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HIV/AIDS: The development of the evidence base and public health policy 1981-1991

Hudson Birden 15 March 2007. HIV/AIDS: The development of the evidence base and public health policy 1981-1991. Hierarchy of evidence. Systematic Reviews/ Meta-analyses Randomized Controlled Trials (RCTs) Cohort studies Case control studies Cross sectional studies (surveys) Case reports.

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HIV/AIDS: The development of the evidence base and public health policy 1981-1991

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  1. Hudson Birden 15 March 2007 HIV/AIDS:The development of the evidence baseandpublic health policy1981-1991

  2. Hierarchy of evidence • Systematic Reviews/ Meta-analyses • Randomized Controlled Trials (RCTs) • Cohort studies • Case control studies • Cross sectional studies (surveys) • Case reports

  3. Multicenter AIDS Cohort Study- Baltimore • Cohort recruited 1983-1985 • baseline for 1983-84 subjects assessed retrospectively • cohort study group= 5,622 men • 2,195 HIV+ at baseline • 3,427 HIV- at baseline • 551 seroconverted through 1997

  4. Opposition to PN for HIV • No treatment available • Long incubation period • Prevention messages should be sufficient • Safe sex avoids risk, need for PN • May provide a disincentive for testing • Fear of driving the epidemic underground • Lack of trust of PH process • Confidentiality of records • Mechanism of PN

  5. Barriers to PN for HIV • insufficient funding or personnel • inability to retain staff • non-cooperation • private providers • community-based organizations • political opposition • men who have sex with men • organizations opposed to condom distribution • absence of mandatory HIV infection reporting • Source: Golden et al STD 2003:30(6);490-496

  6. Fort Pierce, Fla.--A year after Kimberly Bergalis died of AIDS, her parents claim they are frustrated and angry that their daughter's death has not led to mandatory HIV testing of health-care workers UPI 12/08/92 An “innocent victim of AIDS”

  7. Gross: N Engl J Med, Volume 340(24).June 17, 1999.1881-1887

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