How AIDS affects women and children

AIDS has unique effects for women and children. Women at risk are: intravenous drug users, sexual partners of HIV positive men or women, and women receiving semen for artificial insemination. General practitioners are in the best position to provide counseling about HIV testing, safer drug use and safer sexual practices. HIV positive women need particular medical and emotional support. Discrimination is a real possibility so confidentiality and discretion should be exercised. Pregnancy exposes the fetus to the risk of contracting HIV and must be considered by any HIV positive women. Safer sex and contraception should be encouraged including abortion although it should never be forced on an HIV positive women. The care providers of HIV infected women must be informed of all the special needs and precautions that must be met. Children contract HIV form their HIV positive mothers or from transfusions because of hemophilia. It currently takes 15 months to determine whether a child is HIV positive. The added stress of guilt experienced by HIV infected mothers who infect their new born children needs special attention. Most of these children develop AIDS by age 2.     

广州地区HIV感染者的临床和流行特征分析

目的：了解人类免疫缺陷病毒(HIV)感染者中HIV感染途径、HIV／HBV及HIV／HCV合并感染情况和机会性感染的发生率及类型。方法：检测HIV感染者／获得性免疫缺陷综合征(AIDS)患者HBV、HCV感染标志，确定HIV／HBV、HIV／HCV合并感染情况，了解其HIV感染途径，对是否存在机会性感染情况进行临床和实验室指标的综合诊断。结果：55例HIV感染者中静脉吸毒、性接触、输血或血制品及垂直传播分别占40％、36．4％、20．0％及3．6％。HIV／HBV、HIV／HCV合并感染率分别为16．4％和41．8％，两者比较有显著差异。机会性感染发生率为85．5％，感染类型由高至低依次为：肺炎、口腔毛状黏膜白斑(OHL)、口腔真菌感染、各种感染性腹泻、各种结核病、败血症、疱疹病毒感染。结论：广州地区HIV感染途径由高到低的顺序为：静脉吸毒传播、性传播、输血或血制品传播、母婴传播，其中以静脉吸毒和性接触方式感染为主。广州地区存在HIV／HBV、HIV／HCV合并感染情况，尤其是HIV／HCV合并感染率情况较严重；来医院住院治疗的HIV感染者绝大部分为已发生机会性感染的AIDS患者。     

北京市丰台区艾滋病自愿咨询检测人群梅毒和艾滋病病毒感染率及其影响因素分析

目的了解北京市丰台区艾滋病自愿咨询检测(VCT)人群的梅毒和艾滋病病毒(HIV)感染率及其影响因素。方法根据《试点城市检测咨询个案登记表》,2010-2012年对主动来丰台区VCT门诊的就诊人群进行HIV抗体检测、梅毒快速血浆反应素试验(RPR)检测和问卷调查。结果 2010、2011和2012年,VCT就诊人群HIV抗体阳性检出率分别为2.1%、1.5%和5.3%,梅毒RPR阳性率分别为3.9%、2.2%和8.1%。logistic回归显示影响VCT人群HIV阳性率的因素有性别、梅毒感染情况、输血/血制品史、注射毒品史、配偶/固定性伴阳性史及男男同性性行为史。结论配偶/固定性伴阳性史及男男同性性行为史是丰台区VCT门诊求询者HIV传播最主要的传播方式,应进一步做好该人群艾滋病预防宣传干预检测工作。     

Role of women in prevention and control of AIDS

Women in India and AIDS prevention and control are discussed in terms of vulnerability, victimization, required knowledge, reproductive impact, care and prevention after birth, and the demands of the prevailing situation. A WHO world estimate is that 3 million women of childbearing age are infected with HIV out of 8-10 million. Indian women are vulnerable because of their reduced status and lack of power in private and marital life. Also, pregnant women receive blood transfusions, which may be inadequately screened, for anemia. The use of oral contraceptives with estrogen reduces immunity. The use of IUDs may cause inflammation or injury which provides a point of entry for HIV into the bloodstream. Prostitution is an outlet for lack of money, education, and skills, and places women at risk. The transmission from men to women is higher than the reverse. Every women should know their risks and modes of transmission. Women need to know that the risk of fetal infection from an HIV-positive mother is 20-40%, and that the risk is highest if HIV infection occurs or AIDS symptoms occur during pregnancy. Infant mortality from HIV may occur within the 1st several years. The following needs to be understood about reproduction and HIV: the risk of infection is very high when impregnated by an HIV male partner, and if children are desired, artificial insemination should be the preferred method. The reverse holds true, because penetrative sex without a condom allows transmission of the virus. The best option is for avoidance of childbearing if a partner has HIV. Abortion should be provided. Women need to develop the skills in language and confidence to negotiate safer sex, should be particular about choosing a loyal partner, and protect themselves by urging male condom use. The mode of transmission to babies is not from cuddling or handling. Breast feeding carries a meager risk of transmission, and should be continued if HIV infection occurs; the baby should be immunized. All health workers should receive training in order to provide support and care to mother and child in a private and confidential manner. Traditional healers have a role in providing advice on AIDS and condoms, spiritual support, and in changing behavior. Peer counseling is an important strategy for teenagers. There is a great need from society,husbands, and family to change the views of women and sex and to support women. Testing and screening of pregnant women in whom HIV infection is suspected is recommended.     

Drug use and HIV risk--related sex behaviors: a street outreach study of black adults

BACKGROUND: Our street outreach project investigated the relationship between use of noninjecting drugs (alcohol, marijuana, cocaine) and human immunodeficiency virus (HIV) risk-related sex behaviors of black adults. The study focused on three HIV-related risks: multiple sex partners, unprotected sex, and drugs during sex. METHODS: Data for this study were collected in a street outreach community survey for a drug abuse and HIV intervention study in Birmingham, Ala. A total of 780 black men and women completed the survey. RESULTS: High-risk sex behaviors were far more prevalent among cocaine users than marijuana or alcohol users. A greater number of cocaine users reported having multiple sex partners, not using condoms, and using drugs during sex. Female cocaine users showed the same risk level for HIV infection as male cocaine users. CONCLUSIONS: Increased risk of HIV infection through sexual transmission is associated with use of noninjecting cocaine for both men and women. Condom use should be considered as a major component of HIV prevention programs.     

男男性接触者安全套使用情况调查

目的探讨男男性接触者(MSM)与不同性伴对象发生性行为时安全套使用情况及其影响因素。方法招募高校、酒吧、公园、浴室、网络和男性卖淫会所的男男性接触人群作为访谈对象,全部采取个体访谈方式。结果(1)近半数MSM知道固定性伴的H IV感染状况,但由于不信任对方仍然会使用安全套。(2)大多数卖淫男性向客人提供性服务时使用安全套,但性行为前吸毒或饮酒以及无所谓态度会影响安全套的使用。(3)与临时性伴发生性行为时,对方有吸引力会影响使用安全套。(4)多数人觉得和女性发生性行为时没有必要使用安全套。(5)害怕感染艾滋病是使用安全套的共同原因,影响快感是不使用安全套的共同原因。结论男男性接触者与不同性伴对象的安全套使用情况和影响因素各不相同,控制措施应该考虑不同性伴类型对安全套使用的影响。     

Issues concerning women and AIDS: sexuality.

In the US and globally women are contracting the human immunodeficiency virus (HIV) and developing the acquired immunodeficiency syndrome (AIDS) the fastest. Worldwide, HIV is transmitted primarily through heterosexual intercourse. In the US, the proportion of women who have contracted AIDS by heterosexual transmission has increased from 11% in 1984 to 34% in 1990. Women are at a greater risk than men for transmission by heterosexual intercourse as the ratio of women to men who acquire AIDS by heterosexual transmission is 3 to 1. Furthermore, 25% of AIDS cases caused by heterosexual transmission or iv drug use occurs in women. Although women often develop HIV-related serious gynecologic problems, including cervical cancer and refractory vaginal candidiasis, these conditions do not fall within the Centers for Disease Control definition of AIDS. Women who have gynecologic symptoms are not diagnosed as having AIDS, are not eligible for AIDS benefits, and live half as long as men do once they are diagnosed as being HIV infected. Little is known about the characteristics of HIV infection or AIDS in women. Sexually transmitted diseases (STDs) seem to act as cofactors for HIV infection. The human papilloma virus or genital warts, the herpes simplex virus, syphilis, chancroid, recurrent vaginal candidiasis, abnormal Pap smears, cervical neoplasias, and pelvic inflammatory disease have been associated with HIV infection in women. HIV infection should be considered in all women with symptoms of any of these disorders. Nurses must first become aware of the clinical manifestations of HIV infection specific to women. Nursing interventions should educate about safer-sex including condom use with nonoxynol 9, and the risks of sharing needles. Strategies must be developed that provide empowerment skills and are sensitive to the women's cultural, religious, and ethnic background, beliefs, and values.     

2013－2016年浙江省台州市男男性行为人群艾滋病相关危险行为特征和感染状况分析

目的了解2013 — 2016年浙江省台州市男男性行为者（MSM）艾滋病病毒（HIV）感染现状和相关行为学特征,为该人群疾病的防治和干预提供依据。方法利用2013 — 2016年台州市MSM艾滋病哨点监测数据,分析各年HIV感染现状、艾滋病知晓情况和性行为特征,并通过logistics回归分析该人群HIV阳性率及其影响因素。结果纳入哨点监测分析的1 750名研究对象的年龄为（36.50±13.80）岁,在婚或同居者44.80%,本省户籍者67.43%,高中及以上学历者53.78%。 该人群HIV、丙型肝炎病毒和梅毒的感染率分别为12.57%、0.29%和7.77%,HIV知晓率为91.14%。所有调查对象中承认最近6个月与同性发生过肛交性行为、与同性发生过商业性行为和与异性发生过性行为的比例分别为89.96%、6.09%和36.40%,其中,坚持使用安全套的比例分别为42.23%、58.33%和21.66%。 最近6个月与同性发生肛交性行为时坚持使用安全套的比例逐年上升（χ2趋势＝14.207,P＜0.001）,承认吸毒的比例也逐年上升（χ2趋势＝11.002,P＝0.001）。 多因素分析显示,高年龄、外省户籍、感染梅毒是HIV感染的危险因素;文化程度高、与同性肛交时坚持使用安全套、知晓HIV知识、接受过干预服务是HIV感染的保护因素。结论近年来台州市MSM人群HIV抗体阳性率一直较高,艾滋病相关危险行为仍较普遍。因此,有关部门亟需加强干预力度,普及疾病预防知识,提高安全套使用率,减少不安全性行为的发生。     

The i.v. nurse and the i.v. drug abuser: medical and psychosocial implications

When I.V. nurses treat I.V. drug abusers, they must be aware of the medical and psychosocial issues relevant to this group. Medical issues include the I.V. drug abuser's depleted venous access and this group's high rate of infection with HIV and other blood pathogens. Psychosocial issues relate to the various social and psychological problems associated with drug abuse. Further, when caring for these patients who are at high risk for HIV and other serious blood infections, the I.V. nurse may experience a conflict between her desire to care for the patient and her fear of contracting HIV or another infection through patient contact. Education is recommended so that I.V. nurses can reduce their risk of infection with blood-borne diseases and can better understand these patients. Also suggested are a multidisciplinary approach to treatment and referral to drug rehabilitation programs.     

2010-2014年云南省红河哈尼族彝族自治州吸毒哨点人群艾滋病相关行为变化和流行趋势分析

目的 分析2010-2014年红河哈尼族彝族自治州(红河州)吸毒哨点人群艾滋病相关行为变化和流行趋势,为制定艾滋病防控策略和行为干预提供依据。 方法 按照《云南省艾滋病哨点监测方案》对一般人口学特征、行为学特征、血清学信息、艾滋病防治有关信息进行监测,使用SPSS 22.0软件进行统计学分析。 结果 吸毒人群年龄段以20~40岁居多,但20岁年龄组有逐年增加的趋势,40岁以上年龄组有下降趋势。民族以汉族为主,但哈尼族从2010年的4.4%,增加到了2014年的29.6%。吸食毒品以海洛因为主,但占比从2010年99.2%,下降到2014年的80.8%,而冰毒则从0上升到2014年的10.6%。虽然注射吸毒和入所前1个月注射吸毒比例有下降趋势,但是否共用针具和入所前1个月共用针具频率差异却无统计学意义。最近1年发生过商业性性行为的比例有6.8%～26.6%,且吸毒人群不安全的商业性行为比例也比较高。在吸毒人群干预覆盖构成比上却呈现逐年下降趋势。非条件logistic回归分析结果显示,年龄30岁,注射吸毒、共用针具,女性、最近1年有过商业性性行为和干预覆盖率是吸毒哨点人群艾滋病感染的危险因素。 结论 5年监测结果表明吸毒人群HIV感染率呈现下降趋势,但吸毒人群无保护的性行为仍较普遍,同时干预覆盖率呈下降趋势。针对吸毒人群除了需扩大美沙酮维持治疗的试点地区和增加针具交换点以外,还要采取以社区为基础,通过外展服务、培训、同伴教育等多种方式进行吸毒人群的高危行为干预,这对于扼制此类人群通过性途径向一般人群传播艾滋病具有重要的意义。     

2007-2012年广西壮族自治区吸毒人群艾滋病流行趋势分析

目的 分析2007-2012年广西壮族自治区(广西)吸毒人群人类免疫缺陷病毒(human immunodeficiency virus,HIV)阳性率及相关危险行为的变化趋势。 方法 通过全区多个市县设立HIV监测哨点,每年4 7月由统一培训的工作人员通过滚雪球抽样(社区)及连续采样(强戒所)的方法对吸毒人员开展面对面访谈,获取一般人口学、行为学等信息,并采血3~5 ml检测HIV、梅毒及丙型病毒性肝炎(丙肝),数据采用SPSS 20.0软件分析。 结果 吸毒人群HIV阳性率(中位数)从2007年13.9%下降到2012年5.7%,梅毒阳性率(中位数)从2007年3.4%上升到2012年6.0%;吸毒人群曾经共用针具率逐年下降,但2012年最近1个月共用针具率为14.0%,商业性行为比例逐年上升,安全套使用率提高不明显。 结论 2007-2012年广西吸毒人群HIV阳性率呈现逐年下降趋势,各年龄组吸毒人群HIV阳性检出率也在逐年下降。吸毒人群经静脉注射感染HIV呈减缓趋势,但针对吸毒人群的艾滋病综合干预仍不容松懈。     

深圳市龙华区男男性行为人群HIV感染分布特征及影响因素

目的探讨深圳市龙华区男男性行为人群(MSM)人类免疫缺陷病毒(HIV)感染的分布特征,探究其影响因素。方法整理2014年1月—2019年12月深圳市龙华区MSM人群HIV感染资料,并进行统计学分析。结果本研究共搜集2316例男男性行为人群,HIV感染率为5.91%。经过单因素及多因素分析结果显示,年龄偏大、无性行为保护措施、吸毒、合并梅毒感染为MSM人群HIV感染的影响因素(P<0.05)。结论深圳市龙华区MSM人群HIV感染情况不容乐观,年龄大、无性行为保护措施、吸毒、合并梅毒感染为MSM人群HIV感染的高危因素。     

济南市男男性行为者艾滋病感染状况及其危险因素调查

目的了解济南市男男性行为人群艾滋病感染状况和影响因素,为济南市艾滋病防治政策和策略的制定提供参考依据。方法采用连续采样的方法在取得研究对象人群知情同意的前提下,对2012年11月至2013年3月到济南市疾病预防控制中心(CDC)艾滋病自愿咨询检测门诊的男男性行为者(MSM)共300人进行了问卷调查及采血检测艾滋病、梅毒抗体。利用EpiData软件录入数据,用SPSS 17.0软件做logistic回归分析。结果本次调查共有31例艾滋病抗体阳性,感染率为10.33%。在多因素分析中,首次性行为年龄20岁和最近6个月与男性发生肛交性行为时不能每次都使用安全套是艾滋病感染的危险因素。结论男男同性传播艾滋病所占比例逐年提高,已成为济南市报告HIV感染最主要的传播途径。在男男性行为人群中提倡减少性伴和发生性行为时每次都使用安全套应是今后干预工作中的重点。     

在戒毒所开展吸毒人员自愿咨询和检测的研究结果分析

目的研究在戒毒所开展吸毒人员艾滋病(HIV/AIDS)自愿咨询和检测(VCT)的可行性。方法2个戒毒所312名戒毒者参与研究,咨询检测过程和数据收集都在戒毒所进行,所有研究的数据注意保密原则。结果戒毒者中1名男性检出HIV(0.32%),HCV、梅毒感染率分别52.56%和11.22%。男女参与者文化程度相近,注射吸毒比例和注射毒品年数相似。1d内注射毒品2￣3次或更多的占62.50%;在最近12个月中,至少有2个性伙伴者占58.01%;最近用共用注射器注射毒品者占18.91%;最近一次商业性行为中,使用安全套者仅占17.63%。312名吸毒者均接受了VCT,咨询后,92.63%的参与者的HIV/AIDS知识有一定增加。结论戒毒中心开展自愿咨询和检测(VCT)是一个发现具有高危行为吸毒者的可行路径。     

Estimating the risk of blood donation associated with HIV risk behaviours

summary .  A blood donor questionnaire and declaration, with deferral of potential donors at a higher risk of blood-borne infections, was introduced in Australia in the mid-1980s to reduce the risk of donation of HIV-infected blood. However, the absolute risk of HIV transmission through blood donation from high-HIV-risk donors has not been estimated. This study presents a new method of assessing the risk posed to the blood supply by selected HIV risk behaviours. A model was developed to estimate the probability of blood donation during the window period for HIV infection. Five scenarios for blood donors were considered: (1) men who have sex with men (MSM), (2) men who have sex with women in Australia, (3) women who have sex with partners from countries with a high HIV prevalence, (4) men who have sex with commercial sex workers in Australia and (5) people injecting drugs used once in a year. Those estimated to be at highest risk of becoming infected and donating in the window period were MSM. Women who have sex with men from countries of high HIV prevalence are at greater risk than men who have sex with female sex workers from Australia. These three groups under current Australian guidelines are deferred from donating blood for 12 months. In Australia, a single episode of injecting drug use is associated with very low risk of HIV transmission. The model presented in this study can be used to assess the impact of selected individual risk behaviours on the safety of the blood supply.     

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.     

2006年天津市艾滋病高危人群监测报告

目的 对吸毒者、女性商业性工作者和性病门诊就诊者三类艾滋病主要高危人群的监测,摸清其HIV感染的危险因素.方法 在戒毒所、收教所和医疗机构采集样本,进行HIV监测,并通过问卷调查有关行为因素.结果 449例吸毒者HIV感染率为2.00%,梅毒感染率为2.44%,66.36%的人注射毒品,有16.48%的人有性乱行为,注射毒品者中21.14%的人共用注射器;449例女性商业性工作者中共检出2例HIV感染者,感染率为0.45%,51.00%的人从不使用或有时使用安全套;8826例性病门诊就诊者中检出21例HIV感染者,感染率为0.24%,性病感染率为43.27%,55.90%的人有非婚性伴.结论 三类高危人群均存在感染HIV的诸多危险因素,应加大综合干预力度.     

Renal system complications in HIV infection

This article has provided an overview of the effects of HIV on renal function. Most transmission of the virus occurs by sexual, blood, and perinatal contact. CD-4 positive cells, especially those that are integral components of the immune system, serve as the reservoir for the reproduction of the virus. The resulting effect is destruction of the immune system with eventual multisystem failure and death. Renal complications arise from several factors, notably the compounding effects of chronic dehydration, malnutrition, infection, and use of nephrotic agents. Acute renal complication can be reversible with prompt assessment, and management directed at maintaining hydration, preventing sepsis, and carefully monitoring drugs. A chronic, irreversible renal disease in HIV is due, in large part, to a syndrome known as AIDS nephropathy, characterized by glomerular sclerosis and nephrotic-type symptoms, which ultimately lead to the need for dialysis. Aids nephropathy is seen most often in intravenous drug users, Haitians, and blacks with HIV. End-stage disease complicates the course of HIV and contributes to early mortality. A small, but significant number of renal patients acquires HIV infection as a result of multiple blood transfusions or through organ donation. Concentrated exposure to blood and body fluid during dialysis necessitates implementation of meticulous infection control procedures to protect both staff and patients. Guidelines by the CDC suggest that universal precautions adequate to prevent the spread of hepatitis B will suffice for HIV as well. HIV infection presents special challenges for those involved with renal management. Prevention and management of renal complication are made possible by thorough understanding of the complex network and interaction of the disease process.