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

The increasing demand for fertility advice among human immunodeficiency virus (HIV)-positive women under our care led us to review the incidence of infertility and the ethical problems associated with its management. All HIV-positive women who attended the HIV outpatients clinic from October 1990 to the end of January 1996 were studied. The main outcome measures were: the number of women undergoing infertility investigations before and after HIV diagnosis, their demographic and social details, and the outcome of these investigations. Most of the 183 women studied were in their reproductive years (mean age 32.7 +/- 6.7 years). Nine women had undergone infertility investigations, and/or treatment before HIV diagnosis, three of whom were diagnosed with HIV during routine testing prior to IVF treatment. Six declined further infertility treatment after discovering their HIV status. Eight women have undergone infertility investigations after HIV diagnosis but none have achieved pregnancy to date. Management decisions may have been hampered by ethical uncertainties in several cases. In conclusion therefore, as requests for infertility treatment from HIV-infected women occur and may become more common as the prevalence of HIV infection in women continues to rise, the ethical issues associated with the management of this problem demand urgent attention so that clear guidelines are available to aid treatment decisions.
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PMID:Infertility among human immunodeficiency virus-positive women: incidence and treatment dilemmas. 913 Jul 30

During July 1991 to January 1992, in northern Tanzania, health workers conducted a physical examination of, interviewed, and screened 865 villagers aged 15-44 years for HIV-1 infection, sexually transmitted diseases (STDs), and other reproductive tract infections (RTIs) from Oria village at the foot of Mount Kilimanjaro to determine the spectrum and prevalence rates of STDs, other RTIs, and HIV as well as possible biological risk factors associated with HIV infection. Females were more likely to be HIV-infected than males (1.9% vs. 0.7%; odds ratio [OR] = 2.5). Women aged 25-29 years had the highest HIV infection rate (8.7%). Women were much more likely to have an STD (including HIV or other RTIs) than men (46.9% vs. 14.6%; OR = 5). Yet women were less likely than men to be ever treated for genital discharge (OR = 12.6). A history of syphilis, chlamydial infection, and pelvic inflammatory disease (PID) were more common in HIV-infected than HIV-negative women (ORs = 2.1, 2.4, and 1.9, respectively). Chlamydial infection and/or serological signs of past or current syphilis significantly increased the risk for HIV infection in females (OR = 2.7). Among men, risk factors for HIV infection included genital discharge and genital ulcer disease (ORs = 5.1 and 7.1, respectively). Among males, but not females, a medical history of previous treatment for genital discharge or for genital ulcer disease was a predictor of a current RTI (OR = 2 and 3.6, respectively). Among women, there was an association between syphilis and genital ulcer disease (OR = 4.5) and between PID and secondary fertility (OR = 2.1). 9.6% of men and 6.9% of women had chlamydial infection. 7.2% of women suffered from secondary infertility; 3.1% from primary infertility. These findings indicate a need for a more gender-specific approach to HIV and STD prevention, since women had a heavy burden of untreated RTIs.
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PMID:HIV and reproductive tract infections in a total village population in rural Kilimanjaro, Tanzania: women at increased risk. 905 26

Using a survey of family planning clinics in the continental United States that received Title X funding conducted by The Urban Institute in 1993, those clinics were identified that had made substantial efforts to serve male clients. The final sample size was 567 clinics. 10% of their clients were men and 31% reported that their male clientele had increased in the previous 5 years. During January through March 1995 follow-up telephone interviews were conducted with 25 selected clinics that reported a 10% male share of clients. The clinics were classified into 5 types: 1) 7 clinics with a family planning focus beginning to provide primary care to attract more men; 2) 7 clinics with a family planning focus using community outreach and the partners of female clients to recruit men for clinic services; 3) 6 primary health care clinics beginning to place more emphasis on male reproductive health; 4) 3 hospital-based clinics providing comprehensive and reproductive health care for young men; and 5) 2 school-based clinics providing sports physicals, primary health care, and reproductive health services. In Type 1 clinics males made up 10-40% of clients. They also screened for testicular cancer, and provided infertility, mental health, and nutrition counseling services. Type 2 clinics had an average of 10% male clients and offered male infertility services, nutrition counseling, and specific STD and HIV services for males in the Hispanic and immigrant communities. Type 3 clinics promoted the male role in family planning decision making and STD prevention. A substantial proportion of the clientele was low-income males, but men who came for vasectomies tended to have higher incomes. Type 4 clinics catered to 20-40% male clients with outreach programs for gay minority men, and sessions on stopping domestic violence, male role in family planning, and responsible parenthood. Type 5 clinics had 40-45% males and provided mental health counseling, HIV risk assessment, and screening for testicular cancer.
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PMID:Men at family planning clinics: the new patients? 910 9

Infertility is common in Africa. Anthropological studies conducted on the continent have found infertile women to have higher risks of marital instability and possibly more sex partners than fertile women. Findings are reported from a study conducted during 1994 and 1995 in a hospital in northwest Tanzania to determine the prevalence of HIV infection among infertile women. Women presenting with infertility problems to the outpatient clinic were interviewed, examined, and blood was drawn. Women who came to deliver in the hospital, excluding primiparae, comprised the control group. A total of 154 infertile and 259 fertile women were included in the study, all age 24 years and older. 18.2% of infertile women and 6.6% of fertile women were infected with HIV. Data on past sex behavior indicated that infertile women had more marital breakdowns, more lifetime sex partners, and a higher level of exposure to sexually transmitted diseases.
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PMID:HIV infection and sexual behaviour among women with infertility in Tanzania: a hospital-based study. 916 79

A prospective observational study over a 6-month period on women presenting with infertility was conducted at King Edward VIII Hospital (KEH), South Africa. The aim of the study was to establish the patient profile and investigations performed on women presenting with infertility. One hundred women were recruited. The mean age of the women was 31 years and 60% had secondary infertility. The mean duration of infertility was 7.2 years; 61% had histories suggestive of pelvic inflammatory disease and approximately half (49%), had had previous infertility investigations; 16% of the women were HIV (human immunodeficiency virus) antibody positive and 16% had positive syphilis serology. Tubal factors were identifiable in 77%, ovulatory factors in 21% and uterine factors in 21%. Male factor infertility was present in 21%. The study confirms that in developing countries, tubal factors are the commonest cause of infertility.
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PMID:Infertility profile at King Edward VIII Hospital, Durban, South Africa. 970 Feb 83

Clinically, it is important to detect mycoplasmas because these organisms have been implicated in gastric and ovarian cancer, pneumonia, postabortal fever, pelvic inflammatory disease, pyelonephritis, endometritis, urethritis, perinatal mortality, arthritis, spontaneous abortion, infertility and interference with sperm development and they act as cofactors catalyzing the HIV disease state. Recently, the combined polymerase chain reaction and enzyme-linked immunosorbent assay method targeting the consensus DNA of over 15 species of mycoplasmas was shown to be superior for the detection of mycoplasmas. The objective was to determine if there was an association between mycoplasmas and cervical neoplasia. Cervical tissues, histopathologically categorized by cervical intraepithelial neoplasia (CIN) grade, flat or exophytic, and acanthosis or koilocytotic, were used. The results showed that mycoplasmas DNA were present in 21.4% of the condyloma tissues and in 33.3% of condyloma tissues with CIN. In contrast, mycoplasmas DNA were not detected when there were no CIN. The presence or absence of human papillomavirus (HPV) did not make a difference. Mycoplasmas DNA were present in 40.0 and 12.5% of the exophytic and flat condylomas, respectively. A higher percentage of cervical tissues graded with slight koilocytosis had (P = 0.05) mycoplasmas DNA compared with tissues graded with moderate koilocytosis. The detection of mycoplasmas DNA in archived cervical condyloma tissues with CIN corroborated previous reports of an association between mycoplasmas and CIN. However, the association between mycoplasmas and the presence of HPV could not be made in this study.
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PMID:Assessment of archived paraffin-embedded cervical condyloma tissues for mycoplasma-conserved DNA using sensitive PCR-ELISA. 982 68

Sexually transmitted diseases have the greatest impact on the health of women. They are frequently asymptomatic, so screening for infection is important in preventing the long-term sequelae which include infertility, ectopic pregnancy, and chronic pelvic pain. HIV continues to increase in the female population and the gynecologic complications associated with it are unique to this population. Use of zidovudine in pregnant HIV-infected women has substantially decreased the rate of vertical transmission of HIV infection. The epidemiologic synergy between HIV and STDs is well recognized and prevention of one is dependent on prevention of the other.
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PMID:Sexually transmitted diseases and HIV. A female perspective. 989 93

In Sub-Saharan Africa, reproductive health care research and interventions as well as AIDS prevention and STD (sexually transmitted disease) control programs all place a disproportionate emphasis on women and ignore the equally important role of men. STD risk and incidence increased in the region as labor migration of husbands became necessary and the number of sexual partners for both men and women increased. In many cases, the sex behavior of married men is the main risk factor for their wives. Research into STDs and HIV has provided what is known about male sexual behavior, and AIDS has highlighted the importance of behavior in disease transmission and contraception. While HIV risk awareness is increasing, few men report condom use or appropriate changes in their behavior to minimize their risk. The female bias in family planning (FP) programs ignores the fact that in this setting men often control the contraceptive usage of their wives and adolescent children. Inclusion of men in counseling programs has led to an increase in contraceptive usage among their wives, and some data suggest that men are susceptible to change initial biases against FP. FP programs that offer infertility services are also more likely to be accepted, and whereas the women are usually blamed by their husbands for infertility, the husbands in infertile couples should be examined first. Research into sexual relationships, sex behavior, condom acceptance, and cultural constructs surrounding STD and HIV transmission is necessary and should be accomplished using a wide range of data collection methods.
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PMID:Reproductive health and AIDS prevention in sub-Saharan Africa: the case for increased male participation. 1015 80

Laboratory services of the early 21st century will be heavily influenced by significant demographic redistributions and shifts in the incidence and prevalence of disease. A persistent influx of immigrants literally will change the face of the U.S. population. Persons born between 1946 and 1964 will reach middle and old age and will require testing for arthritis, diabetes, cardiac dysfunction, Alzheimer's disease, and stroke. Efforts to combat infertility will expand. Tuberculosis, wrongly assumed to be under control, will continue to proliferate. Testing will be needed for the millions of people living with AIDS and for the millions more infected or suspected to be infected with HIV. Cancer screening and information from genetic markers will widen. Public screenings will be routinely offered in assorted sites. As the national focus shifts from curing illness to promoting health, laboratory tests will assess healthy persons to a greater degree than ever.
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PMID:Changing disease patterns, shifting demographics: effects on laboratory services. 1017 18

The current annual population growth rate of 3.2% in Africa will double the population by the year 2025. The majority of this population is below 15 years of age, and Africa concurrently also has the highest incidence of infertility in the world. Sexual behaviour, which has been poorly studied in Africa, has a direct impact on reproductive health [including fertility, infertility and sexually transmitted diseases (STDs)]. The multiple cultures and religions which characterize the African continent also affect reproductive health. Factors that have a significant effect on reproductive health in Africa include greater prevalence of extramarital/commercial sexual activity, polygamy, lower prevalence of contraceptives, reliance on traditional practices, high incidence of STDs and teenage pregnancies. High risk reproductive behaviours are predominantly displayed by adolescents, and the prevalence of STDs, including HIV (human immunodeficiency virus), is very high in this group. Pregnancy-related complications are the major cause of health-related problems in 15-19 year old girls. Maternal mortality rates in most countries remain high. Literacy rates affect these behaviours. It is apparent that changing the sexual behaviour of adolescents is one way of reversing the adverse trends, such as STD transmission, unwanted pregnancy and poor general reproductive health.
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PMID:Current status of reproductive behaviour in Africa. 1033 65


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