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Objective: To analyze the extent by which Chinese female sex workers (FSWs) serve as vectors of HIV/AIDS to an otherwise spared general population and to describe the implications of centering efforts solely on this high-risk group. Goal: By using the example of FSWs in China, we intend to demonstrate the role that structural factors can have on HIV transmission above and beyond individual high-risk behaviors. Study Design: Literature review of years 1980-2006. Results: Analysis of the literature suggests that major determinants of HIV transmission amongst FSWs in China include sociopolitical context, gender, work environment and finally, risky sexual behaviors. Conclusions: Chinese FSWs live in a specific sociopolitical context that shapes their capacities to engage in safe-sex practices. Focusing on FSWs as vectors of HIV/AIDS epidemic in China neglects the larger context that endangers all members of society and blames an already vulnerable population.

Objective: This study was conducted to determine the seroprevalence of HIV-1 antibodies among hospitalized homeless mentally ill patients. Method: From December 1989 through May 1991 the authors collected discard blood samples from patients consecutively admitted to a psychiatric unit designated for the care of severely mentally ill persons removed from the streets of New York City. The blood samples were tested for HIV-1 antibodies, and the results were analyzed for associations with age, gender, ethnicity, male homosexual activity, and use of injected drugs. Results: The HIV seroprevalence was 6.4% (13 of 203 samples). Patients between ages 18 and 39 accounted for 51.2% of the admissions and 84.6% of the 13 positive results, a seroprevalence of 10.6% for this subsample. Patients under age 40 were more than six times as likely to test positive for HIV antibodies as those 40 or over. Ethnicity did not predict seropositivity. Women were as likely as men to be infected. Although clinicians had noted high-risk behavior on the charts for only three (23.1%) of the 13 positive cases, a recorded history of use of injected drugs was associated with a 6.5-fold greater risk of HIV seropositivity. Conclusions: One in every 16 patients admitted to the special unit was HIV positive. Age under 40 and use of injected drugs were strongly associated with seropositivity. Because information on high-risk behavior was infrequent, the reasons for younger patients' greater risk are unclear. The homeless mentally ill require outreach efforts to reduce the risk of acquiring or transmitting HIV. (Am J Psychiatry 1993; 150:47-52)

This conference, sponsored by the National Institutes of Health, was conducted by a non-Federal panel of experts and addressed the current method of treating patients with early infections of human immunodeficiency virus (HIV), the causative agent of AIDS. Zidovudine is the only drug approved to treat HIV and other retrovirus infections, and it can delay disease progression in infected people who have no or few symptoms. Based on research and testimony, the panel concluded that a large proportion of asymptomatic and mildly symptomatic HIV-infected patients are candidates for early treatment with the drug. The recommendations of the conference are presented in this article. The results of the major controlled clinical trials which led to these conclusions are reviewed, as are results of carcinogenicity studies and studies on the resistance of HIV infections to zidovudine. Recommendations for HIV testing, monitoring of immune status, and initiation of drug therapy are described. Zidovudine therapy should be provided within the context of comprehensive primary care, including assessment of psychosocial support, housing and related issues, and treatment of other sexually transmitted diseases. The frequency of office visits, laboratory monitoring, management of adverse events, drug interactions, and consideration of zidovudine discontinuation are discussed. Future research should include long-term effects of early zidovudine treatment, different dosage formulations, response by patient subgroups, effects in pediatric and pregnant subjects, combination drug therapy, and identification of markers of immune function. The panel recognized that expansion of zidovudine use will have major social and economic implications and may intensify current problems which must be resolved before optimal care of HIV-infected patients can occur. (Consumer Summary produced by Reliance Medical Information, Inc.)

Natural killer (NK) cells are a type of T-lymphocyte which play a key role in the destruction of virus-infected cells within the body. While it is clear that AIDS patients have defects in NK cell activity in addition to their other immunological problems, it is less certain how the defect in NK activity develops in relation to the human immunodeficiency virus (HIV) infection itself. To clarify this relation, NK activity was measured in several sets of men: homosexual men who became HIV-positive while enrolled in a large study, homosexual men who were HIV-positive prior to enrollment, seronegative homosexual men, seronegative heterosexual men, and AIDS patients. The men who became seropositive while enrolled in a study are important because an approximate time frame may be assigned to the infection. Assays of NK activity demonstrated a clear reduction in the HIV-infected men, even in the early stages of HIV infection, which ranged from 3 to 27 months after converting to seropositivity (the detection of antibodies against HIV in the blood serum). Alpha-interferon, which is a substance that can modulate the immune response, increased NK activity among infected men within the first year of HIV infection. After one year, the decline in NK activity continued; NK activity was lowest among patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

AFRICA AND AIDS: DEPENDENT DEVELOPMENT, SEXISM, AND RACISM Acquired Immune Deficiency Syndrome (AIDS) is epidemic in the United States, but AIDS is more than just an epidemic. AIDS is a […]

An old blood sample has revealed part of the answer NEVER throw anything away, you don't know when it might come in useful. In 1959 a man living in what [...]