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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The nurse Margaret Sanger started the 1st American contraception consultation in 1916 in Bronxville, N.Y. Today the Planned Parenthood Federation of America has 800 clinics in all states. A clinic in White Plains, N.Y., had 31,297 visits a year mostly from low-income people. Services consist of contraceptive and abortion counseling, abortion and infertility procedures, cancer tests with colposcopy and breast examination, and tests concerning sexually transmitted disease and human immunodeficiency virus infection. An adolescent pregnancy impact program helps future mothers ages 13-21 with the Lamaze method, health and diet, delivery, child development, family planning (FP), and life style. Abortion figures in New York State in 1989 showed that among white women ages 15-19 there were 49 abortions and 29 births/89 pregnancies, while among nonwhites with identical parameters there were 120 abortions and 77 births/225 pregnancies. Overall 11% of this age group give birth every year and about 5% get an abortion. The Supreme Court decision in the case of Roe v. Wade in 1973 gave women the right to abortion during the 1st trimester. That same year the National Right to Life Committee was formed with the goal of reimposing the ban on abortions. In 1977 the Supreme Court ruled that states did not have to pay for voluntary abortions. Each state determines whether a minor has to inform her parents. From 1985 there have been 22 bomb and arson attempts, 42 cases of vandalism, 2 break-ins, 1 bomb attack against a car, 15 death threats, and 7 instances of maltreatment of FP and abortion clinic staff. In 1989 states were allowed to restrict the right to abortion. In 1991 Utah banned abortion except for incest, rape, and risk to the mother's health. Other states also plan to change their abortion laws.
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PMID:[Family planning in New York]. 176 59

It is estimated that there are between 50,000 and 90,000 drug abusers in the former West Germany. IV drug users are the second largest group of AIDS victims after homosexual and bisexual men. From 1989 to 1990, IV drug users up 16.1% of 1425 reported AIDS cases. 52% of 124 female AIDS cases were drug abusers. 4-12 weeks pass from the time of HIV infections to the appearance of HIV antibodies, thus testing is not foolproof. Heroin abuse often leads to oligo- or amenorrhea. yet 593 female IV drug users in New York City had 2289 pregnancies (often detecting their pregnancy too late for abortion), averaging 2.5 live births and 1.3 abortions. Fetal HIV transmission occurs in 20-40% of cases. The effectiveness of azidothymidine (AZT) prophylaxis is not clear. Only 29% of 50 HIV-infected women had complication-free pregnancies: 34% had premature pain and contractions, and 11 of 49 children were born prematurely before the 35th week. Drugs used include opiates, barbiturates, cocaine, cannabis, amphetamine, LSD, and mescaline. The daily cost of addiction leads to illegal activities. 80% of addicted women turn to prostitution. Methadone has been used for substitution in the US. In Germany, levomethadone (L-Polamidon) is approved and has a half time of 29 hours which is much longer than that of heroin. The heroin substitution regime consists of 4-5 ml of levomethadone and later 1-3 drops/day. Asphyxia of the fetus could occur in unmedicated withdrawal, necessitating the use of levomethadone even during pregnancy. The reduction of .2 ml of this drug every 2 days was well tolerated. Outpatient drug treatment is risky, it should be carried out only in maternal-child care facilities.
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PMID:[Drug abuse, pregnancy and HIV infection]. 177 78

Aspects of abortion services that affect their accessibility to U.S. women are described. Following an overview of the types of providers (both hospital and non-hospital), consideration is given to barriers to abortion, including distance, cost, harassment by antiabortion demonstrators, length-of-gestation constraints, and the reluctance of many facilities to provide services to those who test positive for HIV. The author concludes that abortion services will become increasingly difficult and expensive to obtain.
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PMID:The accessibility of abortion services in the United States. 178 5

Since the end of the 1980s the increase in the heterosexual spread if HIV infection in Sweden has led to infection of women and their children. The family and social care consultation at the psychiatric clinic of Huddinge hospital outside of Stockholm has been active in treating and providing support for pregnant women and their partners with such problems since the mid-1980s. In 1986 a pilot project was launched with the involvement of 22 maternal health care wards and 3 abortion counseling sites and districts with the aim of implementing voluntary HIV testing of all pregnant women. 99% consented, and 1 out of 2500 was found HIV-positive. As a result, all pregnant women are routinely offered an HIV test. The consultation team consists of a midwife, a counselor, a gynecologist, a pediatrician, and a psychiatrist. The team advises them and their partner about the risks to them and the child and about the options of keeping or aborting the child. Another group of HIV-infected women comes from Roslagstulls hospital; these women aware of their condition. Some take the 70% chance of giving birth to a healthy HIV-free child, but others choose abortion to avoid the 30% chance of having an HIV-infected child. The patient newly diagnosed with HIV is referred to a doctor to be informed of new treatment methods in time. The consultation also tries to mitigate the isolation and loneliness of infected patients. If the child is born, it is checked for HIV infection, and it can be declared free of it at the age of 18 months. Breast feeding is not recommended. The ethical questions concerning having a child when both parents are infected and the attitudes of staff towards HIV-positive human beings are also mentioned.
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PMID:[HIV-positive pregnancy. Good care is necessary]. 181 64

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.
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PMID:Role of women in prevention and control of AIDS. 185 51

AZT-therapy during pregnancy is actually contraindicated. Two HIV-positive pregnant women who were due to have an induced abortion in the second trimester of pregnancy, were treated with AZT. Blood samples from mothers and fetuses and amniotic fluid samples were taken simultaneously. AZT crossed the placental barrier in the two patients. AZT and GAZT concentrations from the two fetuses were close to those obtained in the two women and in six non-pregnant volunteers.
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PMID:Placental passage of azathiothymidine (AZT) during the second trimester of pregnancy: study by direct fetal blood sampling under ultrasound. 187 98

Physicians at a district general hospital in London, England admitted a 26 year old pregnant political refugee from Uganda complaining of shortness of breath, fever, and a productive cough for 1 week. She was at 10 weeks gestation and had not yet sought prenatal care. 6 years earlier she had a child and her pregnancy and delivery were normal. They diagnosed an interstitial pneumonia based on an X ray, arterial gases, and quick breathing and administered intravenous (IV) ampicillin and erythromycin for 3 days. Her condition deteriorated nevertheless, so they had her blood tested for HIV. She tested positive and suspected pneumocystosis (later confirmed) and began treatment with IV Septrin and hydrocortisone. She worsened, and by the 10th day of this treatment she was receiving 60% oxygen. They changed her treatment to IV pentamidine and oral rifampicin and isoniazid. By this time, her white blood cell count was 28.7x109/1 and hemoglobin concentration 8.2g/dl. Her condition would not allow her to undergo general anesthesia so an abortion requested by the patient was not performed. Additional treatment included continuous infusion of eflornithine, but she died despite it. This case poses 2 questions. Could she have lived if there had not been a delay in HIV diagnosis? Research shows that CD4 lymphocytes cell counts fall considerably during pregnancy in HIV positive women. So some advocate prophylaxis earlier in these women than other immunocompromised patients. Was it indeed her pregnancy that contributed to the severity of her illness and its inability to respond to treatment? Some researchers find pregnancy accelerates the progress of HIV infection, but researchers do not yet know if it also accelerates the progress of opportunistic infections. If so, terminating pregnancy may be considered.
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PMID:A maternal death caused by AIDS. Case report. 188 2

In 1988, a study was started in three Amsterdam hospitals to investigate the HIV prevalence among pregnant women. In 1989 more hospitals and also midwife clinics were included in the study. From 1990 onwards all hospitals in Amsterdam, 22 midwife practices, 2 abortion clinics and 3 clinics for infertility problems participated. The study was carried out on a voluntary basis. Of the 8423 eligible pregnant women in 1990, 7823 women (92.9%) participated and 600 women (7.1%) decided not to participate. Eight women were found to be positive for HIV antibodies (0.10%, 95% CI 0.09-0.11) (1988: 0.28%; 1989: 0.10%). Of these 8 HIV-seropositive women 5 belonged to one of the known AIDS risk groups and 3 women were not aware of any risk-bearing behaviour. Of the 5 women from an AIDS risk group 2 denied a risk factor at their first visit to the clinic. One of the 8 women was positive for antibodies against HIV-2. Among the 719 women tested in the abortion clinics (23.3% refusers) 3 women were positive for antibodies against HIV-2 and I woman against HIV-I (prevalence 0.56%; 95% CI 0.52-0.59). Of the 476 women tested in the clinics for infertility problems no women were found positive for HIV antibodies. During the period 1988-1990, a total of 19 women were found HIV-seropositive in the screening program for pregnant women. Of the 13 women tested within the first 20 weeks of pregnancy 4 women decided to terminate their pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Results of screening for HIV antibodies in pregnant women, clients of infertility clinics and abortion clinics in the Amsterdam region in 1990]. 194 89

A physician on the consultative committee for noncriminal abortions in the canton of Vaud, Switzerland, offers personal reflections on her view of her role. Physicians at the commission evaluate appeals after an initial refusal, cases of foreigners not residing in the canton for 3 months, and particularly difficult cases referred by colleagues. Members of the commission judge whether the case meets the legal criteria for noncriminal abortions. The procedures followed are basically the same as for any other medical consultation: establishing trust with the patient, gathering and evaluating data on the patient's condition, making a decision and communicating it to the patient, and using the rapport established to further therapeutic and preventive goals. The consultation is of extreme importance to the patient, because it will affect her entire future life. Establishing trust begins before the consultation and is aided by a warm and respectful reception of the woman. During the 1st minute of the consultation, the physician should make introductions, define the function of the interview, and attempt to create an authentic physician-patient relationship. The information gathering stage does not involve a physical examination as the pregnancy has already been confirmed. Linguistic problems may arise with foreign women, but use of an interpreter should be avoided if possible. The physician should seek information on whether both partners are in agreement on the abortion, and about cultural problems likely to affect the patient if the pregnancy is continued or alternatively in case of an abortion. The physician can seek further information if necessary by telephoning the patient's family doctor, social worker, or other sources. The decision should be communicated to the patient by the interviewing physician, and may be made immediately or after a period of reflection. When authorization of an abortion is granted, the patient immediately faces the prospect of the procedure itself and the attendant sadness and ambivalence. If the abortion is denied, the reasons should be explained to the patient. The preventive interventions of the physician should include explaining precisely why approval for the abortion was granted in order to avoid excessive guilt feelings, ensuring that the patient is informed about contraception, and providing accurate information about sexually transmitted diseases and HIV infection.
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PMID:[Role of the physician qualified to provide a notice in compliance of the viewpoint on non-criminal interruption of pregnancy. Experience in the Cantonal Commission of Consultation and Petitions of the canton of Vaud]. 202 Jul 92

We present the baseline results of a prospective cohort study on the perinatal transmission of HIV-1 in Kigali, Rwanda. HIV-1-antibody testing was offered to all women of urban origin delivering a live newborn at the maternity ward of the Centre Hospitalier de Kigali from November 1988 to June 1989; 218 newborns of 215 HIV-positive mothers were matched to 218 newborns of 216 HIV-negative mothers. The matching criteria were maternal age and parity. No differences in socioeconomic characteristics were observed between HIV-positive and HIV-negative women. HIV-positive mothers more frequently reported a history of at least one death of a previously born child (P less than 0.01) and a history of abortion (P less than 0.001). Most of the HIV-positive women were asymptomatic, but 72.4% of them had a CD4; CD8 ratio less than 1 versus 10.1% in the HIV-negative group (P less than 0.001). The frequency of signs and symptoms was not statistically different in the two groups, except for a history of herpes zoster or chronic cough, which was more frequent among HIV-positive women. The rates of prematurity, low birth weight, congenital malformations and neonatal mortality were comparable in the two groups. However, infants of HIV-positive mothers had a mean birth weight 130 g lower than the infants of HIV-negative mothers (P less than 0.01). The impact of maternal HIV-1 infection on the infant seems limited during the neonatal period.
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PMID:Perinatal transmission of HIV-1: lack of impact of maternal HIV infection on characteristics of livebirths and on neonatal mortality in Kigali, Rwanda. 205 69


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