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Background: The long average incubation time from HIV infection to AIDS makes it difficult to estimate recent HIV transmission from AIDS incidence data. Age-period-cohort (APC) analysis can separate out the effects of age, calendar time and birth cohort to provide a clearer picture of transmission trends.Methods: AIDS incidence data from 1981 to 1994 among intravenous drug users (IDU) for 12 Western European countries were used. Yearly incidences per 100,000 population or 100,000 person-years were calculated by age at diagnosis and 5-year birth cohort (1950-1954, 1955-1959, 1960-1964, 1965-1969 and 1970-1974), and corrected for reporting delay. Incidence patterns were compared between birth cohorts and countries.Results: For most countries the impact was greatest on the cohort born 1960-1964. Comparing incidence patterns in the 1965-1969 to 1960-1964 cohorts suggest the epidemic has plateaued at low to intermediate levels in Austria, Greece and the North-Western European countries, and at high levels in France, Italy and Switzerland. For most countries transmission amongst the 1970-1974 as compared to the 1965-1969 cohorts could not be assessed due to small numbers and short follow-up time. In Spain the epidemic was uncontrolled with a high incidence among recent birth cohorts. In Portugal the epidemic was still at an early and expanding phase.Conclusions: The APC analysis revealed large country differences in the dynamics of the HIV/AIDS epidemic among IDU. Full interpretation of these differences is dependent on information from other sources about the local public health response and trends in drug injecting behaviours. Earlier introduction of the virus and higher prevalence of injecting drug use may explain some of the generally higher incidence in Southern European countries, but the larger part of it is most likely explained by local characteristics of drug users, such as younger age and more frequent sharing of needles and syringes, and a less effective public health response. [ABSTRACT FROM AUTHOR]

Background: The effects of the implementation of a new Dutch hepatitis B virus (HBV) vaccination strategy (1991) for expatriates on HBV vaccination status and HBV infection prevalence were evaluated in a group of 864 expatriates returning from HBV-endemic areas.Methods: During a routine medical examination at the participating medical centres Dutch expatriates were asked to complete a questionnaire and to donate a serum sample for HBV testing. Blood was tested for antibodies against the hepatitis B core (anti-HBc) and surface antigens (anti-HBs). The serological data were related to information gathered on aspects of residence, sexual risk behaviour and occupational risks.Results: A significantly higher percentage of expatriates (37%) were vaccinated compared to a previous study in 1987-1989 (14%). However, the percentage of expatriates with HBV infection markers (5%) had not decreased significantly. Moreover, the risk for HBV infection, as determined with a questionnaire, was still affected by well-known risk factors such as homosexual contacts (odds ratio [OR] = 6.6, 95% CI: 1.7-26), more than five casual local partners (OR = 3.6, 95% CI: 1.2-11) and more than five occupational accidents in the last 3 years (OR = 20, 95% CI: 2-187). Detailed analysis of the vaccination status indicated that especially young female expatriates with low risk behaviour (65%) were protected, while older male expatriates with high risk behaviour were less protected (20%).Conclusion: We conclude that the new vaccination strategy has resulted in a higher percentage of expatriates protected. However, only a small proportion was reached of those at highest risk for HBV infection. [ABSTRACT FROM AUTHOR]

Among people who work abroad, sexual activity and therefore the risk of HIV infection appear to be relatively high. Little is known about the factors that influence sexual conduct when staying abroad, separated from their usual social environment. This is why 55 expatriates who had been sexually active in AIDS endemic areas were selected for an in-depth interview from the original sample of 864 Dutch expatriates participating in a study on sexual behaviour and HIV infection. The social and cultural context in which the sexual contacts took place was addressed in these interviews. Qualitative analysis of the data led to the identification of four styles with regard to the meaning of and motivations for having sex abroad: 'the unprepared', 'the fanatical', 'the unaffected' and 'the slightly accessible'. These styles are described separately and attention is paid to the association of these styles with protection behaviour. [ABSTRACT FROM AUTHOR]

In this study on occupational risks of HIV infection among 99 Dutch medics working in AIDS endemic areas, 61% reported percutaneous exposures during an average stay of 21 months. The mean number of injuries was lower among physicians (2.0 versus 3.9 per year) and higher among nurses (1.9 versus 1.2) than in previous research conducted in 1987-1990 among Dutch medics returning from Africa. But the reduction of exposures among physicians might be explained by the fact that the number of procedures they carried out was less in the later study. Also among nurses a shift of tasks was seen. On the basis of an estimated HIV prevalence in the patient population of 19%, a chance of transmission per accident of 0.3%, and 1.9 percutaneous exposures per year, the mean occupational risk of HIV infection per year can be estimated at 0.11% per person. Besides length of stay and number of activities, characteristics of the work setting were associated with the frequency of different kinds of injuries. From the analysis of 109 extensive descriptions of recent accidents, it appeared that the majority of the injuries occurred during routine activities and were self-inflicted. Injuries with hollow needles usually occurred after the actual medical act (e.g. during recapping). Carelessness (e.g. due to fatigue) or being in a hurry (e.g. because of an emergency) were also often the cause of percutaneous injuries, as were the poor quality of the equipment, lack of professional skills, or a combination of these factors. Prevention activities are still important to reduce the frequency of occupational exposures. But they will not eliminate them totally; from the descriptions of recent exposures it was clear that some of the injuries occurred in spite of precautions. [ABSTRACT FROM AUTHOR]

Discusses the clinical epidemiological and resource utilization issues arising from HIV/AIDS disease-associated mental disorder dementia in Europe. Prevalence of dementia in persons with HIV infection; Impact of HIV-related dementia on both the individuals and the health care system; Evaluation of hospital resource utilization.

Within a surveillance programme in a Regional Public Health Laboratory anonym ous information on HIV test, requesting physician and tested individual is automatically selected, regardless of test result. Thereby, personal identifiers are transformed into unique but meaningless num eric codes. Besides, requesting physicians receive a questionnaire on indication for testing (response 87%). Between April 1989 and June 1993 12,219 HIV tests were performed in 10,972 individuals. The percentage of positive tests (2.1%) was twice the percentage of positive individuals (1%). No increase in num ber of new infections was observed over tim e. Of individuals, 41.6% were tested due to third party requests (mainly insurance): HIV was demonstrated once (0.03%). Among the rem ainder, with medical indications, seroprevalence was 1.4%. At relatively little expense, we were able to provide valid information about patterns of HIV-testing and HIV seroprevalences am ong people tested in routine medical practice. Prevention of double counts proved to be important. Extension to other Dutch areas is expected. [ABSTRACT FROM AUTHOR]

In this study it was assessed whether homosexual men who practiced unprotected anogenital intercourse with steady and non-steady partners subjectively perceived their behaviors to be risky. Data were collected from 165 homosexual participants in an ongoing cohort study who reported unprotected anal sex. A variety of psychological factors which could possibly explain why some men were at risk but did not perceive their behavior as such, were investigated. This study showed that the majority of men who engaged in sexual risk behaviors within their primary relationship did not subjectively appraise their behavior as risky. The factors found to explain this discrepancy were not having had sex with a partner known to be HIV infected or to have AIDS (for couples of unknown serostatus) and not having had friends or relatives who were ill or had died (for seronegative couples). Homosexual men who had unprotected anal sex with casual partners generally were aware of the risk involved in their behavior. [ABSTRACT FROM AUTHOR]