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 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The contexts in which the human immunodeficiency virus (HIV) pandemic is occurring are increasingly diverse. Individual-level risks for HIV infection are at the core of these epidemics and are powerfully impacted by social, structural, and population-level risks and protections. The emerging epidemics among injection drug users across Eurasia are largely the result of needle sharing, but the drivers of disease spread include increases in opiate availability, limited HIV infection prevention and programs for drug users, and undermining policy environments. An emerging epidemic of HIV infection among men who have sex with men in developing countries is primarily spread through unprotected anal intercourse but is also driven by limited HIV infection prevention services, social stigma, and the lack of human rights protection. The epidemic in southern Africa, which is spreading largely through heterosexual exposure, is driven by high rates of labor migration, concurrent sexual partnerships, gender inequalities, and the limited availability of male condoms. We need to do much more to control HIV infection, and social and structural risks are crucial intervention targets.
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PMID:HIV epidemiology update and transmission factors: risks and risk contexts--16th International AIDS Conference epidemiology plenary. 1734 54

The Sonagachi Project of Kolkata, India has been recognized as a model community development and human immunodeficiency virus/sexually transmitted infection (HIV/STI) prevention intervention among female sex workers. Limited research has been conducted regarding its applicability outside the South Asian context. This study sought to document the process and effectiveness of integrating community development activities based on the Sonagachi model into an ongoing HIV/STI peer education program with female sex workers in Rio de Janeiro, Brazil. Structured cross-sectional surveys examining HIV/STI-related behaviors and community development measures were conducted among approximately 500 sex workers at pre- and post-intervention. We found that several community development components including social cohesion and mutual aid were significantly associated with consistent condom use among sex workers and their paying clients at pre-intervention. However, only a minority of women actively engaged in community-building activities over the 18-month study period. In turn, limited changes in community development components and no significant increases in the HIV/STI-related protective behaviors assessed were documented. Findings indicate that internalized stigma and socioeconomic pressures may have constrained the scope and pace of community mobilization in this setting during the study observation period.
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PMID:Community development and HIV/STI-related vulnerability among female sex workers in Rio de Janeiro, Brazil. 1736 61

The epidemiology and demographics of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have evolved over the last 25 years in the United States to include more women and minority populations, especially Latinos and African Americans. In addition, there has been a shift in HIV/AIDS cases from large northeastern and western metropolitan areas to persons living in rural areas and the south. The reasons for the changes and the shift are unclear, but major barriers to primary prevention strategies are most likely sociocultural. This article reviews some of the sociocultural barriers in HIV/AIDS prevention and presents a new approach or framework for addressing these barriers. The framework highlights Stigma, Fear, and Denial as barriers in interventions for HIV/AIDS targeted at African Americans living in rural Alabama. The framework uses a culturally competent, community-based approach. It is hoped that this framework could also be used as a model for addressing HIV/AIDS in other communities, as well as addressing other health disparities where stigma, fear, and denial may play a role, such as cancer, diabetes, heart disease, immunizations, and infant mortality.
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PMID:Use of stigma, fear, and denial in development of a framework for prevention of HIV/AIDS in rural African American communities. 1787 38

Rollout of antiretroviral therapy (ART) has been successfully initiated in many countries, but concerns have been raised about the ability to meet treatment needs in areas where there is a high prevalence of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) and where there are severe deficits in human-resource capacity. Many health care workers in resource-poor areas are experiencing burnout, struggling with external and internal stigma, failing to access HIV testing and treatment early, and subsequently becoming sick and dying of AIDS. Although the human-resource deficit is a well-recognized problem, little has been written about the programs that have been established to provide treatment for HIV-infected health care workers. In the present article, we describe staff care programs at McCord Hospital in Durban, South Africa; Mseleni Hospital in northern KwaZulu-Natal, South Africa; and the Tshedisa Institute in Gaborone, Botswana. These programs provide convenient, confidential, and holistic care for HIV-infected health care workers and health care workers affected by caring for HIV-infected patients. All 3 programs have noted that, among health care workers, there is increasing acceptance of counseling, testing, and treatment. We propose that there is an urgent need for the development of HIV/AIDS care and treatment programs for health care workers that remove barriers to access, provide confidentiality in testing, are conveniently located, and are integrated with tuberculosis programs and other treatment services.
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PMID:Caring for the caregivers: models of HIV/AIDS care and treatment provision for health care workers in Southern Africa. 1818 1

Most people with HIV have disclosed their status to someone, often with mixed results. Most health literature seems to favor disclosure by persons living with acquired immunodeficiency syndrome (AIDS), but it could be that to disclose is not always a good thing. We used a descriptive, qualitative research design to explore the experience of human immunodeficiency virus (HIV) and AIDS stigma of people living with HIV or AIDS and nurses involved in their care in Africa. Focus group discussions were held with respondents. We asked them to relate incidents that they themselves observed, and those that they themselves experienced in the community and in families. Thirty-nine focus groups were conducted in five countries in both urban and rural settings. This article is limited to a discussion of data related to the theme of disclosure only. The sub-themes of disclosure were experiences before the disclosure, the process of disclosure, and responses during and after disclosure.
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PMID:Disclosure of HIV status: experiences and perceptions of persons living with HIV/AIDS and nurses involved in their care in Africa. 1823 55

This study used a qualitative interview methodology to explore the barriers to scaling up access to antiretroviral therapy (ART) in Papua New Guinea (PNG). Key informants were selected purposively from organizations active in HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) work throughout PNG. Interviews were taped, transcribed and analyzed thematically. Predicted barriers likely to impede the delivery of ART by the health services included shortages of skilled and experienced personnel; lack of sustainable funding; weak services at the rural periphery; lack of capacity for the management of chronic illness; inadequacies of basic services for people living with HIV/AIDS (PLWHAs); the difficulty of finding the most appropriate method and venue of delivery for ART; and the complexities of establishing social criteria for deciding who to treat. Barriers likely to impede the acceptance of treatment by the community included the cost of treatment to the patient; the low socioeconomic status of PLWHAs; the effects of stigma, particularly in the case of women; and sociocultural factors affecting public perceptions of ART. The study concluded that, given the range of potential barriers, scaling up ART in PNG and other developing countries will be a complex process, requiring careful decisions to be made over how best to utilize available resources.
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PMID:The challenges to scaling up antiretroviral therapy in Papua New Guinea. 1839 10

During the past two decades, great strides have been made in the design of peptidomimetic drugs for the treatment of viral infections, despite the stigma of poor drug-like properties, low oral absorption, and high clearance associated with such compounds. This Account summarizes the progress made toward overcoming such liabilities and highlights the drug discovery efforts that have focused specifically on human immunodeficiency virus (HIV) and hepatitis C virus (HCV) protease inhibitors. The arsenal against the incurable disease AIDS, which is caused by HIV infection, includes peptidomimetic compounds that target the virally encoded aspartic protease enzyme. This enzyme is essential to the production of mature HIV particles and plays a key role in maintaining infectivity. However, because of the rapid genomic evolution of viruses, an inevitable consequence in the treatment of all viral infections is the emergence of resistance to the drugs. Therefore, the incomplete suppression of HIV in treatment-experienced AIDS patients will continue to drive the search for more effective therapeutic agents that exhibit efficacy against the mutants raised by the earlier generation of protease inhibitors. Currently, a number of substrate-based peptidomimetic agents that target the virally encoded HCV NS3/4A protease are in clinical development. Mechanistically, these inhibitors can be generally divided into activated carbonyls that are transition-state mimics or compounds that tap into the feedback mode of enzyme-product inhibition. In the HCV field, there is justified optimism that a number of these compounds will soon reach commercialization as therapeutic agents for the treatment of HCV infections. Structural research has guided the successful design of both HIV and HCV protease inhibitors. X-ray crystallography, NMR, and computational studies have provided valuable insight in to the free-state preorganization of peptidomimetic ligands and their enzyme-bound conformation. Researchers have designed a variety of novel bioisosteric replacements of amino acids and short peptides that contain all of the required pharmacophore moieties and play a key role in inducing conformational changes to the overall molecule. The knowledge gained from these studies will undoubtedly guide the future design of therapeutic agents and further contribute to the success of this field.
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PMID:Peptidomimetic therapeutic agents targeting the protease enzyme of the human immunodeficiency virus and hepatitis C virus. 1868 64

Human immunodeficiency virus (HIV) infection is aptly called the modern day 'plague' and has the potential to decimate people in the productive age group. On the other hand, the increasing life expectancy in developing countries spirals age-related blindness. One therefore reduces economic productivity while the other increases economic dependency. Both lead to increased expenditure of households though in different proportions. Human immunodeficiency virus and blindness are both associated with discrimination, stigma and long-term consequences. They impact the socioeconomic fabric of the affected individuals, communities and countries. The loss in productivity and the cost of support to the affected individuals are seen in both. Each is a potent problem on its own but together they spell disaster in geometric proportions rather than a simple additive effect. Strategies need to be evolved to provide solace and improve the quality of life of an HIV-positive blind individual.
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PMID:The socioeconomic impact of human immunodeficiency virus / acquired immune deficiency syndrome in India and its relevance to eye care. 1871 Dec 68

The Centers for Disease Control and Prevention (CDC) has recommended human immunodeficiency virus (HIV) testing for all persons aged 13 to 64 years in all health care settings. Signed consent would not be required and counseling with referral would be managed as it is for other serious conditions. The goal of the recommendations is to promote earlier entry into care to reduce unnecessary mortality and facilitate prevention by behavioral changes that accompany knowledge of serostatus. Concerns about the change include laws in some states that mandate signed consent and counseling, a perception that counseling is an effective prevention strategy, variability in payment coverage for the test, concerns about the stigma and discrimination that may accompany the HIV diagnosis, and the possibility that other testing policies would be more effective. Eleven of 16 states have changed legislation to reduce barriers to testing, 35 of 74 national professional societies have endorsed the new recommendations, and multiple demonstration projects have shown feasibility. Metrics to evaluate the health outcomes of the CDC's recommendations for HIV testing have been defined, but the data necessary to determine the effects on early entry into care, the actual reduction in disease incidence, and the unanticipated consequences are not yet available.
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PMID:Opt-out testing for human immunodeficiency virus in the United States: progress and challenges. 1915 53

This article examines the dynamic role of law as a tool, and potential barrier, to public health interventions designed to ameliorate the negative impacts of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) globally. Law impacts the lives of persons living with (and at risk of) HIV/AIDS in many ways. Laws may: (1) help to ensure that public health authorities are empowered to provide effective prevention and treatment programmes; (2) effectuate the human rights to life, health, work, education and property ownership of persons living with, or at risk of, HIV/AIDS; and (3) protect persons living with HIV/AIDS from social risks, stigma and other harms by respecting privacy and prohibiting unwarranted discrimination. However, laws can also create legal barriers in many countries that impede effective HIV/AIDS interventions by penalizing those with HIV/AIDS through criminal sanctions or other policies. As a result, it is recommended globally that laws should facilitate the prevention and treatment of HIV/AIDS consistent with scientific and public health practices and with a human rights framework. Effective use of existing laws that promote the public's health, and reforms of laws which impede it, contribute to improved individual and communal health outcomes concerning HIV/AIDS.
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PMID:A global assessment of the role of law in the HIV/AIDS pandemic. 1925 Dec 92


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