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Behaviors that increase the risk of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) among adolescents living in rural areas have been reported to be as frequent as those of lower socioeconomic minority youth living in large urban areas. Little is known, however, about whether rural adolescents possess adequate knowledge upon which to make responsible decisions to avoid exposure to HIV. In order to address this deficit, we administered the Centers for Disease Control (CDC) 1989 Secondary School Health Risk Survey to 294 sixth, seventh, and eighth grade students (30.2% sample) from a rural county with significant social problems including epidemic sexually transmitted diseases STDs, sex-for-drugs, poverty, and drug abuse. The sample was 65% African-American, 50% female, with a mean age of 12.9 +/- 1.3 years. Although 68% reported having received school-based AIDS education, a lower proportion (greater than or equal to 10%) the students were found to correctly answer 8 of 17 AIDS/HIV knowledge questions than those from a national comparison group. The mean was 12.8 +/- 3.1 of 17 items answered correct. Lower AIDS/HIV knowledge was associated with lower school grade (rho = 0.46, p less than or equal to 0.0001); being African-American, Hispanic, or Native American (p less than or equal to 0.043); and never receiving school-based AIDS/HIV education (p less than or equal to 0.0001). Based on multivariate analysis of variance (ANOVA), only school-based AIDS/HIV education was a significant predictor (p less than or equal to 0.0001) of knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:AIDS/HIV knowledge level and perceived chance of having HIV among rural adolescents. 139 Aug 17

Epidemiologic data on morbidity and mortality have shown that the acquired immunodeficiency syndrome/human immunodeficiency virus (AIDS/HIV) epidemic is relatively widespread in the developing countries of the world, especially in the already economically deprived regions of Sub-Saharan Africa. Africa is estimated to have approximately 5 million seropositive individuals, and by the year 2000, this number is expected to include 10 million HIV-infected children. Improved control over this epidemic can only come through a greater understanding of the specifics of the disease and, eventually, the introduction of more effective and innovative health promotion campaigns targeted at medical personnel, traditional healers, families, and persons with AIDS. Comprehensive health promotion campaigns, carefully using mass media strategies in addition to more community-based programs, all operating under "decentralized" AIDS control programs, are reasoned to be the most efficacious approach that African and other developing countries can use to successfully contain the AIDS/HIV epidemic. Given the reality of the following factors: Pattern II (ie, transmission of AIDS via heterosexual sexual activity) is the main mode of HIV transmission in Africa, the traditional dominant roles males have in sexual relations, and the positive relationship between sexually transmitted diseases and AIDS, health promotion campaigns must focus specifically on addressing at-risk culturally related sexual values and behaviors in African communities. Failure to address these and other related factors will certainly lead to an escalation of the AIDS/HIV epidemic in Africa and, therefore, concomitant devastation in the human and societal realms of the region.
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PMID:AIDS/HIV crisis in developing countries: the need for greater understanding and innovative health promotion approaches. 140 73

In the decade since acquired immune deficiency syndrome (AIDS) was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with human immunodeficiency virus (HIV) conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and injection drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "second wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection.
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PMID:Psychological interventions with AIDS and HIV: prevention and treatment. 150 5

In a single decade, the pandemic of human immunodeficiency virus (HIV) infection has become an international health, social, and economic emergency. Early and effective intervention is urgently needed for both prevention of HIV infection and for the amelioration of clinical disease. Results of therapeutic trials have suggested expanding the population for which chemotherapy is indicated. In this paper, we first review the findings from selected recent drug trials, using zidovudine and pentamidine as examples. We then discuss six issues that we believe to be crucial for future epidemiologic research in the service of vaccine and drug development: 1. To identify which complications of HIV infection most urgently require development of new therapies, we must characterize the frequency and severity of specific medical events (outcomes) in persons taking a variety of treatments. 2. Currently, acquired immunodeficiency syndrome (AIDS) therapeutic trials gauge the effectiveness of new therapies by their impact on such clinical parameters as the time to development of AIDS or death. These approaches take too long to provide information. We urgently need to identify surrogate markers of clinical outcome that will be useful in the early assessment of treatment efficacy. 3. Progress in vaccine development is being retarded because we do not have enough data from natural history studies on host immunologic responses to suggest that a given response is protective. We therefore need to identify natural correlates of immunity, which can help set priorities in vaccine development. 4. Discovery that a therapy works in the setting of a clinical trial is only a first step in intervention. We must also assess the impact of new therapies on the health of the public, evaluating access to health care, compliance, and other barriers to treatment. 5. Clinical trials are usually associated with the effort to prevent disease in infected persons. However, other trials are needed to assess efforts to interrupt viral transmission through use of condoms, use of virucides, and treatment of sexually transmitted diseases, and by effecting specific behavioral changes. 6. Traditional methods of conducting clinical therapeutic research may not be adequate to address urgent questions in the AIDS/HIV epidemic. We must develop innovative clinical research methods, including better use of data from observational studies, to infer what we can about the effect of treatment on the clinical course.
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PMID:How can epidemiology assist in guiding interventions for the acquired immunodeficiency syndrome/human immunodeficiency virus? 166 95

Nine patients known to have acquired immunodeficiency syndrome (AIDS) and/or human immunodeficiency virus (HIV) infection and operated on for acute appendicitis are presented. Six of the nine patients did not have an elevation in the white blood cell count preoperatively. Two patients underwent diagnostic laparoscopy prior to exploration. In four cases, a perforated appendix was removed. Seven patients had persistent postoperative fever, while all nine had a significant lack of leukocytosis after surgery. Other than the absence of a preoperative increase in white blood cell count, the presenting characteristics of this group were similar to those expected in immunocompetent patients. However, concern for a possible opportunistic infection etiology and a desire to avoid operating on these patients resulted in an undue delay prior to exploration. The use of diagnostic laparoscopy aided in earlier and more accurate diagnosis. Despite persistent postoperative fever, appendectomy was performed in patients with AIDS/HIV infection without significant increase in morbidity and mortality.
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PMID:Acute appendicitis in patients with AIDS/HIV infection. 182 89

The Report of the Working Group on the Short-Term Prediction of AIDS/HIV (the Cox Report) is reviewed mainly to assess its calculations of the numbers of people in England and Wales who are infected with the human immunodeficiency virus (HIV). Two main methods are used in the report to estimate this total--the direct method and the back projection method. The direct method estimates the number of people infected with HIV by attempting to specify the numbers of people in various at-risk groups, and the percentage infected in those groups. Of particular significance are the estimates given for male homosexuals. The Cox Report suggests that between 4.0% and 4.7% of the male population aged between 16 and 59 are homosexual, and that between 1.9% and 4.5% of these are HIV antibody-positive. The basis on which these estimates are made is not substantiated by the Report, and it is quite possible that the upper limit given for HIV prevalence in male homosexuals represents an understatement of the actual number by a factor of 2.5 or more. The back projection method estimates HIV prevalence from the numbers of cases of the acquired immunodeficiency syndrome (AIDS) and the incubation function, the relationship between HIV infection and the probabilities of AIDS in each of the years following infection. Using this method the Cox Report fails to produce results that are in accordance with our knowledge of how the epidemic developed during the 1980s. As a consequence of this the various calculations of numbers of HIV antibody-positives to 1987 given in the Cox Report are all almost certainly underestimates.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Short-term prediction of HIV infection and AIDS: a critique of the Working Group's Report to the Department of Health. 209 93

Selected survey data concerning human immunodeficiency virus (HIV)- related knowledge, intravenous drug use, and sexual behavior of students 13-18 years in age is summarized. The data was collected from 30 states, 10 cities, and 2 territories during a 5 moth period in 1989. The response rates for the schools and students had a large range; 27%- 100% of the schools and 41% -92% of the students responded. Students reported attaining information regarding AIDS and HIV infections from school (33%-86%) and from adult family members (43%-69%). The majority of students were aware of AIDS and HIV transmission through sharing needles among drug users (93%-100%) and through not using condoms during sexual intercourse (74%-98%). Students reported that transmission could not occur through blood donations (32%-75%), mosquito bites (22%-67%), public toilets (44%-85%), or blood tests (59%-82%). 2%-5% of the students surveyed had used drugs and 0.2%-3% had shared needles. regarding sexual activity, 27%-76% of the students had experiences sexual activity with 7%-40% being involved with 3 partners. Overall, males reported drug use and sexual activity more frequently than females. These findings indicate a high-risk population among high school students for AIDS or HIV infection as a result of active drug use and sexual behavior. Survey data can be employed in establishing and promoting AIDS/HIV educational programs in the school system.
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PMID:HIV-related knowledge and behaviors among high school students--selected U.S. sites, 1989. 223 33

The Chamber of Mines of South Africa employs approximately 750,000 miners from all over southern Africa. Sero-surveys in 1986 showed that, depending on geographical area of origin, between 0.02% and 3.76% of miners were positive for human immunodeficiency virus (HIV) antibodies. As a consequence, an intensive education campaign to stop the spread of HIV infection was launched. A study was undertaken to establish a valid baseline level of knowledge about black miners' beliefs, attitudes and practices related to HIV infection, acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs), and to recommend appropriate changes to the educational efforts of the Chamber of Mines. A structured, pre-tested questionnaire was used to interview in their home language 429 systematically sampled black miners from four different mines. The most relevant findings were that younger age, not being married and how general education predispose to contracting STDs, while a feeling of being at risk for contracting HIV infection is positively correlated with level of education. Close friends were the most important source of information on STDs, but the media and medical staff were the most important sources of information on AIDS/HIV infection. Condoms were used by 31% of respondents, while the main reasons for non-use were trust in the sexual partner and lack of availability. Promotion of a stable family life for miners may significantly impact on the transmission of HIV infection.
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PMID:Knowledge, beliefs and practices among black goldminers relating to the transmission of human immunodeficiency virus and other sexually transmitted diseases. 223 84

After a brief methodological review of acquired immunodeficiency syndrome/human immunodeficiency virus (AIDS/HIV) forecasting methods, some of these methods were applied to the South African situation and short-term predictions of the prevalence of HIV infection among the black population in South Africa were obtained. At present, the prevalence of HIV infection increases exponentially, with a doubling time of 8,5 months (95% confidence interval 7,6-9,6 months). By the end of 1989 the number of HIV-infected black South Africans aged 15-49 years was estimated to be between 45,000 and 63,000, and it is predicted that these numbers will rise to between 119,000 and 168,000 by the end of 1990, and to between 317,000 and 446,000 by the end of 1991. Because of the lack of basic data, these forecasts are tentative, but they nevertheless indicate the great seriousness of the HIV epidemic in South Africa.
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PMID:Short-term predictions of the prevalence of human immunodeficiency virus infection among the black population in South Africa. 232 Nov 3

It is important for nurses and other healthcare workers to recognize that patients who present themselves for health care could already be infected with human immunodeficiency virus (HIV). Therefore, appropriate and sensible infection control precautions should be taken at all times. An assessment of nurses' knowledge of acquired immunodeficiency syndrome (AIDS)/HIV provides information to guide further continuing education efforts. This study describes the learning needs and preferred learning methods regarding AIDS/HIV among registered nurses working in a community in Texas. Respondents confirmed the need for important content areas regarding primary, secondary, and tertiary prevention such as universal precautions, protection from infectious diseases, and occupational hazards for healthcare providers. Several teaching methodologies were included. Self-paced instruction was the least preferred teaching-learning method; hands-on methodology was most preferred for the topics of clinical manifestations, long-term care, testing, and counseling.
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PMID:Perception of learning needs and preferred learning methods about AIDS/HIV among registered nurses working in the community in Texas. 775 25


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