Recent Reports

Ohen, L. Hunte, S. Wallace, C. Who provides Social Advice to HIV Positive Clients? Lambeth Primary Care Trust, London, 2004

The aim of this audit was to identify key informants on Social advice to HIV positive clients in Lambeth. The audit used a cross sectional survey administered in client homes and treatment centres. A representative population of 103 people living with HIV responded to the structured survey. This reports provides the results of the audit together with recommendations for the future.

Papers

The following papers were published in peer-reviewed journals between 1 st August 2004 and 1st October 2004.

Will better HIV treatment mean higher STD rates? Acute infection studies offer prevention window. Aids Alert. 2004;19:suppl-4.
Abstract: Antiretroviral treatment soon will be available to millions more people in sub-Saharan Africa and other developing nations, and international HIV experts say they fear they’ll see increased risk behaviors when the drugs become commonplace

Bentley ME, et al. Acceptability of a microbicide among women and their partners in a 4-country phase I trial. Am.J.Public Health 2004;94:1159-64.
Abstract: This study analyzed qualitative and quantitative data for 98 HIV-negative, low-risk women in Malawi, Zimbabwe, India, and Thailand who participated in a safety and acceptability study of BufferGel, a vaginal microbicide to determine the across-country acceptability of vaginal microbicides among women and their partners. Acceptability was high in all sites (73% of women approved of the microbicide). Women in Africa, where HIV infection rates are highest, were virtually unanimous in their desire for such a product, suggesting that an individual’s perception of being at risk for HIV will outweigh concerns about side effects, problems applying a product, or other factors, when products are shown to be efficacious. Acceptability research across diverse settings through all stages of microbicide research, development, and post-licensure dissemination can help maximize acceptability and use.

Rajamanoharan S, et al A. Genitourinary medicine/HIV services for persons with insecure immigration or seeking asylum in the United Kingdom: a British Co-operative Clinical Group survey. Int.J.STD AIDS 2004;15:509-14.
Abstract: Over the past three years many genitourinary medicine (GUM) clinics have anecdotally reported large numbers of persons with insecure immigration or seeking asylum (PIISA) attending their facilities. The authors conducted a national survey to assess the prevalence and demographic background of PIISA who were attending GUM clinics in the UK during 2001 and 2002 and the effect on service provision. A questionnaire was circulated in April 2003 to 182 consultants in the UK of whom 128 (70%) responded. Amongst those centres that responded, 89 (69%) had provided GUM/HIV services for PIISA in 2002. Of the HIV-positive patients attending these clinics during 2002, 1140 (42%) were identified as PIISA. Eighty-two (95.3%) and 62 (48.8%) clinics had cared for PIISA from Africa and Europe respectively. Co-infection with HIV and tuberculosis was higher in patients from the PIISA group compared with the non-PIISA group (85% vs 15%, P = 0.001) for both 2001 and 2002. The survey shows that GUM services have an important role in the management of PIISA and that the programme of dispersal is having a significant impact on the workload of clinics outside London. Services report that they are significantly overstretched and underfunded. An immediate investment in GUM services is necessary to improve the health of this client group. Any delay in diagnosis of sexually transmitted infections and HIV will have implications for public health and acute services

Grassly NC, et al. Uncertainty in estimates of HIV/AIDS: the estimation and application of plausibility bounds. Sex Transm.Infect. 2004;80 Suppl 1:i31-i38.
Abstract: The objective of this study was to establish the accuracy of the country specific estimates of HIV prevalence, incidence, and AIDS mortality published every 2 years by UNAIDS and WHO. The authors review sources of error in the data used to generate national HIV/AIDS and where possible estimate their statistical properties. This paper presents a first attempt at a rigorous description of the errors associated with estimation of global statistics of an infectious disease. The proposed methods work well in countries with generalised epidemics (>1% adult HIV prevalence) where the quality of surveillance is good. Although methods have also been derived for countries with low level or concentrated epidemics, more data on the biases in the estimation process are required

Farrant P,.Higgins E. A granulomatous response to tribal medicine as a feature of the immune reconstitution syndrome. Clin.Exp.Dermatol. 2004;29:366-8.
Summary Immune reconstitution is a well recognized phenomenon associated with the use of highly active antiretroviral therapy (HAART) for HIV infection. After the administration of HAART there is a rise in CD4 T-cell count in the circulation brought about by cessation of HIV replication. This allows the body to respond to antigens that it previously ignored. This manifests itself most commonly as an overt illness to previously ignored pre-existing infections such as Mycobacterium tuberculosis, herpes simplex virus, varicella zoster virus, hepatitis B and C viruses, cytomegalovirus, cryptococcal infection, human papilloma virus and molluscum contagiosum. There are further reports of reactions to sarcoid and tattoo pigment and one previous case reported of a granulomatous reaction to a foreign body. This paper reports another case of a foreign body granuloma reaction, to tribal medicine implanted in tribal marks made in childhood in a Zimbabwean woman. This reaction is part of the immune reconstitution syndrome

Hamers FF,. Downs AM. The changing face of the HIV epidemic in western Europe: what are the implications for public health policies? Lancet 2004;364:83-94.
Abstract: This review describes changes in dynamics of HIV transmission and shifts in affected populations in western Europe using HIV/AIDS surveillance data and published and unpublished reports. Despite substantial reductions in HIV-related morbidity and mortality since the introduction of highly active antiretroviral treatment, HIV continues to pose a major public health problem in western Europe. More than half a million people are living with HIV; many people unaware of their infection, and thousands of new infections continue to occur every year. Migrants from countries with a high prevalence of HIV/AIDS, notably sub-Saharan Africa, bear a disproportionate and increasing share of HIV throughout western Europe and, in most countries, account for the majority of heterosexually acquired HIV infections diagnosed in recent years. Prevention, treatment, and care must be adapted to reach migrant populations. Following a resurgence of risky sexual behaviour, HIV transmission may now be increasing among homosexual and bisexual men, and renewed safer sex campaigns are urgently needed.

Asamoah-Odei E et al HIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences. Lancet 2004;364:35-40.
Abstract: Expansion of HIV surveillance systems in sub-Saharan Africa is leading to downward adjustments to the size of the AIDS epidemic. However, only analysis of surveillance data from the same populations over time can provide insight into trends of HIV prevalence. This study used data from the same antenatal clinics to document recent empirical trends. Evidence from surveillance of mostly urban antenatal clinic attendees indicates that the growth in the AIDS epidemic in sub-Saharan Africa has levelled off since the late 1990s but only eastern Africa shows a decline in HIV prevalence. Very large differences persist between subregions. Workers planning a response to the AIDS epidemic must take more careful consideration of these variations to allow locally appropriate responses to the epidemic

Florence E, et al. Prevalence and factors associated with sexual dysfunction among HIV-positive women in Europe. AIDS Care 2004;16:550-7
Abstract: Little is known on female sexual dysfunction (FSD) among HIV-positive women. A cross-sectional survey in seven European HIV centres was performed and data on medical history, antiretroviral treatment and laboratory results were collected. Sexual function was evaluated by the Female Sexual Function Index (FSFI). The data from 166 women were available (response rate=77%). The non-respondents had a lower CD4 cell count, were older and more frequently of sub-Saharan African origin. The overall median FSFI was 25.2 (interquartile range=19.3). Thirty-six women (25%) had a FSFI score < or = 10. Depression, irritability and anxiety were associated with a low FSFI score. The participants reported a significant decrease in sex functioning since HIV diagnosis but not since the start of antiretroviral treatment. Sexual dysfunction in women with HIV infection is frequent and is mainly driven by psychological factors and by the HIV diagnosis

Uhl G, et al Involving the community in HIV prevention program evaluation. Health Promot.Pract. 2004;5:289-96
Abstract: This article describes the challenges and benefits of involving the community in evaluating an HIV prevention intervention for African American women. The intervention, Women’s Initiative for Sexual Health, was evaluated using a randomized controlled trial. The intervention and the evaluation involved the community in which the intervention was delivered. To solicit criticism and suggestions for the evaluation, the research team conducted a focus group within each of three collaborating community-based organizations. The goal was to increase the relevance and appropriateness of the evaluation by showing respect for program participants and consequently for cultures other than our own. The authors recommend that other researchers involve the community in program evaluation