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。     

Barriers to accessing safe motherhood and reproductive health services: the situation of women with disabilities in Lusaka, Zambia

Purpose: To ascertain how well health services in Lusaka, Zambia currently meet the safe motherhood and reproductive health care needs of women who have physical impairment leading to disability.

Methods: A qualitative study was conducted in Lusaka, Zambia. In-depth tape-recorded interviews were conducted with 24 purposively selected women with disabilities and with 25 safe motherhood/reproductive public sector health service providers. Qualitative analysis was conducted using NVivo software.

Results: Women with disabilities encounter various social, attitudinal and physical barriers to accessing safe motherhood and reproductive health (RH) services in this particular setting. The strong desire for children and affection can increase vulnerability to sexual exploitation. At the same time, a generalized assumption among reproductive health service providers that women with disabilities will not be sexually active, and not require RH services, leads to increased vulnerability to sexually transmitted infection including HIV. Once pregnant, traditional beliefs about transmission of disabilities can create barriers to integration in ante-natal clinics. Nurse-midwives' fear of delivery complications in women with physical impairments can also result in routine over-referral to a tertiary maternity facility which is outside the locality and harder for women with mobility limitations to get to.

Conclusion: Greater understanding of the influences underpinning societal attitudes towards sexuality and disability in this setting, and more extensive communication between health care staff and women with disabilities would facilitate positive action towards improving safe motherhood and reproductive health services for women with disabilities.     

广西壮族自治区HIV感染孕产妇分娩高暴露风险儿童影响因素分析

目的 分析广西壮族自治区（广西）HIV感染孕产妇分娩高暴露风险儿童的影响因素。方法 通过全国“预防艾滋病、梅毒和乙肝母婴传播管理信息系统”选取广西各级医疗保健机构报告且出生日期为2016年1月1日至2020年12月31日的HIV感染孕产妇分娩的儿童;收集其母亲人口学特征、确诊感染时间、孕期保健情况、抗病毒治疗情况和病毒载量等信息。采用χ2检验进行单因素分析,采用多因素logistic回归模型,分析分娩HIV高暴露风险儿童的影响因素。结果 研究对象2 707例,其中普通暴露风险儿童2 277例,高暴露风险儿童的430例。多因素分析结果显示,HIV感染孕产妇文化程度高是避免儿童发生高暴露风险的保护因素;本次妊娠确诊HIV感染的孕产妇分娩高暴露风险儿童的可能性高于孕前已确诊的孕产妇,OR值（95%CI）为10.928(8.140～14.671);与初检孕周在孕早期的感染孕产妇相比,初检孕周在孕晚期的孕产妇分娩高暴露风险儿童可能性更高,OR值（95%CI）为21.997(15.253～31.723)。高暴露风险儿童HIV母婴传播率为13.44%,普通暴露风险儿童HIV母婴传播率为0.43%。结...     

Barriers to accessing safe motherhood and reproductive health services: the situation of women with disabilities in Lusaka,Zambia

Purpose:?To ascertain how well health services in Lusaka, Zambia currently meet the safe motherhood and reproductive health care needs of women who have physical impairment leading to disability.

Methods:?A qualitative study was conducted in Lusaka, Zambia. In-depth tape-recorded interviews were conducted with 24 purposively selected women with disabilities and with 25 safe motherhood/reproductive public sector health service providers. Qualitative analysis was conducted using NVivo software.

Results:?Women with disabilities encounter various social, attitudinal and physical barriers to accessing safe motherhood and reproductive health (RH) services in this particular setting. The strong desire for children and affection can increase vulnerability to sexual exploitation. At the same time, a generalized assumption among reproductive health service providers that women with disabilities will not be sexually active, and not require RH services, leads to increased vulnerability to sexually transmitted infection including HIV. Once pregnant, traditional beliefs about transmission of disabilities can create barriers to integration in ante-natal clinics. Nurse-midwives' fear of delivery complications in women with physical impairments can also result in routine over-referral to a tertiary maternity facility which is outside the locality and harder for women with mobility limitations to get to.

Conclusion:?Greater understanding of the influences underpinning societal attitudes towards sexuality and disability in this setting, and more extensive communication between health care staff and women with disabilities would facilitate positive action towards improving safe motherhood and reproductive health services for women with disabilities.     

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。     

Effects of antepartal stress on health status during early motherhood

A group of high-risk women who were hospitalized for a pregnancy-risk complication, and a group of low-risk women experiencing normal pregnancy were compared for differences in health status and the effects of antepartal stress on their health status from pregnancy through early motherhood. High-risk women reported a statistically significant poorer health status during pregnancy, early postpartal hospitalization, and at eight months following birth. High-risk women reported greater stress from negative life events in addition to their greater pregnancy risk. Among both groups of women, negative life events' stress had indirect effects on health status over time through either self-esteem, family functioning, mate relationships or perceived support. The effects of a high-risk pregnancy on health status were evident at eight months following birth; high-risk women's feelings about their pregnancy and the extent of stress from hospitalization had direct effects on their health status, while negative life events had indirect effects.     

2011－2020年广东省HIV感染孕产妇不良妊娠结局情况及其影响因素分析

  目的   描述广东省人类免疫缺陷病毒（HIV）感染孕产妇不良妊娠结局的情况,分析导致不良妊娠结局的影响因素,促进艾滋病感染孕产妇及暴露儿童的健康。  方法   对广东省2011—2020年所有区/县确认的3 438例HIV感染孕产妇的相关信息进行χ2检验和非条件logistic回归分析。  结果   共3 438例HIV感染孕妇纳入研究, 955例孕妇发生不良妊娠结局,不良妊娠结局发生率为27.78%。 不同的文化程度、初检时期、传播途径、产次和确认感染时期和妊娠高血压会影响HIV感染孕产妇不良妊娠结局的发生,差异有统计学意义（P<0.05）。 多因素logistic回归分析显示,注射毒品感染、产时或产后确认感染和患有妊娠高血压的HIV感染孕产妇发生不良妊娠结局的OR值分别是1.65（1.04～2.58）、0.61（0.48～0.78）和2.27（1.35～3.80）。  结论   传播途径、确认感染时期及妊娠高血压和HIV感染孕产妇发生不良妊娠结局有关。 需要高度重视HIV感染孕妇的生殖健康,提供优质的咨询服务和孕期保健服务,保障HIV感染孕产妇的健康,改善妊娠结局。     

Continuation of postpartum antiretroviral therapy in a cohort of women infected with human immunodeficiency virus.

A common dilemma for HIV-positive pregnant women is the issue of continuation or cessation of antiretroviral therapy (ART) postpartum. Current guidelines for ART during pregnancy offer no specific recommendations for postpartum ART care. The objective of this study was to ascertain characteristics that would predict cessation or continuation of ART postpartum. In this study, prenatal and medical clinic records were reviewed retrospectively for a cohort of 29 HIV-infected pregnant women who were seen in the Temple University High Risk obstetrics practice from 1997 to 1998. All women took ART during pregnancy, except for one who received i.v. AZT and nevirapine during labor. HIV-specific medical care was provided concurrently during the time of the woman's obstetrics visit by a nurse practitioner and a clinical nurse specialist in consultation with the physician. Factors that were included for review included race, age, use of ART at the time of pregnancy diagnosis, type of ART during pregnancy, CD4 count, HIV-1 ribonucleic acid polymerase chain reaction (RNA PCR) levels, current substance use, disclosure of HIV status to current partner, years of HIV infection, prior HIV infected child, and whether this was a first pregnancy. The two groups of women were divided between those who discontinued ART postpartum and those who continued ART. The data were analyzed with the Kruskal-Wallis test for two groups, or calculations of risk ratios with Fisher's exact test. Study results indicated that 15 out of 29 women (51%) continued ART postpartum. The significant factors for continuation included Latina ethnicity (risk ratio = 0.24, confidence interval = 0.06-0.87), CD4 < 200 mm3 (p = .04), and a greater number of drugs in the antiretroviral regimen 3 versus 2 (p = .05). This study showed that postpartum continuation of ART was associated with identified Latina ethnicity, lower CD4 counts, and a greater number of drugs in the pregnancy regimen. Further study is recommended to understand the clinical impact of intermittent ART, the strategies for postpartum therapy adherence, and clinical follow-up.     

Use of traditional medicine among pregnant women in Lusaka, Zambia

OBJECTIVE: We studied the prevalence of and predictors for traditional medicine use among pregnant women seeking care in the Lusaka, Zambia public health system. SUBJECTS: We surveyed 1128 pregnant women enrolled in a clinical trial of perinatal human immunodeficiency virus (HIV) prevention strategies at two district delivery centers. OUTCOME MEASURES: Postpartum questionnaires were administered to determine demographic characteristics, behavioral characteristics, HIV knowledge, and prior use of traditional medicines. RESULTS: Of the 1128 women enrolled, 335 (30%) reported visiting a traditional healer in the past; 237 (21%) reported using a traditional healer during the current pregnancy. Overall, 54% believed that admitting to a visit to a traditional healer would result in worse medical care. When women who had used traditional medicines were compared to those who had not, no demographic differences were noted. However, women who reported use of traditional medicine were more likely to drink alcohol during pregnancy, have >or=2 sex partners, engage in "dry sex," initiate sex with their partner, report a previously treated sexually transmitted disease, and use contraception (all p < 0.01). HIV-infected women who reported using traditional healers were also less likely to adhere to a proven medical regimen to reduce HIV transmission to their infant (25% versus 50%, p = 0.048). CONCLUSIONS: Use of traditional medicine during pregnancy is common, stigmatized, and may be associated with nonadherence to antiretroviral regimens. Health care providers must open lines of communication with traditional healers and with pregnant women themselves to maximize program success.     

State-mandated HIV testing in Connecticut: personal perspectives of women found to be infected during pregnancy.

In the 5 years after the adoption of state-mandated HIV testing in Connecticut, 33% of HIV-positive pregnant women in the state were newly diagnosed during their pregnancy. Women who first learned that they were HIV-infected during pregnancy comprised of a unique group of people tested, in essence, by state mandate. A total of 11 such women agreed to in-depth interviews to share their personal perspectives regarding the benefits as well as the adverse sequelae of HIV testing for themselves, their children, and the public health. Each woman recalled her initial response to the law, to her HIV diagnosis, and to the seemingly unavoidable challenge to her self-identity and described the ensuing adjustments. There was universal agreement by the study subjects that the law was of overriding and significant benefit.     

Maternal adaptation during childbearing in Norway,Sweden and the United States

The purpose of the study of 147 healthy primiparous women is to investigate the relationship between maternal adaptation during pregnancy and postpartum. This report is part of a larger study of relationships between family dynamics and maternal adaptation during childbearing in Norway, Sweden and the US. Variables included maternal adaptation, age, social status, mother's employment, type of birth, length of hospitalization and mother infant time together in the hospital. Mothers reporting greater adaptation during pregnancy reported greater adaptation postpartum. Mothers who believed themselves adapted indicated that they were better prepared for labour, had more control over their birth experience, a better relationship with their partner, and perceived greater participation in child care from their partner. Few differences were found in maternal adaptation among all mothers, and few relationships were found among selected sociodemographic variables and maternal adaptation. Formation of maternal identity and mother's confidence in her ability to cope with the tasks of motherhood was affected by mothers' prenatal identification with the motherhood role, supporting the notion that knowing what to expect provides a sense of control. Mothers' prenatal identification with the motherhood role directly or indirectly affected her satisfaction with motherhood. Nurses may want to develop practice strategies to support these findings.     

Biographies of pregnancy and motherhood in adolescence within rural settlements in Rio Grande do Sul

The objective of this study was to learn about and understand pregnancy and motherhood experiences in adolescence within rural settlements. The study started from a qualitative approach supported by the biographic method. Witnesses comprised women who experienced pregnancy and motherhood in adolescence. Data collection was performed in January and February 2009, by thematic biographic interview. The biographies show family trajectories of instability and constant moves as well as of precarious housing and employment. Pregnancy acceptance by the families of the adolescents is directly conditioned to the partner taking over the parenthood of the child and the adolescent mother as partner or spouse. The most frequently reported changes in the personal life deriving from pregnancy and motherhood were loss of freedom and increase of responsibility. At institutional level, it is observed the lack of public policies and, consequently, of services addressed to and adequate to health specificities within rural settlements.     

Maternity care professionals' perceptions of supporting employed women in Norway

The World Health Organization calls on health professionals to support women in combining maternity and work. The aim of this study was to explore midwives' and public health nurses' perceptions of supporting employed women to balance work and family life during pregnancy and early motherhood. An exploratory design, including multistage focus group interviews, was used. The focus group consisted of five midwives and one public health nurse who was working in maternity care. The data were analyzed by using qualitative content analysis. The comprehensive theme, "empowering the women when they are in 'another' state of normality", was based on two themes, "being in dialogue with the women" and "supporting the women to manage daily activities". The first theme was based on the subthemes, "perceiving the women to be in 'another' state of normality" and "providing an open atmosphere for dialogue", while the second subtheme was based on "confirming self-esteem" and "suggesting adjustments at work". The midwives and public health nurse empowered the women by enhancing their ability to carry out the self-care that was necessary in order to manage both their work and family life. Collaboration between maternity healthcare providers and employers should be developed in order to support employed women.     

HIV, pregnancy, and zidovudine: what do women know?

AIDS is a major cause of death among women and children, representing the fourth leading cause of death among women ages 25 to 44 and the seventh leading cause of death among children ages 1 to 4 in the United States. In 1994, National Institutes of Health announced the findings of the AIDS Clinical Trials Group study (076) that found that the use of the antiretroviral drug zidovudine (AZT) reduced perinatal transmission of HIV by two thirds. These findings have direct implications for the growing number of women with HIV disease, their children and families, and the multiple systems that deliver ongoing services and care. In response to these findings, complex clinical, legal, and ethical issues have emerged that must be addressed to decrease the incidence of perinatal HIV transmission and to provide quality health care services. The purpose of this research was to assess what HIV-infected women presently know regarding AZT use in pregnancy to reduce prenatal transmission and to identify their views of the impact of this information on reproductive decision making. A one-page survey developed for this study was used to address these questions. A convenience sample of 204 HIV-infected women completed the survey. Data from 192 were usable. Of the sample, 121 (63.7%) women reported knowledge regarding the use of AZT in pregnancy. Only 73.5% of those who reported knowledge regarding AZT prophylaxis demonstrated accurate knowledge about the effects of its use. A relationship was found between knowledge about AZT use during pregnancy and women's decision to consider pregnancy, chi 2(2, N = 146) = 32.7, p = .0001, with women who reported that they were knowledgeable about AZT prophylaxis as more likely to consider pregnancy than those who reported that they were not knowledgeable.     

Factors affecting abnormal Pap smear follow-up among HIV-infected women.

Women with HIV infection are at least 10 times more likely to have an abnormal Pap smear than women who are HIV negative. Unfortunately, many women with HIV do not return for care after an abnormal Pap smear. Through the use of focus groups and individual interviews, HIV-positive women's experiences with abnormal Pap smears and the factors that affected whether they returned for care were explored. Two thirds of the 18 participants were minority women, and the average age was 40. Using techniques of constant comparative analysis, five factors were identified that affected whether women came back for care. These factors included fear, the asymptomatic nature of the problem, life circumstances, the participant's perspectives on health, and the health care provider. The findings from this study have implications for clinical practice and future research regarding adherence and abnormal Pap smear follow-up among women with HIV.     

Transforming possibilities of care: Goan migrant motherhood in New Zealand

Little is known about the maternity experiences of migrant mothers in Aotearoa/New Zealand--and in particular the ways in which women adapt and survive when separated from traditional postnatal practices and family support. This paper reports on a study of the maternity care experiences of women from Goa (India) in Auckland, New Zealand. Multiple research strategies were incorporated into the process to prevent reproduction of deficiency discourses. Interviews were carried out with Goan women who had experiences of migration and motherhood. The findings revealed that as a consequence of motherhood and migration, migrant mothers were able to reclaim and re-invent innovative solutions. Nurses and other health professionals can have a significant role in supporting women and their families undergoing the transition to parenthood in a new country and develop their knowledge and understanding of this dual transition.     

A multicenter study of women's self-reported reproductive health after spinal cord injury

OBJECTIVE: Little attention has been given to women's reproductive health issues in the disabled population. This study documents the unique reproductive health conditions, complications, and behaviors in women with spinal cord injury (SCI). SUBJECTS: A total of 472 women at least 18 years of age who were at least 1 year post-SCI. Their average age at injury was 32 years. DESIGN: An extensive questionnaire regarding gynecologic, sexual, obstetric, and menopausal health issues was developed and piloted. The questionnaire was then administered by a trained woman health care clinician to women who agreed to participate in the study. SETTING: Private outpatient clinics at 10 regional model SCI systems of care. RESULTS: Women reported similar gynecologic problems in both preinjury and postinjury time periods. Exceptions were urinary tract infections and vaginal yeast infections. Sexually transmitted infections appear to be less common after injury, but the difference was not statistically significant. The number of hysterectomies was similar both before and after injury, but reasons differed greatly. Women with SCI were less likely to have routine mammograms. They reported similar preventive practices such as performing self-breast examinations and obtaining Papanicolaou smears. Almost 14% of women with SCI became pregnant after injury (101 pregnancies). Complications from pregnancy, labor, and delivery were reported to be more frequent in their postinjury than in their preinjury obstetric experiences. They tended to have babies of lower birth weight and with more complications at time of delivery. Of the sample, 87% reported having sexual intercourse before injury, with only 67% having intercourse after injury. Years postinjury and level of injury were predictive of intercourse; extent of injury was not. Experience of orgasms and methods of contraception varied among the two groups. There were significant complaints of dysreflexia and bladder incontinence with sexual function. Menopause after injury was reported by 14.6% of the women. Postinjury menopausal symptoms were of low frequency, but more than those reported by women who had undergone menopause before injury. Only 19% of women who had menopause after SCI were placed on hormone replacement therapy. Almost one third of the women who had menopause after injury reported new bone fractures. CONCLUSION: This study illustrates the unique reproductive health concerns of women with SCI. Many pregnancy, labor, and delivery experiences in these women are different. Sexual activity and function have several disability-related consequences and the effects of menopause are still unknown, but may be more problematic than for able-bodied women.