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RESUMEN Introducción:El conocimiento sobre bioseguridad y formas de transmisión del VIH en profesionales de la salud son fundamentales para prevenir las infecciones cruzadas y erradicar la discriminación. Objetivos:Evaluar el nivel de conocimiento en profesionales de la salud, sobre normas de bioseguridad y formas de transmisión de VIH. Relacionar el nivel de conocimiento con los años de recibido, la profesión y los centros participantes. Materiales y Métodos:Estudio observacional descriptivo de corte transverso con encuestas, efectuadas en junio del 2010 a profesionales de los hospitales: Hospital Nacional, Hospital Pediátrico Niños de Acosta Ñú y Hospital San Pablo, Limpio y Capiatá. Resultados:De los 315 participantes 103 (32,7%) eran médicos, 59 (18,7%) Licenciados en enfermería, 49 (15,6%) auxiliares de enfermería, 10(3,2%) técnicos en enfermería, 7 (2,2%) técnicos de laboratorio, 2(0,6%) técnicos de diálisis, 12 (3,8%) bioquímicos, 4 (1,3%) odontólogos, y 69 (21,9%) no especificaron la profesión. El nivel de conocimiento fue regular en 114 casos (36,2%), 96 (30,5%) bueno, 73 (23,2%) deficiente, 29 (9,2%) muy bueno y 3 (1%) excelente. Los profesionales con 1 a 5 años lograron el mejor nivel de conocimiento: 2(1,7%). Los bioquímicos, médicos y Licenciados en Enfermería lograron en mayor proporción un nivel de conocimiento muy bueno y excelente. Los técnicos en diálisis, odontólogos, técnicos de laboratorio y auxiliares de enfermería lograron en mayor proporción un nivel deficiente. Los hospitales que constituyen centros de formación son Hospital Nacional, Hospital Pediátrico Niños de Acosta Ñú y Hospital San Pablo, obtuvieron en mayor proporción un nivel de conocimiento muy bueno y excelente. Conclusiones:Personal de salud muy expuesto a sufrir accidente laboral cuenta con un nivel de conocimiento deficiente en precauciones universales y formas de transmisión del VIH, es necesaria su capacitación.

ABSTRACT Introduction: The knowledge on biosafety and forms of HIV transmission in health care are essential to prevent cross infection and to eradicate discrimination. Objectives: 1. Assess the level of knowledge in health professionals on biosafety standards and modes of transmission of HIV. 2.A ratio level of knowledge over the years of receipt, the profession and the institutions involved. Materials and Methods: Observational study with a cross sectional surveys, conducted in June 2010 at hospital professionals: National Itauguá, Children Ñú Acosta, San Pablo, Clean and Capiatá. Results: Of the 315 participants 103 (32.7%) were physicians, 59 (18.7%) Degree in enf. (Graduates in nursing), 49 (15.6%) Aux. of enf. (Nurse Aide), 10 (3.2%) T. in enf. (technicians, nurses), 7 (2.2%) T. Lab. (Laboratory technicians), 2 (0.6%) T. Dial. (Dialysis Technicians), 12 (3.8%) biochemical, 4 (1.3%) dentists, and 69 (21.9%) did not specify the profession. 114 (36.2%) were considered to have regular level (R), 96 (30.5%), good (B), 73 (23.2%) bad (D), 29 (9.2%) very good (VG) and 3 (1%) Excellent (E). Professionals with 1 to 5 years achieved the highest level of knowledge: 2 (1.7%) E, 15 (13%) MB, 38 (33%) B, 40 (34.8%) R and 20 (17 4%) D. Biochemists, physicians and BA in Enf. managed in a higher proportion of knowledge level MB and E. The T. Dial., dentists, T. Lab., and Aux. of Enf. achieved a level greater extent D. Hospitals are training centers: H. National Children's A. Wildebeest, and Paul, were in greater proportion MB level of knowledge and E. Conclusions:Personal health at serious risk of accident at work has a poor level os knowledge on universal precautions and means of transmission of HIV is required training.

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PIP: The US Centers for Disease Control and Prevention (CDC) recently reported an outbreak of HIV infection among a group of young women in rural Chautauqua county, New York, who apparently contracted HIV from a single, highly infectious man. Although the index case refused to donate blood for analysis, 13 of the 47 women who had sex with the man became infected. The 10 primary contacts who provided blood samples for analysis were infected with highly similar viruses. The 13 women who apparently acquired HIV from the index case had sex with 84 secondary contacts. The resulting AIDS scare led to the counseling and HIV testing of approximately 1400 people in the county, which led to the identification of other HIV-infected individuals unrelated to the index case. The 31% rate of infection transmitted by the index case suggests that HIV can be spread rapidly by only a few individuals. It used to be thought that a person is most likely to transmit HIV either during acute infection, before the immune system has fully responded to the virus, or late in infection when the immune system has been destroyed. Neither sexually transmitted diseases nor IV drug use was associated with HIV transmission in this cluster of cases.^ieng

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PIP: A compilation of statistical records by the Department of Health revealed that as large a percentage as 10% of married women in Metro Manila, Philippines, had acquired chlamydia (a common STD) from their husbands. This report is supported by an analysis which states that by the time a man reaches 30, he can usually earn enough to pay for the services of a "marketable" female sex worker in the 19-29 age range. White-collar workers are more susceptible to STDs since they prefer freelance female sex workers (often disguised as college students from exclusive schools) who do not have regular hygienic check-ups as compared with female sex workers in bars and sauna parlors, who have cards indicating their medical status.^ieng

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PIP: A meta-analysis of studies on the association between breast feeding and HIV estimated a 14% incremental risk of HIV-1 transmission in breast-fed infants born to HIV-infected mothers. In developed countries, where safe alternative sources of milk are available, HIV-infected mothers are encouraged not to breast feed. In developing countries, however, where infectious diseases and malnutrition are important causes of infant mortality, HIV-positive mothers are urged to breast feed. The author of this letter to the editor, a pediatrician from India, challenges this World Health Organization recommendation and urges the Indian Academy of Pediatrics to review the issue. India's infant mortality rate is currently 80/1000 live births. 1.6% of these infant deaths are attributable to gastrointestinal infections. Although this risk, and that from malnutrition, would certainly increase if HIV-positive mothers were to abandon breast feeding, the risk of death attributable to artificial feeding would be substantially lower than the 14% risk of HIV associated with breast feeding.^ieng

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PIP: HIV infection is spreading in China through the routes of shared needles, unprotected sexual intercourse, and mother-child transmission. While contaminated needles are the main source of the infection, unprotected sex is expected to become a larger problem. Official reports list 3341 Chinese with HIV in 1995, but the actual number could be as high as 100,000. From 1966 to 1979, sexually transmitted diseases were almost eradicated in China, but the new market-style economy has been accompanied by increased drug use and prostitution. The biggest problem exists in Yunnan province, which shares a border with Burma, a major drug producer. China's currently unscreened blood supply poses another threat, and the Ministry of Public Health has begun a major AIDS education campaign and has called for rigid blood screening.^ieng

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Current laboratory techniques cannot distinguish the mode of vertical transmission (intrauterine, intrapartum, or postnatal) of human immunodeficiency virus type 1 (HIV-1) from mother to infant. The ability to transmit HIV-1 via breast feeding has been established in 24 case reports, primarily involving mothers who seroconvert after delivery. Whether breast-feeding adds a notable additional risk of HIV-1 infection to the risk from pregnancy is controversial. The importance of the duration and intensity of breast-feeding in modulating the outcome of HIV transmission via breast milk also remains unclear. Factors in breast milk may play important roles in an infant's susceptibility to infection with HIV and in the expression of the virus. Pasteurization and storage enhance the intrinsic, antiviral properties of human milk. Banked human milk is pasteurized to destroy the HIV-1 virus but retains properties that may be helpful to infants of HIV-1-positive mothers in developed countries where breast-feeding is not recommended. For infants in populations where the infant mortality rate is high, the risk of death associated with HIV infection acquired via breast milk is lower than the risk associated with not being breast-fed.

PIP: To date, 24 cases in which breast feeding was the route of HIV infection have been reported in the literature and the prevalence of this form of mother-infant HIV transmission has been estimated at 13-35%. The majority of cases involve mothers who seroconverted after delivery. Overall, the risk appears to be highest in cases of high viremia and low antibody levels, as seen immediately after infection and in end-stage AIDS. This risk can be lowered, however, by zidovudine therapy during pregnancy and at delivery. Evaluation of the risks and benefits of breast feeding when maternal HIV infection is present must be based on factors such as the country's infant mortality rate, infectious disease mortality, HIV prevalence in women of childbearing age, and availability of safe alternative methods of infant feeding. In African countries where the infant mortality rate is high and the rate of HIV transmission via breast milk is about 20%, the HIV-associated infant mortality rate among breast-fed infants is lower than the mortality rate from infectious diseases in non-breast-fed infants. A decision analysis model indicates that, in most cases, the benefits of breast feeding outweigh the risks of HIV transmission in developing but not developed countries. Infants of HIV-infected mothers in developed countries can be fed stored human milk pasteurized to destroy the HIV virus.

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PIP: AIDS has spread worldwide regardless of geographic barriers, race, age, or gender. The most important routes of HIV transmission are sexual contact; exposure to blood, such as through IV drug use and transfusion; and perinatal transmission from infected mothers to their infants. This paper reviews the literature on HIV transmission through blood and other tissues, semen and HIV transmission, the sexual transmission of HIV, and vertical transmission. The sexual transmission of HIV is considered in subsections on the frequency of sexual intercourse, genital and anorectal ulcers, other factors in sexual practices, and therapeutic parameters. Vertical transmission is considered in subsections on the pathophysiological mechanisms, diagnostic technology and pediatric AIDS, factors influencing vertical transmission, and breast feeding and HIV transmission.^ieng

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OBJECTIVES: To date, HIV spread in China has occurred principally among injecting drug users (IDU) in remote border regions of Yunnan province. We therefore sought to better understand the risks for and prevalence of HIV infection among drug users in parts of China outside Yunnan province. METHODS: A behavioral survey of drug use and AIDS-related knowledge was conducted among all consenting drug users who entered treatment from 1 November to 31 December 1993 in seven provincial drug detoxification centers outside Yunnan province. After giving verbal informed consent, all drug users were tested for HIV. RESULTS: Of the 1293 study participants, 207 (16%) reported injecting drugs. The proportion of IDU among all drug users varied widely by region, from 1% in Sha'anxi and Gansu provinces in the northwest region to 58% in Guangxi province in the south. IDU were more likely than non-IDU to be single and unemployed or self-employed, but did not differ in other demographic aspects. Among all drug users, 2% reported sharing needles without cleaning equipment, while 5% shared with some cleaning. Although 1060 (82%) drug users had heard of AIDS and most knew about its sexual (79%), parenteral (77%), and perinatal (60%) modes of transmission, many had misconceptions about its spread by casual contact. Of the 207 IDU tested for HIV, none were HIV-positive (95% confidence interval, 0--1.4). CONCLUSION: The absence of HIV infections detected in this study suggests that the prevalence of HIV is currently low among IDU in China outside the Yunnan province. However, the behavior of these IDU puts them at high risk for HIV infection. Prevention efforts are needed to prevent the spread of HIV among IDU throughout China and to avoid the experience of neighboring countries in Asia.

PIP: Representatives of the World Bank (RWB) claim that a published argument linking some of their policies to the development of a situation which fosters the spread of AIDS can be summarized as claiming that "economic development is bad because it facilitates the spread of communicable disease by bringing people into closer and more frequent contact." The RWB acknowledge that economic development facilitates the spread of infection but defend economic development because it also provides the knowledge and means to combat disease. The RWB claim that the logical conclusion of the alternative development strategy proposed by their critics would mean a return to the stone age. The RWB further accuse their critics of ignoring evidence that countries undergoing structural adjustment have achieved faster economic growth, a reduction in poverty, and an increase in health spending. The critics are charged with failing to ask whether the criticisms leveled at the World Bank's treatment of AIDS as a public health priority are valid, with failing to point out that the labor migration in south Africa which incubated AIDS is older than structural adjustment, and with failure to note that Brazil's avoidance of economic equilibrium during the 1980s impoverished the country. Finally, the RWB charged that their critics disregard economics, public health, and the scientific method in their attempt to make AIDS the only thing that matters.

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PIP: During World War II, venereal disease was regarded as a problem for men in uniform. At that time there were only three common sexually transmitted diseases (STDs): syphilis, gonorrhea, and venereal warts, along with crab lice. Today, there are two dozens STDs, and almost all of them are caused by viruses. They include AIDS, herpes, human papilloma virus, and also chlamydia. In explaining the emergence of the new sexual diseases, STOPP Planned Parenthood has suggested in its November 1987 newsletter that " ...because the contraceptive pill lowers the acid level of the vaginal area it may be a contributing factor to the development and transmission of AIDS." The December 1993 issue of Family Planning Perspectives has reported that "women who test positive for HIV virus and who also use the pill are more likely than non-users to have the virus present in their cervical and vaginal secretions and may be more likely to infect their sex partner... The presence of HIV virus in cervical secretions was nearly 12 times as likely among pill users as among non-users." The newsletter further states that infected women who were taking the pill were also more likely to transmit AIDS to a baby they delivered. Researchers should thoroughly investigate if the contraceptive pill has contributed to the emergence of STDs.^ieng

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OBJECTIVES: To determine the prevalence of drug injection among drug users, the seroprevalence of HIV and risk factors for HIV infection among injecting drug users (IDU), and to determine heterosexual transmission of HIV among IDU and their spouses in southwest China. METHODS: Using a cross-sectional design, we conducted an HIV seroprevalence and behavioral survey in three rural counties of Yunnan province, Ruili, Longchuan and Luxi in southwest China, bordering Myanmar (Burma). A total of 860 drug users were recruited in randomly selected communities at the three study sites (response rate, 97%). In addition, a random sample of 62 wives of HIV-infected IDU were assembled from 460 known HIV-positive IDU in Ruili and Longchuan (response rate, 81%). RESULTS: In the sample of 860 drug users, 33% reported injecting drugs. Among the 282 subjects who injected drugs, 82% began intravenous drug use after 1988; 64% injected drugs at least once every day. All subjects shared needles but none cleaned the injection equipment with alcohol or bleach. Overall, 49% tested HIV-positive. HIV seropositivity was independently correlated with a longer history of drug injecting, daily injecting, frequent needle-sharing, being younger, and living in Ruili county. Among the 62 wives of HIV-positive IDU, none used condoms during sex and 10% tested HIV-positive. CONCLUSIONS: We conclude that the introduction of HIV into drug-using communities and the rapid increase in heroin injecting in this population appear to have triggered an explosive HIV epidemic among IDU in southwest China. We recommend that AIDS prevention efforts should begin immediately and focus on discouraging the shift from opium smoking to heroin injecting, needle-sharing, and unprotected sex among drug users and their partners.

PIP: The authors investigated the prevalence of drug injection among drug users, the seroprevalence of HIV and risk factors for HIV infection among injecting drug users (IVDUs), and the extent of heterosexual transmission of HIV among IVDUs and their spouses in southwest China. Findings are based upon a cross-sectional HIV seroprevalence and behavioral survey in the rural counties Ruili, Longchuan, and Luxi of Yunnan province in southwest China. 860 drug users were recruited in randomly selected communities along with a random sample of 62 wives of HIV-infected IVDUs. 33% of the 860 drug users reported injecting drugs. Of the 282 who injected drugs, 82% began IV drug use after 1988, and 64% injected drugs at least once daily. All subjects shared needles, but none cleaned the injection equipment with alcohol or bleach. 49% overall tested HIV-seropositive. HIV seropositivity was independently correlated with a longer history of drug injecting, daily injecting, frequent needle-sharing, being younger, and living in Ruili county. None of the 62 wives of HIV-positive IVDUs used condoms during sex and 10% tested HIV-positive. The introduction of HIV into drug-using communities and the rapid increase in heroin injecting in the population appear to have triggered an explosive HIV epidemic among IVDUs in the region. It is recommended that AIDS prevention efforts begin immediately with a focus upon discouraging the shift from opium smoking to heroin injecting, needle-sharing, and unprotected sex among drug users and their partners.

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PIP: HIV was introduced in India much later than in other parts of the world, but is spreading with unprecedented rapidity and is becoming a public health problem with enormous social and economic implications. HIV in India is spread mainly through heterosexual intercourse, moving from high-risk behavior populations to the general population as indicated by the growing HIV prevalence among voluntary blood donors and women attending antenatal clinics. The main risk behaviors and practices associated with a higher risk of HIV transmission in India include unprotected sexual intercourse, IV drug use, and transfusion of contaminated blood and blood products. Factors affecting the sexual transmission of HIV include the presence of ulcerative STDs, irregular use of condoms, frequency of sexual contact, and age at sexual initiation. Knowledge, attitudes, and beliefs about sexual practices, low literacy, and economic conditions also affect high-risk sex behaviors. The authors discuss the historical perspective on HIV/AIDS in India, heterosexual transmission, IV drug use, blood transfusion and blood products, transmission in the healthcare system, perinatal transmission of HIV, homosexuality, and homosexual and bisexual behavior. Though openly tolerated by society, sex between men is common in India. There are few data on HIV prevalence among homosexual men. The risk of HIV transmission among homosexual men could be high because only 0-21% use condoms. Homosexual liaisons are short-lived, especially among bisexuals.^ieng

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OBJECTIVE: To investigate risk factors for mother-to-child transmission of HIV-1, particularly sexual behavior before and during pregnancy. DESIGN AND METHODS: This study is part of a prospective cohort study in Butare, Rwanda, of 318 HIV-1-seropositive and 309 HIV-1-seronegative women enrolled during pregnancy and followed for a mean duration of 21 months (range, 8-34 months). Clinical follow-up of the mother-infant pairs was performed at 6-week intervals during the first year of life and at 4-month intervals thereafter. Detailed sexual history interviews were conducted during pregnancy and at the first postnatal visit. RESULTS: Of 184 singleton infants born to HIV-1-infected mothers who survived the neonatal period, 32 (17%) children were classified as HIV-1-infected, 130 (71%) as not infected, and 22 (12%) died with indeterminate HIV-1 infection status. The vertical transmission rate was estimated to be between 20 and 29%. Unprotected sexual intercourse with increased number of partners during the past 5 years was strongly associated with mother-to-child transmission (P < 0.001), even after adjustment for maternal CD4/CD8 ratio, parity, history of sexually transmitted diseases, and evidence of genital infection during pregnancy. In a multivariate analysis, excluding children with indeterminate HIV-1 status, odds ratios for vertical transmission were 2.6 [95% confidence interval (CI), 1.0-6.9] for maternal CD4/CD8 ratio < 0.5 and 3.6 (95% CI, 1.1-11.8) for more than three sexual partners versus a single partner. Women with more than one sexual partner during the first trimester of pregnancy were at particularly high risk of transmitting the virus. CONCLUSION: Unprotected sexual intercourse with multiple partners before and during pregnancy in a population with high HIV-1 seroprevalence may well increase the likelihood of HIV-1 transmission from an infected mother to her child.

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OBJECTIVE: To assess predictors of relapse into unprotected anogenital intercourse with casual partners among homosexual men in Amsterdam, The Netherlands. DESIGN: A prospective study ongoing since October 1984. METHODS: Self-reported data on sexual behaviour were obtained at 12 semi-annual intervals. Participants who reported unprotected anogenital intercourse with casual partners at wave 12 but not at wave 11 were considered to have relapsed into unsafe sex (n = 47). Men who did not report unprotected anogenital intercourse at wave 11 or at wave 12 were considered to have maintained behaviour change (n = 197). RESULTS: Relapse into unsafe sex with casual partners occurred more frequently among men with a less positive attitude towards condom use, lower personal efficacy with respect to using condoms with casual partners, a weaker intention to avoid anogenital intercourse with casual partners and those who were not involved in a primary relationship. Intention to avoid anogenital intercourse with casual partners was related to an individual's attitude, normative beliefs and personal efficacy with respect to avoiding anogenital intercourse. CONCLUSIONS: In order to improve motivation it is important to support homosexual men in their personal decision-making process, which may be more resolute when the outcome is in accordance with individual preferences. Therefore, health education should be community-based and sensitive to individual needs.

PIP: The objective was to assess predictors of relapse into unprotected anogenital intercourse with casual partners among homosexual men in Amsterdam, The Netherlands. In the period 1984-91 1103 predominantly white, well-educated, homosexual men participated in the study. 340 participants were HIV-antibody-positive, and 763 men were HIV-antibody-seronegative. Self-reported data on sexual behavior were obtained at 12 semi-annual intervals. Mean age of the participants at wave 12 was 41.2 years, and participants had been homosexually active for an average of 23.2 years, Participants were categorized according to sexual behavior in waves 11 and 12, the interval in which an increase in unprotected anogenital intercourse with casual partners was observed. Participants who reported unprotected anogenital intercourse with casual partners at wave 12, but not at wave 11, were considered to have relapsed into unsafe sex (n=47). Men who did not report unprotected anogenital intercourse at wave 11 or at wave 12 were considered to have maintained a behavior change (n=197). Possible predictors of relapse into unprotected anogenital intercourse with casual partners included a large number of variables assessed from wave 9 up to wave 12. Bivariate relations between outcome measure and predictors were first assessed. Significant variables were entered in a multivariate logistic regression analysis. 4 variables were multivariately reacted to maintenance of safer sex behaviors versus relapse into unprotected anogenital intercourse with casual partners. The relationships found indicated that relapse was more likely to occur among participants who had less intention to avoid unprotected anal sex with casual partners (odds ratio (OR) 3.75), were less convinced that they can use condoms with casual sex partners (OR 3.54), had a less favorable attitude towards the use of condoms (OR 3.2), and were not involved in a primary relationship

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Drug injectors' have become the second largest HIV transmission category in Argentina and Brazil, as is the case in many pattern I countries, making up more than one-quarter of all AIDS cases reported by 1991. HIV seroprevalence data suggest that the expanding proportion of AIDS cases attributable to drug injection stems from an absolute increase in the number of AIDS cases among drug injectors, and is not merely reflective of a decline in the proportion of cases reported in other transmission categories. Results of a review of studies in Argentina and Brazil indicate that HIV seroprevalence is increasing rapidly, contrary to the situation in some pattern I countries in which HIV seroprevalence among drug injectors is either stably high or increasing only slightly. Also contrary to most pattern I countries, cocaine rather than heroin is the injected drug of choice in Argentina and Brazil. Given that injectors of cocaine are more likely to be HIV infected than are heroin injectors, differences in the type of drug injected between countries may have distinct epidemiological consequences on the spread of HIV.

PIP: AIDS cases attributable to using contaminated needles in nonmedicinal drug injection have increased in Argentina from 11.3% in 1987 to 39% in 1991. A similar increase (from 1.8% in 1985 to over 30% in 1991) occurred in Brazil. To complement existing information, data searches were conducted and personal communications from current researchers were collected for a total of 24 documents from Argentina and 18 from Brazil. The median sample size was 68 in Brazil and 188 in Argentina; most studies were from outpatient facilities, males constituted more than two-thirds of the sample in half of the studies, and the median age (when reported) was between 16 and 29 years old. Analysis of data from selected studies showed that HIV seroprevalence among drug injectors in both countries has increased rapidly, with the greatest increase occurring in Brazil. This rapid increase may also be influenced by the fact that cocaine, rather than heroin, is the drug of choice. Cocaine injection involves drawing blood into the syringe before injection and also more frequent injections. The level of seroprevalence among drug injectors varies among different subpopulations. Sexually transmitted disease clinic attenders who are IV drug users show rates of 6.58% and 51.9% seropositivity. Incarcerated persons who are drug injectors were associated with seropositivity rates of 35% (adults), 60.9% (adolescents), 53.5% (adolescents in security institutes), and 18% (female inmates who volunteered for testing), with drug injection the most important risk factor in 90.4%. Among prostitute injectors, rates were reported of 20% in 1988 and 50% in 1989-90 in the same population. Street children in Rio de Janeiro who use IV drugs (68 of 3389 surveyed) had a rate of 13.2% in 1987-88. The risk factors associated with HIV infection among drug injectors are socioeconomic status and injecting and sex practices. Co-infection patterns among drug injectors have also been found, with concomitant HIV-1 and HTLV-1 reported in 20% of 85 HIV positive drug injectors. Overall, these data suggest that there is an absolute increase in the number of AIDs cases among drug injectors rather than a decline in the proportion of cases reported in other transmission categories. Drug injector transmission poses a threat to the sex partners and offspring of injectors and provides a bridge to the heterosexual infection of women. While there is no obvious quick solution to the problem of IV drug use, there are programs which can slow the spread of HIV among injectors. It is urgent to control sexual transmission and drug injection transmission of HIV in these countries.

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The acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV) and recognised a decade ago, has reached pandemic proportions worldwide. By early 1992, the World Health Organisation estimates that at least 10 to 12 million people are infected with HIV globally. The majority of these infections are the result of heterosexual transmission. In South and South-east Asia, the AIDS pandemic is growing rapidly due to intravenous drug use and heterosexual transmission. Since 1985, the major route of HIV transmission in Singapore has been sexual. The transmission pattern, however, has changed from one that was predominantly homosexual or bisexual to one that is increasingly heterosexual from mid-1990. In addition, HIV infections among intravenous drug users, children and organ recipients who received transplantation overseas have also surfaced since 1990. It is estimated that there will be 400 cases of HIV infection in Singapore by the mid-1990s.

PIP: The case records of all reported patients with HIV infection diagnosed (by ELISA and confirmatory Western blot) and managed at the Communicable Disease Centre (CDC) were reviewed. A total of 118 cases of HIV infection, including 40 cases of AIDS, reported from 1985 to 1992 were studied. 112 were male and 6 were female. The mean age was 31.1 +or- 8.1 years for males, and the mean age for females was 36.5 years. The first cohort of 50 cases reported during a 60-month period prior to mid-1990 was predominantly caused by homosexual and bisexual transmission and only 20% were attributed to heterosexual transmission. In the second cohort of 68 cases reported during a 22-month period after mid-1990, 50% were heterosexually infected persons. The increase was statistically significant (p 0.0001). 42% and 41%, respectively, of the HIV-infected cases were in the most sexually active age groups of 20-29 years and 30-39 years. Of the total 118 HIV infections, 37.3% were attributed to heterosexual transmission, and women accounted for 7% of all cases attributable to heterosexual transmission. Of the first 50 cases, 4% were women and the male-to-female ratio was 24:1, compared with 6% and a ratio of 16:1 for the subsequent 68 cases. Homosexual and bisexual transmissions together accounted for 76% of the first 50 cases, a proportion which declined to 35.2% in the subsequent 68 cases. Transmission patterns not seen prior to mid-1990 emerged in the second wave of HIV infection in Singapore. The first case of paediatric HIV infection attributed to perinatal transmission was detected in a 2-year-old child in 1991. 5 patients with HIV infection were traced to intravenous drug use, and 3 patients who received renal transplantation overseas were reported. Short-term projection of HIV case-loads using the EPi Model computer program developed by the World Health Organization estimates that there will be about 400 cases of HIV infection in Singapore by the mid-1990s, about one-third of them AIDS cases.

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There is very little information on the clinical spectrum and the incubation period among AIDS patients in Latin America. This study reports the clinical spectrum, survival, and the incubation period for a group of Mexican patients infected with HIV-1 as a result of contaminated blood transfusion. We analyzed data from 39 patients of whom date of transfusion and diagnosis were known. The clinical spectrum of the disease was compared with a group of AIDS Mexican patients infected by sexual route. The prevalence distribution of opportunistic infections was similar in both groups. However, there was a significant difference in the distribution of opportunistic malignancies, i.e., Kaposi's sarcoma was observed only in the homosexual group. AIDS developed within 48 months after infection (3% within 12 months after transfusion, 50% within 29 months, 75% within 36 months, and the remaining within four years). The mean survival was of nine months after AIDS is made, the survival in this group of AIDS Mexican patients was similar to that observed in other HIV-1 exposed risk groups in Mexico. These findings suggest that the route of exposure to HIV-1 may have prognostic implications in the natural history of this infection in the Mexican population.

PIP: Transfusions-associated AIDS represents 14.7% of total AIDS cases reported to the National Council of AIDS in Mexico. The incidence of HIV infection via this route and the resulting related prevalence of AIDS patients have rapidly increased since 1987 as a result of the high seroprevalence of HIV-1 infection among the pool of paid blood donors; 7.2% of 9100 donors screened between June and November 1986 were HIV-seropositive. This paper presents the clinical spectrum, survival, and incubation period for 39 Mexican patients with AIDS infected with HIV-1 from contaminated blood transfusions. The authors compare these data with corresponding information on a group of 107 homosexual Mexican AIDS patients at the National Institute of Nutrition infected with HIV through sexual intercourse. The former group was comprised of 13 men and 26 women of mean age 38.8 years over the range 2-76 years from 3 hospitals in Mexico City. The Kaplan-Meier method was used to determine mean survival. The prevalence distribution of opportunistic infections was similar between groups. The distribution of opportunistic malignancies was, however, significantly different between groups, with Kaposi's sarcoma being present among only the homosexuals (47%). Herpes zoster was present among 21% of those infected via transfusion, but in only 7% of the homosexuals. AIDS developed within 48 months after infection in the transfusion-infected individuals and they survived for a mean period of 9 months after being diagnosed with AIDS. This average survival period is similar to that observed in other HIV-1 exposed risk groups in Mexico. These findings suggest that the route of exposure to HIV-1 may have prognostic implications in the natural history of infection in the Mexican population.

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PIP: In the wake of AIDS and HIV, a better framework is needed to model the pattern of contacts between infectious and susceptible individuals. Several network measures have been defined elsewhere which quantify the distance between 2 nodes, and the centrality of a node, in a network. Stephenson and Zelen (S-Z), however, have recently presented a new measure based on statistical estimation theory and applied it to a network of AIDS cases. This paper shows that the closeness measure proposed by S-Z is equivalent to the effective conductance in an electrical network, fits the measure into the existing theory of percolation, and provides a more efficient algorithm for computing S-Z closeness. The S-Z methodology is compared with the closeness measures of maximal flow, first passage time, and random hitting time. Computational problems associated with the measure are discussed in a closing section.^ieng

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PIP: By October 1992, the government's Special Program to Control AIDS (PECOS) registered 717 cases of the disease in Peru; however, the number of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) cases could number thousands. PECOS estimates that the number of cases of HIV is doubling every 2 years. One of the main reasons for the continued spread of HIV is the common perception that the pink plague, as AIDS is called here, affects only homosexuals. While 85% of sexually transmitted HIV and AIDS cases are among gay and bisexual men, in the past 4 years a large number of new cases has been registered among heterosexuals, especially women. In 1987, the ratio of AIDS cases among men and women was approximately 15 to 1. Today, the male to female ratio is 7 to 1. Most people working on AIDS say that the changing profile of the epidemic in Peru is caused by the high costs of prevention programs and the lack of information on the disease, which drastically raise the number of people in high risk groups. Peru's ongoing economic crisis has eaten into the budgets of nongovernment organization's (NGOs) AIDS prevention campaigns and has pushed treatment out of the reach of many people. In 1991, 3 television commercials developed by PECOS to promote the use of condoms were blocked by the Health Ministry. One of the groups that fought against campaigns promoting condom use was the Association of Catholic Doctors. The only way to organize an effective program is through a joint effort that brings together the government, NGOs, and other private and public institutions. Cooperation was demonstrated through the actions carried out for World AIDS Day, when more than 16 public, NGO, and government organizations were involved in a variety of AIDS information activities. In 1993, about 30 NGOs will begin actively working with Peru's Health Ministry to coordinate activities.^ieng

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PIP: Sri Lanka became known as a gay paradise with the advent of tourism in the late 1970s. UNICEF estimates that up to 15,000 boys in Sri Lanka may engage in homosexual prostitution. Nearly 400,000 tourists visited Sri Lanka in 1992, 50,000 of them British. The probable increase of high risk sexual contacts between tourists and Sri Lankan youths worries the government's health department. By early 1993, there were only 22 cases of AIDS and 65 people who tested HIV positive. But the government's chief venereologist says there are around 200,000 cases of sexually transmitted diseases each year, and it is estimated that as many as 2500 Sri Lankans are HIV positive. In a population of 17 million, this figure is small, but it represents an increase of 300% in just over a year. The parallels with nearby Thailand, where HIV spread explosively, are ominous. Unfortunately, cultural taboos make sex education difficult. A UNICEF doctor described the first television commercials about AIDS as ridiculous. Ignorance about AIDS is almost total. Most boy prostitutes have heard of AIDS but few use condoms and none realize that the disease kills. Organizations like Save the Children Fund recognize the magnitude of the problem but admit that reaching the beach boys, who are financially independent, is difficult. In an attempt to attack the problem, 2 social organizations compiled a list of beach boys in Hikkaduwa, the most popular tourist resort, and invited them for counselling and voluntary AIDS testing, but no one showed up.^ieng

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We interviewed 1,716 women attending a family planning clinic in Nairobi between January 1990 and May 1991 about their knowledge of the acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases (STDs). When participants in the study were asked to name spontaneously the STDs they knew, more than 90% of the women named gonorrhea and AIDS, and 75.0% named syphilis; 65.4% could name two or more signs of AIDS; and 96.9%, 66.5%, and 58.3% mentioned sexual transmission, transmission via blood transfusion, and perinatal transmission, respectively, as routes of transmission of AIDS. Knowledge of most symptoms and routes of transmission of AIDS, as well as knowledge of gonorrhea and syphilis, was significantly positively associated with level of education. Unmarried women were significantly less likely to know symptoms and routes of transmission of AIDS than were married women. Level of knowledge of gonorrhea and syphilis was significantly positively associated with number of lifetime sexual partners. Although awareness of AIDS was very high, detailed knowledge of signs of AIDS and routes of transmission was deficient, particularly among less educated women. This positive association of detailed AIDS knowledge with level of education suggests a need to design AIDS prevention activities that are more accessible to, and better understood by, women who have little education.

PIP: Between January 15, 1990 and May 6, 1991, in Kenya, family planning workers interviewed 1716 women who attended 2 peri urban family planning clinics in Nairobi to identify predictors of knowledge about AIDS and other sexually transmitted diseases (STDs). 16.3% of the women reported to have or have had an STD. The majority of the women had spontaneously mentioned gonorrhea, syphilis, and AIDS (95%, 75% and 94.2%, respectively). Reference to syphilis increased with education level (65.3% for none, 71.4% for upper primary, 85.8% for upper secondary; p .001). Few women mentioned herpes, chancroid, chlamydia, warts, and trichomoniasis (2% each) and candidiasis (11.7%). 65.4% of the women were able to correctly name at least 2 signs of AIDS. Knowledge of at least 2 signs of AIDS increased steadily with educational level (50.5% for none, 59.6% for lower primary, 71% for lower secondary; p .001) as it did for infection and diarrhea. The most well-known sign was weight loss regardless of education level (87.7%). Essentially everyone knew that AIDS was transmitted sexually (96.9%). Education level was positively associated with knowledge of its transmission perinatally and through a blood transfusion (p .001). Single women were less likely to be familiar with AIDS signs, perinatal transmission of AIDS, and transmission of AIDS by blood transfusions. The more lifetime sexual partners women had the more likely they were to know about gonorrhea and syphilis. These findings demonstrated the important role education plays in AIDS knowledge and the need to design accessible and easily understood AIDS prevention activities for women with limited education.

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