fc

AP

Advocates of the FC2, a female condom approved by the FDA, say the new version is less costly and more user friendly. They hope the female condom will be used to protect against AIDS and other sexually transmitted diseases.

DHS Indonesia

2007 Indonesia Demographic and Health Survey

The 2007 IDHS includes information on fertility, family planning, childhood mortality, maternal and child health, nutrition, malaria, and knowledge of HIV/AIDS.

Download the full report: http://www.measuredhs.com/pubs/pdf/FR218/FR218.pdf

2007 Indonesia Young Adult Reproductive Health Survey (IYARHS)

The IYARHS focuses on young women and men, age 15-24, and covers topics including education, knowledge and attitudes about reproductive health and family planning, knowledge of HIV/AIDS and STIs, attitudes about sexual activity and marriage, smoking, and use of alcohol and drugs.

Download the full report: http://www.measuredhs.com/pubs/pdf/FR219/FR219.pdf

Concurrent Sexual Partnerships and HIV Infection: Evidence from National Population-Based Surveys (Working Paper)

This working paper analyzes the relationship between concurrent sexual partnership and HIV prevalence, on both individual and country levels. The study finds that, at the individual level, women and men who had concurrent sexual partners in the year before the survey were more likely to be HIV-positive than those who had only one lifetime partner or those with multiple lifetime partners but no overlapping partners in the past year. This relationship does not hold at the community or country level.

Download the full report at: http://www.measuredhs.com/pubs/pdf/WP62/WP62.pdf

Social Context of Disclosing HIV Test Results: HIV Testing in TanzaniaThis study examined the circumstances and social contexts in which individuals in Tanzania were tested and counselled for HIV, and patterns in disclosure of test results to partners, family, and friends. The overall objectives of this study were to understand people’s experiences in showing their own HIV test results to others, to discover the pattern of disclosure among individuals tested (whether or not disclosure occurred, to whom, how it was done, after how long), and to discern the role of social relations in facilitating disclosure to others. Download the full report: http://www.measuredhs.com/pubs/pdf/QRS15/QRS15.pdf

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LJ drug report

Отчёт об успехах наркоторговли

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Guidelines

Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America

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think about it

HIV migration intro

особенности миграции с ВИЧ

• интроспекция

Что было в СССР:

• алкоголь, секс, наркотики

brained HIV

http://www.gay.ru/news/rainbow/2009/04/07-15178.htm

Во время 15-й конференции Британской ассоциации по ВИЧ в Ливерпуле было сделано несколько презентаций новых доказательств того, что даже у людей успешно принимающих терапию против ВИЧ и с хорошим уровнем CD4 могут быть признаки незначительных неврологических нарушений. Одно из исследований выявило потерю нервных клеток мозга у людей с ВИЧ. Тем не менее, большинство исследований показали, что последствия таких нарушений практически незаметны, а изменения в мозгу совсем не обязательно проявляются в результатах тестов.

Ранее в этом году было представлено исследование, которое показало, что у трети людей с ВИЧ есть умеренные нарушения работы мозга (которые могут снизить эффективность таких сложных задач как вождение автомобиля). Однако не все согласны с тем, что это действительно так. В таких крупных исследованиях может быть много участников, чьи познавательные способности мозга снижены по другим причинам. Например, такие нарушения могут быть следствием депрессии, употребления алкоголя и наркотиков, низкого уровня CD4 в прошлом и других инфекций, например, гепатита С. На этой конференции были представлены исследования, проведенные среди маленьких групп людей с ВИЧ, в которых тщательно исключались подобные факторы.

Первое исследование показало, что по сравнению со своими ВИЧ-отрицательными ровесниками, молодые люди с ВИЧ хуже справляются с батареей компьютерных тестов на мышечную координацию, память и способность к обучению, визуальное внимание и способность принимать решения. Ученые протестировали 45 ВИЧ-положительных людей, большинство из них были мужчинами, все они принимали антиретровирусную терапию. Ни у кого из них не было гепатита С, никто не употреблял наркотики или алкоголь на данный момент.

В данном исследовании ученые обнаружили "асимптоматичные нейрокогнитивные нарушения" у 14 пациентов (31%). Среди населения в целом той же возрастной группы такой уровень составляет 16%. Нарушения были наиболее характерны для молодых людей с ВИЧ (до 40 лет). Среди них нарушения встречались у 54%, в то время как среди людей в возрасте 57-67 лет - только у 10%. Исследование слишком маленькое, чтобы делать глобальные выводы, но ученые предполагают, что молодые люди могут быть более уязвимы перед неврологическим воздействием ВИЧ.

В другом исследовании участвовали 40 геев, которые принимали терапию против ВИЧ более шести месяцев, и у которых уровень CD4 никогда не был ниже 200 клеток/мл. Они также никогда не злоупотребляли алкоголем или наркотиком, у них не было вирусных гепатитов и каких-либо психиатрических диагнозов. Участники прошли батарею множества нейропсихологических тестов и четыре метода сканирования мозга. Контрольная группа состояла из 20 ВИЧ-отрицательных геев аналогичного возраста и других характеристик, которые прошли все те же самые тесты.

Ученые определили, что у людей с ВИЧ познавательные нарушения (память, внимание, мышление, обучение, принятие решений) были на 96% хуже, чем среди населения в целом. Сканирование мозга показало специфическую и значительную потерю серого вещества мозга (то есть тех нервных клеток, которые непосредственно отвечают за мышление) у людей с ВИЧ. При этом потеря клеток наблюдалась только в одном-единственном участке мозга - лобной верхней извилине мозга. Этот участок располагается в центре лба и отвечает за выбор и принятие решений. Несмотря на результаты сканирования, не было никакой связи между потерей нервных клеток и реальными нарушениями. Ученые предположили, что возможно, результаты сканирования указывают на риск подобных нарушений в будущем, а не на проблемы в настоящий момент.

Ученые обращают внимание, что принятие решений и переключение с одного задания на другое, это как раз та область, на которую может негативно повлиять гепатит С. Другое исследование показало, что у ВИЧ-положительных людей с острым гепатитом С нарушения работы мозга встречаются на 31% чаще, чем у людей без гепатита С. Исследование было слишком мало, чтобы считать выявленную разницу значительной. Однако пациенты с гепатитом С значительно хуже выполняли тест, в котором нужно было распределять внимание между двумя задачами.

Эти исследования показывают, что такие небольшие нарушения мышления чаще встречаются среди людей с ВИЧ, а также среди людей с гепатитом С. Эти нарушения не стоит путать с классическим ВИЧ-ассоциированным слабоумием, которое встречается на стадии СПИДа. Слабоумие в первую очередь влияет на эмоциональную сферу и память. Эти нарушения имеют совершенно иную природу, и они выявляются только с помощью специальных тестов - для самого человека и его близких они могут быть не заметны. Более того, часто эти нарушения носят обратимый характер, и человек может вернуться к прежнему уровню функционирования мозга.

AIDS: lessons learnt and myths dispelled

One of the most common myths is that HIV prevention is not working. However, much evidence suggests that, in several countries, prevention programmes are effective.

Between 2005 and 2007, coverage of services to prevent mother-to-child transmission of HIV increased from 14% to 33%. As a result, in 2007, we noted for the first time a substantial decrease in the number of children born with HIV.

Prevention is, of course, about not only technology, but also behaviour.

In many countries on several continents, changes in sexual behaviour (such as waiting longer to become sexually active, having fewer partners, and increased condom use) have been followed by reductions in the number of new HIV infections, providing evidence that efforts to change behaviour can and do work.

However, sustaining behaviour change in the long term remains a major challenge.

For example, the number of new HIV diagnoses in men who have sex with men doubled in Germany between 2002 and 2006, and increased by more than three-quarters in Switzerland.

These data could be attributable to complacency about AIDS and the sense that a treatable disease is somehow less threatening than are other diseases, and to a decrease in HIV prevention efforts in western Europe.

Some developing countries that have previously had much success with HIV prevention, such as Uganda, have also had increases in rates of HIV transmission.

Another major challenge is that, nearly 30 years into the epidemic, only about half of countries have national HIV prevention targets, whereas nearly 90% have targets for AIDS treatment.

Furthermore, when prevention programmes do exist, they are often under-resourced and do not have the quality and scale that are needed to have a real effect in communities. They need to be better targeted to where the epidemic is, both in terms of populations at risk and geographic areas.

Much has been published about the need for precise targeting of HIV prevention, especially in concentrated epidemics. But even saturation coverage of vulnerable groups will have little lasting effect without concerted and concrete efforts to change social standards and tackle social factors of the epidemic, such as homophobia and the low status of women in many societies.

Programmes also need to be designed and managed more efficiently, including increased use of skills and practices from the business sector.

An increasingly recurrent myth is that one solution, or a so-called silver bullet, will comprehensively prevent HIV transmission. Elimination of concurrent partnerships, circumcision of all men, focusing of prevention efforts on sex workers, universal HIV testing, and provision of antiretroviral therapy as soon as possible after infection, have all received attention as potential solutions for prevention of HIV transmission.

Scaling up strategies for harm reduction, such as methadone substitution and the provision of clean needles for injecting drug users, remains neglected in many countries in which injection drug use is a major means of HIV transmission.

Although these strategies are all important, no approach will be enough on its own, and the promotion of one solution is, in our view, irresponsible.

If we have learned one lesson in the past 27 years, it is that effective HIV prevention depends on customising the right mix of interventions for every context and ensuring the necessary coverage of them.

If we are to successfully increase access to HIV prevention, we have to be prepared to come to terms with complexity, effectively use all the methods that are available, include affected communities, engage relevant business expertise, and foster leadership to help change harmful social norms.

Another prevailing misconception is that heterosexual transmission of HIV is uncommon outside Africa.

Generalised epidemics are occurring in Haiti and Papua New Guinea, whereas heterosexual transmission drives the epidemic between sex workers, their partners, clients, and clients' partners in Asia and elsewhere.

HIV infections in women are rising worldwide. The main method of transmission in Thailand is no longer between sex workers and their clients or between injecting drug users: it is between married couples.

Furthermore, AIDS remains the leading cause of death in African-American women in the USA.

To characterise all African epidemics as exclusively heterosexual is also incorrect. Methods of transmission and affected groups are many and varied. In Kenya, for example, HIV infections in men who have sex with men and injecting drug users are an increasing cause for concern.

Although such observations neither indicate nor predict extensive or generalised HIV epidemic spread, they do draw attention to the fact that heterosexual transmission of HIV occurs in a wide range of settings. They also show that the HIV epidemic is constantly evolving, and continually surprising.

As we approach the fourth decade of the AIDS epidemic, new global challenges are competing for the attention of political leaders and donors at the same time as they face the present financial crisis.

Alarmingly, a myth has begun to emerge that too much money is spent on AIDS. But AIDS remains the leading cause of death in Africa and the sixth highest cause of mortality worldwide.

It is fitting that investment in fighting AIDS has finally begun to increase substantially, rising from a paltry US$250 million in 1996 to around $14 billion in 2008.

Even so, UNAIDS estimates that available resources at present fall well short of what will be needed to reach coverage targets for 2010.

Moreover, mobilisation around AIDS has increased available resources for tuberculosis and malaria (largely through the Global Fund) to unprecedented amounts and generally contributed to an increase in global funding for health.

Increased resources are beginning to have an effect, as are antiretroviral treatment programmes, which have been established in developing countries for less than 5 years.

Among the first was in Malawi, which recorded a 44% reduction in mortality in workers at the national electricity company—one of the country's largest employers—after the roll-out of antiretroviral treatment.

In Botswana, where HIV prevalence has reached 30%, mortality has begun to fall in the age groups most affected by AIDS since the introduction of antiretroviral treatment.

Source: full text, The Lancet, 20 March 2009

c4p

Call for Papers on Family Planning and HIV

With partial support from USAID, Family Health International and the Imperial College London are collaborating with the journal AIDS to produce a supplemental issue dedicated to family planning and HIV. We are pleased to issue a call for papers for this special issue. Manuscripts are due May 1, 2009.

Submissions may include but are not limited to biomedical research on the safety and effectiveness of contraceptive methods for women with HIV, behavioral research on the contraceptive practices and fertility desires of women and couples with HIV, evaluations of service-delivery approaches for integrating family planning and HIV services, and policy and programmatic case studies of efforts to integrate these services.

AIDS publishes the latest research on HIV and AIDS and has the highest impact of all AIDS-related journals. This special issue will increase attention to evidence-based strategies for integrating services and meeting the unique reproductive health needs of women and couples with HIV.

For more information about the supplement and how you can contribute, see:

http://tinyurl.com/ah46mt.

sex risk behavior

Psychological and behavioural factors associated with sexual risk behaviour among Slovak students

We obtained data on behavioural factors (having been drunk during previous month, smoking during previous week, early sexual initiation), psychological factors (self-esteem, well-being, extroversion, neuroticism, religiousness), and SRB (intercourse under risky conditions, multiple sexual partners, and inconsistent condom use) in 832 Slovak university students (response 94.3%).

Among those with sexual experience (62%), inconsistent condom use was the most prevalent risk behaviour (81% in females, 72% in males). With the exception of having been drunk in males, no factor was associated with inconsistent condom use. Regarding the other types of SRB, early sexual initiation was most strongly associated. In addition, other, mostly behavioural, factors were associated, in particular having been drunk.

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