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

There has been considerable debate as to the risk of suicide, accidents, and homicide in populations at high risk for HIV infection. The purpose of the present investigation was to determine the incidence of sudden and unexpected deaths in a well-defined cohort of homosexual and bisexual men prospectively studied since 1984. All subjects were enrolled in the Pitt Men's Study, the Pittsburgh, Pennsylvania, component of the Multicenter AIDS Cohort Study. Of this group, 861 were between the ages of 20 and 44, and 35% were seropositive for HIV. There were 70 deaths attributed to AIDS. Five additional deaths were classified as sudden and unexpected, an annual rate of 0.08% (80/100,000). Only one of these was classified by the coroner's office as a suicide; three were due to accidents, and one was a drug overdose of undetermined cause. Only two of the five unexpected deaths were HIV seropositive, and none had the diagnosis of AIDS. The sudden and unexpected death rate in this cohort did not significantly differ from the 0.07% (70/100,000) yearly incidence in the age- and race-matched male population. Thus, in this well-defined male gay cohort, there does not appear to be an increased risk of violent and drug-related deaths in persons at risk for, or with a diagnosis of, AIDS.
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PMID:Sudden unexpected death in a male homosexual cohort. 782 57

Seroprevalence for HIV-1 was anonymously evaluated between November 1989 and July 1991 among severely mentally ill patients at two public psychiatric hospitals in New York City. The study population consisted of new admissions and long-stay patients aged 18-59. Of 1116 eligible patients, usable samples were obtained from routine blood drawings on 971 (87%). Seroprevalence was comparable among men (5.2%) and women (5.3%). Age did not predict seropositivity. Men with a recorded history of homosexual behaviour or injection drug use were, respectively, 1.8 and 2.0 times more likely to be seropositive than men without these histories. Women with a recorded history of injection drug use were 4.0 times more likely to be seropositive than women without such a history. Ethnicity was not predictive for men, but Black women were 2.4 times more likely to be HIV-1 positive than non-Black women. Severely mentally ill inpatients had a substantial rate of HIV-1 seropositivity, indicating a need for additional testing, education and counselling efforts for this population.
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PMID:HIV-1 infection at two public psychiatric hospitals in New York City. 783 62

Men with genital ulcer disease (GUD) attending a clinic in Malawi were evaluated and treated with one of five drug regimens. Haemophilus ducreyi was isolated from 204 (26.2%) of 778 patients. Of 677 men, 198 (29.2%) had treponemes detected in ulcer material by direct immunofluorescence or had rapid plasma reagin reactivity of > or = 1:8. Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 58.9% overall and 75.8% among patients reporting a history of GUD (P < .001). By logistic regression analysis, HIV-1 seropositivity was shown to impair ulcer healing (P = .003). Treatment failure rates for culture-proven chancroid were 19% for trimethoprim-sulfamethoxazole, 12.9% and 7.4%, respectively, for low- and high-dose erythromycin regimens, and 8.3% and 0, respectively, for low- and high-dose ciprofloxacin regimens. Herpes antigen was detected by EIA in 6 (23.1%) of 26 nonhealing ulcers. In Malawi, GUD should be managed as a syndrome to assure treatment of both syphilis and chancroid.
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PMID:Sexually transmitted diseases and human immunodeficiency virus control in Malawi: a field study of genital ulcer disease. 784 88

HIV infection is firmly established in the general population of Thailand and will soon exact substantial medical, social, and economic effects at the community and household levels. The primary risk behavior for infection in Thailand is heterosexual intercourse compounded by high levels of other sexually transmitted diseases (STD) and the general cultural acceptance of commercial sex. The June 1993 round of sentinel surveillance for HIV seroprevalence found median and provincial ranges as follows: 35.2% in the range of 13.3-70.8% among IV drug users, 28.7% in the range of 5.1-64.1% among direct sex workers, 7.6% in the range of 0.0-37.3% among indirect sex workers, 8.0% in the range of 0.0-33.0% among men attending STD clinics, 1.4% in the range of 0.0-7.6% among women attending antenatal clinics, and 0.74% in the range of 0.0-8.4% among blood donors. HIV seroprevalence was 4.0% among military conscripts in May 1993. Men and women in Thailand with no other risk factor than sex with a spouse are often at risk of infection with HIV. Urban/rural differentials are minimal, with HIV infection strewn across the country. HIV seroprevalence levels continue to climb despite some success with interventions in slowing the rate of infection among military conscripts and reducing the incidence and prevalence of STDs. Interventions, health care, and coping responses therefore need to be delivered at the community level throughout the country. Although much emphasis has been given to the prevalence of HIV infection in Northern Thailand, seroprevalence data show that other parts of the country will soon experience the same explosion of AIDS cases observed in the North over the past two years.
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PMID:The recent epidemiology of HIV and AIDS in Thailand. 785 57

Enrolling and tracking cohorts for HIV vaccine efficacy trials requires that participants disclose behaviors that place them at risk for exposure to HIV. Brief screening procedures have been suggested for this purpose. In a previous study gay and bisexual men in three U.S. cities reported unprotected anal intercourse on a brief screening instrument. Screen reports were compared to subsequent in-depth, face-to-face interview data; 29% of the men who reported unprotected anal intercourse during the interview failed to disclose this behavior during screening. For recruitment into an HIV vaccine feasibility study at the same study sites, screening procedures were modified to encourage accurate reporting: to lessen stigma, low risk as well as high risk sexual behaviors were assessed, and screens were administered by trained study staff who presented it as a tool for understanding the gay community. Failures to disclose risk decreased to 18%, a rate that, while lower than in the previous study, remains high. Men less likely to disclose unprotected sex during the screen engaged in fewer high risk sexual behaviors, had more stringent norms regarding sexual safety, and were less identified with the gay community than were men who disclosed unprotected sex. Failure to disclose risk may have significant implications for participant selection and behavior tracking during vaccine trials. More systematic assessments that are sensitive to target communities may facilitate disclosure.
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PMID:Preparations for AIDS vaccine trials. Developing brief valid screening instruments for HIV-related sexual risk behavior among gay and bisexual men. 786 20

Tanzania is one of the countries in East Africa most severely affected by the HIV/AIDS epidemic. Population-based HIV surveys have been given high priority by the research community in Tanzania because of their ability to provide information on the progression of the epidemic. One major methodological problem with such surveys, however, is the potential for low participation rates which may, in turn, challenge the validity of the data. The authors compared the demographic and AIDS-related characteristics of people who consented to HIV testing as part of a population survey with those who did not consent to such testing. One ward of Arusha was approached in 1991 through the local government and party leaders in which 360 men and 378 women aged 15-54 years were initially registered as eligible to participate in the study. 138 of the individuals had moved, were traveling outside of town for the duration of the study, or had died, and were therefore ineligible to participate in the study. 372 of the remaining 600 individuals consented to participate in a structured interview; 77.8% of the women and 43.9% of men. Only eight people actually refused to be interviewed. 148 others who were not interviewed had work obligations which had them away from home, while information is lacking on reasons for the nonparticipation of 72 subjects. Men who consented to be interviewed were of mean age 29.1 years compared to non-consenters who were of mean age 31.9 years. 227 of the subjects interviewed gave their consent to be tested for HIV-1. Odds ratio analysis techniques were used to compare consenters and non-consenters. In addition to the sex and age differences between the two groups, subjects with secondary or higher education were more likely to refuse HIV testing than subjects with less formal education. No other demographic or AIDS-related differences were observed between HIV test consenters and non-consenters. Non-consenters did not appear to be at any higher risk for HIV infection than consenters. These study results indicate the existence of a potential conflict between achieving a high participation rate and obtaining informed noncoerced consent for participation in population-based HIV surveys. This problem may be increasing as populations become more aware of the HIV/AIDS epidemic and its consequences.
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PMID:Demographic and AIDS-related characteristics of consenters to a population-based HIV-survey: results from a pilot study in Arusha, Tanzania. 786 36

Positive purpose in life (PIL) has been shown to influence health maintenance, facilitate recovery from illness, and enhance psychological well-being. Among persons diagnosed with human immunodeficiency virus (HIV) disease, PIL has received minimal attention. This study used a convenience sample of 67 men who had a diagnosis of acquired immunodeficiency syndrome (AIDS) or who participated in high-risk sexual behavior associated with HIV disease to measure PIL. Integrating qualitative data into the final analysis contributed to a greater understanding of PIL among persons with HIV disease and those at high risk for the disease. Results of the study demonstrated a significantly lower PIL score for men with AIDS. PIL scores were negatively correlated with religious beliefs for the group, and these scores were not influenced by the interval since the AIDS diagnosis. Men with HIV disease are often isolated and withdrawn from society and appear to lack clear meaning for existence.
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PMID:Purpose in life among gay men with HIV disease. 787 Feb 7

To provide an estimate of the seroprevalence of human immunodeficiency virus (HIV) in a representative sample of the U.S. household population, serum samples from participants in the third National Health and Nutrition Examination Survey (NHANES III) were tested for HIV antibody. The testing was performed anonymously on 5,430 individuals 18-59 years old from phase 1 of NHANES III conducted from 1988 to 1991. Twenty-nine individuals were HIV positive. The total weighted prevalence was 0.39%. The population estimate of infected individuals was 547,000, with a 95% confidence interval of 299,000-1,020,000 infected persons. Black participants were four times more likely to be HIV positive than white/other individuals and three times more likely than Mexican Americans. Men were three times more likely to be infected than women. Higher nonresponse to the survey and to phlebotomy was observed in young white men; therefore these data provide a conservative estimate of HIV infection in the general household population. This estimate does not include individuals who do not live in households and who may be at higher risk of infection, such as persons in penal institutions, the homeless, or certain hospitalized patients.
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PMID:The seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1991. 793 86

We studied the association between socioeconomic status and survival in a prospective study of 364 HIV-infected homosexual men who were recruited during 1982-84. The participants were divided by annual income; those earning above Canadian $10,000 (high-income; n = 274) and those below $10,000 (low-income; n = 90) at recruitment. The latter threshold closely approximated to the poverty level for this population. Low income men were significantly younger than high income men but the groups were similar with respect to baseline CD4 counts, subsequent use of anti-retrovirals and prophylaxis against Pneumocystis carinii pneumonia (PCP), and number of visits attended during follow-up. Subjects were followed for a median of 9.5 years (range 1.8-13.1). By Dec 31, 1993, there were 135 deaths yielding a cumulative mortality rate of mean 45% (SD 4.0) at 11.5 years. Men aged 30 or more at infection had poorer survival than those under 30 (mortality risk ratio 1.56; 95% CI 1.09-2.24; p = 0.015), and longer survival was significantly associated with a higher CD4 count at the earliest seropositive visit. The age-adjusted mortality risk ratio for low income men compared with high income men was significantly increased at 1.63 (95% CI 1.11-2.40; p = 0.013). The significant risk of death for low income men persisted despite adjustment for age at infection, CD4 count, use of zidovudine, dideoxyinosine, and dideoxycytidine, use of PCP prophylaxis, and year of infection. We cannot attribute our findings to income loss as a result of more rapid HIV progression because the same effect was present in people who provided income data before seroconversion. Similarly, our findings are not due to differential access to care because the study was done within the context of a universal health care system, and the two income groups received treatments equally. This finding is consistent with the association of lower socioeconomic status with increased morbidity and mortality observed within large populations and in other diseases.
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PMID:Lower socioeconomic status and shorter survival following HIV infection. 793 88

Studies in both the UK and the USA continue to show that gay and bisexual men put themselves at risk of exposure to HIV through unprotected intercourse, most often with regular partners. As part of a larger study of homosexually active men, 310 men who had had unprotected anal intercourse with a man in the previous year were asked to describe the last occasion on which this had happened. The majority of men had had unprotected intercourse with a regular partner and did not perceived it as risky, although most did not know the HIV status of their partner. Regular and non-regular partners were perceived differently. Men were more likely to be emotionally involved in regular partners and to perceive unprotected penetrative sex with a regular partner as not risky. Future health education initiatives must take into account men's emotional involvement in regular partners and their perception of unprotected intercourse with such partners as not risky.
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PMID:Regular partners and risky behaviour: why do gay men have unprotected intercourse? 794 89


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