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Query: UMLS:C0019693 (HIV)
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To persuade South Africa to abolish its apartheid policy several measures have been taken by the international community, including economic sanctions. The harm done by sanctions to the South African economy is obvious. As economic activity has slowed down, unemployment, especially in the black community, has risen. For the unemployed poverty and hunger are harsh realities while for those lucky enough to have jobs income remains quite high. Prostitution has become a way of redistributing income and for many families it is the only way to avoid starvation. With prostitution, however, has come AIDS: it is estimated that HIV infection is doubling every 5-8 months. On 1 calculation 85% of sexually active blacks could be infected with HIV by 1996; most would proceed to AIDS and die, leaving millions of children without parents. Although economic sanctions have speeded up some measure of reform in South Africa they are now harming the very people they were intended to help. Furthermore insidious voices are already being heard saying the government should stop all reform processes and anti-AIDS campaigns and just "sit it out" for the next few years. A further consequence of an ailing economy is the unavailability of funding for those who wish to curb the spread of AIDS via educational and other programs. [Full text]
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PMID:Apartheid and AIDS. 257 92

Migration, poverty, hunger, HIV epidemia and development of multiresistant TB require more awareness of the problem "tuberculosis'. Investigation and treatment of TB are a challenge to every doctor and require not only knowledge and skills, but also a lot of ability in communication and empathy to master numerous difficult conditions.
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PMID:[The new face of tuberculosis--update for the practitioner]. 906 35

Anorexia is a common problem in HIV infection and occurs via several mechanisms, including local pathology in the oral cavity or esophagus, central nervous system disease affecting eating mechanics or the perception of hunger, or secondary anorexia due to systemic infections, malabsorption, or medications, or to nonmedical factors, such as psychosocial problems, poverty, and isolation. The etiologic diagnosis of disorders of food intake is facilitated by using a diagnostic algorithm. The consideration of nutritional management centers around the body's nutritional reserves in addition to caloric intake. The specific management of a patient with poor food intake is based on the precise cause of the problem, and may include food-based and oral supplement therapies, appetite stimulants, or nonvolitional feeding via the enteral or parenteral route. Anabolic agents, cytokine inhibitors, and other therapies, such as resistance exercise, are adjunctive therapies, and do not replace adequate caloric intake.
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PMID:Nutritional management of patients with AIDS-related anorexia. 982 81

The primary objective of this study was to gain a clearer understanding of the barriers to adherence to highly active antiretroviral therapy (HAART) faced by people living with HIV/AIDS (PLWHIV/AIDS) on Long Island, New York. Focus group, a qualitative research method, was used to study these barriers. The study was conducted in 1998 on Long Island, NY, at five institutions that provide services to 1700 PLWHIV/AIDS. Five focus groups were conducted with 6 to 13 PLWHIV/AIDS in each group, a total of 39 subjects. PLWHIV/AIDS identified eight common barriers to adherence to HAART. In descending order, the barriers include: (1) frequency and severity of side effects, (2) conflicts with daily routines, (3) dietary requirements, (4) frequency of taking medications, (5) number and dosage of medications, (6) psychosocial factors (i.e., stress, feeling good, and bad news), (7) pharmacy refills, and (8) physiological needs (i.e., sleep, hunger, or thirst). Many factors play a role in the success or failure of HAART, including preexisting drug resistance, drug-drug interactions, and the ability of PLWHIV/AIDS to adhere to a rigid and frequently changing medication regimen. The information gleaned from focus groups is limited in that it may not be generalized to a larger population with any known reliability. However, clinicians sensitive to barriers to adherence to HAART, including those identified by PLWHIV/AIDS in this study, may play a more proactive role in supporting adherence to the medication regimen, increasing the durability of effective viral suppression, decreasing morbidity and mortality, and decreasing the selection and transmission of resistant strains of HIV.
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PMID:Barriers to adherence to highly active antiretroviral therapy as expressed by people living with HIV/AIDS. 1081 33

A number of legal and illegal drugs can help stimulate appetite and are used for people with HIV to prevent wasting. Stimulating hunger is important because lower calorie intake and poor absorption of nutrients are associated with wasting. The uses and potential drawbacks of marijuana, thalidomide (Synovir), Marinol, and Megace are described.
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PMID:Stimulating your appetite. 1136 23

Assessments of hunger and/or appetite are common methods of screening for development of illness-related anorexia. There are limited data to determine whether these methods predict actual food intake in persons with HIV disease. Therefore, the authors examined the relationship between self-reported food intake and subjective ratings of hunger and appetite in 31 adults with HIV infection. Participants also indicated presence of additional factors that can decrease amount of food eaten. Subjective ratings of appetite and hunger correlated with each other but not with food intake. Twenty-four additional factors that can affect food intake were reported to be present. The most common were illness-related and factors such as eating with friends or family. These results indicate that measures of hunger and appetite are not sufficient to screen for decreased food intake. Additional factors that can affect food intake should also be included in a comprehensive assessment of adults with HIV infection.
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PMID:Assessment of hunger and appetite and their relationship to food intake in persons with HIV infection. 1138 6

The Fourth Asian and Pacific Population Conference organized by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP) and the United Nations Population Fund (UNFPA) was held in Bali, Indonesia, in August 1992. The highlights included: sustainable population and economic growth in a region with three-fifths of the world's population; the threat to the environment from the consumption of natural resources; high fertility; high dependency ratios and aging; land degradation; and migration. The Director of UNFPA revealed that the average rate of population growth had fallen to 1.7% annually since 1963, but an estimated 17.7 million persons were still being added to the region each year. The Conference urged improvement in reproductive health care to reduce maternal illness and death and the spread of sexually transmitted diseases, especially AIDS, and women-centered programs. Both long- and short-term rural-to-urban and international migration affects the development dynamic. The Conference viewed urbanization as inevitable, but cautioned against neglect of rural development. Improving the status of women through education will help reduce discrimination. The success of family planning efforts in the region is attributable to the changing behavior of women, age at marriage, and the number and spacing of children. 86% of the developing world's elderly will reside in Asia by the year 2000. The Conference recommended economic incentives and tax exemptions to assist families caring for older relatives, but stopped short of pension plans and social security systems. Mortality, however, may be reduced by increasing HIV infection and AIDS prevention. Poverty alleviation figured among agenda items. Robert McNamara noted in a 1991 address that over 1 million people suffer from hunger and over 900 million remain illiterate worldwide. To counter this, education, nutrition, and health services for the poor are needed; also needed are human resources development to raise productivity and income. It was recommended that donors allocate 4% of all development assistance for population programs.
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PMID:Vital to future generations. The Bali Conference has recommended that 4% of all official development assistance be earmarked for population programs. 1228 76

In order to best understand the impact of AIDS on a national level, it may be more important to understand its impact on the magnitude and severity of poverty than on national economic growth. It may also be true that the primary economic impact of AIDS is the concentrated breakdown of vulnerable structures such as the family, community, or even nations. The larger the structure, the more likely it can withstand collapse by distributing the impact, but vulnerability to collapse must be understood to avoid the catastrophe of breakdown. Rwanda may present the first example of the latter. Its AIDS prevalence was among the highest in the world, and the prevalence rate among members of the military was even higher. If studies consider the impact of HIV infection in terms of direct and indirect costs only, more dollars would be saved by preventing one case in the US than in most other countries. If, on the other hand, a hunger index is used (for each case of HIV how many people will go hungry and how many formerly hungry people will become malnourished), the greatest prevention benefit would probably occur in Uganda. In order to understand how economic factors fuel the epidemic and determine its impact, more socioeconomic data must be collected. When making the economic choices that maximize benefits to AIDS victims, the difficulty occurs in defining benefit. Most developing countries cannot provide the resources to prolong life and avert disability. However, there are ways to alleviate the impact of AIDS which all countries can afford: reducing pain, removing the barriers of discrimination, providing support groups, and helping people with the activities of daily life. In order to design the appropriate comprehensive care approaches in different settings, more data must be collected on how HIV-infected individuals perceive the impact of the disease on their lives.
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PMID:Adding the human dimension to economic analysis: why DALYs don't tell the whole story. 1228 11

Child and juvenile prostitution in Brazil has reached such proportions that a parliamentary commission launched an inquiry. The Brazilian Center of Children and Adolescents (CBIA) estimated that there are about 500,000 such prostitutes in the country, a record in Latin America. This type of prostitution flourishes in poor urban areas and in the North and Central-East. Not only girls become prostitutes; in Rio de Janeiro, 4000 boys cater to tourists from the industrialized world. 79% of these youngsters say that they use condoms, but 42% are infected with HIV. In many cases their families tolerate their homosexual encounters because of the extra income received. In the interior of the state of Rio, girls aged 11-15 years are enticed to cities as domestics and end up in prostitution. In Niteroi there is a prostitution network specializing in 13-year-old girls. Although there are 30,000 prostitutes in the state of Rio, the distribution of condoms among them has caused negative reactions among conservatives and Catholics claiming that it would increase licentiousness. The Brazilian Center for the Defense of the Rights of Children and Adolescents countered that condoms help prevent the spread of diseases. In Para, Acre, and Rondonia, 13-, 14-, and 15-year-old girls sell their bodies in order to survive. In the maternity ward of Barbara Heliodora, Rio Branco, Acre, 31% of deliveries are to girls aged 10-16 years. In Sao Paulo and in the neighborhoods of Bras and Belem, girls as young as 10 years of age become prostitutes under the protection of corrupt police who exact sexual favors or a share of receipts. According to CBIA, 80% of sexual violence against children and adolescents occurs in the home, with fathers being the main aggressors. The prostitution of children and adolescents in Brazil is connected to the destruction of the family and is the result of misery and hunger.
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PMID:[Child prostitution: family disintegration, necessary planning, the laziness of the elite]. 1228 21

Women and girls in the Sudan face considerable burdens. Maternal mortality is high (655/100,000 live births). Less than 50% of girls attend primary school. Only 20% attend secondary school. 88% of women cannot read or write. 8.8% of all women 15-19 years old have children. About 80% of the population live in rural areas. Droughts, floods, and plagues trouble the agriculture-based economy. Poverty burdens women at a rate two times that of men. Political unrest and civil war in the south have made widows of many women and orphans of many children. Girls work from a very early age. Women must work with their husbands in the fields or have an alternative source of income. Girls from a low-income family, who are the eldest daughters, or who have younger sisters and brothers must work to feed and clothe the family and to pay school fees. Many women go to Khartoum to find a better life, but few jobs exist, even if the women are well educated. Some women as young as 12 years old sell tea in the street, work as maids for the privileged, or work as sex workers. Some women form groups with an older woman serving as their leader. She promises to protect the women in her group from hunger. Yet, she cannot defend them against HIV or other sexually transmitted diseases. Any woman arrested for soliciting clients may serve 2-3 months in prison. The government has a program for women prisoners informing them about HIV/AIDS and providing them new skills. The IEC (information, education, and communication) coordinator for HIV/AIDS in the Ministry of Health has set up this special program which provides religious advice and handicrafts. The program also shows women prisoners videos on transmission and prevention of HIV/AIDS.
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PMID:Sudanese women carry a double burden. Special report: women and HIV. 1228 50


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