Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Homeless and runaway youth face a variety of health risks, including those related to substance abuse and use of unsterile needles. During 1998-1999, we recruited 201 Minneapolis homeless youths aged 15-22 years; these youths were interviewed by experienced street outreach workers from settings where street youth were known to congregate. Respondents spent a median of 6 months in the previous year living on the streets or "couch hopping." There were 37% who reported having 15 or more alcoholic drinks per week, 41% smoked 1 pack or more of cigarettes per day, and 37% used marijuana 3 or more times a week; 15% reported lifetime injection drug use, including 6% who used injection drugs within the previous month. Twenty percent had received a tattoo, and 18% body piercing with a needle that had not been sterilized or had been used by someone else. There were 68% who had been tested for human immunodeficiency virus (HIV), 52% for hepatitis B, and 25% for hepatitis C. There were 44% who said they did not have enough information about hepatitis B and C. Less than half (43%) received hepatitis B vaccine; however, 51% of unvaccinated youths indicated that they would receive vaccination if offered. These Midwestern homeless youths face multiple health risks, including those related to substance use and exposure to unsterile needles. Despite unsafe behaviors, many of these youths were interested in methods to protect their health, including education, knowing their HIV or viral hepatitis serostatus, and obtaining hepatitis B immunization.
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PMID:Substance abuse and high-risk needle-related behaviors among homeless youth in Minneapolis: implications for prevention. 1179 15

The purpose of this study was to describe the clinical profile of end-stage acquired immune deficiency syndrome (AIDS) since the advent of highly active antiretroviral therapy (HAART). A cross-sectional examination of human immunodeficiency virus (HIV)-infected patients who attended a public HIV outpatient clinic and died between 1996 and 2001 was conducted (n = 669). All clinical and demographic data were collected from the Centers for Disease Control (CDC) Adult Spectrum of Disease database. The prevalence of first-time acquisition of AIDS-defining conditions 12 months before death were evaluated. The prevalence of renal disease, hepatic disease and substance use were also evaluated. The majority of the patients were 35 years old or older, male, African American and HAART-experienced. The six AIDS-defining conditions with the highest percentages of first-time acquisition in the last 12 months of life were HIV dementia (91.8%), progressive multifocal leukoencephalopathy (PML) (91.7%), wasting (90.9%), Mycobacterium avium complex infection (MAC) (80.0%), lymphoma (78.6%), and cytomegalovirus infection (CMV) (78.1%). Forty-four percent of the patients were diagnosed with at least one of these six conditions 12 months before death. More than one third of the patients had renal or hepatic failure, injecting drug use (IDU) as the HIV risk factor, and history of substance use. AIDS-defining conditions continue to have an impact on mortality, especially the neurologic conditions and wasting. However, other conditions, such as renal and hepatic disease, are becoming important causes of mortality because the HIV-infected population now includes more drug users, and HIV-infected patients are surviving for longer periods. These results should help clinicians better time the discussion of end-stage options and improve the patient's quality of life.
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PMID:The clinical profile of end-stage AIDS in the era of highly active antiretroviral therapy. 1187 39

A pre-posttest, randomized pilot study evaluated the effect of two selective prevention interventions on knowledge, attitudes, intentions, and behaviors to prevent and/or reduce substance use and risky sexual behaviors among 50 predominantly Mexican-American, low-income young women. Women were randomly assigned to either a risk and resilience workshop or a health information correspondence course. Comparison tests using t tests and chi-square analyses were conducted to determine the baseline equivalence and pre- and posttest effects of the interventions. Both interventions had consistently similar effects. Neither significantly decreased use of alcohol or cigarettes. Both interventions significantly improved attitude, sexual self-efficacy, and resilience scores. Contraceptive use increased among women in partnered relationships, and both condom use and contraceptive use increased among sexually active, single young women. Both interventions also had significant positive effects on reported ability to discuss precautions to prevent human immunodeficiency virus/acquired immunodeficiency syndrome with sexual partners. Study limitations and implications for clinical practice and future research are provided.
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PMID:Reducing substance use and risky sexual behavior among young, low-income, Mexican-American women: comparison of two interventions. 1217 65

Priority health-risk behaviors, which contribute to the leading causes of mortality and morbidity among youth and adults, often are established during youth, extend into adulthood, are interrelated, and are preventable. This report covers data during February-December 2001. The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults; these behaviors contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity. The YRBSS includes a national school-based survey conducted by CDC as well as state, territorial, and local school-based surveys conducted by education and health agencies. This report summarizes results from the national survey, 34 state surveys, and 18 local surveys conducted among students in grades 9-12 during February-December 2001. In the United States, approximately three-fourths of all deaths among persons aged 10-24 years result from only four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2001 national Youth Risk Behavior Survey demonstrated that numerous high school students engage in behaviors that increase their likelihood of death from these four causes: 14.1% had rarely or never worn a seat belt during the 30 days preceding the survey; 30.7% had ridden with a driver who had been drinking alcohol; 17.4% had carried a weapon during the 30 days preceding the survey; 47.1% had drunk alcohol during the 30 days preceding the survey; 23.9% had used marijuana during the 30 days preceding the survey; and 8.8% had attempted suicide during the 12 months preceding the survey. Substantial morbidity and social problems among young persons also result from unintended pregnancies and STDs, including HIV infection. In 2001, 45.6% of high school students had ever had sexual intercourse; 42.1% of sexually active students had not used a condom at last sexual intercourse; and 2.3% had ever injected an illegal drug. Two-thirds of all deaths among persons aged > or = 25 years result from only two causes: cardiovascular disease and cancer. The majority of risk behaviors associated with these two causes of death are initiated during adolescence. In 2001, 28.5% of high school students had smoked cigarettes during the 30 days preceding the survey; 78.6% had not eaten > or = 5 servings per day of fruits and vegetables during the 7 days preceding the survey; 10.5% were overweight; and 67.8% did not attend physical education class daily. Health and education officials at national, state, and local levels are using these YRBSS data to analyze and improve policies and programs to reduce priority health-risk behaviors among youth. The YRBSS data also are being used to measure progress toward achieving 16 national health objectives for 2010 and 3 of the 10 leading health indicators.
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PMID:Youth risk behavior surveillance--United States, 2001. 1238 72

Survey interviews were conducted with a random sample of 50 primarily indigent, African American and Puerto Rican men and women at an outpatient human immunodeficiency virus (HIV) clinic in the Bronx, New York. Analyses revealed a generally high rate of adherence according to self-report data (i.e., on average, participants reported taking 85% of their medications over the last 3 days). However, adherence to the correct number of pills, dosing schedules, and special instructions was more problematic. No sociodemographic or substance use indicators were associated with adherence. Compared to men, women reported higher scores on the Crowne-Marlowe Social Desirability Scale, which were positively correlated with self-reported adherence. "Forgot" (50%) and "felt worse" (46%) were the most common reasons for missed doses. Mediation analyses provided partial support for our proposed model of social support and adherence. Specifically, regression analyses controlling for social desirability indicated that need for social support was positively correlated with acknowledged nonadherence and that this relationship was mediated by self-efficacy and depressive symptomatology.
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PMID:Mediators of social support and antiretroviral adherence among an indigent population in New York City. 1239 95

This study evaluates the factors associated with initiation of services in the Boston HAPPENS Program, which is a collaborative network of care consisting of multiservice outreach agencies, community health centers and hospitals, for human immunodeficiency virus (HIV)-positive and hard to reach youth who are 12-24 years old. The program served 2116 youth who were 19.8 +/- 2.9 years old; 64% female; 45% youth of color; 16% gay/lesbian, bisexual, or undecided; and 10% homeless or runaway. At first contact with the program, 56% received outreach services; and 91% received a health intervention. Among those receiving a health intervention, 55% had HIV counseling and testing services, 49% medical care, 24% case management, and 9% mental health services. HIV-positive youth needed more contacts before a first medical visit than those who were HIV-negative or untested (p < 0.001). Different kinds of service sites reached different populations of at-risk youth. Logistic regression modeling showed that for young women, older age, lesbian-bisexual orientation, substance use, high-risk sexual behaviours, and receiving outreach services at first contact were independent predictors of initiation of services at outreach agencies; however, unprotected sex with males, and pregnancy were associated with a greater likelihood of care at hospitals or community health centers. For young men, older age, Asian/other ethnicity, and substance abuse were associated with care at outreach agencies; however, positive HIV status and unprotected sex with females were associated with care at hospitals or community health centers. Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect underserved youth to health care.
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PMID:Initiation of services in the Boston HAPPENS Program: human immunodeficiency virus-positive, homeless, and at-risk youth can access services. 1244 35

This study was undertaken to determine the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among homeless persons with co-occurring severe mental illness (SMI) and substance use disorders and to determine associated risk factors. As part of a longitudinal study of the effectiveness of integrated treatment for homeless persons with SMI and substance abuse or dependence, serological testing was performed to ascertain the prevalence of HIV, HBV, and HCV. At baseline, 6.2% of participants (11/172) were HIV-positive. Nearly one third of participants (37/114) had evidence of prior exposure to HBV, and 30% (34/114) were antibody positive for HCV. About 44% of participants (50/114) had a reactive test for either HBV or HCV. Having a reactive test was strongly associated with substance use, especially with a history of injection drug use. A significant threat exists to the health and well-being of homeless person with SMI due to high prevalence of blood-borne pathogens. Mental health providers need to play a proactive role in the identification of health-related needs and to assist with access to general health services for persons with SMI.
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PMID:Prevalence of human immunodeficiency virus, hepatitis B, and hepatitis C among homeless persons with co-occurring severe mental illness and substance use disorders. 1292 7

People living with a mental illness are disproportionately vulnerable to human immunodeficiency virus. The current study sought to examine the influence of psychiatric disorder, substance use disorder, and gender on risky sexual behavior in this vulnerable population. Participants were 228 female and 202 male outpatients (66% mood disorder, 34% schizophrenia), each of whom took part in a Structured Clinical Interview for the DSM-IV and a comprehensive assessment of sexual risk behavior. Univariate and multivariate analyses tested a priori hypotheses. The results indicated that risk behavior was more frequent among patients diagnosed with a mood disorder (compared with those diagnosed with schizophrenia) or a substance use disorder (compared with those without a comorbid disorder) or both. We recommend routine human immunodeficiency virus risk screening and risk reduction programs for this vulnerable population.
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PMID:HIV risk behavior among psychiatric outpatients: association with psychiatric disorder, substance use disorder, and gender. 1506 Apr 3

Prior reports associating substance use with sexual risk behavior have generally used summary measures and have not adjusted for participants' background levels of substance use. In this 1999-2001 US study (the EXPLORE study), the authors determined whether substance use during sex was independently associated with sexual risk during recent sexual episodes, as reported by 4,295 human immunodeficiency virus-negative men who have sex with men. The main outcome measure was serodiscordant unprotected anal sex (SDUA). The influence of participant-level characteristics was examined by using repeated-measures logistic models. In assessing the influence of episode-level predictors on SDUA, the influence of participant-level characteristics, including 6-month substance use, was removed by using conditional logistic regression, in effect making each participant his own control. The authors also adjusted for partner characteristics. Eleven percent of participants reported heavy alcohol use, 37% used poppers, 19% sniffed cocaine, and 13% used amphetamines. In the participant-level analysis, use of poppers, amphetamines, and sniffed cocaine as well as heavy alcohol use in the prior 6 months were independently associated with SDUA. In the conditional analysis, consumption of > or = 6 alcoholic drinks or use of poppers, amphetamines, or sniffed cocaine just before or during sex was independently associated with SDUA. The authors concluded that programs aimed at preventing human immunodeficiency virus transmission should emphasize the influence of substance use during sex on increased risk behavior.
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PMID:Substance use and sexual risk: a participant- and episode-level analysis among a cohort of men who have sex with men. 1512 13

Palliative care for patients infected with human immunodeficiency virus (HIV) includes components of pain and symptom management, advance care planning, prioritization of life goals, and the support of individuals and families throughout the entire continuum of the disease. There are numerous social stressors such as stigma, infected family members and caregivers, loss of housing and independent living, and the increasing influence of substance use in all communities. Because many barriers prevent those with advanced disease from getting comprehensive pain and symptom management as well as option planning, it is important for all HIV care providers to improve their knowledge, sensitivity, and competence regarding this aspect of care. This article provides an overview of critical issues in palliative care and information on how best to improve HIV primary care.
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PMID:Integration of palliative care into primary care for human immunodeficiency virus-infected patients. 1525 40


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