,,,.,,.,.,, ,. l),,,UK Lid l.q92 ~) Lt)nglllall (;I'OLI



A decade of the AIDS epidemic, report on the Seventh International Conference on AIDS, Florence, Italy, 16-21 June 1991 This well organised conference was attended by more than 8000 delegates, the majority of whom came from Europe (53%) and Northern America (38%). Developing countries sent 9% of the delegates. Seventy countries were represented in the 500 oral presentations and 3000 posters. The first scientifically reported cases of Acquired I m m u n e Deficiency Syndrome (AIDS) related illness occurred 10 years ago. Since then this disease has grown into the largest world wide pandemic of this century. Although h u m a n immunodeficiency virus (HIV) infection is stabilising in some communities, the spread to women and children is alarming. The rise of reported cases in India and Thailand poses new challenges for the world health scene.

Transmission In homosexual men, there have been dramatic reductions in the incidence of 'risky' sexual behaviour associated with HIV infection. However, some portions of this population, namely young gay and bisexual men, demonstrate dangerous sexual practices (Hays). Bisexual men may be an epidemiological bridge to H I V transfer between male and female populations (Izazola). A m o n g 3550 women who acquired AIDS through heterosexual contact, 11% reported sex with a bisexual man and no other risk factor (Chu). Based on data collected on 3 million newborn babies since 1980 in the US the incidence of perinatal transmission is 20-30%. Progression of perinatal HIV infection to AIDS is estimated as 25% in the first year, 15% in the second year, and 10% in subsequent years (Gwinn). Chronic vaginitis, cervicitis and genital abrasion have been related to HIV transfer in 40

women. The incidence of chronic infections may be an exacerbation of HIV. However very little data has been collected on the progression of H I V infection in women. T h e r e is now a major effort underway to include women and children in clinical trials and related studies.

Health care workers A h h o u g h educationally informed on the need to use Universal Precautions, health care workers continue not to comply with these infection control regulations in practice_ A study of emergency-room workers demonstrated that workers sell" reported a high level of compliance but observer evaluation found that significant problems exist. Dexterity issues, time constraints, and patient characteristics influence the practice of health care workers_ Hospitals need to support and mandate compliance with Universal Precautions (Henry). Recently an HIV infected US dentist transmitted H I V to a patient during invasive dental procedures. Several studies investigated this risk. T h e risk of transmission of HIV virus from surgeon to patient is estimated at 0.3%. This is the same risk o f seroconversion in a health care worker who has been exposed in a percutaneous HIV work related injury (Lowenfels).

Prevention Reports on IV drug users demonstrated a decrease in seropositivity in syringe exchange programmes (Stimson; Watters). There is a continued societal problem in the need for 'safe sex' practices. Clients of prostitutes resist condom use (Brunet). High risk


sexual activities and denial of personal vulnerability is evident post AIDS education (Agoki). Although the n u m b e r of AIDS education programmes is increasing, a societal attitude change to 'safe sex' practices is necessary.

Vaccine development T h e r e has been a major scientific effort in the area of vaccine development. Eleven vaccines have been tested with good responses noted. T h r e e post-exposure studies have demonstrated increased life spans in the subjects. Controlled trials have been initiated. Long term analysis will be required prior to mass public distribution.

Summary As we enter the second decade of this pandemic, it is known that this virus is generally transmitted sexually. T h e future of HIV infection will be in the heterosexual population, because of the large numbers in this group. T h e impact of this syndrome on all countries is apparent but on under-developed countries it is devastating, in areas of sub-Saharan Africa, AIDS is wiping out crop growers. Consequently, food staples are in desperate decline. U N I C E F projects that by the year 2000 there will be 6 million orphan children in 10 middle African countries. T h e r e will be a changing profile of the syndrome in the 1990s that will demonstrate a rise in female and paediatric AIDS cases. Although areas of vaccine development are promising, especially in the area of post exposure inoculation, the completion of extensive controlled trials is necessary. A pre-expnsure vaccine for the general population will probably not be available by the year 2000. Prevention and early treatment are our greatest options.

Selected conference papers Agoki E et al High risk practices and denial of AIDS a m o n g Nairobi men. University of Nairobi, Kenya; University of Manitoba, Canada


Brunet J B e t al Health related problems and preventive attitudes a m o n g female prostitutes in Paris. (;entre European pour la Surveillance Epidemiologique due SIDA, Paris, France Chu S Y et al Bisexual men with AIDS in the United States: epidemiology and their role in the AIDS epidemic in women. Centers for Disease Control, Atlanta, Georgia, USA Gwinn M et al H I V seroprevalence in childbearing women and predicted incidence of perinatally acquired AIDS, United States. Centers for Disease Control, Atlanta, Georgia; National Institute for Child Health and H u m a n Development, Bethesda, Maryland, USA Hays R B et al Understanding the high rates of HIV risk-taking a m o n g young gay and bisexual men: the young men's survey. (;enter for AIDS Prevention Studies, University of Califl)rnia, San Fransico, California, USA Henry K et al Observed and self-reported compliance with univgrsal precautions a m o n g emergency room d e p a r t m e n t personnel at two suburban community hospitals. University of Minnesota Medical School, Minneapolis, Minnesota, USA IzazolaJ A et al Sexual relationships with women in homosexually identified men: the probability of transmission to other populations_ Mexico Ministry of Health, Harvard School of Public Health, Boston, Massachusetts, USA Lowenfels A B e t al Transmission of H I V infection from surgeon to patient: estimating the risk. New York Medical College, Valhalla, New York, USA Stimson G V et al Decreased levels of syringe sharing, low H I V rates for syringe exchange clients and other UK injectors. Centre for Research on Drugs and Health Behaviour, Charing Cross and Westminster Medical School, London, England Watters J e t al Syringe exchange in San Franscisco: preliminary findings. Prevention Point Research Group, University o f California at San Francisco and Berkeley, California, USA. MARYANNE F LACHAT


A decade of the AIDS epidemic, report on the Seventh International Conference on AIDS, Florence, Italy, 16-21 June 1991.

,,,.,,.,.,, ,. l),,,UK Lid l.q92 ~) Lt)nglllall (;I'OLI Midwifery CONFERENCE REPORTS A decade of the AIDS epidemic, report on the Seventh Internati...
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