The AIDS Pandemic: Impact on Science and Society
Regular price
45.250 KD
inc. VAT
Couldn't load pickup availability
Table of contents
- Cover
- Contentsv
- Contributorsvii
- Prefacexi
- About the Editorsxvii
- Introduction1
- New Century, New World: Scientific Advances in AIDS3
- Prevention Works5
- Globalization7
- Social and Ethical Dimensions9
- References11
- 1 Virology13
- History of the Discovery of HIV15
- AIDS Denial17
- HIV-related Retroviruses of Monkeys18
- HIV-2 – HIV Closely Related to SIV20
- HIV-1 Subtypes21
- Emergence of HIV-1 Disease Phenotypes23
- Viral Load and HIV Pathogenesis24
- Primary HIV Infection and Viral Setpoint26
- HIV Therapy and Viral Load27
- What the Future Holds28
- References29
- 2 Immunology in the Era of HIV/AIDS36
- Introduction36
- A Brief History of Immunology (from Silverstein, 1989)37
- Contributions of Modern Immunology to the Understanding and Treatment of HIV/AIDS40
- Technological Advances40
- Molecular immunology40
- The monoclonal antibody revolution41
- High-throughput single-cell assays42
- Conceptual Advances43
- HIV adaptive immunity43
- Innate immunity46
- Mucosal immunology48
- Mechanisms of immune evasion by viruses50
- Applications of New Discoveries to HIV/AIDS Prevention and Treatment51
- Vaccines51
- Topical microbicides52
- Immunotherapy53
- What the Future Holds54
- References55
- 3 Quantitative Science58
- Lessons60
- Lesson No. 1: Long-term, Excellent Follow-up is Important61
- Lesson No. 2: Pragmatic and Explanatory Trials are Needed66
- Lesson No. 3: Randomized Trials and Observational Studies are Both Important71
- Challenges76
- Challenge No. 1: Creating Lasting, Cost-effective Infrastructures77
- Challenge No. 2: Achieving Simplicity and Cost-effectiveness Without Jeopardizing Trial Conduct and79
- Challenge No. 3: Recruiting and Training Investigators to Participate in Collaborative Trials81
- Summary82
- References83
- 4 The Public Health Response to HIV/AIDS: What Have We Learned?90
- Building San Francisco’s AIDS Program90
- Decision-Making92
- Service Needs95
- Cultural Competency and Privacy97
- Adapting the Disease Prevention Model98
- Advocacy102
- Single-Issue Advocacy103
- New Tactics104
- What the Future Holds105
- References107
- 5 AIDS and Sexually Transmitted Disease Prevention and Control110
- The San Francisco Perspective111
- Origins of STD Control112
- Evolution of HIV Prevention Outside of STD Control Programs115
- STDs and HIV Transmission116
- STD Treatment and HIV Prevention117
- Behavioral Risk Reduction and STD Prevention120
- Condom Policy and Distribution121
- STDs in HIV Surveillance122
- HIV Counseling and Testing in STD Clinics123
- HIV Prevention as STD Control123
- Recreational Drug Use and Risk125
- The Internet and STD Transmission and HIV Prevention127
- Impact of HIV Therapy and HIV Medication Advertising128
- Post-exposure HIV Prophylaxis (PEP) in STD Clinics129
- Venue Notification130
- Collaboration with Community-based Organizations131
- What the Future Holds131
- References133
- 6 HIV Treatment Meets Prevention: Antiretroviral Therapy as Prophylaxis137
- HIV Transmission140
- Antiretroviral Therapy for Prevention143
- The Pharmacology of ART in the Genital Tract143
- Antiretroviral Drugs Reduce Shedding of HIV in the Genital Tract144
- Will ART Reduce Sexual Transmission of HIV?145
- Other Considerations: New Thinking about the HIV-infected Subject148
- Stage of HIV Infection148
- Behavior Change148
- Resistance149
- Prevention Versus Treatment149
- ART for Pre- and Post-exposure Prophylaxis for HIV-negative People150
- Animal Studies150
- Post-exposure Prophylaxis for Vertical Transmission150
- Needlestick Injury150
- Post-exposure Prophylaxis (PEP) for Sexual Transmission of HIV151
- Limitations of PEP152
- Cost Benefit Analysis of PEP to Prevent Sexual Transmission of HIV153
- CDC Guidelines for Non-occupational HIV Exposure (n-PEP) 2004153
- Pre-exposure Prophylaxis153
- What the Future Holds154
- References155
- 7 Challenges in Developing HIV Vaccines162
- The Process of Vaccine Testing164
- Preclinical Testing165
- Clinical Safety and Immunogenicity Studies165
- Clinical efficacy studies166
- Scientific Challenges167
- Humoral and Cellular Immune Responses168
- Models of Protection168
- Immune Correlates of Protection169
- Evasion of the Immune Response170
- Viral Diversity171
- The Vaccine Pipeline172
- Ethical challenges173
- Research in Vulnerable Populations173
- Need to Support HIV Prevention in all Vaccine Trial Participants175
- Vaccine-induced Positive Antibody Tests176
- Access to HIV Vaccines and Treatment for Vaccine Trial Volunteers177
- Developing and Testing Products for the Developing World179
- Practical Challenges in Implementing Clinical Trials180
- Building Clinical Trials Infrastructure181
- Regulatory Issues182
- Economic Considerations183
- Public Health Challenges184
- What the Future Holds185
- References187
- 8 Microbicides190
- Impact of HIV on the Development of Microbicides191
- Parallel Tracks192
- A New Dynamic193
- Defining and Describing the Technology195
- How Microbicides Work196
- Targeting the Incoming Pathogen198
- Blocking the Invader and Strengthening the Host Physical Barriers, Lubrication, Maintenance or En198
- Viral Disruption: Inactivation or Disruption of Membranes202
- Inhibition of Viral Entry and Fusion – Targeting the Viral Envelope202
- Targeting the Host Mucosal Cells, Inhibition of Viral Entry and Fusion – Targeting Receptors and C204
- Inhibiting Replication205
- Looking for Combinations205
- Devices and Desires210
- Microbicides Growing Up210
- The Players212
- Alliance for Microbicide Development (AMD)213
- Family Health International (FHI)213
- Global Campaign for Microbicides (GCM)213
- Global Microbicide Project (GMP)213
- International Family Health (IFH)214
- International Partnership for Microbicides (IPM)214
- Microbicides Development Programme (MDP)214
- Population Council215
- Funding Development Efforts215
- The Public Sector: Government Agencies and Institutions217
- The Philanthropic Sector217
- Microbicides Going Forward218
- Challenges in the Science219
- Basic understandings219
- Other models220
- Clinical evaluation221
- Formulation221
- Clinical trial design222
- Clinical trial infrastructure223
- The Future223
- Assuring access and use223
- Partial effectiveness, condom ‘migration,’ and the public health impact of microbicides224
- Access and the regulatory route225
- Common Cause and Shared Learning226
- What the Future Holds228
- References229
- 9 AIDS Behavioral Prevention: Unprecedented Progress and Emerging Challenges236
- Progress in AIDS Prevention Science237
- Health Psychology Jumpstarted HIV/Sexually Transmitted Disease (STD) Prevention237
- Theoretical Framework for Prevention238
- Phases of Behavioral Prevention Research239
- Phase I: Discovery Phase of Behavioral Prevention Research239
- Phase II: Exploratory Phase of Behavioral Prevention Research240
- Phase III: Efficacy Phase of Behavioral Prevention Research240
- Phase IV: Effectiveness Phase of Behavioral Prevention Research241
- Levels of Prevention242
- Individual-level Interventions243
- Couple-level Interventions243
- Family-level Interventions245
- Community-level Behavioral Prevention Studies245
- Societal-level Interventions247
- Model development248
- Policy development248
- Communications248
- Mass media programs249
- Environmental interventions249
- Contributions of Behavioral HIV/STD Prevention Research250
- Challenges for International Behavioral Research251
- Cross-cultural Adaptation251
- Trained Behavioral Prevention Personnel252
- Research Infrastructure252
- Ethical Conduct of Research253
- What the Future Holds254
- Globalization of HIV/STD Prevention Research254
- Modeling of Prevention Strategies254
- Multiple-level Sustainable Interventions255
- References255
- 10 The Evolution of Comprehensive AIDS Clinical Care261
- Understanding Chronic Viral Immunosuppression263
- Adapting the Care Environment266
- The National US Response267
- New Judicial Protections268
- Transforming Infection Control271
- A New Care Model272
- AIDS Specialty Practice273
- Short-term Versus Long-term Care278
- What the Future Holds279
- The Future of HIV Clinical Care in the US279
- The Future of HIV Clinical Care Internationally280
- Directly Observed Antiretroviral Therapy282
- References283
- 11 The Ever-changing Face of AIDS: Implications for Patient Care286
- AIDS in the World: The Current Situation287
- Stopping AIDS: How have We Done so Far?293
- Limitations to the Current Paradigm294
- AIDS: Access to Care295
- Treating HIV Among the Poor: Integrating Prevention and Care297
- Brazil: Expanding Access to ARV299
- Treating HIV Among the Poor: Community-based Approaches299
- What the Future Holds302
- References304
- 12 Economics307
- Summary of the Current Situation308
- Economic Evolution of the HIV Epidemic in the United States313
- Early Period: Chaos, Catastrophe, and Costly Hospitalizations313
- Middle Period: Transition to Integration Under Subsidy315
- Late Period: Pervasive Effects of Powerful Treatments317
- What the Future Holds320
- References321
- 13 Expanding Global Access to ARVs: The Challenges of Prices and Patents324
- Expanding Access to Treatment325
- Pricing Pharmaceuticals327
- Responding to International Pressures to Lower Prices for AIDS Drugs328
- How Patents Affect Drug Prices332
- International Agreements Affecting Patents: The WTO and TRIPS334
- How TRIPS Affects Access to ARVs336
- Patents for AIDS Medicines337
- Approaches for Expanding Access to Medicines for HIV/AIDS339
- Market-based Approach339
- Differential Pricing340
- Trade Policy-based Approaches341
- Bulk Purchasing342
- Donations342
- What the Future Holds343
- 1. Financing344
- 2. Procurement345
- 3. Infrastructure345
- 4. Stigma and Discrimination345
- 5. Testing and Availability of Diagnostics346
- 6. Treatment Protocols346
- 7. Operational Experience346
- Acknowledgments347
- References347
- 14 The African Experience351
- How Different Countries in Africa are Affected352
- Risk Factors for HIV Infection in Africa356
- Population Migration356
- Truck drivers356
- Migrant labor357
- Gender358
- Youth358
- Sex Workers359
- Sexually Transmitted Infections359
- Consequences of the AIDS Epidemic in Africa359
- HIV Prevention in Africa362
- Responses of African Governments362
- Prevention Successes in Africa362
- Prevention in the Workplace364
- Increasing Access to Condoms364
- Universal Education in Uganda364
- Community-based Programs in Response to HIV/AIDS364
- Prevention Gaps in Africa365
- Provision of Condoms365
- Provision of Voluntary Counseling and Testing366
- Targeted Behavioral Interventions366
- Prevention of Mother-to-Child Transmission366
- Broad-based HIV/AIDS Awareness367
- Diagnosis and Treatment of Sexually Transmitted Infections367
- Supportive Initiatives367
- HIV-related Treatment and Care in Africa367
- What the Future Holds369
- References371
- 15 Asia: Health Meets Human Rights374
- AIDS Enters South-East Asia380
- The Thai Experience381
- Confronting Traditional Sex Roles382
- The Thai Government Responds383
- Empowering Women, Protecting Society384
- Drug Use and Trafficking387
- Blood Transfusion389
- Widening Access to Modern Care390
- What the Future Holds392
- References395
- 16 How HIV/AIDS Changed Gay Life in America: And What Others Can Learn from Our Experience398
- Mobilizing the Community400
- Gay Leaders Step Forward400
- Beginnings of a Gay Health Network and Movement401
- A Tremendous Outpouring of Support402
- Preventing the Spread of HIV402
- Defining ‘Safe Sex’403
- Targeted and Explicit Prevention Works Best404
- Prevention Education Worked – for a While405
- Pushing Medicine’s Limits406
- People with AIDS – Not Victims407
- Information is Power408
- Buyers’ Clubs409
- A New Way of Doing Medical Research – at the Community Level410
- Learning to Do Politics Washington-Style411
- AIDS and the Gay Movement411
- Emergence of the AIDS Lobby412
- The Power of Coalitions413
- The Politics of Mourning415
- A Community in Mourning415
- Mourning Rituals to De-Stigmatize AIDS416
- Looking Ahead417
- Prevention Politics Continue418
- Rethinking Prevention419
- Empowering Health Consumers420
- What the Future Holds421
- References422
- 17 Drug Use424
- Historical Perspective425
- Opiates425
- Stimulants426
- Drug Treatment427
- The Advent of the AIDS Epidemic428
- Worldwide Epidemic429
- Interventions Targeting Behaviors430
- Community Outreach and Bleach Syringe-Cleaning Protocols430
- Harm Reduction431
- Increasing Access – Needle Exchange432
- Health-Related Services at Needle Exchange433
- Scientific Evidence for Needle Exchange434
- Increasing Access – a Sterile Syringe for Every Injection435
- Increasing Legal Access to Sterile Syringes435
- Syringe Prescription436
- Interrupting Sexual Transmission Among MSM Drug Users437
- Treating HIV-Infected Drug Users438
- What the Future Holds441
- References443
- 18 Management of HIV/AIDS in Correctional Settings449
- Epidemiology and Background450
- Survival Experience452
- HIV Transmission in Prisons453
- HIV and Co-morbid Conditions456
- HIV and Tuberculosis456
- Hepatitis C Virus458
- Hepatitis B Virus460
- Sexually Transmitted Diseases: Syphilis, Gonorrhea, and Chlamydia461
- Mental Illness461
- Obstetric and Gynecologic Issues463
- Illicit Drug Use and Prisoners463
- Treatment of Opiate Addiction464
- Methadone464
- Naltrexone465
- Buprenorphine465
- Medical Treatment of HIV-infected Prisoners466
- Adherence to ART and Dispensing Medications Within Prison468
- HIV Testing and Housing Policies470
- Confidentiality471
- Education471
- Other Prevention Measures473
- Discharge Planning474
- Discharge Planning and Community Linkages474
- AIDS Research475
- Legal Issues in US Prisons476
- Prison Hospice478
- What the Future Holds479
- Acknowledgements479
- References480
- 19 Medical Ethics and the Law488
- The Right to Privacy489
- HIV Prevention and Consent494
- Impact on Research Ethics497
- Antidiscrimination Law498
- Criminal Law503
- Incarceration is a Public Health Issue505
- Access to Pharmaceuticals505
- What the Future Holds508
- References509
- Index511
- A511
- B513
- C515
- D518
- E519
- F519
- G520
- H521
- I523
- J525
- K525
- L525
- M525
- N526
- O527
- P527
- Q530
- R530
- S530
- T533
- U535
- V535
- W536
- Y537
- Z537
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
* 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