Effects of HIV-related stigma among an early sample of patients receiving antiretroviral therapy in Botswana.

Botswana, with its estimated HIV prevalence of 37%, instituted a policy of universal access to antiretroviral therapy (ART) in 2002. Initial enrolment lagged behind expectations, with a shortfall in voluntary testing that observers have attributed to HIV-related stigma - although there are no published data on stigma among HIV-positive individuals in Botswana. We interviewed 112 patients receiving ART in 2000, finding evidence of pervasive stigma in patterns of disclosure, social sequelae, and delays in HIV testing. Ninety-four percent of patients reported keeping their HIV status secret from their community, while 69% withheld this information even from their family. Twenty-seven percent of patients said that they feared loss of employment as a result of their HIV status. Forty percent of patients reported that they delayed getting tested for HIV; of these, 51% cited fear of a positive test result as the primary reason for delay in seeking treatment, which was often due to HIV-related stigma. These findings suggest that success of large-scale national ART programmes will require initiatives targeting stigma and its social, economic and political correlates.

Content of minor and trace elements, and organic nutrients in representative mixed total diet composites from the USA.

As part of an international nutrition project sponsored by the International Atomic Energy Agency (see footnote), Vienna, Austria, a number of bench-mark mixed total diet composites from the United States were collected and analyzed for minor and trace elements. In this segment of the project, the daily dietary intakes of the minor elements Ca, Cl, K, Mg, N and P and the trace elements Al, As, Au, Br, Cd, Co, Cr, Cs, Cu, Fe, Hg, I, Mn, Mo, Ni, Pb, Rb, Sb, Sc, Se, Sn, Sr, V, Zn and W were determined in mixed total diet composites of foods collected in the FDA Total Diet Study (FDA-TDS). These diets are representative of foods consumed by 25-30-year-old males (representing the mixed population groups in the United States), the highest of eight intake groups in the TDS scheme. In order to link the US mixed diet composite results from this study group to the more comprehensive information generated by the FDA-TDS, the results are compared with the same age-sex group published by the FDA-TDS scheme. The FDA-TDS scheme is based on individual analysis of the 201 food items, with resultant calculation of the daily intake representative of various age-sex groups. The comparison shows excellent agreement for 21 elements which have been investigated by both approaches. Additional elements are reported in the US mixed diet composites from the present study which demonstrate a valuable supplement to the data obtained by FDA-TDS scheme. Further the mixed total diet composite approach has also proven useful for the assessment of dietary intake of proximates (protein, fat, carbohydrates), fiber and phytate. In addition, vitamins thiamin, riboflavin, niacin, B6, B12, pantothenic acid, folic acid and biotin were also assayed in these composites.

Social skills training for young adolescents: cognitive and performance components.

An assertiveness training curriculum that was an expansion of two previous programs with young adolescents (Thompson, Bundy, & Broncheau, 1995; Wise, Bundy, Bundy, & Wise, 1991) was presented to 22 fifth graders. Cognitive acquisition and retention of the symbolic assertiveness information were measured with multiple-choice pre- and posttests used in the two prior programs. The performance components, including verbal (word choice) and non-verbal (body orientation, posture, and gestures) aspects of assertive behavior were measured in pretest and posttest role-play situations, with the posttest administered at two levels of motivation. When trained students were compared to control groups on the cognitive measures, a significant effect for treatment (p < or = .000); a significant effect for measures (p < or = .000); and a significant Treatment x Measures interaction (p < or = .000) were found. However, the results did not show that training facilitated assertiveness on the performance components. When trained and control subjects' performance scores were combined, a significant effect for measures was found across role-play tests on some of the performance measures. Discussion focuses on factors that facilitate adolescents' appropriate application of stored symbolic information regarding assertiveness. Suggestions are offered for designing programs aimed at developing adolescents' assertive behavior in ways that will generalize to their lives beyond the training context.

Prefascial marsupialization of the pregnant uterus.

A case report is presented of a white woman, gravida 4, para 2, abortus 1, who experienced protrusion of a gravid uterus through the anterior rectus fascia. The uterus subsequently became entrapped and was reduced only after cesarean section at 34 weeks' gestation.