-sexual contact. Physicians may discount their symptoms and may need to be educated about gynecological problems associated with HIV. Other issues involve coping with being both ill and a mother, disclosing information to children about the illness, and loss of reproductive choice.
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PMID:A group approach to psychosocial issues faced by HIV-positive women. 142 96

The Neuropsychiatric AIDS Rating Scale, which classifies HIV-related cognitive impairment along a six-stage continuum, was used to explore the relationship between the severity of impairment and management and residential problems among 318 persons in San Francisco with suspected HIV-related cognitive impairment. Nearly half of the sample were in the moderate, severe, or end stage of impairment. One-third of the 318 persons, most of whom were in the moderate and severe stages, were reported to present residential placement problems. The management problems most associated with placement difficulties were home safety, wandering, confusion, and memory difficulties. More than a fourth of the moderately to severely impaired patients were living alone with no outside help or were homeless and living on the streets. Results of this study support the development of specialized residential programs for patients with HIV-related cognitive impairment.
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PMID:Management and residential placement problems of patients with HIV-related cognitive impairment. 154 44

With increasing numbers of HIV-infected patients, practitioners will play a crucial role in the prevention of HIV infection and in the care of infected persons. To assess the need for accurate education programs we investigated by questionnaire the current practice, attitudes and knowledge of 1057 practitioners (general, internists, surgeons, dermatologists, gynecologists), on care, prevention and treatment of HIV infection and HIV-related problems in the Canton of Berne (population 1 million), Switzerland. 65% of the practitioners provided completely evaluable responses. More than 90% had already prescribed HIV tests by the end of 1989. A majority rejected routinely performed tests (e.g. for all pregnant women, for all patients before surgery). Only about 50% considered a patient's informed consent mandatory before each test. Primary prevention by sexual history-taking was only rarely done in current practice. All recommendations from the Swiss "Stop Aids" campaign were supported, and even experimental measures such as allowing i.v. drug use in street corner agencies or controlled distribution of heroin were supported by the majority. Mandatory testing of risk groups was favored by about 50% but almost nobody wanted to establish name records of persons with risk behaviour. By the end of 1989 about one third of practitioners regularly cared for HIV-infected persons. Most practitioners would prefer to care independently for asymptomatic HIV-infected persons, but would favor a specialist support when caring for symptomatic patients. Lack of medical skills and knowledge was the main reason for their reluctance in caring for patients. Skilled and experienced practitioners were more prone to care for additional patients and were more active in prevention. Knowledge about HIV transmission, HIV-related complications and treatment was good among general practitioners and internists. However, there was some confusion about the indications for active vaccination in Aids patients. The readiness of Bern practitioners to care for HIV-infected persons is already large and could be increased by improving their medical knowledge. However, it is unlikely that more medical information alone will improve their prevention activities. It appears that education programs aimed at improving the prevention activities of practitioners are best designed and performed by their skilled and experienced colleagues.
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PMID:[HIV infection: survey among practicing physicians in Bern]. 162 52

It goes without saying that the members of any professional group are more likely to modify their behavior if they are provided with logical, rational reasons to enact the suggested change. In the mid 1980s, health care providers, including dental personnel, were advised to adopt universal precautions and to alter their infection control habits with minimal justification, apart from the general unease and paranoia surrounding AIDS. Therefore, it is understandable that some practitioners would react with scepticism to the idea that their traditional infection control techniques were less than adequate, while others would overwhelmingly embrace the new recommendations in the misguided belief that personal, patient, staff and family safety would be enhanced. This predictable confusion is epitomized by the dentist who "sterilizes" extraction forceps by immersing them in alcohol for 10 minutes, versus the dentist who wears gloves, mask and disposable gown to conduct a recall examination. And if dentists are perplexed, it is clear that their staffs are equally, if not more confused, since they are exposed to the exaggerated claims and counter claims of sales agents. The microbes encountered in dental practise, apart from the hepatitis B virus, pose no significant risk to dental personnel or their patients, and the danger of hepatitis B transmission is reduced most effectively by vaccination. In reality, the genesis of dentistry's current emphasis on infection control resides entirely with HIV disease. But there is no credible clinical evidence to suggest that HIV infection is transmitted via dental treatment. Indeed, it may be theorized that for such a transmission to occur, the blood stream of the susceptible recipient would have to be invaded directly by a pathogenic inoculum of the virus--an unlikely event in the normal practise of dentistry. Under such circumstances, infection control practises should ignore the danger of HIV transmission, but concentrate on: Sterilization of all surgical and invasive instruments to protect patients from potential cross-infection. All dental staff receiving hepatitis B vaccinations. Dental staff wearing gloves, especially while performing intraoral procedures with blood release, and handling used instruments, to protect them from direct contact with potential pathogens. Working in a clean environment, in which blood spills and splatters are removed mainly for esthetic reasons. Such measures reflect the actual potential for disease transmission, as it exists in dentistry. They are justified and economical, and will be implemented by concerned but knowledgeable dental staff.
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PMID:Concerns regarding infection control recommendations for dental practice. 151 56

The present study concurrently measured psychological distress (state anxiety, depression, confusion, and intrusive thoughts), neuroendocrine (plasma cortisol concentrations), and immunologic [lymphocyte proliferative responses to phytohemagglutinin (PHA) and pokeweed mitogen (PWM)] changes in the 5-week periods preceding and following serostatus notification among asymptomatic Human Immunodeficiency Virus-type 1 (HIV-1) seropositive and seronegative gay men. Seropositives, as opposed to seronegatives, showed a disparity in predicted relationships among distress, cortisol, and immunologic measures across the prenotification to postnotification period. Individual difference analyses suggested that among seropositives, in contrast to seronegatives, plasma cortisol concentrations were negatively correlated with psychological distress and positively correlated with responses to PHA (assessed at study entry and after serostatus notification). This pattern in seropositives could not be explained by differences in prenotification perceived risk of infectivity, extraneous environmental stressors, or CD4 cell counts within the seropositive group.
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PMID:Disparities in psychological, neuroendocrine, and immunologic patterns in asymptomatic HIV-1 seropositive and seronegative gay men. 167 4

Health workers took blood samples from 94 HIV positive patients (cases) and 86 HIV negative patients (controls) at the Kenyatta National Hospital in Nairobi, Kenya. Researchers compared the serological results of both groups to determine if any serological evidence of reactivation of latent infection existed and, if so, whether this reactivation could be related to acute toxoplasmosis. Laboratory personnel tested all serum with EIA and latex agglutination and dye tests to determine the presence of anti-Toxoplasma antibodies (Toxoplasma IgG). Both the EIA and latex test were more sensitive and specific in detecting Toxoplasma IgG than the dye test. The dye test revealed 54% of all patients had Toxoplasma IgG. Further 22% of the cases had IgG levels 180 units/ml whereas only 1% of controls had these levels. None of the patients exhibited any signs or symptoms of toxoplasmic encephalitis. Further no correlation between high Toxoplasma IgG titers and signs of central nervous system dysfunction or confusion occurred. Even though 35% of cases had considerable lymphadenopathy, it was not associated with Toxoplasma IgG levels. Moreover Toxoplasma IgG levels were not related to AIDS or death. The researchers concluded that high serum IgG levels were indicative of early Toxoplasma reactivation and necessarily associated with disease.
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PMID:Toxoplasma antibodies in HIV-positive patients from Nairobi. 180 45

Testing for HIV is a procedure with possible dire consequences; hence, reports should not be rendered to the patient without appropriate counseling. And this must be based on firm information whether the individual is truly infected if the report is positive. The reactive results of the EIA screening test should always be confirmed by supplemental testing. However, it must be remembered that a nonreactive serum does not exclude the possibility of the individual being infected; only by additional research studies, such as the polymerase chain reaction, can one be sure that the patient is not in the phase in which antibodies have not yet developed but the virus is present and the patient can transmit the infection. Our studies have found that the accuracy of testing HIV serum specimens is excellent. The biggest problem may be the potential confusion caused by the laboratory reports. All clinicians (nurses, educators, and physicians) who counsel or test potential HIV patients must be sure that they understand their laboratory's report. If there is any doubt about the report content, it must be clarified by contacting the laboratory director. The results of HIV antibody testing are so important to the patient that the significance of the report must be crystal clear to the counselor and any possible ambiguity clarified.
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PMID:The laboratory diagnosis of HIV infection. 184 Sep 42

Although early reports of an etiological role of HTLV-I in AIDS are not supported by subsequent epidemiologic and biologic data, all AIDS specialists should be aware of the possible infection of AIDS risk group members with the HTLV viruses. In the United States, HTLV-II and HIV co-exist in high prevalence among IVDU, and coinfected IVDU may progress more quickly to AIDS. The health effects of solitary HTLV-II infection are currently unknown. In Africa and the Caribbean, where HTLV-I is endemic, the epidemic of HIV infection will likewise produce coinfection and possibly faster progression to AIDS. In addition, adult T-cell leukemia/lymphoma and HTLV-associated myelopathy (HAM/TSP) may occur in persons infected with HTLV-I alone. Clinical care of HTLV infected patients is difficult because of societal confusion of these viruses with HIV. The full health effects of both HTLV-I and HTLV-II are not yet known, and even the two known disease outcomes of HTLV-I infection occur in only a few percent of those infected. Without prognostic indicators, and with the long latency from infection to disease, counseling and medical follow-up of patients is difficult. Further research into the clinical effects of HTLV-I and HTLV-II is urgently needed.
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PMID:The clinical significance of HTLV-I and HTLV-II infection in the AIDS epidemic. 186 10


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