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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The control of sexually transmitted diseases (STDs) is vital to combat AIDS in developing countries. The 1993 World Development Report showed the cost effectiveness of STD control per healthy life-year saved. A meeting of the Network of AIDS Researchers in East and Southern Africa was held on this issue in Mwanza, Tanzania, attended by 20 experts from 5 countries in the region. The World Health Organization recommends that STDs should be managed without laboratory tests, at the primary health care level in developing countries, using drugs of proven local efficacy. In Africa, this policy has been implemented only in Zimbabwe, but without a striking fall in STDs, since in 1991 STDs were responsible for over 20% of visits by adults at primary health care clinics in Harare. A contact-tracing study in Harare indicated that only 20 contacts were found after 3 months' work by 6 staff members. Asymptomatic STDs in women have hampered STD control, but a community study from Mwanza has also shown that 6% of men were infected with gonorrhea or chlamydia and 90% had no symptoms. A WHO risk-assessment protocol is being evaluated in Mwanza among women with vaginal discharge. A controlled trial of mass treatment for gonorrhoea, chlamydia infection, chancroid, and syphilis is to start in Uganda early in 1994 in a community where the incidence of HIV has remained static at 2% per annum in the general adult population (over 6% in young women) despite intensive education campaigns. Even when symptoms are present, most patients seek unofficial treatment in Africa. Increasing antimicrobial resistance among sexually transmitted pathogens in Africa makes STD treatment more expensive. The introduction of user charges in Nairobi led to a sudden fall in attendances at the main STD clinic and in other countries in the region. The treatment of the STDs prevents future infections, thus STD treatment should be free with the help of international donors.
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PMID:STD research in Africa. 790 91

The authors interviewed 675 male and female adolescents aged 14-19 years of mean age 18.2 attending the adolescent antenatal clinic of Kenyatta National Hospital and the Special STD and Skin Disease Clinic in Nairobi between April 1, 1991 and July 31, 1991. The interviews were conducted to determine participants level of awareness on sexually transmitted diseases (STD), HIV infection, AIDS, and contraception relating to their sexual and contraception behaviors. The adolescents comprised 27.6% of clinic attendees; 52.9% were male, 56.5% of males and 77.8% of females were not formally employed and some were students. Respondents mentioned being aware of only three STDs in the following proportions: 70.4% gonorrhea, 56.5% syphilis, and 54.3% AIDS. 76.6% cited print and electronic media as their main sources of information on such subjects. Although the youngest reported age at first coitus was 8 years, the mean age for first intercourse among males and females were, respectively, 15.1 and 16.0 years. 22.6% and 8.3% respectively, of males and females had experienced sexual intercourse by age 14. 93.3% had been sexually active during the preceding 12 months, with 42.4% of these youths reporting having had sex with two or more partners during the period. 37.3% had had sexual intercourse with strangers, bar attendants, and prostitutes, although males were more likely to be involved with such individuals. 75.9% had not used any form of contraception. Communication and education on the risks of unprotected sexual activity are urgently needed in this sexually active population of youths which thus far remains largely ignorant about StDs and contraception.
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PMID:Knowledge of sexually transmitted diseases, HIV infection and AIDS among sexually active adolescents in Nairobi, Kenya and its relationship to their sexual behaviour and contraception. 792 41

The purpose of this study was to evaluate the effects of a brief intervention programme on STD knowledge, condom use and gonorrhoea incidence among sex workers in Singapore. A controlled before-and-after study design with non-random assignment of sex workers was used, supplemented by multivariate analysis to adjust for baseline differences. Control (n = 221, denoted C1) and experimental (n = 221, denoted E1) groups were interviewed on 2 occasions 3 months apart. Two supplementary groups were interviewed once each at the end of the 3-month period (n = 145 who had received the intervention and n = 151 who had not). Basic knowledge of STD symptoms and HIV transmission was high in all groups. There were misconceptions about casual transmission of HIV which improved dramatically at the second interview for group E1 (from 37-56% correct responses to 82-90%). Overall condom use was high (about 75%) and did not change after the intervention. Gonorrhoea rates were correspondingly low (0.4 episodes/worker/year) and also did not change. This brief intervention improved the STD knowledge of sex workers. However, behaviour as measured by reported condom use and gonorrhoea incidence did not change. Implications for future intervention programmes are discussed.
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PMID:Evaluation of a safe-sex intervention programme among sex workers in Singapore. 794 57

In India, staff at the National Institute of Virology used the anti-HIV-1 antibody ELISA to conduct primary screening of blood samples from 63 men, 19-46 years old, who engaged in oral and anal intercourse with men (56 homosexuals and 7 bisexuals), who were attending 2 sexually transmitted disease (STD) clinics in Bombay over a 6-month period. Researchers wanted to determine the prevalence of HIV-1, HIV-2, or dual HIV-1 and HIV-2 infections among sexually active men who had sex with men. The Western blot test confirmed ELISA results. Staff used line immunoassay to distinguish between HIV-1 and HIV-2 infection. Ten samples reacted to ELISA for HIV-1 infection and were confirmed to be HIV-1 positive by Western blot. The 3 samples that were borderline reactive by ELISA were reactive to HIV-2 by line immunoassay. Both HIV-1 and HIV-2 infection were identified in 2 samples. Clinically-diagnosed STDs among the 63 men were: condylomata acuminata (22), herpes (20), gonorrhea (15 confirmed by gram stains of urethral smear), candidiasis (3), and syphilis (3). HIV infection was particularly common in men with condylomata infection (12 or 92.3% of all HIV-positive cases). These findings show that, even though heterosexual transmission of HIV is the most common transmission mode in India, homosexual transmission is rather frequent in a large city.
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PMID:Detection of human immunodeficiency virus antibody among homosexual men from Bombay. 797 77

HIV infection is highly endemic in Kigali, Rwanda. The authors report findings from a study conducted from September 1, 1989 to March 31, 1990, to determine the etiology of acute arthritis observed in adults and its relationship with HIV-1 infection in the city. Careful medical histories and full clinical evaluations were conducted upon each new patient admitted with acute arthritis to the outpatient and inpatient services of the Department of Internal Medicine at the Centre Hospitalier de Kigali over the period. 27 men and 9 women of mean age 31 years in a range of 18-65 years presented, of whom 72% were HIV seropositive. Aseptic arthritis was diagnosed in 16 patients of whom 14 were HIV seropositive. 12 patients fulfilled the criteria of spondylarthropathy of whom 10 were HIV seropositive. There were 4 cases of HIV-related polyarthritis, while septic arthritis was identified in 11 patients of whom 9 were HIV seropositive, including 4 with gonococcal, 2 with staphylococcal, 1 with Salmonella B, and 2 with tuberculosis arthritis. The authors stress on the basis of these findings the need in an area highly endemic for HIV to consider acute arthritis a possible manifestation of HIV infection which necessitates the testing for HIV.
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PMID:Acute arthritis and human immunodeficiency virus infection in Rwanda. 801 42

The authors interviewed and tested 91 male and 84 female sexually transmitted disease (STD) patients for HIV infection to determine the feasibility of establishing a sentinel HIV surveillance system involving patients with STDs attending private clinics and a government STD clinic in Kuala Lumpur, Malaysia. 77.3% of the women were aged 20-34 years and 7.1% under age 20. Information was collected on risk behaviors for HIV infection. 41.7% of the women reported working as prostitutes, while others worked as masseuses, hairdressers, waitresses, salesgirls, receptionists, factory workers, and in other capacities. 58.3% of the women had 100 or more sex partners during the preceding month and 99% had six or more sex partners. Only 4.8% of the women, however, had their male partners use condoms most of the time, while 11.9% hardly used condoms at all. Gonorrhea was most commonly diagnosed, while nonspecific genital infections, pelvic inflammatory disease, genital herpes, and syphilis were also diagnosed. Among the males, 93.3% were heterosexual and 6.7% bisexual, with 41.1% having 6-20 different partners in the previous year. 78.0% had prostitutes as their sex partners most of the time, 41.8% had experiences in Thailand and the Philippines, 73.6% never used condoms, 19.8% used condoms rarely, and 6.6% used condoms most of the time. Despite such behavior, all tested negative for antibodies to HIV. Lot quality assurance sampling methods did, however, indicate that the upper limits of prevalences for females and males were 3.5% and 3.3% respectively, at a 5% type I error. An HIV prevalence of several percent could therefore exist. While offering useful baseline data for future comparisons, this study found it feasible to carry out a sentinel surveillance program among STD patients.
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PMID:Patterns of risk behaviour for patients with sexually transmitted diseases and surveillance for human immunodeficiency virus in Kuala Lumpur, Malaysia. 803 14

Between October 1989 and May 1991 in Kenya, clinicians interviewed and took cervical cultures from 4404 women attending 2 periurban family planning clinics in predominantly lower socioeconomic areas of Nairobi to determine risk factors for sexually transmitted diseases (STDs) among low-risk women. Most women were married and/or had only one sexual partner in the past year. The STD prevalence rates were 3.2% for gonorrhea, 1.9% for syphilis, 5.2% for trichomonas, and 4.9% for HIV infection. The crude analysis showed that unmarried status and at least 2 sexual partners in the last year were significantly correlated with each STD. When the researchers controlled for each disease and for other risk factors, however, neither unmarried status nor at least 2 sexual partners were associated with the STDs. The population attributable risks (PARs) for unmarried women were 9.7% for gonorrhea, 9.1% for syphilis, and 15.9% for trichomonas. The PARs for more than 1 sexual partner were 7.7%, 7.2%, and 7.4%, respectively. These PARs were relatively low due to the considerable proportion of married and monogamous women in the sample. HIV seropositivity was the most significant predictor of gonorrhea, syphilis, and trichomonas infections (odds ratio = 1.9-3.4). The pelvic examinations of most women who had microbiological evidence of an STD were normal. The clinical diagnostic algorithms for STDs in the study used the most readily accessible and significant risk factors and physical examination findings. They had a relatively high specificity (76 - 99%) but low sensitivity ( 1 - 38%). These findings showed that none of the risk factors or the physical examination could be sufficiently used to predict an STD diagnosis. They also indicate the need for inexpensive diagnostic tests to identify and treat women at a relatively low risk of STDs in family planning and other clinics.
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PMID:Risk factors for gonorrhoea, syphilis, and trichomonas infections among women attending family planning clinics in Nairobi, Kenya. 803 77

Even though the population of developing countries is heterogeneous, it is young, and the incidence and prevalence of sexually transmitted diseases (STDs) are likely to increase among persons aged 20-40. STD epidemiologic data tend to be unreliable in most developing countries. Zimbabwe, a country with a good information system, has about 1 million reported STD cases each year (40% urethritis, about 25% genital ulcers, and 20% vaginal discharge and/or pelvic inflammatory disease). Gonococcal infections among pregnant women vary from 2% to 20% in Africa and are 10-20 times higher here than in comparable populations in the West. Chlamydial infection rates in developing countries tend to be similar to and lower than rates in the West. Syphilis prevalence rates range from 1% to 20% in some developing countries. STD complications and their sequelae pose an important public health problem for developing countries. They mostly affect women and newborns. STD complications and their sequelae include spontaneous abortion, fetal death, low birth weight, congenital syphilis, blindness, infertility, and social and personal damage. It appears that STDs facilitate HIV transmission. HIV-related immune deficiency increases one's susceptibility to genital ulcers. Increasing resistance to antibiotics complicates treatment of gonorrhea and chancroid. HIV infected persons respond poorly to classic treatment of chancroid. Two major STD interventions are prevention through behavior modification and promotion of barriers and limiting the duration of infection through optimal case management and case finding activities. The emergence of HIV has placed primary prevention as an absolute priority. Social marketing of condoms has been successful in several developing countries. Provision of accessible and affordable care can change health seeking behavior of persons with STDs such that they seek care from medical services. The primary health care systems of several developing countries use simple diagnostic algorithms to identify STD cases.
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PMID:Epidemiology and control of sexually transmitted diseases in developing countries. 804 15

The HIV situation in Africa was very dismal in 1994, with about 10 million people infected. The causes of the rapid spread were the high incidence of sexually transmitted diseases (STDs), urbanization, and breakup of families because of migrations, since men often seek work at other places. In the age group of 15-19 years in Malawi, Uganda, and Zimbabwe, there were 5 HIV-infected women for 1 infected man, but in the 30-39 year age group, there 3 infected men for every 1 woman. A report from Kenya showed that 69% of boys and 25% of girls were sexually active, while 50% had more than 4 partners. Among 15-24 year old pregnant women, 36% had STDs. A study from the Ivory Coast indicated that HIV prevalence increased from 27% in 1987 to 53% in 1992 among patients who were seeking care for an STD in Abidjan. Among tuberculosis (TB) patients this increased from 16% to 35%, and among pregnant women from 7% in 1987 to 14% in 1992. Another group, 745 prostitutes, were also studied in Abidjan. 48% were infected with HIV and 34% were infected both with HIV-1 and HIV-2. It is estimated that 50-75% of HIV-infected people in Africa also had STDs, compared to 20% of the HIV-infected in Thailand and India and 5% in Brazil. It has been proven in a US cohort study that the treatment of STDs reduces the spread of HIV. In Gambia, Rwanda, Zaire, and Kenya, 50-100% of gonococcal isolates were resistant to penicillin and tetracycline, and 40% of women with symptoms of STD infection did not receive adequate treatment. A study from England indicated that both HIV and TB follow the same epidemiological patterns among men 30-39 and among women 20-29 years old. In developing countries HIV is the main risk factor for developing TB. About 4-5 million people have TB as a cofactor for HIV infection, of whom 80% are in Africa. In 1994 about 3% of TB cases were associated with HIV, which will increase to 10% by the year 2000.
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PMID:[HIV spreads fast in Africa. Women and children especially, are at high risk]. 805 21

Treatment regimens for sexually transmitted infections continue to evolve. The natural history of syphilis in HIV-infected patients is leading to more aggressive policies in terms of both investigation and treatment. In particular, treatment protocols for late syphilis, especially neurosyphilis, are under scrutiny. Epidemiological change typified by the spread of penicillinase-producing Neisseria gonorrhoeae (PPNG) has led to a search for new agents to treat gonorrhoea, with a more extensive use of cephalosporin and quinolone antibiotics emerging. The problem of compliance with the antibiotic courses presently required for chlamydial infection may be close to being solved with the development of newer macrolide agents. Single dose azithromycin, although expensive, seems to be as effective as longer courses with other agents. Furthermore, its efficacy in gonococcal infection is also encouraging. Increased understanding of the pathogenesis and natural history of pelvic inflammatory disease (PID) and bacterial vaginosis (BV) has led to rationalization of treatment policies for these conditions.
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PMID:Antibiotic chemotherapy of bacterial sexually transmitted diseases in adults: a review. 806 Oct 86


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