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[Geneva, Switzerland], WHO, 1991 Dec.  p. (WHO/GPA/IDS/HCS/91.6)Infections and tumours are the paramount clinical problems confronting health care providers caring for patients with HIV-related disease. Treatment of these infections and tumours is of great importance as it decreases suffering and prolongs life in the absence of effective and non-toxic antiretroviral drugs or immunotherapy against HIV itself. However, clear treatment guidelines are lacking in many parts of the world and health care workers have often not received training in the management of HIV-related disease. To respond to this situation, the WHO Global Programme on AIDS (GPA) has developed guidelines for the clinical management of HIV infection in adults. There are wide variations in the presentation of HIV-related diseases, availability of resources and health infrastructures. It is hoped that the guidelines will provide a model to assist all countries, but especially those in the developing world, to formulate national guidelines in accordance with their own particular needs and resources. Adaptation of these guidelines should take place through national/institutional workshops. The guidelines represent the consensus of a number of clinical experts working in this area, and will be revised from time to time in the light of experience. Comments are welcome and should be sent to the Global Programme on AIDS, World Health Organization, 1211 Geneva 27, Switzerland. (excerpt)
Tabular information on legal instruments dealing with HIV infection and AIDS. Part 1. All countries and jurisdictions, including the USA (other than state legislation).
[Unpublished] 1991 May. 136 p. (WHO/GPA/HLE/91.1)National, subnational, and organization-level legal instruments regarding AIDS and HIV infection are presented in tabular format. Legislation from 83 countries (from Algeria to Yugoslavia, including European nations and the US) is included, as well as from Hong Kong. Listings include instrument type and number, a brief description, and reference location in the International Digest of Health Legislation where appropriate. The 2 extranational organizations listed are the Council of Europe and the European Communities. The former lists policy recommendations, while the latter spells out the basis of community policy on some aspects of AIDS, and addresses medical and health research coordination.
Towards developing a community based monitoring system on the social and economic impact of AIDS in East and Central Africa.
[Unpublished] 1991. 4,  p.Proposed is a short-term, initial study of the potential of a community-based system to monitor the social and economic impact of acquired immunodeficiency syndrome (AIDS) in Eastern and Central Africa. The study was requested by the United Nations Development Program (UNDP). Its initial phase, which will be conducted in the UK, will consist of a literature review and preparation of a proposal for a pilot project. Particular emphasis will be placed on poor households in which family survival is threatened by the death from AIDS of an economically active adult. Assessed will be the extent to which a community-based monitoring system can aid households and communities in coping with the excess mortality created by AIDS and also provide information to national leaders that can be used to guide the formulation of national AIDS policy. Components of such a monitoring system are the regular collection of data, processing of the data into a form where they can be used as the basis for initiating actions, and definition of a set of interventions. Such an activity assumes the existence of both institutions that can collect and process the data and agencies capable of initiating interventions. Examples of successful monitoring systems exist in the areas of food security and child malnutrition. Their success appears to have been based on the availability of data at the points where action is to be taken, involvement of existing community institutions, a convergence of community and external agency objectives, and a common perception of problems and their relative importance. The pilot project is expected to involve a small number of areas in one or two countries of East and Central Africa with a high incidence of AIDS.
Colombo, Sri Lanka, Family Planning Association of Sri Lanka, 1991. , 54,  p.This report describes the accomplishment of the Family Planning Association of Sri Lanka (FPASL) during the 1990-91 year. The report opens with a section describing 1990 highlights, a year that witnessed great strides in clinical, contraceptive retail marketing, rural motivational, and AIDS education activities. In June, FPASL hosted the Regional Council Meeting of the South Asia Region, a meeting attended by IPPF Secretary Dr. Halfdan Mahler, who praised the efforts of the association. Designed to coincide with the regional meeting, FPASL organized a national seminar on "Family Planning Research and the Emerging Issues for the Nineties." IPPF invited FPASL to be one of the 6 countries do develop a new strategic plan for the 1990s. Other FPASL highlights included: increased AIDS education, Norplant promotion campaigns, and the establishment of a counselling center for young people. Following the highlight section, the report provides an overall program commentary. The report then examines the following components of FPASL: 1) the Community Managed Integrated Family Health Project (CMIRFH), which is the associations' major family planning information, education, and communication (IEC) program; 2) the Nucleus Training Unit, established in 1989, whose primary emphasis is to organize and conduct AIDS education programs; 3) the Youth Committee, whose activities include populations and AIDS education; 4) the Clinical Program, whose attendance increased by 15% (this section describes the types of services provided); and 5) the Contraceptive Retail Sales Program. While condom sales increased by 5%, the sales of oral contraceptives and foam tablets decreased -- a declined explained by the turbulent situation of the country.
Report of an International Consultation on AIDS and Human Rights. Geneva, 26-28 July 1989. Organized by the Centre for Human Rights with the technical and financial support of the World Health Organization Global Programme on AIDS.
New York, New York, United Nations, 1991. iii, 57 p.In July 1989, ethicists, lawyers, religious leaders, and health professionals participated in an international consultation on AIDS and human rights in Geneva, Switzerland. The report addressed the public health and human rights rationale for protecting the human rights and dignity of HIV infected people, including those with AIDS. Discrimination and stigmatization only serve to force HIV infected people away from health, educational, and social services and to hinder efforts to prevent and control the spread of HIV. In addition to nondiscrimination, another fundamental human right is the right to life and AIDS threatens life. Governments and the international community are therefore obligated to do all that is necessary to protect human lives. Yet some have enacted restrictions on privacy (compulsory screening and testing), freedom of movement (preventing HIV infected persons from migrating or traveling), and liberty (prison). The participants agreed that everyone has the right to access to up-to-date information and education concerning HIV and AIDS. They did not come to consensus, however, on the need for an international mechanism by which human right abuses towards those with HIV/AIDS can be prevented and redressed. International and health law, human rights, ethics, and policy all must go into any international efforts to preserve human rights of HIV infected persons and to prevent and control the spread of AIDS. The participants requested that this report be distributed to human rights treaty organizations so they can deliberate what action is needed to protect the human rights of those at risk or infected with HIV. They also recommended that governments guarantee that measures relating to HIV/AIDS and concerning HIV infected persons conform to international human rights standards.
Weekly Mail. 1991 Jun 21-27;  p..Dr. James Chin, the head of surveillance and forecasting for the WHO Global Program on AIDS, presented the statistics on the global spread of HIV infections. It is reported that by mid-1990s, 3 million HIV infections are projected for Asia. In Africa, the number of HIV individuals was projected to increase from 6 million to 10 million over the next years, leading to increases in mortality and decreases in life expectancy. Furthermore, in the US and all other western nations combined, it was estimated that fewer than 2 million people are infected with the AIDS virus. A key reason for the lower rate is that AIDS education and prevention programs in industrialized nations are far more extensive, and therefore more effective, in triggering behavior changes to minimize the risk of infection. In addition, reported intensive educational programs in Thailand and Zaire have significantly lowered the number of new HIV infections.
INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING. 1991; 14:129-39.This article explores the introduction of a unified theory for HIV/AIDS counseling. Counseling intervention adopted by the WHO Global Program on AIDS was guided and informed by the behavioral theory of counseling. This approach was aimed at preventing the spread of infection and providing psychosocial support to those who are already sick. It is argued that counseling based on behavioral theory provides a limited therapeutic intervention and fails to meet all the needs that are associated with HIV/AIDS issues. Thus, other theoretical sources were explored which resulted to a unified theory of counseling that drew upon three main sources including behavioral, psychoanalytic, and humanistic theories. It is argued that future counseling interventions should be redirected from a disease-centered approach to a person-centered approach. Introduction of the unified theory can be facilitated by the use of the self-concept model. In conclusion, the unified theory provides the therapeutic foundation upon which a comprehensive counseling intervention can be based.
AIDS. 1991; 5 Suppl 1:S177-81.This review gives greater weight to WHO/Global Program on AIDS (GPA)-supported knowledge, attitudes, beliefs, and practices (KABP) surveys that have been completed in several African countries, including the Central African Republic, Chad, Ivory Coast, Lesotho, Mauritius, Rwanda, Sudan, Togo, and Tanzania. The percentage of individuals who had heard of AIDS ranged from 60% in Chad to 98% in Rwanda. Over 75% of respondents knew that AIDS is sexually transmitted. A similar proportion (except in Sudan) knew about perinatal transmission. Misconceptions nevertheless endure: e.g., over 40% of individuals in the Central African Republic, Mauritius, Togo, and Tanzania believed that insect bites transmit HIV. At least 20% of respondents in the Central African Republic, Lesotho, Mauritius, Rwanda, Togo, and Tanzania believed that HIV was transmitted through touching or sharing utensils/food. 29% of respondents in Togo, 27% of interviewees from Chad, 21% of individuals in Rwanda, and 19% of participants from Lesotho asserted that AIDS was curable. Only 40% of interviewees from Chad and 25% or fewer of respondents from Lesotho, Mauritius, Sudan, Togo, and Tanzania perceived themselves to be susceptible to AIDS. 80% or more of respondents, except from Chad, where the figure was only 23%, believed that AIDS could be prevented by behavior change. WHO/GPA data indicate that, despite widespread awareness of AIDS, the proportion who have heard of condoms varies from 33% in Chad and 39% in Togo to 77% in Lesotho and 84% in Mauritius. Excluding Mauritius, less than 20% of respondents spontaneously mentioned condoms as a mode of protection against HIV and less than 20% had ever used a condom. Data from the World Fertility Survey and Demographic and Health Survey closely support these observations, confirming that women's knowledge and use of condoms is lower in sub-Saharan Africa than elsewhere. At present, condom use by women in union in Mauritius, Botswana, and Zimbabwe is 9%, 1%, and 1%, respectively, and under 1% elsewhere.
TIDSSKRIFT FOR DEN NORSKE LAEGEFORENING. 1991 May 30; 111(14):1729-33.The 4 cornerstones of reproductive health according to the WHO are family maternal care neonatal and infant care, and the control of sexually transmitted diseases. In recent years, the AIDS epidemic has caused concern in the world. The world's population doubled to 4 billion from 1927 to 1974, and it will reach 6 billion by the year 2000. The rate of growth is 1.4% in China and 2% in India vs. .3% in Europe. Contraceptive prevalence is 15-20% in Africa, 30% in South Asia, and 75% in East Asia. Shortage of contraceptives leads to abortion in eastern Europe. In 1985 in the USSR, there were 115.7 abortions/1000 women (mostly married) aged 15-44; and 6.4 million abortions for 5.5 million births in 1989. RU-486 or mifepristone combined with prostaglandin has produced abortion in 90% of first trimester pregnancies. After approval in France in 1987, it was used in 40,000 abortions in the following year. 90% of the estimated annual 500,000 maternal deaths occur in developing countries. In Norway, the rate is fewer than 10/100,000 births vs. 100/100,000 in Jamaica. In the mid-1980s, 26% of rural women in Thailand, 49% in Brazil, 54% in Senegal, and 87% in Morocco went without maternal care. In Norway, infant mortality is 6-8/1000 live births vs. 75-150/1000 in developing countries. A WHO investigation on causes of infertility in 25 countries found a 31% rate of tubal pathology in 5800 couples. In Africa, over 85% f infertility in women was infection related. Venereal diseases and infertility are associated with premarital sexual activity in young people. Various donor agencies and the WHO Special Program of Research, Development, and Research Training in Human Reproduction are providing help and resources including AIDS research.
POPULATION AND DEVELOPMENT REVIEW. 1991 Dec; 17(4):749-51.The report of the Secretary General of the UN on the social and economic conditions in Africa notes the worsening of conditions during 1986-90. Declines were apparent in education, health, nutrition, employment, and income. Government spending on health declined from 6% in 1985 to 5% in 1990 and on education from 15% to 11%. School enrollment declined from 77% in 1980 to 72% in 1987 and 70% in 1990. Primary school enrollments were also affected; i.e., only 65% of those enrolled in 1986 were still in school in 1990. Illiteracy rates dropped from 59.1% in 1985 to 52.7% in 1990, but the absolute numbers rose from 133.6 million to 138.8 million. Female illiteracy is very high at 66% compared to 46% for males. Government funding cuts have also had an impact on nutrition. There were 70 million more severely undernourished Africans in 1989 than in the mid 1970s (80 million), and 40% of preschool children suffered from acute protein energy deficiency, which is an increase of 25% from 1985. There was evidence of large numbers of underweight (26.6%), wasting (10.2%), and stunted children )53.3%). Diseases such as malaria, trypanosomiasis, and schistosomiasis, which had been under control or eradicated reappeared. The <5 years mortality rate remained stable and high at 182/1000. Improvements have been made in expansion of immunization, 22 countries achieved 75% immunization in 1990. There were fewer deaths from measles and diarrheal diseases. Maternal mortality remains high at 1120/1000. AIDS is a serious social problems. By 1991, 6 million people had been infected with HIV including 3 million women an increases are expected. 900,000 HIV-infected babies were born as of 1990. The number of AIDS orphans is increasing. Real wages declined by 30% during the 1980s, and unemployment grew an average of 10%/year between 1986-90. Formal sector employment stagnated, and informal sector employment showed tremendous increases. Substance farming became a survival strategy. Poverty has affected as much as 50% of the African population. Brain drain emigration has resulted in the loss of an estimated 50-60,000 people. For Africa, the future emphasis will be on efficacy, tough minded realism, self-reliance, and grassroots initiatives.
Lancet. 1991 Aug 17; 338(8764):436-7.The professional blood donor organizations in Bombay, India, face difficulties, since many donors have become infected with the human immunodeficiency virus (HIV). Professional donors meet more than half of the demand from hospitals for blood. More than 5 million liters of blood are bought every year at an annual cost of more than 29 million pounds. The government suspended the manufacture of blood products, and a blood screening program was launched, yet up to 95% of donated blood is unsafe. In a WHo study, it was disclosed that 80% of Bombay's blood sellers are infected with HIV, and 1/3 of them show signs of AIDS or AIDS-related complex. India is expected to have 250,000 HIV carriers and at least 60,000 cases of AIDS by 1995. Medical organizations like the Indian Health Organization (IHO) and the WHO are educating blood donors and prostitutes about AIDs and are promoting safe sex. An IHO team consisting of a doctor, social worker, and health educator regularly visits the district of Bombay where 200,000 prostitutes ply their trade. Team members distribute literature, organize slide shows, and hand out free condoms to prostitutes and their clients.
Human immunodeficiency virus (HIV) infection codes and new codes for Kaposi's sarcoma. Official authorized addenda ICD-9-CM (revision no. 2). Effective October 1, 1991.
MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT. 1991 Jul 26; 40(RR-9):1-19.The addenda for Volumes 1 and 2 of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) were reported by the Collaborating Center for Classification of Diseases for North America at the National Center for Health Statistics. This was the second revision of these codes for the classification of HIV infection. THe addenda, effective October 1, 1991, replace the addendum containing codes for human immunodeficiency virus (HIV) infection that went into effect January 1, 1988. The structure of the classification, the codes within the classification, and the use of the codes remained the same. 3 basic modifications were accepted. A new 3-digit category was created for Kaposi's sarcoma; several new clinical conditions were added (acute or subacute endocarditis, microsporidiosis, acute or subacute myocarditis, bacterial and pneumococcal pneumonia, histiocytic or large cell lymphoma, secondary cardiomyopathy and nephritis and nephropathy); and several categories of HIV manifestations were expanded to include similar conditions (viral pneumonia, encephalitis, encephalomyelitis and myelitis). These modifications will improve the accuracy of reporting and allow public health officials, clinical researchers, and agencies which finance health care to monitor diagnoses of AIDS and other manifestations of HIV infection. HIV infection is divided into 3 categories: HIV infection with specified secondary infections or malignant neoplasms, or AIDS; HIV infection with other specified manifestations; and other HIV infections not classifiable above. AIDS is not synonymous with HIV infection or with such terms as pre-AIDS or AIDS-related complex. To use these codes correctly, the physician must provide complete information and state the relationship between HIV infection and other conditions.
In: Tradition and transition: NGOs respond to AIDS in Africa, edited by Mary Anne Mercer, Sally J. Scott. Baltimore, Maryland, Johns Hopkins School of Public Health, Institute for International Programs, 1991 Jun. 59-63.In January 1990 Experiment in International Living founded the AIDS Information Center (AIC) with a consortium of 10 groups: WHO, Experiment in International Living, The AIDS Support Organization, the main blood bank in Kampala, InterAid, USAID, and Red Cross. The AIC incorporates pretesting for HIV and post-test counseling. In post test counseling clients discuss safer sex, watch videos, or talk individually with a doctor about symptoms of the disease. The commercial condom promotion of SOMARC, the social marketing group, was welcome. Case Western Reserve University is tracking people who have been tested in the AIC to ascertain if their sexual behavior is altered radically. The key to sustainability is the local nongovernmental organization (NGO) status and the commitment from the consortium. Current plans call for opening 4 more centers throughout the country within 3 years. Issues in Ministry of Health (MOH) collaboration with an NGO were raised by a district medical officer. The World Vision HIV/AIDS prevention project started in 1989 in the Marondera district. Attempts were made not to restrict the project to AIDS activities alone and to set up a monitoring system in agreement with the host government policy. Both MOH and World Vision staff were trained in health education, and counselors on the MOH staff also underwent training. A World Vision representative responded to these concerns stating that Zimbabwe has a sophisticated system and substantial numbers of trained personnel. Sustainability is influenced by tensions between the government and NGOs, finances and technical capacity. World Vision will collaborate with the MOH to ensure that the expertise of social scientists brought into the medical field in Marondera will remain over the long term. In some countries community-based condom distribution systems are already in places. However, a condom distribution should be awarded to the most qualified parties.
In: Tradition and transition: NGOs respond to AIDS in Africa, edited by Mary Anne Mercer, Sally J. Scott. Baltimore, Maryland, Johns Hopkins School of Public Health, Institute for International Programs, 1991 Jun. 15-22.Many people at risk of HIV infection are changing their behavior drastically when they are referred for HIV testing, as a result of more access to information. Featured as a theme for World AIDS Day, women are particularly vulnerable, since they have less power than men to influence their interpersonal relationships. Women with HIV/AIDS often are asked to make the unrealistic decision to avoid childbearing, but the status of a women in Africa depends on her reproductive ability. The traditional role of women as caregivers both as professional health workers, or in home care, is critical in HIV/AIDS disease. Preservation of the health of the 5-14 age group, who is uninfected, is a priority. Adolescents must be specially targeted in preventive counseling on the consequences of early sexual activity such as teenage pregnancies and sexually transmitted diseases. Sex education in the schools should start at a much earlier age. Studies in Zimbabwe show that women are being infected 5-10 years earlier than men, and there are even cases in 15, 16, and 17 year old women. Most HIV-infected people are afraid of being ostracized or fired from jobs. Women have lost their jobs when their HIV status became known, although the Minister of Health has issued a directive that HIV infection is not a valid reason for discharging an employee. Women are especially vulnerable because they may be rejected by their families and their partners, while having small children who also may be infected. Empowerment of women is needed so that destructive relationships do not continue only because of economic dependence. Ministries of Health, Labor, and Social Welfare need to develop strategies with NGOs to cope with demand to find resources for increasing numbers of desperate people. Community-based care is ideal, and positive trends are emerging to combat the destructive effects of AIDS that divide families leaving the most vulnerable uncared for.
MINERVA GINECOLOGICA. 1991 Dec; 43(12):609-10.AIDS continues to pose a grave global problem because it is spreading in the general population by increasing heterosexual transmission and vertical transmission from seropositive mothers to fetuses. A minor rate of transmission has been observed from blood transfusion and blood products. On October 31, 1990 WHO data indicated that a total of 298,914 AIDS cases had been reported. In Africa there were 75,642 cases: 15,569 were in Uganda, 11,732 in Zaire, 9139 in Kenya, 7160 in Malawi, 3647 in the Ivory Coast, 3494 in Zambia, and 3134 in Zimbabwe, with the rest averaging less than 4% of the total African caseload. There were 180,663 cases in the Americas: 149,498 in the US, 11,070 in Brazil, 4941 in Mexico, 4427 in Canada, 2456 in Haiti, 1368 in the Dominican Republic, 870 in Venezuela, 743 in Honduras, 710 in Argentina, 648 in Trinidad an Tobago, 643 in Colombia, 507 in the Bahamas, and 203 in Panama, the rest being less than 200. Asia had only 790 cases: 290 in Japan, 116 in Israel, 48 in India, 45 in Thailand, 37 each in Turkey and the Philippines, 31 in Lebanon, and 27 in Hong Kong. Europe had 39,526 cases: 9718 in France and 6701 in Italy as of June 30, 1990, however, by December 31, 1990 there were 8227 cases reported of whom 4074 had died. There were 6210 in Spain, 5266 in the German Federal Republic, 3798 in England, 1462 in Switzerland, 1443 in the Netherlands, 999 in Romania, 764 in Belgium, 663 in Denmark, 481 in Portugal, 450 in Austria, 443 in Sweden, and 347 in Greece. Little attention has paid to notification in eastern Europe: 40 cases in the USSR, 43 in Poland, 23 in Czechoslovakia, 22 in the German Democratic Republic, 42 in Hungary which is contrasted to 999 cases in Romania. Oceania had 2293 cases: 2040 in Australia, 207 in New Zealand, 16 in French Polynesia, 14 in New Caledonia, 13 in New Guinea, 2 in Tonga, 1 in Fiji, and 1 in the Federated States of Micronesia.
REVUE DE L INFIRMIERE. 1991 May 21; 41(10):27-32.The coordinator and nurse of the anti-AIDS program of the Red Cross in Tanzania relates that families affected by the disease are helped with food, clothes, and moral support. The new illness appeared in 1983 in a zone at the Tanzanian-Ugandan frontier. The first victim of AIDS was a Ugandan merchant, and the infection spread to the large cities of the country mostly by heterosexual transmission facilitated by the prevalent practice of having multiple sexual partners. According to January 1991 WHO figures there were 7128 cases reported in the country among 24 million inhabitants, but this figure ought to be multiplied by 2 or more. 30% of women were found seropositive at Kigali in the north and 20% in Dar-es-Salaam. Certain informal sources project 64,000 AIDS cases for 1992. If the WHO estimation that 50-100 seropositive persons hide behind 1 patient with AIDS is correct, one could calculate 3.2-6.4 million of seropositive people for 1992. Officially, this is not admitted because of the hesitation to tarnish the image of the country trying to attract tourists. The Muhimbili Hospital in Dar-es-Salaam has 45 beds, but it can accommodate 60 patients on mattresses. Hospitalization is mostly for opportunistic infections, and often for tuberculosis. AZT is very expensive, even in countries where it is available. The association WAMATA, in existence since 1989, offers help to seropositive people or AIDS victims trying to stress prevention and educate people about the use of the condom, although the modification of people's behavior in a culture where sexuality and fertility are closely linked is difficult. The government budget is not sufficient for buying condoms for protecting the whole population. The National AIDS Control Program has the objective of sensitization of young people by sex education and by belatedly discouraging traditional wedding ceremonies where guests get drunk and engage in love-making.
TROPICAL AND GEOGRAPHICAL MEDICINE. 1991 Jul; 43(3):S13-21.Tuberculosis (TB) has long been recognized as a complication of immune suppression. It poses a particularly major public health threat to developing countries. Many developing countries suffer high prevalence and incidence of TB infection. By suppressing host cell-mediated immunity, HIV exacerbates TB infection by helping to facilitate the transition of latent TB into active disease. Higher prevalence of active disease in population then leads to increasing rates of TB transmission. The World Bank estimates an annual incidence of greater than 7.1 million TB cases in the developing world. Cost-effective interventions have, however, been incorporated as components of national programs in Tanzania and other developing countries. The World Health Organization and World Bank are also working on new strategies to revitalize global efforts against tuberculosis. Finding TB cases early and treating them with chemotherapy are specifically recommended.
ANNALS OF THE NEW YORK ACADEMY OF SCIENCES. 1991; 626:1-10.WHO defines reproductive health as people having the ability to reproduce, to regulate fertility, and to practice and enjoy sexual relationships. It also means safe pregnancy, child birth, contraceptives, and sex. Procreation should include a successful outcome as indicated by infant and child survival, growth, and healthy development. 60-80 million infertile couples live in the world. Core infertility, i.e., unpreventable and untreatable infertility, ranges from 3% to 5%. Sexually transmitted diseases, aseptic abortion, or puerperal infection are common causes of acquired infertility. Sub-Saharan Africa has the highest prevalence of acquired infertility. In 1983, the world contraceptive use rate stood at 51% with the developed countries having the highest rate (70%) and Africa the lowest rate (14%). About 40 countries in Africa and the Arabian Peninsula practice female circumcision. The percent of low birth weight infants is greater in developing countries than in developed countries (17% vs. 6.8%). Intrauterine growth retardation is responsible for most low birth weight infants in developing countries while in developed countries it is premature birth. About 15 million infants and children die each year. Maternal mortality risk is highest in developing countries especially those in Africa (1:21) and lowest in developed countries (1:9850). Sexually transmitted diseases continue to be a major problem in the world especially in developing countries. Chlamydia afflicts 50 million people each year. The proportion of women with AIDS is growing so that between the 1980s and 1990s it will grow between 25% and 50%. More available contraceptive choices enhance safety in fertility regulation. Socioeconomic conditions that determine reproductive health are poverty, literacy, and women's status. Sexual behavior, reproductive behavior, breast feeding, and smoking are life style determinants of reproductive health. Availability, utilization, and efficiency of health care services and level of medical knowledge also determine women's reproductive health.
WORLD HEALTH FORUM. 1991; 12(4):496-7.WHO estimates that the number of AIDS cases worldwide will grow from about 1.5 million to 12-18 million by 2000--a 10 fold increase. Further it expects the cumulative number of HIV infected individuals to increase from 9-11 million to 30-40 million by 2000--a 3-4 fold increase. Dr. Hiroshi Nakajima, the Director-General of WHO, points out that despite the rise in AIDS, there is something for which to be thankful--neither air, nor water, nor insects disseminate HIV and causal social contact does not transmit it. Further since AIDS is basically a sexually transmitted disease, health education can inform people of the need to make life style changes which in turn prevents its spread. In addition, Dr. Nakajima illustrates how frank health education and information campaigns in the homosexual community in developed countries have resulted in reduced infection rates. In fact, many of the people disseminating the safer sex message in the homosexual community were people living with HIV and AIDS. HIV has infected >7 million adults and children in Sub-Saharan Africa since the AIDS pandemic began. It is now spreading quickly in south and southeast Asia where at least 1 million people carry HIV. In fact, WHO believes that by the mid to late 1990s HIV will infect more Asians than Africans. Further Latin America is not HIV free and it can be easily spread there too. Heterosexual intercourse has replaced homosexual intercourse and needle sharing by intravenous drug users as the leading route of HIV transmission.
Global Programme on AIDS. Update, AIDS cases reported to Surveillance, Forecasting and Impact Assessment Unit (SFI).
[Unpublished] 1991 Jun. , 7 p. (GPA/ER/CAS/91.06)As of June 1, 1991, the WHO Global Programme on AIDS (GPA) reported a cumulative total of 366,455 AIDS cases from 162 countries. The number for May 1, 1991 consisted of 7000 fewer cases. The number rose because WHO received reports from Africa, the Americas, and Europe in the interim. The Americas had the highest reported cumulative AIDS cases (217,729) followed by Africa (92,922), Europe (51,914), Oceania (2802), and Asia (1088). Tanzania reported the highest cumulative number of AIDS cases in Africa (21,719), but the last time it reported number to WHO was December 1990. The Seychelles claimed to have no AIDS cases and Sao Tome and Principe only 1. The US had the highest cumulative number in the Americas (174,893; last reporting date April 1991) followed by Brazil (17,373); February 1991). Montserrat had only 1 case (March 1990). The Sudan had the highest number in WHO's Eastern Mediterranean region (265; January 1990). 4 countries in this region had no cases. By March 1991, France led Europe in the number of cases (14,449) followed by Italy (9053). Thailand reported the most cases in the South East Asia region (106; April 1991). 6 of the 11 SE Asian countries reported either 1 or no cases. Australia had the highest cumulative number of AIDS cases for the Western Pacific region (2494; February 1991) followed by Japan (374; March 1991). 9 of the other Western Pacific nations had either 1 or no cases. GPA intended to publish the last monthly report of AIDS cases in July 1991. After July 1991, it planned on issuing quarterly reports--the 1st to begin in October 1991.
NURSING RSA. 1991 Feb; 6(2):29.Africa is confronted with the problem of a lost generation--estimated 10 million orphans whose parents will die of AIDS. In Uganda, the problems of 40,000 children orphaned by the disease have alerted the international community to the fact that AIDS can no longer be compartmentalized as a health problem. It has unprecedented socioeconomic consequences, affecting Africa's work force, its ability to man industries, grow food, and export enough to repay its debts. According to recent surveys, in the next 5-10 years 45% of the South African work force and 90% of skilled Zimbabweans may be infected by HIV. As the 1990s progress, Uganda--with an estimated 1.3 m HIV-positive people--can expect 12,000 new AIDS cases a month. Earlier this month the World Bank and 20 other major donors sent delegates to Uganda to work out a multisectoral AIDS strategy. Everyone agreed that putting money into schools, agriculture, roads, and economic planning as well as health, was needed. But a bitter war took place between the bank and WHO, which holds the UN mandate to control AIDS programs. A myriad of small, nongovernmental organizations, which actually do the work, ganged up to stop the World Bank from imposing a monster bureaucracy on them. But Uganda welcomed the World Bank's provision of $30m (about R78m) worth of soft loans for infrastructure such as clinics, schools, and roads. It seems WHO swallowed its pride, realizing it has enough on its plate coping with AIDS statistics and policies. In the past 4 years the only people who have done anything to help 25,000 AIDS orphans in Uganda's worst-hit district of Rakai are a few irish nuns from a mission hospital. Norway's Redda Barna of Save the Children Fund (SCF) has recently set up nearby and Oxfam and SCF UK have backed work in Rakai. But just 90 minutes' drive south of the Ugandan capital of Kampala, a chronic emergency has passed unnoticed. "There are villages here of children only," an official said recently. Sally Fegan-Wyles, representative for the UN Children's Fund, says everyone was "paralyzed by the enormity of it, we had never experienced anything like it before." (full text)
In: Disease and mortality in Sub-Saharan Africa, edited by Richard G. Feachem, Dean T. Jamison. Oxford, England, Oxford University Press, 1991. 119-21.This article is an overview of comprehensive up-to-date accounts of the current literature on infective and parasitic diseases and malnutrition found in part II of the 1991 World Bank publication entitled Disease and Mortality in Sub-Saharan Africa. It also points out that the region has a problem with insufficient health information systems and lack of surveillance. Malaria is still a major cause of morbidity and mortality in Sub-Saharan Africa. Further the mosquito vectors become resistant to insecticides and the parasite becomes resistant to drugs. It poses many challenges to epdiemiologists, malariologist, pharmacologists, and immunologists. Yet there are not enough of African malaria scientists to address these problems. Diarrhea remains a leading cause of morbidity and mortality in small children in Sub-Saharan Africa. It includes the dysenteries, typhoid, other salmonella infections, cholera, and intestinal parasitic infections such as hookworm and ascaris. Countries in Sub-Saharan Africa need to emphasize good hygiene, safe excreta disposal, and safe water supply to prevent these conditions. Another major cause of disease and mortality in children is acute respiratory infections (ARIs) such as pneumonia. Antibiotics can treat some of these ARIs. WHO's Expanded Programme on Immunization (EPI) operates in many Sub-Saharan African countries and coverage is often high. For example, the Gambia has reached 80% coverage in children <2 years old with measles, DPT-3, BCG, polio-3, and yellow fever. Yet the 6 disease of EPI continue to afflict children. The AIDS epidemic exacerbates the burden of Sub-Saharan Africa which is already fraught with disease. Children in Sub-Saharan Africa also bear a nutritional burden (40% prevalence of stunting and 9% of wasting). Further many children also suffer from micronutrient deficiencies such as vitamin A. Other health problems in Sub-Saharan Africa include leprosy, meningococcal meningitis, and physical handicaps.
Report of a WHO Consultation on the Prevention of Human Immunodeficiency Virus and Hepatitis B Virus Transmission in the Health Care Setting, Geneva, 11-12 April 1991.
[Unpublished] 1991. , 8 p. (WHO/GPA/DIR/91.5)The transmission of both Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) in health care settings causes concern among patients, health care workers, and national policymakers. This document reports recommendations from a consultative meeting on the issue organized by the World Health Organization Global Program on AIDS. The meeting was held at the request of member states to review risks of transmission of HBV and HIV in the health care setting, and to provide guidance on policies and strategies to minimize such risks. In order of declining incidence and likelihood, HBV and HIV may be transmitted from patient to patient, patient to worker, and worker to patient. The risk of infection depends on the prevalence of infected individuals in the population, the frequency of exposure to contaminated medical instruments, relative viral infectivity, and the concentration of virus in the blood. The risk of acquiring HBV from a needlestick exposure to blood of an infected patient is estimated at 7-30%, while less than 0.5% of health care workers exposed in similar fashion to HIV+ blood have become infected with HIV. General recommendations and specific measures for WHO and national authorities to adopt in the prevention of these infections are listed. Central to prevention is the adoption by health care workers of universal precautions which assume that all blood and certain bodily fluids are infectious. HBV vaccines for both health care workers and as a routine infant immunogen are recommended where appropriate. Routine and/or mandatory blood testing of workers or patients is not recommended, and is considered potentially counterproductive to AIDS control.
New York, New York, UNFPA, . , 46 p. (Report)This report provides an overview of the Follow-up Consultative Meeting on Contraceptive Requirements in Developing Countries in the 1990s, a meeting convened by UNFPA on May 31, 1991. Over 40 representatives from donor countries, developing countries, intergovernmental organizations, and nongovernmental organizations attended the consultative meeting. The report first summarizes the proceedings and then presents 4 technical papers that were prepared for the meeting. The meeting itself focused on the following agenda items: 1) country-specific estimates of contraceptive requirements, including current status, methodological problems, and future plans and options; 2) program needs for logistics management of contraceptives; 3) options for local production of contraceptives; 4) coordinated procurement of contraceptives; and 5) future resource needs for contraceptives. As it was pointed out during the meeting, just to maintain the developing world's combined contraceptive prevalence of 51% will require providing contraceptives to an additional 108 million married women of reproductive age. A recurring theme at the meeting was the impact of AIDS on the logistics management of contraceptives. The report provides a summary of the discussions and conclusions reached by the participants. The 2nd section of the report contains the following papers presented at the meeting: County-Specific Estimates of Contraceptive Requirements, Programme Needs for Logistics Management of Contraceptives, Options for Local Production of Contraceptives, and Coordinated Procurement of Contraceptives.
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.