HIV knowledge and its correlation with the Undetectable = Untransmittable slogan in Brazil

ABSTRACT Knowledge about HIV transmission and prevention is a necessary step for adopting preventive behaviors. We assessed HIV knowledge and its correlation with the perceived accuracy of the "Undetectable = Untransmittable" (U=U) slogan in an online sample with 401 adult Brazilians. Overall, 28% of participants showed high HIV knowledge level. The perceived accuracy of the U=U slogan significantly correlated with HIV knowledge. Younger participants, those reporting lower income or lower education, or who had never tested for HIV showed poorer HIV knowledge. Filling gaps of knowledge among specific populations is urgent in order to increase preventive behaviors and decrease HIV stigma.

Interplay Between Geography and HIV Transmission Clusters in Los Angeles County.

BACKGROUND: Clusters of HIV diagnoses in time and space and clusters of genetically linked cases can both serve as alerts for directing prevention and treatment activities. We assessed the interplay between geography and transmission across the Los Angeles County (LAC) HIV genetic transmission network. METHODS: Deidentified surveillance data reported for 8186 people with HIV residing in LAC from 2010 through 2016 were used to construct a transmission network using HIV-TRACE. We explored geographic assortativity, the tendency for people to link within the same geographic region; concordant time-space pairs, the proportion of genetically linked pairs from the same geographic region and diagnosis year; and Jaccard coefficient, the overlap between geographical and genetic clusters. RESULTS: Geography was assortative in the genetic transmission network but less so than either race/ethnicity or transmission risk. Only 18% of individuals were diagnosed in the same year and location as a genetically linked partner. Jaccard analysis revealed that cis-men and younger age at diagnosis had more overlap between genetic clusters and geography; the inverse association was observed for trans-women and Blacks/African Americans. CONCLUSIONS: Within an urban setting with endemic HIV, genetic clustering may serve as a better indicator than time-space clustering to understand HIV transmission patterns and guide public health action.

Conhecimento sobre a transmissao de HIV/AIDS entre adolescentes com 11 anos de idade do Sul do Brasil / HIV/AIDS transmission knowledge among adolescents aged 11 years from Southern Brazil

Objetivo: Investigar o efeito de fatores demográficos, socioeconômicos, educacionais e familiares sobre o conhecimento acerca do HIV/AIDS em adolescentes com 11 anos de idade. Métodos: Foram estudados 3.949 adolescentes de Pelotas/RS. O conhecimento acerca do HIV/AIDS foi avaliado por meio de um questionário autoaplicado e mensurado através de cinco perguntas sobre relação heterossexual, relação homossexual, compartilhamento de seringas, beijo na boca e abraçar alguém com AIDS. As análises foram ajustadas com base em um modelo hierárquico, usando regressão de Poisson com ajuste robusto da variância. Resultados: Os percentuais de respostas erradas para as questões examinadas foram: 17,2% para transmissão em relações heterossexuais; 44,1% para relações homossexuais; 34,9% para compartilhar seringas; 25,6% para beijo na boca e 16,2% para abraçar pessoa com AIDS. Na análise ajustada, menor grau de conhecimento foi demonstrado pelos meninos, por adolescentes de menor nível econômico, cujas mães possuíam menor escolaridade, para os adolescentes que não haviam conversado sobre sexo com a mãe e entre os que não tiveram aula sobre educação sexual na escola. O grau de conhecimento não esteve associado com o tipo de escola, cor da pele, tampouco com a conversação com o pai sobre sexo. Conclusão: Fornecer informações aos adolescentes é fundamental para melhorar o conhecimento sobre o risco de transmissão de HIV e de outras infecções sexualmente transmissíveis, principalmente entre jovens do sexo masculino e de menor nível socioeconômico. As políticas públicas devem considerar o rol que a mãe e a escola desempenham ...

Objective: To investigate the effect of demographic, socioeconomic, educational and family variables on HIV/AIDS knowledge among adolescents aged 11 years. Methods: 3,949 adolescents born in Pelotas (Brazil). HIV/AIDS knowledge was assessed through a self-administered questionnaire and measured through five questions about HIV transmission: heterosexual intercourse, homosexual intercourse, needle sharing, open-mouth kissing and hugging someone with AIDS. All the analyses were adjusted based on a hierarchical model, using Poisson regression with robust adjustment of variance. Results: Prevalence of wrong answers to the examined questions were 17.2% for heterosexual transmission, 44.1% for homosexual intercourse, 34.9% for needle sharing, 25.6% for kiss on the mouth and 16.2% for hugging someone with AIDS. In adjusted analysis, lower knowledge levels were more prevalent among boys, adolescents with lower socioeconomic status and with less maternal education level, among those who had not talked about sex with mother and without sexual education lessons at school. Knowledge was not associated with school type (public or private), skin color or talk about sex with father. Conclusion: Providing information to adolescents is essential to improve knowledge about HIV and other sexually transmitted infections, especially among young males, with lower socioeconomic status and with lower maternal education level. Public policies aimed to reducing HIV infection should consider maternal and school relevance to improve knowledge on adolescents. .

A certain fate: spread of HIV among young injecting drug users in Manipur, north-east India.

This study aimed to measure risk behaviours and seroprevalence of HIV and hepatitis C virus in IDUs in Manipur, North-East India, and evaluate the impact of the recently established Syringe and Needle Exchange Program (SNEP). Sampling strategy was based on social networks. Peer interviewers administered the study questionnaire and collected blood for anti-HCV and anti-HIV testing. One hundred and ninety-one IDUs (85% male) took part. Average age at first injection was 19 years and average length of time injecting was 3.7 years. The main drug currently injected was heroin (66%). Most (93%) reported having shared injecting equipment and only 42% had used the SNEP. Three-quarters (74.7%) were infected with HIV and almost all (98%) with HCV. Age (p < 0.001) and length of time injecting (p < 0.001) were significantly associated with being HIV-positive. Over two-thirds were sexually active, but only 3% consistently used condoms. Almost three-quarters of IDUs in this study were infected with HIV, most within the first two years of injecting, indicating infection continues to spread at very high rates. Unsafe sexual practices place partners of infected IDUs at risk of infection. The SNEP must increase its coverage to young and new IDUs before they are exposed to blood-borne viruses.

Limits on oral transmission of HIV-1.

PIP: This article discusses the potential of acquiring an HIV-1 infection through an oral route, with a view of offering clues for its prevention. In a study of adult animals given low concentration cell-free simian immunodeficiency virus (SIV) orally, histological examination suggested that SIV infected lymphoid tissue through the antigen-transporting crypt epithelium rather than through dendritic cells. The investigators found no evidence of acquiring SIV via the gastrointestinal tract. For humans, HIV transmission from saliva or intimate family contact seems to be extremely rare. This could be because of the low concentration of HIV-1 in saliva. A study of 40 people found that significantly less HIV was found in salivary secretions than in plasma. Another possible explanation for inefficient oral transmission might be that HIV-1 in the oropharynx is inhibited by components found in salivary secretions. Conversely, studies have noted that risk of oral transmission of HIV from contaminated breast milk and semen is higher than from saliva. Breast-feeding by an HIV-infected woman puts the baby at substantial risk of infection and receptive fellatio cannot be considered a safe sex act.^ieng

Transmission of HIV from injecting drug users to their wives in India.

We aimed to identify factors associated with transmission of human immunodeficiency virus (HIV) from injecting drug users (IDUs) to their wives in Manipur, northeast India, where the prevalence of HIV among IDUs is 80% via a case-control study. One hundred and sixty-one HIV-infected IDUs and their wives were recruited from September 1996 to August 1997 inclusive. HIV status was determined by enzyme-linked immunosorbent assay (ELISA) plus Western blot, Interviews were administered anonymously. Regression analysis identified factors associated with transmission of HIV from IDU husbands to their non-injecting wives. Seventy-two wives (45%) were HIV-positive. Only 15% of the couples reported regular usage of condoms during intercourse. On multivariate analysis, a sexually transmitted disease (STD) in either member, reported by the husband, estimated duration of HIV in the husband for >8 years, and a history of blood transfusions were associated with infection in the wife. In conclusion, STDs are associated with transmission of HIV from husband to wife. Improved control of STDs, condom promotion, and improved blood screening are urgently needed in Manipur.

Sexual bridging by Cambodian men: potential importance for general population spread of STD and HIV epidemics.

BACKGROUND: Linkages between sexual networks influence STD and HIV epidemics. GOAL: This study quantifies male sexual "bridging" and associated factors in Cambodia's 1997 behavioral surveillance survey. STUDY DESIGN: Among persons randomly selected from clusters of military, police, and motorcycle taxidrivers in five cities, associations between individual characteristics, behaviors, social context, and "active bridging" were tested using logistic regression analyses. RESULTS: The authors defined 20.5%, 15.7%, and 14.7% of military, police, and motorcycle taxidrivers as active bridgers (men who have unprotected sex with high and low risk partners). Among the military and police, logistic regression revealed that age (odds ratio [OR], 1.05), age of first sexual intercourse (OR, 0.89), having friends who frequent sex workers (OR, 3.31), and residence in the port city (OR, 3.34) were associated with active bridging. Among motorcycle taxidrivers, residence in the border city (OR, 2.23) or the port city (OR, 2.84) was associated with active bridging. Sexually transmitted disease symptoms during the past year were significantly associated with active bridging. CONCLUSIONS: Social characteristics influence sexual bridging more than individual ones. The pervasiveness of bridging and the association with sexually transmitted disease symptoms underscore the potential of men who are active bridgers to spread sexually transmitted disease and HIV in Cambodia beyond high-risk groups.

Advances and research directions in the prevention of mother-to-child HIV-1 transmission.

Although substantial progress has been made in preventing mother-to-child HIV-1 transmission in the past decade, critical research questions remain. Two perinatal epidemics now exist. In more-developed countries, integration of prenatal HIV-1 counselling and testing programmes into an existing antenatal infrastructure, availability of effective antiretroviral prophylaxis, and access to infant formula have resulted in new perinatal infections becoming rare. However, identification of missed prevention opportunities, the causes of prophylaxis failure, and the potential effects of in-utero antiretroviral exposure have become a priority. In less-developed countries, antenatal care is limited, testing programmes are almost non-existent, effective interventions remain unimplemented, and prevention of postnatal transmission through breastmilk while maintaining adequate infant nutrition is a major dilemma. The challenge for the next decade is to simultaneously address questions relevant to both epidemics while bridging the gap in prevention of perinatal transmission between more-developed and less-developed countries.

Factors affecting attitudes towards mother-to-child transmission of HIV among pregnant women in a maternal and child hospital in Thailand.

This study determines the factors which correlate with attitudes towards mother-to-child transmission of HIV in pregnant women. Using a structured questionnaire, 527 pregnant women who visited a hospital to have prenatal checkups were interviewed. The survey items were: sociodemographic characteristics, experiences of pre-test counselling, knowledge of mother-to-child transmission, and attitude towards termination of pregnancy. Results showed that many pregnant women (80%) did not have proper knowledge of the possibility of mother-to-child transmission. Logistic regression analysis also indicates that age and knowledge of the possibility of mother-to-child transmission were the significant determinants of attitudes towards termination of pregnancy. Older women who believe that all the babies of pregnant women with HIV will be infected are most likely to terminate their pregnancy when they are diagnosed as HIV positive. Considering the importance of informed decisions regarding pregnancy, this study must have important implications for future support programmes for HIV-positive pregnant women.

Experiences of breastfeeding and vulnerability among a group of HIV-positive women in Durban, South Africa.

While international guidelines are currently being drawn up about HIV and infant feeding practices, and national and regional guidelines are under discussion in South Africa, there have been remarkably few studies that have sought to elicit HIV-positive mothers' experiences of breastfeeding and of paediatric infection. There is an urgent need to document this 'grass roots' knowledge in different sites, and for this data to be used to inform policy development, and for advocacy and counselling purposes. This qualitative investigation reports on the experiences and decisions taken around breastfeeding by a peer support group of 13 HIV-positive mothers meeting at King Edward VIII Hospital, Durban. In this study, the particular focus of information-giving and decision-making as to breast or formula feed is concerned with the impact on individual HIV-positive women and their babies. The most significant finding is that at no stage during their pregnancy were any of these mothers given information about the risks of HIV transmission through breastmilk. The study data were elicited in an in-depth group discussion, and individual women were invited to re-enact their stories in a follow-up discussion for clarification purposes. The women also discussed how they dealt with problems surrounding confidentiality in cases where few have been able to disclose their status to the extended family. There have been renewed calls for further investment in counsellors, with an enhanced role for community activists as peer educators. While there are severe resource constraints and low morale among many overworked nurses, one of the general problems in hospital settings remains the vertical health paradigm. This does not accommodate women's experiences, preferences, social networks and lay knowledge, and inhibits many women from becoming full participants in decisions affecting their own and their family's health.

Mobile workers and HIV / AIDS in Botswana.

PIP: This paper examines the impact of internal migration and external population movements and interactions on the spread of the HIV/AIDS epidemic in Botswana. A total of 292 mobile workers in selected rural and urban areas were interviewed. Focus group discussions were conducted in all sites. The study showed that migration has a significant influence on public health and HIV/AIDS spread in the country. The frequency of sexual intercourse among migrant workers and their return visits back home, intensifies the spread of HIV/AIDS. Unprotected sex is a primary mode of HIV/AIDS and sexually transmitted disease transmission among the population. Despite the high level of knowledge about HIV/AIDS, its transmission and effects, there remained an insufficient use of condoms. Areas that are sites of major development projects, where a large number of migrant workers concentrate, have higher HIV and STD rates than areas that are not.^ieng

Rising HIV infection through blood transfusion worries Nigerian health experts.

PIP: Blood transfusion is the second largest source of HIV infection in Nigeria, after unprotected sex. The major reason for this problem is the proliferation of illegal and lucrative blood banks that were being established. It has been discovered that most of these blood banks rely on "blood touts" for the supply of blood, which is later sold to needy patients. Lack of modern testing equipment and few private hospitals and government hospitals screening blood that is meant for transfusion compounded this problem. In response to the menace of unscreened blood for transfusion, the Lagos State Government declared a law to regulate blood transfusions and the activities of blood banks in the State. The objectives of this law were to curb the activities of owners of blood banks who were peddling unscreened blood to unsuspecting patients. Among the provisions of the law was that medical laboratories and hospitals that have blood banks should register their blood donors at any of the screening centers in the State. This law further prescribed fines and imprisonment for offenders. The law, however, turned out to be unenforceable because the reagents and testing equipment required were largely unavailable. It is noted that in the absence of a national blood transfusion policy, most blood banks continue to sell unscreened blood; in turn, HIV infections in Nigeria continue to rise.^ieng

Unsafe injections in the developing world and transmission of bloodborne pathogens: a review.

Unsafe injections are suspected to occur routinely in developing countries. We carried out a literature review to quantify the prevalence of unsafe injections and to assess the disease burden of bloodborne infections attributable to this practice. Quantitative information on injection use and unsafe injections (defined as the reuse of syringe or needle between patients without sterilization) was obtained by reviewing the published literature and unpublished WHO reports. The transmissibility of hepatitis B and C viruses and human immunodeficiency virus (HIV) was estimated using data from studies of needle-stick injuries. Finally, all epidemiological studies that linked unsafe injections and bloodborne infections were evaluated to assess the attributable burden of bloodborne infections. It was estimated that each person in the developing world receives 1.5 injections per year on average. However, institutionalized children, and children and adults who are ill or hospitalized, including those infected with HIV, are often exposed to 10-100 times as many injections. An average of 95% of all injections are therapeutic, the majority of which were judged to be unnecessary. At least 50% of injections were unsafe in 14 of 19 countries (representing five developing world regions) for which data were available. Eighteen studies reported a convincing link between unsafe injections and the transmission of hepatitis B and C, HIV, Ebola and Lassa virus infections and malaria. Five studies attributed 20-80% of all new hepatitis B infections to unsafe injections, while three implicated unsafe injections as a major mode of transmission of hepatitis C. In conclusion, unsafe injections occur routinely in most developing world regions, implying a significant potential for the transmission of any bloodborne pathogen. Unsafe injections currently account for a significant proportion of all new hepatitis B and C infections. This situation needs to be addressed immediately, as a political and policy issue, with responsibilities clearly defined at the global, country and community levels.

PIP: Unsafe injections and the consequent transmission of bloodborne pathogens are suspected to occur routinely in the developing world. This paper presents a review of the literature to determine the prevalence of unsafe injection practices and assess the disease burden of bloodborne infections. Quantitative data on injection usage and unsafe injection practices, such as the reuse of unsterilized syringe or needles between patients, is obtained by reviewing published articles and unpublished reports of the WHO. In addition, the transmissibility of hepatitis B and C viruses and HIV was determined using information from studies of needle-stick injuries. All epidemiological researches that associate injections with bloodborne diseases were examined to assess the attributable burden of bloodborne infections. It was estimated that each person in developing countries receives an average of 1.5 injections per annum. However, institutionalized children, children and adults who are sick or confined in hospitals, often receive 10-100 times as many injections. Of these injections, 95% are therapeutic, a majority of which are unnecessary. At least 50% of injections in 14 of 19 countries were unsafe. Furthermore, 18 studies present convincing evidence on the association of unsafe injection practices and the transmission of bloodborne viruses such as hepatitis B and C, Ebola, Lassa virus infections and malaria. Such practices account for a significant number of hepatitis B and C infections.

Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates.

Thousands of millions of injections are delivered every year in developing countries, many of them unsafe, and the transmission of certain bloodborne pathogens via this route is thought to be a major public health problem. In this article we report global and regional estimates of the number of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections that may occur from unsafe injections in the developing world. The estimates were determined using quantitative data on unsafe injection practices, transmission efficiency and disease burden of HBV, HCV and HIV and the prevalence of injection use obtained from a review of the literature. A simple mass-action model was used consisting of a generalized linear equation with variables accounting for the prevalence of a pathogen in a population, susceptibility of a population, transmission efficiency of the pathogen, proportion of injections that are unsafe, and the number of injections received. The model was applied to world census data to generate conservative estimates of incidence of transmission of bloodborne pathogens that may be attributable to unsafe injections. The model suggests that approximately 8-16 million HBV, 2.3-4.7 million HCV and 80,000-160,000 HIV infections may result every year from unsafe injections. The estimated range for HBV infections is in accordance with several epidemiological studies that attributed at least 20% of all new HBV infections to unsafe injections in developing countries. Our results suggest that unsafe injections may lead to a high number of infections with bloodborne pathogens. A major initiative is therefore needed to improve injection safety and decrease injection overuse in many countries.

PIP: This paper reports global and regional estimates of the prevalence of hepatitis B virus (HBV), hepatitis C virus (HBV), and HIV infections that may occur as a result of unsafe injection practices in the developing countries. The estimates were determined using quantitative information on unsafe injection practices, transmission efficiency of pathogen, and disease burden of hepatitis B and C viruses, as well as HIV and the prevalence of injection usage as observed in the literature reviews. A simple mass-action model was utilized in the study and was applied to world census data to generate the conservative estimates of interest. The model showed that about 8-16 million HBV, 2.3-4.7 million HCV, and 80,000-160,000 HIV infections may result from unsafe injections each year. It was also noted that the estimated range of HBV infection is consistent with a number of epidemiological studies that attribute at least 20% of all new cases of HBV infection to unsafe injections in the developing world. Given that unsafe injections may contribute to a high number of infections with bloodborne pathogens, a major effort is necessitated to improve injection safety and reduce injection overuse in many countries.

The cost of unsafe injections.

Unsafe injection practices are associated with substantial morbidity and mortality, particularly from hepatitis B and C and human immunodeficiency virus (HIV) infections. These inadvertently transmitted bloodborne diseases become manifest some considerable time after infection and hence may not be appropriately accounted for. Annually more than 1.3 million deaths and US$ 535 million are estimated to be due to current unsafe injection practices. With the global increase in the number of injections for vaccination and medical services, safer injecting technologies such as auto-disable syringes must be budgeted for. Investment in health education and safer disposal will also reduce infections associated with unsafe injecting practices. Safer injecting practices are more expensive than current less safe practices, but the additional cost is more than offset by the reduction in disease that would result.

PIP: Unsafe injection practices, defined as the use of unsterilized injection equipment in patients, are linked with substantial morbidity and mortality in certain bloodborne diseases including hepatitis B and C infections, as well as infection with HIV. It is estimated that over 1.3 million lives are lost annually as a result of unsafe injection practices and more than US$535 million is spent each year to treat emerging bloodborne diseases. With the significant increases in the number of injections for immunization and medical services globally, safer injecting technologies such as the use of auto-disable syringes and oral aerosol or oral formulations must be considered. Likewise, investment in health education and promoting safe, convenient, and effective disposal of injection equipment will also decrease infections associated with unsafe injection practices. Finally, although safer injecting technologies are more costly than the existing less safe practices, the additional cost is more than offset by the resultant decrease in bloodborne diseases.

Predictors and impact of losses to follow-up in an HIV-1 perinatal transmission cohort in Malawi.

BACKGROUND: Large simple trials which aim to study therapeutic interventions and epidemiological associations of human immunodeficiency virus (HIV) infection, including perinatal transmission, in Africa may have substantial rates of loss to follow-up. A better understanding of the characteristics and the impact of women and children lost to follow-up is needed. METHODS: We studied predictors and the impact of losses to follow-up of infants born in a large cohort of delivering women in urban Malawi. The cohort was established as part of a trial of vaginal cleansing with chlorhexidine during delivery to prevent mother-to-infant transmission of HIV. RESULTS: The HIV infection status could not be determined for 797 (36.9%) of 2156 infants born to HIV-infected mothers; 144 (6.7%) with missing status because of various sample problems and 653 (30.3%) because they never returned to the clinic. Notably, the observed rates of perinatal transmission were significantly lower in infants who returned later for determination of their infection status (odds ratio = 0.94 per month, P = 0.03), even though these infants must have had an additional risk of infection from breastfeeding. In multivariate models, infants of lower birthweight (P = 0.003) and, marginally, singletons (P = 0.09) were less likely to return for follow-up. The parents of infants lost to follow-up tended to be less educated (P < 0.001) and more likely to be in farming occupations, although one educated group, teachers and students, were also significantly less likely to return. Of these variables, infant birthweight, twins versus singletons, and maternal education were also associated with significant variation in the observed risk of perinatal transmission among infants of known HIV status. CONCLUSIONS: Several predictors of loss to follow-up were identified in this large HIV perinatal cohort. Losses to follow-up can impact the observed transmission rate and the risk associations in different studies.

PIP: Predictors and the impact of losses to follow-up of infants born to a large HIV- infected cohort of delivering women in urban Malawi were studied. The women enrolled in an intervention trial including vaginal cleansing with chlorhexidine at the time of delivery. Findings showed that of the 2156 infants born to HIV- infected mothers, about 1359 (63.1%) had been diagnosed with HIV infection, 797 (36.9%) with undetermined status, 144 (6.7%) with missing status, and about 653 (30.3%) were never brought back for follow-up. The odds of HIV positivity decreased in the determination of infectious status (P = 0.03) despite the probability of additional transmission from breast-feeding. Late-coming and lost children of less educated parents had similar birth weight (P = 0.50) and were likely less to return. This was probably due to the fact that the fathers of the lost children were farmers. Besides, infant birth weight, twins vs. singletons, and maternal education were affiliated with significant variation in the observed risk of perinatal transmission among HIV-positive infants. Thus, with regard to the intervention trial, the LFU were approximately equal in both groups. There was no evidence that the losses were unbalanced between arms in relation to the predictors of transmission.

Infant feeding and HIV-1 transmission.

PIP: Anna Coutsoudis and colleagues present a potentially important piece of the puzzle concerning the transmission of HIV-1 through breast-feeding in the first few months of life. Breast-feeding poses a substantial risk of acquiring HIV-1 infection for the baby of an HIV-1-infected mother. Samples from 549 infants were tested by HIV-DNA PCR on day 1 and at ages 1 month and 3 months. Results revealed that the percentages of infection were similar for the three groups between 1 month and 3 months, and that the real increase in rate of infection occurred after the first month of life. This suggests that there may be a protective early effect of exclusive breast-feeding and that hence a breast-feeding HIV-1-infected mother should avoid giving any other foods for at least the first 3 months of life. Results in this study highlight the need for re-evaluation of the role of breast-feeding in the transmission of HIV-1.^ieng

Preventing HIV infection: lessons from Mwanza and Rakai.

PIP: The impact of enhanced syndromic diagnosis of symptomatic sexually transmitted infections (STIs) upon the incidence of HIV infections was evaluated in 8 paired villages in Mwanza, Tanzania, over a 2-year period. Shortly thereafter, a study was conducted in Uganda's Rakai district which focused upon treating all members of 5 clusters of paired communities, including those with symptomatic and asymptomatic STIs. In August 1995, the results of the Mwanza study showed that almost 40% of HIV infections had been prevented in the communities receiving the intervention. No other HIV intervention has had such a major effect upon infection rates. In contrast, however, no HIV infections were prevented in the Rakai intervention communities. The Mwanza results could reflect the short-term impact of STD prevention and control in an immature epidemic, while the Rakai study reflects the short-term impact in a mature epidemic. The probability of transmission, the duration of infectiousness, and the number of sex partners are discussed as factors which influence the generation of an HIV epidemic in a susceptible population. The 2 studies' results indicate that STD prevention and control is feasible, effective, and affordable.^ieng

Feasibility of hospital-based blood banking: a Tanzanian case study.

The demand for blood transfusion is high in sub-Saharan Africa because of the high prevalence of anaemia and pregnancy related complications, but the practice is estimated to account for 10% of HIV infections in some regions. The main response to this problem by the international donor community is to establish vertically implemented blood transfusion services producing suitable (safe) blood at a cost of US$25-40 per unit. However, the economic sustainability of such interventions is questionable and it is argued here that hospital-based blood transfusion services operating at a basic adequate level are sufficient for low-income African countries. The results of a project aimed at improving such services in Tanzania are presented. The main findings are: (1) the cost per suitable blood unit produced was US$12.4; (2) at an HIV test sensitivity of 93.5% during the study period, discounted financial benefits of the interventions exceeded costs by a factor of between 17.2 and 37.1; (3) the cost per undiscounted year of life saved by use of these interventions was US$2.7-2.8; and (4) safe blood transfusion practices can be assured at an annual cost of US$0.07 per capita. Recommendations are made to ensure safe blood transfusion practices at hospital-based blood banks in Tanzania.

PIP: The demand for blood transfusion was high in sub-Saharan Africa because of the high prevalence rate of anemia and pregnancy related complications, but the practice was estimated to account for 10% of HIV infections in some regions. The most common response by the international donor community to the problem was to establish vertically implemented blood transfusion producing suitable safe blood units at a cost of US$25-40/unit. This paper presents an economic evaluation of the feasibility of a hospital-based blood banking in Tanzania. The project on which this study was based started in 1992 in Mwanza region with the aim of implementing the interventions required to assure safe blood-transfusion practices, as formulated by the Tanzanian Ministry of Health. The main findings of this study include: 1) the cost per suitable blood unit produced was US$12.4; 2) at an HIV test sensitivity of 93.5% during the study period, discounted financial benefits of the interventions exceeded costs by a factor of between 17.2 and 37.1; 3) the cost per undiscounted year of life saved by use of these interventions was US$2.7-2.8; and 4) safe blood transfusion practices can be assured at an annual cost of US$0.07 per capita. For a low-income country like Tanzania, provision of safe blood transfusion services through a hospital-based banking system was a feasible horizontal alternative to the more costly vertical approach.

Where are Kenya's homosexuals?

PIP: While African leaders continue to assert that male homosexuality only occurs on the continent as the result of a "pernicious Western influence," networks of homosexuals can be found throughout Africa. Many homosexuals adopt heterosexual lifestyles in an attempt to fit in. In Kenya, where homosexuality is illegal, sex between men (or between men and boys) is estimated to cause less than 5% of the cases of HIV/AIDS. The head of the Kenya AIDS NGO (nongovernmental organization) Consortium reports that male homosexuality is fashionable among young men and is practiced in prisons, boarding schools, and colleges. While homosexuals meet publicly in a building near the University of Nairobi, most homosexuals lead a clandestine sex life. In the coastal regions of Kenya, however, male homosexuality is more accepted, and marriages between men may be recognized. No one knows the extent to which the wives of homosexual men face the risk of HIV/AIDS from their husbands' homosexual behavior. The taboos surrounding homosexuality impede the provision of AIDS education and support, and there is no official recognition of the role homosexuals play in transmitting the virus. A representative of the Ministry of Health contends that HIV/AIDS transmission by homosexuals is so negligible that it does not justify attention.^ieng