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Introducing new vaccines into developing countries: obstacles, opportunities and complexities.

Infectious diseases are thought to account for nearly 25% of all deaths worldwide, and extract a disproportionate toll in developing countries. Moreover, infectious diseases are now appreciated to be major causes of the poverty and economic underdevelopment that characterize the world's poorest countries. Development and deployment of new vaccines to prevent infectious diseases in developing countries have therefore become high priorities in the global health agenda.

Developing Countries↗

Progress and obstacles in the development of an AIDS vaccine.

Recent experimental observations suggest approaches to immunization that might finally result in at least a partially effective vaccine against infection with HIV-1. In particular, advances in our understanding of the contribution of vaccine-elicited cellular immunity to protecting memory CD4(+) T cells from virus-mediated destruction provide rational strategies for the development of this vaccine. This is therefore an ideal time to review our current understanding of HIV-1 and its control by the immune system, as well as the remaining problems that must be solved to facilitate the development of an effective vaccine against AIDS.

AIDS Vaccines↗

When an erection alone is not enough: biopsychosocial obstacles to lovemaking.

Giving men firm erections is relatively straightforward these days; getting them to make use of it regularly in lovemaking is more complicated. Discontinuation rates for any of the available medical treatments for erectile dysfunction, including sildenafil, have been found to range from 50% to 60%. Thus, there is a disproportionately high number of individuals who fail to continue using medical interventions compared to those for whom treatment is efficacious. If not efficacy, then what factors contribute to this puzzling dropout phenomenon? This article discusses the psychological resistances of men, women, and couples that contribute to their stopping treatment for erectile dysfunction. Some of the factors that may be responsible include: (1) the length of time the couple was asexual before seeking treatment; (2) the man's approach to resuming a sexual life with his partner; (3) the man's expectations of how sildenafil will change his life; (4) the partner's physical and emotional readiness to resume lovemaking; (5) the meaning for each partner of using a medical intervention to restore lovemaking; (6) the quality of the nonsexual relationship; and (7) unconventional sexual arousal patterns in the man. To be effective, clinicians must go beyond the simple restoration of erectile function to help patients become active lovemakers again.

Combined Modality Therapy↗