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

The objective of the study was to monitor the HIV prevalence in the years 1988-1991 among pregnant women in the Amsterdam region, visitors to an abortion clinic and 3 outpatient infertility clinics. All women attending these clinics were asked to participate in the study on a voluntary basis and were tested with informed consent. The women were questioned about risk-bearing behaviour of themselves and their sexual partner(s). In the period 1988-1991, of the 23,827 eligible pregnant women, 22,165 women participated (93.0%). Twenty-seven women were found to be positive for HIV antibodies (0.12%, 95% CI: 0.08%-0.17%), of whom twenty belonged to a known HIV risk group or had a partner who belonged to one of these groups and 7 women had no known HIV risk. Seventeen of the 27 women had a foreign nationality. The annual HIV prevalence among pregnant women was: 1988: 0.28%; 1989: 0.10%; 1990: 0.10%; 1991: 0.11%. In the years 1990 and 1991, of the 1,128 eligible women visiting the abortion clinic 953 (84.5%) were tested. Eleven women were HIV-seropositive (1.15%, 95% CI: 0.6%-2.0%), of whom 9 were from an AIDS endemic region, 1 woman had a partner from this region and 1 woman had no known HIV risk. Four African women had HIV-2 antibodies. At the 3 outpatient infertility clinics 1 woman was found to be HIV-positive (0.13%; 95% CI: 0.02-0.9). She had no other risk than a partner from an AIDS endemic area. In the Amsterdam region there was a steady and low HIV prevalence (0.1%) among pregnant women through the years 1988-1991. The prevalence in the abortion clinic was ten times higher. The program was able to detect possible high risk groups within the population. Migration and travelling can play an important role in the spread of HIV in the general heterosexual population.
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PMID:The HIV prevalence among pregnant women in the Amsterdam region (1988-1991). 785 45

24 international experts on reproductive health met in Italy in February 1993 to explore ways of making family planning (FP) services available to postabortion women. They agreed that a range of contraceptive methods, accurate information, sensitive counseling, and referral for ongoing care should be available to all women postabortion. Furthermore, policy-makers and health care providers should be responsible for ensuring that women have access to such services. Thus, abortion care facilities and FP programs need to work closely, and safe abortion care and postabortion Fp should be an integral part of all safe motherhood initiatives. Finally, postabortion contraceptive protocols should take into account the psychological and social needs of the clients. It was recommended that 1) all abortion-care facilities offer FP services or referral to FP services and counseling; 2) abortion services be offered as part of comprehensive reproductive health care; 3) abortion services be offered on an outpatient level in primary health care settings; and 4) protocols on postabortion FP be developed and a supply of contraceptives be available at abortion facilities. FP programs should likewise either offer or refer women to abortion services to the fullest extent permissible by law. Issues of safety, counseling, respecting the rights of clients, and confidentiality were also found to be important. Finally, the group recommended that further research be performed on 1) incorporating women's perspectives into program design, 2) attitudes and interactions of users and providers of abortion care, 3) programs for adolescents and for women with HIV, and 4) ways of linking abortion and FP services. Efforts to reduce the deaths, disability, and poor health caused by unsafe abortion and poorly timed childbearing should be forwarded without delay.
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PMID:Post-abortion family planning. 787 25

In answer to a June 1992 postal survey question about whether the British 1967 Abortion Act should be extended to Northern Ireland, about 50% of the 43 Irish gynecologists surveyed indicated opposition. Seven supporters indicated that abortion is acceptable only with restrictions, eight agreed with the extension, 21 disagreed, and 2 were uncertain. One gynecologist considered it unfair that women with sufficient resources could go to England to buy an abortion, while those without resources were forced to continue their pregnancies. Another said he will not perform abortions. Three desiring restrictions did not agree with abortion for social reasons, and another said absolutely no abortion on demand. Abortion was recommended only for women up to 20-22 weeks. If a woman's health is at risk, 26 agreed with abortion, eight agreed depending on the circumstances, and three disagreed. Where a woman is HIV positive, 23 agreed with abortion, 11 agreed depending, and eight disagreed. Where fetal handicap is diagnosed, 22 agreed with abortion, 14 agreed depending, and three disagreed. If the woman was raped, 26 agreed with abortion, seven agreed depending, and four disagreed. One gynecologist agreed in all cases. All except one agreed that birth control facilities should be improved for teenagers as a solution to unwanted teenage pregnancy. About 75% wanted improved birth control and less premarital sex. 68.4% thought that the decision to end a pregnancy should be between a woman and her doctor. Those opposed were all older. A British poll of 305 respondents indicates that about 73% support a woman's decision, when it is made in consultation with a physician. 18 indicated conscientious objection to performing an abortion, but only two indicated a willingness to refuse to perform an abortion. The findings are similar to those in British research conducted 27 years ago before the Act was passed. Doctors are concerned about an increased workload and prefer to deal with wanted pregnancies. The strong physician indication that the decision should be made in consultation with a doctor suggests resentment of the law interfering with clinical decisions. The conclusion is that the inconsistent responses reflect a need for rationalization.
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PMID:Gynaecologists and abortion in Northern Ireland. 792 86

The objective was to study the changes in pregnancy HIV prevalence with time. Data were collected from multiple sources to provide a comprehensive record of all HIV seropositive pregnant women identified in the Edinburgh area (Scotland) until December 1992. There were 177 pregnancies in 108 HIV seropositive identified women. Risk factors were injection drug use (79% of pregnancies) and a known HIV seropositive injection drug-using partner (16%). Prevalence has decreased for Edinburgh City women from 0.5% of all pregnancies in 1986 to 0.1% in 1992; It was higher for induced abortion (0.6%) than for delivery (0.2%). HIV testing in pregnancy has declined. Comparison with unlinked anonymized testing showed that in 1990-1991, 20/22 seropositive women were known. In 1992, only 3 of 10 seropositive pregnancies were identified. The cohort initially infected by exposure to a 'drug related' risk factor between 1983 and 1985 may have increasingly finished childbearing, deliberately decided against pregnancy because of HIV status, and declined because of death, illness and emigration from the area, There may not have been major early tertiary heterosexual spread; however, data from 1992 suggest that this could now be impacting on pregnancy prevalence. Local testing policies have not adapted to this possible change.
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PMID:HIV testing and prevalence in pregnancy in Edinburgh. 803 9

Even though the population of developing countries is heterogeneous, it is young, and the incidence and prevalence of sexually transmitted diseases (STDs) are likely to increase among persons aged 20-40. STD epidemiologic data tend to be unreliable in most developing countries. Zimbabwe, a country with a good information system, has about 1 million reported STD cases each year (40% urethritis, about 25% genital ulcers, and 20% vaginal discharge and/or pelvic inflammatory disease). Gonococcal infections among pregnant women vary from 2% to 20% in Africa and are 10-20 times higher here than in comparable populations in the West. Chlamydial infection rates in developing countries tend to be similar to and lower than rates in the West. Syphilis prevalence rates range from 1% to 20% in some developing countries. STD complications and their sequelae pose an important public health problem for developing countries. They mostly affect women and newborns. STD complications and their sequelae include spontaneous abortion, fetal death, low birth weight, congenital syphilis, blindness, infertility, and social and personal damage. It appears that STDs facilitate HIV transmission. HIV-related immune deficiency increases one's susceptibility to genital ulcers. Increasing resistance to antibiotics complicates treatment of gonorrhea and chancroid. HIV infected persons respond poorly to classic treatment of chancroid. Two major STD interventions are prevention through behavior modification and promotion of barriers and limiting the duration of infection through optimal case management and case finding activities. The emergence of HIV has placed primary prevention as an absolute priority. Social marketing of condoms has been successful in several developing countries. Provision of accessible and affordable care can change health seeking behavior of persons with STDs such that they seek care from medical services. The primary health care systems of several developing countries use simple diagnostic algorithms to identify STD cases.
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PMID:Epidemiology and control of sexually transmitted diseases in developing countries. 804 15

Family planning and its association with women's health and the health of families, communities, and societies will be a central theme of the International Conference on Population and Development in Cairo, Egypt, in September 1994. The conference will provide an opportunity to determine new directions for the development of family planning programs. Making family planning programs woman-friendly is to insure that they: are based on the principle of voluntary informed choice; are available to all; offer confidentiality in counseling and services; provide a broad choice of traditional and modern methods; make the user's safety a prime concern; encourage male involvement; are supportive of women with unwanted pregnancies; and provide protection from, as well as management of, sexually transmitted diseases. The need to encourage male involvement and sharing in responsibilities is essential. Although the bulk of contraceptive methods are for use by women, many require the active cooperation of men. With the spread of sexually transmitted diseases and HIV/AIDS, barrier methods and cooperation between sex partners will gain importance. The responsibilities of men as partners, fathers, and family members should be emphasized in all family planning programs. Policy makers must insure that family planning programs offer high quality counseling, the prevention of unsafe abortion, and the management of genital infections, sexually transmitted diseases, infertility and diseases of the reproductive tract.
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PMID:Family planning and health. 808 66

The main objectives of the Vietnamese family planning policies to the turn of the century are to: a) achieve a 2-child family; b) reduce the infant mortality rate from 45/1000 to 25/1000; c) reduce child malnutrition from 50% to 25%; d) reduce maternal mortality from around 120/100,000 to 50/100,000; and e) increase the contraceptive prevalence rate annually by 2% from its present rate of 32-33%. It is also planned to reduce the total fertility rate from 4.0 to around 2.8 by the year 2000. Government policy aims to broaden and alter the existing pattern of family planning methods currently in use. In 1988, the contraceptive prevalence rate was 38%, and in 1991, 42%. In 1990 there were 1.02 million abortions (1.34 million in 1992), while there were around 967,000 IUD insertions (1.05 million in 1992), around 223,000 pill users, and 23,000 cases of sterilization. Acceptance of male sterilization is increasing in some northern provinces. 60-65% of all family planning acceptors use the IUD, pill or condom. Menstrual regulation is legal and free, and available even at commune level. Natural family planning methods such as the rhythm method are also used, to accomodate cultural and religious sensitivities. There are plans to reduce the incidence of genital tract infections (30% in females) and to phase out abortion. Research is in progress on injectable and implanted contraceptives under the World Health Organization's Special Programme of Research in Human Reproduction. Non-scalpel vasectomy is also being developed. Government policy emphasizes increased local production of contraceptives and IUDs other than the widely used Tcu 380A. Increased use of condoms is also desired to prevent the human immunodeficiency virus infection. After 1996, a mix of imported and locally-produced contraceptives is envisioned. Viet Nam is also exploring quinacrine-pellet nonsurgical female sterilization. Following experience of a field trial involving nearly 32,000 women in 24 provinces between 1989 and 1992, research is continuing on the safety and efficacy of the method.
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PMID:Family planning in Viet Nam: a vigorous approach. 808 69

Only Cuba has met the problem of AIDS with a traditional public health approach, which includes routine testing, contact tracing, partner notification, close medical surveillance, and partial isolation of infected individuals. The social behavior of Cubans (an absence of iv drug use, hostility toward homosexuals, and sexual puritanism) as well as access to abortion have contributed to the low incidence of the disease. Puerto Rico, with one-third the population of Cuba, has more than 8000 cases of AIDS, whereas Cuba has 927 cases of HIV seropositivity (as of May 31, 1993) and 187 cases of AIDS. Cuba acted promptly and decisively to control the epidemic, banning the importation of blood products in 1983 and administering the first of 12 million HIV tests in 1985. Whereas health screening is a familiar activity for Cubans, the isolation of HIV seropositive individuals in the Santiago fe las Vegas sanatorium was new. What began as a military-style hospital for HIV-infected soldiers returning from Africa was quickly transformed into a community which grants "leaves" to trustworthy residents who have completed a 6-month probationary period. Residents receive their old salaries whether or not they are working and are offered a choice of treatment regimens. As of July 1993, trustworthy residents can return home to live. If Cuba could have contained AIDS through a public educational campaign (and it has the infrastructure to have done so), then the human rights of the confined individuals were violated beyond restitution. International criticism of Cuba centers on this and largely ignores the equally troubling fact that abortions are universally recommended in HIV-positive women. In the parts of the world where AIDS has been regarded as primarily a human rights challenge instead of a public health crisis and preventive actions were dictated by a fear of further stigmatizing certain groups, personal freedoms have been protected, but many lives have been lost.
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PMID:AIDS, public health, and human rights in Cuba. 810 9

Between December 1989 and September 1990 in Baltimore, Maryland, researchers interviewed 363 pregnant women attending the Johns Hopkins Hospital obstetric clinic concerning their perspectives on HIV infection and childbearing. All women who agreed to be tested for HIV infection (91%) tested negative for HIV infection. The women lived in a community with a high prevalence of HIV infection. 90% were African-American. As the stated probability of vertical transmission increased so did the women's stated willingness to undergo an abortion. Specifically, if the stated transmission rate was 30%, 28% said they would have an abortion. If the rate was 50%, 47% would have an abortion. At a 70% transmission rate, 68% would have an abortion. At a 100% transmission rate, 74% would have an abortion. 23% of the women would never have an abortion, even if the vertical transmission rate were 100%. 36% of the women had had at least 1 abortion. They were more likely than the non-abortion group to have an abortion at all stated transmission rates. 74% of the women stated that prayer was important during personal problems. 28% of women had a planned pregnancy. These 2 aforementioned groups were less likely than their counterparts to have an abortion at the 30% transmission rate. 48% reported that HIV infection is the only reason for an abortion. An increase in the stated probability of vertical transmission did not strongly influence the women's willingness to avoid pregnancy. 78% would avoid pregnancy at the 30% transmission rate. At the 50% transmission rate, 97% would avoid pregnancy. 99% would avoid pregnancy at the 70% transmission rate. Only 3 women would not avoid pregnancy at the 100% transmission rate. These findings suggest that HIV-positive pregnant women need access to health care providers who are as comfortable respecting and supporting decisions to continue their pregnancies as they are referring them to abortion facilities.
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PMID:Reproductive preferences of pregnant women under shifting probabilities of vertical HIV transmission. 811 Dec 39

According to the World Health Organization, between 1980 and 1985 the total fertility rate was 2.0 in the wealthy countries and 4.1 in the less developed countries. The highest rate was found in Kenya with 8.1. The risk of maternal mortality in connection with pregnancy and childbirth was 1/10,000 in Northern Europe, but 1/21 in Africa. Every year about 500,000 women die because of complications before, during, or after delivery. The maternal mortality rate (30/100,000 live births in Europe) is still 500-800/100,000 in the developing countries, although Tanzania has succeeded in cutting its rate from 450/100,000 to 170/100,000. The main causes of maternal mortality are: 1) unrecognized obstructed labor, 2) postpartum bleeding that could be managed by massaging the uterus, administration of oxytocin or by the manual removal of the placenta, 3) postpartum infections that could be treated by timely administration of antibiotics, 4) preeclampsia that could be detected and treated, and 5) abortion complications requiring effective treatment. Among indirect causes of death is anemia: 66% of pregnant women in developing countries are anemic, compared to 14% in industrialized countries. So far the cause of the reduction of partial immunity against malaria parasites in primiparas has not been explained. A significant percentage of deaths (11-47%) can be traced to unqualified and negligent personnel, especially in the slums and rural areas. Only 52% of deliveries are attended by well-trained health personnel, although in 10% of pregnancies complications arise. Young age is another factor: in 1989 in Tanzania the first pregnancy occurred on the average at age 17.6 years compared to 27 years in England. In the beginning of the 1990s there were an estimated 3 million HIV-infected women, therefore maternal mortality as a consequence of AIDS is going to increase. In high prevalence areas the population growth rate will decline from 3% to 2.4%. Traditional birth attendants could be trained and used effectively to reduce maternal mortality by 3-11% as part of a functioning referral system.
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PMID:[Obstetrics in the Third World]. 811 19


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