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South Africa's HIV/AIDS pandemic is considered to he the largest in the world, with more than 5 million South Africans living with the disease (1). This unprecedented scale of HIV [...]

This paper explores adolescents' definitions of what it means to be a man and a woman, the psycho-social context surrounding the formation of gender ideologies and their relationship to HIV/STI prevention. Semi-structured, in-depth interviews were conducted with 50 African-American adolescents living in Baltimore, Maryland. Female gender ideologies included economic independence, emotional strength and caretaking. Male gender ideologies emphasized financial responsibility, toughness and sexual prowess. Findings suggest that stronger adherence to male gender ideologies related to toughness and sexual prowess is influenced by male participants' perceived inability to fulfill their primary gender role as economic providers and the importance of gaining approval from male peers in the absence of adult male role models. Stronger adherence to female gender ideologies related to emotional strength and caretaking may be linked to a heightened desire for male intimacy and tolerance of male sexual risk behavior. Implications of the gender ideologies documented and their commonalities are discussed in terms of HIV/STI prevention., Introduction More than half of all new infections with the human immunodeficiency virus (HIV) globally as well as in the United States (US) occur among people under age 25 (UNAIDS, [...]

Background to the debate: Uganda is one of the few African countries where rates of HIV infection have fallen, from about 15 percent in the early 1990s to about five [...]

Women are the fastest growing segment of the adult population acquiring HIV, and most women infected with HIV are in their reproductive years. The success of HAART is highly dependent upon the ability and willingness of the individual to adhere to complex antiretroviral regimens. Improved adherence among HIV-infected pregnant women will delay disease progression in the mother and should also reduce HIV transmission to the baby. Modified directly observed therapy (MDOT), may benefit this population. MDOT has been shown to be an acceptable and feasible intervention among HIV + substance users; however, no-one has yet evaluated the use of MDOT in pregnant and postpartum women. Based on semi-structured interviews with 17 Latina women with HIV infection, we explored women's adherence patterns and barriers to adherence and their perceptions of a hypothetical MDOT program. The vast majority of women positively appraised the MDOT program as an effective means to increase and reinforce adherence to demanding drug regimens. Respondents cited the face-to-face contact, the supportive nature of the relationship, and the practical approach of the program as the primary reasons for the effectiveness of MDOT. Results indicate that MDOT could be an acceptable intervention for pregnant and postpartum Latina women to improve adherence to HAART. doi:10.1300/J013v44n04_04 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: HaworthPress, Inc. All rights reserved.] KEYWORDS, Women, HIV/AIDS, adherence, Modified Directly Observed Therapy (MDOT), pregnant women, postpartum women

HIV/AIDS infection is the fourth leading cause of death worldwide, and one in every 100 adults aged 15-49 years is HIV-infected. Forty percent of AIDS patients suffer from neurological symptoms, but the selective profile of damage caused by HIV in the brain is not well understood. Here, we report 3D maps revealing how AIDS affects the human cerebral cortex, identifying the most vulnerable regions and where deficits link with cognitive decline and immune-system suppression. With high-resolution brain MRI scans, we created composite maps of cortical gray-matter thickness in 26 AIDS patients and 14 healthy controls to establish the selective pattern of brain deficits in AIDS. In AIDS, primary sensory, motor, and premotor cortices were 15% thinner. Thinner frontopolar and language cortex correlated with immune system deterioration measured through blood levels of CD[4.sup.+] T lymphocytes. Prefrontal and parietal tissue loss correlated with cognitive/motor deficits. T cell depletion and cognitive impairment are, therefore, associated with specific 3D brain-deficit patterns visualized with MRI. These quantitative MRI-based maps reveal that HIV selectively damages the cortex. They provide an approach to gauge the impact of AIDS on the living brain and show that the brain is still vulnerable to infection even when patients are receiving antiretroviral therapy. brain | MR | disease | Tcell | immunity

Incarcerated men in the US are at increased risk for HIV, STDs and hepatitis, and many men leaving prison have unprotected sex with a primary female partner immediately following release from prison. This paper addressees risk to the primary female partners of men being released from prison (N = 106) by examining the prevalence of men's concurrent unprotected sex with other partners or needle sharing prior to and following release from prison (concurrent risk). Rates of concurrent risk were 46% prior to incarceration, 18% one month postrelease, and 24% three months postrelease. Multivariate analysis showed concurrent risk was significantly associated with having a female partner who had one or more HIV/STD risk factors and having a history of injection drug use. Findings demonstrate need for prevention programs for incarcerated men and their female partners. [Article copies available for a fee from The Haworth Document Deliver), Service: 1-800-HAWORTH. E-mail address: Website: [c] 2005 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Prison, parolees, HIV/AIDS, STD risk behavior, female partners, reentry

The former Soviet Bloc had strict control on the movement of people and contact with foreigners, so the HIV virus was not able to spread to this region. In 1991, after the collapse of the Soviet Union, the barriers against the world tumbled down and today the fastest growing rates of infection are seen here.

South Africa is a democracy but the health care system is not adequately functional. Africa has 5 million people affected with HIV and the government is making various efforts to control the spread of this disease.

HIV and hepatitis C virus (HCV) coinfection is a serious concern in North America, mainly among injection drug users (IDUs). Approximately 40% of individuals living with HIV infection are coinfected with HCV and among HIV-positive IDUs approximately 50% to 90% are coinfected with HCV, hence it is suggested that appropriate public health interventions should be implemented immediately.

The epidemiology of the recent rise in HIV cases in Britain highlights the need for more research among the heterosexual African migrant population. New research should not, however, only extend the limited number of studies that describe observable patterns in sexual health but should also seek to determine their underlying social causation. To achieve this, both methodological and ontological shifts are necessary in the existing research paradigm; we advocate that a broad range of qualitative techniques be deployed both to uncover the empirical details of specifically African sexual behaviours and to highlight and explore the 'relational' nature of sexual decision-making. Rather than fixing on individuals, analysis must situate them within the broader discursive and material frames that structure the boundaries of decision-making. In addition, researchers need to utilise the parallel literature on the social embeddedness of HIV in Africa to inform analysis of the British context. It would then be possible to address the crucial question of whether the social conditions known to cause high-risk behaviours and facilitate transmission in Africa persist, or are transformed, after migration to the UK. A key, and neglected, dimension of this is the role of spatial context in relational sexual decision-making and the constitution of social relationships in particular arenas. This needs further thought, particularly in relation to domestic space and gender identities. We believe that the research agenda proposed herein has much to contribute to interventions and service provision. Nevertheless, we are mindful of the need for self-reflexivity about our role in the production of powerful knowledges about sex. Our final proposal is that researchers seek ways to work with, not on, African communities in order to facilitate their own informed management of sexual health. Keywords: HIV; Sexual behaviour; 'Black Africans'; Research method; UK

Worldwide, 90% of HIV-1 infections are transmitted heterosexually. Because the genital mucosa are the sites of initial contact with HIV-1 for most exposed individuals, study of the virus from the genital tract is critical for the development of vaccines and therapeutics. Previous analyses of HIV-1 in various tissues have documented compartmentalization of viral genomes. Whether compartmentalization was associated with viral phenotypic differences or immune status, however, was not well understood. We compared HIV-1 gp120 env sequences from the genital tract and plasma of 12 women. Eight women displayed compartmentalized HIV-1 RNA genomes, with viral sequences from each site that were clearly discrete, yet phylogenetically related. The remaining four exhibited env sequences that were intermingled between the two sites. Women with compartmentalized HIV-1 genomes had higher CD4+ cell counts than those displaying intermingled strains (P = 0.02). Intrapatient HIV-1 recombinants comprising sequences that were characteristic of both sites were identified. We next compared viral phenotypes in each compartment. HIV-1 coreceptor usage was often compartmentalized (P [less than or equal to] 0.01). The number of N-linked glycosylation sites, associated with neutralization resistance, also differed between compartments (P < 0.01). Furthermore, disparities between the density of gp120 glycosylations in each compartment correlated with higher CD[4.sup.+] counts (P = 0.03). These data demonstrate that the genital tract and plasma can harbor populations of replicating HIV-1 with different phenotypes. The association of higher CD[4.sup.+] cell counts with compartmentalization of viral genomes and density of gp120 glycosylations suggests that the immune response influences the development of viral genotypes in each compartment. These findings are relevant to the prevention and control of HIV-1 infection.

The rate of HIV-infection today compels researchers in the medical and sociological fields to speak of a pandemic rather than an epidemic. The 2003 statistics of UNAIDS describes the current [...]

This study examines coping in response to HIV infection, using longitudinal data from a nationally representative sample (n = 2, 864) of HIV-infected persons. We investigated configurations of coping responses, the correlates of configuration membership, the stability of coping configurations, and the relationship of coping to emotional well-being. Four coping configurations emerged from cluster analyses: relatively frequent use of blame-withdrawal coping, frequent use of distancing, frequent active-approach coping, and infrequent use of all three coping strategies ('passive' copers). Passive copers had few symptoms, high levels of physical functioning, and high emotional well-being; blame-withdrawal copers had the opposite pattern. Of those completing a second interview 1 year after baseline, 46% had the same coping configuration. Increases in the number of HIV-related symptoms raised the probability of blame-withdrawal coping at follow-up, whereas decreases raised the probability of passive coping. Infrequent use of coping responses at baseline was related to greater emotional well-being 1 year later. This result, in conjunction with the high levels of emotional well-being in the passive cluster, suggests that high levels of distress can induce blame-withdrawal coping whereas coping efforts are minimal when social support and emotional well-being are high. Results highlight issues in ascertaining the causal direction between coping and psychological outcomes, as well as in specifying the nature of stressful situations with which people are coping. KEY WORDS: coping responses; HIV infection; chronic illness.

Few rigorously tested primary prevention programs have been developed to prevent HIV infection among immigrant communities in the United States. This is in part because of the lack of culturally specific behavioral theories that can inform HIV prevention for immigrant communities in the United States. This article aims to develop such theories for a population--Asian/Pacific Islanders (A/PIs) immigrant communities--who have been overlooked in theory development and program evaluation. Frontline community-based organization (CBO) peer educators, an underutilized source of expertise regarding cultural factors specific to HIV infection among A/PI communities, are the sample of study Asian/Pacific Islander peer educators working at an urban AIDS service organization devoted to health promotion for this population; (N = 35). They were interviewed to examine (1) detailed narratives describing instances of behavior change and (2) culturally anchored theories of behavior change which the narratives imply. Theories of the influence of positive cultural symbols on the taboo of HIV/AIDS, moderators of the effectiveness of social network influences on behavior change, and setting- and community-level processes predicting HIV risk behavior were implicit in the peer educators' narratives. Implications for future research, methodology and prevention practice are discussed. KEY WORDS: Asians; immigrants; prevention; HIV; AIDS; community; culture; race; ethnicity; community-based organizations; evaluation.

To examine behaviors that could influence STD/HIV transmission in Bangladesh's trucking industry, a survey was orally administered to 388 truck drivers/helpers at Tejgaon truck stand in Dhaka. A two-tiered sampling strategy was used: 38 trucking agencies were randomly selected and a mean of 10.2 subjects was recruited from each agency. Focus group and in-depth interviews were also conducted. The focus was on behaviors that affect (i) exposure to STD/HIV infection, (ii) efficiency of transmission of infection and (iii) duration of infectiousness. The findings illustrated that intravenous drug use was not an important risk factor; only 1 subject had used drugs intravenously. Sexual risk behaviors, however, were prevalent: the mean number of sexual partners in the past year was 4.57 (SD = 8.70) and in the past 3 months was 1.82 (SD = 3.27). Premarital and extramarital sex was common, often with commercial sex workers (CSW); 54% of all subjects had relations with at least 1 CSW in the past year. In a multiple logistic regression analysis, subjects who engaged in other types of socially risky behavior (drinking alcohol, ingesting or smoking recreational drugs, having sex with other men) were significantly (p < 0.05) more likely to have had sex with a CSW in the past year. While 7.2% of subjects had a male sex partner in the past year, 21% had ever had one (likely youthful experimentation for most). Condom use was very infrequent: of the 343 subjects who had ever had sexual intercourse only 31% had ever used a condom and most of those subjects had used only once or occasionally. Having sex with CSWs, being married, having heard of AIDS and age were significantly associated (p < 0.05) with ever use of condoms. Frequently, subjects who had genital symptoms either did not have those symptoms treated at all or treated in a timely fashion, and over 1/3 did not change their sexual behavior while infected. To reduce the potential for the spread of STD/HIV in this population, appropriate treatment practices for sexually transmitted infections need to be encouraged and condom use promoted, particularly in the context of casual sexual relations. Keywords: Sexually transmitted diseases; HIV; Injections; Truck drivers; Bangladesh

Currently, there are only two programs that screen a large cross-section of the United States population for infection with HIV, the human immunodeficiency virus; these are blood donor screening and testing of military personnel. Data on the rates of HIV infection are valuable because they are more current than statistics concerning cases of AIDS, which usually originate from infection many years prior. This report presents the results of a large-scale military screening program in which most active duty US Army soldiers were tested for antibodies to HIV. Out of the total of 648,032 soldiers screened, 1,588 tested positive for HIV infection, which translates into 2.5 per 1,000. The factors that were most strongly linked to HIV seropositivity were age (more positive results among older soldiers), being male, being black or Hispanic as opposed to white, being single versus married, having a medical occupation, and being assigned to a location where AIDS is endemic. Among male medical personnel, being unmarried was strongly linked to positive results for HIV infection. The additional risk for HIV infection among the medical personnel was apparently related to factors other than exposure to the virus through their work. (Consumer Summary produced by Reliance Medical Information, Inc.)

The duration of survival time from diagnosis of AIDS (acquired immunodeficiency syndrome) to death was evaluated for 4,323 persons living in San Francisco. These cases were reported to the public health department between July 1981 and December 31, 1987 and were followed until death or through the end of the study in December 1988. The average survival time was 12.5 months. Only 3.4 percent lived for at least five years following diagnosis and the patient with the longest recorded survival lived 8.1 years. Survival was better for patients who were diagnosed with Pneumocystis carinii pneumonia during 1986 and 1987, but mortality increased from 1981 to 1987 for persons diagnosed with Kaposi's sarcoma, a form of skin cancer. No change in mortality was observed among AIDS patients with other opportunistic infections or complications. Patients between the ages of 20 and 39 lived the longest, while both younger and older individuals had shorter survival times. Men lived longer than women, but few cases of women with AIDS were reported. Patients treated with zidovudine (AZT) survived longer than patients who received no antiviral therapy. Data were lacking on the use of treatments other than antiviral drugs, so their influence on mortality could not be evaluated. In conclusion, short-term survival has improved in recent years for some AIDS patients, and new treatments such as zidovudine may be responsible. (Consumer Summary produced by Reliance Medical Information, Inc.)

National trends in the short-term survival of patients with AIDS (acquired immunodeficiency syndrome) were evaluated using records from the Centers for Disease Control, state and local health departments, and other sources. Nationwide, 36,847 persons over age 13 were diagnosed with AIDS between January 1984 and September 1987. Over this time, more patients for whom Pneumocystis carinii pneumonia (PCP) was one of the first symptoms were still alive one year after the initial AIDS diagnosis. The number surviving one full year after diagnosis increased from 42.7 percent between 1984 and 1985, to 54.5 percent in 1986 and 1987. This improved survival occurred among homosexual men, male and female intravenous drug users, and in all age, race, and geographic groupings. Patients who did not have PCP as an initial symptom of AIDS did not, as a group, show increased survival rates over the same time periods. Factors that may explain this reduced short-term mortality include improved diagnostic procedures and treatments for AIDS, especially the drug zidovudine (AZT), which was introduced in 1986. These results may be affected by underreporting of deaths due to the inability of local or state health departments to trace patients who move out of the area. This phenomenon would not, however, explain the improved survival observed only in persons with PCP as an initial manifestation. The author believes the data show a real improvement in the short-term survival of these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Estimates of the present and future extent of the prevalence of HIV (human immunodeficiency virus) infection throughout the world are continually updated by the World Health Organization (WHO) and the Global Programme on AIDS (GPA), using available data and annual progression rates. Large increases in the number of AIDS cases have been projected for the early 1990s. The Delphi method of estimation is now being used by WHO to supply qualified estimates by knowledgeable 'experts' via questionnaire responses. The Delphi projection of cases of HIV infection for the year 2000 is between 3 and 4 times the 1988 estimate of 5.1 million cases. This figure takes into account the successful prevention of almost half of all new HIV infections, which would otherwise occur between 1988 and 2000 without HIV/AIDS prevention and control programmes. Recent data suggest that only minor variations occur in the progression rate of HIV infection to the development of AIDS in various areas of the world, and among infection transmission routes. The only clear exception to this rule is that AIDS progression is much faster in HIV-infected children than in adults. To date the only progression estimates that are available for the adult population are that 20 percent of infected individuals will have AIDS within 5 years, and 50 percent will develop AIDS within 10 years. These statistical estimates lead to grim conclusions. The Delphi group estimates that the second decade of the HIV/AIDS pandemic, the 1990s, will be much worse than the first one, with cumulative adult AIDS cases rising from one million by 1990, to over five million during the 1990s. These estimates highlight the importance of developing health and social service networks capable of responding to this greatly increasing need. (Consumer Summary produced by Reliance Medical Information, Inc.)

Byline: P. Nigam, S. Shrivastava Sir, Heterosexual intercourse is the dominant mode of HIV transmission in most parts of the world. Commercial sex workers (CSWs) are associated with high incidence [...]

The plight of rural women affected by HIV/AID is presented, using the case of KwaZulu Natal (KZN), South Africa The solution provided, reveals a need to support and improve the position and realities of the women in rural KZN.