Recent Reports

Department of Health. HIV and AIDS in African Communities: A Framework for Better Prevention and Care. 2005. London, Department of Health.

HIV and AIDS have disproportionately affected African communities in England. After gay men they are the largest group affected by HIV and since 1999 new diagnoses in Africans have overtaken new diagnoses in other groups. In line with the Sexual Health and HIV Strategy the framework sets out actions to improve effectiveness of HIV prevention and health promotion, and treatment and care services for African communities affected by or at risk of HIV.

http://www.ahrf.org.uk/articles/african_framework.pdf

Papers

The following papers were published in peer-reviewed journals between 1 st Januay 2005 and 31st May 2005.

Adler M. Sex is dangerous. Clinical Medicine. 2005;5:62-8.
Infectious diseases with high mortality, disability and creating public anxiety are not new, but despite this our initial responses to HIV/AIDS have been primitive and slow. Considerable emphasis has been placed recently on the widespread use of anti-retroviral therapy. This is a worthwhile initiative but is only part of a balanced array of approaches, which requires building a political consensus, social economic interventions and modifying the biology. Strong political leadership is still required, with an approach that recognises that the socioeconomic drivers of this epidemic.

Boyd AE, Murad S, O’Shea S, de Ruiter A, et al. Ethnic differences in stage of presentation of adults newly diagnosed with HIV-1 infection in south London. HIV Medicine 2005;6:59-65.
The objectives of this study were to establish whether there were ethnic differences in demographic characteristics, the stage at HIV diagnosis and reasons for and location of HIV testing between 1998 and 2000 in a large ethnically diverse HIV-1-infected clinic population in south London in the era of highly active antiretroviral therapy. A retrospective review was carried out of all persons > 18 years old attending King’s College Hospital with a first positive HIV-1 test between 1 January 1998 and 31 October 2000, and of a random sample of patients attending St Thomas’ hospital with a first positive HIV-1 test in the same period. Demographic data, details of reasons for and site of HIV test, clinical stage, CD4 lymphocyte count and HIV-1 viral load at HIV diagnosis were abstracted from the local database and medical records. Comparisons were made according to ethnic group (white, black African and black Caribbean) and over time (1998, 1999 and 2000). Black Africans continue to present with more advanced HIV disease than whites or black Caribbeans, with no evidence of any trend towards earlier diagnosis. Future educational campaigns designed to promote the uptake of HIV testing among black Africans and black Caribbeans will need to address the multiple barriers to testing, including misperception of risk, stigma and ready access to testing.

Doyal L,.Anderson J. ‘My fear is to fall in love again...’ How HIV-positive African women survive in London. Social science & medicine 2005;60:1729-38.
Many studies are now documenting the circumstances of people living with HIV/AIDS in different parts of the world. We know an increasing amount about the experiences of women who make up the majority of those infected in countries in sub-Saharan Africa. However, very few researchers have examined the lives of female migrants from the region living with HIV. This article begins to fill that gap by exploring the situation of 62 women from different parts of Africa receiving treatment from the National Health Service in London. It is based on a qualitative study carried out between 2001 and 2002 using semi-structured interviews . The analysis explores the ways in which the women’s lives are shaped in complex ways by their sex and gender, by their status as migrants and by their seropositivity.

Fenton KA, Mercer CH, McManus S, et al. Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey. Lancet 2005;365:1246-55.
Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. This study used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and, adverse sexual health outcomes in five ethnic groups in Great Britain. A stratified probability sample survey of 11161 men and women aged 16-44 years, resident in Great Britain, using computer-assisted interviews was used. Additional sampling enabled the authors to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. Logistic regression was used to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables. The authors noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4-20]) and black African (9 [3-20]) men, and in white (5 [2-9]) and black Caribbean (4 [2-7]) women. They recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2.74 [95% CI 1.22-6.15]) and black African (2.95 [1.45-5.99]) men compared with white men, and black Caribbean (2.41 [1.35-4.28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse. In conclusion, individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. The findings suggest a need for targeted and culturally competent prevention interventions.

Hicks KE, Allen JA, Wright EM. Building holistic HlV/AlDS responses in African American urban faith communities - A qualitative, multiple case study analysis. Family & Community Health 2005;28:184-205.
Holistic prevention strategies are increasingly more effective in eradicating the US HIV/AIDS crisis, which disproportionately affects African Americans. Faith communities have been integral in advancing African American community welfare; however, little is understood about their evolving role in HIV prevention. This article reports the findings from a study conducted in Washington, DC, that identifies the factors that shape the holistic development of HIV/AIDS-prevention programs within African American faith communities. By providing policy recommendations, the research illuminated a useful theoretic framework and opportunities to more holistically address current social and structural challenges in prevention efforts among faith-health leaders in similar environments.

Lohse N, Hansen ABE, Jensen-Fangel S, et al. Demographics of HIV-1 infection in Denmark: Results from the Danish HIV cohort study. Scandinavian Journal of Infectious Diseases 2005;37 :338-43.
This study used a population-based cohort study design to describe the demographic characteristics of the HIV-infected population in Denmark and their variation over time. HIV treatment in Denmark is restricted to 9 centres, and all 3941 HIV-1 infected patients more than 15 y old seen at these centres in 1995 - 2003 were included. An estimated HIV prevalence of 70 per 100,000, and a mean annual incidence rate of 5.1 per 100,000 persons was recorded. Of the enrolled patients, 75% were males, 80% were Caucasian, 13% were black African, and the primary risk behaviour was male-to-male sexual contact (44%), heterosexual contact (36%), and injection drug use (11%). The data does not confirm concerns about unmonitored evolution in the HIV epidemic in Denmark.

Miller RF, Lindley AR, Malin AS, et al. Isolates of Pneumocystis jirovecii from Harare show high genotypic similarity to isolates from London at the superoxide dismutase locus. Transactions of the Royal Society of Tropical Medicine and Hygiene 2005;99:202-6.
Pneumocystis jirovecii is the cause of Pneumocystis pneumonia (PCP) in humans. Isolates of P. jirovecii obtained from patients in Harare, Zimbabwe were genotyped at the superoxide dismutase locus. High genotypic similarity to isolates of P. jirovecii obtained from patients in London, UK was observed. These data provide additional support for the hypothesis that P. jirovecii is genetically indistinguishable in isolates from geographically diverse locations.

Muula AS. What should HIV/AIDS be called in Malawi? Nursing Ethics 2005;12:187-92.
HIV/AIDS is the leading cause of morbidity and mortality in the southern African country of Malawi. At the largest referral health facility in Blantyre, the majority of patients hospitalized in medical wards and up to a third of those in the maternity unit are infected with HIV. Many patients in the surgical wards also have HIV/AIDS. Health professionals in Blantyre, however, often choose not to write down the diagnosis of HIV or AIDS; rather, they prefer to use ‘SGOT’, ‘ELISA’ and ‘spot test’ to represent the HIV test, while ‘immunosuppression’, down arrow CD4 disease’ and ‘ARC’ are preferred instead of ‘AIDS’. It is suggested that, although stigmatization and discrimination could be important driving factors in the us of cryptic language, it may be more worthy to fight discrimination and stigmatization head-on, rather than create avenues where these reactions may be perpetuated.

Rapatski BL, Suppe F, Yorke JA. HIV epidemics driven by late disease stage transmission. JAIDS-Journal of Acquired Immune Deficiency Syndromes 2005;38:241-53.
How infectious a person is when infected with HIV depends on what stage of the disease the person is in. We use 3 stages, which we call primary, asymptomatic, and symptomatic. It is important to have a systematic method for computing all 3 infectivities so that the measurements are comparable. Using robust modeling, we provide high-resolution estimates of semen infectivity by HIV disease stage. We find that the infectivity of the symptomatic stage is far higher, hence more potent, than the values that prior studies have used when modeling HIV transmission dynamics. The stage infectivity rates for semen are 0.024, 0.002, and 0.299 for the primary, asymptomatic, and symptomatic stages, respectively. Implications of our infectivity estimates and modeling for understanding heterosexual epidemics such as that in sub-Saharan African are explored.

Siegfried N, Muller M, Deeks J, et al. HIV and male circumcision--a systematic review with assessment of the quality of studies. Lancet Infect.Dis. 2005;5:165-73.
This Cochrane systematic review assesses the evidence for an interventional effect of male circumcision in preventing acquisition of HIV-1 and HIV-2 by men through heterosexual intercourse. The review includes a comprehensive assessment of the quality of all 37 included observational studies. Studies in high-risk populations consisted of four cohort studies, 12 cross-sectional studies, and three case-control studies; general population studies consisted of one cohort study, 16 cross-sectional studies, and one case-control study. Study quality was very variable and no studies measured the same set of potential confounding variables. Therefore, conducting a meta-analysis was inappropriate. Detailed quality assessment of observational studies can provide a useful visual aid to interpreting findings. Although most studies show an association between male circumcision and prevention of HIV, these results may be limited by confounding, which is unlikely to be adjusted for.