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information was supplemented with published HIV prevalence and sexually transmitted disease case reporting information, unpublished reports, and expert evaluations.Results: Of the newly registered cases of HIV, the proportion of women rose from 13.0% in 1995 to 44.0% in 2006 in the Russian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.     

Modelling HIV/AIDS in the presence of an HIV testing and screening campaign

Preventing and managing the HIV/AIDS epidemic in South Africa will dominate the next decade and beyond. Reduction of new HIV infections by implementing a comprehensive national HIV prevention programme at a sufficient scale to have real impact remains a priority. In this paper, a deterministic HIV/AIDS model that incorporates condom use, screening through HIV counseling and testing (HCT), regular testing and treatment as control strategies is proposed with the objective of quantifying the effectiveness of HCT in preventing new infections and predicting the long-term dynamics of the epidemic. It is found that a backward bifurcation occurs if the rate of screening is below a certain threshold, suggesting that the classical requirement for the basic reproduction number to be below unity though necessary, is not sufficient for disease control in this case. The global stabilities of the equilibria under certain conditions are determined in terms of the model reproduction number R₀. Numerical simulations are performed and the model is fitted to data on HIV prevalence in South Africa. The effects of changes in some key epidemiological parameters are investigated. Projections are made to predict the long-term dynamics of the disease. The epidemiological implications of such projections on public health planning and management are discussed.     

Constitutional values and HIV/AIDS in the workplace: reflections on Hoffman v. South African Airways

South Africa is experiencing an HIV/AIDS epidemic of enormous proportions. The workplace, like all the other sectors, is adversely affected. The tendency of a significant proportion of employers has been to discriminate against employees and job applicants living with HIV/AIDS through use of HIV testing to exclude those that are HIV-positive. In the case of Hoffmann v South African Airways, the Constitutional Court was asked to determine the constitutionality of excluding a job applicant on account of an HIV-positive status. The Court ruled in favour of the applicant and ordered instatement. Through an analysis of Hoffmann v South African Airways, the article examines how constitutional values are impacting on HIV/AIDS-related ethics in the workplace.     

Non-Chinese Immigrants: Challenge Faced by Yunnan of China to Achieve the 90–90–90 Goals

正China’s AIDS epidemic started among people who inject drugs(PWID)in Ruili county-level city,a China–Myanmar border city of Yunnan Province,in 1989(Fig.1).Since then HIV has spread rapidly across the country(He and Detels 2005).China launched a‘‘Four Frees and One Care’’policy in 2003 to fight against HIV/AIDS.As one of     

Assessing the effects of drug misuse on HIV/AIDS prevalence

Drug misuse (injecting drug users-IDU) has been recognized to have a significant effect on the spread of HIV/AIDS epidemic. A deterministic model to assess the contribution of drug misuse and sex in the spread of HIV/AIDS is investigated. The threshold parameters of the model are determined and stabilities are analysed. Analysis of the reproduction number has shown that increase in drug misuse results in an increase in HIV infections. Furthermore, numerical simulations of the model show that drug misuse enhances HIV transmission and progression to AIDS. Thus, in a population with intravenous drug users, advocating for safe sex alone will not be enough to control the HIV/AIDS epidemic.     

An epidemic like any other? Rights and responsibilities in HIV prevention.

Throughout the 1980s and into the 1990s, HIV prevention has been closely associated with the protection of individual human rights. Traditional public health measures such as compulsory testing and isolation have largely been rejected as ineffective in public health terms and inappropriate in the context of human rights protection. HIV prevention has been based instead chiefly on elective measures --information, education, counselling, and voluntary testing. In the past five years there have been important clinical, epidemiological, and social developments in the AIDS epidemic. These changes, combined with a growing recognition of possible weaknesses inherent in a strictly voluntarist approach to HIV prevention, may herald a new approach to AIDS control which places more weight on social responsibility in the context of HIV prevention.     

Effects of public health educational campaigns and the role of sex workers on the spread of HIV/AIDS among heterosexuals

This paper presents a sex-structured model for heterosexual transmission of HIV/AIDS in which the population is divided into three subgroups: susceptibles, infectives and AIDS cases. The subgroups are further divided into two classes, consisting of individuals involved in high-risk sexual activities and individuals involved in low-risk sexual activities. The model considers the movement of individuals from high to low sexual activity groups as a result of public health educational campaigns. Thus, in this case public health educational campaigns are resulting in the split of the population into risk groups. The equilibrium and epidemic threshold, which is known as the basic reproductive number (R0), are obtained, and stability (local and global) of the disease-free equilibrium is investigated. The model is extended to incorporate sex workers, and their role in the spread of HIV/AIDS in settings with heterosexual transmission is explored. Comprehensive analytic and numerical techniques are employed in assessing the possible community benefits of public health educational campaigns in controlling HIV/AIDS. From the study, we conclude that the presence of sex workers enlarges the epidemic threshold R0, thus fuels the epidemic among the heterosexuals, and that public health educational campaigns among the high-risk heterosexual population reduces R0, thus can help slow or eradicate the epidemic.     

Attitudes and sexual behaviours of unmarried people with HIV/AIDS living in the Niger Delta region of Nigeria

Background Increasing morbidity and mortality associated with HIV/AIDS may be attributable to the lifestyle of individuals. Appropriate sexual behaviour and lifestyle modification may be helpful strategies for prevention and control of HIV/AIDS in many countries.Aim The study was designed to assess the impact of attitudes and sexual behaviour on control of HIV/AIDS among unmarried people living with HIV/AIDS in Uyo, a community in the Niger Delta region of Nigeria.Method A total of 365 unmarried individuals living with HIV/AIDS were assessed at the HIV clinic of the University of Uyo Teaching Hospital. Attitudes and sexual behaviour were evaluated using the Attitude and Sexual Behaviour Questionnaire adapted from previous studies.Results Of the 365 individuals living with HIV/AIDS, 142 (38.9%) were male and 223 (61.1%) were female. The majority of the subjects were below 50 years of age. The mean ages (± SD) of men and women were 36.8 ± 3.9 and 29.2 ± 1.7 years, respectively. Sexual attitudes and behaviours were variable. There was no change in the partner''s reaction to sex for 28.9% of men and 27.8% of women, abstinence in 7.7% of men and 8.1% of women, and breakdown of the relationship with the partner for 4.9% of men and 7.2% of women. More women than men agreed to undergo testing after their partners had tested positive for HIV. Sexual activity was higher in women than men, with 4.9% of men and 10.3% of women reporting daily sexual intercourse, 16.2% of men and 15.7% of women reporting weekly intercourse, and occasional sexual intercourse being reported by 44.4% of both men and women. After testing positive, 58.4% of male partners and 56.9% of female partners were persuaded to use condoms during sexual intercourse.Conclusion This study has demonstrated unhealthy attitudes and sexual behaviour among individuals living with HIV/AIDS in the Niger Delta region of Nigeria. This can potentially limit efforts and investment in controlling HIV/AIDS in this region. Therefore there is a need to initiate concrete policies and programmes that would encourage people living with HIV/AIDS in the Niger Delta region to adopt a healthy lifestyle.     

Keeping the faith: African American faith leaders' perspectives and recommendations for reducing racial disparities in HIV/AIDS infection

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders' recommendations for tailoring HIV prevention for a faith-based audience.     

Judge attacks South African government's response to AIDS

During the 13th international AIDS conference in Durban, Judge Edwin Cameron of the High Court in Johannesburg, castigated the South African government for its flirtation with those who claim that AIDS is not caused by HIV, and for its slow response to the epidemic. In his deliberation of the Jonathan Mann memorial lecture, the government was admonished for failing to adopt a program to prevent vertical transmission of HIV infection by providing pregnant women with antiretroviral therapy. Quoting an article by the African intellectual Dr. Mamphela Ramphele, he commented that failure to recognize HIV as the country's utmost priority is an irresponsibility that borders on criminality on the part of the government. Moreover, Cameron called on the pharmaceutical industry and developed countries to take steps to lower the prices of drugs and make them more readily available to poverty stricken countries that are more affected by the epidemic.     

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.     

Through a glass, darkly: data and uncertainty in the AIDS debate

The HIV/AIDS epidemic is the greatest threat to development in much of Africa. It is already the main cause of death in many countries, especially those in Southern Africa. However there is an absence of solid data on the scale and scope of the disease and how it is evolving. In this article we discuss the data on the epidemic – where it comes from and how it is presented. We note the limitations of the use of antenatal clinic surveys – which provide the bulk of our information.
We then turn to the evidence of impact. The paper shows that the long incubation period between infection and illness means that it takes time for HIV infections to turn into AIDS cases, and AIDS cases to translate into deaths with all the consequences of orphaning, poverty and changing population structures. Furthermore it means that once the HIV prevalence has peaked, AIDS impact will take years to work through – this epidemic is a 'long-wave' event.
The paper is premised on the view that HIV causes AIDS and AIDS causes death. It notes that insufficient and/or unreliable data have allowed leaderships to deny the scope and scale of the problem and that this is unacceptable. However it is incumbent on all to accept the moral responsibility for and the moral consequences of their work, and this includes those who gather, interpret and use the data.     

益生菌治疗艾滋病相关腹泻的研究现状和进展

摘要：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。     

Development,Calibration and Performance of an HIV Transmission Model Incorporating Natural History and Behavioral Patterns: Application in South Africa

Understanding HIV transmission dynamics is critical to estimating the potential population-wide impact of HIV prevention and treatment interventions. We developed an individual-based simulation model of the heterosexual HIV epidemic in South Africa and linked it to the previously published Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International Model, which simulates the natural history and treatment of HIV. In this new model, the CEPAC Dynamic Model (CDM), the probability of HIV transmission per sexual encounter between short-term, long-term and commercial sex worker partners depends upon the HIV RNA and disease stage of the infected partner, condom use, and the circumcision status of the uninfected male partner. We included behavioral, demographic and biological values in the CDM and calibrated to HIV prevalence in South Africa pre-antiretroviral therapy. Using a multi-step fitting procedure based on Bayesian melding methodology, we performed 264,225 simulations of the HIV epidemic in South Africa and identified 3,750 parameter sets that created an epidemic and had behavioral characteristics representative of a South African population pre-ART. Of these parameter sets, 564 contributed 90% of the likelihood weight to the fit, and closely reproduced the UNAIDS HIV prevalence curve in South Africa from 1990–2002. The calibration was sensitive to changes in the rate of formation of short-duration partnerships and to the partnership acquisition rate among high-risk individuals, both of which impacted concurrency. Runs that closely fit to historical HIV prevalence reflect diverse ranges for individual parameter values and predict a wide range of possible steady-state prevalence in the absence of interventions, illustrating the value of the calibration procedure and utility of the model for evaluating interventions. This model, which includes detailed behavioral patterns and HIV natural history, closely fits HIV prevalence estimates.     

Prevention of Parent to Child Transmission (PPTCT) Program Data in India: An Emerging Data Set for Appraising the HIV Epidemic

Background

Evidence based resource allocation and decentralized planning of an effective HIV/AIDS response requires reliable information on levels and trends of HIV at national and sub-national geographic levels. HIV sentinel surveillance data from antenatal clinics (HSS-ANC) has been an important data source to assess the HIV/AIDS epidemic in India, but has a number of limitations. We assess the value of Prevention of Parent to Child Transmission (PPTCT) programme data to appraise the HIV epidemic in India.

Methods/Findings

HIV data from PPTCT sites were compared to HSS-ANC and general population level surveys at various geographic levels in the states of Karnataka, Maharashtra and Andhra Pradesh. Chi-square tests were used to ascertain statistical significance. PPTCT HIV prevalence was significantly lower than HSS-ANC HIV prevalence (0.92% vs. 1.22% in Andhra Pradesh, 0.65% vs. 0.89% in Karnataka, 0.52% vs. 0.60% in Maharashtra, p<0.001 for all three states). In all three states, HIV prevalence from PPTCT centres that were part of the sentinel surveillance was comparable to HSS-ANC prevalence but significantly higher than PPTCT centres that were not part of the sentinel surveillance. HIV prevalence from PPTCT data was comparable to that from general population surveys. In all three states, significant declines in HIV prevalence between 2007 and 2010 were observed with the PPTCT data set. District level analyses of HIV trends and sub-district level analysis of HIV prevalence were possible using the PPTCT and not the HSS-ANC data sets.

Conclusion

HIV prevalence from PPTCT may be a better proxy for general population prevalence than HSS-ANC. PPTCT data allow for analysis of HIV prevalence and trends at smaller geographic units, which is important for decentralized planning of HIV/AIDS programming. With further improvements to the system, India could replace its HSS-ANC with PPTCT programme data for surveillance.     

The Relationship Between Scientific Knowledge and Behaviour: An HIV/AIDS Case

Debates on the role of scientific knowledge to affect behaviour are continuing. The theory of planned behaviour suggests that behaviour is influenced by attitudes, subjective norms and perceived behavioural control and not by knowledge. However, a large body of knowledge argues that increased HIV/AIDS-related knowledge leads to the adoption of safe behavioural practices. The purpose of this non-experimental survey study, therefore, was to investigate the correlation between academic HIV/AIDS knowledge, functional HIV/AIDS knowledge and self-reported behavioural preferences of 300 biology and 243 non-biology students from nine South African schools. Results suggest a correlation between students’ understanding of academic and functional HIV/AIDS knowledge. The behavioural preferences of both biology and non-biology students were generally the same and safe. Among biology students, correlation was observed between academic HIV/AIDS knowledge and self-reported safe behavioural preferences, which was not the case for non-biology students, where functional HIV/AIDS knowledge correlated with self-reported safe behavioural preferences. Within schools, however, no correlation was found between both forms of HIV/AIDS knowledge and self-reported safe behavioural preferences. There were indications that context-specific local factors have a greater influence on behavioural preferences. These findings suggest that the type of knowledge that could influence behaviour is informed by context-specific dynamics.     

Hospitalizations for HIV/AIDS: Differences between sexes

Background: Women are especially vulnerable to HIV infection because of biological, social, cultural, and economic factors. In Brazil, AIDS was initially seen predominantly in homosexual men, but the epidemic gradually reached a gender balance as increasing numbers of women became infected with HIV.Objective: The aim of the present study was to identify the clinical and epidemiologic characteristics of hospitalized patients with HIV/AIDS of both sexes and compare the differences between them.Methods: This epidemiologic cross-sectional study evaluated gender differences in demographic, social, clinical, and epidemiologic characteristics of patients diagnosed with HIV/AIDS who were admitted for any reason to the Public Hospital of the Medical School of the Federal University of Triângulo Mineiro, Uberaba, Minas Gerais State, Brazil.Results: A total of 363 patients were included in the analysis, with a male/female ratio of 1.1:1.0. Forty-one percent of women were pregnant. Mean age at hospitalization and duration of hospitalization were significantly greater among men (P<0.05). Men and nonpregnant women were admitted because of infection significantly more often than were pregnant women (P<0.05). Significantly more single men who reported homosexual, bisexual, or heterosexual behavior associated with drug use were admitted compared with women (P<0.05). Women admitted for treatment were significantly more likely than men to be employed (P<0.05). Adherence to antiretroviral treatment and T CD4+ lymphocyte count indicated important differences between the sexes, with better parameters observed among nonpregnant and pregnant women compared with men.Conclusions: In the present study, women with HIV/AIDS who were admitted to the hospital for any reason were in better clinical condition compared with men. This observation may be partially explained by the proportion of pregnant women in the study population. These findings suggest that future studies should examine pregnant women with HIV/AIDS as a separate population group to avoid bias in analysis.     

HIV/AIDS knowledge, women's education, epidemic severity and protective sexual behaviour in low- and middle-income countries

A fundamental public health strategy to reduce the risk of HIV/AIDS is to increase levels of awareness and knowledge about the disease. Although knowledge about HIV/AIDS and protective sexual behaviour are linked theoretically, relatively little is known about their empirical relationship. Using Demographic and Health Survey data from 23 low- and middle-income countries, this study used multilevel logistic regression models: to examine cross-national variability in the relationship between HIV/AIDS knowledge and protective behaviour (condom use and restricted sex); to investigate the moderating influences of women's educational attainment on this relationship; and to test the extent to which severity of the HIV/AIDS epidemic accounts for cross-national variability in the association between HIV/AIDS knowledge and protective behaviour. There was an association between increased knowledge of HIV/AIDS and condom use that varied in strength and form cross-nationally. This cross-national variation was accounted for partially by the socioeconomic characteristics of women resident in the study countries and between-country differences in the severity of the HIV epidemic. While education modified the association between HIV/AIDS knowledge and protective behaviour--stronger associations at lower levels of education--epidemic severity exerted a stronger influence on behaviour than any other characteristic. Finally, this study indicates that protective sexual practices are disturbingly low. In eight of 23 countries, overall levels of condom use to prevent STDs and HIV/AIDS were less than 5.0%. Waiting for the spread of HIV/AIDS infection to change sexual practices in low- and middle-income countries will result in dramatic unnecessary suffering.     

HIV/AIDS in rural India: context and health care needs

Primary research on HIV/AIDS in India has predominantly focused on known risk groups such as sex workers, STI clinic attendees and long-distance truck drivers, and has largely been undertaken in urban areas. There is evidence of HIV spreading to rural areas but very little is known about the context of the infection or about issues relating to health and social impact on people living with HIV/AIDS. In-depth interviews with nineteen men and women infected with HIV who live in rural areas were used to collect experiences of testing and treatment, the social impacts of living with HIV and differential impacts on women and men. Eight focus group discussions with groups drawn from the general population in the four villages were used to provide an analysis of community level views about HIV/AIDS. While men reported contracting HIV from sex workers in the cities, women considered their husbands to be the source of their infection. Correct knowledge about HIV transmission co-existed with misconceptions. Men and women tested for HIV reported inadequate counselling and sought treatment from traditional healers as well as professionals. Owing to the general pattern of husbands being the first to contract HIV women faced a substantial burden, with few resources remaining for their own or their children's care after meeting the needs of sick husbands. Stigma and social isolation following widowhood were common, with an enforced return to the natal home. Implications for potential educational and service interventions are discussed within the context of gender and social relations.