Summary of track D: social science: research, policy and action.

SCOPE: This review summarizes the main issues discussed during Track D, which examined the societal impact of HIV/AIDS, and responses to the epidemic by individuals, families, communities and societies worldwide. Micro- and macrolevel issues addressed included the development, implementation and evaluation of programmes for prevention and care; policy development and implementation; structural issues such as the impact of gender relations, development and migration on the development of the epidemic; and the social and economic impact of HIV/AIDS on affected societies and communities. RECURRENT THEMES: Presentations provided strong evidence that peer-led, community-based programmes offer particularly effective ways of working, and that participatory research involving affected communities provides useful results for the design and evaluation of programmes and policies. This is the case across settings, issues, populations and countries. FUTURE DIRECTIONS: Emerging needs include how best to ensure sustainability of national and international responses, how best to scale up successful interventions for wider reach, and how best to work with systematically marginalized, neglected groups and populations. Research priorities include the characterization of the multiple determinants of HIV-related vulnerability, and the evaluation of interventions that take these complex determinants as their starting point. A more coherent and strategic response requires less separation between the different constituencies involved in AIDS work, and the more sustained involvement of people living with HIV/AIDS themselves.

Differences in the incidence of myocardial infarction among occupational groups.

An inverse relationship between social class and coronary heart disease has been observed in several countries, but few studies have investigated the incidence of this disease over different occupational groups. A case-referent study was carried out to estimate the relative risk of a first myocardial infarction in various occupational groups. Cases of myocardial infarction (N = 36,602) were identified from both hospital discharge and death records. Two referents for each case were randomly selected from the study base. Information about occupation was obtained from two consecutive censuses. An increased incidence, compared with that of others employed, was found for persons in some occupations in production work, transport work (men), and service work (women). Low relative risk were found mainly for persons in occupations demanding a high education. The relative risks ranged from 0.3 to 2.8. Several factors, occupational as well as nonoccupational, may be of importance in explaining the findings.