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

This article discusses the integration of sexually transmitted disease (STD) care within family planning (FP) programs and the cost effectiveness of integrated services in development countries. Examples are taken from experiences in Colombia, India, the US, and Kenya. The 1994 International Conference on Population and Development urged the integration of reproductive health care within FP. The more than 330 million annual new STD cases increase HIV transmission and cause pain and infertility. Women are biologically more susceptible to STDs, are more likely to be asymptomatic, and face harsher consequences, including death. Women with STDs should avoid the IUD and use barrier methods. Maintaining laboratories, training staff, and supplying drugs can overburden strained health budgets, but may lower long-term medical costs, increase productivity in employment, and decrease pain and suffering. STDs are viewed by some US health professionals as a "best buy" for being one of the least expensive of the reproductive health options. A Kenyan study found that treating STDs and providing oral contraceptives saved money by collapsing treatment into one instead of two visits. The savings were in overhead and staff costs. Evaluations of cost effectiveness should consider local STD prevalence, cultural setting, client needs, and available resources. In some cases, referral of cases to STD clinics may be the most cost-effective. A US study found that chlamydia screening for all FP clients was more cost-effective than screening selectively. Another US study found that universal screening for chlamydia would provide long-term medical savings even if prevalence was only 2%. Developing countries have the lower-cost option of offering syndromic management of STDs for symptomatic women rather than lab tests. A program in India cut costs by educating and encouraging barrier methods.
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PMID:Integrating services involves cost issues. 1229 37

There are an estimated 87,000 deaf people in Kenya; yet campaigns against HIV/AIDS have failed to address the communication needs of this special segment of the population. This paper examines the communication environment of deaf Kenyans. Though a minor group, the deaf community exists as a distinct cultural entity in the country. The Kenyan deaf culture has evolved from within the deaf communities, mainly in the 38 academic institutions and associations of the deaf. The isolation of these communities helped them to cultivate a unique way of life complete with a language--the Kenya Sign Language (KSL). Greatly bypassed by the information on AIDS, there is danger that the deaf Kenyan community will be wiped out by the epidemic because of the many obstacles. Among these obstacles are the use of the English language in literatures on HIV/AIDS, the lack of KSL interpretation on the television and on many AIDS related programs as well as in local public meetings. In addition, deaf people cannot benefit from the services that are offered by some organizations such as telephone hotline for counseling purposes, as well as for medical counseling services unless there is an interpreter. However, the presence of an interpreter beats the main purpose of these services, which is to offer anonymity and confidentiality. Providing relevant HIV/AIDS information to this forgotten segment of the population is a challenge to the health care community. In this regard, a number of recommendations are discussed.
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PMID:Addressing special populations. Forgotten: a view of the social and political obstacles to the prevention and treatment of AIDS in Kenyan deaf people. 1229 92

In Kenya, Professor Arthur Obel claimed that he has discovered a wonder drug, Pearl Omega, which can reverse HIV-positive status in some patients. In response to criticism, Obel modified his claim to assert that his drug alleviates the suffering of AIDS patients and prolongs their lives. Obel refused to provide proof that 7 of 32 HIV-positive patients who received Pearl Omega had become seronegative. While the Kenyan government supports local initiatives in the world-wide search for a cure for AIDS, it insists that all drugs being used to treat the disease undergo rigorous testing. With 5% of the Kenyan population believed to be HIV positive, medical authorities expect that the Pearl Omega debate is far from over.
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PMID:New cure or same old story? International (Africa). 1231 84

According to UNAIDS, fewer than 5% of AIDS cases in Kenya are the result of sexual transmission of HIV between men. However, studies by AMREF of STDs among truck drivers show evidence of homosexual activity, especially between older men and boys aged 12-16 years. The studies are supported by anecdotal evidence which suggests that sex between men in Kenya is more common than generally believed. Statistics are hard to come by as homosexuality is a criminal offense. As society disapproves, homosexuals often manage to keep their sexuality a secret but unprotected sex with their wives and male partners increases the risk of HIV transmission. On the Kenyan coast, homosexuality is more accepted and there are "marriages" between men. Maina Kahindo of the Ministry of Health does not see this as a area needing urgent attention: "Taking into account other modes of transmission of HIV/AIDS, homosexuality is negligible and should not take up our resources and time." Also in Kenya, the Nakuru District Commissioner has been speaking at the opening of a 2-day workshop for youth. He announced that nearly 28% of the district's youth were infected with HIV.
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PMID:HIV and Kenya's homosexuals. 1232 17

By 2000, women will likely comprise 50% of HIV-infected persons worldwide. Women, regardless of number of sexual partners, are especially vulnerable to HIV. One act of intercourse puts women at an 18 times greater risk than men of acquiring HIV. Traditional gender roles denying women the power to protect their own health exacerbate their biological susceptibility to HIV infection. AIDSCAP's Women's Initiative (AWI) aims to secure culturally and gender-sensitive AIDSCAP interventions and strategies and to advance AIDSCAP's leadership role in developing HIV/AIDS prevention models for women. More than 50% of AIDSCAP current projects target women. AWI integrates a broader gender perspective into AIDSCAP's project design, technical assistance, evaluation and monitoring, and policy projects. It has expanded target women's groups beyond the groups traditionally considered at high risk. To date, various AIDSCAP projects have trained and educated about one million women. The Christian Reformed World Relief Committee (CRWRC) is involved in HIV/AIDS prevention activities. Its AIDS and Sexually Transmitted Disease (STD) Health Promotion Prevention Program with Market Women in Senegal targets self-employed market women and urban female youth in Dakar, Kaoloack, and Thies. CRWRC worked with two women's groups to develop a sexual health promotion package with HIV/AIDS and STD IEC (information, education, and communication) materials and has trained 20 facilitators to use the promotion package. It helps the two collaborating groups to develop their organization capacities so they can implement and evaluate sustainable HIV/STD prevention programs. AIDSCAP also supports training of Kenyan family planning provider activities in HIV prevention of the JSI Family Planning Sector Project. It collaborates with the Center of Women Workers in Haiti to provide women factory workers IEC and condoms to promote risk reduction behavior. AWI also conducts research and policy activities (e.g., perceptions of the female condom in 3 countries).
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PMID:AIDSCAP initiative expands prevention efforts for women. 1234 6

AIDSCAP is undertaking a project designed to encourage Kenya's private sector to participate in HIV/AIDS prevention efforts. Part of that project involves estimating the impact of HIV/AIDS on Kenya's commercial sector. AIDSCAP and Kenyan researcher estimates are based upon financial data from a sugar estate, a transportation company, a wood processing plant, a textile factory, and a light manufacturing company, a small sample representing the diversity of industries in the country. Most are medium-sized companies with 1200-2200 employees. Preliminary results suggest that absenteeism, training costs, and HIV-related health care will cause the greatest losses to Kenyan businesses. Projections show that the HIV/AIDS epidemic could increase labor costs for some Kenyan businesses by 17% by the year 2005. Despite increasing labor costs, however, the epidemic may not cause a significant drop in profits for larger, capital-intensive Kenyan businesses. Some companies could still find their profits cut by 15-25% within the next 10 years. Study findings and implications for workplace prevention programs are discussed.
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PMID:The impact of HIV / AIDS on Kenya's commercial sector. 1234 76

This paper focuses on the impact of HIV/AIDS on child survival and development in Kenya. The rapid spread of HIV, mainly through heterosexual contact and mother-to child transmission, contributes to the increasing rates of infant and under-five mortality in Kenyan provinces. Moreover, the impact of AIDS on the well-being of children is likely to worsen, as preliminary findings of the 1999 sentinel surveillance data indicate that HIV prevalence among the adult population is still rising. Poverty increases the vulnerability of children to HIV/AIDS. In addition, it may increase the likelihood that women become commercial sex workers as an alternative source of income. Poverty also increases the risk of illness and death through poor access to basic services. Poor environmental sanitation and lack of access to safe water sources increase the vulnerability of children to the impact of the infection. As a consequence, more and more children will be infected and affected by HIV/AIDS, and the ability of HIV-positive parents to care for their children will be impaired, while the number of orphans will continue to increase dramatically as parents die within a short period. Recommended strategies in combating the epidemic and improving the well-being of children are outlined.
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PMID:The impact of HIV / AIDS on child survival and development in Kenya. 1234 35

In sub-Saharan Africa, respiratory tract infections (RTI) are the leading cause of serious morbidity and mortality in HIV-infected persons. This study sought to investigate demographic, socioeconomic, and environmental risk factors for pneumonia in a cohort of HIV-infected women. The authors performed a nested case-control study in a cohort of HIV-1-infected adults followed in Nairobi, Kenya. Thirty-nine women who developed pneumonia during the follow-up period were selected as cases, and 66 women who did not develop pneumonia were randomly chosen to serve as control subjects. A questionnaire was administered in subjects' homes that assessed demographics, home environment, and socioeconomic status. Women were followed in the cohort for a median of 36.8 months (range, 27.3-39.3). Adjusting for length of follow-up period, factors associated with lower socioeconomic status (lower monthly spending [OR = 3.2; 95% CI, 1.2-8.4 per 10,000 Kenyan shilling decrease], having no savings [OR = 4.1; 95% CI, 1.4-11.9], less sturdy home construction material such as mud or cement walls [OR = 2.6; 95% CI, 1.1-5.9] or dirt floors [OR = 2.8; 95% CI, 1.0-7.6], and lack of a window in the home [OR = 5.5; 95% CI, 0.9-32.2]) and being widowed (OR = 4.3; 95% CI, 1.2-15.1) or single (OR = 3.3; 95% CI, 1.0-11.2) were associated with an increased risk of pneumonia. In multivariate analysis, widowed (AOR = 5.9; 95% CI, 1.3-26.3), single (AOR = 7.7; 95% CI, 1.6-36.4), and divorced (AOR = 4.5; 95% CI, 1.0-20.1) women, those without savings (AOR = 3.7; 95% CI, 1.2-11.7), and those living in more crowded and contagious conditions (AOR = 1.5; 95% CI, 1.1-2.1) remained at increased risk of pneumonia. If confirmed by prospective investigation, these findings could help identify persons and subpopulations of HIV-infected women with the greatest risk of pneumonia.
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PMID:Risk factors for pneumonia in urban-dwelling HIV-infected women: a case-control study in Nairobi, Kenya. 1257 34

The heterosexual character of HIV/AIDS transmission in sub-Saharan Africa, a context where men are dominant in sexual and reproductive matters, underscores the importance of assessing male behavior in sexual and related health arenas. Despite condom use being the recommended and expected behavioral response to knowledge about the fatal outcome of HIV/AIDS infection, use continues to be extremely low in sub-Saharan Africa. This article explores the relationship between various facets of knowledge about HIV/AIDS and condom use among married Kenyan men. The main finding is one of a significant interaction effect of the recognition that it is impossible to visually identify infected parties and one's perception of self-risk. Although neither is in itself significant, simultaneously recognizing that healthy-looking persons may be infected and perceiving that one is himself not at risk significantly reduces condom use among men. This finding--of an interaction effect--plausibly explains why a perception of self-risk, on its own, does not necessarily translate into safe behavior. After all, those who believe they can identify infected persons may think they are at low risk because they avoid contact with the infected and, in selecting partners they deem free of infection, they may be less inclined to use condoms. This finding has implications for how specific aspects of AIDS-related knowledge are imparted to communities and individuals as well as for our understanding of other health-related behaviors.
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PMID:AIDS-related knowledge and behavior among married Kenyan men: a behavioral paradox? 1263 87

The emergence of azole-resistant Candida spp. is a significant problem after long-term treatment of recurrent oropharyngeal candidiasis in HIV-infected patients. Several mechanisms can cause this resistance. An important mechanism of azole resistance is reduced intracellular accumulation of the drug. Among the multidrug efflux transporters, ABC transporters and the major facilitator superfamily are reported to cause the resistance. Erg11p, sterol C14 alfa-demethylase, is a target of azole derivatives. It was reported that ERG11 over-expression had only a modest effect on the development of azole resistance. However, mutations in the ERG11 gene can cause the resistance, probably by reducing binding of azole to the target enzyme. We sequenced the ERG11 gene in a high-level azole resistant C. albicans strain, Darlington, and found that two amino acid substitutions, Y132H and I471T, had been encoded in the Darlington ERG11 gene. To assess the significance of these substitutions, we replaced one of the two copies of ERG11 gene in anazole-susceptible strain of C. albicans with a copy of the Darlington ERG11 and this resulted in a modest increase in azole resistance. Furthermore, to estimate the effect of Y132H and I471T individually, ERG11 genes with either or both mutations were expressed in S. cerevisiae. The I471T substitution, not previously described, conferred azole resistance when overexpressed alone and increased this resistance when added to the Y132H substitution. Alterations in the sterol biosynthetic pathway are another resistance mechanism. Inhibition of 14 alfa-demethylase by azole results not only in ergosterol depletion but also in accumulation of methylated sterol 14 alfa-methylergosta-8, 22(28)-dien-3 beta, 6 alfa-diol. We deleted the ERG3 gene, which encodes a sterol 5, 6-desaturase, in C. albicans, and the deletion resulted in reduced susceptibility of the mutant to azoles.Sterol analysis revealed that erg3 mutant lost both ergosterol and diol when cultured with fluconazole.
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PMID:[Azole resistance in Candida spp]. 1274 89


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