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The process of incorporating HIV education and counseling into the Mount Sinai Medical Center's prenatal clinic in New York City is provided in terms of background, the patient program, evaluation, and conclusions. There have been endorsements for inclusion of HIV testing and education in the practice of prenatal care and reported effectiveness in delaying the onset of AID's associated infections. The prenatal clinic provides health care to predominantly minority women (36% African American and 55% Hispanic) of whom 10-12% report intravenous or nonintravenous drug use; clinic births are about 1600 a year. Early attempts in 1986-7 to provide anonymous testing and counseling demonstrated the need to reach a large audience. Observations were that considerable staff training and support was needed for an effective patient program. Encouragement and support was also needed by patients. 8 one hour training sessions were provided to the nurses, as well as a 21 hour state certification program for the social workers, both groups of whom worked directly with patients. Intense reactions to caring for HIV infected persons occurs and emotional support must be included in the training. Additional staff support was provided through an AIDs prevention grant for a year. Continuous staff training is required. Another grant provided a clinical social worker and program coordinator who worked closely with the clinic director. The target was to integrate the HIV/AIDs information into routine clinic services; specifically, a 45 minute orientation session during patient's first medical visit. The groups discussion session is lead by the nurse's introduction to the clinic, patient care, and screening, and followed by the social worker's comments on voluntary HIV screening. Nonambiguous language which is understood by various educational levels was used. Patients needed more time to discuss the concerns for dealing with their partners about STD's and contraception. Testing was available throughout the prenatal clinic period. Posttest counseling is also provided as a review, and for those seropositive or high risk patients as initial crisis intervention and case management. There was nonjudgemental discussion about termination of pregnancy. 1453 patients out of 1600 were involved in the orientation, with 20% (297) rather than the preceding years 40 screened. Success is attributed to strong collaborative working relationships with medical, nursing, social work, and clerical staffs, and extensive prior education. Those identified as seropositive were followed up in a separate clinic.
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PMID:Incorporating HIV education and counseling into routine prenatal care: a program model. 187 35

Florida has the 3rd highest cumulative number of AIDs cases among states in the US, and 12% in Florida are women, which is 3% higher than the national average. The study describes the AIDs knowledge and sexual behavior of women at high risk of HIV infection in 1989 from Dade and Broward counties in Florida. As part of a 3-year project, it was designed to develop a cross sectional description of women at risk, and to develop and evaluate interventions aimed at perinatal AIDs prevention. 620 nonpregnant women were recruited from county jails and detention centers (59.3%), county health, STD, and family planning clinics (26%), alcohol/drug treatment centers (13.6%), and other (1.1%). The mean age of respondents was 28.9 years. 51% were never married, and 76% had 1-3 children. 45% were unemployed. 21% reported income from prostitution and 17% from illegal activity. 44% had ever engaged in prostitution. 83% had used an illegal substance of which 22% was IV drugs. 8.7% were seropositive. 71% received AIDs, STDs, contraception, and sexuality information from the mass media, and 59% from medical professionals and public health clinics. The limitations were the representatives of the sample, and the validity and reliability of the questionnaire. The results of AIDs knowledge, risk behavior, and vulnerability revealed that the majority were well informed about AIDs and HIV infection, with the exception of Haitians. The findings support treating Haitian women as a special population for AIDs prevention programs. Those 20 and 41 years tended to believe myths about AIDs and casual contact and perceived risk based on the appearance of an individual. 75% were unaware of bleach as a remedy for dirty needles. As a subcultural influence, people need more knowledge about safer drug use. Knowledge did not influence risky behavior. Transmission appears to be from heterosexual contact. A greater prevalence of sexual risk behavior was reported with main partners even though 75% agreed one couldn't trust lovers in reporting STDs. Program focus on prostitutes may have limited impact. Hispanics reported the greatest prevalence of risk behaviors, followed by whites, blacks, and Haitians. Over 40% of Hispanic and Haitian and 20% of black women reported intention to not use a condom with a seropositive partner. Economics and gender role norms are a great influence. There was a general lack of perceived vulnerability. Successful community and society level strategies involve continued education, sociocultural sensitivity, gender role issues, sexual decision making, and economic factors.
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PMID:AIDS knowledge and risk behaviors among culturally diverse women. 187 40

Antibodies against human immunodeficiency virus, other infectious agents and neopterin levels were determined in 253 patients in a rural area of North-West Tanzania. Seroprevalence for HIV was 3.2%. In one case serology was positive for HIV-1 and HIV-2 antibodies and questions whether there was a real double infection or a cross reaction not only concerning core region proteins but also transmembrane protein. The specificity in the diagnosis of HIV-infection is markedly increased with newer serological methods using recombinant peptides but did not improve sensitivity on African sera. Neopterin was determined as a sensitive indirect marker for the activation of T-cells and is therefore correlated with the susceptibility of HIV infection and with progression of disease. High seroprevalence rates for various infectious agents were determined and may explain the high rate of elevated neopterin levels in 80% of the Africans. Neopterin levels were even higher in HIV patients. Viral p24 antigen was found only in two persons, one of whom had no antibodies detectable.
Int J STD AIDS
PMID:Evaluation on HIV serology and immune-stimulation on patients in Tanzania. 190 99

Perception of risk has been suggested as an important element of sexual behaviour change among people who engage in behaviours which place them at risk of HIV infection. A study of the relationship between perception of risk of HIV infection and risk-related sexual behaviours was conducted in a genitourinary medicine clinic. The sample comprised 767 patients attending over a 3-month period; data collection was by self-completed questionnaire. A total of 574 questionnaires were suitable for analysis, representing a response rate of 75%. The majority of people in the sample reported behaviours which increased their risk of HIV infection, but only 19% (n = 112) of the sample perceived themselves to be personally 'at risk', despite adequate knowledge of HIV transmission and methods of risk reduction. Significant differences between social class groups were found for knowledge scores, with highest scores among professionals and lowest among unemployed subjects (Kruskal Wallis test chi 2 = 24.6, P less than or equal to 0.001). Increasing age was significantly associated with better knowledge; significantly more young people aged 16-20 years who did not perceive themselves 'at risk' (64%), had lower knowledge scores than older people who did not perceive themselves 'at risk' (41%). Among heterosexuals who reported having sex with other people in addition to their regular partner, 79% did not perceive themselves as 'at risk' of HIV infection, and of these, 64% reported only infrequent condom use with casual sexual partners. Significantly more heterosexual men (67%) than women (44%) reported multiple sex partners.(ABSTRACT TRUNCATED AT 250 WORDS)
Int J STD AIDS
PMID:AIDS-related risk perception and sexual behaviour among sexually transmitted disease clinic attenders. 181 71

In order to study the prevalence of human immunodeficiency virus (HIV) infections and related risk factors, Dutch expatriates who returned from sub-Saharan Africa were asked to complete a questionnaire on sexual, occupational, and other risk factors, and to donate a sample of blood to test for antibodies against HIV. The 1968 participants were involved in various professions and their families included those over 16 years of age who were posted in sub-Saharan African countries by Dutch governmental, nongovernmental, and commercial organizations for at least 6 months cumulative between January 1, 1979-January 1, 1990. Antibodies against HIV-1 were found among 4 of 1122 men (0.4%) and 1 of 846 women (0.1%). The woman and 3 of the men had had sexual contact with African partners and had been treated for sexually transmitted diseases, 2 of these 3 men also had an African life partner. One man reported occupational exposure only. Of the 1968 participants, 89 men (7.9%) and 18 women (2.1%) lived with an African partner; 344 men (30.7%) and 111 women (13.1%) had heterosexual contact with other African partners. Only 22.3% (men) and 18.6% (women) of casual sexual contacts with African partners were always protected by a condom. 232 of 408 (56.9%) paramedics reported needlesticks. Groups at risk of HIV infection through sexual exposure were identified using logistic regression models. In conclusion, the observed prevalence of HIV-1 is low. However, unprotected sexual contact with African partners and needlestick accidents were common. This study underscores the continuous need for health education of expatriates on the risks of transmission of HIV in Africa.
Int J STD AIDS
PMID:Risk of HIV infection among Dutch expatriates in sub-Saharan Africa. 191 56

This study evaluated the impact of psychosocial and knowledge-related antecedent factors on adolescents' sexual, alcohol-use, and drug-use behaviors associated with the transmission of STDs, including HIV. Additionally, the study examined the role of peer influences in determining STD and HIV risk behaviors, relative to knowledge and other psychosocial factors. Researchers surveyed 544 freshmen (9th graders) at 4 urban high schools, collecting the data through anonymous, self-administered questionnaires. The report provides a tabulation of the students' demographic and other characteristics. In order to analyze the data, the researchers employed a multiple regression model. The results of this analysis indicates that higher levels of STD and AIDS knowledge were associated with lower levels of STD and AIDS anxiety, fewer negative attitudes towards people with AIDS, stronger perceptions of self-efficacy in preventing infection, and stronger peer affiliation. Moreover, negative attitudes toward people with AIDS were inversely related to knowledge, social support, and perceived self-efficacy. The study also found that perceived peer norms and strong peer affiliation served as predictors of alcohol and drug use, while lower levels of knowledge and perceived peer norms served as predictors for nonuse of condoms. The findings of this study reveal several factors related to adolescents' risk of acquiring STDs: the connection between peer influence and adolescent risk behaviors, the relationship between the use of alcohol and drugs and sexual risk behavior, and the role of knowledge in determining the specific risk behavior of nonuse of condoms.
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PMID:Psychosocial and behavioral factors associated with risk of sexually transmitted diseases, including human immunodeficiency virus infection, among urban high school students. 194 94

In Vienna, legalized prostitution is tightly controlled by the advisory board of the Viennese Public Health Service. Registered prostitutes are routinely screened for all important STDs, such as syphilis, HIV, gonorrhea, chlamydial- and yeast-infections, and Trichomonas vaginalis. Furthermore, cytological smears are obtained from the cervix and chest X-rays are performed at least once a year. In all pathological findings, an appropriate therapy is implemented. Presenting data of 1989, out of the 713 weekly controlled registered prostitutes, Neisseria gonorrhoeae was detected in 0.3% of all examinations (110/35,368). In non-registered prostitutes, the infection rate of N. gonorrhoeae was 6.9% (27/354), and so far, 20 times higher than in registered ones. The infection rate of Chlamydia trachomatis, which has been routinely diagnosed in registered prostitutes for several years, has decreased from 20.4% in 1980 to 2.2% in 1989 compared with 31.4% and 10.9% in non-registered prostitutes. In registered prostitutes, the prevalence of genital infections, such as C. trachomatis, T. vaginalis, and yeasts was shown to be 4.9%. The corresponding data in non-registered prostitutes were much higher (18.8%). Due to examinations for cervical malignancy the incidence of Papanicolaou stain IV and V has decreased from 3.1% in 1988 to 1.6% in 1989. There was no serologic evidence for syphilis and HIV infection in both special risk groups. The data demonstrate, that due to a good health surveillance of STD-risk groups, a good information service, and free treatment, the prevalence of STDs can be reduced in prostitutes.
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PMID:Medical health care for Viennese prostitutes. 194 14

To describe homosexual men who continue to engage in unprotected oral and anal sex, 601 men who attended three urban STD clinics and who had engaged in these behaviors with a male partner in the previous 4 months were interviewed regarding their sexual and drug-use behaviors. Although approximately one fourth of participants had engaged in 1 to 2 episodes of unprotected anal sex, more than 20% reported engaging in greater than 23 episodes. Higher frequency of anal sex was associated with lower condom use rates. Although 50% had primary relationships, less than 22% had sex with just one partner, and less than 10% were in relationships concordant for HIV-antibody status. Multiple regression analyses showed that number of drugs used each month, sex in a steady relationship, and Hispanic ethnicity were the most consistent predictors of risk behavior across sites. Careful evaluation of the diverse nature and characteristics of these men is essential to target risk-reduction programs for this population.
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PMID:Homosexual men who engage in high-risk sexual behavior. A multicenter comparison. 194 16

This study compared the distributions of known human immunodeficiency virus (HIV) and acute hepatitis B virus (HBV) infection among drug injectors in Glasgow over a 3.5 year period. Data were obtained from all relevant laboratory request forms submitted to Glasgow's 3 virology laboratories during the period 1 January 1986 to 30 June 1989. The overall prevalence of HIV among those tested was 3.7% (66/1786). There were 125 cases of acute HBV infection. The male:female ratios for HIV and acute HBV were 1:1 and 2:1, respectively. Thirty-four per cent of persons with HIV were aged under 21 years compared with 53% with acute HBV. Three out of 10 areas of the city accounted for 92% of HIV infection but only 66% of acute HBV infection. HIV infection was not detected among drug injectors in 4 areas of the city but at least 2 cases of acute HBV infection were recorded in all 10 areas. The geographical and age distribution of acute HBV infection in Glasgow suggests that the potential for future spread of HIV among drug injectors remains considerable.
Int J STD AIDS
PMID:Distribution of HIV and acute hepatitis B infection among drug injectors in Glasgow. 195 20

Epstein-Barr virus is an important aetiological factor in certain HIV-related syndromes, with its opportunist expression related to the level of host immunodeficiency. In asymptomatic people co-infected with HIV, EBV activity is reflected by increased viral shedding and rises in anti-EBV titres; as immunodeficiency ensues EBV manifests as epithelial hyperproliferation in OHL, and later as B-cell lymphoma in AIDS. The suggested role of EBV as a co-factor in the progression of HIV infection and development of AIDS has not been established, although another herpesvirus, cytomegalovirus, might play such a role. Advances in our understanding of HIV regulation and its interaction with other latent (herpes) viruses should provide important molecular and pharmacological approaches to the clinical management of advanced HIV disease.
Int J STD AIDS 1990 Sep
PMID:Acquired immunodeficiency syndrome and Epstein-Barr virus. 196 85


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