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Nkulu-Kalengayi FK, Hurtig AK, Linander I. "Discrimination is harder to live with than the disease": an interview study of the perceptions and experiences of sexual and reproductive health and rights among women living with HIV in Sweden. Sex Reprod Health Matters 2023; 31:2245197. [PMID: 37671828 PMCID: PMC10484027 DOI: 10.1080/26410397.2023.2245197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Around 40% of people living with human immunodeficiency virus (HIV) in Sweden are women. However, little is known about their experiences, particularly those related to sexual and reproductive health and rights (SRHR). This study aims to explore perceptions and experiences of SRHR among women living with HIV (LWH). Twelve interviews were conducted with women LWH from September to October 2019 and analysed using thematic analysis. The central theme describing participants' experiences of social relationships, intimate encounters and reproductive life, "Discrimination is harder to live with than the disease itself", is based on three themes that contain subthemes. Theme 1 describes how participants reconsider and reorient their sexual and reproductive life after diagnosis. Theme 2 highlights how (mis)perceptions of HIV affect sexual and reproductive life and lead to abusive treatment and internalisation. Theme 3 describes a paradoxical shift of responsibilities where participants experience being compelled to take greater responsibility in some situations and stripped of the right to decide in others. This study suggests that despite notable progress in HIV treatment, stigma and discrimination stemming from outdated beliefs and (mis)conceptions, ambiguous policies and guidelines, and unequal access to information affect SRHR experiences of women LWH more than the virus itself. The results emphasise the need to: update knowledge within healthcare settings and among the public; clarify ambiguous legislations and guidelines; ensure equal access to information to enable all women LWH to take informed decisions, make fully informed choices and realise their SRHR; and consider the diversity of women LWH and enable shared decision-making.
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Affiliation(s)
| | - Anna-Karin Hurtig
- Professor, Department of Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden
| | - Ida Linander
- Associate Professor, Department of Epidemiology and Global Health, Umeå University, Umeå SE-901 87, Sweden
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Igerc I, Schrems B. Sexual well-being needs of patients with chronic illness expressed in health care: A scoping review. J Clin Nurs 2023; 32:6832-6848. [PMID: 37323097 DOI: 10.1111/jocn.16773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/22/2022] [Accepted: 05/17/2023] [Indexed: 06/17/2023]
Abstract
AIMS To systematically identify and summarize the needs of chronically ill people concerning their sexual well-being in peer-reviewed published literature, to enable healthcare professionals to provide support in self-management satisfying the needs. DESIGN A scoping review was performed according to the framework of (JBI Manual for Evidence Synthesis. JBI Global Wiki, 2020). Findings are reported in line with the PRISMA extension for scoping reviews. REVIEW METHODS A literature search and thematic analysis were conducted. DATA SOURCES Full research was carried out in 2022 in the search engine BASE and the following databases: Scopus, MEDLINE, Science Citation Index Expanded, Social Sciences Citation Index and CINAHL. Peer-reviewed articles published after 2011 were included. RESULTS Fifty articles could be found. Seven categories of needs could be identified. People with chronic diseases want their providers to initiate discussions about sexual concerns and treat them trustfully and respectfully. Most of the patients would like the issue of sexuality to be included in routine care. They perceive their medical specialists and psychologists as preferred providers to talk to about this issue. Nurses are seen as primary contact persons but in a smaller number of studies. CONCLUSION Although the scoping review included different types of chronic diseases, the needs of chronically ill patients concerning their sexual well-being are not very different. Healthcare professionals, especially nurses, who are often the first point of contact for people with chronic illnesses, should take the initiative for open discussions about sexual issues. That requires a new understanding of the role of nurses, training and further education. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Providing patient education and facilitating an open discussion about sexuality require further training in the new understanding of the role of the nurse and the concept of sexual well-being. IMPACT What problem did the study address? Chronic diseases have an impact on patients' sexuality. Patients want to be informed about sexual issues, but providers often do not address them. What were the main findings? Patients with a chronic condition expect providers to initiate discussions about sexual well-being, regardless of the type of chronic disease. Where and on whom will the research have an impact? The research will impact healthcare professionals', especially nurses', future educational standards and ultimately patients. REPORTING METHOD PRISMA extension for scoping reviews. NO PATIENT OR PUBLIC CONTRIBUTION Not required as it was a literary work (scoping review).
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Affiliation(s)
- Irina Igerc
- Department of Nursing Science, University of Vienna, Vienna, Austria
| | - Berta Schrems
- Department of Nursing Science, University of Vienna, Vienna, Austria
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Rodriguez S, Yaya I, Huntingdon B, Juraskova I, Preau M, Etemadi F, Dimi S, Carrieri MP, Bessonneau P, Chassany O, Duracinsky M. Positive relations between sexual quality of life and satisfaction with healthcare in women living with HIV and/or HCV: Results from a multicountry study. PLoS One 2023; 18:e0278054. [PMID: 36662750 PMCID: PMC9858467 DOI: 10.1371/journal.pone.0278054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/08/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The sexual quality of life is a neglected concern in women living with HIV (WHIV) or with HCV (WHCV), which can further be affected by their experience with stigma, social instability, fear of transmission and reduced access to treatment. The objective of this study was to identify sociodemographic, psychosocial, and behavioural factors associated with sexual quality of life (SQoL) in this study group. METHODS Between December 2017 and December 2018, PROQoL-Sex Life questionnaire was administered to 404 WHIV and WHCV in five countries. PROQoL-SQoL consists of four dimensions: positive sexual perception (Psp), stigma and social distress (Sti), soft sexual practices (Sof), sexual practices with a partner (Sp), all of which were scored from 0 to 100 and considered as main outcomes, lower scores mean better sexual quality of life. Linear mixed effects models were used to evaluate the association with sociodemographic and psychosocial factors. RESULTS Of the participants analyzed, 191 were living with HCV, 180 with HIV and 33 with HIV and HCV, median age was 48. Among WHIV, a higher satisfaction with health care, and talking about sexuality with healthcare workers were associated with lower scores in all the dimensions of the SQoL, while psychoactive substance use was associated with lower scores of Sti and Sof. Moreover, higher satisfaction with health care, talking about sexuality with healthcare workers, and psychoactive substance use (except cocaine use) in WHCV were associated with lower scores in Psp, Sti, and Sof. Besides, cocaine use was associated with higher scores of Sof. CONCLUSION This study highlighted strong relationship between the quality of health care, and psychoactive substance use (except cocaine) and the sexual quality of life in WHIV and WHCV in these five countries. These findings draw attention to the different interventions that can be proposed for improving the sexual quality of life.
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Affiliation(s)
- Sara Rodriguez
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Issifou Yaya
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- Patient-Centered Outcomes Research Unit, UMR 1123, INSERM, Université de Paris, Paris, France
| | - Ben Huntingdon
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ilona Juraskova
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, New South Wales, Australia
| | - Marie Preau
- Groupe de Recherche en Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France
| | - Fatima Etemadi
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Svetlane Dimi
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Maria Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Pascal Bessonneau
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- Patient-Centered Outcomes Research Unit, UMR 1123, INSERM, Université de Paris, Paris, France
| | - Olivier Chassany
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- Patient-Centered Outcomes Research Unit, UMR 1123, INSERM, Université de Paris, Paris, France
| | - Martin Duracinsky
- Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- Patient-Centered Outcomes Research Unit, UMR 1123, INSERM, Université de Paris, Paris, France
- Département de Médecine Interne et d’Immunologie Clinique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
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de Souza MR, Guimarães RA, do Amaral WN, da Cunha VE, de Moura BDM, Barbosa MA, Brunini SM. Reproductive Desire in Women Living with HIV/AIDS with Serodiscordant Partners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113763. [PMID: 36360643 PMCID: PMC9655051 DOI: 10.3390/ijerph192113763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To estimate the prevalence and factors associated with reproductive desire in a sample of women living with HIV/AIDS (WLHA) with serodiscordant partners. STUDY DESIGN Between September 2015 and August 2016, a cross-sectional study was conducted among 110 WLHA from HIV/AIDS treatment services and non-governmental organizations. An interview was conducted using a structured questionnaire to collect sociodemographic data, reproductive desire, and potential predictor variables. Poisson regression was used to analyze the factors associated with reproductive desire in the sample. RESULTS The prevalence of reproductive desire was 32.7% (95% Confidence Interval: % CI: 24.7-42.0%). In regression analysis, we observed an association between reproductive desire and the following variables: age < 30 years; relationship time < 2 years; reproductive desire for the partner; and absence of children. CONCLUSIONS The prevalence of reproductive desire in the investigated sample was relatively high. Young age and reproductive desire for the partner were the main associated factors.
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Affiliation(s)
- Marise Ramos de Souza
- Curso de Enfermagem, Universidade Federal de Jataí, Jataí 75801-615, GO, Brazil
- Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
| | - Rafael Alves Guimarães
- Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
| | | | | | | | - Maria Alves Barbosa
- Faculdade de Medicina, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
- Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
| | - Sandra Maria Brunini
- Faculdade de Enfermagem, Universidade Federal de Goiás, Goiânia 74690-900, GO, Brazil
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ter Haar A, Fieten A, Van den Hof M, Malekzadeh A, Laan E, Oostrom K, Pajkrt D. Sexual Development in Perinatally HIV-Infected Young People: A Systematic Review and Explorative Study. Sex Med 2022; 10:100578. [PMID: 36274460 PMCID: PMC9780776 DOI: 10.1016/j.esxm.2022.100578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Similar to other young people with a chronic health condition, perinatally HIV-infected (PHIV) adolescents may have an impacted sexual development. OBJECTIVES This paper aims to compare sexual milestones of PHIV to HIV uninfected peers, through a systematic review (SR) and explorative study. METHODS We performed a systematic search in 4 electronic databases (Medline, Embase, Web of Science, and Scopus), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Last search in all databases was performed in May 2021. We included studies that reported on quantitative data of any of the main outcomes and compared PHIV to HIV uninfected control groups. Main outcomes were defined as the occurrence and/or debut age of sexual milestones (falling in love, having been in a romantic relationship, masturbation, kissing, non-genital caressing (feeling or petting, touching), genital caressing (fingering, handjob), giving or receiving oral sex, and penetrative sex (vaginal or anal). We excluded case reports, audits, guidelines, editorials, abstracts, studies that reported on behaviorally infected HIV patients, studies that did not include an HIV uninfected control group and studies that could not be translated to English or Dutch. We used the Agency for Health Care Research and Quality (AHRQ) Checklist for quality assessment. We performed qualitative synthesis of the data. In the explorative study, we compared sexual milestones of PHIV and HIV uninfected controls matched for age, sex, ethnicity and educational level, using a subset of questions of a validated questionnaire. RESULTS We included eighteen studies in the SR, describing outcomes of an estimated 1,963 participants. Seventeen studies compared the occurrence and/or debut age of intercourse in PHIV and HIV uninfected controls and 4 studies reported on any of the other sexual milestones. The majority of studies found no difference in occurrence (12 of 16 studies) or debut age (6 of 8 studies) of intercourse in PHIV compared to controls. Two of 4 studies reporting on any of the other milestones found no significant differences between PHIV and HIV uninfected controls. In the explorative study, we included ten PHIV participants and 16 HIV uninfected, matched controls. PHIV tended to report a later debut age of sexual milestones than controls (not significant). STRENGTHS AND LIMITATIONS The SR includes only a small number of studies and few studies report on non-penetrative milestones. The explorative study adds to this review by including non-penetrative milestones and comparing PHIV to HIV-uninfected, well-matched controls. However, the sample size was small. CONCLUSION PHIV seem to engage in sexual activities and achieve sexual milestones at a similar rate as their HIV uninfected peers, with a tendency of a later start in well treated PHIV. The review was registered in the PROSPERO database (CRD42021252103) and funded by AIDSfonds. AIDSfonds had no role in the study design or interpretations of this study. ter Haar AM, Fieten A, Van den Hof M, et al. Sexual Development in Perinatally HIV-Infected Young People: A Systematic Review and Explorative Study. Sex Med 2022;10:100578.
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Affiliation(s)
- A.M. ter Haar
- Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, The Netherlands,Corresponding Author: A. M. ter Haar, MSc, Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9 1105 AZ Amsterdam. Tel: +31 20 56 8668; Fax: +31 (0)20 5669683
| | - A. Fieten
- Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, The Netherlands
| | - M. Van den Hof
- Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, The Netherlands
| | - A. Malekzadeh
- Department of Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E.T.M. Laan
- Department of Sexology and Psychosomatic Gynecology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, The Netherlands
| | - K.J. Oostrom
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, The Netherlands
| | - D. Pajkrt
- Pediatric Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, The Netherlands
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Skerritt L, Kaida A, Savoie É, Sánchez M, Sarmiento I, O’Brien N, Burchell AN, Bartlett G, Boucoiran I, Kestler M, Rouleau D, Loutfy M, de Pokomandy A. Factors and Priorities Influencing Satisfaction with Care among Women Living with HIV in Canada: A Fuzzy Cognitive Mapping Study. J Pers Med 2022; 12:jpm12071079. [PMID: 35887575 PMCID: PMC9320512 DOI: 10.3390/jpm12071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Engagement along the HIV care cascade in Canada is lower among women compared to men. We used Fuzzy Cognitive Mapping (FCM), a participatory research method, to identify factors influencing satisfaction with HIV care, their causal pathways, and relative importance from the perspective of women living with HIV. Building from a map of factors derived from a mixed-studies review of the literature, 23 women living with HIV in Canada elaborated ten categories influencing their satisfaction with HIV care. The most central and influential category was “feeling safe and supported by clinics and healthcare providers”, followed by “accessible and coordinated services” and “healthcare provider expertise”. Participants identified factors that captured gendered social and health considerations not previously specified in the literature. These categories included “healthcare that considers women’s unique care needs and social contexts”, “gynecologic and pregnancy care”, and “family and partners included in care.” The findings contribute to our understanding of how gender shapes care needs and priorities among women living with HIV.
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Affiliation(s)
- Lashanda Skerritt
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (A.K.); (M.S.)
| | - Édénia Savoie
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Margarite Sánchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (A.K.); (M.S.)
- Viva Women, Vancouver, BC V5Z 0C9, Canada
| | - Iván Sarmiento
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
| | - Nadia O’Brien
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (N.O.); (D.R.)
| | - Ann N. Burchell
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada;
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Isabelle Boucoiran
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC H3T 1C5, Canada;
| | | | - Danielle Rouleau
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada; (N.O.); (D.R.)
| | - Mona Loutfy
- Women’s College Research Institute, Toronto, ON M5S 1B2, Canada;
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC H3S 1Z1, Canada; (L.S.); (I.S.); (G.B.)
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Correspondence: ; Tel.: +1-514-843-2090
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Mezones-Holguín E, Arriola-Montenegro J, Cutimanco-Pacheco V, Al-Kassab-Córdova A, Niño-García R, Zeta LA, Urrunaga-Pastor D, Blümel JE, Chedraui P, Pérez-López FR. Low sexual function is associated with menopausal status in mid-aged women with human immunodeficiency virus infection. Menopause 2022; 29:317-326. [PMID: 35213519 DOI: 10.1097/gme.0000000000001914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the association between menopausal status and female sexual function among mid-aged women with human immunodeficiency virus (HIV) infection. METHODS We carried out a cross-sectional study of 221 sexually active HIV-infected women ages 40 to 59 years, based on a secondary analysis of a three-hospital survey in Lima, Perú. We classified menopausal status according to Stages of Reproductive Aging Workshop criteria (STRAW+10); this exposure variable was categorized as binary (non-postmenopausal and postmenopausal) and-for exploratory analysis-as multinomial (pre-, peri-, and postmenopausal). We defined low sexual function (LSF) using the 6-item Female Sexual Function Index (total score ≤19). Socio-demographic and clinical variables were assessed, including age, used highly active antiretroviral therapy scheme, disease duration, depressive symptoms, and co-morbidities. We performed Poisson generalized linear models with a robust variance to estimate 95% confidence interval (CI), crude prevalence ratios (cPRs), and adjusted prevalence ratios (aPRs) by epidemiological and statistical approaches using nonparametric method of bias-corrected and accelerated bootstrap resampling with 1,000 repetitions. RESULTS Studied women had a median age of 47.0 years (interquartile range: 7.5); 25.3% were premenopausal, 25.8% were perimenopausal, and 48.9% were postmenopausal. Also, 64.3% had LSF. The frequency of LSF was 53.6% in non-postmenopausal and 75.0% in postmenopausal women. Postmenopausal status was associated with LSF in both the crude (cPR = 1.39; 95% CI: 1.13-1.71) and the adjusted regression models (aPR = 1.38; 95% CI: 1.12-1.71). CONCLUSIONS HIV-infected postmenopausal women have a higher prevalence of LSF than those non-postmenopausal ones, even when adjusting for multiple potential confounders.
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Affiliation(s)
- Edward Mezones-Holguín
- Universidad San Ignacio de Loyola, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Perú
- Epi-gnosis Solutions, Piura, Perú
| | - José Arriola-Montenegro
- University of Minnesota, Internal Medicine, Minneapolis, MN
- Universidad Peruana de Ciencias Aplicadas, Facultad de Ciencias de la Salud, Lima, Perú
| | | | - Ali Al-Kassab-Córdova
- Universidad Peruana de Ciencias Aplicadas, Facultad de Ciencias de la Salud, Lima, Perú
| | - Roberto Niño-García
- Universidad Nacional de Piura, Sociedad Científica de Estudiantes de Medicina (SOCIEMUNP), Piura, Perú
| | - Ludwing A Zeta
- Universidad Nacional de Piura, Sociedad Científica de Estudiantes de Medicina (SOCIEMUNP), Piura, Perú
| | | | - Juan E Blümel
- Universidad de Chile, Facultad de Medicina Sur, Santiago de Chile, Santiago, Chile
| | - Peter Chedraui
- Universidad Católica de Santiago de Guayaquil, Facultad de Ciencias Médicas, Instituto de Investigación e Innovación en Salud Integral, Guayaquil, Ecuador
| | - Faustino R Pérez-López
- University of Zaragoza, Faculty of Medicine, Department of Obstetrics and Gynecology, Zaragoza 50009, Spain
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Moseholm E, Aho I, Mellgren Å, Pedersen G, Katzenstein TL, Johansen IS, Bach D, Storgaard M, Weis N. Psychosocial health in pregnancy and postpartum among women living with - and without HIV and non-pregnant women living with HIV living in the Nordic countries - Results from a longitudinal survey study. BMC Pregnancy Childbirth 2022; 22:20. [PMID: 34996383 PMCID: PMC8740861 DOI: 10.1186/s12884-021-04357-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum. METHODS In a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019-2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum. RESULTS A total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis. CONCLUSIONS A high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.
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Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Hvidovre, Denmark. .,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Inka Aho
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Åsa Mellgren
- Department of Infectious Diseases, Region Vestra Gotland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Diana Bach
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Carter A, Gormley B, Muchenje M, Zhu D, Patterson S, Kestler M, Hankins C, Logie CH, Brotto LA, Tharao W, Lee M, Li J, Ding E, de Pokomandy A, Loutfy M, Kaida A. Prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. WOMEN'S HEALTH 2022; 18:17455065221074877. [PMID: 35088623 PMCID: PMC8801632 DOI: 10.1177/17455065221074877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We assessed the prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. Methods: We analyzed cross-sectional survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (2017–2018). Self-identified women living with HIV were asked about sexual concerns post-HIV diagnosis and associated distress (none, mild, moderate, severe). Five areas of concern were assessed, including difficulties related to sexual self-esteem, sexual function, relationships, and emotional and behavioral aspects of sex. Logistic regression analyses identified correlates of reporting any sexual concerns and severe distress about these concerns. Results: Of 906 participants (median age 48, Q1–Q3 = 41–55), 596 (65.8%) reported sexual concerns post-HIV diagnosis. We found a high prevalence of concerns related to relationships (43.3%), sexual self-esteem (49.4%), and emotional aspects of sex (45.4%), relative to sexual functioning (38.4%) and behavioral aspects (33.7%). Of those with sexual concerns, 36.7% reported severe distress. Reports of severe distress were the highest for relationship difficulties (32.5%), relative to other areas of concern (21.4%–22.8%). In adjusted analyses, women reporting sexual dissatisfaction and high HIV-related stigma had significantly higher odds of reporting sexual concerns. Conversely, those reporting higher resilience, better mental health, African, Caribbean, and Black identity, and sex as somewhat unimportant, not at all important, or neutral to their lives had lower adjusted odds. Factors associated with severe distress about sexual concerns included older age, body dissatisfaction, sexual dissatisfaction, and high HIV-related stigma, while better mental health and getting support from someone living with HIV were protective. While 84.4% of women had discussed with a provider how viral load impacts transmission risk, only 40.6% had conversations about sexual wellbeing. Conclusion: More attention to women’s sexual wellbeing within social and relational contexts is critical to ensure the sexual rights of women living with HIV are upheld.
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Affiliation(s)
- Allison Carter
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Becky Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marvelous Muchenje
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Denise Zhu
- Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Sophie Patterson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Mary Kestler
- Division of Infectious Diseases, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
| | | | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jenny Li
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | | | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
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Huertas-Zurriaga A, Palmieri PA, Aguayo-Gonzalez MP, Dominguez-Cancino KA, Casanovas-Cuellar C, Linden KLV, Cesario SK, Edwards JE, Leyva-Moral JM. Reproductive decision-making of Black women living with HIV: A systematic review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221090827. [PMID: 35404192 PMCID: PMC9006353 DOI: 10.1177/17455057221090827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Black women living with HIV account for a higher proportion of new HIV diagnoses than other groups. These women experience restricted access to reproductive services and inadequate support from healthcare providers because their position in society is based on their sexual health and social identity in the context of this stigmatizing chronic disease. By recognizing the analytical relevance of intersectionality, the reproductive decision-making of Black women can be explored as a social phenomenon of society with varied positionality. OBJECTIVE The purpose of this review was to synthesize the evidence about the reproductive decision-making of Black women living with HIV in high-income countries from the beginning of the HIV epidemic to the present. METHODS This systematic review was guided by the JBI evidence synthesis recommendations. Searches were completed in seven databases from 1985 to 2021, and the review protocol was registered with PROSPERO (CRD420180919). RESULTS Of 3503 records, 22 studies were chosen for synthesis, including 19 observational and three qualitative designs. Nearly, all studies originated from the United States; the earliest was reported in 1995. Few studies provided detailed sociodemographic data or subgroup analysis focused on race or ethnicity. Influencing factors for reproductive decision-making were organized into the following seven categories: ethnicity, race, and pregnancy; religion and spirituality; attitudes and beliefs about antiretroviral therapy; supportive people; motherhood and fulfillment; reproductive planning; and health and wellness. CONCLUSION No major differences were identified in the reproductive decision-making of Black women living with HIV. Even though Black women were the largest group of women living with HIV, no studies reported a subgroup analysis, and few studies detailed sociodemographic information specific to Black women. In the future, institutional review boards should require a subgroup analysis for Black women when they are included as participants in larger studies of women living with HIV.
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Affiliation(s)
- Ariadna Huertas-Zurriaga
- Àrea de Suport a la Recerca en Cures, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
| | - Patrick A Palmieri
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- South American Center for Qualitative Research, Universidad Norbert Wiener, Lima, Perú
- College of Graduate Health Studies, A.T. Still University, Kirksville, MO, USA
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
| | - Mariela P Aguayo-Gonzalez
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Karen A Dominguez-Cancino
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Escuela de Enfermería, Universidad Científica del Sur, Lima, Perú
- Escuela de Salud Pública, Universidad de Chile, Santiago de Chile, Chile
| | - Cristina Casanovas-Cuellar
- Àrea de Suport a la Recerca en Cures, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Kara L Vander Linden
- Department of Research, Saybrook University, Pasadena, CA, USA
- Glaser Center for Grounded Theory, Institute for Research and Theory Methodologies, Poway, CA, USA
| | - Sandra K Cesario
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, TX, USA
| | - Joan E Edwards
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, TX, USA
| | - Juan M Leyva-Moral
- Evidence-Based Health Care South America: A JBI Affiliated Group, Lima, Peru
- Center for Global Nursing, Texas Woman’s University, Houston, TX, USA
- Department d’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad y Salud (GRIVIS), Universitat Autònoma de Barcelona, Barcelona, Spain
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11
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Moseholm E, Aho I, Mellgren Å, Johansen IS, Storgaard M, Pedersen G, Scofield D, Katzenstein TL, Weis N. The experience of pregnancy among women living with HIV in Nordic countries: A qualitative narrative enquiry. WOMEN'S HEALTH 2022; 18:17455065211068688. [PMID: 34983258 PMCID: PMC8744157 DOI: 10.1177/17455065211068688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: The success of antiretroviral therapy has resulted in the normalization of
pregnancy among women living with HIV and a very low risk of perinatal
transmission of HIV. Despite these advances, women living with HIV still
face complex medical and psychosocial issues during pregnancy. The purpose
of this study is to describe experiences of pregnancy and the relevance of
social support among women living with HIV in Nordic countries. Methods: This qualitative study examined data from pregnant women living with HIV from
sites in Denmark, Sweden and Finland from 2019 to 2020. Data were collected
in the third trimester via individual interviews using a hybrid,
narrative/semistructured format. The transcribed interviews were analyzed
using narrative thematic analysis. Results: In total, 31 women living with HIV were enrolled, of whom 61% originated from
an African country and 29% from a Nordic country. The analysis generated
four primary narrative themes: just a normal pregnancy, unique
considerations and concerns, interactions with healthcare, and social
support. Women living with HIV have a strong desire to have normal
pregnancies and to be treated like any other pregnant woman. However, this
normality is fragile, and being pregnant and living with HIV does come with
unique considerations and concerns, such as fear of transmission,
antiretroviral therapy, and the need for specialized care, which are
fundamental to the women’s experiences. Interactions with healthcare
providers and social support influence their experiences in both positive
and negative ways. Conclusion: The findings emphasize a sense of normality in pregnancy among women living
with HIV. However, pregnancy does come with unique considerations and
concerns, which highly influence the women’s experience of pregnancy.
Healthcare providers should focus on person-centered care, ensuring
continuity and that women living with HIV do not feel discriminated against
throughout their pregnancy.
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Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Inka Aho
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Åsa Mellgren
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Ditte Scofield
- Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Shikhansari S, Khalesi ZB, Rad EH. Factors associated with the reproductive health of women living with HIV in Iran. Eur J Obstet Gynecol Reprod Biol X 2022; 13:100136. [PMID: 35118370 PMCID: PMC8792468 DOI: 10.1016/j.eurox.2021.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/16/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background Insight on reproductive health status in women living with HIV is associated with improved psychological well-being, health behaviors, and physical wellness. The overall aim of this paper is to gain insight into the reproductive health of women living with HIV and related factors. Method An analytical cross-sectional study was carried on women living with HIV (N = 112) attending high-risk behavior consultation centers in Rasht and Tehran, Iran. The sampling of respondents was in the form of consecutive and available. The data gathering including questionnaires that were divided into three parts: sociodemographic and health characteristics, reproductive behaviors information, and reproductive health assessment tool for women living with HIV. Result The sub-dimension of responsible behavior received the highest total mean score (54.27 ± 22.18). The mean scores in the sub-dimension of coping with the diagnosis, life instability, disease disclosure, disease-related concerns, and support needs for self-care were 50.14, 49.23, 44.27, 40.08, 38.25, and 33.25 respectively. Conclusion The results clearly showed that the reproductive health situation of women living with HIV needs particular attention. Strategic planning and context-specific interventions are needed to improve women’s access and utilization of reproductive health services.
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Affiliation(s)
| | - Zahra Bostani Khalesi
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding author.
| | - Enayatollah Homaei Rad
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
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13
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de Brito ES, Knauth DR, Brand ÉM, Calvo KDS, Vigo Á, Pilecco FB, Machado FV, de Teixeira MA, de Almeida FM, Hentges B, Silva DL, Teixeira LB. Factors Associated with HIV and Vulnerability Contexts for Women in Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3247-3256. [PMID: 33864176 DOI: 10.1007/s10508-021-01960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 01/31/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to identify factors associated with HIV and vulnerability contexts for women in Porto Alegre, Brazil. The participants were 1326 women recruited by complex sampling design, divided into two groups: 640 women with HIV (WLH) and 686 women who did not have HIV (WNLH). Gross and weighted statistical analyses were performed. Logistic regression models were used to estimate the odds ratio (OR) for 12 variables. The main results demonstrated that WLH had lower income (p < .001) and poorer education (p = .038), and few used condoms during their first sexual intercourse (p < .001). The occurrence of HIV was higher among the black population (p < .001). Sex in exchange for money (p < .001) and sexually transmitted infections (p < .001) were more frequent among WLH than among WNLH. The age of sexual debut and age difference from the partner at first sexual intercourse (FSI) were not associated with the outcome. The high percentage of non-use of condoms during the FSI shows how vulnerable individuals are right at the beginning of their sexual lives. More effective prevention strategies can be developed by nurses in view of the contexts of vulnerability surrounding women.
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Affiliation(s)
- Emerson Silveira de Brito
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Daniela Riva Knauth
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Évelin Maria Brand
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Karen da Silva Calvo
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
- School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Álvaro Vigo
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Bulegon Pilecco
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Frederico Viana Machado
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Marsam Alves de Teixeira
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Franciele Moletta de Almeida
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil
| | - Bruna Hentges
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Danielle Lodi Silva
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Barcellos Teixeira
- Department of Collective Health, School of Nursing, Federal University of Rio Grande do Sul, 90620-110, Porto Alegre, Brazil.
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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14
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Huertas-Zurriaga A, Palmieri PA, Edwards JE, Cesario SK, Alonso-Fernandez S, Pardell-Dominguez L, Dominguez-Cancino KA, Leyva-Moral JM. Motherhood and decision-making among women living with HIV in developed countries: a systematic review with qualitative research synthesis. Reprod Health 2021; 18:148. [PMID: 34246286 PMCID: PMC8272303 DOI: 10.1186/s12978-021-01197-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/24/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries. METHODS A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo, and SciELO). Studies published in journals from 1995 to 2019 with qualitative data about reproductive decision-making among WLH in developed countries were eligible for inclusion. Developed country was operationalized by membership in the OECD for comparative conditions of social wellbeing and economic stability. The CASP and JBI checklists for qualitative research were used to assess study quality and methodological integrity. Thematic analysis and qualitative meta-summary techniques were used for the synthesis. RESULTS Twenty studies from 12 developed countries were included in the synthesis. Findings were organized into 3 meta-themes from 15 themes and 45 subthemes, including: (1) Shattered identity, (2) Barriers, inequities, and misinformation, (3) Coping, resiliency, and support. Reproductive decision-making was perceived as a complex process influenced by facilitators and barriers. The facilitators helped WLH cope with their new situation to become more resilient, while the barriers made their situation more difficult to manage. CONCLUSION WLH encounter reproductive decision-making with knowledge deficits and limited social support. An integrated approach to holistic care with comprehensive multidisciplinary counseling is needed to support WLH. Clinicians could benefit from professional development to learn how to be authentically present for WLH, including engaging in conversations, demonstrating compassion, and understanding situations. Evidence-based clinical practice guidelines need to be tailored for the family planning and sexual health needs of WLH.
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Affiliation(s)
- Ariadna Huertas-Zurriaga
- Hospital Universitari Germans Trias I Pujol, Badalona, 08916 Barcelona, Spain
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Patrick A. Palmieri
- South American Center for Qualitative Research, Universidad Norbert Wiener, Av. Arequipa 444, Torre 2, Piso 4, Lima, 15046 Perú
- College of Graduate Health Studies, A. T. Still University, 800 W. Jefferson Street, Kirksville, MO 63501 USA
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
| | - Joan E. Edwards
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
| | - Sandra K. Cesario
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
- Nelda C. Stark College of Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030 USA
| | - Sergio Alonso-Fernandez
- Recerca i Innovació en Cures Infermeres, Hospital Universitari Germans Trias I Pujol, Badalona, 08916 Barcelona, Spain
| | - Lidia Pardell-Dominguez
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Department D’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
| | - Karen A. Dominguez-Cancino
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Escuela de Enfermería, Universidad Científica del Sur, Carr. Panamericana Sur 19, Villa EL Salvador, Lima, 15067 Perú
- Escuela de Salud Pública, Universidad de Chile, Independencia 939, Independencia, 8380453 Santiago de Chile, Chile
| | - Juan M. Leyva-Moral
- Grupo de Investigación Enfermera en Vulnerabilidad Y Salud (GRIVIS), Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Suite 402, Lima, 15023 Peru
- Department D’Infermeria, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda. Can Domènech, Edifici M. Despatx M3/213, Bellaterra (Cerdanyola del Vallès), 08193 Barcelona, Spain
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15
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Skerritt L, de Pokomandy A, O'Brien N, Sourial N, Burchell AN, Bartlett G, Schuster T, Rouleau D, Proulx-Boucher K, Pick N, Money D, Gormley R, Carter A, Yudin MH, Loutfy M, Kaida A. Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort. Sex Reprod Health Matters 2021; 29:1932702. [PMID: 34165395 PMCID: PMC8231384 DOI: 10.1080/26410397.2021.1932702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Antiretroviral therapy effectively prevents sexual and vertical transmission of HIV. Yet, some women living with HIV report having unmet needs for reproductive health care. This study measured the prevalence of women discussing reproductive goals with any current healthcare provider and assessed the effect of the current HIV care provider's gender on such discussions and whether comfort was a mediator. We analysed baseline and 18-month survey data from 533 women living with HIV enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) (2013-2017), a community-based participatory study, restricting the analysis to participants aged 16-45 years. We used causal mediation analysis to estimate direct and indirect effects of the gender of one's HIV care provider on reproductive discussions, incorporating mediating and interaction effects of women having any provider with whom they felt comfortable discussing reproductive goals. Between the baseline and 18-month follow-up surveys, 34.3% (183/533) of women discussed their reproductive goals with a healthcare provider. Having a woman HIV care provider was associated with a 1.18 excess relative risk (ERR) of discussion (95%CI: 0.15, 2.20). The mediating effect of comfort was primarily explained by the fact that those participants with women providers felt more comfortable discussing their reproductive goals compared to participants with men providers, accounting for 66% (95%CI: 32%, 99%) of the total effect. Findings support that HIV provider gender affects women's comfort and whether they discuss reproductive goals, which must be acknowledged and addressed in care delivery.
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Affiliation(s)
- Lashanda Skerritt
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra de Pokomandy
- Associate Professor, Department of Family Medicine, McGill University, Montreal QC, Canada; Clinician-Scientist, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia O'Brien
- PhD Candidate, Department of Family Medicine, McGill University, Montreal, QC, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia Sourial
- Assistant Research Professor, Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Ann N Burchell
- Associate Professor, Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Gillian Bartlett
- Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Tibor Schuster
- Assistant Professor, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danielle Rouleau
- Associate Professor, Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Karène Proulx-Boucher
- Research Coordinator, Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Neora Pick
- Medical Director, Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada; Clinical Professor, Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deborah Money
- Professor, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Clinician-Scientist, Women's Health Research Institute, Vancouver, BC, Canada
| | - Rebecca Gormley
- Research Coordinator, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Allison Carter
- Research Fellow, Faculty of Medicine, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mark H Yudin
- Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Mona Loutfy
- Professor, Faculty of Medicine, University of Toronto, Toronto, Canada; Clinician-Scientist, Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Angela Kaida
- Associate Professor and Canada Research Chair in Global Perspectives in HIV and Sexual and Reproductive Health, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. Correspondence:
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Carlsson-Lalloo E, Mellgren Å, Berg M, Rusner M. Supportive conditions for sexual and perinatal wellbeing in women living with HIV in Sweden: A phenomenological study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100640. [PMID: 34087654 DOI: 10.1016/j.srhc.2021.100640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 03/26/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Women living with HIV have specific needs regarding sexuality, pregnancy, and childbirth. However, there is lack of knowledge about how these needs can be met. The aim of this study was to identify supportive conditions for sexual and perinatal wellbeing in women living with HIV in Sweden. METHODS A phenomenological reflective lifeworld research approach was used. Transcribed interviews with 18 women living with HIV in Sweden were analyzed focusing on the meanings of the study phenomenon. RESULTS When living with HIV, "feeling safe with oneself and in relationships with others" is essential for sexual and perinatal wellbeing. This is constituted by having good overall health, being in a caring context, having access to high quality information about HIV, and being ensured the same rights as other women. CONCLUSIONS The study shows that women living with HIV have specific needs for the support of their sexual and perinatal wellbeing. This knowledge can be used by all those engaged in HIV care and HIV prevention in order to improve and implement supportive conditions for women living with HIV. It is important that all those involved in the care of women living with HIV constantly update their knowledge about HIV and women's experiences of living with HIV in order to provide safe arenas and caring contexts that support the wellbeing of these women.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Regional Cancer Center West, Region Västra Götaland, Medicinaregatan 18 G, 413 45 Gothenburg, Sweden.
| | - Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen 10, 416 50 Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Department of Obstetrics, Sahlgrenska University Hospital, Region Västra Götaland, Diagnosvägen 15, 416 50 Gothenburg, Sweden; Department of Gynaecology and Obstetrics, Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, The Democratic Republic of the Congo
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Brämhultsvägen 53, 501 82 Borås, Sweden
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Villegas N, Cianelli R, De Oliveira G, Toledo C, Jacobson F, Davenport E, Webb D, Wolf B. Exploring Intimate Partner Relationships before and after HIV Diagnosis among Minority Older Women. Clin Gerontol 2021; 44:273-287. [PMID: 33126832 DOI: 10.1080/07317115.2020.1838682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Literature shows that sexual activity remains important at older age and is a valued part of life. However, little is known about the intimate partner relationships (IPR) among minority older women living with Human Immunodeficiency Virus (HIV). The purpose of this study is to explore the effect HIV diagnosis had on the intimate partner relationships (IPR) among minority older women living with HIV (MOWH). METHODS Qualitative descriptive study. A total of 28 MOWH (Black and Latinas) aged 50 years and older participated in face to face semi-structured in-depth interviews. Interviews were analyzed using content analysis. RESULTS Three themes emerged from the analysis: (a)"Intimate partner relationships before HIV diagnosis" that revealed sexual practices increasing the risk for HIV in their intimate relationships; (b)"Facing relationship consequences of HIV disclosure after diagnosis" explored the consequences of HIV disclosure, and how disclosure determined the future of their intimate relationships; and (c) "Intimate partner relationships after HIV diagnosis" described the quality of intimate partner relationships and changes after HIV diagnosis. CONCLUSIONS Results from this study contribute to understanding and increasing awareness of the effect of HIV on the intimacy of MOWH. CLINICAL IMPLICATIONS Education provided by health care workers and interventions targeting MOWH should address the effect of HIV in IPR, address MOWH's concerns about it, and help them to improve their overall health.
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Affiliation(s)
- Natalia Villegas
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA.,School of Nursing, Pontificia Universidad Catolica de Chile
| | - Giovanna De Oliveira
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Christine Toledo
- College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Forest Jacobson
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Eloise Davenport
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Dana Webb
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Bryce Wolf
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
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Shojaeian Z, Khadivzadeh T, Sahebi A, Kareshki H, Tara F. Perceived Risk in Women with High Risk Pregnancy: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:168-174. [PMID: 34036066 PMCID: PMC8132863 DOI: 10.4103/ijnmr.ijnmr_32_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/30/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022]
Abstract
Background: Risk perception in high-risk pregnancies influences the mothers' adherence to medical treatments and recommendations. Because of the lack of information about the women's perception of risk, the aim of this study was to explain perception of risk in high-risk pregnancies. Materials and Methods: This qualitative study was conducted on 25 women with a high-risk pregnancy in educational hospitals of Mashhad, Iran, from August 2017 to August 2018. Data were collected through semi-structured interviews and data saturation was reached after 29 interviews. Data collection and analysis were simultaneously carried out using the qualitative content analysis method adopted by Elo and Kyngäs in MAXQDA software. Results: Data analysis resulted in the four main categories of perception of risk control ability (risk controlling through experience, risk tolerance through relying on a higher power, and risk tolerance to reach family goals), wrong estimation of risk (wrong calculation of possible risks based on wrong beliefs and knowledge, and incorrect risk estimation caused by misunderstanding), possibility of mutual vulnerability of pregnancy and risk condition (possibility of vulnerability of the fetus to risk factors, and possibility of the mother's vulnerability to risk factors), and induced risk (risk induced by negative experiences, induced threat of unknown pregnancy outcome, and fear of ambiguous medical terms). Conclusions: The results of this study promoted our understanding of risk perception in women with high-risk pregnancies. Therefore, it will help to establish a-Ž better link between women with a high-risk pregnancy and the health team, enhance and improve maternal and fetal care.
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Affiliation(s)
- Zahra Shojaeian
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Sahebi
- Department of Psychology, William Glaser institute, Sydney, Australia
| | - Hossein Kareshki
- Department of Counseling Educational Psychology, School of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Fatemeh Tara
- Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran
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Carter A, Anam F, Sanchez M, Roche J, Wynne ST, Stash J, Webster K, Nicholson V, Patterson S, Kaida A. Radical Pleasure: Feminist Digital Storytelling by, with, and for Women Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:83-103. [PMID: 33231828 DOI: 10.1007/s10508-020-01822-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
Despite the fact that HIV can be controlled with medication to undetectable levels where it cannot be passed on, stigmatization of women living with HIV persists. Such stigmatization pivots on stereotypes around sex and sexism and has force in women's lives. Our aim was to create an inspirational resource for women living with HIV regarding sex, relationships, and sexuality: www.lifeandlovewithhiv.ca (launched in July 2018). This paper describes the development and mixed-method evaluation of our first year and a half activities. We situated our work within a participatory arts-based knowledge translation planning framework and used multiple data sources (Google Analytics, stories and comments on the website, team reflections over multiple meetings) to report on interim outcomes and impacts. In our first 1.5 years, we recruited and mentored 12 women living with HIV from around the world (Canada, Australia, New Zealand, Kenya, South Africa, Spain, Nigeria, and the U.S.) to write their own stories, with the support of a mentor/editor, as a way of regaining control of HIV narratives and asserting their right to have pleasurable, fulfilling, and safer sexual lives. Writers published 43 stories about pleasure, orgasm, bodies, identities, trauma, resilience, dating, disclosure, self-love, and motherhood. Our social media community grew to 1600, and our website received approximately 300 visits per month, most by women (70%) and people aged 25-44 years (65%), from more than 50 cities globally, with shifts in use and demographics over time. Qualitative data indicated the power of feminist digital storytelling for opportunity, access, validation, and healing, though not without risks. We offer recommendations to others interested in using arts-based digital methods to advance social equity in sexual health.
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Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales, Level 6, Wallace, Wurth Building, Sydney, NSW, 2052, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Florence Anam
- Medécins Sans Frontières, Johannesburg, South Africa
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA Women, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | | | - S T Wynne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Just Stash
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Muthelo L, Mgwenya JP, Malema RN, Mothiba T. How is becoming pregnant whilst HIV-positive? Voices of women at a selected rural clinic in Mpumalanga Province of South Africa. SAHARA J 2020; 17:1-8. [PMID: 33307995 PMCID: PMC7733978 DOI: 10.1080/17290376.2020.1857299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Pregnancy decision-making is complicated for HIV-positive women because they have to contend with unpredictable symptoms, potential vertical transmission, and often a problematic life context including poverty, abuse, and stigma. Purpose The purpose of the study was to explore the views of HIV-positive women attending a support group at a clinic in the Mpumalanga Province, on becoming pregnant. Methods A qualitative, descriptive, and phenomenological research design was adopted to conduct one-on-one interviews using a semi-structured interview guide. Purposive sampling aided the selection of fifteen HIV-positive women who were members of the HIV/AIDS support group at the clinic. Data saturation was reached at participant number 15. Lincoln and Guba's four criteria for ensuring the trustworthiness of data were applied. Data were analysed using the open coding technique. Results The following categories emerged: Mitigating fears of becoming pregnant through the prevention of mother-to-child transmission (PMTCT) programme; relationship between becoming pregnant and stigma attached to HIV/AIDS; cultural and social norms about becoming pregnant and the relationship between support groups and becoming pregnant. Conclusion The study concluded that the desire to become pregnant amongst HIV-positive women is influenced by several aspects such as knowledge about the prevention of mother to child transmission, cultural values and social norms, and belonging to support groups where they were able to share experiences. Furthermore, becoming pregnant was viewed as an obligation to satisfy their partners/husbands and security to maintain marriages.
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Affiliation(s)
- Livhuwani Muthelo
- Department of Nursing Science, University of Limpopo, Sovenga, South Africa
| | | | | | - Tebogo Mothiba
- Department of Nursing Science, University of Limpopo, Sovenga, South Africa.,Faculty of Health Sciences Executive Dean's Office, University of Limpopo, Sovenga, South Africa
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Toupin I, Engler K, Lebouché B, Otis J, Lévy JJ, Fernet M. Decision-making about motherhood among women living with HIV in Canada: a negotiation of multidimensional risks. CULTURE, HEALTH & SEXUALITY 2019; 21:432-446. [PMID: 29993351 DOI: 10.1080/13691058.2018.1487585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 06/07/2018] [Indexed: 06/08/2023]
Abstract
Little research in Canada has examined the perspectives of women living with HIV on decision-making across the stages of motherhood. In 2004-2005, semi-structured interviews were conducted with 42 African, Caucasian and Haitian HIV-positive women recruited in Montreal. All were or wished to be biological mothers. Transcripts underwent thematic analysis organised by three culturally informed models of motherhood described by the participants, which influenced decision-making and perceived risks. For women who saw motherhood as 'self-fulfilment and completeness', vertical HIV transmission was a primary concern. It threatened their identity as a 'good mother', which also meant adhering to antiretrovirals. For women who viewed motherhood as a 'social realisation' (all African or Haitian), fears of compromised fertility dominated. Not becoming pregnant threatened their social status and presumed health within their community. Antiretrovirals were abandoned after delivery, fearing they would reveal their HIV status. For women endorsing a 'personal growth' model of motherhood (all Caucasian), threats to personal health were paramount. Pregnancy meant purifying body and soul. Antiretrovirals, seen as pollutants, were stopped after delivery. These findings can inform current research and sensitise health providers to the complex biological, psychological, social and spiritual risks that HIV-positive women negotiate in motherhood-related decision-making, towards more patient-centred care.
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Affiliation(s)
- Isabelle Toupin
- a Department of Sexology , Université du Québec à Montréal , Montreal , Canada
- b École de santé publique , Université de Montréal , Montreal , Canada
- c Centre for Outcomes Research & Evaluation , Research Institute of the McGill University Health Centre , Montreal , Canada
- d Department of Family Medicine , McGill University , Montreal , Canada
| | - Kim Engler
- c Centre for Outcomes Research & Evaluation , Research Institute of the McGill University Health Centre , Montreal , Canada
- d Department of Family Medicine , McGill University , Montreal , Canada
| | - Bertrand Lebouché
- c Centre for Outcomes Research & Evaluation , Research Institute of the McGill University Health Centre , Montreal , Canada
- d Department of Family Medicine , McGill University , Montreal , Canada
| | - Joanne Otis
- a Department of Sexology , Université du Québec à Montréal , Montreal , Canada
| | - Joseph J Lévy
- a Department of Sexology , Université du Québec à Montréal , Montreal , Canada
| | - Mylène Fernet
- a Department of Sexology , Université du Québec à Montréal , Montreal , Canada
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Gómez‐Suárez M, Mello MB, Gonzalez MA, Ghidinelli M, Pérez F. Access to sexual and reproductive health services for women living with HIV in Latin America and the Caribbean: systematic review of the literature. J Int AIDS Soc 2019; 22:e25273. [PMID: 30958638 PMCID: PMC6452919 DOI: 10.1002/jia2.25273] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/07/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Systematic reviews show that women living with HIV (WLHIV) have high unmet sexual and reproductive health (SRH) needs due to barriers to access sexual and reproductive health services (SRHS). In Latin America and the Caribbean (LAC), as of 2016, there were nearly one million WLHIV, but the existing evidence of their SRH needs comes from a few individual studies. This systematic review provides an overview of these women's needs to help define new and/or adapt existing public health strategies to the local context. This review synthesizes the evidence from the literature on the use of and access to SRHS related to family planning, antenatal care, abortion services and violence against WLHIV in LAC. METHODS Using a systematic review of mixed studies, a search was performed in MEDLINE, EMBASE, LILACS, INASP, POPLINE, SCOPUS, for studies conducted in LAC, from 2004 to 2017, as well as contact with authors and hand search as needed. Two independent reviewers evaluated the quality of the studies using the Mixed Methods Appraisal Tool; inclusion was conducted according to the PRISMA flow diagram. An exploratory narrative synthesis followed by quantitative synthesis data was undertaken. Group analysis or meta-analysis was not considered appropriate given the level of heterogeneity of the studies. RESULTS A total of 18 studies in 13 LAC countries for a population of 5672 WLHIV were included. Data from individual studies reported unmet family planning needs; higher, but inconsistent use of condom as the sole contraceptive method OR=1.46 [1.26 to 1.69]; lesser use of other non-permanent contraceptive methods OR=0.26 [0.22 to 0.31]; more unplanned pregnancies OR=1.30 [1.02 to 1.66]; more induced abortions OR=1.96 [1.60 to 2.39]; higher risk of immediate postpartum sterilization; and higher exposure to sexual and institutional violence by WLHIV when compared with women without HIV. CONCLUSIONS This review presents evidence from LAC about the SRH unmet needs of WLHIV that must be addressed by decreasing institutional and structural barriers, facilitating services and reducing stigma, and discrimination among healthcare providers to improve access to SRHS based on human rights, so women independently of their HIV status can make their own reproductive decisions, free of violence and coercion.
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Affiliation(s)
- Marcela Gómez‐Suárez
- The National University of ColombiaInterfaculty Doctoral Program in Public HealthBogotáColombia
| | - Maeve B Mello
- Department of Communicable Diseases and Environmental Determinants of HealthHIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections UnitPan American Health OrganizationWashingtonDCUSA
| | - Mónica Alonso Gonzalez
- Department of Communicable Diseases and Environmental Determinants of HealthHIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections UnitPan American Health OrganizationWashingtonDCUSA
| | - Massimo Ghidinelli
- Department of Communicable Diseases and Environmental Determinants of HealthHIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections UnitPan American Health OrganizationWashingtonDCUSA
| | - Freddy Pérez
- Department of Communicable Diseases and Environmental Determinants of HealthHIV, Hepatitis, Tuberculosis, and Sexually Transmitted Infections UnitPan American Health OrganizationWashingtonDCUSA
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Carlsson-Lalloo E, Berg M, Mellgren Å, Rusner M. Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study. Int J Qual Stud Health Well-being 2018; 13:1487760. [PMID: 29972346 PMCID: PMC6032009 DOI: 10.1080/17482631.2018.1487760] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
The effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Mellgren
- Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Research, Södra Älvsborg Hospital, Borås, Sweden
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Carter A, Greene S, Money D, Sanchez M, Webster K, Nicholson V, Brotto LA, Hankins C, Kestler M, Pick N, Salters K, Proulx-Boucher K, O'Brien N, Patterson S, de Pokomandy A, Loutfy M, Kaida A. Supporting the Sexual Rights of Women Living With HIV: A Critical Analysis of Sexual Satisfaction and Pleasure Across Five Relationship Types. JOURNAL OF SEX RESEARCH 2018; 55:1134-1154. [PMID: 29624080 DOI: 10.1080/00224499.2018.1440370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the context of human immunodeficiency virus (HIV), a focus on protecting others has overridden concern about women's own sexual well-being. Drawing on feminist theories, we measured sexual satisfaction and pleasure across five relationship types among women living with HIV in Canada. Of the 1,230 women surveyed, 38.1% were completely or very satisfied with their sexual lives, while 31.0% and 30.9% were reasonably or not very/not at all satisfied, respectively. Among those reporting recent sexual experiences (n = 675), 41.3% always felt pleasure, with the rest reporting usually/sometimes (38.7%) or seldom/not at all (20.0%). Sex did not equate with satisfaction or pleasure, as some women were completely satisfied without sex, while others were having sex without reporting pleasure. After adjusting for confounding factors, such as education, violence, depression, sex work, antiretroviral therapy, and provider discussions about transmission risk, women in long-term/happy relationships (characterized by higher levels of love, greater physical and emotional intimacy, more equitable relationship power, and mainly HIV-negative partners) had increased odds of sexual satisfaction and pleasure relative to women in all other relational contexts. Those in relationships without sex also reported higher satisfaction ratings than women in some sexual relationships. Findings put focus on women's rights, which are critical to overall well-being.
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Affiliation(s)
- Allison Carter
- a Faculty of Health Sciences , Simon Fraser University
- b Epidemiology and Population Health , British Columbia Centre for Excellence in HIV/AIDS
| | | | - Deborah Money
- d Department of Obstetrics and Gynecology and Department of Medicine, Faculty of Medicine , University of British Columbia
| | | | - Kath Webster
- a Faculty of Health Sciences , Simon Fraser University
| | | | - Lori A Brotto
- f Department of Obstetrics and Gynecology, Faculty of Medicine , University of British Columbia
| | - Catherine Hankins
- g Amsterdam Institute for Global Health and Development, Department of Global Health , University of Amsterdam
- h Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine , McGill University
| | - Mary Kestler
- i Division of Infectious Diseases, Faculty of Medicine , University of British Columbia
| | - Neora Pick
- i Division of Infectious Diseases, Faculty of Medicine , University of British Columbia
- j Oak Tree Clinic , British Columbia Women's Hospital and Health Centre
| | - Kate Salters
- a Faculty of Health Sciences , Simon Fraser University
- b Epidemiology and Population Health , British Columbia Centre for Excellence in HIV/AIDS
| | | | - Nadia O'Brien
- k Chronic Viral Illness Service , McGill University Health Centre
- l Department of Family Medicine , McGill University
| | - Sophie Patterson
- a Faculty of Health Sciences , Simon Fraser University
- m Department of Public Health and Policy , University of Liverpool
| | - Alexandra de Pokomandy
- k Chronic Viral Illness Service , McGill University Health Centre
- o Department of Medicine , University of Toronto
| | - Mona Loutfy
- n Women's College Research Institute , Women's College Hospital
- o Department of Medicine , University of Toronto
| | - Angela Kaida
- a Faculty of Health Sciences , Simon Fraser University
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Pinho ADA, Barbosa RM, Brignol S, Villela W, Monteiro SS. Drivers of Sexual Inactivity Among Women Living with HIV and AIDS: Findings of the GENIH Study in São Paulo, Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1983-1993. [PMID: 29468346 DOI: 10.1007/s10508-017-1110-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 06/08/2023]
Abstract
The advances on HIV/AIDS diagnosis and treatment have enabled people living with HIV/AIDS (PLHA) better quality of life. However, the persistence of HIV-related stigma and discrimination, and the risks triggered by HIV disclosure, may be a barrier to the sexual exercise of PLHA. We investigated the prevalence of sexual inactivity and the reasons given for it among a representative sample of women of reproductive age living with HIV/AIDS (WLWHA) in the municipality of São Paulo, Brazil. We surveyed 918 WLWHA with probability proportional to average number of visits in each of the 18 referral HIV/AIDS services. Sexual inactivity was defined as not having had vaginal sexual intercourse in the year prior to research. Statistical modeling of the factors associated with sexual inactivity was carried out by way of bivariate and multivariate analysis. In all, 22.2% (n = 200) of the women did not have sexual relations in the year prior to the interview. The majority reported a reduction in desire (64.5%) and sexual activity (68%). Among the women not in a relationship, the predictors of sexual inactivity were: being older (35-49) (ORa = 2.25); not being Catholic (ORa = 2.91); having kept the diagnosis secret from their partner (ORa = 2.45); having had up to five sexual partners throughout life (ORa = 3.81). The diagnosis of HIV seems to have more of an effect on the desire for and frequency of sexual activity than on its interruption. Sexual inactivity was influenced by the stigma of HIV/AIDS, by age, and by moral-religious values.
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Affiliation(s)
- Adriana de Araujo Pinho
- Laboratory of Education in Health and Environment-Oswaldo Cruz Institute, Avenida Brasil, 4365, Pavilhão Laura Travassos (Room 49), Rio de Janeiro, RJ, 21040-360, Brazil.
| | - Regina Maria Barbosa
- Center for Population Studies "Elza Berquó", State University of Campinas, Campinas, Brazil
- Center for Referrals and Training in STDs/AIDS, Secretary of the Health of the State of São Paulo, São Paulo, Brazil
| | - Sandra Brignol
- Collective Health Institute, Universidade Federal Fluminense, Niterói, Brazil
| | - Wilza Villela
- Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Simone Souza Monteiro
- Laboratory of Education in Health and Environment-Oswaldo Cruz Institute, Avenida Brasil, 4365, Pavilhão Laura Travassos (Room 49), Rio de Janeiro, RJ, 21040-360, Brazil
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Schönnesson LN, Zeluf G, Garcia-Huidobro D, Ross MW, Eriksson LE, Ekström AM. Sexual (Dis)satisfaction and Its Contributors Among People Living with HIV Infection in Sweden. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2007-2026. [PMID: 29441436 PMCID: PMC6097728 DOI: 10.1007/s10508-017-1106-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 06/08/2023]
Abstract
Earlier research reports lower sexual satisfaction among people living with HIV (PLHIV) compared to HIV-negative persons. A number of psychosocial factors directly associated with sexual dissatisfaction have been identified. Little is known about sexual satisfaction and their contributors among PLHIV in Sweden. The aim of this study was to examine direct and indirect effects of variables within sociodemographic, clinical HIV-related, psychological, and sexual domains on sexual (dis)satisfaction among PLHIV in Sweden. Data for this study were derived from a nationally representative, anonymous survey among PLHIV conducted in 2014 (n = 1096). Statistical analysis included four steps: descriptive analyses, identification of variables associated with sexual (dis)satisfaction, identification of variables associated with those contributors of sexual (dis)satisfaction, and a path model integrating all these analyses. A total of 49% of participants reported being sexually dissatisfied, and no significant differences were observed when non-heterosexual men, heterosexual men, and women were compared. Among women, a negative change in sex life after HIV diagnosis and distress with orgasmic difficulties was directly associated with sexual dissatisfaction. For men, hopelessness, high HIV stigma, sexual inactivity in the last 6 months, and a negative change in sex life after HIV diagnosis were directly associated with sexual dissatisfaction. Path analyses showed in both men and women significant indirect associations between not being involved in an intimate relationship, lower self-reported CD4 cell counts, and perceiving obligation to disclose HIV status to sexual partners as a barrier to look for a long-term partner and sexual dissatisfaction. Our results show that despite good treatment outcomes, the HIV diagnosis has a negative bearing on sexual satisfaction. The need for gender-tailored interventions and clinical implications of these findings are discussed.
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Affiliation(s)
- Lena Nilsson Schönnesson
- Department of Public Health (Global Health/IHCAR), Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Galit Zeluf
- Department of Public Health (Global Health/IHCAR), Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Diego Garcia-Huidobro
- Departamento de Medicina Familiar, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michael W Ross
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of Health Sciences, City, University of London, London, UK
| | - Anna Mia Ekström
- Department of Public Health (Global Health/IHCAR), Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Department Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Rodgers BL, Jacelon CS, Knafl KA. Concept Analysis and the Advance of Nursing Knowledge: State of the Science. J Nurs Scholarsh 2018; 50:451-459. [DOI: 10.1111/jnu.12386] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Beth L. Rodgers
- Gamma Omega , Chair, Adult Health and Nursing Systems Department, Nursing Alumni Endowed Professor; Virginia Commonwealth University; Richmond VA USA
| | - Cynthia S. Jacelon
- Beta Zeta , Professor, College of Nursing; University of Massachusetts Amherst; Amherst MA USA
| | - Kathleen A. Knafl
- Frances Hill Fox Distinguished Professor, School of Nursing; University of North Carolina at Chapel Hill; Chapel Hill NC USA
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Chang AY, Nabbaale J, Nalubwama H, Okello E, Ssinabulya I, Longenecker CT, Webel AR. Motivations of women in Uganda living with rheumatic heart disease: A mixed methods study of experiences in stigma, childbearing, anticoagulation, and contraception. PLoS One 2018; 13:e0194030. [PMID: 29590159 PMCID: PMC5874006 DOI: 10.1371/journal.pone.0194030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 02/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Rheumatic heart disease (RHD) is a leading cause of premature mortality in low- and middle-income countries (LMICs). Women of reproductive age are a unique and vulnerable group of RHD patients, due to increased risk of cardiovascular complications and death during pregnancy. Yet, less than 5% of women of childbearing age with RHD in LMICs use contraceptives, and one in five pregnant women with RHD take warfarin despite known teratogenicity. It is unclear whether this suboptimal contraception and anticoagulant use during pregnancy is due to lack of health system resources, limited health literacy, or social pressure to bear children. Methods We conducted a mixed methods study of 75 women living with RHD in Uganda. Questionnaires were administered to 50 patients. Transcripts from three focus groups with 25 participants were analyzed using qualitative description methodology. Results Several themes emerged from the focus groups, including pregnancy as a calculated risk; misconceptions about side-effects of contraceptives and anticoagulation; reproductive decision-making control by male partners, in-laws, or physicians; abandonment of patients by male partners; and considerable stigma against heart disease patients for both their reproductive and financial limitations (often worse than that directed against HIV patients). All questionnaire respondents were told by physicians that their hearts were not strong enough to support a pregnancy. Only 14% used contraception while taking warfarin. All participants felt that society would look poorly on a woman who cannot have children due to a heart condition. Conclusions To our knowledge, this is the first qualitative study of female RHD patients and their attitudes toward cardiovascular disorders and reproduction. Our results suggest that health programs targeting heart disease in LMICs must pay special attention to the needs of women of childbearing age. There are opportunities for improved family/societal education programs and community engagement, leading to better outcomes and patient empowerment.
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Affiliation(s)
- Andrew Y. Chang
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Juliet Nabbaale
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Haddy Nalubwama
- School of Public Health, Makerere University, Kampala, Uganda
| | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | | | - Christopher T. Longenecker
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
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Villela WV, Barbosa RM. [Trajectories of women living with HIV/AIDS in Brazil. Progress and permanence of the response to the epidemic]. CIENCIA & SAUDE COLETIVA 2018; 22:87-96. [PMID: 28076532 DOI: 10.1590/1413-81232017221.14222016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/24/2016] [Indexed: 11/22/2022] Open
Abstract
This article analyzes the trajectories of 85 women living with HIV/AIDS in six Brazilian cities: Belém, São Paulo, Ribeirão Preto, Goiânia, Recife and Pelotas, to understand some specific aspects of their experiences before and after diagnosis. It is based on in-depth interviews conducted in 2009 addressing women diagnosed with HIV between 1 and 20 years previously. The results show a profile characterized by limited access to school, health services and labor and a marked presence of violence. The reasons for applying HIV tests vary over time and there is an increase in prenatal testing, although no modifications in the context of the infection are apparent. For some women, the diagnosis determines changes in lifestyle. However, for the majority, social and labor experiences and the decisions about love, sexuality and reproduction seem to respond to their immediate demands and opportunities. The management of the diagnosis and the support received influence living with HIV/AIDS. These results show the need for actions for prevention and testing not restricted to pregnant women, even in the context of a concentrated epidemic. Studies adopting a biographical perspective can contribute to prevent or improve living with HIV/AIDS appropriate to the different moments of the womens' trajectories.
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Affiliation(s)
- Wilza Vieira Villela
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo. R. Botucatu 740/4°, Vila Clementino. 04023-062 São Paulo SP Brasil.
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Fair C, Allen H, Trexler C, D'Angelo LJ. Experiences of Young Parents with Perinatally Acquired HIV. AIDS Patient Care STDS 2017; 31:479-485. [PMID: 29087743 DOI: 10.1089/apc.2017.0141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This research explores the perceptions of adolescents and young adults (AYA) living with perinatally acquired HIV (PHIV) as they transition into parenthood. We conducted hour-long, semistructured audio-recorded interviews with a purposive sample of 17 AYA parents with PHIV who were current or former patients at two US pediatric/adolescent infectious diseases clinics. Participants were asked about challenges/rewards of parenting and anticipated future fertility desires/intentions. Analysis of the transcribed interviews was guided by grounded theory. Mean age of participants was 22 years. The majority were African American (n = 8) or Hispanic (n = 6) and female (n = 14). Two participants were pregnant and others had a range of 1-3 children (mean = 1.4), one of whom was HIV positive. Analyses revealed that time with their child was a valuable commodity. Participants expressed concerns about not "being there" for their child due to sickness and worries that their child may experience HIV-related discrimination once a parent's HIV status was disclosed. The importance of being a role model and present in their child's life over time was emphasized and served as motivation to pursue education and employment opportunities. Those parents who intended to have another child were motivated by a strong desire to create a legacy and a family of their own as a way to deal with HIV-related losses and stigma. Participants reported the importance of emotional support offered by providers, as well as concrete social services available in that care setting even if they had transitioned to adult care. AYA also expressed parenting rewards/challenges similar to those of their uninfected peers. As youth with PHIV continue to mature, increasing numbers will become parents. It is incumbent upon both pediatric and adult providers to support newly formed families living in the context of intergenerational HIV infection.
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Affiliation(s)
- Cynthia Fair
- Public Health Studies and Human Service Studies, Department Chair of Public Health Studies, Elon University, Elon, North Carolina
| | - Hannah Allen
- University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Connie Trexler
- Adolescent Clinical Research, Burgess Clinic, Children's National Medical Center, Washington, District of Columbia
| | - Lawrence J. D'Angelo
- Youth Pride and Burgess Clinics, Division of Adolescent and Young Adult Medicine
- Occupational Health, Children's National Health System
- Department of Pediatrics, Medicine and Epidemiology, George Washington University, Washington, District of Columbia
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The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0826-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Safier LZ, Sauer MV. Fertility care interventions should be provided as the first line options for HIV+ serodiscordant couples who desire children in settings with affordable access to care, regardless of their fertility status. J Int AIDS Soc 2017; 20:21294. [PMID: 28361501 PMCID: PMC5577707 DOI: 10.7448/ias.20.2.21294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION With increasing life expectancy, couples with at least one partner afflicted with HIV are more commonly pursuing the opportunity to have biologic offspring. Currently, there are no universally accepted recommendations regarding first line reproductive treatments for HIV serodiscordant couples lacking a history of infertility. We strongly believe that fertility care intervention should be the first line treatment, when affordably accessible, over natural conception for HIV serodiscordant couples to achieve pregnancy in a safe and efficacious manner. Discussion In the era of highly active anti-retroviral therapy, in combination with timed intercourse and pre-exposure prophylaxis for the HIV negative partner, some members of the medical community are arguing in favour of natural conception as a means of achieving pregnancy in this patient population. In our opinion, laboratory assisted fertility methods, including intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection with semen washing should be the first line treatment recommendation for HIV serodiscordant couples desiring pregnancy for the following reasons: (1) abundance of evidence in the medical literature supporting the safety profile and efficacy of fertility care intervention in couples with HIV; paucity of data addressing safety of natural conception in comparison to fertility intervention techniques (2) unknown public health impact of promoting natural conception as a safe means of achieving pregnancy (3) ethical implications: patients should be offered the available and accessible treatment option posing the lowest possible known risk to the uninfected partner. Conclusions We believe that physician assisted fertility care, when affordably accessible, should be the treatment of choice over natural conception. While the preliminary data on natural conception in couples using highly active anti-retroviral therapy/pre-exposure prophylaxis/timed intercourse appears promising, we believe that this approach should be limited to patients in resource poor settings where more sophisticated measures do not exist or for patients that simply cannot afford subspecialty care. There are likely to be unknown psychological and behavioural factors impacted by promoting natural conception and diminishing the importance of safe sex practices. Additionally, it is our moral obligation to patients to offer the affordably accessible treatment interventions that pose the least known risk when considering reproductive options.
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Affiliation(s)
- Lauren Zakarin Safier
- Department of Obstetrics and Gynecology, New York Presbyterian-Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Mark V Sauer
- Department of Obstetrics and Gynecology, New York Presbyterian-Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, New York, USA
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Hoffmann IC, dos Santos WM, Padoin SMDM, de Barros SMO. A five-year review of vertical HIV transmission in a specialized service: cross-sectional study. SAO PAULO MED J 2016; 134:508-512. [PMID: 28076637 PMCID: PMC11448727 DOI: 10.1590/1516-3180.2016.0139140616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/01/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it. DESIGN AND SETTING: Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil. METHODS: A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children. RESULTS: The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported. CONCLUSIONS: The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.
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Affiliation(s)
- Izabel Cristina Hoffmann
- PhD. Nurse, University Hospital, Universidade Federal de Santa Maria (UFSM), Santa Maria (RS) Brazil.
| | | | - Stela Maris de Mello Padoin
- PhD. Professor, Department of Nursing, Universidade Federal de Santa Maria (UFSM), Santa Maria (RS), Brazil.
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