Reduced HIV transmission at subsequent pregnancy in a resource-poor setting

Several studies indicate that HIV-infected women continue to have children. We set out to determine the trend in HIV transmission at subsequent pregnancies. From 2002–2003, pregnant women were enrolled in a single dose nevirapine-based Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. Six years later, women with subsequent children in this cohort were identified and their children's HIV status determined. From 330 identified HIV-infected mothers, 73 had second/subsequent children with HIV results. Of these, nine (12.3%, 95% confidence interval [CI]: 4.6–20.1%) children were HIV-infected. Of the 73 second children, 51 had older siblings who had been initially enrolled in the study with definitive HIV results with an infection rate of 17/51 (33.3%, 95% CI: 19.9–46.7). About 35% of the women had been on antiretroviral drugs. These results demonstrate lower subsequent HIV transmission rates in women on a national PMTCT programme in a resource-poor setting with the advent of antiretroviral therapy

Quality of life and coping styles of HIV positive compared to HIV negative women in Zimbabwe participating in the prevention of mother to child transmission of HIV program

Objectives: To describe the quality of life of women participating in the prevention of mother to child transmission of HIV (PMTCT) program and how it has influenced their coping towards risky sexual behaviors. Methods: A cross-sectional study with a total of 273 women, 189(69%) HIV positive and 84(31%) HIV negative. These are women in their reproductive age ranging from 17 to 41 years, mean age of 27.7 years who delivered their index babies under the (PMTCT) program in Zimbabwe. A questionnaire was interview administered to the women from three months postpartum. The modified questions were derived from the Medical Outcomes Survey- HIV (MOS-HIV). This instrument is used to assess functional status and well-being, measuring subject perceptions of overall health, physical, role and social functioning and mental health. Coping was assessed according to Lazarus and Folkman’s concept of problem focused and emotion focused strategies and the available social supports. Risky sexual behaviors were assessed by asking about contraceptive use, condom use, future pregnancies, and disclosure of HIV status and knowledge of sexual partner’s HIV status. Results: HIV infection risk increases with age with those above 24 years most infected 86% versus 46% for the younger women (p=<.01). Being single and formally employed exposed one to higher risk of HIV infection. Women were significantly compromised in mental health and family functioning domain, with the HIV positive reporting highest in the “poor” facet 43% (p=<.01), 45% (p=0.01) respectively. Among the HIV positive women, 22% did not use any contraceptive method versus 14% among HIV negative (p=<.01). Moreover as many as 47% HIV positive and 87% HIV negative women did not use condoms currently (p=<.01). 24% HIV positive had not disclosed status and 11% were divorced due to disclosure of status. 13% HIV positive women expressed desire to have more children versus 49% among HIV negative (p=<.01). Most available type of support was informational (p=0.01) with the family as the highest unit providing ongoing support 40% HIV positive versus 54% among HIV negative (p=0.03). Conclusion: There is need to target interventions that address and promote mental well being and provision of adequate mental health services. The family unit needs to be strengthened and equipped with resources, so as to be able to cope with the demands of the HIV infected family members. Health education should be targeted on reduction of sexual risky behaviors by involving male partners. At antenatal booking male partners should be encouraged to be screened for HIV. Interventions that enhance women’s social networks and encouragement of health promoting behaviors should be developed and evaluated constantly for their effectiveness. There is need for further analysis, identifying barriers and facilitator’s women experience in practicing health promoting behaviors. Quality of life evaluation is an important outcome measure which can identify areas of need for the HIV positive people especially in poor resource countries where HIV laboratory markers are beyond the reach of many

Prevention of gynecologic contact bleeding and genital sandy patches by childhood anti-schistosomal treatment

Schistosoma haematobium infection may cause genital mucosal pathology in women with and without urinary schistosomiasis. This report seeks to explore the long-term effect of anti-schistosomal treatment on the clinical manifestations of S. haematobium infection in the lower genital tract. Prior treatment was reported by 248 (47%) of 527 women. Treatment received before the age of 20 years was significantly associated with the absence of sandy patches and contact bleeding, and this association was independent of current waterbody contact. Treatment in the past five years did not influence the prevalence of gynecologic schistosoma-induced lesions. The study indicates that early treatment may be more efficient for gynecologic morbidity control. Findings warrant an exploration into several chemotherapeutic agents administered at an early age, as well as in adults

The first community-based report on the effect of genital Schistosoma haematobium infection on female fertility.

A cross-sectional study in an Schistosoma haematobium endemic area of rural Zimbabwe examined 483 resident women between the ages of 20 and 49 years who were interviewed about fertility. S. haematobium ova in genital tissue was found to be significantly associated with infertility

Simple clinical manifestations of genital Schistosoma haematobium infection in rural Zimbabwean women.

Up to 75% of women with urinary schistosomiasis have Schistosoma haematobium ova in the genitals. This study aimed to describe the prevalence of gynecologic S. haematobium infection and to differentiate the disease from sexually transmitted infections (STIs). Gynecologic and laboratory investigations for S. haematobium and STIs were performed in 527 women between the ages of 20 and 49 in rural Zimbabwe. Genital homogenous yellow and/or grainy sandy patches, the commonest type of genital pathology, were identified in 243 (46%) women. Grainy sandy patches were significantly associated with S. haematobium ova only. Genital S. haematobium ova was also significantly associated with homogenous yellow sandy patches, mucosal bleeding, and abnormal blood vessels. The presence of ova was not a predictor for ulcers, papillomata, leukoplakia, polyps, or cell atypia. Mucosal sandy patches seem to be pathognomonic for S. haematobium infection in the female genitals. Coexistence of ova and other lesions may not be causal

Female genital schistosomiasis--a differential diagnosis to sexually transmitted disease: genital itch and vaginal discharge as indicators of genital Schistosoma haematobium morbidity in a cross-sectional study in endemic rural Zimbabwe.

Genital schistosomiasis may be a differential diagnosis to the STDs in women who have been exposed to fresh water in endemic areas. Because of the chronic nature of the disease in adults, we suggest to pay special attention to the prevention of morbidity

Female genital schistosomiasis - a differential diagnosis to sexually transmitted disease:genital itch and vaginal discharge as indicators of genital <em>Schistosoma haematobium</em> morbidity in a cross-sectional study in endemic rural Zimbabwe

Genital schistosomiasis may be a differential diagnosis to the STDs in women who have been exposed to fresh water in endemic areas. Because of the chronic nature of the disease in adults, we suggest to pay special attention to the prevention of morbidity