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Query: UMLS:C0019693 (HIV)
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10-20% of all pregnancies in most developing countries and in some developed countries (e.g., US) occur in adolescents. The number of such pregnancies is steadily rising. Adolescent pregnancies tend to be high risk pregnancies. Many adolescent pregnancies are unwanted and unplanned and often occur to unmarried youth. They often end in legal or illegal abortion, practiced under poor medical and psychological conditions. The health consequences of adolescent pregnancy and even the consequences on one's life are grave: death and morbidity (e.g., infertility). Education programs on sexually responsible behavior prevent unwanted pregnancies and sexually transmitted diseases (STDs). Youth are uncertain about family planning. Hormonal contraceptives perfectly suit youth with no contraindications (e.g., cardiovascular conditions). They are reversible and do not affect future fertility. IUDs tend to be contraindicated for youth due to risk of pelvic infection or infertility. Condoms protect against STDs and AIDS. Diaphragms and cervical caps are not well suited for youth because these barrier methods depend on prior knowledge about having sexual intercourse and require manipulations a bit complicated for youth. Periodic abstinence is difficult to use when menstrual cycles are irregular and because sexual intercourse is unexpected. Youth cannot depend on withdrawal because male youth are not used to practicing it. Spermicides have no contraindications but can be costly for youth. They also do not protect against HIV. Jamaica has a reception center for young mothers, which aims to get mothers to return to school. Young fathers also participate in center activities. The center provides confidential information on contraception. The Family Guidance Association of Ethiopia targets urban street-youth. It distributes condoms and diaphragms while educators provides counseling. It hopes to next have voluntary educators throughout Addis Ababa.
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PMID:[Adolescents]. 1231 71

"The aim of this study was to examine people's beliefs about the causes of marital instability in a rural population cohort in south-west Uganda. Results from a baseline survey of HIV-1 infection in the cohort of over 4,000 adults (over 12 years old) showed a twofold increase in risk of infection in divorced or separated persons when compared with those who are married. A purposive sample of 134 respondents (seventy-two males, sixty-two females) selected to represent different ages, religions and marital status were asked in semi-structured interviews to comment on the reasons for continuing marital instability in their community. The most common reasons suggested for marital instability were sexual dissatisfaction, infertility, alcoholism and mobility....HIV infection was not mentioned as a direct cause of separation, but a small independent study revealed that seven out of ten couples separated on learning of a positive HIV test result of one or both partners. Marital instability is not uncommon in this population; there is evidence that HIV infection is making the situation worse." (SUMMARY IN FRE)
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PMID:Marital instability in a rural population in south-west Uganda: implications for the spread of HIV-1 infection. 1232 88

Each year as a consequence of pregnancy and delivery at least 500,000 women die, 99% of them in developing countries. Most maternal deaths are avoidable. For each death, 10-15 other women suffer serious health effects which may lead to chronic pain or even social isolation. Childbirth is riskier for women who are too young or too old, who have many children, or whose births are too closely spaced. Limiting family size reduces both maternal and child deaths. In developed countries, 5-30 women die per 100,000 births, compared to 50-800 in developing countries. Maternal mortality rates at 2 hospitals in Yaounde, Cameroon, have declined significantly in recent years, probably due to establishment of high risk pregnancy clinics, improved monitoring during labor, and child spacing clinics. Improved obstetric services and child spacing could reduce maternal mortality in developing countries as they have in the developed world. The use of contraception has been a controversial topic in traditional African societies, but by now the majority of governments of developing countries include family planning programs in their development plans for their health as well as their economic benefits. Despite gradual increases, fewer than 5% of women in most African countries use modern contraception. African men play an insignificant role in family planning. The continuing practices of prolonged lactation and postpartum abstinence in rural areas have compensated to some extent for the absence of modern contraception. Oral contraceptives are the most widely used reversible method. They may protect against vaginal infection, iron deficiency anemia, ectopic pregnancy, benign breast disease, ovarian and endometrial cancer, dysmenorrhea, endometriosis, and rheumatoid arthritis. There is evidence that some steroid hormones have a beneficial effect in stabilizing the cellular membranes of red blood cells in women with sickle cell anemia. The danger of infection with the IUD is largely limited to the 1st 4 months of use and to women with sexually transmitted diseases. Careful selection of candidates, aseptic insertion, and regular follow-up are needed to ensure IUD safety. The IUD is contraindicated for nulliparas. Barrier methods provide contraception as well as some protection against sexually transmitted diseases. Condoms have a significant protective effect against HIV infection. Diaphragms, cervical caps, and vaginal sponges provide some protection against infections like gonorrhea and chlamydiae that invade the cervical cells. Many adolescents resist condoms because they diminish sensation. But condoms provide protection against sexually transmitted diseases and are appropriate for individuals with sporadic sex lives. Oral contraceptives are more effective but adolescents are at risk of forgetting pills. IUDs are the least attractive option for adolescents because of the danger of infection and subsequent infertility.
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PMID:[High risk pregnancies and family planning]. 1234 59

Much attention has recently been given to the serious health implications of AIDS, hepatitis B infection and the human papillomavirus. In spite of these, syphilis/gonorrhea are still the most common of the "old" sexually transmitted diseases (STDs) and syphilis is, with the exception of AIDS, the STD with potentially the most destructive sequelae. Recent observations indicate that syphilis may be an important cofactor in facilitating transmission of HIV. A history of syphilis or a positive serologic test for syphilis is associated with HIV seropositivity in men. Although the incidence of syphilis in the UK is 1 of the lowest in the world, syphilis is increased in most countries. In several areas of the US there has been a dramatic increase in the prevalence of syphilis and in some first-world areas congenital syphilis is now considered epidemic. Syphilis is considerably more common in Africa than in Europe/US. Syphilis is also prevalent in most developing countries. The worldwide resurgence of syphilis has a serious implication on neonatal morbidity. The aim of this study was to evaluate the seroprevalence of syphilis in men attending and infertility clinic. Blood samples from 782 males were screened using the titrated RPR/TPHA tests. If either of these tests was positive, FTA-Abs IgG was performed. The RPR was positive in 63 (8%) cases. In 24 (3%) patients the titer was or= 1/8 with positive TPHA and FTA-Abs IgG tests and these were regarded as current infections. 39 (5%) cases had RPR titers 1/8 with positive specific tests (Table 1). These were probably patients either treated inadequately, or in the early stage of primary syphilis. In addition 92 (2%) patients were RPR negative but TPHA and FTA positive. This was evidence of previous exposure to syphilis. The overall seropositivity in this group was 20% (155 cases). 627 (80%) tested negative with RPR and TPHA. Syphilis may still have a major impact on health in Southern Africa. Since syphilis is significantly associated with HIV seropositivity, efforts to prevent and control syphilis may also be important in limiting HIV spread. The 3-8% incidence of active disease among an asymptomatic group of men, referred for evaluation of infertility underlines the statement that "serologic screening should be done at the least indication". A community-based program with continuous adequate screening and treatment would be of great help. While the absolute yield for such screening may be low, the potential for reducing the morbidity and mortality of congenital syphilis is great. (full text)
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PMID:Syphilis serology in men at an andrology clinic in South Africa. 1234 7

This work argues that contraceptive education urgently requires a new approach that will take into account the client's sexuality at the time the choice of method is made. Emotional factors such as a conscious or unconscious desire for pregnancy or motherhood, family pressures to produce a grandchild, or shame and distrust of contraception may contribute to contraceptive failure. Methods applied at the time of coitus such as condoms or spermicides may not be appropriate for clients for who contraception is a source of anxiety or guilt. The more effective, noncoital-dependent methods including oral contraceptives (OCs), IUDs, and sterilization may generate anxiety over infertility. Their efficacy may lack appeal for clients who enjoy an element of risk. The practitioner's attitude and knowledge may be further influences on the counseling over method choice. Among reversible methods, OCs are ideal for most women as long as they individually prescribed. OCs may be particularly important to the sexual expression of specific groups such as those over 35 with no risk factors other than age. Low-dose progestin-only OCs may be prescribed for this group, although about 10% of users change methods because of menstrual problems. IUDs are usually successfully used by women who have been carefully selected to exclude contraindications. In some cases the partner may be annoyed by the string, which can be rolled up and pushed out of the way or shortened by the practitioner. IUDs are often the best alternative for women with contraindications to OCs or who tolerate their side effects poorly. Spermicides may cause dermatoses or allergies that cause the woman to avoid intercourse. Some women dislike using spermicides because they must be applied prior to each use. Their bad taste is a disadvantage for some couples. Involving the male partner in application of the spermicide may remove some objections. The Billings or cervical mucus method should be avoided by women with irregular cycles and those who are reluctant to touch their genitalia. Diaphragms and cervical caps can be inserted by the male partner is desired. Menstrual extraction, insertion of an IUD within 72 hours of unprotected intercourse, or use of sufficiently high dose of oral hormones prevent pregnancy in most cases, but should not be relied upon for routine contraception. Much misinformation persists about the side effects of female sterilization, which is said to cause weight gain or sexual problems or to be followed inevitably by total hysterectomy. Most women are satisfied with the operation and express no regrets. Although reversal rates are improving, sterilization should be considered definitive. Condom use remains limited despite some increases related to fear of HIV infection. Condoms may increase performance anxiety in some men. Couples should be taught to use condoms in a more sensual manner. Withdrawal is still widely used throughout the world despite lack of esthetics appeal and high failure rate.
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PMID:[Contraception and sexology]. 1234 92

To be effective and acceptable, family planning programs must directly confront sexual and reproductive health needs. In turn, this requires creation of an environment conducive to raising and discussing questions in this area through the provision of education, counseling skills, and support to staff. At greatest need of attention to sexual issues are unmarried women under 20 years of age. Over 50% of young women in sub-Saharan Africa and Latin America give birth before the age of 20 years, and pregnancy-related complications are the leading cause of death among teenagers in these regions. Unsafe abortion is especially prevalent among Latin American teenagers, but is preventable through sexual and contraceptive education and services and the legalization of safe abortion. In addition, family planning programs have a responsibility to promote condom use among young girls to prevent sexually transmitted diseases and the sequelae of pelvic inflammatory disease, infertility, and greater susceptibility to human immunodeficiency virus infection. Finally, family planning programs in Egypt and parts of Africa must make the elimination of female genital mutilation an integral effort given its tremendous threat to women's physical and psychological health.
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PMID:A global picture. Overview. 1234 67

HIV-positive individuals are often discriminated against in the health care system because of their sexual orientation and practices, especially when HIV-positive people are interested in conceiving, bearing, and raising children. Providers get uncomfortable and admonish or become angry with clients while possibly inflating their intent. After such encounters, clients often do not return to providers for future counseling. Fertility services should never be denied on the basis of socioeconomic status, sexual orientation, marital status, or HIV status. To that end, the author describes a harm reduction model approach most often used with injection drug users. Harm reduction is a philosophy in which the professional health care provider sets aside all judgements in order to meet clients at their own level regarding a problem or crisis. The professional also commits to help the client with technical information toward achieving the client's goal. The setting aside of judgements allows clients' goals to be considered and entertained without bias. After all, we all engage in risk-taking behaviors. Harm reduction techniques improve client/provider relationships and allow an opportunity for intervention. The model will facilitate providing support for achieving healthy sexual and reproductive responses in HIV-positive clients. The author discusses the harm reduction model in sexual counseling, applying the technique, initiating discussions regarding childbearing goals, and interventions for heterosexual couples, single women/lesbians, lesbian couples, single men/gay men, and infertility work-ups.
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PMID:Applying harm reduction to sexual and reproductive counseling. A health provider's guide to supporting the goals of people with HIV / AIDS. 1234 62

A year after refugees from Liberia began arriving in Ghana in 1990, the National Council on Women and Development arranged a meeting to discuss the introduction of family planning (FP) services to the refugees who were increasingly concerned about an increase in adolescent pregnancies and worried about the spread of sexually transmitted diseases (STDs) and HIV infection. The Planned Parenthood Association of Ghana (PPAG) agreed to provide reproductive health education and nonclinical contraceptives. By 1993, the PPAG built a clinic at the camp in order to offer clinical services to the refugees. Settlers soon became well informed about FP, but only 56 clients used contraceptives. By 1993, this figure increased to 120 with a further 217 obtaining FP supplies from pharmacies. 149 women used oral contraceptives, 110 used injectable contraceptives, and 140 used condoms. The project is currently expanding to deal with STDs and women with infertility problems. In 1994, efforts to involve men will intensify through the formation of "Daddies' clubs" and through the use of men as community-based distributors.
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PMID:Taking services to refugees in Ghana. 1234 37

The number of women who learn of their HIV seropositivity and still want to have a child is growing. If the woman is HIV seropositive, pregnancy is not advised, but it is difficult if not impossible to prevent a young woman from a having wanted child. No rational argument can suppress this desire that the life-threatening illness exacerbates. The counselor must consider the clinical and immune status of the mother, the serostatus and health status of the partner, and the likelihood of family members raising the child. If the woman is HIV seronegative and her partner is HIV seropositive, the counselor must first make sure that the women does not seroconvert and that her desire for a child is real. Then the counselor must evaluate the partner's clinical and immune status. The risk of HIV transmission to the woman increases with the degree of immune suppression of the partner. It is also important to determine the stability of the discordant couple because about 33% separate after childbirth. It is only after having analyzed all these elements that the counselor and the couple can consider one of the proposed solutions. Since techniques of sperm decontamination having not yet been established, the decision is boiled down to extreme solutions: artificial insemination with sperm from an HIV negative donor or, after a spermogram and hysterography, the natural method involving intercourse only during successive periods of ovulation. The partner needs to take zidovudine to reduce the amount of sperm ejaculated. In case of pregnancy, it is necessary to recognize seroconversion, an indication for AZT. ELISA and studies on p24 antigenemia must be conducted each month of the pregnant woman. Couples must continue to use condoms after the delivery because a seroconversion would nullify all earlier efforts. Breast feeding can transmit HIV to the infant. Professional guidelines forbid tubal infertility surgery and in vitro fertilization in couples where the woman or man is HIV infected. The opinion of the French National Ethics Commission will be sought on less invasive infertility therapy.
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PMID:[HIV seropositivity and desire for children]. 1234 36

According to World Health Organization estimates, there are 333 million new cases of sexually transmitted diseases (STDs) each year. The total number of reproductive tract infections (RTIs) is even higher since these infections may have few visible symptoms, especially in women. Left untreated, however, RTIs can lead to infertility. Common symptoms include: unusually thick or foul-smelling vaginal or urethral discharge, genital sores, anal sores, genital itching, pain when urinating and during sexual intercourse, painful swelling in the lymph glands or groin, and lower abdominal pain. The open sores associated with STDs such as syphilis, chancroid, and genital herpes greatly increase the risk of HIV transmission, as may STDs such as gonorrhea that are associated with urethral or vaginal discharge. To facilitate the prompt diagnosis and treatment of RTIs, this article briefly describes the diagnosis and long-term effects of gonorrhea, syphilis, chancroid, chlamydia, pelvic inflammatory disease, genital herpes, genital warts, candida, and bacterial vaginosis.
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PMID:Common infections. 1234 38


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