Slowing the spread of human immunodeficiency virus in developing countries.

PIP: This article assesses the current status of the AIDS epidemic and discusses interventions and policies needed to control the spread of the disease. The authors explain that the lack of effective therapies and vaccines makes changing human behavior and introducing preventive measures all the more crucial. In some areas of sub-Saharan Africa, the epidemic has reached alarming proportions, with up to 1/10 to 1/3 of all sexually active adults carrying the AIDS virus. Epidemiological studies indicate that throughout Africa, the doubling time of the disease is 1-5 years, the female prostitutes constitute one of the main transmission routes, and the condom use does slow the transmission of HIV. Mathematical model reveal the benefits of early intervention strategies aimed at high-risk groups, and highlight the need to alter the sexual contact patterns between high-risk and low-risk groups. Some of the intervention strategies suggested by the article include: implementing HIV and AIDs education programs; encouraging fewer sexual partners and more safe-sex practices; reinforcing messages through multiple communications channels; promoting condom distribution, improving diagnosis and treatment programs; and improving drug abuse treatment programs and access to clean needles. The authors discuss the cost, time factors, bureaucratic obstacles, and effectiveness of these measures. Concerning policy, the authors list some of the issues that need to be addressed. These include the need to focus resources according to the prevalence of HIV; the need for multiple intervention strategies; the need for early and well-funded programs; the need to take into consideration the impact of population growth on the spread of the virus; and the need to care for AIDS-stricken patients.^ieng

Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group.

Since 1985, a population of over 1,000 predominantly HIV-positive female prostitutes residing in a low-income area of Nairobi, has been enrolled in a sexually transmitted disease (STD)/HIV control programme. The major elements of the programme include the diagnosis and treatment of conventional STD, and the promotion of condom use to prevent the transmission of HIV and other sexually transmitted infections. Using estimates of numbers of HIV-seropositive prostitutes, numbers of sexual contacts, susceptibility of clients to HIV, HIV transmission efficiency, rates of condom use and the basic reproductive rate of HIV infection in Kenya, we estimate that the programme is responsible for preventing between 6,000 and 10,000 new cases of HIV infection per year among clients and contacts of clients. The total annual operating cost of the programme is approximately US$77,000 or between US$8.00 and US$12.00 for each case of HIV infection prevented. Programmes to reduce the transmission of HIV and other sexually transmitted infections which are targeted at high-frequency STD transmitters, such as prostitutes, can be effective and relatively inexpensive to undertake. More such programmes should be developed and evaluated in different settings.

Increase in condom sales following AIDS education and publicity, United States.

Data from a national probability sample of drug stores show that condom sales rose from 240 million annually in 1986 to 299 million in 1988. The greatest increase occurred in 1987 after the Surgeon General's report on AIDS was released. Sales of latex condoms with spermicide rose 116 percent. Sales of other types of condoms increased less. These data suggest that Americans are using more condoms and probably more effective condoms in response to AIDS education.

Condom vending machines in Canada's secondary schools.

PIP: A case study of 1 of the 3 school boards approving in 1989 installation of condom machines is presented: The Lisgar Collegiate Institute, Ottawa, Canada. The school is characterized as having 1000 college preparatory students from middle and upper middle class homes and university educated parents. The project was student initiated and involved 1) meeting with communication consultants to determine feasibility, 2) conducting an informal peer consultation to seek out interest and support, 3) meeting with public health officials to gain support and ideas, and 4) conducting research. Condom machine installation (2) was only 1 component; a pilot sexuality education program was included as well. The student proposal was presented and rejected by the principal and the Superintendent of Student Services. Students then lobbied the school board trustees. 2 students lobbies each school board member. Letters of support were obtained from parents' advisory groups, parents, the student council, and other influential people. The media provided coverage in a popular morning television show. The student proposal was submitted to the Board of Education's Education Committee in June 1989; students were assisted by teachers and the Parents Advisory Committee. The school board approved. In the fall of 1989, sexuality awareness week was designated as October 30-November 3. Parents were asked for comments on the designated program, but only 50 contributed in a supportive way. During this week lunch-hour displays and videos, peer-facilitated discussion groups, informal talks by experts, and student theater presentations were sponsored activities. Following this event, the school board arranged for the installment of machines in the men's and women's washrooms near where social events were held and in toilet cubicles in order to provide privacy, as requested by students. The individual cost is US$1/condom. Evaluation is planned. Students have been amused by the amount of public response to this action. Other participating schools include Qualicum School District in Vancouver Island, British Columbia, and Toronto's 36 secondary schools.^ieng

[Prevention of AIDS. A campaign in the municipality of Copenhagen of providing free condoms in general practice]. / Forebyggelse af AIDS. Københavns Kommunes kampagne med gratis udlevering af kondom i almen praksis.

PIP: In order to limit AIDS infections, condoms are issued free of charge to groups at high risk in metropolitan Copenhagen. The value of this campaign was assessed by means of a questionnaire distributed among patients and general practitioners. The frequency of partners among patients with risky sexual behavior was found to be about 5/year/patient. No significant difference was observed in the frequency of partners between those who used condoms and those who did not. 45% of the patients did not use condoms. On the whole, patients had positive attitudes toward the campaign, but only 10% thought that it would change their sexual habits, including their use of condoms. Among the physicians surveyed, 14% opposed issuing condoms free of charge in their practices while 50% considered that this could be done in association with advice. 64% of the physicians thought that the campaign had increased patients' understanding of the sexual role in the spread of AIDS and that condom use offers protection. Only 46% if the physicians approved of the information about AIDS prevention that had been distributed. However, 82% were prepared to make special efforts in their practices to limit the spread of AIDS. The investigators conclude that the advice given to patients was variable and that well defined goals should be set for including preventative activities in general practice.^ieng