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An introduction is presented in which the editor discusses articles in the issue on the topics including papers from 14th AIDSImpact conference with broad range of global considerations; and psychological ramifications of the epidemic need as much understanding as the virological challenge.

The world in 2010 is a very different place to 1987 when Bhugra's paper on homophobia was published. Huge shifts have occurred in society's attitudes to gender, sex, sexuality and identity - notably by the internet, changes in HIV treatment, media representation of homosexuality and feminism and the role of women in society. This paper updates the literature review on homophobia revisiting society's assumptions about homosexuals. Changes are discussed in the context of definitions of homophobia, socio-cultural and politico-legal perspectives and homophobia and medicine. New current assumptions are drawn up and offered as a way of understanding both development and limitations - whilst there has been a reduction in the fear associated with gay men and women, discrimination remains. Newer issues such as internalised homophobia, globalisation and mainstream representations of homosexuality add complexity to this ongoing concern. [ABSTRACT FROM AUTHOR]

Government AIDS education campaigns are based on a number of tacit assumptions. They presuppose that an increase in knowledge of HIV transmission routes will produce behavior change in and of itself. In addition, the major slogans used in nationwide media campaigns make three further assumptions: 1. there are objective facts that are undisputably true, 2. such facts can be assessed via scientific inquiry, and 3. individual freedom of behavioral choice. Research reported in this paper aims to assess to what extent a consensus with regard to these assumptions can be expected among ‘the general public’. The material presented in this paper is based on a series of depth interviews with 12 representative individuals. Qualitative analysis of interview transcripts via the identification of fundamental assumptions about the world in respondents' discourse revealed a concern with emotional and psychological factors which is not matched by national AIDS slogans. [ABSTRACT FROM AUTHOR]

Ethnostatistics is the study of the social practices surrounding the construction and interpretation of statistics. This paper considers certain ethnostatistical aspects of the official statistics on AIDS cases - the monthly updated figures on AIDS cases supplied by the Department of Health and derived from the English and Scottish voluntary reporting schemes. The paper focuses on problems in the classification of cases according to the route of virus transmission, particularly where multiple risk practices may be reported. Some (but not all) classification problems can be avoided by adopting a cross-tabular format of presentation. The data on reported Scottish AIDS cases are re-analysed in order to illustrate such a cross-tabular representation. These data are the basis for a concluding statement on the difficulties in projecting future heterosexual epidemic spread. [ABSTRACT FROM AUTHOR]

This think-piece sets out, from a donor perspective, the growing momentum behind social protection as a mechanism for reaching vulnerable children affected by multiple shocks such as HIV/AIDS and the global financial crisis. It briefly documents the evidence base underlying this consensus amongst development partners and the opportunities it presents. This paper also highlights some of the key challenges in accelerating the scale-up of social protection programmes, particularly in low-income settings, and highlights the importance of strengthening of social protection systems, both state and non-state partners, as a strategic long-term investment. [ABSTRACT FROM AUTHOR]

This paper is based on data collected in 2009 for the international Stigma Index Study which measured the experiences of stigma among participants living with HIV in the UK. Data were collected using a self-completed survey questionnaire and focus group discussions. Quantitative data were analysed using SPSS, while qualitative data were subjected to thematic analysis. The Stigma Index attempts to establish a baseline for documenting the experience of stigma and discrimination by people living with HIV while also acting as an advocacy tool whose power lay in the involvement of people living with HIV in the design of study instruments and data collection. Participants were recruited through collaborations with a broad range of UK HIV support organisations. The ethics protocols used were those described in the Stigma Index guidebook. A total of 867 people living with HIV took part, of whom 276 described themselves as 'immigrants'. Most of this 'migrant' subsample (70%) was women. Nearly, all (91%) identified as heterosexual, while 9% were attracted to someone of the same sex as them. Socioeconomic deprivation was a key theme and they reported other stigmatised chronic conditions in addition to HIV. It is not possible to ascertain from the questionnaire, the migrants' countries of origin and length of stay in the UK. Control of information about HIV was critically managed, with respect to family and partners. Felt stigma increased anxieties about personal safety, particularly among men. Strategies for safeguarding against the negative impact of stigma included avoiding social gatherings, intimacy, and clinical and HIV social care settings. Most participants were unaware of policies and declarations that protected them as persons living with HIV. Specific recommendations include creating awareness about rights as enshrined in various legal frameworks that protect the right of people living with HIV, which has been reconfigured as a 'disability'. [ABSTRACT FROM AUTHOR]

During the last 20 years, both the United Kingdom and the Russian Federation have seen changes to clinical services for sexually transmitted diseases (STDs) health systems and other mechanisms through which STDs are controlled. In the UK these changes followed the description of the acquired immunodeficiency syndrome (AIDS) and the human immunodeficiency virus (HIV); its causal agent. In Russia, the breakdown of the Soviet Union following glasnost and perestroika, and its associated political, social and economic changes generated substantial developments to the ideological and legislative framework within which STD control is achieved as well as a revolution in the financial base upon which clinical STD services operate. The purpose of this paper is to sketch these developments in STD services within the 2 countries to provide a context for the series of papers presented in this edition. [ABSTRACT FROM AUTHOR]

The core of this paper' is a case study of how a District Health Authority (Paddington and North Kensington, now Parkside DHA following a recent merger with Brent DHA) in Inner London responded to a major new health care issue of the 1980s-Aids, but the paper also seeks to locate this case study material within wider debates. What theories are there of organisational change which could be used to illuminate policy and service change in the health care sector? How, indeed, do we best study change in health care organisations? The paper is thus in three parts. In the first section we identify some streams of literature which act as a frame of reference defining our initial research question and discuss implications for methodology. The second section presents the case itself, while the last section discusses some emerging findings. [ABSTRACT FROM AUTHOR]

This paper outlines the changing face of HIV and AIDS in the UK over the past quarter of a century against the backdrop of the global pandemic. It discusses the changing pattern of the HIV infection and its treatment, and associated shifting attitudes and prejudices. It considers the influence of migration to the UK of individuals from high prevalence countries, on both the epidemiology of HIV and the resultant health needs of today's multicultural UK population. Finally, it recommends a refocusing on the subject by the government and professionals involved in health preventive services within the community setting. [ABSTRACT FROM AUTHOR]

In the UK, substantial numbers of new HIV diagnoses are within migrant communities, especially African communities. Current surveillance shows that despite health promotion efforts and advances in therapy these communities are accessing HIV care late. This paper explores the issues influencing the access and uptake of HIV care by migrant Africans in Britain. Using Kleinman's model of health care systems (Kleinman, 1980) as a theoretical framework, we highlight the importance of placing health within its broader context if we are to make significant improvement to the health of HIV-infected Africans in Britain. [ABSTRACT FROM AUTHOR]

Knowledge of HIV and AIDS is widely seen as an important determinant of anxiety about such infection in health care workers. However, existing measures of this knowledge suffer from a number of methodological problems and few demonstrate adequate reliability and validity. This paper documents the development of a new measure detailing its reliability and validity. Knowledge, and also confidence in knowledge, were assessed across seven domains of relevant information (e.g. epidemiology, personal risk, symptomatology) in one non-expert group (non-medical undergraduate psychologists) and in three groups with greater expertise (nursing students and third year and final year medical students). The measure was shown to be reliable and to discriminate between the four groups in a manner consistent with the level of education received by each group and in terms of both the scale scores for the seven domains and the individual items. In general, final year medical students were shown to be more knowledgeable, and more confident in their knowledge, than the other groups. The non-medical undergraduates showed the lowest level of knowledge. In general, the groups appeared under-confident in their knowledge about HIV/AIDS. This was interpreted in terms of members of these groups exhibiting caution and the perceived fluctuating nature of the HIV knowledge base. Implications for the training of health care workers in relation to HIV/AIDS are discussed. [ABSTRACT FROM AUTHOR]

Two statistical issues that have arisen in the course of a study of mortality and disease related to the human immunodeficiency virus (HIV) in the haemophilia population of the UK are discussed. The first of these concerns methods of standardization for age and it is shown that, when the mortality of HIV-infected individuals with different severities of haemophilia are compared, an analysis based on the ratio of observed to national expected deaths suggests that mortality in HIV-infected individuals depends on the severity of their haemophilia. This conclusion is inappropriate and mortality in HIV-infected individuals is, in fact, similar regardless of severity of haemophilia. The second part of the paper discusses the effect of using various end points for studies of survival and progression of HIV-related disease. In the present example it was possible to calculate relative survival in HIV-infected individuals, i.e. survival after correcting for mortality expected in the absence of HIV infection. An analysis based on absolute survival gave a very similar picture of the effect of age at infection to an analysis based on relative survival, whereas an analysis based on the time to diagnosis of acquired immune deficiency syndrome (AIDS) underestimated the effect substantially and the possible alternative end point of time to AIDS or HIV-related death was shown to be subject to considerable misclassification error. [ABSTRACT FROM AUTHOR]

Since the late 1980s, regular monitoring of the human immunodeficiency virus epidemic in England and Wales has been carried out through the work of successive national working groups. One of their tasks has been to provide short-term projections of the incidence of acquired immune deficiency syndrome. In this paper the data and methods used in this projection work are reviewed and results critically assessed with the aim of highlighting the strong interaction between methodological developments and data acquisition. [ABSTRACT FROM AUTHOR]

Background: People who use drugs with life-limiting illnesses experience substantial barriers to accessing palliative care. Demand for palliative care is expected to increase during communicable disease epidemics and pandemics. Understanding how epidemics and pandemics affect palliative care for people who use drugs is important from a service delivery perspective and for reducing population health inequities. Aim: To explore what is known about communicable disease epidemics and pandemics, palliative care, and people who use drugs. Design: Scoping review. Data sources: We searched six bibliographic databases from inception to April 2021 as well as the grey literature. We included English and French records about palliative care access, programs, and policies and guidelines for people ⩾18 years old who use drugs during communicable disease epidemics and pandemics. Results: Forty-four articles were included in our analysis. We identified limited knowledge about palliative care for people who use drugs during epidemics and pandemics other than HIV/AIDS. Through our thematic synthesis of the records, we generated the following themes: enablers and barriers to access, organizational barriers, structural inequity, access to opioids and other psychoactive substances, and stigma. Conclusions: Our findings underscore the need for further research about how best to provide palliative care for people who use drugs during epidemics and pandemics. We suggest four ways that health systems can be better prepared to help alleviate the structural barriers that limit access as well as support the provision of high-quality palliative care during future epidemics and pandemics. [ABSTRACT FROM AUTHOR]

Abstract: Over the last two decades, HIV and AIDS have been framed as a “global problem”. In the process, transnational advocacy networks have emerged as important actors, and particular places are recognised as key nodes in global HIV and AIDS governance. Using the example of London, UK, this paper examines how these networks are involved in local articulations of global governance and reveals that ‘global’ processes are inflected by the locations through which networks are routed. The example suggests the need for further analysis of the geographies through which HIV and AIDS is reconfiguring power relations at a variety of spatial scales. [Copyright &y& Elsevier]

Advertising has a dual function for British public health. Control or prohibition of mass advertising detrimental to health is a central objective for public health in Britain. Use of mass advertising has also been a more general public health strategy, such as during the initial government responses to HIV/AIDS in the 1980s. We trace the initial significance of mass advertising in public health in Britain in the postwar decades up to the 1970s, identifying smoking as the key issue that helped to define this new approach. This approach drew from road safety and drink driving models, US advertising theory, relocation of health education within the central government, the arrival of mass consumption, and the rise of the "new public health" agenda. [ABSTRACT FROM AUTHOR]

Objectives: To investigate risk of AIDS and mortality after transition from paediatric to adult care in a UK cohort of young people with perinatally acquired HIV. Methods: Records of people aged ≥ 13 years on 31 December 2015 in the UK paediatric HIV cohort (Collaborative HIV Paediatric Study) were linked to those of adults in the UK Collaborative HIV Cohort (CHIC) cohort. We calculated time from transition to a new AIDS event/death, with follow‐up censored at the last visit or 31 December 2015, whichever was the earliest. Cumulative incidence of and risk factors for AIDS/mortality were assessed using Kaplan–Meier and Cox regression. Results: At the final paediatric visit, the 474 participants [51% female, 80% black, 60% born outside the UK, median (interquartile range) age at antiretroviral therapy (ART) initiation = 9 (5–13) years] had a median age of 18 (17–19) years and CD4 count of 471 (280–663) cell/μL; 89% were prescribed ART and 60% overall had a viral load ≤ 400 copies/mL. Over median follow‐up in adult care of 3 (2–6) years, 35 (8%) experienced a new AIDS event (n = 25) or death (n = 14) (incidence = 1.8/100 person‐years). In multivariable analyses, lower CD4 count at the last paediatric visit [adjusted hazard ratio = 0.8 (95% confidence interval: 0.7–1.0)/100 cells/μL increment] and AIDS diagnosis in paediatric care [2.7 (1.4–5.5)] were associated with a new AIDS event/mortality in adult care. Conclusions: Young people with perinatally acquired HIV transitioning to adult care with markers of disease progression in paediatric care experienced poorer outcomes in adult care. Increased investment in multidisciplinary specialized services is required to support this population at high risk of morbidity and mortality. [ABSTRACT FROM AUTHOR]

The contract is the main mechanism for governing transactions within public sector ‘quasi markets’. This article explores the nature of the contracting process in the light of new empirical data from a qualitative study of the development of contracting for HIV/AIDS services within the National Health Service, These data are compared with four possible models of the contracting process emerging from the academic literature, classical, relational, regulated and pseudo contracting. The White Paper on the NHS reforms uses a classical concept of contracting, in which purchasers are represented as making well informed and unrestricted choices between competing options. This bore little relation to the process observed within the four purchasing organizations studied. Instead, elements of all the models were observed, with the dominance of any one model varying with different situations, tinges and localities. Competition was only patchily evident, with purchasers more commonly encouraging co-operative relationships between providers to preserve stability. Attempts to utilize the contract process to mould and reconfigure services were often hampered by restrictions imposed by regulations and slow implementation of new mechanisms. Contracting was also adversely affected by rapid organizational change and lack of adequate information. It is concluded that contracting in the NHS is an evolving process and has yet to achieve its full potential as a management mechanism. [ABSTRACT FROM AUTHOR]

The literature on strategic change is based mostly on research in the private sector. This paper suggests that change in public sector organizations is equally worthy of study and can offer novel insights. Findings from research into the development of services for HIV/AIDS in NHS health districts are used to illustrate six generic themes in strategic change processes. The first theme concerns the role of context in potentiating change, and in promoting a diverse response in different localities despite unifying government guidelines. A second theme introduces the initiators of change, the 'product champions', a less homogeneous group than is sometimes suggested. Although personal status, energy and pro-activity were shared characteristics, individuals differed in style and methods used to attain goals. Theme three highlights social movements as mediators of change. Consumerism has affected both private and public sector industry, but for HIV/AIDS the process has been particularly visible. The mobilising role of crisis comes next. A three phase model is suggested, linking 'crisis-as-threat' and 'crisis-as-opportunity' theories. A fifth theme concerns changes in organizational culture provoked by HIV/AIDS, and the role played by symbolism -- often unpredictable and not easily manipulated by management. The last theme is organizational learning; how learning about HIV/AIDS diffused through the districts, and how well learning generalizes to other issues. In conclusion, it is argued that the study of processes of change in a public sector organization can contribute to general models of strategic change and help to develop organizational theory. [ABSTRACT FROM AUTHOR]

Late diagnosis of human immunodeficiency virus (HIV) (CD4 < 350) remains common in the UK and missed opportunities (MOs) for testing are often evident. National guidelines recommend HIV clinics conduct look-back reviews in all patients presenting late; however, a standardised methodology is not available and reviews are not routinely performed. This multi-centre audit reviewed all new, late HIV diagnoses across three centres in North East England. A standardised review process (incorporating a shared regional pathology system and summary care records) was used to identify MOs. Of 45 late diagnoses reviewed (median age 45 years, 76% male, median CD4 cell count 134), 28 (62%) had one or more MO, with a median of 18 months from MO to presentation. Sixty-two per cent of MOs occurred in primary care and most (82%) consisted of indicator conditions. At HIV presentation, 27 (60%) suffered moderate harm, 16 (36%) presented with acquired immune deficiency syndrome (AIDS) and 10 (22%) suffered severe harm, including 3 (7%) who died. Despite challenges in eliciting full medical records, the comprehensive review process described, which incorporates two regional electronic records, was more effective than previous methodologies and identified more MOs. Many people present with late HIV infection or AIDS and increased efforts are needed to improve testing. [ABSTRACT FROM AUTHOR]

“Health psychology” is a newer sub-discipline whose research methodologies, theories, and practices were borrowed from diverse areas of psychology. It appeared later in France than in the United States or United Kingdom. In 1966, I adopted a perspective between anthropology and psycho-sociology of medicine. I never have self-identified as a “Health Psychologist”, continuing to work outside of disciplinary boundary constraints, but studied health questions moving first from psychology (and anthropology), through social psychology to sociology. By the 1980s, I adopted an even broader multi-disciplinary approach to health, as the HIV/AIDS epidemic urgently challenged health researchers/practitioners, in France and worldwide. [ABSTRACT FROM AUTHOR]

Objectives We sought to compare all-cause mortality of people living with HIV and accessing care in Canada and the UK. Methods Individuals from the Canadian Observational Cohort ( CANOC) collaboration and UK Collaborative HIV Cohort ( UK CHIC) study who were aged ≥ 18 years, had initiated antiretroviral therapy ( ART) for the first time between 2000 and 2012 and who had acquired HIV through sexual transmission were included in the analysis. Cox regression was used to investigate the difference in mortality risk between the two cohort collaborations, accounting for loss to follow-up as a competing risk. Results A total of 19 960 participants were included in the analysis ( CANOC, 4137; UK CHIC, 15 823). CANOC participants were more likely to be older [median age 39 years (interquartile range ( IQR): 33, 46 years) vs. 36 years ( IQR: 31, 43 years) for UK CHIC participants], to be male (86 vs. 73%, respectively), and to report men who have sex with men ( MSM) sexual transmission risk (72 vs. 56%, respectively) (all P < 0.001). Overall, 762 deaths occurred during 98 798 person-years ( PY) of follow-up, giving a crude mortality rate of 7.7 per 1000 PY [95% confidence interval ( CI): 7.1, 8.3 per 1000 PY]. The crude mortality rates were 8.6 (95% CI: 7.4, 10.0) and 7.5 (95% CI: 6.9, 8.1) per 1000 PY among CANOC and UK CHIC study participants, respectively. No statistically significant difference in mortality risk was observed between the cohort collaborations in Cox regression accounting for loss to follow-up as a competing risk (adjusted hazard ratio 0.86; 95% CI: 0.72-1.03). Conclusions Despite differences in national HIV care provision and treatment guidelines, mortality risk did not differ between CANOC and UK CHIC study participants who acquired HIV through sexual transmission. [ABSTRACT FROM AUTHOR]

Thirty years on from the dramatic and unprecedented AIDS advertising campaign in the UK organised by the Conservative government of the late 1980s, this article reassesses the experience drawing upon subsequent memoirs and interviews. It does so in the context of an emergence of risk politics in the UK in the 1980s, situated within an historical perspective on the development of risk within modernity. I emphasise the forgotten pragmatic, amoral core of the campaign which challenged the illiberal climate of the times, and how it was possible for a government defined by high moralism to challenge it. I outline the range of pressures that led to the campaign, including the conscious attempt to limit stigmatisation amidst the mood of wartime emergency that prevailed in late 1986/early 1987. Its emergency character meant little direct legacy of harm reduction has endured, but I argue for a wider significance of the campaign as a key moment in the emergence of risk politics in the UK and beyond. [ABSTRACT FROM AUTHOR]

We present the updated British Association for Sexual Health and HIV guidelines for HIV post-exposure prophylaxis following sexual exposure (PEPSE). This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE should and should not be considered. We also review which medications to use for PEPSE, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving PEPSE. Special scenarios, cost-effectiveness of PEPSE, and issues relating to service provision are also discussed. Throughout the document, the place of PEPSE within the broader context of other HIV prevention strategies is considered. [ABSTRACT FROM AUTHOR]

An obituary for former consultant chemical pathologist Aram Soli Rudenski is presented.

In the UK there are limited data about university students’ risky sexual behaviour. A cross-sectional web-survey was conducted to investigate factors associated with high-risk sex among students at two UK universities. High-risk sex was reported by 25% of 1108. High personal sexually transmitted infection (STI) risk perception and permissive attitudes towards casual sex were associated with high-risk sex for both men (odds ratio [OR]: 12.12; 95% confidence interval [CI]: 4.10–35.81; OR: 2.49; 95%CI: 1.11–5.56, respectively) and women (OR: 22.31; 95% CI: 9.34–53.26; OR: 3.02; 95% CI: 1.82–5.01, respectively). For men, drinking alcohol (OR: 17.67; 95% CI: 1.90–164.23) and for women age and frequent drinking (OR: 2.02; 95% CI: 1.05–3.89; OR: 1.89; 95% CI: 1.08–3.31, respectively) were associated with high-risk sex. However, perceiving an average student as more likely to contract STIs (men, OR: 0.34; 95% CI: 0.16–0.75) or HIV (men, OR: 0.44; 95% CI: 0.20–0.96; women, OR: 0.42; 95% CI: 0.28–0.63) and finding it difficult to discuss sexual matters (women, OR: 0.60; 95% CI: 0.39–0.91) were negatively associated with high-risk sex. Most of the factors found were similar to other populations, but some psychosocial factors showed complex patterns of association that require further investigation. [ABSTRACT FROM AUTHOR]

This feature explores the information behaviour of people infected with or affected by HIV/ AIDS. It investigates specifically the difficult issue of stigma and how this shapes the ways in which people interact with vital information. The study adopted an ethnographic whereby the researcher worked as a part-time volunteer at an HIV support centre in the North of England for over a year. This is the first time that such an approach has been reported in this feature and is interesting from this perspective alone. The very rich data which was gathered as a result of the approach is also instructive. The study formed part of a PhD thesis, which Robinah Kalemeera Namuleme completed at the University of Sheffield in March 2013. [ABSTRACT FROM AUTHOR]

In 2010/2011, regional commissioners withdrew payment for the fixed-dose combination Combivir, forcing a switch to component drugs. This was deemed clinically acceptable and annual savings of £44 k expected. We estimated the true costs of switching and examined patient outcomes. Information for 46 patients using Combivir was extracted from case notes for each clinical contact in the 12 months pre- and post-switch (clinician seen, tests, antiretrovirals). Post-switch care costs £93/patient more annually versus pre-switch (95% CI £424 to £609), yielding £4278/year more post-switch for all patients. Drug and pathology costs were more expensive post-switch and extra clinical visits required. None of these results were statistically significant. Forty-two per cent of patients switched directly or in the subsequent year to an alternative fixed-dose combination rather than generics. Costs in this group were significantly higher post-switch driven by drug cost. Six patients (13%) reported problems with the switch including confusion around dosing and new side effects. As less-expensive generic antiretroviral drugs become available, it may appear cheaper to switch from fixed-dose combinations to component drugs. However, the additional clinical costs involved may outweigh the initial cost savings of the drugs and switching may cause confusion for some patients, risking loss of adherence. [ABSTRACT FROM AUTHOR]

In this Poll Trends study, 13 different sources are used to document public opinion toward homosexuality and gay rights in Great Britain in the postwar period. Three broad sets of indicators are examined: general attitudes toward homosexuality; acceptability of homosexuals in particular roles; and attitudes toward homosexual rights. Opinion was overwhelmingly negative in the 1940s and 1950s but started to liberalize following the decriminalization of homosexuality in 1967. Attitudes suffered a temporary setback with the advent of AIDS in the mid-1980s, but the thaw resumed from the early 1990s and accelerated following the millennium, especially during the second half of the first decade of the 2000s, culminating in the successful campaign for legalization of same-sex marriage in England and Wales. This trend toward liberalization has direct parallels in growing public support for several other facets of equality in Britain, notably gender, race, and religion. It also coincides with a significant reduction in religious allegiance. [ABSTRACT FROM PUBLISHER]

Objective: In many high-income countries with low HIV prevalence, significant numbers of persons living with HIV (PLHIV) remain undiagnosed. Identification of PLHIV via HIV testing offers timely access to lifesaving antiretroviral therapy (ART) and decreases HIV transmission. We estimated the effectiveness and cost-effectiveness of HIV testing in the United Kingdom (UK), where 25% of PLHIV are estimated to be undiagnosed. Design: We developed a dynamic compartmental model to analyze strategies to expand HIV testing and treatment in the UK, with particular focus on men who have sex with men (MSM), people who inject drugs (PWID), and individuals from HIV-endemic countries. Methods: We estimated HIV prevalence, incidence, quality-adjusted life years (QALYs), and health care costs over 10 years, and cost-effectiveness. Results: Annual HIV testing of all adults could avert 5% of new infections, even with no behavior change following HIV diagnosis because of earlier ART initiation, or up to 18% if risky behavior is halved. This strategy costs £67,000–£106,000/QALY gained. Providing annual testing only to MSM, PWID, and people from HIV-endemic countries, and one-time testing for all other adults, prevents 4–15% of infections, requires one-fourth as many tests to diagnose each PLHIV, and costs £17,500/QALY gained. Augmenting this program with increased ART access could add 145,000 QALYs to the population over 10 years, at £26,800/QALY gained. Conclusions: Annual HIV testing of key populations in the UK is very cost-effective. Additional one-time testing of all other adults could identify the majority of undiagnosed PLHIV. These findings are potentially relevant to other low-prevalence, high-income countries. [ABSTRACT FROM AUTHOR]

Although available for over a decade, use of nonoccupational postexposure prophylaxis (nPEP) remains controversial in the United States. There are concerns over sexual assault survivors' adherence, or lack thereof, leading to increased costs without an appreciable decrease in human immunodeficiency virus (HIV) transmission. This review examines and synthesizes the available literature from the past 10 years to determine the true rates of provision and adherence to nPEP regimens in sexual assault survivors in low HIV prevalence, industrialized nations. Findings suggest that further prospective research is necessary to better understand the process of post-assault nPEP evaluation and subsequent follow-up and adherence. [ABSTRACT FROM AUTHOR]

Background: A significant research literature exists that details the sexual health and sexual behaviour of gay and bisexual men who have diagnosed HIV. However, much of this research has focussed on HIV transmission risk behaviours among this group, rather than seeking to understand their sexual health and sexual well-being more broadly. There have been growing calls for interventions to support people with diagnosed HIV to achieve health and well-being, including sexual health and well-being. A detailed understanding of the problems people in this group face, and how they might be overcome, is required to facilitate such interventions. Methods: One thousand two hundred and seventeen gay and bisexual men with diagnosed HIV were recruited by convenience sampling through charitable AIDS service organisations, genitourinary medicine clinics and local authority agencies to complete a survey of their health and social care needs. Respondents were asked to report any problems they had with regards to sex during the 12 months prior to survey completion. They were also asked to describe what support might help them to overcome any problems they experienced. Results: Overall, 70.5% of the gay and bisexual men with diagnosed HIV completing the survey reported one or more problems with sex within the previous 12 months. Most commonly reported problems include loss of libido (44.0%, n=540), poor self-image or low self confidence (43.9%, n=534), worries about passing HIV to potential sexual partners (37.3%, n=454), and fears of rejection from sexual partners (34.7%, n=422). Responses varied according to age, time since diagnosis, and whether or not the respondent was currently taking anti-retroviral therapy. Qualitative analysis of data relating to what support might help men overcome problems with sex indicate a need for therapeutic support to increase self esteem and confidence, clarity on criminalisation of HIV transmission, the tackling of HIV related stigma and help to achieve a higher quality (as opposed to quantity) of sex. Conclusions: The findings indicate a need for the maintenance and expansion of services to meet the significant needs of people with diagnosed HIV, especially as these intersect with their ability to negotiate sex that is satisfying. [ABSTRACT FROM AUTHOR]

The author reflects on the nursing profession and issues related to palliative care in Great Britain. He commented that nursing, established as an academic discipline with undergraduate degree courses and postgraduate study, has increased and that training nurses on drug prescription has been available. He added that palliative care remains to be marginalized from mainstream medicine. Furthermore, the author discussed about HIV/AIDS considered as a major palliative care issue.

Understanding the definition and meaning of the word 'sex' has implications for sexual medicine, HIV/AIDS research, and clinical practices. Previous studies have reported variations in the definition of having 'had sex' and the necessity of using behaviorally specific terminology when taking sexual histories and assessing sexual risk. The purpose of the current study is to assess gay men's definitions of what constitutes having 'had sex.' Two international convenience samples are compared: a UK sample of 180 self-identified gay men ranging from 18 to 56 years of age (M=36 years; SD=8.29) and a US sample of 190 self-identified gay men ranging 18-74 years of age (M=33.9 years; SD=12.49). Both groups were asked to indicate whether each of a list of sexual behaviors was considered having 'had sex.' Almost all participants (~95%) believed that penile-anal intercourse constituted having 'had sex.' US and UK gay men differed in defining the following as having 'had sex': giving oral-genital stimulation (US 71.6%, UK 84.9%, P=0.002); giving (G) and receiving (R) manual-anal stimulation (G: US 53.4%, UK 70.9%, P=0.001; R: US 53.7%, UK 71.2%, P=0.001); giving and receiving oral-anal stimulation (G: US 61.2%, UK 78.4%, P<0.001; R: US 59.3%, UK 78.1, P<0.001); and giving and receiving sex-toy stimulation (G: US 55%, UK 77.1%, P<0.001; R: US 56.1%, UK 77.7%, P<0.001). It is important to note that regardless of country there was not overall consensus on which behaviors constituted having 'had sex.' These findings reinforce the need for behavioral specificity in documenting sexual histories and assessing sexual risk. Further, researchers and clinicians should exercise caution by not assuming that their own definitions of the term 'sex' is shared by their gay male participants or patients. [ABSTRACT FROM AUTHOR]

This article aims to examine patterns of and concerns about drug use among a convenience sample of MSM in 2005, and compare the prevalence of illicit drug use among 1999 and 2005 samples of MSM in England and Wales. It draws on data from cross-sectional surveys of MSM in gay community venues and services across England and Wales, 2480 in 1999 and 3913 in 2005. We report that in 2005, cocaine, cannabis and alkyl nitrites were the drugs most commonly used in the previous year by MSM inside and outside London. Drug use was significantly more common among men who were younger and resided in London, and among those who reported greater numbers of male sexual partners and were HIV-positive. Frequency of use was generally high among those who used a drug, and poly-drug use was also high. A substantial minority of men who used illicit drugs were worried about use. More men in 2005 than in 1999 reported using various drugs including cocaine, ecstasy and ketamine. We conclude that use of drugs is widespread among the MSM surveyed. Exclusive use of any one drug is rare. There is an urgent need for drug prevention and treatment interventions, which are accessible and acceptable to MSM. [ABSTRACT FROM AUTHOR]

Background. Confidentiality is considered a cornerstone of the medical consultation. However, the telephone, previously used mainly to negotiate appointments, has become increasingly employed as a means of consultation and may pose new problems in respect to maintaining confidentiality. [ABSTRACT FROM PUBLISHER]

The National Institute for Health and Clinical Excellence (NICE) contracted public health historians to assess a collection of grey literature inherited from the Health Development Agency (HDA). The records stem mainly from the HDA's forerunners, the Health Education Authority and the Health Education Council. Material in the collection spans the period 1970-2004, although the majority of records date from the 1980s and 1990s A broad range of health topics are covered and the main focus of the collection is public health education The issue of smoking and health is strongly represented throughout the timeline of the collection. From the 1980s, material on HIV/AIDS is equally well represented Indeed, the AIDS material held in this collection is particularly significant, as the Health Education Authority took responsibility for the national AIDS education campaign from the mid-1980s The collection offers possibilities for research into the post-war history of public health but its future is currently uncertain. [ABSTRACT FROM AUTHOR]

The article informs that a considerable number of students undertaking pre-registration nurse education in UK are international students from Zimbabwe. The traditional strength of nursing education in Zimbabwe itself has been the large labor pool available for recruitment into the programmes. Factors prompting migration to the UK are reported to include the emphasis on education as a means of social mobility; the economic crisis, and the disruption of family ties by the HIV epidemic. Educational courses for nursing are the means to prevent their aspirations for professional occupation floundering on current economic and political instability in Zimbabwe, rather than a positive career choice.

The aim of this study was to describe the needs of people living with HIV in the UK. A questionnaire addressing 17 areas of need was completed by 1821 people living with HIV in the UK. The core need indicator was a personal assessment of happiness with current state. A quarter of all respondents were happy with their current state across all needs. For each need, the following proportions were unhappy with their current state: sex, 40%; anxiety/depression, 33%; sleep, 32%; self-confidence, 32%; money, 28%; household chores and self-care, 18%; housing, 18%; appetite, eating and drinking, 17%; friendships, 17%; discrimination, 16%; mobility, 15%; dealing with health professionals, 15%; relationships, 14%; drugs and alcohol, 9%; taking treatments regularly, 5%; HIV treatment knowledge, 4%; looking after children, 2%. Although some people with HIV are coping well with minimal unmet need, the overall picture of need is dominated by personal, social and economic issues. [ABSTRACT FROM AUTHOR]

Traditional criminal law scholarship in the field of offences against the person fails adequately to problematize core concepts, such as responsibility, harm and causation. This article considers different ways in which we might think about such concepts, by exploring questions relating to responsibility for the sexual transmission of HIV. It is argued that the complex meanings associated with HIV transmission are inadequately captured if we think of it simply as a corporeal harm inflicted on one person by another,and that lawyers should be open to alternative interpretations of the harm which transmission represents. [ABSTRACT FROM AUTHOR]

The data set of 2,182 gay/bisexual men's month-long sexual diaries collected by the United Kingdom Socio-sexual Investigations of Gay Men and Aids (Project SIGMA) was used to analyse the extent to which acts of anal intercourse (AI) are distributed among gay men, using the Lorenz/Gini methodology for measuring concentration. Most individuals (60%) who engage in AI do so only once or twice a month, but there is a long tail of those who do it much more. In terms of the amount of AI acts, one tenth of the individuals are performing half of the acts of AI. The Gini coefficient of concentration is high (0. 55). Factors most affecting rates and concentration of risk behaviour include relationship status, HIV sero-status and concordant/discordant partner status. [ABSTRACT FROM AUTHOR]

Short-term projections of the acquired immune deficiency syndrome (AIDS) epidemic in England and Wales have been regularly updated since the publication of the Cox report in 1988. The key approach for those updates has been the back-calculation method, which has been informally adapted to acknowledge various sources of uncertainty as well as to incorporate increasingly available information on the spread of the human immunodeficiency virus (HIV) in the population. We propose a Bayesian formulation of the back-calculation method which allows a formal treatment of uncertainty and the inclusion of extra information, within a single coherent composite model. Estimation of the variably dimensioned model is carried out by using reversible jump Markov chain Monte Carlo methods. Application of the model to data for homosexual and bisexual males in England and Wales is presented, and the role of the various sources of information and model assumptions is appraised. Our results show a massive peak in HIV infections around 1983 and suggest that the incidence of AIDS has now reached a plateau, although there is still substantial uncertainty about the future. [ABSTRACT FROM AUTHOR]

Reports the impact of the paper, 'Working for Patients' to the services for AIDS patients in Great Britain. Interests of the British Medical Association to discuss reforms on AIDS care; Requirement of an integrated care system for the patients; Neglect for other disease groups who failed to represent their views.

The article focuses on practical problems and issues associated with HIV counseling. Motivating people at risk of HIV infection to make a reliable change in their sexual behavior is believed to be the only available way to stop the HIV pandemic. A series of studies in Great Britain have shown that advertisements about AIDS failed to adjust public misconception and anxieties on the disease.

The article highlights the practical challenges associated with the management of AIDS-related psychiatric disorder. It is claimed that most psychiatrist hospitals are not capable of handling cases involving violent AIDS patients. Training of health professionals in relation to problems presented by AIDS is necessary.

The article focuses on the beliefs and attitudes regarding AIDS among college students in Great Britain. It is clear that uncertainty and disagreement remain over the possibilities of transmission via contact with saliva and the risks attached to sexual activities. More attention needs to be given to the social and moral issues surrounding the AIDS problem. The results also highlight clearly the confusing intersection of health beliefs, risk assessments, social attitudes and moral values which characterize individual responses to AIDS. Students are not much serious about the AIDS epidemic or in their personal concern about being directly or indirectly affected by it.