AIDS

A retrovirus belonging to the family of recently discovered human T-cell leukemia viruses (HTLV), but clearly distinct from each previous isolate, has been isolated from a Caucasian patient with signs and symptoms that often precede the acquired immune deficiency syndrome (AIDS). This virus is a typical type-C RNA tumor virus, buds from the cell membrane, prefers magnesium for reverse transcriptase activity, and has an internal antigen (p25) similar to HTLV p24. Antibodies from serum of this patient react with proteins from viruses of the HTLV-I subgroup, but type-specific antisera to HTLV-I do not precipitate proteins of the new isolate. The virus from this patient has been transmitted into cord blood lymphocytes, and the virus produced by these cells is similar to the original isolate. From these studies it is concluded that this virus as well as the previous HTLV isolates belong to a general family of T-lymphotropic retroviruses that are horizontally transmitted in humans and may be involved in several pathological syndromes, including AIDS.

@article{doi101126science6189183,
    author = "Barré‐Sinoussi, Françoise and Chermann, Jean‐Claude and Rey, FA and Nugeyre, M.T. and Chamaret, S. and Gruest, J and Dauguet, C. and Axler-Blin, C. and Vézinet-Brun, F. and Rouzioux, C. and Rozenbaum, Willy and Montagnier, Luc",
    title = "Isolation of a T-Lymphotropic Retrovirus from a Patient at Risk for Acquired Immune Deficiency Syndrome (AIDS)",
    year = "1983",
    journal = "Science",
    abstract = "A retrovirus belonging to the family of recently discovered human T-cell leukemia viruses (HTLV), but clearly distinct from each previous isolate, has been isolated from a Caucasian patient with signs and symptoms that often precede the acquired immune deficiency syndrome (AIDS). This virus is a typical type-C RNA tumor virus, buds from the cell membrane, prefers magnesium for reverse transcriptase activity, and has an internal antigen (p25) similar to HTLV p24. Antibodies from serum of this patient react with proteins from viruses of the HTLV-I subgroup, but type-specific antisera to HTLV-I do not precipitate proteins of the new isolate. The virus from this patient has been transmitted into cord blood lymphocytes, and the virus produced by these cells is similar to the original isolate. From these studies it is concluded that this virus as well as the previous HTLV isolates belong to a general family of T-lymphotropic retroviruses that are horizontally transmitted in humans and may be involved in several pathological syndromes, including AIDS.",
    url = "https://doi.org/10.1126/science.6189183",
    doi = "10.1126/science.6189183",
    openalex = "W1977282539",
    references = "doi1010160002934382901747, doi101016jwem201011007, doi101016s0140673666907653, doi101016s014067367890925x, doi101038227608a0, doi101073pnas77127415, doi101126science6600519, doi101126science6981847, doi101128jvi3839069151981, openalexw2337457582"
}

Several isolates of a human type-C retrovirus belonging to one group, known as human T-cell leukemia virus (HTLV), have previously been obtained from patients with adult T-cell leukemia or lymphoma. The T-cell tropism of HTLV and its prevalence in the Caribbean basin prompted a search for it in patients with the epidemic T-cell immune deficiency disorder known as AIDS. Peripheral blood lymphocytes from one patient in the United States and two in France were cultured with T-cell growth factor (TCGF) an shown to express HTLV antigens. Virus from the U.S. patient was isolated and characterized and shown to be related to HTLV subgroup I. The virus was also transmitted into normal human T cells from umbilical cord blood of a newborn. Whether or not HTLV-I or other retroviruses of this family with T-cell tropism cause AIDS, it is possible that patients from whom the virus can be isolated can also transmit it to others. If the target cell of AIDS is the mature T cell as suspected, the methods used in these studies may prove useful for the long-term growth of these cells and for the identification of antigens specific for the etiological agent of AIDS.

@article{doi101126science6601823,
    author = "Gallo, Robert C. and Sarin, Prem S. and Gelmann, E P and Robert-Guroff, Marjorie and Richardson, Ersell and Kalyanaraman, V. S. and Mann, Dean L. and Sidhu, Gurdip D. and Stahl, Rosalyn E. and Zolla‐Pazner, Susan and Leibowitch, J and Popovič, Mikuláš",
    title = "Isolation of Human T-Cell Leukemia Virus in Acquired Immune Deficiency Syndrome (AIDS)",
    year = "1983",
    journal = "Science",
    abstract = "Several isolates of a human type-C retrovirus belonging to one group, known as human T-cell leukemia virus (HTLV), have previously been obtained from patients with adult T-cell leukemia or lymphoma. The T-cell tropism of HTLV and its prevalence in the Caribbean basin prompted a search for it in patients with the epidemic T-cell immune deficiency disorder known as AIDS. Peripheral blood lymphocytes from one patient in the United States and two in France were cultured with T-cell growth factor (TCGF) an shown to express HTLV antigens. Virus from the U.S. patient was isolated and characterized and shown to be related to HTLV subgroup I. The virus was also transmitted into normal human T cells from umbilical cord blood of a newborn. Whether or not HTLV-I or other retroviruses of this family with T-cell tropism cause AIDS, it is possible that patients from whom the virus can be isolated can also transmit it to others. If the target cell of AIDS is the mature T cell as suspected, the methods used in these studies may prove useful for the long-term growth of these cells and for the identification of antigens specific for the etiological agent of AIDS.",
    url = "https://doi.org/10.1126/science.6601823",
    doi = "10.1126/science.6601823",
    openalex = "W2070558900"
}

@article{doi101038312763a0,
    author = "Dalgleish, Angus and Beverley, Peter C. L. and Clapham, Paul R. and Crawford, Dorothy H. and Greaves, Melvyn F. and Weiss, Robin A.",
    title = "The CD4 (T4) antigen is an essential component of the receptor for the AIDS retrovirus",
    year = "1984",
    journal = "Nature",
    url = "https://doi.org/10.1038/312763a0",
    doi = "10.1038/312763a0",
    openalex = "W2113282092",
    references = "doi101002ijc2910170504, doi101038312767a0, doi101073pnas79144395, doi101073pnas81144510, doi101126science6189183, doi101126science6200935, doi101126science6200936, doi101126science6200937, doi101126science6328660, doi101126science7053569"
}

APPROXIMATELY three years ago an apparently new and unexplained disorder called the acquired immunodeficiency syndrome (AIDS) was recognized. Prompt worldwide recognition of this syndrome was brought about by a truly remarkable collaboration between practicing physicians in several parts of the United States and epidemiologists at the Centers for Disease Control. AIDS immediately became the subject of a number of reports, many of which have appeared in the Journal.1 2 3 4 5 6 7 8 9 The disorder is an epidemic immunosuppressive disease that predisposes to life-threatening infections with opportunistic organisms, Kaposi's sarcoma, and less commonly, other neoplasms such as non-Hodgkin's lymphomas. Characteristically, AIDS is associated with...

@article{doi101056nejm198411153112006,
    author = "Broder, Samuel and Gallo, Robert C.",
    title = "A Pathogenic Retrovirus (HTLV-III) Linked to AIDS",
    year = "1984",
    journal = "New England Journal of Medicine",
    abstract = "APPROXIMATELY three years ago an apparently new and unexplained disorder called the acquired immunodeficiency syndrome (AIDS) was recognized. Prompt worldwide recognition of this syndrome was brought about by a truly remarkable collaboration between practicing physicians in several parts of the United States and epidemiologists at the Centers for Disease Control. AIDS immediately became the subject of a number of reports, many of which have appeared in the Journal.1 2 3 4 5 6 7 8 9 The disorder is an epidemic immunosuppressive disease that predisposes to life-threatening infections with opportunistic organisms, Kaposi's sarcoma, and less commonly, other neoplasms such as non-Hodgkin's lymphomas. Characteristically, AIDS is associated with...",
    url = "https://doi.org/10.1056/nejm198411153112006",
    doi = "10.1056/nejm198411153112006",
    openalex = "W1997685222"
}

The human T-cell leukemia (lymphotropic) virus type III (HTLV-III) appears to be central to the causation of the acquired immune deficiency syndrome (AIDS). Two full-length integrated proviral DNA forms of HTLV-III have now been cloned and analyzed, and DNA sequences of the virus in cell lines and fresh tissues from patients with AIDS or AIDS-related complex (ARC) have been characterized. The results revealed that (i) HTLV-III is an exogenous human retrovirus, approximately 10 kilobases in length, that lacks nucleic acid sequences derived from normal human DNA; (ii) HTLV-III, unlike HTLV types I and II, shows substantial diversity in its genomic restriction enzyme cleavage pattern; (iii) HTLV-III persists in substantial amounts in cells as unintegrated linear DNA, an uncommon property that has been linked to the cytopathic effects of certain animal retroviruses; and (iv) HTLV-III viral DNA can be detected in low levels in fresh (primary) lymphoid tissue of a minority of patients with AIDS or ARC but appears not to be present in Kaposi's sarcoma tissue. These findings have important implications concerning the biological properties of HTLV-III and the pathophysiology of AIDS and Kaposi's sarcoma.

@article{doi101126science6095449,
    author = "Shaw, George M. and Hahn, Beatrice H. and Arya, Suresh K. and Groopman, Jerome E. and Gallo, Robert C. and Wong‐Staal, Flossie",
    title = "Molecular Characterization of Human T-Cell Leukemia (Lymphotropic) Virus Type III in the Acquired Immune Deficiency Syndrome",
    year = "1984",
    journal = "Science",
    abstract = "The human T-cell leukemia (lymphotropic) virus type III (HTLV-III) appears to be central to the causation of the acquired immune deficiency syndrome (AIDS). Two full-length integrated proviral DNA forms of HTLV-III have now been cloned and analyzed, and DNA sequences of the virus in cell lines and fresh tissues from patients with AIDS or AIDS-related complex (ARC) have been characterized. The results revealed that (i) HTLV-III is an exogenous human retrovirus, approximately 10 kilobases in length, that lacks nucleic acid sequences derived from normal human DNA; (ii) HTLV-III, unlike HTLV types I and II, shows substantial diversity in its genomic restriction enzyme cleavage pattern; (iii) HTLV-III persists in substantial amounts in cells as unintegrated linear DNA, an uncommon property that has been linked to the cytopathic effects of certain animal retroviruses; and (iv) HTLV-III viral DNA can be detected in low levels in fresh (primary) lymphoid tissue of a minority of patients with AIDS or ARC but appears not to be present in Kaposi's sarcoma tissue. These findings have important implications concerning the biological properties of HTLV-III and the pathophysiology of AIDS and Kaposi's sarcoma.",
    url = "https://doi.org/10.1126/science.6095449",
    doi = "10.1126/science.6095449",
    openalex = "W2032790020"
}

A cell system was developed for the reproducible detection of human T-lymphotropic retroviruses (HTLV family) from patients with the acquired immunodeficiency syndrome (AIDS) or with signs or symptoms that frequently precede AIDS (pre-AIDS). The cells are specific clones from a permissive human neoplastic T-cell line. Some of the clones permanently grow and continuously produce large amounts of virus after infection with cytopathic (HTLV-III) variants of these viruses. One cytopathic effect of HTLV-III in this system is the arrangement of multiple nuclei in a characteristic ring formation in giant cells of the infected T-cell population. These structures can be used as an indicator to detect HTLV-III in clinical specimens. This system opens the way to the routine detection of HTLV-III and related cytopathic variants of HTLV in patients with AIDS or pre-AIDS and in healthy carriers, and it provides large amounts of virus for detailed molecular and immunological analyses.

@article{doi101126science6200935,
    author = "Popovič, Mikuláš and Sarngadharan, M. G. and Read, Elizabeth J. and Gallo, Robert C.",
    title = "Detection, Isolation, and Continuous Production of Cytopathic Retroviruses (HTLV-III) from Patients with AIDS and Pre-AIDS",
    year = "1984",
    journal = "Science",
    abstract = "A cell system was developed for the reproducible detection of human T-lymphotropic retroviruses (HTLV family) from patients with the acquired immunodeficiency syndrome (AIDS) or with signs or symptoms that frequently precede AIDS (pre-AIDS). The cells are specific clones from a permissive human neoplastic T-cell line. Some of the clones permanently grow and continuously produce large amounts of virus after infection with cytopathic (HTLV-III) variants of these viruses. One cytopathic effect of HTLV-III in this system is the arrangement of multiple nuclei in a characteristic ring formation in giant cells of the infected T-cell population. These structures can be used as an indicator to detect HTLV-III in clinical specimens. This system opens the way to the routine detection of HTLV-III and related cytopathic variants of HTLV in patients with AIDS or pre-AIDS and in healthy carriers, and it provides large amounts of virus for detailed molecular and immunological analyses.",
    url = "https://doi.org/10.1126/science.6200935",
    doi = "10.1126/science.6200935",
    openalex = "W1991670386",
    references = "doi101016jwem201011007, doi101056nejm198112103052401, doi101056nejm198112103052402, doi101073pnas77127415, doi101073pnas78106476, doi101073pnas7962031, doi101126science181845, doi101126science6189183, doi101126science6200936, doi101126science6200937, doi101126science6601823"
}

Peripheral blood lymphocytes from patients with the acquired immunodeficiency syndrome (AIDS) or with signs or symptoms that frequently precede AIDS (pre-AIDS) were grown in vitro with added T-cell growth factor and assayed for the expression and release of human T-lymphotropic retroviruses (HTLV). Retroviruses belonging to the HTLV family and collectively designated HTLV-III were isolated from a total of 48 subjects including 18 of 21 patients wih pre-AIDS, three of four clinically normal mothers of juveniles with AIDS, 26 of 72 adult and juvenile patients with AIDS, and from one of 22 normal male homosexual subjects. No HTLV-III was detected in or isolated from 115 normal heterosexual subjects. The number of HTLV-III isolates reported here underestimates the true prevalence of the virus since many specimens were received in unsatisfactory condition. Other data show that serum samples from a high proportion of AIDS patients contain antibodies to HTLV-III. That these new isolates are members of the HTLV family but differ from the previous isolates known as HTLV-I and HTLV-II is indicated by their morphological, biological, and immunological characteristics. These results and those reported elsewhere in this issue suggest that HTLV-III may be the primary cause of AIDS.

@article{doi101126science6200936,
    author = "Gallo, Robert C. and Salahuddin, Syed Zaki and Popovič, Mikuláš and Shearer, Gene M. and Kaplan, Mark H. and Haynes, Barton F. and Palker, T J and Redfield, Robert R. and Oleske, James M. and Safai, Bijan and White, Gilbert and Foster, Paul S. and Markham, Phillip D.",
    title = "Frequent Detection and Isolation of Cytopathic Retroviruses (HTLV-III) from Patients with AIDS and at Risk for AIDS",
    year = "1984",
    journal = "Science",
    abstract = "Peripheral blood lymphocytes from patients with the acquired immunodeficiency syndrome (AIDS) or with signs or symptoms that frequently precede AIDS (pre-AIDS) were grown in vitro with added T-cell growth factor and assayed for the expression and release of human T-lymphotropic retroviruses (HTLV). Retroviruses belonging to the HTLV family and collectively designated HTLV-III were isolated from a total of 48 subjects including 18 of 21 patients wih pre-AIDS, three of four clinically normal mothers of juveniles with AIDS, 26 of 72 adult and juvenile patients with AIDS, and from one of 22 normal male homosexual subjects. No HTLV-III was detected in or isolated from 115 normal heterosexual subjects. The number of HTLV-III isolates reported here underestimates the true prevalence of the virus since many specimens were received in unsatisfactory condition. Other data show that serum samples from a high proportion of AIDS patients contain antibodies to HTLV-III. That these new isolates are members of the HTLV family but differ from the previous isolates known as HTLV-I and HTLV-II is indicated by their morphological, biological, and immunological characteristics. These results and those reported elsewhere in this issue suggest that HTLV-III may be the primary cause of AIDS.",
    url = "https://doi.org/10.1126/science.6200936",
    doi = "10.1126/science.6200936",
    openalex = "W1968873679",
    references = "doi101016jwem201011007, doi101056nejm198112103052401, doi101056nejm198112103052402, doi101056nejm198112103052403, doi101073pnas77127415, doi101126science6189183, doi101126science6200935, doi101126science6200937, doi101126science6324345, doi101126science6601823, doi101126science6981847"
}

The two main subgroups of the family of human T-lymphotropic retroviruses (HTLV) that have previously been characterized are known as HTLV-I and HTLV-II. Both are associated with certain human leukemias and lymphomas. Cell surface antigens (p61 and p65) encoded by HTLV-I are frequently recognized, at low titers, by antibodies in the serum of patients with acquired immunodeficiency syndrome (AIDS) or with signs or symptoms that precede AIDS (pre-AIDS). This suggests an involvement of HTLV in these disorders. Another subgroup of HTLV, designated HTLV-III, has now been isolated from many patients with AIDS and pre-AIDS. In the studies described in this report, virus-associated antigens in T-cell clones permanently producing HTLV-III were subjected to biochemical and immunological analyses. Antigens of HTLV-III, specifically detected by antibodies in serum from AIDS or pre-AIDS patients and revealed by the Western blot technique, are similar in size to those found in other subgroups of HTLV. They include at least three serologically unrelated antigenic groups, one of which is associated with group-specific antigens (p55 and P24) and another with envelope-related (p65) proteins, while the antigens in the third group are of unknown affiliation. The data show that HTLV-III is clearly distinguishable from HTLV-I and HTLV-II but is also significantly related to both viruses. HTLV-III is thus a true member of the HTLV family.

@article{doi101126science6200937,
    author = "Schüpbach, Jörg and Popovič, Mikuláš and Gilden, Raymond V. and Gonda, Matthew A. and Sarngadharan, M. G. and Gallo, Robert C.",
    title = "Serological Analysis of a Subgroup of Human T-Lymphotropic Retroviruses (HTLV-III) Associated with AIDS",
    year = "1984",
    journal = "Science",
    abstract = "The two main subgroups of the family of human T-lymphotropic retroviruses (HTLV) that have previously been characterized are known as HTLV-I and HTLV-II. Both are associated with certain human leukemias and lymphomas. Cell surface antigens (p61 and p65) encoded by HTLV-I are frequently recognized, at low titers, by antibodies in the serum of patients with acquired immunodeficiency syndrome (AIDS) or with signs or symptoms that precede AIDS (pre-AIDS). This suggests an involvement of HTLV in these disorders. Another subgroup of HTLV, designated HTLV-III, has now been isolated from many patients with AIDS and pre-AIDS. In the studies described in this report, virus-associated antigens in T-cell clones permanently producing HTLV-III were subjected to biochemical and immunological analyses. Antigens of HTLV-III, specifically detected by antibodies in serum from AIDS or pre-AIDS patients and revealed by the Western blot technique, are similar in size to those found in other subgroups of HTLV. They include at least three serologically unrelated antigenic groups, one of which is associated with group-specific antigens (p55 and P24) and another with envelope-related (p65) proteins, while the antigens in the third group are of unknown affiliation. The data show that HTLV-III is clearly distinguishable from HTLV-I and HTLV-II but is also significantly related to both viruses. HTLV-III is thus a true member of the HTLV family.",
    url = "https://doi.org/10.1126/science.6200937",
    doi = "10.1126/science.6200937",
    openalex = "W1991569036",
    references = "doi101002ijc2910290606, doi101073pnas7694350, doi101073pnas77127415, doi101073pnas80123618, doi101126science6189183, doi101126science6200935, doi101126science6200936, doi101126science6324345, doi101126science6601823, doi101126science6981847"
}

In cats, infection with T-lymphotropic retroviruses can cause T-cell proliferation and leukemia or T-cell depletion and immunosuppression. In humans, some highly T4 tropic retroviruses called HTLV-I can cause T-cell proliferation and leukemia. The subgroup HTLV-II also induces T-cell proliferation in vitro, but its role in disease is unclear. Viruses of a third subgroup of human T-lymphotropic retroviruses, collectively designated HTLV-III, have been isolated from cultured cells of 48 patients with acquired immunodeficiency syndrome (AIDS). The biological properties of HTLV-III and immunological analyses of its proteins show that this virus is a member of the HTLV family, and that it is more closely related to HTLV-II than to HTLV-I. Serum samples from 88 percent of patients with AIDS and from 79 percent of homosexual men with signs and symptoms that frequently precede AIDS, but from less than 1 percent of heterosexual subjects, have antibodies reactive against antigens of HTLV-III. The major immune reactivity appears to be directed against p41, the presumed envelope antigen of the virus.

@article{doi101126science6324345,
    author = "Sarngadharan, M. G. and Popovič, Mikuláš and Bruch, L and Schüpbach, Jörg and Gallo, Robert C.",
    title = "Antibodies Reactive with Human T-Lymphotropic Retroviruses (HTLV-III) in the Serum of Patients with AIDS",
    year = "1984",
    journal = "Science",
    abstract = "In cats, infection with T-lymphotropic retroviruses can cause T-cell proliferation and leukemia or T-cell depletion and immunosuppression. In humans, some highly T4 tropic retroviruses called HTLV-I can cause T-cell proliferation and leukemia. The subgroup HTLV-II also induces T-cell proliferation in vitro, but its role in disease is unclear. Viruses of a third subgroup of human T-lymphotropic retroviruses, collectively designated HTLV-III, have been isolated from cultured cells of 48 patients with acquired immunodeficiency syndrome (AIDS). The biological properties of HTLV-III and immunological analyses of its proteins show that this virus is a member of the HTLV family, and that it is more closely related to HTLV-II than to HTLV-I. Serum samples from 88 percent of patients with AIDS and from 79 percent of homosexual men with signs and symptoms that frequently precede AIDS, but from less than 1 percent of heterosexual subjects, have antibodies reactive against antigens of HTLV-III. The major immune reactivity appears to be directed against p41, the presumed envelope antigen of the virus.",
    url = "https://doi.org/10.1126/science.6324345",
    doi = "10.1126/science.6324345",
    openalex = "W2043015697",
    references = "doi101126science6200937"
}

Lymphadenopathy associated virus (LAV) has been isolated from patients with the acquired immunodeficiency syndrome (AIDS) or lymphadenopathy syndrome. Since the immune deficiency in AIDS seems to be primarily related to the defect of the helper-inducer T lymphocyte subset, the possibility that LAV is selectively tropic for this subset was investigated. Fractionation of T lymphocytes was achieved by cellular affinity chromatography with monoclonal antibodies. In a hemophilic patient who was a healthy carrier of LAV, reverse transcriptase activity and virus particles detected by electron microscopy were found only in cultures of helper-inducer lymphocytes. When infected with LAV in vitro, lymphocyte subsets from normal individuals yielded similar results. Virus production was associated with impaired proliferation, modulation of T3-T4 cell markers, and the appearance of cytopathic effects. The results provide evidence for the involvement of LAV in AIDS.

@article{doi101126science6328660,
    author = "Klatzmann, David and Barré‐Sinoussi, Françoise and Nugeyre, Marie Thèrése and Danguet, Claude and Vilmer, E and Griscelli, C and Brun-Veziret, Francoise and Rouzioux, Christine and Gluckman, Jean Claude and Chermann, Jean‐Claude and Montagnier, Luc",
    title = "Selective Tropism of Lymphadenopathy Associated Virus (LAV) for Helper-Inducer T Lymphocytes",
    year = "1984",
    journal = "Science",
    abstract = "Lymphadenopathy associated virus (LAV) has been isolated from patients with the acquired immunodeficiency syndrome (AIDS) or lymphadenopathy syndrome. Since the immune deficiency in AIDS seems to be primarily related to the defect of the helper-inducer T lymphocyte subset, the possibility that LAV is selectively tropic for this subset was investigated. Fractionation of T lymphocytes was achieved by cellular affinity chromatography with monoclonal antibodies. In a hemophilic patient who was a healthy carrier of LAV, reverse transcriptase activity and virus particles detected by electron microscopy were found only in cultures of helper-inducer lymphocytes. When infected with LAV in vitro, lymphocyte subsets from normal individuals yielded similar results. Virus production was associated with impaired proliferation, modulation of T3-T4 cell markers, and the appearance of cytopathic effects. The results provide evidence for the involvement of LAV in AIDS.",
    url = "https://doi.org/10.1126/science.6328660",
    doi = "10.1126/science.6328660",
    openalex = "W2137267461",
    references = "doi101016jwem201011007, doi101073pnas77127415, doi101073pnas80175402, doi101126science6189183, doi101126science6200935, doi101126science6200936, doi101126science6600519, doi101126science6695172, doi101126science6695196, doi10732600034819995585"
}

@article{doi101038313277a0,
    author = "Ratner, Lee and Haseltine, William A. and Patarca, Roberto and Livak, Kenneth J. and Starcich, B and Josephs, Steven F. and Doran, Ellen R. and Rafalski, J. Antoni and Whitehorn, Erik A. and Baumeister, Kirk and Ivanoff, Lucinda A. and Petteway, Stephen R. and Pearson, Mark and Lautenberger, James A. and Papas, Takis S. and Ghrayeb, John and Chang, Nancy and Gallo, Robert C. and Wong‐Staal, Flossie",
    title = "Complete nucleotide sequence of the AIDS virus, HTLV-III",
    year = "1985",
    journal = "Nature",
    url = "https://doi.org/10.1038/313277a0",
    doi = "10.1038/313277a0",
    openalex = "W2030017358",
    references = "doi1010160022283682905150, doi101016s0076687980650599, doi101038312763a0, doi101073pnas74125463, doi101073pnas77127415, doi101073pnas7863824, doi101093nar102459, doi101126science6189183, doi101126science6200935, doi101126science6200936, doi101126science6200937, doi101126science6328660"
}

The acquired immune deficiency syndrome (AIDS) is thought to result from infection of T cells by a pathogenic human retrovirus, human T-lymphotropic virus type III (HTLV-III) or lymphadenopathy-associated virus (LAV). In this report, we describe the antiviral effects of a thymidine analogue,3'-azido-3'-deoxythymidine (BW A509U), which, as a triphosphate, inhibits the reverse transcriptase of HTLV-III/LAV. This agent blocks the expression of the p24 gag protein of HTLV-III/LAV in H9 cells following exposure to virus. The drug also inhibits the cytopathic effect of HTLV-IIIB (a virus derived from a pool of American patients) and HTLV-III/RF-II (an isolate obtained from a Haitian patient that differs by about 20% in the amino acid sequence of the envelope gene from several isolates of HTLV-III/LAV, including HTLV-IIIB, analyzed so far). 3'-Azido-3'-deoxythymidine also completely blocks viral replication as assessed by reverse transcriptase production in normal human peripheral blood mononuclear cells exposed to HTLV-IIIB. Finally, at concentrations of 3'-azido-3'-deoxythymidine that block the in vitro infectivity and cytopathic effect of HTLV-IIIB, the in vitro immune functions of normal T cells remain basically intact.

@article{doi101073pnas82207096,
    author = "Mitsuya, Hiroaki and Weinhold, Kent J. and Furman, P A and Clair, M H St and Lehrman, Sandra Nusinoff and Gallo, Robert C. and Bolognesi, Dani P. and Barry, David W. and Broder, S",
    title = "3'-Azido-3'-deoxythymidine (BW A509U): an antiviral agent that inhibits the infectivity and cytopathic effect of human T-lymphotropic virus type III/lymphadenopathy-associated virus in vitro.",
    year = "1985",
    journal = "Proceedings of the National Academy of Sciences",
    abstract = "The acquired immune deficiency syndrome (AIDS) is thought to result from infection of T cells by a pathogenic human retrovirus, human T-lymphotropic virus type III (HTLV-III) or lymphadenopathy-associated virus (LAV). In this report, we describe the antiviral effects of a thymidine analogue,3'-azido-3'-deoxythymidine (BW A509U), which, as a triphosphate, inhibits the reverse transcriptase of HTLV-III/LAV. This agent blocks the expression of the p24 gag protein of HTLV-III/LAV in H9 cells following exposure to virus. The drug also inhibits the cytopathic effect of HTLV-IIIB (a virus derived from a pool of American patients) and HTLV-III/RF-II (an isolate obtained from a Haitian patient that differs by about 20\% in the amino acid sequence of the envelope gene from several isolates of HTLV-III/LAV, including HTLV-IIIB, analyzed so far). 3'-Azido-3'-deoxythymidine also completely blocks viral replication as assessed by reverse transcriptase production in normal human peripheral blood mononuclear cells exposed to HTLV-IIIB. Finally, at concentrations of 3'-azido-3'-deoxythymidine that block the in vitro infectivity and cytopathic effect of HTLV-IIIB, the in vitro immune functions of normal T cells remain basically intact.",
    url = "https://doi.org/10.1073/pnas.82.20.7096",
    doi = "10.1073/pnas.82.20.7096",
    openalex = "W2086186867",
    references = "doi101126science6200935, doi101126science6200936, doi101126science6200937, doi101126science6328660"
}

@article{doi1010160092867486905908,
    author = "Maddon, Paul J. and Dalgleish, Angus and McDougal, J. Steven and Clapham, Paul R. and Weiss, Robin A. and Axel, Richard",
    title = "The T4 gene encodes the AIDS virus receptor and is expressed in the immune system and the brain",
    year = "1986",
    journal = "Cell",
    url = "https://doi.org/10.1016/0092-8674(86)90590-8",
    doi = "10.1016/0092-8674(86)90590-8",
    openalex = "W1971057735",
    references = "doi1010160022283677900523, doi1010160042682273903413, doi101021bi00591a005, doi101038312763a0, doi101038312767a0, doi101073pnas77127415, doi101073pnas79144395, doi101073pnas81144510, doi101126science6189183, doi101126science6200935, doi101126science6200936, doi101126science6328660, doi101126science7053569, doi101146annurevbi47070178001343, openalexw2468119228"
}

@article{doi101016s0140673686908858,
    author = "Wofsy, ConstanceB and Hauer, LaurieB and Michaelis, B. and Cohen, JudithB and Padian, NancyS and Evans, LouiseA and Levy, JayA.",
    title = "ISOLATION OF AIDS-ASSOCIATED RETROVIRUS FROM GENITAL SECRETIONS OF WOMEN WITH ANTIBODIES TO THE VIRUS",
    year = "1986",
    journal = "The Lancet",
    url = "https://doi.org/10.1016/s0140-6736(86)90885-8",
    doi = "10.1016/s0140-6736(86)90885-8",
    openalex = "W1993296353"
}

The acquired immunodeficiency syndrome (AIDS) is epidemic in Central Africa. To determine the prevalence of AIDS virus infection in East Africa, we studied 90 female prostitutes, 40 men treated at a clinic for sexually transmitted diseases, and 42 medical personnel in Nairobi, Kenya. Antibody to human T-cell lymphotropic virus Type III (HTLV-III) was detected in the serum of 66 percent of prostitutes of low socioeconomic status, 31 percent of prostitutes of higher socioeconomic status, 8 percent of the clinic patients, and 2 percent of the medical personnel. The presence of the antibody was associated with both immunologic and clinical abnormalities. The mean T-cell helper/suppressor ratio was 0.92 in seropositive prostitutes and 1.82 in seronegative prostitutes (P less than 0.0001). Generalized lymphadenopathy was present in 54 percent of seropositive prostitutes and 10 percent of seronegative prostitutes (P less than 0.0001). No constitutional symptoms, opportunistic infections, or cases of Kaposi's sarcoma were present. Our results indicate that the epidemic of AIDS virus infection has, unfortunately, spread extensively among urban prostitutes in Nairobi, Kenya. Sexual exposure to men from Central Africa was significantly associated with HTLV-III antibody among prostitutes, suggesting transcontinental spread of the epidemic.

@article{doi101056nejm198602133140704,
    author = "Kreiss, Joan K. and Koech, Davy and Plummer, Francis A. and Holmes, King K. and Lightfoote, Marilyn M. and Piot, Peter and Ronald, Allan and Ndinya-Achola, J O and D'Costa, L J and Roberts, Pacita L. and Ngugi, Elizabeth and Quinn, Thomas C.",
    title = "AIDS Virus Infection in Nairobi Prostitutes",
    year = "1986",
    journal = "New England Journal of Medicine",
    abstract = "The acquired immunodeficiency syndrome (AIDS) is epidemic in Central Africa. To determine the prevalence of AIDS virus infection in East Africa, we studied 90 female prostitutes, 40 men treated at a clinic for sexually transmitted diseases, and 42 medical personnel in Nairobi, Kenya. Antibody to human T-cell lymphotropic virus Type III (HTLV-III) was detected in the serum of 66 percent of prostitutes of low socioeconomic status, 31 percent of prostitutes of higher socioeconomic status, 8 percent of the clinic patients, and 2 percent of the medical personnel. The presence of the antibody was associated with both immunologic and clinical abnormalities. The mean T-cell helper/suppressor ratio was 0.92 in seropositive prostitutes and 1.82 in seronegative prostitutes (P less than 0.0001). Generalized lymphadenopathy was present in 54 percent of seropositive prostitutes and 10 percent of seronegative prostitutes (P less than 0.0001). No constitutional symptoms, opportunistic infections, or cases of Kaposi's sarcoma were present. Our results indicate that the epidemic of AIDS virus infection has, unfortunately, spread extensively among urban prostitutes in Nairobi, Kenya. Sexual exposure to men from Central Africa was significantly associated with HTLV-III antibody among prostitutes, suggesting transcontinental spread of the epidemic.",
    url = "https://doi.org/10.1056/nejm198602133140704",
    doi = "10.1056/nejm198602133140704",
    openalex = "W2099873434",
    references = "doi101016s014067368490240x, doi101016s0140673684902411, doi101016s0140673685904623, doi101056nejm198402233100804, doi1010970000743519850400000002, doi101126science6238406, doi10732600034819992145, doi10732600034819992151, openalexw2260646769"
}

A novel human B-lymphotropic virus (HBLV) was isolated from the peripheral blood leukocytes of six individuals: two HTLV-III seropositive patients from the United States (one with AIDS-related lymphoma and one with dermatopathic lymphadenopathy), three HTLV-III seronegative patients from the United States (one with angioimmunoblastic lymphadenopathy, one with cutaneous T-cell lymphoma, and one with immunoblastic lymphoma), and one HTLV-III seronegative patient with acute lymphocytic leukemia from Jamaica. All six isolates were closely related by antigenic analysis, and sera from all six virus-positive patients reacted immunologically with each virus isolate. In contrast, only four sera from 220 randomly selected healthy donors and none from 12 AIDS patients without associated lymphoma were seropositive. The virus selectively infected freshly isolated human B cells and converted them into large, refractile mono- or binucleated cells with nuclear and cytoplasmic inclusion bodies. HBLV is morphologically similar to viruses of the herpesvirus family but is readily distinguishable from the known human and nonhuman primate herpesviruses by host range, in vitro biological effects, and antigenic features.

@article{doi101126science2876520,
    author = "Salahuddin, S. Zaki and Ablashi, Dharam V. and Markham, Phillip D. and Josephs, Steven F. and Sturzenegger, Susi and Kaplan, Mark H. and Halligan, Gregory E. and Biberfeld, Peter and Wong‐Staal, Flossie and Kramarsky, Bernhard and Gallo, Robert C.",
    title = "Isolation of a New Virus, HBLV, in Patients with Lymphoproliferative Disorders",
    year = "1986",
    journal = "Science",
    abstract = "A novel human B-lymphotropic virus (HBLV) was isolated from the peripheral blood leukocytes of six individuals: two HTLV-III seropositive patients from the United States (one with AIDS-related lymphoma and one with dermatopathic lymphadenopathy), three HTLV-III seronegative patients from the United States (one with angioimmunoblastic lymphadenopathy, one with cutaneous T-cell lymphoma, and one with immunoblastic lymphoma), and one HTLV-III seronegative patient with acute lymphocytic leukemia from Jamaica. All six isolates were closely related by antigenic analysis, and sera from all six virus-positive patients reacted immunologically with each virus isolate. In contrast, only four sera from 220 randomly selected healthy donors and none from 12 AIDS patients without associated lymphoma were seropositive. The virus selectively infected freshly isolated human B cells and converted them into large, refractile mono- or binucleated cells with nuclear and cytoplasmic inclusion bodies. HBLV is morphologically similar to viruses of the herpesvirus family but is readily distinguishable from the known human and nonhuman primate herpesviruses by host range, in vitro biological effects, and antigenic features.",
    url = "https://doi.org/10.1126/science.2876520",
    doi = "10.1126/science.2876520",
    openalex = "W1963829537",
    references = "doi101126science6200935"
}

One of the common neurological complications in patients with the acquired immune deficiency syndrome (AIDS) is a subacute encephalopathy with progressive dementia. By using the techniques of cocultivation for virus isolation, in situ hybridization, immunocytochemistry, and transmission electron microscopy, the identity of an important cell type that supports replication of the AIDS retrovirus in brain tissue was determined in two affected individuals. These cells were mononucleated and multinucleated macrophages that actively synthesized viral RNA and produced progeny virions in the brains of the patients. Infected brain macrophages may serve as a reservoir for virus and as a vehicle for viral dissemination in the infected host.

@article{doi101126science3016903,
    author = "Koenig, Scott and Gendelman, Howard E. and Orenstein, Jan M. and Canto, Mauro C. Dal and Pezeshkpour, G. and Yungbluth, Margaret and Janotta, Frank and Aksamit, Allen J. and Martin, Malcolm A. and Fauci, Anthony S.",
    title = "Detection of AIDS Virus in Macrophages in Brain Tissue from AIDS Patients with Encephalopathy",
    year = "1986",
    journal = "Science",
    abstract = "One of the common neurological complications in patients with the acquired immune deficiency syndrome (AIDS) is a subacute encephalopathy with progressive dementia. By using the techniques of cocultivation for virus isolation, in situ hybridization, immunocytochemistry, and transmission electron microscopy, the identity of an important cell type that supports replication of the AIDS retrovirus in brain tissue was determined in two affected individuals. These cells were mononucleated and multinucleated macrophages that actively synthesized viral RNA and produced progeny virions in the brains of the patients. Infected brain macrophages may serve as a reservoir for virus and as a vehicle for viral dissemination in the infected host.",
    url = "https://doi.org/10.1126/science.3016903",
    doi = "10.1126/science.3016903",
    openalex = "W2030692398",
    references = "doi101038312763a0, doi101126science6200935, doi101126science6328660"
}

Cases of the acquired immune deficiency syndrome (AIDS) have been reported in countries throughout the world. Initial surveillance studies in Central Africa suggest an annual incidence of AIDS of 550 to 1000 cases per million adults. The male to female ratio of cases is 1:1, with age- and sex-specific rates greater in females less than 30 years of age and greater in males over age 40. Clinically, AIDS in Africans is often characterized by a diarrhea-wasting syndrome, opportunistic infections, such as tuberculosis, cryptococcosis, and cryptosporidiosis, or disseminated Kaposi's sarcoma. From 1 to 18% of healthy blood donors and pregnant women and as many as 27 to 88% of female prostitutes have antibodies to human immunodeficiency virus (HIV). The present annual incidence of infection is approximately 0.75% among the general population of Central and East Africa. The disease is transmitted predominantly by heterosexual activity, parenteral exposure to blood transfusions and unsterilized needles, and perinatally from infected mothers to their newborns, and will continue to spread rapidly where economic and cultural factors favor these modes of transmission. Prevention and control of HIV infection through educational programs and blood bank screening should be an immediate public health priority for all African countries.

@article{doi101126science3022379,
    author = "Quinn, Thomas C. and Mann, Jonathan M. and Curran, James W. and Piot, Peter",
    title = "AIDS in Africa: An Epidemiologic Paradigm",
    year = "1986",
    journal = "Science",
    abstract = "Cases of the acquired immune deficiency syndrome (AIDS) have been reported in countries throughout the world. Initial surveillance studies in Central Africa suggest an annual incidence of AIDS of 550 to 1000 cases per million adults. The male to female ratio of cases is 1:1, with age- and sex-specific rates greater in females less than 30 years of age and greater in males over age 40. Clinically, AIDS in Africans is often characterized by a diarrhea-wasting syndrome, opportunistic infections, such as tuberculosis, cryptococcosis, and cryptosporidiosis, or disseminated Kaposi's sarcoma. From 1 to 18\% of healthy blood donors and pregnant women and as many as 27 to 88\% of female prostitutes have antibodies to human immunodeficiency virus (HIV). The present annual incidence of infection is approximately 0.75\% among the general population of Central and East Africa. The disease is transmitted predominantly by heterosexual activity, parenteral exposure to blood transfusions and unsterilized needles, and perinatally from infected mothers to their newborns, and will continue to spread rapidly where economic and cultural factors favor these modes of transmission. Prevention and control of HIV infection through educational programs and blood bank screening should be an immediate public health priority for all African countries.",
    url = "https://doi.org/10.1126/science.3022379",
    doi = "10.1126/science.3022379",
    openalex = "W2067766620",
    references = "doi101056nejm198602133140704"
}

We conducted a double-blind, placebo-controlled trial of oral azidothymidine (AZT) in 282 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Although significant clinical benefit was documented (N Engl J Med 1987; 317:185-91), serious adverse reactions, particularly bone marrow suppression, were observed. Nausea, myalgia, insomnia, and severe headaches were reported more frequently by recipients of AZT; macrocytosis developed within weeks in most of the AZT group. Anemia with hemoglobin levels below 7.5 g per deciliter developed in 24 percent of AZT recipients and 4 percent of placebo recipients (P less than 0.001). Twenty-one percent of AZT recipients and 4 percent of placebo recipients required multiple red-cell transfusions (P less than 0.001). Neutropenia (less than 500 cells per cubic millimeter) occurred in 16 percent of AZT recipients, as compared with 2 percent of placebo recipients (P less than 0.001). Subjects who entered the study with low CD4 lymphocyte counts, low serum vitamin B12 levels, anemia, or low neutrophil counts were more likely to have hematologic toxic effects. Concurrent use of acetaminophen was also associated with a higher frequency of hematologic toxicity. Although a subset of patients tolerated AZT for an extended period with few toxic effects, the drug should be administered with caution because of its toxicity and the limited experience with it to date.

@article{doi101056nejm198707233170401,
    author = "Fischl, Margaret A. and Richman, Douglas D. and Grieco, Michael H. and Gottlieb, Michael S. and Volberding, Paul A. and Laskin, Oscar L. and Leedom, John M. and Groopman, Jerome E. and Mildvan, Donna and Schooley, Robert T. and Jackson, George Gee and Durack, David T. and King, Dannie H. and Group, The AZT Collaborative Working",
    title = "The Efficacy of Azidothymidine (AZT) in the Treatment of Patients with AIDS and AIDS-Related Complex",
    year = "1987",
    journal = "New England Journal of Medicine",
    abstract = "We conducted a double-blind, placebo-controlled trial of oral azidothymidine (AZT) in 282 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Although significant clinical benefit was documented (N Engl J Med 1987; 317:185-91), serious adverse reactions, particularly bone marrow suppression, were observed. Nausea, myalgia, insomnia, and severe headaches were reported more frequently by recipients of AZT; macrocytosis developed within weeks in most of the AZT group. Anemia with hemoglobin levels below 7.5 g per deciliter developed in 24 percent of AZT recipients and 4 percent of placebo recipients (P less than 0.001). Twenty-one percent of AZT recipients and 4 percent of placebo recipients required multiple red-cell transfusions (P less than 0.001). Neutropenia (less than 500 cells per cubic millimeter) occurred in 16 percent of AZT recipients, as compared with 2 percent of placebo recipients (P less than 0.001). Subjects who entered the study with low CD4 lymphocyte counts, low serum vitamin B12 levels, anemia, or low neutrophil counts were more likely to have hematologic toxic effects. Concurrent use of acetaminophen was also associated with a higher frequency of hematologic toxicity. Although a subset of patients tolerated AZT for an extended period with few toxic effects, the drug should be administered with caution because of its toxicity and the limited experience with it to date.",
    url = "https://doi.org/10.1056/nejm198707233170401",
    doi = "10.1056/nejm198707233170401",
    openalex = "W2333399282",
    references = "doi1010021097014219481114634aidcncr282001041030co2l, doi101056nejm198707233170402, doi101073pnas82207096, doi101073pnas83218333, doi10108001621459196310500879, doi101111j251761611972tb00899x, doi101126science6189183, doi101126science6200935, doi101126science6200936, doi1023071268531"
}

Questionnaires were mailed to a random sample of students at a university in Southern California. The results revealed that for the most part, students were engaging in few activities that would protect them from contracting the human immunodeficiency virus (HIV). Regression analyses were used to evaluate several variables related to sexual risk‐taking, i.e., condom use, number of sexual partners in the last three months, and casual sex. The most consistent predictors of cautious sexual behaviors were age at first intercourse, average number of partners per year, being female and using seatbelts while driving. Safer sexual practices were not influenced by religiosity or having had a course on human sexuality or religiosity. The findings lead us to conclude that AIDS‐related education must not rely solely on programs designed to relay AIDS information only, but must also stress the value of certain lifestyle habits, social responsibility, and caution in face of risky activities.

@article{doi10108000224498809551454,
    author = "Baldwin, John D. and Baldwin, Janice I.",
    title = "Factors affecting aids‐related sexual risk‐taking behavior among college students",
    year = "1988",
    journal = "The Journal of Sex Research",
    abstract = "Questionnaires were mailed to a random sample of students at a university in Southern California. The results revealed that for the most part, students were engaging in few activities that would protect them from contracting the human immunodeficiency virus (HIV). Regression analyses were used to evaluate several variables related to sexual risk‐taking, i.e., condom use, number of sexual partners in the last three months, and casual sex. The most consistent predictors of cautious sexual behaviors were age at first intercourse, average number of partners per year, being female and using seatbelts while driving. Safer sexual practices were not influenced by religiosity or having had a course on human sexuality or religiosity. The findings lead us to conclude that AIDS‐related education must not rely solely on programs designed to relay AIDS information only, but must also stress the value of certain lifestyle habits, social responsibility, and caution in face of risky activities.",
    url = "https://doi.org/10.1080/00224498809551454",
    doi = "10.1080/00224498809551454",
    openalex = "W2077607687"
}

Monocytes were maintained in tissue culture for greater than 3 mo in media supplemented with rCSF-1. These cultures provided susceptible target cells for isolation and propagation of virus from PBMC of HIV-infected patients. HIV isolated into monocytes readily infected other rCSF-1-treated monocytes but only inefficiently infected PHA-stimulated lymphoblasts. Similarly, laboratory HIV strains passaged in T cell lines or virus isolated from patients' leukocytes into PHA-stimulated lymphoblasts inefficiently infected rCSF-1-treated monocytes. Persistent, low-level virion production was detected in macrophage culture fluids by reverse transcriptase activity or HIV antigen capture through 6-7 wk. Marked changes in cell morphology with cell death, syncytia, and giant cell formation were observed in monocyte cultures 2 wk after infection, but at 4-6 wk, all cells appeared morphologically normal. However, the frequency of infected cells in these cultures at 6 wk was 60-90% as quantified by in situ hybridization with HIV RNA probes or by immunofluorescence with AIDS patients' sera. Ultrastructural analysis by EM also showed a high frequency of infected cells; virtually all HIV budded into and accumulated within cytoplasmic vacuoles and virus particles were only infrequently associated with the plasma membrane. Retention of virus within macrophages and the macrophage tropism of HIV variants may explain mechanisms of both virus persistence and dissemination during disease.

@article{doi101084jem16741428,
    author = "Gendelman, Howard E. and Orenstein, Jan M. and Martin, Malcolm A. and Ferrua, C and Mitra, Ruchira and Phipps, T J and Wahl, L A and Lane, H. Clifford and Fauci, Anthony S. and Burke, Danielle",
    title = "Efficient isolation and propagation of human immunodeficiency virus on recombinant colony-stimulating factor 1-treated monocytes.",
    year = "1988",
    journal = "The Journal of Experimental Medicine",
    abstract = "Monocytes were maintained in tissue culture for greater than 3 mo in media supplemented with rCSF-1. These cultures provided susceptible target cells for isolation and propagation of virus from PBMC of HIV-infected patients. HIV isolated into monocytes readily infected other rCSF-1-treated monocytes but only inefficiently infected PHA-stimulated lymphoblasts. Similarly, laboratory HIV strains passaged in T cell lines or virus isolated from patients' leukocytes into PHA-stimulated lymphoblasts inefficiently infected rCSF-1-treated monocytes. Persistent, low-level virion production was detected in macrophage culture fluids by reverse transcriptase activity or HIV antigen capture through 6-7 wk. Marked changes in cell morphology with cell death, syncytia, and giant cell formation were observed in monocyte cultures 2 wk after infection, but at 4-6 wk, all cells appeared morphologically normal. However, the frequency of infected cells in these cultures at 6 wk was 60-90\% as quantified by in situ hybridization with HIV RNA probes or by immunofluorescence with AIDS patients' sera. Ultrastructural analysis by EM also showed a high frequency of infected cells; virtually all HIV budded into and accumulated within cytoplasmic vacuoles and virus particles were only infrequently associated with the plasma membrane. Retention of virus within macrophages and the macrophage tropism of HIV variants may explain mechanisms of both virus persistence and dissemination during disease.",
    url = "https://doi.org/10.1084/jem.167.4.1428",
    doi = "10.1084/jem.167.4.1428",
    openalex = "W1975258429"
}

@article{doi101126science2457946,
    author = "Marx, Jean L.",
    title = "The AIDS Virus Can Take on Many Guises",
    year = "1988",
    journal = "Science",
    url = "https://doi.org/10.1126/science.2457946",
    doi = "10.1126/science.2457946",
    openalex = "W2046423159",
    references = "doi101126science3375831"
}

Infection with human immunodeficiency virus type 1 (HIV-1) is frequently complicated in its late stages by the AIDS dementia complex, a neurological syndrome characterized by abnormalities in cognition, motor performance, and behavior. This dementia is due partially or wholly to a direct effect of the virus on the brain rather than to opportunistic infection, but its pathogenesis is not well understood. Productive HIV-1 brain infection is detected only in a subset of patients and is confined largely or exclusively to macrophages, microglia, and derivative multinucleated cells that are formed by virus-induced cell fusion. Absence of cytolytic infection of neurons, oligodentrocytes, and astrocytes has focused attention on the possible role of indirect mechanisms of brain dysfunction related to either virus or cell-coded toxins. Delayed development of the AIDS dementia complex, despite both early exposure of the nervous system to HIV-1 and chronic leptomeningeal infection, indicates that although this virus is "neurotropic," it is relatively nonpathogenic for the brain in the absence of immunosuppression. Within the context of the permissive effect of immunosuppression, genetic changes in HIV-1 may underlie the neuropathological heterogeneity of the AIDS dementia complex and its relatively independent course in relation to the systemic manifestations of AIDS noted in some patients.

@article{doi101126science3277272,
    author = "Price, Richard W. and Brew, Bruce J. and Sidtis, John J. and Rosenblum, Marc K. and Scheck, Adrienne C. and Cleary, Paul D.",
    title = "The Brain in AIDS: Central Nervous System HIV-1 Infection and AIDS Dementia Complex",
    year = "1988",
    journal = "Science",
    abstract = {Infection with human immunodeficiency virus type 1 (HIV-1) is frequently complicated in its late stages by the AIDS dementia complex, a neurological syndrome characterized by abnormalities in cognition, motor performance, and behavior. This dementia is due partially or wholly to a direct effect of the virus on the brain rather than to opportunistic infection, but its pathogenesis is not well understood. Productive HIV-1 brain infection is detected only in a subset of patients and is confined largely or exclusively to macrophages, microglia, and derivative multinucleated cells that are formed by virus-induced cell fusion. Absence of cytolytic infection of neurons, oligodentrocytes, and astrocytes has focused attention on the possible role of indirect mechanisms of brain dysfunction related to either virus or cell-coded toxins. Delayed development of the AIDS dementia complex, despite both early exposure of the nervous system to HIV-1 and chronic leptomeningeal infection, indicates that although this virus is "neurotropic," it is relatively nonpathogenic for the brain in the absence of immunosuppression. Within the context of the permissive effect of immunosuppression, genetic changes in HIV-1 may underlie the neuropathological heterogeneity of the AIDS dementia complex and its relatively independent course in relation to the systemic manifestations of AIDS noted in some patients.},
    url = "https://doi.org/10.1126/science.3277272",
    doi = "10.1126/science.3277272",
    openalex = "W2059865376"
}

@article{marx1988the,
    author = "Marx, Jean L.",
    title = "The AIDS Virus Can Take on Many Guises",
    year = "1988",
    journal = "Science",
    url = "https://doi.org/10.1126/science.2457946",
    doi = "10.1126/science.2457946",
    number = "4869",
    pages = "1039-1040",
    volume = "241"
}

@misc{marx1988the1,
    author = "Marx, J. L",
    title = "The AIDS Virus Can Take on Many Guises",
    year = "1988",
    howpublished = "Science, v. 241, p. 1039-1040",
    note = "talkorigins\_source = {true}; raw\_reference = {Marx, J. L., 1988, The AIDS Virus Can Take on Many Guises: Science, v. 241, p. 1039-1040.}"
}

The literature on AIDS has attempted to teach us the facts about this new disease or to provide a narrative account of scientific discovery and developing public health policy. But AIDS has precipitated a crisis that is not primarily medical, or even social and political; AIDS has precipitated a crisis of signification the of AIDS is hotly contested in all of the discourses that conceptualize it and seek to respond to it. AIDS: Cultural Analysis/Cultural Activism is the first book on the subject that takes this battle over meaning as its premise. Contributors Leo Bersani, author of The Freudian Body; Simon Watney, who serves on the board of the Health Education Committee of London's Terrence Higgens Trust; Jan Zita Grover, medical editor at San Francisco General Hospital; Suki Ports, former executive director of the New York City Minority Task Force on AIDS; and Sander Gilman, author of Difference and Pathology. Also included are essays by Paula A. Treichler, who teaches in the Medical School and in communications at the University of Illinois; Carol Leigh, a member of COYOTE and contributor to Sex Work; and Max Navarre, editor of the People With AIDS Coalition monthly Newsline. In addition to these essays, the book contains a portfolio of manifestos, articles, letters, and photographs from the publications of the PWA Coalition, an interview with three members of the AIDS discrimination unit of the New York City Commission on Human Rights; and presentations for the independent video documentaries on AIDS, Testing the Limits and Bright Eyes. An October Book.

@book{openalexw565929067,
    author = "Crimp, Douglas and Bersani, Leo",
    title = "AIDS: cultural analysis, cultural activism",
    year = "1988",
    abstract = "The literature on AIDS has attempted to teach us the facts about this new disease or to provide a narrative account of scientific discovery and developing public health policy. But AIDS has precipitated a crisis that is not primarily medical, or even social and political; AIDS has precipitated a crisis of signification the of AIDS is hotly contested in all of the discourses that conceptualize it and seek to respond to it. AIDS: Cultural Analysis/Cultural Activism is the first book on the subject that takes this battle over meaning as its premise. Contributors Leo Bersani, author of The Freudian Body; Simon Watney, who serves on the board of the Health Education Committee of London's Terrence Higgens Trust; Jan Zita Grover, medical editor at San Francisco General Hospital; Suki Ports, former executive director of the New York City Minority Task Force on AIDS; and Sander Gilman, author of Difference and Pathology. Also included are essays by Paula A. Treichler, who teaches in the Medical School and in communications at the University of Illinois; Carol Leigh, a member of COYOTE and contributor to Sex Work; and Max Navarre, editor of the People With AIDS Coalition monthly Newsline. In addition to these essays, the book contains a portfolio of manifestos, articles, letters, and photographs from the publications of the PWA Coalition, an interview with three members of the AIDS discrimination unit of the New York City Commission on Human Rights; and presentations for the independent video documentaries on AIDS, Testing the Limits and Bright Eyes. An October Book.",
    openalex = "W565929067"
}

This article examines the reasons for resistance to condom use among high-risk women (primarily intravenous drug users and/or the sexual partners of intravenous drug users) in two New York City AIDS prevention programs. The data collected indicate that a lack of economic, social, cultural, sexual, and technological options combine to lead vulnerable women to concentrate on addressing the more immediate risks in their lives: poverty, homelessness, and the frequent disruption of socioeconomic support systems. Resistance to condom use was also found to be related to its negative associations (promiscuity, for example). The process by which decisions are made about using condoms (and other contraceptives) is related to a complex mixture of social, economic, and cultural influences that promote the role of motherhood for a woman, even when she knows that she might already be infected with human immunodeficiency virus (HIV). The implications of these findings have far-reaching effects, as the socioeconomic context of these women's lives, as well as imbalances in power in the relationships between the women and their male partners, are replicated in many communities where AIDS is already present.

@article{doi1023071966433,
    author = "Worth, Dooley",
    title = "Sexual Decision-Making and AIDS: Why Condom Promotion among Vulnerable Women is Likely to Fail",
    year = "1989",
    journal = "Studies in Family Planning",
    abstract = "This article examines the reasons for resistance to condom use among high-risk women (primarily intravenous drug users and/or the sexual partners of intravenous drug users) in two New York City AIDS prevention programs. The data collected indicate that a lack of economic, social, cultural, sexual, and technological options combine to lead vulnerable women to concentrate on addressing the more immediate risks in their lives: poverty, homelessness, and the frequent disruption of socioeconomic support systems. Resistance to condom use was also found to be related to its negative associations (promiscuity, for example). The process by which decisions are made about using condoms (and other contraceptives) is related to a complex mixture of social, economic, and cultural influences that promote the role of motherhood for a woman, even when she knows that she might already be infected with human immunodeficiency virus (HIV). The implications of these findings have far-reaching effects, as the socioeconomic context of these women's lives, as well as imbalances in power in the relationships between the women and their male partners, are replicated in many communities where AIDS is already present.",
    url = "https://doi.org/10.2307/1966433",
    doi = "10.2307/1966433",
    openalex = "W2049557384"
}

Since the acquired immunodeficiency syndrome (AIDS) epidemic is partly a social phenomenon changes in the social behaviors that spread the disease are as necessary as the development of vaccines and other therapies. To help in the design implementation and evaluation of programs to curb the spread of AIDS there is a need for greater understanding of the human behaviors that transmit human immunodeficiency virus (HIV) infection as well as the social contexts in which these behaviors occur. Toward this end the US Committee on AIDS Research and the Behavioral Social and Statistical Sciences was asked to: 1) describe what is known about the spread of HIV and AIDS in the US with special attention to the quality of information at hand and the kind of additional information that is needed; 2) identify critical populations and indicate objectives and tasks related to them; 3) describe existing research findings in the behavioral and social sciences that should be useful in planning and choosing among interventions designed to control the spread of HIV infection; 4) describe existing research on interventions intended to facilitate behavior changes and ways to evaluate their effectiveness; and 5) identify new research that should be undertaken in these areas. The 7 chapters of the resultant report are divided into 3 parts: Understanding the Spread of HIV Infection; Intervening to Limit the Spread of HIV Infection; and Impediments to Research and Intervention. Also included are 6 background papers. Among the recommendations of the Committee are: vigorous programs of basic social and behavioral research on human sexual behavior; availability of condoms and treatment for sexually transmitted diseases through local public health authorities; drug treatment upon request for intravenous drug users; trials of sterile needle programs; and anonymous HIV antibody testing with appropriate counseling on a voluntary basis.

@article{doi1023071973720,
    author = "Bongaarts, John and Turner, Charles F. and Miller, Heather G. and Moses, Lincoln E.",
    title = "AIDS: Sexual Behavior and Intravenous Drug Use.",
    year = "1989",
    journal = "Population and Development Review",
    abstract = "Since the acquired immunodeficiency syndrome (AIDS) epidemic is partly a social phenomenon changes in the social behaviors that spread the disease are as necessary as the development of vaccines and other therapies. To help in the design implementation and evaluation of programs to curb the spread of AIDS there is a need for greater understanding of the human behaviors that transmit human immunodeficiency virus (HIV) infection as well as the social contexts in which these behaviors occur. Toward this end the US Committee on AIDS Research and the Behavioral Social and Statistical Sciences was asked to: 1) describe what is known about the spread of HIV and AIDS in the US with special attention to the quality of information at hand and the kind of additional information that is needed; 2) identify critical populations and indicate objectives and tasks related to them; 3) describe existing research findings in the behavioral and social sciences that should be useful in planning and choosing among interventions designed to control the spread of HIV infection; 4) describe existing research on interventions intended to facilitate behavior changes and ways to evaluate their effectiveness; and 5) identify new research that should be undertaken in these areas. The 7 chapters of the resultant report are divided into 3 parts: Understanding the Spread of HIV Infection; Intervening to Limit the Spread of HIV Infection; and Impediments to Research and Intervention. Also included are 6 background papers. Among the recommendations of the Committee are: vigorous programs of basic social and behavioral research on human sexual behavior; availability of condoms and treatment for sexually transmitted diseases through local public health authorities; drug treatment upon request for intravenous drug users; trials of sterile needle programs; and anonymous HIV antibody testing with appropriate counseling on a voluntary basis.",
    url = "https://doi.org/10.2307/1973720",
    doi = "10.2307/1973720",
    openalex = "W2005807233"
}

An unprecedented number of human sexuality studies have been initiated in response to the acquired immune deficiency syndrome (AIDS) epidemic. Unfortunately, methodological developments in the field of sex research have been slow in meeting the demands of AIDS investigations focusing on the diverse populations at risk for infection with the human immunodeficiency virus (e.g., adolescents, gay men, intravenous-drug users, ethnic minorities, elderly transfusees). In this article, we review and integrate current literature on measurement error and participation bias in sex research, with an emphasis on collecting sexual information in the context of AIDS. The relevance of these findings for AIDS-related sex research is discussed, and recommendations are made to guide future investigations.

@article{doi101037003329091083339,
    author = "Catania, Joseph A. and Gibson, David R. and Chitwood, Dale D. and Coates, Thomas J.",
    title = "Methodological problems in AIDS behavioral research: Influences on measurement error and participation bias in studies of sexual behavior.",
    year = "1990",
    journal = "Psychological Bulletin",
    abstract = "An unprecedented number of human sexuality studies have been initiated in response to the acquired immune deficiency syndrome (AIDS) epidemic. Unfortunately, methodological developments in the field of sex research have been slow in meeting the demands of AIDS investigations focusing on the diverse populations at risk for infection with the human immunodeficiency virus (e.g., adolescents, gay men, intravenous-drug users, ethnic minorities, elderly transfusees). In this article, we review and integrate current literature on measurement error and participation bias in sex research, with an emphasis on collecting sexual information in the context of AIDS. The relevance of these findings for AIDS-related sex research is discussed, and recommendations are made to guide future investigations.",
    url = "https://doi.org/10.1037/0033-2909.108.3.339",
    doi = "10.1037/0033-2909.108.3.339",
    openalex = "W2048694374",
    references = "doi101177109019819001700107"
}

We evaluated three cellular and five serologic markers that are affected by infection with the human immunodeficiency virus type 1 (HIV-1) for their ability to predict the progression to clinical acquired immunodeficiency syndrome (AIDS). The cellular markers were the number of CD4+ T cells, the number of CD8+ T cells, and the ratio of CD4+ T cells to CD8+ T cells. The serologic markers were the serum levels of neopterin (a product of stimulated macrophages), beta 2-microglobulin, soluble interleukin-2 receptors, IgA, and HIV p24 antigen. We evaluated the usefulness of these measures as markers of the progression to AIDS prospectively, over four years, in a cohort of 395 HIV-seropositive homosexual men who were initially free of AIDS. CD4+ T cells (expressed as an absolute number, a percentage of lymphocytes, or a ratio of CD4+ to CD8+ T cells) were the best single predictor of the progression to AIDS, but the serum neopterin and beta 2-microglobulin levels each had nearly as much predictive power. The neopterin level appeared to be a slightly better predictor than the beta 2-microglobulin level. The levels of IgA, interleukin-2 receptors, and p24 antigen had less predictive value. A stepwise multivariate analysis indicated that the best predictors, in descending order, were CD4+ T cells (the percentage of lymphocytes or the CD4+: CD8+ ratio), the serum level of neopterin or beta 2-microglobulin, the level of IgA, that of interleukin-2 receptors, and that of p24 antigen. The last three markers had little additional predictive power beyond that of the first two. We conclude that of the eight markers studied, progression to AIDS was predicted most accurately by the level of CD4+ T cells in combination with the serum level of either neopterin or beta 2-microglobulin. At least one of these two serum markers, which reflect immune activation, should be used along with measurement of CD4+ T cells in disease-classification schemes and in the evaluation of responses to therapy.

@article{doi101056nejm199001183220305,
    author = "Fahey, John L. and Taylor, Jeremy M. G. and Detels, Roger and Hofmann, Bo and Melmed, Raphael N. and Nishanian, P and Giorgi, Janis V.",
    title = "The Prognostic Value of Cellular and Serologic Markers in Infection with Human Immunodeficiency Virus Type 1",
    year = "1990",
    journal = "New England Journal of Medicine",
    abstract = "We evaluated three cellular and five serologic markers that are affected by infection with the human immunodeficiency virus type 1 (HIV-1) for their ability to predict the progression to clinical acquired immunodeficiency syndrome (AIDS). The cellular markers were the number of CD4+ T cells, the number of CD8+ T cells, and the ratio of CD4+ T cells to CD8+ T cells. The serologic markers were the serum levels of neopterin (a product of stimulated macrophages), beta 2-microglobulin, soluble interleukin-2 receptors, IgA, and HIV p24 antigen. We evaluated the usefulness of these measures as markers of the progression to AIDS prospectively, over four years, in a cohort of 395 HIV-seropositive homosexual men who were initially free of AIDS. CD4+ T cells (expressed as an absolute number, a percentage of lymphocytes, or a ratio of CD4+ to CD8+ T cells) were the best single predictor of the progression to AIDS, but the serum neopterin and beta 2-microglobulin levels each had nearly as much predictive power. The neopterin level appeared to be a slightly better predictor than the beta 2-microglobulin level. The levels of IgA, interleukin-2 receptors, and p24 antigen had less predictive value. A stepwise multivariate analysis indicated that the best predictors, in descending order, were CD4+ T cells (the percentage of lymphocytes or the CD4+: CD8+ ratio), the serum level of neopterin or beta 2-microglobulin, the level of IgA, that of interleukin-2 receptors, and that of p24 antigen. The last three markers had little additional predictive power beyond that of the first two. We conclude that of the eight markers studied, progression to AIDS was predicted most accurately by the level of CD4+ T cells in combination with the serum level of either neopterin or beta 2-microglobulin. At least one of these two serum markers, which reflect immune activation, should be used along with measurement of CD4+ T cells in disease-classification schemes and in the evaluation of responses to therapy.",
    url = "https://doi.org/10.1056/nejm199001183220305",
    doi = "10.1056/nejm199001183220305",
    openalex = "W2029777784"
}

Zidovudine (AZT) is a potent inhibitor of the replication of the human immunodeficiency virus (HIV), and it has been shown to improve survival in advanced HIV disease. We conducted a randomized, double-blind trial in adults with asymptomatic HIV infection who had CD4+ cell counts of fewer than 500 per cubic millimeter on entry into the study. The subjects (92 percent male) were randomly assigned to one of three treatment groups: placebo (428 subjects); zidovudine, 500 mg per day (453); or zidovudine, 1500 mg per day (457). After a mean follow-up of 55 weeks (range, 19 to 107), 33 of the subjects assigned to placebo had the acquired immunodeficiency syndrome (AIDS), as compared with 11 of those assigned to receive 500 mg of zidovudine (P = 0.002; relative risk, 2.8; 95 percent confidence interval, 1.4 to 5.6) and 14 of those assigned to receive 1500 mg of zidovudine (P = 0.05; relative risk, 1.9; 95 percent confidence interval, 1.0 to 3.5). In the three treatment groups, the rates of progression (per 100 person-years) to either AIDS or advanced AIDS-related complex were 7.6, 3.6, and 4.3, respectively. As compared with those assigned to placebo, the subjects in the zidovudine groups had significant increases in the number of CD4+ cells and significant declines in p24 antigen levels. In the 1500-mg zidovudine group, severe hematologic toxicity (anemia or neutropenia) was more frequent than in the other groups (P less than 0.0001). In the 500-mg zidovudine group, nausea was the only toxicity that was significantly more frequent (in 3.3 percent) than in the placebo group (P = 0.001). We conclude that zidovudine is safe and effective in persons with asymptomatic HIV infection and fewer than 500 CD4+ cells per cubic millimeter. Additional study will be required to determine whether such treatment will ultimately improve survival for persons infected with HIV.

@article{doi101056nejm199004053221401,
    author = "Volberding, Paul A. and Lagakos, Stephen W. and Koch, Matthew and Pettinelli, Carla and Myers, Maureen and Booth, David K. and Balfour, Henry H. and Reichman, Richard C. and Bartlett, John A. and Hirsch, Martin S. and Murphy, Robert L. and Hardy, William D. and Soeiro, Ruy and Fischl, Margaret A. and Bartlett, John G. and Merigan, Thomas C. and Hyslop, Newton E. and Richman, Douglas D. and Valentine, Fred and Corey, Lawrence",
    title = "Zidovudine in Asymptomatic Human Immunodeficiency Virus Infection",
    year = "1990",
    journal = "New England Journal of Medicine",
    abstract = "Zidovudine (AZT) is a potent inhibitor of the replication of the human immunodeficiency virus (HIV), and it has been shown to improve survival in advanced HIV disease. We conducted a randomized, double-blind trial in adults with asymptomatic HIV infection who had CD4+ cell counts of fewer than 500 per cubic millimeter on entry into the study. The subjects (92 percent male) were randomly assigned to one of three treatment groups: placebo (428 subjects); zidovudine, 500 mg per day (453); or zidovudine, 1500 mg per day (457). After a mean follow-up of 55 weeks (range, 19 to 107), 33 of the subjects assigned to placebo had the acquired immunodeficiency syndrome (AIDS), as compared with 11 of those assigned to receive 500 mg of zidovudine (P = 0.002; relative risk, 2.8; 95 percent confidence interval, 1.4 to 5.6) and 14 of those assigned to receive 1500 mg of zidovudine (P = 0.05; relative risk, 1.9; 95 percent confidence interval, 1.0 to 3.5). In the three treatment groups, the rates of progression (per 100 person-years) to either AIDS or advanced AIDS-related complex were 7.6, 3.6, and 4.3, respectively. As compared with those assigned to placebo, the subjects in the zidovudine groups had significant increases in the number of CD4+ cells and significant declines in p24 antigen levels. In the 1500-mg zidovudine group, severe hematologic toxicity (anemia or neutropenia) was more frequent than in the other groups (P less than 0.0001). In the 500-mg zidovudine group, nausea was the only toxicity that was significantly more frequent (in 3.3 percent) than in the placebo group (P = 0.001). We conclude that zidovudine is safe and effective in persons with asymptomatic HIV infection and fewer than 500 CD4+ cells per cubic millimeter. Additional study will be required to determine whether such treatment will ultimately improve survival for persons infected with HIV.",
    url = "https://doi.org/10.1056/nejm199004053221401",
    doi = "10.1056/nejm199004053221401",
    openalex = "W2009226722",
    references = "doi101056nejm198707233170401"
}

@article{doi1073260003481911286351,
    title = "The Epidemiology of AIDS: Expression, Occurrence, and Control of Human Immunodeficiency Virus Type 1 Infection",
    year = "1990",
    journal = "Annals of Internal Medicine",
    url = "https://doi.org/10.7326/0003-4819-112-8-635\_1",
    doi = "10.7326/0003-4819-112-8-635\_1",
    openalex = "W4300196833"
}

At present, there is a lot of concern about the acquired immune deficiency syndrome (AIDS). Efforts are being made to educate the public about AIDS, so that individuals can take precautions against acquiring or transmitting the disease. Many people with a mental handicap may not benefit from the current education campaign because of limitations in their general understanding and poor or non-existent reading skills. Two cases are presented to illustrate the difficulties encountered in educating people with a mental handicap about AIDS.

@article{doi101111j136527881991tb00430x,
    author = "Robertson, P. E. and Bhate, Surya and BHATE, M. S.",
    title = "AIDS: education and adults with a mental handicap",
    year = "1991",
    journal = "Journal of Intellectual Disability Research",
    abstract = "At present, there is a lot of concern about the acquired immune deficiency syndrome (AIDS). Efforts are being made to educate the public about AIDS, so that individuals can take precautions against acquiring or transmitting the disease. Many people with a mental handicap may not benefit from the current education campaign because of limitations in their general understanding and poor or non-existent reading skills. Two cases are presented to illustrate the difficulties encountered in educating people with a mental handicap about AIDS.",
    url = "https://doi.org/10.1111/j.1365-2788.1991.tb00430.x",
    doi = "10.1111/j.1365-2788.1991.tb00430.x",
    openalex = "W2078012431",
    references = "doi101192bjp1546754"
}

As the AIDS epidemic in Africa assumes major proportions, the need to understand the social context in which heterosexual transmission occurs takes on urgent importance. In this article we explore how the intersection of traditional culture with the colonial legacy and present-day political economy has influenced family structure and sexual relations, and particularly the social position of women. Drawing on Zimbabwe's historical experience, we show how land expropriation, rural impoverishment, and the forcible introduction of male migrant labor fostered new patterns of sexual relations, characterized by multiple partners. Traditional patriarchal values reinterpreted in European law resulted in further subjugation of women as even limited rights to ownership were withdrawn. For many women, sexual relations with men, either within marriage (for the majority) or outside, become inextricably linked to economic and social survival. In this setting, all sexually transmitted diseases became rampant, including genital ulcer, which facilitates transmission of the human immunodeficiency virus (HIV). Intervention programs to halt the spread of AIDS need to take into the account the epidemic's historical roots and social nature. For example, efforts to reduce risk of HIV transmission should seek to expand women's limited options, both technically (e.g., by providing alternatives to condoms) and socially (e.g., by promoting employment).

@article{doi102190n0njfkxbct25pa09,
    author = "Bassett, Mary T. and Mhloyi, Marvellous",
    title = "Women and Aids in Zimbabwe: The Making of an Epidemic",
    year = "1991",
    journal = "International Journal of Health Services",
    abstract = "As the AIDS epidemic in Africa assumes major proportions, the need to understand the social context in which heterosexual transmission occurs takes on urgent importance. In this article we explore how the intersection of traditional culture with the colonial legacy and present-day political economy has influenced family structure and sexual relations, and particularly the social position of women. Drawing on Zimbabwe's historical experience, we show how land expropriation, rural impoverishment, and the forcible introduction of male migrant labor fostered new patterns of sexual relations, characterized by multiple partners. Traditional patriarchal values reinterpreted in European law resulted in further subjugation of women as even limited rights to ownership were withdrawn. For many women, sexual relations with men, either within marriage (for the majority) or outside, become inextricably linked to economic and social survival. In this setting, all sexually transmitted diseases became rampant, including genital ulcer, which facilitates transmission of the human immunodeficiency virus (HIV). Intervention programs to halt the spread of AIDS need to take into the account the epidemic's historical roots and social nature. For example, efforts to reduce risk of HIV transmission should seek to expand women's limited options, both technically (e.g., by providing alternatives to condoms) and socially (e.g., by promoting employment).",
    url = "https://doi.org/10.2190/n0nj-fkxb-ct25-pa09",
    doi = "10.2190/n0nj-fkxb-ct25-pa09",
    openalex = "W1967597243"
}

The epidemiology of AIDS reflects interactions among biological, psychological and social factors. The immune response to the infectious agent is relatively ineffectual; the course of the disease it produces is chronic. The long interval between HIV infection and the appearance of clinical disease maximizes "silent" transmission. The infection is transmitted behaviourally; that is, primarily via specific sexual acts and contaminated paraphernalia employed by IV drug users. The virus entered human populations in an era when such behaviours had become very much more prevalent in response to social change. The public health response to the epidemic was seriously compromised by the stigma attached to the persons victimized by the disease; thus, the mobilization of adequate resources was markedly delayed. Irrational fears of contamination led to proposals for mandatory population-wide screening, in utter disregard of the high false to true positive ratio in screening tests when prevalence is low. Welcome as a vaccine to prevent HIV infection would be, it is not likely to be available, if it can be produced at all, before the end of the century. Control of the epidemic demands that stigma be vigorously combated and that all groups of the population be educated about ways to minimize the likelihood of becoming infected and of transmitting the virus.

@article{doi10310900048679109062631,
    author = "Eisenberg, Leon",
    title = "There's no Quick Fix for AIDS",
    year = "1991",
    journal = "Australian \& New Zealand Journal of Psychiatry",
    abstract = {The epidemiology of AIDS reflects interactions among biological, psychological and social factors. The immune response to the infectious agent is relatively ineffectual; the course of the disease it produces is chronic. The long interval between HIV infection and the appearance of clinical disease maximizes "silent" transmission. The infection is transmitted behaviourally; that is, primarily via specific sexual acts and contaminated paraphernalia employed by IV drug users. The virus entered human populations in an era when such behaviours had become very much more prevalent in response to social change. The public health response to the epidemic was seriously compromised by the stigma attached to the persons victimized by the disease; thus, the mobilization of adequate resources was markedly delayed. Irrational fears of contamination led to proposals for mandatory population-wide screening, in utter disregard of the high false to true positive ratio in screening tests when prevalence is low. Welcome as a vaccine to prevent HIV infection would be, it is not likely to be available, if it can be produced at all, before the end of the century. Control of the epidemic demands that stigma be vigorously combated and that all groups of the population be educated about ways to minimize the likelihood of becoming infected and of transmitting the virus.},
    url = "https://doi.org/10.3109/00048679109062631",
    doi = "10.3109/00048679109062631",
    openalex = "W2045936840",
    references = "doi101016014067369091743t, doi101016s0140673686914224, doi101056nejm198011273032204, doi101056nejm199004053221401, doi101126science2457946, doi101126science2460924, doi101126science2460925, doi101126science6189183, doi1023073426023, doi105860choice265093, marx1988the, openalexw2424524499"
}

This article contains a comprehensive, critical review of the acquired immunodeficiency syndrome (AIDS)-risk-reduction literature on interventions that have targeted risky sexual behavior and intravenous drug use practices. A conceptually based, highly generalizable model for promoting and evaluating AIDS-risk behavior change in any population of interest is then proposed. The model holds that AIDS-risk reduction is a function of people's information about AIDS transmission and prevention, their motivation to reduce AIDS risk, and their behavioral skills for performing the specific acts involved in risk reduction. Supportive tests of this model, using structural equation modeling techniques, are then reported for populations of university students and gay male affinity group members.

@article{doi101037003329091113455,
    author = "Fisher, Jeffrey D. and Fisher, William A.",
    title = "Changing AIDS-risk behavior.",
    year = "1992",
    journal = "Psychological Bulletin",
    abstract = "This article contains a comprehensive, critical review of the acquired immunodeficiency syndrome (AIDS)-risk-reduction literature on interventions that have targeted risky sexual behavior and intravenous drug use practices. A conceptually based, highly generalizable model for promoting and evaluating AIDS-risk behavior change in any population of interest is then proposed. The model holds that AIDS-risk reduction is a function of people's information about AIDS transmission and prevention, their motivation to reduce AIDS risk, and their behavioral skills for performing the specific acts involved in risk reduction. Supportive tests of this model, using structural equation modeling techniques, are then reported for populations of university students and gay male affinity group members.",
    url = "https://doi.org/10.1037/0033-2909.111.3.455",
    doi = "10.1037/0033-2909.111.3.455",
    openalex = "W1986977853",
    references = "doi10103700223514414607, doi1010370033295x865452, doi101111j14680009200500425x, doi101177009385488000700401, doi101177109019819001700107, doi1023071292957, openalexw115795869, openalexw126774542, openalexw1491644571, openalexw2036389121"
}

An unusual mycoplasma, which was isolated from the urine of a human immunodeficiency virus-positive male homosexual patient, has an elongated flask shape and two unique sharply divided internal compartments. The tiplike compartment is densely packed with fine granules, and the body compartment is loosely filled with coarse granules consistent with ribosomal structures. The organism has properties of adherence, hemadsorption, and cytadsorption and invades many different types of mammalian cells. Adhesion and penetration apparently involve the terminally located tiplike structure. Cholesterol is required for growth, and the mycoplasma ferments glucose and hydrolyzes arginine, but does not hydrolyze urea. The results of DNA homology studies revealed that this organism is not genetically related to previously described mycoplasma species that have the same biochemical properties. The results of serologic studies demonstrated that this organism is antigenically distinct from all previously described mycoplasmas. We propose that this new mollicute species should be named Mycoplasma penetrans sp. nov. The type strain is strain GTU-54-6A1 (= ATCC 55252).

@article{doi10109900207713423357,
    author = "Lo, Shyh‐Ching and Hayes, Morgan and Tully, Joseph G. and Wang, R. Y.-H. and Kotani, Hitoshi and Pierce, Phillip F. and ROSE, D. L. and Shih, J W",
    title = "Mycoplasma penetrans sp. nov., from the Urogenital Tract of Patients with AIDS",
    year = "1992",
    journal = "International Journal of Systematic Bacteriology",
    abstract = "An unusual mycoplasma, which was isolated from the urine of a human immunodeficiency virus-positive male homosexual patient, has an elongated flask shape and two unique sharply divided internal compartments. The tiplike compartment is densely packed with fine granules, and the body compartment is loosely filled with coarse granules consistent with ribosomal structures. The organism has properties of adherence, hemadsorption, and cytadsorption and invades many different types of mammalian cells. Adhesion and penetration apparently involve the terminally located tiplike structure. Cholesterol is required for growth, and the mycoplasma ferments glucose and hydrolyzes arginine, but does not hydrolyze urea. The results of DNA homology studies revealed that this organism is not genetically related to previously described mycoplasma species that have the same biochemical properties. The results of serologic studies demonstrated that this organism is antigenically distinct from all previously described mycoplasmas. We propose that this new mollicute species should be named Mycoplasma penetrans sp. nov. The type strain is strain GTU-54-6A1 (= ATCC 55252).",
    url = "https://doi.org/10.1099/00207713-42-3-357",
    doi = "10.1099/00207713-42-3-357",
    openalex = "W2071462877"
}

Infection with human immunodeficiency virus (HIV) causes AIDS. As a consequence of the interaction of gp120 envelope with the CD4 receptor molecule expressed by a subset of T lymphocytes and by mononuclear phagocytes (MPs), a second envelope protein (gp41) mediates fusion of the virion membrane with the target membrane. In these events the role of adhesion molecules such as LFA-1 has recently been highlighted. Following viral entry, reverse transcription of the virion-associated RNA and integration of proviral DNA into the host genome are crucial steps in HIV infection, which can lead to expression of high levels of new HIV or to silent infection for indefinite periods, a condition defined as viral latency. Several factors in addition to endogenous viral regulatory proteins have been reported as capable of modulating the state of viral latency and expression in vitro, including the cytokine network that normally modulates immune homeostasis as well as the immune response to inflammatory stimuli. Finally, recent studies have underscored the observation that the CD4+ T lymphocytes are the major reservoir of HIV in the peripheral blood compartment and in the lymphoid tissues, which are characterized by a greater viral burden, whereas in nonlymphoid organs such as the brain and the lung, local infection is predominantly sustained by MPs.

@article{doi101056nejm199302043280508,
    author = "Epstein, Franklin H. and Pantaleo, Giuseppe and Graziosi, Cecilia and Fauci, Anthony S.",
    title = "The Immunopathogenesis of Human Immunodeficiency Virus Infection",
    year = "1993",
    journal = "New England Journal of Medicine",
    abstract = "Infection with human immunodeficiency virus (HIV) causes AIDS. As a consequence of the interaction of gp120 envelope with the CD4 receptor molecule expressed by a subset of T lymphocytes and by mononuclear phagocytes (MPs), a second envelope protein (gp41) mediates fusion of the virion membrane with the target membrane. In these events the role of adhesion molecules such as LFA-1 has recently been highlighted. Following viral entry, reverse transcription of the virion-associated RNA and integration of proviral DNA into the host genome are crucial steps in HIV infection, which can lead to expression of high levels of new HIV or to silent infection for indefinite periods, a condition defined as viral latency. Several factors in addition to endogenous viral regulatory proteins have been reported as capable of modulating the state of viral latency and expression in vitro, including the cytokine network that normally modulates immune homeostasis as well as the immune response to inflammatory stimuli. Finally, recent studies have underscored the observation that the CD4+ T lymphocytes are the major reservoir of HIV in the peripheral blood compartment and in the lymphoid tissues, which are characterized by a greater viral burden, whereas in nonlymphoid organs such as the brain and the lung, local infection is predominantly sustained by MPs.",
    url = "https://doi.org/10.1056/nejm199302043280508",
    doi = "10.1056/nejm199302043280508",
    openalex = "W2339006876",
    references = "doi101126science3014648"
}

CDC has revised the classification system for HIV infection to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions. This classification system replaces the system published by CDC in 1986 [1] and is primarily intended for use in public health practice. Consistent with the 1993 revised classification system, CDC has also expanded the AIDS surveillance case definition to include all HIV-infected persons who have <200 CD4+ T-lymphocytes/µL, or a CD4+ T-lymphocyte percentage of total lymphocytes of <14. This expansion includes the addition of three clinical conditions—pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer—and retains the 23 clinical conditions in the AIDS surveillance case definition published in 1987 [2]; it is to be used by all states for AIDS case reporting effective January 1, 1993.

@article{doi101093clinids174802,
    author = "Castro, K. G. and Ward, Jill and Slutsker, Laurence and Buehler, James W. and Jaffe, H. W. and Berkelman, Ruth L. and Curran, James W.",
    title = "1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults",
    year = "1993",
    journal = "Clinical Infectious Diseases",
    abstract = "CDC has revised the classification system for HIV infection to emphasize the clinical importance of the CD4+ T-lymphocyte count in the categorization of HIV-related clinical conditions. This classification system replaces the system published by CDC in 1986 [1] and is primarily intended for use in public health practice. Consistent with the 1993 revised classification system, CDC has also expanded the AIDS surveillance case definition to include all HIV-infected persons who have <200 CD4+ T-lymphocytes/µL, or a CD4+ T-lymphocyte percentage of total lymphocytes of <14. This expansion includes the addition of three clinical conditions—pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer—and retains the 23 clinical conditions in the AIDS surveillance case definition published in 1987 [2]; it is to be used by all states for AIDS case reporting effective January 1, 1993.",
    url = "https://doi.org/10.1093/clinids/17.4.802",
    doi = "10.1093/clinids/17.4.802",
    openalex = "W2116258000",
    references = "doi101001jama268121581, doi101016009082589090077x, doi101056nejm198903023200901, doi101056nejm199001183220305, doi101056nejm199004053221401, doi101126science3001934, doi1073260003481911210727, doi1073260003481911498185, openalexw1641039948, openalexw2418847381"
}

Representational difference analysis was used to isolate unique sequences present in more than 90 percent of Kaposi's sarcoma (KS) tissues obtained from patients with acquired immunodeficiency syndrome (AIDS). These sequences were not present in tissue DNA from non-AIDS patients, but were present in 15 percent of non-KS tissue DNA samples from AIDS patients. The sequences are homologous to, but distinct from, capsid and tegument protein genes of the Gammaherpesvirinae, herpesvirus saimiri and Epstein-Barr virus. These KS-associated herpesvirus-like (KSHV) sequences appear to define a new human herpesvirus.

@article{doi101126science7997879,
    author = "Chang, Yuan and Cesarman, Ethel and Pessin, Melissa S. and Lee, Frank and Culpepper, Janice and Knowles, Daniel M. and Moore, Patrick S.",
    title = "Identification of Herpesvirus-Like DNA Sequences in AIDS-Sssociated Kaposi's Sarcoma",
    year = "1994",
    journal = "Science",
    abstract = "Representational difference analysis was used to isolate unique sequences present in more than 90 percent of Kaposi's sarcoma (KS) tissues obtained from patients with acquired immunodeficiency syndrome (AIDS). These sequences were not present in tissue DNA from non-AIDS patients, but were present in 15 percent of non-KS tissue DNA samples from AIDS patients. The sequences are homologous to, but distinct from, capsid and tegument protein genes of the Gammaherpesvirinae, herpesvirus saimiri and Epstein-Barr virus. These KS-associated herpesvirus-like (KSHV) sequences appear to define a new human herpesvirus.",
    url = "https://doi.org/10.1126/science.7997879",
    doi = "10.1126/science.7997879",
    openalex = "W2032438721",
    references = "doi10100210970142198003154561472aidcncr282045062930co2a, doi101016014067369090001l, doi1010160140673692907933, doi101016s0022283605803602, doi101038310207a0, doi101038335606a0, doi101093oxfordjournalsajea117008, doi10109900207713423357, doi101126science8438152, doi101128jvi668504750581992"
}

Stigma is a social construction which dramatically affects the life experiences of the individuals infected with the human immunodeficiency virus (HIV) and their partners, family and friends. While it has been generally recognized that the nature of stigma varies across illnesses, it has usually not been considered as changing and emerging over the course of a single illness. In this paper, HIV/AIDS is analyzed in terms of a stigma trajectory. The primary purpose is to conceptualize how individuals with HIV/AIDS experience stigma and to demonstrate how these experiences are affected by changes in the biophysical dimensions of HIV/AIDS. Four phases of the HIV/AIDS stigma trajectory are depicted: (1) at risk: pre-stigma and the worried well; (2) diagnosis: confronting an altered identity; (3) latent: living between illness and health; and (4) manifest: passage to social and physical death. The essential processes through which individuals personalize the illness, dilemmas encountered in interpersonal relations, strategies that are used to avoid or minimize HIV-related stigma, and subcultural networks and ideologies that are drawn upon to construct, avow, and adapt to an HIV identity are considered across the stigma trajectory.

@article{doi1010160277953694003846,
    author = "Alonzo, Angelo A. and Reynolds, Nancy R.",
    title = "Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory",
    year = "1995",
    journal = "Social Science \& Medicine",
    abstract = "Stigma is a social construction which dramatically affects the life experiences of the individuals infected with the human immunodeficiency virus (HIV) and their partners, family and friends. While it has been generally recognized that the nature of stigma varies across illnesses, it has usually not been considered as changing and emerging over the course of a single illness. In this paper, HIV/AIDS is analyzed in terms of a stigma trajectory. The primary purpose is to conceptualize how individuals with HIV/AIDS experience stigma and to demonstrate how these experiences are affected by changes in the biophysical dimensions of HIV/AIDS. Four phases of the HIV/AIDS stigma trajectory are depicted: (1) at risk: pre-stigma and the worried well; (2) diagnosis: confronting an altered identity; (3) latent: living between illness and health; and (4) manifest: passage to social and physical death. The essential processes through which individuals personalize the illness, dilemmas encountered in interpersonal relations, strategies that are used to avoid or minimize HIV-related stigma, and subcultural networks and ideologies that are drawn upon to construct, avow, and adapt to an HIV identity are considered across the stigma trajectory.",
    url = "https://doi.org/10.1016/0277-9536(94)00384-6",
    doi = "10.1016/0277-9536(94)00384-6",
    openalex = "W2107258061"
}

Heterosexual transmission is responsible for most infection with the human immunodeficiency virus (HIV). The increase in pediatric HIV infection has had a substantial impact on childhood mortality, both in industrialized countries, such as the United States,1 and in developing countries.2 In some areas in sub-Saharan Africa, 10 to 30 percent of pregnant women are HIV-infected, and infection is now spreading to parts of Southeast Asia.Reporting of pediatric cases of the acquired immunodeficiency syndrome (AIDS) to public health authorities, registers of HIV-infected children, and unlinked anonymous testing of antenatal and neonatal blood samples make it possible to monitor the prevalence...

@article{doi101056nejm199508033330507,
    author = "Peckham, Catherine and Gibb, Diana M.",
    title = "Mother-to-Child Transmission of the Human Immunodeficiency Virus",
    year = "1995",
    journal = "New England Journal of Medicine",
    abstract = "Heterosexual transmission is responsible for most infection with the human immunodeficiency virus (HIV). The increase in pediatric HIV infection has had a substantial impact on childhood mortality, both in industrialized countries, such as the United States,1 and in developing countries.2 In some areas in sub-Saharan Africa, 10 to 30 percent of pregnant women are HIV-infected, and infection is now spreading to parts of Southeast Asia.Reporting of pediatric cases of the acquired immunodeficiency syndrome (AIDS) to public health authorities, registers of HIV-infected children, and unlinked anonymous testing of antenatal and neonatal blood samples make it possible to monitor the prevalence...",
    url = "https://doi.org/10.1056/nejm199508033330507",
    doi = "10.1056/nejm199508033330507",
    openalex = "W2337128795"
}

The relation between viremia and clinical outcome in individuals infected with human immunodeficiency virus-type 1 (HIV-1) has important implications for therapeutic research and clinical care. HIV-1 RNA in plasma was quantified with a branched-DNA signal amplification assay as a measure of viral load in a cohort of 180 seropositive men studied for more than 10 years. The risk of acquired immunodeficiency syndrome (AIDS) and death in study subjects, including those with normal numbers of CD4+ T cells, was directly related to plasma viral load at study entry. Plasma viral load was a better predictor of progression to AIDS and death than was the number of CD4+ T cells.

@article{doi101126science27252651167,
    author = "Mellors, John W. and Rinaldo, Charles R. and Gupta, Phalguni and White, Roseanne M. and Todd, John A. and Kingsley, Lawrence",
    title = "Prognosis in HIV-1 Infection Predicted by the Quantity of Virus in Plasma",
    year = "1996",
    journal = "Science",
    abstract = "The relation between viremia and clinical outcome in individuals infected with human immunodeficiency virus-type 1 (HIV-1) has important implications for therapeutic research and clinical care. HIV-1 RNA in plasma was quantified with a branched-DNA signal amplification assay as a measure of viral load in a cohort of 180 seropositive men studied for more than 10 years. The risk of acquired immunodeficiency syndrome (AIDS) and death in study subjects, including those with normal numbers of CD4+ T cells, was directly related to plasma viral load at study entry. Plasma viral load was a better predictor of progression to AIDS and death than was the number of CD4+ T cells.",
    url = "https://doi.org/10.1126/science.272.5265.1167",
    doi = "10.1126/science.272.5265.1167",
    openalex = "W2012139740"
}

The chemokine receptor 5 (CKR5) protein serves as a secondary receptor on CD4(+) T lymphocytes for certain strains of human immunodeficiency virus-type 1 (HIV-1). The CKR5 structural gene was mapped to human chromosome 3p21, and a 32-base pair deletion allele (CKR5Delta32) was identified that is present at a frequency of approximately0.10 in the Caucasian population of the United States. An examination of 1955 patients included among six well-characterized acquired immunodeficiency syndrome (AIDS) cohort studies revealed that 17 deletion homozygotes occurred exclusively among 612 exposed HIV-1 antibody-negative individuals (2.8 percent) and not at all in 1343 HIV-1-infected individuals. The frequency of CKR5 deletion heterozygotes was significantly elevated in groups of individuals that had survived HIV-1 infection for more than 10 years, and, in some risk groups, twice as frequent as their occurrence in rapid progressors to AIDS. Survival analysis clearly shows that disease progression is slower in CKR5 deletion heterozygotes than in individuals homozygous for the normal CKR5 gene. The CKR5Delta32 deletion may act as a recessive restriction gene against HIV-1 infection and may exert a dominant phenotype of delaying progression to AIDS among infected individuals.

@article{doi101126science27352831856,
    author = "Dean, Michael and Carrington, Mary and Winkler, Cheryl A. and Huttley, Gavin and Smith, Michael W. and Allikmets, Rando and Goedert, James J. and Buchbinder, Susan and Vittinghoff, Eric and Gomperts, Edward D. and Donfield, Sharyne and Vlahov, David and Kaslow, Richard A. and Saah, Alfred J. and Rinaldo, Charles R. and Detels, Roger and O’Brien, Stephen J.",
    title = "Genetic Restriction of HIV-1 Infection and Progression to AIDS by a Deletion Allele of the CKR5 Structural Gene",
    year = "1996",
    journal = "Science",
    abstract = "The chemokine receptor 5 (CKR5) protein serves as a secondary receptor on CD4(+) T lymphocytes for certain strains of human immunodeficiency virus-type 1 (HIV-1). The CKR5 structural gene was mapped to human chromosome 3p21, and a 32-base pair deletion allele (CKR5Delta32) was identified that is present at a frequency of approximately0.10 in the Caucasian population of the United States. An examination of 1955 patients included among six well-characterized acquired immunodeficiency syndrome (AIDS) cohort studies revealed that 17 deletion homozygotes occurred exclusively among 612 exposed HIV-1 antibody-negative individuals (2.8 percent) and not at all in 1343 HIV-1-infected individuals. The frequency of CKR5 deletion heterozygotes was significantly elevated in groups of individuals that had survived HIV-1 infection for more than 10 years, and, in some risk groups, twice as frequent as their occurrence in rapid progressors to AIDS. Survival analysis clearly shows that disease progression is slower in CKR5 deletion heterozygotes than in individuals homozygous for the normal CKR5 gene. The CKR5Delta32 deletion may act as a recessive restriction gene against HIV-1 infection and may exert a dominant phenotype of delaying progression to AIDS among infected individuals.",
    url = "https://doi.org/10.1126/science.273.5283.1856",
    doi = "10.1126/science.273.5283.1856",
    openalex = "W2007021820",
    references = "doi1010160092867486905908, doi101016s0092867400813136, doi101038325031a0"
}

The Epstein–Barr virus (EBV) was discovered 36 years ago by electron microscopy of cells cultured from Burkitt's lymphoma tissue by Epstein, Achong, and Barr.1 Four years later, in 1968, EBV was shown to be the etiologic agent of heterophile-positive infectious mononucleosis.2 EBV DNA was detected in tissues from patients with nasopharyngeal carcinoma in 1970.3 In the 1980s, EBV was found to be associated with non-Hodgkin's lymphoma and oral hairy leukoplakia in patients with the acquired immunodeficiency syndrome (AIDS).4,5 Since then, EBV DNA has been found in tissues from other cancers, including T-cell lymphomas and Hodgkin's disease.6,7 EBV is...

@article{doi101056nejm200008173430707,
    author = "Cohen, Jeffrey I.",
    title = "Epstein–Barr Virus Infection",
    year = "2000",
    journal = "New England Journal of Medicine",
    abstract = "The Epstein–Barr virus (EBV) was discovered 36 years ago by electron microscopy of cells cultured from Burkitt's lymphoma tissue by Epstein, Achong, and Barr.1 Four years later, in 1968, EBV was shown to be the etiologic agent of heterophile-positive infectious mononucleosis.2 EBV DNA was detected in tissues from patients with nasopharyngeal carcinoma in 1970.3 In the 1980s, EBV was found to be associated with non-Hodgkin's lymphoma and oral hairy leukoplakia in patients with the acquired immunodeficiency syndrome (AIDS).4,5 Since then, EBV DNA has been found in tissues from other cancers, including T-cell lymphomas and Hodgkin's disease.6,7 EBV is...",
    url = "https://doi.org/10.1056/nejm200008173430707",
    doi = "10.1056/nejm200008173430707",
    openalex = "W2331216044",
    references = "doi101073pnas81144510"
}

Introduction Early in the epidemic, the public perception of AIDS as a highly fatal acute illness with a rapid downward trajectory was crystallized. Nevertheless, as early as 1991 in the nursing and medical sociology literature, a few investigators were already discussing HIV/AIDS as a chronic illness (for example [1,2]). Shortly thereafter, a number of psychosocial investigations of small groups of long-term AIDS survivors appeared in the literature, although these cases were still seen as infrequent exceptions (see [3] for a review). It was not until the advent of protease inhibitors in 1996, which ushered in the era of highly active antiretroviral therapy (HAART), that the view of AIDS as a chronic illness became widely accepted. These medications were touted in the mass media as ‘miraculous’ because they reduced the risk of opportunistic infections and extended survival by suppressing viral replication and increasing CD4 cell counts. Their availability was said to have “reinserted the word ‘hope’ into the discussion about AIDS for the first time in a decade of treatment trials” [4] (p. 161), and to have offered infected individuals the opportunity for a “second life” [5]. Among those at advanced stages of the disease, recoveries have often been so dramatic that the phenomenon has been dubbed the ‘Lazarus Syndrome’, referring to the seeming rising from the dead made possible by these new medications [6]. While in the United States recent treatment advances have had a profound impact on the illness trajectory and thus life expectancy of many infected individuals [7], AIDS-related mortality continues to rise unabated in parts of the world where access to the new therapies is limited. The prohibitively high prices of antiretrovirals coupled with inadequate and inefficient health delivery systems have allowed AIDS to reach catastrophic levels in many developing countries [8]. Even in the United States, however, not all infected persons have access to or choose to adopt the new treatments. Some physicians are less likely to offer HAART to patients they assume to be at risk for poor adherence, such as those with a history of drug use, the homeless, and the mentally ill [9–11], although the evidence supporting their actions remains inconclusive [12, 13]. Other research indicates that women, African-Americans, and those with low levels of education are less likely to have ever used the new therapies [14–17]. These findings have been attributed not only to a lack of access to these medications among these socio-economically disadvantaged groups, but also to their own reluctance to use them due to such factors as fear of medication side-effects and distrust of physicians. Similar issues were identified as barriers to antiretroviral use and medication adherence before HAART became available [18,19]. Chronic illness and AIDS Chronic illnesses are typically incurable, and thus the goals of medical care are usually containment, slowing disease progression and symptom management rather than cure. Beyond this, chronic diseases tend to share a variety of characteristics [20–23]. Frequently, they have an uncertain course or disease trajectory often characterized by alternating periods of remission and recurrence, or stable periods interrupted by episodic exacerbations of symptoms. Most require adherence to a treatment regimen, although these differ significantly across diseases in complexity and efficacy. Chronic disease also typically requires considerable self-care (including self-monitoring of symptoms) on the patient's part, since most of the day-to-day management of the illness takes place outside formal health institutions or facilities. As illness is a form of deviance and thus an undesirable state, chronic conditions also carry some degree of stigma. However, this varies greatly across diseases and depends on a variety of factors, such as whether the individual is perceived as being responsible for having acquired the illness, whether the illness is contagious and whether there is visible disfigurement. In addition, changes in roles and relationships are common. Illness almost always necessitates some degree of dependency, at least at the more advanced stages of a disease. Roles and responsibilities in relationships and families typically must be re-negotiated in light of the patient's limitations or disabilities. Finally, chronic diseases often bring about identity changes as the patient attempts to integrate the illness into his/her life and self-perception over the long haul. Psychological distress is a prevalent concomitant of living with chronic conditions, because of the uncertainty inherent in many of these illness characteristics. Each of these aspects of chronic disease posses an adaptive task or challenge (e.g., tolerating uncertainty, managing stigma, adhering to treatment) that is stressful for the individual to confront. How well the chronically ill individual will adapt to one's disease will depend in large part on his/her ability to master, or at least successfully manage, these tasks. Today, AIDS meets the criteria for a chronic illness [24]. While available treatments can render a viral load undetectable, they cannot fully eradicate it from the body and, left untreated, the viral load will rebound. Consequently, there is still no cure for the disease. Furthermore, while the natural history of the disease has been delineated, the course of HIV disease progression varies considerably among individuals [25]. Current multi-drug regimens remain complex, often requiring that many pills be taken on a rigid schedule while following strict dietary guidelines. Yet, similar to many other chronic illnesses, the regimens for HIV infection are not equally effective for all patients [26]. It is also well recognized that HIV/AIDS has a profound impact on intimate and social relationships. The fact that the disease can be transmitted through sexual behaviors renders intimate relationships fraught with anxiety and ambivalence. Moreover, infected adults often feel that others are unwilling to enter into long-term relationships with them for fear of having to assume care-giving responsibilities when the disease progresses. Additionally, self-care is a component of living with HIV. Many patients engage in self-initiated strategies (e.g., diet, relaxation exercises, stress avoidance) aimed at managing illness or treatment-related symptoms, boosting their immune system, or alleviating stress. In the present paper, we discuss several of the principal characteristics of chronic illnesses, reviewing in each case the relevant available literature. In each section, we attempt to highlight continuities and discontinuities between the pre-HAART and the HAART eras. In addition, we discuss prevention in the context of AIDS as a chronic illness. We conclude with some suggestions for future research in the field of HIV/AIDS and chronic illness. Emotional distress From the outset of the AIDS epidemic, there has been considerable documentation of the adverse psychological consequences of knowing one is infected. When AIDS was viewed as a highly fatal illness with an inexorable downhill course, much of this work focused on assessing depression (depressive symptomatology or clinical depression) and suicidal ideation or acts. While the findings of studies sometimes differed, the preponderance of evidence from the pre-HAART era suggested that depression was prevalent and that suicidal ideation and risk were elevated [27–30]. Infected individuals seemed particularly emotionally vulnerable shortly after diagnosis, when HIV-related symptoms first appeared, in the later stages of the disease, and after suffering multiple AIDS-related losses in their social network. It is a widely held, although largely unexamined, assumption that the experience of living with HIV infection in the HAART era is significantly less distressing compared with the past because of the prospects for extended survival and enhanced quality of life offered by the new treatments. Only recently, however, has this issue begun to be empirically investigated. Rabkin et al. [31] followed a sample of gay and bisexual men with symptomatic illness over a period that included the time before and after the availability of protease inhibitors. On all measures of psychological distress employed, the sample as a whole showed a statistically significant, although clinically modest, decline over time (when CD4 cell count, HIV symptoms, physical limitations, and social support were included as co-variates). However, when they further compared subjects whose status on medical markers had improved and had not improved, no significant differences in decline in hopelessness or improvement in quality of life were observed. In another study [32], changes in depressive symptomatology were investigated among 456 HIV-infected individuals (433 men) receiving antiretroviral treatment who were asked to complete a self-administered questionnaire annually. All study participants had completed at least one survey before and one after using protease inhibitors. The investigators found that, between assessment points, the percentage of individuals with a score indicative of probable clinical depression declined from 52 to 46%. While this change was not statistically significant, there were improvements in the total score of the Center for Epidemiological Studies—Depression scale, as well as on the depressive mood, positive affect and somatic symptom subscales. Similarly, in another study [33], changes in depressive symptomatology among 125 HIV-infected adults (most homosexual/bisexual males) assessed at 6-month intervals over a 2-year period were examined. The investigators found a pattern of declining scores on the Beck Depression Inventory over time, especially after the third assessment (12 months after baseline), when 51% of study participants were receiving HAART. There was, however, substantial drop-out before the 6-month assessment, and the number of cases included at each assessment point varied. It thus seems that the evidence on whether living with HIV infection is less psychologically distressing since the availability of HAART remains inconclusive. If ultimately it is shown to be so, this could have implications for needed mental health services. Catalan et al. [34], for example, suggest that as AIDS becomes a more manageable disease there will be a diminished need for acute mental health services (e.g., psychiatric hospitalization, crisis intervention), and a greater need for interventions assisting individuals in adjusting long-term to chronic-illness-related psychosocial stressors. While this may be true among gay and bisexual men and drug users who can recall infected individuals’ bleaker prospects in the pre-HAART era, the need for acute psychiatric services may grow among more recently impacted populations, such as infected adults living in rural America, adolescents, and heterosexual women without a history of drug use. Members of these populations often do not recognize that they were at risk for infection, making diagnosis a more psychologically disruptive event. Uncertainty Individuals living with HIV/AIDS have always confronted uncertainty. Early in the epidemic, this uncertainty revolved around issues such as when one had become infected, where one was in the disease trajectory, how long one was likely to survive, and whether any effective treatments for slowing or halting progression of one's disease would be developed. With the advent of zidovudine and other drugs of the pre-HAART era, uncertainty centered on issues such as whether to get tested, when to initiate treatment, and whether one would have a positive response to treatment. With the availability of HAART, new uncertainties have emerged [35] while old ones persist. For example, many infected individuals who realize extended survival as a result of new treatment regimens may confront emerging opportunistic infections that, in the past, patients did not live long enough to experience. Also, because these medications are new, there is uncertainty about their long-term safety. There is also a lack of clarity about how functional a restored immune system is likely to be [36,37]. The meaning of an improved CD4 cell count, a fundamental disease marker, is also ambiguous. For instance, is an individual who was diagnosed earlier as having AIDS solely on the basis of a CD4 cell count below 200 and who now has a count above that threshold still considered as having AIDS [35]? Those with advanced disease who had expected to die, but have now experienced a ‘reprieve’ on protease inhibitors, may feel insecure about their new-found well-being. While no longer imminently facing death, and possibly they recognize that they could experience a at any time, and The of many is by the fact that they have been to significant in their Finally, as in the pre-HAART era, and uncertainty to the of the time to initiate medication use Those who have not HAART recognize that not or can the Furthermore, those who have experienced recognize that they may be over an extended period of time adherence to the [26]. another of uncertainty is the risk of developing drug with Roles and relationships health has allowed infected individuals to the assumption of new social roles or the to old ones (e.g., For example, the in that zidovudine treatment could significantly of the from an infected to allowed infected women to more With the advent of HAART, more may now as a significant in viral load further the risk of survival and improved health due to HAART may also earlier about not being to or long enough to a However, the adverse of on their health to be of HIV-infected women the and of in the HAART Many infected individuals from HAART are also to work to their to become more to feel more and to however, uncertainty the impact of the stress of work their their after a long period of and their ability to their their health decline Many also about and in the Moreover, not all those using the new treatments feel to but may feel to do so the public perception of the new therapies as infected persons may that others view them as The of extended survival has also many infected individuals to the they have made their relationships Those a many of the confronted before HAART, the anxiety of one's HIV one's and Moreover, in an era of viral the of and may a considerable in relationships. The of living longer and may those who have in relationships because of about health and to the of these relationships Furthermore, the of of and sexual relationships may be anxiety when infected individuals do not feel for these changes The diagnosis of a chronic illness typically necessitates identity work Infected individuals differ in how they integrate their illness in their one are those who their life around their illness. These individuals may work or for AIDS are in or social on of infected and largely their social to other infected the other are those who have to and their illness while as much as possible with their to the illness from a in their In the era, many living with HIV/AIDS now have the opportunity to as living with a chronic illness rather than from a disease. Furthermore, new treatments have patients to feel and to their for longer periods of time, thus the and of the illness and the of the patient However, patients may feel their medication regimens are a of their patient From the outset of the epidemic, infected individuals have been and by have been to and social among physicians and in the United States to care for HIV-infected individuals has been well since early in the reluctance to care for these patients between 1991 and in HIV-related in the United States some but also some of stigma, support for (e.g., had significantly in almost of the that those with AIDS were responsible for the illness. Furthermore, significant they would be or having their with a with AIDS or having an with AIDS or at a where the had AIDS substantial also in that HIV could be transmitted through with AIDS on the a with them and using public all likely to be with to and HIV-infected has also that AIDS is on the it may be and at infected groups and of infected individuals may be greater in developing countries where there has been public education about the disease study of HIV-infected women in rural their that the to them at the time of delivery because of their infected that the medical were infected patients to the were also by study and so was their fear that their would or them Many infected individuals and the and feel and however, the and the and to public patients to remain for longer periods of time, the new treatments have made it possible for them to their illness longer and to as Their social identity as is thus and the many infected individuals experience with their distressing consequences are Yet, they may the psychological of having to a identity and possibly needed adherence The by of the of protease inhibitors was by the that adherence to these and regimens was often a task has been attributed to the to medication fear of the high that medication use will to of illness, and the of For these many individuals treatment or have been unwilling to use protease inhibitors from their physicians to do so While the of the recently regimens for treatment are being the impact of these of treatment on adherence remains to be While the of intervals may adherence because patients can to these treatment they also may adherence by patients to initiate their own who are to adherence to treatment regimens may engage in and have a of Those adhering to but not the dramatic health that early media with the ‘miraculous’ new medications may experience a of anxiety and fear and have also that, before HAART, all infected individuals a from the illness. However, now that some from treatment while others do of and has been by one of as becomes more that can be by and individual but also the to and (p. Finally, because many will not from HAART, those who do may experience a of similar to that in gay men who and to AIDS earlier in the care an part of the management of most chronic Many individuals living with HIV/AIDS engage in a variety of self-care to their immune system, to disease to stress and to symptoms. may be as as that their in a that for periods of so as to manage, for instance, remains a although we have an study infected individuals’ self-initiated for managing symptoms that they to the illness or to antiretroviral The research has focused on the use of and the of the new treatment use by HIV-infected persons has not diminished in the HAART era and and and or are used by infected adults in an to their immune system, to symptoms or medication and to stress. However, as most research has been on gay men with high levels of these findings may not be to other more disadvantaged populations, such as and In own we have found that infected adults often to when they cannot the side-effects of antiretrovirals or they Furthermore, most as than treatments. to these therapies is also by since the of many of are not by health in the era of HAART There is a that the of the new HAART and the availability of may to an in for a variety of the that AIDS is a chronic illness may significantly the of infection that has the of risk with considerably extended for may be a task for especially they feel well and become in relationships. some that having an viral load the of the to a on the impact of the new therapies on infected and although that the new treatments are about the of and sometimes also behaviors In a study of women and of heterosexual were asked about their and sexual behaviors the of viral and the new treatments. While many study that they were not as about being HIV positive because of the improved and they viewed AIDS as a less illness in the protease inhibitors era, they also that viral load and the new therapies (including have not them from Other however, evidence that the new treatments are in of sexual especially among gay and bisexual In one investigators found that, among active gay and bisexual those having sexual were more likely to the that having a who protease inhibitors or whose viral load is is less Additionally, a study of and heterosexual found that gay and bisexual men were more likely to sexual with or status in the HAART era while the sexual of heterosexual Finally, in a study of men and women who were and in more since the new therapies became available for future research for future research are suggested by the present that in survival and quality of life made possible by HAART can only be by those to these we must the treatment are the characteristics and of infected individuals who choose to remain antiretroviral to to their disease through or some other form or The phenomenon of long-term survivors be a one as treatments to the life expectancy of infected How is the of of later impacted by this illness. How HIV/AIDS or In the United States, HIV/AIDS has been a health in rural however, the of research on the disease has been on where health and social are more available and infected individuals may be more research whether the of living with HIV/AIDS in rural the rapid into rural among adolescents, heterosexual women, and future prevention and studies need to these more recently of risk behaviors and interventions behaviors were from work with gay and often these and interventions are in and long-term adherence to among the more recently populations be investigated. The of the epidemic, extended and new of AIDS as a manageable chronic illness may the of new prevention of the consequences that the new of AIDS as a manageable disease will have on and active of HIV-infected individuals is also As the treatment advances the and the health of will the fear and with the disease and, will social of those infected The issue of also be examined. HIV-infected individuals feel less about their illness, and are they more to their HIV status to in light of recent treatment advances and their consequences for those living with the As the present there are many continuities as well as discontinuities in the experience of living with HIV/AIDS over the past There is to feel by the that has been made since the of the in the diagnosis, treatment and clinical management of this disease. however, are still many of the psychosocial as in the pre-HAART era, in While we AIDS as a chronic illness, we to and we have about to with the illness, since many of the issues remain as the

@article{doi1010970000203020021600400010,
    author = "Siegel, Karolynn and Lekas, Helen‐Maria",
    title = "AIDS as a chronic illness: psychosocial implications",
    year = "2002",
    journal = "AIDS",
    abstract = "Introduction Early in the epidemic, the public perception of AIDS as a highly fatal acute illness with a rapid downward trajectory was crystallized. Nevertheless, as early as 1991 in the nursing and medical sociology literature, a few investigators were already discussing HIV/AIDS as a chronic illness (for example [1,2]). Shortly thereafter, a number of psychosocial investigations of small groups of long-term AIDS survivors appeared in the literature, although these cases were still seen as infrequent exceptions (see [3] for a review). It was not until the advent of protease inhibitors in 1996, which ushered in the era of highly active antiretroviral therapy (HAART), that the view of AIDS as a chronic illness became widely accepted. These medications were touted in the mass media as ‘miraculous’ because they reduced the risk of opportunistic infections and extended survival by suppressing viral replication and increasing CD4 cell counts. Their availability was said to have “reinserted the word ‘hope’ into the discussion about AIDS for the first time in a decade of treatment trials” [4] (p. 161), and to have offered infected individuals the opportunity for a “second life” [5]. Among those at advanced stages of the disease, recoveries have often been so dramatic that the phenomenon has been dubbed the ‘Lazarus Syndrome’, referring to the seeming rising from the dead made possible by these new medications [6]. While in the United States recent treatment advances have had a profound impact on the illness trajectory and thus life expectancy of many infected individuals [7], AIDS-related mortality continues to rise unabated in parts of the world where access to the new therapies is limited. The prohibitively high prices of antiretrovirals coupled with inadequate and inefficient health delivery systems have allowed AIDS to reach catastrophic levels in many developing countries [8]. Even in the United States, however, not all infected persons have access to or choose to adopt the new treatments. Some physicians are less likely to offer HAART to patients they assume to be at risk for poor adherence, such as those with a history of drug use, the homeless, and the mentally ill [9–11], although the evidence supporting their actions remains inconclusive [12, 13]. Other research indicates that women, African-Americans, and those with low levels of education are less likely to have ever used the new therapies [14–17]. These findings have been attributed not only to a lack of access to these medications among these socio-economically disadvantaged groups, but also to their own reluctance to use them due to such factors as fear of medication side-effects and distrust of physicians. Similar issues were identified as barriers to antiretroviral use and medication adherence before HAART became available [18,19]. Chronic illness and AIDS Chronic illnesses are typically incurable, and thus the goals of medical care are usually containment, slowing disease progression and symptom management rather than cure. Beyond this, chronic diseases tend to share a variety of characteristics [20–23]. Frequently, they have an uncertain course or disease trajectory often characterized by alternating periods of remission and recurrence, or stable periods interrupted by episodic exacerbations of symptoms. Most require adherence to a treatment regimen, although these differ significantly across diseases in complexity and efficacy. Chronic disease also typically requires considerable self-care (including self-monitoring of symptoms) on the patient's part, since most of the day-to-day management of the illness takes place outside formal health institutions or facilities. As illness is a form of deviance and thus an undesirable state, chronic conditions also carry some degree of stigma. However, this varies greatly across diseases and depends on a variety of factors, such as whether the individual is perceived as being responsible for having acquired the illness, whether the illness is contagious and whether there is visible disfigurement. In addition, changes in roles and relationships are common. Illness almost always necessitates some degree of dependency, at least at the more advanced stages of a disease. Roles and responsibilities in relationships and families typically must be re-negotiated in light of the patient's limitations or disabilities. Finally, chronic diseases often bring about identity changes as the patient attempts to integrate the illness into his/her life and self-perception over the long haul. Psychological distress is a prevalent concomitant of living with chronic conditions, because of the uncertainty inherent in many of these illness characteristics. Each of these aspects of chronic disease posses an adaptive task or challenge (e.g., tolerating uncertainty, managing stigma, adhering to treatment) that is stressful for the individual to confront. How well the chronically ill individual will adapt to one's disease will depend in large part on his/her ability to master, or at least successfully manage, these tasks. Today, AIDS meets the criteria for a chronic illness [24]. While available treatments can render a viral load undetectable, they cannot fully eradicate it from the body and, left untreated, the viral load will rebound. Consequently, there is still no cure for the disease. Furthermore, while the natural history of the disease has been delineated, the course of HIV disease progression varies considerably among individuals [25]. Current multi-drug regimens remain complex, often requiring that many pills be taken on a rigid schedule while following strict dietary guidelines. Yet, similar to many other chronic illnesses, the regimens for HIV infection are not equally effective for all patients [26]. It is also well recognized that HIV/AIDS has a profound impact on intimate and social relationships. The fact that the disease can be transmitted through sexual behaviors renders intimate relationships fraught with anxiety and ambivalence. Moreover, infected adults often feel that others are unwilling to enter into long-term relationships with them for fear of having to assume care-giving responsibilities when the disease progresses. Additionally, self-care is a component of living with HIV. Many patients engage in self-initiated strategies (e.g., diet, relaxation exercises, stress avoidance) aimed at managing illness or treatment-related symptoms, boosting their immune system, or alleviating stress. In the present paper, we discuss several of the principal characteristics of chronic illnesses, reviewing in each case the relevant available literature. In each section, we attempt to highlight continuities and discontinuities between the pre-HAART and the HAART eras. In addition, we discuss prevention in the context of AIDS as a chronic illness. We conclude with some suggestions for future research in the field of HIV/AIDS and chronic illness. Emotional distress From the outset of the AIDS epidemic, there has been considerable documentation of the adverse psychological consequences of knowing one is infected. When AIDS was viewed as a highly fatal illness with an inexorable downhill course, much of this work focused on assessing depression (depressive symptomatology or clinical depression) and suicidal ideation or acts. While the findings of studies sometimes differed, the preponderance of evidence from the pre-HAART era suggested that depression was prevalent and that suicidal ideation and risk were elevated [27–30]. Infected individuals seemed particularly emotionally vulnerable shortly after diagnosis, when HIV-related symptoms first appeared, in the later stages of the disease, and after suffering multiple AIDS-related losses in their social network. It is a widely held, although largely unexamined, assumption that the experience of living with HIV infection in the HAART era is significantly less distressing compared with the past because of the prospects for extended survival and enhanced quality of life offered by the new treatments. Only recently, however, has this issue begun to be empirically investigated. Rabkin et al. [31] followed a sample of gay and bisexual men with symptomatic illness over a period that included the time before and after the availability of protease inhibitors. On all measures of psychological distress employed, the sample as a whole showed a statistically significant, although clinically modest, decline over time (when CD4 cell count, HIV symptoms, physical limitations, and social support were included as co-variates). However, when they further compared subjects whose status on medical markers had improved and had not improved, no significant differences in decline in hopelessness or improvement in quality of life were observed. In another study [32], changes in depressive symptomatology were investigated among 456 HIV-infected individuals (433 men) receiving antiretroviral treatment who were asked to complete a self-administered questionnaire annually. All study participants had completed at least one survey before and one after using protease inhibitors. The investigators found that, between assessment points, the percentage of individuals with a score indicative of probable clinical depression declined from 52 to 46\%. While this change was not statistically significant, there were improvements in the total score of the Center for Epidemiological Studies—Depression scale, as well as on the depressive mood, positive affect and somatic symptom subscales. Similarly, in another study [33], changes in depressive symptomatology among 125 HIV-infected adults (most homosexual/bisexual males) assessed at 6-month intervals over a 2-year period were examined. The investigators found a pattern of declining scores on the Beck Depression Inventory over time, especially after the third assessment (12 months after baseline), when 51\% of study participants were receiving HAART. There was, however, substantial drop-out before the 6-month assessment, and the number of cases included at each assessment point varied. It thus seems that the evidence on whether living with HIV infection is less psychologically distressing since the availability of HAART remains inconclusive. If ultimately it is shown to be so, this could have implications for needed mental health services. Catalan et al. [34], for example, suggest that as AIDS becomes a more manageable disease there will be a diminished need for acute mental health services (e.g., psychiatric hospitalization, crisis intervention), and a greater need for interventions assisting individuals in adjusting long-term to chronic-illness-related psychosocial stressors. While this may be true among gay and bisexual men and drug users who can recall infected individuals’ bleaker prospects in the pre-HAART era, the need for acute psychiatric services may grow among more recently impacted populations, such as infected adults living in rural America, adolescents, and heterosexual women without a history of drug use. Members of these populations often do not recognize that they were at risk for infection, making diagnosis a more psychologically disruptive event. Uncertainty Individuals living with HIV/AIDS have always confronted uncertainty. Early in the epidemic, this uncertainty revolved around issues such as when one had become infected, where one was in the disease trajectory, how long one was likely to survive, and whether any effective treatments for slowing or halting progression of one's disease would be developed. With the advent of zidovudine and other drugs of the pre-HAART era, uncertainty centered on issues such as whether to get tested, when to initiate treatment, and whether one would have a positive response to treatment. With the availability of HAART, new uncertainties have emerged [35] while old ones persist. For example, many infected individuals who realize extended survival as a result of new treatment regimens may confront emerging opportunistic infections that, in the past, patients did not live long enough to experience. Also, because these medications are new, there is uncertainty about their long-term safety. There is also a lack of clarity about how functional a restored immune system is likely to be [36,37]. The meaning of an improved CD4 cell count, a fundamental disease marker, is also ambiguous. For instance, is an individual who was diagnosed earlier as having AIDS solely on the basis of a CD4 cell count below 200 and who now has a count above that threshold still considered as having AIDS [35]? Those with advanced disease who had expected to die, but have now experienced a ‘reprieve’ on protease inhibitors, may feel insecure about their new-found well-being. While no longer imminently facing death, and possibly they recognize that they could experience a at any time, and The of many is by the fact that they have been to significant in their Finally, as in the pre-HAART era, and uncertainty to the of the time to initiate medication use Those who have not HAART recognize that not or can the Furthermore, those who have experienced recognize that they may be over an extended period of time adherence to the [26]. another of uncertainty is the risk of developing drug with Roles and relationships health has allowed infected individuals to the assumption of new social roles or the to old ones (e.g., For example, the in that zidovudine treatment could significantly of the from an infected to allowed infected women to more With the advent of HAART, more may now as a significant in viral load further the risk of survival and improved health due to HAART may also earlier about not being to or long enough to a However, the adverse of on their health to be of HIV-infected women the and of in the HAART Many infected individuals from HAART are also to work to their to become more to feel more and to however, uncertainty the impact of the stress of work their their after a long period of and their ability to their their health decline Many also about and in the Moreover, not all those using the new treatments feel to but may feel to do so the public perception of the new therapies as infected persons may that others view them as The of extended survival has also many infected individuals to the they have made their relationships Those a many of the confronted before HAART, the anxiety of one's HIV one's and Moreover, in an era of viral the of and may a considerable in relationships. The of living longer and may those who have in relationships because of about health and to the of these relationships Furthermore, the of of and sexual relationships may be anxiety when infected individuals do not feel for these changes The diagnosis of a chronic illness typically necessitates identity work Infected individuals differ in how they integrate their illness in their one are those who their life around their illness. These individuals may work or for AIDS are in or social on of infected and largely their social to other infected the other are those who have to and their illness while as much as possible with their to the illness from a in their In the era, many living with HIV/AIDS now have the opportunity to as living with a chronic illness rather than from a disease. Furthermore, new treatments have patients to feel and to their for longer periods of time, thus the and of the illness and the of the patient However, patients may feel their medication regimens are a of their patient From the outset of the epidemic, infected individuals have been and by have been to and social among physicians and in the United States to care for HIV-infected individuals has been well since early in the reluctance to care for these patients between 1991 and in HIV-related in the United States some but also some of stigma, support for (e.g., had significantly in almost of the that those with AIDS were responsible for the illness. Furthermore, significant they would be or having their with a with AIDS or having an with AIDS or at a where the had AIDS substantial also in that HIV could be transmitted through with AIDS on the a with them and using public all likely to be with to and HIV-infected has also that AIDS is on the it may be and at infected groups and of infected individuals may be greater in developing countries where there has been public education about the disease study of HIV-infected women in rural their that the to them at the time of delivery because of their infected that the medical were infected patients to the were also by study and so was their fear that their would or them Many infected individuals and the and feel and however, the and the and to public patients to remain for longer periods of time, the new treatments have made it possible for them to their illness longer and to as Their social identity as is thus and the many infected individuals experience with their distressing consequences are Yet, they may the psychological of having to a identity and possibly needed adherence The by of the of protease inhibitors was by the that adherence to these and regimens was often a task has been attributed to the to medication fear of the high that medication use will to of illness, and the of For these many individuals treatment or have been unwilling to use protease inhibitors from their physicians to do so While the of the recently regimens for treatment are being the impact of these of treatment on adherence remains to be While the of intervals may adherence because patients can to these treatment they also may adherence by patients to initiate their own who are to adherence to treatment regimens may engage in and have a of Those adhering to but not the dramatic health that early media with the ‘miraculous’ new medications may experience a of anxiety and fear and have also that, before HAART, all infected individuals a from the illness. However, now that some from treatment while others do of and has been by one of as becomes more that can be by and individual but also the to and (p. Finally, because many will not from HAART, those who do may experience a of similar to that in gay men who and to AIDS earlier in the care an part of the management of most chronic Many individuals living with HIV/AIDS engage in a variety of self-care to their immune system, to disease to stress and to symptoms. may be as as that their in a that for periods of so as to manage, for instance, remains a although we have an study infected individuals’ self-initiated for managing symptoms that they to the illness or to antiretroviral The research has focused on the use of and the of the new treatment use by HIV-infected persons has not diminished in the HAART era and and and or are used by infected adults in an to their immune system, to symptoms or medication and to stress. However, as most research has been on gay men with high levels of these findings may not be to other more disadvantaged populations, such as and In own we have found that infected adults often to when they cannot the side-effects of antiretrovirals or they Furthermore, most as than treatments. to these therapies is also by since the of many of are not by health in the era of HAART There is a that the of the new HAART and the availability of may to an in for a variety of the that AIDS is a chronic illness may significantly the of infection that has the of risk with considerably extended for may be a task for especially they feel well and become in relationships. some that having an viral load the of the to a on the impact of the new therapies on infected and although that the new treatments are about the of and sometimes also behaviors In a study of women and of heterosexual were asked about their and sexual behaviors the of viral and the new treatments. While many study that they were not as about being HIV positive because of the improved and they viewed AIDS as a less illness in the protease inhibitors era, they also that viral load and the new therapies (including have not them from Other however, evidence that the new treatments are in of sexual especially among gay and bisexual In one investigators found that, among active gay and bisexual those having sexual were more likely to the that having a who protease inhibitors or whose viral load is is less Additionally, a study of and heterosexual found that gay and bisexual men were more likely to sexual with or status in the HAART era while the sexual of heterosexual Finally, in a study of men and women who were and in more since the new therapies became available for future research for future research are suggested by the present that in survival and quality of life made possible by HAART can only be by those to these we must the treatment are the characteristics and of infected individuals who choose to remain antiretroviral to to their disease through or some other form or The phenomenon of long-term survivors be a one as treatments to the life expectancy of infected How is the of of later impacted by this illness. How HIV/AIDS or In the United States, HIV/AIDS has been a health in rural however, the of research on the disease has been on where health and social are more available and infected individuals may be more research whether the of living with HIV/AIDS in rural the rapid into rural among adolescents, heterosexual women, and future prevention and studies need to these more recently of risk behaviors and interventions behaviors were from work with gay and often these and interventions are in and long-term adherence to among the more recently populations be investigated. The of the epidemic, extended and new of AIDS as a manageable chronic illness may the of new prevention of the consequences that the new of AIDS as a manageable disease will have on and active of HIV-infected individuals is also As the treatment advances the and the health of will the fear and with the disease and, will social of those infected The issue of also be examined. HIV-infected individuals feel less about their illness, and are they more to their HIV status to in light of recent treatment advances and their consequences for those living with the As the present there are many continuities as well as discontinuities in the experience of living with HIV/AIDS over the past There is to feel by the that has been made since the of the in the diagnosis, treatment and clinical management of this disease. however, are still many of the psychosocial as in the pre-HAART era, in While we AIDS as a chronic illness, we to and we have about to with the illness, since many of the issues remain as the",
    url = "https://doi.org/10.1097/00002030-200216004-00010",
    doi = "10.1097/00002030-200216004-00010",
    openalex = "W2043394588",
    references = "doi101001archinte158202257, doi101016s0738399101002191, doi101056nejm200106073442306, doi101086313849, doi1010970000203019990204000016, doi1010970000203020000331000005, doi10111114679566ep10491512, doi101176ajp153111430, doi1011770002764299042007004, doi102105ajph923371"
}

@article{julesrosette2002afropessimisms,
    author = "Jules-Rosette, Bennetta",
    title = "Afro-Pessimism's Many Guises",
    year = "2002",
    journal = "Public Culture",
    url = "https://doi.org/10.1215/08992363-14-3-603",
    doi = "10.1215/08992363-14-3-603",
    number = "3",
    pages = "603-605",
    volume = "14"
}

Uganda has the one of the oldest recognised AIDS epidemics. The first people found to be sick with AIDS in 1982 in southwestern Uganda became infected in the mid-1970s. For several years, Uganda has been widely recognised as the first and most dramatic African success story, with estimated national HIV prevalence falling from about 15 per cent in 1992 to 5 per cent in 2001. This is truly good news! As the epidemic proceeds through its third decade, many observers suggest that Uganda's prevention efforts are a model to follow. What is the situation there, and what can we learn from Uganda?

@article{doi10108003,
    author = "Schoepf, Brooke Grundfest",
    title = "Uganda: lessons for aids control in Africa",
    year = "2003",
    journal = "Review of African Political Economy",
    abstract = "Uganda has the one of the oldest recognised AIDS epidemics. The first people found to be sick with AIDS in 1982 in southwestern Uganda became infected in the mid-1970s. For several years, Uganda has been widely recognised as the first and most dramatic African success story, with estimated national HIV prevalence falling from about 15 per cent in 1992 to 5 per cent in 2001. This is truly good news! As the epidemic proceeds through its third decade, many observers suggest that Uganda's prevention efforts are a model to follow. What is the situation there, and what can we learn from Uganda?",
    url = "https://doi.org/10.1080/03",
    doi = "10.1080/03",
    openalex = "W2077568393",
    references = "doi101016s0277953601000272"
}

This article reviews 22 studies that test a variety of interventions to decrease AIDS stigma in developed and developing countries. This article assesses published studies that met stringent evaluation criteria in order to draw lessons for future development of interventions to combat stigma. The target group, setting, type of intervention, measures, and scale of these studies varied tremendously. The majority (14) of the studies aimed to increase tolerance of persons living with HIV/AIDS (PLHA) among the general population. The remaining studies tested interventions to increase willingness to treat PLHA among health care providers or improve coping strategies for dealing with AIDS stigma among PLHA or at-risk groups. Results suggest some stigma reduction interventions appear to work, at least on a small scale and in the short term, but many gaps remain especially in relation to scale and duration of impact and in terms of gendered impact of stigma reduction interventions.

@article{doi101521aeap1514923844,
    author = "Brown, Lisanne and Macintyre, Kate and Trujillo, Lea",
    title = "Interventions to Reduce HIV/AIDS Stigma: What Have We Learned?",
    year = "2003",
    journal = "AIDS Education and Prevention",
    abstract = "This article reviews 22 studies that test a variety of interventions to decrease AIDS stigma in developed and developing countries. This article assesses published studies that met stringent evaluation criteria in order to draw lessons for future development of interventions to combat stigma. The target group, setting, type of intervention, measures, and scale of these studies varied tremendously. The majority (14) of the studies aimed to increase tolerance of persons living with HIV/AIDS (PLHA) among the general population. The remaining studies tested interventions to increase willingness to treat PLHA among health care providers or improve coping strategies for dealing with AIDS stigma among PLHA or at-risk groups. Results suggest some stigma reduction interventions appear to work, at least on a small scale and in the short term, but many gaps remain especially in relation to scale and duration of impact and in terms of gendered impact of stigma reduction interventions.",
    url = "https://doi.org/10.1521/aeap.15.1.49.23844",
    doi = "10.1521/aeap.15.1.49.23844",
    openalex = "W2168885219",
    references = "doi1011391aidsr19996104"
}

Abstract Fishing communities are often among the highest‐risk groups in countries with high overall rates of HIV/AIDS prevalence. Vulnerability to HIV/AIDS stems from complex, interacting causes that may include the mobility of many fisherfolk, the time fishermen spend away from home, their access to daily cash income in an overall context of poverty and vulnerability, their demographic profile, the ready availability of commercial sex in fishing ports and the subcultures of risk taking and hypermasculinity among some fishermen. The subordinate economic and social position of women in many fishing communities in low‐income countries makes them even more vulnerable. HIV/AIDS in fishing communities was first dealt with as a public health issue, and most projects were conducted by health sector agencies and NGOs, focusing on education and health care provision. More recently, as the social and economic impacts of the epidemic have become evident, wider social service provision and economic support have been added. In the last 3 years, many major fishery development programmes in Africa, South/South‐East Asia and the Asia‐Pacific region have incorporated HIV/AIDS awareness in their planning. The HIV/AIDS pandemic threatens the sustainability of fisheries by eclipsing the futures of many fisherfolk. The burden of illness puts additional stresses on households, preventing them from accumulating assets derived from fishing income. Premature death robs fishing communities of the knowledge gained by experience and reduces incentives for longer‐term and inter‐generational stewardship of resources. Recent projects championing local knowledge and resource‐user participation in management need to take these realities into account. If the fishing communities of developing countries that account for 95% of the world's fisherfolk and supply more than half the world's fish are adversely impacted by HIV/AIDS, then the global supply of fish, particularly to lower‐income consumers, may be jeopardized.

@article{doi101111j14672679200400153x,
    author = "Allison, Edward H. and Seeley, Janet",
    title = "HIV and AIDS among fisherfolk: a threat to ‘responsible fisheries'?",
    year = "2004",
    journal = "Fish and Fisheries",
    abstract = "Abstract Fishing communities are often among the highest‐risk groups in countries with high overall rates of HIV/AIDS prevalence. Vulnerability to HIV/AIDS stems from complex, interacting causes that may include the mobility of many fisherfolk, the time fishermen spend away from home, their access to daily cash income in an overall context of poverty and vulnerability, their demographic profile, the ready availability of commercial sex in fishing ports and the subcultures of risk taking and hypermasculinity among some fishermen. The subordinate economic and social position of women in many fishing communities in low‐income countries makes them even more vulnerable. HIV/AIDS in fishing communities was first dealt with as a public health issue, and most projects were conducted by health sector agencies and NGOs, focusing on education and health care provision. More recently, as the social and economic impacts of the epidemic have become evident, wider social service provision and economic support have been added. In the last 3 years, many major fishery development programmes in Africa, South/South‐East Asia and the Asia‐Pacific region have incorporated HIV/AIDS awareness in their planning. The HIV/AIDS pandemic threatens the sustainability of fisheries by eclipsing the futures of many fisherfolk. The burden of illness puts additional stresses on households, preventing them from accumulating assets derived from fishing income. Premature death robs fishing communities of the knowledge gained by experience and reduces incentives for longer‐term and inter‐generational stewardship of resources. Recent projects championing local knowledge and resource‐user participation in management need to take these realities into account. If the fishing communities of developing countries that account for 95\% of the world's fisherfolk and supply more than half the world's fish are adversely impacted by HIV/AIDS, then the global supply of fish, particularly to lower‐income consumers, may be jeopardized.",
    url = "https://doi.org/10.1111/j.1467-2679.2004.00153.x",
    doi = "10.1111/j.1467-2679.2004.00153.x",
    openalex = "W2136112260",
    references = "doi101016s0277953601000272"
}

@article{doi1011391aidsr19996104,
    author = "誠一, 市川",
    title = "AIDS Education and Prevention",
    year = "2004",
    journal = "The Journal of AIDS Research",
    url = "https://doi.org/10.11391/aidsr1999.6.104",
    doi = "10.11391/aidsr1999.6.104",
    openalex = "W582336903"
}

Fishing communities have been identified as among the highest-risk groups for HIV infection in countries with high overall rates of HIV/AIDS prevalence. Vulnerability to HIV/AIDS stems from, the time fishers and fish traders spend away from home, their access to cash income, their demographic profile, the ready availability of commercial sex in fishing ports and the sub-cultures of risk taking and hyper-masculinity in fishermen. The subordinate economic and social position of women in many fishing communities makes them even more vulnerable to infection. In this paper we review the available literature to assess the social, economic and cultural factors that shape many fisherfolks' life-styles and that make them both vulnerable to infection and difficult to reach with anti-retroviral therapy and continued prevention efforts. We conclude from the available evidence that fisherfolk will be among those untouched by planned initiatives to increase access to anti-retroviral therapies in the coming years; a conclusion that might apply to other groups with similar socio-economic and sub-cultural attributes, such as other seafarers, and migrant-workers including small-scale miners, and construction workers.

@article{doi10108009540120412331336698,
    author = "Seeley, Janet and Allison, Edward H.",
    title = "HIV/AIDS in fishing communities: Challenges to delivering antiretroviral therapy to vulnerable groups",
    year = "2005",
    journal = "AIDS Care",
    abstract = "Fishing communities have been identified as among the highest-risk groups for HIV infection in countries with high overall rates of HIV/AIDS prevalence. Vulnerability to HIV/AIDS stems from, the time fishers and fish traders spend away from home, their access to cash income, their demographic profile, the ready availability of commercial sex in fishing ports and the sub-cultures of risk taking and hyper-masculinity in fishermen. The subordinate economic and social position of women in many fishing communities makes them even more vulnerable to infection. In this paper we review the available literature to assess the social, economic and cultural factors that shape many fisherfolks' life-styles and that make them both vulnerable to infection and difficult to reach with anti-retroviral therapy and continued prevention efforts. We conclude from the available evidence that fisherfolk will be among those untouched by planned initiatives to increase access to anti-retroviral therapies in the coming years; a conclusion that might apply to other groups with similar socio-economic and sub-cultural attributes, such as other seafarers, and migrant-workers including small-scale miners, and construction workers.",
    url = "https://doi.org/10.1080/09540120412331336698",
    doi = "10.1080/09540120412331336698",
    openalex = "W2004124022",
    references = "doi101016s0277953601000272"
}

Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes.

@article{doi101136sti2004012468,
    author = "Harcourt, Christine",
    title = "The many faces of sex work",
    year = "2005",
    journal = "Sexually Transmitted Infections",
    abstract = "Developing comprehensive sexual health promotion programmes requires a complete understanding of the types of sex work in a particular area. This study provides a checklist for developing appropriate and targeted programmes.",
    url = "https://doi.org/10.1136/sti.2004.012468",
    doi = "10.1136/sti.2004.012468",
    openalex = "W2152914556",
    references = "doi101007bf01541599, doi101016s0277953601000272, doi101016s0277953699003172, doi101056nejm198602133140704, doi1010579780230375130, doi1010970000203020021122000003, doi101177095646249400500212, doi1011771463499603003002005, doi10230727509069, openalexw178211676"
}

For the past several years, diverse and often confused concepts of stigma have been invoked in discussions on AIDS. Many have argued compellingly that AIDS-related stigma acts as a barrier to voluntary counseling and testing. Less compelling are observations regarding the source of stigma or its role in decreasing interest in HIV care. We reviewed these claims as well as literature from anthropology, sociology, and public health. Preliminary data from research in rural Haiti suggest that the introduction of quality HIV care can lead to a rapid reduction in stigma, with resulting increased uptake of testing. Rather than stigma, logistic and economic barriers determine who will access such services. Implications for scale-up of integrated AIDS prevention and care are explored.

@article{doi102105ajph2003028563,
    author = "Castro, Arachu and Farmer, Paul",
    title = "Understanding and Addressing AIDS-Related Stigma: From Anthropological Theory to Clinical Practice in Haiti",
    year = "2005",
    journal = "American Journal of Public Health",
    abstract = "For the past several years, diverse and often confused concepts of stigma have been invoked in discussions on AIDS. Many have argued compellingly that AIDS-related stigma acts as a barrier to voluntary counseling and testing. Less compelling are observations regarding the source of stigma or its role in decreasing interest in HIV care. We reviewed these claims as well as literature from anthropology, sociology, and public health. Preliminary data from research in rural Haiti suggest that the introduction of quality HIV care can lead to a rapid reduction in stigma, with resulting increased uptake of testing. Rather than stigma, logistic and economic barriers determine who will access such services. Implications for scale-up of integrated AIDS prevention and care are explored.",
    url = "https://doi.org/10.2105/ajph.2003.028563",
    doi = "10.2105/ajph.2003.028563",
    openalex = "W2110157376"
}

Objective: This study examines the levels of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) related stigma among the Iranian population and the factors that contribute to the formation of stigma within the study population. Design: A quantitative research design was used in this research whereby participants completed a self-administrated questionnaire. A sample of 236 adults aged 20–65 were collected using non-probability sampling techniques. Setting: The study was carried out in the Sydney (Australia) metropolitan area and data were collected in 2007. Method: To obtain a desirable sample size, multivariate techniques including snowball were used. Herek’s (1986) functional approach to attitudes was used to analyze HIV/AIDS stigma in the study population. Results: The findings illustrate that HIV/AIDS-related stigma was dominant among the study population. Overall, participants had negative feelings toward people with HIV/AIDS (PWHA); they were in favour of punitive policies against them and were more likely to avoid having contact with people who had contracted HIV/AIDS. Multiple regression analysis revealed that both instrumental (fear of contamination) and symbolic factors (attitudes towards homosexuals and injecting drug user) independently contributed to HIV/AIDS stigma. Conclusion: The findings suggest that HIV/AIDS stigma has instrumental and symbolic function, and concentrating solely on instrumental (HIV/AIDS transmission routes) factors is less likely to address it properly. Therefore, educational campaigns to reduce HIV/AIDS stigma should also focus on symbolic factors. The findings contribute to the knowledge area of better understanding of HIV/AIDS stigma among ethnic minorities of similar characteristics. The results are valuable for the Iranian community, health service providers, health educators and policy makers.

@article{doi1011770017896910386529,
    author = "Hosseinzadeh, Hassan and Hossain, Syeda Zakia and Niknami, Shamsaddin",
    title = "Levels and functions of HIV/AIDS stigma within the Iranian community living in the Sydney metropolitan area",
    year = "2010",
    journal = "Health Education Journal",
    abstract = "Objective: This study examines the levels of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) related stigma among the Iranian population and the factors that contribute to the formation of stigma within the study population. Design: A quantitative research design was used in this research whereby participants completed a self-administrated questionnaire. A sample of 236 adults aged 20–65 were collected using non-probability sampling techniques. Setting: The study was carried out in the Sydney (Australia) metropolitan area and data were collected in 2007. Method: To obtain a desirable sample size, multivariate techniques including snowball were used. Herek’s (1986) functional approach to attitudes was used to analyze HIV/AIDS stigma in the study population. Results: The findings illustrate that HIV/AIDS-related stigma was dominant among the study population. Overall, participants had negative feelings toward people with HIV/AIDS (PWHA); they were in favour of punitive policies against them and were more likely to avoid having contact with people who had contracted HIV/AIDS. Multiple regression analysis revealed that both instrumental (fear of contamination) and symbolic factors (attitudes towards homosexuals and injecting drug user) independently contributed to HIV/AIDS stigma. Conclusion: The findings suggest that HIV/AIDS stigma has instrumental and symbolic function, and concentrating solely on instrumental (HIV/AIDS transmission routes) factors is less likely to address it properly. Therefore, educational campaigns to reduce HIV/AIDS stigma should also focus on symbolic factors. The findings contribute to the knowledge area of better understanding of HIV/AIDS stigma among ethnic minorities of similar characteristics. The results are valuable for the Iranian community, health service providers, health educators and policy makers.",
    url = "https://doi.org/10.1177/0017896910386529",
    doi = "10.1177/0017896910386529",
    openalex = "W2022963453",
    references = "doi10310900048679109062631"
}

This study attempts to provide a concrete understanding to the embodied experience of HIV/AIDS. PLWHA have to cope with physical changes, especially lipodystrophy, caused by HIV and its treatment. These clinical manifestations make the disease socially visible and form a potential source of stigmatization. Visibility seems to transform the personal experience of this particular illness into a collective one. The changing body image and the stigma, which is often internalized by individuals, along with other consequences of chronic illness, such as alteration of life plans and social relationships, constitute new elements that appear in their life after diagnosis. These new experiences can break one's biographical continuity, especially in cases like HIV/AIDS. Semi-structured and in-depth interviews were conducted with 18 HIV-positive individuals (13 men, 5 women) with lipodystrophy. Their ages ranged from 36 to 65 years. The analysis of data revealed three main themes: loss of control over the body, ambivalence about visibility of HIV/AIDS, attributing positive meaning to HIV/AIDS. Physical changes caused by lipodystrophy are a source of dysphoria for PLWHA. This dissatisfaction was closely associated with the absence of control over their own body, due to the virus and the side effects of medication. Furthermore, it became evident that there was ambivalence among participants about the visibility of HIV, as it was in parallel a source of stigmatization, but also a part of their identity and biography. Results indicate that individuals were in search of meaning and constitute strategies in order to "answer" to the disruptive aspects of HIV. These were the normalization of illness, the integration into personal identity and the recognition of positive effects of HIV in their lives (e.g., stopping drug and alcohol abuse). Further research is required to identify the factors that determine the selection of each "answer" by these particular individuals who belong to broader social groups.

@article{doi1010800954012120151119782,
    author = "Alexias, George and Savvakis, Manos and Stratopoulou, Ιfigenia",
    title = "Embodiment and biographical disruption in people living with HIV/AIDS (PLWHA)",
    year = "2015",
    journal = "AIDS Care",
    abstract = {This study attempts to provide a concrete understanding to the embodied experience of HIV/AIDS. PLWHA have to cope with physical changes, especially lipodystrophy, caused by HIV and its treatment. These clinical manifestations make the disease socially visible and form a potential source of stigmatization. Visibility seems to transform the personal experience of this particular illness into a collective one. The changing body image and the stigma, which is often internalized by individuals, along with other consequences of chronic illness, such as alteration of life plans and social relationships, constitute new elements that appear in their life after diagnosis. These new experiences can break one's biographical continuity, especially in cases like HIV/AIDS. Semi-structured and in-depth interviews were conducted with 18 HIV-positive individuals (13 men, 5 women) with lipodystrophy. Their ages ranged from 36 to 65 years. The analysis of data revealed three main themes: loss of control over the body, ambivalence about visibility of HIV/AIDS, attributing positive meaning to HIV/AIDS. Physical changes caused by lipodystrophy are a source of dysphoria for PLWHA. This dissatisfaction was closely associated with the absence of control over their own body, due to the virus and the side effects of medication. Furthermore, it became evident that there was ambivalence among participants about the visibility of HIV, as it was in parallel a source of stigmatization, but also a part of their identity and biography. Results indicate that individuals were in search of meaning and constitute strategies in order to "answer" to the disruptive aspects of HIV. These were the normalization of illness, the integration into personal identity and the recognition of positive effects of HIV in their lives (e.g., stopping drug and alcohol abuse). Further research is required to identify the factors that determine the selection of each "answer" by these particular individuals who belong to broader social groups.},
    url = "https://doi.org/10.1080/09540121.2015.1119782",
    doi = "10.1080/09540121.2015.1119782",
    openalex = "W2192710166",
    references = "doi1011771357034x04047855"
}

Anthropologists working on HIV are increasingly reframing their research as taking place in “the age of treatment,” marking a shift from “the age of AIDS.” The age of treatment is characterized by the increasing biomedicalization of HIV, which has come about as a result of improved pharmaceutical and surveillance technologies and the presumption by international experts in global health that HIV could be eradicated in the near future through biomedical interventions. Despite this radical transformation, I argue that there are many important epistemological continuities for anthropologists researching HIV/AIDS in the twenty-first century. This review identifies such continuities between anthropological research conducted prior to and that conducted since the availability of life-saving treatment for HIV.

@article{doi101146annurevanthro102214014235,
    author = "Moyer, Eileen",
    title = "The Anthropology of Life After AIDS: Epistemological Continuities in the Age of Antiretroviral Treatment",
    year = "2015",
    journal = "Annual Review of Anthropology",
    abstract = "Anthropologists working on HIV are increasingly reframing their research as taking place in “the age of treatment,” marking a shift from “the age of AIDS.” The age of treatment is characterized by the increasing biomedicalization of HIV, which has come about as a result of improved pharmaceutical and surveillance technologies and the presumption by international experts in global health that HIV could be eradicated in the near future through biomedical interventions. Despite this radical transformation, I argue that there are many important epistemological continuities for anthropologists researching HIV/AIDS in the twenty-first century. This review identifies such continuities between anthropological research conducted prior to and that conducted since the availability of life-saving treatment for HIV.",
    url = "https://doi.org/10.1146/annurev-anthro-102214-014235",
    doi = "10.1146/annurev-anthro-102214-014235",
    openalex = "W2135125804",
    references = "doi101080014597402014890618"
}

Just two years after the publication of The Collected Fiction of Katherine Mansfield in two volumes comes another handsomely produced and admirably edited book, The Poetry and Critical Writings of Katherine Mansfield, the third volume in The Edinburgh Edition of the Collected Works of Katherine Mansfield....

@incollection{mitchell2015katherine,
    author = "Mitchell, J. Lawrence",
    title = "Katherine Mansfield in Many Guises",
    year = "2015",
    booktitle = "Katherine Mansfield and Translation",
    abstract = "Just two years after the publication of The Collected Fiction of Katherine Mansfield in two volumes comes another handsomely produced and admirably edited book, The Poetry and Critical Writings of Katherine Mansfield, the third volume in The Edinburgh Edition of the Collected Works of Katherine Mansfield....",
    url = "https://doi.org/10.3366/edinburgh/9781474400381.003.0014",
    doi = "10.3366/edinburgh/9781474400381.003.0014",
    openalex = "W4237457771"
}

Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.

@article{doi10100214651858cd001431pub5,
    author = "Stacey, Dawn and Légaré, France and Lewis, Krystina B. and Barry, Michael J. and Bennett, Carol and Eden, Karen and Holmes‐Rovner, Margaret and Llewellyn‐Thomas, Hilary A. and Lyddiatt, Anne and Thomson, Richard and Trevena, Lyndal",
    title = "Decision aids for people facing health treatment or screening decisions",
    year = "2017",
    journal = "Cochrane Database of Systematic Reviews",
    abstract = "Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.",
    url = "https://doi.org/10.1002/14651858.cd001431.pub5",
    doi = "10.1002/14651858.cd001431.pub5",
    openalex = "W1943745580",
    references = "doi10100214651858cd001431pub5, doi101002hec4730020305, doi101016s0277953696002213, doi1010970000763219830300000004, doi101136bmj38926629329ae, doi101136bmjd4002, doi1011770272989x9501500105, doi101371journalpone0029202, doi101377hlthaff20121061, doi107249cb361"
}

@article{legoff2017same,
    author = "Le Goff, Jacques",
    title = "Same work, many guises",
    year = "2017",
    journal = "Revue Projet",
    url = "https://doi.org/10.3917/pro.361.0018",
    doi = "10.3917/pro.361.0018",
    number = "6",
    pages = "18-27",
    volume = "No 361"
}

@incollection{littlejohn2018the,
    author = "Littlejohn, Allison and Hood, Nina",
    title = "The Many Guises of MOOCs",
    year = "2018",
    booktitle = "SpringerBriefs in Education",
    url = "https://doi.org/10.1007/978-981-10-8893-3\_1",
    doi = "10.1007/978-981-10-8893-3\_1",
    openalex = "W2797995505",
    pages = "1-19",
    references = "doi101016jcompedu201408005, doi101086669930, doi101109hicss2011207, doi1013140rg2124020009, doi101353jhe20140028, doi1019173irrodlv16i32112, doi105334201218, doi1054337nlcv79190, doi106018red502, openalexw2774218083"
}

@incollection{deręgowski2023on,
    author = "Deręgowski, Jan B.",
    title = "On Perspective in Many Guises",
    year = "2023",
    booktitle = "Vision, Illusion and Perception",
    url = "https://doi.org/10.1007/978-3-031-23348-7\_3",
    doi = "10.1007/978-3-031-23348-7\_3",
    openalex = "W4362500461",
    pages = "53-66",
    references = "doi101068p230005, doi10108800319112223028, doi101111j204482951997tb02662x, doi1023071578439, doi1023073332304"
}