The AIDS pandemic : impact on science and society

✍ Scribed by Kenneth H Mayer; Hank Pizer

• Publisher: Elsevier Academic Press
• Year: 2005
• Tongue: English
• Leaves: 560
• Category: Library

✦ Synopsis

The AIDS Pandemic explores the ways in which HIV/AIDS has, and continues to transform the wide range of related disciplines it touches. Novel perspectives are provided by a unique panel of internationally recognised experts who cover the unprecedented impact onf AIDS on culture, demographics and politics around the world, including how it affected the worlds' economy, health sciences, epidemiology and public health. This important far- reaching analysis uses the lessons learned from a wide array of disciplines to help us understand the current status and evolution of the pandemic, as it continues to evolve. * Unique and timely presentation of new theories and perspectives * Concentrates on the changes that have taken place in a broad array of related disciplines * Provides key contextual information, for those new to the field or at interface areas between disciplines * Includes an international focus on evolving African and Asian experiences * Focuses on the current strategies for developing vaccines and microbicides * Outlines harm reduction and prevention programs * Explores issues related to delivery of life-saving AIDS medications in resource-constrained environments.  Read more... Virology / Phyllis J. Kanki and Myron E. Essex -- Immunology in the era of HIV/AIDS / Deborah J. Anderson -- Quantitative science / James D. Neaton -- The public health response to HIV/AIDS : what have we learned? / Mitchell H. Katz -- AIDS and sexually transmitted disease prevention and control / Jeffrey D. Klausner -- HIV treatment meets prevention : antiretroviral therapy as prophylaxis / Myron S. Cohen and Mina C. Hosseinipour -- Challenges in developing HIV vaccines / Laurence Peiperi and Susan Buchbinder -- Microbicides / Polly F. Harrison and Trisha L. Lamphear -- AIDS behavioral prevention : unprecedented progress and emerging challenges / Willo Pequegnat -- The evolution of comprehensive AIDS clinical care / Kenneth H. Mayer and Sreekanth K. Chaguturu -- The ever-changing face of AIDS : implications for patient care / Jennifer Furin, David Walton and Paul Farmer -- Economics / Samuel A. Bozzette -- Expanding global access to ARVs : the challenges of prices and patents / Michael R. Reich and Priya Bery -- The African experience / Salim S. Abdool Karim -- Asia : health meets human rights / Chris Beyrer, N. Kumarasamy and H.F. Pizer -- How HIV/AIDS changed gay life in America : and what others can learn from our experience / John-Manuel Andriote -- Drug use / Patricia Case and Steffanie A. Strathdee -- Management of HIV/AIDS in correctional settings / Frederick L. Altice and Sandra A. Springer -- Medical ethics and the law / Zita Lazzarini and Jonathan E. Von Kohorn

✦ Table of Contents

Cover......Page 1
The AIDS Pandemic: Impact on Science and Society......Page 4
Contents......Page 6
Contributors......Page 8
Preface......Page 12
About the Editors......Page 18
Introduction......Page 24
New Century, New World: Scientific Advances in AIDS......Page 26
Prevention Works......Page 28
Globalization......Page 30
Social and Ethical Dimensions......Page 32
References......Page 34
1 Virology......Page 36
History of the Discovery of HIV......Page 38
AIDS Denial......Page 40
HIV-related Retroviruses of Monkeys......Page 41
HIV-2 – HIV Closely Related to SIV......Page 43
HIV-1 Subtypes......Page 44
Emergence of HIV-1 Disease Phenotypes......Page 46
Viral Load and HIV Pathogenesis......Page 47
Primary HIV Infection and Viral Setpoint......Page 49
HIV Therapy and Viral Load......Page 50
What the Future Holds......Page 51
References......Page 52
Introduction......Page 59
A Brief History of Immunology (from Silverstein, 1989)......Page 60
Molecular immunology......Page 63
The monoclonal antibody revolution......Page 64
High-throughput single-cell assays......Page 65
HIV adaptive immunity......Page 66
Innate immunity......Page 69
Mucosal immunology......Page 71
Mechanisms of immune evasion by viruses......Page 73
Vaccines......Page 74
Topical microbicides......Page 75
Immunotherapy......Page 76
What the Future Holds......Page 77
References......Page 78
3 Quantitative Science......Page 81
Lessons......Page 83
Lesson No. 1: Long-term, Excellent Follow-up is Important......Page 84
Lesson No. 2: Pragmatic and Explanatory Trials are Needed......Page 89
Lesson No. 3: Randomized Trials and Observational Studies are Both Important......Page 94
Challenges......Page 99
Challenge No. 1: Creating Lasting, Cost-effective Infrastructures......Page 100
Challenge No. 2: Achieving Simplicity and Cost-effectiveness Without Jeopardizing Trial Conduct and Patient Safety......Page 102
Challenge No. 3: Recruiting and Training Investigators to Participate in Collaborative Trials......Page 104
Summary......Page 105
References......Page 106
Building San Francisco’s AIDS Program......Page 113
Decision-Making......Page 115
Service Needs......Page 118
Cultural Competency and Privacy......Page 120
Adapting the Disease Prevention Model......Page 121
Advocacy......Page 125
Single-Issue Advocacy......Page 126
New Tactics......Page 127
What the Future Holds......Page 128
References......Page 130
5 AIDS and Sexually Transmitted Disease Prevention and Control......Page 133
The San Francisco Perspective......Page 134
Origins of STD Control......Page 135
Evolution of HIV Prevention Outside of STD Control Programs......Page 138
STDs and HIV Transmission......Page 139
STD Treatment and HIV Prevention......Page 140
Behavioral Risk Reduction and STD Prevention......Page 143
Condom Policy and Distribution......Page 144
STDs in HIV Surveillance......Page 145
HIV Prevention as STD Control......Page 146
Recreational Drug Use and Risk......Page 148
The Internet and STD Transmission and HIV Prevention......Page 150
Impact of HIV Therapy and HIV Medication Advertising......Page 151
Post-exposure HIV Prophylaxis (PEP) in STD Clinics......Page 152
Venue Notification......Page 153
What the Future Holds......Page 154
References......Page 156
6 HIV Treatment Meets Prevention: Antiretroviral Therapy as Prophylaxis......Page 160
HIV Transmission......Page 163
The Pharmacology of ART in the Genital Tract......Page 166
Antiretroviral Drugs Reduce Shedding of HIV in the Genital Tract......Page 167
Will ART Reduce Sexual Transmission of HIV?......Page 168
Behavior Change......Page 171
Prevention Versus Treatment......Page 172
Needlestick Injury......Page 173
Post-exposure Prophylaxis (PEP) for Sexual Transmission of HIV......Page 174
Limitations of PEP......Page 175
Pre-exposure Prophylaxis......Page 176
What the Future Holds......Page 177
References......Page 178
7 Challenges in Developing HIV Vaccines......Page 185
The Process of Vaccine Testing......Page 187
Clinical Safety and Immunogenicity Studies......Page 188
Clinical efficacy studies......Page 189
Scientific Challenges......Page 190
Models of Protection......Page 191
Immune Correlates of Protection......Page 192
Evasion of the Immune Response......Page 193
Viral Diversity......Page 194
The Vaccine Pipeline......Page 195
Research in Vulnerable Populations......Page 196
Need to Support HIV Prevention in all Vaccine Trial Participants......Page 198
Vaccine-induced Positive Antibody Tests......Page 199
Access to HIV Vaccines and Treatment for Vaccine Trial Volunteers......Page 200
Developing and Testing Products for the Developing World......Page 202
Practical Challenges in Implementing Clinical Trials......Page 203
Building Clinical Trials Infrastructure......Page 204
Regulatory Issues......Page 205
Economic Considerations......Page 206
Public Health Challenges......Page 207
What the Future Holds......Page 208
References......Page 210
8 Microbicides......Page 213
Impact of HIV on the Development of Microbicides......Page 214
Parallel Tracks......Page 215
A New Dynamic......Page 216
Defining and Describing the Technology......Page 218
How Microbicides Work......Page 219
Blocking the Invader and Strengthening the Host – Physical Barriers, Lubrication, Maintenance or Enhancement of Normal Microflora, Mobilization of Natural Defense…......Page 221
Inhibition of Viral Entry and Fusion – Targeting the Viral Envelope......Page 225
Targeting the Host Mucosal Cells, Inhibition of Viral Entry and Fusion – Targeting Receptors and Co-receptors......Page 227
Looking for Combinations......Page 228
Microbicides Growing Up......Page 233
The Players......Page 235
Global Microbicide Project (GMP)......Page 236
Microbicides Development Programme (MDP)......Page 237
Funding Development Efforts......Page 238
The Philanthropic Sector......Page 240
Microbicides Going Forward......Page 241
Basic understandings......Page 242
Other models......Page 243
Formulation......Page 244
Clinical trial design......Page 245
Assuring access and use......Page 246
Partial effectiveness, condom ‘migration,’ and the public health impact of microbicides......Page 247
Access and the regulatory route......Page 248
Common Cause and Shared Learning......Page 249
What the Future Holds......Page 251
References......Page 252
9 AIDS Behavioral Prevention: Unprecedented Progress and Emerging Challenges......Page 259
Health Psychology Jumpstarted HIV/Sexually Transmitted Disease (STD) Prevention......Page 260
Theoretical Framework for Prevention......Page 261
Phase I: Discovery Phase of Behavioral Prevention Research......Page 262
Phase III: Efficacy Phase of Behavioral Prevention Research......Page 263
Phase IV: Effectiveness Phase of Behavioral Prevention Research......Page 264
Levels of Prevention......Page 265
Couple-level Interventions......Page 266
Community-level Behavioral Prevention Studies......Page 268
Societal-level Interventions......Page 270
Communications......Page 271
Environmental interventions......Page 272
Contributions of Behavioral HIV/STD Prevention Research......Page 273
Cross-cultural Adaptation......Page 274
Research Infrastructure......Page 275
Ethical Conduct of Research......Page 276
Modeling of Prevention Strategies......Page 277
References......Page 278
10 The Evolution of Comprehensive AIDS Clinical Care......Page 284
Understanding Chronic Viral Immunosuppression......Page 286
Adapting the Care Environment......Page 289
The National US Response......Page 290
New Judicial Protections......Page 291
Transforming Infection Control......Page 294
A New Care Model......Page 295
AIDS Specialty Practice......Page 296
Short-term Versus Long-term Care......Page 301
The Future of HIV Clinical Care in the US......Page 302
The Future of HIV Clinical Care Internationally......Page 303
Directly Observed Antiretroviral Therapy......Page 305
References......Page 306
11 The Ever-changing Face of AIDS: Implications for Patient Care......Page 309
AIDS in the World: The Current Situation......Page 310
Stopping AIDS: How have We Done so Far?......Page 316
Limitations to the Current Paradigm......Page 317
AIDS: Access to Care......Page 318
Treating HIV Among the Poor: Integrating Prevention and Care......Page 320
Treating HIV Among the Poor: Community-based Approaches......Page 322
What the Future Holds......Page 325
References......Page 327
12 Economics......Page 330
Summary of the Current Situation......Page 331
Early Period: Chaos, Catastrophe, and Costly Hospitalizations......Page 336
Middle Period: Transition to Integration Under Subsidy......Page 338
Late Period: Pervasive Effects of Powerful Treatments......Page 340
What the Future Holds......Page 343
References......Page 344
13 Expanding Global Access to ARVs: The Challenges of Prices and Patents......Page 347
Expanding Access to Treatment......Page 348
Pricing Pharmaceuticals......Page 350
Responding to International Pressures to Lower Prices for AIDS Drugs......Page 351
How Patents Affect Drug Prices......Page 355
International Agreements Affecting Patents: The WTO and TRIPS......Page 357
How TRIPS Affects Access to ARVs......Page 359
Patents for AIDS Medicines......Page 360
Market-based Approach......Page 362
Differential Pricing......Page 363
Trade Policy-based Approaches......Page 364
Donations......Page 365
What the Future Holds......Page 366
1. Financing......Page 367
4. Stigma and Discrimination......Page 368
7. Operational Experience......Page 369
References......Page 370
14 The African Experience......Page 374
How Different Countries in Africa are Affected......Page 375
Truck drivers......Page 379
Migrant labor......Page 380
Youth......Page 381
Consequences of the AIDS Epidemic in Africa......Page 382
Prevention Successes in Africa......Page 385
Community-based Programs in Response to HIV/AIDS......Page 387
Provision of Condoms......Page 388
Prevention of Mother-to-Child Transmission......Page 389
HIV-related Treatment and Care in Africa......Page 390
What the Future Holds......Page 392
References......Page 394
15 Asia: Health Meets Human Rights......Page 397
AIDS Enters South-East Asia......Page 403
The Thai Experience......Page 404
Confronting Traditional Sex Roles......Page 405
The Thai Government Responds......Page 406
Empowering Women, Protecting Society......Page 407
Drug Use and Trafficking......Page 410
Blood Transfusion......Page 412
Widening Access to Modern Care......Page 413
What the Future Holds......Page 415
References......Page 418
16 How HIV/AIDS Changed Gay Life in America: And What Others Can Learn from Our Experience......Page 421
Gay Leaders Step Forward......Page 423
Beginnings of a Gay Health Network and Movement......Page 424
Preventing the Spread of HIV......Page 425
Defining ‘Safe Sex’......Page 426
Targeted and Explicit Prevention Works Best......Page 427
Prevention Education Worked – for a While......Page 428
Pushing Medicine’s Limits......Page 429
People with AIDS – Not Victims......Page 430
Information is Power......Page 431
Buyers’ Clubs......Page 432
A New Way of Doing Medical Research – at the Community Level......Page 433
AIDS and the Gay Movement......Page 434
Emergence of the AIDS Lobby......Page 435
The Power of Coalitions......Page 436
A Community in Mourning......Page 438
Mourning Rituals to De-Stigmatize AIDS......Page 439
Looking Ahead......Page 440
Prevention Politics Continue......Page 441
Rethinking Prevention......Page 442
Empowering Health Consumers......Page 443
What the Future Holds......Page 444
References......Page 445
17 Drug Use......Page 447
Opiates......Page 448
Stimulants......Page 449
Drug Treatment......Page 450
The Advent of the AIDS Epidemic......Page 451
Worldwide Epidemic......Page 452
Community Outreach and Bleach Syringe-Cleaning Protocols......Page 453
Harm Reduction......Page 454
Increasing Access – Needle Exchange......Page 455
Health-Related Services at Needle Exchange......Page 456
Scientific Evidence for Needle Exchange......Page 457
Increasing Legal Access to Sterile Syringes......Page 458
Syringe Prescription......Page 459
Interrupting Sexual Transmission Among MSM Drug Users......Page 460
Treating HIV-Infected Drug Users......Page 461
What the Future Holds......Page 464
References......Page 466
18 Management of HIV/AIDS in Correctional Settings......Page 472
Epidemiology and Background......Page 473
Survival Experience......Page 475
HIV Transmission in Prisons......Page 476
HIV and Tuberculosis......Page 479
Hepatitis C Virus......Page 481
Hepatitis B Virus......Page 483
Mental Illness......Page 484
Illicit Drug Use and Prisoners......Page 486
Methadone......Page 487
Buprenorphine......Page 488
Medical Treatment of HIV-infected Prisoners......Page 489
Adherence to ART and Dispensing Medications Within Prison......Page 491
HIV Testing and Housing Policies......Page 493
Education......Page 494
Other Prevention Measures......Page 496
Discharge Planning and Community Linkages......Page 497
AIDS Research......Page 498
Legal Issues in US Prisons......Page 499
Prison Hospice......Page 501
Acknowledgements......Page 502
References......Page 503
19 Medical Ethics and the Law......Page 511
The Right to Privacy......Page 512
HIV Prevention and Consent......Page 517
Impact on Research Ethics......Page 520
Antidiscrimination Law......Page 521
Criminal Law......Page 526
Access to Pharmaceuticals......Page 528
What the Future Holds......Page 531
References......Page 532
A......Page 534
B......Page 536
C......Page 538
D......Page 541
F......Page 542
G......Page 543
H......Page 544
I......Page 546
M......Page 548
N......Page 549
P......Page 550
S......Page 553
T......Page 556
V......Page 558
W......Page 559
Z......Page 560