La desesperacion: migrant and seasonal farm workers living with HIV/AIDS.

Migrant seasonal farm workers (MSFWs) in south Texas are predominantly Mexican American and represent one of the most impoverished and medically underserved populations in the United States. La Frontera is a collaborative partnership between the University of Texas Health Science Center at San Antonio, migrant organizations, and HIV service delivery organizations to study and address special needs of MSFWs in Hidalgo and Maverick counties of south Texas. The purpose of this qualitative study is to explore the health-seeking experiences of HIV-positive MSFWs living in the La Frontera service area. Denzin's interpretive interactionism methodology guided the study. Thirteen participants were interviewed and audiotaped as they described their experiences. Findings from content analysis of the interviews revealed a description of the life of an HIV-positive MSFW as la desesperacion (a separate way of life). After their diagnosis of HIV/AIDS, the major themes in their lives were living in secrecy (a silent cry), finding and receiving health care, and accepting the disease (may it be the will of God).

The care of women with AIDS: special needs and considerations.

The growing number of women being diagnosed with HIV/AIDS mandates the need to focus attention on the special needs of this population. Although women have many of the same devastating physical manifestations of HIV infection as men do, they face unique psychological and social issues that influence their ability to respond to their disease in the same ways. Women with HIV/AIDS are disproportionally poor or minority women who lack resources to maintain their health. It is impossible to address HIV infection in women without considering such factors as poverty, discrimination, and gender role expectations. This article uses a biopsychosocial framework to discuss a range of specific issues affecting the health and well-being of women with HIV/AIDS.

Stress in families of HIV-positive children living in south Texas.

The purpose was to conduct a pilot study of the extent of stress and differences in sources of stress experienced by HIV+ and HIV- caregivers of HIV+ children living in South Texas. 13 infected and 9 uninfected caregivers each completed the Questionnaire on Resources and Stress for their preschool-aged HIV+ child. Both HIV+ and HIV- caregivers experienced clinically significant stress. HIV+ caregivers reported that relative to the HIV- group, they perceived themselves to be in poorer physical or emotional health, to receive less social support from others, and to be less pessimistic about the future of their child or family.

Pediatric AIDS: adolescence, delinquency, drug abuse, and AIDS.

Sexual promiscuity often is part of the lifestyle of teenagers who are delinquent and abuse drugs, and that behavior puts them at increased risk of contracting HIV infection/AIDS. Many of these juveniles are runaways or live in disorganized homes, and as a result they are hard to reach and it is extremely difficult to provide health and other services to them. Indeed, these youths at risk most frequently may be identified and helped when they run afoul of the law and enter the judicial system. With that in mind, concerned professionals in San Antonio have developed an innovative program to provide primary care, drug abuse treatment and rehabilitation, and AIDS prevention education to the youthful offenders admitted to the Juvenile Detention Center of Bexar County. They hope it will give some of these youngsters the help and the opportunity they need to grow up, become productive citizens, and stay alive.

Pediatric AIDS: psychosocial impact.

There is no question that the domain of the American family has been invaded by the HIV infection/AIDS epidemic. The disease, and particularly its form affecting children (pediatric AIDS), has had marked psychosocial impact on patients and families (intellectual/cognitive, emotional/behavioral, spiritual, and financial) and on our society in general (adverse or favorable). These impacts of pediatric AIDS are discussed in the present communication.

Pediatric AIDS: systematic approach to patient management.

In order to provide comprehensive care to infants, children, and adolescents with HIV infection/AIDS, a systematic approach to clinical management had to be developed. This approach involves "case management" by experienced health professionals, including initial evaluation and needs assessment, planning of services, brokerage of services, continuity of intervention until an outcome is reached. The care is delivered in hospitals, clinics, homes, residential facilities, respite care centers, and hospices. The care team needs to be multidisciplinary and well integrated.

Pediatric AIDS: impact on health systems.

For 9 years we have recognized HIV infection/AIDS as an unstoppable epidemic affecting infants, children, and adolescents as well as adults. Now we see the tremendous impact of this disease on the health systems of this country. During these past 9 years, we have witnessed the transformation of the epidemic from one primarily affecting male homosexuals to one invading the average US family through heterosexual and vertical transmissions and through needle-sharing practices of intravenous drug abuse. It has been estimated that 2% to 3% of the HIV infection/AIDS cases involve the pediatric age group. If 1.5 million Americans have HIV infection by 1991, as predicted, we should anticipate 30,000 to 45,000 infected pediatric patients by the end of that year. What has been the impact of this epidemic on the health systems involved in care, prevention, and research of pediatric HIV infection/AIDS? This article investigates that question.

Pediatric AIDS: prevention of HIV infection in infants and children.

The Centers for Disease Control reported that 109,167 cases of AIDS had been diagnosed since 1981 and that approximately 40,000 persons were living with AIDS at the time of this writing. These numbers, however, are the tip of an iceberg that consists of approximately 1.5 million Americans who are infected by the human immunodeficiency virus (HIV). As we described in earlier articles of this series, the HIV infection/AIDS epidemic has invaded the domain of the American family through heterosexual transmission, vertical transmission, drug abuse, and sexual abuse of children. Therefore, physicians for children are now facing the prospects of having to deal with this disease in their practices. If there is something unique about pediatrics and other specialties of the medical profession dealing with infants and children, it is that "prevention" of disease can be and has been used effectively. One only needs to remember the 1950s, when the poliomyelitis epidemic was causing the same, if not greater, concerns in the lives of the American families. The development and application of the "polio" vaccines has virtually eliminated the threat of poliomyelitis in our society. Similarly, the incidence of diphtheria, tetanus, and smallpox has decreased to the point that these diseases present practically no threat to the US population. Armed with these positive experiences, we need to examine what we can do today to curb the spread of the HIV infection/AIDS among infants and children, and by extension, among the general population of our country.

Pediatric AIDS: treatment and outcome of patients.

The treatment of pediatric patients with HIV infection/AIDS is structured according to the clinical classification of the disease by the Centers for Disease Control; it involves prophylaxis, therapy against the human immunodeficiency virus, and therapy for the opportunistic infections and non-infectious complications of this disease. In spite of all these forms of therapy, the universal outcome of HIV infection/AIDS is the death of the patients. Prevention remains the only effective means to curb this epidemic.

Pediatric AIDS: clinical presentation and diagnosis.

HIV infection/AIDS in infants and children under the age of 13 years expresses itself clinically so differently from the same infection in adults that a separate classification of the symptomatology has been adopted. Recurrent bacterial infections, as well as various opportunistic infections predominate, and while Kaposi's sarcoma is infrequent in pediatric patients, lymphomas occur with high frequency. The diagnosis of HIV infection/AIDS in children is presented.

Pediatric AIDS: a new health problem on the Texas horizon.

The current epidemic of HIV infection/AIDS initially limited to homosexual males appears to be spreading through heterosexual transmission and intravenous drug abuse. Infants, children, and adolescents are affected. We examine the modes of transmission of HIV infection in this population and the impact the spreading of this infection in the pediatric age group will have on Texas.