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Pregnant and Nonpregnant Women in Cape Town, South Africa: Drug Use, Sexual Behavior, and the Need for Comprehensive Services
Hendrée E. Jones,Felicia A. Browne,Bronwyn J. Myers,Tara Carney,Rachel Middlesteadt Ellerson,Tracy L. Kline,Winona Poulton,William A. Zule,Wendee M. Wechsberg
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/353410
Abstract: The multiple risks associated with methamphetamine use are of serious concern for women. These risks and consequences are magnified during pregnancy. This secondary analysis of a parent study compared 26 pregnant to 356 nonpregnant women in Cape Town, South Africa, on selected demographic, psychosocial, and HIV-risk domains to identify their treatment service needs. Proportionally, more pregnant than nonpregnant women are using methamphetamine, =.01, although a very high rate of women used methamphetamine. Women reported similar monthly rates of sexual intercourse, but pregnant women were significantly less likely to report condom use, <.0001, maintaining their risky behavior. Both groups reported elevated Center for Epidemiological Studies Depression Scale CES-D means, suggesting a need for depression treatment. Results demonstrate a pervasive need for women's comprehensive treatment, regardless of pregnancy status. Moreover, findings support the urgent need for women-focused and pregnancy-specific treatment services for methamphetamine use. Finally, a job-skills training/employment component focus is suggested.
Initial Feasibility and Acceptability of a Comprehensive Intervention for Methamphetamine-Using Pregnant Women in South Africa  [PDF]
Hendrée E. Jones,Bronwyn Myers,Kevin E. O’Grady,Stefan Gebhardt,Gerhard B. Theron,Wendee M. Wechsberg
Psychiatry Journal , 2014, DOI: 10.1155/2014/929767
Abstract: The purpose of the present study was to determine the feasibility, acceptability, and initial efficacy of a women-focused intervention addressing methamphetamine use and HIV sexual risk among pregnant women in Cape Town, South Africa. A two-group randomized pilot study was conducted, comparing a women-focused intervention for methamphetamine use and related sexual risk behaviors to a psychoeducational condition. Participants were pregnant women who used methamphetamine regularly, had unprotected sex in the prior month, and were HIV-negative. Primary maternal outcomes were methamphetamine use in the past 30 days, frequency of unprotected sexual acts in the past 30 days, and number of antenatal obstetrical appointments attended. Primary neonatal outcomes were length of hospital stay, birth weight, and gestational age at delivery. Of the 57 women initially potentially eligible, only 4 declined to participate. Of the 36 women who were eligible and enrolled, 92% completed all four intervention sessions. Women in both conditions significantly reduced their methamphetamine use and number of unprotected sex acts. Therefore, delivering comprehensive interventions to address methamphetamine use and HIV risk behaviors among methamphetamine-using pregnant women is feasible in South Africa. Further testing of these interventions is needed to address methamphetamine use in this vulnerable population. 1. Introduction Substance use during pregnancy is a critical health care concern. In Cape Town, South Africa, high rates of methamphetamine use have been found among women of childbearing age [1–3], including pregnant women [4]. Methamphetamine use is associated with several deleterious short- and long-term physical and psychological effects. A wide variety of physical effects have been associated with methamphetamine use, including respiratory and cardiac problems, palpitations, tremors, convulsions, stroke, and an increased risk of death [5]. Furthermore, its use is associated with risky sexual activities that place women at risk for acquiring HIV [1, 3, 6]. Psychological effects can be pronounced and include hallucinations, delusions, paranoia, and amphetamine psychosis [7]. Methamphetamine use has a high dependence risk and an extended withdrawal period, with frequent relapse. Prenatal stimulant exposure has been associated with being born small for gestational age [8], a risk factor for later developmental problems [9, 10] and poorer neurobehavioral outcomes [11]. Nonetheless, there are no substance use treatment models in South Africa that are tailored to address
Social risk factors that influence the spread of HIV among pregnant women in Ukraine  [PDF]
Slobodianyk, Liudmyla,Andreeva, Tatiana
Tobacco Control and Public Health in Eastern Europe , 2011,
Abstract: BACKGROUND. HIV infection in Ukraine is gaining large scale, affecting various population groups including those which are not considered risk groups for HIV infection. Injection drug users (IDUs) remain the main source of HIV infection. The potential penetration of the virus into the general population is determined by the chain of transmission of HIV through unprotected sexual contacts of individuals who do not inject drugs with IDUs. The level of HIV infection among women attending prenatal clinics quite accurately reflects the level of HIV prevalence and trends of the epidemic among the general population.METHODS. The project is developed by the Ukrainian National AIDS Centre. Project timeframe is January–August 2011. Expected number of participants is 1041. Target group includes HIV-positive women who were pregnant and first registered as HIV-positive in 2009-2010 and gave birth to their babies in 2010-2011. Preliminary data analysis anticipates identification of traditional risk groups (IDUs, sexual workers’ clients, prisoners, HIV-positives) among sexual partners of women from the study group. Social, demographic, and behavioral risk factors are to be estimated among the target group, and the probable transmission routes among the study participants are to be elucidated. As the study is in progress, we report here the results of the analysis of a pilot group of 21 filled-in questionnaires.RESULTS. The majority of the study population are young women aged 15-30 with university (28.6%) or college (23.8%) education. Most of them are city-dwellers and are married. Nine in ten respondents were tested as HIV-positive during pregnancy. Two thirds of respondents indicated the heterosexual way of transmission as the most probable. Nine in ten denied having injected drugs; however, 15% of them had hepatitis C virus and hepatitis B virus antibodies.CONCLUSION. According to preliminary results, HIV-positive women are young married city-dwelling women who do not belong to HIV high-risk groups.
Adapting an evidence-based HIV prevention intervention for pregnant African-American women in substance abuse treatment  [cached]
Wendee M Wechsberg,Felicia A Browne,Winona Poulton,et al
Substance Abuse and Rehabilitation , 2011,
Abstract: Wendee M Wechsberg1, Felicia A Browne1, Winona Poulton1, Rachel Middlesteadt Ellerson1, Ashley Simons-Rudolph1, Deborah Haller2, 1RTI International,* Research Triangle Park, NC, USA; 2Columbia University College of Physicians and Surgeons, New York, NY, USA, *RTI International is a trade name of Research Triangle InstituteAbstract: An adaptation of an evidence-based, woman-focused intervention designed to reduce HIV risk behaviors was conducted for pregnant, African-American women in substance abuse treatment in North Carolina. The intervention adaptation process included focus groups, expert panels, and the filming of women who spoke about their experiences with pregnancy, drug use, sex risk behaviors, HIV testing and treatment, need for substance abuse treatment, violence, and victimization. The assessment instrument was adapted for pregnant women and the intervention was organized into a 4-session PowerPoint presentation, with an additional session if a woman tested positive for HIV. All sessions and assessment instrument were installed on laptop computers for portability in treatment programs. We pilot tested our adaptation with 59 pregnant African-American women who had used an illicit drug within the past year and were enrolled in substance abuse treatment. At baseline, 41% were currently homeless, 76% were unemployed, 90% had not planned their current pregnancy, and approximately 70% reported drug use since finding out about the pregnancy. This sample of participants rated the intervention sessions and were highly satisfied with their experience, resulting in a mean satisfaction score of 6.5 out of 7. Pregnant African-American women who use drugs need substance abuse treatment that they do not currently access. Woman-focused HIV interventions help to address intersecting risk behaviors and need for treatment prevalent among this vulnerable group.Keywords: African-American woman, HIV prevention pregnancy, drug use, violence, sexual risk
Pregnant women's knowledge of and attitudes to HIV testing at Komfo Anokye Teaching Hospital, Kumasi
VN Addo
Ghana Medical Journal , 2005,
Abstract: A questionnaire survey on the knowledge about human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and attitudes to voluntary counselling and testing (VCT) in pregnancy of 334 antenatal attendants at Komfo Anokye Teaching Hospital (KATH) was conducted. The survey showed that HIV/AIDS is recognized as a life-threatening condition and is mainly acquired through unprotected sexual intercourse with an infected partner, use of unsterile sharp instruments and blood transfusion. Knowledge about mother to child transmission (MTCT) was lacking. The majority of women who had done the test did so as a pre-requisite for church blessing of their marriage. VCT would be acceptable especially when anonymity is ensured and drug treatment is available for mother and child should the pregnant woman test positive for HIV.
Epidemiologic and clinical characteristics of pregnant women living with HIV/AIDS in a region of Southern Brazil where the subtype C of HIV-1 infection predominates
Manenti, Sandra Aparecida;Galato Júnior, Jo?o;Silveira, Elizangela da Silva;Oenning, Roberto Teixeira;Sim?es, Priscyla Waleska Targino de Azevedo;Moreira, Jeverson;Fochesato, Celine Maria;Brígido, Luís Fernando de Macedo;Rodrigues, Rosangela;Rom?o, Pedro Roosevelt Torres;
Brazilian Journal of Infectious Diseases , 2011, DOI: 10.1590/S1413-86702011000400008
Abstract: southern brazil has the highest prevalence rate of aids in the country and is the only region in the americas where hiv-1 subtype c prevails. objective: we evaluated the epidemiologic and clinical characteristics of pregnant women living with hiv/aids in the south region of santa catarina, brazil. methods: all pregnant women with hiv infection attending the obstetric outpatient clinic of criciúma, state of santa catarina, in 2007 (n = 46) were invited to participate. data of 36 eligible participants were obtained through a standardized questionnaire. results: the great majority were young, with a steady partner, low family income, low education level and referring early first sexual intercourse. many reported use of illicit non-injecting drugs (55.5%) and unprotected sex with partners that were hiv-positive (57.7%), injecting drug user (22.2%), male inmate (19.4%), truck driver (13.8%), with history of sexually transmitted disease (11.1%) or men who have sex with men (msm) (2.8%). most (66.7%) of the participants had their hiv diagnosis done during the pregnancy, 7 (19.4%) had a previous history of hiv mother-to-child transmission. therapy based on highly active antiretroviral therapy (94%) was initiated at 19.3 weeks on average and 33% showed irregular antiretroviral adherence. conclusion: these results confirm previous data on hiv epidemiology in brazil and suggest that the women partners' sexual behavior and unprotected sexual intercourse are important aspects of hiv epidemic. additional efforts in education, prophylaxis and medication adherence are needed.
A Community-Supported Clinic-Based Program for Prevention of Violence against Pregnant Women in Rural Kenya  [PDF]
Janet M. Turan,Abigail M. Hatcher,Merab Odero,Maricianah Onono,Jannes Kodero,Patrizia Romito,Emily Mangone,Elizabeth A. Bukusi
AIDS Research and Treatment , 2013, DOI: 10.1155/2013/736926
Abstract: Objective. Pregnant women are especially vulnerable to adverse outcomes related to HIV infection and gender-based violence (GBV). We aimed at developing a program for prevention and mitigation of the effects of GBV among pregnant women at an antenatal clinic in rural Kenya. Methods. Based on formative research with pregnant women, male partners, and service providers, we developed a GBV program including comprehensive clinic training, risk assessments in the clinic, referrals supported by community volunteers, and community mobilization. To evaluate the program, we analyzed data from risk assessment forms and conducted focus groups ( groups) and in-depth interviews ( ) with healthcare workers and community members. Results. A total of 134 pregnant women were assessed during a 5-month period: 49 (37%) reported violence and of those 53% accepted referrals to local support resources. Qualitative findings suggested that the program was acceptable and feasible, as it aided pregnant women in accessing GBV services and raised awareness of GBV. Community collaboration was crucial in this low-resource setting. Conclusion. Integrating GBV programs into rural antenatal clinics has potential to contribute to both primary and secondary GBV prevention. Following further evaluation, this model may be deemed applicable for rural communities in Kenya and elsewhere in East Africa. 1. Introduction Gender-based violence (GBV) is a major source of preventable mortality and morbidity for women globally [1–3]. In Kenya, 47% of ever-married women report having ever experienced emotional, physical, and/or sexual violence from their spouse—among the highest rates in the world [4, 5]. Violence towards pregnant women in Kenya is estimated to be 13.5% [6], a higher prevalence than many conditions routinely screened for during pregnancy [7]. Global research suggests that when pregnant women experience GBV, there is a higher likelihood of miscarriage [3, 8], premature labor [9], low birthweight [8, 10, 11], and infant death [12]. Demographic Health Survey data from Kenya suggests that experiencing lifetime GBV is associated with child stunting and under-2 mortality [12]. GBV is also a driver of the global HIV epidemic, particularly in sub-Saharan Africa where women are disproportionately at risk of both GBV and HIV infection. GBV increases risk of HIV acquisition [13, 14], and HIV-positive women are more likely to experience GBV than their HIV-negative counterparts [15]. Pregnant women are especially vulnerable to the intersecting risks and adverse outcomes related to HIV infection
Adaptation and validation of a questionnaire about risk behaviors for AIDS among drug users
Pechansky, Flavio;Hirakata, Vania;Metzger, David;
Revista Brasileira de Psiquiatria , 2002, DOI: 10.1590/S1516-44462002000300006
Abstract: objectives: to initiate the process of validation of an instrument based on an american self-reported questionnaire named rab (risk assessment battery) ? called cra in its brazilian version ?, which covers aspects related to drug use, hiv testing, sexual behavior and concern with the transmission of the virus. the questionnaire was back-translated and its concurrent validity was tested, as well as the utility of an overall risk score (ors) for the transmission of the hiv virus or of subscores for drug use (sdu) or sexual risk (ssr). methods: case vignettes of ten typical cases had their questionnaire scores compared with the impression of independent referees. results: there were systematic differences in the comparison with the specific referees for each area, suggesting that only the ors has clinical validity, specifically regarding the exposure to risk of infection/reinfection by hiv. conclusion: the questionnaire in its current use and format is not adequate to express impairment already caused by exposure to the virus. the specific subscores were not clinically valid to express such risk, and the instrument needs the addition of a more comprehensive section about intravenous drug use to be used in future studies.
Adaptation and validation of a questionnaire about risk behaviors for AIDS among drug users  [cached]
Pechansky Flavio,Hirakata Vania,Metzger David
Revista Brasileira de Psiquiatria , 2002,
Abstract: Objectives: To initiate the process of validation of an instrument based on an American self-reported questionnaire named RAB (Risk Assessment Battery) -- called CRA in its Brazilian version --, which covers aspects related to drug use, HIV testing, sexual behavior and concern with the transmission of the virus. The questionnaire was back-translated and its concurrent validity was tested, as well as the utility of an Overall Risk Score (ORS) for the transmission of the HIV virus or of subscores for Drug Use (SDU) or Sexual Risk (SSR). Methods: Case vignettes of ten typical cases had their questionnaire scores compared with the impression of independent referees. Results: There were systematic differences in the comparison with the specific referees for each area, suggesting that only the ORS has clinical validity, specifically regarding the exposure to risk of infection/reinfection by HIV. Conclusion: The questionnaire in its current use and format is not adequate to express impairment already caused by exposure to the virus. The specific subscores were not clinically valid to express such risk, and the instrument needs the addition of a more comprehensive section about intravenous drug use to be used in future studies.
Drug Use and Sex Work: Competing Risk Factors for Newly Acquired HIV in Yunnan, China  [PDF]
Junjie Xu, M. Kumi Smith, Guowei Ding, Jennifer Chu, Haibo Wang, Qinghua Li, Dongfang Chang, Guixiang Wang, Hong Shang, Yan Jiang, Ning Wang
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0059050
Abstract: Objective To investigate the HIV incidence and its related factors among female sex workers (FSWs) in a high prevalence area where injection drug use is also widely documented. Method A cross-sectional study of 1642 female sex workers (FSWs) was conducted in Honghe Prefecture of Yunnan Province. Interviewed-questionnaires were administrated to collect information on sexual partnerships, condom use and illicit drug using behaviors etc. Blood samples were collected to test for HIV antibodies, and all HIV seropositive specimens were tested with the BED IgG capture-based enzyme immunosorbent assay (BED-CEIA) to distinguish between new and established HIV infection (<153 days). Results 15.9% (261/1642) of participants reported ever having used drugs, and 7.4% had injected in recent 3 months. The overall HIV prevalence was 10.2% (168/1642), among which 16.7% (28/168) were identified as recent infections using BED-CEIA. The crude HIV incidence estimated from BED-CEIA results was 4.4 (95%CI 2.8–6.0) /100 person years (PY). Multivariate logistic analysis showed that an illicit drug using history (by either self-reporting or urine opiates testing) was both significant risk factors both for HIV established and recent infection (each p<0.05). Drug using FSWs (DU-FSW) reported more male clients in the previous week, and had significantly higher prevalence of HIV, chlamydia trachomatis and HSV-2 as compared to non DU-FSW (each p<0.05). Conclusion Our results show that a history of drug use poses significant risks for both new and established HIV infection among FSWs, and that HIV-incidence among Honghe FSWs is relatively high compared to similar populations. Comprehensive interventions targeted at DU-FSWs' injection drug using and high risk sexual behaviors are urgently needed to reduce the rapid spread of HIV epidemic.
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