“Something of an Adventure”: Postwar NIH Research Ethos and the Guatemala STD Experiments

2013 ◽  
Vol 41 (3) ◽  
pp. 697-710 ◽  
Author(s):  
Kayte Spector-Bagdady ◽  
Paul A. Lombardo
Keyword(s):  
Sex Workers ◽  
Psychiatric Patients ◽  
Transmitted Disease ◽  
Medical Community ◽  
Sexually Transmitted ◽  
Expert Analysis ◽  
History Of ◽  
Research Standards ◽  
Scientific Value ◽  
History Of Medical Ethics

Since their revelation to the public, the sexually transmitted disease (STD) experiments in Guatemala from 1946 to 1948 have earned a place of infamy in the history of medical ethics. During these experiments, Public Health Service (PHS) researchers intentionally exposed over 1,300 non-consenting Guatemalan soldiers, prisoners, psychiatric patients, and commercial sex workers to gonorrhea, syphilis, and/or chancroid under conditions that have shocked the medical community and public alike. Expert analysis has found little scientific value to the experiments as measured by current or contemporaneous research standards.Such an obvious case of research malfeasance, which violated research norms in place both in the past and now, has been uniformly repudiated. The Guatemala STD experiments were labeled “clearly unethical” by President Barack Obama and “reprehensible” by the Secretaries of State and Health and Human Services.

The role of sex worker clients in transmission of HIV in Cambodia

2005 ◽  
Vol 16 (2) ◽  
pp. 170-174 ◽  
Author(s):  
Leng Bun Hor ◽  
Roger Detels ◽  
Sopheab Heng ◽  
Phalkun Mun
Keyword(s):  
Sex Workers ◽  
Hiv Transmission ◽  
Control Strategies ◽  
Transmitted Disease ◽  
Hiv Knowledge ◽  
Sex Worker ◽  
Sexually Transmitted ◽  
Hiv Test ◽  
History Of ◽  
High Level

The study investigated whether clients of sex workers are a bridge for transmission of HIV to the general population of Cambodia. We interviewed and collected blood from 468 clients attending 30 randomly selected brothels in three provinces of Cambodia. The levels of HIV knowledge and condom use, and prevalence of HIV (9.2%) were high. Almost 40% of those interviewed had sex with women other than sex workers (wives, girlfriends, etc.), but rarely used condoms. Sexually transmitted disease (STD) rates were high, but most sought treatment from pharmacies. HIV infection was correlated with a history of STD, having had an HIV test, not living with one's wife, a high level of HIV/AIDS knowledge, and condom slippage/breakage. Clients are a major bridge for HIV transmission from sex workers. Current condom promotion programmes need to target non-sex worker intercourse. More effective, acceptable STD-control strategies need to be implemented and evaluated.

Co-infection with genital gonorrhoea and genital chlamydia in female sex workers in Yunnan, China

2006 ◽  
Vol 17 (5) ◽  
pp. 329-332 ◽  
Author(s):  
Xiang-Sheng Chen ◽  
Yue-Ping Yin ◽  
Guo-Jun Liang ◽  
Xiang-Dong Gong ◽  
Hua-Sheng Li ◽  
...  
Keyword(s):  
Sex Workers ◽  
Female Sex Workers ◽  
Vaginal Discharge ◽  
Transmitted Disease ◽  
Clinical Information ◽  
Gonococcal Infection ◽  
Structured Interviews ◽  
Sexually Transmitted ◽  
Female Sex ◽  
Control Programmes

An observational study on prevalence of co-infection with gonorrhoea and chlamydia was conducted among female sex workers (FSWs) in Kunming, China. A total of 505 FSWs participated in the study. All eligible participants gave informed consent. Demographic, behavioural and clinical information of the participants was gathered by direct structured interviews. Tampon swabs were collected to test for Chlamydia trachomatis and Nesseria gonorrhoeae. One-hundred and twenty-four (24.6%) FSWs were co-infected with these two pathogens. Of the 191 FSWs with gonorrhea, 124 (64.9%, 95% confidence interval [CI] = 57.9–71.3%) were co-infected with chlamydia which was significantly higher than the proportion (41.9%, 95% CI = 36.4–47.6%) co-infected with gonorrhoea among 296 FSWs with chlamydia ( P < 0.001). Only 47 of 191 (24.6%) FSWs with gonococcal infection and 28 of 124 (22.6%) with co-infection with gonorrhoea and chlamydia reported vaginal discharge. The results of the study justify the recommendation in the national sexually transmitted disease (STD) guidelines that patients infected with gonorrhoea also be treated routinely with an anti-chlamydial regimen. However, a periodic mass treatment may be considered in some circumstances in STD control programmes to rapidly reduce the infections in this population.

scholarly journals 945. Prevalence of HIV Associated Non-AIDS Conditions and Associated Risk Factors among Hospitalized HIV-infected Patients in India

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S504-S505
Author(s):  
Amyeo A Jereen ◽  
Celia Kucera ◽  
Saniya Pervin ◽  
Muralidhar Varma ◽  
Radhakrishnan Rajesh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transmitted Disease ◽  
Multivariate Logistic Regression Analysis ◽  
Patient Risk ◽  
Sexually Transmitted ◽  
Factors Associated ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Artery Disease ◽  
Associated Risk Factors

Abstract Background HIV-associated non-AIDS (HANA) conditions are becoming common as People Living with Human Immunodeficiency Virus (PLWHIV) age. However, data estimating the prevalence of HANA conditions and associated risk factors is lacking in developing countries. This study evaluates reasons for hospitalizations among PLWHIV in Udupi, India in the antiretroviral era, and describes associated risk factors. Methods Demographic and clinical data were extracted from medical charts of 1280 HIV-infected patients 18 years and older who were admitted to Kasturba Hospital, Manipal, India between January 1, 2013 and December 31, 2017, for a total of 2157 hospitalizations. Primary reasons for hospitalization were categorized into AIDS-defining vs Non-AIDS-defining and HANA vs Non-HANA conditions (Fig 1). Multivariate logistic regression analysis was performed to estimate demographic and clinical factors associated with hospitalizations due to AIDS-defining illness and HANA conditions. Categorization of Reasons for Hospitalization Results Patients’ median age was 45 (18-80) years; 70% male. Median age of patients with AIDS-defining illness (45% of hospitalizations) was lower at 44 (18-75) years compared with HANA (15% of hospitalizations) at 48 (21-80) years. Age (OR, 95% CI) (0.985, 0.974-0.995), admission CD4 (0.998, 0.997 - 0.998), history of hypertension (HTN) (0.59, 0.42-0.82), stroke (0.49, 0.24 - 0.93), diabetes (1.56, 1.10 - 2.19), and AIDS-defining cancers (1.74, 1.05 - 2.89) were associated with AIDS-defining hospitalizations (Fig 2). Additionally, age (1.016, 1.001 - 1.031), history of HTN (1.70, 1.16 - 2.46), coronary artery disease (CAD) (4.02, 1.87- 9.02), chronic kidney disease (CKD) (2.30, 1.15 - 4.61), stroke (2.93, 1.46 - 5.96), Hepatitis B (3.32, 1.66- 6.72), Hepatitis C (16.1, 2.84 - 314), sexually transmitted disease (STD) (3.76, 1.38- 10.8), and HANA-associated cancer (2.44, 1.28- 6.42) were associated with HANA hospitalizations (Fig 3). Patient Risk Factors for AIDS-related Hospitalization Patient Risk Factors for HANA-related Hospitalization Conclusion Prevalence of HANA conditions was lower than AIDS-defining illnesses possibly because of a younger population. Patients with AIDS-defining illnesses were also likely to have HANA conditions. Early detection and effective treatment of both HIV and HANA conditions is essential to decrease hospitalizations in low-resource settings. Disclosures All Authors: No reported disclosures

Demographic Change, Prostitution, and Sexually Transmitted Infection Rates in China

2016 ◽  
Author(s):  
Avraham Ebenstein ◽  
Ethan J. Sharygin
Keyword(s):  
Sex Work ◽  
Sex Workers ◽  
Census Data ◽  
Supply And Demand ◽  
Transmitted Infection ◽  
Demand And Supply ◽  
Sexually Transmitted ◽  
Policy Responses ◽  
Large Numbers ◽  
History Of

China has experienced an explosion in the sex ratio at birth, with 25 million more men than women younger than 20 (2005 census). This chapter examines the implications of large numbers of men failing to marry on the supply-and-demand dynamics of sex work, with a focus on how this affects the prevalence of sexually transmitted infections (STIs). The chapter begins with a history of prostitution in China and describes the massive increase in sex work following economic reforms in the late 1970s. It then analyzes the current dynamics of demand and supply for sex work in China, using national census data and detailed microdata on sex workers. The authors find a clear link between high-population sex ratios, the prevalence of sex work, and STI rates. The analysis concludes with projections for the future and a discussion of policy responses in light of an anticipated increase in sex work.

Prevalence of HIV-1, HIV-2 and HTLV antibody, in Fortaleza, Ceara, Brazil, 1993-1994

1996 ◽  
Vol 7 (5) ◽  
pp. 365-369 ◽  
Author(s):  
N. Broutet ◽  
A. de Queiroz Sousa ◽  
F. Placido Basilio ◽  
H. Luis Sa ◽  
F. Simon
Keyword(s):  
Pregnant Women ◽  
Sex Workers ◽  
Transmitted Disease ◽  
Risk Groups ◽  
Northeastern Brazil ◽  
Cross Sectional ◽  
Sexually Transmitted ◽  
T Lymphotropic Virus ◽  
Commercial Enzyme Immunoassay ◽  
Hiv 1

To evaluate the respective part of HIV-1, HIV-2 and human T lymphotropic virus (HTLV) infection in Fortaleza, the principal city of the Ceara state (Northeast of Brazil), a cross-sectional seroepidemiological survey was conducted from July 1993 to February 1994 in 6 selected groups: pregnant women, tuberculosis (Tb) patients, sexually transmitted disease (STD) patients, female and male commercial sex workers (CSWs) and prisoners. Sera were screened by Mixt HIV-1/HIV-2 commercial enzyme immunoassay and ELISA HTLV I/II. Each serum found positive by ELISA was confirmed by Western blot. A total of 2917 persons were interviewed, of whom 2754 (94.4%) agreed to participate and gave a blood sample. Twenty-eight were found to be HIV-1 antibody positive. The prevalence ranged from 0.25% in pregnant women to 2.9% in male CSWs. The prevalence was 1% in STD patients and 0.44% in Tb patients. None of the sera was found positive for HIV-2. The prevalence of antibodies to HTLV-I varied from 0.12% in pregnant women to 1.21% in female CSWs. Five sera were positive for HTLV-II. These results confirm the hypothesis that the HIV epidemic in Northeastern Brazil is still limited to high risk groups. Repeated cross-sectional surveys of this type should be performed as a surveillance tool to study the dynamics of this epidemic in low prevalence areas. Defining risk factors should allow targeting of intervention strategies.

Determination of factors associated with condom use among women infected with human immunodeficiency virus

1997 ◽  
Vol 8 (4) ◽  
pp. 229-233 ◽  
Author(s):  
Rebecca A Clark ◽  
Patricia Kissinger ◽  
Ariane L Bedimo ◽  
Patrice Dunn ◽  
Helena Albertin
Keyword(s):  
Human Immunodeficiency Virus ◽  
Condom Use ◽  
Transmitted Disease ◽  
Convenience Sample ◽  
Sexually Transmitted ◽  
Younger Age ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Hiv Women

Summary: To better understand potential barriers to condom use and the sexual behaviour of women infected with human immunodeficiency virus (HIV), an anonymous self-administered survey was performed on a convenience sample of 83 predominantly single HIV+ women. Most women had only one sexual partner who usually knew of the subject's serostatus. Only a minority of partners (26%) were known to also be HIV infected. Subjects were surprisingly more likely to use condoms with their main partner as opposed to other partners. Factors found to be associated with condom non-use included younger age, low education level, partner HIV+, history of a sexually transmitted disease (STD), and use of drugs or alcohol during sex. Although most subjects indicated the decision was mutual when deciding not to use a condom, 20% stated it a was a partner decision. Future intervention efforts should target these identified high-risk individuals and optimally involve the partners of HIV-infected women.

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