Care for women with HIV: gender perspectives

When women face social and cultural inequality they inevitably bear increased HIV infection risks. The success of antiretroviral therapies in suppressing HIV's viral load and prolonging patient lives has made HIV a treatable chronic disease. Given the same follow-up treatments, research shows no significant differences between men and women in terms of either clinical, immunological or virological parameters at baseline or mortality after one year of antiretroviral therapy. Also, advances in assisted reproductive technologies now makes having HIV-free children possible for HIV couples. Gender equality and human right are essential to effective HIV prevention. Nurses must take all appropriate measures to eliminate discrimination against women in HIV prevention, treatment and care programs in order to ensure equal gender access to critical healthcare services.     

Women's worries during pregnancy: testing the Cambridge Worry Scale on 200 Swedish women

The Cambridge Worry Scale (CWS) is an instrument including 16 items measuring women's major worries during pregnancy. The aim of the study was to test the scale, translated into Swedish, on pregnant women in Stockholm. We also wanted to explore whether these women were worried about any item not included in the scale. An additional aim was to study possible variation in women's worries related to gestational week. Two hundred women were recruited. The average age was 31 years and 56% were primiparas. Gestational age ranged from 8 to 42 weeks, with a median of 28 weeks. The reliability of the scale was satisfactory (Cronbach's alpha coefficient 0.81). The major worries were about the baby's health, giving birth and miscarriage. These items, all related to pregnancy outcomes, were followed by worries about financial matters. An additional concern not included in the scale was about the maternity services in Stockholm, i.e. that the hospital would be overbooked, the staff being too busy or the medical safety not being guaranteed. Few women worried about their relationship with their partner or if he would be present at birth. Some of the items showed a pattern with a period of less worry in midpregnancy.     

HIV testing policies for pregnant women: A roundtable discussion

The Institute of Medicine's (IOM) Committee on Perinatal Transmission of HIV released its report in October 1998. Universal and routine HIV testing with the right of refusal for all pregnant women in the United States was recommended. This recommendation differed from the CDC guidelines in 1995 that recommended universal counseling but only voluntary testing for all pregnant women. Dr. Nancy Kass from the IOM committee and Dr. Howard Minkoff of the Maimonides Medical Center discuss the policy and its implications with Dr. Deborah Cotton, editor of AIDS Clinical Care and IOM committee member. Medical and social advantages of the policy are described, and steps are detailed for implementing IOM's recommendations.     

The epidemiology, clinical manifestations and health-maintenance needs of women infected with HIV.

The growing epidemic of HIV infection poses a serious threat to women's health in the United States and abroad. In the United States, HIV disproportionately affects African-American and Hispanic-American woman. Primary care providers will be faced with an increasing need to provide counseling and clinical services to these women. It is not yet clear whether gender affects the natural history of HIV infection; differences in survival rates may reflect lack of access to care rather than true biologic differences. Opportunistic infections among women with HIV infection are similar to those found among men with AIDS who use injection drugs. Unique expressions of HIV disease associated with women's reproductive tracts include persistent vaginal candidiasis, human papillomavirus infections and cervical dysplasia. Women with HIV infection should receive thorough gynecologic screening, including Pap smears, every six months. Women who know they are HIV positive may choose to become pregnant; these clients require extensive prenatal care and state-of-the-art HIV management.     

Safety of hair products during pregnancy: personal use and occupational exposure

QUESTION: Several of my pregnant patients who are hairdressers have asked me if exposure to products they use is harmful to their unborn babies. They also want to know if their pregnant clients' personal use of hair products should be of concern. ANSWER: There is no evidence of teratogenic effects for pregnant women exposed to these products from occupational use (ie, hairdressing); however, it is recommended that pregnant hairdressers wear gloves to minimize exposure, work for no more than 35 hours per week, avoid standing for prolonged periods of time, and ensure that the salons where they work have adequate ventilation. Evidence suggests there is minimal systemic absorption of hair products, so personal use by pregnant women 3 to 4 times throughout pregnancy is not considered to be of concern.     

Vulnerability of women in common-law marriage to becoming infected with HIV/AIDS: a study of social representations

This article discusses the social representations of women living in common-law marriage in terms of their vulnerability to becoming infected with HIV/AIDS. Data were obtained through the free association of words, and consisted of an excerpt of a study founded on the Social Representations Theory developed with HIV-negative women living in the state capital and cities in the interior of Bahia. The correspondence factor analysis showed significance for the variables: origin, education level and time spent in common-law marriage. Their acceptance of marital affairs emerged as a vulnerability factor for respondents with one to five years spent in common-law marriage, living in cities in the interior. Women from the capital, with 6-10 years spent in common-law marriage, reported monogamy as a form of prevention. Women with a longer common-law marriage who had completed only a primary education reported feeling invulnerable, which was the opposite of those with one to five years in common-law marriage with a secondary education. Results show there is a need for more interventions aiming to denaturalize the socio-cultural coercions that generate representations and make women in common-law marriages more vulnerable to AIDS.     

The Ontario HIV seroprevalence study of childbearing women: results from the first year of testing.

The Ontario HIV Seroprevalence Study of Childbearing Women is an unliked anonymous seroprevalence study designed according to the well-established ethical and legal guidelines for such studies. Commencing in November, 1989, randomly selected neonatal heelprick specimens were tested for the presence of HIV antibodies after all identifying information had been permanently and irrevocably unlinked from the specimens. During the first year of the study 94,119 (approximately 60% of all submitted specimens) were tested. Twenty-six specimens which were repeatedly reactive by EIA were confirmed as positive for an overall crude seroprevalence rate of 2.8 per 10,000 women having live births (95% CI: 1.8-4.1). Twenty-five of the 26 confirmed seropositive results came from babies born in hospitals in the Metropolitan Toronto, Ottawa-Carlton, or Hamilton-Peel-Halton regions.     

艾滋病孕产妇手术时的医院感染管理

总结艾滋病病毒感染孕产妇手术时的医院感染管理。管理重点是严格执行医院感染管理条目，落实各项消毒隔离措施，手术前做好手术间及需用物品的准备，对参与手术人员加强艾滋病相关知识的培训；手术中严格实施安全防护措施，做好医疗废弃物的分类放置；手术后规范患者及工作人员处置，规范手术用物及医疗废弃物的分类处理，手术间严格消毒。     

Management of HIV infection during pregnancy: new options, new questions

ACTG 076 demonstrated that the frequency of perinatal HIV transmission can be reduced by administering AZT to HIV-infected pregnant women and their newborns. The rate of vertical transmission in ACTG 076 was approximately eight percent, or one-third of the rate among infants of untreated mothers. This information has affected the clinical management of HIV-infected pregnant women. Commonly raised questions address the validity of HIV testing and counseling for all pregnant women; the effects of pregnancy on HIV disease progression; the times in pregnancy when AZT treatment is appropriate; the relation of CD4 counts to AZT administration; the administration of other antiviral medications to women who have developed resistance to AZT; the recommended prophylactic therapy for opportunistic infections; the prevention of primary toxoplasma and CMV infection; the management of labor; and the benefits of AZT. These questions are answered in the context of clinical, ethical, and cost-benefit issues as they relate to pregnant women and their infants.     

Factors related to the continuation of employment during pregnancy among Japanese women

Aim: To determine the relationship between the working situation (full‐time housewife, stopped working during pregnancy, or currently employed) and the lifestyle factors, reasons for stopping work during pregnancy, and effects of working conditions in order to identify the factors that are related to the continuation of employment among pregnant Japanese women. Methods: In a cross‐sectional study, a questionnaire was administered to pregnant women who visited an obstetrics clinic in a Tokyo suburb for an outpatient medical check‐up during July and August 2004. Results: The data of 530 healthy pregnant women were analyzed. The pregnant women who stopped working during their pregnancy had lower mental health scores than the full‐time housewives and employed pregnant women. In each trimester, the employed pregnant women reported a shorter daytime sleep duration than the pregnant women who stopped working during their pregnancy and the full‐time housewives. The reasons for stopping work during pregnancy were categorized as somatic symptoms due to pregnancy, working conditions, and a sense of values or social reasons. The employed women in the third trimester more often reported the availability of, and access to, a rest area in their company, compared to those in the first and second trimesters. Conclusion: The lifestyle factors of the pregnant women were different, based on their work situation. In particular, the employed pregnant women had a shorter daytime sleep duration. The pregnant women who stopped working during their pregnancy could have benefited from mental health support. In addition, the reasons for stopping work during pregnancy were different in the three trimesters. A flexible system is needed for working women that adapts to the physical changes that occur during pregnancy.     

广州市孕产妇人群HIV-1亚型分布和耐药特征分析

目的 了解广州市孕产妇人群艾滋病病毒1型（HIV-1）亚型和耐药情况。 方法 收集广州市2009 — 2014年孕产妇人群HIV-1抗体阳性样本,扩增蛋白酶（PR）和反转录酶（RT）基因序列,测序后构建系统进化树确定亚型,并与斯坦福大学HIV耐药数据库比对进行耐药分析。 结果 成功获得178份基因片段,其中10份为外籍病例;中国籍病例以CRF01_AE ［42.86%（72/168）］ 和CRF07_BC ［31.55%（53/168）］为主,外籍病例以C和CRF01_AE为主,各占30.00%（3/10）。 中、外籍病例的亚型分布差异有统计学意义（P＜0.001）。 样本总体耐药突变率为12.36%（22/178）,低度以上耐药率为5.62%（10/178）,蛋白酶抑制剂（PIs）、核苷酸反转录酶抑制剂（NRTIs）和非核苷酸反转录酶抑制剂（NNRTIs）耐药率分别为2.81%（5/178）、1.12%（2/178）和2.25%（4/178）。 耐药突变率最高的亚型为C亚型［50.00%（3/6）］。 5例外籍病例携带耐药突变,其中3例为耐药病例。 3.37%（6/178）样本被预测对单类药物呈高度耐药,未发现对多类药物呈高度耐药的样本。 结论 广州市HIV感染的孕产妇人群中有12种病毒亚型,以CRF01_AE和CRF07_BC为主,耐药突变率及耐药率低,但存在PIs或NRTIs或NNRTIs的高度耐药毒株且外籍病例具有较高耐药突变率和耐药率。