AIDS: A public health and psychological emergency.

Reviews the current status and knowledge of acquired immune deficiency syndrome (AIDS), focusing on the demographic characteristics of high-risk groups (e.g., homosexual and bisexual men), assumptions and findings that have guided research to date, and problems that have hampered this research. Because most AIDS research has dealt with gay and bisexual men, misperceptions about this group and their health, lifestyles, and sexual activity, which are common, have fostered flawed research designs. Confidentiality is another sensitive issue in AIDS detection and research. The psychological ramifications of AIDs involve the social stigmas attached to the lifestyles of high-risk groups and the fear of contracting AIDS held by the general public. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AIDS and public policy: A legislative view.

Discusses public policy concerning acquired immune deficiency syndrome (AIDS) research, prevention, patient care, and treatment. Government research has been understaffed and underfunded, and improvements are needed in equipment, instrumentation, and oversight of federal agencies. Prevention efforts have been hindered by restrictions on explicitness about sexual behaviors and drug use. Priority should be given to changing public attitudes, counseling and testing of high-risk groups, and community-based programs with access to such groups. Treatment efforts should focus on services for those in the early stages of infection, psychosocial and specialized programs, and financing of AIDS-related health care. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of HIV counseling and testing for women: Behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n?=?106) and a comparison group of never-tested women (n?=?54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Purpose in life among gay men with HIV disease

Positive purpose in life (PIL) has been shown to influence health maintenance, facilitate recovery from illness, and enhance psychological well-being. Among persons diagnosed with human immunodeficiency virus (HIV) disease, PIL has received minimal attention. This study used a convenience sample of 67 men who had a diagnosis of acquired immunodeficiency syndrome (AIDS) or who participated in high-risk sexual behavior associated with HIV disease to measure PIL. Integrating qualitative data into the final analysis contributed to a greater understanding of PIL among persons with HIV disease and those at high risk for the disease. Results of the study demonstrated a significantly lower PIL score for men with AIDS. PIL scores were negatively correlated with religious beliefs for the group, and these scores were not influenced by the interval since the AIDS diagnosis. Men with HIV disease are often isolated and withdrawn from society and appear to lack clear meaning for existence.     

Cost of care for patients with human immunodeficiency virus infection. Patterns of utilization and charges in a public health care system

BACKGROUND: The increasing impact of human immunodeficiency virus (HIV) infection on the health care delivery system requires surveillance of current patterns of HIV-related health care utilization to adequately plan for future needs. Most studies to date have concentrated on inpatient care for patients with the acquired immunodeficiency syndrome (AIDS). Outpatient utilization has been less well studied and there are few data regarding HIV-infected patients without a diagnosis of AIDS. METHODS: Denver Health and Hospitals is a public system delivering comprehensive health care to mostly indigent residents of the city and county of Denver. Patients with HIV infection in this system were identified through multiple surveillance sources, and billing system records for these patients were analyzed. RESULTS: During 1990, 812 patients with HIV infection of 13 years or more were accessed in the Denver Health and Hospitals. During that year, the total HIV-related health care charges were $7,858,690, of which 57% were for inpatient care and 43% for ambulatory care. Patients with AIDS (34% of patients) accounted for 62% of all charges, and patients with HIV infection but without a diagnosis of AIDS (66% of patients) for 38% of charges. Compared with national predictions, patients with AIDS in our system had lower inpatient and higher outpatient utilization. CONCLUSIONS: These results are consistent with a shift from inpatient to outpatient health care services in patients with AIDS. A significant proportion of HIV-related health care costs are incurred by patients who have not yet developed AIDS.     

Impact of human immunodeficiency virus infection on mortality among young men and women in Spain

BACKGROUND: This paper describes the impact of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) mortality among young adults in Spain with specific reference to other causes of death. METHODS: Based on death registration data for the period 1980-1993, HIV/AIDS was compared against all other causes of death by gender, using specific rates in the 25-44 age group and standardized rates for potential years of life lost (PYLL). RESULTS: In 1993, HIV/AIDS was the leading cause of death among men aged 25-44 years (21.8% of all deaths) and the second leading cause of death among women (14.9%), exceeded only by cancer. Since 1982, the trend in the overall standardized mortality rate for men in the 25-44 age group has been reversed, showing a progressive increase. Similarly, since 1984 there has been a halt in the decline in female mortality. For both sexes, maintenance of these trends in mortality was largely ascribable to the effect of HIV/AIDS deaths which registered a marked rise, a rise far sharper than that witnessed for variations in all other causes studied. In 1993, the adjusted PYLL rate for HIV/AIDS for ages 1-70 rose to 615 per 100,000 population in men and 156 in women. These values accounted for 9.2% and 5.8% of PYLL for all causes, thereby ranking HIV/AIDS behind motor vehicle accidents as the second leading cause of premature death in men, and behind motor vehicle accidents and breast cancer as the third leading cause in women. For both sexes, the rise in the PYLL rate for HIV/AIDS from 1992 to 1993 proved far greater than that for all other causes of death. CONCLUSION: In Spain, HIV/AIDS has become the leading cause of death among young adults and is counteracting improvements in mortality due to other causes. It should therefore be regarded as a priority public health problem.     

The virology of AIDS.

In the short time since the cause of AIDS was identified, a considerable amount of knowledge has been gathered. The responsible agent, human immunodeficiency virus (HIV), is a retrovirus that changes the genetic composition of the cells it enters and subsequently destroys. Current knowledge about the virus suggests that it invades cells of the central nervous system, thus contributing to AIDS dementia complex. Vaccines are at present ineffective against the virus, in part because the molecular structure of the protein envelope is so changeable. Psychologists need to understand the virology and immunology of AIDS because components of the virus can alter central nervous system function in ways that have an impact on high-risk behavior. This may be a direct consequence of the virus or an indirect consequence of the production of immune system products in response to the virus. This article discusses the current state of knowledge of HIV and offers ways in which this knowledge may be used by psychologists to formulate a psychosocial and behavioral research agenda and strategies for improved, more effective patient care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification and management of pregnancy-related low back pain

A nonconcurrent prospective study was done on the relationship between a number of variables and the progression to AIDS among persons diagnosed with the human immunodeficiency virus (HIV). The variables included sociodemographic ones, behavioral ones, and, most importantly, those persons' difficulties in obtaining public health services for HIV/AIDS. The course of the infection was monitored from the first to the last visit to the health services by means of an individual, diagnostic-based classification, using categories established in 1993 by the Centers for Disease Control and Prevention of the United States of America. Participating in the study were 758 patients seen between 1989 and 1992 in the public AIDS referral services of the city of Belo Horizonte (Minas Gerais). All the persons had been diagnosed with HIV and classified in a pre-AIDS stage. Both the patients who developed AIDS during the study as well as those who did not were assessed according to the selected study characteristics. During the study period, 39.5% of the patients developed AIDS. For the group as a whole, the median time without AIDS was 32.4 months. Multivariate analysis showed that the patients who had less risk of developing AIDS were those who had had fewer than 8.8 medical consultations per year (relative risk = 0.36; 95% confidence interval, 0.26 to 0.50) and an interval of at least 6 months between consultations (RR = 0.37; 95% CI, 0.25 to 0.55). The risk was greater in patients age 30 and older (RR = 1.37; 95% CI, 1.03 to 1.84), in those who were not treated with zidovudine (AZT) (RR = 1.91; 95% CI, 1.37 to 2.64), and those who were initially classified in stage "B" of the disease (RR = 4.83; 95% CI, 3.59 to 6.48). The results of this investigation show the dynamics of the supply and demand of services by these patients, and the information will be useful in planning and organizing care for persons with HIV. Recommendations include giving priority to early intervention with a focus on ongoing outpatient care, and more study of the process that persons with HIV follow in seeking and obtaining health care.     

Prevalence of HIV infection and HIV risk behaviors associated with living place: on-the-street homeless drug users as a special target population for public health intervention

The study described here examined the prevalence of HIV infection as a function of place of residence and high-risk behaviors in six subpopulations of out-of-treatment drug injectors and crack cocaine users who participated in the National Institute on Drug Abuse (NIDA) Cooperative Agreement project. The subpopulations were blacks, Hispanics, and non-Hispanic whites sampled separately by gender. The research asked three questions: (a) Is the HIV infection rate higher among the on-the-street homeless than among those in other places of residence? (b) Do high-risk drug-related behaviors differ by housing status? and (c) What are the joint effects of high-risk drug-related behaviors and housing status on the probability of HIV infection? Overall, on-the-street homeless had a significantly higher HIV+ rate (19.0%) than the study population as a whole (11.2%). Rates differed by gender and race, with exceptionally high HIV+ rates for on-the-street homeless Hispanic males (29%) and females (32%) and for on-the-street homeless black females (38%). Having used drug works previously used by a HIV-infected person was a strong predictor of HIV+ status, as was frequency of drug injections and crack use. Having multiple sex partners was also a significant risk behavior. Findings argue against considering on-the-street homelessness as equivalent to shelter dwelling or aggregated homelessness for purposes of the AIDS epidemic. On-the-street homeless drug users were at strong risk for acquisition and transmission of HIV infection and therefore in need of targeted-racially relevant, ethnically relevant, and gender-relevant-public health interventions to help prevent the spread of AIDS.     

Pulmonary sequestration: the setting sun sign

Acquired immune deficiency syndrome (AIDS) has become a topic of increasing public concern. Several conditions have been described in patients who are afraid that they have acquired AIDS, including depression, somatization disorders, hypochondriasis, adjustment disorders and various psychoses. This paper presents a case study of a young man with persistent fear of having AIDS. In spite of negative HIV test results, the patient still insisted that he suffered from AIDS. The psychiatric diagnosis was major depressive disorder with delusion of having AIDS. The patient was treated with fluoxetine 40 mg qd and sulpiride 400 mg qn. After two weeks on medication, his fear of AIDS subsided and he improved remarkably. The most important intervention in patients with delusion of having AIDS is to identify and treat the underlying psychopathology. The following case is representative of our experience.     

Effects of diabetes and difluoromethylornithine treatment on hyperplasia, activity of MAP-kinase, and activity and association with cyclin B of p34cdc2 kinase in rat jejunal mucosa

BACKGROUND AND OBJECTIVES: The development of a vaccine to prevent human immunodeficiency virus (HIV) infection is a highly desirable goal. However, there may be a number of psychosocial barriers to HIV vaccine acceptance. The purpose of this study was to begin to examine some factors that might influence attitudes about HIV immunization. GOAL: To evaluate the relationship of health beliefs and vaccine characteristics to acceptability of hypothetical HIV immunization. STUDY DESIGN: The subjects were 222 college students who completed self-administered questionnaires that addressed health beliefs, vaccine characteristics, and acceptability of hypothetical HIV vaccines. RESULTS: Health beliefs independently predictive of HIV vaccine acceptability included perceived susceptibility to HIV, perceived nonmembership in a traditionally defined acquired immune deficiency syndrome (AIDS) risk group, and fear of the vaccine causing AIDS. Of the vaccine characteristics, efficacy influenced vaccine acceptability most strongly, followed by type of vaccine. CONCLUSION: These results suggest that universal HIV vaccine acceptance cannot be assumed and that vaccine characteristics and individuals' health beliefs are likely to influence decisions regarding HIV immunization.     

Implications of HIV treatment advances for behavioral research on AIDS: Protease inhibitors and new challenges in HIV secondary prevention.

Protease inhibitor combination therapies can reduce HIV viral load, improve immune system functioning, and decrease mortality from AIDS. These medical developments raise a host of critical new issues for behavioral research on HIV/AIDS. This article reviews developments in HIV combination therapy regimens and behavioral factors involved in these regimens and focuses on four key behavioral research areas: (a) the development of interventions to promote treatment adherence, (b) psychological coping with HIV/AIDS in the context of new treatments for the disease, (c) the possible influence of treatment on continued risk behavior, and (d) behavioral research in HIV prevention and care policy areas. Advances in HIV medical care have created important new opportunities for health psychologists to contribute to the well-being of persons with HIV/AIDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The tragus as a donor area of cartilage grafts: anatomic study

The American Dental Association (ADA) has developed many resources to address growing concerns regarding HIV (human immunodeficiency virus) issues in dental practice, including continuing education courses, workshops, journal articles, and monographs. In addition, the ADA Council on Dental Practice has established a network for dentists with HIV/AIDS (acquired immune deficiency syndrome). The network has been named PEERS, which stands for Prevention, Education, Ethics, Resources, and Support. This paper provides guidelines for developing programs in each state to address the needs of dentists with HIV/AIDS.     

Causal attributions predict rate of immune decline in HIV-seropositive gay men.

Research has suggested that attributions—the perceived causes of events—may affect psychological and physical health and the immune system. The authors hypothesized that attributions reflecting negative beliefs about the self, the future, and control would affect helper T cell (CD4) decline and onset of AIDS in individuals with HIV, either directly or through associations with psychological states such as depression. HIV+ gay men (N?=?86) participated in a structured interview from which causal attributions were extracted and coded. Attributing negative events to aspects of the self significantly predicted faster CD4 decline over 18 months following the interview, controlling for potential psychological, behavioral, social, and health mediators such as depression and health behavior. However, attributions did not predict AIDS diagnosis during the study period. The results support the idea that causal attributions related to beliefs about the self may have an influence on the immune system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurosyphilis. A comparative study of the effects of infection with human immunodeficiency virus

BACKGROUND: The course of neurosyphilis has been reported to be altered by human immunodeficiency virus (HIV) infection. Prior reports of neurosyphilis occurring in association with HIV infection have been largely anecdotal and have failed to compare neurosyphilis in patients with HIV infection with an uninfected control group. This study was performed to determine if the clinical presentation encountered is different in the presence of HIV infection. DESIGN: A retrospective, hospital-based, case series study based on chart review encompassing a 64-month period. SETTING: The study was performed in a large, university-affiliated, public health trust hospital in south Florida. PATIENTS: Forty-six hospitalized patients with neurosyphilis were identified; 13 patients fulfilled Centers for Disease Control and Prevention (Atlanta, Ga) criteria for acquired immunodeficiency syndrome (AIDS), 11 were HIV seropositive only, and 22 were HIV uninfected. Neurosyphilis was determined by a reactive cerebrospinal fluid VDRL slide test. RESULTS: The HIV-infected patients (both AIDS and HIV-seropositive groups) were younger and more frequently had features of secondary syphilis, such as rash, fever, adenopathy, headache, or meningismus. Significant differences were observed in cerebrospinal fluid measurements when the HIV-infected group was compared with the HIV-uninfected group, including a higher mean white blood cell count in patients with AIDS and a higher mean protein level and a lower mean glucose level in the HIV-infected group. Syphilitic meningitis was more common in HIV-seropositive patients, although the HIV-uninfected patients presented with a greater variety of types of neurosyphilis. Ophthalmic syphilis was observed more frequently in the HIV-infected group. CONCLUSIONS: Significant differences exist between neurosyphilis occurring in the presence and absence of HIV infection.     

Psychological factors that predict AIDS high-risk versus AIDS precautionary behavior.

Men (N?=?526) who patronized gay bars in three cities completed measures of sexual behavior covering the previous 3 months and psychological measures theoretically pertinent to AIDS risk. Thirty-seven percent of the sample reported engaging in unprotected anal intercourse, the behavior most strongly associated with transmission of human immunodeficiency virus (HIV) infection. Perceived peer norms concerning the acceptability of safer sex practices, AIDS health locus of control scores, risk behavior knowledge, age, and accuracy of personal risk estimation, but not personal HIV serostatus knowledge, were associated with high-risk and precaution-taking behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The HIV-epidemic among drug addicts in Norway

Up to 1996, 368 persons in Norway (population 4.3 million) had been reported as being HIV-infected because of intravenous drug use. 72 of these had developed AIDS and 59 had died from AIDS. HIV-testing is very common among drug users in Norway and new cases are rarely detected at treatment centres or at autopsy. Some 15-30 cases may still be undiagnosed. HIV spread very rapidly among drug users in Norway in 1984 and 1985, by around 100 new cases per year. Since then, the annual incidence has decreased from 30-40 cases in 1986 to 10-15 in 1995. Although the drug users seldom shared syringes even before the advent of the HIV epidemic, we believe that the public rehabilitation programmes, needle exchange programmes and health information have contributed to control HIV in this group. We expect an annual incidence of 10-15 cases the next five years.     

Culturally tailored HIV-AIDS risk-reduction messages targeted to African-American urban women: impact on risk sensitization and risk reduction

African-American women recruited from low-income housing projects in Chicago (N = 106) were randomly assigned to view 1 of 3 20-min videotapes: a standard public health service tape on prevention of acquired immunodeficiency syndrome (AIDS), the same public health service tape but matching presenter and participant ethnicity and sex, or a tape that included the same content but was framed in a context specifically intended to increase cultural relevance. Participants who viewed the tapes presented by African-American women were significantly more sensitized to AIDS and were more likely to have discussed AIDS with friends, to be tested for human immunodeficiency virus (HIV) antibodies during the follow-up interval, and to request condoms at follow-up. These results support the use of culturally sensitive AIDS prevention messages targeted to specific populations, particularly to promote HIV-antibody testing.     

An epidemic of stigma: Public reactions to AIDS.

The AIDS epidemic has been accompanied by intensely negative public reactions to persons presumed to be infected by the human immunodeficiency virus (HIV). In this article, we define such reactions as AIDS-related stigma. We discuss two major sources of this stigma: the identification of AIDS as a deadly disease and the association of AIDS in the United States with already stigmatized groups, especially gay men. We describe some of the social and psychological processes that contribute to AIDS-related stigma and offer suggestions for eradicating stigma through public policy and individual education. (PsycINFO Database Record (c) 2010 APA, all rights reserved)