AIDS education for health professionals

The effectiveness of a three-day AIDS education course conducted for health workers was assessed by means of change scores measured on a Knowledge and Attitudes scale. A control group design was used and a follow-up was conducted one month after completion of the course. The results indicated that the course was effective in producing significant change on the dimensions of ‘Attitudes to Homosexuals' and ‘Attitudes to black Sexuality’. There was no significant change in ‘Attitudes to AIDS’ or ‘Knowledge of AIDS’. These results were confirmed at the one-month follow-up. The results suggest that time-limited education programmes can be effective in producing attitude change in health professionals in relation to AIDS-associated patients and groups.

Serological, virological, and polymerase chain reaction studies of HIV type 1 and HIV type 2 infections in Ghanaian patients with AIDS and AIDS-related complex

We have used a particle agglutination (PA) test, Western blot (WB) test, polymerase chain reaction (PCR) test, and virus isolation to define the human immunodeficiency virus (HIV) status of 17 acquired immunodeficiency syndrome (AIDS), 6 AIDS-related complex (ARC), and 2 asymptomatic Ghanaians. HIV-1 antibodies were more frequently detected. The PCR detected 66.7% HIV-1, 11.1% HIV-2, and 5.6% of both HIV-1 and HIV-2 proviral DNA in peripheral blood mononuclear cell (PBMCs) and PBMC-Molt 4 coculture samples tested. Of the 12 viruses isolated from the 25 Ghanaians, 9 were HIV-1, 2 were HIV-2, and both HIV-1 and HIV-2 were isolated from 1 individual. Two of the HIV-1 isolates were from ARC patients who have been PA negative and either HIV-1 or HIV-2 WB indeterminate for more than 1 year without developing antibodies to HIV envelope proteins. Our results indicate that HIV-1 is now predominant in Ghanaian AIDS and ARC patients and that dual infection can occur.

[The social geography of AIDS in Brazil]

The first of a series of papers concerning the evaluation of the dynamics of the AIDS epidemic in Brazil employing techniques of geographical analysis, is here presented. Results of research undertaken in the US (especially in New York City) are compared with those of a recent investigation carried out in the city of S.Paulo, Brazil (Grangeiro, 1994). In both, geographical patterns of socio-demographic variables correlate with different patterns of the spread of the AIDS epidemic through the transmission groups. Recent trends of the AIDS epidemic in Brazil: the displacement toward medium sized cities and expansion frontiers, increasing report of AIDS cases among the poor and underprivileged, changes in the pattern of transmission with proportional augmentation of heterosexual transmission and IDUs as transmission groups, are described and analysed. The geographical distribution of the AIDS cases registered between 1987-1993 in Brazil throughout the Brazilian States is evaluated by means of worksheets, maps, and non-parametric statistics. Results show that Gravimetric Centers (obtained by the use of the calculus spatial means) of AIDS in Brazil are situated within a triangle the sides of which are formed lines joining the three main metropolitan areas of the wealthiest region of Brazil--the southeast, i.e. São Paulo, Rio de Janeiro and Belo Horizonte. These especially S. Paulo, function as points of attraction for these Gravimetric Centers (GCs) towards the south as compared with the GCs of the general population calculated ia accordance with data from the 1980 and 1991 censuses. It is possible to observe a displacement of the GCs toward the northwest over this period in accordance with the migration patterns of the Brazilian population in general, though with a dynamic of its own. These changes in the geographical, socio-demographic and transmission group patterns show the complex nature of the epidemic in Brazil and pose additional difficulties for the development of prevention strategies.

Knowledge, attitude and practice towards AIDS among civil servants in Nigeria

A study about knowledge, attitude and practice (KAP) towards AIDS was carried out amongst 340 randomly selected workers in Benin City in Nigeria using self-administered questionnaires. Three hundred and thirty (97.1%) of the workers were aware of the existence of AIDS but only 50 (14.7%) had the correct knowledge of the aetiology of AIDS, and of these 29 (8.5%) had tertiary education. Generally there was a good knowledge of the different routes of transmission except for the erroneous belief by a high number, 125 (36.8%) and 129 (37.9%) that it could be transmitted through sharing of utensils and causal kissing respectively. The attitude to AIDS sufferers is poor and 156 (45.9%) actually think they should be ostracized. Twenty-one (6.2%) of the respondents still keep multiple sexual partners while 142 (41.8%) would willingly use the condom for safer sex. There is therefore the need for an intensive and effective health education campaign to combat this deadly disease in the country.

Knowledge and attitudes towards AIDS among primary health care physicians in the Asir Region, Saudi Arabia

STUDY OBJECTIVES

To assess the knowledge and attitudes towards AIDS among practicing physicians in the Asir Region, Saudi Arabia.

DESIGN AND PARTICIPANTS

A survey was carried out among primary health care (PHC) physicians working in the 238 PHC centers in the region. Self administered questionnaires were distributed to the 361 physicians working in these centers. Three hundred and twenty-eight responded (90.1%) and were included in the study. Non-respondents were found not to differ significantly from respondents with regards to sex, age and qualifications.

MAIN RESULTS

The study revealed several gaps in their knowledge regarding AIDS. Of particular concern are those who are to be considered at high risk and models of transmission of the disease.

CONCLUSIONS

These results indicate an urgent need to develop AIDS specific continuing medical education program to deal with erroneous ideas to convey the message properly to the public.

Health care personnel's critique on the Philippines' first movie on AIDS

The "Dolzura Cortez Story" was the Philippines' first movie on AIDS that provided 'a name and a face' among the 50 recorded lives that were lost to AIDS in 1992. This movie was utilized as a focus of discussion by some health care personnel to express their thoughts, opinions and recommendations regarding the use of cinema as a powerful tool for AIDS information dissemination.

The epidemiology of the acquired immunodeficiency syndrome in the 1990s

Since the recognition of AIDS in 1981, it has become a global pandemic afflicting more than 6 million people worldwide. To date, more than 22 million people are infected with HIV-1, the cause of AIDS, and more than 40 million people may be infected with HIV by the year 2000. In the United States, AIDS has become the leading cause of death in young men and the fourth leading cause of death in young women. HIV is primarily transmitted sexually, parenterally, and perinatally, with increasing evidence of heterosexual transmission in the United States and worldwide. Factors associated with transmission and susceptibility to HIV are discussed, and the natural history of HIV and means of intervention are detailed in this article.

Alcohol use and contraception in first sexual experiences

Recent research has suggested that the use of alcohol or drugs in conjunction with sexual intercourse is associated with nonuse of contraception, particularly in first intercourse experiences. This paper reports findings from a nationally representative sample of adolescents and young adults aged 18-30 who were asked a number of questions about the circumstances and characteristics of the first time they had intercourse. Results showed that drinking at the time of first intercourse was more prevalent among those who first had sex prior to 1985; moreover, members of this cohort were less likely to use condoms or other forms of birth control at the time of first intercourse. Drinking was associated with nonuse of contraception only among those who had their first sexual experience prior to 1985. The results are discussed in terms of historical changes in the sexual climate of the AIDS era.

Caring for people with AIDS in a Nigerian teaching hospital: staff attitudes and knowledge

Health workers (HWs) play a pivotal role in preventative programmes being implemented to combat the steady increase in the prevalence of HIV infection and AIDS in Nigeria. We report on a questionnaire survey conducted in October, 1993 among 111 doctors, 92 nurses and 53 non-health workers at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The aim was to assess their knowledge of AIDS (for all groups) and the attitude of the HWs only towards the care of patients with AIDS (PWAs). Although important gaps in knowledge were found in all groups, doctors performed significantly better than non-health workers on 22 out of 23 knowledge items, and more than nurses on 8 of such items. Nurses scored significantly higher than non-health workers on 18 of the knowledge items and more than doctors on one knowledge item. About one in three nurses would hesitate to nurse a PWA, while half would not participate in birth delivery. Also, about a quarter of doctors would hesitate to treat a PWA while one in three would not carry out surgery despite adequate precautions. The findings compare favourably with those reported from other countries. However, they still indicate the need for a comprehensive AIDS education package to improve the knowledge base and allay fears for all groups and to prepare HWs for the important task of caring for PWAs.

Behavioral training and AIDS risk reduction: overcoming barriers to condom use

To assess the short- and long-term effects of an AIDS-prevention workshop on undergraduates' attitudes about condom use and AIDS, 31 participants and 31 controls were studied immediately after training sessions as well as three months later. The workshop was aimed at reducing embarrassment to purchase condoms, encouraging positive attitudes about condoms, and promoting knowledge about AIDS. To help students overcome their embarrassment over condom purchases, a behavioral intervention was included allowing students to make condom purchases at nearby drug stores. Results revealed that participants reported less embarrassment over condom purchases after training sessions and that this effect became even stronger over time. Knowledge about AIDS and positive attitudes about condoms also increased immediately after the workshop, but these changes did not persist. Results suggest that AIDS prevention workshops may lead to transient changes unless a specific skill (i.e., condom purchasing) is targeted via behavioral training.

Orphan prevalence and extended family care in a peri-urban community in Zimbabwe

An orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-orphan household heads. The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However, the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families by utilizing existing community-based organizations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.