Call for more behavioural research into AIDS

Call for more behavioural research into AIDS published last week by the US Institute of Medicine’ has recommended a national survey of sexual behaviour and lifting the ban on use of Federal funds for needle research and exchange programmes. Both proposals are likely to be opposed by right-wing members of Congress. The Institute’s 14-member committee, chaired by Keith Brodie, professor of . psychiatry and law at Duke University, also recommended that the National Institutes of Health, through its institutes on alcohol and drug abuse and mental health, should substantially increase the attention given to the study of social, psychological, and biological factors that determine high-risk behaviours. The goal of this research effort is to prevent HIV: transmission through behavioural interventions. : Intervention studies have shown that condom use can be increased, with a reduction in prevalence of sexually transmissible disease and HIV positivity; highrisk behaviours can be diminished (eg, by reducing the frequency of change of partners and unprotected anal intercourse, needle-exchange schemes are successful and needle sharing can be reduced; and levels of knowledge and comfort when discussing sexual behaviour can be improved upon. These changes have been induced among a range of populations, including the homeless and injecting drug users. The difficult task now is to develop these themes further and to transfer : knowledge into the service sector. Critical areas of research identified by A report

Beef irradiation to halt foodborne disease? panel investigating ways to halt the growing incidence of Escherichia coli ; 0157:H7 infections has recommended sweeping changes in the way meat is slaughtered, processed, and prepared in the US. Current US meat inspection practices, in which inspectors rely on the

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feel, and smell of meat to detect contamination, are not adequate to prevent E coli 0157:H7 infections and should be replaced with more sensitive microbiological tests, said the panel, which also recommends that meat products be irradiated before they are sent to market. In addition, public health officials should institute active surveillance and outbreak control programmes and require that routine stool cultures include tests to detect the presence of E coli 0157:H7. : "This is a system-wide problem, which appearance,

it requires a system-wide solution", said Dr Martin Brotman, panel chairman and chairman of the American Gastroenterological Association Foundation, one of ’.,

means

the committee included prevention methods controllable by women (eg, female condoms); behaviours within high-risk

UK healthcare:

doggedness versus settings (eg, shooting galleries); the stocktaking biology of sexuality and substance abuse; and AIDS-related dementia and other

With the

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general up neurological sequelae of HIV disease. the government how should years away, Moreover, politically sensitive issues with its health reforms? Three about how class, ethnicity, and gender proceed answers emerged last week. The departrelations influence the risk of acquiring to

This latest move is another example of central principle of the NHS reforms in action-the devolution of responsibility from central government to the local level, where the number of people working in a management capacity has been growing. But this latest commitment to downward push is not limited to those in management : the department reiterated its determination to make negotiation of pay for other professionals the responsibility of trusts and other employers, and to phase a

of

daunting one. Richard Horton

out

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ment of health indicated its intentions with the publication of three documents that outline plans for a rapid and swingeing overhaul of central and local NHS management, and the effects these changes will have on the organisation of public health in England.’ The stated aim of these major structural changes is to strengthen accountability and avoid duplication. As a result of the conclusions of the reports, there will be "substantial reductions in the number of staff in both the NHS Executive Headquarters and the rest of the Department". Implementation is likely to be rapid, with the first job losses scheduled for this autumn.

be addressed. : Finally, implementation of these recommendations must be carefully planned. : The multiplicity of institutes and agencies that are involved in AIDS research often leads to impossible bureaucratic obstacles. : Furthermore, according to Curtis Decker, executive director of the National Association of Protection and Advocacy Systems, "so much of this research is hampered by politics". The committee proposed that a full-time AIDS coordinator was needed to oversee this new research programme and they charged the Office of AIDS Research with much of the responsibility for ensuring its success. William Paul, OAR’s director, is being asked to promote cooperation between agencies-eg, NIH and the Centers for Disease Control and Prevention-that are traditionally deeply suspicious of one another. He is also being-: encouraged to solve the complexities NIH peer review and help cross-disciplinary research to flourish. His task is a HIV also needs

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Auerbach JD, Wypijewska C, Brodie HKH, eds. AIDS and behavior: an integrated approach. Washington: Institute of Medicine, 1994.

public-sector pay policies.

There are, however, no plans as yet to extend this organisational change to the responsibility for negotiation of contracts for postgraduate medical education and the organisations sponsoring the E coli : training. "The key responsibilities for medical workforce planning will remain at 0157:H7 Consensus Development Cona national level, including the planning of ference. Other sponsors were the US Centres for Disease Control and Prevention, specialist training", said the report. The the Food and Drug Administration, the postgraduate deans will negotiate training Department of Agriculture, the national placements in trusts and will hold the Cattleman’s Association, and the National training budget (currently C352 million Restaurant Association. E coli 0157:H7 per year), raised by a national levy on sergained national attention last year when vice purchasers. more than 500 people feel ill in the Pacific: Robert Maxwell, chief executive of the Northwest after eating contaminated King’s Fund, an influential think-tank on hamburgers from a fast-food restaurant health-service issues, published his views chain. Several children required colectoon the next step for London’s healthcare.2 and 3 died from my haemolytic-uraemic He emphasised the need for a slowing in syndrome. : the pace of change, and the need to avoid The panel called for a campaign to educontinuing "doggedly with current policate physicians, farmers, and meat hancies, regardless of opposition and critidlers about the dangers of E coli 0157:H7 cism". "At a minimum", he said, "there is contamination and special programmes to a need to re-establish confidence, revise protect vulnerable populations, such as time-scales and review the management of the elderly in nursing homes and children the transition". He argued that while it is necessary to change the balance of serattending day-care. It also urged that convices in London, this must be done at a sumers be taught food hygiene. "The action of the consumer serves as the last steadier pace than of late. He advocated a critical control point’ in preventing E coli greater degree of openness and flexibility 0157:H7 infections", the panel said. : in the changes to come, to counter the alarm and misgivings that the transition Michael McCarthy has sparked off so far. "The Government

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