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

To determine how the patterns of inpatient hospital care for HIV-infected patients have evolved in recent years, we analyzed data obtained from a statewide hospital discharge database from Maryland for the years 1988, 1990, and 1992. For each of these years, we compared demography, diagnoses, lengths of stay, use of the intensive care unit, third-party payer, and hospital charges (inflation-adjusted to 1992 dollars). HIV-infected patients accounted for 0.42% of all Maryland's hospital admissions in 1988, 0.68% in 1990, and 1.1% in 1992, with progressively more women and African-Americans hospitalized. Average lengths of stay fell from 11.7 days (1988) to 10.7 days (1990) and 9.5 days (1992) (p < 0.0001). Average charges per admission fell from $11,634 (1988) to $9,938 (1990) and $8,618 (1992) (p < 0.0001). Medicare or Medicaid paid for 50.9% of hospital admissions in 1988, 56.8% in 1990, and 66.8% in 1992 (p < 0.001). In-hospital mortality rates (7.8% in 1988, 7.9% in 1990, and 7.7% in 1992; p = 0.783) were stable, as was severity of illness. P. carinii pneumonia (PCP) was the most common principal diagnosis, but it declined in prevalence from 13.6% in 1988 to 9.1% in 1992 (p < 0.0001). Principal diagnoses of other opportunistic infections remained stable (8.0% in 1988, 9.9% in 1990, 8.6% in 1992; p = 0.90), as did other nonopportunistic infections (32.8% in 1988, 27.2% in 1990, and 30.0% in 1992; p = 0.16). Non-PCP pneumonias increased from 7.6% (1988) to 10.2% (1992) (p < 0.0001). Substance abuse as a principal or secondary diagnosis increased from 30.9% (1988) to 34.3% (1992) (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hospital admissions of HIV-infected patients from 1988 to 1992 in Maryland. 788 1

An ongoing study of interventions designed to increase nontraditional social supports among women at high risk for HIV infection was in the field during the 1992 Los Angeles riot in those neighborhoods most affected by the urban unrest. Using data from structured interviews, the psychosocial characteristics, drug abuse patterns, and distress levels among the women who were recruited for the project in the six months before and after the riot were examined. While substance abuse levels among participants did not increase or decrease as a function of the riot, there were a smaller number of social supports and marginally greater levels of already high psychological distress. Women in the community specifically mentioned a lack of social supports from counselors available in affected areas after the riot. An ethnographic analysis discusses the experience of the participants in the community during the same period of time. Problems in social supports are pointed out. The results are discussed in terms of a general theory of service provision by increasing nontraditional social supports, especially immediately after a major cataclysm.
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PMID:Psychological functioning and substance abuse before and after the 1992 Los Angeles riot in a community sample of women. 788 5

This paper examines sexual risk-taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n = 383), and identifies correlates of unprotected anal sex within this group. Sexual risk-taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90-day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non-primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non-primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV-tested, and used reappraisal/problem-solving coping strategies showed greater risk with a primary partner only. Sexual risk with non-primary partners was greater for those who used more drugs, reported more difficulty avoiding high-risk sex when aroused and were HIV+. The paper discusses the implications of these findings for the design of sexual risk-reduction interventions.
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PMID:Correlates of sexual risk-taking among gay male substance abusers. 795 Aug 55

We conducted a study to determine the prevalence and sociodemographic distribution of unsafe sexual behaviors among psychiatric inpatients and to investigate an association between crack cocaine use and these behaviors. Two hundred thirty-nine patients admitted to two Philadelphia hospitals during a 12-month period were interviewed to obtain a detailed sexual history and substance abuse history. A history of multiple sex partners was reported by 42.6% of male patients and 13.0% of female patients (p < .01). A history of receptive anal intercourse in the past 6 months was reported by 11.6% of females and 2.1% of males (p < .05). Only about half the study subjects who were sexually active reported ever using a condom during the past 6 months. Crack cocaine use among males and cocaine use among females was statistically significantly associated with a history of having sex with a high risk partner. This study draws attention to the role of crack cocaine and other types of cocaine in the spread of human immunodeficiency virus infection in this population and the need for intensive acquired immunodeficiency syndrome prevention programs on inpatient psychiatric units.
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PMID:The high prevalence of unsafe sexual behaviors among acute psychiatric inpatients. Implications for AIDS prevention. 796 76

Feigned HIV infection or acquired immunodeficiency syndrome (AIDS), in which people mimic infection with or disease due to HIV, accounted for 1.7% of admissions to our specialist HIV unit in Central London over a 5 year period. Of 12 patients with feigned HIV/AIDS, 11 were HIV antibody-negative, and one refused testing. Presenting histories were sometimes grandiose, unusually tragic, or unlikely in relation to the patients' healthy appearance, and often included admissions to other specialist HIV units. Substance abuse was suspected in over half of the patients described, a higher frequency than that observed in our HIV-infected patient population. The possibility of feigned HIV/AIDS should be remembered in persons with self-reported HIV infection. Recognition of this condition is important to avoid costly and potentially dangerous investigation and therapy.
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PMID:Feigned HIV infection/AIDS: malingering and Munchausen's syndrome. 800 41

Considering the official figure on drug-related deaths in Austria, the problem of substance abuse has dramatically worsened over the last years. There is a distinct lack of comprehensive information concerning drug-related deaths in Austria, although deaths of drug users may be potentially important indicators of the extent of drug-related problems in the population. The results of examinations performed on 372 deceased substance abusers at the Institute of Forensic Medicine in Vienna between 1985 and 1992 are presented. Drug-related deaths are defined according to the official definition issued by the Austrian Federal Ministry of Internal Affairs. A distinction was made between injecting drug users and non-injecting drug users with respect to infectious diseases transmitted by sharing of paraphernalia. Between 1985 and 1992 there was a distinct increase in drug-related deaths. In approximately 30% an accidental single substance intoxication, mainly due to morphine, was found. A connection with a better quality of street drugs is assumed but not proven. In 207 corpses more than one drug, including alcohol, was detected. During the investigation there was an evident trend towards multi-substance abuse patterns. Furthermore, blood alcohol concentration, an additional risk factor for narcotic overdose, was strongly associated with higher age. The small number of examined drug injectors found positive for the human immunodeficiency virus type-1 (HIV-1) makes it difficult to draw any kind of conclusion regarding the HIV-I seroprevalence among injecting drug users in Vienna.
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PMID:Drug-related deaths between 1985 and 1992 examined at the Institute of Forensic Medicine in Vienna, Austria. 808 Nov 83

By the year 2000, Hispanics will outnumber African Americans and become the majority minority. Statistics reveal that health problems of the three main groups of Hispanics in the United States (Mexican Americans, Puerto Ricans, and Cubans) include diabetes, injuries and violence, substance abuse, HIV/AIDS, limited access to health care, and many other problems shared by the poor and disenfranchised. The health care provider may intervene with Hispanic clients and communities in culturally sensitive ways such as viewing culture as an enabler rather than a resistant force, incorporating cultural beliefs into the plans of care, stressing familialism, taking the time for "pleasant conversation," refraining from harsh criticism, and involving the community in preventive health care programs. Such interventions require providers who are knowledgeable about the culture, customs, beliefs, and language of the Hispanics within their practice area. Health care providers also need to be alert to and active in health care policy making that will improve access to health care for the growing Hispanic population.
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PMID:Providing culturally sensitive health care to Hispanic clients. 793 59

The aim of this study was to determine the contribution of injected-drug-use complications to the utilization of inpatient care by persons infected with human immunodeficiency virus (HIV). Retrospective chart review was done of all hospital admissions between January 1, 1991, and December 31, 1991, with outpatient records reviewed to establish CD4 counts within 3 months of the date of admission. The participants included 284 consecutive admissions (189 patients); admissions were divided into two groups according to the Center for Disease Control 1993 expanded AIDS definition: those with AIDS (CD4 count, < 200 cells/microliters) and those with early HIV disease (CD4 count, > 200 cells/microliters). Thirty percent of admissions occurred among persons with early HIV disease. Among 189 individuals admitted to the hospital, 84% were male, 62% were white, and 48% had injected drugs. Early HIV disease admissions were more likely to involve active injection-drug users (82% vs. 33%; p < 0.01). Admissions related to injected-drug use constituted 60% of early HIV disease hospitalizations, and this number rises to 72% if bacterial pneumonia is included as a substance abuse complication. Admissions related to injected-drug use constituted 27% of AIDS admissions; this number rises to 51% if bacterial pneumonia is included. Early HIV disease admissions were significantly shorter (9.9 vs. 12.6 days) and less expensive (mean charge, $9,592 vs. 12,873) than AIDS admissions but still accounted for 25% of inpatient HIV charges. Hospitalizations among HIV-infected persons early in the course of HIV disease are most often related to the medical complications of injected-drug use and account for a substantial expenditure of hospital resources.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Injected-drug use: complications and costs in the care of hospitalized HIV-infected patients. 815 41

Whether they "come out" or hide their sexual orientation, most gay and lesbian youth experience the effects of prejudice and stigmatization emanating from society's homophobia. Having to cope with a disparaging and oppressive society creates unique stresses and developmental variations in identity development that are cofactors for HIV infection and disease. These cofactors include cognitive, emotional, and social isolation; feelings of alienation and despair; suicidal ideation; alcohol and other substance abuse; and furtive sexual contacts. Nurses and other providers need to be informed about these cofactors so they may provide meaningful HIV/AIDS prevention education to gay and lesbian youth.
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PMID:Homophobia: a cofactor of HIV disease in gay and lesbian youth. 816 10

Each program within the AIDS Health Project is designed to work with individuals at different points along the continuum between a state of health at one end of the spectrum and the clinical disorder of AIDS at the other. Thus, individual programs reflect different levels of prevention. For example, the Prevention and Support Services (formerly the Worried Well) Program is an example of primary prevention; i.e., services are provided to healthy individuals who are at risk in an attempt to keep them from contracting the disease. The HIV Positives Being Positive Program is an example of secondary prevention in which services are provided to those who have premonitory symptoms of disease but have not yet developed the full-blown illness. The AIDS antibody counseling and testing program has elements of both primary and secondary prevention, as individuals who are counseled may prove to have either a positive or a negative test. Finally, the Mental Health Program at San Francisco General Hospital and the AIDS and Substance Abuse Program (ASAP) are examples of tertiary prevention. (Note: The ASAP actually incorporates all three levels of prevention through its various activities. As the original impetus for its development was to provide services to people with AIDS, however, we have listed it as a tertiary program.) In these programs, services are provided to individuals with the illness in an attempt to prevent psychological decompensation, to provide relief of current distress, and, perhaps, to delay disease progression.
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PMID:The University of California at San Francisco AIDS Health Project. A community psychiatry approach to the AIDS epidemic. 819 Jun 66


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