HIV infection in the penitentiaries of Ukraine

In connection with a sharp increase of the number of HIV-infected persons in the Ukraine the natural growth of the number of such persons in penitentiary institutions was registered, starting from 1995 (455 persons in 1995, 2,937 persons in 1996, 2,779 persons in 1997 and 173 persons during 5 months of 1998). 83% of HIV infection persons were drug addicts introducing drugs intravenously. In 1997 the strategy of decreasing the risk of infection in penitentiary institutions was worked out in collaboration with UNAIDS experts: repressive and isolation measures were replaced with measures aimed at the "decrease of harm". Special attention is given to circumstances aggravating the epidemic situation in HIV infection, and particularly at the sharp growth of morbidity in tuberculosis and syphilis (10.6 and 10.3 times respectively in 1997 in comparison with 1993). In addition, in 1997 the number of person having drug addiction was noted to increase 2.3 times in comparison with 1993. The necessity of taking constant information and educational measures aimed at decreasing the risk of the spread of HIV infection is emphasized.     

The determinants of the spread of HIV among injection drug addicts in Ukraine

The main tendencies in the development of drug addiction in the Ukraine, the dynamics of the spread of HIV among drug addicts introducing drugs intravenously, epidemiological data on HIV, AIDS and drug addiction, as well as prognoses on the development of HIV infection are presented. Since 1995 the number of HIV-infected persons grew 34-fold, the number of cases of HIV infection resulting from the intravenous use drugs rose to 70% simultaneously with the rise (about 34-fold) of the number of persons infected with HIV through sexual contacts (about 13 fold). In 1996-1997 such tendency increased. On the whole, the proportion of drug addicts introducing drugs by intravenous injection was 83% in the Ukraine. By April 1, 1998, official registration covered 18,800 HIV-infected persons, including 270 foreign nationals, as well as 499 AIDS patients, including 487 Ukrainian citizens, among them 28 children. Out of 18,800 HIV-infected persons, 78.3% were drug addicts, most of them young people aged 15-30 years; about 18% were young people under 20 years of age, 80% being males. According to the model the rapid spread of HIV from the group of drug addicts to the heterosexual population, the total number of HIV-infected persons reaching 1,500,000 is expected in the country by 2014.     

The epidemiological characteristics of HIV infection in Turkmenistan

In the presence of the low spread of HIV infection a sharp increase in sexually transmitted diseases is noted. Nevertheless, taking into account a rise in STD, the reality of the potential risk of the spread of HIV is emphasized. Thus, in 1996 morbidity is syphilis was found to grow 7.2 times in comparison with 1992, amounting to 37.5 cases per 100,000 of the population; morbidity in gonorrhea amounted to 32.4 cases per 100,000 of the population with the proportion coming to medical institutions not exceeding 30%. A high proportion of hepatitis B virus carriers was also established (from 15% to 30% of healthy persons), while morbidity in virus hepatitides rose twofold for the period of 1994-1995. During recent years the service for the prophylaxis of AIDS was noted to considerably decrease measures on mass screening. At the same time the article attracts attention to the necessity of increasing the work on the dissemination of information and education on HIV/AIDS drug among addicts, prostitutes and homosexuals. The Draft National Program of the Prophylaxis of HIV infection and STD for 1998-2002 has been worked out. Great importance of methodological and financial assistance rendered since 1994 by international organizations, including WHO, UNFPA, etc., have been emphasized.     

Emergency measures to control the spread of diseases caused by the human immunodeficiency virus

Since the middle of 1996 the growth of HIV-infected persons and AIDS morbidity are registered in Russia. In 1997 4,300 new cases of HIV infection were registered, which exceeded 1.6 times the total number of cases for the period of 1987-1996. The highest morbidity rate was observed in the cities of the European part of Russia: Kaliningrad (west), Krasnodar and Rostov-on-Don (south), Nizhny Novgorod and Moscow (center). AIDS patients and HIV-infected persons were registered in 73 out of 89 regions of the country. 90% of HIV-infected persons were drug users in 1997. In 1992-1997 the number of drug addicts increased 3.5 fold and young women in 1987-1997, 6.5 fold. 71 HIV-infected children were registered were born from HIV-infected mothers at present time. The article deals with the main provisions of the federal laws aimed at the prevention of the spread of HIV infection in Russia and characterizes scientific research on AIDS. Evidence is presented that the early detection of HIV-infected persons, as well as rendering timely medical and social assistance to such persons, makes it possible to increase their mean survival time and check the spread of human immunodeficiency virus.     

Specific features of the HIV infection epidemic in Moscow

Retrospective analysis of the epidemic of HIV infection in Moscow allowed to mark out two periods: the first--from 1987 to 1993 and the second one--from 1994 to 2000. The characteristic feature of the first period of the epidemic was the sexual transmission of the agent mainly among homosexuals; the most affected group were persons aged 20-39 years and the number of AIDS patient decreased with a simultaneous growth in lethality. During the second stage of the HIV infection epidemic changes in the prevailing transmission routes of the agent occurred: injection drug addicts took the leading role. Changes in the ratio of HIV-infected men and women took place along with active involvement of persons aged 13-18 years into the epidemic process. The established changes in the epidemiological situation require corrections in the strategy and tactics of epidemic control and prophylactic measures.     

The priorities in realizing prophylactic programs in a region with a high level of HIV infection

The analysis of changes in the epidemic situation with HIV infection in Kaliningrad Province, the first territory in Russia involved into the epidemic, is presented. The experience in the realization of preventive programs is discussed with the analysis of both successes and problems arising in Kaliningrad, whose inhabitants constitute the absolute majority among HIV-infected persons in the region. The expediency of creating a new section--service of information, consultation and psychological assistance in the AIDS Centers is proposed for discussion.     

Strategic problems in counteracting the spread of HIV infection in the Altai Territory

The Altai Territory belongs at present to regions with the insignificant level of the spread of HIV infection. By December 1, 1999, the Altai Territory had 31 registered cases of HIV infection, which constituted 1.33 per 10,000 of the population (the corresponding figure for the whole of Russia being 14.92). But the situation with HIV/AIDS showed the general tendency to the development of the epidemic of HIV infection due to steady growth and the wide involvement of injecting drug users in the epidemic process. Before 1999 all cases of HIV infection registered in the Altai Territory were imported. Out of 31 HIV infected persons detected in the territory, 18 were injecting drug users. In 1999 local foci of HIV infection were formed among drug users in two big cities of the Altai Territory, which was indicative of the gradual transition of HIV infection from the phase of the registration of individual cases to the phase of the formation of local foci among some groups of the population.     

Development of HIV infection epidemic among intravenous drug users in the Sverdlovsky region

The Sverdlovsky region takes the fourth place among the 89 subjects of the Russian Federation by the number of registered cases of HIV infection. Drug addiction has reached an excessive scale in this region: according to the data of express evaluation carried out by the Regional Narcological Hospital and the Regional AIDS Center, not less than 7-8% of persons aged 15-30 years constantly use injection drugs. The large-scale epidemic of injection drug addiction has led to the rapid spread of HIV among addicts. The first penetration of HIV into this population took place in 1996 and, starting from the year 2000, rapid, development of the epidemic began, taking the character of an avalanche. The peak of new cases of HIV infection fell on 2001 (9,230 cases were registered). The concentrated stage of the epidemic development is observed in the region at present, the prevalence of HIV infection among drug addicts being 13.8%. Children born from HIV-infected drug addicted mothers now represent a new risk group due to great difficulties in the prophylaxis of the vertical virus transmission.     

The characteristics of HIV infection during a sharp activation of the epidemic process in Rostov Province

A considerable growth in cases of HIV infection in Rostov Province was registered in 1996-1997. Number of men was 525, number of women--196 cases, were registered. The highest index of HIV infection was noted in group of tested by epidemiological evidence (4494,4 per 100,000 tested persons), which was 57.2 times higher than the average level for this region. The growth in the number of infected persons was due to the import of HIV from the territory of Ukraine and the subsequent spread of the virus among drug addicts introducing drugs by intravenous injection.     

HIV infection in Saint Petersburg: the changing face of the epidemic

The specific features of the epidemiological situation in St. Petersburg at the first stage (1987-1995) and the second stage (1986-1999) of the development of HIV infection are described. During this period morbidity in HIV infection, starting from the insignificant rate of growth, sharply increased. For the first time injecting drug users were noted to come out to the foreground in the structure of the contingent of persons affected by HIV infection (57.5% and 72.6% in 1998 and 1999 respectively). Such change on the epidemic situation requires corrections in the strategy and tactics of preventive measures and medical assistance. To control HIV infection among drug users, only the combination of medical assistance given by narcologists with the realization of all elements of the program "Harm Reduction" can be effective.     

The epidemic of human immunodeficiency virus-caused infection among users of psychotropic preparations in Russia

The development of the epidemic of HIV infection among the intravenous injecting users of psychotropic substances in Russia in 1994-1999 is described on the basis of the data provided by territorial centers for the prevention and control of AIDS. In addition, the results of the screening in individual groups of the population of Russia for antibodies to HIV, carried out at the period of 1994 to the first half of 1999, are presented. In 1999 a considerable rise in the number of newly detected cases of HIV infection, mainly among persons injecting psychotropic drugs intravenously for non-medical purposes, was noted. The conclusion was made that the spread of HIV among drug addicts led to its passage to other groups of the population, mainly by heterosexual transmission.     

HIV/AIDS epidemic in Eastern Europe: Recent developments in the Russian Federation and Ukraine among women

Background: The Russian Federation and the Ukraine are among the Eastern European countries with the fastest growing number of cases of HIV. According to data from the Joint United Nations Program on HIV/AIDS, nearly 90% of newly reported HIV diagnoses in Eastern Europe in 2006 were from the Russian Federation (66%) and the Ukraine (21%). A growing number of women are infected with HIV. The impact of gender on HIV/AIDS is an important factor in understanding the development and evolution of the HIV/AIDS epidemic in Eastern Europe.Objective: The aim of this study was to assess the importance of integrating gender consideration into the creation of HIV programs and to examine the effect of gender on HIV/AIDS.Methods: Reported HIV/AIDS cases from the official epidemiological register of the Ukrainian Centre for AIDS Prevention alongside data from the Russian Federal AIDS Center were analyzed. Joint United Nations Program on HIV/AIDS country fact sheets were reviewed and analyzed, and this information was supplemented with published HIV prevalence and sexually transmitted disease case reporting information, unpublished reports, and expert evaluations.Results: Of the newly registered cases of HIV, the proportion of women rose from 13.0% in 1995 to 44.0% in 2006 in the Russian Federation, and from 37.2% in 1995 to 41.9% in 2006 in the Ukraine. There has also been a considerable increase in mother-to-child transmission of HIV since 1995. Between 1987 and 1994, the proportion of children among the people newly infected with HIV in the Ukraine was 2.2%; in 2006 it was 17.6%. In 2006, 16,078 new HIV cases were registered in the Ukraine and 39,652 new HIV cases in the Russian Federation. Large increases in the number of HIV-infected women were reported from both countries.Conclusions: The data examined in this study suggest subregional differences in the magnitude of the HIV/AIDS epidemic in the Russian Federation and the Ukraine and the importance of the impact of gender on the rapid spread of the HIV/AIDS epidemic among women and women of child-bearing age. To protect women from HIV infection, it is important to find ways to empower them by implementing policies and specific prevention measures that increase their access to knowledge about HIV/AIDS; the empowerment of women is vital to reversing the HIV/AIDS epidemic.     

Making the health care system 'safe' for persons with HIV infection or AIDS.

If health care reform is implemented in states and nationally, the safety of this process needs to be examined for persons with human immunodeficiency virus (HIV) infection or the acquired immunodeficiency syndrome (AIDS). Reform should assure ongoing prevention and transmission control of HIV and continuous coverage of medical costs for persons ill with HIV or AIDS. These persons currently benefit from various state and federal categoric programs designed to assure access to preventive and personal care services. Washington State has passed health care reform legislation that envisions integrating these programs to provide a system of population-based and personal health care. This legislation was analyzed using existing epidemiologic and entitlement information about persons with HIV infection or AIDS in the state to assess its effect. The relationship between public health and personal care services will be a central concern for those with HIV infection or AIDS, and complete coverage of this group may be achieved relatively late in the process of implementing health care reform. Health personnel planning under health care reform will affect the delivery of HIV- and AIDS-related services. Including treatment of AIDS in the basic benefit package merits particular attention. These issues parallel those being faced by the nation as a whole as it seeks to ensure epidemic disease control and compassionate care for long-term disabling illness if health care reform is implemented.     

Children, adolescents and HIV infection

The analysis of the occurrence of HIV infection in adults, children and adolescents under 18 years of age on the basis of statistical data by February 1, 1997, is presented. The total number HIV-infected persons registered by this date was 6,232; among them 902 (14.5%) were children and adolescents. 267 children were infected in the hospital focus of HIV infection; of these, 80 children (30%) died of AIDS during the period of 1989-1997. In 1992 only 16 adolescents, HIV infected were registered, while in 1995 the number of HIV-infected adolescents was 34, in 1996 their number rose to 144 and in 1997, to 435. The main cause of adolescent infections (80%) was the intravenous injection of narcotic drugs.     

The behavioral risk factors for contracting HIV infection in the intravenous administration of narcotics in abusers of psychoactive substances in the city of Rostov-on-Don

150 persons (drug users) who had applied to the department of psycho-social consultations and voluntary tests for the presence of HIV infection and STD of the Regional AIDS Control Center, as well as partners of HIV-infected addicts in the intravenous use of drugs, were examined. Out of 150 examined persons 63 were found to be positive for HIV infection. Among dangerous behavioral patterns, characteristic of drug addicts introducing drugs intravenously, the practice of repeated aspiration of the drug into syringes from the dose of the drug solution, common for the whole group of addicts, was noted as the most widespread habit.     

Prevention and control of HIV infection in the Osh region of the Kyrgyz Republic

A total of 178 cases of HIV infection were diagnosed in the Osh region of the Kyrgyz Republic for January 1, 2003, the intensity of the prevalence of HIV infection being 14.5 per 100,000 of the population with this figure for the whole republic being equal to 5.9. In the dynamics of the HIV infection epidemic two periods were detected. During the first 3 years (1998-2000) a few individual imported cases of HIV infection were registered in the region. During the last 2 years (2001-2002) 98.8% of all cases of HIV infection registered in the region, as well as the presence of an epidemic outbreak among injection drug users (IDU), were detected. The risk factors of getting HIV infection were the intravenous use of drugs and a low level of information among young people concerning the routes of transmission of this infection and means of protection from HIV/AIDS: the promotion of healthy life style among young people, the introduction of the programs of "harm reduction" among IDU and the rules of safe sex.     

Incidence of tuberculosis among reported AIDS cases in Quebec from 1979 to 1996

BACKGROUND: The impact of HIV infection on tuberculosis (TB) rates in Quebec has not been fully established. Because concurrent HIV infection is the single most important factor in TB reactivation, the authors used Quebec AIDS surveillance data to quantify the extent of TB among reported AIDS cases and to identify the characteristics of AIDS patients with TB. METHODS: The study population comprised people aged 15 years and over with AIDS diagnosed between Jan. 1, 1979, and Dec. 31, 1996, and reported by Mar. 13, 1997. Patients with TB (all forms) and those without TB were compared. Multivariate logistic regression analysis was used to examine the independent effect of each variable on the AIDS-TB cases. The authors also compared the number of AIDS-TB cases with the number of TB cases to estimate the effect of HIV infection on TB incidence. RESULTS: Of the 4684 people with AIDS reported in Quebec, 242 (5.2%) had active TB at some point during the course of their illness. During 1992-1995, 9.6% of the people with TB in Montreal, and 5.8% in the province of Quebec, also had HIV infection. Those with AIDS and TB were predominantly male (75.2%), manual workers (40.1%) and residents of Montreal (86.4%) and were born in an HIV-endemic country (63.8%). The multivariate analysis indicated that AIDS patients who were born in HIV-endemic countries in the Caribbean, sub-Saharan Africa or other developing regions were 21.8 times (95% confidence interval [CI] 19.5-28.5), 17.9 times (95% CI 12.7-27.1) and 4.9 times (95% CI 3.5-7.0) more likely to have TB than those born in Canada; manual workers and unemployed people with AIDS were 1.6 times (95% CI 1.3-2.0) and 2.0 times (95% CI 1.5-2.6) more likely to have TB than professional workers; and people who acquired HIV infection through heterosexual contact were 2.1 times (95% CI 1.6-3.1) more likely to have TB than men who acquired it through sexual contact with other men. INTERPRETATION: AIDS seems to contribute significantly to the number of TB cases. The results of this study reinforce the importance of offering HIV testing to people in high-risk groups, such as those born in a country where HIV and TB is endemic.     

A large-scale epidemic of diphtheria in Moscow in recent years: patterns of development

Data on the dynamics of diphtheria morbidity in Moscow in 1958-1999 are presented. The last epidemic which started at the end of the 1980s and reached its peak in 1994, giving a 59-fold rise in morbidity in comparison with the pre-epidemic period, is characterized in detail. During the epidemic 12,267 persons fell ill, 454 of them died (mortality rate was 4%). Having started in Moscow, the epidemic gradually spread not only over the territory of Russia, but also over some other republics of the former Soviet Union (Ukraine, Belarus, etc.). Possible causes of this epidemic emergency are considered. The ever increasing share of adult population among persons affected by the epidemic (75%) is noted. The infection adults is characterized by severity of clinical manifestations and increased morbidity among adults, is shown. Under complicated social and economic conditions (crisis situation) the increase of groups of high risk which included unemployed adults of working age, retirees as well as socially non-adapted persons, was registered. Mainly these groups determined tense epidemiological situation in diphtheria in Moscow.     

Modeling the AIDS epidemic in Mexico City

To study the future course of the AIDS epidemic in Mexico City, we use an open compartmental model to forecast new AIDS cases among homosexual and bisexual males and among heterosexual males and females. For each group three compartments are defined: uninfected persons, infected but asymptomatic persons, and persons diagnosed with AIDS. It is assumed that the AIDS epidemic will follow the propagation of infectious disease model, where spread of infection is proportional to the product of the number of healthy persons and the number of infected ones. The compartmental model is represented by a system of nonlinear differential equations describing the rate of change in the number of persons in each compartment. The impact of preventive measures is explored by decreasing the probability of HIV transmission, which is one of the model parameters representing behavioral patterns. By April 1989, 491 AIDS cases had been reported in Mexico City and classified as sexually related. Our model predicts that the AIDS incidence will continue to rise in Mexico City for the foreseeable future and will spread among the heterosexual population. Decreasing the transmission probability by 10% in all groups (through education programs) will result in a decrease of 18.1% in the number of accumulated cases over a 5-year period. A 20% decrease would prevent more than 31% of the cases. We conclude that mathematical models can be valuable in predicting the spread of the AIDS epidemic and the impact of behavioral change on its spread.     

益生菌治疗艾滋病相关腹泻的研究现状和进展

艾滋病（AIDS）是一种具有极大危害性的传染性疾病。AIDS发病和死亡都呈现明显上升趋势,传播模式发生变化,疫情由高危人群向一般人群扩散。因此,AIDS/HIV已成为中国的一个严重的公共卫生问题,政府对此极为重视。目前AIDS的治疗药物主要包括NNRTIs、NRTIs、PIs、FIs、CRIs和INIs这6大类,因长期使用这些药物的副作用以及此病合并的并发症特性,探讨其发病机制及寻找新的治疗思路,一直是此病研究领域中的热点。随着肠道微生态学研究领域的发展,应用人体无害的益生菌治疗HIV感染相关腹泻逐渐受到全球关注,就此作一综述。