Suchergebnisse

LEGAL ACCESS TO STERILE INJECTION EQUIPMENT HAS BEEN A PRIMARY STRATEGY FOR PREVENTING THE SPREAD OF ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) AMONG INTRAVENOUS DRUG USERS IN ALMOST ALL DEVELOPED COUNTRIES. BUT THIS STRATEGY HAS REMAINED HIGHLY CONTROVERSIAL IN THE UNITED STATES, WITH ONLY A SMALL NUMBER OF LOCALITIES ADOPTING IT. IN THIS ARTICLE, THE AUTHORS REVIEW DIFFERENT TECHNIQUES FOR PROVIDING LEGAL ACCESS (OVER-THE-COUNTER SALES AND SYRINGE EXCHANGES), RESEARCH DESIGN ISSUES RELEVANT TO EVALUATING LEGAL-ACCESS PROGRAMS, AND THE FINDINGS FROM THE STUDIES CONDUCTED TO DATE. THE FINDINGS ARE CONSISTENT IN SHOWING DECREASES IN AIDS RISK BEHAVIOR AND NO INCREASE IN ILLICIT DRUG USE RELATED TO LEGAL-ACCESS PROGRAMS. THE DESIGN OF LEGAL-ACCESS PROGRAMS FOR MAXIMAL IMPACT AND THE ULTIMATE EFFECT OF THE DECREASES IN AIDS RISK BEHAVIOR ON TRANSMISSION OF THE HUMAN IMMUNODEFICIENCY VIRUS REMAIN TO BE DETERMINED.

Human immunodeficiency virus type 1 (HIV-1) was discovered in the early 1980s when the virus had already established a pandemic. For at least three decades the epidemic in the Western World has been dominated by subtype B infections, as part of a sub-epidemic that traveled from Africa through Haiti to United States. However, the pattern of the subsequent spread still remains poorly understood. Here we analyze a large dataset of globally representative HIV-1 subtype B strains to map their spread around the world over the last 50 years and describe significant spread patterns. We show that subtype B travelled from North America to Western Europe in different occasions, while Central/Eastern Europe remained isolated for the most part of the early epidemic. Looking with more detail in European countries we see that the United Kingdom, France and Switzerland exchanged viral isolates with non-European countries than with European ones. The observed pattern is likely to mirror geopolitical landmarks in the post-World War II era, namely the rise and the fall of the Iron Curtain and the European colonialism. In conclusion, HIV-1 spread through specific migration routes which are consistent with geopolitical factors that affected human activities during the last 50 years, such as migration, tourism and trade. Our findings support the argument that epidemic control policies should be global and incorporate political and socioeconomic factors.