毛里塔尼亚育龄期妇女人类免疫缺陷病毒感染情况调查

背景数据报告非洲地区撒哈拉以南的16个国家艾滋病病毒感染者多达2450万.目的了解居于撒哈拉腹地的毛里塔尼亚育龄期妇女人类免疫缺陷病毒的感染及类型,为艾滋病的防治工作提供研究方向和基本资料.设计随机抽样调查.单位苏州大学放射医学与公共卫生学院流行病与卫生统计学教研室,哈尔滨医科大学碘缺乏病研究所,哈尔滨医科大学公共卫生学院流行病与卫生统计学教研室.对象调查于2001-03/2001-06在毛里塔尼亚14个行政区(省)进行,纳入标准毛里塔尼亚14个行政区(省)育龄期妇女,年龄15～49岁,均知情同意.排除标准拒绝调查及非育龄期妇女.总数为331 548名,拟抽样调查4 000～6 000名,抽样率为1.2%～1.8%.方法抽查育龄期妇女,采静脉血、分离血清;用酶联免疫吸附试验做初筛试验,用蛋白印迹试验做确证试验,检测人类免疫缺陷病毒的感染及其类型;用每个行政区人类免疫缺陷病毒感染的检出率乘以该行政区育龄期妇女数,即为该行政区育龄妇女人类免疫缺陷病毒感染的估计人数.主要观察指标检测人类免疫缺陷病毒的感染及其类型;计算不同城市、不同人群的人类免疫缺陷病毒感染率,并加以分析.结果艾卡欧特行政区(省)因故未调查,在13个行政区中抽查了4 648名,抽样率为1.4%.在4 648名15～49岁育龄期妇女中,检出人类免疫缺陷病毒感染者24例,总感染率为0.516%.其中,人类免疫缺陷病毒-1型22例,人类免疫缺陷病毒-2型2例;有5个城市感染率在0.50%～1.01%之间,有3个城市感染率在0～0.50%之间,有5个城市未检出;15～29岁人类免疫缺陷病毒感染23例,占95.83%;在全国13个主要城市中,人类免疫缺陷病毒感染者总数估计在l 400例左右.结论毛里塔尼亚13个主要城市育龄期妇女人类免疫缺陷病毒总感染率为0.516%;人类免疫缺陷病毒感染以人类免疫缺陷病毒-1型为主;人类免疫缺陷病毒感染有地区差异;15～29岁人类免疫缺陷病毒感染占95%以上;毛里塔尼亚艾滋病的流行态势属于传入后的传播扩散阶段.     

Women,Aging, and HIV: Clinical Issues and Management Strategies

Women are living longer with human immunodeficiency virus (HIV) infection. The best way to manage the multiple comorbidities and polypharmacy that are a hallmark of HIV-infected individuals has not been studied. We explore incorporating principles of gerontology, particularly multimorbidity and polypharmacy, to optimize the health of HIV-infected women. Multimorbidity and polypharmacy are important issues for HIV-infected women. Incorporating a gerontological approach may optimize outcomes until research provides more definitive answers as to how best to collaborate with HIV-infected women to provide them with optimal care. A case study is used to guide the discussion.     

Knowledge, personal risk and experiences of HIV/AIDS among people with disabilities in Swaziland

Although there has been research focused on the disabling consequences of HIV/AIDS, there has been very little documented information about HIV/AIDS for individuals with disability prior to infection. There is evidence to suggest that people with disabilities face inequalities in accessing health information and services. The aim of this study was to explore whether disabled and non-disabled young adults in Swaziland perceive HIV/AIDS similarly. A qualitative study using focus-group discussions was conducted. Four focus groups were conducted with a total of 56 non-disabled adults (aged 16-29 years) and four focus groups were conducted with a total of 32 adults with either a physical or hearing disability (aged 18-32 years). The focus-group schedule explored knowledge about HIV/AIDS, personal risk and experiences of health-seeking practices. Information and awareness about HIV/AIDS was good in both rural and urban areas among the non-disabled participants, who obtained their information from a wide range of sources. In contrast, participants with disability, who obtained information about HIV/AIDS from a limited range of sources, lacked knowledge about HIV/AIDS and were misinformed about modes of transmission. Women with disabilities described experiences of sexual exploitation and abuse, which was perceived to be higher among disabled women than their non-disabled peers; they felt this was because disabled women were perceived to be 'free' from the HIV virus by non-disabled men. Further research is necessary to enable HIV/AIDS programmes to address the specific needs of people with disabilities.     

Incidence and correlates of physical violence among HIV-infected women at risk for pregnancy in the southeastern United States.

To identify the incidence and correlates of physical and sexual violence among HIV-infected women at risk for pregnancy, a cross-sectional examination was conducted within a longitudinal study of reproductive decision making. Participants consisted of 275 HIV-infected women 17 to 49 years of age (mean = 30.1 years). Women were predominantly African American (87%) and single (82%), with annual incomes of $10,000 or less (66%). Overall, 68% of the women reported experiencing lifetime physical and/or sexual violence. Before becoming HIV infected, 65% of the women reported having been physically or sexually abused. After HIV diagnosis, 33% of the women reported experiencing physical or sexual abuse. Women reporting greater violence were more likely to disclose their HIV-seropositive status to their sex partner. Using logistic regression, greater intent to get pregnant (odds ratio [OR] = 0.933), decreased present life satisfaction (OR = 1.048), having three or more children (OR = 0.474), and history of drug use (OR = 0.794) significantly distinguished between women who reported physical and/or sexual violence and those who did not.     

Rapid HIV screening for women in labor

Women now comprise approximately half of all HIV-infected individuals and the epidemic of pediatric HIV disease continues unabated in the developing world. The issue of mother-to-child transmission has been a major concern for public health officials since the early years of this epidemic. Not uncommonly, the first opportunity to ascertain the HIV status is when a woman presents to a hospital in labor. Rapid HIV tests can provide fast results, allowing time for the provider to offer antiretroviral therapy. Several effective antiretroviral regimens are now available for the intrapartum patient whose rapid HIV test comes back as positive. Antiretroviral therapy should be initiated as soon as possible after a positive rapid HIV test result and prior to standard confirmatory testing. This article summarizes the epidemiology of HIV and focuses on testing policies, technologies for rapid screening for HIV infection and antiretroviral regimens that can reduce the risk of perinatal transmission from the intrapartum patient whose rapid HIV test comes back positive.     

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.     

Association of increased upper trunk and decreased leg fat with 2-h glucose in control and HIV-infected persons

OBJECTIVE

Changes in body fat distribution and abnormal glucose metabolism are common in HIV-infected patients. We hypothesized that HIV-infected participants would have a higher prevalence of impaired glucose tolerance (IGT) compared with control subjects.

RESEARCH DESIGN AND METHODS

A total of 491 HIV-infected and 187 control participants from the second examination of the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM) underwent glucose tolerance testing (GTT). Multivariable regression was used to identify factors associated with GTT parameters.

RESULTS

The prevalence of impaired fasting glucose (IFG) (>110 mg/dL) was similar in HIV-infected and control participants (21 vs. 25%, P = 0.23). In those without IFG, the prevalence of IGT was slightly higher in HIV-infected participants compared with control subjects (13.1 vs. 8.2%, P = 0.14) and in HIV+ participants with lipoatrophy versus without (18.1 vs. 11.5%, P = 0.084). Diabetes detected by GTT was rare (HIV subjects 1.3% and control subjects 0%, P = 0.65). Mean 2-h glucose levels were 7.6 mg/dL higher in the HIV-infected participants (P = 0.012). Increased upper trunk subcutaneous adipose tissue (SAT) and decreased leg SAT were associated with 2-h glucose and IGT in both HIV-infected and control participants. Adjusting for adipose tissue reduced the estimated effects of HIV. Exercise, alcohol use, and current tenofovir use were associated with lower 2-h glucose levels in HIV-infected participants.

CONCLUSIONS

In HIV infection, increased upper trunk SAT and decreased leg SAT are associated with higher 2-h glucose. These body fat characteristics may identify HIV-infected patients with normal fasting glucose but nonetheless at increased risk for diabetes.The estimated prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in the general U.S. population is 26 and 15%, respectively (1). Approximately 25% of adults with IFG or IGT progress to diabetes over 3–5 years. However, there are relatively little data regarding the prevalence of IGT in HIV-infected persons. The factors associated with IFG and IGT in the HIV-infected population have also not been well characterized.In HIV infection, the prevalence of IFG ranges from 2.2% in Kenyans to 21% in U.S. men (2–5). In women receiving antiretroviral therapy, the prevalence of IGT was 17% compared with 9% of uninfected control subjects (6). In another study, 16% of HIV-infected men receiving antiretroviral therapy had IGT versus 18% of uninfected control participants (3). In healthy control subjects taking protease inhibitors (PIs) and HIV-infected subjects receiving combination antiretroviral therapy, diabetes is more likely to be diagnosed by glucose tolerance testing (GTT) than by fasting glucose (7,8). Peak PI levels acutely inhibit insulin-mediated glucose disposal, which may explain increased abnormalities with GTT compared with fasting glucose (7,8). Increased visceral adipose tissue (VAT) and upper trunk subcutaneous adipose tissue (SAT) were independently associated with insulin resistance in both HIV-infected and control participants in the Study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM). The prevalence of insulin resistance defined by homeostasis model assessment (HOMA) >4 was 37% in HIV-infected participants and 28% in control subjects (P = 0.005) (9). In HIV-infected subjects, age, alcohol use, and male sex were associated with insulin resistance.During the second FRAM examination, GTT was performed. Because insulin resistance, IFG, and IGT are not equivalent concepts, analysis of the latter parameters can provide insight into glucose metabolism in HIV infection and its relation to demographic factors and regional adiposity.     

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.     

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

Abstract Introduction: Studies of advance care planning (ACP) completion rates in HIV-infected persons pre-date the "graying" of the HIV epidemic. We sought to examine current ACP completion rates and factors influencing completion among HIV-infected persons. Methods: HIV-1-seropositive persons aged 45-65 years on effective antiretroviral therapy for a minimum of 6 months were enrolled in a cross-sectional survey. Likelihood of ACP was assessed by demographic and clinical characteristics, tested with odds ratios (OR) and 95% Wald confidence intervals (CI), and adjusted for gender. Results: Of 238 participants, 112 (47%) completed ACP. Persons ≥55 years of age (OR 2.8; CI 1.6,5.0; p<0.001), males (OR 4.1; CI 1.8,9.3; p=0.004), and persons with higher education (OR 2.2; CI 1.3,4.0; p=0.007) were more likely to have completed ACP. Persons with a cardiac event were more likely to have completed ACP (OR 5.5; CI 1.6,25; p=0.03), although this effect was diminished after adjusting for gender (OR 4.5; CI 0.95,21.4; p=0.06). HIV infection diagnosed for greater than 5 years was not associated with ACP completion (OR 1.3; CI 0.7,2.7; p=0.4). Current CD4(+) cell counts were similar between those completing and not completing documentation (588 cells/μL and 604 cells/μL, respectively; p=0.7). The likelihood of ACP did not significantly differ with other comorbidities. Discussion: Less than 50% of middle-aged patients in HIV care had documented ACP. In particular, women and those with lower education were at greatest risk of non-completion and may need interventions to improve ACP.     

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.     

Airway hyperresponsiveness and inflammation in Japanese patients with human immunodeficiency virus 1 infection

IntroductionDespite the growing population of long-term survivors with human immunodeficiency virus 1 (HIV) exhibiting asthma-like features worldwide, the pathogenesis underlying airway hyperresponsiveness (AHR) and airway inflammation remains unclear. We aimed to investigate AHR and airway inflammation in an HIV-infected Japanese population.MethodsOf 94 Japanese participants, 10 HIV-infected participants with asthma were excluded from the study. We compared the characteristics of HIV-infected (n = 34) and non-HIV-infected participants (n = 50). Eosinophilic, neutrophilic, mixed (eosinophilic and neutrophilic), and paucigranulocytic airway inflammatory phenotypes were classified based on induced sputum characteristics.ResultsThe prevalence of AHR in HIV-infected participants (32.4%) was significantly higher than that in their non-HIV-infected counterparts (10.0%) (P = 0.0213). The multivariate nominal logistic regression analysis revealed HIV as an independent risk factor for AHR. HIV-infected participants were significantly more likely to have a neutrophilic airway inflammatory phenotype than non-HIV-infected participants (P = 0.0358). Furthermore, HIV-infected participants with AHR demonstrated a significant correlation between AHR levels and the percentage of sputum neutrophils (r = ?0.65, P = 0.0316). The percentage of sputum neutrophils was negatively associated with the blood CD4 cell count (r = ?0.66, P = 0.0266).ConclusionsWe observed the high prevalence of AHR and neutrophilic airway inflammatory phenotype in Japanese participants with stable HIV infection. Our findings provide insight into the mechanisms of AHR and may facilitate the development of novel treatment for individuals with AHR and HIV infection.     

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.     

Mother-child HIV disease: a model for collaborative care

Women Connected and the Maternal Child Clinic are two unique dyad-centered programs for providing quality care to HIV-infected women and their children. Each is a collaborative effort to maintain standard of care for these patients within a large county facility. Women Connected facilitates their inpatient treatment and care, while the Maternal Child HIV Clinic provides follow-up outpatient health and social services.     

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.     

HIV Infection in Inner-City African American Women: The Role of Optimism in Predicting Depressive Symptomatology

This study examined the role of optimism in longitudinally predicting depressive symptomatology. Participants were 160 inner-city African American women, 96 who reported no history of HIV infection and 64 who reported current HIV infection. HIV-infected women, relative to the women without a history of HIV infection, were less optimistic and had higher levels of depressive symptomatology based on both self-report and interviewer rating. Consistent with the proposed hypothesis, a curvilinear relationship emerged between optimism at Time 1 and depressive symptomatology at Time 2 in both samples. However, the shape of the curve differed substantially for the two samples. As predicted, therewas a U-shaped curve for the noninfected women; however, for the HIV-infected women the curve had an inverted U-shape. We discuss these findings in lightof previous conceptualizations of optimism and psychological functioning, the contextual environment in which the participating women live, unique contributions of HIV to the optimism–depressive symptomatology, and the implicationsfor infected women.     

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。