The role of educational programs on the prevention of HIV infection and the development of a healthy life style for adolescents

On the basis of answers to questionnaires more active use of local TV channels for educational work in the dissemination of knowledge on the prophylaxis of HIV infection is recommended. It is advisable to enlist the cooperation of school psychologists in the work on the social adaptation of adolescents with a view to make them resistant to negative influences affecting their life and health.     

Occupational HIV infection. Medical workers and HIV prevention

The analysis of the possibility of suffering injuries at a work place, their causes, the knowledge of HIV infection, attitude towards the infected person is presented. The work was carried out, starting from 1990. Every 2 years the anonymous questioning of members of the medical personnel of different specialties at medical institutions of different profile and level was carried out. Five questionings on injuries suffered during work, the knowledge of HIV infection and the attitude of members of the medical profession towards HIV-positive persons. In most cases injuries are inflicted by injection needles (79%), during operations (12%), by splinters of broken medical glassware and appliances (3%) and in other cases (6%). In 91% of cases injuries caused by needles occur in the process of placing caps on the needles. In the course of 9 years changes in the level of knowledge and the attitude towards HIV-infected persons occurred. Changes in the outlook and the knowledge of AIDS were due to the positive influence of intensive education directly at work places.     

Development of a selective HDAC inhibitor aimed at reactivating the HIV latent reservoir

The synthesis and SAR development of a trisubstituted imidazole HDAC inhibitor is described. The compounds were synthesized with high diastereocontrol by leveraging Ellman sulfinyl imine chemistry. Structural elucidation provided insight into binding mode and supported design rational. Pharmacokinetic properties of lead compounds were determined.     

Cellular immunity for prevention and clearance of HIV infection

Despite the major strides that have been made in HIV therapy with the advent of potent anti-retroviral drugs, these medications are quite expensive and are still not readily available for the vast majority of infected individuals worldwide. Even when available, the long-term toxicities associated with anti-retroviral medications and the frequent emergence of drug-resistance mutations can complicate therapy, making the formulation of effective vaccines imperative. This chapter will review the current state of understanding regarding cell-mediated immune responses that are associated with control of HIV replication. This knowledge has generated sound hypotheses regarding the prospects for augmenting cell-mediated immunity through immune-based therapies. With regard to prophylactic vaccines, it is presently unclear which vaccine-induced immune responses will protect against infection. While much progress has been made in formulating vaccine constructs designed to elicit cell-mediated immune responses, sterilizing immunity is unlikely to be achieved with the current vaccines. However, the ability to control viremia and prevent disease progression in animal infection models looks promising. The ability to measure immune responses has also advanced markedly over the past few years and will allow investigators to more accurately measure the immunogenicity of vaccine constructs, and correlate the magnitude and breadth of these responses with protection.     

Passive immunization for the treatment and prevention of HIV infection.

Passive immunization using serum or immunoglobulin preparations has been used in the prophylaxis and treatment of many bacterial and viral diseases. Preliminary attempts to use these methods to prevent HIV infection in chimpanzees have been promising. With the identification of polyclonal and monoclonal antibodies with protective activity against HIV in in vitro systems, the possibility of using these reagents in vivo takes on new relevance. The potential and problems of using passively administered anti-HIV antibodies for HIV prophylaxis and treatment are discussed, as well as the relative merits of polyclonal versus monoclonal reagents.     

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.     

Integrating prevention of mother-to-child HIV transmission programs to improve uptake: a systematic review

Background

We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries.

Methods

We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources.

Results

Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04–1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001).

Conclusion

Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs.     

The role of public organizations in the prevention of HIV infection in Russia

The problem of the role of public organizations in the prevention of the spread of HIV infection in Russia is discussed. The correctly chosen strategy of cooperation between governmental structures and non-governmental public associations corresponds to the modern principles of state policy of enhancing the interest of the population in the problems of public health. Relationships built on the principles of mutual respect and partnership in the common work on the prevention of the spread of HIV infection in Russia must increase its effectiveness.     

The evaluation of a mass media campaign aimed at weight gain prevention among young Dutch adults

Objective: The objective was to evaluate a 3‐year nationwide mass media campaign aimed at preventing weight gain. The campaign was aimed primarily at raising awareness of the importance of weight‐gain prevention and bringing these issues to the attention of the Dutch public. Research Methods and Procedures: Eleven serial, independent, cross‐sectional, population‐based telephone surveys were used to assess campaign awareness and impact (N ranged between 483 and 493 for each of the 11 surveys). The surveys were conducted before and after six campaign waves. Multiple linear and logistic regression analyses were used to test for trends over time and for differences among the surveys for campaign awareness, message recall, perceived body weight status, overweight‐related risk perceptions, attitudes, perceived social support, self‐efficacy expectations, and motivations for preventing weight gain. Results: Campaign awareness ranged from 61% after the 1st campaign wave to 88.4% after the final wave. The campaign's television broadcasting activities were an important source of campaign awareness, from both the campaign's television commercials and television‐based free publicity. Message recall ranged from 41.9% to 68.1%. Small positive differences were found in attitudes, perceived social support, and intentions for preventing weight gain. Additionally, the results suggest mixed effects on self‐efficacy expectations and a negative effect on risk perception. Discussion: The campaign resulted in high campaign awareness, especially as a result of television commercials and free publicity on television. The results suggest that the campaign was able to create more positive attitudes and motivation but lower risk perceptions and efficacy for preventing weight gain.     

Plant-based strategies aimed at expressing HIV antigens and neutralizing antibodies at high levels. Nef as a case study

The first evidence that plants represent a valid, safe and cost-effective alternative to traditional expression systems for large-scale production of antigens and antibodies was described more than 10 years ago. Since then, considerable improvements have been made to increase the yield of plant-produced proteins. These include the use of signal sequences to target proteins to different cellular compartments, plastid transformation to achieve high transgene dosage, codon usage optimization to boost gene expression, and protein fusions to improve recombinant protein stability and accumulation. Thus, several HIV/SIV antigens and neutralizing anti-HIV antibodies have recently been successfully expressed in plants by stable nuclear or plastid transformation, and by transient expression systems based on plant virus vectors or Agrobacterium-mediated infection. The current article gives an overview of plant expressed HIV antigens and antibodies and provides an account of the use of different strategies aimed at increasing the expression of the accessory multifunctional HIV-1 Nef protein in transgenic plants.     

Reaching impaired populations with HIV prevention programs: a clinical trial for homeless mentally ill African-American men.

This study tested an intervention to reduce sexual risk behaviors in a high risk impaired population: homeless African-American, Caucasian and Hispanic men with mental illness. In a comparison group clinical trial, men were assigned to an experimental cognitive-behavioral or a control intervention and followed up over 16 months. Men were recruited from a psychiatric program in two shelters for homeless men in Nashville, Tennessee. An ethnically mixed cohort of subjects (54% African-American, 42% Caucasian and 4% Hispanic) were included in the study. Most had a chronic psychiatric disorder and a co-morbid substance abuse disorder. The 257 participants who were sexually active (130 experimental, 127 control) prior to the trial were the main target of the intervention. An experimental intervention (SexG), adapted from Susser and Associates (51), comprised 6 group sessions. The control intervention was a 6-session HIV educational program. Sexual risk behavior was the primary outcome. The experimental and control groups were compared with respect to the mean score on a sexual risk index. Complete follow-up data were obtained on 257 men (100%) for the initial six-month follow-up. These individuals have been followed for the remainder of the 16-month follow-up. This intervention, (SexG), successfully reduced sexual risk behaviors of homeless mentally ill African-American, Caucasian and Hispanic men. Similar approaches may be effective in other impaired high-risk populations.     

Level of IgE at different stages of HIV infection

The content of total IgE in 109 patients at different stages of HIV infection are presented. The infection was at the asymptomatic stage in 30 patients, the stage of generalized lymphadenopathy in 29 patients, the stage of secondary manifestations in 36 patients, the stage of AIDS in 14 patients. The concentration of IgE was found to increase, on the average, at all stages of HIV infection (p < 0.001), the maximum level being observed at the stage of AIDS. The occurrence of high and low concentrations of total IgE was the same at the asymptomatic stage and the stage of generalized lymphadenopathy. At the stage of secondary manifestations the occurrence of low concentrations of IgE increased twofold. In the presence of parasitosis a significant rise in the content of total IgE was registered in HIV-infected patients.     

HIV infection: the psychological indices at different stages of the disease

The pronounced forms of depression and the levels of neuro-psychical adaptation and subjective control (attitude to the disease) were studied in 27 patients with HIV infection. 14 patients were at stage A, 8 patients were at stage B and 5 patients were at stage C of the CDC classification (1994). Starting from the early stages of the disease, neuro-psychical adaptation disturbances were noted: at stage A 10 patients belonged to group 5 of health, at stage B 8 patients and at stage C 2 patients. Most of the patients (15) had a low level of subjective control, 12 patients exhibited a medium level, which should be taken into consideration in prescribing and carrying out curative and diagnostic procedures.     

Knowledge and beliefs of international travellers about the transmission and prevention of HIV infection.

OBJECTIVES: To measure the perceived risk of acquired immunodeficiency syndrome (AIDS) among international travellers, to measure their knowledge of the transmission and prevention of HIV infection abroad and to identify some of the determinants of this knowledge. DESIGN: Survey. SETTING: Travellers'' immunization clinic providing mostly primary preventive care to international travellers. PARTICIPANTS: All clients aged 18 to 50 years seen at the clinic between Oct. 2 and Dec. 21, 1989, before their departure. MAIN OUTCOME MEASURES: Sixteen statements measured knowledge of transmission and prevention of HIV infection. Standardized scales measured health beliefs. RESULTS: The response rate was 81% (331/409). Compared with other diseases AIDS was perceived to be associated with a low risk except by those travelling to countries with a high prevalence of AIDS. Most of the clients were found to have a good knowledge of HIV transmission to travellers, although some myths remained popular and some real routes of transmission, especially blood, remained underrated. In all, 70% of the subjects believed in the efficacy of condoms when used with local people, as compared with 79% when used with other tourists; this difference was greatest among travellers who perceived AIDS as being particularly severe but difficult to prevent. The determinants of the knowledge of HIV transmission and prevention were a high level of education, a mother tongue other than French, unmarried status, a high prevalence of AIDS at the destination, the duration of the trip and a high perceived risk of HIV infection. CONCLUSIONS: Counselling should teach travellers (a) not to underestimate their risk of HIV infection during their trip, (b) to decrease the risk of requiring health care in developing countries and (c) to rely on their own prudent sexual behaviour rather than on their assessment of the level of risk posed by the environment.