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.     

Clinical clues to AIDS. Recognizing the dermatologic and nondermatologic manifestations

As more types of human immunodeficiency virus (HIV) are recognized and as the incidence of acquired immunodeficiency syndrome (AIDS) increases, more and more manifestations of HIV infection will be recognized. Dermatologic conditions often provide a means of making the presumptive diagnosis. Months or years of asymptomatic disease may have elapsed before cutaneous symptoms appear. However, care must be taken not to over-diagnose on the basis of a single nonspecific finding. To say that all patients with psoriasis have AIDS, for example, would be absurd. Yet an explosive flare of psoriasis or an atypical new presentation should alert the clinician to the possibility of HIV infection. Certainly, multiple suggestive dermatologic findings in any patient would essentially confirm the diagnosis of AIDS regardless of the status of antibody reactivity. A wide range of nondermatologic physical findings can also signal HIV infection. None are specific for AIDS, but again, findings that are rare, atypical, or severe in a normal host should be viewed with suspicion, and any of the signs in an at-risk patient should prompt the clinician to consider AIDS and to include specific tests in the workup. By becoming familiar with the many faces of HIV infection, the clinician can recognize its varied manifestations that may suggest the diagnosis in the absence of other findings.     

Reducing the rate of mother-to-child HIV transmission in Africa.

Currently there are about twenty four million HIV/AIDS (human immunodeficiency virus and acquired immunodeficiency syndrome) cases on the continent of Africa. Over the past two years, many health care professionals have been in a stage of denial concerning this problem. According to researchers attending the XIII International AIDS Conference held in Durban, South Africa, the world became aware that cost-effective strategies are needed desperately to stop the rapid spread of HIV/AIDS in Africa. Recent studies suggest that modest antiretroviral drug therapies for HIV-positive pregnant women can reduce one-half of the risk of HIV transmission to the unborn child. Challenges to the governments of Africa such as the high cost of drugs, lack of health care infrastructure and cultural barriers, priority to treat only pregnant women has been a difficult decision, while other infected persons with HIV are not treated.     

新疆艾滋病高发地区经母婴传播的HIV感染儿童及其母亲保健服务利用情况分析

目的了解新疆维吾尔自治区（新疆）艾滋病高发地区经母婴传播的HIV感染儿童及其母亲接受孕产期保健和预防艾滋病母婴传播（PMTCT）服务情况,为制定新疆消除儿童艾滋病感染方案提供依据。方法从“新疆维吾尔自治区艾滋病综合防治信息系统”和“预防艾滋病、梅毒和乙肝母婴传播管理信息系统”中获得2011 — 2017年出生的调查对象基本信息,使用自行设计的问卷通过一对一、面对面的询问方式,回顾性调查HIV感染儿童和母亲孕产期接受保健服务和PMTCT服务的有关信息。结果144例HIV感染儿童的母亲初中及以下文化程度者占81.25%（117/144）,81.25%（117/144）是农民和家庭妇女;孕期产前检查比例为61.81%,住院分娩比例为79.17%,孕产期HIV抗体检测比例为72.22%,HIV抗体阳性检出比例为75.96%;母亲在孕产期纳入PMTCT服务体系比例为44.44%;南疆地区HIV感染儿童母亲纳入PMTCT服务体系比例为38.18%,北疆地区为64.71%,二者差异有统计学意义。结论新疆南部和北部地区HIV感染儿童母亲接受孕产期保健和PMTCT服务利用方面存在较大差距。 HIV感染儿童的母亲文化程度偏低,缺乏孕产期保健意识,PMTCT服务利用不足,应持续加强育龄妇女和孕产妇PMTCT健康教育。     

艾滋病母婴传播与护理

目的:探讨妊娠合并HIV感染患者母婴传播情况及护理措施。方法:对我市2009年1～12月HIV感染孕产妇及所生婴儿进行追访并提供全方位的护理。结果:发现4例HIV感染孕妇,通过护理干预,2例进行了引产,2例分娩,现仍在继续提供护理指导。结论:对HIV孕产妇和婴儿进行正确的护理,是保障母婴健康、控制儿童艾滋病流行的重要措施。     

广西壮族自治区确诊HIV感染的孕产妇母婴阻断服务利用情况分析

目的了解广西壮族自治区（广西）预防艾滋病母婴传播综合干预措施服务利用情况。方法收集信息管理系统中广西分娩日期为2017年7月1日至2018年6月30日感染人类免疫缺陷病毒（HIV）的产妇及所生婴儿的干预服务利用情况信息，将HIV感染的孕产妇分为孕前确诊组和孕后确诊组，使用SPSS 22.0软件比较两组孕产妇及所娩儿童预防母婴传播服务利用与差异情况。结果共纳入HIV感染孕产妇595例，HIV暴露儿童598例。 其中孕前确诊组孕产妇454例，HIV暴露儿童456例；孕后确诊组孕产妇141例，HIV暴露儿童142例。 HIV感染孕产妇的年龄为（30.8±5.4）岁；孕前确诊组和孕后确诊组孕产妇在年龄、文化程度、婚姻状况、孕次及产次等人口学特征构成比差异有统计学意义；民族和职业构成比差异无统计学意义。 两组对于预防母婴传播干预服务利用均存在不足，但孕前确诊组的孕产期保健、抗病毒治疗、婴儿HIV检测等服务利用均优于孕后确诊组。结论广西HIV感染孕产妇对于预防艾滋病母婴传播综合干预措施利用不足，孕期保健服务利用晚、抗病毒治疗利用不足是工作的薄弱环节；加强宣教，提高预防母婴传播知识的知晓率，进而提高综合干预措施服务利用率，是实现消除母婴传播目标的关键措施。     

ISSUES OF WOMEN DUALLY DIAGNOSED WITH HIV INFECTION AND SUBSTANCE USE PROBLEMS IN THE CAROLINAS

A growing number of women are being dually diagnosed with HIV infection and substance use problems. Forty-two percent of all women diagnosed with AIDS have been infected through injection drug use. Many more women with HIV are exposed to nonintravenous drugs that potentially affect their quality of life and illness experience. This study sought to identify from the perspective of women factors that most influenced their ability to obtain treatment for their HIV infection and control their substance use. A focus group approach was used for data collection. Twenty-five HIV-infected women participated in one of four focus groups. Women were asked to identify and discuss their concerns and needs related to HIV/AIDS and substance use. Twenty-four women were African-American; one was white. All the women reside in South Carolina or North Carolina. Each focus group session was audiotaped and transcribed. Content analysis, following Krippendorff's (1980) methodology, was used to analyze the data. Five themes emerged: 1) AIDS as a life-altering event; 2) spirituality; 3) mental health issues; 4) barriers to health care services; and 5) environmental influences. It was concluded that the coexistence of HIV and substance abuse adds to the complexity of women's treatment needs. For these women, an HIV diagnosis can serve to alter their lives either positively or negatively. Dually diagnosed women have needs that require integration of physical and interventions. These women may benefit from services of psychiatric or mental health nurse who have the skills necessary to address the psychosocial issues women face as well as provide treatment. Additionally, drug treatment services to be expanded and made more comprehensive. Drug programs need to be developed specifically for and these services need to be made accessible to women with substance abuse problems. Further, drug programs need to provide comprehensive services can appropriately integrate the treatment of HIV and substance abuse.     

Issues of women dually diagnosed with HIV infection and substance use problems in the Carolinas

A growing number of women are being dually diagnosed with HIV infection and substance use problems. Forty-two percent of all women diagnosed with AIDS have been infected through injection drug use. Many more women with HIV are exposed to nonintravenous drugs that potentially affect their quality of life and illness experience. This study sought to identify from the perspective of women factors that most influenced their ability to obtain treatment for their HIV infection and control their substance use. A focus group approach was used for data collection. Twenty-five HIV-infected women participated in one of four focus groups. Women were asked to identify and discuss their concerns and needs related to HIV/AIDS and substance use. Twenty-four women were African-American; one was white. All the women reside in South Carolina or North Carolina. Each focus group session was audiotaped and transcribed. Content analysis, following Krippendorff's (1980) methodology, was used to analyze the data. Five themes emerged: 1) AIDS as a life-altering event; 2) spirituality; 3) mental health issues; 4) barriers to health care services; and 5) environmental influences. It was concluded that the coexistence of HIV and substance abuse adds to the complexity of women's treatment needs. For these women, an HIV diagnosis can serve to alter their lives either positively or negatively. Dually diagnosed women have unique needs that require integration of physical and psychosocial interventions. These women may benefit from the services of psychiatric or mental health nurse practitioners who have the skills necessary to address the many psychosocial issues women face as well as provide physical treatment. Additionally, drug treatment services need to be expanded and made more comprehensive. Drug treatment programs need to be developed specifically for women, and these services need to be made accessible to poor women with substance abuse problems. Further, drug treatment programs need to provide comprehensive services that can appropriately integrate the treatment of HIV disease and substance abuse.     

How many persons in Canada have been infected with human immunodeficiency virus? An exploration using backcalculation methods.

We have used the technique of backcalculation to estimate the number of persons in Canada who have been infected with human immunodeficiency virus type 1 (HIV) as of July 1989. We first corrected national AIDS surveillance data in Canada for reporting delay and for underreporting. We then used standard Weibull natural history models as well as an alternative progression model in which the hazard of AIDS was dampened in keeping with observed data from large cohorts. Maximum likelihood techniques were then used to derive the infection curve most consistent with these data. Our best estimate based on this alternative progression model, an underreporting rate of 20%, and a logistic infection curve, was that approximately 29,000 persons in Canada had ever had HIV infection as of July 1989. In a sensitivity analysis utilizing less likely assumptions, the estimates ranged from 17,243 to 48,277. Restricting the same backcalculation process to females under the same assumptions, we estimated that approximately 2,900 females in Canada had ever had HIV infection as of July 1989. The best fitting step function infection curve in females appears to be continuing to rise. Given these estimates, it follows that approximately one in ten infected persons in Canada is female. However, females have only accounted for about one in seventeen AIDS cases. These data are in accord with the widespread impression that transmission of HIV to women has occurred more recently and is on the rise across Canada. The current estimate is lower than previous estimates which placed the number of infected Canadians in the 50,000 to 100,000 range. This lowering should not be taken to mean the situation is improving; rather, the early estimates were simply too high having been based on inadequate data and a rudimentary understanding of the natural history of HIV. Backcalculation is an excellent technique for modelling the incidence of HIV infection several years in the past, but it is not reliable for the most recent few years. A significant increase in HIV infection rates may have occurred in the past few years and it would be beyond the capacity of backcalculation to detect. Backcalculation and unlinked cross-sectional specimen surveys together have the potential to provide an effective means of monitoring the HIV epidemic.     

Complications of HIV infection: a systems-based approach

Patients with human immunodeficiency virus (HIV) infection often develop multiple complications and comorbidities. Opportunistic infections should always be considered in the evaluation of symptomatic patients with advanced HIV/AIDS, although the overall incidence of these infections has decreased. Primary care of HIV infection includes the early detection of some complications through screening at-risk and symptomatic patients with routine laboratory monitoring (e.g., comprehensive metabolic and lipid panels) and validated tools (e.g., the HIV Dementia Scale). Treatment of many chronic complications is similar for patients with HIV infection and those without infection; however, combination antiretroviral therapy has shown benefit for some conditions, such as HIV-associated nephropathy. For other complications, such as cardiovascular disease and lipoatrophy, management may include switching antiretroviral regimens to reduce exposure to HIV medications known to cause toxicity.     

AIDS: a special challenge for health care workers.

The human immunodeficiency virus (HIV) has spread widely in the United States and elsewhere. Health workers may be at risk because of job responsibilities and/or lifestyle. This paper will focus on the physical and mental health of professional and nonprofessional health workers who come into contact with AIDS patients and others infected with HIV. It will review and make recommendations concerning infection control, ethical, behavioral, emotional, and educational issues.     

HIV counseling, testing, and referral

Over the past decade, the annual number of new cases of human immunodeficiency virus (HIV) infection has been relatively stable but remains unacceptably high (an estimated 40,000 new cases per year). Furthermore, the demographics for HIV infection are changing. Rates of new infections are declining in newborns, older men who have sex with men, and whites. However, rates of new infections are rising in young persons, women, Hispanics, and blacks. In 2001, the Centers for Disease Control and Prevention issued revised guidelines for HIV counseling, testing, and referral. The guidelines focus on the reduction of barriers to testing, voluntary routine testing of high-risk populations and persons with risk factors, case management and partner tracing for infected persons, and universal testing of pregnant women. Effective strategies for reducing HIV infection include behavioral interventions, comprehensive school-based HIV and sex education, access to sterile drug equipment, screening of the blood supply, and postexposure prophylaxis for health care workers.     

The Georgia Rural-Based Nurse Model: Primary Care for Persons with HIV/AIDS

Abstract The need for specialized HIV education for nurses working in rural areas will increase as the incidence of HIV infection increases in rural areas. Public health nurses provide a viable alternative to providers in acute care facilities and will continue to be the primary care providers for persons with HIV/AIDS in rural areas. While approaches to HIV/AIDS education should include clinical treatment as the core, clinical knowledge alone will not promote the development of caring communities. The Rural-Based Nurse Model provides a comprehensive curriculum that addresses the many complex issues associated with the care of persons with HIV/AIDS. Additionally, participants are linked with care providers who serve clients across the continuum of HIV disease. Through meaningful educational opportunities and provider networking, this program has the potential for improving the quality of care in rural areas for persons with HIV/AIDS. HIV/AIDS education programs will require individualized community strategies that consider existing resources and barriers. However, the Rural-Based Nurse Model provides a formula for HIV/AIDS education that can be easily adapted to other settings.     

HIV worldwide. What has happened? What has changed?

The human immunodeficiency virus (HIV) has resulted in a worldwide pandemic of infection. By 1991 more than 350,000 AIDS cases had been reported to the World Health Organization, but it is estimated that there are now more than 10 million people infected worldwide. HIV can rapidly spread in new populations: The pandemic is composed of multiple smaller epidemics. In the United States, it is estimated that over a million people are infected with HIV. Methods of estimating this number include extrapolation from the number of reported cases of AIDS, use of mathematical modeling and back-calculation, and seroprevalence surveys. Minorities continue to be overrepresented among those infected, and the prevalence of HIV in women is increasing. In serosurveys, it has been found that as HIV prevalence rates rise, the ratio of infected males to infected females approaches 1:1, suggesting an increased proportion of hetero-sexual transmission. HIV is now variably present but widespread across the United States. The epidemiology of HIV-related illnesses is also changing, as can be seen with current patterns of tuberculosis. HIV continues to be an increasingly complex and dangerous global burden.     

Acquired immunodeficiency syndrome: the nurse's legal duty to serve.

Some nurses are reluctant to care for human immunodeficiency virus (HIV)-infected clients because of fear of contagion and discomfort in caring for people with alternate life-styles. Various federal, state, and local antidiscrimination statutes limit the right of the nurse to refuse to care for people with acquired immunodeficiency syndrome (AIDS) or HIV infection. Other constraints are employment contracts, ethical codes of professional organizations, and regulations of state licensing boards. Nurses have rights as well as responsibilities in caring for AIDS or HIV-infected patients. They also have a professional responsibility to institute measures that minimize the need for litigation and ensure access to health care for everyone.     

Women and AIDS: sociopolitical issues.

HIV infection and AIDS in women will continue without adequate diagnosis and treatment as long as women are not treated as full partners in society. Until issues related to women and their place in society are considered within the sociopolitical context, women who are at risk for HIV infection, those infected with the HIV virus, and those with AIDS will continue to receive inadequate attention. The National Center for Nursing's National Action Agenda, Nursing and the HIV Epidemic, provides some direction for addressing these issues and those that relate to practice, education, research, and health policy. It is incumbent on nurse researchers to conduct research related to the critical issues associated with HIV infection and AIDS in women, disseminate the findings of that research, and use those findings to inform and move health policy in this area forward. It is equally important to understand the issues that affect women--ethnic considerations, sexual practices, IV drug use--within the context or present political climate of our society. That climate allowed an NIH study that could identify risky sexual behaviors of adolescent and adult subjects who consent to participate in such a study to be called to a halt--not because of concerns about the study design or the scientific rigor of the study, but because of an elected official's fear that asking such questions will encourage these behaviors and his personal belief that such issues should not be discussed in polite society. These issues must be brought forward, acknowledged, and discussed if they are to be dealt with effectively. Otherwise, the relentless course of AIDS will continue.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mothers who silence themselves: a concept with clinical implications for women living with HIV/AIDS and their children

The number of women newly infected with the human immunodeficiency virus (HIV) continues to rise. Women living with HIV or the acquired immunodeficiency syndrome (AIDS) are often mothers who deal with the unenviable task of balancing the stigma and physical needs of illness with the needs of their families and, in particular, their children (DeMarco, Johnsen, Fukuda, & Deffenbaugh, 2001). This article addresses both the communication style and subsequent concept identified in women living with HIV/AIDS called "silencing the self," and the clinical implications for pediatric nurses who support and offer family-centered care to their patients. Mothers living with HIV/AIDS, often view the needs of the children primary as they deal with the trajectory of their own illness. In doing this, they effectively "silence" their own needs and may actually put their own psychosocial and physical needs in abeyance. It is critical that nurses in pediatric practice consider how to tangibly assess, refer, and educate mothers who silence their own needs in the process of providing care for their children.     

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。     

The state of science: violence and HIV infection in women.

Violence and human immunodeficiency virus (HIV) are two critical public health problems affecting the lives of millions of women today. The purpose of this article is to review the state of science that exists in linking the phenomena of violence and HIV infection in women. The history and scope of violence and HIV infection is presented. Theoretical models for the phenomena of violence and abuse against women and HIV risk behavior reduction are explored. The literature review consists of 44 research articles that examine risk factors for violence and HIV, violence associated with HIV/AIDS disclosure, history of violence and HIV/AIDS, forced or coercive sex and HIV/AIDS, and violence associated with HIV self-protection conduct. Implications for nursing practice and nursing research are presented.