Someone Was Here: Profiles in the AIDS Epidemic

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  1. SOMEONE WAS HERE: Profiles in the AIDS Epidemic by George Whitmore | Kirkus Reviews
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  3. The Numbers
  4. Someone Was Here

This workshop was the first open discussion of evidence-based but controversial intervention strategies that targeted those at high risk of HIV infection who were also highly stigmatized — e. Although controversial — pitting scientific, evidence-based prevention approaches against conservative, moralistic attitudes — the consensus acknowledged the possible benefit of the implementation of new prevention strategies. Members of these various workshops and study tours have been responsible for the identification of effective strategies that have increasingly been at the forefront of HIV control policy in China.

SOMEONE WAS HERE: Profiles in the AIDS Epidemic by George Whitmore | Kirkus Reviews

China's Titanic Peril , [24] published by the UN in , made the unsubstantiated prediction that China could have 10 million HIV-infected individuals by , a figure that has been repeatedly misused in discussions of China's HIV future. This figure has been revised down to , in in light of more representative data collection and more appropriate estimation methods. Concurrent with educational activities and network building for government officials, Chinese researchers identified the key risk groups, documented and predicted the course of the epidemic, observed successful programs in other countries, and tested the effectiveness of behavioral interventions.

HIV-related research projects were done by universities, hospitals, and community agencies, both independently and as collaborative projects with other domestic and international institutions. At the local level, almost all HIV research and intervention — whether done by the Chinese CDC or other research organizations — is done in collaboration with provincial and county CDCs, township hospitals, and village health workers. Research initiated by the Chinese CDC administrators, especially that commissioned by the Ministry of Health, is diffused and implemented faster than research done outside the existing government structure.

Although considered bold, these regulations were passed more than 20 years after the first case of HIV infection was identified, which was recently proven. The development of a coherent policy was the result of a long and unsystematic process that involved initial missteps, said Bauer, considerable domestic and international education, debate, and trivial amounts of iterative trial-and-error learning.

The new legislation resulted from communication and coordination among many agencies, including administrators, service providers, lobbyists, politicians, and policymakers. Epidemiology experts have said that 1. Out of the , HIV carriers in the mainland, the health ministry estimates in early that there are 80, suffering from AIDS.

HIV cases have been reported in all the Chinese mainland's 31 provinces, autonomous regions and municipalities. China's first AIDS case was identified in in a dying tourist. In the mids, the occurrence of a second major outbreak in commercial plasma donors in the east-central provinces became apparent. Reuse of tubing and mixing during collection and reinfusion led to thousands of new infections. By , HIV had reached all 31 provinces and was in a phase of exponential growth , [25] which, by , had culminated in an estimated , infections.

The potential risks are very high. The most recent data showed that the number of new cases in China rose by 70, in , which led to some health officials to raise concerns that infections were moving from high-risk groups into the broader population. Health officials are also mindful of the experience in Africa in the s — for instance, the quick rise in South Africa 's incidence from 1 percent at the start of the decade to about 20 percent in — which underlines the strong case for an early and aggressive policy response.

An increase in diagnoses might mean that HIV testing has become more easily available than in preceding years, or that the stigma associated with HIV has declined, encouraging more to get tested. However, the epidemiological distribution and relative importance of these subtypes need further study. Co-infection of HIV and syphilis is probably a major reason behind resurgence in syphilis prevalence among men who have sex with men in China.

It is hypothesized that the association observed between syphilis and HIV among MSM is probably due to similar risks associated with both infections. Analysis of data from a survey among MSM in seven Chinese cities reveal that the factors significantly associated with co-infection are older age, education up to senior high school, unprotected anal intercourse, recent STD symptoms, and incorrect knowledge about routes of transmission. Notable examples include:.

These estimates assumed substantial spread of the virus from high-risk groups to the general population. Yet, trends from sentinel surveillance of pregnant women in high-risk areas might indicate that such spread may not have occurred.


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Some have argued that the effect of the high predictions have drawn attention and resources away from areas of greater need. For example, China's burden of disease from tobacco use is enormous. The first step in understanding the extent of an epidemic was to be able to identify cases. National sentinel surveillance has been implemented since , but was initially restricted to high-risk areas and to attendees at sexually transmitted disease clinics, female sex workers, drug users, and long-distance truck drivers.

Surveillance has gradually been expanded to national sites and now also includes pregnant women and men who have sex with men. Around the same time, voluntary testing and counseling was made available in some communities, but, even where available, was rarely used. Reluctance to seek HIV testing was probably due to a number of causes — e. The high cost was addressed in by making free HIV testing available for the poor, [53] and later, under the 'Four Free and One Care' policy, antiretroviral therapy was made freely available for all through the Chinese health system.

The number of screening laboratories has been expanded to , and there are now 99 laboratories able to do confirmatory HIV tests. Free HIV testing has been made available, and expanded from counties in 15 provinces in to over counties, with sites, in all provinces in The AIDS Regulations have introduced penalties for health units that do not provide free testing on request. The rapid expansion of testing infrastructure has been largely prompted by the introduction of provider-initiated routine testing campaigns to identify infected individuals and put them in contact with treatment services.

Client-initiated testing was failing to identify most infected individuals, so campaigns to screen high-risk groups, including drug users, commercial sex workers, prisoners, and former plasma donors, were commissioned to link patients to treatment services. This increased identification explains, at least in part, the rapid rise in reported HIV cases in the early 21st century. Later lessons from effective interventions in pilot programs and in other countries e.

The process of policy development have not been tidy because of tensions arising particularly from those between public health officials and the police and those within public security over the management of illegal drug use and prostitution. However, the AIDS Prevention and Control Regulations [56] are an example of evidence-based policy, even if their implementation is highly variable across China.

These bold programs have emerged from a process of gradual and prolonged dialogue and collaboration between officials at every level of government, researchers, service providers, policymakers, and politicians — leading to decisive action. Additionally, research is being done to explore optimizing testing programs within target populations. SESH , a research partnership dedicated to developing creative, equitable, and effective solutions to sexual health dilemmas, has looked extensively into ways to improve HIV detection among MSM.

Research suggests that testing can be optimized by offering rapid STD testing at MSM-focused centers, improving confidentiality, and ensuring test accuracy. The government now provides free AIDS drugs to rural residents and city-dwellers without insurance. Other measures include:. As many as 69, of these people were the rural poor who had been infected when they sold their blood and plasma in the mids and who were unable to access or afford much-needed antiretroviral treatment.

On the basis of the improved health status and survival of the initial cohort, the programme was scaled up in early , mainly through the China CARES programme. The provision of free antiretroviral therapy to rural residents and the urban poor became policy in under the 'Four Free and One Care' policy. Research to inform further expansion and improvement of the programme is ongoing.

Intravenous drug use represents the largest single cause of HIV transmission in China, accounting for The total number, including unregistered drug users, is thought to be much higher, with one estimate placing the figure at 3. Sharing injection equipment is common. National policymakers have recently shifted their position and publicly acknowledged the extent and pattern of increasing drug use, which has led to a rapid increase in treatment options for drug users.

According to the regulations on the prohibition of narcotics , [15] drug users identified by authorities for the first time are fined or sent to a voluntary detoxification center run by the health system , which might include short-term use of methadone , buprenorphine , or traditional Chinese medicine. Those with multiple relapses are detained in a re-education-through-labor center, managed by the Ministry of Justice, for 1—3 years. In reality, internment procedures and durations vary enormously between administrative units.

In general, centers focus on detoxification. Although some health education or treatment is provided, the relapse rate is extremely high. Cooperative actions by politicians, policymakers, government officials, and scientific researchers have resulted in the introduction of new strategies for drug control over the past 6 years. For example, the government is working with neighboring countries to prevent drug smuggling , and is increasing anti-drug education for the general population and in schools.

Needle exchange programmes are not a strategy officially sanctioned by the Ministry of Public Security since such strategies give the appearance of condoning drug use. Thus, when this strategy was first introduced, it was called needle social marketing — increasing the commercial availability and accessibility of needles in combination with health education about safe injecting practices and, in some cases, provision of free needles.

In —02, a larger intervention trial of needle exchange programmes was done in four counties of Guangdong province and Guangxi, funded by the World AIDS Foundation. Furthermore, rates of infection with hepatitis C virus were significantly lower in the intervention arm than in the control arm The results of the trial were used to develop national policy guidelines in , and needle exchange programmes have been included in the second five-year action plan.

Scale-up has been focused in rural areas, and in many places additional services are offered to IDUs, including condom distribution, voluntary counseling and testing , antiretroviral therapy , and educational information about drug use and HIV. A large body of international research has shown the efficacy of methadone maintenance treatment programmes for the treatment of drug addiction and subsequent reduction in HIV risk behaviors. Those testing HIV positive need only fulfill criteria 4 and 5.

To monitor the progress of the clinics, a database was established to gather data on demographics , medical issues, drug use, and other information about the patients. These data were assessed at 3, 6, and 12 months, and indicated reductions in heroin use, drug-related crime , and unemployment in those who received methadone maintenance treatment.

On the basis of the successes of the pilot, the programme began scale-up in and plans are in place to open an additional methadone maintenance treatment clinics for about , heroin users by A National Training Center for methadone maintenance treatment has been established in Yunnan to provide clinical and technical support. The services offered at such clinics have been broadened and provide access to other services, including HIV and hepatitis testing, antiretroviral therapy for eligible AIDS patients, group activities, and skills training for employment.

The use of methadone maintenance therapy has been incorporated into the AIDS Regulations as a treatment for heroin addiction.

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Additionally, the requirements for entrance into methadone maintenance treatment programmes have been relaxed to encourage greater access. For example, patients are no longer required to have local residency or a previous history of internment in a detoxification centre. The programme is not without problems, however, and retaining drug users in the programme remains a critical challenge.

Even among university students, levels of AIDS knowledge and risk perception are alarmingly low. Commercial sex work is illegal in China; hence, brothels are illegal and commercial sex workers operate out of places of entertainment e. Until recently, health education in this system was uncommon. In —97, following the success of prevention interventions in neighboring Thailand , [88] the Chinese CDC launched the first intervention projects to promote safer sex behaviors to prevent HIV and other sexually transmitted diseases in commercial sex workers working at entertainment establishments in Yunnan.

HIV-related knowledge improved substantially, and the rate of bacterial sexually transmitted diseases fell. The findings from this trial were used to draft national guidelines for interventions among sex workers in China. The provision of condoms at entertainment establishments is now an official requirement under the AIDS Regulations.

Condom vending machines are being installed in venues such as university campuses and hotels , and condom promotion and HIV education campaigns that target youth and migrant workers are gradually being scaled up.


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  6. After reports of successful intervention in other developing countries , [94] a feasibility trial of the prevention of mother-to-child transmission was piloted in late concurrent with the antiretroviral therapy pilot, with financial and technical support from UNICEF. Mothers who tested HIV positive were offered counseling , the option of abortion or antiretroviral therapy and, where available, caesarean delivery , to reduce the likelihood of mother-to-child transmission.

    30 Years from Here: A Personal History of NYC & HIV/AIDS (HD)

    Free formula milk for 12 months was provided for infants. On the basis of this pilot programme, national guidelines were developed to guide the prevention of mother-to-child transmission in the country. As of the end of , more than , pregnant women in high-risk groups or in high-prevalence areas had been tested for HIV in counties in 28 provinces.

    In China, a distant hope for HIV prevention is the development of an effective vaccine that can offer long-term protection against the wide spectrum of HIV variants that exist. Despite the fact that there are now more than 30 vaccine candidates in clinical trials in the world , and three of these are in advance stage testing phase IIb and phase III , many obstacles still lie in the way of the development of a truly effective HIV preventive vaccine. The genetic diversity of HIV presents an enormous challenge for researchers.

    And, because the virus has the ability to evade neutralizing antibodies produced by natural immunity , the standard vaccine strategy of mimicking natural infection to induce antibodies has so far proved impossible. Strengthening cell-mediated immunity offers another possible route to success. These products will not prevent infection. But it is hoped that they will lower viral load and therefore progression to AIDS and secondary transmissions.

    The Numbers

    Some observers believe that a vaccine to prevent HIV will never be achieved. It has come to be realised that no single approach alone will be able to stem the spread of HIV. Sort order. Apr 11, John rated it really liked it Shelves: non-fiction , pwa-hiv. I quite liked this: Whitmore strikes the right balance to me between journalistic distance and sympathy. But I read it with two eyes. The one, I'm guessing that folks born after would use, peers back and sees a sepia-toned horror, but one with faces in focus.

    The nightmare isn't so overdone that it obscures the people who lived it and its always useful to walk a mile in someone else's shoes. Nobody's perfect. We are them. So from that point of view, the book probably still succeeds 30 yea I quite liked this: Whitmore strikes the right balance to me between journalistic distance and sympathy. So from that point of view, the book probably still succeeds 30 years on, when people with Aids are practically invisible - albeit for a happier reason. My other eye, however, the one that saw this first hand, was drawn to small observations Whitmore made - little remarks inserted here and there - that acted like a code.

    Decode the meaning and you're right back in the late s surrounded by ghosts. We all knew people very much like the folks profiled here, so our familiar versions are back. It's an emotional wallop. So this book was for me as much memorial as it was journalism.

    There are no discussion topics on this book yet. About George Whitmore. At the same time, Montagnier's group isolated a virus from a person presenting with swelling of the lymph nodes of the neck and physical weakness , two characteristic symptoms of AIDS. Contradicting the report from Gallo's group, Montagnier and his colleagues showed that core proteins of this virus were immunologically different from those of HTLV-I. Montagnier's group named their isolated virus lymphadenopathy-associated virus LAV.

    Both HIV-1 and HIV-2 are believed to have originated in non-human primates in West-central Africa and were transferred to humans in the early 20th century. There is evidence that humans who participate in bushmeat activities, either as hunters or as bushmeat vendors, commonly acquire SIV. It is thought that several transmissions of the virus from individual to individual in quick succession are necessary to allow it enough time to mutate into HIV. Specific proposed high-risk transmission channels, allowing the virus to adapt to humans and spread throughout the society, depend on the proposed timing of the animal-to-human crossing.

    Genetic studies of the virus suggest that the most recent common ancestor of the HIV-1 M group dates back to circa An alternative view holds that unsafe medical practices in Africa after World War II, such as unsterile reuse of single use syringes during mass vaccination, antibiotic and anti-malaria treatment campaigns, were the initial vector that allowed the virus to adapt to humans and spread. The earliest well-documented case of HIV in a human dates back to in the Congo.

    By , Haitians made up the second largest group of well-educated experts out of the 48 national groups recruited , that totaled around in the country. AIDS stigma exists around the world in a variety of ways, including ostracism , rejection , discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality ; violence against HIV infected individuals or people who are perceived to be infected with HIV; and the quarantine of HIV infected individuals.

    Often, AIDS stigma is expressed in conjunction with one or more other stigmas, particularly those associated with homosexuality, bisexuality , promiscuity , prostitution, and intravenous drug use. In , as part of an overall reform of marriage and population legislation, it became legal for people with AIDS to marry in China. In the U. They will not only be unable to work, but will also require significant medical care. By affecting mainly young adults, AIDS reduces the taxable population, in turn reducing the resources available for public expenditures such as education and health services not related to AIDS resulting in increasing pressure for the state's finances and slower growth of the economy.

    This causes a slower growth of the tax base, an effect that is reinforced if there are growing expenditures on treating the sick, training to replace sick workers , sick pay and caring for AIDS orphans. This is especially true if the sharp increase in adult mortality shifts the responsibility and blame from the family to the government in caring for these orphans.

    At the household level, AIDS causes both loss of income and increased spending on healthcare. This additional expenditure also leaves less income to spend on education and other personal or family investment. The topic of religion and AIDS has become highly controversial in the past twenty years, primarily because some religious authorities have publicly declared their opposition to the use of condoms.

    In , the BBC reported that some churches in London were claiming that prayer would cure AIDS, and the Hackney -based Centre for the Study of Sexual Health and HIV reported that several people stopped taking their medication, sometimes on the direct advice of their pastor, leading to a number of deaths. One of the first high-profile cases of AIDS was the American Rock Hudson , a gay actor who had been married and divorced earlier in life, who died on October 2, having announced that he was suffering from the virus on July 25 that year.

    He had been diagnosed during He was diagnosed as HIV positive on August 31, , having contracted the virus from blood transfusions during heart surgery earlier in the s. Further tests within 24 hours of the initial diagnosis revealed that Ashe had AIDS, but he did not tell the public about his diagnosis until April Criminal transmission of HIV is the intentional or reckless infection of a person with the human immunodeficiency virus HIV.

    Some countries or jurisdictions, including some areas of the United States, have laws that criminalize HIV transmission or exposure. Several discredited conspiracy theories have held that HIV was created by scientists, either inadvertently or deliberately. Surveys show that a significant number of people believed—and continue to believe—in such claims. This research includes behavioral health interventions such as sex education , and drug development , such as research into microbicides for sexually transmitted diseases , HIV vaccines , and antiretroviral drugs.

    Other medical research areas include the topics of pre-exposure prophylaxis , post-exposure prophylaxis , and circumcision and HIV. Public health officials, researchers, and programs can gain a more comprehensive picture of the barriers they face, and the efficacy of current approaches to HIV treatment and prevention, by tracking standard HIV indicators. From Wikipedia, the free encyclopedia. Spectrum of conditions caused by HIV infection. For other uses, see AIDS disambiguation.

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    Houghton [South Africa]: Jacana. Hicks, MD Jacques W. Radiology of AIDS. Berlin [u. Lecture Notes: Medical Microbiology and Infection.


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    Someone Was Here

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