In the first 10 years of AIDS epidemic in China, intravenous drug users (IDUs) and Former Plasma Donors (FPDs) were hardly hit in the late 1980s and mid 1990s respectively. In the last 10 years, while IDU epidemic keeps at a fast pace, sexual transmitted cases of HIV have been steadily increasing. All signs indicate that the HIV epidemic in China is at a turning point, spreading from high risk groups to the general population. Learning from the SARS epidemic, China has recently launched an impressive AIDS campaign by making serious political commitments, and by strengthening the public health system and implementing an aggressive Four Free One Care Policy. There remains huge challenges both at the societal level which form the roots of the AIDS epidemic and at increasing the capabilities of the implementation teams. In addition to other needed efforts, enhancing AIDS research through international collaborations will strengthen China's ability to conduct her huge control program efficiently. Only with a scientific approach and evidence-based strategy, can China seize the opportunity to stop AIDS at an early stage. China reported its first HIV/AIDS cases among hemophiliac patients in Zhejiang province in 1985 . There wIn the early 1990s, the epidemic was mainly along the southwest border regions where more than two-thirds of China's total reported cases of HIV/AIDS originated. The majority of affected people were IDUs, who accounted for about 70% of the country's total reported cases . In the The large scale blood contamination events among plasma donors were quickly controlled within a short period of time after they were discovered . HoweverThe HIV/AIDS epidemic in China has deep roots in a weakened social structure as well as a health infrastructure which are the products of economic reforms from the past two to three decades. Understanding the root causes of these problems is key to finding long-term, effective solutions. For one thing, AIDS must not be treated simply as a medical problem. Social roots for the spread of AIDS include unbalanced development between eastern and western regions of the country; poverty; huge mobile population; inadequate investment in public health; as well as social problems such as drug abuse and prostitution. The most seriously hit population and regions are where social and public health problems are rampant rendering a large number of people vulnerable to infectious diseases. In China, the AIDS epidemic is predominantly among farmers in underdeveloped southwest and northwest border regions as well as inland agricultural provinces. It has been debated in China whether the government should or should not bear the responsibility of providing treatment to AIDS patients. For many years, the AIDS control program in China had only a prevention arm, without treatment and care components. There was no incentive for people to go in for testing, and many people living with HIV/AIDS hid in fear of discrimination.The SARS epidemic in 2003 was a wake-up call for the Chinese government and society as a whole. It has now been widely recognized that public health is not merely a medical issue but rather a security issue, affecting economic growth and social stability. On World AIDS Day 2003, Premier Jiabao Wen announced a new national AIDS control policy, "Four Frees and One Care" , free Prevention of Mother to Child Transmission (PMCT) and free schooling for AIDS orphans, and provision of social relief for HIV patients). By the end of 2005, 20,453 AIDS patients were receiving antiretroviral therapy in 605 counties within 28 provinces. The policy was a breakthrough for China's AIDS control program and had a profound impact even far beyond the AIDS field. The new policy reconnects prevention and treatment, long lost chain in AIDS control work in China. With the government providing free testing and treatment, people living with HIV/AIDS and people at risk are now voluntarily seeking testing and collaborating more frequently with health care workers. Since the adoption of the new policy, there has been a two-fold increase in newly detected cases of HIV/AIDS. In the meantime, more than twelve thousand patients have been treated, and thousands of lives have been saved.There are many challenges facing China in implementing the Four Frees and One Care policy and other new initiatives. Bottlenecks impeding rapid and effective implementation of AIDS control programs are no longer political or financial issues. Rather, the greatest problem is the lack of technical capacity, in particular, a shortage of well-trained public health professionals who can manage large scale programs as well as experienced clinical teams who can provide care to patients in rural areas. Even though many early stage HIV/AIDS cases have been identified due to large scale screening programs in the last two years , only abThe recent policy breakthrough and new initiatives on AIDS have shown that the Chinese government is fully committed to solving today's public health problems like it did in the 1950s to 1970s. Public health being high on the political agenda has led to significant funding increases and mobilization of public health agencies and local communities. As a result, one can be confident that the AIDS epidemic will be effectively controlled in China in the same way as her past successful history of controlling other infectious diseases. At the same time, what remains concerning is that the national context has changed from a planned economy to a market economy in today's China. Novel disease control measures suitable to the current social and economic structures need to be developed. This can only be achieved through focused research efforts with large groups of scientists specializing in both basic and applied research. China's AIDS research infrastructure is still not adequately established. In ARV treatment and many other AIDS research areas, Chinese researchers have limited experience. Therefore, international collaboration in AIDS research is urgently needed to build up and strengthen China's AIDS research infrastructure. Most of the current international AIDS programs in China do not have a research component. We should encourage both Chinese and international AIDS researchers to work more closely together in the future. Their research collaboration will help China formulate evidence-based treatment, prevention, and control strategies, which can be the bedrock for long-term, effective management of China's national AIDS control programs.


In China, the national plan to open 1000 methadone clinics over a five-year period provides a unique opportunity to assess the impacts of harm reduction in a country with concentrated HIV epidemic amongst heroin users. To track the progress of this public health response, data were collected from the first methadone clinic in Liuzhou, Guangxi, a province with a high HIV prevalence. In the first 15 months of its operation, a cumulative total of 488 heroin users, 86% of which male, had joined the programme. The first dose of methadone was given efficiently at a median of 2 days after registration. Of the 240 heroin users attending the clinic in August 2006, 61% took methadone for four days or more each week. The number of active methadone users, however, leveled off at around 170 after the first two months, despite the availability of capacity to deliver more services. The reasons for this observation are: firstly, the provision of one single service that may not be convenient to all heroin users; and secondly, concerns of heroin users who may feel insecure to come forward. As broad  coverage is essential in ultimately reducing HIV risk, a low threshold  approach is crucial, which should be supported by the removal of  social obstacles and a refinement of the administrative procedures. The epidemic of heroin addiction has fuelled the global spread of HIV, a phenomenon that is clearly visible in many parts of Asia . The groThere are lessons to be learned from the recent initiatives of China where the HIV spread in heroin users has taken root in some provinces, especially those bordering the Golden Triangle . Of the Liuzhou is the second largest city of Guangxi. The reported number of heroin users in the Liuzhou City is around 7000. The clinic is housed within the Skin and Sexually Transmitted Disease Clinic of the City's Centre for Disease Control. While the Clinic is not situated at the heart of the City, it's within reach (3 Km radius) from where most heroin users cumulate. The Clinic is staffed by 5 doctors, 1 counselor, 2 nurses, 2 pharmacists and other supporting administrative personnel. We reviewed the case records and workload statistics of the Clinic since the clinic's opening in May 2005. An unstructured interview of 10 randomly selected clients was conducted by two of the authors at the clinic. Approval was sought from the local health department. Ethical approval was obtained from the Ethics Committee of the Chinese University of Hong Kong.Overall, between 11 and 56 (mean = 35) new drug users each month registered at the Liuzhou Methadone Clinic since its opening. As of the end of August 2006, a cumulative total of 488 heroin users, 86% of which male, had joined the programme. Registration is required for joining the programme, with the following entry criteria: (a) heroin use for over one year; (b) age 20 or above; (c) resident of the city; and (d) having passed the physical checkup. Individual application is then submitted for official endorsement by the authorised office. The first dose of methadone is given at a median of 2 days after registration (range: 0 to 9 working days). Of the 240 heroin users attending the clinic in August 2006, 61% took methadone at least 4 days each week.The number of active methadone users has however leveled off at around 170 after the first two months  declare that they have no competing interests.SL and MH conceptualized the study; YT collected data and conducted analysis; SL and TY conducted the interviews; ML, ZG and JM participated in data analysis and contributed to study design; SL prepared the manuscript and incorporated opinions from all others.


And Africa: cradle of humankind, burdened by colonization, famine, poverty and civil war. In what ways do ethics, AIDS and Africa go together, and how is our thinking challenged by their relationship?Ethics, AIDS, and Africa – three concepts that conjure up a host of powerful associations. Ethics: our fragile human attempts to negotiate acceptable paths through conflicts of value. AIDS: the world's deadliest epidemic since the Black Plague of the 14Editors Van Niekerk and Kopelman have assembled an impressive list of well-respected authors to deal with this question. Their contributions focus on the impact of AIDS in sub-Saharan Africa and take on some of the key ethical issues raised by HIV/AIDS research, policy and clinical practice in the region. Although rich in details, it is fair to say that four general themes dominate this book: the ethical role of national governments in tackling the AIDS epidemic, with special focus on the South African case; the epidemic and responses to it as reflections of global inequity; the ethical responsibilities of pharmaceutical companies in the struggle against HIV/AIDS, and the dilemmas involved in HIV prevention research, particularly in vaccine studies.For a book on ethics, there is an unusual amount of agreement. None of the authors seriously doubts the terrifying social impact HIV/AIDS is currently having in sub-Saharan Africa. There is general condemnation of the lack of leadership and intransigence of the South African government in its approach to both rolling out AIDS treatment and redoubling its HIV prevention efforts. There is also no question among the contributors that poverty, lack of education, gender inequality and inadequate health care infrastructure both fuel the spread of the virus and limit access to treatment, and that tackling the epidemic in Africa is inseparable from larger economic, social, political, human rights and development issues.But there are also interesting cracks in the consensus. Solomon Benatar argues that the AIDS epidemic in Africa has exposed our world as fundamentally inequitable and unstable, and little progress will be made unless current international relations in politics and trade are rethought and remade. Anton Van Niekerk counters that efforts in low-resource countries should focus on what is doable in the short-term, rather than a quixotic pursuit for global reform, and he argues that national governments in Africa cannot be mere passive beneficiaries of international funding – they have an ethical duty to create policies and programs that sustain global AIDS initiatives. David Resnik claims that pharmaceutical companies have ethical responsibilities towards those suffering from AIDS in the developing world, but given the money-making imperatives of big pharma, this responsibility can only realistically take the form of some investment in R&D in the developing world, discounts on drug prices or drug give-aways. For Richard Ashcroft and Udo Schuklenk, such 'charity' on the part of multinational corporations is simply not good enough. When a country is experiencing a devastating public health crisis, compulsory licensing of essential AIDS treatment may be the most effective and ethically justified way of getting medication to those who need it. In this way, Ashcroft and Schuklenk provide the activist slogan "Patients before patents" with a deeper philosophical justification.Kevin De Cock, WHO's Director of the Department of HIV/AIDS, recently stated at the last International AIDS Conference in Toronto that 'we cannot treat our way out of this epidemic.' HIV prevention research and policies are crucial: the former to find novel ways of preventing new infections, and the latter to channel prevention strategies into practice. The chapters by Keymanthri Moodley, Godfrey Tangwa and Melissa Stobie et. al. offer an excellent overview of the ethical and cultural issues encountered in conducting HIV vaccine research in sub-Saharan Africa with adults and children. Both Tangwa and Moodley tantalizingly claim that the informed consent process – cornerstone of the ethical conduct of biomedical research in the West – inappropriately assumes that the African research participant can be separated from his kinship and community ties. What would count as a more 'culturally sensitive' consent process, however, remains elusive. Stobie et. al. usefully discuss the tensions between ethical concerns for individuals and concern for social groups in HIV vaccine research. On the one hand, it would be in the best interest of children as a class for there to be an efficacious HIV vaccine, at least for children growing up in a high HIV prevalence setting. But it may or may not be in an individual child's best interest to participate in an HIV vaccine trial. The discussion of the deep ambiguities in South African laws and guidelines concerning the best interests of children, the limits of parental consent to research involving children and the determination of risk in pediatric studies is both illuminating and sobering. It is not as if laws and guidance on pediatric research are much clearer elsewhere.There are some minor limitations to this book. Although the title refers to Africa, the focus is really on sub-Saharan Africa, with a special emphasis on South Africa. To a certain extent, this is understandable and justified. South Africa has an estimated 5.5 million persons living with HIV and approximately 1000 persons dying of AIDS daily. The South Africa government is a reliable source of bizarre HIV-related publicity, be it the President's embrace of rogue scientists who deny HIV causes AIDS, a health minister who suggests garlic and nutritional supplements are as effective as anti-retrovirals in controlling AIDS, or a previous head of the South African AIDS Council who claims a post-coital shower (after sex with an HIV positive woman) can protect him against the virus. South Africa also, as it turns out, has exceptional centers for bioethics and research ethics at Cape Town and Pretoria. Nevertheless, the book might have profited by looking farther afield and incorporating voices of West and East Africans, and Africans living above the Sahara.Many of the pieces in the book seem to have been originally written around 2001, and therefore the factual data and the ethical commentary based on the data sometimes appear a bit dated. The results of the efforts by the Global Fund, PEPFAR, the Clinton Foundation and the Bill and Melinda Gates Foundation over the last five years are not well-represented. HIV prevention research is currently focused on more on female-controlled methods (microbicides) and controversial surgical interventions  as the development of an effective vaccine still seems a lot way off. Keeping the ethics up to date is clearly a difficult task, given the rapid evolution in disease dynamics and in the political, economic and scientific responses to the HIV/AIDS epidemic.Ethics and AIDS in Africa is a highly illuminating, stimulating and informative guide to the ethical dilemmas faced by researchers, policy-makers and health care providers in the countries hardest hit by HIV/AIDS. The book clearly delivers on its promise that HIV/AIDS, as it continues to ravage low-resource countries of Africa, challenges everyone's ethical thinking.These minor reservations aside,


Dr. Pedro Cahn, International AIDS Society (IAS) President and Mr. Craig McClure, IAS Executive Director, provide their thoughts and analysis on the current and future role of the IAS as part of the global response to HIV/AIDS. In 1981 the first indication of a disturbing new illness that defied medical classification appeared in the Center for Disease Control and Prevention's Morbidity and Mortality Weekly Report [As the world's leading independent association of professionals working in HIV, the International AIDS Society (IAS) has a unique role to play as part of the global response to this epidemic in the decades to come. With over 10,000 members from 171 countries, the IAS represents individuals working at every level of the response, from scientists and clinicians to policymakers and community educators. The IAS was established as a non-profit organization in 1988, with a mandate to organize the biennial International AIDS Conferences, although the Stockholm-based staff remained small and responsibility for organizing the conferences was primarily undertaken by professional conference organizers. That changed in 2004, when the Governing Council of the IAS decided to upgrade its structure by strengthening the professional staff at the secretariat and moving the headquarters to Geneva, Switzerland. The move was intended to strengthen links with other health NGOs and UN multilateral agencies. Since then the IAS secretariat has grown to a professional staff of 30, and the Governing Council has established an ambitious agenda of work for the organization over the coming years, outlined in Stronger Together: Strategic Framework 2005 – 2009, available on the IAS website [An initial priority for the IAS in 2005 was to undertake a comprehensive review of the International AIDS Conference, which had evolved from a small medical meeting in Atlanta in 1984 to a massive, multisectoral health conference attended by over 15,000 participants in Bangkok in 2004, and over 20,000 in Toronto in 2006. The IAS consulted broadly with stakeholders on how to maximize the reach and impact of the conference. The IAS received input through group consultations, confidential interviews, internet fora, and other meetings. The recommendations from those consultations – among others, to improve the quality of science, to broaden diversity, to facilitate cross-disciplinary linkages and dialogue, and to strengthen the focus on youth – began to be implemented in the planning for the XVI International AIDS Conference (AIDS 2006) in Toronto and will be implemented more fully in planning for the XVII International AIDS Conference (AIDS 2008) in Mexico City. The report from the Future Directions project, including detailed recommendations, is available on the IAS website. We are also strengthening the conference's role as an accountability mechanism, a focus reflected in the conference theme of AIDS 2006, Time to Deliver, that has implications across disciplines and the three programme areas of science, community and leadership.In addition to the large international conferences, the IAS also organizes the biennial Pathogenesis, Treatment and Prevention conference, which will be held next in Sydney, Australia, 22–25 July 2007. This is the premier open, international scientific meeting on HIV, and was recently expanded to recognize and encourage the importance of biomedical prevention research. It provides researchers and clinicians with opportunities to hear and discuss the latest advances in HIV research across the three major scientific tracks , and to address how advances in research can be rapidly applied to practice. The IAS is committed to continuously improving the conferences and strengthening their role beyond three or five-day events to become part of an ongoing cycle of education, networking, promotion of best practice and advocacy in the fight against HIV/AIDS.The IAS is also strengthening its commitment to regional development, expanding our involvement in three main areas: collaboration with regional societies, engagement with regional conferences, and supporting and expanding IAS membership in each region. The IAS was a co-organizer of the first Eastern European and Central Asian Conference on AIDS (EECAAC), held 14 – 17 May 2006 in Moscow, and has also provided technical support and advice to other regional conferences including the African regional meeting in Abuja, Nigeria last year. Of course, there is no "one size fits all" approach to regional activities. The unique characteristics of each region require that we build strong relations with key players in each region, learn all we can about the particular issues facing HIV professionals there and tailor our activities to meet the needs and requests for collaboration that we receive.In addition to its conferences and regional development activities, the IAS coordinates several initiatives. The IAS Industry Liaison Forum is a unique initiative designed to accelerate scientifically promising, ethical research in resource-limited settings, with a particularly focus on the role and responsibility of industry as sponsors and supporters of research. ILF supports dialogue between the pharmaceutical industry, independent investigators and major contributors to research investment such as the Bill & Melinda Gates Foundation. The IAS, under both the ILF and our work with the Bill & Melinda Gates Foundation, has become a significant force in placing pre-exposure prevention prophylaxis (PREP) research on the agenda of policymakers and opinion-leaders. The IAS also co-publishes the electronic Journal of the International AIDS Society (eJIAS) with Medscape General Medicine, a peer-reviewed, open-access scientific journal aimed at publishing research focused on the developing world. Under the leadership of Editor Mark Wainberg (who was recently joined by Ugandan clinician Dr. Elly Katabira as Co-Editor), the volume of submissions to this journal has grown rapidly since its launch in July 2004. It is fully indexed on PubMed and available online . The IASThe IAS has been increasingly involved in policy and advocacy debates over the past two years. We have advocated strongly for the availability of methadone and buprenorphine in Eastern Europe and Central Asia, where injecting drug use is fuelling that epidemic; on the need for greater political accountability on setting and meeting treatment and prevention targets through the UNGASS process; on increased investment to train, hire and sustain human resources required for scaling up prevention, treatment and care programmes in the developing world. A detailed policy and advocacy strategy, currently in development, will ensure the IAS is an effective advocate for its membership, bringing its voice and influence on key policy issues, in collaboration with other stakeholders engaged in the response to HIV/AIDS.The role of the IAS as a global knowledge-broker, a facilitator of dialogue, and an independent voice on key HIV/AIDS policy and advocacy issues will strengthen as we move forward in our work in the coming years; the expansion of our membership beyond its traditional base among clinicians and the scientific community requires careful planning in how we develop and deliver training, professional development and networking opportunities to meet the challenges of the coming decades.The IAS has a unique opportunity – and responsibility – to bring together individuals working in diverse settings and disciplines, from areas of the world separated by geography, culture, language and resources, and to leverage the expertise and knowledge of its members in an effective, sustained global response. If there is a lesson to be learned from our history with this disease, it is that we can do far more collectively than we can individually. As the IAS embarks on an ambitious new phase in its development, we are looking forward to strengthening our engagement with the scientific community, while we build new partnership with NGOs, activists and others working on the frontlines of the response. The IAS encourages all professionals working in the HIV/AIDS field to become members. We are convinced that in the struggle against this epidemic we will be stronger together.Pedro Cahn, IAS PresidentCraig McClure, IAS Executive Director


Nigeria has an estimated 3.6 million people with HIV/AIDS and is home to one out of every 11 people with HIV/AIDS worldwide. This study is the first population-based assessment of discrimination against people living with HIV/AIDS in the health sector of a country. The purpose of this study was to characterize the nature and extent of discriminatory practices and attitudes in the health sector and indicate possible contributing factors and intervention strategies. The study involved a cross-sectional survey of 1,021 Nigerian health-care professionals  in 111 health-care facilities in four Nigerian states.Fifty-four percent of the health-care professionals  were sampled from public tertiary care facilities. Nine percent of professionals reported refusing to care for an HIV/AIDS patient, and 9% indicated that they had refused an HIV/AIDS patient admission to a hospital. Fifty-nine percent agreed that people with HIV/AIDS should be on a separate ward, and 40% believed a person's HIV status could be determined by his or her appearance. Ninety-one percent agreed that staff and health-care professionals should be informed when a patient is HIV-positive so they can protect themselves. Forty percent believed that health-care professionals with HIV/AIDS should not be allowed to work in any area of health-care that requires patient contact. Twenty percent agreed that many with HIV/AIDS behaved immorally and deserve the disease. Basic materials needed for treatment and prevention of HIV were not adequately available. Twelve percent agreed that treatment of opportunistic infections in HIV/AIDS patients wastes resources, and 8% indicated that treating someone with HIV/AIDS is a waste of precious resources. Providers who reported working in facilities that did not always practice universal precautions were more likely to favor restrictive policies toward people with HIV/AIDS. Providers who reported less adequate training in HIV treatment and ethics were also more likely to report negative attitudes toward patients with HIV/AIDS. There was no consistent pattern of differences in negative attitudes and practices across the different health specialties surveyed., discriminatory behavior and attitudes toward patients with HIV/AIDS exist among a significant proportion of health-care professionals in the surveyed states. Inadequate education about HIV/AIDS and a lack of protective and treatment materials appear to contribute to these practices and attitudes.While most health-care professionals surveyed reported being in compliance with their ethical obligations despite the lack of resources Results of a survey of attitudes and actions of over 1000 Nigerian health care professionals . With an estimated 3.5 million people with HIV/AIDS, Nigeria is home to one of every 11 of the 40 million people with HIV/AIDS worldwide . AccordiPeople living with HIV/AIDS (PLWA) in Nigeria have been found to be subject to discrimination and stigmatization in the work place, and by family and communities ,6. PLWA Anecdotal information suggests that health-care professionals in Nigeria may engage in discrimination against and stigmatization of PLWA ,15. The At the time of the study, approximately 120,000,000 people were living in the 36 states and Federal Capital Territory of Nigeria . We condThe 104-item health-care professional survey included questions on respondent demographics; practices regarding informed consent, testing, and disclosure; treatment and care of patients with HIV/AIDS; and attitudes and beliefs about treatment and care of patients with HIV/AIDS including informed consent, testing, and disclosure.Treatment and care practices of patients with HIV/AIDS were assessed using Likert-type scales . Attitudes and beliefs were assessed by a response of “agree” or “disagree” with statements regarding testing, treatment, and care of patients with HIV/AIDS.Using a separate 103-item survey instrument, we obtained information about each facility's capacity, resources, and policies from the person in charge of the facility. The questionnaires were written and interviews conducted in English. Seven regional, human rights, and medical experts reviewed the questionnaires for content validity. The instruments were pilot tested among 20 participants in Lagos and suggestions regarding clarity and cultural appropriateness were incorporated.After completing an intensive training program, 24 Nigerian surveyors conducted the survey interviews. Interviewer training consisted of 5 d of classroom teaching and role-playing followed by several days of field observation and ongoing supervision by PHR and Nigerian researchers.All interviews were conducted over 5 wk in October and November 2002. Interviews lasted approximately 20–30 min and were conducted in the most private setting possible within each health-care facility. All questionnaires were reviewed for completeness and for correctness of recording after the interview by the interviewers themselves, by the Nigerian research team leaders, and by PHR field supervisors at the end of each day.In the surveys, informed consent was defined as ensuring that a patient who is competent to make decisions is informed and consulted about his or her care. Respondents were informed that this included the responsibility of the clinician to let the patient know about any procedure or medical decision, reasonable alternatives to it, and the risks, benefits, uncertainties, and possible consequences related to each alternative. The clinician must carry out the discussion in layperson's terms, assess the patient's understanding along the way, and ensure that the patient understands the information and consents to it voluntarily . UniversThis study was reviewed and approved by an independent ethics review board of individuals with expertise in clinical medicine, public health, bioethics, and international HIV/AIDS and human rights research developed for this research project by PHR. In reviewing the research, the review board was guided by the relevant provisions of Title 45 of the US Code of Federal Regulations , and comThe data were analyzed using Stata 7 . To contOf the 163 facilities sampled, 20 were no longer operational; for ten, contact could not be established after two attempts at the time of sampling; and 15 were not eligible. Of the 118 eligible facilities where contact was established, 111 participated in the study . Over half of the facilities were general hospitals (54%) and 23% were primary health centers.Eighty-four percent of facility directors reported not having antiretroviral medications in their facility. Moreover, the availability of other medications and dietary supplements was limited, and protective materials and other supplies and utilities were not always available .Of the 1,103 professionals sampled, 23 were not eligible, five were not available after two attempts at the time of sampling, eight were interrupted during the course of the interview, and 46 refused to participate. Consequently, 1,021 professionals participated in the study (93% response rate). Although we did not gather information on nonrespondents, most of the 46 nonrespondents who refused to participate cited lack of time as the reason they were unable to participate (36), with other nonrespondents citing other obligations (four), fear of reprisal (one), and opposition to the study (three).Professionals were predominantly female (67%) with a mean age of 36 y. Fifty-six percent were nurses, 31% were physicians, and 12% were certified midwives .Most professionals reported having some training on HIV/AIDS . CurrentSeventeen percent of surveyed health-care professionals reported that their facility had a written HIV testing policy . RespondOver 50% of professionals reported obtaining informed consent of patients for HIV tests half of the time or less, including 14% who reported never obtaining consent for HIV tests . Fifty-fNinety-one percent of professionals agreed that staff and health-care professionals should be informed when a patient is HIV-positive so they can protect themselves . Over thForty percent believed that health-care professionals with HIV/AIDS should not be working in any area of the health professions that requires patient contact. Twenty percent of respondents agreed that many of those who have HIV/AIDS behaved immorally and deserve the disease .Providers working in facilities that did not always practice universal precautions  were significantly more likely than those working in facilities that always observed universal precautions to agree that people with HIV/AIDS should not be employed in the health field  and should not work in areas that require patient contact. They also had higher odds of agreeing that under certain circumstances, patients could be tested for HIV without their knowledge or permission  Working in a facility that did not always practice universal precautions, being a nurse or midwife, and reporting inadequate training in HIV/AIDS treatment were all associated with agreeing that patients with HIV/AIDS should be on a separate ward in a hospital or clinic. Nurses and midwives both had more than five times the odds of agreeing that people with HIV/AIDS should not be employed in the health field than doctors and that the charts or beds of HIV patients should be marked. Nurses and midwives also had almost twice the odds of physicians of agreeing that under certain circumstances it is acceptable to test patients for HIV without their consent or knowledge.Among health-care professionals, the three most important concerns about treating patients with HIV/AIDS were fear of becoming contaminated (81%), contamination of facility, materials, or instruments (17%), and not having materials needed to treat them (10%) . SeventyNine percent of professionals reported refusing to care for a patient with HIV/AIDS, and 9% indicated that they had refused a patient with HIV/AIDS admission to a hospital . Sixty-sThirty-eight percent of professionals reported giving confidential information to a patient's family member without the patient's consent, and 53% had observed this behavior. Twelve percent of professionals reported giving confidential information to a person not related to a patient without consent, and 22% had observed this behavior .Providers who reported inadequate training in HIV/AIDS treatment and in ethics were significantly more likely to have refused to treat a patient with HIV/AIDS than those reporting adequate training in those two areas . Providers working in facilities that did not always practice universal precautions were not more likely to have refused care to a patient themselves but were significantly more likely to report having observed other providers refuse to care for a patient with HIV/AIDS . There were no differences among specialties in reporting having refused to care for a patient with HIV/AIDS.To prevent discrimination by health-care professionals against patients with HIV/AIDS, most participants (87%) indicated that health-care professionals who engage in discriminatory practices should be educated and counseled. Health facility policies against discrimination were cited as solutions by 19% of professionals, and stronger laws against discrimination were suggested by 11% .Ninety-four percent indicated that medications to treat opportunistic infections may prolong the life of a patient who is HIV-positive . Over haNurses had higher odds than physicians of agreeing that treating opportunistic infections in patients with HIV/AIDS is a waste of resources , but physicians were 50% more likely than nurses to agree that they could refuse to treat a patient with HIV/AIDS to protect themselves and their family. Respondents who reported inadequate training in HIV/AIDS treatment also were significantly more likely to agree it was acceptable to refuse to treat a patient for these reasons . Physicians had significantly higher odds than either nurses or midwives of agreeing that there were circumstances under which it was appropriate to reveal a person's HIV status to others without the patient's knowledge or permission.Most health-care professionals in the four states where the study was conducted appeared to be providing care to patients who were HIV-positive and complying with their ethical responsibilities despite their lack of training on HIV/AIDS and their having insufficient supplies of materials needed for treatment and prevention in the facilities where they work. A significant number, however, reported engaging in discriminatory and/or unethical behavior. These practices are corrosive to the health professions as they taint all health professionals and erode trust in them. They also represent missed opportunities for prevention, positive living education, and treatment, thereby undermining Nigeria's concerted national efforts to address the HIV/AIDS epidemic. Our study findings suggest that there are several factors that may contribute to such discriminatory and/or unethical behavior by health-care professionals against people with HIV/AIDS in Nigeria.The vast majority of professionals expressed an interest in additional information and suggested education as a way to address discriminatory behaviors by their colleagues. An immediate investment to ensure the education of all existing clinical staff about HIV/AIDS, including modes of transmission, universal precautions, and the rights of PLWA would likely reduce the number of discriminatory practices towards PLWA and may improve these patients' care and access to health services. This assertion is supported by previous studies that demonstrate the effect of HIV/AIDS education of nurses and other health workers on their attitudes and behavior towards patients who are HIV-positive in Nigeria and elsewhere –26. ThesThis study further suggests that the lack of protective and other materials needed to treat and prevent the spread of HIV and related conditions contributes to discriminatory behavior. While the issue of access to affordable antiretroviral treatment is the subject of much debate in Nigeria ,27, manyIn order to do their jobs safely and effectively, health professionals must be provided with adequate supplies of essential protective materials. Further, the lack of basic medications hampers the ability of health professionals to provide appropriate treatment. Without these materials, it is unlikely that education of health professionals and implementation of anti-discrimination policies alone will have the desired impact on practice.It is likely that in other low-resource contexts, the absence of medications needed to treat HIV/AIDS-related illnesses, a lack of materials needed for protection of health personnel, and insufficient knowledge of health personnel about HIV/AIDS may contribute to discriminatory behavior towards people with HIV/AIDS. The role of these factors should be investigated. While addressing these factors may not eliminate all discriminatory behavior, these basic investments in the health-care sector are likely to result in improvements.HIV infection is both a product of and a factor contributing to human rights violations . The docNumerous international and regional human rights instruments, to which Nigeria is a party , protectThe above instruments set out Nigeria's obligations to protect the rights of PLWA including the right to life , the rigSeveral of the instruments to which Nigeria is a party include the right to health –37,40. T1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;(b) The improvement of all aspects of environmental and industrial hygiene;(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.In 2000, the Committee on Economic Social and Cultural Rights (ESCR Committee), responsible for interpretation and monitoring of the International Covenant on Economic, Social, and Cultural Rights, published General Comment 14 on the Right to the Highest Attainable Standard of Health . The ESCIn General Comment 14, the ESCR Committee also set out the core obligations of a state party to protect the right to health, which include ensuring “the right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalized groups,” the provision of essential drugs “as from time to time defined by WHO's Action Programme on Essential Drugs,” and ensuring “equitable distribution of all health facilities, goods and services.” In addition to these and other core obligations, the ESCR Committee also set out “obligations of comparable priority” , including a state party's obligation “to take measures to prevent, treat and control epidemic and endemic diseases,” “to provide education and access to information concerning the main health problems in the community, including methods of preventing and controlling them,” and “to provide appropriate training for health personnel, including education on health and human rights.”The ESCR Committee also stated in General Comment 14 that “any person or group who is a victim of a violation of the right to health should have access to effective judicial or other appropriate remedies at both national and international levels.”As a state party, Nigeria is bound by the provisions of the International Covenant on Economic, Social, and Cultural Rights and the authoritative interpretations of the ESCR Committee. This study finds that some PLWA have been excluded from access to health care because of their HIV status and that, at this time, PLWA have no access to judicial or other remedial processes to address this. The data further suggest that inadequate education of health personnel about HIV/AIDS along with a lack of protective and treatment materials likely contribute to these behaviors by health professionals. It is therefore likely that Nigeria has not met its core obligations to fulfill and protect the right to health. The findings of this study suggest that, in order to fulfill its obligations, the government of Nigeria should continue to address gaps in policy and legislation and work together with the international community to ensure that health professionals receive the training, protective materials, and medications they need to treat PLWA.Rules of Professional Conduct for Medical and Dental Practitioners in Nigeria [International principles of medical ethics and Nigerian codes of conduct clearly provide for patient autonomy, i.e., the right to informed consent and confidentiality of patient information. In addition to representing violations of human rights, the denial of treatment and breaches of informed consent and confidentiality detailed in this paper contravene international principles of medical ethics and Nigerian health professional codes of conduct. The  Nigeria  states tNigerian medical practitioners also have a duty under these rules to report any unethical conduct by their peers to the Medical and Dental Council of Nigeria. According to the rules, “every doctor or dentist must be his brother's keeper, with regard to the observance and indeed the enforcement of the rules and regulations which guide the profession. Doctors and dentists should expose without fear or favour, before the Medical and Dental Council of Nigeria either directly or through the Nigerian Medical Association, any corrupt, dishonest, unprofessional or criminal act or omission on the part of any doctor or dentist.” There is no indication that this may have happened in the case of the breaches documented in this study. At the time of publication, no specific medical ethics principles on HIV and AIDS have been articulated by the Medical and Dental Council of Nigeria.The study was conducted in four states in Nigeria with a total population of 17 million . It is pAlthough the findings of this study can not be generalized to Nigeria as a whole, it is likely that, depending on resources and training available to the health-care sector, the level of discriminatory behavior may differ in other parts of the country.The apparent discrepancy between reported and observed behavior may indicate under- or overreporting of discriminatory behavior or may result from health-care professionals within the same institution having observed the same incidents.While this study focused on HIV/AIDS, it is possible that health-care professionals also engage in inappropriate behavior toward or breach the confidentiality of people with other conditions. The health-care system in Nigeria is underfunded and suffers from fundamental problems including material scarcity and inadequacies in infrastructure, which may contribute to this behavior overall ,42,43. WDespite efforts to ensure privacy during interviews, the lack of privacy, or concern about job status, may have resulted in an underreporting of discriminatory behavior and/or an overreporting of “correct” practices or attitudes. Although interviewers were careful to explain that there would be no material gain or penalty to the respondent or his or her facility from participation in the study, the responses may have been inaccurate if respondents judged it in their material or political interest to exaggerate or conceal certain behaviors.Despite these limitations, the study documents a significant proportion of health professionals in four states in Nigeria as reporting discriminatory attitudes and engaging in discriminatory and unethical behavior toward patients with HIV or AIDS, including denial of care, breach of confidentiality, and non-consented HIV testing. The breaches of confidentiality and testing for HIV without informed consent reported by participants are in contravention of international principles of medical ethics , and arePeople living with HIV/AIDS experience discrimination all over the world, often in both their private and professional lives, and sometimes by health-care personnel, including doctors and nurses.The researchers, who are part of a not-for-profit organization called Physicians for Human Rights, wanted to find out whether discrimination existed among health workers in Nigeria. Nigeria is home to one in 11 people living with HIV/AIDS, and antiretroviral drugs to treat patients are not widely available in the country.They developed a survey and trained interviewers to get answers from 1,021 Nigerian health-care professionals—including 324 physicians, 541 nurses, and 133 midwives—about their attitudes and actions towards patients with HIV/AIDS. These health-care professionals worked in 111 different facilities in four of Nigeria's 36 states. The survey included questions such as “have you refused to care for an HIV/AIDS patient?” and “do you believe that a person's HIV status can be determined by his/her appearance?”They found that while most of the interviewed people said that they treated people with HIV/AIDS in accordance with ethical and medical guidelines, a significant number of them reported attitudes and behavior that the researchers found worrisome. For example, 20% agreed that many individuals with HIV/AIDS had behaved immorally and deserved their infection, and 8% felt that treating someone with HIV/AIDS was a waste of resources. It didn't seem that there were big differences between the three groups . Negative attitudes were higher among people from facilities that were not always able to take precautions against HIV infection (owing to lack of supplies). The same was true for facilities that did not have antiretroviral drugs to treat patients.It means that quite a few of the professionals surveyed—whose job it is to care for patients with HIV/AIDS—have negative attitudes towards them, and some of them have behaved in discriminating ways.It is not clear how representative the attitudes and behaviors reported by the participants in this study are, and future studies in Nigeria and in other countries are necessary to answer that question. Despite its limitations, this study suggests three things might help to reduce discrimination: educating health-care workers about HIV/AIDS and ethics, making sure that all facilities take appropriate precautions against HIV transmission, and making sure that all facilities can provide adequate care for patients with HIV/AIDS, including antiretroviral drugs.Information about stigmatization of people living with AIDS can be found at the following sources.Joint United Nations Program on HIV/AIDS:http://www.unaids.org/en/in+focus/hiv_aids_human_rights/stigma_discrimination.aspUnited Kingdom National AIDS Trust:http://www.areyouhivprejudiced.org/AboutUs.aspxIndian Journal of Medical Ethics:An article from the http://www.issuesinmedicalethics.org/082mi060.htmlhttp://www.phrusa.org/Physicians for Human Rights home page: Physicians for Human Rights Web page on HIV and human rights:http://www.phrusa.org/campaigns/aids/aidsandhr.htmlWHO work on HIV and human rights:http://www.who.int/hhr/activities/publications/en/index.html


Muslim countries, previously considered protected from HIV/AIDS due to religious and cultural norms, are facing a rapidly rising threat. Despite the evidence of an advancing epidemic, the usual response from the policy makers in Muslim countries, for protection against HIV infection, is a major focus on propagating abstention from illicit drug and sexual practices. Sexuality, considered a private matter, is a taboo topic for discussion. Harm reduction, a pragmatic approach for HIV prevention, is underutilized. The social stigma attached to HIV/AIDS, that exists in all societies is much more pronounced in Muslim cultures. This stigma prevents those at risk from coming forward for appropriate counseling, testing, and treatment, as it involves disclosure of risky practices. The purpose of this paper is to define the extent of the HIV/AIDS problem in Muslim countries, outline the major challenges to HIV/AIDS prevention and treatment, and discuss the concept of harm reduction, with a cultural approach, as a strategy to prevent further spread of the disease. Recommendations include integrating HIV prevention and treatment strategies within existing social, cultural and religious frameworks, working with religious leaders as key collaborators, and provision of appropriate healthcare resources and infrastructure for successful HIV prevention and treatment programs in Muslim countries. AIDS is far more than a medical and biological problem . Around In recent years, increasing attention is being paid to the manner in which social and cultural variables influence risk behaviors related to HIV infection transmission. Though the association of contentious ethical and moral issues with HIV risk behaviors exists in all societies, it is much more pronounced in the Muslim world. Thus understanding the role of social and cultural variables affecting HIV transmission in Muslim countries is critical for the development and implementation of successful HIV prevention programs.Harm reduction is a pragmatic philosophy that aims to reduce risks to the individual and the community associated with some often stigmatized, antisocial or illegal behaviors. For HIV/AIDS prevention in Muslim countries, the concept of harm reduction is just as important as in non-Muslim countries. The perspective of harm reduction, developed primarily from work on AIDS and drug problems in the Netherlands [herlands ,4 and Unherlands ,6, is a purpose of this paper is to explore the extent of the HIV/AIDS problem in Muslim countries and discuss the modalities of employing a cultural approach as a strategy for harm reduction and, hence, prevention of further spread of the disease.The The reliability of the available HIV/AIDS incidence, prevalence and mortality data for Muslims is low because many Muslim countries either do not report their statistics or are under-reporting. Global epidemiological indicators, including data from the World Health Organization's Global Health Atlas, do indicate evidence of the burgeoning threat of an HIV/AIDS crisis in Muslim countries. Table The continent of Africa, particularly the southern region, continues to have the highest HIV/AIDS incidence and prevalence rates globally . The numThe under-reporting of HIV and AIDS cases in Muslim countries has serious bearings on disease surveillance and monitoring. In the Eastern Mediterranean Region, an estimated 700,000 people are currently living with HIV/AIDS but only 14,198 AIDS cases have been officially registered since the start of the epidemic, indicating under detection, under-reporting, and surveillance difficulties . Of the Reasons for the spread of HIV in Muslim countries are open to speculations. Islam places a high value on chaste behavior and prohibits sexual intercourse outside of marriage. It specifically prohibits adultery, homosexuality, and the use of intoxicants . Then hoWith regard to curtailing the spread of disease, it is particularly troublesome that a majority of governments in countries with primarily Muslim populations have been slow to respond to the rapidly spreading disease. Despite the evidence of an advancing epidemic, the typical response from the policy makers in Muslim countries is to propagate Muslim ideals, mainly abstention from illicit drug and sexual practices, for protection against HIV infection. Sexuality, considered a private matter, is taboo for discussion. More importantly, there is a denial by most governments in Muslim countries that they are facing an increasing HIV/AIDS threat.The issue of HIV/AIDS prevention in Muslim countries is a complex problem and requires a multifaceted approach with particular attention to cultural norms. In order to devise harm reduction strategies for HIV prevention in these countries, it is important to study the social dynamics and practices of the populations at risk. Analysis of the cultural context in which risk behaviors occur provides meaningful insight into those factors that shape and define the external reality within which these behaviors take place. Knowledge of why people behave in certain ways and the resources available to them becomes helpful in assisting them to access and utilize available preventive and therapeutic resources. In the context of high-risk groups, it is important to understand that even within them, some individuals choose to indulge in risk behaviors while others do not.Philipson and Posner  note thaIn the context of HIV/AIDS prevention and treatment in Muslim countries, the principles of harm reduction or harm minimization can certainly be utilized to prevent or minimize the spread of HIV infection. However, a clear distinction needs to be made that this approach does not advocate illicit drug and sex related practices. The harm reduction concept which has been successfully applied in substance abusers can also be applied to other high risk groups, such as commercial sex workers. Because consistent condom use has been linked to reductions in HIV seroincidence ,20,21, aIn the Muslim World, religion defines culture and the culture gives meaning to every aspect of an individual's life. The following contentious issues need particular attention when designing HIV prevention programs for Muslim countries:In a majority of Muslim societies, there exists an imbalance in power between men and women, which is apparent in heterosexual relations as well as in the economic and social spheres of life – with men having greater power than women. For most women, the private life within the sanctuary of their houses is their whole life. Women remain uneducated and deprived of resources, making them unaware of their civil, legal and sexual rights, economically vulnerable and largely dependent on men. Due to these inequalities, women are more susceptible to contracting HIV/AIDS as they are less likely to be able to negotiate with their partners infected with HIV/AIDS. Women also are easy targets for abusive relationships and are less able to cope with illness once infected.The social stigma attached to HIV/AIDS that exists in all societies is much more pronounced in Muslim cultures due to the religious doctrine regarding illicit sex and drug related practices. There are greater negative sanctions for illicit sexual conduct than drug use. Even if there is a suspicion of illicit sexual conduct, the affected person(s) is discriminated against and shunned by the family as well as by the community. The stigma attached to risk behaviors thus prevents those at risk from coming forward for appropriate counseling, testing and treatment, as this would involve disclosure of their risky practices. This results in creating barriers to successful implementation of prevention and treatment strategies where they do exist.In developed countries, a majority of the population is aware of the modes of transmission for HIV infection, whereas in the developing countries, misconceptions about the disease and its causes are rampant. Most persons residing in Muslim countries assume that all HIV infections are transmitted only through immoral sexual behaviors and are unaware that it can also be transmitted inadvertently through mother-to-child, accidental pricking of skin and contact with contaminated blood  or the possibility of an innocent spouse getting infected by the husband who may have acquired HIV though sexual or drug related contact with other infected persons. Therefore, due to lack of education, expression of compassion towards HIV/AIDS patients is perceived as tolerance towards the practices that lead to acquiring the infection.In addition to the issues outlined above, the main challenges to instituting an HIV prevention approach include poverty and economic instability, lack of education, wars, internal conflicts, refugees, migrant labor forces, intimidating role of religious leaders and activists, and lack of healthcare resources and infrastructure.In summary, the existing social, cultural and religious frameworks in Muslim countries do not provide an environment for any safe disclosure for persons who are infected. Hence, the development of effective prevention and support services is often impeded. Meanwhile, growing gender imbalances in HIV rates among women, and the tendency for the virus to be found disproportionately among marginalized and disadvantaged populations throughout the Muslim world, mirror deeply entrenched systems of societal inequality that help to fuel further spread of the epidemic. For those who are not educated, cultural expectations are very difficult to disregard. Containment of the HIV/AIDS epidemic in Muslim countries depends on a combination of individual and community level efforts to effect change in behavior and lifestyle to break the chain of transmission.There is an urgent need for developing and implementing policy and programs that provide AIDS education and awareness, prohibit stigmatization, and advocate compassion. Like most religions, Islam condemns homosexuality, drug use, and sex outside of marriage. Though the most important means of protection is obviously abstinence from sex and to remain faithful to the marriage partner, however, Muslims must recognize that in many instances there is a gap between religious teaching and practice; risky behaviors that may not be allowed by Islam are indeed practiced. The main challenge is how to bridge this gap. Religious scholars seem to be divided on the concept of harm reduction. In countries where HIV/AIDS is a rapidly rising threat, such as Uganda  and IndoAny effort directed at harm reduction and HIV prevention needs to take into consideration the powerful impact of religious leaders in the community as they play a critical role in Muslim culture. It is important to be cognizant of the reality that religious leaders take issue with harm reduction strategies due to the moral issue involved with the idea of harm reduction. There is a perception  that promoting safe injection and sex related practices will promote illicit drug and sex behaviors. Hence, for HIV prevention programs to be successful, collaboration with religious scholars and leaders is a key element. It is critical to win their confidence and educate them.  Not all cases of HIV and AIDS are contracted through needle exchange or sexual intercourse, and second, regardless of the route of transmission, once a person is infected, he/she should not be treated as a criminal but should be considered a patient suffering from a disease. Just as patients afflicted with any disease deserve the provision of clinical care and support from their family and the society, patients suffering from HIV/AIDS have all the rights to the same services, support and compassion.Examples of successful prevention efforts that involved religious leaders in Muslim societies include those of Uganda  and SeneSenegal also is one of the best examples regarding HIV/AIDS prevention by engaging religious institutions in a proactive role. In March 1990, 260 religious leaders attended a conference on AIDS and reached a consensus to make AIDS control a national priority. Unlike other African countries, HIV/AIDS prevention is a regularly discussed topic in the Friday prayers in mosques in Senegal. From 1989 to 1996, the levels of HIV infection estimated in four sentinel urban regions remained stable at around 1.2 percent in the population of pregnant women, and at three percent in male STD patients . The curThe reasons for Senegal's successful HIV control are: 1) a good STD tracking system that has been in place since 1969; and 2) AIDS education, utilizing religious institutions and mass media sources such as the radio . From avIn the context of the AIDS epidemic, limited attention has been paid to the manner in which political, economic and social variables constrain or enable individual behavior related to AIDS . The assThere also is an urgent need in Muslim countries for increasing infection surveillance and enhancing HIV preventive and therapeutic services for high-risk groups, such as commercial sex workers, drug abusers, and those with alternative sexual lifestyles, not simply those who identify themselves as being either infected or possibly infected. In addition, legislative and social changes, such as protecting the legal rights of the infected, promoting safer alternative behaviors among high-risk groups, and spreading the message that being a good Muslim can include taking care of those infected by HIV would be helpful in combating the spread of the disease. HIV/AIDS education and control efforts could also become part of each citizen's duty. The international community can also assist by helping poorer countries establish social programs or simply sharing experience in drug treatment and behavioral change efforts .summary, our recommendations to stem the spread of HIV in Muslim countries include:In 1. Addressing the underlying societal problems such as poverty, lack of education and gender imbalance;2. Developing collaborative prevention and care models ;3. Development and provision of appropriate healthcare resources and infrastructure including:• Blood safety and infection control• Appropriate surveillance and reporting mechanisms• Drug abuse prevention and rehabilitation services• Medical care and social support including HIV counseling, testing and treatment facilities• Adequate number of trained health care workforce• Appropriate reproductive health care programs• Broader efforts directed at enhancing information, education and communication.The challenge of addressing the rising threat of the spread of HIV/AIDS in Muslim countries/societies is significant. The most effective public health method of controlling the spread of AIDS is education and changing the way people behave. Political, financial, and social barriers have often kept the most effective prevention and treatment strategies from reaching persons at the highest risk. There is a need to ensure sustained access to preventive and treatment services for all high-risk groups. The goal of prevention is best achieved through an ongoing process, open to change and flexible to adaptation. Incorporating such change within religious and cultural frameworks is no easy task. This is the challenge we are facing and it is up to us, individually and collectively, as health care professionals and researchers to respond.To ensure ongoing usefulness of public health policies related to HIV prevention, we must learn to synthesize old knowledge with new, and, at the same time, utilize opportunities to choose new directions. The framework proposed in this paper can serve as an initial model for appropriate HIV prevention and care programs in Muslim countries. Risk needs to be viewed within the context of the social subculture of Muslim countries to design strategies to reduce risk behaviors related to HIV transmission. The social dimension of health mandates that policy and program measures to stop AIDS be a balance of social and biomedical scientific efforts. Our recommendations include education, involvement and mobilization of diverse stakeholders, particularly religious leaders; establishing sustainable financing for AIDS treatment and drug procurement; institutingregulatory mechanisms to ensure blood safety and appropriate delivery of HIV/AIDS counseling, screening and treatment services; improvement in health infrastructure; and training of health care workers. None of the above will be successful without reducing the stigma associated with HIV and AIDS, developing compassion for those afflicted, and designing harm reduction strategies which would be conceptually integrated within the existing social, cultural, and religious frameworks in Muslim countries.


Objective: To address the putative association of antibiotic use and subsequent yeast vaginitis in a population ofnon-pregnant women.Methods: Three hundred and sixteen women who received medical care in rural family medicine clinics enrolledin this study. Participants were pre-menopausal and non-pregnant and were followed until they used a course ofantifungal therapy for vaginitis, became pregnant or moved from the catchment area. At entry subjects were freeof vaginitis symptoms and had taken no antibiotics for 30 days.Patients were followed by repeated review of clinic records, hospital records and telephone or personal interviews.Data collection included documentation of episodes of antifungal treatment for vulvovaginal candidiasis andconfirmed antibiotic treatment or credible history of antibiotic use prior to the use of antifungal therapy.Physician-reported uses of antibiotic and antifungal as well as patient-reported uses of these were recorded.Results: There were four reported cases of antifungal therapy following within a month of antibiotic use, incontrast to 484 antibiotic uses not followed by antifungal use. If time of observation was extended to 6 monthsfrom antibiotic use, there were 13 uses of antifungal therapy after antibiotics and 475 uses of antibiotics notfollowed by antifungal therapy.Conclusion: Our results cast doubt on the association of antibiotics as a putative cause of yeast vulvovaginitis.


The AIDS Cancer and Specimen Resource (ACSR) supports scientific discovery in the area of HIV/AIDS-associated malignancies. The ACSR was established as a cooperative agreement between the NCI  and regional consortia, University of California, San Francisco (West Coast), George Washington University (East Coast) and Ohio State University (Mid-Region) to collect, preserve and disperse HIV-related tissues and biologic fluids and controls along with clinical data to qualified investigators. The available biological samples with clinical data and the application process are described on the ACSR web site.The ACSR tissue bank has more than 100,000 human HIV positive specimens that represent different processing (43), specimen (15), and anatomical site (50) types. The ACSR provides special biospecimen collections and prepares speciality items, e.g., tissue microarrays (TMA), DNA libraries. Requests have been greatest for Kaposi's sarcoma (32%) and non-Hodgkin's lymphoma (26%). Dispersed requests include 83% tissue (frozen and paraffin embedded), 18% plasma/serum and 9% other. ACSR also provides tissue microarrays of, e.g., Kaposi's sarcoma and non-Hodgkin's lymphoma, for biomarker assays and has developed collaborations with other groups that provide access to additional AIDS-related malignancy specimens. ACSR members and associates have completed 63 podium and poster presentations. Investigators have submitted 125 letters of intent requests. Discoveries using ACSR have been reported in 61 scientific publications in notable journals with an average impact factor of 7.The ACSR promotes the scientific exploration of the relationship between HIV/AIDS and malignancy by participation at national and international scientific meetings, contact with investigators who have productive research in this area and identifying, collecting, preserving, enhancing, and dispersing HIV/AIDS-related malignancy specimens to funded, approved researchers at no fee. Scientific discovery has been advanced by this unique biorepository. Investigators are encouraged to browse the ACSR Internet site for materials to enhance their own scientific initiatives. Human Immunodeficiency Virus (HIV) infection continues its global spread with almost 40 million HIV-infected individuals worldwide. More than half are women . While AThe need to obtain and provide tumor tissue from patients with AIDS was originally identified at a conference on AIDS Lymphoma in May, 1992. The request for a resource for such specimens was made both by investigators participating in clinical trials research and laboratory investigators. Thus the National Cancer Institute (NCI) established the unique AIDS Malignancy Bank (AMB) in 1994 as a cooperative agreement to collect HIV positive and control biological specimens, with associated clinical data, to support translational research into HIV/AIDS-related malignancies . This AMIn addition to serving as a resource for specimens acquired from the consortia sites, the ACSR is a national repository of specimens that reflects the temporal changes, and thus the history, associated with HIV disease. During the course of the last decade, the ACSR has established itself as a singular specialized resource for collection, storage, and provision of specimens with associated clinical, diagnostic, and epidemiologic data collected from HIV-infected individuals participating in clinical trials, observational cohort studies, and other research studies conducted by AIDS investigators both domestically and internationally. During the life of the ACSR, the biorepository cost of specimens has decreased significantly making the ACSR a good value to support research by RO1/R21 funded investigators engaged in HIV/AIDS malignancy studies.The ACSR bank has more than 100,000 specimens from HIV infected and control patients available from different processing (43), specimen (15), and anatomical site (50) types. Specimens are representative of the HIV/AIDS evolving epidemic and are from a wide variety of patients, including those with early, as compared to late-stage disease, multi-site autopsy specimens with involved and uninvolved tissue, and specimens obtained from patients with defined anti-retroviral or chemotherapy histories. In addition, the inventory contains donations from the AIDS epidemics in developing countries outside the United States.Detailed viral typing studies. The ACSR has expanded tissue collection at international sites including Africa, Brazil, and Thailand to obtain specimens from patients who develop malignancies associated with infection from different subtypes of HIV, HHV-8, EBV, and HPV. These types of specimens are critical for determining the role of virus associated carcinogenesis in the natural epidemic setting, as opposed to clinical settings where there is anti-viral therapy intervention.• Neoplastic and non-neoplastic specimens from women. Gynaecologic tissues, breast, and obstetrical specimens from HIV-infected women come from collaborative efforts with ongoing clinical studies of HIV-disease in women, i.e. Women's Interagency HIV Study (WIHS). Expansion of this collection to include specimens for recently discovered agents and unusual malignancies associated with HIV-disease is ongoing. The coordinated study between WIHS and the Rwanda Women's HIV Study, provides fresh gynaecological specimens  and biological fluids from infected women including normal tissue through cervical cancer.• Specimens from AIDS-related malignancies clinical treatment trials. AIDS-related malignancy clinical trial groups (ACTG) obtain specimens that are collected and stored longitudinally. Samples retained from the early clinical trials are now available through the ACSR to approved investigators.• Specialty sub-bank samples. Disease specific  tissue micro-arrays (TMAs) for rapid assessment of tissue molecular targets or reagents  are available. Specimens preserved specifically for transmission electron microscopy are available and provide optimal samples to carry out ultrastructural studies of malignant, infectious, and reactive tissue processes. Specimens preserved in fixatives recently shown to enhance immunohistochemical and in situ hybridization results are currently available or could be developed by request of approved investigators.• ACSR data interface. The ACSR has developed a national computerized database of specimens with patient information and clinical history. Over time, this system will interface with electronic databases of other cooperative banking groups, as well as with clinical trial groups. A version of the ACSR database, stripped of patient identifiers, is made available online; researchers can search for useful specimens using various patient, specimen and clinical criteria.• full applications and 37 in short applications. Of the full applications, 73 were approved to receive multiple samples, 64 received samples, 8 are still waiting funding or identification of appropriate specimens, and 14 were not approved for a variety of reasons including scientific merit, sample request size, or lack of available specimens. The latter investigators were referred to other bio-repositories or resources, when appropriate. Of the full approved applications, 83% were for tissue, 18% for serum/plasma and 9% for cell lines, bone marrow, or urine. Some applications were approved for mixed sample types. Of the 37 short form applications received, 36 were approved. The 23 remaining inquires included 19 for which no final application for samples was received and researcher inquires that were referred to other biological sample resources. Requests for Kaposi's sarcoma specimens accounted for 32% of the total served requests, lymphoma for 26%, and the remainder were for a variety of other disease types and controls.Investigators made 148 specimen availability inquires to the ACSR, 88 resulted in Investigators have used the ACSR's HIV infected and non-infected control biological samples and clinical data to contribute significant discoveries. Included are: markers of selective B cell activation during lymphomagenesis , effect Investigations into the pathobiology of HIV infection have used human tissue to provide translation from important discoveries made in cell culture or animal studies. HIV insertion sites within human tissues including somatic cells , macrophThe use of ACSR resources has resulted in sixty-one scientific reports added to the scientific literature and others are in preparation. Appendix I contains the list of these reports. Table in vivo HIV sequences using an HIV bioinformatics facility. HIV sequence analysis was performed using the HIVbase® software . HIV DNA was identifiable  in:The ACSR tested the suitability of: banked tissues to evaluate a) >50% of blood derived T cell preparationsb) >33% of blood CD14+ monocytesc) AIDS lymphomasd) AIDS lymphoid tissuee) kidney and seminal vesicle tissues, andf) >90% of brain tissues from patients with HIV dementia.Studies of HIV gene sequence selection/evolution in human HIV infected tissues from patients with AIDS malignancies as compared to other classes of HIV related disease can therefore be facilitated by ACSR resources . The ACSin situ hybridization techniques are routinely employed on TMAs. In general, all ACSR TMAs also contain positive cores  and negative control cores along with the disease specific cores allowing validation of novel tissue biomarkers. The ACSR provides non-Hodgkin's lymphoma and KS TMA slides to approved researchers interested in characterizing these tumors using applicable tissue probes. Other TMAs are planned, e.g., various subtypes of lymphoma characterized by immunohistochemistry and DNA.Tissue micro-arrays (TMA)  are usefPreview and selection of TMAs by researchers are enhanced by the development and deployment of virtual whole slide images of digitized TMA stained sections and associated clinical data on an ACSR Internet site . Online The quality of each TMA is directly related to the individual donor tissue core characteristics. Older archived paraffin embedded tissues may be antigen negative or weakly reactive and require optimal antigen retrieval methods and high antibody titres for positive results. Core donor tissues specifically prepared by optimal fixation and processing provide the most favourable TMA sections for studies with novel probes. Donor tissue characteristics are available with each TMA to provide guidance to the investigator. Cut sections from each TMA are stained by H & E to assure the presence of target tissues and by appropriate immunohistochemical stains (IHC) to assure tissue immunoreactivity for expected molecular targets prior to listing TMA availability on the Internet site.The national ACSR was formed as a cooperative agreement between the NCI, Office of the Director, Division of Cancer Treatment and Diagnosis (DCTD) and regional ACSR consortia: University of California, San Francisco for the West Coast, George Washington University for the East Coast and The Ohio State University for the Mid-Region. The ACSR steering committee, comprised of the principal investigators from each consortium, developed policies and procedures for standardized operation across the organization. An outside Research Evaluation and Decision Panel (REDP), comprised of experts in the field, evaluates requests for specimens as shown in Figure Local Institutional Review Boards (IRBs) approve and monitor the activity of each ACSR site. The local ACSR maintains a research protocol to protect biologic sample donor privacy and to maintain confidentially of clinical data as required by federal standards including the requirements of HIPPA . Local IThe ACSR established a database containing information on ACSR specimen types and associated clinical data obtained from patients with HIV/AIDS-related malignancies and control specimens. Each consortium sends electronic de-identified data quarterly to the central ACSR database. Records are maintained at each local site in accordance with the local IRB approved protocol. Some specimen collections have other databases that enable investigators to perform studies on specimens linked with a defined clinical or epidemiologic pedigree.The ACSR has quality practices for biorepository operation that are consistent with International Society for Biological and Environmental Repositories (ISBER) best practices , NCI OffThe ACSR has strategies to market the availability of HIV/AIDS-associated malignancy specimens. Through word of mouth, directed mailings, newsletters, and presence  at national and international meetings, the ACSR reaches increasing numbers of potential researchers interested in utilization of the resource and have steadily increased the number of applications. The ACSR seeks feedback from its investigator community to identify future needs, gaps, and shortcomings.Specimen Search web page 7. Flickinger M, McGrath M, Silver S, Orenstein J, Miles S, Ayers LW. AIDs malignancy bank: a source for tissue and biological fluids of HIV-related malignancies. 12th World AIDS Conference Geneva, Switzerland, June 28 – July 3, 1998 20. Ayers LW, Romer D, Yi H, and The Midregion AIDS and Cancer Specimen Bank (ACSB), and Division of Informatics, Department of Pathology, The Ohio State University, Columbus, OH 43210. AIDS-Associated Malignant Tissue Research using Tissue Micro-Arrays (TMAs) Facilitated by a Graphical Microsoft Access Database. Fifth International AIDS Malignancy Conference Bethesda, MD, April 23–26, 2001 [program only]21. Garcia D, McGrath MS, Silver S, Miles S, Ayers L, Axiotis C. AIDS and Cancer Specimen Bank. Fifth International AIDS Malignancy Conference Bethesda, Maryland, 26, April 23–25, 2001 27. Ayers LW, D. Romer, H Yi. The Midregion AIDS and Cancer Specimen Bank (ACSB). A Tissue Array Management System (TAMS) for the AIDS Cancer and Specimen Bank (BANK) Developed to Manage Numerical and Digital Image Cancer Research Data From Tissue Microarrays (TMAs). Sixth International Conference on Malignancies in AIDS and Other Immunodeficiencies: Basic, Epidemiologic and Clinical Research Bethesda, MD, April 22–24, 2002 [program only]28. Garcia DL, Ayers LW, Axiotis C, Orenstein J, Miles S, Silver S, McGrath MS. ACSB CODCC, AIDS and Cancer Specimen Bank: A Resource for Your Research. Sixth International Conference on Malignancies in AIDS and Other Immunodeficiencies: Basic, Epidemiologic and Clinical Research Bethesda, MD, April 22–24, 2002 36. Yu S, Lamers S, Jin X, Reis J, McGrath MS. Restricted HIV genomic variability in AIDS dementia and lymphoma. Keystone Symposia, Molecular mechanisms of HIV Pathogenesis Whistler, British Columbia, April 12–18, 2004 [Abstracts from the 8th International Conference on Malignancies in AIDS and Other Immunodeficiencies: Basic, Epidemiologic and Clinical Research Bethesda, MD, April 29–30, 2004. 2004:74.37. Ayers LW, Jin X, Bauer JA, McGrath M. HIV Integration Sites Found in Cardiac Myocyte Nuclei and Adjacent PCNA Positive Macrophage Nuclei from AIDS Cardiomopathy Heart Tissue. 38. Lamers S, Yu S, McGrath MS. Genetic analysis of HIV-1 from site-specific brain tissue: Does compartmentalization occur within the brain? 11th International Workshop, HIV Dynamics and Evolution Stockholm, Sweden, April 29-May 4, 2004Abstracts from the 8th International Conference on Malignancies in AIDS and Other Immunodeficiencies: Basic, Epidemiologic and Clinical Research, Natcher Conference Center Bethesda, MD, April 29–30, 2004. 2004:75.39. Nohle DG, Hackman B, Ayers L. Tissue Micro-Array Data Using TMA Standard and Public Tool Linked Legend and Clinical Details at ACSR.Mid-Region.org. Tissue Micro-Array Data Using TMA Standard and Public Tool Linked Legend and Clinical Details at acsr.mid-region.org. AIDS and cancer specimen resource: A resource for HIV reservoir research. The XV International AIDS Conference, 2004 Abstract no. A10525.40. McGrath MS, Garcia D, Ayers L, Silver S, Orenstein J, Lamers S. Restricted HIV genomic variability in AIDS dementia and lymphoma. The XV International AIDS Conference, 2004 Abstract no. ThOrA1399.41. McGrath MS, Yu S, Jin X, Reis J, Lamers S. 42. Silver S, Ayers L, Orenstein J, McGrath M. AIDS and Cancer Specimen Resource (ASCR): A Resource for Your Research. International Society of Biological and Environmental Repositories, Perugia, Italy, October 200443. Lee Z, Muzic R, Gagon D. Dynamic PET for Animal Model of HCC. Presented at Annual Meeting of Biomedical Engineering Society, October 200444. Silver S, Ayers L, Orenstein J, McGrath M. The AIDS and Cancer Specimen Resource (ACSR) Model for Cancer Research Facilitation. International Society of Biological and Environmental Repositories, Bellevue, WA, May 2005Advancing Practice, Instruction, and Innovation Through Informatics (APIII 2004): Scientific Session and E-Poster Abstracts. Arch Pathol Lab Med. 2005 Jun;129(6):811–834.45. Nohle DG, Hackman BA, Ayers LW. A Document Type Definition for the API standard tissue micro-array XML data exchange specification, In HIV-1 envelope domains derived from AIDS related lymphoma tissues display unique substitution patterns as compared to published envelope domains. The 3rd IAS Conference on HIV Pathogenesis and Treatment, 2005 Abstract no. MoPe14.2B17.46. Lamers SL, Salemi M, McGrath MS. HIV sequence evolution in the brain: Distinctly different evolutionary pathways between HAD and primary CNS lymphoma associated strains of HIV. The 3rd IAS Conference on HIV Pathogenesis and Treatment, 2005 Abstract no. WePe8.13B04.47. McGrath MS, Lamers SL, Salemi M. Adding style to the API Tissue Micro-array Data Exchange Specification, In Advancing Practice, Instruction, and Innovation Through Informatics (APIII 2005): Scientific Session and E-Poster Abstracts. Arch Pathol Lab Med.48. Nohle DG, Hackman BA, Ayers LW. 49. McGrath MS, Salemi M, Lamers SL. Genetic Analysis of HIV in AIDS Malignancies. Oral presentation by Michael S. McGrath, MD, PhD at the 2005 International Meeting of the Institute of Human Virology, Baltimore, MD, Aug 29-Sep 2, 2005.50. Dittmer DP, Staudt MR, Fakhari FD, Hilscher C, Sin S, Chaput A. Regulation of KSHV Latent gene expression. Abstracts from the 9th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies: Basic, Epidemiologic and Clinical Research, Marriott Bethesda North Hotel & Conference Center, North Bethesda, MD, September 26–27, 2005. 51. Levine AL, Seaberg EC, Hessol NA, Preston-Martin S, Li M, Silver S, Cohen M, Anastos K, Minkoff H, Black J, Watts DH. HIV is not a risk factor for lung cancer in women: data from the women's interagency HIV study (WIHS). Abstracts from the 9th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies: Basic, Epidemiologic and Clinical Research, Marriott Bethesda North Hotel & Conference Center, North Bethesda, MD, September 26–27, 2005. 52. Mbulaiteye SM, Katabira ET, Wabinga H, Parkin DM, Virgo P, Ochai R, Workneh M, Coutinho A, Engels EA. Spectrum of cancers among HIV-infected persons in Africa: the Uganda AIDS-cancer registry match study. Abstracts from the 9th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies: Basic, Epidemiologic and Clinical Research, Marriott Bethesda North Hotel & Conference Center, North Bethesda, MD, September 26–27, 2005. 53. McGrath MS, Lamers S, Salemi M. Evolutionary distinct forms of HIV in AIDS lymphoma and dementia. Abstracts from the 9th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies: Basic, Epidemiologic and Clinical Research, Marriott Bethesda North Hotel & Conference Center, North Bethesda, MD, September 26–27, 2005. 54. McGrath MS, Lamers SL, Salemi M. HIV infected macrophages associated with dementia (HAD) and lymphoma (ARL) show distinct patterns of evolution in vivo. Poster presentation at the 6th International Workshop on HIV, Cells of Macrophage/Dendritic Lineage & Other Reservoirs, Varenna, Italy, Oct 5–7 2005.55. Curry CL, Reed LL, Nickoloff BJ, and Foreman KE. Targeting Notch in Kaposi's sarcoma inhibits tumorigenesis. Oral presentation at Society of Investigative Dermatology Meeting, 2004; Oral presentation at Seventh International Workshop on Kaposi's Sarcoma-Associated Herpesvirus (KSHV/HHV8) and Related Agents, 2004; Poster presentation at EMBO Notch Workshop, 2005.56. Shikuma CM, Shiramizu B, McGrath M, Shagrun L, Chow D, Gerschenson M. HIV Infected Monocytes and Macrophages in Adipose Tissue Contribute to the Development of Lipatrophy. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 13–16 Nov 2005 in Dublin, Ireland.Analysis of YY1 and XIAP expression, proteins that regulate resistance, in AIDS-NHL tissue arrays. Blood  2005 106: Abstract 1933 2005 Dec;106 (11).57. Huerta-Yepez S, Vega M, Gui D, Said J, Bonavida B. 58. Zhang RZ, Gascon R, Miller RG, Gelinas DF, Mass J, Lancero M, Narvaez A, McGrath MS. MCP-1 Chemokine Receptor CCR2 Is Absent on Circulating Monocytes in Sporadic ALS. Poster presentation at the 16th International Symposium on ALS/MND in Dublin, Ireland, Dec 8–10, 2005.59. Do H, Hadlock KG, Miller RG, Yu S, Mass J, Zhang RZ, Gascon R, Narvaez A, Katz J, McGrath, MS. Transcriptional Program of Peripheral Blood Cells in ALS: Evidence for Systemic Immune Activation. Poster presentation at the 16th International Symposium on ALS/MND in Dublin, Ireland, Dec 8–10, 2006.60. Jin X, Hadlock KG, Yu S, Do H, Miller R, Mass J, Katz J, Zhang RZ, Gascon R, McGrath MS. Mutational Recovery of Viral Open Reading Frames in Selected HERV-K-Related Endogenous Retro Viruses in ALS Patients. Poster presentation at the 16th International Symposium on ALS/MND in Dublin, Ireland, Dec 8–10, 2005.61. Yu S, Hadlock KG, Miller RG, Do H, Mass J, Zhang RZ, Gascon R, Lancero M, Narvaez A, Katz J, McGrath MS. Detection of ALS by Quantitative Real Time RT-PCR of Peripheral Blood Cells. Poster presentation at the 16th International Symposium on ALS/MND in Dublin, Ireland, Dec 8–10, 2005.62. Gruzman AL, Prasad MD, Miller RG, Lingappa V & Liu J. Identification of Biomarkers for ALS. Poster presentation at the 16th International Symposium on ALS/MND in Dublin, Ireland, Dec 8–10, 2005.63. Marchiò S., Bagnod R., Traversa S., Fumero S., Bussolino F.: A new peptide inhibitor of HIV-1 entry. Poster presented at the congress "PepTalk", San Diego, CA. January 11th-13th, 2006.64. McGrath MS, Galligan D, Lamers S, Salemi M. HIV Infected Macrophages Associated with Lymphoma (ARL) Show Distinct Patterns of Evolution in Vivo. Accepted for poster presentation at 13th Conference on Retroviruses and Opportunistic Infections, Denver CO, Feb 5–9, 2006.65. Galligan D, Lamers SL, de Oliveira T, Salemi, M, McGrath MS. HIV-1 Molecular Dynamics in Multisite Lymphoma Biopsies. Accepted for poster presentation at HIV Pathogenesis Symposium, Keystone CO, Mar 27-Apr 2, 2006.66. Lamers SL, Salemi T, de Oliveria T, Beason S, Compton R, Goodenow M, McGrath MS. A Protocol for HIV-1 env Alignments Assists in Determining the Evolutionary Dynamics of the V1, V2 and V4 Hypervariable Domains. Presented to HIV Pathogenesis Symposium, Keystone CO, Mar 27-Apr 2, 200667. Nohle DG, Ayers LW. Extending the API TMA data exchange specification to single specimen and cutting edge matrix assembly (CEMA). ASIP INFORMATICS, Experimental Biology 2006: Advancing the Biomedical Frontier. The Moscone Convention Center, San Francisco, CA, April 1 – 5, 2006.68. Ayers LW, McGrath MS, Silver S, Orenstein J, Bhatia K. RNA, DNA and Molecular Targets in Archived Paraffin-embedded Tissue Samples, 1980–2005. Presented to International Society for Biological and Environmental Repositories (ISBER) 2006 Annual Meeting, Bethesda, MD. April 30-May 3, 2006.69. Ayers LW, Hackman BA, Nohle DG. Software-Assisted Image Analysis for ACSR Tissue Microarays (TMA) Quality Control. Presented to International Society for Biological and Environmental Repositories (ISBER) 2006 Annual Meeting, Bethesda, MD. April 30-May 3, 2006.70. Kulkarni AL, Handorf CR. Legal Issues Involving Research Utilization of Archived Formalin Fixed Paraffin Embedded Tissue. Presented to International Society for Biological and Environmental Repositories (ISBER) 2006 Annual Meeting, Bethesda, MD. April 30-May 3, 2006.71. Ayers LW, McGrath MS, Silver S. Orenstein J., Bhatia K. The AIDS and Cancer Specimen Resource (ACSR) provides Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL) specimens for translational research. Presented at the 9th Annual Workshop on KS Associated Herpesvirus & Related Viruses, Cape Cod, MA. July 12–15, 2006.72. Carroll PA. Latent KSHV Infection of Endothelial Cells Activates Hypoxia-Induced Factors. Accepted for oral presentation (Abstract 36) at 9th Annual KSHV Workshop, Hyannis, MA. July 12–15, 2006. (Michael Lagunoff lab)73. Lagos D, Trotter MW, Vart RJ, Wang HW, Matthews NC, Hansen A, Gotch F, Boshoff C. Kaposi Sarcoma Herpesvirus Employs Transcriptional Mechanisms to Regulate Antigen Presentation in Lymphatic Endothelial Cells. Accepted for oral presentation (abstract 64) at 9th Annual KSHV Workshop, Hyannis, MA. July 12–15, 2006.74. Lamers SL, Galligan D, Zhao L, Yu S, Shagrun L, De Oliveria T, Salemi M, McGrath MS. Multi-site tissue autopsy samples from patients with dementia and AIDS related lymphoma show distinct patterns of HIV evolution in vivo. Poster presentation at the XVI International AIDS Conference in Toronto ON. August 13–18, 2006Software-assisted visual analysis and review of tissue microarray (TMA) images facilitated by XML. Poster presentation at APIII 2006 11th Annual Conference, Vancouver BC, August 15–18, 2006.75. Nohle DG, Hackman BA, Ayers LW. HIV/AIDS-related Lymphoma Immunophenotypes in Biopsy Samples from Patients During Pre and Post HAART Treatment Periods. Presented to 10th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies: Basic, Epidemiologic and Clinical Research, North Bethesda, MD, October 16–17 2006.76. Ayers LW, Hackman BA, McGrath MS, Silver S, Orenstein J, Bhatia K. 77. Shagrun LS, Morris A, McGrath MS. "ProMacs" in cases of HIV+ and HIV- Large Cell Lymphoma. Presented to 10th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies: Basic, Epidemiologic and Clinical Research, North Bethesda, MD, October 16–17 2006.th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies in North Bethesda, Maryland; October 16–17, 2006.78. Mwanda OW, Orem J, Fu P, Banura C, Kakembo J, Ness A, Johnson J, Subbiah V, Bako J, Black J, Katongole-Mbidde E, Remick SC. Dose modified oral chemotherapy for AIDS-related non-Hodgkin's Lymphoma (AR-NHL) in East Africa: Impact on CD4+ count and HIV-1 replication; and retrospective look at similar regimen in pre-HAART era in the USA. AB# 13 presented to 10th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies in North Bethesda, Maryland; October 16–17, 2006.79. Mwanda OW, Orem J, Fu P, Banura C, Kakembo J, Ness A, Johnson J, Subbiah V, Bako J, Black J, Katongole-Mbidde E, Remick SC. Dose modified oral chemotherapy for AIDS-related non-Hodgkin's Lymphoma (AR-NHL) in East Africa. AB# 47 presented to 10th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies in North Bethesda, Maryland; October 16–17, 2006.80. Bako J, Mwanda OW, Orem J, Fu P, Subbiah V, Banura C, Kakembo J, Ness A, Johnson J, Katongole-Mbidde E, Remick SC. Comparative retrospective study of patients at diagnosis with AIDS-related non-Hodgkin's Lymphoma (AR-NHL) treated with oral chemotherapy in the pre-HAART era in East Africa and the USA. AB# 48 presented to 10th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies in North Bethesda, Maryland; October 16–17, 2006.81. Subbiah V, Mwanda OW, Orem J, Fu P, Banura C, Kakembo J, Ness A, Johnson J, Bako J, Katongole-Mbidde E, Remick SC. Analyses of prognostic factors for survival in East African patients with AIDS-related non-Hodgkin's Lymphoma (AR-NHL) treated with dose modified oral chemotherapy. AB# 50 presented to 10th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies in North Bethesda, Maryland; October 16–17, 2006.82. Orem J, Mwanda OW, Fu P, Banura C, Kakembo J, Ness A, Johnson J, Subbiah V, Bako J, Katongole-Mbidde E, Remick SC. Implications of oral chemotherapy for AIDS-related non-Hodgkin's lymphoma (AR-NHL). AB# 51 presented to 1083. Zhang RZ, Miller RG, Gascon R, Gelinas DF, Katz J, Mass J, Scholtz D, Lancero M, Narvaez A, McGrath MS. Evidence for abnormal monocyte immunoglobulin receptor expression in sporadic amyotrophic lateral sclerosis (sALS). Accepted for Poster presentation at the 17th International Symposium on ALS/MND in Yokohama, Japan, November 30 – December 2, 2006Grant Support: National Cancer Institute (NCI), U01-CA66529, U01-CA96230, and U01-CA066531Requests for reprints: Debra Garcia, ACSR CODCC, 995 Potrero Avenue, Building 80, Ward 84, San Francisco, CA 94110