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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Between 1986 and 1990, 171 patients with mandibular and 129 with mid-face fractures were treated in our service. Both groups were separated into patients with HIV infection and patients without HIV infection. We carried out a retrospective review of these cases. The incidence of HIV+ve patients was higher in the mandibular fracture group (19.8%) than the group with mid-face fractures (7.75%). The most important aetiology of fractures was violence and the HIV infection was acquired through intravenous drug use (heroin). HIV infection was an independent associated factor where there was concomitant infection of mandibular fractures but not in mid-face fractures. In mandibular fractures, preoperative infections were significantly higher in HIV+ve patients (26.4%) than HIV-ve patients (6.5%) (p < 0.0001). Postoperative infections were higher in HIV+ve cases than HIV-ve cases, but this difference was not statistically significant (p > 0.05). Miniplates were a good osteosynthesis medium in HIV+ve patients and intermaxillary fixation seems to increase the infection rate in the HIV+ve group. The infections were treated with antibiotics with excellent results in preoperative infections and in the majority of postoperative cases, in both HIV+ve and HIV-ve patients.
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PMID:Maxillofacial trauma: influence of HIV infection. 140 Nov 7

In Brazil, the Prostitution and Civil Rights Program works to fight against stigma and violence against sex workers and to foster self-esteem, self-determination, and greater access to civil rights. It sponsors the Brazilian Prostitutes' Network. In 1988, the Ministry of Health asked the program to join the Ministry to produce sexually transmitted disease/AIDS prevention materials. The materials were ready for distribution in early 1991 when the program began recruiting prostitutes and transvestites for its Health Education Project. The aforementioned groups and the Brazilian chapter of International Planned Parenthood Federation are working together on this project. By mid-1992, the project recruited 17 community-based health agents (15 female and 2 male prostitutes) from different prostitution areas and through a network of contacts from these areas of Rio de Janeiro. After informal training in April or June 1991, they went into their communities to inform people of their health agent role, distributed free condoms and AIDS education material, and promoted the project. Health agents maintain a weekly report of condom and education material distribution. This allows them to monitor their progress. Health agents now meet with their peers to discuss sex and health issues. The communities have opened their doors to the groups. The project is also geographically mapping the sex trade to target health care and other resources in each area. It is pursuing a reference/counterreference relationship within the existing public health system in Rio de Janeiro. Involvement of sex workers in all phases contributes to the success of the project so far. Future research is needed to determine whether the project is reducing risk of HIV transmission, however.
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PMID:Organizing a project with community-based health agents recruited from prostitutes in Rio de Janeiro. 160 25

This paper describes adaptational and survival strategies of homeless youths as observed from pilot research started in 1982 in the western US and 1988 in Rio de Janeiro, Brazil. Strong correlation was found between both survival strategies and the AIDS pandemic, and the life styles of youths in the 2 regions. The 1982 ethnographic study on homeless youths was conducted over a 2-year period in San Francisco, Los Angeles, and Seattle. Interviews and participant observations were conducted with a group of 250 males and females aged 15-19, with contact maintained with 27. Interviews were conducted with 100 "kept" youths aged 16-19, and a pilot study of HIV infection in teens was undertaken in 1986. This latter study lasted over 4 months, and tested and interviewed 19 and 31 sexually active males and females, respectively, of which 11 were homeless. Finally, 103 street youths were studies in Rio in 1988. The youths expressed an urgent need to secure personal and immediate survival, with money seen as central to providing for this security. Many therefore sold goods, used clothing, panhandled dealt drugs, stole, and provided sex in return for money. Kept youths were often ensconced within the world of pornography and organized prostitution, and virtually invisible to most health care professionals; 28 of 52 interviewed who spoke about sex did not use condoms. Significant incidents of HIV exist in these communities, with 10.5% of youths in Covenant House New York in 1988 and 68.6% of males aged 11-23 prostituting in downtown Rio being HIV+. Moreover, these youths face physical violence and sexual abuse from family members, police, drug dealers and addicts, mentally disturbed and homeless adults, service providers, tourists, and peers. Without families, jobs, and education. they suffer low self-esteem, and therefore have additional psychological reasons for high-risk sexual activity beyond basic economic necessity Strong commonalities exist between these and the estimated 100 million street youths worldwide; social inequality and familial disruptions are common to all countries. The Society for Adolescent Medicine, UNICEF, PAHO, and WHO address the problems of these youths. The authors call for immediate and massive preventive action at national and international levels, including but not limited to the development of large-scale long term housing, and an informational exchange network supportive of collaborative research initiatives.
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PMID:Street youth: adaptation and survival in the AIDS decade. 177 87

Our hypothesis was that a one-day survey of all patients hospitalized on Adult General Care would demonstrate a need for expanded addiction services in a municipal teaching hospital in East Harlem. We interviewed 276 patients in Adult General Care on February 16, 1990 to assess whether they abused drugs or alcohol or were hospitalized for reasons related to substance use. Of the 276 patients interviewed, 18 percent used alcohol alone, 14 percent used drugs alone, 17 percent used both drugs and alcohol and 2 percent were hospitalized for reasons related to substance use. One hundred forty or 51 percent of all patients were admitted because of substance use and its sequelae or as a result of violence associated with the buying or selling of drugs. The percentage was highest on one medical floor where 89 percent of the patients were substance users and on medical floors in general where the average was 60 percent. Forty patients or 14 percent were known to be HIV seropositive. Given the high mortality in Harlem, the results of our one-day survey indicate a need for expanded addiction services.
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PMID:How can we combat excess mortality in Harlem: a one day survey of substance abuse in adult general care. 177 27

Family planning (FP) services were integrated into 13 drug treatment programs in July 1989 in Philadelphia providing services to 1250 women a year on birth control methods, sexually transmitted diseases (STDs), HIV risk assessment, and pregnancy testing. Among 599 female drug treatment clients aged 16-56 baseline interviews were conducted followed up by interviews 9 months and 15 months later. 58% were black, 37% white, and 5% Asian. 58% had a high school education. 14% were married, and 36% were divorced, separated, or widowed. 81% already had 1 child. 25% had injected heroin and 16% cocaine in the previous 4 weeks. 76% of sexually active women had not used condoms. FP clients made 3139 visits in the course of 24 months for counseling and medical purposes. 6 focus groups with 30 men and 35 women aged 16-60 were conducted 12 months after the integration of services. Most were aware about the availability of FP services: 61% of 958 women received STD advice, 67% of 258 women at 4 sites were screened for gonorrhea and 40% for syphilis. 76% of 599 women stated that their last pregnancy had been unintended. Most thought that contraceptives caused weight gain, headache, water retention, mood swings, blood clots, bleeding, or cancer. Among the sample of 599 women 15% had used the condom, 55 had used the pill, 7% had used the sponge, the IUD, or others, 38% had not used any method in the preceding 4 weeks. 42% of 873 of sexually active women receiving FP counseling planned to use the condom. 27% of drug treatment clients had been sterilized. Most women did not use the condom or other contraceptives in order to preserve their relationships. Many had experienced violence, incest, sexual abuse, and rape. In an all-male focus group all had been either victims or committed sexual violence. Both staff and clients liked the integration of drug treatment and FP.
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PMID:Barriers to family planning services among patients in drug treatment programs. 178 7

This chapter identified three methods by which crack cocaine is distributed at the retail level: the street-corner or walk-up sales system, the runners and beepermen system, and the crack house. The chapter devoted primary attention to the crack house, because it appears as the most popular method for distribution. In examining the crack house, it is noted that there are identifiable styles of crack-house operations. If the quality and quantity of social interaction, as well as the situation in which sellers posture themselves, are taken as indices, then a typology can be created characterizing crack-house operations. One end of the scale is an austere method in which social interaction between buyer and seller is severely restricted; on the other, crack houses operate as tavern-style exchange locations, which include socialization above and beyond that required for the exchange of money for crack. The nature of these exchanges are themselves important, since they involve social behaviors that are of concern. One concern is the degree and nature of violence as it is associated with drug abuse. The data in this chapter describe some ways in which violence appears within the crack subculture. This violence comes from multiple sources, but some prominent ones appear to be the businesslike operations of crack distribution, the personal disorganization that surrounds and characterizes the crack-consuming environment, and the distortions of character that crack users describe as often accompanying significant binges of crack consumption. Distributors use violence to control situations. Violence is most prominently used for security at the point of retail sale, to periodically resolve conflicts with rivals, and to discipline employees when necessary. Insofar as it is described by this group of informants, crack as a social phenomenon is tied to violent and abusive behavior. This chapter reports on behaviors that, although not traditionally violent, are of concern and bear upon public health and safety. Tavern-style crack houses may encourage and make possible hypersexuality among participants and thus increase STD and HIV risks. The use of barter as a supplement to a cash economy in the crack trade represents further complications in creating social policies in reaction to this behavior. A range of other illegal and problematic behaviors was also described, illustrating the complexity of interactions that constitute the life of street-level crack users. The social policies that may be called for in response to these social events are not simple and are most certainly not defined by these particular data.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The operational styles of crack houses in Detroit. 209 93

The health of health care workers is mentioned in the early occupational health literature but the significance of these populations in occupational health has only recently received widespread attention. The health care industry now employs about 5% of the national workforce and, despite its size and the multiplicity of its occupational hazards, little systematic enquiry has taken place to quantify these risks. The occupational health services available to health service staff are often rudimentary. Current health concerns include evidence that the mortality experience of subgroups is not as favourable as for comparable socio-economic groups. Specific areas of concern are occupational exposures to biological agents such as HIV and hepatitis B, pharmaceutical products, allergens, violence, electromagnetic fields and chemical carcinogens. Psychosocial factors and excessive hours of work may, in part, explain the high suicide rates experienced by some subsections of the workforce. New initiatives to investigate and monitor this complex working environment are clearly needed.
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PMID:The health of health care workers. The Ernestine Henry lecture 1990. 221 74

In a health education pilot study for a programme to reduce HIV transmission among commercial sex workers (CSWs), 113 CSWs were interviewed and observed in Bulawayo, Zimbabwe during 1989. The educational level of the sample was low and less than a quarter had another job, either as a self-employed vendor/hawker or a domestic servant. Inability to earn income in other ways was the major reason cited for engaging in commercial sex. Nearly half the sample went for check-ups every 3 months or more often. All interviewees had heard about AIDS, but they were uniformed about several facets of AIDS. CSWs reported that they worked an average of 3.6 nights a week, averaged 1.3 clients a night and charged a mean of U.S. $2.8 a session and U.S. $6.5 a night. CSWs reportedly saw a total of 221 clients in the past 7 days and used condoms with 87 (39.3%) clients. Nearly all CSWs said they had done something to reduce the risk of getting AIDS, but when asked what they had done, only 40% said they were using condoms more frequently and many cited ineffective precautions. CSWs who had a job, charged higher fees, experienced little client violence and believed that they were susceptible to AIDS were more likely to use condoms. Clients were a cross-section of Bulawayo society, with widely varying education, incomes and occupations and shared little except an interest in commercial sex. Ethnographic approaches demonstrated a lack of cohesion among CSWs and a consequent need to foster organized, motivated groups for health education, the importance of incorporating clients in health education and the feasibility of using bar security and sales personnel as health educators. It is concluded that health education is urgently needed among CSWs, but that it is equally important to direct health interventions at clients, many of whom are resistant to condom use.
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PMID:A pilot study for an HIV prevention programme among commercial sex workers in Bulawayo, Zimbabwe. 221 43

In Norway, clinical neuropsychology is approved as an exclusive speciality in psychology. Clinical neuropsychological assessment is a well-proven method for which thorough validation studies and international norms are available. The method has a clear application in the assessment of dysfunctions and resources of alcohol-dependent inpatients. Cross-national comparisons show that neuropsychological findings are fairly consistent for alcohol-abusing individuals. A neuropsychological frame of reference is essential for secondary prevention among important groups. Some areas of central interest include alcohol and drug abuse among the elderly, occupational exposure to solvents, impulsiveness and violence, residual Attention Deficit Disorders, HIV/AIDS conditions, and other neuropsychiatric conditions.
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PMID:[Clinical neuropsychological investigation and personality assessment in alcohol abuse]. 232 Nov 95


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