The Internet as recruitment tool for HIV studies: viable strategy for reaching at-risk Hispanic MSM in Miami?

Although use of the Internet as a vehicle for HIV/STI research is increasing, its viability to recruit at-risk populations such as Hispanic men who have sex with men (HMSM) to participate in community-based HIV studies is in its infancy. We report on the first 171 participants enrolled in an ongoing study exploring use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in Miami-Dade County, Florida to participate in community-based studies. We report our initial success with chat-room recruitment and describe the sexual and drug use practices of the initial set of participants who were recruited through the Internet. In addition, we describe the formative work conducted to develop the Internet recruitment procedures we are testing. In two months, we spent 211 hours recruiting in chat-rooms and engaged 735 chatters. One hundred and seventy-six men came to our community sites; 172 (98%) were eligible and completed an audio computer-assisted self-interview. In the previous six months, 94.7% of participants had anal sex; 48.9% did not use condoms for anal sex or used them inconsistently; and 48.5% had used club drugs. Six-month use rates for individual drugs were: poppers (31.6%), cocaine (15.8%), ecstasy (14%) and crystal methamphetamines (11.7%). Use of club drugs was significantly associated with unprotected insertive and unprotected receptive anal sex. These initial findings point to the Internet's potential as a tool for recruiting at-risk Hispanic MSM for community studies.

To test or not to test: are Hispanic men at highest risk for HIV getting tested?

This study examined how HIV testing history and future testing intentions were related to sexual risk and perceptions of risk in a community sample of 1,052 Hispanic men. This sample is noteworthy in its diverse representation of Hispanics, its high ratio of participants born outside the USA, and its inclusion of heterosexuals and men who have sex with men (MSM). We used area-based sampling to recruit participants at public venues. Data were collected via anonymous, structured interviews from December 1999 to February 2001. Lifetime testing rates were high (76%), but only 45% had been tested in the last 12 months. Results indicate that men at highest risk-those who were MSM, had more partners and had STDs-were more likely to have been tested, and to have been tested recently, than men with lower risk. Being MSM and having been previously tested predicted future testing intentions. Inconsistent condom users with more than five partners were less likely to intend to be tested than men with more than five partners who used condoms consistently. Studying men who have successfully routinized HIV prevention practices (including testing) will assist in the development of interventions for those who remain at risk.

Creating an agenda for research and evaluation: HIV service delivery, the Ryan White CARE Act, and beyond.

HRSA, AHCPR and NCAP convened a working meeting in November 1992, to discuss creation of a national agenda for research and evaluation on HIV service delivery systems that are cost-effective, responsive to the needs of the diverse populations affected by the epidemic, and reflective of the lessons learned so far. In this article, the interests and goals of the conveners are described, the meeting's process and outcomes are discussed, and the nine key study areas that were identified and chosen by the meeting participants are presented. It is hoped that this article will stimulate further interest among private and public funders and among the research community in fostering the implementation of HIV service delivery-related research and evaluation studies. If this is accomplished, decision-makers will be better enabled to make informed and responsive policy decisions.

Delivery of oral health care through the Ryan White CARE Act to people infected with HIV.

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 was passed by Congress "to improve the quality and availability of care for individuals and families with HIV disease." The act targets those individuals infected with HIV who lack financial resources to pay for care. While provision of oral health care is not mandated by the legislation, many oral health services are supported through five different programs receiving CARE Act funding. Legislative mandates, program guidance materials, grant applications, and other related materials were reviewed to analyze oral health care services supported or proposed through the CARE Act. In fiscal year 1991, an estimated $5.8 million of the total CARE Act funds ($229.6 million) were used for oral health care, and there is evidence that oral health concerns will receive increasing attention by grantees in future years. Opportunities exist for local oral health professionals to become involved in CARE Act programs and in the priority development process. It is possible that CARE Act grantees will serve as catalysts for the development of partnerships between private practitioners and public sector programs--relationships that could lead to improved access and quality of care for people with HIV infection.

States' responses to Title II of the Ryan White CARE Act.

Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 provides formula-based grants to States to help them improve the quality, availability, and organization of health care and support services for people with human immunodeficiency virus (HIV) infection. This article reviews State expenditures during the first year of CARE Act funding (April 1991-March 1992) within the context of Title II guidelines and the federally funded grant programs that preceded and helped shape Title II. The authors also discuss future challenges that require development of resources, the assessment of program impact, and the evaluation of the quality and appropriateness of HIV-related services. Ninety-one percent of the $77.5 million awarded to States during fiscal year 1991 went for the provision of medical and support services through HIV care consortia, drug reimbursement programs, home and community-based care programs, and health insurance initiatives. The remaining monies were used for planning, evaluation, and program administration. Forty States allocated $38.9 million for the establishment of HIV care consortia to assess service needs and to develop comprehensive continuums of health and support services in the areas most affected by HIV disease. Fifty States allocated an additional $28.3 million for the continuation or expansion of FDA-approved drug therapies for low-income people with HIV infection. Twenty-five States allocated $2.2 million for the provision of home- and community-based health services, and 16 States allocated $1.3 million for programs that help low-income people with HIV infection to purchase or maintain health insurance coverage.

First year of AIDS services delivery under Title I of the Ryan White CARE Act.

This is a review of (a) the emergency assistance for ambulatory HIV medical and support services provided in the first year by eligible metropolitan areas (EMAs) funded under Title I of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990, (b) the varied responses and processes by which the 16 urban areas receiving Title I funds in 1991 met legislative mandates, (c) the central nature of planning councils under Title I and their formation and functioning, and (d) issues related to current implementation and future expansion of Title I to additional eligible metropolitan areas. Integral to the review is a brief discussion of the history of AIDS and HIV infection, particularly in cities receiving CARE Act funding, an overview of Title I requirements, and a description of the organizational structures cities are using to implement Title I. Information on Title I EMAs is based on analysis of their 1991 applications, bylaws of their HIV service planning councils, intergovernmental agreements between Title I cities and other political entities, and contracts executed by Title I grantees with providers for the delivery of services. Interviews with personnel in several Title I EMAs, including planning council members and grantee staff members, provided additional information. This is the first descriptive accounting of activities related to the 1991 applications for and uses of Title I funds, and the administrative and service issues related to this process.

An expert system for water quality modelling.

The RAISON-micro (Regional Analysis by Intelligent System ON a micro-computer) expert system is being used to predict the effects of mine effluents on receiving waters in Ontario. The potential of this system to assist regulatory agencies and mining industries to define more acceptable effluent limits was shown in an initial study. This system has been further developed so that the expert system helps the model user choose the most appropriate model for a particular application from a hierarchy of models. The system currently contains seven models which range from steady state to time dependent models, for both conservative and nonconservative substances in rivers and lakes. The menu driven expert system prompts the model user for information such as the nature of the receiving water system, the type of effluent being considered, and the range of background data available for use as input to the models. The system can also be used to determine the nature of the environmental conditions at the site which are not available in the textual information database, such as the components of river flow. Applications of the water quality expert system are presented for representative mine sites in the Timmins area of Ontario.

Condom use with regular and casual partners among women attending family planning clinics.

A survey of 16,632 women attending family planning clinics in Pennsylvania found that only 13 percent of the sample used condoms. Moreover, 67 percent of the women with regular partners never used condoms with those partners, and 72 percent of women who had casual partners never used them with those partners. Levels of condom use with both regular and casual partners were higher among women younger than 20, those who were nonwhite, those with multiple partners and those who reported a previous STD infection. However, women who had sex partners who used intravenous drugs were less likely to use condoms with regular or casual partners than were women who did not have drug-using partners.

Risk behaviors for HIV infection in clients of Pennsylvania family planning clinics.

Responses from a statewide survey of risk behaviors among clients of Planned Parenthood clinics in Pennsylvania indicate that a sizable proportion of these women are at intermediate or high risk for exposure to the human immunodeficiency virus (HIV). Overall, nearly five percent of the 15,499 women in the sample reported personal behavior, or a partner's behavior, that placed them at high risk, while an additional 20 percent were at intermediate risk. Among all women surveyed, 13 percent had had three or more partners in the past year, 12 percent had had a sexually transmitted disease, four percent had partners who were intravenous (IV) drug users, two percent were either current or past IV drug users, one percent had bisexual partners and less than one percent had partners who had hemophilia or who were infected with the AIDS virus.

PIP: Responses from a statewide survey of risk behaviors among clients of Planned Parenthood clinics in Pennsylvania indicate that a sizeable proportion of these women are at intermediate or high risk for exposure to the human immunodeficiency virus (HIV). Overall, nearly 5% of the 15,499 women in the sample reported personal behavior or a partner's behavior, that places them at high risk, while an additional 20% were at intermediate risk. Among all women surveyed, 13% had had 3 or more partners in the past year, 12% had had a sexually transmitted disease, 4% had partners who were intravenous (IV) drug users, 2% were either current or past IV drug users, 1% had bisexual partners and 1% had partners who had hemophilia or who were infected with the AIDS virus. Of the 16,553 clinic patients who supplied demographic information, 86% were white and 78% were aged 15-24. Information on marital status and education was compiled for women aged 20 and older. Of these 70% had never married and 91% had completed at least a high school education.

Assessing behavioral risk for HIV infection in family-planning and STD clinics: similarities and differences.

Four hundred fifty-five women in family-planning and sexually transmitted disease (STD) clinics were surveyed to determine the degree of participation in behaviors known to be associated with increased risk of human immunodeficiency virus (HIV) infection. A previous history of STD (20%) and multiple sexual partners (73%) were shown to be the high-risk behaviors most prevalent in these populations. Sexual intercourse with persons in high-risk groups (6%) and intravenous (IV) drug use (3.7%) were less prevalent. Differences between the populations from each type of clinic and between races were noted. Overall, almost one third of family-planning clinic clients and nearly half of STD clinic clients reported participation in at least one risk behavior, emphasizing the need for educational efforts toward disease prevention in these settings.

Education for AIDS prevention: not our only voluntary weapon.

Authorities frequently state that education is the "only" method we have to stop the AIDS (acquired immunodeficiency syndrome) epidemic until a vaccine and/or curative therapy is available. We suggest that education, while critically important to our efforts to stop transmission of the human immunodeficiency virus (HIV), needs to be bolstered by additional voluntary approaches. Control of parenteral drug use, prevention of ulcerative sexually transmitted diseases, provision of expanded contraceptive services to seropositive reproductive age women, and reinforcement of risk-reduction behaviors through extended follow-up interventions are required as well. The support of these voluntary programs is a necessary complement to educational approaches which impact on HIV transmission and eventually on the AIDS epidemic.

The ecology of Colorado tick fever in Rocky Mountain National Park in 1974. III. Habitats supporting the virus.

Ecologic studies of small mammals in Rocky Mountain National Park (RMNP) were conducted in 1974 in order to identify the specific habitats within the Lower Montane Forest that support Colorado tick fever (CTF) virus. Data was collected on the abundance and distribution of 4 primary rodent species, tick infestation, CTF virus, and neutralizing antibody prevalence. Rodents were captured along transects crossing different habitats. Open stands of ponderosa pine and shrubs on dry, rocky surfaces were found to be important for maintaining CTF virus.

Current CDC efforts to prevent and control human immunodeficiency virus infection and AIDS in the United States through information and education.

The human immunodeficiency virus (HIV) is estimated to have infected more than a million people in the United States and millions more in other countries. Even though there is no vaccine or effective treatment, HIV infection can be prevented through behavioral change. As the lead Public Health Service Agency for disease prevention, the Centers for Disease Control (CDC) has designed and implemented information and education activities with the ultimate goal of preventing HIV infection and AIDS in the United States. The target populations include the general public, school- and college-aged populations, persons infected or at increased risk of infection, minorities, and health workers. Because AIDS will be with us for a long time, CDC views educating the public as a long-term undertaking. The agency has initiated an intensive continuing national public information campaign, an informational brochure to be distributed to every U.S. household, a national AIDS information toll-free hotline, and a clearinghouse system that will maintain a comprehensive inventory of AIDS information resources and services. CDC also supports public information and education efforts by State and local health agencies. To reach school- and college-age youth, CDC, in consultation with governmental and national private sector organizations, developed guidelines for effective school health education to assist school health personnel in determining the scope and content of AIDS education. CDC also works with State and local education agencies to help carry out and evaluate educational efforts to prevent the spread of HIV among school- and college-age youth. The populations with the highest priority for AIDS information and education efforts are those who are at increased risk of acquiring or transmitting the AIDS virus because they use illicit intravenous drugs and share needles, engage in anal intercourse, have many sexual partners, practice prostitution, or engage in sex with those who practice these behaviors. Another high-priority population, because they can infect their offspring,is reproductive age women engaging in high-risk behavior and women infected with HIV who become pregnant. CDC programs targeted to these groups include community health education and risk reduction interventions, counseling and testing for HIV infection, AIDS community demonstration projects, perinatal AIDS prevention projects,and programs focused on preventing AIDS in minority populations. CDC is developing a variety of educational approaches for health workers in clinical settings because they are an important channel for providing accurate AIDS information, helping to assess risk, and counseling to actively reduce risk for the patient, sex partners of the patient, friends, and family members of the patient. CDC has conducted research and provided information and training on the use of HIV laboratory tests. CDC has also developed numerous scientific and technical guidelines and recommendations in consultation with practitioners, public health officials, and others and disseminated these through the Morbidity and Mortality Weekly Report. In addition,CDC has provided information about the risk of HIV transmission in the workplace and about methods of prevention. CDC will continue to evaluate these activities and support research in education and related interventions that may be necessary to prevent infection by the HIV virus. By providing educational support for behavior changes that decrease HIV transmission, we can contribute to AIDS prevention in the 1990s.

Arbovirus investigations in Argentina, 1977-1980. I. Historical aspects and description of study sites.

This is the introductory paper to a series on the ecology of arboviruses in Argentina. Epizootics of equine encephalitis have occurred since at least 1908, principally in the Pampa and Espinal biogeographic zones, with significant economic losses; human cases of encephalitis have been rare or absent. Both western equine and eastern equine encephalitis viruses have been isolated from horses during these epizootics, but the mosquitoes responsible for transmission have not been identified. A number of isolations of Venezuelan equine encephalitis (VEE) virus were reported between 1936 and 1958 in Argentina, but the validity of these findings has been seriously questioned. Nevertheless, serological evidence exists for human infections with a member of the VEE virus complex. Serological surveys conducted in the 1960s indicate a high prevalence of infection of humans and domestic animals with St. Louis encephalitis (SLE), and 2 SLE virus strains have been isolated from rodents. Human disease, however, has rarely been associated with SLE infection. Only 7 isolations of other arboviruses have been described (3 of Maguari, 1 of Aura, 2 of Una, and 1 of an untyped Bunyamwera group virus). In 1977, we began longitudinal field studies in Santa Fe Province, the epicenter of previous equine epizootics, and in 1980 we extended these studies to Chaco and Corrientes provinces. The study sites are described in this paper.

Arbovirus investigations in Argentina, 1977-1980. IV. Serologic surveys and sentinel equine program.

Serologic surveys of wild and domestic birds, wild mammals, and horses were conducted during arbovirus field studies in Argentina from 1977 through 1980, a non-epizootic interval. The prevalence of neutralizing antibodies to eastern equine encephalitis (EEE) was consistently higher than to western equine encephalitis (WEE) virus in all species and all areas. The presence of antibodies in short-lived avian species and in young unvaccinated horses and the demonstration of seroconversions in horses during the period, indicated that these viruses are either enzootic in, or annually reintroduced into, Argentina. Antibodies to AG80-646, a new subtype of WEE virus isolated in the subtropical north (Chaco Province) from Culex (Melanoconion) mosquitoes, were found in horses and rodents in that region. Antibodies to the TC-83 strain of Venezuelan equine encephalitis (VEE) virus were found in all areas studied. The presence of antibodies in some horses was probably related to vaccination, but the demonstration of seroconversions in sentinel horses and of antibodies in birds and wild mammals indicates active transmission of VEE virus. In 1980 a new enzootic subtype of VEE virus (AG80-663) was isolated from mosquitoes in Chaco; neutralizing antibodies to this virus were prevalent in horses and rodents in this area. Infections with Aura and Una viruses were most common in the subtropical northern provinces. Infection with St. Louis encephalitis was prevalent and widespread, and birds, principally passerine and columbiform species, appear to be the principal hosts. An interesting and unexplained finding was the absence of arbovirus antibodies, in particular SLE antibodies in house sparrows (Passer domesticus). Antibody prevalences in horses exceeded 50% in all areas, and 12% of horses surveyed in Santa Fe Province developed antibody in a 17-month period. Antibodies to other flaviviruses were rare. A high prevalence of immunity to Maguari virus was found in horses; this agent is considered to be a potential equine pathogen. Antibodies to 2 new viruses, Barranqueras and Resistencia, which had been isolated from Cx. (Melanoconion) in Chaco Province, were found in rodents there. Immunity to Gamboa group viruses was prevalent, and birds were implicated as principal hosts.

Surveillance of Lyme disease in the United States, 1982.

Lyme disease is a tick-borne illness that has been reported from three regions in the United States--the Northeast, Midwest, and West--which correspond to the distribution of the recognized vectors of the disease, Ixodes dammini and Ixodes pacificus. In 1982, a surveillance system designed to define the morbidity and geographic distribution for Lyme disease by using a clinical case definition received information on 491 definite cases and 38 probable cases. Of the definite cases, 489 were acquired in endemic areas of the Northeast or Midwest; one case was acquired in Utah and one in western Pennsylvania, two areas where the illness had not been previously reported. Three states that previously had not reported cases of Lyme disease (Kentucky, Indiana, Montana) reported probable cases. In 37% of the definite cases, the patients had neurological symptoms (most commonly reported was headache with stiff neck, suggestive of meningitis), 10% cardiac symptoms (most commonly reported was palpitations), and 54% arthritic symptoms (most commonly reported in large joints). The occurrence of Lyme disease in areas outside the currently recognized endemic regions, as well as the recent description of Amblyomma americanum as a probable vector, suggest that additional vectors may be described in the future.