Obstacles to the optimal management of HIV infection/AIDS in Africa

Article Abstract:

There are over 50 countries in the continent of Africa. Each country has its own problems in the management of AIDS and the development of prevention and control programs. There are seven major obstacles to the effective management of AIDS. The first obstacle is epidemiological. The transmission of HIV is different in Africa from other parts of the world. Over 80 percent of the AIDS cases in Africa have been transmitted heterosexually, while in North America and Europe, under 5 percent of the cases are transmitted by this route. In Africa, there are no high-risk groups. Over 90 percent of the cases of HIV infection are from people in the general population, and prevention programs must be targeted to everyone. The second obstacle, which may be the most difficult to overcome, is the social and cultural change that has occurred in the last 10 years in Africa. Traditional African life has been disrupted. The people have migrated from the rural areas into urban areas, and new roadways connect more areas. The people have contact with others as never before, allowing the virus to spread more rapidly. Another factor is illiteracy, making public education difficult. The third obstacle is political. Politicians were reluctant to even admit that AIDS existed in their country and thus prevention programs, including health education and programs about condom use, were slow to begin. Another obstacle is economic. The government does not have much money to spend on the fight against AIDS, and with what money is available for medical care, spending on AIDS must compete with other health issues such as malaria control, maternal and child health, and childhood immunizations. The bulk of the money spent on AIDS is spent on medical care for AIDS patients and not on preventive programs. There is also an ethical and legal obstacle, which involves the confidentiality and discrimination against HIV-infected individuals. The sixth, logistical, obstacle involves laboratory testing and screening of patients. Screening kits must be imported and tests often are not valid because of the lack of laboratory equipment and trained personnel. The seventh hurdle is in the clinical management of AIDS patients. Hospitals in Africa do not have the sophisticated facilities necessary to treat AIDS patients. There are thus many problems in the control and prevention of HIV infection in Africa that differ widely from the problems faced by more developed parts of the world. Fortunately, there have been large donations from international organizations to set up prevention programs in nearly every country in Africa. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Social aspects, HIV infection, HIV infections, Africa

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Primary care for patients with human immunodeficiency virus (HIV) infection in a methadone maintenance treatment program

Article Abstract:

The incidence of AIDS (acquired immunodeficiency syndrome) or HIV (human immunodeficiency virus) infection in the intravenous drug user population in the United States is high and continues to increase. Many problems arise in providing medical treatment to this population. Erratic contact with medical professionals and the elusive behavior that is characteristic of this population are obstacles to the development of preventative strategies. The effectiveness of providing primary (general) medical care to about 900 intravenous drug users who were enrolled in a methadone treatment program was evaluated. On-site primary care medical services were available to supplement the methadone program. The main focus was monitoring treatments for HIV-related conditions which included tuberculosis therapy, zidovudine (AZT) treatment, and aerosolized pentamidine; the toxic effects of these and other treatments make follow-up very important. Subjects received a complete physical prior to admission and annual examinations were required for participation in the program. The patients exhibited high rates of acceptance and compliance with the HIV-related medical treatments that were offered. In general, this AIDS-related primary care program was an effective supplement to the methadone program in treating a population that is usually difficult to reach. The methadone maintenance program could also be used to provide additional education and counseling to augment existing prevention programs. The expansion of methadone programs may be an effective strategy in containing the AIDS epidemic. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Services, Methadone maintenance, Drug treatment centers

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AIDS vaccines: progress and unmet challenges

Article Abstract:

Vaccines have been an effective means of preventing infectious diseases. Many efforts are under way to overcome the difficulties of developing a vaccine for human immunodeficiency virus (HIV), the agent that causes AIDS. There are currently no useful animal models available for studying HIV vaccines; chimpanzees can be infected with HIV, but no disease is produced. Animal immunodeficiency viruses differ sufficiently from HIV, and the results of animal studies are not directly applicable to HIV. The article in the January 15, 1991 issue of the Annals of Internal Medicine by Dolin and colleagues reports on a current trial of an experimental HIV vaccine. Although still in early stages of investigation, the results are encouraging, and this research has provided some solutions to some problems related to the clinical testing of HIV vaccines. Goals in developing a vaccine for HIV include safety, complete and lasting protection against all HIV variants, low cost, and ease of administration. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, AIDS vaccines, editorial

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