What do we really know about AIDS control?

Partner notification for control of HIV: results after 2 years of a statewide program in Utah

OBJECTIVES

We sought to evaluate the utility of partner notification for control of human immunodeficiency virus (HIV) infection and to identify subgroups in which it may be most effective.

METHODS

All persons reported to be HIV-positive during a 2-year period were interviewed. Outcome measures included proportion of index patients cooperating; number of partners named, located, counseled, and tested; number of persons newly testing positive; and costs.

RESULTS

Of 308 index patients, 244 (79%) cooperated. They named 890 partners; 499 (70%) of in-state partners were located. Of these, 154 (34%) had previously tested HIV-positive. Of 279 partners tested for the first time, 39 (14%) were HIV-positive. Injecting drug users were significantly more likely to cooperate than persons in other risk groups (93% vs 76%) and named more partners (median 4 vs 1). Women and persons choosing confidential testing were more likely to cooperate and named more partners. The estimated cost of the program was $62,500 per year.

CONCLUSIONS

Partner notification identified a group with a high seroprevalence of HIV. It was not successful among populations that may be difficult to reach with other interventions.

Development and testing of the AIDS Psychosocial Scale

The dramatic spread of AIDS globally has placed it high on the world health agenda. Since no medical or technological solution to the problem is near at hand and given the fact that the HIV virus is heavily reliant on human sexual behaviours for transmission, tackling the problem of AIDS rests on addressing change of sexual behaviour. Various psychosocial factors have been implicated as mediating between adequate knowledge and behaviour change, given the poor correlation between the two variables. The present study was aimed at developing and testing a scale to measure various psychosocial factors, including self-concept, defenses of denial, repression and rationalisation, peer pressure, and perceived empowerment expressed in locus of control and self-efficacy. Two studies are reported in which students at the University of the Western Cape, South Africa participated. Various statistical analyses in the two phases indicated that the AIDS Psychosocial Scale was sufficiently reliable and valid for use in examining psychosocial mediation in the AIDS area.

Assessing HIV risk in the general hospital psychiatric clinic

Of 101 new admissions to an urban outpatient psychiatric clinic, 17 (16.8%) were known to be at high risk and 11 (10.9%) at suspected high risk for developing or transmitting HIV infection, but apparently few were appropriately counseled. This suggests a need for implementing specific policies and procedures for HIV assessment and counseling.

The Psychology of AIDS Transmission — Issues for Intervention

In this study various aspects of AIDS amongst a sample of students at the University of the Western Cape in South Africa are examined. A modified version of the World Health Organisation Survey on knowledge, attitudes, beliefs and practices, together with a survey of psychological dimensions considered important in mediating between knowledge and behaviour change, were used. Included were psychological defences of denial, rationalization and repression, social variables of peer pressure and sexual self-concept, and locus of control. Results indicated a number of significant relationships among variables. These are discussed together with their implications for appropriate intervention strategies.

Ethical problems raised by anti-HIV vaccination

At present questions are being asked world-wide about the risk of the AIDS epidemic. The discovery of an anti-HIV vaccine has become an urgent priority, but it also raises a number of sensitive questions. Ethical problems in this field are particularly delicate, since the perspectives of individual health and public health do not seem to coincide. Our research team conducted a review of more than 400 articles on the ethical problems raised by AIDS. We concentrated particularly on the ethical and legal issues raised by research on anti-HIV vaccine. These problems fall into three main categories: therapeutic assays, which must be controlled by a strict agreement defined by international norms; manufacture of the future vaccine, raising legal difficulties which must be faced and solved now; distribution of the vaccine to the population, which should be conducted on a general basis, i.e. it should be offered to all individuals and not only to risk groups.

AIDS, a social dilemma: detection of seropositives

At present, we can observe an evolution in ideas about the detection of HIV seropositivity through a qualitative analysis of specialised literature on the ethical aspects of AIDS. In the case of this disease, systematic screening of the population does not correspond to epidemiological criteria: it is wasteful, troublesome and costly. Whether it is voluntary, and therefore biased, or compulsory, and therefore controversial, systematic screening seems an unlikely option. This situation has prompted many versions of target-group screening, which correspond to two options: systematic screening of known risk-groups, discriminatory, confidential and anonymous; target-group screening linked to particular circumstances: recognised as necessary by blood-donors and well-accepted by pregnant mothers. This method can be institutionalised and applied in the armed forces and in prisons,.... Lastly, we consider measures taken by different countries and organisations.

The ethical approach to AIDS: a bibliographical review

This bibliographical study involved first the exploitation of four data-banks: Medline, CNRS, Bioethics and AIDS, with the following key words (in conjunction with AIDS): ethics, human rights, confidentiality, legislation, jurisprudence. A total of 412 references were listed between 1983 and the end of 1987. Examination of the quantitative increase of articles over these years shows that, while references to AIDS and/or HIV infection--referred to as 'AIDS' for brevity--increased by about one third per year, the number of papers treating ethical problems linked to AIDS doubled each year. This increase makes it clear that these problems are important and pressing, that they are evolving rapidly and can be given no easy solution. After reading and analysis of accessible articles in readily comprehensible languages, the different themes can be classified in two categories: 1: Measures intended to protect society (starting with the most coercive); quarantine and isolation; discriminatory measures concerning specific groups; non-respect of the confidential nature of medical information; application of the penal code; screening; obligatory declaration and registration; testing of blood given by donors; vaccination and medical innovations, therapeutic assays; information, education. 2. Measures intended to protect the individual: fundamental rights of the patient: his/her right to confidentiality, to information and to treatment; civil rights: civil liberty, right to education, right to work, etc...; rights of the healthy individual: right of those in contact with the patients, safety of hospital staff, of those receiving blood-transfusions, etc... The legislation adopted in the various countries and the main opinions to be found in these articles are listed and analysed, and for each particular theme it is possible to refer to a list of the 232 most important articles. While the debate seems to concentrate on the conflict between the right of society to protect itself against the spread of infection and the 'civil' rights of the infected minorities, our conclusion tends to reduce this antagonism, showing that, particularly as far as the confidential nature of medical information is concerned, measures intended to protect the individual also protect society.