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

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

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

A prospective cohort study of Norplant use in the immediate postpartum period among asymptomatic HIV-1-positive women was conducted in Bangkok, Thailand. The objectives of this study were to evaluate side effects and menstrual patterns of the Norplant system in this group. A total of 88 asymptomatic HIV-1-positive mothers were recruited for this study. All of them voluntarily accepted the use of the Norplant implant as a contraceptive method immediately postpartum. Their mean age was 24.9 years. Most of them had completed primary school. The follow-up period was 24 weeks. There were eight participants lost from the study because of loss of contact. Irregular bleeding was the most common menstrual pattern in these participants. The major side effects were headache, followed by hair loss. No subject terminated Norplant use during the study period. The Norplant implant appears to be safe and well tolerated in asymptomatic HIV-1-positive parturients when inserted immediately postpartum.
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PMID:Use of Norplant implants in the immediate postpartum period among asymptomatic HIV-1-positive mothers. 1153 12

Couples in the Philippines are free to choose the family planning method that best satisfies their health needs and religious beliefs. All service delivery outlets of the Philippines Department of Health and participating agencies should have all approved, safe, effective, and legal family planning methods available. Oral contraceptives (OCs), IUDs, tubal ligation, and vasectomy are at least 92% effective. OCs protect against pelvic infection and reduce the risk of ovarian and uterine cancer. Older OC users who smoke face an increased risk of blood clotting, stroke, and heart attack. The progestogen-only pill is the best OC for lactating women. The IUD can be effective for 6 years assuming no pain or other side effects. Breast feeding mothers can use the IUD safely. IUD contraindications are anemia, active cervical or pelvic infection, abnormal vaginal bleeding, and genital cancer. Condoms protect against pregnancy as well as sexually transmitted diseases, including HIV/AIDS. When practiced correctly, natural family planning methods are 70-90% effective. They are the cervical mucus method, basal body temperature method, sympto-thermal method, and breast feeding. Norplant contraceptive implants are available to Philippine women on a trial basis. They release a progestin slowly into the blood stream, suppressing ovulation and thickening cervical mucus. The long-acting contraceptive injectables are DMPA, Cycloprovera, and HRP 102. Women must receive an injection every 3 months to protect against pregnancy. The first injection should occur within the first 5 days of the menstrual cycle. Women choosing tubal ligation and men choosing vasectomy should be sure in their decision because they are permanent methods and sterilization reversal procedures are rare in the Philippines. Men with diabetes, an infection at the incision site, clotting disorders, enlarged or painful testicles, and an inguinal hernia should not have a vasectomy.
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PMID:The family planning methods. 1217 21

At least 8 new male contraceptives have emerged and most can be used now, but little promotion of these new methods has occurred. No-scalpel vasectomy developed in China consists of a small puncture instead of an incision through which the health worker either cuts or blocks the vas deferens. This technique is safer and heals faster than the conventional technique. The Association for Voluntary Surgical Contraception has a list of US physicians trained in this technique. Another new male contraceptive is injection of chemicals in the vas deferens thereby blocking sperm movement. It is permanent. Research in China shows the injectable plug in the vas deferens to be an effective, potentially reversible method. Similarly the surgically implanted "shug" performs the same purpose as the injectable plug and has the same potential to be reversible. Another method is injection of a spermicide into the vas deferens which temporarily brings about infertility. Animal trials indicate it is safe and effective. Human trials are now going on in India and will soon be underway in the US. The wet heat method has been known since the 4th century B.C. It involves placing the testes in hot water (116 degrees Fahrenheit) for 45 minutes every night for 3 weeks. This provides protection for 6 months. A similar method is artificial cryptorchidism where men wear special underwear during the day to keep the testes inside the inguinal canal which increases their temperature. Applying ultrasound to the testes for 10 minutes once every 6 months also brings about azoospermia. Ultrasonography requires physician intervention but wet heat and artificial cryptorchidism do not. Funding agencies have not provided monies to male contraception research, claiming men are not committed to contraception, yet vasectomies comprise 12% of global contraceptive use. Another excuse is that new male contraceptives do not prevent HIV transmission but neither does Norplant. Men should familiarize themselves with the new male contraceptives and then pressure authorities to sponsor their research and development.
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PMID:New nonhormonal contraceptive methods for men. 1228 17

The US Food and Drug Administration (FDA) has notified the manufacturers of oral contraceptives, IUDs implantable and injectable contraceptives, and natural membrane (lambskin) condoms that labeling accompanying their products must state in clear language displayed prominently that they do not provide protection from sexually transmitted diseases (STDs) including AIDS. FDA is taking this action as part of ongoing education efforts to reduce the risk of HIV infection and other STDs in sexually active individuals, particularly adolescents and young adults. Since 1987, FDA has strongly recommended that the labeling on latex condoms provide information regarding their effectiveness in preventing pregnancy and protecting users from STDs. Oral contraceptives, Norplant, Depo Provera, natural membrane (lambskin) condoms, and IUDs are intended to prevent pregnancy and do not protect against HIV infection (AIDS) and other STDs. If used properly, latex condoms will help to reduce the risk of transmission of HIV infection (AIDS) and many other STDs. This message is to appear on individual condom wrappers, as well as on the outer package. FDA, is conjunction with the National Institutes of Health and the national Centers for Disease Control and Prevention, is currently reviewing the scientific literature to determine whether the labeling for other contraceptives, such as spermicides, cervical caps, diaphragms, and the newly approved female condom should be changed as well.
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PMID:New labeling to provide information about contraceptives and STDs. 1228 98

The US Food and Drug Administration approved the contraceptive implant Norplant in December 1990. Many US physicians and nurse practitioners have received training in inserting the implant, but few health educators know enough about Norplant and potential users to provide adequate education and counseling. The 6-capsule system steadily releases 50-80 mg levonorgestrel into the bloodstream for five years for a contraceptive effectiveness rate greater than 99%. Levonorgestrel keeps the pituitary gland from releasing two hormones needed for ovulation, thickens the cervical mucus, and suppresses endometrial development. Irregular bleeding is the most common side effect. Contraindications for Norplant include liver tumors, active liver disease, breast cancer, active thrombophlebitis, unexplained uterine bleeding, pregnancy, blood clots in the eyes or lungs, diabetes, hypertension, and cigarette smoking. Advantages are its 5-year effectiveness period, that it is easy and convenient to use, does not require compliance, and is reversible. Disadvantages are that it offers no protection against sexually transmitted diseases, especially HIV/AIDS; it requires a surgical procedure; and its cost ($500-$750/patient). Few studies present a profile of US women using Norplant. Potential users are adolescents, vulnerable women, low income women with children, and women who do not want to become pregnant for a long time but do not consider the pill or sterilization viable options. Extensive research indicates that Norplant is safe in the short and intermediate term. More research is needed to identify the demographic profile of a typical user, why she chooses Norplant, how well she understands it, or whether she was well informed about it; to learn about satisfaction with Norplant; and to find out who discontinues Norplant before the end of 5 years. This information would help health educators in their counseling and education strategies.
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PMID:Norplant: what health educators need to know. 1228 63

Researchers are developing new progestin-only contraceptives that are more appealing and may improve safety for certain users than such existing progestin methods as injectables (e.g., DMPA), the contraceptive implant Norplant, and progestin-only contraceptive pills (POPs). Progestin-only vaginal methods (rings and suppositories) allow users control over when to start and to discontinue their use. After removal of vaginal rings, the progestin level decreases within 24 hours and fertility returns quickly. Potential concerns about rings include expulsion, interference with intercourse, cervical changes, vaginal irritation, infection, and that they are more expensive to produce than other methods. A vaginal suppository being developed by the Contraceptive Research and Development Program is inserted daily, regardless of intercourse, and releases the natural female hormone progesterone. New implant systems should ease insertion and removal (e.g., a 2- or 1- rod vs. the existing 6-rod system) or avoid the need for removal (e.g., 4-5 biodegradable rice-grain-sized capsules of norethindrone and cholesterol). New injectable contraceptives have a lower amount of hormone than do other injectables without compromising the high contraceptive effectiveness. There is a need for more research on long-term effects of progestins (e.g., cardiovascular effects) as well as on whether progestins affect HIV transmission and whether DMPA has any effect on bone density. Another issue is how to reduce menstrual irregularities among users of progestin-only methods. The US National Institute of Child Health and Development has commissioned five new studies to address menstrual irregularities. The new progestin Nestorone (ST-1435), may be more beneficial for lactating mothers because it is not readily absorbed into an infant's system. It is being used for vaginal rings, implants, and a transdermal contraceptive cream. The IUD that releases levonorgestrel may prevent pregnancy for up to five years.
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PMID:New approaches seek greater safety, appeal. 1228 31

Key issues that must be considered before a new contraceptive is introduced center on the need for a trained provider to begin or terminate the method, its side effects, duration of use, method's ability to meet users' needs and preferences, and extra training or staff requirements. Logistics and economic issues to consider are identifying a dependable way of effectively supplying commodities, planning extra services needed for the method, and cost of providing the method. Each contraceptive method presents a different side effect pattern and burdens the service delivery setting differently. The strategy developed to introduce or expand the 3-month injectable Depo-Provera (DMPA) can be used for any method. It includes a needs assessment and addresses regulatory issues, service delivery policies and procedures, information and training, evaluation, and other concerns. Viet Nam's needs assessment showed that Norplant should not be introduced until the service delivery system becomes stronger. Any needs assessment for expansion of contraceptive services should cover sexually transmitted disease/HIV issues. A World Health Organization strategy helps officials identify the best method mix for local situations. Introductory strategies must aim to improve the quality of family planning programs and expand choices. Many begin by examining existing data and conducting interviews with policymakers, users, providers, and women's health advocates. Introductory programs for Norplant focus on provider training, adequate counseling and informed consent for users, and ready access to removal. They need a well-prepared service delivery infrastructure. The first phase of the DMPA introductory strategy for the Philippines comprised a social marketing campaign and DMPA introduction at public clinics in 10 pilot areas with strong service delivery. Successful AIDS prevention programs show that people tend to use barrier methods when they are available. USAID is currently studying whether or not women in developing countries will use the female condom.
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PMID:Introduction strategies raise key questions. 1229 Apr 71


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