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Query: UMLS:C0019693 (HIV)
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Men from the Multicenter AIDS Cohort Study were classified as "susceptible" and "resistant" to HIV infection. Resistant men were still HIV antibody negative in 1993 and were estimated to have had > 45 different anal intercourse partners (median, 92; range, 46-504) in the 2.5 years before visit 2 (1985). Susceptible men were seroconverters who were estimated to have had < 13 different anal partners (median, 4; range, 0-12). Leukocyte groups were compared between the two groups of men. Values were excluded for 12 months before the first antibody-positive visit in the susceptible men. White blood cells, polymorphonuclear neutrophils, total lymphocyte count, CD8+ percentage and number, and CD3+ and CD4+ number were higher in the resistant men. Logistic regression analyses were used to develop 50 bivariate models. Higher levels of neutrophils and CD8+ cells were included in four of the six best-fitting bivariate models, suggesting that each is associated with resistance to HIV-1 infection. These results support the hypothesis that CD8+ cells may modulate the outcome of HIV-1 exposure.
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PMID:Resistance to HIV-1 infection. Multicenter AIDS Cohort Study. 796 37

Religion, culture, socioeconomics, political factors, and even geography play important roles in the spread of HIV in Thailand. The author discusses these factors, emphasizing the role of Thailand's significant commercial sex trade. Politics, poverty, and geography together form much of the basis of the patterns of HIV's spread throughout Thailand. Although 80% of the Thai population lives in rural areas, the Thai government since the 1950s has invested disproportionately large amounts of resources in the urban sector at the expense of rural areas. Opportunities for economic gain and overall advancement are therefore greater in urban centers. Girls and young women of predominantly poor rural households therefore migrate to Thai cities to work in brothels. As prostitutes, they make, without education, better wages than they could working in factories. After buying what they need to accommodate their urban lifestyles, the women may send money in support of their rural-based families as well as to monasteries and temples. These latter contributions are made in keeping with Theravada Buddhism, the predominant faith, which regards female prostitutes are very low on the cosmological scale in the quest for nirvana both because they are women and they come from poor families. It is hoped that by contributing to the faith, one's karma will be improved, thus allowing return in the next lifetime as a man, preferably wealthy. There are an estimated 80,000-1,000,000 prostitutes in Thailand. Each may have sexual intercourse with up to twenty clients per day. Their clients include international tourists as well as local Thai men. At least 450,000 Thai men visit prostitutes daily, with at least 75% of Thai men having had paid sex at least once. One researcher found that 72% of the low-class prostitutes were HIV-seropositive, while another examination of a few brothels found all prostitutes to be infected. 50% of Thai men reported in a 1990 study that they never use a condom, 26% had multiple sex partners in the preceding six months, and 86% believed that there is only a small chance of contracting AIDS. This high prevalence of HIV infection among prostitutes, frequent sexual intercourse, and lack of condom use in Thailand is ideal for the continued spread of HIV throughout the population. Men from hill tribes who have sex with prostitutes and use IV drugs also help take HIV into the most remote areas of Thailand.
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PMID:A plague in prostitution: HIV and AIDS in Thailand. 801 15

The success of efforts to prevent continued transmission of the human immunodeficiency virus (HIV) and to increase compliance with HIV prophylactic interventions among homosexual and bisexual men will depend in part on health care professionals' understanding of and ability to establish linkages with these men. In order to recruit men into a research project and an educational program, staff at the Pitt Men's Study, an epidemiological investigation of HIV infection, developed a process described here as "brokering," which was based on community organizing and marketing principles. Brokering is a dynamic process by which researchers and public health professionals exchange goods and services with formal and informal leaders of the gay community in order to establish strong, long-term linkages. To date, this process yielded 2,989 homosexual and bisexual recruits into the study, which began in 1983. After 8 years, 79% of those still alive continue to return for follow-up. While recruitment techniques will need to vary from city to city, the importance of establishing linkages with the local indigenous leadership remains of major importance.
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PMID:Brokering: a process for establishing long-term and stable links with gay male communities for research and public health education. 802 44

During October-November 1988 in Kenya, 344 undergraduate male and female students at Kenyatta University completed a questionnaire designed to determine their knowledge, attitude, and practices towards AIDS. This survey also aimed to shed some light on the success of the media campaign launched in February 1988. 98% were familiar with AIDS. Men and women were equally familiar with AIDS. The leading sources of information on AIDS were newspapers (166) and radio (123). Most students knew that weight loss was a symptom of AIDS. Many also knew that coughing was a symptom. Students had vague knowledge of HIV. Students tended to know that AIDS is transmitted through heterosexual intercourse. Men were more likely to have sexual experience than women (72% vs. 28%). The most common way the students would reduce the risk of contracting AIDS was having 1 sex partner (204 students). Few students (44) would use a condom. Creating awareness (174) was the leading way society should fight AIDS. Only 25 students mentioned condom use as a way to prevent AIDS. Most students (60%) thought that persons with AIDS should be quarantined. Most students had an apathetic attitude if they themselves had AIDS. The leading responses to what the students would do if they learned that they had AIDS included wait to die (193) and commit suicide (120). 20% would not help a family member with AIDS and would let him/her die. These findings suggest that, even though almost everyone knew about AIDS, their misperceptions about and attitudes towards persons with AIDS reflect a need for more information on AIDS prevention and on dealing with HIV infected persons. The Ministry of Health needs to put more effort into counseling AIDS patients and to reduce the hopelessness and stigmatizing of persons with AIDS.
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PMID:Kenyan university students' views on AIDS. 803 74

In April and May 1991 in Papua New Guinea, interviews were conducted with 896 randomly selected men and women living in or near Lae, Goroka, and Mt. Hagen and in 12 villages 25 km from Madang to obtain baseline data on AIDS knowledge and condom-related attitudes and behaviors. 93% were familiar with the word AIDS. Only 3% demonstrated a high level of knowledge concerning HIV transmission and prevention. Virtually no one mentioned vertical transmission of HIV from mother to infant as a mode of HIV transmission. Only 14% mentioned blood contact. Knowledge of sexual transmission was relatively high. Only around 18% knew that AIDS prevention requires consistent condom use during sexual intercourse. Urban residents were just as informed as rural people about AIDS prevention. Men with university education were 2 times more likely to use condoms than those with no education. Less than 50% of all respondents believed condoms can prevent HIV transmission. Messages stating that one is protected if there is only 1 sexual partner and avoidance of sexual intercourse with prostitutes did not address the reality of sexual culture in Papua New Guinea. Even though many men said that they would use condoms, explicit and culturally appropriate education needs to be promoted to effect a significant change in condom usage patterns.
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PMID:Knowledge of AIDS in Papua New Guinea. 805 44

Though HIV prevention campaigns in Zimbabwe have increased public awareness of HIV, they have not meaningfully changed sexual behaviour. Possibly these campaigns are based on wrong assumptions about sexual behaviour. By means of 111 structured interviews with hospital patients, secondary school students and teachers, and 11 focus group discussions with traditional healers, midwives, village community workers, secondary school students and teachers, and commercial sex workers in a rural district of Matabeleland in Zimbabwe, this low-budget study explores attitudes towards sex and sexual behaviour in order to define more appropriate health education messages. Results indicate that traditional sex education no longer takes place and that communication between sexual partners is limited. The almost ubiquitous expectation of women to get rewards for sex outside marriage motivates mostly single women out of economic necessity to meet the male demand for sexual partners, which is created by large scale migrant labour and men's professed 'biological' need for multiple partners. Types of sexual behaviour other than penetrative vaginal sex are uncommon and considered deviant. Safe sex messages from the West therefore are inappropriate in the Zimbabwean context. Recommendations are given to restore traditional communication about sexual matters across generations and to urge sexual partners to discuss sex. Women who, for economic reasons, engage in casual sex should at least learn to negotiate the use of condoms. Men seriously need to reconsider their attitudes to sex and sexual practices in view of the high HIV sero-prevalence. Faithfulness, rather than multiple sexual contacts, should become a reason to boast.
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PMID:Attitudes to sex and sexual behaviour in rural Matabeleland, Zimbabwe. 806 Oct 79

Clinical trials have shown that the prophylactic use of zidovudine and aerosolized pentamidine (or other antibiotics used as prophylaxis against Pneumocystis carinii pneumonia) in acquired immunodeficiency syndrome (AIDS)-free human immunodeficiency virus (HIV)-infected persons delays the development of AIDS, but the effectiveness of such therapy in general use in the population still remains largely undocumented. To help answer this question, the authors estimate the effectiveness of this therapy in a population-based cohort of HIV-infected homosexual and bisexual men in San Francisco. The authors use a continuous-time Markov process to model the decline of CD4+ T-lymphocytes (T4-cells) measured in cells/microliter in HIV-infected persons. The model partitions the HIV (type 1) infection period into six progressive T4-cell count intervals (stages), followed by a seventh stage: AIDS diagnosis. The authors use maximum likelihood methods to fit the model to the observed transitions for 428 HIV-infected men during June 1984 to March 1991, from the San Francisco Men's Health Study. Since zidovudine was not widely used before 1988, the model has a component that controls for calendar time-related biases. The fitted model provides statistical estimates and confidence intervals for measuring therapy effectiveness. The authors estimate that prophylactic therapy reduces the progression rate from stage 4 (T4-cell count, 350-499) to stage 5 (T4-cell count, 200-349) by a factor of 0.26 (95% confidence interval (CI) -0.22 to 0.55); from stage 5 to stage 6 (T4-cell count < 200) by a factor of 0.33 (95% CI 0.04-0.54); and from stage 6 to 7 (AIDS) by a factor of 0.62 (95% CI 0.47-0.73). In addition, therapy started by an HIV-infected person in stage 4 is estimated to reduce the risk of developing AIDS by a factor of 0.83 (95% CI 0.46-0.94) at 6 months and 0.68 (95% CI 0.35-0.89) at 24 months after entering stage 4. Therapy started by HIV-infected persons in more advanced stages is estimated to reduce the risk of developing AIDS by factors ranging from 0.70 (95% CI 0.39-0.90), early in stage 5, to 0.28 (95% CI 0.14-0.45), late in stage 6. Thus, the prophylactic use of zidovudine and pentamidine in routine medical care has a strong, consistent, and significant effect in slowing the clinical course of HIV infection in a population-based cohort.
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PMID:Effect of routine use of therapy in slowing the clinical course of human immunodeficiency virus (HIV) infection in a population-based cohort. 810 Jun 82

More than 1 in 40 young adults in South Africa were estimated to be infected with HIV through the end of 1992. The rate of infection has slowed so that the current doubling time is 16 months; 400 people are nonetheless newly infected daily. HIV and AIDS were first noted among gay White Men in the Cape of South Africa. Education and support from within the gay community, however, prompted the rapid and substantial decrease in the incidence of infection. The 1st evidence of infection among Black heterosexuals was then noted in 1987. It is mainly young adults who are infected, with women affected earlier than and at least as often as men. The arrival of HIV to South Africa and its expected pattern of transmission should have been no surprise to country health policymakers and administrators. Sexually transmitted diseases (STD) facilitate the spread of HIV infection and tuberculosis (TB) fosters the development of AIDS once people are infected with HIV. An estimated 3 million cases of STD present annually in South Africa and almost half of the adult population is infected with quiescent TB. The failure to learn from experiences with HIV in some central and eastern Africa countries simply highlights the extent of poor public health in South Africa. South Africa has the infrastructure and health funding needed to check AIDS, but failed to take action. The central health ministry did not respond to the epidemic until 1990 with the establishment of an AIDS unit, secondary school AIDS prevention programs and packages in 8 languages, a neutral national information campaign, workshops to increase awareness, and funding to organizations targeting hard-to-reach groups. The AIDS unit was soon merged into a health promotion section and the unit's head fired, with all the prevention initiatives terminated except the continued availability of pamphlets in only English and Afrikaans. An official complaint has been made to no avail against the health department official who closed the AIDS campaign. Meanwhile, the government contends that it holds no responsibility for educating its population in the prevention of AIDS. These recent actions suggest that the government is committing genocide by allowing excess mortality from AIDS to decimate Black heterosexuals during the impending period of interim rule and political transition. These observations and conclusions are based in part on the author's experience as medical advisor to South Africa's AIDS unit in 1991/92.
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PMID:HIV in South Africa. 810 97

A self-complete questionnaire to assess satisfaction with dental care was administered to two groups of dental patients: men with asymptomatic HIV infection attending a dedicated dental clinic and men, presumed to be HIV negative, attending a general dental practice. Both settings were staffed by the same dentist. Men attending the dedicated clinic expressed satisfaction with the technical competence of their treatment and the affective behaviour of their dentist comparable with satisfaction expressed by participants at the general dental practice. However, men at the dedicated clinic expressed dissatisfaction with the availability of treatment. This may be related to the staffing level at the clinic. Men with asymptomatic HIV infection wanted more dentists who specialized in their needs and thought there was not enough information available on oral health.
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PMID:The satisfaction of men with HIV infection attending a dedicated dental clinic: a controlled study. 818 76

AIDS constitutes a major health problem in Haiti which continues to grow through what seems to be mainly heterosexual relations. Over 1989-90, 8.9% of 1720 pregnant women attending a prenatal clinic in a suburban slum were identified as HIV-seropositive. Among initial blood donors in 1990, 5.8% of 1199 males and 1.9% of 15 female donors were seropositive for HIV. In-depth interviews, focus groups, and a national cross-sectional survey of 1300 men and 1300 women aged 15-49 years were conducted in an effort to assess participants' AIDS-related knowledge, attitudes, beliefs, and practices. 38.1% of the 1118 sexually active male survey respondents engaged in high-risk behavior. Men were considered to be at high risk for infection/transmission if they had ever visited a prostitute or had more than 1 sex partner in the month preceding the interview. Most in Haiti have heard of AIDS, but many misconceptions remain about how HIV is transmitted. Women did, however, tend to better informed than men. Even though the women may be comparatively better informed about HIV transmission, their lack of ability to negotiate condom use still impedes the more widespread use of condoms. The belief that condom lubricant may cause health problems also impedes condom use. Finally, the study found a tendency to ostracize people with AIDS, especially outside of Port-au-Prince, and the belief that individuals acquire AIDS deterministically according to fate. A coordinated national effort is needed to correct these misconceptions and increase the prevalence of condom usage.
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PMID:AIDS-related knowledge, attitudes, beliefs, and practices in Haiti. 822 May 18


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