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This study reports on four empirical models likely to contribute to understanding the behaviors linked with human immunodeficiency virus (HIV) among intravenous drug users. The sample comprises 1,637 intravenous drug users recruited between May 1989 and June 1990 in San Juan, Puerto Rico. Adjusting for sociodemographics, four logistic regression models were constructed to assess the association of risk behaviors with HIV seropositivity. In model 1, the variables found to be significantly associated with HIV seropositivity were injecting four times a day, injection as the only route of consuming drugs, and years of injection. In model 2, the only risk behavior significantly associated with HIV seropositivity was injecting drugs in shooting galleries. In model 3, all sex risk variables failed to meet the adjusted level of significance. In model 4, pneumonia, hepatitis, and syphilis were significantly linked with HIV infection. In order to assess the individual effects of the significant variables in each one of the four models, a logistic regression analysis was performed simultaneously controlling for all of the variables. After adjustment for the Bonferroni correction, age group 25-34 years, injection as the only route of using drugs, number of years of injection, and syphilis were the only significant variables remaining.
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PMID:Behavioral risk factors and human immunodeficiency virus (HIV) prevalence among intravenous drug users in Puerto Rico. 157 Aug 19

Ten years into the AIDS epidemic, how are we doing? Have we managed to significantly alter the course of infection with human immunodeficiency virus (HIV)? Have we defined factors that accelerate or decelerate the rate of progression of infection to clinical disease? Are we better able to predict who is most likely to develop AIDS, to substantially alter the course of infection, and to prevent or delay HIV-related morbidity and mortality? Advances made during the past decade that have furthered our understanding of the virus itself have been remarkable. We now understand a great deal about how the virus attaches to the CD4 cell receptor; how it is internalized, transcribed onto DNA of the host, and incorporated into the host's genome; and how its expression is latently controlled by a series of regulatory genes. However, translating this basic understanding of the virus into significant clinical advances still seems tediously slow for clinicians caring for HIV-infected individuals. I asked Dr. Alan R. Lifson of the University of California San Francisco School of Medicine and his colleagues from the San Francisco Department of Public Health and the California Department of Health Services to summarize the current status of our attempts to alter the course of HIV infection.
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PMID:Progression and clinical outcome of infection due to human immunodeficiency virus. 768 May 84

Estimating the current prevalence of human immunodeficiency virus (HIV) and projecting the future incidence of AIDS require that trends in incidence be analyzed and interpreted. We analyzed AIDS incidence trends in the United States by exposure category and selected demographic factors. In 1987, the trend in United States AIDS incidence changed as growth in the number of cases diagnosed per quarter began to decline. The slowing in growth is due in large part to a plateau in quarterly incidence in men who have sex with men in the New York City, San Francisco, and Los Angeles metropolitan statistical areas (MSAs), and in injecting drug users in the New York City MSA and New Jersey. Incidence has also reached a plateau in both adult/adolescent and pediatric blood and blood product recipients. Quarterly U.S. AIDS incidence was roughly constant during 1990, but appears to have increased to a higher level during the first half of 1991. The variation in incidence trends among subgroups suggests that several factors have affected the trend in total incidence and that the burden of severe symptomatic HIV disease may be shifting.
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PMID:Changes in AIDS incidence trends in the United States. 158 89

We examined factors associated with the subsequent development of AIDS-related Kaposi's sarcoma in a cohort of 353 homosexual men infected with human immunodeficiency virus (HIV). Cumulative incidence curves for the development of Kaposi's sarcoma and opportunistic infection were stratified over a wide range of variables at enrollment, including those related to demographics, sexual behavior, illicit drug use, and medical history. We found no strong associations between any of these variables and the development of opportunistic infection, but two were related to Kaposi's sarcoma: use of nitrite inhalants (relative risk, 2.3; 95% confidence interval, 1.0-5.0) and high numbers of sexual contacts during the period 1978-1982 in the AIDS epidemic centers of San Francisco, Los Angeles, and/or New York (relative risk, 3.5; 95% confidence interval, 1.6-7.6). The latter variables remained independently associated with risk of Kaposi's sarcoma even after multivariate adjustment for a number of classical HIV risk factors. These results are consistent with the hypothesis that Kaposi's sarcoma is caused by a sexually transmitted cofactor that has remained more prevalent in the original epidemic centers. The effect of nitrites could be due to an independent biological mechanism or to enhancement of transmission of the cofactor.
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PMID:Evidence for a sexually transmitted cofactor for AIDS-related Kaposi's sarcoma in a cohort of homosexual men. 159 16

Strategies for reaching intravenous drug users (IVDUs) not in treatment and reducing risk behaviors are urgently needed to reduce the human immunodeficiency virus (HIV) epidemic. Of special concern is the need to detect which types of risk behaviors are more likely to change and which are resistant to change. The present paper analyzes changes occurring in HIV transmission risk behaviors among 778 IVDUs not in treatment, in the city of San Juan, Puerto Rico. Results show discontinuation rates of risk behaviors to be substantial. Discontinuation rates of injection equipment sharing practices varied from 33% in shared use of cookers to 74.2% in sharing needles with strangers. Drug injection and use of shooting galleries were also reduced, although to a lesser extent (8.5% and 19.3% respectively). Among protective behaviors, use of new needles was found to increase nearly twice as much as the use of bleach (20.6% vs. 11.3% respectively). The results suggest the need to understand the factors facilitating/inhibiting change in specific behaviors and the need to study the stability of these changes over longer periods of time.
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PMID:Changes in HIV risk behaviors among intravenous drug users in San Juan, Puerto Rico. 159 12

Data from the 1989 Communication Technologies cross-sectional survey of gay men in San Francisco indicate that both levels and correlates of sexual risk are different between younger and older gay men. Gay men under the age of 30 report higher risk behavior for human immunodeficiency virus (HIV) infection than do gay men who are 30 years of age or older. Further, the set of correlates of unprotected anal intercourse are different between younger and older gay men. Both young and old gay men report that having a primary partner and a lower perceived impact of the AIDS epidemic on their sexual behavior are associated with risk. However, among young gay men, reporting a lower attributed risk for HIV infection to unprotected anal intercourse, higher concern about AIDS risks, and shorter length of residence in San Francisco are positively correlated with risk-taking behavior. These associations were not statistically significant among gay men 30 years of age or older. It appears that the circumstances and/or reasons for taking sexual risk are different between older and younger gay men. Prevention programs must be designed so that they are sensitive to the needs of each generation of gay men.
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PMID:A comparison of younger and older gay men's HIV risk-taking behaviors: the Communication Technologies 1989 Cross-Sectional Survey. 161 66

We investigated factors influencing attitudes and practices among San Francisco physicians toward physician-assisted suicide in the context of AIDS. To explore this topic a questionnaire was developed for use in comparing two physician groups. This self-administered instrument was completed by 69 physician members of the San Francisco County Community Consortium (CCC), a community-based clinical research organization whose members care for persons with human immunodeficiency virus (HIV) disease. A comparison group consisted of 86 randomly sampled San Francisco physicians recruited from the California Medical Association mailing list. Anonymity of respondents was maintained. Chi-squares and t-tests were conducted to compare physician groups with regard to demographics and experiences with AIDS. Factor analytic techniques and correlational analyses were used to identify attitudinal and behavioral predictors of willingness to assist in a patient suicide. Twenty-three percent of the total sample would be likely to grant the patient's initial request for assistance in committing suicide. When faced with an adamant request, CCC members would be more likely to assist than comparison group physicians. Ethical beliefs were the strongest predictor of physicians' intention to assist. Identification with the AIDS patient also had significant predictive value.
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PMID:Physicians' attitudes toward assisted suicide in AIDS. 161 71

Seeking ways to improve their health, gay men with human immunodeficiency virus (HIV) infections living in San Francisco are developing information networks and patterns of self-care behavior. Drawing from a set of explanatory theories, this cross-sectional survey with retrospective elements examined patterns and potential predictors of information-seeking activity in a cohort or 162 HIV seropositive (HIV+) men, 60 of whom provided complete data sets. The study suggests that 1 year after becoming aware of an HIV+ health status, most patients have developed multifaceted information networks. The amount of tangible aid acquired from these networks and frequency of consultation is positively related to patterns of HIV self-care behaviors and "feeling calm" (p less than 0.01), suggesting that these variables may be important markers for the need of supportive-educative nursing care. Suggestions for nursing practice and research are also described.
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PMID:Potential predictors of information-seeking behavior by homosexual/bisexual (gay) men with a human immunodeficiency virus seropositive health status. 161 17

Being a health care worker in today's world is not without risks. Accidental exposure to blood carries with it a definite risk of transmission of infection by various bloodborne pathogens, especially the hepatitis B, hepatitis C, and human immunodeficiency viruses. While infectious disease specialists, hospital epidemiologists, and infection control clinicians can develop many important strategies to reduce this risk--aggressive training, utilization of safer needles, identification of high-risk activities, and efficient disposal systems--their overriding responsibility is to design and implement a comprehensive plan for expeditiously and effectively dealing with accidental exposures when they occur. Among other things, the plan must address a number of key issues, including testing, administering postexposure prophylaxis, providing short- and long-term follow-up care, and, particularly, counseling for helping the health care worker deal with the tremendous anxiety associated with the injury. Drs. Julie L. Gerberding of the University of California, San Francisco, and San Francisco General Hospital and David K. Henderson of the National Institutes of Health and the Warren G. Magnuson Clinical Center have both made significant contributions in this area; in this month's AIDS Commentary they discuss the essential elements of such a plan.
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PMID:Management of occupational exposures to bloodborne pathogens: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. 768 Feb 38

Patients who have severe trauma have been reported to have a substantially increased rate of seropositivity for human immunodeficiency virus when compared with the general population. We reviewed the records of 1226 consecutive Code-3 trauma patients who were treated at our institution in San Antonio, Texas, between 1987 and 1989. All of the patients had serum drawn to be tested for the human immunodeficiency virus. In contrast with previously published studies, only 0.8 per cent of these trauma patients were seropositive. There was no appreciable difference between the prevalence of seropositivity in patients who sustained blunt trauma and those who sustained penetrating trauma. Exposure to human immunodeficiency virus for medical personnel who care for trauma patients remains a concern, but the risk may be lower than previously reported.
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PMID:The prevalence of seropositivity for human immunodeficiency virus in patients who have severe trauma. 162 79


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