Perfil sociodemográfico e a evolução clínica dos pacientes com síndrome da imunodeficiência humana / Sociodemographic profile and the clinical evolution of patients with human immunodeficiency syndrome

Objetivo: avaliar o perfil sociodemográfico e a evolução clínica dos pacientes com síndrome da imunodeficiência humana. Método: trata-se de pesquisa quantitativa, retrospectiva e descritiva realizada em um serviço de saúde especializado. Coletaram-se os dados no serviço de arquivamento médico e estatístico, em prontuários. Aplicou-se um formulário contendo variáveis de caracterização do perfil clínico e sociodemográfico dos pacientes. Utilizou-se amostra probabilística que totalizou 172 prontuários. Analisaram-se os dados pelo software Statistical Package for the Social Sciences. Resultados: verificou-se o predomínio de homens adultos, solteiros, na cor parda e com média de idade de 40 anos e baixo nível socioeconômico, com prevalência das coinfecções causadas por protozoários, seguidas pelas infecções bacterianas. Conclusão: percebe-se que há uma mudança do perfil das pessoas que vivem com o vírus da imunodeficiência humana com o aumento de casos entre mulheres e interiorização dessa patologia. Infere-se que tais achados podem contribuir para a adoção de ações de saúde direcionadas e adaptadas ao perfil evidenciado.(AU)

Objective: to evaluate the sociodemographic profile and clinical evolution of patients with human immunodeficiency syndrome. Method: it is a quantitative, retrospective and descriptive research carried out in a specialized health service. The data was collected in the medical and statistical archival service, in medical records. A form containing variables characterizing the clinical and sociodemographic profile of the patients was applied. A probabilistic sample was used, which totaled 172 medical records. Data was analyzed by the software Statistical Package for the Social Sciences. Results: the prevalence of adult males, single, in the brown color and with a mean age of 40 years and low socioeconomic level, with prevalence of co-infections due to protozoa, followed by bacterial infections were observed. Conclusion: it is noticed that there is a change in the profile of people living with the human immunodeficiency virus with the increase of cases among women and the internalization of this pathology. It is inferred that such findings can contribute to the adoption of health actions directed and adapted to the profile evidenced.(AU)

Objetivo: evaluar el perfil sociodemográfico y la evolución clínica de los pacientes con síndrome de inmunodeficiencia humana. Método: se trata de investigación cuantitativa, retrospectiva, descriptiva, realizada en un servicio de salud especializado. Se recogió los datos en el servicio de archivo médico y estadístico, en prontuarios, se aplicó un formulario conteniendo variables de caracterización del perfil clínico y sociodemográfico de los pacientes. Se utilizó muestra probabilística que totalizó 172 prontuarios. Se analizaron los datos por el software Statistical Package for the Social Sciences. Resultados: se verificó el predominio de hombres adultos, solteros, de color pardo y con promedio de edad de 40 años y bajo nivel socioeconómico, con prevalencia de las coinfecciones causadas por protozoarios, seguida por las infecciones bacterianas. Conclusión: se percibe que hay un cambio del perfil de las personas que viven con el virus de la inmunodeficiencia humana con aumento de casos entre mujeres e interiorización de esa patología. Se infiere que tales hallazgos pueden contribuir a la adopción de acciones de salud dirigidas y adaptadas al perfil evidenciado.(AU)

Look into the HIV Epidemic of Gay Community with a Socio-Cultural Perspective: A Qualitative Study in China, 2015-2016.

BACKGROUND: Current Chinese studies continue to view male homosexuality through a disease focused lens which pays limited attention to socio-cultural aspects of sexual behavior and HIV transmission. This qualitative study aimed to investigate how socio-cultural factors influence gay men's sexual beliefs and behaviors in contemporary China, and their implications for HIV epidemic. METHODS AND FINDINGS: Qualitative methodology was used in this study. During 2015-2016, in-depth interviews were conducted with 61 self identified gay men in Jiangxi, Henan, Heilongjiang, Guangdong, Jiangsu provinces and Chongqing municipality of China. Our study revealed that: 1) influenced by Chinese traditional culture, gay men have conflicts on self-identity, which led to low self-acceptance and negative attitude on sex, and huge socio-psychological stress; 2) a generational differences within gay community was observed, reflected in varied sexual attitudes and practices as well as way for approaching new friends, both of which have implications and challenges on HIV control and prevention; 3) socio-cultural barriers, including open minds towards casual sex and nonmonogamous relationship, and low priority of health demands were widely observed and led to negative coping with AIDS among gay community. CONCLUSIONS: It is essential to take a holistic view into gay men's HIV epidemic in China. Socio-cultural barriers for HIV control and prevention found in this study call for serious and imperative consideration on integrated measures, including targeted efforts towards effective sex education and further inclusion of socio-cultural perspectives in HIV/AIDS interventions for gay men.

Avaliação da testagem anti-HIV no pré-natal e na assistência ao parto no Rio de Janeiro, Brasil / An evaluation of HIV testing during preand perinatal care in Rio de Janeiro, Brazil

Avaliar a testagem anti-HIV durante a assistência pré-natal e ao parto no Sistema Único de Saúde. Métodos: estudo transversal conduzido em 2009 em 15 maternidades no Rio de Janeiro, sendo entrevistada amostra representativa de 835 parturientes e observados prontuários. Para avaliação da adequação da testagem anti-HIV foi elaborado um modelo lógico. Resultados: segundo informação das parturientes, 86,7 por cento dispunham de sorologia não reagente do pré-natal e 55,7 por cento foram submetidas ao teste rápido anti-HIV no hospital; em 49,9 por cento dos casos o procedimento relativo ao teste rápido anti-HIV no hospital foi considerado adequado: mães com status ignorado de HIV do pré-natal submetidas ao teste rápido e mães com status conhecido não submetidas ao mesmo. Segundo dados do prontuário, 68,0 por cento dispunham de sorologia não reagente e 79,6 por cento foram submetidas ao teste rápido anti-HIV; em 50,9 por cento dos casos o procedimento relativo ao teste rápido anti- HIV no hospital foi adequado. Conclusões: o protocolo de exames anti-HIV no pré-natal e na maternidade, vigentes em 2009, não foram cumpridos a contento, tanto por gerar procedimentos desnecessários quanto falhas na testagem da população alvo, ameaçando a instituição oportuna de medidas profiláticas de controle da transmissão vertical...

To evaluate HIV testing during preand perinatal care in the Brazilian National Health System. Methods: a cross-sectional study was carried out in 2009 covering 15 maternity hospitals in Rio de Janeiro. Interviews were conducted with a sample of 835 pregnant women and their medical records consulted. A logical model was drawn up to assess the adequacy of HIV testing. Results: according to the information gathered from the pregnant women, 86.7 percent underwent a prenatal non-reactive serology test and 55.7 percent a rapid HIV test in hospital.In 49.9 percent of cases, the rapid hospital HIV test procedure was deemed to be adequate both for mothers with unknown prenatal HIV status undergoing the rapid test and for those with known HIV status who did not undergo this test. According to medical records, 68.0 percent underwent the non-reactive serum testand 79.6 percent the rapid HIV test.In 50.9 percent of cases the rapid hospital HIV test procedure was found to be adequate. Conclusions: the pre- and perinatal HIV test protocol in force in 2009 was not followed in a satisfactory manner, as unnecessary tests were performed and the target population was not fully tested, thereby jeopardizing the adoption of adequate prophylactic measures to control vertical transmission...

High-dose vitamin D3 reduces deficiency caused by low UVB exposure and limits HIV-1 replication in urban Southern Africans.

Cape Town, South Africa, has a seasonal pattern of UVB radiation and a predominantly dark-skinned urban population who suffer high HIV-1 prevalence. This coexistent environmental and phenotypic scenario puts residents at risk for vitamin D deficiency, which may potentiate HIV-1 disease progression. We conducted a longitudinal study in two ethnically distinct groups of healthy young adults in Cape Town, supplemented with vitamin D3 in winter, to determine whether vitamin D status modifies the response to HIV-1 infection and to identify the major determinants of vitamin D status (UVB exposure, diet, pigmentation, and genetics). Vitamin D deficiency was observed in the majority of subjects in winter and in a proportion of individuals in summer, was highly correlated with UVB exposure, and was associated with greater HIV-1 replication in peripheral blood cells. High-dosage oral vitamin D3 supplementation attenuated HIV-1 replication, increased circulating leukocytes, and reversed winter-associated anemia. Vitamin D3 therefore presents as a low-cost supplementation to improve HIV-associated immunity.

Outcomes of comprehensive care for children empirically treated for multidrug-resistant tuberculosis in a setting of high HIV prevalence.

BACKGROUND: Few studies have examined outcomes for children treated for multidrug-resistant tuberculosis (MDR-TB), including those receiving concomitant treatment for MDR-TB and HIV co-infection. In Lesotho, where the adult HIV seroprevalence is estimated to be 24%, we sought to measure outcomes and adverse events in a cohort of children treated for MDR-TB using a community-based treatment delivery model. METHODS: We reviewed retrospectively the clinical charts of children ≤15 years of age treated for culture-confirmed or suspected MDR-TB between July 2007 and January 2011. RESULTS: Nineteen children, ages two to 15, received treatment. At baseline, 74% of patients were co-infected with HIV, 63% were malnourished, 84% had severe radiographic findings, and 21% had extrapulmonary disease. Five (26%) children had culture-confirmed MDR-TB, ten (53%) did not have culture results available, and four (21%) subsequently had results indicating drug-susceptible TB. All children with HIV co-infection who were not already on antiretroviral therapy (ART) were initiated on ART a median of two weeks after the start of the MDR-TB regimen. Among the 17 patients with final outcomes, 15 (88%) patients were cured or completed treatment, two (12%) patients died, and none defaulted or were lost to follow-up. The majority of patients (95%) experienced adverse events; only two required permanent discontinuation of the offending agent, and only one required suspension of MDR-TB treatment for more than one week. CONCLUSIONS: Pediatric MDR-TB and MDR-TB/HIV co-infection can be successfully treated using a combination of social support, close monitoring by community health workers and clinicians, and inpatient care when needed. In this cohort, adverse events were well tolerated and treatment outcomes were comparable to those reported in children with drug-susceptible TB and no HIV infection.

Evolução clínica dos pacientes vítimas de trauma com e sem infecção por HIV admitidos no Hospital Central de Maputo, de Junho a Setembrode 2010 / Clinical evolution of patients victims of trauma with and without HIV infection admitted to the Maputo Central Hospital, from June to September 2010

A infecção pelo Vírus da Imunodeficiência Adquirida (HIV) é um problema importante de Saúde Pública em Moçambique onde a prevalência é uma das mais elevadas do mundo. O Trauma é uma das principais causas de morte particularmente em adultos jovens e adolescentes, sendo por muitos considerada uma doença negligenciada. Há pouca informação sobre as características dos pacientes com trauma admitidos através dos nossos Serviços de Urgência (SUR) e sobre a prevalência da infecção por HIV nos pacientes traumatizados; sabe-se que esta está relacionada a uma pobre evolução clínica em pacientes gravemente traumatizados. Objectivos: Caracterizar o perfil dos pacientes admitidos por trauma, determinar a prevalência da infecção por HIV nos mesmos e avaliar a influência desta infecção e contagem das células CD4 (CcCD4) na sua evolução clínica. Métodos: Estudo observacional tipo cohorte prospectivo, realizado no Hospital Central de Maputo entre Maio e Setembro de 2010. Foram estudados 441 pacientes vítimas de trauma admitidos no SUR deste hospital. Os pacientes foram testados para HIV: aos seropositivos HIV (PHP) foi feita a CcCD4. Procedeu-se à recolha da informação relativa aos dados demográficos, sinais vitais, mecanismos de lesão, áreas com lesão, antecedentes clínicos, e foram calculadas escalas de gravidade de trauma (RTS - A escala revista de trauma e ISS - Escala de gravidade das lesões). A evolução clínica foi analisada com base nas complicações desenvolvidas durante o internamento, dias de internamento no hospital (DIH) e cuidados intensivos (DICI), e na mortalidade. Os resultados foram comparados de acordo com o estado serológico para HIV e CcC4. Resultados: Dos pacientes admitidos 73,5% eram do sexo masculino. A média das idades foi de 31,6 anos, com 85,3% pacientes abaixo dos 45 anos. Os acidentes de viação (AV) foram o principal mecanismo de lesão sendo 57,8% peões e 30,1% passageiros. Os traumas ocorreram principalmente na via pública (60,0%): o consumo de álcool foi evidenciado em 38,4% das admissões. A maioria dos pacientes apresentavam trauma ligeiro e o tempo médio de internamento foi de 8 dias (±10,67). Ocorreram 29 óbitos, sobretudo por AV (58,6%). A prevalência da infecção por HIV foi de 25,9%, afectando 22,5 % homens e 35,0% mulheres (p=0,0080). Anteriormente à admissão apenas 8,8% dos PHP havia feito o teste (p<0,001), e 55,0% destes tinham CD4<350 céls/mm3. Os mecanismos de lesão foram semelhantes entre os dois grupos (PHP e HIV seronegativos - PHN) à excepção das mordeduras humanas (6,1% PHP vs 0,9% PHN; p=0,026). Os PHP apresentaram mais complicações infecciosas ou não, contudo, os dois grupos tiveram RTS, ISS, DIH, DICI e mortalidade semelhantes. O CD4 não influenciou nos dias de internamento nem na mortalidade. Conclusões: Os PHP desenvolveram mais complicações infecciosas, contudo a infecção por HIV e a CcCD4 não influencia os DIH, DICI nem a mortalidade pós trauma. Recomenda-se aconselhamento e testagem voluntária para HIV neste grupo de pacientes, pois estes podem beneficiar de cuidados x adicionais como a terapia anti-retroviral. Julga-se importante a implementação dum sistema de vigilância intra-hospitalar para o trauma.

The Infection with Human Immunodeficiency Virus (HIV) is an important public health problem in Mozambique where the prevalence of this infection is one of the highest in the world. Trauma is a leading cause of death mainly among young adults and adolescents, for several regarded as a neglected disease. Information about the characteristics of trauma patients admitted through our emergency service (ES) and on the prevalence of HIV infection in this group of patients is scarce, and it is known that this is related to a poor clinical outcome in severely traumatized patients. Aims: To characterize the profile of trauma patients admitted, to determine the prevalence of HIV infection among them, and to evaluate the influence of this infection and CD4 count (CD4c) in the clinical outcome after trauma. Methods: An observational prospective cohort study, conducted at the Maputo Central Hospital (HCM) between May and September 2010. We studied 441 trauma patients admitted in this hospital through the ES. Patients were evaluated for HIV: in HIV positives patients (PHP) CD4c was done. Collection of information on demographics, vital signs, mechanisms of injury, areas of injury and medical history was done, and Injury severity scores (RTS - The revised trauma score and ISS ­ Injury severity score) were calculated. The clinical outcome based on the complications developed during hospitalization, hospital length of stay (HLOS), intensive care length of stay (ILOS) and mortality was analyzed. The results were compared according to HIV status and level of CD4c. Results: of the studied patients, 73.5% were male. The mean age was 31.6 years, and 85.3% of the patients were below 45 years age. Road traffic accidents (RTA) were the major mechanism of injury, affecting 57.8% pedestrians and 30.1% passengers. The injuries occurred mostly on the streets (60.0%), alcohol consumption was found in 38.4% of admissions. Most patients had mild trauma and the average hospital stay was 8 days (± 10.7). Death have occurred in 29 patients, mainly by RTA (58.6%).The overall HIV infection prevalence was 25.9% (22.5% in men and 35.0% in women, with p = 0.0080). Only 8.8% of PHP had done the test prior to admission, (p <0,001), and 55.0% of these had CD4 <350 cells/mm3. The mechanisms of injury were similar between the two groups (PHP and HIV negative - NHP) except for human bites (6.1% PHP vs 0.9% NHP, p = 0.026). PHP had more infectious and non infectious complications; however, the two groups (PHP and NHP) had similar RTS, ISS, HLOS and mortality. The CD4 did not affect HLOS, ILOS or mortality. Conclusions: PHP developed more infectious complications; however HIV infection and CD4c xi did not influence HLOS, ILOS or mortality after trauma. Counseling and voluntary testing for HIV is recommended in this group of patients since they may benefit from additional care such as antiretroviral therapy. It is deemed important to implement an in-hospital surveillance system for trauma.

Trends of HIV and sexually transmitted infections, estimated HIV incidence, and risky sexual behaviors among gay bathhouse attendees in Taiwan: 2004-2008.

Five serial cross-sectional surveys were done at eight gay bathhouses in Taiwan to investigate the trends of HIV and sexually transmitted infections (STIs) and estimated HIV incidence between 2004 and 2008. Bathhouse attendees completed a questionnaire and tests for HIV, syphilis, hepatitis C virus, and amoebiasis. Twenty-nine (38.6%) were identified as having recent HIV-1 infections. There was a significant increase in HIV incidence, from 7.8% in 2004 to 15% in 2007 (χ(2) = 17.59, P-trend <0.001). Recreational drug use is the primary risk behavior. Comprehensive screening programs in gay bathhouses for early detection of HIV and STIs are important.

Unmet need for contraception among HIV-positive women in Lesotho and implications for mother-to-child transmission.

In Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26.4%), low knowledge of HIV status and a total fertility rate of 3.5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15-49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services.

Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns.

BACKGROUND: The Botswana government recently implemented a policy of routine or "opt-out" HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. METHODS AND FINDINGS: We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favor of routine testing. The majority believed that this policy would decrease barriers to testing (89%), HIV-related stigma (60%), and violence toward women (55%), and would increase access to antiretroviral treatment (93%). At the same time, 43% of participants believed that routine testing would lead people to avoid going to the doctor for fear of testing, and 14% believed that this policy could increase gender-based violence related to testing. The prevalence of self-reported HIV testing was 48%. Adjusted correlates of testing included female gender (AOR = 1.5, 95% CI = 1.1-1.9), higher education (AOR = 2.0, 95% CI = 1.5-2.7), more frequent healthcare visits (AOR = 1.9, 95% CI = 1.3-2.7), perceived access to HIV testing (AOR = 1.6, 95% CI = 1.1-2.5), and inconsistent condom use (AOR = 1.6, 95% CI = 1.2-2.1). Individuals with stigmatizing attitudes toward people living with HIV and AIDS were less likely to have been tested for HIV/AIDS (AOR = 0.7, 95% CI = 0.5-0.9) or to have heard of routine testing (AOR = 0.59, 95% CI = 0.45-0.76). While experiences with voluntary and routine testing overall were positive, 68% felt that they could not refuse the HIV test. Key barriers to testing included fear of learning one's status (49%), lack of perceived HIV risk (43%), and fear of having to change sexual practices with a positive HIV test (33%). CONCLUSIONS: Routine testing appears to be widely supported and may reduce barriers to testing in Botswana. As routine testing is adopted elsewhere, measures should be implemented to assure true informed consent and human rights safeguards, including protection from HIV-related discrimination and protection of women against partner violence related to testing.

HIV risk perception and prevalence in a program for prevention of mother-to-child HIV transmission: comparison of women who accept voluntary counseling and testing and those tested anonymously.

OBJECTIVE: To determine whether data from voluntary counseling and testing (VCT)/prevention of mother-to-child transmission (PMTCT) programs can be used for HIV surveillance. METHODS: Women attending an antenatal clinic at the district hospital in Entebbe, Uganda, from May 2002 to April 2003 were offered counseling and HIV testing with same-day results (VCT) and nevirapine for PMTCT was provided for HIV-positive women and their babies. Those who declined VCT were tested for HIV anonymously. RESULTS: Overall, 2635 women accepted VCT; 883 were tested anonymously. HIV prevalence was higher in VCT than in anonymously tested women in the first month of the program (20% vs. 11%, P=0.05) and in months with <70% VCT uptake (17% vs. 8%, P<0.001) but was similar in months with high uptake. Uptake of VCT was higher in women who had risk factors for HIV, especially those who believed themselves to have been exposed (84% vs. 73%, P<0.001). CONCLUSION: There was a bias to accepting VCT in women with HIV, or risk factors for HIV infection, the former most apparent when there was low coverage. Data from VCT/PMTCT programs cannot replace anonymous surveillance for monitoring of HIV epidemic trends where coverage is incomplete within clinics or communities.

Treatable factors associated with severe anaemia in adults admitted to medical wards in Blantyre, Malawi, an area of high HIV seroprevalence.

Severe anaemia is a common presentation in non-pregnant adults admitted to hospital in southern Africa. Standard syndromic treatment based on data from the pre-HIV era is for iron deficiency, worms and malaria. We prospectively investigated 105 adults admitted consecutively to medical wards with haemoglobin < 7 g/dl. Those with acute blood loss were excluded. Patients were investigated for possible parasitic, bacterial, mycobacterial and nutritional causes of anaemia, including bone marrow aspiration, to identify potentially treatable causes. Seventy-nine per cent of patients were HIV-positive. One-third of patients had tuberculosis, which was diagnosed only by bone marrow culture in 8% of HIV-positive patients. In 21% of individuals bacteria were cultured, with non-typhi salmonella predominating and Streptococcus pneumoniae rare. Iron deficiency, hookworm infection and malaria were not common in HIV-positive anaemic adults, although heavy hookworm infections were found in 6 (27%) of the 22 HIV-negative anaemic adults. In conclusion, conventional treatment for severe anaemia in adults is not appropriate in an area of high HIV prevalence. Occult mycobacterial disease and bacteraemia are common, but iron deficiency is not common in HIV-positive patients. In addition to iron supplements, management of severe anaemia should include investigation for tuberculosis, and consideration of antibiotics active against enterobacteria.

Cost effectiveness of autologous blood transfusion--a developing country hospital's perspective.

An autologous blood donation program was set up at National Orthopaedic Hospital, Igbobi Lagos in 1992 in response to the rising sero prevalence of HIV observed in our "relative replacement" donors. A retrospective batch analysis of patients who received autologous transfusion and those who received homologous blood in our hospital in 1997 was carried out. Based on hospital charges, the mean charge (from the day of operation and excluding the cost of surgery) was dollars 116 (+/- dollars 7), median dollars 102 for those who donated and used their own blood compared to the mean charge of dollars 259.7 (+/- 116.3), median dollars 224, for homologous blood recipients (P=008). This was found to be due to a significant difference in the means of length of hospital stay of 21 days for autologous blood recipients, 34 for homologous blood recipients (P=0.009). The rate of infection was 85.7% for homologous blood recipients and 14.3% for autologous blood recipients. There was no significant difference in the means hospital charges, length of hospital stay and rate of infection in the entire population of patients who received blood transfusion when analysed by ward and consultant. We conclude that homologous blood transfusion in this hospital is significantly more expensive than autologous transfusion mainly due to greater infective morbidity in homologous blood recipients.

The relentless spread of tuberculosis in Zambia--trends over the past 37 years (1964-2000).

OBJECTIVE: To review trends in the rates of tuberculosis (TB) case notifications over a 37-year period. DESIGN: A retrospective study of Ministry of Health records on TB notifications between 1 January 1964 and 31 December 2000. SETTING: Zambia, sub-Saharan Africa. METHODS: Retrospective analysis of case-notification data for TB of the Zambia Ministry of Health annual returns. OUTCOME MEASURES: Annual TB case-notification rates and trends over the past 37 years. RESULTS: TB case-notification data from 1964 to 2000 show a 12-fold increase over the past two decades, and apparent gains in controlling TB seen in the 1960s and 1970s have been reversed over the past two decades. A stable situation during the period 1964-1984 (case-notification rate remained around 100 per 100,000 population) was followed by an exponential increase since the mid-1980s. The absolute number of new TB cases increased from 8,246 in 1985 (124/100,000) to 38,863 (409/100,000) in 1996 and 52,000 (512/100,000) in 2000. Comparison of case-notification rates over the past 2 decades with neighbouring countries (Zimbabwe, Malawi and Tanzania) show that Zambia has one of the highest case-notification rates in the region. CONCLUSIONS: Zambia, like many countries in Africa, is in the midst of a serious TB epidemic and there are no signs that it is abating. This increase was most likely due to the impact of the HIV/AIDS epidemic and subsequent breakdown of TB services. Concerted donor-government efforts should invest appropriately in long-term plans for TB control.

Some characteristics of the HIV epidemic in Morocco.

The first case of AIDS in Morocco was declared in 1986 and since then the number of AIDS cases has steadily increased. According to the Ministry of Health, the cumulative number of AIDS cases in December 2002 was 1085. HIV in Morocco is acquired mainly through heterosexual intercourse. Individuals aged between 30 and 39 years and in the regions of Marrakech and Agadir have been the most affected. Monitoring of the trend of the epidemic by sentinel surveillance surveys indicates that Morocco is still a low prevalence zone, since prevalence among pregnant women is less than 1%. The estimated number of HIV-infected people in Morocco is around 15 000. It is not clear why the epidemic here has not evolved as it has in the sub-Saharan countries where it is spreading at an alarming rate. Late introduction of HIV-1 subtype B in Morocco, which is relatively less transmissible, circumcision and reduced risk behaviours of Muslims may explain this. Nonetheless, because prevalence has increased in recent years, unless preventive measures are strengthened, the HIV epidemic will worsen in Morocco.

HIV prevalence remains low among Calgary's needle exchange program participants.

OBJECTIVES: To determine the demographic characteristics, risk behaviours and prevalence of HIV-1 among injection drug users (IDU) attending Calgary's needle exchange program (NEP). METHODS: A survey was conducted from June through September 1998 among IDU attending Calgary's NEP. Demographic and behaviour characteristics were determined by personal interview and saliva was tested for HIV antibody. RESULTS: There were 278 participants providing 272 saliva specimens. Nine were positive for HIV-1 (3.3%, 95% C.I. 1.6-6.4%). Sexual and injecting practices, cities where drugs had been used, incarceration, addiction treatment and demographic characteristics were described, and a subanalysis for women, youth and Aboriginals was carried out. CONCLUSIONS: HIV prevalence remains low among NEP attenders in Calgary, although high-risk behaviours are common. Women, youth and Aboriginals have unique risk behaviour profiles. Many IDU want to participate in addiction treatment, and strategies should be made to provide accessible, appropriate treatment services.

HIV/AIDS social and behavioural research: past advances and thoughts about the future.

This paper is an introduction to the various contributions in this special issue of Social Science & Medicine which are an attempt to synthesise the main debates of the 2nd European Conference on Social and Behavioural Research on AIDS held in Paris, in January 1998. The paper discusses how the recent advent of highly active antiretroviral therapies (HAART) and new trends in the epidemic (its concentration in the socially most vulnerable groups and countries) have affected the research agenda of European social and behavioural sciences (SBS) in HIV/AIDS. Questions which had already been thoroughly studied by SBS (like determinants of HIV-related risk behaviours, or impact of gender and socio-economic inequities as well as discrimination on the diffusion of HIV) will have to be "revisited" in light of these recent changes. New issues (such as risk behaviours among already infected patients. impact of therapeutic advances on psychosocial and daily life management of their disease by people living with HIV/AIDS, adherence to treatment, or "normalisation" of AIDS public policies) will have to be strongly and quickly dealt with, in order for SSB to keep the pace with the rapid evolution of the epidemic and of the societal responses to it. Finally, the paper argues that to face these challenges, new theoretical and methodological advances will have to go beyond the classical oppositions in internal debates among SSB between individualistic and holistic approaches, or between radical criticism of the existing state of the world and practical involvement in public health decision-making.

Seroprevalence of HIV among female sex workers in Bangkok: evidence of ongoing infection risk after the "100% condom program" was implemented.

BACKGROUND: After implementation in 1991 of a nationwide campaign to promote condom use during commercial sex, HIV-1 seroprevalence among young men began to decrease in 1994. However, it is unknown to what degree female sex workers (FSWs) have been protected from infection. METHODS: FSWs attending a government clinic in Bangkok in 1997 and 1998 were interviewed, counseled, and tested for evidence of prior syphilis by Treponema pallidum hemagglutination assay (TPHA) and for HIV-1 antibodies. RESULTS: Among the 500 participants, women who began sex work more recently reported less risky sex behavior when they were first potentially exposed to HIV infection, and TPHA reactivity rates were lower among these women. However, their HIV infection rates were higher. HIV seroprevalence was 5.5% among 91 women who began sex work before 1989, 8.0% among 87 women who began during 1990 to 1993, and 12.5% among 322 women who had begun since 1994. CONCLUSIONS: Although condom use is critical to HIV prevention, women in this study who began sex work after the condom promotion campaign was implemented were still at high risk for HIV infection. Additional measures are needed to prevent HIV infection among the many young women who initiate or continue to engage in commercial sex.