HIV infection epidemic in Russian Federation and its features at the present stage

The problem of HIV infection spread in Russian Federation is examined in the article. Data on HIV infection dynamics and predominate risk groups of the population during different years are presented. Age structure of HIV infected individuals in Russian Federation is examined. Main factors that promote HIV infection spread in Russian Federation are specified and means of control are proposed.     

The UNAIDS strategy in the prevention of HIV/AIDS in the countries of Eastern Europe

Grounds for the necessity of the formation of effective approaches to the prevention of HIV epidemic with a view to counteract the rapid spread of infection in East European countries are presented. Attention is specially drawn to fact that the epidemic will not be limited by drug users, but will quickly cross the boundaries of this group. The development of preventive measures must be based on the use of the world experience. New effective approaches to work with vulnerable groups (the strategy of harm reduction, work in communities, consultations, etc.) must be widely used. The program of actions of the UNAIDS European Section, stipulating the strengthening and extension of the potential of the countries in the region for the effective counteraction to the epidemic, is formulated. As priority areas, activities covering vulnerable groups and with young people have been determined. The strategy of UNAIDS is realized through 20 UN theme groups on HIV/AIDS in the countries of Eastern Europe. Special attention is drawn to the creation of methodological networks. The creation of a unified strategic plan for counteraction the epidemic of HIV/AIDS is regarded by UNAIDS as its perspective for the future.     

On transient effects in the HIV/AIDS epidemic

During the initially exponential spread of the human immunodeficiency virus (HIV—the causative agent of AIDS) the growth rate of the number of AIDS cases decreases from plus infinity to the growth rate of HIV infections. A sensitivity analysis shows that for all reasonable values of the parameters of the HIV epidemic (incubation period, initial doubling time, etc.) the effect of this positive transient becomes negligible when the annual number of AIDS cases reaches a few dozen. Necessary and sufficient conditions are given for the growth rate of the number of AIDS cases to be monotonically decreasing during the positive transient. A mildly pathological density function for the incubation period of AIDS provides an example of a growth rate of AIDS that does not decrease monotonically, even though HIV is spreading exponentially. A negative transient occurs when the growth rate of HIV begins to decrease. In this context a somewhat surprising result emerges under the assumption that the growth rate of HIV is non-increasing: the growth rate of AIDS is at all times larger than the growth rate of HIV. A logistic HIV epidemic illustrates this result, and implications for the growth of the HIV epidemic in the United States and Europe are discussed. In particular, it is shown that the positive transient must have passed by 1982 in the United States and by 1986 or 1987 for the five European countries with the largest caseloads.     

The HIV/AIDS epidemic in sub-Saharan Africa

Knowledge useful to the fight against HIV/AIDS in sub-Saharan Africa cannot be extrapolated to those coming from industrialized countries. The aim of this article is to review specificities of the African epidemy, in terms of epidiomolgy, natural history, validated therapeutic interventions, and unexplored questions. Far from being without effective tools and research tracks to fight against this plague which decimates a continent, one is above all confronted with a deficit of both mobilization and means.     

Seroprevalence of Toxoplasma gondii Infection among HIV/AIDS Patients in Eastern China

Toxoplasmosis, a neglected tropical disease caused by the protozoan parasite Toxoplasma gondii, occurs throughout the world. Human T. gondii infection is asymptomatic in 80% of the population; however, the infection is life-threatening and causes substantial neurologic damage in immunocompromised patients such as HIV-infected persons. The major purpose of this study was to investigate the seroprevalence of T. gondii infection in subjects infected with HIV/AIDS in eastern China. Our findings showed 9.7% prevalence of anti-T. gondii IgG antibody in HIV/AIDS patients, which was higher than in intravenous drug users (2.2%) and healthy controls (4.7%), while no significant difference was observed in the seroprevalence of anti-Toxoplasma IgM antibody among all participants (P>0.05). Among all HIV/AIDS patients, 15 men (7.7%) and 10 women (15.9%) were positive for anti-T. gondii IgG antibody; however, no significant difference was detected in the seroprevalence of anti-Toxoplasma IgG antibody between males and females. The frequency of anti-Toxoplasma IgG antibody was 8.0%, 13.2%, 5.5%, and 0% in patients with normal immune function (CD4⁺ T-lymphocyte count ≥500 cells/ml), immunocompromised patients (cell count ≥200 and <500 cells/ml), severely immunocompromised patients (cell count ≥50 and <200 cells/ml), and advanced AIDS patients, respectively (cell count <50 cells/ml), while only 3 immunocompromised patients were positive for anti-T. gondii IgM antibody. The results indicate a high seroprevalence of T. gondii infection in HIV/AIDS patients in eastern China, and a preventive therapy for toxoplasmosis may be given to HIV/AIDS patients based on CD4⁺ T lymphocyte count.     

The clinico-epidemiological characteristics of HIV infection and AIDS in Ukraine

The summarized results of the observations of 449 hospitalized patients, aged mainly 18-37 years (40 patients with active AIDS, 43 patients with AIDS, other patients were HIV carriers and infected at the stage of lymphadenopathy). In most of the HIV-infected patients the infection process progressed in 3-5 years, which was manifested by associated candidiasis in 74.7% of cases. In AIDS patients opportunistic infections of viral etiology (herpes simplex, cytomegalovirus infection, etc.) prevailed. 14 patients were found to have tuberculosis. Clinico-epidemiological analysis made it possible to come to the conclusion that the specific features of HIV carriership and AIDS were greatly linked with different groups of risk to which the patients belonged. Thus, a shorter period of carriership, the prevalence of opportunistic viral infections were mostly characteristic of drug addicts.     

Infectious diseases in natural reservoirs: epidemic situation and morbidity in the Russian Federation and prophylactic measures

The analysis of morbidity in infections with natural foci in Russia for the period of 1999-2000 indicates that a rise in the number of cases of hemorrhagic fever with the renal syndrome, tick-borne encephalitis, Crimean hemorrhagic fever and West Nile fever with a high proportion of urban population among the patients is registered annually. An increase in the epizootic activity of the natural foci of plague is noted in the absence of morbidity among humans. The appearance of the outbreaks of tularemia is linked nor only with the increased activity of the natural foci, but also with the reduced coverage of the population with prophylactic immunization in endemic regions. This analysis infers that morbidity prognosis in infections with natural foci for 2001 remains unfavorable. The growth of morbidity in these infections is mainly due to the reduction of measures for controlling their vectors both is open nature and in settlements, as well as to low coverage with prophylactic immunization. Urgent complex measures which may ensure effective antiepidemic and prophylactic work for controlling infections with natural foci are presented.     

Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk,Russian Federation

Russian Federation’s (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number {"type":"clinical-trial","attrs":{"text":"NCT00675961","term_id":"NCT00675961"}}NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed.     

The development of HIV infection in the Far-Eastern region of the Russian Federation

By May 18, 1998, 108 HIV-infected persons were registered in the Far-Eastern region. In recent years young people using narcotic drugs were involved in the epidemic process. The sources of the infection were mainly migrants arriving to the Far East from the Ukraine. HIV-infected persons also were registered in settlements lying north of the Arctic Circle.     

Contraceptive knowledge,attitudes and use among women attending health clinics in St. Petersburg,Russian Federation

This study describes women's knowledge, attitudes, and use of contraception in Russia. Data were obtained from a sample of 917 women attending 44 women's consulting centers in St. Petersburg during January 15-30, 1995. Findings indicate that 68% were married; 21% were single. 56.1% worked full-time, 7.2% worked part-time, and 9.4% were students. 50.9% reported having received sex education, of whom 73.8% learned about birth control methods and 70.7% learned about abortion. Over 90% of the entire sample knew about condoms, IUDs, and oral contraceptives. About 60-70% knew about rhythm, withdrawal, and female sterilization. 49-56% were aware of vaginal suppositories and vasectomy. Under 23% were aware of the diaphragm, sponge, jelly, and foam. People talked about family planning with doctors and partners. 58.7% preferred joint responsibility for family planning. 909 women responded to the question about the current method being used: 41% reported using condoms; 33.8%, IUDs; 32.8%, pills; 23.7%, the rhythm method; and 17.2%, withdrawal. Many women used multiple methods, but the questions did not clearly distinguish single from concurrent multiple method use or switching between a few methods. 20.6% report nonuse. 115 of 187 were pregnant or desiring a pregnancy. Nonusers were concerned about side effects. Method choice was based on effectiveness and ease of use. Few were dissatisfied with their method choice. About 75% reported method switching over time. Most of the 452 oral contraceptive users knew 2-3 side effects. 25.1% of the 319 condom users were usual users.     

Rate of growth of AIDS epidemic in Europe: a comparative analysis

Estimates of the rate of increase of the AIDS epidemic for each of 18 European countries are obtained by fitting a Poisson process with exponential rate of growth to data. A linear regression model of these estimates on the proportion of cases that are intravenous drug users, homosexuals/bisexuals and heterosexuals, was estimated and suggested that the rates of growth of the epidemics amongst these groups are different and in increasing order. Empirical Bayes estimates of the rates are obtained for each country.     

A different disease: HIV/AIDS and health care for women in poverty

The goal of this paper is to demonstrate that HIV/AIDS for poor women is a qualitatively different disease than the one first defined in the United States in the 1980s. HIV/AIDS for poor women is not a new disease; it is only another life-threatening condition which parallels serious health problems already experienced by these populations. A time-honored and broad continuum of disease and death for poor women is linked to such factors as poverty, self-medication, infant morbidity, infant mortality and cervical cancer. The programmatic responses to HIV/AIDS in poor women have been grafted onto existing services established by and for homosexual men or onto the obstetrical-gynecological and prenatal systems already in place. Furthermore, the primary socio-psychological mechanisms of denial and dependency that characterize poor women are far more salient than notions of risk-taking or sexual lifestyles. These conclusions lead to somber predictions for the course of the epidemic and the prognosis for treatment and care for poor women with HIV.     

Using the Kalman filter and dynamic models to assess the changing HIV/AIDS epidemic

Many factors, including therapy and behavioral changes, have modified the course of the HIV/AIDS epidemic in recent years. To include these modifications in HIV/AIDS models, in the absence of appropriate external data sources, changes over time in the parameters can be incorporated by a recursive estimation technique such as the Kalman filter. The Kalman filter accounts for stochastic fluctuations in both the model and the data and provides a means to assess any parameter modifications included in new observations. The Kalman filter approach was applied to a simple differential model to describe the observed HIV/AIDS epidemic in the homo/bisexual male community in Paris (France). This approach gave quantitative information on the time-evolution of some parameters of major epidemiological significance (average transmission rate, mean incubation rate, and basic reproduction rate), which appears quite consistent with the recent epidemiological literature.     

The prevention of HIV/AIDS among injection drug abusers and women in the sex business in the city of Kharkiv

A steady increase of the number of persons with drug addiction has been noted both on Kharkov and Kharkov Province. Since 1996 a considerable number of HIV-infected persons has been detected among injecting drug users (80-82% of them infected parenterally). Rapid evaluation, carried out in 1997 within the project "Harm Reduction", served as the basis for the creation of the Charity Fund "Scarlet Ribbon" collaborating with the UNAIDS Representation in the Ukraine and other international organizations. The information and educational activity of the Fund among injecting drug users is presented. The necessity of organizing additional stationary and mobile exchange stations of the syringe is pointed out.     

Impulsive SUI epidemic model for HIV/AIDS with chronological age and infection age

This paper develops an impulsive SUI model of human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS) epidemic for the first time to study the dynamic behavior of this model. The SUI model is described by impulsive partial differential equations. First, the well-posedness of the model is attained by the method of characteristic lines and iterative method. Secondly, the basic reproduction number R₀(q,T) of the epidemic which depends on the impulsive HIV-finding period T and the HIV-finding proportion q is obtained by mathematical analysis. Our result shows that HIV/AIDS epidemic can be theoretically eradicated if we can have the suitable HIV-finding proportion q and the impulsive HIV-finding period T such that R₀(q,T)<1. We also conjecture that the infection-free periodic solution of the SUI model is unstable when R₀(q,T)>1.     

Contraceptive decisions and HIV/AIDS concerns among married couples in Malawi

This study investigates current contraceptive use among Malawi couples. The data examined are from the 2001 Malawi Diffusion and Ideational Change Project (MDICP). The aim of the study is to explore whether contraceptive use among married couples is affected by the couple's concerns about HIV/AIDS and couple's age difference. Contraceptive use was found to be associated with the couple's HIV concern and family planning goals. There is no significant association between spousal age difference and contraceptive use. The findings are important for future work on the connection of marital concerns about HIV/AIDS with contraceptive behaviours, especially the use of condoms, and for informing HIV preventive strategies in marriage.