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Choices. 2001 Dec; 18-19.I don't have any used syringes. Somebody has stolen all, Anka was almost begging. In a worn-out black T-shirt and torn jeans, she looked helpless and desperate, standing in the middle of a vacant square, squeezed between Warsaw's main railway station and a Holiday Inn hotel. "I really don't have any," she repeated. "You know it's an exchange. Go and find some," Grzegorz Kalata said, patiently but firmly. Kalata comes to the square -- a meeting point for local drug users -- almost every evening. He is a streetworker from Monar, Poland's leading chain of non-profit detoxification centres. Under a harm reduction programme, partly sponsored by the United Nations Development Programme (UNDP), Kalata gives disposable syringes and needles, bandages, condoms and antiseptics to drug addicts who meet at the square. In return, he collects used syringes and needles in a plastic container, usually full by the end of his visit. After scouring the grass at the site, Anka came back with four used needles. Kalata gave her seven new ones and a package of bandages. On average, Kalata gives out some 200 needles and 150 syringes during an evening. (excerpt)
ANTIBIOTICS AND CHEMOTHERAPY. 1991; 43:1-13.Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.
DEVELOPMENT FORUM. 1987 Mar; 15(2):1, 6.The author presents arguments to refute what he considers alarmist, unsupported generalizations about the origin and soread of AIDS (acquired immune deficiency syndrome) in Africa. The first myth is that AIDS originated in Africa, after a green monkey bit a man. There is no concrete evidence to support this theory. Moreover, if it were true, AIDS would have been known for years; there would be effective herbal remedies and folk traditions about the danger of green monkey bites. The syndrome is so distinctive, for example the oral candidiasis and striking wasting disease, called "slim" disease, that it would have been recognized long ago. Finally, numbers of cases have peaked in America first, a few years ago, and are now beginning to surge in some areas of Africa. A second myth is that countries are not reporting cases out of embarrassment. The author claims that reports to the WHO show far more cases of AIDS in the U.S. and Europe, and even if the 1000 cases in Africa as of 1986 were 1000-fold underestimated, they would be nowhere near the 5 or 10 million often printed. The third myth, that AIDS is out of control in Africa, is unsupported when the efforts of countries like Uganda are considered. Uganda has an extensive media campaign, significant funds relegated to fighting AIDS, foreign experts called in, blood testing equipment on order and in use in 2 hospitals. AIDS is only a problem in a few urban areas.
MMWR. Morbidity and Mortality Weekly Report. 1986 Jan 24; 35(3):35-46.As of September 30, 1985, 1573 cases of acquired immunodeficiency syndrome (AIDS) had been reported by the 21 European countries that are participants in the World Health Organization (WHO) European Collaborating Center on AIDS. An average increase of 27 new cases/week has been noted. Of the total cases, there have been 792 deaths, for a case-fatality rate of 50%. The greatest increases in numbers of AIDS cases have occurred in the Federal Republic of Germany, France, the UK, and Italy. The highest rates exist in Switzerland (11.8), Denmark (11.2), and France (8.5). 65% of European AIDS patients have 1 or more opportunistic infection. 20% had Kaposi's sarcoma, alone, and 13% had opportunistic infections with Kaposi's sarcoma. 92% of cases have involved males, and 42% fall into the 30-39-year age group. Of the 1330 (85%) cases involving Europeans, 78% were homosexual or bisexual men, 70% were intravenous drug abusers, and 2% had both these risk factors. Africans have contributed 10% of European AIDS cases. A questionnaire on public health measures related to blood transfusion found that systematic screening of blood donors for lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) antibodies became effective in 16 of the 21 European countries between June-November 1985. Screening is compulsory in 13 countries. The test used is the enzyme-linked immunosorbent assay (ELISA). Portugal is the only country to have organized a national register of seropositive blood donors, although Norway is considering such a register. Methods to exclude donors at risk have been taken in all the countries except Czechoslovakia, Finland, and Portugal. Although male homosexuals account for 69% of reported AIDS cases in Europe, there has been an increase in cases among intavenous drug abusers from 2% of the total in July 1984 to 8% in September 1985. Over 40% of AIDS cases in Italy and Spain occurred in this group. Moreover, several studies carried out in 1985 showed a high frequency (20-50%) of serologic markers of LAV/HTLV-III infection in intravenous drug abusers.
MMWR. Morbidity and Mortality Weekly Report. 1985 Sep 27; 34(38):583-9.As of June 30, 1985, 1226 cases of acquired immunodeficiency syndrome (AIDS) had been reported by the 18 countries participating in the World Health Organization (WHO) European Collaborating Center on AIDS. 285 new cases were reported by the 17 countries that were corresponding with the Center on March 31, 1985, for an average increase of 22 new cases/week. The greatest increases in numbers of cases were observed in France, Federal Republic of Germany, and the United Kingdom. The highest rates of AIDS cases/millon population in 1985 occurred in Switzerland (9.7), Denmark (9.4), and France (7.0). A total of 626 deaths were reported for the 1226 AIDS cases, yielding a case-fatality rate of 5.1%. 795 (65%) of cases presented with at least 1 opportunistic infection. 245 (20%) had Kaposi's sarcoma alone and 171 (14%) had opportunistic infections with Kaposi's sarcoma. Males accounted for 91% of cases, and 42% occurred in the 30-39-year age group. 29 cases involving children under 15 years of age have been reported. 82% of total cases in Europe have involved Europeans, 3% have involved Caribbeans, and 12% have involved Africans. Of the European patients, 80% were homosexual or bisexual, 5% were intravenous drug abusers, and 1% were from both risk groups. AIDS patients belonging to the male homosexual risk group comprise 60-100% of the total number of AIDS cases in 11 of 15 European countries, but less than 50% of cases in Belgium, Greece, Italy, and Spain. Patients not belonging to any identified risk group contribute the 2nd largest number of cases. 9 countries have reported cases among intravenous drug abusers, 9 have reported AIDS in hemophilia patients, and 5 have reported cases among blood transusion recipients. 3 patterns have been noted: 1) in northern Europe (Denmark, Finland, Netherlands, Norway, and Sweden), most cases occur among male homosexuals; 2) in certain countries in southern Europe (Italy, Spain), most cases occur among those with no identifiable risk factor, but intravenous drug abusers seem to be more affected than in other countries; and 3) in Belgium, most cases occur among patients from central Africa.