- Email: [email protected]
AIDS AND ACADEMIC BOYCOTTS
386 PREVALENCE OF THYROID DISEASE
* All euthyrotd and 5 younger than 10 years old at time of explosion. tAU in remission and 1 has a history of Graves’ disease before fallout. taspiration biopsy findings not shown.
the explosion and had been there for at least 10 years was only 247. However, the attendance rate (184 of 247) was high. There are no records for radioactivity in Nishiyama at the time of the explosion. 137Cs radioactivity in soil suggests radiation doses up to 12-24 rad (0 12-0-24 Gay) 4 However, data on isotopes with short half-lives are not recorded. In summary, the high prevalence of solid thyroid nodule in Nishiyama district is the first report which demonstrates the delayed effect of radioactive fallout of the atomic bomb. We thank the case-workers of the RERF in Nagasaki, council members of Nishiyama district, and members of endocrine group of Nagasaki University (S. Yamashita, S. Morita, N. Yokoyama, S. Harakawa, Y. Nagayama, K. Eishima, K. Matsuo, K. Ashizawa) and Yumi Takahara and Mamiko
Shimada.
First Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki 852, Japan; and Radiation Effects Research Foundation, Nagasaki
SHIGENOBU NAGATAKI HIDESHI HIRAYU MOTOMORI IZUMI SHUJI INOUE*
SHUNZO OKAJIMA* KATSUTARO SHIMAOKA*
Okajima S. Dose estimation from residual and fallout radioactivity, fallout in the Nagasaki-Nishiyama district. J Radiat Res 1975; 16 (suppl): 35-41. 2. Okajima S, Takeshita K, Antoku S, et al. Radioactive fallout effects of the Nagasaki Atomic Bomb. Health Phys 1978; 34: 621-33. 3. Yokoyama N, Nagayama Y, Kakezono F, et al. Determination of the volume of the thyroid gland by a high resolutional ultrasonic scanner. Nucl Med 1986; 27: 1.
1475-79. 4. Roesch WC, ed. US-Japan joint reassessment of atomic bomb radiation dosimetry in Hiroshima and Nagasaki. Hiroshima: Radiation Effects Research Foundation, 1986; vol II: 1-520.
AIDS AND ACADEMIC BOYCOTTS
SIR,-That Professor Nelson (July 1, p 50) had to wait until retirement before feeling able to visit South Africa is a sad indictment of the influence exerted by university authorities with little or no first-hand experience of the country and its medical
problems. Boycotts-political, economic, sporting, or academic-have long been promulgated as measures for producing change in apartheid but, as Nelson points out, academics are one of the most vociferous groups opposing apartheid, and attempts to penalise them cannot be expected to alter health-care inequalities. Most academics practise medicine to a first-world standard and are well motivated to keep pace with
new developments. However, some health care departments in which an emphasis is placed on service rather than research have not kept up and third-world standards are now accepted. Nowhere is this more apparent than in sexually transmitted diseases (STD).
South Africa’s STD classification system was drawn up in 1958 and does not mention many common STDs-namely, herpes, trichomoniasis, candidiasis, scabies, pediculosis, molluscum contagiosum, and anaerobic vaginosis. Herpes is a risk factor for HIV seroconversion1 and is associated with anti-HIV concordance amongst heterosexual couples in Zimbabwe.2 In a recent study of 100 males and 100 females with genital ulceration attending the STD department at this hospital for blacks, herpes was isolated in 10 males and 18 females. Trichomonas vaginalis was detected in 42% of local females with vaginal discharge3 and is an important cause of inflammatory cytological change,4 which may be related to HIV transmissions
In many sub-Saharan countries AIDS cases have been underestimated not only through a lack of awareness but also by data manipulation. In Zimbabwe reported cases of AIDS notified to WHO dropped by half without official explanation6 and in Durban, following the recognition of black STD clinic attenders as being at risk of HIV infection/ testing was suspended by the city’s health department. Some indication of the population at risk in Durban may be drawn from the fact that the hospital STD clinic for whites is open for 2 hours per week and that for blacks sees 200-300 patients a day. Despite reports 5 years ago implicating heterosexual transmission in the AID S epidemic in Africa,",9 STD clinic facilities for blacks have not improved. The argument that AIDS has mainly affected white homosexual men fails to acknowledge STD clinic and blood donor datalO that blacks are now the group at highest risk of acquiring HIV infection in South Africa. One method of gauging quality of care is by external peer review but in South Africa outside influence and exchange of ideas are conspicuous by their absence. There are many reasons for the spread of AIDS in southern Africa. Academic boycotts may become another. King Edward VIII Hospital, Congella, Durban, South Africa
NIGEL O’FARRELL
1. Stamm WE, Handsfield HH, Rampalo AM, Ashley RL, Roberts PL, Corey L. The association between genital ulcer disease and acquisition of HIV infection in homosexual men. JAMA 1988; 260: 1429-33. 2. Katzenstein DA, Latif A, Bassett MT, Emmanuel JC. Risks for heterosexual transmission of HIV in Zimbabwe. III International Conference on AIDS. (Washington, June, 1987); abstr M8.3. 3. Hoosen AA, Van Den Ende J, O’Farrell N. The spectrum of vaginal infection at King Edward VIII Hospital. Presented at Symposium on Infections in Developing
Countries (Johannesburg, Aug 29-Sept 1, 1988). WA, Thin RN. Cervical cytology in genital infection. Br J Ven Dis 1975; 51: 331-32. 5. Van De Perre P, De Clercq A, Cogniaux-Leclarc J, Nzaramba D, Butzler J-P, Sprecher-Goldberger S. Detection of HIV p17 antigen in lymphocytes but not epithelial cells from cervicovaginal secretions of women seropositive for HIV: Implications for heterosexual transmission of the virus. Genitourin Med 1988; 64: 30-33. 6. Anon. AIDS monitor: Zimbabwe slams the door on free discussion. New Sci 1988; 118: 32-33. 7. O’Farrell N, Windsor I. Prevalence of HIV antibody in recurrent attenders at a sexually transmitted disease clinic. S Afr Med J 1988; 74: 104-05. 8. Van de Perre P, Rouvert D, Lepage P, et al. Acquired immunodeficiency syndrome in Rwanda. Lancet 1984; ii: 62-65. 9. Piot P, Quinn TC, Taelman H, et al. Acquired immunodeficiency syndrome in a heterosexual population in Zaire. Lancet 1984; ii: 65-69. 10. Schoub BD, Smith AN, Lyons SF, et al. Epidemiological considerations of the present status and future growth of the acquired immunodeficiency syndrome in South Africa. S Afr Med J 1988; 74: 153-57. 4. Atia
HIV TESTING IN 25% OF SWEDISH POPULATION AGED 16-44
SIR,-Sweden’s National Board of Health and Social Welfare recommends that HIV tests should be offered not only to homosexuals, intravenous drug users, prostitutes, and other risk groups but also to anyone who is concerned that he or she might have been infected, and the Government’s AIDS Delegation, through an educational campaign, encourages anyone who is concerned about carrying HIV to have the test. As a result of the authorities’ positive attitude toward voluntary HIV testing and the guarantee of anonymity the test has been used extensively. The cost of HIV testing in Sweden during 1987 was twice the cost of providing all health care to HIV-infected persons and AIDS patients (124 million compared with 57 million Swedish crowns). The costs for testing in 1990 are expected to be nearly the same as the health and medical care costs.! The National Swedish Bacteriological Laboratory registers both the number of HIV-positive individuals and the number of HIV tests done in Sweden. At the end of March, 1989, the register showed 2058 HIV-infected individuals in Sweden. 275 (32-8 per million inhabitants) had AIDS. Around 20 people infected with HIV were identified when donating blood. Nearly 90% of those infected were younger than 45 when identified. About 960 000 HIV tests had been done in Sweden by March, 1989. Since mid-1985, all blood donors have been routinely tested,
* All euthyrotd and 5 younger than 10 years old at time of explosion. tAU in remission and 1 has a history of Graves’ disease before fallout. taspiration biopsy findings not shown.
the explosion and had been there for at least 10 years was only 247. However, the attendance rate (184 of 247) was high. There are no records for radioactivity in Nishiyama at the time of the explosion. 137Cs radioactivity in soil suggests radiation doses up to 12-24 rad (0 12-0-24 Gay) 4 However, data on isotopes with short half-lives are not recorded. In summary, the high prevalence of solid thyroid nodule in Nishiyama district is the first report which demonstrates the delayed effect of radioactive fallout of the atomic bomb. We thank the case-workers of the RERF in Nagasaki, council members of Nishiyama district, and members of endocrine group of Nagasaki University (S. Yamashita, S. Morita, N. Yokoyama, S. Harakawa, Y. Nagayama, K. Eishima, K. Matsuo, K. Ashizawa) and Yumi Takahara and Mamiko
Shimada.
First Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki 852, Japan; and Radiation Effects Research Foundation, Nagasaki
SHIGENOBU NAGATAKI HIDESHI HIRAYU MOTOMORI IZUMI SHUJI INOUE*
SHUNZO OKAJIMA* KATSUTARO SHIMAOKA*
Okajima S. Dose estimation from residual and fallout radioactivity, fallout in the Nagasaki-Nishiyama district. J Radiat Res 1975; 16 (suppl): 35-41. 2. Okajima S, Takeshita K, Antoku S, et al. Radioactive fallout effects of the Nagasaki Atomic Bomb. Health Phys 1978; 34: 621-33. 3. Yokoyama N, Nagayama Y, Kakezono F, et al. Determination of the volume of the thyroid gland by a high resolutional ultrasonic scanner. Nucl Med 1986; 27: 1.
1475-79. 4. Roesch WC, ed. US-Japan joint reassessment of atomic bomb radiation dosimetry in Hiroshima and Nagasaki. Hiroshima: Radiation Effects Research Foundation, 1986; vol II: 1-520.
AIDS AND ACADEMIC BOYCOTTS
SIR,-That Professor Nelson (July 1, p 50) had to wait until retirement before feeling able to visit South Africa is a sad indictment of the influence exerted by university authorities with little or no first-hand experience of the country and its medical
problems. Boycotts-political, economic, sporting, or academic-have long been promulgated as measures for producing change in apartheid but, as Nelson points out, academics are one of the most vociferous groups opposing apartheid, and attempts to penalise them cannot be expected to alter health-care inequalities. Most academics practise medicine to a first-world standard and are well motivated to keep pace with
new developments. However, some health care departments in which an emphasis is placed on service rather than research have not kept up and third-world standards are now accepted. Nowhere is this more apparent than in sexually transmitted diseases (STD).
South Africa’s STD classification system was drawn up in 1958 and does not mention many common STDs-namely, herpes, trichomoniasis, candidiasis, scabies, pediculosis, molluscum contagiosum, and anaerobic vaginosis. Herpes is a risk factor for HIV seroconversion1 and is associated with anti-HIV concordance amongst heterosexual couples in Zimbabwe.2 In a recent study of 100 males and 100 females with genital ulceration attending the STD department at this hospital for blacks, herpes was isolated in 10 males and 18 females. Trichomonas vaginalis was detected in 42% of local females with vaginal discharge3 and is an important cause of inflammatory cytological change,4 which may be related to HIV transmissions
In many sub-Saharan countries AIDS cases have been underestimated not only through a lack of awareness but also by data manipulation. In Zimbabwe reported cases of AIDS notified to WHO dropped by half without official explanation6 and in Durban, following the recognition of black STD clinic attenders as being at risk of HIV infection/ testing was suspended by the city’s health department. Some indication of the population at risk in Durban may be drawn from the fact that the hospital STD clinic for whites is open for 2 hours per week and that for blacks sees 200-300 patients a day. Despite reports 5 years ago implicating heterosexual transmission in the AID S epidemic in Africa,",9 STD clinic facilities for blacks have not improved. The argument that AIDS has mainly affected white homosexual men fails to acknowledge STD clinic and blood donor datalO that blacks are now the group at highest risk of acquiring HIV infection in South Africa. One method of gauging quality of care is by external peer review but in South Africa outside influence and exchange of ideas are conspicuous by their absence. There are many reasons for the spread of AIDS in southern Africa. Academic boycotts may become another. King Edward VIII Hospital, Congella, Durban, South Africa
NIGEL O’FARRELL
1. Stamm WE, Handsfield HH, Rampalo AM, Ashley RL, Roberts PL, Corey L. The association between genital ulcer disease and acquisition of HIV infection in homosexual men. JAMA 1988; 260: 1429-33. 2. Katzenstein DA, Latif A, Bassett MT, Emmanuel JC. Risks for heterosexual transmission of HIV in Zimbabwe. III International Conference on AIDS. (Washington, June, 1987); abstr M8.3. 3. Hoosen AA, Van Den Ende J, O’Farrell N. The spectrum of vaginal infection at King Edward VIII Hospital. Presented at Symposium on Infections in Developing
Countries (Johannesburg, Aug 29-Sept 1, 1988). WA, Thin RN. Cervical cytology in genital infection. Br J Ven Dis 1975; 51: 331-32. 5. Van De Perre P, De Clercq A, Cogniaux-Leclarc J, Nzaramba D, Butzler J-P, Sprecher-Goldberger S. Detection of HIV p17 antigen in lymphocytes but not epithelial cells from cervicovaginal secretions of women seropositive for HIV: Implications for heterosexual transmission of the virus. Genitourin Med 1988; 64: 30-33. 6. Anon. AIDS monitor: Zimbabwe slams the door on free discussion. New Sci 1988; 118: 32-33. 7. O’Farrell N, Windsor I. Prevalence of HIV antibody in recurrent attenders at a sexually transmitted disease clinic. S Afr Med J 1988; 74: 104-05. 8. Van de Perre P, Rouvert D, Lepage P, et al. Acquired immunodeficiency syndrome in Rwanda. Lancet 1984; ii: 62-65. 9. Piot P, Quinn TC, Taelman H, et al. Acquired immunodeficiency syndrome in a heterosexual population in Zaire. Lancet 1984; ii: 65-69. 10. Schoub BD, Smith AN, Lyons SF, et al. Epidemiological considerations of the present status and future growth of the acquired immunodeficiency syndrome in South Africa. S Afr Med J 1988; 74: 153-57. 4. Atia
HIV TESTING IN 25% OF SWEDISH POPULATION AGED 16-44
SIR,-Sweden’s National Board of Health and Social Welfare recommends that HIV tests should be offered not only to homosexuals, intravenous drug users, prostitutes, and other risk groups but also to anyone who is concerned that he or she might have been infected, and the Government’s AIDS Delegation, through an educational campaign, encourages anyone who is concerned about carrying HIV to have the test. As a result of the authorities’ positive attitude toward voluntary HIV testing and the guarantee of anonymity the test has been used extensively. The cost of HIV testing in Sweden during 1987 was twice the cost of providing all health care to HIV-infected persons and AIDS patients (124 million compared with 57 million Swedish crowns). The costs for testing in 1990 are expected to be nearly the same as the health and medical care costs.! The National Swedish Bacteriological Laboratory registers both the number of HIV-positive individuals and the number of HIV tests done in Sweden. At the end of March, 1989, the register showed 2058 HIV-infected individuals in Sweden. 275 (32-8 per million inhabitants) had AIDS. Around 20 people infected with HIV were identified when donating blood. Nearly 90% of those infected were younger than 45 when identified. About 960 000 HIV tests had been done in Sweden by March, 1989. Since mid-1985, all blood donors have been routinely tested,