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

Mortality is the greatest concern in assessing risks of modern reversible contraception. The problems identified with older oral contraceptives (OCs) have decreased with the lower doses in current OCs. These problems include cardiovascular and thrombotic effects, changes in lipid metabolism, breast cancer, liver cancer, increased risk of chlamydia cervicitis, no protection against sexually transmitted diseases (STDs) and HIV, and interferes with breast feeding. On the other hand, OCs protect against anemia, menstrual disorders, ectopic pregnancy, acute pelvic inflammatory disease (PID), and ovarian and endometrial cancer. Since the contraceptive implant, Norplant, has no estrogens, it does not have the cardiovascular risks associated with OCs. Possible risks from Norplant use include changes in carbohydrate, liver, and lipid metabolism but they tend to be clinically insignificant and no protection against STDs/HIV. Menstruation disorders are the major side effect. Apparent benefits of Norplant are protection against anemia and ectopic pregnancy and no effect on lactation. The injectable contraceptive, Depo-Provera, causes menstrual changes, may slightly increase the risk of breast cancer, may decrease bone density, and does not protect against STDs/HIV. It protects against endometrial cancer. It has no effect on metabolism. Risks associated with the IUD include PID, perforation, anemia, increased menstrual bleeding, and pregnancy. IUDs do not affect the quantity of composition of breast milk. They are best suited for women in a mutually monogamous, long-term relationship. Barrier methods provide some degree of protection against STDs/HIV and PID. Condoms provide the most protection. They do not affect lactation. Their major complications are contraceptive failure and risks associated with pregnancy. For all women, especially those in high risk categories, one must balance the risks of modern contraceptive use with the risks of childbearing and with their benefits.
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PMID:The safety of modern contraceptives. 784 6

The current literature on the transmission of HIV and the use of oral contraceptives (OCs), injectables, IUDs, spermicides, and the female condom was reviewed. Some of the methodological difficulties involved study design (observational studies, cross-sectional, case control, and prospective studies) and confounding factors (age, marital status, sexual partners). The impact of OC use on HIV transmission is likely to be minor, but some factors contributing to transmission include cervical ectropion, which enhances HIV transmission. Nevertheless, in a 1990 Nairobi study of 4404 women no such association was detected. Sexually transmitted diseases (STDs) have been risk factors in HIV transmission. OCs that decrease irregular bleeding may protect against HIV. Progestin-only pills could act on the risk of HIV transmission by thickening cervical mucus and thinning the vaginal epithelial layer. 21 epidemiological studies were identified on the use of OCs and transmission. Except for a 1990 Nairobi study among prostitutes none of them reported a significant association between OC use and HIV seropositivity. Injectables (Depo Provera) could theoretically increase HIV transmission, but no such conclusive evidence has surfaced. Increased risk of transmission or seropositivity has been reported with IUD use, but this needs confirmation by prospective studies. Among spermicides the nonoxynol-9 sponge slightly increased HIV seroconversion in 139 sex workers in Nairobi in a 1992 study. However, this trial was contradicted by other prospective studies conducted in Cameroon and Zambia. Nonoxynol-9 kills HIV but also damages the cervical and vaginal mucosa enhancing HIV transmission. In 1992 in vitro activity in 26 out of 131 other spermicides screened inhibited HIV. The female condom was tested in 104 women in a 1993 prospective study in the US and no recurrences of trichomonas occurred in 20 women who used it consistently over a 6-week period. More prospective epidemiological studies are needed, and the risk of HIV infection should be part of counseling on contraceptives.
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PMID:Contraceptive methods and the transmission of HIV: implications for family planning. 820 68

During May 10-July 20, 1993, clinic staff interviewed 3136 women aged 12-45 attending 13 family planning clinics in southeastern Texas so researchers could determine the frequency of condom use for prevention of sexually transmitted diseases (STDs) in women using other forms of contraception for pregnancy prevention. 30% had had unprotected intercourse at least once in the last month. Clients who planned to always use a contraceptive method in the future increased from 58% to 83% after counseling. After counseling, 31% planned to always use a condom in the future. Before the visit, 10% had always used a condom. After counseling, condom use with oral contraceptives, IUD, diaphragm, cervical cap, implants, Depo Provera, or sexual sterilization increased from 28% to 42%. 35% of clients used condoms when they thought that protection was needed. 72% were currently in a monogamous relationship. 10% considered themselves not at risk of HIV. Women with one sexual partner tended to think that they were not at risk of HIV or not concerned about HIV. They were much less likely to intend to use condoms in the future with another method than their counterparts. Three women had HIV infection. 4% had genital herpes. 13% had had another STD. 260 women (8%) had had intercourse with partners engaging in risky behavior. 47% of clients had at least one risk factor for HIV (e.g., recent STD). After counseling, condom use increased among clients with risk factors for HIV. These same clients were also more likely to use condoms than those with no risk factors. 17% of these clients planned to reduce condom use in the future, however. 22% of clients planned to decrease condom use in the future and use a contraceptive method to protect against pregnancy rather than STDs. These findings show that many women at risk for STDs who request contraception do not protect themselves from STDs, indicating an additional unmet need. The researchers suggest that there should be research and development for intervention methods for women at risk for STDs who stop using condoms when they receive another contraceptive method.
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PMID:A cross-sectional survey of condom use in conjunction with other contraceptive methods. 858 24

Risk testing for HIV serostatus is unlikely to detect more than 20% of HIV-positive pregnant women. Of the 11 pregnant women discovered to be HIV-infected at Port Moresby General Hospital in Papua New Guinea in 1994-95, only four had more than two sexual partners since 1992 and none was an intravenous drug user. The deleterious effect of pregnancy on HIV disease progression appears to be small but variable, with more serious effects in the later stages of disease. The risk of vertical transmission increases when viral loads are high, the general maternal condition is poor, and delivery is preterm. In developing countries, where HIV-infected pregnant women are likely to be malnourished and to have concomitant infections such as malaria and tuberculosis, the risks of preterm labor, small-for-gestational age infants, and chorioamnionitis are increased. HIV-related gynecologic conditions such as pelvic inflammatory disease, vulvovaginal candidiasis, and cervical neoplasia may be resistant to treatment and tend to recur. Pregnancy prevention through effective contraceptive methods such as Depo-Provera and tubal ligation may be more important to HIV-infected women than prevention of viral transmission, especially when both partners are seropositive.
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PMID:HIV infections in obstetrics and gynaecology. 979 61

The case presented in this paper suggests that the levonorgestrel intrauterine system may be an excellent contraceptive method for HIV-positive women. At presentation to a UK family planning clinic, a 32-year-old nulliparous woman was using Depo-Provera for contraception; however, she was bleeding irregularly and complained of acne and lack of vaginal lubrication. The Mirena intrauterine system was considered because it offered lighter menstrual periods or amenorrhea, no need for regular clinic visits, reliable contraception, and fewer systemic side effects than other progestogen-only methods. At follow-up 6 weeks after Mirena insertion, the woman reported one light period, pain on the day of fitting only, and no progestogenic side effects. The reduced blood loss associated with this method is beneficial if mild anemia is present and may reduce exposure of an HIV-negative male partner to infected blood. Moreover, the system's effectiveness is not compromised by the broad-spectrum antibiotics or liver enzyme-inducing drugs taken by women with HIV/AIDS.
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PMID:Successful use of levonorgestrel intrauterine system in a HIV positive woman. 1022 47

The female condom is the latest in a series of sexual and reproductive technologies to be imported into the third world, following the contraceptive pill, the Depo-Provera injection, the latex male condom, and others. It is an example of "traveling technology", which accrues different meanings and connotations in the different settings into which it is introduced in its journey through the circuits of international technological diffusion, from the headquarters of international NGOs and bilateral aid programs, through the bureaucracies of national ministries of health to the communities in urban and rural settings where the condoms are distributed. The female condom almost always carries connotations of women's empowerment, and the possibility of greater sexual autonomy for women. This association is a result of the female condom being the first new "post-Cairo" technology, the diffusion of which was spurred by the consensus reached at the 1994 International Conference on Population and Development in Cairo, at which the need to promote women's empowerment was moved to the center of international family planning and population movements. However, I demonstrate that "empowerment" is an ambiguous term, interpreted in different ways in different contexts. I illustrate this through interviews conducted in 1998 and 1999 with stakeholders in the female condom in Cape Town, Nairobi, and in rural western Kenya. These stakeholders range from directors of US-based development programs to heads of national AIDS-prevention efforts to community-based distributors and primary health care nurses at the village level. I argue that three different notions of empowerment are being articulated with respect to the female condom--two which correspond to Maxine Molyneux's typology of strategic and practical gender interests, and a third in which women's empowerment is conceived of as something which diminished the power of men. I argue further that the disjunctures between these three different notions of what "empowerment" means will pose a challenge for people at all levels which are seeking to make the female condom more widely accessible to women at risk of HIV/AIDS.
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PMID:"It's some kind of women's empowerment": the ambiguity of the female condom as a marker of female empowerment. 1121 80

The National Institute of Child Health and Human Development (NICHD) in Bethesda, MD, is conducting a study on how various contraceptives affect HIV transmission. Diaphragms and cervical caps are effective contraceptive shields, but are less reliable against pregnancy and sexually transmitted diseases than the male condom. NICHD is evaluating a new customized cervical cap that would be fitted in one visit by a health care provider. Other contraceptives, including a modified diaphragm, a vaginal sponge, and vaginal ring that would release a contraceptive hormone, are also in development. Only three new contraceptives have been approved this decade: the female condom; Norplant, a hormonal implant; and Depo-Provera, an injectable hormone. The NICHD is also investigating whether the use of hormonal contraceptives increases HIV risk. The agency recently reported that the physiologic effects of hormonal contraceptives may affect HIV transmission.
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PMID:Contraceptives' role in HIV transmission is examined. 1136 41

Several small studies conducted by the Centers for Disease Control and Prevention (CDC) have shown that although progesterone appears to increase the likelihood of simian immunodeficiency virus (SIV) transmission in exposed monkeys, women using hormone contraceptives do not appear to have the same increased risk for HIV. The results, published in the May issue of Science, show little, if any, increase in the rate of HIV infection in women on Depo-Provera, an injectable contraception containing progestin, compared to those who were not taking it. Another study, conducted in Thailand, found similar results. However, this contrasts sharply with the results of a monkey study that found that rhesus monkeys given progesterone experienced significant thinning of the vaginal wall. Researchers are examining the effects of progesterone on the lining of the vagina. Researchers are finding some thinning, but not to a significant degree. The CDC continues to stress that only abstinence or the use of latex condoms can prevent the spread of AIDS.
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PMID:Progesterone-HIV link questioned by new studies. 1136 49

After a recent study showing that monkeys given progesterone are more likely to acquire simian immunodeficiency virus (SIV), women's reproductive health experts are advising clinicians to stress the importance of condom use and calm worried women by pointing out that other studies are needed to understand the relationship between hormones and HIV risk. Researchers have learned that progestin causes a thinning of the vaginal wall--possibly an explanation for the increase in SIV infection in the monkey study. Because Depo-Provera and Norplant are long-acting progestin-based contraceptives, women using them to prevent pregnancy may be especially alarmed by reports of the monkey study. Women should be advised that using these contraceptives do protect them from pregnancy; women should assess the risk of contracting HIV or other sexually transmitted diseases; and women should modify their behavior to lower their risk.
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PMID:Advice for women seeking progesterone counseling. 1136 50

An animal study with rhesus macaque monkeys showed that those who received subcutaneous progesterone implants were 7.7 times more likely to become infected with SIV. The findings raised strong concerns about two contraceptives on the market that contain progesterone, Depo-Provera and Norplant. The findings are not necessarily applicable to humans, and further research is needed to learn how hormones affect HIV transmission in women. Researchers caution that the findings do not merit a woman changing her birth control method.
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PMID:The influence of hormones and HIV genital transmission in women. 1136 34


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