Johanna Pindyck

Behavior changes after notification of HIV infection.

BACKGROUND To learn more about how people who did not volunteer for testing react to information about HIV infection, we assessed short-term behavior changes in HIV-positive blood donors. METHODS Blood donors who were notified at the New York Blood Center that they were HIV positive were asked to participate in a study. A nurse elicited a medical history, performed a limited medical examination, and asked participants to complete a questionnaire that included questions about drug use, sexual behavior, and psychological characteristics. Participants were asked to return in 2 weeks to complete another questionnaire. RESULTS Many fewer men and women reported engaging in unsafe sexual behaviors in the 2 weeks preceding the follow-up visit than had reported such behaviors prior to notification. These changes were greater than those other investigators have reported, but about 40% of the participants still reported unsafe sexual activity at the follow-up interview. CONCLUSIONS To make nonvolunteer screening programs for HIV infection more effective in reducing the spread of HIV infection, we need to learn more about how to help people change their high-risk behaviors.

A randomized trial of an education and support program for HIV-infected individuals

ObjectivesTo assess the effectiveness of an intervention for providing information, and support to HIV-positive donors on changes in their sexual behavior, and to assess which donor characteristics are predictive of behavior change. DesignSubjects were randomly assigned to a structured intervention or community referral group. Follow-up assessments were conducted every 6 months. SettingNew York City, New York, USA. ParticipantsA cohort of 271 HIV-infected persons who donated blood to the New York Blood Center. InterventionDonors randomized to the structured intervention program met individually with a nurse for counseling, and were offered a six-session support group. The program was designed to provide information, encourage safer sexual behavior, and provide support. Main outcome measuresSexual behavior, psychological distress, and psychological help seeking, and immune function. ResultsIn both groups there was a large decrease over time in reports of unsafe sexual activity. However, more than 30% of participants in both groups reported unsafe sexual activity at the 1-year follow-up visit. Donors randomized to the structured intervention program did not report significantly more behavior change at the 1-year follow-up. ConclusionsBetter programs to promote behavior change in seropositive individuals are needed.

Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion. Evidence of volunteer blood donor cooperation.

We studied whether volunteers giving blood to the Greater New York Blood Program (GNYBP) cooperated with procedures implementing public health recommendations intended to decrease the risk of acquired immunodeficiency syndrome (AIDS) transmission by blood transfusion. Predonation medical screening was expanded to exclude donors who might be ill with AIDS. To exclude possible asymptomatic carriers of the disease, members of groups at increased risk of AIDS were asked either not to give blood or to give it for laboratory studies. A confidential questionnaire, administered to all donors after medical screening, provided the vehicle for donors to advise the GNYBP whether their donation was for laboratory studies or for patient transfusion. We found that the number of male donors decreased; AIDS‐related questions in medical history led to a 2 percent increase in donor rejections; 97 percent of donors said their blood could be used for transfusions; 1.4 percent said their blood could be used for laboratory studies only; and 1.6 percent did not respond. Only units designated for transfusion were released to hospitals.

Sociodemographic and behavioral characteristics of HIV antibody-positive blood donors.

This paper describes the sociodemographic and behavioral characteristics of 173 blood donors who were confirmed by Western blot tests to have antibodies to human immunodeficiency virus (HIV), the etiologic agent for acquired immunodeficiency syndrome (AIDS). Seropositive donors were predominantly young, unmarried, and male, and major risk factors could be identified for almost all donors. However, more than 20 per cent of the study participants were women, and many participants were not aware that they were at risk of infection. The heterogeneity of the study population, the lack of awareness among many subjects of risk factors and self-exclusion procedures, and the high level of distress among many subjects after notification, emphasize the need for intensive, well-designed education and support programs.

Health Education about AIDS among Seropositive Blood Donors

The New York Blood Center is developing a health education and psychosocial sup port program for blood donors who are notified that they are HIV antibody positive. The goals of that program are: (1) to provide accurate and intelligible information about the test results to notified donors; (2) to encourage behavior that will reduce the likelihood of spreading the virus; (3) to encourage notified donors to behave in ways that will reduce the probability that they will develop AIDS; and (4) to provide sup port and facilitate functional coping responses. This article reviews the theoretical and empirical work which informs the intervention program, and it describes how the pro gram is being implemented.

Structural analysis of fibrinogen synthesized by cultured chicken hepatocytes in the presence or absence of dexamethasone

Hepatocyte monolayers, derived from chick embryos and cultured in chemically defined medium without hormones, synthesize and secrete fibrinogen that resembles chicken plasma fibrinogen immunochemically and structurally. Addition of a synthetic glucocorticoid, dexamethasone, to the cultured cells resulted in an appreciable and relatively selective increase in fibrinogen synthesis. Autoradiography of fibrinogen that had been metabolically labelled with [35S]methionine and then subjected to SDS-polyacrylamide gel electrophoresis, unreduced or under disulfide-reducing conditions, revealed that only dimeric forms of fibrinogen, containing undegraded A alpha, B beta, and gamma chains, were secreted under stimulated and unstimulated culture conditions.

Human T-cell lymphotropic virus in volunteer blood donors

Serum samples collected in 1985 and 1986 from 18,257 donors to the Greater New York Blood Program were screened by enzyme‐linked immunoassay for antibody to human T‐cell lymphotropic virus (anti‐ HTLV). Fifteen samples (0.08%) were confirmed positive: 7 by radioimmunoprecipitation assay (RIPA) alone, 6 by Western blot alone, and 2 by combined results from both tests. One donor, whose original test result was uninterpretable because multiple nonspecific bands were present on RIPA, clearly tested positive on subsequent specimens. Follow‐up testing of individuals with this type of result may be needed to resolve their HTLV status. Anti‐HTLV prevalence increased with age and was significantly more common in black or Hispanic donors and in those born in the Caribbean than in other donors. All anti‐HTLV‐ positive donors were negative for antibody to HIV‐1, and only one donor (7% of those positive) would have been excluded by any of the routine donor screening tests used at that time.

Serum stimulation of plasma protein synthesis in culture is selective and rapidly reversible

Primary hepatocyte monolayers, derived from chick embryos, can be cultured from the onset in a completely chemically defined medium, free of added hormones. The liver cells synthesize and secrete a wide spectrum of plasma proteins for several days in this serum-free environment. Addition of fetal bovine serum elicits a 3-5-fold increase in the production of certain plasma proteins: fibrinogen, albumin, and the alpha1-globulin M. This effect of serum is selective; transferrin and plasminogen syntheses are enhanced less than 1.5-fold. Significant stimulation is observed with 0.1% fetal bovine serum, and half-maximal values for individual plasma proteins are obtained with concentrations ranging between 0.4 and 1%. The stimulatory activity of serum shows no developmental or species specificity. Plasma is active as serum derived from the same blood sample. The hepatocytes respond rapidly to serum, significant changes in albumin synthesis occurring less than 1 h after serum addition or removal. The effect of short exposure is fully reversible. These results establish the capacity of low concentrations of serum to stimulate plasma protein synthesis and underscore the importance of studying the effects of hormones and other factors under serum-free conditions. The findings suggest that, in addition to the classical hormones, ubiquitous but as yet uncharacterized serum components play a role in controlling this major hepatic function.

Prevalence of viral antibodies and leukocyte abnormalities among blood donors considering themselves at risk of exposure to AIDS.

The seriousness of the acquired immune deficiency syndrome (AIDS) ’ and the possibility of transmission of a causative agent by transfusion of blood and blood products * has prompted an intensive search for screening assays capable of identifying carriers of the disease. This has proven to be a difficult task: the etiologic agent(s) has not yet been identified, and the epidemiologic definition of individuals at risk of exposure to AIDS is based on social and ethnic criteria. Although these social and ethnic groups are not likely to express exclusive biological markers, a number of nonspecific assays have been proposed as “surrogate” tests for the identification of individuals at risk. The prevalence of some of these assays in blood donors is described in this paper.

Reconciling Patients' Wishes with the Public Good

Most recently, a new issue has given rise to such a conflict. This issue is the advisability of permitting patients to select the donors of blood that they may receive in the future. Patients are now requesting the right to select their own donors because of fear that blood otherwise provided may be contaminated with infectious agents that might cause serious disease. This issue has not only occasionally led to an antagonistic relationship between patients and blood service providers, but has also, at times, divided the medical community. The basis for this conflict lies in