Graham Neilsen

The authors report on 29 notifications of Human Immunodeficiency Virus infection in Aborigines and Torres Strait Islanders in Queensland from 1 July 1985 to 31 August 1991. Despite previously expressed concerns regarding the potential for a Pattern II (heterosexual) epidemic, based on reported data for other Sexually Transmitted Diseases, there have been no published reports confirming HIV infection in the Aboriginal and Torres Strait Islander population prior to this study. Although the prevalence of diagnosed HIV infection is comparable to that of the remaining population, there are early indications of differences in the pattern of infection and transmission.

Smoking is a leading cause of morbidity and premature mortality among people living with HIV (PLHIV), who have high rates of tobacco smoking. Vaporised nicotine products (VNPs) are growing in popularity as a quit aid and harm reduction tool. However, little is known about their acceptability and use among PLHIV. Using a pragmatic, uncontrolled, mixed methods design this exploratory clinical trial aims to examine the feasibility of conducting a powered randomised clinical trial of VNPs as a smoking cessation and harm reduction intervention among vulnerable populations, such as PLHIV who smoke tobacco. Convenience sampling and snowball methods will be used to recruit participants (N = 30) who will receive two VNPs and up to 12 weeks' supply of nicotine e-liquid to use in a quit attempt. Surveys will be completed at weeks 0 (baseline), 4, 8, 12 (end of treatment) and 24 (end of the study) and qualitative interviews at weeks 0 and 12. As far as we are aware, this feasibility study i...

The appearance of AIDS and recent diagnostic and treatment advances has forced the medical profession to become more sophisticated in approaching sexually transmitted diseases. Effective prevention and quality care are fundamental to a sexual health consultation. Obtaining an accurate history on which to base prevention counselling is essential. Treatment of syphilis has not changed in recent years and is not included in this article.

ART programs in many resource-limited settings have expanded treatment towards universal access. Ethiopia is one of the countries that have been scaling up ART towards universal access, but with very few data on long-term outcomes and their determinants. The objective of this study was to identify the level of long-term outcomes and their determinants in patients on ART in Ethiopia. A retrospective cohort study was conducted in three health facilities (two hospitals and one health center) between July and September 2014. Loss to follow-up, death, attrition and retention were the primary outcomes. Data were collected from patient registers and medical records for the period 2005/6 - 2011/12. A total of 11,731 patients were included in the study. The overall retention rate was 78 per 100 person-months. Retention rates were 82%, 74% and 72% at 24, 60, and 84 months on ART, respectively. Retention was associated with male gender, adolescent age, marital status, advanced HIV disease, ill...

The appearance of AIDS and recent diagnostic and treatment advances has forced the medical profession to become more sophisticated in approaching sexually transmitted diseases. Effective prevention and quality care are fundamental to a sexual health consultation. Obtaining an accurate history on which to base prevention counselling is essential. Treatment of syphilis has not changed in recent years and is not included in this article.

To describe the epidemiology of HIV infection based on notifications of HIV infection in Aboriginal and Torres Strait Islander people in Queensland and to review their implications for Aboriginal and Torres Strait Islander communities. Descriptive study of data obtained through HIV notifications to the AIDS Medical Unit, Specialised Health Services, Queensland Health from 1 July 1985 to 31 August 1991. Aboriginal and Torres Strait Islander people of Queensland. Centers for Disease Control (CDC) classification of HIV infection, as at 31 August 1991. Twenty-nine individuals identified as Aboriginal or Torres Strait Islander were notified as positive for HIV antibodies in the period 1 July 1985 to 31 August 1991. Of those diagnosed, three were female and 26 male. At 31 August 1991, only 10 were asymptomatic (CDC Group II, III), eight were symptomatic (AIDS-related complex) and 11 were diagnosed as having AIDS. Seven of those with a diagnosis of AIDS had died by the end of the study period. By comparison, 1158 non-Aboriginal or Torres Strait Islander people were notified for the same time period. Of these, 48 were female, 1105 were male and five were transsexual. In the non-Aboriginal and Torres Strait Islander group, 633 were asymptomatic and 297 were diagnosed with AIDS. By the end of the study period, 228 had died. The data show an estimated prevalence of diagnosed HIV infection in Aboriginal and Torres Strait Islander people in Queensland comparable with the rest of the population. Cases are distributed throughout the State, though some clustering is evident. There has been a stable pattern of notifications over the past five years. The proportion of asymptomatic (CDC groups II, III) HIV-positive Aboriginal and Torres Strait Islander clients was significantly lower than for the non-Aboriginal and Torres Strait Islander group. These data have implications in terms of projections of total cases, diagnosed and undiagnosed, and relative access to the advantages attending early diagnosis.

The authors report on 29 notifications of Human Immunodeficiency Virus infection in Aborigines and Torres Strait Islanders in Queensland from 1 July 1985 to 31 August 1991. Despite previously expressed concerns regarding the potential for a Pattern II (heterosexual) epidemic, based on reported data for other Sexually Transmitted Diseases, there have been no published reports confirming HIV infection in the Aboriginal and Torres Strait Islander population prior to this study. Although the prevalence of diagnosed HIV infection is comparable to that of the remaining population, there are early indications of differences in the pattern of infection and transmission.

The appearance of AIDS and recent diagnostic and treatment advances has forced the medical profession to become more sophisticated in approaching sexually transmitted diseases. Effective prevention and quality care are fundamental to a sexual health consultation. Obtaining an accurate history on which to base prevention counselling is essential. Treatment of syphilis has not changed in recent years and is not included in this article.

... Letters Section Editor: Robert M. Golub, MD, Senior Editor. Previous Section. References. 1. Moses S, Ngugi EN, Costigan A, et al. ... Proportion of HIV infections attributable to sexually transmitted diseases in Mwanza and Rakai—results based on a simulation model. ...

To determine the long-term safety of inactivated hepatitis A virus (HAV) vaccine in men infected with HIV-1. A 1-year prospective case-control study. Targeted primary care and sexually transmitted diseases clinics. Ninety HIV-1-positive patients who participated in an earlier efficacy study of HAV vaccination. Ninety HIV-1-positive men, matched for CD4+ lymphocyte percentage at baseline, who did not receive HAV vaccine. All cases were assigned to receive two intramuscular doses of 1440 enzyme-linked immunosorbent assay units of inactivated HAV vaccine (Havrix) either 1 or 6 months apart. Development of AIDS, survival, and T-cell subsets after 1 year of follow-up. No significant differences were seen between cases and control for the development of AIDS (10.1 versus 10.7%), deaths (7.3 versus 7.6%) nor for mean decline in circulating CD4+ lymphocyte count (125 versus 123 x 10(6)/1) after 1 year. Vaccination against HAV appears to be safe in the longer term for HIV-1-infected men.

Abstract: The basis of HIV exposure category classification was investigated among selected cases of newly diagnosed HIV infection. Questionnaires seeking specific information on patient-reported exposure to HIV were forwarded to doctors who had requested the HIV antibody test for patients who met the study sample criteria. The cases of interest were those newly diagnosed between 1 January and 31 October 1991 and notified to state and territory health authorities as having been attributed to exposures to HIV other than male homosexual contact or receipt of blood, blood products or tissue. A total of 158 questionnaires was forwarded and 59 per cent were returned. Among the returned questionnaires included in the study sample, exposure to HIV on the original notification to the health authority was given as injecting drug use (8 per cent, 3 of 37), heterosexual contact (46 per cent, 17 of 37), or unavailable (46 per cent, 17 of 37). A clear basis for HIV exposure category classification was provided on the questionnaires for 70 per cent (7 of 10) of cases among women, whereas among men whose infection was attributed to heterosexual contact, a basis for exposure category classification was specified for only 43 per cent (10 of 23) of cases. Although the study was limited by the low response rate, use of the questionnaire provided a relatively simple means for assessing self-reported HIV exposure history.

There is overwhelming and compelling evidence that control efforts for sexually transmitted infection (STI) have a major role to play in the prevention of HIV transmission. Community-based randomized controlled trials are set as the highest standard of evidence for showing the efficacy of STI interventions to prevent HIV transmission. The negative results of recent randomized controlled trials have cast doubt on the positive findings of the Mwanza study. Deeper analysis of the result of these trials has improved understanding of the role of STI interventions and augmented the wealth of evidence provided by numerous epidemiologic and biomedical studies. Apart from the biologic impact of effective treatment of curable STIs on HIV transmission, clinical services also support the reduction of HIV risk behaviors. STI interventions should limit the scale of the impending epidemics in Asia and Eastern Europe, depending on the priority that they are given by governments and major donor agencies.

To estimate the prevalence of simultaneous use of multiple condoms (SUMC) and identify the characteristics of the multiple condoms users. Cross-sectional survey among military men from a purposively selected Cambodian military region. Military men were interviewed face to face. From the 1638 respondents, 40% never had sex with female sex workers (FSWs), 55% had used condom(s), and 5% had unprotected sex at their last encounter with a FSW. Among those reporting sex with FSWs, 21% had used multiple condoms simultaneously at their last sex with a FSW. Compared with single condom users, multiple condom users were younger, had lower rank, had first sex more recently, had lower knowledge of HIV transmission, had received less HIV peer-education sessions, were more likely to have visited multiple FSWs, and were more likely to have sought their HIV serostatus. As it is unknown if SUMC increases or decreases condom effectiveness, more research is needed to investigate the effect of SUMC on condom failure rates.

Notifications of HIV infection in Indonesia are increasing, but there are few data on other sexually transmitted infections (STIs), especially in the eastern islands of Indonesia. We aimed to measure the prevalence of STIs among female sex workers (FSWs) in Kupang, West Timor, and to develop screening algorithms to detect cervical infections with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT). During 6 months in 1999, we recruited all the FSWs at Kupang's only brothel complex and a smaller number of independent FSWs. The women were examined at dedicated clinics and most laboratory tests were performed at provincial laboratories. Algorithms based on the strongest associations of variables with NG/CT were compared with the laboratory diagnoses. We recruited 288 women. The prevalence of N gonorrhoeae infection was 31%, that of C trachomatis infection was 24%, that of Trichomonas vaginalis infection was 5%, and that of syphilis was 13%. No case of HIV infection was detected. Few women had symptoms of STI. The only variables significantly associated with NG/CT after logistic regression analysis were the presence of cervical discharge (either yellow or clear) and a high count of polymorphonuclear leukocytes on gram-stained endocervical smear. Several algorithms to screen for NG/CT achieved high (>80%) sensitivity, but the highest specificity among these was only 50%. Although several of the generated algorithms may be useful in the absence of simple, accurate, affordable diagnostic tests, the high rates of STIs in this population could justify a more aggressive strategy incorporating periodic presumptive treatment to rapidly reduce prevalence.

This study was conducted at the ICDDR, B: Centre for Health and Population Research with the support of cooperative agreement HRN-A-00 to 96-90005 to 00 from USAID. ICDDR, B acknowledges with gratitude the commitment of USAID to the center's research efforts. The authors thank ...