Women Exiting Street-Based Sex Work: Correlations between Ethno-Racial Identity, Number of Children, and Violent Experiences

Through this article the authors examine data collected from 126 women seeking services at a transitional housing facility, primarily for women leaving street-based prostitution. Descriptive statistics on the women's ethno-racial identity, numbers of children, and experiences with violence are presented and analyzed to determine correlations and implications for social service providers working with this unique population of women. 

Nearly half of respondents are women of color, a majority have given birth to at least one child, and more than half are in a non-commercial intimate partnership, with a significant number reporting extensive experiences with violent trauma and abuse. 

Results indicate statistically significant differences in women's ethno-racial self-identification and their experiences of sex work and violence, as well as their marital status. Most notably, African-American and Hispanic women face the greatest and most diverse forms of intimate partner violence and negative sex industry experiences, with African-Americans more likely to engage in sex work as minors, be sexually abused as children, work for a pimp, and face physical assault and instances of sex trafficking. 

Results also support existing research showing correlations between traumatic childhood events and adult substance abuse, sexual assault, and other negative outcomes.

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By:  Hankel J1, Dewey S2, Martinez N3.

• 1 Independent scholar , Denver , Colorado , USA.
• 2 Gender & Women's Studies, University of Wyoming , Laramie , Wyoming , USA.
• 3 Street's Hope , Denver , Colorado , USA.
• J Evid Inf Soc Work. 2016 Apr 4:1-13. 

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John Henryism Active Coping as a Cultural Correlate of Substance Abuse Treatment Participation among African American Women

The rates of illicit drug use among African American women are increasing, yet African American women are least likely to participate in treatment for substance use disorders when compared to women of other racial groups. 

The current study examined family history of substance use, perceived family support, and John Henryism Active Coping (JHAC) as correlates to seeking treatment for substance abuse. The underlying theoretical frame of JHAC (James et al., 1983) suggests that despite limited resources and psychosocial stressors, African Americans believe that hard work and self-determination are necessary to cope with adversities. 

The current study is a secondary data analyses of 206 drug-using African American women (N=104 urban community women with no criminal justice involvement and N=102 women living in the community on supervised probation) from urban cities in a southern state. It was expected that African American women with a family history of substance abuse, higher levels of perceived family support, and more active coping skills would be more likely to have participated in substance abuse treatment. 

Step-wise logistic regression results reveal that women on probation, had children, and had a family history of substance abuse were significantly more likely to report participating in substance abuse treatment. 

Perceived family support and active coping were significant negative correlates of participating in treatment. Implication of results suggests coping with psychosocial stressors using a self-determined and persistent coping strategy may be problematic for drug-using women with limited resources.

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By:  Stevens-Watkins D1, Knighton JS2, Allen K3, Fisher S2, Crowell C2, Mahaffey C2, Leukefeld C2, Oser C2.

• 1University of Kentucky. Electronic address: d.stevenswatkins@uky.edu.
• 2University of Kentucky.
• 3Florida State University. 
• J Subst Abuse Treat. 2016 Apr;63:54-60. doi: 10.1016/j.jsat.2016.01.004. Epub 2016 Jan 15.

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Race Is Associated with Sexual Behaviors and Modifies the Effect of Age on Human Papillomavirus Serostatus among Perimenopausal Women

BACKGROUND:

Human papillomavirus (HPV) causes oropharyngeal and cervical cancers. Oropharyngeal cancer primarily affects whites, but cervical cancer is more common among blacks. Reasons for this distinct epidemiology are unclear.

METHODS:

Serum was collected from women aged 35 to 60 years in the HPV in Perimenopause cohort and evaluated for antibodies to 8 HPV types. Demographic and behavioral data were collected by telephone questionnaire. Associations between sexual behaviors, race, age, HPV serostatus, and strength of serologic response to HPV were evaluated.

RESULTS:

There were 781 women in this analysis, including 620 white (79%) and 161 (21%) black women. Whites were less likely to report 5+ vaginal sex partners (prevalence ratio [PR], 0.86; 95% confidence interval [CI], 0.77-0.97), but more likely to report 5+ oral sex partners (PR, 2.38; 95% CI, 1.62-3.49) compared with blacks. Seropositivity to most individual HPV types and at least 3 types was significantly lower in whites than in blacks (PR, 0.62; 95% CI, 0.47-0.80). Human papillomavirus seropositivity was independently associated with younger age among blacks, but with sexual exposures among whites. Furthermore, strength of serologic response to most HPV types significantly decreased with older age among blacks, but not among whites.

CONCLUSIONS:

Racial differences in immune markers of HPV exposure and the epidemiology of HPV-related cancers may be linked to differences in patterns of sexual behaviors.

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By:  Rettig EM1, Fakhry C, Rositch AF, Burke AE, Chang K, Silver MI, Viscidi R, Gravitt P.

• 1From the *Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; †Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of ‡Gynecology and Obstetrics and §Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; and ¶Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM.
• Sex Transm Dis. 2016 Apr;43(4):231-7. doi: 10.1097/OLQ.0000000000000426. 

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A Multilevel Understanding of HIV/AIDS Disease Burden among African American Women

Disproportionate HIV/AIDS rates among African American women have been examined extensively—primarily from an individually-centered focus. Beyond individual behaviors, factors such as the hyper-incarceration of African American men and geographically concentrated disadvantage may better explain inequitable disease burden. This paper proposes a conceptual model of individual, social, and structural factors that influence HIV transmission among African American women. The model can be used to develop comprehensive assessments and guide prevention programs in African American communities.

…Limited educational attainment, poverty, and imbalanced male-female sex ratios all fuel the HIV epidemic among African American populations (Dean & Fenton, 2010). Thus, structural interventions should continue to be incorporated in our HIV prevention dialogue, especially since they have proven to be efficacious (Adimora & Auerbach, 2010). Similar to others, this author argues that HIV is an individual, social and structural concern, requiring community engagement and mobilization toward its eradication. Although a universal “test-and-treat” model could potentially eliminate new HIV infections over time, social and structural barriers exist to widespread implementation and sustainability (Kulkarni, Shah, Sarma, & Mahajan, 2013). Neither a biomedical nor behavioral approach to HIV prevention can be sustained in the absence of considering the broader contexts. It is important to note, however, that there are substantial challenges associated with the implementation of structural interventions so as not to minimize the arduous nature in which they are executed (Auerbach et al., 2011). This becomes particularly difficult when opposing entrenched systems and interests that continue to marginalize and oppress certain groups (Miller, Reed, Francisco, & Ellen, 2012), such as African American women…

Below:  A Conceptual Model (with Presumed Pathways [P_x]) for Understanding Geobehavioral Vulnerability to HIV among African Americans

Full article at:   http://goo.gl/hIrFc9

By:  Bridgette M. Brawner, PhD, APRN, Assistant Professor of Nursing

Bridgette M. Brawner, Center for Health Equity Research, Center for Global Women's Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., 4th Floor, Room 419, Philadelphia, PA 19104-4217, 215-898-0715 (office), 215-746-3374 (fax),

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"Come on Baby. You Know I Love You": African American Women's Experiences of Communication with Male Partners and Disclosure in the Context of Unwanted Sex

We examined African American women's experiences of communication with their male intimate partners a couple of hours before and after an incident of unwanted sex. 

We also examined women's experiences of disclosure following an incident of unwanted sex. Semi-structured qualitative interviews were conducted with a community-based sample of sexually active African American women (n = 19) reporting at least one incident of sexual coercion (i.e., being pressured into unwanted sex without consent) by an intimate male partner since the age of 18. Our analysis was guided by "the sexual division of power" from Connell's (1987) theory of gender and power. Data were analyzed inductively by examining the interviews for common themes in the following domains: communication before the unwanted sex, communication after the unwanted sex, and disclosure to others. 

Men pressured partners for unwanted sex through verbal and non-verbal tactics, ranging from pestering and blunt requests for sex to verbal bullying and violence. Many women responded by clearly saying no. However, many women also described eventually ceasing to resist their partners and engaging in unwanted sex. After the unwanted sex, men actively and passively avoided discussing the incident. Although many women discussed the unwanted sex with family and friends, less women disclosed to trained professionals. In some cases, women did not discuss the incident with anyone at all. 

These findings indicate that, when addressing sexual violence against women, there is a need to target men as well as the norms of masculinity that underpin physical and sexual violence against women.

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By:  Gutzmer K1,2, Ludwig-Barron NT3, Wyatt GE4, Hamilton AB4,5, Stockman JK6.

• 1Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
• 2Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
• 3Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA.
• 4Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
• 5VA Greater Los Angeles Healthcare System, Los Angeles, Los Angeles, CA, USA.
• 6Division of Global Public Health, Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507, USA. jstockman@ucsd.edu. 
• Arch Sex Behav. 2016 Feb 18.

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Racial & Ethnic Differences in Women’s Preferences for Features of Contraceptive Methods

Objectives

To understand women’s preferences for specific features of contraceptive methods, the extent to which features of existing methods match women’s preferences, and whether this match differs by racial and ethnic subgroups.

Study Design

Using data from 1,783 women in family planning and abortion clinics across the United States, we performed analyses of racial and ethnic differences in contraceptive features reported to be “extremely important” by participants. We explored how preferences vary for more and less effective contraceptive methods.

Results

In multivariate analysis non-Hispanic Black, Latinas and Asian Pacific Islander women were more likely to report the following features as “extremely important” compared to non-Hispanic Whites (p<0.05): being able to stop using the method at any time, using a method only with intercourse, and the method not changing her menstrual periods. Non-Hispanic Black and Latina women were statistically more likely to report that protection against sexually transmitted diseases, having control over when and whether to use the method and being able to become pregnant after stopping use were extremely important. The contraceptive feature preferences of racial and ethnic minority women in our study had a relatively lower match with high efficacy methods and higher match for low efficacy methods compared to White women (p<0.05).

Conclusions

High rates of unintended pregnancy among minority women may be due in part to differences in contraceptive features preferences, and discrepancy between their preferences and the features of currently available highly effective methods.

Implications

In the context of disparities in rates of unintended pregnancy by racial and ethnic group, this variation in preferences for contraceptive features by race/ethnicity may explain differences in contraceptive use and can inform the development of more acceptable methods of contraception.

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By:  Andrea V. Jackson, Deborah Karasek, Christine Dehlendorf, Diana Greene Foster

Affiliations

Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF

Bixby Center for Global Reproductive Health, UCSF

Corresponding author at: University of California San Francisco, Women’s Health Center, 2356 Sutter Street, J-140, San Francisco, CA 94115

jacksona@obgyn.ucsf.edu

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Infected Lives: Lived Experiences of Young African American HIV-Positive Women

This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. 

One pattern, Infected Lives, and three themes-Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal-emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. 

They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. 

Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma.

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By:   Peltzer JN1, Domian EW2, Teel CS2.

• 1University of Kansas School of Nursing, Kansas City, USA jpeltzer2@kumc.edu.
• 2University of Kansas School of Nursing, Kansas City, USA.
• West J Nurs Res. 2016 Feb;38(2):216-30. doi: 10.1177/0193945914552167. Epub 2014 Sep 18. 

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Trauma History in African-American Women Living with HIV: Effects on Psychiatric Symptom Severity and Religious Coping

Women living with HIV (WLHIV) have rates of post-traumatic stress disorder (PTSD) up to 5 times higher than the general population. Individuals living with HIV and a concurrent diagnosis of PTSD have poorer HIV-related outcomes; however, the prevalence and impact of PTSD on African-American WLHIV seeking mental health treatment is unknown. 

The aim of this study is to examine the associations between PTSD symptoms with psychiatric symptom severity and psychological/religious coping strategies in African-American WLHIV who are seeking mental health treatment. This is a cross-sectional study of 235 African-American WLHIV attending an urban community mental health clinic. Bivariate analyses were conducted to evaluate associations between a PTSD symptoms scale (PSS≥21 versus PSS<21) and (1) psychiatric severity, (2) coping strategies, and (3) religious coping strategies. 

Thirty-six percent reported symptoms consistent with PTSD (PSS≥21). These women were significantly more likely to have worse mental health symptoms and were more likely to employ negative psychological and religious coping strategies. On the contrary, women with a PSS<21 reported relatively low levels of mental health symptoms and were more likely to rely on positive psychological and religious coping strategies. 

Over one-third of African-American WLHIV attending an outpatient mental health clinic had symptoms associated with PTSD. These symptoms were associated with worse mental health symptoms and utilization of dysfunctional religious and nonreligious coping strategies. 

Untreated PTSD in WLHIV predicts poorer HIV-related health outcomes and may negatively impact comorbid mental health outcomes. Screening for PTSD in WLHIV could identify a subset that would benefit from evidence-based PTSD-specific therapies in addition to mental health interventions already in place. PTSD-specific interventions for WLHIV with PTSD may improve outcomes, improve coping strategies, and allow for more effective treatment of comorbid mental health disorders.

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By:   Brownley JR1, Fallot RD, Wolfson Berley R, Himelhoch SS.

• 1 Department of Psychiatry , University of Maryland School of Medicine, Baltimore , MD , USA. 

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Healing Pathways: Longitudinal Effects of Religious Coping & Social Support on PTSD Symptoms in African American Sexual Assault Survivors

African American women are at a slightly increased risk for sexual assault (A. Abbey, A. Jacques-Tiaura, & M. Parkhill, 2010). However, because of stigma, experiences of racism, and historical oppression, African American women are less likely to seek help from formal agencies compared to White women (Lewis et al., 2005; S. E. Ullman & H. H. Filipas, 2001) and/or women of other ethnic backgrounds (C. Ahrens, S. Abeling, S. Ahmad, & J. Himman, 2010). Therefore, the provision of culturally appropriate services, such as the inclusion of religion and spiritual coping, may be necessary when working with African American women survivors of sexual assault. Controlling for age and education, the current study explores the impact of religious coping and social support over 1 year for 252 African American adult female sexual assault survivors recruited from the Chicago metropolitan area. Results from hierarchical linear regression analyses reveal that high endorsement of religious coping and social support at Time 1 does not predict a reduction in posttraumatic stress disorder (PTSD) symptoms at Time 2. However, high social support at Time 2 does predict lower PTSD at Time 2. Also, it is significant to note that survivors with high PTSD at Time 1 and Time 2 endorse greater use of social support and religious coping. Clinical and research implications are explored...

[F]indings of the present research among African American survivors of sexual assault support are important as they underscore the need for longitudinal studies. The earlier cross-sectional findings of reduction in PTSD for those using social support did not manifest over a 1-year follow-up period. This is critical for clinicians and researchers to understand and explore further, as it points to the potential devastating effects of sexual assault that coping alone may not address. It is important to consider additional factors such as revictimization and other contextual factors in understanding and addressing the mental health outcomes of survivors. The use of religion to ameliorate distress and post-traumatic symptoms can be attributed to historical and/or present experiences of racism and discrimination, which may make African American women less likely to seek help from organized institutions and mental health providers, and more likely to turn to religious and spiritual supports for healing. The use of religion may also be reflective of greater stigma in the African American community towards mental health services (Farris, 2007), in which case efforts, such as public mental health campaigns with culturally respected spokespersons, should be made to reduce the stigma of such services and to provide culturally appropriate services that incorporate spiritual and/or religious coping. Additionally the development of spiritual/religious cultural competence is important for clinicians, as they should not overlook the presence of faith traditions of numerous African American clients. Instead, it is important for clinicians to assess for and recognize the presence of spiritual/religious beliefs and practices among clients.

Full article at:   http://goo.gl/O4Is9p

By:   Thema Bryant-Davis, PhD, Sarah Ullman, PhD, Yuying Tsong, PhD, Gera Anderson, MA, Pamela Counts, MA,Shaquita Tillman, PhD, Cecile Bhang, MA, and Anthea Gray, MA

Thema Bryant-Davis, Pepperdine University;

Contributor Information.

Correspondence regarding this manuscript should be addressed to Thema Bryant-Davis, PhD; Pepperdine University; GSEP: 16830 Ventura Blvd.; Encino, CA 91436. Email: ude.enidreppep@tnayrbt

Authors’ Complete Mailing Addresses

Thema Bryant-Davis, PhD; Pepperdine University; GSEP: 16830 Ventura Blvd.; Encino, CA 91436

Sarah Ullman, PhD; University of Illinois, Chicago; Department of Criminal Justice (M/C 141) 1007 West Harrison St.; Chicago IL 60607-7140

Yuying Tsong, PhD; California State University, Fullerton; Department of Human Services; Health Promotion Research Institute; 800 N. State College Blvd., KHS 115B; Fullerton, CA 92831-3599

Gera Anderson; Pepperdine University; GSEP: 16830 Ventura Blvd.; Encino, CA 91436

Pamela Counts; Pepperdine University; GSEP: 16830 Ventura Blvd.; Encino, CA 91436

Shaquita Tillman; Pepperdine University; GSEP: 16830 Ventura Blvd.; Encino, CA 91436

Cecile Bhang; Pepperdine University; GSEP: 16830 Ventura Blvd.; Encino, CA 91436

Anthea Gray, MA; Pepperdine University; GSEP: 16830 Ventura Blvd.; Encino, CA 91436

J Trauma Dissociation. 2015 Jan-Feb; 16(1): 114–128. doi:  10.1080/15299732.2014.969468 

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Differences Between African-American and European-American Women in the Association of Childhood Sexual Abuse with Initiation of Marijuana Use and Progression to Problem Use

OBJECTIVE:

Childhood sexual abuse (CSA) is associated with elevated risk of early marijuana use and cannabis use disorder (CUD). Both the prevalence of CSA and the course of marijuana use differ between African Americans and European Americans. The current study aimed to determine whether these differences manifest in racial/ ethnic distinctions in the association of CSA with early and problem use of marijuana.

METHOD:

Data were derived from female participants in a female twin study and a high-risk family study of substance use (n = 4,193, 21% African-American). Cox proportional hazard regression analyses using CSA to predict initiation of marijuana use and progression to CUD symptom(s) were conducted separately by race/ethnicity. Sibling status on the marijuana outcome was used to adjust for familial influences.

RESULTS:

CSA was associated with both stages of marijuana use in African-American and European-American women. The association was consistent over the risk period in European-American women. In African-American women, the HRs for initiation were 2.52 at ages 15-17, and nonsignificant after age 17. In the CUD symptom model, CSA predicted onset only at age 21 and older.

CONCLUSIONS:

The association of CSA with initiation of marijuana use and progression to problem use is stable over time in European-American women, but in African-American women, it varies by developmental period. Findings suggest the importance of considering race/ethnicity in prevention efforts with this high-risk population.

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By:   Sartor CE1,2, Agrawal A2, Grant JD2, Duncan AE3, Madden PA2, Lynskey MT4, Heath AC2, Bucholz KK2.

• 1Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
• 2Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
• 3George Warren Brown School of Social Work, Washington University, St. Louis, Missouri.
• 4National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
• J Stud Alcohol Drugs. 2015 Jul;76(4):569-77.

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“Out of All of This Mess, I Got a Blessing”: Perceptions & Experiences of Reproduction & Motherhood in African American Women Living with HIV

HIV disproportionately impacts African American women of childbearing age residing in the Southern United States. 

Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. 

The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. 

Our respondents held positive views about pregnancy and motherhood, despite non-supportive pregnancy messages from interpersonal influences, including health care providers. 

Study findings uncovered the need for programs and interventions to support women’s reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.

Purchase full article at:   http://goo.gl/04aQKX

By:   Faith Fletcher, PhD, MA (Assistant Professor), Lucy Annang Ingram, PhD, MPH (Assistant Professor), Jelani Kerr, PhD, MSPH (Assistant Professor), Meredith Buchberg, MPH (Regional Coordinator), Donna L. Richter, EdD, FAAHB (Distinguished Professor Emeritus), Richard Sowell, PhD, RN, FAAN (Professor Nursing)

Affiliations

• University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA

Correspondence

• Corresponding author: Faith Fletcher.

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Mode of Delivery among HIV-Infected Pregnant Women in Philadelphia, 2005-2013

OBJECTIVE:

Current guidelines call for HIV-infected women to deliver via scheduled Caesarean when the maternal HIV viral load (VL) is >1,000 copies/ml. We describe the mode of delivery among HIV-infected women and evaluate adherence to relevant recommendations.

STUDY DESIGN:

We performed a population-based surveillance analysis of HIV-infected pregnant women in Philadelphia from 2005 to 2013, comparing mode of delivery (vaginal, scheduled Caesarean, or emergent Caesarean) by VL during pregnancy, closest to the time of delivery (≤1,000 copies/ml versus an unknown VL or VL >1,000 copies/ml) and associated factors in multivariable analysis.

RESULTS:

Our cohort included 824 deliveries from 648 HIV-infected women, of whom 69.4% had a VL ≤1,000 copies/ml and 30.6% lacked a VL or had a VL >1,000 copies/ml during pregnancy, closest to the time of delivery. Mode of delivery varied by VL: 56.6% of births were vaginal, 30.1% scheduled Caesarean, and 13.3% emergent Caesarean when the VL was ≤1,000 copies/ml; when the VL was unknown or >1,000 copies/ml, 32.9% of births were vaginal, 49.9% scheduled Caesarean and 17.5% emergent Caesarean. In multivariable analyses, Hispanic women (adjusted odds ratio (AOR) 0.17, 95% Confidence Interval (CI) 0.04-0.76) and non-Hispanic black women (AOR 0.27, 95% CI 0.10-0.77) were less to likely to deliver via scheduled Caesarean compared to non-Hispanic white women. Women who delivered prior to 38 weeks' gestation (AOR 0.37, 95% CI 0.18-0.76) were also less likely to deliver via scheduled Caesarean compared to women who delivered after 38 weeks' gestation. An interaction term for race and gestational age at delivery was significant in multivariable analysis. Non-Hispanic black (AOR 0.06, 95% CI 0.01-0.36) and Hispanic women (AOR 0.03, 95% CI 0.00-0.59) were more likely to deliver prematurely and less likely to deliver via scheduled C-section compared to non-Hispanic white women. Having a previous Caesarean (AOR 27.77, 95% CI 8.94-86.18) increased the odds of scheduled Caesarean delivery.

CONCLUSIONS:

Only half of deliveries for women with an unknown VL or VL >1,000 copies/ml occurred via scheduled Caesarean. Delivery prior to 38 weeks, particularly among minority women, resulted in a missed opportunity to receive a scheduled Caesarean. However, even when delivering at or after 38 weeks' gestation, a significant proportion of women did not get a scheduled Caesarean when indicated, suggesting a need for focused public health interventions to increase the proportion of women achieving viral suppression during pregnancy and delivering via scheduled Caesarean when indicated.

Below:  Maternal characteristics among HIV-infected pregnant women by gestational age, Philadelphia, 2005–2013

Full article at:   http://goo.gl/QR2URI

By:   Thompson DR1, Momplaisir FM2, Adams JW3, Yehia BR4,5, Anderson EA3, Alleyne G6, Brady KA3,4.

• 1Center for Women's and Children's Health Research, Christiana Care Health Systems, Newark, Delaware, United States of America.
• 2Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America.
• 3AIDS Activities and Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, United States of America.
• 4Division of Infectious Diseases, University of Pennsylvania Hospital, Philadelphia, Pennsylvania, United States of America.
• 5Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
• 6Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America. 

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