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The number of new patients referred to the HIV/AIDS Counselling Unit at the Royal Free Hospital, London, increased from 926 in 1989-90 to 1450 in 1990-91. Follow-up contacts nearly doubled during the same period of time. Growing demand for HIV testing as well as the shift to the treatment of HIV as a chronic condition increased the workload of the HIV/AIDS counsellors.
Int J STD AIDS
PMID:Increasing workload of an HIV/AIDS counselling service in a London teaching hospital, 1990-91. 157 84

HIV and AIDS are rapidly invading parts of Africa. To prevent the continued spread of the pandemic, sex and health education interventions aim to increase awareness about AIDS and HIV transmission, and condom use is promoted as a specific preventive tool. Increased awareness, however, does not necessarily promote and lead to individual behavioral change. This study explores AIDS awareness, HIV transmission knowledge, and prevention among 2 samples of university students in the continent's most populated country, Nigeria. 2 sample groups of 60 each were identified in 1989, via accidental sampling technique. 1 group was comprised of medical students, while the other was comprised of students studying non health disciplines. Knowledge level and perceptions generally differed between groups. 58.3% an 48.3% of medical students and non medical students, respectively considered AIDS to be a dreadful sexually transmitted disease. 3.3% and 20.0% of medical students and nonmedical students held AIDS to be God's punishment for man's sexual excesses. While 89% and 61.2% of medical students and nonmedical students, respectively, believed that condoms could prevent AIDS, few favored their use. None of the students attributed AIDS to mystical forces, while some associated it with affluence. These results demonstrate the failure of knowledge alone to effect behavioral change away from risky sexual activities. Instead of trying to further increase knowledge levels, and in spite of the sociocultural factors that work against effective disease control in Nigeria, greater effort must be given to directly bringing about behavioral change.
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PMID:Conception of AIDS and its prevention among students in a Nigerian university. 157 23

This study monitored HIV seroprevalence among STD clinic attenders as part of a sentinel surveillance program at the Elig Essono STD clinic in Yaounde, Cameroon, between February 1989 and December 1990. 1161 randomly selected patients were evaluated for HIV and syphilis seroprevalence. 26 of the 1161 patients (2.4%; CI 95%; 1.5%-3.3%) tested were found to be HIV positive (mostly due to HIV-1) and 35.4% had antibodies to Treponema pallidum. There was no association between HIV seropositivity and sex, marital status, or educational level. Genital ulcer disease did not correlate with HIV seroprevalence. However, patients with a positive serological test for T. pallidum were more likely to have HIV infection (rr = 2.4; 95% CI; 1.1-3.0). Results from 1990 were double those of 1989 (3.3% vs. 1.6% p = 0.02). Compared with the findings among the same groups in metropolitan areas of various other African countries, the HIV seroprevalence is still low. This could be the result of several factors, such as the recent introduction of the virus into the country, a different spectrum of STDs, and the high level of circumcision of males. HIV infection trends should continue to be monitored among risk groups such as STD patients and control programs implemented in order to reduce the rapid spread of AIDS across the country.
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PMID:HIV prevalence in patients with sexually transmitted diseases in Yaounde, (Cameroon) in 1989 and 1990: necessity of an STD control programme. 158 54

In September 1991, the 7th IUVDT Regional Conference on Sexually Transmitted Diseases (STDs) convened in Kuala Lumpur, Malaysia, to exchange information on the importance of controlling STDs and HIV-AIDS in Asia. Speakers from Thailand, Malaysia, and Japan provided the latest HIV-AIDS epidemiological data. In Thailand, heterosexual transmission of HIV is catching up with iv drug use. Most infected women are 15-24 years old. In Malaysia, drug use iv drug use trails heterosexual transmission of HIV. In Japan, hemophiliacs comprise 85% of HIV-positive people. Current problems do not compare to the sizable task Asian countries face in affecting the progression of the HIV-AIDS epidemic. All countries need to implement control measures quickly and at the same time. They should not pretend traditional values and beliefs would shield their people from the epidemic. Asian countries should especially stop promoting themselves as places of sexual adventure. Control programs should also target STDs. Australian presenters discussed the results of the Sydney Sexual Lifestyle Study and a study on the effect of zidovudine therapy on the prognosis of AIDS. Another presentation focused on the possibility of a vaccine for chlamydia infection. Several papers centered on the treatment of chancroid and gonococcal and nongonococcal urethritis and evaluation of a detection test for chlamydia infection. 1 participant reviewed the role of human papilloma virus in cervical carcinogenesis. Another participant demonstrated a link between bacterial vaginosis and adnexal tenderness and pelvic infection. The conference concluded with a presenter challenging everyone to meet the HIV-AIDS challenge. Reasons why current control measures do not work include inadequate facilities to manage STDs, tendency not to consider HIV another STD, failure to promote and lack of condoms, and not educating school children about HIV-AIDS.
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PMID:Seventh IUVDT Regional Conference on Sexually Transmitted Diseases, Kuala Lumpur, 5-7 September 1991. 158 59

The prevalence of biologic false-positive (BFP) reactions for syphilis (reactive rapid plasma reagin [RPR] test, nonreactive fluorescent treponemal antibody absorption [FTA-ABS] test) among patients attending two sexually transmitted disease (STD) clinics was evaluated to assess relationships between BFP reactions and human immunodeficiency virus (HIV) infection. Among 4863 patients, 357 (7.3%) had serologic evidence of syphilis and 4.9% had HIV infection. Only 40 patients (0.8% of total patients, 11% of those with reactive RPR tests) had BFP serologic tests for syphilis. There were no demographic differences between true syphilis and BFP patients as to sex, age, or intravenous drug use. BFP patients tended to have lower RPR titers (less than or equal to 1:4) than did true syphilis patients. After excluding 317 patients with reactive FTA-ABS tests, BFP RPR tests were seen in 6 (4%) of 159 HIV-seropositive patients and 34 (0.8%) of 4387 HIV-seronegative patients (odds ratio, 5.0; 95% confidence interval, 1.9-12.7). Although more common among HIV-infected than HIV-uninfected patients, BFP reactions are relatively rare among STD clinic patients, and 89% of patients with reactive RPR or VDRL serologic tests for syphilis had current or prior syphilis infection. The RPR test remains useful for guiding decisions regarding therapy for syphilis.
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PMID:Association of biologic false-positive reactions for syphilis with human immunodeficiency virus infection. 158 32

Human immunodeficiency virus (HIV) infection among adolescents is causing increasing concern, and teenagers attending sexually transmitted disease (STD) clinics run a high risk of contracting it. To determine the status of HIV infection in a Mississippi adolescent population, we evaluated seroprevalence rates for adolescents attending Mississippi State Department of Health STD clinics from 1988 to 1990. During this 2-year period, 9855 adolescents (aged 13 to 20 years) attended STD clinics, and HIV antibody was confirmed in 39 (seroprevalence rate 4.0/1000; 95% confidence interval [CI] 2.7 to 5.2). Seropositive rates were almost equal for male and female subjects (4.1/1000 and 3.8/1000, respectively), suggesting predominantly heterosexual transmission. Rates among blacks were 3.5 times higher than among whites. Adolescents with HIV infection were identified throughout the state, irrespective of urban centers. Rates among the smallest counties (ie, population less than 25,000) were not significantly different from those of the largest counties (ie, population greater than 100,000). Mississippi's rank in the top 10 states for other STDs and the state's high teenage pregnancy rate make it an epicenter of the HIV epidemic among adolescents.
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PMID:Seroprevalence of human immunodeficiency virus among adolescent attendees of Mississippi sexually transmitted disease clinics: a rural epidemic. 158 96

Zimbabwe has experienced a rapid rise in HIV seroprevalence in recent years. As many as 1 million people (10% of the population) are predicted to become seropositive by 2000. We examined social and behavioral factors associated with HIV infection in a case-control study among male factory workers who donated blood before the launching of the AIDS Awareness Campaign. There were 188 subjects: 69 were HIV-positive and 119 were HIV-negative. High-risk behavior was common in both groups. Among seronegative men, 73.1% reported a sexually transmitted disease (STD), 55.5% reported cash payment for sex, and 73.1% had outside girlfriends. Nonetheless, HIV-positive men were more likely to report a history of STD (OR = 3.9; 95% CI = 1.5-11.9), particularly genital ulcers (OR = 2.4; 95% CI = 1.2-4.8), and extramarital partners (OR = 2.8; 95% CI = 1.1-7.1). HIV-positive men reported more lifetime partners (16.5 vs. 12; p less than 0.05) and were less likely to live with their wives (OR = 0.51; 95% CI = 0.23-1.15). Our findings support the importance of genital ulcer as a risk factor and suggest widespread high-risk sexual behavior among urban working-class men.
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PMID:Sexual behavior and risk factors for HIV infection in a group of male factory workers who donated blood in Harare, Zimbabwe. 158 90

Neurosyphilis, a sexually transmitted disease that can cause neurologic damage, has become increasingly prevalent in the AIDS era. HIV carriers can contract neurosyphilis without the presence of other concurrent opportunistic infections. Because MR findings of neurosyphilis are seldom reported, we retrospectively reviewed and evaluated contrast-enhanced MR images of six young (average age, 33 years) HIV-positive men with high serum and CSF VDRL titers indicative of neurosyphilis. All six patients tested negative for concurrent opportunistic infections. Five patients had acute or subacute strokelike symptoms involving the basal ganglia or middle cerebral arteries; one had a parietal convexity mass mimicking meningioma with headache and ataxia. Contrast-enhanced MR images showed patchy enhancement involving the basal ganglia and middle cerebral artery territories in the first five patients and the convexity mass in the sixth patient. On the basis of brain biopsy, a convexity mass was diagnosed in the patient with syphilitic gumma. The imaging findings of the remaining five patients represented ischemic infarct caused by meningovascular syphilis. After penicillin treatment, serum and CSF VDRL titers decreased, and neurologic signs and symptoms improved in all six patients. A follow-up MR study in the patient with the gumma showed that the lesion resolved almost completely. In young HIV patients with stroke symptoms or a convexity mass, neurosyphilis should be considered. Contrast-enhanced MR can reveal the extent of involvement by neurosyphilis and should be used to facilitate diagnosis and proper treatment.
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PMID:Neurosyphilis in HIV carriers: MR findings in six patients. 159 Jan 35

An unlinked seroprevalence survey of human immunodeficiency virus (HIV) antibody was conducted using stored sera from all patients who attended the sexually transmitted disease (STD) clinic in Halifax, Nova Scotia between 1980 and 1986. None of the sera collected from 584 patients during 1980 were HIV positive. Of the 2867 patients who visited the clinic between 1981 and 1986, 27 (0.9%; 95% CI 0.6% to 1.2%) had the antibody. None of the 784 female patients were HIV seropositive. Of the 1,884 heterosexual men in the study, 5 (0.3%; 95% CI 0.1% to 0.5%) were HIV seropositive, and 22 (11.1%; 95% CI 6.7% to 15.5%) of the 199 homosexual men were HIV seropositive. There was a strong association between a history of syphilis and HIV antibody among heterosexual men (OR = 76.8; 95% CI 12.0 to 491.3; P = 0.001). Among homosexual men younger than 30 years of age, HIV infection was associated with a history of syphilis (OR = 18.2; 95% CI 5.1 to 64.7; P = 0.035) and a history of gonorrhea (OR = 8.2; 95% CI 4.2 to 16.0; P = 0.001). The association between a history of gonorrhea and HIV infection was strongest among homosexual men who had three or more sexual partners in the last month. These findings supplement existing evidence that STDs increase the likelihood of HIV transmission.
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PMID:Prevalence of human immunodeficiency virus in the patient population of a sexually transmitted disease clinic. Association with syphilis and gonorrhea. 159 13

Understanding the role of other sexually transmitted diseases (STDs) in the transmission of human immunodeficiency virus (HIV), the role of STDs in progression of HIV disease, and the role of HIV infection in alterations of natural history, diagnosis, or response to therapy of STDs is critical to the development of optimal strategies for HIV control. One hundred sixty-three studies on the interrelationships between HIV infection and other STDs were examined. Of 75 studies on the role of STDs in HIV transmission, the 15 analyses of examination or laboratory evidence of STDs adjusted for sexual behavior showed that both ulcerative and nonulcerative STDs increase the risk of HIV transmission approximately 3- to 5-fold. Due to limited data, the role of STDs in progression of disease remains unclear. Preliminary data from 83 reports on the impact of HIV infection on STDs suggest that, at a community level, HIV infection may increase the prevalence of some STDs (e.g., genital ulcers). If coinfection with HIV prolongs or augments the infectiousness of individuals with STDs, and if the same STDs facilitate transmission of HIV, these infections may greatly amplify one another. This "epidemiological synergy" may be responsible for the explosive growth of the HIV pandemic in some populations. Effective STD control programs will be essential to HIV prevention in these communities.
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PMID:Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. 159 15


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