Womans And Aids Essay, Research Paper

Understanding the Issues of Women and HIV/AIDS

Rachel Seldin,

Colgate University, Hamilton NY 13346

ABTRACT:

Infection with the human immunodeficiency virus ( HIV ) had emerged as a major wellness job for adult females in the United States. Family doctors can play an of import function in the sensing and attention of HIV-infected adult females. The epidemiology and natural history of HIV infection in adult females were reviewed. HIV infection is now a taking cause of morbidity and mortality among immature adult females in the United States, peculiarly adult females of racial and cultural minorities. Most instances of acquired immunodeficiency syndrome ( AIDS ) in adult females occur as a consequence of injection-drug usage or heterosexual transmittal. Based on limited information, adult females and work forces appear to hold similar AIDS-defining conditions. Gynecological jobs are common n HIV-infected adult females. Pregnancy does non look to be affected by early HIV infection, but adult females with advanced disease might be at increased hazard for obstetric complications. More adult females need to be included in natural history surveies and clinical drug tests. Early consciousness of HIV infection and better entree to wellness attention services are required to better the intervention and endurance of HIV-infected adult females.

KEYWORDS: Acquired Immunodeficiency Syndrome ( AIDS ) , Human Immunodeficiency Virus ( HIV ) , Pregnancy, Zidovudine ( AZT ) , Vaginal Candidasis, Transmission Methods of HIV/AIDS, Perinatal Transmission, Women and HIV

Introduction:

& # 8220 ; Acquired Immunodeficiency Syndrome ( AIDS ) has been declared? the public wellness menace of the century? & # 8221 ; ( 1 cited in 2 ) . The US Surgeon General has designated it as the state? s figure one wellness precedence ( 2 ) . AIDS is a disease that affects the immune system. The term immunodeficiency refers to the inability of the immune system to work decently, therefore doing the single susceptible to a assortment of infections non typically found in a healthy immune system ( 3 ) . A syndrome is a group of symptoms or unwellnesss arising from one cause. The chief agent doing AIDS is a retrovirus known as Human Immunodeficiency Virus ( HIV ) . HIV is the agent of a sexually familial disease that can besides be contracted through blood transfusions or IV drug usage ; the disease can besides be passed on to a foetus during gestation. When people are infected with HIV, they are non needfully besides infected with AIDS. A individual is non infected with AIDS until HIV reduces immune map to a certain degree or when one or more serious unwellnesss related to HIV occurs. ( 4 )

Everyone is at hazard of undertaking the HIV virus, although adult females with HIV/AIDS face more troubles populating with this disease than make work forces. HIV/AIDS adult females are of particular involvement because they are the major beginning of infection of babies. Not merely do they have to believe about the effects on their ain lives, but besides they must believe about their babies if they choose to gestate. In my paper, I will reexamine the ways in which HIV/AIDS affects adult females otherwise than work forces, through clinical issues and gynaecological manifestations. I will besides discourse the virus itself and issues refering HIV positive adult females who are be aftering to gestate.

WHAT IS AIDS?

In early 1983, a squad at the Pasteur Institute in Paris, France led by Dr. Luc Montagnier foremost announced the find of HIV ( 5 ) . They originally named it LAV, or lymphadenopathy-associated virus. However, it was non until the American squad, led by Dr. Robert Gallo, called the virus HTLV-3 or human T-cell lymphotrophic virus that both squads collaborated and simplified it to merely HIV ( 5 ) .

HIV can do a scope of conditions, of which AIDS is the worst. For illustration, it can take to relentless puffiness of the lymph nodes ( 5 ) . Other people may hold more serious symptoms but still demo no mark of AIDS. This status is known as AIDS related-complex ( ARC ) ( 5 ) . Some of the symptoms of ARC include conceited secretory organs, severe or chronic diarrhoea, terrible weariness, rapid unexplained weight loss, swamping dark workout suits, febrilities, and yeast infections, Although it can be serious, ARC is non fatal ( 5 ) .

The cause of AIDS is non to the full understood. There are other factors are involved in the development of AIDS. Once a individual tests positive to HIV, intoxicant or drug usage, hapless nutrition, high emphasis degrees, frequent exposure to other disease ( particularly sexually familial disease ) , have all been suggested to increase the hazard of developing full blown AIDS ( 5 ) .

HIV transmittal can be tracked accurately. However, anxiousness environments AIDS because its transmittal from one individual to another is non to the full understood. Many people believe that it is possible to acquire AIDS through, normal mundane contact with an septic individual. This is non the instance. The bulk of the people infected with HIV have contracted it through sexual intercourse with an septic individual ( 5 ) . Bodily fluids such as blood, seeds, and vaginal secernments all may incorporate the virus. Using a rubber can diminish the hazard of reaching the HIV virus during intercourse with an septic spouse. Another method of infection is through blood transfusion during surgery. A individual may have unseasoned, septic blood, hence incorporating the disease. Through mid 1992, 2 % of HIV infected grownups and 12 % of HIV septic kids were infected with HIV via blood transfusion ( 15 ) . However, the ELISA ( enzyme linked immunosorbent check ) trial was developed to test the state? s blood supply before used during transfusion processs ( 15 ) . Sharing acerate leafs during IV drug usage is yet another method of undertaking HIV. Infected users pass the needle back and Forth increasing the hazard of distributing HIV. Finally, another method of conveying this disease is from female parent to infant during gestation. Babies may be infected with HIV while in the uterus or perchance at birth if the female parent is infected ( 5 ) .

WOMEN AND THE HIV ILLNESS:

HIV/AIDS was foremost identified in the United States among homosexuals and bisexual work forces, and for the first decennary of the epidemic, the disease was chiefly associated with homosexualism and endovenous drug usage in work forces ( 6 ) . In recent old ages, there has been a turning realisation that HIV/AIDS is distributing quickly among adult females, and rates of HIV infection in adult females may finally mirror those in the planetary epidemic ( 6 ) . Approximately 61,4000 adult females had been diagnosed with AIDS in the United States as of December 1994 ( 7 ) . In the last decennary, the proportion of AIDS instances in adult females has about tripled ( 7 ) . In 1985, there was a 7 % addition of AIDS instances among adult females, which grew to about 20 % in 1996 ( 8 ) . Of that entire figure of instances reported among adult females, the proportion attributable to heterosexual contact besides increased ( 9 ) . In 1994, AIDS instances in adult females attributable to transmission via heterosexual contact surpassed the figure attributable to transmission via injection drug usage ; nevertheless, sexual contact with a adult male who injects drugs histories for the bulk of heterosexual acquired AIDS instances ( 9 ) . AIDS is the 4th taking cause of decease in adult females ages 25-44 old ages in the United States ( 9 ) , and is the taking cause of decease among Afro-american adult females in the same age group ( 10 ) . Yet adult females remain understudied and unmarked. The deficiency of research particular to adult females leaves wellness attention suppliers unprepared to recognized and react to adult females? s symptoms or experiences and uninformed about their wellness demands ( 11 ) . As a consequence, adult females are diagnosed at ulterior phases of clinical impairment and have fewer wellness attention services to assist them last the unwellnesss associated with AIDS ( 11 ) . Therefore, adult females die earlier from AIDS than work forces do.

Clinical Manifestations:

A recent surveillance survey has indicated that from 1995 to 1996 there has been a 23 % lessening in the figure of deceases from AIDS ( 6 ) . There has besides been a 6 % lessening in the figure of HIV-infected persons diagnosed with AIDS ( 6 ) . The lessening in AIDS-related morbidity and mortality are attributed to the betterments in the medical attention, every bit good as the increased handiness of therapies. However, these diminishing tendencies do non concern adult females infected with HIV and AIDS. During this same clip, adult females with AIDS-related unwellnesss increased by 2 % with merely a 10 % lessening in the Numberss of AIDS related decease ( 6 ) . The differences reported for adult females are due to the increasing AIDS instances in adult females and the deficiency of drug therapies specific to adult females ( 6 ) .

In 1982, the Center for Disease Control and Prevention ( CDC ) developed a instance definition of AIDS based on a list of related diseases and lab grounds for or against HIV infection ( 12 ) . Over the old ages, this definition has been modified and used for epidemiological surveies and clinical appraisals, which often tied it to the commissariats of certain wellness and societal services ( 12 ) . In 1993, the CDC expanded the instance definition for AIDS in striplings and grownups when they added invasive cervical malignant neoplastic disease to the list of AIDS-related diseases ( 6 12 ) . Although adult females develop recurrent and immune gynaecological jobs as a effect of HIV infection, they do non run into the CDC standards for an AIDS diagnosing ( 12 ) . Hence, without this diagnosing, many adult females are unable to have wellness benefits and services available to those with an & # 8220 ; official & # 8221 ; AIDS diagnosing ( 12 ) . Further data that show that adult females with AIDS do non last as long after diagnosing as work forces and, one time diagnosed, go ill faster and decease sooner than work forces with AIDS ( 12 ) . Some surveies suggest this be attributed to gender differences or to detain diagnosing of adult females, inferior entree to wellness attention and P

oor use of service ( 12 ) .

Use of the prescribed drug therapies may impact the class of HIV/AIDS in adult females. Evidence suggests that a figure of HIV-infected adult females are loath to take antiretroviral drugs because of concerns about their effectivity and side effects, every bit good as beliefs that drugs are experimental ( 6 ) . Many adult females have negative positions of available drug therapies because of the deficiency of relationship between them and their wellness attention supplier? s ( 6 ) . Consequently, adult females decide against taking the drugs to assist their HIV infection. These clinical manifestations underscore the immediate demand for more aggressive survey of HIV infection in adult females. With more extended research and clinical attention, adult females populating with the infection may be able to avoid farther AIDS-related unwellnesss and adult females without the disease may be able to cut down their hazard of infection.

Gynecological Manifestations:

Until late, AIDS diagnosings have excluded the serious gynaecological manifestations of HIV that have been identified in adult females for some clip ( 7 ) . Most of the unwellnesss associated with HIV are found in clean adult females, but occur less often, or badness ( 10 ) . Although the CDC has merely recognized cervical malignant neoplastic disease in the instance definition of AIDS, suppliers must be watchful to the other female-specific conditions that their patients might meet ( 12 ) .

Candidasis:

Vaginal Candidasis has been described as one of the earliest manifestations of immunosuppression in adult females ( 12 ) . Refactory Candidasis may be an early warning of HIV infection ( 7,12 ) . In an early survey, 24 % of adult females had chronic refactory Vaginal Candidasis as a ailment ( 7 ) . As the unwellness progresses, the vaginal infection may travel to esophageal and tracheal engagement, and finally to the tummy in some really terrible instances ( 12 ) . Candida infection of the gorge has been reported as the most frequent AIDS-defining symptoms in early surveies of HIV-positive adult females ( 12 ) . It is so common because of the frequent usage of antibiotic ( 13 ) . However, this unwellness normally responds good to the conventional intervention in adult females with early HIV infection, but advanced therapy may be called for in a more terrible instance ( 13 ) .

Herpes Simplex Virus Infection ( HSV or venereal herpes ) :

Genital herpes simplex infection is dominant in adult females infected with the HIV virus ( 7,12 ) . The venereal lesions associated with HSV may be an chance for the entry of the virus ( 12 ) . Therefore, lesions that last longer than one month should be looked at and tested for HIV infection ( 7 ) . HSV is sometimes unresponsive to therapy ( 10 ) and can be an AIDS-defining status and necessitate long-run suppressive therapy ( 7 ) .

Pelvic Inflammatory Disease ( PID ) :

Several surveies have found a high rate of HIV infection among adult females with pelvic inflammatory disease ( 13 ) . Whether HIV is a cofactor or merely a mark for increased hazard of infection has yet to be established. One survey showed that HIV infected adult females with pelvic inflammatory disease are less likely to hold a white-cell count great than 10,000 ( 13 ) , which puts a patient at much higher hazard for infection. Recommended intervention, is to be hospitalization and intervention with endovenous antibiotics ( 7,12,13 ) .

Further survey is needed in many facets of gynaecological disease in adult females with HIV. If the epidemic of the female infections is to be reduced, wellness attention suppliers must have instruction about these dangerous diseases.

PREGNANCY AND HIV:

Because most HIV septic adult females are of childbearing age, considerable research has been conducted on pregnancy-related issues. There is a 25 % to 35 % hazard of perinatal transmittal ( 13 ) , with an estimated 50 to 80 per centum of infections happening tardily in gestation or during birth ( 10 ) . HIV may be transmitted when maternal blood enters the foetal circulation, or by mucous secretion exposure to the virus during labour and bringing ( 10 ) .

Hazards of perinatal transmittal are increased if the female parent has an advanced instance of the HIV disease, big sums of HIV in her blood watercourse, or few immune system cells, CD4+ T cells, which are the chief marks of HIV ( 10 ) . Other factors that may increase the hazard of transmittal are maternal drug usage, terrible redness of foetal membranes, or a drawn-out period between membrane rupture and bringing ( 10,13,14 ) . In one survey, HIV infected adult females who gave birth more than four hours after their foetal membranes were ruptured were twice every bit likely to convey the HIV virus to the baby as compared to adult females who gave birth within that four hr period ( 10 ) . In the same survey, HIV infected adult females who used diacetylmorphine or crack/cocaine during gestation were besides twice every bit likely to convey HIV to their babes than were adult females infected with the virus who were non shooting drugs.

Another hazard of transmittal is from a nursing female parent to her baby ( 5,10,14 ) . A recent analysis suggested that breast-feeding introduces an extra hazard of HIV transmittal of approximately 14 % ( 10 ) . In one instance, an clean adult females who received a Cesarean subdivision needed a blood transfusion due to the monolithic sums of lost blood. The babe male child was breast Federal, and it was subsequently found that the blood that was given to the adult females was contaminated with HIV. The female parent and babe were both tested and both found to transport the antibodies of HIV. The female parent was seemingly infected with the disease after bringing. Hence, the babe could hold merely been infected through chest eating ( 5 ) . For this ground, adult females who are infected with HIV are recommended to remain manner from breast-feeding, despite the little opportunity of infection ( 5,10,14 ) .

To forestall transmittal of HIV to babies, Zidovudine ( AZT ) ( 10,13,15 ) and prophylaxis are recommended for pregnant adult females ( 13 ) . There is limited cognition with AZT. However, it is known that it crosses the placenta and can be detected in foetal tissue and amnionic fluids ( 13 ) . When AZT is given shortly before curative abortion of bringing, serum sums in the neonates are similar to those in the female parent ; therefore cut downing the hazard of maternal-infant transmittal by two tierces ( 10 ) . AZT is still being studied and perfected. With farther progresss, AZT may be able to cut down the hazard of transmittal to an undetectable sum, giving HIV septic adult females a less nerve-racking determination when make up one’s minding whether or non to go on with their gestation.

Decision:

More adult females are going infected with HIV. With earlier testing and intervention, adult females can populate with HIV every bit long as work forces can. However, in a male-dominated medical constitution, adult females? s wellness issues are frequently ignored ( 16 ) . Some adult females go directly to their deceases, while others are diagnosed after it is excessively late ( 16 ) . Womans need to cognize more about how they can be infected, and should acquire tested for HIV if they think that there is any opportunity that they have been exposed to the virus. This is particularly true for pregnant adult females. Not merely are they jeopardizing their ain lives, they may be seting an unborn kid at hazard for a disease that might hold been evitable.

If the rhythm of female infection is to be broken, wellness workers must be able to supply appropriate instruction, reding and attention to adult females ( 16 ) . If adult females are to have optimum AIDS wellness attention, research must be done specifically to aim adult females ( 16 ) . In the interim, people? s frights and ignorance about HIV and AIDS must stop by increasing the instruction of the affects of HIV on adult females. Until the apprehension of AIDS as it relates to adult females becomes clear plenty to wellness attention workers, adult females will still endure from the lifting AIDS epidemic.

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