US Institute of Medicine urges more HIV-prevention efforts

US Institute of Medicine urges more HIV-prevention efforts

POLICY AND PEOPLE US Institute of Medicine urges more HIV-prevention efforts ajor improvements in HIV treatment have lulled Americans into a false se...

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US Institute of Medicine urges more HIV-prevention efforts ajor improvements in HIV treatment have lulled Americans into a false sense of security and a dangerous complacency about HIV prevention, concluded an Institute of Medicine (IOM) panel on Sept 27. The panel called for an allout effort to reduce new HIV infections, by use of “proven, cost-effective” HIV prevention strategies, abandonment of unproven abstinence-only prevention programmes, and elimination of barriers to proven needle-exchange and comprehensive sex-education programmes. Congressional mandates forbid using federal funds for comprehensive sex-education and needleexchange programmes. “We hope that whoever is elected will find the report a blueprint for


HIV prevention”, says Harvey Fineberg, panel co-chair and provost of Harvard University. “HIV prevention is not a partisan problem. Our goal ought to be to avert as many new HIV infections as possible with the resources available for HIV prevention.” Yet funding allocations parallel AIDS cases, and are “ten years behind where the epidemic has gone”, the panel reported. New cases are increasingly concentrated among ethinic minorities, black people, women, and young people—with heterosexual transmission and drug use being the more common modes of transmission, according to committee member Michael Merson, dean of Yale’s school of public health. To determine how the HIV epidemic is progressing, the panel called

for the testing of a sample of individuals taken from “sentinel” sites, where at-risk individuals are likely to be found. Making use of the most cost-effective, scientifically proven HIV-prevention strategies, the panel predicts that its blueprint could make a huge difference in the number of new cases. Carrying out prevention “in the care setting”, Merson points out, where it is currently not reimbursed, and use of rapid tests, could also help avoid transmission. Besides a reduction in social and economic barriers to prevention, the panel backed investment in several promising prevention techniques, such as use of female condoms, new antiretroviral drugs, and vaccines. Laura Newman

Amnesty International denounces treatment of Saudi women international conventions that support n Sept 27, Amnesty International women’s rights. “Time is long over(AI) released a report that due for the Saudi women to be given denounces Saudi Arabia for its treatmore opportunity to ment of women, particuenjoy their full rights as larly immigrant Rights were not human beings”, says domestic workers, who granted to AI’s Secretary General. the report argues, face The report is the “double discriminainclude this third in a series by AI tion”. According to AI, image in that documents humanthe situation for women electronic media. rights violations perpehas been “untenable” by Please refer to trated by the state as any legal or moral stanthe printed well as non-state eledard, affecting virtually ments such as employall aspect of women’s journal. ers. The report alleges lives, including family that domestic workers, life, decision-making, many of whom are from employment, education, Rights in focus less-developed counand the justice system. tries, are often locked inside homes, AI has called on the Saudi governbeaten, and raped by their Saudi ment to commission a comprehensive employers. review of its legislation, and ratify


Because current laws make it difficult for women to report such abuses, many women refuse to report these crimes. If they do, the government rarely investigates. The report highlights a number of women who have had unfair trials and then been executed, mostly on the basis of uncorroborated confessions. AI welcomes the new public debate on women’s rights, the media’s recognition of domestic violence, and Saudi Arabia’s signature on the UN Convention on the Elimination of All Forms of Discrimination Against Women, but spokesperson Neil Durkin adds: “there is still concern that practices on the ground will change little for women”. Khabir Ahmad

Nursing-home beds in the Netherlands pose risks to patients 2% of beds in nursing homes pose a safety risk, according to a recent survey by the Dutch Health Inspectorate, an agency of the Dutch Health Ministry that oversees quality standards in health care. Prompted by the annual four to five yearly fatalities in the Netherlands as a result of patients getting trapped in beds, the Health Inspectorate examined the safety of hospital beds in 60 randomly selected nursing homes. Within the 60 nursing homes (with a total of 11 000 beds) 162 combinations of beds, mattresses, and railings were assessed for potential safety



risks. By measuring distances between the bed and the railing, between the bars of the railing, and between railing and mattress, researchers assessed the risk of falling out of bed or getting trapped. In 43% of beds assessed, the mattress was higher than the railing, conferring a substantial risk to the patient of falling out of bed. Another possible risk was posed by thin mattresses (38%), which could slide underneath the railing, trapping the patient. Sharp protruding parts of beds and railings were also noted. In total, 72% of beds posed a degree of

risk to patients. “We are not saying here that all 72% of beds are unsafe”, says Jenneke van Veen, Health Inspectorate, The Hague, Netherlands. “Accidents are always caused by combinations of factors, but these beds pose a risk when they are used for vulnerable persons, for example demented or confused patients”. Most problems were encountered in older beds, because these were purchased before 1991 when European standards for safety were implemented. Wim Weber

THE LANCET • Vol 356 • October 7, 2000

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