The impact of dementia on women internationally: An integrative review

Women are disproportionately affected by dementia, both in terms of developing dementia and becoming caregivers. We conducted an integrative review of English language literature focusing on the issues affecting women in relation to dementia from an international perspective. The majority of relevant studies were conducted in high-income countries, and none were from low-income countries. The effects of caregiving on health, well-being, and finances are greater for women; issues facing women, particularly in low- and middle-income countries, need to be better understood. Research should focus on building resilience to help people adjust and cope long term.     

Impact of peer group education on HIV prevention among women in Botswana

A peer group HIV prevention intervention based on social-cognitive learning theory, gender inequality, and the primary health care model for community-based health promotion was developed for more than 300 urban employed women in Botswana. All women volunteered to participate in the intervention. To control for self-selection, matched workplaces were assigned to the intervention group or to the delayed control group. Compared with women in the delayed control group, women in the intervention group had significantly higher postintervention levels of knowledge of HIV transmission, sexually transmitted diseases (STDs), and HIV prevention behaviors; positive condom attitudes and confidence in condom use; personal safer sex behaviors; and positive attitudes toward persons living with HIV/AIDS and community HIV/AIDS-related activities. The peer group leaders have sustained the program for more than 5 years after the end of research funding. Peer groups are a low-cost and sustainable intervention that can change HIV prevention knowledge, attitudes, and behaviors for ordinary urban employed women in sub-Saharan Africa.     

Impact of quadrivalent HPV vaccine dose spacing on immunologic response in women living with HIV

HPV vaccination schedules have changed as evidence has supported reduced dosing and extended intervals. Women living with HIV (WLWH) represent an important population with no data on alternative dosing.Girls and WLWH received quadrivalent HPV (qHPV) vaccine in a pan-Canadian study of immunogenicity and efficacy. Serology was performed at months 0/2/7/12/18/24. Medical and sexual history was collected throughout. Linear regression was used to determine if spacing of doses was associated with peak antibody titer.Multivariable analyses demonstrated significant relationships between peak antibody titer and time to blood draw post last vaccine dose, naivety to the relevant HPV type, and HIV viral load for all qHPV types. There was a significant relationship between peak HPV16/18 antibody titer and age.Taking age, time to serology, CD4 cell count, CD4 nadir, HIV viral load, and HPV naivety into account, spacing of the three qHPV vaccine doses did not significantly impact peak antibody titers.     

HIV抗体不确定及HIV抗体检测非特异反应的人群回顾性研究

目的阐明我国HIV抗体不确定结果的发生频率、在预示HIV感染方面的价值。方法对122 165例临床患者、160 747名新兵体检人群、654例吸毒人群、2950例生化或免疫异常人群,合计286 516例的HIV抗体检测数据进行回顾性分析。结果临床患者(0.027%)、新兵体检人群(0.009%)、吸毒人群(0.0%)、生化或免疫异常人群(0.10%)等;4类人群的HIV不确定发生率显著不同(P0.05);肝移植、骨折和皮肤科就诊患者HIV抗体不确定发生率分别为0.014%、0.13%、1.32%,显著高于体检人群0.024%(P0.05);自身免疫性疾病患者中类风险因子(RF)水平高的HIV不确定是抗核抗体(ANA)阳性组的20倍(2%vs0.1%),但差异无统计学意义;肝、肾、肺部疾病患者HIV抗体非特异反应较高。结论 HIV不确定发生率在不同人群中显著不同,高危人群中的非特异反应及不确定结果的发生率最低;疾病因素与HIV不确定的发生相关。     

Impact of HIV infection on malaria in adults

Malaria and HIV are two major public health issues, especially in sub-Saharan Africa. The impact of HIV infection on malaria depends on the patient's immune status: immunodepression level but also immunity against Plasmodium. HIV infection increases the incidence of clinical malaria, inversely correlated with the degree of immunodepression, but the severity and mortality are increased only in areas of unstable malaria. In severe malaria the level of parasitemia is similar in HIV-positive and HIV-negative patients. During pregnancy, HIV infection increases the incidence of clinical malaria, maternal morbidity, and fetal and neonatal morbi-mortality. Sulfa-based therapies reduce the risk of malaria, most importantly in pregnancy. HIV infection increases the risk of treatment failure, mainly with sulfa-based therapies, due to re-infection or parasitic recrudescence. Further studies are needed to determine the pathophysiological interactions between HIV infection and malaria.     

Impact of HIV/AIDS on African children

In Central and East Africa, pediatric human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are becoming increasing threats to child health due to the predominance of heterosexual transmission of HIV, high HIV infection rates in women of reproductive age and high birth rates. This paper examines the potential impact of HIV/AIDS on orphanhood and under-five mortality in 10 Central and East African countries. The author estimates that, in the 10 countries studied, HIV/AIDS in children under age five will cause between one-quarter and half a million child deaths annually by the year 2000. Whereas the United Nations estimate (without AIDS) and target for the under-five mortality rate in this 10-country region by the year 2000 are 132 and 78, respectively, HIV/AIDS will cause the under-five mortality rate to rise to between 159 and 189. Increasing HIV/AIDS-related adult mortality is creating a large and growing number of children under age 15 whose mothers have died of HIV/AIDS. During the 1990s, HIV/AIDS will kill a total of between 1.5 and 2.9 million women of reproductive age in this region, producing between 3.1 and 5.5 million AIDS orphans--which means that between 6 and 11% of the population under age 15 will be orphaned. National and international government and nongovernment service providers in Central and East Africa need to recognize this potential impact of HIV/AIDS on children, expand AIDS-prevention efforts, and develop policies and programs to address children's HIV/AIDS-related needs.     

HIV infection in women: impact on contraception

A study was performed to evaluate the impact of knowledge of HIV infection (diagnosis) on contraception information and choices for HIV infected women. A questionnaire was given to 140 HIV infected women. Most of the studied population included young women with a low educational level. A significant increase in the knowledge of contraceptive methods was observed after diagnosis of being HIV infected. The data suggested that the women who received information had never received it before, or that the diagnosis created a stronger motivation to listen to the counseling offered. A significant increase in the use of contraceptive methods was also found, especially male condoms and tubal ligation. Total number of children had a strong impact on contraceptive method at the time of interview. Only 5 of 23 HIV infected women who had no children used hormonal contraceptives, while 15 of 23 preferred condom use, and 3 of 23 chose not to use any contraceptive method. Tubal ligation was performed in approximately 9% of the women who had only one child. However, 12.4% of the sexually active HIV infected women were still not using any contraceptive method at the time of the interview. A combined method (male condom plus another contraceptive) was used by only 27% of sexually active HIV infected women, despite health service counseling. In conclusion, the realization of being HIV infected had a strong impact on contraceptive practice among these women. It is expected that HIV and family planning clinics will address HIV infected women's needs and be prepared to integrate contraception and gynecological care.     

HIV discrimination and the health of women living with HIV

Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.     

HIV/AIDS and women

Women are the fastest growing segment of people with acquired immunodeficiency syndrome (AIDS), yet they often receive this diagnosis when the disease is in its advanced stages. New therapies have caused human immunodeficiency virus (HIV) to become a chronic and treatable disease for many of those afflicted. Primary care providers must be cognizant of the initial symptoms to facilitate early diagnosis and prompt treatment for women with HIV. Early signs of HIV in women are subtle. Providers must consider a diagnosis of HIV in women who present with vaginal infections, abnormal pap smears, or sexually transmitted diseases that are unusually severe, recurrent, and resistant to treatment efforts. These signs and symptoms, along with a corroborating history, may be early clues to HIV. Primary care providers, in conjunction with HIV specialists, must strive to decrease the incidence, morbidity, and mortality of the disease in women.     

Impact of Interim Methadone Maintenance on HIV Risk Behaviors

The extent to which interim methadone (IM) without counseling reduces HIV risk behavior has not been reported. The AIDS Risk Assessment scale was administered at baseline and 4-month follow-up to 319 adult heroin-dependent participants randomly assigned to IM or waiting list. On an intent-to-treat basis, there was a significantly greater reduction in drug injection and unprotected sex while high from baseline to follow-up, favoring the IM condition. Remedying the shortage of methadone capacity through the expansion of IM would be a worthwhile approach to reducing the spread of HIV infection.     

Impact of peer education on HIV infection in Zimbabwe

The Zimbabwe AIDS Prevention Project (ZAPP) conducted a randomized trial to investigate the effectiveness of peer education in preventing HIV infection. Initial research revealed that if health education could successfully promote a reduction in the number of sex partners and condom use, HIV risk could be greatly reduced. In 1993, ZAPP began enrolling men working at 40 factories in a study. The men were tested for sexually transmitted diseases (STD) and HIV every six months and had access to a ZAPP clinic for counseling, testing, and STD treatment. In June 1994, ZAPP randomly chose 20 factories to receive an additional peer education intervention. Educators were trained for a week and were given refresher courses every six months. Comparison of the incidence of HIV between the control and intervention groups was measured by determining incidence for all individuals and by comparing overall incidence at each factory. Of the 2219 men who were HIV negative after the introduction of peer education, 78% completed one follow-up, and HIV incidence was 2.52%/year. Controlling for time enrolled in the program revealed that the peer education resulted in significantly fewer new HIV infections. Because the voluntary testing and counseling were available at factories with control and intervention programs, this study exposed the independent impact of peer education. It is concluded that peer education, condom distribution, and treatment of STDs should be the cornerstone of HIV prevention policies.     

HIV阳性孕产妇的发现时机及接受阻断情况分析

目的通过对HIV阳性孕产妇的发现时机及接受阻断的情况分析,了解当前HIV母婴阻断工作中存在的问题。方法收集在湖北、山西、河北部分县市发现的179名阳性孕产妇（189孕次）发现时机及接受阻断的情况,对所发现的HIV阳性孕产妇未接受综合阻断措施的原因进行分析。结果纳入本研究的项目县,孕检人群HIV阳性率为0.26‰。在发现的HIV阳性孕产妇中产前、产时、产后所占的比例分别为66.7%、7.4%、25.9%,各期发现的HIV阳性孕产妇均有部分未接受综合阻断措施。产前发现未接受抗病毒药物阻断的阳性孕产妇中,个别孕妇不接受药物阻断;产时发现的孕产妇,多数因未获得药物而未用药阻断;而产后才发现的孕产妇则错过了阻断时机。结论我国HIV母婴阻断工作已取得很大成绩,但仍存在HIV阳性孕产妇发现不及时,接受综合阻断措施比率较低等问题,亟需改进。     

HIV与HBV单独感染及共感染对妊娠结局的影响

HIV和HBV有较高的流行率,威胁人类健康。越来越多的研究发现孕产妇HIV/HBV感染与不良妊娠之间存在联系,而且孕产妇HIV/HBV感染还会增加HIV、HBV母婴传播的风险。但目前有关这两种病毒共感染对不良妊娠结局和母婴传播的影响尚不清楚,有待进一步深入研究,为制定有效的预防措施提供科学依据,促进母婴健康。     

Reproductive choices for women with HIV

Access to reproductive health services for women with HIV is critical to ensuring their reproductive needs are addressed and their reproductive rights are protected. In addition, preventing unintended pregnancies in women with HIV is an essential component of a comprehensive prevention of mother-to-child transmission (PMTCT) programme. As a result, a call for stronger linkages between sexual and reproductive health and HIV policies, programmes and services has been issued by several international organizations. However, implementers of PMTCT and other HIV programmes have been constrained in translating these goals into practice. The obstacles include: (i) the narrow focus of current PMTCT programmes on treating HIV-positive women who are already pregnant; (ii) separate, parallel funding mechanisms for sexual and reproductive health and HIV programmes; (iii) political resistance from major HIV funders and policy-makers to include sexual and reproductive health as an important HIV programme component; and (iv) gaps in the evidence base regarding effective approaches for integrating sexual and reproductive health and HIV services.However, we now have a new opportunity to address these essential linkages. More supportive political views in the United States of America and the emergence of health systems strengthening as a priority global health initiative provide important springboards for advancing the agenda on linkages between sexual and reproductive health and HIV. By tapping into these platforms for advocating and by continuing to invest in research to identify integrated service delivery best practices, we have an opportunity to strengthen ties between the two synergistic fields.