Article

HIV and Reproduction: Fertility, Contraception, and Preconception Issues and Interventions

Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Infectious Diseases in Obstetrics and Gynecology 12/2012; 2012(rr-4):736864. DOI: 10.1155/2012/736864
Source: PubMed
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Available from: Susan Cu-Uvin, Jan 22, 2014
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    ABSTRACT: Advances in HIV treatment and prevention of mother to child transmission have effectively reduced mortality and morbidity for women living with HIV and significantly reduced new infections in infants. Women living with HIV require comprehensive, integrated clinical services to address their reproductive and maternal healthcare needs. Guidelines for safer conception counseling with fertile couples recommend discussing fertility and childbearing, addressing contraception with those not wishing to conceive, and clarification of strategies to conceive for those wishing to do so. Services pre-conception to postpartum should emphasize HIV testing for mother, partner and infant, encourage the maintenance of medication adherence and promote engagement and retention in care, and ensure supportive and non-judgmental patient education by healthcare providers. Behavioral, psychosocial and healthcare factors can have profound effects on pregnancy outcomes, and male involvement and enhanced provider involvement throughout the reproductive process has been recommended to reduce transmission and enhance medication adherence and uptake.
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    ABSTRACT: Background Male injecting drug users drove the onset of the HIV epidemic in Indonesia but over time more women have been diagnosed. We examined the relative proportion of female patients in an HIV cohort and characterized their probable transmission route and reproductive profile. Designs Prospective cohort study in a referral hospital in West Java. Methods Interviews with standardized questionnaires, physical and laboratory examinations were done for 2622 individuals enrolled in HIV care between 2007 and 2012. The proportion of women in this cohort was compared with national estimates. The general characteristics of HIV-infected women and men as well as the sexual and reproductive health of HIV-infected women were described. Results The proportion of female patients enrolled in HIV care increased from 22.2 % in 2007 to 38.3 % in 2012, in line with national estimates. Women were younger than men, fewer reported a history of IDU (16.1 vs. 73.8 %, p < 0.001) and more were tested for HIV because of a positive partner (25.5 vs. 4.0 %, p < 0.001). The majority of women were in their reproductive age, had children, and were not using contraceptives at the time of enrolment. Conclusion HIV-infected women in Indonesia have specific characteristics that differ them from women in the general population. Further research to elucidate the characteristics of women exposed to HIV, their access to testing and care and sexual and reproductive needs can help reduce transmission to women and children in the context of concentrated HIV epidemic in Indonesia.
    Full-text · Article · Dec 2015 · BMC Research Notes