Armando Peruga

Correlates of AIDS knowledge in samples of the general population

Eighty studies presenting original research are reviewed to explore the correlates of AIDS knowledge in samples of the general population. Results from these studies indicate that being highly educated, young or white increases the chances of being knowledgeable about AIDS and that a relationship exists between strong religious beliefs or conservative political convictions and low AIDS knowledge. Other social or demographic variables appear to have little effect on AIDS knowledge. Evidence from these studies is divided between findings indicating no association and those showing some relationship between low AIDS knowledge and high level of concern. Restrictive attitudes toward persons with AIDS are associated with low level of knowledge. The literature examining the correlates of AIDS knowledge in samples of the general population is characterized by an abundance of studies with small convenience samples of adolescents or students. Larger and more representative samples of the general population tend to confirm the results of the less methodologically sound convenience samples. However, future studies should take into account potential confounders when examining the relation between knowledge and explanatory variables to assess the nature and reliability of purported associations.

The role of public policies in reducing smoking prevalence and deaths: the Argentina Tobacco Policy Simulation Model

OBJECTIVES To compare tobacco control policies independently and as a package through a simulation model to project smoking prevalence and associated future premature mortality in Argentina beginning in 2001. METHODS A simulation model of tobacco control policies known as SimSmoke was modified using data for Argentina on population, fertility and mortality, smoking prevalence, and tobacco control policies in effect between 2001 and 2004. We used the Argentina Tobacco Policy Simulation model (ATPSM) to consider the effect on smoking prevalence of changes in taxes and prices, clean air laws, media campaigns, cessation programs, and youth access policies on smoking initiation and cessation rates. Smoking prevalence and relative risks of smoking were used to estimate smoking-attributable mortality. The ATPSM was used to project smoking prevalence and smoking-attributable deaths during the period 2001-2034. RESULTS The largest reductions in smoking prevalence and premature mortality were predicted for a comprehensive tobacco control policy package, but relative reductions of as much as 30% were also predicted for large tax increases. Adding a media campaign along with programs to publicize and enforce clean air laws, advertising bans, and youth access laws would further reduce smoking rates by up to 45% by the year 2034, and would save almost 16 000 lives per year. CONCLUSIONS Tobacco control policies can substantially reduce smoking rates, which can save many lives. Without such policies, deaths from smoking, and associated medical costs, will increase. The ATPSM is expected to provide guidance in filling the most important information gaps pertinent to both modeling and policy-making in Argentina, e.g., the lack of data on initiation and cessation rates, and the need for studies on the impact of policies. Similar models might be developed for other Latin American countries.

OPPORTUNISTIC INFECTIONS IN PEDIATRIC HIV INFECTION: A study of 74 Autopsy Cases from Latin America

A postmortem analysis of opportunistic infections in 74 pediatric AIDS cases from Argentina Brazil and Mexico was conducted to establish a baseline for future monitoring of HIV in children in Latin America. The collaborative study emerged from a 1992 meeting of Latin American pathologists organized by the Pan American Health Organization. The mean age of autopsied children was 2.7 years; 72% of cases were 12 months of age or under. Fungal infections--especially Candida (29 cases 39.18%) and Pneumocystis carinii (15 cases 20.27%)--were the most common opportunistic infections. Viral infections were found in 31 cases 25 (38.7%) of which were cytomegalovirus. Additional infections detected were cryptosporidiosis (6 cases) Mycobacterium avium intracellulare (4 cases) and tuberculosis (1 case). Nonspecific bacterial bronchopneumonia was present in 11 cases. 4 cases of toxoplasmosis 3 of which were localized in the central nervous system were found. Cytomegalovirus and P carinii was the most common combination of infections. Despite a slightly higher frequency of cases of histoplasmosis and brain toxoplasmosis these findings are generally comparable to those of pediatric AIDS autopsies conducted in North America.

Mitos sobre la prevención y el control de las enfermedades no transmisibles en América Latina

Given the increase of the burden of non-communicable diseases (NCD) and the possibility to avoid it, it is urgent to implement or strengthen NCD preventive programs in Latin America. However, many myths hinder the implementation of NCD programs. Myths on NCD include: a) NCD are degenerative and incurable; b) they are diseases of the elderly; c) they are diseases of the rich. Like wise there are myths about NCD preventive programs are: a) difficult to implement, b) expensive, and c) ineffective. We present data that demonstrate how these myths are untrue and discuss the challenges to find a balanced health policy that emphasizes the importance of NCD without overlooking other diseases.

Role of drug injection in the spread of HIV in Argentina and Brazil.

Drug injectors have become the second largest HIV transmission category in Argentina and Brazil, as is the case in many pattern I countries, making up more than one-quarter of all AIDS cases reported by 1991. HIV seroprevalence data suggest that the expanding proportion of AIDS cases attributable to drug injection stems from an absolute increase in the number of AIDS cases among drug injectors, and is not merely reflective of a decline in the proportion of cases reported in other transmission categories. Results of a review of studies in Argentina and Brazil indicate that HIV seroprevalence is increasing rapidly, contrary to the situation in some pattern I countries in which HIV seroprevalence among drug injectors is either stably high or increasing only slightly. Also contrary to most pattern I countries, cocaine rather than heroin is the injected drug of choice in Argentina and Brazil. Given that injectors of cocaine are more likely to be HIV infected than are heroin injectors, differences in the type of drug injected between countries may have distinct epidemiological consequences on the spread of HIV.

Opportunistic Infections in Pediatric HIV Infection: A study of 74 Autopsy Cases from Latin America: The Latin American AIDS Pathology Study Group

The present report describes opportunistic infections found at 74 autopsies of pediatric HIV/AIDS patients performed at several hospitals in Latin American countries. Fungal infections were the most common (53 cases), Candida sp. (39.18%) and Pneumocystis carinii (20.27%) being the most frequently recognized. Other fungal diseases included histoplasmosis, aspergillosis, and cryptococcosis. Viral infections were present in 31 cases, 38.7% being due to cytomegalovirus. Other viruses recognized included herpes simplex and adenovirus. Additional opportunistic infections were due to Mycobacterium avium-intracellulare, toxoplasmosis, and tuberculosis. Nonspecific bacterial bronchopneumonia was present in 11 cases. Cytomegalovirus and P. carinii coinfection was the most common association found. In this series patients died at a younger age (72% at or younger than 1 year old) and there was a slightly higher number of cases of histoplasmosis and brain toxoplasmosis than in other previously published series of infants and children.

Análisis de la participación en encuestas de cinco países: relevancia para la investigación en salud pública

This study compares participation rates and reasons for nonresponse in surveys conducted in five countries of Latin America and the Caribbean. The objective of the surveys was to measure the prevalence of risk behaviors affecting the transmission of human immunodeficiency virus. The surveys were based on probability samples of the population of both sexes between 15 and 49 years old, except in Mexico, where only men were included. Proportions of three components of participation were estimated: residences interviewed, interviewed residences with eligible persons, and eligible persons who completed the interview. In addition, an overall index that combined the three components was calculated. The overall response rate ranged from 35.6% in Mexico to 81.4% in Chile. The component with the greatest variability was the participation of eligible persons, which ranged from 50% in Mexico to 95% in Cuba. These values were lower than what had been expected, especially among men, and will serve to guide future surveys, since rejection rates higher than the ones expected in the protocol should be considered. The results make it possible to infer the validity of the prevalence estimates for the various observed risk behaviors. The results also establish a benchmark to calculate the sample size in future surveys and to improve research methodology.