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Pilecco FB, Ravalihasy A, Guillaume A, Desgrées du Loû A. HIV and induced abortion among migrants from sub-Saharan Africa living in Île-de-France: Results of the PARCOURS study. J Migr Health 2024; 10:100237. [PMID: 38989051 PMCID: PMC11233997 DOI: 10.1016/j.jmh.2024.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2023] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction HIV heavily affects sub-Saharan African women living in France and can impact reproductive decisions. It was investigated whether HIV was associated with induced abortion in pregnancies held after migration by women from sub-Saharan Africa living in Île-de-France. Methods We used data on ANRS Parcours, a retrospective life event survey conducted in health facilities in the metropolitan region of Paris, between February 2012 and May 2013, with migrants from sub-Saharan Africa. Data on the history of pregnancies were collected among women living with HIV (HIV group) and those attending primary care centers (reference group). We investigated 242 women in the reference group, who had 729 pregnancies, and the 277 women in the HIV group, who had 580 pregnancies. The association between abortion and HIV was evaluated using clustered logistic models, successively adjusted for women and pregnancy characteristics, for the whole sample, and stratified by pregnancy intendedness. Results In the reference group, 11.0 % of pregnancies were terminated in abortion, the same situation as 14.1 % in the HIV group (p = 0.124). HIV was not associated with abortion in the crude and adjusted models. However, after adjustments, HIV exhibited a non-significant trend towards reducing the likelihood of abortion, particularly when considering the intendedness of pregnancy variable. Conclusions Factors that shape the overall context of women's lives and pregnancies, which are shared with the reference group, may have a more significant impact on reproductive decision-making than HIV alone. Health services must pay attention to the intendedness of pregnancies, providing advice and support on the prevention of mother-to-child transmission to women living with HIV who intend to become pregnant, in addition to strengthening the provision of family planning and the prevention of unintended pregnancies.
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Affiliation(s)
- Flávia B. Pilecco
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais. Avenida Alfredo Balena, 190, sala 803. Zip Code: 30130-100. Belo Horizonte, MG, Brazil
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal de Minas Gerais. Avenida Alfredo Balena, 190, sala 803. Zip Code: 30130-100. Belo Horizonte, MG, Brazil
| | - Andrainolo Ravalihasy
- Centre Population & Développement (UMR 196 - Université Paris Cité/IRD). 45 rue des Saints-Pères. Zip Code: 75006. Paris, France
| | - Agnès Guillaume
- Centre Population & Développement (UMR 196 - Université Paris Cité/IRD). 45 rue des Saints-Pères. Zip Code: 75006. Paris, France
| | - Annabel Desgrées du Loû
- Centre Population & Développement (UMR 196 - Université Paris Cité/IRD). 45 rue des Saints-Pères. Zip Code: 75006. Paris, France
| | - the Parcours Study Group
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais. Avenida Alfredo Balena, 190, sala 803. Zip Code: 30130-100. Belo Horizonte, MG, Brazil
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal de Minas Gerais. Avenida Alfredo Balena, 190, sala 803. Zip Code: 30130-100. Belo Horizonte, MG, Brazil
- Centre Population & Développement (UMR 196 - Université Paris Cité/IRD). 45 rue des Saints-Pères. Zip Code: 75006. Paris, France
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Ngumbau N, Unger JA, Wandika B, Atieno C, Beima-Sofie K, Dettinger J, Nzove E, Harrington EK, Karume AK, Osborn L, Sharma M, Richardson BA, Seth A, Udren J, Zanial N, Kinuthia J, Drake AL. Mobile solutions to Empower reproductive life planning for women living with HIV in Kenya (MWACh EMPOWER): Protocol for a cluster randomized controlled trial. PLoS One 2024; 19:e0300642. [PMID: 38557692 PMCID: PMC10984530 DOI: 10.1371/journal.pone.0300642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Women living with HIV (WLWH) face unique reproductive health (RH) barriers which increase their risks of unmet need for contraception, contraceptive failure, unintended pregnancy, and pregnancy-related morbidity and mortality and may prevent them from achieving their reproductive goals. Patient-centered counseling interventions that support health care workers (HCWs) in providing high-quality RH counseling, tailored to the needs of WLWH, may improve reproductive health outcomes. METHODS AND DESIGN We are conducting a non-blinded cluster randomized controlled trial (cRCT) of a digital health intervention for WLWH (clinicaltrials.gov #NCT05285670). We will enroll 3,300 WLWH seeking care in 10 HIV care and treatment centers in Nairobi and Western Kenya. WLWH at intervention sites receive the Mobile WACh Empower intervention, a tablet-based RH decision-support counseling tool administered at baseline and SMS support during two years of follow-up. WLWH at control sites receive the standard of care FP counseling. The decision-support tool is a logic-based tool for family planning (FP) counseling that uses branching logic to guide RH questions based on participants' reproductive life plans, tailoring counseling based on the responses. Follow-up SMSs are based in the Information-Motivation-Behavioral (IMB) Skills model of behavioral change and are tailored to participant characteristics and reproductive needs through separate SMS "tracks". Follow-up visits are scheduled quarterly for 2 years to assess plans for pregnancy, pregnancy prevention, and contraceptive use. The primary outcome, FP discontinuation, will be compared using an intent-to-treat analysis. We will also assess the unmet need for FP, dual method use, viral load suppression at conception and unintended pregnancy. DISCUSSION The Mobile WACh Empower intervention is innovative as it combines a patient-centered counseling tool to support initial reproductive life decisions with longitudinal SMS for continued RH support and may help provide RH care within the context of provision of HIV care.
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Affiliation(s)
- Nancy Ngumbau
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jennifer A. Unger
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Brenda Wandika
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Celestine Atieno
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Emmaculate Nzove
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Elizabeth K. Harrington
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Agnes K. Karume
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Lusi Osborn
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Barbra A. Richardson
- Departments of Biostatistics, Global Health, University of Washington, Seattle, Washington, United States of America
| | - Aparna Seth
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jenna Udren
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Noor Zanial
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L. Drake
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Zachek CM, Coelho LE, Clark JL, Domingues RMSM, Luz PM, Friedman RK, de Andrade ÂCV, Veloso VG, Lake JE, Grinsztejn B, De Boni RB. Reproductive health syndemics impact retention in care among women living with HIV in Rio de Janeiro, Brazil. Braz J Infect Dis 2023; 27:102779. [PMID: 37230150 PMCID: PMC10245108 DOI: 10.1016/j.bjid.2023.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/29/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Syndemic psychosocial and reproductive factors affecting women's retention in HIV care remain understudied. We analyzed correlates of non-retention in a cohort of women with HIV in Brazil from 2000‒2015. Participants self-reported exposure to physical/sexual violence, illicit drug use, adolescent pregnancy, or induced abortion. Lifetime history of these psychosocial stressors were used to create a syndemic score based on the presence or absence of these conditions. All dichotomous variables were summed (range 0 to 4), with greater scores indicating more syndemic factors experienced. Logistic regression models identified predictors of non-retention, defined as < 2 HIV viral load or CD4 results within the first year of enrollment. Of 915 women, non-retention was observed for 18%. Prevalence of syndemic factors was adolescent pregnancy (53.2%), physical/sexual violence (38.3%), induced abortion (27.3%), and illicit drug use (17.2%); 41.2% experienced ≥ 2 syndemic conditions. Syndemic scores of 2 and 3 were associated with non-retention, as well as low education, years with HIV and seroprevalent syphilis. Psychosocial and reproductive syndemics can limit women's retention in HIV care. Syphilis infection predicted non-retention and could be explored as a syndemic factor in future studies.
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Affiliation(s)
- Christine M Zachek
- University of California San Francisco, School of Medicine, San Francisco, CA, USA.
| | - Lara E Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Jesse L Clark
- University of California Los Angeles David Geffen School of Medicine, Department of Medicine, Los Angeles, CA, USA
| | - Rosa M S M Domingues
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Ruth K Friedman
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | | | - Valdilea G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Jordan E Lake
- The University of Texas Health Science Center at Houston (UTHealth), Department of Medicine, Houston, TX, USA
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Raquel B De Boni
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
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Kabunga A, Acanga A, Akello Abal J, Kambugu Nabasirye C, Namata H, Mwesigwa D, Grace Auma A, Kigongo E, Udho S. Phenomenology of Induced Abortion in Northern Uganda Among HIV-Positive Women Following an Unintended Pregnancy. Open Access J Contracept 2023; 14:73-82. [PMID: 37101706 PMCID: PMC10124552 DOI: 10.2147/oajc.s407547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
Background More than half of pregnancies in Uganda are unintended, and nearly a third of these end in abortion. However, little research has focused on women living with HIV's subjective experiences following induced abortion. We explored how women living with HIV subjectively experience induced abortions in health facilities in Lira District, Uganda. Materials and Methods This was a descriptive-phenomenological study between October and November 2022. The study was conducted among women of reproductive age (15-49 years) who were HIV positive and had undergone induced abortion following an unintended pregnancy. Purposive sampling was used to sample 30 participants who could speak to the research aims and have experience with the phenomenon under scrutiny. The principle of information power was used to estimate the sample size. We conducted face-to-face, in-depth interviews to collect data. Data were presented as direct quotes while providing a contextual understanding of the lived experiences of the study participants. Results The results showed that the major causes of induced abortion were financial constraints, concern for the unborn babies, unplanned pregnancy, and complex relationships. Regarding induced abortion-related experiences, three themes emerged: loss of family support, internalized and perceived stigma, and feelings of guilt and regret. Conclusion This study highlights the lived experiences of women living with HIV following an induced abortion. The study shows that women living with HIV had induced abortions due to numerous reasons, including financial concerns, complicated relationships, and a fear of infecting their unborn babies. However, after induced abortion, the women living with HIV faced several challenges like loss of family support, stigma, and feelings of guilt and regret. Based on HIV-infected women who underwent induced abortion and an unexpected pregnancy, they may need mental health services to reduce the stigma associated with induced abortion.
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Affiliation(s)
- Amir Kabunga
- Department of Psychiatry, Lira University, Lira, Uganda
- Correspondence: Amir Kabunga, Department of Psychiatry, Lira University, Lira, Uganda, Tel +256777929576, Email
| | - Alfred Acanga
- Department of Public Administration and Management, Lira University, Lira, Uganda
| | - Judith Akello Abal
- Department of Commerce and Business Management, Lira University, Lira, Uganda
| | | | - Halimah Namata
- Department of Mental Health, Makerere University, Lira, Uganda
| | - David Mwesigwa
- Department of Public Administration and Management, Lira University, Lira, Uganda
| | | | - Eustes Kigongo
- Department of Infectious Diseases, Lira University, Lira, Uganda
| | - Samson Udho
- Department of Midwifery, Lira University, Lira, Uganda
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Ajayi AI, Ahinkorah BO, Seidu AA, Adeniyi OV. Prevalence and correlates of induced abortion: results of a facility-based cross-sectional survey of parturient women living with HIV in South Africa. Reprod Health 2022; 19:220. [PMID: 36471337 PMCID: PMC9721078 DOI: 10.1186/s12978-022-01520-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/01/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND There is a paucity of studies examining the prevalence and correlates of induced abortion among women living with HIV. Our study fills this gap by examining the prevalence and correlates of induced abortion among parturient women living with HIV in Eastern Cape, South Africa. METHODS We analysed cross-sectional survey data of the East London Prospective Cohort Study, which took place between September 2015 and May 2016 in three large maternity facilities in the Buffalo/Amathole districts of the Eastern Cape Province of South Africa. A total of 1709 parturient women living with HIV who gave birth over the study period were recruited. We carried out descriptive and inferential statistics. RESULTS The prevalence of induced abortion was 19% (95% CI: 17.2-20.9%), but varied by women's socio-demographic characteristics. Induced abortion prevalence was higher among women aged 25 years and over (21.4%), than among women aged less than 25 years (11.0%). Those ever married or cohabiting (26.8%) reported a higher level of induced abortion than those never-married women (15.6%). Those already diagnosed HIV positive before their index pregnancy (20.2%) had a higher prevalence of induced abortion than those diagnosed during their index pregnancy (14.1%). In the adjusted logistic regression, women were more likely to have ever induced abortion if they were ever married or cohabiting (aOR; 1.86 95% CI; 1.43-2.41), ever smoked (aOR: 1.51; 95% CI: 1.01-2.28) and diagnosed with HIV before their index pregnancy (aOR:1.44; 95% CI: 1.02-2.05) but less likely if younger than 25 years (aOR; 0.51 95% CI:0.35-0.73). CONCLUSION About one in five women living with HIV had ever induced abortion in the study settings, indicating that abortion service is one of the main reproductive health services needed by women living with HIV in South Africa. This is an indication that the need for abortion is somewhat high in this group of women. The finding, therefore, highlights the need for concerted efforts from all stakeholders to address the unmet need for contraception among women living with HIV to prevent unintended pregnancy.
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Affiliation(s)
- Anthony Idowu Ajayi
- grid.413355.50000 0001 2221 4219Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, APHRC Campus, Manga Close, Nairobi, Kenya
| | - Bright Opoku Ahinkorah
- grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology, Sydney, Australia
| | - Abdul-Aziz Seidu
- grid.511546.20000 0004 0424 5478Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana ,grid.1011.10000 0004 0474 1797College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia
| | - Oladele Vincent Adeniyi
- grid.412870.80000 0001 0447 7939Department of Family Medicine, East London Hospital Complex, Walter Sisulu University/Cecilia Makiwane Hospital, East London, South Africa
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Kowalska JD, Pelchen-Matthews A, Ryom L, Losso MH, Trofimova T, Mitsura VM, Khromova I, Paduta D, Stephan C, Domingo P, Bakowska E, Monforte AD, Oestergaard L, Jablonowska E, Kuznetsova A, Moreno S, Vasylyev M, Pradier C, Battegay M, Vandekerckhove L, Castagna A, Raben D, Mocroft A. Prevalence and outcomes of pregnancies in women with HIV over a 20-year period. AIDS 2021; 35:2025-2033. [PMID: 34033590 DOI: 10.1097/qad.0000000000002954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate time trends in pregnancies and pregnancy outcomes among women with HIV in Europe. DESIGN European multicentre prospective cohort study. METHODS EuroSIDA has collected annual cross-sectional audits of pregnancies between 1996 and 2015. Pregnancy data were extracted and described. Odds of pregnancy were modelled, adjusting for potential confounders using logistic regression with generalized estimating equations. RESULTS Of 5535 women aged 16 to <50 years, 4217 (76.2%) had pregnancy information available, and 912 (21.6%) reported 1315 pregnancies. The proportions with at least one pregnancy were 28.1% (321/1143) in East, 24.5% (146/596) in North, 19.8% (140/706) in West/Central, 19.3% (110/569) in Central East and 16.2% (195/1203) in South Europe. Overall 319 pregnancies (24.3%) occurred in 1996-2002, 576 (43.8%) in 2003-2009 and 420 (31.9%) in 2010-2015. After adjustment, the odds of pregnancy were lower in 1996-2002, in South, Central East and East compared to West/Central Europe, in older women, those with low CD4+ cell count or with prior AIDS, and higher in those with a previous pregnancy or who were hepatitis C virus positive.Outcomes were reported for 999 pregnancies in 1996-2014, with 690 live births (69.1%), seven stillbirths (0.7%), 103 spontaneous (10.3%) and 199 medical abortions (19.9%). CONCLUSIONS Around 20% of women in EuroSIDA reported a pregnancy, with most pregnancies after 2002, when more effective antiretroviral therapy became available. Substantial differences were seen between European regions. Further surveillance of pregnancies and outcomes among women living with HIV is warranted to ensure equal access to care.
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Affiliation(s)
- Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lene Ryom
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Tatiana Trofimova
- Novgorod Centre for AIDS prevention and control, Novgorod the Great, Russian Federation
| | | | - Irina Khromova
- Centre for HIV/AIDS & Infectious Diseases, Kaliningrad, Russian Federation
| | | | | | - Pere Domingo
- Department of Infectious Diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Elzbieta Jablonowska
- Clinic of Infectious Diseases and Hepatology, Medical University of Lodz, Łódź, Poland
| | | | - Santiago Moreno
- Servicio Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Vasylyev
- Lviv Regional HIV/AIDS Prevention and Control Center, Lviv, Ukraine
| | | | - Manuel Battegay
- Department of Medicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Dorthe Raben
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
- CHIP Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Hachfeld A, Atkinson A, Calmy A, de Tejada BM, Hasse B, Paioni P, Kahlert CR, Boillat-Blanco N, Stoeckle M, Aebi-Popp K. Decrease of condom use in heterosexual couples and its impact on pregnancy rates: the Swiss HIV Cohort Study (SHCS). HIV Med 2021; 23:60-69. [PMID: 34476886 PMCID: PMC9290944 DOI: 10.1111/hiv.13152] [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: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
Introduction Following the ‘Swiss statement’ in 2008 it became an option to omit the use of condoms in serodiscordant couples and to conceive naturally. We analysed its impact on condom use and pregnancy events. Methods In all, 3023 women (aged 18–49 years) participating in the Swiss HIV Cohort Study were included. Observation time was divided into pre‐ and post‐Swiss statement phases (July 2005–December 2008 and January 2009–December 2019). We used descriptive statistics, Poisson interrupted time series analysis for pregnancy incidence, and logistic regression to identify predictors of live births, spontaneous and induced abortions. Results Condomless sex in sexually active women increased from 25% in 2005 to 75% in 2019, while pregnancy incidence did not. Women after 2008 experienced higher spontaneous abortion rates (12.1% vs. 17.2%, p = 0.02) while induced abortion and live birth rates did not change significantly. Spontaneous abortions were more common in older women [adjusted odds ratio (aOR) = 1.4, 95% CI: 1.2–1.7, p < 0.001], in women consuming alcohol (aOR = 2.8, 95% CI: 1.9–4.1, p < 0.001) and in those with non‐suppressed viral load (aOR = 0.2, 95% CI: 0.1–0.4, p ≤ 0.001). Induced abortions were more likely in women with depression (aOR = 3.4, 95% CI: 1.8–6.3, p < 0.001) and non‐suppressed viral load (aOR = 0.3, 95% CI: 0.2–0.7, p = 0.003). Conclusions The publication of the Swiss statement resulted in more condomless sex in heterosexual women, but this did not result in a higher incidence of pregnancy. Maternal age and spontaneous abortion rates increased over time, while induced abortion rates were not significantly affected. Women living with HIV in Switzerland have an unmet need regarding family planning counselling.
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Affiliation(s)
- Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.,Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Alexandra Calmy
- Department of Infectious Diseases, Geneva University Hospitals, HIV/AIDS Unit, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Division, Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christian R Kahlert
- Children's Hospital of Eastern Switzerland and Cantonal Hospital, St. Gallen, Switzerland
| | | | - Marcel Stoeckle
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
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Ralph JA, Yeh C, Cowett A, Hirschhorn LR, Hammond C. Get PrEPPT (pre-exposure prophylaxis and pregnancy termination): an exploration of the values, attitudes and preferences regarding HIV and PrEP among women seeking abortion. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:e6. [PMID: 33122259 DOI: 10.1136/bmjsrh-2020-200623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) for the prevention of HIV transmission is under utilised by women in the US. Women seeking abortion have a higher HIV prevalence than women who continue prenatal care and could benefit from HIV risk assessment and PrEP counselling. We assessed the knowledge, attitudes, and preferences of women seeking abortion care regarding their HIV risk and knowledge of PrEP, and identified individual and system barriers to PrEP access. METHODS We performed a cross sectional descriptive study of English speaking women at a freestanding abortion clinic through an anonymous survey. Participants with indications for PrEP care included those who performed sex work, experienced a recent sexually transmitted infection, or had multiple sexual partners and inconsistent condom use. We performed descriptive statistics on response data; Wilcoxon tests were used to compare continuous variables across groups. RESULTS 64 (32.3%) participants had indications for PrEP, but only 31 (16.1%) had previous knowledge of PrEP. After the concept was explained, attitudes towards PrEP were generally positive, and 54 participants (27.8%) would consider starting PrEP in the next 6 months. Participants were most interested in receiving PrEP care from their primary care provider rather than from an abortion clinic. CONCLUSIONS Among women seeking abortion, women vulnerable to HIV infection outnumbered those with PrEP knowledge by 2 to 1. Prior knowledge of PrEP as an HIV prevention method was low, but women found PrEP acceptable. While women reported preferring to receive PrEP from a primary care provider, the abortion clinic visit may also represent an important time for HIV education and risk screening.
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Affiliation(s)
- Jessika Ann Ralph
- Obstetrics and Gynecology, Section of Family Planning, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chen Yeh
- Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Allison Cowett
- Obstetrics and Gynecology, Section of Family Planning, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lisa R Hirschhorn
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cassing Hammond
- Obstetrics and Gynecology, Section of Family Planning, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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9
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Domingues RMSM, Silva CMFPD, Grinsztejn BGJ, Moreira RI, Derrico M, Andrade AC, Friedman RK, Luz PM, Coelho LE, Veloso VG. Prevalence of induced abortion and associated factors in a cohort of women living with HIV/AIDS, Rio de Janeiro, Brazil, 1996-2016. CAD SAUDE PUBLICA 2020; 36Suppl 1:e00201318. [PMID: 32049128 DOI: 10.1590/0102-311x00201318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/12/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to verify the prevalence of induced abortion and associated factors at the time of inclusion in a cohort of women living with HIV/AIDS in the city of Rio de Janeiro, Brazil, from 1996 to 2016. Eligibility criteria for inclusion in the cohort were female sex at birth, age 18 years and older, and confirmed HIV infection. At the baseline visit, data on sexual, reproductive, and behavioral aspects and HIV infection were obtained through a face-to-face interview with the attending physician. Lifetime prevalence of induced abortion was calculated, and factors associated with induced abortion were verified by multiple logistic regression for all the women and for those with previous pregnancy. In the entire cohort of women, 30.4% reported a history of induced abortion, compared to 33.5% in women with previous pregnancy. Frequency of reported induced abortion showed a significant reduction during the period (41.7% in 1996-2000 versus 22.5% in 2011-2016, p < 0.001). Factors associated with induced abortion, both for the entire cohort and for the women with previous pregnancy, were age, schooling, ≥ 5 lifetime sexual partners, teenage pregnancy, lifetime use of any illicit drug, and inclusion in the cohort after the year 2005. Changes in the socioeconomic, sexual, reproductive, and HIV infection profile are possible explanations for the reduction in abortions during the period. Studies that use direct methods to measure abortion should be conducted in other populations to confirm the downward trend in induced abortion and its determinants in Brazil.
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Affiliation(s)
| | | | | | - Ronaldo Ismerio Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Monica Derrico
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Angela Cristina Andrade
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ruth Khalili Friedman
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Valdiléa G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Domingues RMSM, Fonseca SC, Leal MDC, Aquino EML, Menezes GMS. Aborto inseguro no Brasil: revisão sistemática da produção científica, 2008-2018. CAD SAUDE PUBLICA 2020; 36Suppl 1:e00190418. [DOI: 10.1590/0102-311x00190418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 08/28/2019] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo é atualizar o conhecimento sobre o aborto inseguro no país. Foi realizada uma revisão sistemática com busca e seleção de estudos via MEDLINE e LILACS, sem restrição de idiomas, no período 2008 a 2018, com avaliação da qualidade dos artigos por meio dos instrumentos elaborados pelo Instituto Joanna Briggs. Foram avaliados 50 artigos. A prevalência de aborto induzido no Brasil foi estimada por método direto em 15% no ano de 2010 e 13% no ano de 2016. Prevalências mais elevadas foram observadas em populações socialmente mais vulneráveis. A razão de aborto induzido por 1.000 mulheres em idade fértil reduziu no período 1995-2013, sendo de 16 por 1.000 em 2013. Metade das mulheres referiu a utilização de medicamentos para a interrupção da gestação e o número de internações por complicações do aborto, principalmente complicações graves, reduziu no período 1992-2009. A morbimortalidade materna por aborto apresentou frequência reduzida, mas alcançou valores elevados em contextos específicos. Há um provável sub-registro de óbitos maternos por aborto. Transtornos mentais comuns na gestação e depressão pós-parto foram mais frequentes em mulheres que tentaram induzir um aborto sem sucesso. Os resultados encontrados indicam que o aborto é usado com frequência no Brasil, principalmente nas regiões menos desenvolvidas e por mulheres socialmente mais vulneráveis. O acesso a métodos mais seguros provavelmente contribuiu para a redução de internações por complicações e para a redução da morbimortalidade por aborto. Entretanto, metade das mulheres ainda recorre a outros métodos e o número de internações por complicações do aborto é ainda elevado.
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11
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Pinho ADA, Villela WV, Barbosa RM, Monteiro SS. Abortion among women living with or not living with HIV/AIDS users of public health services in São Paulo municipality: prevalence, contexts and reasons. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: we investigated the lifetime prevalence of abortion and life contexts and reasons reported for first abortion among women living (WLHA) and not living with HIV/AIDS(WNLHA). Methods: representative samples of 975 users of public health care reference network for HIV/AIDS and of 1,003 users of the primary care public services in São Paulo municipality were selected by cluster-stratified sampling and answered an electronic socio-behavioral questionnaire. Results: the prevalence of abortion was 11.9% (CI95%9.8-13.9) among WLHA and 3.0% (CI95%2.4-5.7) for WNLHA.Most abortions (128) among WLHA occurred before diagnosis and 28 after diagnosis or during pregnancy when diagnosis was given. The majority of women did not use any contraception at the time of the first abortion. The use of misoprostol was the most reported method. Having HIV was very important in deciding to abort for half of the WLHA. Absence of marital life and the lack of desire to have children were the most reported reasons by both groups. Conclusions: the similarity in contexts and reasons to abort among WLHA and WNLHA suggests that they share experiences molded by gender and social inequalities that affect their ability to access sexual and reproductive health resources and services.
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12
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Zachek CM, Coelho LE, Domingues RMSM, Clark JL, De Boni RB, Luz PM, Friedman RK, de Andrade ÂCV, Veloso VG, Lake JE, Grinsztejn B. The Intersection of HIV, Social Vulnerability, and Reproductive Health: Analysis of Women Living with HIV in Rio de Janeiro, Brazil from 1996 to 2016. AIDS Behav 2019; 23:1541-1551. [PMID: 30652206 PMCID: PMC6536320 DOI: 10.1007/s10461-019-02395-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Comprehensive care for sexual and reproductive health (SRH) and social needs for women living with HIV remains limited globally. We aimed to assess trends in baseline sociodemographic, clinical, sexual, and reproductive characteristics among a cohort of HIV-infected women in Rio de Janeiro from 1996 to 2016. Participants were stratified into four time periods based on year of enrollment; we compared cross-sectional data from each period. Of 1361 participants (median age 36), most were black or mixed race (60.1%), unemployed (52.1%), and without secondary education (54%). Adolescent pregnancy was common (51.5%), and 18.3% reported sexual debut at < 15 years old. Nearly half (45.2%) had < 5 lifetime sexual partners, yet prior syphilis and oncogenic human papillomavirus prevalence were 10.9% and 43.1%, respectively. Lifetime prevalence of induced abortion was 30.3%, and 16% used no contraceptive method. Future research should explore interactions between social vulnerability, HIV, and poor SRH outcomes and healthcare models to alleviate these disparities.
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Affiliation(s)
- Christine M Zachek
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, South American Program in HIV Prevention Research (SAPHIR), Los Angeles, CA, USA.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rosa M S M Domingues
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse L Clark
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, South American Program in HIV Prevention Research (SAPHIR), Los Angeles, CA, USA
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ruth K Friedman
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan E Lake
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, South American Program in HIV Prevention Research (SAPHIR), Los Angeles, CA, USA
- Department of Medicine, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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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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Taft AJ, Powell RL, Watson LF, Lucke JC, Mazza D, McNamee K. Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women's Health. Aust N Z J Public Health 2019; 43:137-142. [PMID: 30727034 DOI: 10.1111/1753-6405.12874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/01/2018] [Accepted: 12/01/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE A trend analysis of associations with induced abortion. METHODS Secondary analysis of the 1973/78 cohort of the Australian Longitudinal Study of Women's Health of women responding to two or more consecutive surveys out of five (N=9,042), using generalised estimating equations. RESULTS New abortions dropped from 7% to 2% at surveys 4 and 5. By survey 5, 16% of respondents reported abortions, only 2% of them new. Women aged in their twenties were more likely to terminate a pregnancy if they reported less-effective contraceptives (aOR2.18 CI 1.65-2.89); increased risky drinking (aOR1.65 CI 1.14-2.38); illicit drugs ≤12 months (aOR3.09 CI 2.28-4.19); or recent partner violence (aOR2.42 CI 1.61-3.64). By their thirties, women were more likely to terminate if they reported violence (aOR2.16 CI 1.31-3.56) or illicit drugs <12 months (aOR2.69 CI 1.77-4.09). Women aspiring to be fully- (OR1.58 CI 1.37-1.83) or self-employed (OR1.28 CI 1.04-1.57), with no children (OR1.41 CI 1.14-1.75) or further educated (OR 2.08 CI 1.68-2.57) were more likely to terminate than other women. CONCLUSIONS Abortion remains strongly associated with factors affecting women's control over reproductive health such as partner violence and illicit drug use. Implications for public health: Healthcare providers should inquire about partner violence and illicit drug use among women seeking abortion, support women experiencing harm and promote effective contraception.
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Affiliation(s)
| | | | | | - Jayne C Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria.,School of Public Health, University of Queensland
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
| | - Kathleen McNamee
- Department of Obstetrics and Gynaecology, Monash Health, Victoria
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Saleem HT, Narasimhan M, Ganatra B, Kennedy CE. Medical and surgical abortion for women living with HIV. Cochrane Database Syst Rev 2018; 12:CD012834. [PMID: 30566226 PMCID: PMC6516981 DOI: 10.1002/14651858.cd012834.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The World Health Organization (WHO) guidelines for safe abortion recommend medical abortion with mifepristone and misoprostol or surgical abortion with vacuum aspiration or dilation and evacuation as safe and effective options for women. However, no specific clinical considerations are stipulated within these guidelines for women living with HIV. Concerns have been raised that women living with HIV may be at greater risk of adverse abortion outcomes compared to HIV-uninfected women due to immunosuppression, high rates of co-infection with other sexually transmitted infections, and possible contraindications between medications used for medical abortion and antiretroviral therapy regimens. OBJECTIVES Our primary objective was to assess the effectiveness and safety of medical versus surgical abortion among women living with HIV. Our secondary objectives were to: (1) compare outcomes of medical and surgical abortion between women living with HIV and women without HIV and (2) describe outcomes of medical and surgical abortion among women living with HIV. SEARCH METHODS We conducted our search on 17 April 2018. We searched for all published and unpublished trials and observational studies of medical and surgical abortion among women living with HIV. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform using a combination of terms for abortion and HIV. We searched conference websites for relevant abstracts. We also sought unpublished data stratified by HIV status that could be newly analyzed. SELECTION CRITERIA We considered randomized controlled trials (RCTs), non-RCTs, and observational studies. We considered: (1) studies on the effectiveness and safety of medical versus surgical abortion among women living with HIV; (2) studies comparing outcomes of abortion for both methods between women living with HIV and women without HIV; and (3) studies that described outcomes of abortion among women living with HIV. DATA COLLECTION AND ANALYSIS One review author screened the titles, abstracts, citation information, and descriptor terms for citations initially identified by the search. We obtained the full-text articles of all potentially eligible studies when these were available. Two review authors independently examined the full-text articles for compliance with the inclusion criteria and determination of final study selection. We planned to conduct meta-analysis if a sufficient number of studies (at least three) addressed the same research question and presented data on sufficiently comparable outcomes. MAIN RESULTS Of 3840 records screened, we identified just one conference abstract that met our inclusion criteria. This prospective cohort study assessed the efficacy and acceptability of home administration of misoprostol for early medical abortion among women living with HIV who were of less than 63 days amenorrhea in Ukraine. Medical abortion was effective in 65 of 68 cases (96%) examined. The small number of failures included incomplete abortion (n = 1), heavy bleeding (n = 1), and ongoing pregnancy (n = 1). There were no serious infections. AUTHORS' CONCLUSIONS Due to the paucity of studies, we were unable to determine if outcome differences exist between women living with HIV and women without HIV who undergo medical or surgical abortion. We found no evidence suggesting that medical or surgical abortions are unsafe for women living with HIV. While additional research would strengthen the evidence base, healthcare providers should not be deterred from providing access to safe abortion to their patients living with HIV.
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Affiliation(s)
- Haneefa T Saleem
- Johns Hopkins Bloomberg School of Public HealthDepartment of International Health, Social and Behavioral Interventions Program615 N. Wolfe Street, Suite E5033BaltimoreMarylandUSA21205
| | - Manjulaa Narasimhan
- World Health OrganizationDepartment of Reproductive Health and ResearchGenevaSwitzerland
| | - Bela Ganatra
- World Health OrganizationDepartment of Reproductive Health and ResearchGenevaSwitzerland
| | - Caitlin E Kennedy
- Johns Hopkins Bloomberg School of Public HealthDepartment of International Health, Social and Behavioral Interventions Program615 N. Wolfe Street, Suite E5033BaltimoreMarylandUSA21205
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Choi H, Kim MH, Lee SJ, Kim EJ, Lee W, Jeong W, Jung IY, Ahn JY, Jeong SJ, Ku NS, Baek JH, Choi YH, Kim HY, Kim JM, Choi JY. Pregnancy Rates and Outcomes of HIV-Infected Women in Korea. J Korean Med Sci 2018; 33:e296. [PMID: 30450024 PMCID: PMC6236080 DOI: 10.3346/jkms.2018.33.e296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/16/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Antepartum, intrapartum, and postpartum preventive measures with antiretroviral drugs, appropriate delivery methods, and discouraging breastfeeding significantly decrease the risk of mother-to-child transmission of human immunodeficiency virus (HIV) infection. Herein, we investigated the pregnancy outcomes in HIV-infected Korean women. METHODS We retrospectively reviewed medical records of childbearing-age HIV-infected women between January 2005 and June 2017 at four tertiary care hospitals in Korea. RESULTS Among a total of 95 HIV infected women of child-bearing age with 587.61 years of follow-up duration, 15 HIV-infected women experienced 21 pregnancies and delivered 16 infants. The pregnancy rate was 3.57 per 100 patient-years. Among the 21 pregnancies, five ended with an induced abortion, and 16 with childbirth including two preterm deliveries at 24 and 35 weeks of gestation, respectively. The two preterm infants had low birth weight and one of them died 10 days after delivery due to respiratory failure. Among the 14 full-term infants, one infant was small for gestational age. There were no HIV-infected infants. CONCLUSION The pregnancy rate of HIV-infected women in Korea is lower than that of the general population. Although several adverse pregnancy outcomes were observed, mother-to-child transmission of HIV infection was successfully prevented with effective preventive measures.
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Affiliation(s)
- Heun Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Hyun Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Se Ju Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Woonji Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Wooyong Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - In Young Jung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Young Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - June Myung Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
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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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18
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Pinho ADA, Cabral CDS, Barbosa RM. Differences and similarities in women living and not living with HIV: contributions by the GENIH study to sexual and reproductive healthcare. CAD SAUDE PUBLICA 2017; 33:e00057916. [PMID: 29267678 DOI: 10.1590/0102-311x00057916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 03/22/2017] [Indexed: 11/22/2022] Open
Abstract
This quantitative study in the city of São Paulo, Brazil, compared contexts of social vulnerability and sexual and reproductive behavior in a sample of 975 women living with HIV/AIDS (WLHIV) and 1,003 women not living with HIV, the latter recruited among users of the primary healthcare system. WLHIV experienced situations of greater vulnerability that potentially increased their risk of HIV infection and unplanned pregnancy and abortion. Compared to women users of the primary healthcare system, WLHIV reported higher rates of drug use, sex for money, exposure to intimate partner violence, difficulties in access to services for prevention and early diagnosis, unplanned pregnancies, induced abortion, and teenage pregnancy. A considerable number of the women users of the primary healthcare system shared these same experiences, but at lower rates. The identification of contexts of vulnerability and the integration of HIV testing services with sexual and reproductive health services should constitute lines of care for these women, both in specialized and primary care services.
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Affiliation(s)
| | | | - Regina Maria Barbosa
- Núcleo de Estudos de População Elza Berquó, Universidade Estadual de Campinas, Campinas, Brasil
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Teixeira LB, Pilecco FB, Vigo Á, Drachler MDL, Leite JCDC, Knauth DR. Factors associated with post-diagnosis pregnancies in women living with HIV in the south of Brazil. PLoS One 2017; 12:e0172514. [PMID: 28222175 PMCID: PMC5319676 DOI: 10.1371/journal.pone.0172514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/05/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives To analyze the factors associated with the occurrence of pregnancies after the diagnosis of infection by HIV. Methods Cross-sectional study with women of a reproductive age living with HIV/AIDS cared for in the public services of the city of Porto Alegre, in southern Brazil. The data was analyzed from a comparison between two groups: women with and women without pregnancies after the diagnosis of HIV. Poisson regression models were used to estimate the reasons of prevalence (RP). Results The occurrence of pregnancies after the diagnosis of HIV is associated with a lower level of education (RP adjusted = 1.31; IC95%: 1.03–1.66), non-use of condoms in the first sexual intercourse (RP = 1.32; IC95%: 1.02–1.70), being 20 years old or less when diagnosed with HIV (RP = 3.48; IC95%: 2.02–6.01), and experience of violence related to the diagnosis of HIV (RP = 1.28; IC95%: 1.06–1.56). Conclusions The occurrence of pregnancies after the diagnosis of infection by HIV does not indicate the exercise of the reproductive rights of the women living with HIV/AIDS because these pregnancies occurred in contexts of great vulnerability.
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Affiliation(s)
- Luciana Barcellos Teixeira
- Department of Professional Assistance and Guidance, Nursing School, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Public Health, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | - Flávia Bulegon Pilecco
- Department of Social Medicine, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | - Álvaro Vigo
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Department of Statistics, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria de Lourdes Drachler
- Graduate Studies Program in Public Health, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Daniela Riva Knauth
- Department of Social Medicine, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul), Porto Alegre, Rio Grande do Sul, Brazil
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