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Background: This study examines the association between optimistic perceptions about AIDS and unprotected sex among men who have sex with men (MSM) in the city of São Paulo, Brazil., Methods: A cross-sectional study was carried out among MSM in leisure areas of São Paulo in 2003. We interviewed 161 participants aged 18-30 years., Results: Thirty-nine per cent (95% confidence interval 32-47%) reported unprotected anal sex with steady or casual partners in the previous 6 months. The optimistic perception score created for this study was associated with unprotected sex (P = 0.01) and higher education (P = 0.02). The quartile with the most optimistic perception was 1.8 times more likely to engage in unprotected anal sex compared with the quartile with the least optimistic perception., Conclusion: This study suggests that the current situation regarding AIDS, which is seemingly favourable, may create optimistic perceptions leading to unprotected sexual practices. Prevention programmes, particularly for MSM, need to take this into account.

Background: São Paulo State has had the largest number of paediatric AIDS cases in Brazil. Since 1996, São Paulo (and Brazil nationally) has implemented an aggressive programme to reduce perinatal transmission. We have gathered available indicators to examine the programme's impact., Methods: We obtained data on reported AIDS cases from the AIDS surveillance system; data on the number of mother/infant pairs treated with zidovudine from the state logistics office responsible for distributing HIV medication; and the rates of perinatal transmission from a multicity study of the Brazilian Pediatric Society that includes a number of São Paulo facilities, which were compared with an independent study in 1995. The years for which data were available varied according to the source of the indicator., Results: Annual reported cases of AIDS as a result of perinatal transmission fell 58.9% from 1997 to 2002. The number of cases treated with zidovudine increased 73.7% from 1997 to 2004. The rate of perinatal transmission among babies born to HIV-positive mothers fell from 16% in 1995 to 2.4% in 2002 in the reference clinics that participated in the Brazilian Pediatric Society study., Conclusion: Both process and outcome indicators point to the effectiveness of efforts to reduce perinatal transmission in São Paulo State.

Background: As AIDS patients live longer, the management of co-morbidities becomes increasingly important. Previous studies from developed countries give conflicting results as to whether co-infection with hepatitis C virus (HCV) lowers the life expectancy of individuals with AIDS., Methods: This retrospective cohort study was based on a medical record review of a nationally representative sample of 2821 adult AIDS cases diagnosed in 1995 and 1996 in Brazil. We compared the characteristics and survival of patients known to be positive and negative for HCV., Results: A total of 833 patients received HCV testing, and the prevalence was 33%. HCV-positive patients received less intensive antiretroviral treatment. The crude mortality was greater for HCV-positive patients (hazard ratio 1.26; P = 0.04), but HCV status was not a significant predictor in a multivariate analysis that included other predictors of survival., Conclusion: Brazilian AIDS patients with hepatitis C have a shorter survival than those without, but this seems to be mainly as a result of their receiving less antiretroviral treatment. We cannot say whether this is because of the fear of hepatotoxicity, an inability to tolerate treatment, or for other reasons. To improve survival, these patients need optimal treatment of their HIV disease.

Background: Since the last study of survival time among Brazilian AIDS patients, care has improved steadily, culminating in a controversial policy of universal free access to triple antiretroviral treatment since 1996. This large, national study examined how these changes have impacted survival., Methods: Using national data for cases diagnosed in 1995 and 1996, we randomly selected 3930 adult AIDS cases from 18 cities in seven states representing all regions of Brazil. Trained abstracters reviewed medical records, determining dates of diagnosis and death or last contact, exposure category, treatment, and demographics. After review, 2821 cases met the inclusion criteria and were available for Kaplan-Meier and proportional hazards analysis. Data from the earlier study were re-analyzed for comparison., Results: Median survival was 5 months for cases diagnosed in the 1980s, 18 months for those diagnosed in 1995, and 58 months for those diagnosed in 1996. Predictors of longer survival in univariate analysis included antiretroviral treatment, year of diagnosis, higher education, sexual exposure category, female sex, and Pneumocystis carinii pneumonia prophylaxis. In multivariate analysis, the predictive value of most of these was attenuated or disappeared, leaving antiretroviral treatment as the main predictor of survival., Conclusions: Survival time has increased substantially for adult Brazilian AIDS patients. The timing of these gains and analysis of the predictors of survival both indicate antiretroviral treatment as the cause. These findings demonstrate that universal access to antiretroviral treatment in a developing country can produce benefits on the same scale as in richer countries.

Background: In the second decade of the AIDS epidemic in Brazil, public sector and non-governmental organization (NGO) initiatives multiplied, fostered by state AIDS Control Programmes. A growing gap between capacity and a need for programme evaluation and the dissemination of findings from experience in the field, combined with the failure of traditional training approaches to bridge this gap adequately, inspired this non-degree research training programme at a major Brazilian university., Objectives: To train health professionals and activists working with HIV/AIDS prevention and services to evaluate and disseminate their experiences, and to enable them to multiply this training in their organizations, working in a collaborative process with graduate students and senior researchers., Procedures: As part of a 9-month research methods course, 52 representatives from NGO and public health services produced research protocols that were reviewed and strengthened through a formal peer review process. Eleven protocols judged to be the best received funding and close mentorship over the next 21 months for their implementation, analysis, and dissemination., Lessons Learned: Participants increased their ability to master and review critically the AIDS literature, to conduct a research protocol and to disseminate the results of their studies. After completion of the 30-month process, many participants were able to present their findings at scientific conferences or publish their results in peer-reviewed scientific journals. This model of close NGO-university successful collaboration may inspire other models of research training for those in the front-lines of the fight against the epidemic.

Objectives: To determine the prevalence of HIV and syphilis and related risk behavior in a sample of truck drivers in Santos, Brazil., Subjects and Methods: A cross-sectional study was performed of 300 male truck drivers recruited in the port of Santos, Brazil, including a face-to-face interview and blood sampling for HIV and syphilis serology., Results: Of 300 subjects, 4 (1.3%) were positive for HIV, 25 (8.3%) for syphilis by the Venereal Disease Research Laboratory (VDRL) test and 38 (13%) were positive for syphilis by the fluorescent treponemal antibody (absorbed) test (FTA-Abs). Seventy-one per cent had been employed as truck drivers for more than 10 years and 93% lived outside of Santos. Most participants were married (72%); 40% reported having more than one sex partner; 21% reported sex with commercial sex workers; 14% reported sex with girls that they met on the road; 16% had sex with other men's wives; and 3.3% reported sex with men during the past year. The use of rebite, an oral stimulant, was reported by 43% and was associated with being FTA-Abs-positive (P = 0.04). Being HIV-positive was associated with having sex with friends (P = 0.04), partners usually considered 'safe' by truck drivers. Being syphilis-positive (VDRL) was significantly associated with sex with partners also considered as 'safe', namely primary sex partners, steady partners and other men's wives., Discussion: This is the first study to determine HIV and syphilis seroprevalence among truck drivers in South America. Findings confirm that this group has a high potential risk for HIV infection and other sexually transmitted diseases, and thus currently presents an opportunity for prevention.

Objective: To estimate the prevalence and correlates of condom use with casual sex partners by men in urban Uganda and to identify barriers to condom use that are amenable to intervention., Design: Cross-sectional, door-to-door survey of men residing in a poor area of Kampala, Uganda., Subjects and Methods: A multistage, probability sample was approximated by recruiting participants within randomly selected neighborhoods. A total of 301 men between the ages of 18 and 45 years answered questions about condom knowledge, attitudes, beliefs and practices. The respondents also provided demographic and HIV risk-related information., Results: Condom use was higher than previously found in studies in Uganda: 46% of men reported using a condom at the last casual sexual encounter; 31% reported always using condoms with casual partners. In multivariate analysis, independent correlates of condom use included higher condom self-efficacy (4-item scale, odds ratio 1.3 per scale point), lower embarrassment around condoms (3-item scale, odds ratio 0.44 per scale point), knowing where to buy a condom (odds ratio 3.9), knowing how to use a condom (8-item scale, odds ratio 1.4 per scale point), and increasing number of casual sex partners (odds ratio 1.4 per partner)., Conclusions: These data suggest that condom use may be further increased in this population by conducting demonstrations of condom use skills, preparing individuals to anticipate circumstances that make using condoms difficult and using a variety of outlets to dispense condoms.

Objective: To characterize HIV seroprevalence and risk behavior among injecting drug users (IDUs) in Rio de Janeiro, Brazil, between 1990 and 1996., Design: We report data from three separate cross-sectional samples of IDUs in Rio de Janeiro: the World Health Organization (WHO) sample (n = 479), the Proviva sample (n = 138) and the Brasil sample (n = 110). These data provide the most comprehensive view available, to date, of this understudied population in Rio., Methods: Demographic characteristics, HIV/AIDS risk behavior and HIV seroprevalence were compared across the three samples and combined analyses were performed to determine the factors associated with injecting risk behavior, sexual risk behavior and HIV seropositivity., Results: The overall HIV seroprevalence among IDUs was 25%. Two encouraging findings of the present analysis were the lower levels of needle-sharing among participants recruited in the latest years (1995-1996) and the lower HIV seroprevalence in the Proviva sample composed mainly of less educated, poorer IDUs living in deprived neighborhoods. No trends toward safer behavior were found for sexual risk, younger age being the principal factor associated with high risk., Conclusions: Levels of needle-sharing and sexual risk among IDUs in Rio remain high, demonstrating the urgent need to increase the limited preventive measures undertaken so far. Seroprevalence levels for HIV remain significantly lower in the most deprived sample, arguing for the fundamental importance of prompt and effective prevention strategies to keep infection rates from rising among the poorest and largest strata of Rio's IDUs.

Objective: To assess trends in HIV risk behaviors over a 3-year period in eight population groups in Bangkok, Thailand., Design and Subjects: Using a repeated cross-sectional survey design with a structured questionnaire, we collected five sets of self-reported sexual behavior data related to HIV risk from the following subject groups at the same sampling sites during 1993-1996: direct and indirect female sex workers, male attenders of sexually transmitted disease (STD) clinics, female attenders of antenatal care clinics, male and female vocational students, and male and female factory workers., Results: Reported patronage of commercial sex by the three male groups declined by an overall average of 48% over the 3-year period. Other non-regular sexual partnerships declined among male STD clinic attenders and vocational students. Condom use during most recent sexual intercourse between sex workers and clients peaked at high levels (>90%) in the early data waves, while among indirect sex workers and their clients, consistent condom usage increased from 56% to 89%. Low condom use persisted among sex workers and their non-paying sex partners. Single women reported low levels of sexual activity and condom use with no signs of an increase. Similarly, married women from antenatal clinics reported low condom use with their husbands, with no change throughout the period of the study., Conclusions: HIV risk behavioral surveillance is a useful way of determining whether behavior change has occurred in specific population groups. The results here confirm and add to a growing set of evidence of risk behavior reduction in Thailand. The behavioral changes did not occur uniformly but varied depending on the sexual dyad and the population group under study. Behavioral surveillance should be promoted and its methodologies strengthened in attempts to understand the local dynamics of HIV epidemics.

Background: In the developing world, HIV is spreading in many epidemiologic patterns, ranging from slow spread in limited segments of the population to exponential growth to mature epidemics. These differences are superimposed on widely varying cultures and patterns of behavior, creating unique challenges for prevention in each setting. Local prevention research is continually necessary to respond appropriately and effectively to local prevention needs and to best use scarce resources., The Research Agenda: We propose a research agenda for AIDS prevention in the developing world, consisting of three main components: epidemiologic and behavioral surveillance; enhancing local understanding of HIV risk behavior; and testing interventions. We review examples of each. This 'bottom-up' research is contrasted with 'top-down' research conducted in the developing world by scientists from developed countries to answer questions of general interest., Results: The articles published in this volume exemplify the scope and importance of AIDS prevention research in the developing world. They also show what can be accomplished through international collaboration directed towards meeting local needs.

Objectives: To describe sexual risk for HIV infection among adult night school students in São Paulo, Brazil, and to evaluate the effect of an HIV/AIDS prevention workshop to reduce sexual risk., Subjects and Methods: A longitudinal study was conducted among four demographically similar public night schools in the inner city of São Paulo. Schools were randomized into intervention and control conditions. Of 394 young adults who took part in the baseline survey, 304 (77%) completed a postintervention questionnaire., Interventions: In a workshop consisting of four sessions of 3 h each, the students discussed AIDS symbolism, the impact of AIDS on their lives, risk perception, the way in which sexual norms shape knowledge and attitudes, AIDS-related knowledge, reproduction and sexual pleasure, and condom use negotiation. We fostered community-building through AIDS training courses for teachers in the schools, peer support programs and public events., Results: At baseline, 87% had been sexually active at some time and 76% had had sex in the past 6 months. Among those who reported vaginal intercourse and/or anal intercourse, condom use was low. The workshops were positively process-evaluated and supported by the community, the students, their teachers and their parents. We obtained statistically significant effects from the workshops for females only, who reported improved communication with partners about sex and AIDS and less unprotected sex with non-monogamous partners after the intervention., Conclusion: These data show that the sexual risk of HIV infection can be lowered when Brazilian disenfranchized communities support AIDS prevention workshops. Even more impressive results may be achieved if the need to address socioeconomic obstacles and gendered sexual roles is emphasized through further long-term community development programs.

Objective: To provide the first data which evaluates an HIV risk reduction intervention designed to reduce HIV high-risk sexual behavior in African-American homosexual and bisexual men., Subjects: Participants (n = 318) were recruited from bars, bathhouses, and erotic bookstores, and through homosexual African-American organizations, street out-reach, media advertisements, and personal referrals of individuals aware of the study., Methods: Participants were randomized into a single or triple session experimental group or a wait-list control group. Both experimental interventions included AIDS risk education, cognitive-behavioral self-management training, assertion training, and attempts to develop self-identity and social support. Data collection involved assessments of self-reported changes in sexual behavior at 12- and 18-month follow-up., Results: Participants in the triple session intervention greatly reduced their frequency of unprotected anal intercourse (from 46 to 20%) at the 12-month follow-up evaluation and (from 45% to 20%) at the 18-month follow-up evaluation. However, levels of risky behavior for the control group remained constant (from 26 to 23% and from 24 to 18%) at 12- and 18-month follow-up evaluations, respectively. In addition, levels of risky behavior for the single session intervention decreased only slightly (from 47 to 38% and from 50 to 38%) at the 12- and 18-month follow-up evaluations, respectively., Conclusions: Results were interpreted to demonstrate the superiority of a triple session over a single session intervention in reducing risky sexual behavior in this cohort.

Objective: To assess reported knowledge of a partner's AIDS diagnosis, perceived risk of HIV infection, need for HIV testing and future support plans among women partners of male Ugandan AIDS patients., Subjects and Methods: A cross-sectional descriptive survey was conducted at New Mulago Hospital, Kampala, Uganda. The subjects were women partners of consecutive male AIDS patients admitted to medical wards., Results: Only 12% reported their partner's AIDS diagnosis; women who reported knowing were less likely to be financially dependent on the partner. Most women (76%) reported being at risk of HIV; in general, these women were older, in a newer relationship, had less children and were in customary rather than civil or cohabiting marriages. More than half (56%) of the women reported a need for HIV testing, though few (5%) had been tested. Those who stated the need for HIV testing were in a newer relationship, had less children and were more financially independent of their husbands; women in a cohabiting type marriage were less likely to report their need for testing than those in a civil or customary marriage. About half (56%) reported plans for future support if their husbands did not recover; these women were more likely to be in an older relationship and to have more children., Conclusions: Most women partners of AIDS patients in New Mulago Hospital reported no knowledge of their husbands' diagnosis. Over half perceived a need to be tested but very few reported having been tested, and only half reported having planned for the future of their families. Interventions are urgently needed to address barriers to knowledge and to acknowledgement of a partner's AIDS diagnosis, to HIV testing and to planning for the future.

Objective: The Brazilian Carnival is thought to be a time when the risk of HIV infection is likely to be high. We therefore compared the risk during Carnival to risk in the past month among male samba school participants in São Paulo, Brazil., Subjects and Methods: A cross-sectional study was conducted among 380 male samba school drummers randomly sampled during rehearsal for the 1993 Carnival in São Paulo by means of a 20-min interviewer-administered questionnaire. The main outcome variable was condom use with non-steady partners., Results: The sexual behavior of 36.1% of subjects risked HIV infection, but only 9.7% of all subjects were at risk only during Carnival. Subjects with a sexual risk of HIV differed from those without risk in substance use, attitudes towards condoms and expectations about Carnival; those who were at risk only during Carnival did not differ from those who were at risk at other times. About half of the subjects had been given free condoms during Carnival, although few of the men at risk had actually used them., Conclusions: Though more than a third of the drummers were at risk of HIV infection, only a small per cent were at risk only during Carnival. The level of sexual risk of HIV infection is probably better explained by factors in the men's daily lives, rather than through information on risks taken during Carnival. These results raise questions concerning the efficacy of universal condom distribution during Carnival, since about half of the men were given condoms but few of those at risk actually used them. A targeted distribution of condoms to populations with a high demonstrated risk may be more effective in preventing new HIV infection.

Objectives: To describe 'dry sex' practices intended to decrease vaginal secretions and to determine whether these practices are related to HIV infection., Subjects and Methods: A cross-sectional study was conducted in a sexually transmitted diseases clinic in a teaching hospital in Lusaka, Zambia. The subjects comprised 329 women aged 15-50 years presenting consecutively for an initial evaluation of sexually transmitted disease symptoms. Dry sex practices were assessed by questionnaire, and serological testing for HIV antibodies was performed., Results: Fifty percent of women had engaged in at least one dry sex practice. The most common practices were drinking 'porridge' (a liquid or suspension believed to cause drying of the vagina; 28%), removing vaginal secretions with a cloth (22%) and placing leaves in the vagina (11%). The most frequent reasons given for drinking porridge were to increase the partner's sexual enjoyment and to tighten the vagina, while cleaning the vagina was mentioned often by those using cloth or leaves. Swelling or peeling of the vagina was reported by approximately 10% of women using cloth or leaves. Overall, the HIV seroprevalence in the sample was 58%. In bivariate analysis, no practice was statistically significantly associated with HIV infection. Multiple logistic regression had little impact on these findings., Conclusions: Although a variety of practices with potential relevance to HIV transmission were reported, there was no evidence in this study population of a strong relationship between these practices and HIV infection. Women should be counseled about the potential risks of these practices, but prevention efforts should continue to emphasize measures of known effectiveness, particularly limiting the numbers of sexual partners, consistently using condoms and obtaining appropriate treatment for sexually transmitted diseases.

Objectives: To determine how HIV risk behavior and the prevalences of sexually transmitted diseases vary according to socioeconomic status and city among sex workers in São Paulo State, Brazil., Subjects and Methods: A cross-sectional study of 600 female sex workers (100 of a higher socioeconomic status and 100 of a lower socioeconomic status in each city) was conducted in the cities of São Paulo, Campinas and Santos. HIV risk behavior was assessed by questionnaire; serological tests were administered to assess prior exposure to HIV-1, syphilis and hepatitis B., Results: Only statistically significant (P < 0.05) findings are reported here. Compared to those with a higher socioeconomic status, sex workers with a lower socioeconomic status worked longer hours each day (9.6 versus 7.9), had more clients per day (5.4 versus 2.6) and had fewer episodes of intercourse per client per encounter (1.1 versus 1.4). Levels of condom use for vaginal, anal and oral sex were significantly higher in Santos than in São Paulo or Campinas. Twenty-three per cent of the women said they feared violence if they insisted that their clients wear condoms; 74% voiced similar fears regarding their non-client sexual partners. Overall, 11% of sex workers were positive for exposure to HIV-1, 45% for syphilis and 39% for hepatitis B. Those with a lower socioeconomic status were more likely than those with a higher socioeconomic status to be infected with HIV-1 (17 versus 4%), syphilis (66 versus 24%) and hepatitis B (52 versus 26%), but there were no differences in prevalence rates by city., Conclusions: These data demonstrate substantial heterogeneity in HIV risk behavior and the prevalence of HIV-1 and other sexually transmitted diseases among sex workers in São Paulo State, many of which were related to differences in socioeconomic status. Interventions to prevent HIV transmission among sex workers must be tailored to the local environment and, in particular, to the socioeconomic status of these workers.

Background: Prevention through behavior change is the only way to control the spread of HIV infection in the developing world. Success in prevention requires consistent and persistent intervention over time, a clear understanding of the realities of target populations and involvement of members of these populations in prevention efforts. Applied local research is urgently needed, especially in the developing world, to design interventions that meet these criteria and to test their effectiveness., Center for Aids Prevention Studies (caps) Model of International Collaborative Research: Each year, eight to 10 scientists from developing countries visit CAPS in San Francisco for 10 weeks of intensive learning and collaboration. The main emphasis is on designing a protocol for a research project related to AIDS prevention in the visiting scientist's home country. CAPS provides pilot study funding and technical assistance to implement the project., Results: The quality of the resulting collaborative research is represented by the articles published in this volume and by the many alumni of the program who have undertaken additional research projects and/or assumed leadership positions in AIDS control efforts in their countries.

Objectives: To describe adolescent knowledge, attitudes and behavior relevant to sexuality and the prevention of AIDS in Saint Petersburg, Russia., Subjects and Methods: A cross-sectional descriptive study was designed, taking a random sample of 10th grade students at 14 Saint Petersburg grade schools, which were stratified by socio-economic district. A total of 185 female and 185 male students completed a self-administered 46-item questionnaire, with a response rate of 94%., Results: From the questionnaires, 20% of females and 31% of males reported having had sexual intercourse and 25% of females and 12% of males reported being sexually abused. These adolescents displayed much misinformation about sexual matters and AIDS prevention. Only 25% of the females and 34% of the males believed that condoms should be used just once, and 38% of each sex believed that if washed, they could be used multiple times. Many respondents, especially males, rated their knowledge about sexual matters as high or adequate. Support for sex education was strong, especially among females, and respondents generally saw sex education as improving sexual pleasure. Most information sources about sexual activity were either not considered very credible, or not adequately accessible., Conclusions: Substantial reported rates of sexual abuse, sexual experience and much misinformation and unwarranted attitudes toward condoms, safer sexual practices and HIV/AIDS suggest the need for vigorous sex education programs for Russian youth. The early and sustained education of girls is especially important. Sex education should be introduced at an early age so that children can be taught how to reduce the risks of sexual abuse, HIV infection and other sexually transmitted diseases, and to improve their sexual experiences as responsible adults.

Objectives: To describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors., Subjects and Methods: A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in four demographically similar public high schools in a semi-urban district of Metro Manila, the Philippines. Of 845 high school students who participated in the baseline survey, 804 (95%) completed a postintervention questionnaire., Intervention: An AIDS prevention program was developed by public high school teachers together with local AIDS experts, social scientists and health educators. The teacher-led AIDS program was designed to provide students with accurate information about AIDS, particularly in dispelling misconceptions about casual contagion, to foster positive attitudes towards people with AIDS and to develop skills aimed at clarifying values and assessing intended behavior., Results: At baseline, 11% of students (20% of males and 4% of females) reported ever having had sexual intercourse (mean age 14 years). Among these, condom use was low (24%). After implementation of the AIDS prevention program, statistically significant effects favoring the intervention group were observed in knowledge and attitudes towards people with AIDS. While there was no statistically significant overall effect on intended preventive behavior, the program appeared to delay the students' intended onset of sexual activity., Conclusions: A sizable number of Filipino high school students are sexually active but condom use is low. School-based AIDS prevention programs can be developed and implemented in developing countries with the assistance of school personnel to address sexual issues. Our program was successful in increasing AIDS-related knowledge and improving attitudes towards people with AIDS. Supplementation with other preventive activities may be needed to achieve lasting changes in students' risk-taking behavior.

Objective: To evaluate an AIDS education intervention for health workers in Metro Manila hospitals., Methods: A randomized controlled education program consisting of lectures, role-plays, posters and pamphlets was delivered to physicians, nurses, laboratory technologists and orderlies in Manila hospitals. Knowledge, attitudes and infection control practices were measured before, immediately after, and 2 months after the intervention., Results: Baseline survey among 641 hospital workers revealed poor knowledge, negative attitudes towards AIDS patients, and inappropriate infection control practices. Immediately after the intervention, there was significant improvement in (1) knowledge scores (8.7-11.2 in the intervention group versus 8.5-9.5 in the control group; range, 0-14), (2) attitude scores (54.4-60.6 versus 54.6-56.8; range, 22-88), and (3) needle-recapping practices (14-43% versus 39-43%) (all P values < 0.001). After 2 months, attitude scores in the experimental group fell to the same level as those of the control group, while improvements in knowledge and needle recapping were largely maintained. Role-playing was considered by the participants to be the most effective component of the intervention., Conclusions: These results suggest that AIDS training for hospital workers in the Philippines and in similar countries is necessary and can be effective. Ideally, such training should include role-playing and should be ongoing in order to sustain the effect.

Objective: Little has been published about the length and determinants of survival for persons with AIDS in developing countries. This study examined the survival experience of Brazilian AIDS patients from 1982 to 1989., Design: A retrospective cohort study involving record review of reported AIDS cases., Methods: We obtained information about 2135 adult AIDS patients in Brazil. Local health officials supplied data regarding demographic and clinical characteristics and length of survival. Statistical techniques of survival analysis were applied., Results: Median survival was 5.1 months, much shorter than in developed countries, and there was no improvement in survival for cases diagnosed more recently. Younger patients and those in the intravenous drug use exposure category lived longer than other AIDS patients. Those presenting with Kaposi's sarcoma, esophageal candidiasis, and tuberculosis fared relatively well, while those presenting with multiple diagnoses or toxoplasmosis did more poorly., Conclusions: These results tend to confirm the predictors of AIDS survival previously reported from developed countries and to document the poor survival of AIDS patients in the developing world.