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Query: UMLS:C0019693 (HIV)
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Sexual practices and condom usage in a cohort of homosexual and bisexual men in Sydney, Australia were investigated in 1987. Of the 420 subjects, 205 (48.8%) were HIV seropositive, and 215 (51.2%) were HIV seronegative based on and confirmed by enzyme-linked immunosorbent assay. The questionnaire examined drug abuse, history of illnesses, presence of physical symptoms, and related life style factors such as sexual behavior and practices with the regular male sexual partner in the preceding 6 months. Partners were grouped by HIV or unknown status. The following practices defined sexual activity: deep kissing, insertive oroanal intercourse, receptive oroanal intercourse, unprotected receptive anal intercourse with ejaculation; receptive anal intercourse with a condom, receptive anal intercourse with withdrawal, unprotected insertive anal intercourse with ejaculation, insertive anal intercourse with a condom, receptive oral intercourse with ejaculation, receptive oral intercourse without ejaculation, receptive fisting, insertive fisting, mutual masturbation, and the use of sex toys. Analysis was based on Student's t test, Wilcoxon's rank sum test, and Fisher's exact test. Multiple stepwise logistic regression models were tested with the subject's response for a sexual activity against his partner's antibody status and subject's antibody status and response for each of the sexual practices. The results for age were a mean of 39.4 years for those HIV seronegative and 37.3 years for those HIV seropositive. For number of sexual partners, seronegative subjects had a median of 4 and seropositive subjects a median of 3. In the overview of anal intercourse, seropositive subjects had practiced significantly more receptive anal intercourse at least once in 6 months, and for seronegative subjects, more insertive anal intercourse. Condom use was appreciable in both groups. However, 13.5% of seronegative men engaged in unprotected receptive anal intercourse vs. 6.3% of seropositive men. Condom breakage was reported as 5.1% on occasions of receptive anal intercourse and 7.3% of insertive anal intercourse. Seropositive men had 5.4% breakage in receptive and 4.6% in insertive anal intercourse. Subjects' sexual practices with a regular male sexual partner by HIV status are analyzed separately. The most commonly reported practices of seronegative or positive men with 1 partner were deep kissing, mutual masturbation, and receptive oral intercourse without ejaculation. Seronegative men were more likely to engage in receptive anal intercourse with a condom and mutual masturbation. The implications are that seronegative men are at risk because of sexual practices, but neither condom usage nor partner selection is based on HIV status. Condom usage and withdrawal were used by a great number of subjects. Safer practices appear to have been used prior to screening availability.
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PMID:Sexual practices and condom usage in a cohort of homosexual men in relation to human immunodeficiency virus status. 259 42

Limiting the use of contaminated syringes is an important step in the battle against hepatitis B and HIV epidemics. In 1987 a project, the first of its kind, was started in Larvik and the county of Vestfold in Norway. Syringe dispensers were put up in order to ensure that drug addicts had access to sterile syringes throughout the day and night. Looking back on one year's operation, the results and reactions are positive. The programme led to increased availability of syringes, reduced use of contaminated syringes, no pollution problems of significance and a decrease in the incidence of hepatitis B. We have also been able to channel increased information to a group hitherto difficult to reach. The involvement of the local public-health authorities has increased their contact with intravenous drug users. This has in turn laid the foundation for better future cooperation with this group. Setting up syringe dispensers has been shown to be an important factor in the battle against hepatitis B and HIV epidemics. This project has also provided a starting point for further work on drug abuse.
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PMID:[The syringe dispenser project in Larvik. Experiences after one year]. 259 7

When I.V. nurses treat I.V. drug abusers, they must be aware of the medical and psychosocial issues relevant to this group. Medical issues include the I.V. drug abuser's depleted venous access and this group's high rate of infection with HIV and other blood pathogens. Psychosocial issues relate to the various social and psychological problems associated with drug abuse. Further, when caring for these patients who are at high risk for HIV and other serious blood infections, the I.V. nurse may experience a conflict between her desire to care for the patient and her fear of contracting HIV or another infection through patient contact. Education is recommended so that I.V. nurses can reduce their risk of infection with blood-borne diseases and can better understand these patients. Also suggested are a multidisciplinary approach to treatment and referral to drug rehabilitation programs.
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PMID:The i.v. nurse and the i.v. drug abuser: medical and psychosocial implications. 260 Jul 25

As HIV continues to spread among chemically dependent populations, chemical dependence treatment programs are beginning to address the issue of routine HIV-antibody testing. While there are many rationales given for testing, only two are deemed acceptable in chemical dependence treatment programs: to permit medical personnel to institute therapy promptly; and to assist in behavior modification (risk reduction). Early intervention is deemed premature because federal regulations disallow the use of drugs, such as AZT, until T-4 cell counts are lower than 200. In addition, many clients may not stay in treatment long enough to institute therapy and ongoing treatment. Many experimental drug trials exclude drug addicts and women. Chemically dependent individuals have neither the knowledge nor the funds to obtain experimental drugs from other countries. Moreover, current protocols of HIV test-related counseling are insufficient to assist clients in changing their high-risk behaviors. Many chemically dependent clients who receive a positive test result relapse to drug abuse or act out sexually; many who receive a negative test result deny the need to change behaviors to avoid infection. Additionally, test result validity and discrimination are presented as deterrents to testing. In long-term treatment situations, where HIV/AIDS education and counseling are done over time as part of treatment and where support systems are in place, HIV testing can be an aid in behavior change.
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PMID:The argument against HIV-antibody testing in chemical dependence treatment programs. 262 14

HIV infection creates difficulties for patients and staff in drug abuse treatment programs. This article reviews significant problems and coping strategies, drawing on experience in a drug abuse treatment program where a third of the patients are HIV infected. Patient-related problems include denial, anger, depression, and isolation. The coping strategies that patients use can exacerbate their illness. Effective coping strategies may involve the development of mutual-support groups and public education. Staff-related problems include the fear of infection, protecting confidentiality, the need to develop new treatment goals, and recognizing the limitations of drug abuse treatment. To lessen the fears of infection, programs can exercise clear body substance precautions, conduct frequent inservice training, and hold periodic updates for staff. To adequately protect confidentiality, programs can keep up with rapidly changing laws and guidelines. To modify treatment goals, programs can alter admission standards for HIV-infected patients, change treatment methods to minimize the impact of occasional relapses, develop medical referral networks, and give special consideration to counselors who treat HIV-infected patients. To cope with the limitations of drug abuse treatment, programs can support counseling staff in coping with emotionally stressful clinical problems and to avoid burnout.
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PMID:Coping with AIDS: strategies for patients and staff in drug abuse treatment programs. 262 17

In a small clinic in a deprived area of Amsterdam, a city with a high incidence of recreational drug use, sexually transmitted diseases and social problems, the association between drug use and disease was notable. Frequent presentation with sexually transmitted diseases, repeated trauma, unexplained recurrence of infections of the skin and respiratory tract, or severe dental caries may alert the physician to the possibility of recreational drug use and with it an increased possibility of HIV related illness. The group of drug users staying permanently in the city appeared to be ageing, without being replenished by youngsters. Very young drug users were mainly 'drug tourists' from neighbouring countries who were without medical insurance or money.
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PMID:Morbidity at an Amsterdam inner city clinic in relation to drug use. 263 8

Participant observation has long been utilized as a valuable research methodology in the study of illicit drug abuse. It should not be viewed in isolation, but seen as an essential complement to the quantitative analysis of trends in drug use, such as epidemiological studies and the monitoring of services for drug users. Fieldwork conducted at the Drug Indicators Project and other relevant studies highlight the practical and ethical problems faced by the participant observer, including issues of access, co-operation and confidentiality. This is particularly pertinent when working with drug users not in contact with services. When working with drug users in a treatment context, the need to be flexible and sensitive to the needs of agency staff is stressed, and the ways in which participant observers can operate as volunteers are explored. Contemporary concern about HIV infection, AIDS, and risk behaviour amongst drug users, raises the potential for an expansion and redefinition of the role of the participant observer to take on some of the functions of health educator, and two options are suggested.
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PMID:Participant observation and its place in the study of illicit drug abuse. 264 97

Vertical transmission of human immunodeficiency virus (HIV) from an infected mother to her fetus or infant can occur in utero and probably during labor and delivery. Transmission via breast milk has also been documented. Because of limitations of conventional HIV testing in infants, it is difficult to determine the rate of transmission from an infected mother to her fetus or infant, but it is probably between 20% and 60%, depending on the mother's health status. Perinatal HIV infection is a significant problem particularly in "Pattern II" countries, where HIV is spread primarily by heterosexual contact. In "Pattern I" countries, where HIV predominantly affects homosexual and bisexual men, children are infected by mothers who acquired the infection through I.V. drug abuse or sexual contact with an infected partner.
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PMID:Perinatal transmission of the human immunodeficiency virus. 265 94

Pathologic findings in 25 autopsies of AIDS. The common and severe changes of the central nervous system, lungs, adrenals, heart, kidneys and gonads are reviewed in a series of autopsies of AIDS. In the brain, HIV infection induces directly inflammatory infiltrates including the typical multinucleated giant cells described by Sharer. In addition, primary lymphomas are seen as well as reactive and inflammatory lesions that are caused by opportunistic infections, such as those of poliomavirus, Cytomegalovirus and Toxoplasma gondii. In the lung, interstitial inflammation prevails, which may be related to direct HIV infection and include rare multinucleated giant cells like the ones described by Sharer. Opportunistic infections are often associated, and are commonly sustained by Cytomegalovirus and Pneumocystis carinii. A peculiar findings is the evolution from septal inflammation to fine fibrosis and hyaline degeneration, either focal or diffuse. We believe that the severe respiratory insufficiency that is commonly seen in the advanced stages of AIDS could be related to the interstitial damage. In the adrenal gland, the most common change is Cytomegalovirus infection affecting both the cortex and the medulla, and inducing massive necrosis in the cortex with little or no reaction. Again, adrenal involvement should be related to adrenal functional insufficiency, which may be over-looked clinically because of the preponderant lesions of other sites. In the heart, myocarditis is often discrete, and may be complicated by perivascular fibrosis and rare foci of myocytolysis; in some cases primary lymphomas may also develop. In the kidney, several histological lesions are found, including glomerular damage with segmental necrosis, cortical areas of hyporeactive necrosis, and mild interstitial inflammation. In the gonads, the changes are partly induced by drug abuse, and consist of atrophy with secondary hypoplasia of the germ cells and interstitial fibrosis. In conclusion, the most important abnormalities consist of opportunistic infections, hyporeactive necrosis, fibrotic evolution of the inflammatory infiltrates and neoplasias (Kaposi's sarcoma and lymphomas). In this work, the changes of the lymphoid organs are only mentioned, for they have been widely reviewed elsewhere.
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PMID:[Anatomo-pathologic findings in 25 autopsy cases of AIDS]. 266 74

A 26-year-old man, with a personal history of drug abuse and positive serology for HIV, had Reiter's syndrome for six years. He experienced progressive worsening of his cutaneous lesions after initiation of indomethacin therapy. The skin lesions were almost completely resolved after the discontinuance of the drug and its reintroduction resulted in a similar deterioration. To our knowledge, indomethacin has not been reported to aggravate Reiter's syndrome. This case study documents anti-inflammatory drugs as possible causal factors for triggering Reiter's syndrome. Possible implicated mechanisms are also discussed.
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PMID:[Reiter's syndrome exacerbated by indomethacin]. 266 96


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