Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings.

Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely.

[Travel advice on the prevention of infectious diseases insufficiently obtained by indigenous and non-native inhabitants of Amsterdam, the Netherlands]. / Onvoldoende bereik van reizigersadvisering over infectieziektepreventie onder autochtone en allochtone Amsterdammers.

OBJECTIVE: To determine the travel behaviour of inhabitants of Amsterdam, the Netherlands, with respect to age and ethnicity, as well as the impact of travel advice, in particular regarding hepatitis A vaccination of Turkish and Moroccan children. DESIGN: Descriptive. METHOD: In a sample of 2000 inhabitants of Amsterdam, a survey was carried out during the period October 1999-November 2000 on seeking medical advice prior to travelling. In addition, 429 Turkish and Moroccan parents were questioned about hepatitis A vaccination of their children when travelling to their country of origin. RESULTS: In the three years preceding the survey one third of the Amsterdam population travelled to a country where infectious diseases such as malaria and hepatitis A were endemic. Many travellers (18%) went to Asia, Central or Latin America and Africa. Others (12%) travelled to the Middle-East or North Africa. One third of the travellers had sought advice from the Municipal Public Health Service of Amsterdam. Other travellers were advised by their general practitioner (10%). A large group (38%) did not seek any advice at all. Almost one third of the travellers went to their country of origin, particularly Turkish and Moroccan inhabitants of Amsterdam. Seventy percent of Turkish and Moroccan travellers had not sought travel advice. More than half the Turkish and Moroccan parents did not have their children vaccinated against hepatitis A when travelling to their country of origin. CONCLUSION: One fifth of the indigenous Dutch population received no travel advice. More than half of Turkish and Moroccan children travelling to their country of origin were not vaccinated against hepatitis A.

[Increase of malaria in the Dominican Republic]. / Toename van malaria in de Dominicaanse Republiek.

In November 1999 nine European cases of malaria caused by Plasmodium falciparum reportedly were imported by tourists from the Dominican Republic. The incidence of malaria has increased since the hurricane George and since building activities for tourist centres have favoured growth of the mosquito population. Travellers to the Dominican Republic are advised to take precautions against mosquitoes and to take proguanil prophylaxis also malaria should be considered in patients with fever who have visited the area, if only as tourists.

[Thiomersal in gammaglobulin for pregnant travellers may not be safe for the fetus. National Coordination Center for Travel Advisory]. / Thiomersal in gammaglobuline voor zwangere reizigers mogelijk niet veilig voor de foetus.

It is not advisible to use thiomersal-containing gammaglobulin preparations for the prevention of hepatitis A in pregnant women. The current preparation of Sanquin-Centraal Laboratorium voor de Bloedtransfusiedienst will yield per 5 ml about 285 micrograms of ethylmercury. This exposure to ethylmercury may not be safe for the foetus and alternatives without ethylmercury are readily available.