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

Researchers analyzed 1991 data on 678 12-45 year old women attending either a university-based family planning clinic, 8 Planned Parenthood clinics, or the private practice or health maintenance organization clinic of 8 physicians in southeast Texas to determine the characteristics of these women who accepted Norplant shortly after its approval in the US and their overall attitude towards Norplant. Most acceptors were 25 years old (64.1%) and not married (67.4%). In fact, 45% were 21 years old which was higher than expected. Norplant was 1 of the first contraceptives used by 44% of the women. Further, these women had only recently chosen to prevent unplanned pregnancy. The mean family size was 1.2. 35 of the women did not want any more children. The remaining 67% used Norplant to space births. 32.5% of the women had experienced at least 1 abortion, which was significantly higher than the national adjusted rate. The leading reasons for choosing Norplant included dissatisfaction with previous methods (55.5%), its convenience (38.7%), and confidence in its effectiveness (20.8%). 44% of the women were not concerned about Norplant. The main concerns of the other women were pain during insertion (21.9%), menstrual changes (17.9%), and hormonal effects (16.2%). Further, 11.8% were worried about Norplant's effect on future pregnancies. Most women (61.1%) had previously used oral contraceptives (OCs). 5.3% had used no method in the last 3 months. 42.2% had used condoms either alone or with a spermicide. Yet, 48% of them would now either stop using them or use them sometimes. They constituted 40% of the unmarried women. This resulted in an increased risk of acquiring a sexually transmitted disease or HIV among 25% of the sample. Medicaid patients paid nothing for Norplant or its insertion. Patients who received Norplant via the physician training program paid nothing for Norplant but did for its insertion. Some clinic patients made required copayments of $9-$100. Private practice patients paid $500-$750 for Norplant and its insertion.
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PMID:Characteristics and attitudes of early contraceptive implant acceptors in Texas. 142 82

There is an emerging policy debate over the inclusion of Norplant incentives in welfare reform. Even if women were guaranteed access to the implant and payment for its removal were assured, the possibility of increased human immunodeficiency virus infection would remain a strong argument against its use. Although this article focuses on Norplant, many of the arguments apply to other long-acting contraceptives that may become available in the future.
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PMID:Implantable hormonal contraceptives: emerging controversy. 789 50

The author collected data on birth control and HIV infection among HIV-seropositive pregnant women in the obstetrics and gynecology department of Chonburi Hospital from January 1, 1990, through December 31, 1993. 137 of the 16,370 pregnant women attending the antenatal clinic over the period were found to be seropositive for HIV, while another 10 women not seen in the clinic were also positive, resulting in 147 women aged 17-40 years in the study. 90 women were housewives by occupation and 115 women were married. Women of gestational age less than 24 weeks were advised to abort their fetus, while women of gestational age over 24 weeks were allowed to deliver at full term. After termination of pregnancy or delivery, all HIV-seropositive women were advised on birth control methods such as tubal resection, oral contraceptive pills, injectable contraception, and Norplant. In addition to counseling on contraception, they were advised to use condoms with nonoxynol during each episode of sexual intercourse. The women were followed-up and their newborns tested for HIV. Newborns were not allowed to be breast fed. 27 of the women who were of gestational age less than 24 weeks decided to have abortions. Afterwards, 12 opted for tubal resection, 8 for oral contraception, 5 for injectables, and 2 for Norplant. Of 106 women of greater gestational age, 19 underwent tubal resection, 38 chose oral contraception, and 49 chose injectables after delivery. 35 babies born in 1990 and 1991 were followed, with 19 babies lost to follow-up and 5 of the 16 who received blood tests after 18 months testing HIV-seropositive.
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PMID:Management of HIV infected pregnant women in Chonburi Hospital. 784 96

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

A set of new guidelines were formulated by an expert group meeting in Sweden organized by the pharmaceutical office during March 31-April 1, 1993. It contains various methods to avoid an undesired pregnancy and also advice about postcoital contraception. Among barrier methods, the condom is the only reversible method for men with a method failure of 2 and user failure of 10. It protects against gonorrhea, chlamydia, condyloma, herpes simplex, HIV, and hepatitis B. The diaphragm can be used with a spermicide and protects to a lesser degree against chlamydia, gonorrhea, and cervical cancer. The female condom is as effective as the condom. Among spermicides, nonoxynol-9 is not only effective against sperms but also against bacteria, viruses, and certain vaginal and cervical cells. The vaginal sponge is impregnated with nonoxynol-9 and is effective up to 24 hours. The copper IUD, with a method failure of less than 1, can cause profuse menstrual bleeding, dysmenorrhea, and endometritis-salpingitis. Hormonal methods include combination pills (2-phase and 3-phase pills) and gestagen methods (high dose with 150 mg of medroxyprogesterone acetate injection every 3 months and low-dose minipills with levonorgestrel, norethisterone, or lynestrol). Mechanisms of action concern combination pills, gestagen methods, minipills, Norplant, and Levonova. Drug cross reaction can reduce effectiveness. Side effects include bleeding and amenorrhea. Risk-benefit determination is based on health effects. Possible risks are associated with breast cancer, cervical cancer, blood pressure increase, venous thromboembolism, and heart infarction. Various phases of the reproductive age include young women, lactating women, and women in the later part of the reproductive age. Special groups include those who have experienced ectopic pregnancy, infections (candida, sexually transmitted diseases: chlamydia trachomatis, HIV infections), obesity, cardiovascular diseases, diabetes mellitus, tumors of the reproductive organs, liver diseases, migraine, epilepsy, surgery, and handicapped women. Postcoital contraception is used only in need, and methods for postcoital contraception include hormonal method and the copper IUD.
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PMID:[Contraception. Recommendations from a group of experts]. 790 65

In the last decade, global use of contraceptive methods has increased. About 50% of couples of childbearing age use a modern contraceptive method. This evolution and a positive change in attitude towards male contraception has encouraged research in fertility regulation to enlarge and to improve acceptance of the contraceptive mix. Current injectable contraceptives interfere with the menstrual cycle. Research is exploring ways to minimize such secondary effects by reducing the total hormone dose and by changing the way the active product is delivered (e.g., microspheres). An injectable prototype is an analogue of levonorgestrel (HRP 002). A new IUD is made of leather suspended by a nylon suture which has been inserted into the uterine muscle. RU-486, often used to interrupt early pregnancy, is being tested as an oral contraceptive (OC). It inhibits secretion of gonadotropins and ovulation. It holds promise as an OC with no estrogen component. Since it also inhibits endometrial development and thus prevents implantation, it may someday be used for emergency contraception (i.e., postcoital contraception). New contraceptive implants under study include Norplant RII (2 rods of levonorgestrel lasting for 3 years), Implanon (desogestrel), and Capranor (biodegradable implant lasting 2 years). The female condom consists of a flexible polyurethane sheath with a flexible ring at each end. It has the potential to protect against sexually transmitted diseases since it covers the labial lips and is impermeable to HIV. France and Switzerland have both approved its use. It will enter the UK market at the end of the year. Approval for marketing has been sought in the US.
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PMID:[Contraception in the future]. 797 27

The long acting depot levonorgestrel, Norplant, satisfies the needs of women whose needs include long term protection against pregnancy, ample birth spacing, avoiding significant side effects found with other contraceptives, and using a contraceptive which does not require self or partner participation and is independent of timing of intercourse. Hundreds of teenagers have used it, but no published information on its use in teenagers exists. In an outpatient clinic, physicians insert 6 flexible silastic capsules with levonorgestrel (Norplant) under the dermis of the underside of the upper arm. Norplant suppresses ovulation and makes cervical mucus impassable to sperm. Levonorgestrel has already been available to women in progestin-only and combined oral contraceptives, but the change in delivery method has made Norplant the most effective, reversible, long term contraceptive available. Since patient compliance is not needed, it prevents pregnancies for 5 years. Thus, Norplant may be the ideal contraceptive for teenagers, especially since they experience a significant number of unplanned pregnancies in the US. Despite the many advantages of Norplant, 80% of users suffer heavy, irregular bleeding. This side effect leads many women to discontinue Norplant use. A potential problem is reduced condom use with Norplant, resulting in an increased risk of sexually transmitted diseases, e.g., HIV and hepatitis B. There is concern about the possibility of parents or health care workers coercing teenagers to use Norplant. Another concern is the encouragement its use by targeted groups. Health care workers must ensure that coerciveness does not happen. Norplant should be added to the contraceptive menus for teenagers, but only they should choose their contraceptive.
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PMID:Depot levonorgestrel (Norplant) use in teenagers. 843 76

In the US, recognition of the interaction between health and social issues has led to proposed social policies that would require health care professionals to implement the goals of other social agencies in ways which might compromise the effectiveness of their own work. Physicians are asked (and in some states mandated) to test pregnant women (without seeking their specific consent) for suspected drug abuse and to report results to child protective or criminal justice authorities. Physicians have also been asked to carry out legal mandates such as the insertion of contraceptive implants in women found guilty of child abuse. Insertion of Norplant has been proposed as a requirement for continuing receipt of welfare. However, the physician-patient relationship is based on informed consent (which has always invoked when medical personnel have provided evidence in cases involving rape or assault), on confidentiality (but courts have ruled against psychiatrists who failed to release confidential information that may have prevented a crime), and on the assumption that the physician will be an advocate for the patient's well-being. This assumption is compromised when physicians are asked to comply with laws that do not advance the individual's clinical need (to insert Norplant when it is contraindicated or to submit to a "gag rule" and not provide abortion counseling and referral). Resolution of the current debate about mandatory HIV screening of pregnant women will, therefore, impact the patient-physician relationship. The blurring of professional boundaries between the field of reproductive health and child protection has occurred because of cultural assumptions justifying actions as in the best interests of the child. Efforts to achieve interdisciplinary collaboration overlook contradictions (women may avoid prenatal care if it includes drug testing). Proposed policies should be assessed for their impact on the legal and ethical rights and obligations of patients and physicians, their immediate and long-term efficacy, and their consequences for the doctor-patient relationship and for medical integrity.
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PMID:Reproductive health and blurred professional boundaries. 893 62

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

A women-centered contraceptive research agenda was the focus of a 1996 Institute of Medicine Committee report. Priority was given to research on methods that act as a chemical or physical barrier to conception and to STDs including HIV; to menses inducers and once-per-month methods; and to male contraceptive methods. Much progress has been made since the 1996 report. This paper summarizes this progress. New research has been developed in the three priority areas, collaboration activities have been developed between the public and private sectors, and emergency contraception has been introduced to the US. Controversies are discussed in relation to immunocontraception, stem cell research and fetal tissue research. Finally there is a brief report on the lessons to be learned from the experience of the introduction of the implant, Norplant, in the US.
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PMID:Pushing the frontiers of science: reflections on an Institute of Medicine study. 1066 46


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