Your search found 21 Results

  1. 1

    Blood safety and AIDS: UNAIDS point of view.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 1997 Oct. 7 p. (UNAIDS Point of View; UNAIDS Best Practice Collection)

    Eighty percent of the world's population live in developing countries, but developing countries use only 20% of the world's blood supply for transfusions. The human immunodeficiency virus (HIV) which causes AIDS is easily transmitted through blood transfusions. In fact, the chances that someone who has received a transfusion with HIV-infected blood will himself or herself become infected are estimated at over 90%. While millions of lives are saved each year through blood transfusions, in countries where a safe blood supply is not guaranteed, recipients of blood run an increased risk of infection with HIV. Other diseases -- such as hepatitis B, hepatitis C, syphilis, Chagas disease and malaria -- can also easily be transmitted through blood transfusions. Worldwide, up to 4 million blood donations a year are not tested for either HIV or hepatitis B. Very few donations are tested for hepatitis C. (excerpt)
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  2. 2
    Peer Reviewed

    Global AIDS epidemic worsens.

    Stephenson J

    JAMA. 2004 Jan 7; 291(1):31-32.

    The global AIDS epidemic infected an estimated 5 million individuals in 2003, bringing the world total of individuals living with human immunodeficiency virus (HIV) and AIDS to 40 million, said officials from the Joint United Nations Programme on HIV/AIDS (UNAIDS). The disease claimed about 3 million lives--the highest toll ever for a single year. Although sub-Saharan Africa remains the most severely affected region, tallying two thirds of all infections and more than two thirds of all deaths, HIV also is spreading rapidly in Eastern Europe and making worrisome inroads in Asia, threatening the immense populations of China and India. (excerpt)
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  3. 3
    Peer Reviewed

    What's going on at the World Health Organization?

    McCarthy M

    Lancet. 2002 Oct 12; 360(9340):1108-1110.

    This paper reports on the organization and administration of WHO under the management of Director-General Gro Harlem Brundtland. It describes the three broad categories of the work of WHO and the several areas that are considered to be organization-wide priorities for WHO.
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  4. 4

    Global Blood Safety Initiative. Minimum targets for blood transfusion services. Geneva, 20-22 March 1989.

    World Health Organization [WHO]. Global Programme on AIDS. Health Laboratory Technology Unit; League of Red Cross and Red Crescent Societies

    [Unpublished] 1989. 4 p. (WHO/GPA/INF/89.14; WHO/LAB/89.5)

    The World Health Organization's minimum targets for blood transfusion services are multiple and may be implemented at different levels of sophistication. The following outline is to be a minimum requirement to ensure a safe blood supply. A national blood transfusion advisory committee should be formed and a blood policy should be formulated. Directors, supporting personnel, and ancillary staff must be of adequate numbers and possess levels of training that meet a minimum standard set by the committee. Operational responsibility should be clearly defined. collaboration with the military should create a national pool of resources in order to better respond to emergencies. Blood donations must collected in an organized manner with adequate record keeping to ensure a healthy and adequate supply. Safety must be of a minimum level in order to ensure adequate public response. Blood collection centers should include refrigerators that can reliably maintain a temperature of 20-6 degrees C. Rh typing and ABO grouping must be consistent and reliable. Screening for HIV, hepatitis, and other blood transmittable diseases must be reliable and efficient. Verifiable records must be kept and inventory must be tightly controlled. Hospital transfusion services should be similarly set up. Training and education programs must be set up for health care professionals.
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  5. 5
    Peer Reviewed

    WHO's blood-safety initiative: a vain effort?

    Larkin M

    Lancet. 2000 Apr 8; 355(9211):1245.

    On April 7, 2000, the WHO launched the new blood-safety campaign, which aims to increase the availability of safe blood in developing countries. The organization issued facts and figures on the state of the world's blood supply to spur governments to establish national transfusion systems. However, critics reported that the approach is unworkable in the very regions that it aims to protect. Jean Emmanuel, WHO director of blood safety and clinical technology, claimed that efficacy of transfusion services depends on national coordination and government support. On the other hand, Josef DeCosas, director of the Southern African AIDS Training Program in Zimbabwe, states that the success of organized blood-transfusion services in Zimbabwe depends on the network of roads and telephones and the availability of vehicles and fuel. In other African countries, these organized central blood-transfusion services take an enormous chunk of the health care budget. Furthermore, he stated that the central blood-bank scheme of the WHO would work for only a short while and would eventually fall since it does not complement the rest of the health care system, road system and electric supply.
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  6. 6

    WHO blames lack of governments' support for unsafe blood supply.

    AIDS WEEKLY. 2000 Apr 17-24; 17.

    The WHO reported that more than half of the world's countries fail to perform full tests on donated blood, increasing the risk of spreading AIDS and other diseases. It has been estimated that about 5-10% of people with HIV were infected via blood transfusions. The noncompliance of the WHO guidelines on blood donation screening mostly occurs in developing countries, which the WHO concedes as expensive. In the next 5 years, WHO is planning to install, or to assist member states in installing, a national blood safety program to help offset the infected blood supply. On the other hand, nongovernmental organizations like the Red Cross encourages blood donors to be honest with health workers in describing any diseases and ensure that their blood does not endanger the health of the recipient. The WHO, likewise, proposes to bulk-buy testing kits for developing countries, and provide extensive training and program development.
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  7. 7
    Peer Reviewed

    Blood safety in developing countries.

    Gibbs WN; Corcoran P

    VOX SANGUINIS. 1994; 67(4):377-81.

    As part of an effort to monitor the safety of global blood transfusion services, the World Health Organization circulates a questionnaire for use in a database on blood safety. In 1992, 67% of countries responding to the survey (100% of developed, 66% of developing, and 46% of less developed countries) were screening all blood donations for HIV antibodies and 87% of these countries (100% of developed, 92% of developing, and 63% of less developed countries) carried out supplementary testing to confirm positive results. All developed countries, 72% of developing, and 35% of less developed countries screen blood for hepatitis B surface antigen and 94%, 71%, and 48%, respectively, screen for syphilis. The primary reasons for inadequate blood testing are the cost of test kits and reagents and the unreliability of supplies. The proportion of safe donors is highest in systems where all donors are voluntary and nonremunerated--conditions that exist in 85% of developed countries but only 15% of developing and 7% of less developed countries. Blood safety would also be improved by more appropriate use of transfusions and the provision of alternatives such as saline and colloids. Other problems include insufficient blood supply (e.g., none of the less developed and only 9% of developing countries collect 30 units or more per 1000 population per year) and inadequate quality assurance in all aspects of preparatory testing.
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  8. 8

    Malawi wakes up to harsh AIDS reality.

    AIDS ANALYSIS AFRICA. 1996 Feb; 6(1):1.

    Considerable data on AIDS in Malawi are available at the local level, but much of the information long languished instead of being formally collected and put together to provide an overall picture of the epidemic in the country. A World Health Organization (WHO) epidemiologist, however, has completed the first comprehensive, nationwide survey of HIV prevalence rates in Malawi. 1.6 million of Malawi's 11 million population are infected with HIV, making it one of countries in Africa worst affected by the epidemic. In 1995 alone, there were an estimated 265,000 new HIV cases and 74,900 deaths from AIDS. There are also fears about the safety of the blood supply. The WHO survey suggests that three of the country's 62 hospitals are not testing blood for HIV. Moreover, the effectiveness of the system is undermined by the widespread carelessness and dishonesty of overworked technicians who conduct the tests. While the reasons are many and complex for the spread of HIV, it seems that the policies of former President Hastings Kamuzu Banda were a contributory factor. President Banda's neglect of grassroots health care, especially in rural areas, and his refusal to allow public debate on the disease no doubt fueled the spread of HIV in Malawi. Traditional sex practices also probably play a role. For example, in some ethnic groups, young teenage girls are sexually initiated by men specially chosen for their physical prowess. Any one of these men who happens to be HIV-seropositive and has sex with many of these young girls may pass the virus on to many other people.
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  9. 9

    Blood transfusion services.

    Koistinen J; De Zoysa N

    In: Health and disease in developing countries, edited by Kari S. Lankinen, Staffan Bergstrom, P. Helena Makela, Miikka Peltomaa. London, England, Macmillan Press, 1994. 503-11.

    Blood transfusion is a routine hospital function. Whole blood and red cell concentrates are needed for managing anemia and hemorrhage, while plasma, coagulation factors, white cell and platelet concentrates are used for the management of burns, hemophilia, and hematological disorders. The blood transfusion services (BTS) should be part of the national health plan. Transfusion medicine consists of donor recruitment and retention, collection, testing, processing, storage of blood, and training of physicians in appropriate use of blood. Estimation of the need of blood and blood components is usually difficult to make. An annual collection of 5 units of blood per hospital and in acute care is sufficient. Formulation of a national blood policy is necessary for every country. The policy should define: 1) the responsible organization for implementation of the blood program, 2) the method of funding the BTS, 3) the concept of blood donation, and 4) the regulations of blood donation and transfusion. Already 61% of developing and 32% of the least developed countries have adopted such a policy. Responsibility for the organization of transfusion services lies with the ministries of health, which may delegated it to a governmental or nongovernmental organization. The Red Cross is most often associated with BTS. Provision of funding is effected by an annual allocation or on a cost recovery basis. Processing and storage requires refrigeration. Costing of blood transfusion services must include the capital and overhead costs. Other topics included in this report are: national blood transfusion service; recruitment and selection of blood donors (voluntary unpaid blood donation and donor recruitment utilizes the importance of this service to society); collection and processing of blood (testing ABO and Rh groups, HIV, hepatitis B and C, syphilis, Chagas disease, and malaria); blood transfusion service in a small hospital; recruitment and training of personnel; and international organizations dealing with blood transfusion.
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  10. 10
    Peer Reviewed

    AIDS, public health and the panic reaction (Part II).

    Priya R

    NATIONAL MEDICAL JOURNAL OF INDIA. 1994 Nov-Dec; 7(6):288-91.

    Salient points of AIDS control in India are summarized. An autonomous national AIDS control organization has been set up, which received a sizable loan from the World Bank. As a result, the central health budget became skewed with one-fourth of its expenditures going for AIDS and not enough spent on general health services. Among issues inadequately addressed are: 1) HIV surveillance; 2) diagnosis of AIDS; 3) appropriate and safe medical care; 4) wasteful expenditure; 5) educating health workers; and 6) blood bank services. HIV surveillance and testing centers have been attached to a few large hospitals and medical colleges, but more testing and treatment services will be needed. The World Health Organization (WHO) recommends testing only after informed consent has been obtained; however, in India this is impossible because of the high rate of illiteracy. Instead, counseling is provided by special social workers and testing is prescribed by doctors. Special AIDS clinics might be the solution, although they lead to isolation and stigmatization of patients. Doctors and nurses should be made aware about the importance of informed consent and counseling to encourage voluntary and anonymous testing. The present WHO definition of AIDS for diagnosis is too general and is based on the African experience. Its use may lead to misdiagnosis of many cases of tuberculosis, diarrhea, and malnutrition as AIDS. Clinical criteria applicable to the Indian reality need to be developed urgently. Private practitioners have also entered HIV testing, but often they rely only on the ELISA test without confirmation which might result in a high rate of false positives. General medical care of AIDS cases have to be strengthened with routine sterilization to avoid wasteful expenditures, health workers have to be reeducated, blood bank services need to be streamlined, and more AIDS-related research is also required.
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  11. 11

    Prevention of disease the answer.

    AIDS WEEKLY. 1994 Oct 3; 14-5.

    The director general of the World Health Organization (WHO), Hiroshi Nakajima, in an interview following a two-day visit to Rwanda stressed the need to restore safe blood transfusion services to prevent the spread of AIDS as well as distribution of essential drugs and vaccines. According to WHO, health facilities were looted, while 75% of the more than 5000 health workers fled or were killed since ethnic violence broke out April 6, 1994. Fighting between the majority Hutu-led government and Tutsi-dominated Rwandan Patriotic Front claimed more than 500,000 lives and forced more than two million people to seek refuge in neighboring countries. The WHO will provide training, equipment, and laboratory supplies in order to strengthen epidemiological monitoring of preventable epidemic diseases like cholera, dysentery, acute respiratory infections, meningitis, tuberculosis, and malaria. Of particular concern, was the need to monitor systematically forms of cholera and bacillary dysentery which has the ability to change its resistance to different antibiotics A dysentery epidemic has already claimed thousands of lives in refugee camps in Tanzania, Zaire and Rwanda. War and massive population displacements have dramatically increased transmission of HIV, as HIV prevalence was about 30% in Kigali among women and up to 50% among soldiers. Before the war, HIV infection rates ranged from 20 to 30% among the urban population and less than 10% in rural areas. More than 200,000 persons were already infected with HIV in Rwanda in 1992. The WHO will provide blood transfusion kits to ensure collection, testing and transfusion of blood. It will also train 60 blood transfusion technicians. The WHO will help to supply the management system of the Central Rwandan Pharmaceutical Office and provide essential drugs and vaccines to supplement stocks supplied by international donors. Nakajima appealed to both the international community and Africa to help Rwanda.
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  12. 12

    Concern over "invisible problem" of HIV blood in developing countries.

    Butler D

    NATURE. 1994 Jun 9; 369(6480):429.

    Receiving a transfusion of HIV-contaminated blood carries a roughly 95% risk of HIV infection compared with a 0.1-1.0% risk through sexual transmission. Accordingly, industrialized countries began screening blood supplies for HIV ten years ago. Blood screening in the overwhelming majority of developing countries, however, remains patchy. 10% of seropositives in these latter countries are still being infected with HIV through transfusions, with transfusions still accounting for 5-10% of infections worldwide. Nonetheless, blood safety has not been given priority by the international community. Even before HIV was recognized for the infectious agent which it is, most developing countries offered only inadequate and poorly coordinated blood services plagued with no refrigeration, bacterial contaminants, and a lack of basic testing facilities for common agents. The present lack of screening for HIV combines with the high number of infected donors to make clearly unsafe blood supplies. Officials in these developing countries, however, are loathe to admit their blood is unsafe, while international agencies do not want to expose individual countries for fear that they will be accused of failing to provide proper support. There has definitely been a lack of coordination and operational mismanagement among international organizations. Some World Health organization (WHO) officials feel that it is better to invest in preventing the sexual transmission of HIV. This sentiment is manifest in the phasing out of funding for HIV blood screening in the Global Program on AIDS and the failure of the Global Blood Safety Initiative to get off the ground when announced five years ago. The recently approved establishment of a new blood safety unit will hopefully not succumb to the same underfunding and understaffing suffered by its predecessor. In closing, the needs to build production facilities for blood substitutes and to manage blood only after considering local cultures with proper staff training and foreign supervision are stressed.
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  13. 13
    Peer Reviewed

    The AIDS epidemic in Tanzania: rate of spread of HIV in blood donors and pregnant women in Dar es Salaam.

    Haukenes G; Shao J; Mhalu F; Nome S; Sam NE


    Based on test results from blood samples of blood donors, pregnant women, and children (ages 5 to 15 years), data on reported acquired immunodeficiency syndrome (AIDS) cases, and the calculated influence of the "transient effect" (an effect caused by the variability of individual incubation periods), the prevalence of human immunodeficiency virus (HIV) in the total population of Tanzania is approximately 2.8% (650-700,000 cases in 24 million people). For pregnant women, the prevalence of HIV rose evenly from 1.3% in 1984-85 to 14% in 1991, a tenfold increase with an average doubling time of about 24 months. The prevalence in blood donors rose from 2.0% in 1984-85 to 10.0% in 1988, with an average doubling time of about 21-32 months. No children tested positive. The cumulative number of AIDS cases in Tanzania reported to the World Health Organization (WHO) rose from 462 in July 1986 to 27,396 in September 1991, resulting in an average doubling time of 10 months. However, based on information from the Epidemiology Unit of the Tanzanian National AIDS Control Programme, the doubling time for reported AIDS cases, calculated annually, rose from less than half a year to 2 years. In view of this, estimates of rates of spread and future projections should not be based on the number of reported AIDS cases in the first 5 years of the epidemic when the "transient effect" is greatest (a large number of cases will have a short incubation period). Since the doubling times calculated from seroprevalence studies agree with those calculated from AIDS case data in 6-8 year old epidemics, projections should be made based on the former. Epidemiological studies involving sexual behavior would identify target populations for intervention.
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  14. 14

    Researchers report much grimmer AIDS outlook.

    Altman LK

    NEW YORK TIMES. 1992 Jun 4; A1, B10.

    The international AIDS Center at the Harvard School of Public Health led a coalition of AIDS research from around the world in an analysis of more than 100 AIDS programs and discovered that the HIV/AIDS pandemic is more serious than WHO claims. Its findings are in the book called AIDS in the World 1992. AIDS programs do not implement efforts that are known to prevent the spread of HIV. For example, clinicians in developing countries continue to transfuse unscreened blood to many patients, even though HIV serodiagnostic test have existed since 1985. Further, programs do not evaluate what works in other programs. As long as people debate whether or not to distribute condoms, exchange needles, or offer sex education and whether people with AIDS deserve care, the fight against HIV/AIDS is hindered. The report recommends that leader come up with a new strategy to address the AIDS pandemic. WHO claims to have done just that at its May 1992 meeting. An obstacle for WHO is political pressure from member nations. On the other hand, the private Swiss foundation, Association Francois-Xavier Bagnoud, finances the Harvard-based AIDS program, allowing members more freedom to speak out. The head of the Harvard program believes the major impact of AIDS has not yet arrived. Contributing to the continual spread of HIV is the considerable difference of funding for AIDS prevention and control activities between developed and developing countries (e.g., $2.70 per person in the US and $1.18 in Europe vs. $.07 in sub-Saharan Africa and $.03 in Latin America). Even though developed countries provide about $780 million for AIDS prevention and care in developing countries, they do not enter in bilateral agreements with developing countries. 57 countries limit travel and immigration of people with HIV/AIDS. Further, efforts to drop these laws have stopped. Densely populated nations impose travel constraints to prevent an explosive spread of HIV.
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  15. 15

    Clinical update: AIDS. Women and AIDS.

    NURSING RSA. 1992 Aug; 7(8):11.

    South Africa needs to implement effective interventions immediately to prevent the AIDS pattern which exists in other African countries; e.g., Uganda, where 25% of the youth have AIDS. An official from the Department of National Health and Population Development's AIDS Unit said at a national conference on home based care for persons with AIDS in June 1992 that 1 in 50 young adults in South Africa is HIV positive. HIV prevalence is greatest in Natal and lowest in the Cape. HIV infection is greatest in people with sexually transmitted diseases and in those with newly diagnosed tuberculosis. By August 1994, 750,000 people will be infected with HIV. Interventions espoused and implemented by the AIDS Unit include condom distribution and a communication and education campaign encouraging condom use and partner reduction. Another speaker at the conference highlighted the disadvantages women face which make them vulnerable to acquiring HIV. These disadvantages include the traditional subordinate role of women (particularly Black women) in the family, economic dependency on men, and inadequate access to education. Based on these disadvantages, WHO's Global Program on AIDS is developing a woman-based strategy which includes health and social services for women, home-based care, HIV surveillance of women attending certain clinics, distribution of information and education for women, and supportive social environment. The Program for Appropriate Technology in Health has developed a dipstick test for HIV antibodies (HIV Immuno-Dot), designed to reduce HIV transmission through blood transfusions. It does not need a skilled technician, a refrigerator, or a laboratory. It is inexpensive and produces results in 3 hours. 8 tabs, making up a strip, have dots of a synthetic peptide from the GP41 molecule, and HIV-1 envelope protein. HIV-1 antibodies bind to the strip. Placing the strip in a solution turns the dots red if the blood is HIV-1 infected. This red dot warns health workers not to use the donated blood.
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  16. 16

    Global epidemiology. AIDS -- a global perspective.

    Von Reyn CF; Mann JM

    WESTERN JOURNAL OF MEDICINE. 1987 Dec; 147(6):694-701.

    This article describes AIDS case definitions and reporting and the problems with serologic studies of HIV antibody detection. These problems include technical limitations of HIV antibody testing, false positive results due to the presence of malaria antibodies, and cross reactions between HIV 1 and HIV 2. There is a summary of the three basic modes of transmission: sexual, perenteral, and perinatal. Geographic patterns of transmission differ with the frequency of the three modes of transmission and the ways in which HIV infection occurs in different cultures. Three patterns are identified. Pattern I involves homosexual and bisexual transmission with some heterosexual transmission and significant perenteral transmission through intravenous (IV) drug use. Population seroprevalence is 1%. Countries with this pattern are North America, Europe, some areas of South America, Australia, and New Zealand. Pattern II involves larger risk groups and heterosexual transmission. There is high seroprevalence among women, and, as a result, perinatal transmission is evident. Seroprevalence is >1%. Examples of this pattern are central, eastern and southern Africa and Haiti. In Pattern III, the phenomena is recent and transmission is homosexual and heterosexual, particularly among prostitutes or persons from known HIV endemic areas. Imported blood and blood products have contributed to parenteral transmission. Middle Eastern and Asian countries exemplify this pattern. The global epidemiology is discussed by region: the Americas, Europe, Africa, and Oceania. Case reports from 127 countries to WHO have totaled 62,811 in 1987. 70% of the cases reported are from the United States. The estimated number of AIDS cases worldwide is 100,000-150,000, and HIV infected people are thought by WHO to number 5-10 million. In the United States, reported AIDS cases continue to double every year. There is some evidence for stabilization in at least one homosexual population. Between 1985-86, there was a 130% increase in heterosexual the number of heterosexuals (mostly women) who acquired AIDS from contact with IV drug users or bisexual men. Brazil has the second largest number of cases and follows Pattern I. Europe reported 5687 cases by 1987 compared to 44,000 for the US. The highest rate of AIDS cases in Europe is from Switzerland at 34.9/million (which compares to 140.2/million in the US). 50% of the reported cases in Europe are in people from Africa or the Caribbean. African AIDS is distinguished by 50% of cases being in women. AIDS cases from transfusion are still a problem. Perinatal transmission occurs. Nonmedical parenteral transmission (ritual scarification, circumcision, and so on) and medical injections play a role in transmission of HIV infection among children. Surveillance has improved. Oceania reported 569 cases by 1987. Australia has the highest rate in Oceania at 23.8/million and a male to female sex ratio of 26:1; pattern I predominates. Other countries which have reported cases are Thailand, Japan, the Philippines, Israel, and 2 cases from China.
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  17. 17

    Current and future dimensions of the HIV / AIDS pandemic: a capsule summary.

    World Health Organization [WHO]. Global Programme on AIDS

    [Unpublished] 1992. [2], 15 p. (WHO/GPA/RES/SFI/92.1)

    A summary of current state and future trends to HIV infections and AIDS cases in world regions prepared from the most recent information on file at the WHO Global Programme on AIDS as of January 1992. HIV infection and AIDS began in the 1980s or earlier in homosexual or bisexual men and intravenous drug users in urban Americas, Australia, and Western Europe, and in heterosexuals in East and Central Africa. There is another virus called HIV-2 with a lower virulence, but similar mode of transmission and clinical syndrome prevalent in West Africa. By 1992 450,000 AIDS cases were reported to WHO, but about 1.5 million AIDS cases are thought to have occurred, including 500,000 in children. About 9-11 million HIV infections, including 1 million in children, are estimated to exist. In Australia, North America, and Western Europe, spread of HIV to homosexuals has decreased, but growth in the intravenous drug-using population and heterosexuals may still occur. In Latin America prevalence is high in homosexual or bisexual men, injecting drug users, and prostitutes, and is increasing dramatically in women. In Africa heterosexual transmission is still the rule; infections from blood products account for about 10% of cases. In East and Central Africa 2/3 of the HIV cases are in 9 countries, where urban HIV prevalence reaches 25-33% in adults. In Africa there is also a growing problem of 750,000 pediatric AIDS so far, and possible 10 million orphans in the 1990s. Spread of HIV in high risk populations in South East Asia is rapid, notably in Bangkok, Thailand, in Yangon, Myanmar, and in Bombay and in northeastern India. The potential for spread in this region is a great concern. Areas of East Asia contiguous with South East Asia are also at risk. In Eastern Europe there are clusters of outbreaks related to improper use of blood products. WHO predicts that 4 million people have HIV and TB. WHO projects that global HIV infection will amount to 15-20 million by 2000. A major research topic and concern is estimation of when and at what level HIV prevalence will peak in world regions.
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  18. 18

    Essential elements of obstetric care at first referral level.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 1991. vii, 72 p.

    Members of WHO's Technical Working Group on Essential Obstetric Functions at First Referral Level have prepared a book geared towards district, provincial, regional, national, and international decision makers, particularly those in developing countries, whose areas of expertise include planning, financing, and organization and management of obstetric services. The guidelines should allow them to improve referral services' standards at the district level. They should also help them decide how far and by what means they may possibly expand some of these services to more peripheral levels, e.g., renovating facilities and improving staff. When developing these guidelines, WHO took in consideration that many countries confront serious economic obstacles. The book's introduction briefly discusses maternal morbidity and mortality in developing countries and maternity care in district health systems. The second chapter, which makes up the bulk of the book, addresses primary components of obstetric care related to causes of maternal death. This chapter's section on surgical obstetrics examines cesarean section and repair of high vaginal and cervical tears among others. Its other sections include anesthesia, medical treatment, blood replacement, manual procedures and monitoring labor, family planning support, management of women at high risk, and neonatal special care. The third section provides guidelines for implementation of these services, including cost and financial considerations. It emphasizes the need at the first referral level to have the least trained personnel perform as many health care procedures as possible, as long as they can do so safely and effectively. Other implementation issues are facilities, equipment, supplies, drugs, supervision, evaluation, and research. Annexes list the required surgical and delivery equipment, materials for side ward laboratory tests and blood transfusions, essential drugs, and maternity center facilities and equipment.
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  19. 19

    Safe blood: the WHO sets out its principles.

    Koistinen J

    AIDS ANALYSIS AFRICA. 1992 Nov-Dec; 2(6):4, 6.

    Developing countries face considerable obstacles to ensuring a safe blood supply and safe blood transfusions. There is a tendency for developing countries to not have enough available blood so they depend on family blood donors. Blood donors receive money for their donation. Testing is unreliable as is recording of results. Many clinicians do not have the experience to adequately determine when a transfusion is needed, e.g., physicians ordered a blood transfusion for a 5-year old African girl with pneumonia who had anemia (hemoglobin level of 52 m) after the 1st HIV test was negative. Yet this anemia case did not require a blood transfusion. A repeat of the test revealed the donated blood was indeed HIV positive. 2 other children also received that blood. The basic principles of blood safety are enough safe blood donors, a responsible blood transfusion service which can ensure appropriate and safe processing and testing of blood, and appropriate use of blood. A safe blood donor is healthy and has no risk factors for HIV and other infections. 40-60% of donated blood in developing countries goes to pregnant women often during delivery and children. The leading source of blood in the least developed and developing countries is replacement donors (88% and 81% respectively) who tend to be family members or friends. Yet often relatives of the patient pay someone they do not know to donate their blood. Blood banks also pay for donations and more than 56% of them are uncoordinated banks in hospitals. So organized blood donation services which can safely test and process blood would reduce the risk of transmitting HIV and other infections. WHO has set up a blood safety policy that encourages member countries to establish their own national blood transfusion policy. It supports countries along these lines via its global Programme on AIDS an the Global Blood Safety Initiative. Any blood safety activities can only succeeded with political commitment.
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  20. 20

    AIDS without HIV: fire without smoke [editorial]

    Bird AG

    BMJ. British Medical Journal. 1992 Aug 8; 305(6849):325-6.

    The press widely publicized investigative findings at the international AIDS conference in Amsterdam, the Netherlands about patients with signs or symptoms consistent with AIDS or AIDS-related complex but who did not have HIV-1 or HIV-2 antibodies or the viruses themselves. Yet the formal scientific sessions ignored this topic and the conference summaries only casually mentioned it. Tests used to try to detect HIV were antibody testing, virus isolation, or molecular detection techniques. The press suggested several emotive questions not based on clinical data such as the safety of national blood supplies. 4 of the 5 patients in New York City had HIV risk factors. The only clinical indications of immunodeficiency in 1 patient was Mycobacterium tuberculosis infection and 2 somewhat low CD4 counts which may have actually been due to tuberculosis. Laboratory personnel have not yet reconfirmed reverse transcriptase activity of lymphocytes from 2 patients. So far these cases do not exhibit epidemiological criteria for a new transmissible agent. There has been no case clustering or a pattern of sexual or vertical association of cases. These cases may only be more detections of cases of rare spontaneous primary or secondary immunodeficiency disease. If epidemiological support does suggest a transmissible agent, laboratory personnel may find it difficult to isolate and identify agent. The US Centers for Disease Control and WHO wants to coordinate reporting and classification of cases so epidemiologists can quickly verify or reject laboratory findings based on a larger series of cases. Only with full evaluation of ongoing research and development of sensitive and specific detection systems for new pathogens can the scientific community address questions concerning the safety of blood supplies. This reaction of the press indicates a need for the peer review system to continue to establish the soundness of research before its release to the press to avoid undue concern.
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  21. 21
    Peer Reviewed

    India: national plan for AIDS control.

    Ramalingaswami V

    Lancet. 1992 May 9; 339(8802):1162-3.

    HIV infection was detected in India in 1986 in 6 female prostitutes. Current estimates are that 1 million people in India are HIV positive. The official number of AIDS cases to date is 112. In Bombay, Pune, and Madras, 33% of the prostitutes and 50% of the IV drug users have become HIV positive. There have been reports of HIV positive blood donors and new born infants with HIV. To complicate matters, India is currently experiencing a tuberculosis epidemic with 9 million cases and 500,000 deaths annually. India is receiving US$84 million from the World Bank over the next 5 years plus special WHO funding for a national AIDS prevention and control campaign.
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