HIV Positive Women Should Not Become Pregnant - Research Paper Example

HIV positive women should not become pregnant al affiliation Introduction Most of the worldwide population people living with HIV are women predominantly infected through heterosexual transmission. Women infected with HIV may wish to avoid pregnancy or limit their family since they have reproductive patterns similar to HIV negative women. Pregnancy in an HIV positive woman has been associated with emotional disorder and somatic symptoms which can cause morbidity. Physicians and health care workers are faced with challenges while caring for pregnant women that have been diagnosed with HIV. Previous research also indicates that HIV positive mothers are at an increased risk of complications after operations when delivered by the caesarean section. There is also a risk of higher post operative complications among severely immunodepressed HIV infected women. Moreover, pregnant women with HIV are affected by stigmatization. A cross-sectional study done on 1525 women attending antennal clinics in Kenya indicated that the rates of stigma was high which led them to refuse testing (Turan, Bukusi, Onono, Holzemer, & Cohen, 2011) . This paper focuses on evidence based review of literature why HIV positive women should not become pregnant. Epidemiology There is an estimation of about 1.5 million women living with HIV globally with over 90% concentrated in the Sub-Saharan Africa. According to Centre for Disease Control and Prevention (2014), perinatal transmission is HIV transmission from mother to child during pregnancy, labor and delivery. In the United States, 88% of persons under 13 diagnosed with HIV acquired it perinatally. The African American population represented 63%, Hispanics were 22%, while whites were 13% of the dignoses of perinatal HIV infection at the end of 2009. Despite the increase in the number of women with HIV gving birth, there has been a decline in perinatal infections from 2007 to 2009. The transmission rates are high, 15- 45% when no interventions are put in place. Implementing best known practices into clinical setting In developed countries, the mother to child transmission (MTCT) of HIV has been almost eliminated due to effective prevention programs. There are significant challenges facing prevention mother to child transmission (PMTCT) programs in developing countries therefore causing significant gaps in reducing the rates of MTCT. HIV positive women are recommended by the World Health Organization to be assessed for the eligibility to start highly active anterotroviral therapy (HAART). In this regard, PMTCT programs present a major opportunity to HIV positive women to enable prevention of infant infections as well as allow diagnosis of and management of previously unrecognized maternal HIV infection (Watson-Jones, Balira, Ross, Weiss, & Mabey, 2012). It is recommended that there should be simple, routine and voluntary HIV testing for all pregnant women in antenatal settings to reduce perinatal HIV transmission. The voluntary testing aims to give the woman the right to make decisions on testing and ensuring a conducive relationship between the caregivers and the expectant mothers. However, the diagnosis of HIV in pregnant mothers may cause stress or depression that may lead to suicidal thoughts. Transmission to new born infants can be reduced through administration of antiretroviral treatment to the pregnant women with HIV and to the newborns to prevent them from acquiring the virus. Practices that ensure safe delivery should be followed and mothers should be guided on suitable feeding options for their newborns. Design a health promotion program Preventing pregnancy in HIV positive women has affirmative implications such as reduction in maternal to child HIV transmission and general improvement on the woman’s health. Hormonal contraceptives help to avoid pregnancy safely and effectively (Robinson, Jamshidi, & Burke, 2012). Therefore, due to several risks that HIV positive pregnant women are associated with, a health promotional program should be designed to target use of long term contraception and family planning among the group. There would be moderate reductions in unintended pregnancies among HIV infected women which would lead to reduction in HIV infections in infants. There would be major reductions in HIV infections and orphans due to addition of family planning to counseling programs. It is also cost effective to increase contraceptive use in HIV positive women than investment in prenatal care programs to HIV infected mothers. Purpose The main aim of HIV counseling programs addressing the use of contraceptives and family planning methods is to prevent HIV positive women from becoming pregnant. This will improve the general health of the women and reduce the rates of mother to child transmissions. In addition, prevention of pregnancy reduces mother to child transmissions that may cause complications to the infants in future. Plan HIV positive women should be provided for reproductive choices by health professionals. The women should be counseled and be provided for appropriate contraception provision. The women could be provided for contraceptive methods of either use of barrier methods and hormonal contraceptives. Barrier contraceptives methods such as condom use prevent transmission of both HIV to uninfected persons and pregnancy (Stanwood, Cohn, Heiser, & Pugliese, 2005). It has been found out that women receiving highly active antiretroviral therapy are more likely to use contraceptive methods. Therefore HIV positive women are encouraged to use contraceptives. The integration of reproductive health and HIV and AIDS services for women who are HIV positive (Andia, et al., 2009) Implementation The promotional health program of preventing pregnancy among HIV positive women can be implemented by educating HIV positive women on family planning methods and the affirmative outcomes of not having children. The women living with HIV should be provided sexual and reproductive health services while supporting their right in achieving their fertility goals. The HIV positive women could also be provided with family planning options, such as hormonal or barrier methods in preventing pregnancy. Evaluation Contraception has an affirmative effect on reducing the number of infant HIV infections. The effect of contraception is cost effective compared to PMTCT services. Integration of family planning and treatment of HIV will help reduce pregnancy. This will help reduce mother to child transmissions and generally improve on the health of the women living with HIV. In conclusion, there should be a continued care among HIV positive pregnant women attending antenatal services especially those who are not eligible to antiretroviral treatment. There is a heighten risk of HIV positive pregnant women becoming lost to follow-up from HIV care (Clouse, et al., 2013). Preconception and reversible methods of contraception counseling would want to benefit HIV positive women who have the desire to have children. Research is also needed to identify obstacles to effective long term contraception among women living with HIV. Reference Andia, I., Kaida, A., Maier, M., Guzman, D., Emenyonu, N., Pepper, L., et al. (2009). Highly Active Antiretroviral Therapy and Increased Use of Contraceptives Among HIV-Positive Women During Expanding Access to Antiretroviral Therapy in Mbarara, Uganda. American Jlournal Public Health , 99 (2), 340-347. Centres for Disease Control and Prevention. (2014). HIV among Pregnant Women , Infants, and Children. Georgia: Centre for Disease Control and Prevention. Clouse, K., Pettitor, A., Shearer, K., Maskew, M., Basset, J., Larson, B., et al. (2013). Loss to follow-up before and after delivery amnogwomen during Pregnancy in Johannesburg, South Africa. Tropical Medicine & International Health , 18 (4), 451-460. Robinson, J. A., Jamshidi, R., & Burke, A. E. (2012). Contraception for the HIV-Positive Woman: A Review of Interactions between Hormaonal Contraception and ANtiretrovial Therapy. Infectious Disease in Obstetrics and Gynecology , 2012, 1-16. Stanwood, N. L., Cohn, S. E., Heiser, J. R., & Pugliese, M. (2005). Contraception and fertility plans in a corhort of HIV-positive women in care. An International Reproductive Health Journal of Contraception , 75 (4), 294-298. Turan, J. M., Bukusi, E. A., Onono, M., Holzemer, W. L., & Cohen, C. (2011). HIV/AIDS Stigma and Refusal of HIV Testing Among Pregnant Women in Rural Kenya: Results from the MAMAS Study. AIDS and Behavior , 15 (6), 1111-1120. Watson-Jones, D., Balira, R., Ross, D. A., Weiss, H. A., & Mabey, D. (2012). Missed Opportunities: Poor Linkage into Ongoing Care for HIV-Positive Pregnant Women in Mwanza, Tanzania. PLOS , 7 (7). Read More