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

This case involves the examination of an ethically problematic event that arose while we were conducting an outreach/early intervention research demonstration project targeted at women who exchange sex for drugs. Subjects were drug abusers--primarily crack-cocaine smokers--recruited by outreach workers on "the street" and in jail. Participants were offered counseling, HIV and syphilis screening, and risk-reduction education. A woman who was a jail inmate tested positive for HIV. In order to obtain medical and other assistance, she would have to reveal her serostatus to jail officials. This could result in isolation and the possibility of harm from others in the jail once the information about her circulated. The case highlights the problems inherent in HIV testing of incarcerated drug abusers, especially in low HIV seroprevalence areas. We recommend that a community empanel a committee composed of substance abuse treatment and medical professionals, civil rights advocates, criminal justice personnel, and ethicists to formulate humane and effective policy in light of its drug abuse and HIV problems and its resources.
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PMID:Conducting HIV outreach and research among incarcerated drug abusers: a case study of ethical concerns and dilemmas. 845 May 78

Recent data suggest that the homeless and those with chronic mental illness may be at increased risk for HIV infection. A review of the recent literature reveals insufficient rigorously collected data to identify with confidence any particular subgroup of chronically mentally ill patients at increased risk. Nonetheless, it seems reasonable to suspect that those with acute psychosis, a history of substance abuse, or a history of sexual abuse may be at higher risk. Conversely, some data currently support the conclusion that homeless persons are at increased risk for infection due to human immunodeficiency virus (HIV). Clinicians of all disciplines should be aware of these findings and be particularly vigilant when patients are members of both aforementioned groups. Future research should focus upon improving service delivery to the homeless and mentally ill, particularly with regard to sex education and substance abuse intervention. Also, continued research into causal influences of homelessness will ultimately lead to more definitive intervention.
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PMID:Risk of HIV infection in the homeless and chronically mentally ill. 845 64

The purpose of this article is to sensitize clinicians working in the field of childhood physical/sexual abuse to the connection between untreated childhood traumatization and HIV high-risk behaviors. The characteristic abuse symptoms of chronic depression, sexual compulsivity, revictimization, and substance abuse are identified as barriers to HIV education and intervention for survivors. An overview of the existing HIV/child abuse connection research, an illustrative case history and a discussion regarding the clinical implications of these connections are offered.
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PMID:HIV vulnerability and the adult survivor of childhood sexual abuse. 847 81

The purpose of this project was to study women at high risk for contracting AIDS from intravenous drug use or from sexual contact with addicts. Characteristics of the population, differences between HIV+ and HIV- women, substance abuse in primary caretakers of this high risk population, and changes in drug use when learning of HIV status were investigated. Subjects were mothers at high risk for contracting HIV, whose children were referred to a pediatric AIDS clinic of a large urban hospital because of AIDS risk factors. HIV testing revealed that 27 women were HIV+ and 13 were HIV-. The most common source of infection reported by the HIV+ women was sexual contact (17 subjects), with the remainder reporting that they were unsure of the source or reported intravenous drug use as their source of infection. There were significant differences between HIV+ and HIV- mothers with regard to the presence and impact of substance abuse in their own primary caretakers before age 16. Substance abuse in the parents of subjects was apparently reflected in behaviors reflecting health risk in subsequent generations. Subjects did not report changes in AIDS risk behavior when informed of their own HIV status or that of their children.
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PMID:Women at high risk of HIV infection from drug use. 847 44

A review of the literature on unplanned and teenage pregnancies was undertaken for four District Health Authorities. This work was carried out within a national context of increasing conception rates for teenage women aged 16 and under and in the knowledge that pregnant teenagers and their children tend to have poor life chances. The Health of the Nation White Paper has now focused attention on this by the inclusion of a target to reduce pregnancies to under 16-year-old women by half. To achieve this, health authorities need some understanding of the types of services which might be effective. Whilst there is limited evaluative work on the effectiveness of services for young people in this country, international comparisons suggest that some methods for reducing unintended teenage pregnancies may be more effective than others. The specific service issues identified are the need for advice and support pre-conceptually, during pregnancy and after abortion/birth; the need for easier access to contraception; the need for improved information on risky behaviour--particularly relating to pregnancy, sexually transmitted diseases, HIV/AIDS and substance abuse, and the need for improved medical and social care for pregnant teenage women. The most effective approaches for preventing unintended teenage pregnancy would appear to be the development of comprehensive advisory and family planning services, including sex education and the commitment by central and local government to tackle the adverse socio-economic factors which are associated with teenage pregnancy.
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PMID:Preventing unintended teenage pregnancies. 848 11

The resurgent tuberculosis epidemic represents--especially in New York City--a failure to maintain a public health infrastructure that was focused on preventing active disease in high-risk populations (i.e., individuals with the human immunodeficiency virus [HIV]) and on treating active tuberculosis patients until cured. Although the tuberculosis problem in New York City and other localities is worsened by homelessness, poverty, and substance abuse, it is possible to bring tuberculosis under control by directing public health resources into targeted programs that enhance compliance with tuberculosis treatment regimen and expand chemoprophylaxis efforts among HIV-infected individuals. These two avenues will decrease, respectively, the number of cases of multidrug-resistant tuberculosis and the total number of new cases.
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PMID:Commentary: tuberculosis in New York City--the consequences and lessons of failure. 848 68

A survey of male street prostitutes in New Orleans, Louisiana, on the social, economic, and psychological barriers to human immunodeficiency virus (HIV)-related risk reduction behaviors has significant implications for the design of health education programs. The 211 subjects, ages 18-51 years, were tested for HIV antibodies and interviewed through use of a semi-structured schedule aimed at eliciting data on life-style and based on the Health Belief Model. 37 (17.5%) of study subjects were HIV-positive. HIV risk behavior was measured on the basis of participation in anal-genital and oral-genital sex, sexual orientation, and syphilis serostatus. High-risk behavior was found to be significantly positively associated with economic dependence on hustling, enjoyment of sex with tricks, and perceived control over hustling, negatively with frequency and quantity of substance abuse. These variables accounted for 6%, 3%, 4% and 4%, respectively, of the total variance in risk behavior. 96% of male prostitutes identified HIV as a serious condition; however, risk-taking behavior was found to increase with increased levels of perceived susceptibility to HIV infection. Finally, risk-taking behaviors increased along with increased in perceptions of the availability and efficacy of condoms. These findings suggest that health education efforts based on promoting HIV infection as a serious condition or emphasizing the effectiveness of condom use will be ineffective without attention to the social context of population groups at greatest risk of HIV infection. Measures most likely to reduce HIV-taking behaviors among male prostitutes are, according to these findings, elimination of the economic incentive for engaging in unsafe sex through the provision of alternative income sources, empowering male prostitutes to exert control over the hustling situation, and promotion of achievement of sexual pleasure through safe sex.
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PMID:Barriers to human immunodeficiency virus related risk reduction among male street prostitutes. 849 37

Thirty-seven nondemented HIV-seropositive and 17 seronegative control subjects were administered the Sternberg speed of memory scanning task, a procedure frequently employed to study mental slowing in patients with subcortical dementing disorders. Experimental and control subjects did not differ in speed of memory scanning, as indexed by the slopes of set size-reaction time functions, nor on mean 0-intercepts for the RT functions, which index stimulus detection and motor response time. Intercept values were significantly greater for subjects with a positive alcohol abuse history and for subjects with greater self-reported depression, but slopes were not significantly correlated with substance abuse history or psychological distress. Cognitive slowing in early HIV-1 infection is not a nonspecific effect observed across all measures of information processing speed. Underlying component functions measured must be carefully considered when selecting reaction time tasks for study with HIV-seropositive subjects. The term "subcortical" dementia may be too general a descriptor, and RT task performance may provide an alternative basis for classification of dementia types.
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PMID:Speed of memory scanning is not affected in early HIV-1 infection. 849 53

Neuropsychological impairment has been reported to occur in persons at all stages of infection with the human immunodeficiency virus (HIV). However, the findings of studies to characterize the incidence and pattern of impairment have been limited by inconsistent definitions of impairment and the failure to control for confounding variables, such as hematological abnormalities, history of head injury, or substance abuse. In the present study, neuropsychological tests were administered to 141 persons at four stages of HIV infection. Significant differences were found in the percentage of persons who showed impairment at each stage of infection. Further, participants' performance on the tests tended to decline across progressive stages of infection. These findings may help psychiatric nurses identify and manage the changes associated with HIV infection.
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PMID:Characterizing the neuropsychological functioning of persons with human immunodeficiency virus (HIV) infection, Part II. Neuropsychological functioning of persons at different stages of HIV infection. 849 5

This study was performed to identify specific high-risk behaviors, such as unprotected oral, anal, and vaginal intercourse and substance abuse, associated with human immunodeficiency virus infection among adolescents attending three diverse clinics located in a localized geographic area: a university-based clinic, a Planned Parenthood clinic, and an inner-city public health clinic (PHC). Six hundred seventy-one female and 207 male adolescents attending one of the three clinics completed a structured questionnaire. Similarities among patients at the clinic sites included high rates of anal intercourse (21%), unprotected vaginal sex (95%), oral sex (73%), and poor communication skills (42%). Some differences appeared as well, including higher rates of homosexual experiences, no birth control use, and having multiple partners among adolescents attending the PHC (p < 0.001). In contrast, adolescents attending either the university-based clinic or the Planned Parenthood Clinic had higher rates of substance abuse around sexual activity than those who attended the PHC (p < 0.001). We conclude that adolescents attending general medical clinics in the San Francisco Bay area engage in high-risk behaviors that place them at risk for transmission of human immunodeficiency virus even though many have had previous education about acquired immunodeficiency syndrome and sexually transmitted disease. Specific risk factors include unprotected receptive anal intercourse, unprotected vaginal intercourse with new and unknown partners, experience in homosexual behavior, high rates of oral sex, multiple partners, poor communication skills, and frequent use of illicit substances in conjunction with sex. The differences found among sites indicate the need for health care providers and prevention programs to provide emphasis on practices specific to the adolescents in their service area.
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PMID:Risks of human immunodeficiency virus infection among adolescents attending three diverse clinics. 849 69


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