Factors Related to Pregnancy among Female Sex Workers Living with HIV in the Dominican Republic

Female sex workers (FSWs) living with HIV are a vulnerable population for multiple health concerns and have been vastly understudied in public health literature. This study analyzes factors related to pregnancy among 268 FSWs living with HIV in the Dominican Republic. 

Results indicate that 

• 34% of participants had been pregnant since HIV diagnosis. 

Multivariate analysis revealed significant associations between 

• pregnancy after HIV diagnosis and ART interruption, 
• knowledge of mother-to-child transmission, 
• serostatus disclosure to a sex partner, 
• older age 
• and a more negative perception of their health provider. 

Results indicate noteworthy associations between having been pregnant and the health provider experience and ART interruption, indicating a significant need for further research on this population to ensure both maternal and child health.

Purchase full article at:   http://goo.gl/c9TS6h

By:  Cernigliaro D¹, Barrington C², Perez M³, Donastorg Y³, Kerrigan D⁴.

¹Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, HH287, 624 N. Broadway St., Baltimore, MD, 21205, USA. danacern@gmail.com.

²The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

³HIV Vaccine Research Unit, Instituto Dermatalógico y Cirugia de Piel Dr. Humberto Bogart Diaz, Santo Domingo, Dominican Republic.

⁴Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, HH287, 624 N. Broadway St., Baltimore, MD, 21205, USA.

AIDS Behav. 2016 May 4. [Epub ahead of print]

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Pregnancy-Associated Homicide & Suicide in 37 US States with Enhanced Pregnancy Surveillance

BACKGROUND:

Pregnant and postpartum women may be at increased risk of violent death including homicide and suicide relative to non-pregnant women, but US national data have not been reported since implementation of enhanced mortality surveillance.

OBJECTIVE:

To estimate homicide and suicide ratios among women who are pregnant or postpartum and to compare their risk of violent death to non-pregnant/non-postpartum women.

STUDY DESIGN:

Death certificates (n=465,097) from US states with enhanced pregnancy mortality surveillance from 2005-2010 were used to compare mortality among four groups of women age 10-54: pregnant, early postpartum (pregnant within 42 days of death), late postpartum (pregnant within 43 days to 1 year of death) and non-pregnant/non-postpartum. We estimated pregnancy-associated mortality ratios and compared to non-pregnant/non-postpartum mortality ratios in order to identify differences in risk after adjusting for potential levels of pregnancy misclassification as reported in the literature.

RESULTS:

Pregnancy-associated homicide victims were most frequently young, Black, and undereducated while pregnancy-associated suicide occurred most frequently among older White women. 

After adjustments, pregnancy-associated homicide risk ranged from 2.2-6.2 per 100,000 live births, depending on the degree of misclassification estimated, compared to 2.5-2.6 per 100,000 non-pregnant/non-postpartum women aged 10-54. 

Pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births after adjustments compared to 5.3-5.5 per 100,000 women aged 10-54 among non-pregnant/non-postpartum women. 

Assuming the most conservative published estimate of misclassification, risk of homicide among pregnant/postpartum women was 1.84 times that of non-pregnant/non-postpartum women while risk of suicide was decreased.

CONCLUSION:

Pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the US.

Purchase full article at:   http://goo.gl/ZBI6KL

By:  Wallace ME1, Hoyert D2, Williams C3, Mendola P4.

• 1Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd Rockville, MD 20852.
• 2Mortality Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, 3311 Toledo Road, Room 7318, Hyattsville, Maryland 20782.
• 3Department of Health Behavior, University of Kentucky, 151 Washington Ave, 342 Bowman Hall, Lexington, KY 40508.
• 4Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd Rockville, MD 20852. Electronic address: pauline.mendola@nih.gov. 
• Am J Obstet Gynecol. 2016 Mar 26. pii: S0002-9378(16)00532-9. doi: 10.1016/j.ajog.2016.03.040.

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Transgender Men and Pregnancy

Transgender people have experienced significant advances in societal acceptance despite experiencing continued stigma and discrimination. While it can still be difficult to access quality health care, and there is a great deal to be done to create affirming health care organizations, there is growing interest around the United States in advancing transgender health. 

The focus of this commentary is to provide guidance to clinicians caring for transgender men or other gender nonconforming people who are contemplating, carrying, or have completed a pregnancy. Terms transgender and gender nonconforming specifically refer to those whose gender identity (e.g., being a man) differs from their female sex assigned at birth. Many, if not most transgender men retain their female reproductive organs and retain the capacity to have children. 

Review of their experience demonstrates the need for preconception counseling that includes discussion of stopping testosterone while trying to conceive and during pregnancy, and anticipating increasing experiences of gender dysphoria during and after pregnancy. The clinical aspects of delivery itself fall within the realm of routine obstetrical care, although further research is needed into how mode and environment of delivery may affect gender dysphoria. Postpartum considerations include discussion of options for chest (breast) feeding, and how and when to reinitiate testosterone. 

A positive perinatal experience begins from the moment transgender men first present for care and depends on comprehensive affirmation of gender diversity.

Full article at:   http://goo.gl/Fo1LMb

By:  Juno Obedin-Maliver1,2 and Harvey J Makadon3,4

¹Department of Medicine, University of California San Francisco, San Francisco, CA, USA

²Department of Gynecology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA

³National LGBT Health Education Center, The Fenway Institute, Boston, MA, USA

⁴Harvard Medical School, Boston, MA, USA

Harvey J Makadon, National LGBT Health Education Center, The Fenway Institute, 1340 Boylston Street, Boston, MA, USA

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Women’s Awareness and Knowledge of Abortion Laws: A Systematic Review

Background

Incorrect knowledge of laws may affect how women enter the health system or seek services, and it likely contributes to the disconnect between official laws and practical applications of the laws that influence women’s access to safe, legal abortion services.

Objective

To provide a synthesis of evidence of women’s awareness and knowledge of the legal status of abortion in their country, and the accuracy of women’s knowledge on specific legal grounds and restrictions outlined in a country’s abortion law.

Methods

A systematic search was carried for articles published between 1980–2015. Quantitative, mixed-method data collection, and objectives related to women’s awareness or knowledge of the abortion law was included. Full texts were assessed, and data extraction done by a single reviewer. Final inclusion for analysis was assessed by two reviewers. The results were synthesised into tables, using narrative synthesis.

Results

Of the original 3,126 articles, and 16 hand searched citations, 24 studies were included for analysis. Women’s correct general awareness and knowledge of the legal status was less than 50% in nine studies. In six studies, knowledge of legalization/liberalisation ranged between 32.3% - 68.2%. Correct knowledge of abortion on the grounds of rape ranged from 12.8% – 98%, while in the case of incest, ranged from 9.8% - 64.5%. Abortion on the grounds of fetal impairment and gestational limits, varied widely from 7% - 94% and 0% - 89.5% respectively.

Conclusion

This systematic review synthesizes literature on women’s awareness and knowledge of the abortion law in their own context. The findings show that correct general awareness and knowledge of the abortion law and legal grounds and restrictions amongst women was limited, even in countries where the laws were liberal. Thus, interventions to disseminate accurate information on the legal context are necessary.

Full article at:   http://goo.gl/GN3ps1

By:  Anisa R. Assifi,1,* Blair Berger,2 Özge Tunçalp,1 Rajat Khosla,1 and Bela Ganatra1

¹WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland

2

²Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America

1WHO Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland

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Contraceptive Failure Rates in the Developing World

More and via (PDF):    http://goo.gl/KoClzO

Married Women’s Decision Making Power on Family Planning Use & Associated Factors in Mizan-Aman, South Ethiopia

Background

Women’s use of family planning service is influenced by many factors, especially by their decision making power. A woman’s decision-making power, be it individual or decision made in collaboration with a partner, is the most important factor in the use of family planning in a household. The purpose of this study was to assess the impact of women’s decision making power on family planning use and its associated factors.

Methods

A community-based cross-sectional study was conducted on married women in the child bearing age. The women who were living in Mizan city were selected using the simple random sampling method. Trained nurses collected the data by interview, using a structured and pre-tested questioner. Bivariable and multivariable binary logistic regression analysis was used to identify the associated factors, and the odds ratio with a 95 % CI was computed to assess the strength of the association. Collinearity was also assessed by looking at standard errors in the final fitted model.

Result

Overall, more than two-thirds [67.2 %] of the married women were found to be more autonomous to decide family planning use. Secondary education, government employment, being wives of government employed spouses, having husbands with college or university education, and being in the younger age were significantly associated with women’s decision-making power on family planning.

Conclusions

In this study, women had a high decision making power in family planning use. Age category (34–44-years), formal education, and occupational status had effects on women’s decision making power. Promoting parental adult education and engaging women in out of house employment is essential to improve their decision making power in using family planning.

Knowledge of married women’s decision making power in family planning use and associated factors in Mizan-Aman, South Ethiopia, 2013

Variables	Frequency (%)
Source of information
HEWs	247 (43.6)
Radio	214 (37.7)
Television	377 (66.7)
Health centers	277 (48.9)
Formal Education	68 (12.0)
Places where to get FP services
Hospital	404 (71.3)
Health center	432 (76.2)
Health post	141 (24.9)
Pharmacy	227 (40.0)
Clinics	239 (42.2)
Types of family planning methods
Pills	425 (75.0)
IUCD	344 (60.7)
Inject able	539 (95.1)
Implant/Norplant	361 (63.7)
Female condom	93 (16.4)
Tuba ligation	136 (24.0)
Vasectomy	68 (12.0)
Male condom	294 (51.9)
Emergency contraceptive	169 (29.8)
Calendar method	181 (31.9)

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

By:  Abeba Daniel Belay, Zelalem Birhanu Mengesha, Manay Kifle Woldegebriel, and Yalemzewod Assefa Gelaw

Woman, Children and Youths Affairs Bureau, Bench Maji Zone, Mizan Aman, Ethiopia

Institute of Public Health, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia

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Trends in Contraceptive Use Worldwide, 2015

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‘Pregnancy Has Its Advantages’: The Voices of Street Connected Children and Youth in Eldoret, Kenya

Objective

Little is known about the reproductive health or family planning needs of street-connected children and youth in resource-constrained countries. The study objective was to describe how street-connected children and youth (SCCY) in Eldoret, Kenya, perceive pregnancy.

Methods

This qualitative study was conducted between August 2013 and February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside known as “bases/barracks”; and 3) Street youth community-based organizations. In-depth interviews and focus group discussions were audio recorded, transcribed, and translated into English. Content analysis was performed after thematic coding by 4 independent coders.

Results

The majority of SCCY interviewed were male (69%) and sexually active (81.5%). None had gone beyond primary level of education. The strong desire for SCCY to go through conventional life experiences including marriage and child bearing was evident. Sub-themes around desired pregnancies included: sense of identity with other SCCY, sense of hope, male ego, lineage, source of income, and avoiding stigmatization. The desire for children was highly gendered with male SCCY more focused on their social status in the street community, while for females it was primarily for survival on the street. Female SCCY generally lacked agency around reproductive health issues and faced gender-based violence. Abortions (either assisted or self-induced), infanticide, and child abandonment were reported. Respondents described a lucrative market for babies born to SCCY and alleged that healthcare workers were known to abduct these babies following hospital deliveries.

Conclusion

Our findings indicate gender differences in the reasons why SCCY become pregnant and have children. We also noted gender inequalities in reproductive health decisions. SCCY friendly interventions that provide tailored reproductive health services are needed.

Full article at:   http://goo.gl/3F7Dwx

By:  

Juddy Wachira, Violet Naanyu, Paula Braitstein 
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

Allan Kamanda 

Moi Teaching and Referral Hospital, Eldoret, Kenya

Lonnie Embleton, Paula Braitstein 

Dalla Lana School of Public Health, University of Toronto, Ontario, Canada

Violet Naanyu, David Ayuku, Paula Braitstein 

College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya

Paula Braitstein 

Indiana University, Fairbanks School of Public Health, Department of Epidemiology, Indianapolis, Indiana, United States of America

Paula Braitstein 

Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America

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Sexuality and Reproduction in HIV-Positive Women: A Meta-Synthesis

The increased access to effective antiretroviral treatment (ART) has made HIV comparable to a chronic disease in terms of life expectancy. Needs related to sexuality and reproduction are central to overall health and well-being. An interpretative meta-synthesis was performed to synthesize and assess how HIV-positive women's experiences of sexuality and reproduction have been described in qualitative studies. A total of 18 peer-reviewed qualitative studies were included, which comprised a total of 588 HIV-positive interviewed women. The studies originated from resource-rich countries outside the Asian and African continents. The analysis, resulting in a lines-of-argument synthesis, shows that HIV infection was a burden in relation to sexuality and reproduction. The weight of the burden could be heavier or lighter. Conditions making the HIV burden heavier were: HIV as a barrier, feelings of fear and loss, whereas motherhood, spiritual beliefs, and supportive relationships made the HIV burden lighter. The findings are important in developing optimal health care by addressing conditions making the burden of HIV infection lighter to bear. In future research there is a need to focus not only on examining how HIV-positive women's sexual and relationships manifest themselves, but also on how health care professionals should provide adequate support to the women in relation to sexuality and reproduction.

...Ah, it's just always in the bedroom, HIV. It's always there^33, p.7

...In holistic care, it is important for health care professionals to see the women as whole individuals and not only focus on the disease. The result emphasizes the strength of support from health care professionals. But support is not only offering information; support is also about listening. There were narratives in the included studies of experiences of violence, which the women might need help to handle. As health care professionals, we have to ask and be open to stories of, for example, rape, or abuse. Supporting self-acceptance and awareness are only a few of the many areas where care providers outside the medical context can be important for patients' ongoing well-being.⁸ The importance of support from other HIV-positive women is emphasized in the meta-synthesis.^{20,22,30,34,36} Even though it is difficult for some women to attend support meetings like this, as it means they have to disclose their HIV-positive status, it is important to motivate women to meet other HIV-positive persons.

...There is a need for practical information about contraceptives, medical risks, and interventions related to the risk of HIV transmission and barriers between fertility intentions, and pregnancy seeking behavior also need to be illuminated.⁶⁵ Women actively trying to conceive intend not to talk with their provider about safer conception strategies and they expressed confusion and concern on how to conceive safely.⁶⁶ Reproductive counseling initiated by health care providers is needed to reduce risk of transmission to partners and infants, which can have major health implications.⁶⁶

Disclosure of HIV-positive status seems problematic, and some women may need the presence of a health care professional when the disclosure is made.⁶⁷ Everything has to be done without judgment; it is important for health care professionals not to relate to their personal sexual behaviors as the sexual norm.

In clinical practice, it might be of importance to address all these conditions that make the burden easier, to support pregnancy, to support the desires of these women, and to help them cope with negative feelings, in order to promote the sexual and reproductive health of HIV-positive women.

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

By:  Ewa Carlsson-Lalloo, RN, MHCSci,*1,,2 Marie Rusner, RN, MSc, PhD,1,,3 Åsa Mellgren, MD, PhD,2,,3 and Marie Berg, RN, RM, MNSci, MPH, PhD1,,4

¹Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden.

²Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden.

³Department of Research, Södra Älvsborg Hospital, Borås, Sweden.

⁴Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.

*Corresponding author.

Address correspondence to:, Ms. Ewa Carlsson-Lalloo, Institute of Health and Care Sciences, Box 457, University of Gothenburg, 405 30 Gothenburg, Sweden,
E-mail:  es.ug@oollal.nosslrac.awe

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Maternal Tenofovir Disoproxil Fumarate Use in Pregnancy and Growth Outcomes among HIV-Exposed Uninfected Infants in Kenya

Background. 

Tenofovir disoproxil fumarate (TDF) is commonly used in antiretroviral treatment (ART) and preexposure prophylaxis regimens. We evaluated the relationship of prenatal TDF use and growth outcomes among Kenyan HIV-exposed uninfected (HEU) infants. Materials and 

Methods. 

We included PCR-confirmed HEU infants enrolled in a cross-sectional survey of mother-infant pairs conducted between July and December 2013 in Kenya. Maternal ART regimen during pregnancy was determined by self-report and clinic records. Six-week and 9-month z-scores for weight-for-age (WAZ), weight-for-length (WLZ), length-for-age (LAZ), and head circumference-for-age (HCAZ) were compared among HEU infants with and without TDF exposure using t-tests and multivariate linear regression models. 

Results. 

Among 277 mothers who received ART during pregnancy, 63% initiated ART before pregnancy, of which 89 (32%) used TDF. No differences in birth weight (3.0 kg versus 3.1 kg, p = 0.21) or gestational age (38 weeks versus 38 weeks, p = 0.16) were detected between TDF-exposed and TDF-unexposed infants. At 6 weeks, unadjusted mean WAZ was lower among TDF-exposed infants (-0.8 versus -0.4, p = 0.03), with a trend towards association in adjusted analyses (p = 0.06). There were no associations between prenatal TDF use and WLZ, LAZ, and HCAZ in 6-week or 9-month infant cohorts. 

Conclusion. 

Maternal TDF use did not adversely affect infant growth compared to other regimens.

Full article at:   http://goo.gl/WcUCw4

By:  Pintye J¹, Langat A², Singa B³, Kinuthia J⁴, Odeny B⁵, Katana A², Nganga L², John-Stewart G⁶, McGrath CJ⁷.

¹Department of Global Health, University of Washington, Seattle, WA 98104, USA; Department of Nursing, University of Washington, Seattle, WA 98195, USA.

²United States Centers for Disease Control and Prevention (CDC), Nairobi 00202, Kenya.

³Center for Microbiology Research and Center for Clinical Research, Kenya Medical Research Institute, Nairobi 00202, Kenya.

⁴Department of Global Health, University of Washington, Seattle, WA 98104, USA; Department of Obstetrics & Gynecology, Kenyatta National Hospital, Nairobi 00202, Kenya.

⁵Department of Global Health, University of Washington, Seattle, WA 98104, USA.

⁶Department of Global Health, University of Washington, Seattle, WA 98104, USA; Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Epidemiology, University of Washington, Seattle, WA 98195, USA.

⁷Department of Global Health, University of Washington, Seattle, WA 98104, USA; University of Texas Medical Branch, Galveston, TX 77555, USA

Infect Dis Obstet Gynecol. 2015;2015:276851. doi: 10.1155/2015/276851. Epub 2015 Dec 28.

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