HIV-infected pregnant women and their infants. Primary health care implications.

Human immunodeficiency virus infection in women and infants is a significant and growing health care problem in the United States. Young adult black or Hispanic women are at particular risk, especially if they use intravenous drugs or are the sexual partner of someone who does. However, acquired immunodeficiency syndrome/HIV infection is a significant cause of mortality in women of reproductive age (i.e., 15 to 44 years). In addition, the incidence of AIDS in infants directly correlates to the incidence of AIDS in childbearing women. HIV-infected pregnant women need on-going comprehensive prenatal care with a special focus on HIV management. Antepartum care should include an HIV-focused history and physical examination, as well as additional laboratory assessments to screen for viral and bacterial infections. Intrapartum care should focus on avoiding contact with infected or potentially infected secretions and body fluids. Postpartum care should emphasize development of a comprehensive and integrative plan of care for mother, baby and family unit prior to discharge. Avoidance of breastfeeding and strategies to prevent further HIV transmission must be stressed.     

沂蒙山区某县外来妇女艾滋病流行病学调查分析

目的了解山东省某县外来妇女HIV感染状态及流行病学特征。方法通过流行病学现状调查掌握外来妇女HIV感染状态以及感染者的流行病学特征。结果全县共有外省或外籍嫁入女性1107人,在接受HIV检测的787人中有19人感染HIV,感染率高达2.41%。流行病学个案调查,结果显示,有13人来自云南,4人来自缅甸,1人来自贵州;嫁入到本地的时间不等,自2个月至5年;嫁入本地前均有过婚姻史或性接触史;夫妻性生活中均从不使用安全套;有2人的丈夫HIV阳性;1例婴儿感染HIV;对17位女性感染者进行了CD4+T细胞计数,有3人少于200个/mm3。结论部分农村地区外来妇女人口中可能感染有HIV,需要对这一人群加强艾滋病的咨询检测、健康教育和行为干预,对感染者进行随访,防止家庭内的二代传播。     

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.     

2011年浙江省衢州市柯城区暗娼哨点监测结果分析

目的 分析浙江省衢州市柯城区暗娼人群基本情况、艾滋病防治知识认知情况、艾滋病相关行为学特征和艾滋病病毒(HIV) 感染流行趋势, 为艾滋病综合防治提供信息和依据。 方法 利用国家级暗娼监测哨点的数据资料进行分析。 结果 暗娼人群对艾滋病的传播途径知识正确率均在95.0%以上,对艾滋病非传播途径的认识不足,正确率为60.0%;最近一次商业性行为中坚持使用安全套比例为81.0%,最近1 个月商业性行为中安全套每次使用率为79.3%;艾滋病防治知识知晓率的影响因素是居住时间与文化程度;安全套使用的影响因素档次、居住时间、文化程度、年龄段;最近一次性行为安全套使用率、最近1个月安全套每次使用率与知晓率相关系数为0.350,0.344;暗娼人群 HIV 感染率为0。 结论 暗娼人群对艾滋病非传播途径的知识的正确率较低,安全套使用比例有一定的提高,商业性行为中坚持使用安全套比例仍然较低, 暗娼人群 HIV 感染率总体处于较低水平, 但是艾滋病流行的危险因素仍然存在,需进一步加强暗娼人群干预力度。     

Prevention strategies other than male condoms employed by low-income women to prevent HIV infection

This study sought to determine HIV prevention strategies other than male condom use employed by low-income women who have sex with men (WSM) and to identify variables that predict use of these strategies. A cross-sectional survey of nearly 4,000 women receiving Women, Infants, and Children (WIC) benefits in 21 Missouri counties was conducted. The response rate was 58%, with 2,256 completed questionnaires returned. Women were asked to indicate one or more of nine methods they had ever used to prevent HIV infection. Women were also asked about their use of male condoms, preference for male condoms versus female condoms, and which partner usually made decisions about STD/HIV prevention. Of the 2,256 questionnaires returned, 1,325 WSM indicated use of at least one HIV prevention strategy other than condom use. Strategies were: being tested for HIV (68.2%), partner being tested for HIV (44.1%), asking partner about his sex history (41.1%), using oral contraceptives (18.8%), asking him if he has HIV (13.7%), douching (11.8%), withdrawal (9.4%), and having anal or oral sex (6.6%). Common predictors of these strategies were race, education, history of STD, condom use, and marital status. Basic misunderstandings about HIV prevention are common in specified subpopulations of low-income women. HIV prevention programs for low-income WSM should capitalize on women's efforts to prevent HIV by designing programs to help women replace ineffective prevention strategies with effective prevention strategies.     

Sexual Risk Behavior Among Urban Women of Childbearing Age: Implications for Clinical Practice

Cox's interaction model of client health behavior was used as an organizing framework to describe the demographic characteristics, motivation, problem-solving, self-esteem, and sexual risk behaviors among urban women of childbearing age ( N = 125; average age = 32 years). Eighty-five percent of the women were African American. Sexual risk behaviors were defined as more than one sex partner and not using a condom. Eight women were at the highest risk in that they reported having more than one sex partner and not using condoms. Participants reported low self-esteem, intrinsic motivation, and adequate problem-solving abilities. Motivation scores were significantly different based on number of sex partners ( t = 2.26, p = .03). Women with more than one partner had lower scores compared to women with only one partner. There was a significant variation in reported self-esteem among women who used condoms ( t = 2.36; p = .22). Women who did not use condoms reported lower self-esteem than women who said that they used condoms.     

HIV/AIDS knowledge and risk behaviour in Hong Kong Chinese pregnant women

BACKGROUND: With the increase in HIV infection among childbearing aged women in Hong Kong, health department policy-makers are considering the implementation of antenatal HIV screening to identify infected mothers. However, little is known about women's understanding of HIV/AIDS, and their attitudes towards HIV screening. AIM: The aim of this study was to explore pregnant women's knowledge about HIV/AIDS, their perceptions of risk, risk behaviour and management, and their attitudes towards HIV screening. METHODS: A cross-sectional study was carried out, and all Chinese pregnant women who attended an antenatal clinic of a regional hospital in Hong Kong in the month of December 2000 were invited to complete a questionnaire. FINDINGS: Hong Kong pregnant women had fairly good general knowledge of HIV/AIDS (mean score = 4.8/6), but were less knowledgeable on specific mother-to-child HIV transmission (mean score = 3.6/6). There were statistically significant differences between those with different levels of education (chi2 = 19.81; P < 0.001) and between Hong Kong born residents and immigrants from the Chinese mainland (z = -4.03; P < 0.001). Over a third (36.7%) of all pregnant women perceived a risk of contracting HIV. If HIV infection were suspected, over 70% would have HIV screening together with their spouse. If HIV was confirmed, 24% would terminate the pregnancy. As many as 78.5% and 72.8% of women believed that HIV screening should be carried out before marriage and pregnancy respectively. Only 4.7% would choose universal opt-out antenatal HIV testing. RECOMMENDATIONS: Health educators should provide tailored-made education programmes for women at risk, particularly those at lower education levels and those who have come from the Chinese mainland, to enhance their knowledge about mother-to-child HIV transmission, and to promote awareness of safe sex. Health policy-makers should consider the possibility of providing pre-marriage and pre-pregnancy HIV screening for women.     

暗娼HIV综合监测结果分析

目的获取柳州市第一个综合监测年暗娼有关艾滋病的生物学及行为学监测资料,为艾滋病流行提供早期预警,为艾滋病的干预措施及效果评价提供信息。方法对娱乐服务场所及妇教所(入所<1)月的暗娼362人进行匿名问卷调查和采血。结果(1)调查对象平均年龄为20.5岁,卖淫时间从1月至3年不等,暗娼的商业性伴多,最近一次安全套使用率为76.0%,从未使用安全套的有9.0%;暗娼在与固定性伴(配偶或男友)发生性关系时安全套的使用率较其在性交易中安全套的使用率低,仅为54.7%;暗娼对艾滋病的3种传播途径的知晓率达84%以上,60.4%的暗娼认为自己没有感染艾滋病的可能,对艾滋病的严重性认识不足。(2)暗娼感染艾滋病的有11例,占3.0%,感染梅毒的有40例,占11.0%,合并艾滋病和梅毒感染的有5例,占1.4%;暗娼自愿做过HIV检测的较少,仅占13.3%。结论多数暗娼对艾滋病严重性认识不足,在卖淫活动中未能100%地使用安全套进行安全的性行为,存在着感染与传播艾滋病的高危险性,提示当今防制艾滋病的工作亟需抓紧高危人群,加强综合监测与科学防控。     

2013年太原地区男男性行为人群行为特征和HIV/STI感染情况的调查

目的了解太原市男男性行为人群(mem who have sex with men,MSM)行为特征、艾滋病防治知识知晓率、艾滋病/梅毒/丙型病毒性肝炎(丙肝)感染状况及影响因素。方法 2013年3-8月对MSM人群进行问卷调查,了解其人口学特征、性行为及性经历、性伴类型及数量、艾滋病相关知识、接受行为干预等内容,采集血样进行HIV、梅毒及丙肝抗体检测。采用χ2检验和logistic回归模型对感染HIV的影响因素进行分析。结果 255名符合标准的MSM参加了调查,自认同性恋占54.12%,双性恋占43.14%;首个性伴是男性占70.98%、女性占29.02%;与同性发生性行为时主动、被动肛交都做占45.88%;有固定性伴占55.29%,无44.71%;近6个月发生性行为,同性占85.49%,同性商业性行为占5.96%,异性占21.57%,性伴中位数为2人(1~200人),寻求男性性伴网络占71.56%,与不同性伴安全套使用率低下。HIV感染率为18.90%、梅毒7.48%、丙肝0.72%、HIV与梅毒合并感染2.36%。知识知晓率为91.76%。Logistic回归多因素分析显示,HIV感染与以下因素有关联:年龄﹥25岁(OR=3.04,95%CI:1.52~6.08),在本地居住时间2年以上(OR=0.76,95%CI:0.62~0.94),有性病感染(OR=3.818,95%CI:1.11~15.02)。结论 MSM人群属于性活跃人群,拥有性伴类型复杂多样,高危行为发生率高,使HIV及性病在该人群中广泛传播,加大对该人群的干预力度,减低高危行为,提高安全套的使用率,降低HIV在MSM人群中的传播。     

The interrelationship between violence, HIV/AIDS, and drug use in incarcerated women.

The purpose of this study was to examine how violence co-occurs with drug use and HIV/AIDS high-risk behaviors among women incarcerated for drug use. This study was a supplement to a larger, experimental study designed to reduce HIV/AIDS high-risk behaviors among incarcerated female drug users. The women who participated (N = 170) reported that violence was a major part of their lives and affected many of their behaviors. Among these 170 women, 26.6% used condoms for oral sex, 46.4% for vaginal intercourse, and 65% were either sexually or physically abused. Intimate partner abuse was reported by 33.9% of the women. About 16% reported forced sexual activity, and 17.5% feared their partners. Women who refused to give oral sex to their male partners and those who insisted on condom use during oral sex prior to jail were more likely to be sexually or physically abused (chi 2 = 4.104; chi 2 = 3.886, p < .05, respectively). Although statistically significant interrelationships were not found among the three variables, significant bivariate relationships were found between intimate violence and HIV/AIDS high-risk behaviors.     

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。     

2012年山西省太原市男男性行为人群艾滋病哨点监测分析

目的 了解太原市男男同性性行为人群(men who have sex with men,MSM)中艾滋病高危行为特征、艾滋病防治知识知晓率及艾滋病/性病感染状况。方法 按照《全国艾滋病哨点监测实施方案操作手册》(2012年版),对MSM人群进行问卷调查,并采集静脉血样进行人类免疫缺陷病毒(human immunodeficiency virus, HIV,艾滋病病毒)、梅毒和丙型病毒性肝炎的血清学检测。结果 2012年太原市共监测254例MSM,HIV抗体阳性率为13.78%;梅毒阳性率10.23%;丙型病毒性肝炎阳性率0.79%。监测对象艾滋病知识知晓率为90.55%。被调查者调查前6个月有78.74%的人与男性发生过肛交性行为,每次使用安全套占44.50%,其中4.50%与同性发生过商业性行为;30.31%的MSM与女性发生过性行为, 每次都使用安全套占41.56%。结论 太原市MSM人群艾滋病/性病感染率较高,高危行为较普通,应继续加强对该人群的行为干预,遏制艾滋病在MSM人群中的传播。     

九江市浔阳区艾滋病高危人群行为与认知情况调查

目的了解九江市浔阳区艾滋病高危人群的分布、HIV感染情况和主要危险因素,为制定艾滋病防治措施提供依据,探索合适的健康教育和行为干预模式。方法采用方便抽样法抽取暗娼人群360人,采用方便抽样法和滚雪球法抽取吸毒人群360人,通过问卷调查有关行为因素。结果 360名暗娼艾滋病基本知识总体知晓率为75.2%,安全套使用率为67.8%,采集暗娼血样149份,未发现HIV抗体和梅毒抗体阳性。360名吸毒人群的艾滋病基本知识总体知晓率为83.7%,最近一个月66.9%的人注射过毒品,共针率为47.6%。吸毒人群安全套使用率偏低,采集吸毒人员血样198份,发现HIV抗体阳性1份,梅毒抗体阳性5份,HIV和梅毒感染率分别为0.51%和2.53%。结论艾滋病高危人群暗娼、吸毒人群存在感染HIV的诸多危险因素,应做好艾滋病的综合健康教育和行为干预工作,完善高危人群监测体系。     

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.     

Safer Sex and Partner Violence in a Sample of Women

Sexually transmitted infections (STIs), including HIV, continue to be associated with significant morbidity and mortality among women. Intimate partner violence (IPV), affecting approximately 25% of women, has been shown to be a risk factor for HIV and STIs. This study describes the relationship between sexual risk, safer sex, and partner violence in a sample of women. Women who experienced IPV reported greater coercive sexual risk behaviors and a decreased ability to practice some safer sex behaviors. Nurse practitioners should be aware of the relationship between IPV and sexual risk and screen all women during routine visits.     

东莞市103名卖淫妇女艾滋病梅毒监测报告

目的　了解东莞市卖淫妇女性病艾滋病流行情况,为采取艾滋病性病的干预控制措施提供科学依据。方法　对东莞市妇女教养所10 3名收教的卖淫妇女进行调查、逐个询问:并各采集5ml静脉血进行HIV抗体和梅毒抗体检测。结果　10 3名卖淫妇女中,最小年龄16岁,平均年龄2 2岁;初中文化75人;未婚86人;外省流动人群97人。从未或有时使用安全套71人;共用注射器吸毒7人。查出HIV感染者1例;梅毒感染者12例。结论　卖淫妇女的艾滋病相关危险行为发生率和性病感染率较高,应加强对该人群艾滋病性病监测,积极开展性病艾滋病知识宣传,是控制其传播的重要措施.     

A randomized clinical trial of an HIV-risk-reduction intervention among low-income Latina women

BACKGROUND: HIV infection has increased within the Latina community more than in any other ethnic or racial group within the United States. Latinas comprise only 13% of the U.S. population, yet they account for 20% of the cumulative reported cases of AIDS. OBJECTIVES: The purpose of the study was to evaluate a randomized culturally tailored intervention to prevent high-HIV-risk sexual behaviors for Latina women residing in urban areas. METHODS: Mexican and Puerto Rican women (18-44 years of age; N = 657) who were sexually active during the previous 3 months were recruited and randomized into intervention and control groups. The intervention, facilitated by bilingual, bicultural, trained Latina women, consisted of culturally tailored sessions on understanding their bodies, HIV/AIDS and sexually transmitted diseases, condoms (myths and use), negotiating safer sex practices, violence prevention, and partner communication. Bivariate and multivariate analyses assessed changes from baseline. RESULTS: The intervention improved HIV knowledge, partner communication, risk-reduction behavioral intentions, and condom use, and decreased perceived barriers to condom use. DISCUSSION: The efficacy of a culturally-sensitive intervention to reduce HIV/AIDS-risk behaviors in Latina women was demonstrated in the current study.     

Condomless sex and HIV transmission among serodifferent couples: current evidence and recommendations

Human immunodeficiency virus (HIV) infection remains a global pandemic. The primary driver of HIV incidence is sexual transmission between serodifferent individuals. Condoms, when used consistently and correctly, are effective at preventing sexually transmitted HIV infections and are considered an integral component of a comprehensive approach to HIV prevention. However, the demonstrated effectiveness of antiretroviral therapy (ART) to prevent HIV transmission, known as treatment as prevention and of pre-exposure prophylaxis, have raised an intriguing dilemma on the necessity and additive preventive benefit of condom use among individuals in serodifferent relationships utilizing these prevention strategies. Recent published evidence, although of limited follow-up duration, has shown no linked HIV transmissions with condomless sex among serodifferent couples where the infected partner was on ART and virologically suppressed. This paper will review the evidence surrounding HIV transmission risk among serodifferent couples with and without the use of condoms and will highlight factors that increase or attenuate this risk. It will also address the important benefits that condomless sex offers couples. This paper aims to provide a template for providers to have personalized discussions with their patients, particularly those with an HIV-positive sexual partner, around their individual risk of HIV transmission and the role of condom use.     

舟山海岛地区卖淫妇女HIV感染情况调查分析

目的　了解卖淫妇女的性行为特征及HIV感染情况 ,以便实施对STD/AIDS的综合监测有效的干预措施。方法　对舟山市收容所 113例卖淫妇女 ,采用统一表格匿名填写调查方法进行问卷。性交易地点 ,首次性交 ,开始卖淫年龄 ,年限 ,接待嫖客人数 ,安全套使用 ,同时采集静脉血 3ml作HIV抗体检测。结果　调查人群中年龄最小 17岁 ,主要在宾馆、美容美发店及租房等服务场所进行卖淫 ,首次性交年龄 ,首次卖淫在 19岁以下 ,分别占 34.51%、17.7%。外省流动妇女占 86.73% (98/113)。卖淫年限最长 10年。每日接嫖客高达 20多个 ,从来不用安全套 15.93% (18/113)。检出HIV抗体阳性 1例。结论　卖淫人群不安全性行为传播HIV危险 ,加大该人群健康教育和干预措施的实施 ,阻止AIDS经性的传播。     

AIDS prevention for women: a community-based approach.

There were approximately 3 million HIV-positive women in the world, most of them in reproductive age according to the WHO's 1991 estimates. One third of the world's HIV-positive individuals are women; by the year 2000, women will account for half of the HIV-positive population. There are at least 200,000 HIV-positive women in Asia, mainly in Thailand, India, and China. The community-based Botswana project approach to AIDS prevention for women was based on a community-based model project at the University of Illinois to promote health in 2 low-income communities in Chicago by teams of trained residents and a nurse. Program elements included: women as health promoters; acceptance of primary health care; and emphasis on self-care in basic health. In Botswana the fertility rate is 5%, and approximately 40% of the women use contraceptives. The overall mortality rate is 37 per 1000. The 1st case of AIDS in Botswana was identified in 1985. As of January 1991, there were 180 cases and 59 AIDS-related deaths. There are 20,000 to 47,000 HIV-positive individuals in Botswana. There have been more women than men among reported AIDS cases in Botswana. Most women in their childbearing years are at moderate risk of HIV infection because of weak partner ties and occasional multiple partners. A 2-stage study of the effectiveness of nurse-managed peer education and support groups for AIDS prevention for women has been in operation for the 2nd year. In the 1st phase, interviews with more than 50 urban women explored their current risk of HIV infection and the risk-reduction strategies. The strategy for change used peer education and support groups led by trained community women to achieve lasting behavioral changes that promote health. The target group approach will include all women in the community. Heterosexual transmission of HIV is the predominant route of infection for women, hence promotion of safer sex is central in the Botswana intervention. The same AIDS preventive practices also protect against other sexually transmitted diseases including gonorrhea, syphilis, and chlamydiosis, which have high prevalence rates in Botswana.