Eastern European Alliance for Reproductive ChoiceEastern European Alliance for Reproductive Choice

REPRODUCTIVE CHOICE FOR HIV-REPRODUCTIVE CHOICE FOR HIV-INFECTED WOMENINFECTED WOMEN

Prof. POSOKHOVA S.P.Prof. POSOKHOVA S.P.UKRAINEUKRAINE

УКРАЇНАУКРАЇНАУКРАЇНАУКРАЇНА

July 2008 e

Total: 33 million (30 – 36 million)

Western & Central Europe

730 000730 000[580 000 – 1.0 million][580 000 – 1.0 million]

Middle East & North Africa

380 000380 000[280 000 – 510 000][280 000 – 510 000]Sub-Saharan Africa

22.0 million22.0 million[20.5 – 23.6 million][20.5 – 23.6 million]

Eastern Europe & Central Asia

1.5 million 1.5 million [1.1 – 1.9 million][1.1 – 1.9 million]

South & South-East Asia

4.2 million4.2 million[3.5 – 5.3 million][3.5 – 5.3 million]Oceania

74 00074 000[66 000 – 93 000][66 000 – 93 000]

North America1.2 million

[760 000 – 2.0 million]

Latin America1.7 million1.7 million

[1.5 – 2.1 million][1.5 – 2.1 million]

East Asia740 000740 000

[480 000 – 1.1 million][480 000 – 1.1 million]Caribbean230 000

[210 000 – 270 000]

Adults and children estimated to be living with HIV, 2008

July 2008 e

Estimated adult and child deaths from AIDS, 2008

Western & Central Europe

80008000[4800 – 17 000][4800 – 17 000]

Middle East & North Africa27 00027 000

[20 000 – 35 000][20 000 – 35 000]Sub-Saharan Africa

1.5 million1.5 million[1.3 – 1.7 million][1.3 – 1.7 million]

Eastern Europe & Central Asia

58 000 58 000 [41 000 – 88 000][41 000 – 88 000]

South & South-East Asia

340 000340 000[230 000 – 450 000][230 000 – 450 000]Oceania

10001000[<1000 – 1400][<1000 – 1400]

North America23 000

[9100 – 55 000]

Latin America63 00063 000

[49 000 – 98 000][49 000 – 98 000]

East Asia40 00040 000

[24 000 – 63 000][24 000 – 63 000]Caribbean

14 000[11 000 – 16 000]

Total: 2.0 million (1.8 – 2.3 million)

The number of HIV-infected people in Ukraine increased at about 1.5% of the population (175 000)80% of all HIV-infected people are in the reproductive age50% are women

The number of HIV-infected people in Ukraine increased at about 1.5% of the population (175 000)80% of all HIV-infected people are in the reproductive age50% are women

УКРАЇНАУКРАЇНАУКРАЇНАУКРАЇНАHIV in Ukraine

Population in Ukraine is 46,3 million

Reproductive rights

• Women with HIV have a right to decide about their reproductive choice

• European multicentral study found that 22% of HIV positive pregnant women had terminated a pregnancy since their HIV diagnosis, and 29% of them reported more than one pregnancy

• If HIV-infected woman chooses not to have children, she should be able to make informed, voluntary decisions about contraception and then received her method of choice.

Family planning and HIV-related services

• Integrating family planning and HIV/AIDS services aimed to:

• Ensure that HIV-positive women receive available family planning information and services

• Support the reproductive rights and fertility choices of HIV-positive women

• Prevent new HIV infections by encouraging dual protection

• Prevent unintended pregnancies of HIV-positive women and girls of reproductive age

• Treat sexually transmitted infections• Reduce HIV transmission from mother to child• Decrease the number of AIDS orphans

Reproductive Health in HIV-infected women

• We examined 870 HIV-infected women in family planning center during 2 years. We diagnosed:

• Chronic inflammatory gynecological diseases – 25% of women

• Cervical pathology – 31.7% (cervical cancer – 0.8%)

• STI: syphilis – 3.5%, trichomoniasis – 12.5%, herpes symplex – 8.5%, HPV- 12.5%, chlamydiosis – 18%

Family planning methods

1%5,90%7,90%

9,50%

12,50%

20%

43,20%

Female condom Sterilisation COC Depo-provera

IUD Any methods Male condom

Contraception for HIV-infected

• According to WHO’s Medical Eligibility Criteria for Contraceptive Use (2008) – most contraceptive methods are considered to be safe and effective for HIV positive women, both asymptomatic HIV and AIDS.

• Therefore, the consistent use of condoms is recommended not only for preventing HIV transmission, but also for preventing unintended pregnancies.

• Dual protection option – consistent use of condoms with one’s of another effective method of contraceptive

Barrier methods

• Current data suggest that male and female condoms are highly effective in protecting against pregnancy and STI’s.

• Our data showed that only 42.3% of HIV-infected couples used male condoms and less 1% of HIV-infected women used female condoms.

• These data showed lack of knowledge in HIV-infected people about the possibility re-infection of HIV and STI’s

Barrier methods

• Other barrier methods are generally not recommended for women with HIV

• Frequent use of spermicides containing nonoxylon-9 may increase risk of re-infection because N-9 can disrupt the lining of the vagina, making it more vulnerable to infection.

• N-9 offers no protection against STI’s.• Giaphragms and cervical caps are not

recommended for women with HIV.

Intrauterine device (IUD)

• Under the revised WHO guidelines, most HIV-infected women generally can initiated and use IUD and the levonorgestrel-releasing intrauterine system, and IUD users who became infected with IUD may continue using the device.

• The only exceptions are for insertions among women who developed AIDS and are not received ARV drugs or women with AIDS who are not responding well to ARV treatment

Hormonal methods

• The WHO recommends that HIV-infected women can safely use hormonal contraceptive – including combined oral contraceptives (COC), the injectables DMPA and implants (Norplant)

• According our data only 15% of HIV –infected women use hormonal methods

• These data explain not only the low awareness of women, but their inaccessibility due to the high cost of contraceptive

Emergency contraception (EC)

• For women living with HIV who suffer from sexual violence, access to emergency contraception may be vital.

• In general, women living with HIV and discordant couples still seem to have far too little knowledge of emergency contraception.

• For example, in Ukraine, qualitative studies conducted in our clinic attendees showed that only 1% of women and men living with HIV had some knowledge of EC or how to access it.

The number of abortion in HIV-infected women

• About 2.5 million women who become pregnant each year worldwide are HIV-positive.

• Very little research has been done on whether HIV-positive women have an increased risk of morbidity following abortions than HIV-negative women.

• Among HIV-infected women, the risk of complications was associated with immune status for surgical abortion

HIV and abortion

• Both MVA and medical methods of abortion are safe if provided according to international standards.

• For pregnancies up to 12 weeks gestation, MVA should be the preferred method overD&C

• HIV infected women may experience more complications than their HIV negative peers, due to the risk of infection, sepsis and haemorrage, anaemia.

The number of abortion in HIV-infected women in Ukraine

10,20%10,50%

2,70% 2,90%

0% 0%

2,50%

2,80%

0,00%

2,00%

4,00%

6,00%

8,00%

10,00%

12,00%

2008 2009

2,35%

2,40%

2,45%

2,50%

2,55%

2,60%

2,65%

2,70%

2,75%

2,80%

2,85%

Surgical abortion

Misccarriage

Medical abortion

Second tr. abortion

Medical abortion for HIV-infected women

• Our data showed the lack of knowledge about medical abortion is widespread, not only among HIV positive women, but also among service providers, policymakers.

• It has been suggested that medical abortion might be a preferable alternative to surgical abortion for HIV-positive women

Summary

• HIV-infected women face few restrictions on their use of modern contraceptive methods.

• Furthermore, use of effective contraception can play a key role in preventing HIV-positive births.

• For termination of pregnancy for HIV-infected should be used only safe methods of termination, as medical abortion or vacuum aspiration.

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