Predictors of HIV infection among newly sentenced male prisoners.

The prevalence of individuals with or at risk for HIV infection in prisons and jails is severalfold higher than age-adjusted rates in surrounding communities. This HIV serosurvey of 975 newly sentenced male prisoners employed a new methodology that anonymously linked individual information to HIV serologic data. The HIV prevalence was 6.1%; multivariate regression analysis indicated injection drug use (OR = 18.9), black race (OR = 5.5), Hispanic ethnicity (OR = 3.4), psychiatric illness (OR = 3.1) and a history of having had a sexually transmitted disease (OR = 2.2) were independent predictors of HIV infection. Laboratory markers such as hypoalbuminemia, an elevated aspartate aminotransferase (AST) level, leukopenia, anemia, and thrombocytopenia suggest increased risk for HIV among prisoners, particularly in settings where HIV testing resources are scarce. This study, unlike those reported in other geographic regions, indicated that the majority (71%) of HIV-seropositive persons self-reported their HIV status. This finding may suggest that HIV-infected individuals will self-report their status if HIV care is comprehensive and consistent. The large number of HIV-infected individuals within prisons makes prisons important sites for the introduction of comprehensive HIV-related care. This is particularly relevant in that development of new guidelines issued for the management of HIV infection in which potent combination antiretroviral therapy has been demonstrated to decrease morbidity and mortality. The high prevalence of HIV-seronegative inmates with self-reported high-risk behaviors also suggests the importance of prisons as sites for the introduction of appropriate risk-reduction interventions.

HIV testing patterns: where, why, and when were persons with AIDS tested for HIV?

OBJECTIVE: To describe the location of, primary reason for, and time between the first positive HIV test and AIDS diagnosis in a sample of persons with newly diagnosed AIDS. DESIGN: Interviews supplementing information routinely collected through AIDS case reporting. SETTING: Eleven US states and cities. PATIENTS: Persons with AIDS (2441) diagnosed between January 1990 and December 1992. MAIN OUTCOME MEASURES: Location of first positive HIV test, primary reason for testing, and time interval between first positive HIV test and AIDS diagnosis. RESULTS: Overall, persons were tested late in their course of HIV infection: 36% were tested for HIV within 2 months and 51% within 1 year of their AIDS diagnosis. Sixty-five per cent were HIV-tested in acute health-care settings: 33% in hospitals, 28% in physicians' offices, and 4% in emergency departments. Testing during hospitalization was most common among injecting drug users (43%) and persons infected through heterosexual contact (50%). Persons primarily sought HIV testing because of illness (58%); other reasons included being in a known risk group (13%) and having had a known HIV-infected sex partner (8%). Testing because of being in a known risk group was least common among persons infected through heterosexual contact (1%). Among persons in these exposure categories, testing differed by race/ethnicity. CONCLUSION: Most persons with AIDS were tested relatively late in their course of HIV infection, in acute health-care settings, and because of illness. Not knowing one's serostatus precludes early medical intervention and may increase transmission.

Who are the primary caretakers of children born to HIV-infected mothers? Results from a multistate surveillance project.

OBJECTIVE: To determine the primary caretakers of children born to women with human immunodeficiency virus (HIV) infection. METHODS: We interviewed women at least 18 years of age who have been reported with HIV infection or acquired immunodeficiency syndrome to local health departments in 10 cities and states regarding the primary caretaker of their children born since 1977. RESULTS: Of 541 HIV-infected women who had been pregnant since 1977, 88% had living children. These women comprised 478 family units (mother and children); 234 (49%) of these units consisted of two or more children. The most common primary caretakers for all children within a family unit were the mother alone (46%), grandparents (16%), and both mother and father (15%). When the mother used injection drugs or lived alone, in a shelter, or with friends, almost one quarter of all children were cared for by their grandparents. Only 30% of the mothers knew about child care assistance services, and only 8% had contacted or used these services. CONCLUSIONS: Mothers with HIV, often alone, are the primary caretakers of their children. Increased provisions for child care assistance and planning for future permanent placement of orphaned children are urgently needed.

Risk behaviors of persons with heterosexually acquired HIV infection in the United States: results of a multistate surveillance project.

To describe past risk behaviors among persons with heterosexually acquired human immunodeficiency virus (HIV) infection, we interviewed 497 persons > or = 18 years of age with heterosexually acquired HIV infection reported to 11 state and city health departments in the United States. Thirty-nine percent of persons reported using noninjection drugs in the past 5 years; noninjection drug use was highest among men whose sex partners injected drugs (53%). Sixteen percent of all persons used crack, and 17% were classified as potential alcoholics; among men, 29% were classified as potential alcoholics. Of the 49% of men who reported paying a woman for sex, 86% did so multiple times. Most persons had multiple sex partners in the past 5 years; however, 35% of the women had only one sex partner. Thirty-four percent of the women and 50% of the men had been treated for a sexually transmitted disease in the past 10 years. Seventy-four percent of the women and 68% of the men had never used condoms in the 5 years before they knew they were HIV positive. Among these people with heterosexually acquired HIV, noninjection drug use was common, many men have paid someone for sex, and many women have not had multiple sex partners. These findings have important implications for the types of prevention programs that can most successfully lessen the spread of HIV among heterosexuals.

Socioeconomic differences among people with AIDS: results from a Multistate Surveillance Project.

To characterize the socioeconomic status of persons with acquired immunodeficiency syndrome (AIDS), 11 U.S. state and city health departments interviewed 2,898 persons > or = 18 years of age reported with AIDS between June 1, 1990, and January 31, 1993. Among men who have sex with men, white men reported the lowest percentage (9%), and Central/South American (50%) and Mexican men (40%) reported the highest percentages not completing 12 years of school. Among intravenous drug users (IDUs), 35% of white men, 64% of black men, 67% of Puerto Rican men, 29% of white women, and 63% of black women had not completed 12 years of school. Overall, 77% of the men and 90% of the women were unemployed; we also found racial/ethnic differences by employment but to a lesser degree than differences in education. Among women, but not among men, differences in household income by race and ethnicity were marked; 76% of white and 91% of black female IDUs reported a household income of $10,000. Human immunodeficiency virus (HIV) prevention programs must be targeted toward the educational level of the populations served, and HIV services must adapt to the financial circumstances of their clientele.

Health insurance coverage among persons with AIDS: results from a multistate surveillance project.

To determine factors associated with health insurance coverage among persons with acquired immunodeficiency syndrome (AIDS), we interviewed 1958 persons 18 years of age or older who were reported to have AIDS in 11 states and cities. Overall, 25% had no insurance, 55% had public insurance, and 20% had private insurance. Factors associated with lack of insurance varied by current employment status. Employed persons with an annual household income of less than $10,000 were 3.6 times more likely to lack insurance than employed persons with a higher income. Unemployed persons diagnosed with AIDS for less than 1 year were two times more likely to lack health insurance than unemployed persons diagnosed for a longer time. Making insurance available to persons identified as most likely to lack insurance should improve access to care for persons with AIDS.

Sociodemographics and HIV risk behaviors of bisexual men with AIDS: results from a multistate interview project.

OBJECTIVE: To describe the sociodemographic characteristics and sexual and drug use behaviors of men with AIDS who engage in bisexual activity. METHODS: We interviewed 2120 men aged > or = 18 years who were reported with AIDS in 11 states and cities. Men were considered bisexual if they reported having had sex with a man and a woman in the previous 5 years. RESULTS: Of the 2020 men with AIDS who reported being sexually active in the previous 5 years, 1150 (57%) had had male partners only, 522 (26%) had had female partners only and 348 (17%) had had both. White men were least likely to report bisexual behavior (15%; 161 out of 1071). Men of Latin American descent were most likely to report bisexual behavior (24%; 37 out of 155), especially those born outside the United States who had lived there for < or = 10 years (38%; 11 out of 29). Bisexual Latin American men, regardless of birthplace, were more likely to be currently married than all other bisexual men (22 versus 7%; P < 0.05). HIV risk behaviors differed between men reporting bisexual and those reporting exclusively homosexual or heterosexual activity. Injecting drug use in the previous 5 years was more common among bisexual than homosexual men (12 versus 6%; P < 0.05). Bisexual men were more likely (P < 0.05) to have received money for sex (11%) than homosexual (4%) or heterosexual men (4%). This difference was even greater among injecting drug users receiving money for sex: bisexual (29%), homosexual (13%), heterosexual (3%). CONCLUSIONS: Demographics and HIV risk behaviors of bisexual men with AIDS differ from those of homosexual and heterosexual men with AIDS. These findings indicate that special efforts are needed to prevent sexual transmission of HIV among bisexual men.

The epidemiology of AIDS in Connecticut.

From 1980 to 30 September 1990, 1,769 Connecticut cases of AIDS have been diagnosed and reported. The epidemiology of AIDS in Connecticut continues to differ from national patterns in several important ways. Intravenous drug users (IVDUs) have been the most prominent source of new cases since 1986 and made up 49% of all cases reported in 1990. Women comprise 20% of the total adult caseload; twice the national average. Connecticut's pediatric cases are 3.3% of total cases, the highest proportion among US reporting areas with 100 or more total AIDS cases. Blacks and Hispanics comprise 55% of cases, although they represent only 11% of the total population of Connecticut. The most recent annual incidence rate for Connecticut is similar to that for the country as a whole (13.3/100,000). However, Connecticut's three central cities had annual incidence rates that are much higher: Bridgeport, 28.7/100,000; New Haven, 55.5/100,000; and Hartford, 64.9/100,000. The Department of Health Services estimates that approximately 12,000 persons in Connecticut are currently infected with the human immunodeficiency virus (HIV). About 4,200 intravenous drug users are already infected. In addition, we estimate that approximately 800 new infections will occur in adults and adolescents each year. Data from various New Haven based seroprevalence studies indicate that seropositivity is high. Among patients in clinics for sexually transmitted diseases, one in every 25 was infected with HIV; among women attending women's health clinics, one in 91 was infected.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV seroprevalence among childbearing women in Connecticut.

A seroprevalence survey of human immunodeficiency virus (HIV) among childbearing women in Connecticut is being conducted as one of the family of HIV seroprevalence surveys funded by the Centers for Disease Control (CDC). Between 1 April 1989 and 30 March 1990 dried blood specimens submitted from all newborns (45,890) for metabolic screening were examined for HIV antibodies by standard laboratory techniques in a blinded manner. The overall HIV prevalence rate was 0.30% (138 newborns). Rates did not differ significantly by mother's age group in the overall population. Rates of seropositivity were higher among blacks (1.2%) and Hispanics (0.69%) than among whites (0.10%). Seropositivity by town was highest in New Haven (1.6%) where one in every 63 residents who gave birth was infected. Based upon this survey, we estimate that 45 HIV-infected children were born in Connecticut during the one-year study period and that approximately 2,300 women of childbearing age are currently infected.

Infection control practices in Connecticut's skilled nursing facilities.

Questionnaires were sent to all skilled nursing homes in Connecticut as part of a larger study of nosocomial infections, infection risks, and infection control programs. This article describes surveillance practices, isolation practices, control measures, and employee health activities of skilled nursing homes in Connecticut. The overwhelming majority of skilled nursing homes used written criteria to determine nosocomial infections, and all undertook surveillance; the majority did surveillance at least weekly and 21% did on a daily basis. The most frequent source of information for reporting infections were microbiology reports and information from the charge nurse. Three fourths of the skilled nursing homes stated that the responsibility of reporting communicable disease is that of the infection control practitioner. Two thirds of the skilled nursing homes stated that they had policies on the reporting of isolation practices, including the refusal or acceptance of patients with infections; 38% had residents under isolation precautions. Of all the patient care control measures, only that of changing urinary catheters on a routine basis was associated with facility size. More than 90% of facilities reported having an employee health program, but the benefit was limited.

Infection control practitioners and committees in skilled nursing facilities in Connecticut.

All skilled nursing facilities (SNFs) in Connecticut were surveyed and more than 71% responded to a Centers for Disease Control-funded project, a component of which is reported herein. The study describes the infection control practitioner (ICP), assistance provided ICPs from external sources, and infection control committees. Almost all ICPs received some training in infection control and worked in the field for an average of 3 1/2 years. Both the number of hours devoted to infection control and the percentage of time spent by the ICP on infection control activities increased with the size of the facility. More than one half of the ICPs in SNFs have relationships with hospital ICPs. The majority of SNF infection control committees met quarterly. The chairperson most often was a physician, although ICPs held this office in almost one third of the reporting SNFs. We conclude that ICPs in Connecticut SNFs have increased in number and that they devote more time and effort to infection control than in previous years.

Epidemiological and clinical features of 1,149 persons with Lyme disease identified by laboratory-based surveillance in Connecticut.

Laboratory-based surveillance of Lyme disease in Connecticut during 1984 and 1985 identified 3,098 persons with suspected Lyme disease; 1,149 were defined as cases. Lyme disease incidence in Connecticut towns ranged from none to 1,407 cases per 100,000 population in 1985. A comparison of 1985 data with data from 1977 epidemiologic studies indicated that incidence increased by 129 percent to 453 percent in towns previously known to be endemic for Lyme disease and that Lyme disease had spread northward into towns thought to be free of Lyme disease in 1977. Children aged five to 14 years had the highest incidence. Of persons with Lyme disease, 83 percent had erythema migrans, 24 percent had arthritis, 8 percent had neurologic sequelae, and 2 percent had cardiac sequelae. The distribution of symptoms was age-dependent: case-persons less than 20 years old were almost twice as likely to have arthritis than older case-persons (35 percent versus 18 percent). Of persons with arthritis, 92 percent of those less than 20 years of age, compared to 68 percent of older persons, did not have antecedent erythema migrans. We conclude that Lyme disease is increasing in incidence and geographic distribution in Connecticut. Of those with Lyme disease, children may be more likely than adults to develop arthritis and have it as their first major disease manifestation.

Survey of purchasers of The APIC Curriculum for Infection Control Practice: findings and recommendations.

A survey of purchasers of The APIC Curriculum for Infection Control Practice was conducted in early 1985 by the APIC Curriculum Committee to determine characteristics of purchasers, usability of the text, reasons for purchase, and availability of references cited. Data were obtained from 342 (54.3%) respondents to a nationwide mail survey sent to a 20% sample (630) of all who were purchasers prior to January 1985. The average purchaser was an Infection Control Practitioner (ICP) who was a nurse employed by an acute care community hospital and had 6.9 years experience in infection control practice; 41% of purchasers worked in hospitals with greater than 300 beds. APIC members represented 93% of the respondents, and their disciplines were similar to those of the membership. Primary reasons for purchasing the Curriculum were to use it as the major reference for infection control information and to study for the Infection Control Certification Examination. Almost half of the respondents had taken and passed the examination. The overall satisfaction with format and style suggests that it was well-received and usable. Purchase of the Curriculum was strongly associated with hospital size. ICPs practicing in hospitals with less than 100 beds were less likely to have purchased the book than those in larger hospitals. Availability of references was also associated with hospital size. Future editions of the Curriculum need to reflect consideration of the relationship between hospital size and availability of references in their approach to completeness of information.(ABSTRACT TRUNCATED AT 250 WORDS)

A cluster of Acinetobacter Pneumonia in foundry workers.

In a 3-month period, three men who had worked for 5 to 19 years as welders or grinders of steel castings in a foundry acquired pneumonia caused by Acinetobacter calcoaceticus variety anitratus serotype 7J. Two of the men died, and postmortem examination showed mixed-dust pneumoconiosis with iron particles in the lungs. A calcoaceticus variety anitratus serotype 7J was isolated from the air in the foundry but the source was not found. The prevalence of antibody titers of 64 or greater to the 7J strain was significantly higher among foundry workers (15%) than among community controls (2%) (p less than 0.01). Sampling showed that the concentrations of total and metallic particles (especially iron) and of free silica in air inhaled by welders and grinders at the foundry frequently exceeded acceptable levels. These findings suggest that chronic exposure to such particles may increase susceptibility to infection by this organism, which rarely affects healthy people.

An epidemic of resistant Salmonella in a nursery. Animal-to-human spread.

A Salmonella heidelberg epidemic in a hospital nursery was traced to infected calves on a dairy farm where the mother of the index patient lived. The Salmonella isolates from all cases were resistant to chloramphenicol, sulfamethoxazole, and tetracycline. Verification of the spread of infection from the farm animals to a hospital population is unusual and raises questions about the hazards of antibiotic animal-feed preparations that may induce infection with resistant organisms in humans.