Rationale for an HIV / AIDS prevention and mitigation strategy for Africa: combatting the multisectoral impact of the epidemic.

Unlike most infectious diseases in Africa, HIV/AIDS affects the urban elite as well as the rural poor, and generally during their most economically productive years. An increase in deaths among young adults of the magnitude predicted is likely to have substantial adverse effects on economic, political, and military/security stability throughout Africa. AIDS is causing increased stress on fragile African economic infrastructures as labor productivity declines, particularly in agricultural, labor-dependent economies. AIDS is causing obstacles to trade, foreign investment and tourism. Health systems and social coping mechanisms already are overburdened. High rates of HIV infection among police and military personnel threaten internal security. Furthermore, the demobilization of military forces in Africa may exacerbate the epidemic when HIV-infected soldiers return home and spread the virus. This presentation will illustrate why African AIDS Programs must be expanded to mitigate the multisectoral impact of the epidemic while preserving its spread.

Complex, humanitarian emergencies: III. Measures of effectiveness.

Complex humanitarian emergencies lack a mechanism to coordinate, communicate, assess, and evaluate response and outcome for the major participants (United Nations, International Committee of the Red Cross, non-governmental organizations and military forces). Success in these emergencies will depend on the ability to accomplish agreed upon measures of effectiveness (MOEs). A recent civil-military humanitarian exercise demonstrated the ability of participants to develop consensus-driven MOEs. These MOEs combined security measures utilized by the military with humanitarian indicators recognized by relief organizations. Measures of effectiveness have the potential to be a unifying disaster management tool and a partial solution to the communication and coordination problems inherent in these complex emergencies.

Clinical, haematological and parasitological response to treatment of visceral leishmaniasis in Kenya. A study of 64 patients.

Sixty four Kenyan patients with visceral leishmaniasis were treated with sodium stibogluconate (Pentostam) (40 patients) or various combinations of Pentostam and allopurinol (24 patients). Three patients, initially considered cured after Pentostam, relapsed but responded to further treatment. Sixty two were cured and two patients died. The treatment and the clinical, haematological and parasitological response to treatment are described in detail. If follow up is impossible or unlikely it is advised to continue treatment until parasitological cure is obtained. Prolonged courses of Pentostam, which were required in some patients, resulted in cures and apparently were non toxic. Consideration is to be given to extended treatment with Pentostam before more toxic drugs such as pentamidine and amphotericin B are given.

Clinical presentation of visceral leishmaniasis in Kenya: a prospective study of 64 patients.

Clinical and laboratory findings of a series of 64 consecutive patients with visceral leishmaniasis are presented. The diagnosis was established by demonstration of parasites in splenic aspirates. Findings are discussed in comparison with those of former reports from Kenya and elsewhere.

Prevalence and disease spectrum in a new focus of visceral leishmaniasis in Kenya.

A cross-sectional community study was conducted in the village of Kivaa in Machakos District, Kenya, to determine the prevalence and disease spectrum of visceral leishmaniasis. The disease was first diagnosed in 1978. Demographic data was collected from 50 households comprising 374 individuals. Clinical examination, laboratory investigations and leishmanin skin tests were performed. The results showed that in spite of the presence of a susceptible population, visceral leishmaniasis occurred with a low prevalence in Kivaa as evidenced by the small number of individuals with active disease (0.30%), a low leishmanin positivity rate (7.2%) and the presence of leishmanial antibodies in only 3.7% of the population. The infection affected individuals in homesteads with or without nearby termite hills. Leishmanial antibodies and leishmanin positivity were found among asymptomatic household contacts of patients as well as in isolated individuals in non-infected homesteads. These findings suggest the existence of a spectrum of disease ranging from asymptomatic to self-healing to severe clinical illness. Furthermore, there was significant clustering of leishmanin reactors in the households of patients. The aetiology of this striking focality of visceral leishmaniasis remains obscure. Possible explanations are discussed.

Allopurinol in the treatment of visceral leishmaniasis.

Allopurinol was used in the treatment of 10 patients with kala-azar. Of six patients who had previously failed to respond satisfactorily to Pentostam, "cures" were achieved in four. However, it was necessary to add Pentostam to the allopurinol in one, and another relapsed after apparent "cure" but again responded to allopurinol. The response of four patients who had had no previous treatment for kala-azar was less satisfactory.