ABSTRACT
ABSTRACT Objective: To identify the representational contents of pregnant women living with HIV. Method: Exploratory, descriptive, qualitative study, conducted with pregnant women with HIV from August 2017 to January 2018. Semi-structured interview was opted for. The IRAMUTEQ software was used for analysis, organizing the data into 2 blocks: a) moment of discovery, impacts, representational contents of HIV; and b) representational contents in living with the disease. Results: The participating pregnant women amounted to 25. Initially, the social representation of HIV translated the representation of death; however, this construction changes as women understand information of the pathology, which starts to be seen as a disease which demands more care. Conclusion: The conception of HIV as frightful is mainly due to concern about transmission to the fetus. The resignification of HIV was perceived among pregnant women, which favors new behaviors and attitudes towards the representational contents related to a deeper knowledge about the virus, demystifying the idea that this is a deadly disease.
RESUMEN Objetivo: Identificar los contenidos representacionales de mujeres embarazadas que viven con el VIH. Método: Investigación exploratoria, descriptiva y cualitativa realizada con mujeres embarazadas con VIH entre agosto de 2017 y enero de 2018. Se optó por entrevistas semiestructuradas. Para el análisis, se utilizó el software IRAMUTEQ, organizando los datos en dos bloques: a) momento del descubrimiento, impactos y contenidos representacionales del VIH; y b) contenidos representacionales de la convivencia con la enfermedad. Resultados: Participaron 25 mujeres embarazadas. Inicialmente, se observó que la representación social del VIH traduce la representación de la muerte; sin embargo, la construcción cambia a medida que las mujeres comprenden la información sobre la patología, que comienza a ser vista como una enfermedad que requiere mayores cuidados. Conclusión: El VIH aún se concibe como algo digno de miedo, principalmente debido al temor de transmitirlo al feto. Se constata la resignificación del VIH entre las mujeres embarazadas, algo que favorece nuevos comportamientos y actitudes a partir de contenidos representacionales relativos al conocimiento más profundo sobre el virus y desmitifica la idea de que se trata de una enfermedad mortal.
RESUMO Objetivo: Identificar os conteúdos representacionais de gestantes vivendo com o HIV. Método: Pesquisa exploratória, descritiva, com abordagem qualitativa, realizada com gestantes com HIV entre agosto de 2017 e janeiro de 2018. Optou-se por entrevista semiestruturada. Para a análise se utilizou o software IRAMUTEQ, organizando os dados em 2 blocos: a) momento da descoberta, impactos e conteúdos representacionais do HIV; e b) conteúdos representacionais no viver com a doença. Resultados: Participaram 25 gestantes. Inicialmente, observou-se que a representação social do HIV traduz a representação da morte; porém, essa construção se altera à medida que as mulheres compreendem as informações sobre a patologia e esta passa a ser vista como uma doença que requer maiores cuidados. Conclusão: Ainda se concebe o HIV como algo digno de temor, principalmente devido ao receio de transmiti-lo ao feto. Constatou-se a ressignificação do HIV entre as gestantes, algo que favorece novos comportamentos e atitudes diante de conteúdos representacionais relativos ao conhecimento mais aprofundado sobre o vírus e desmistifica a ideia de que se trata de uma doença mortal.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Perception , Pregnancy Complications, Infectious/psychology , Acquired Immunodeficiency Syndrome/psychology , Pregnant Women/psychologyABSTRACT
ABSTRACT Aim To reflect on the lonely experience of women during the pregnancy-puerperal cycle in times of pandemic by the SARS-CoV-2 virus. Method Theoretical-reflective study on the new Brazilian guidelines for care for women during pregnancy, childbirth and postpartum in times of Covid-19 and its influence on the exacerbation of maternal loneliness. The discussion about the transformations of women in this period refers to Maldonado's studies. Results Motherhood is a lonely process for women. The new technical norms that are in force bring important changes in the assistance to this cycle, mainly with regard to the importance of social distance, which intensifies the feeling of loneliness and helplessness. Final considerations This reflection can guide health professionals, especially the work of nurses in the scope of obstetrics, so that during the assistance to women in the pregnancy-puerperal cycle, they pay attention to the subtlety of feelings of loneliness that can interfere with maternal well-being fetal.
RESUMEN Objetivo Reflexionar sobre la experiencia solitaria de las mujeres durante el ciclo embarazo-puerperal en tiempos de pandemia por el virus SARS-CoV-2. Método Estudio teórico-reflexivo sobre las nuevas pautas brasileñas para el cuidado de las mujeres durante el embarazo, el parto y el posparto en tiempos de Covid-19 y su influencia en la exacerbación de la soledad materna. La discusión sobre las transformaciones de las mujeres en este período se refiere a los estudios de Maldonado. Resultados La maternidad es un proceso solitario para las mujeres. Las nuevas normas técnicas vigentes traen cambios importantes en la asistencia a este ciclo, principalmente con respecto a la importancia de la distancia social, que intensifica el sentimiento de soledad e impotencia. Consideraciones finales Esta reflexión puede orientar a los profesionales de la salud, especialmente la labor del enfermero en el ámbito de la obstetricia, para que durante la asistencia a la mujer en el ciclo embarazo-puerperal, preste atención a la sutileza de los sentimientos de soledad que pueden interferir con el bienestar materno fetal.
RESUMO Objetivo Refletir acerca da vivência solitária da mulher durante o ciclo gravídico-puerperal em tempos de pandemia pelo vírus SARS-CoV-2. Método Estudo teórico-reflexivo sobre as novas diretrizes brasileiras para atendimento às mulheres na gestação, parto e pós-parto em tempos de COVID-19 e sua influência na exacerbação da solidão materna. A discussão acerca das transformações da mulher nesse período remete aos estudos de Maldonado. Resultados A maternidade é um processo solitário para as mulheres. As novas normas técnicas que estão vigorando trazem importantes mudanças na assistência a esse ciclo, principalmente no que tange a importância do distanciamento social, que intensifica o sentimento de solidão e desamparo. Considerações finais Esta reflexão pode nortear os profissionais de saúde, sobretudo enfermeiras do âmbito da obstetrícia, para que durante a assistência à mulher no ciclo gravídico-puerperal atentem-se para as sutilezas de sentimentos de solidão que podem interferir no bem-estar materno-fetal.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications, Infectious/psychology , Peripartum Period/psychology , Pandemics , COVID-19/psychology , Loneliness , Anxiety , Postnatal Care , Prenatal Care , Delivery, Obstetric/psychology , Pregnant Women/psychology , Physical Distancing , Maternal Welfare , Nurse MidwivesABSTRACT
INTRODUCCIÓN: Ante el escenario de pacientes obstétricas diagnosticadas por la nueva enfermedad por coronavirus (COVID-19), se hace imprescindible la necesidad de realizar un seguimiento adecuado tanto desde el punto de vista de obstétrico como del cuadro viral, durante el período de aislamiento domiciliario. Con este objetivo, se desarrolló un programa de seguimiento remoto por la Unidad de Medicina Materno Fetal (MMF) de nuestro centro, desde el diagnóstico de la infección hasta el alta médica según los criterios vigentes del Ministerio de Salud (MINSAL). OBJETIVO: Evaluar la satisfacción del paciente en el seguimiento remoto de embarazadas y puérperas con diagnóstico de infección por SARS-CoV-2. Material y Métodos: Estudio descriptivo mediante la aplicación de una encuesta anónima y voluntaria de satisfacción usuaria, a través de una plataforma online. El instrumento fue una adaptación de la versión en español del "Telehealth Usability Questionnaire" (TUQ) previamente validado. RESULTADOS: Se obtuvo un 94,5% de respuestas a la encuesta. El 86% de las pacientes evaluó como "Muy Bueno" o "Bueno" el control virtual. El 91% no experimentó problemas técnicos. El 14% de las pacientes prefiere un control virtual, el 26% presencial y el 60% un control mixto. El 80% cumplió todas sus necesidades con el control virtual. CONCLUSIONES: En el contexto de pandemia e infección por SARS-CoV-2, el seguimiento remoto ha sido evaluado globalmente en forma positiva con niveles aceptables de satisfacción de las pacientes.
INTRODUCTION: Given the scenario of obstetric patients diagnosed with the new coronavirus disease (COVID-19), the need for proper follow-up both obstetric and of the infection, during the period of home isolation, is essential. A remote monitoring program was developed by the Maternal Fetal Medicine Unit (MFM) of our center from the diagnosis of the infection until medical discharge according to the current criteria of the Ministry of Health (MINSAL). OBJECTIVE: To assess patient satisfaction of remote monitoring of pregnant and postpartum patients diagnosed with SARS-CoV-2 infection. METHODS: This is a descriptive-survey research. We performed a patient satisfaction survey through an online platform to pregnant and postpartum patients with remote monitoring for SARS-CoV-2 infection in our center. The survey was anonymous and voluntary. The instrument for this purpose was the Spanish adapted version of "Telehealth Usability Questionnaire" (TUQ) that has been previously validated. RESULTS: The survey was answered by 94,5% of the patients. The results show that 86% of the patients rated the virtual control as "Very Good" or "Good"; 91% did not experienced technical problems. 14% of the patients prefer virtual control, 26% prefer face-to-face control and 60% both virtual and face-to-face control. 80% fulfilled all their needs with virtual control. CONCLUSIONS: In the context of pandemic and SARS-CoV-2 infection, remote monitoring has been positively evaluated with acceptable levels of patient's satisfaction.
Subject(s)
Humans , Female , Pregnancy , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Pregnancy Complications, Infectious/psychology , Pregnancy Complications, Infectious/therapy , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Postpartum Period , Epidemiology, Descriptive , Surveys and Questionnaires , Follow-Up Studies , Patient Satisfaction , Telemedicine/methods , Pandemics , Betacoronavirus , Virtual RealityABSTRACT
Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences to pregnancies has made governments, national and international agencies issue advices and recommendations to women. There is a clear need to investigate how the Zika outbreak affects the decisions that women take concerning their lives and the life of their families, as well as how women are psychologically and emotionally dealing with the outbreak. We conducted a qualitative study to address the impact of the Zika epidemic on the family life of women living in Brazil, Puerto Rico, and the US, who were affected by it to shed light on the social repercussions of Zika. Women were recruited through the snowball sampling technique and data was collected through semi-structured interviews. We describe the effects in mental health and the coping strategies that women use to deal with the Zika epidemic. Zika is taking a heavy toll on women's emotional well-being. They are coping with feelings of fear, helplessness, and uncertainty by taking drastic precautions to avoid infection that affect all areas of their lives. Coping strategies pose obstacles in professional life, lead to social isolation, including from family and partner, and threaten the emotional and physical well-being of women. Our findings suggest that the impacts of the Zika epidemic on women may be universal and global. Zika infection is a silent and heavy burden on women's shoulders.
A infecção pelo vírus Zika durante a gravidez é causa de anomalias congênitas do sistema nervoso central do feto. As graves consequências gestacionais fizeram com que governos nacionais e agências internacionais emitissem conselhos e recomendações para as mulheres. Existe uma necessidade clara de investigar de que maneira a epidemia de Zika afeta as decisões das mulheres sobre suas próprias vidas e de suas famílias, e de como as mulheres estão lidando psicológica e emocionalmente com a epidemia. Realizamos um estudo qualitativo para avaliar o impacto social da epidemia de Zika na vida familiar das mulheres no Brasil, Porto Rico e Estados Unidos. As mulheres foram recrutadas através da técnica de "bola de neve", e os dados foram coletados com entrevistas semiestruturadas. O artigo descreve os efeitos sobre a saúde mental e as estratégias das mulheres para enfrentar a epidemia do vírus Zika. O vírus está tendo um impacto pesado no bem-estar emocional das mulheres. Elas estão lidando com sentimentos de medo, desamparo e incerteza, ao tomar precauções drásticas para evitar uma infecção que afeta todas as áreas de suas vidas. As estratégias de enfrentamento envolvem obstáculos na vida profissional, levam ao isolamento social, inclusive em relação à família e ao companheiro e ameaçam o bem-estar emocional e físico das mulheres. Nossos achados sugerem que os impactos da epidemia de Zika sobre as mulheres podem ser universais e globais. A infecção pelo vírus Zika põe uma carga pesada e silenciosa nos ombros das mulheres.
La infección por el virus del Zika durante el embarazo es una causa de anormalidades cerebrales congénitas. Sus consecuencias para los embarazos han hecho que los gobiernos, las agencias nacionales e internacionales emitan consejos y recomendaciones para las mujeres. Existe una clara necesidad de investigar cómo el brote de Zika afecta las decisiones que toman las mujeres con respecto a sus vidas y la de sus familias y también cómo las mujeres están lidiando psicológica y emocionalmente con el brote. Llevamos a cabo un estudio cualitativo para abordar el impacto de la epidemia de Zika en la vida familiar de las mujeres que se vieron afectadas por la enfermedad, y que viven en Brasil, Puerto Rico y los EE.UU., para arrojar luz sobre las repercusiones sociales del Zika. Las mujeres fueron reclutadas a través de la técnica de muestreo de bola de nieve y los datos fueron recolectados a través de entrevistas semiestructuradas. Describimos los efectos en la salud mental y las estrategias de afrontamiento que las mujeres usan para lidiar con la epidemia de Zika. La enfermedad está afectando mucho el bienestar emocional de las mujeres. Están enfrentando sentimientos de miedo, impotencia e incertidumbre tomando precauciones drásticas para evitar infecciones que afectan todas las áreas de sus vidas. Las estrategias de afrontamiento representan obstáculos en la vida profesional, conducen al aislamiento social, incluso de la familia y la pareja, y ponen en peligro el bienestar emocional y físico de las mujeres. Nuestros hallazgos sugieren que los impactos de la epidemia de Zika en las mujeres pueden ser universales y globales. La infección por Zika es una carga silenciosa y pesada para los hombros de las mujeres.
Subject(s)
Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy Complications, Infectious/psychology , Disease Outbreaks , Women's Health , Sickness Impact Profile , Zika Virus Infection/epidemiology , Puerto Rico/epidemiology , United States/epidemiology , Brazil/epidemiology , Qualitative Research , Zika Virus Infection/psychologyABSTRACT
Objective: To understand how the HIV diagnosis combines with other factors that influence the decision to abort. Methodology: Data were collected during a crossover study of women aged between 18 and 49 years old and seen in public health services in Porto Alegre, Brazil. The life stories of 18 interviewees who had post-diagnosis abortion were reconstructed on a timeline, using information collected quantitatively. Results: The time between the diagnosis and abortion was 2 years or less for more than half of the women. For some, post-diagnosis abortion did not mean the end of reproductive life. The most frequent reason for terminating pregnancy was to be living with HIV; however, only some of the women who stated having this motivation did not have post-diagnosis children. Changing partners between pregnancies was a recurring finding; however, in most pregnancies that ended in abortion, the women lived with their partners. Discussion: The analysis of the reproductive trajectory of the women studied showed that there is no specific profile of the woman who aborts after receiving the HIV diagnosis. Although this diagnosis may be involved in the decision to terminate a pregnancy, it does not necessarily result in the end of a woman's reproductive trajectory. Thus, abortion should be understood within a diversity of decision-making processes and the specific moment of a woman's life story. .
Objetivo: Compreender como o diagnóstico de HIV se conjuga com outros fatores que concorrem para a decisão pelo aborto. Metodologia: Os dados são provenientes de um estudo transversal, com mulheres de 18 a 49 anos, que frequentavam serviços públicos de saúde, em Porto Alegre. As trajetórias de vida de 18 entrevistadas que tiveram aborto pós-diagnóstico foram recompostas, através de uma linha do tempo, a partir de informações coletadas de forma quantitativa. Resultados: Para mais da metade das mulheres, o tempo entre o diagnóstico e o aborto foi de 2 anos ou menos. Para parte delas, o aborto pós-diagnóstico não encerrou a vida reprodutiva. A razão mais frequente para o término da gestação foi estar vivendo com HIV; entretanto, apenas parte das mulheres que declararam essa motivação não tiveram filhos pós-diagnóstico. A troca de parceria entre gestações foi recorrente, embora, na maioria das gestações findadas em aborto, a mulher coabitasse com o parceiro. Discussão: A análise da trajetória reprodutiva evidencia que não há um perfil específico de mulher que aborta após o diagnóstico de HIV. Esse diagnóstico, apesar de poder estar envolvido na decisão pelo término da gestação, não implica, necessariamente, no fim da trajetória reprodutiva. Assim, o aborto deve ser compreendido dentro de uma diversidade de processos decisórios e ao momento específico da trajetória de vida. .
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Young Adult , Pregnancy Complications, Infectious/psychology , Acquired Immunodeficiency Syndrome/psychology , Abortion, Induced/psychology , Abortion, Induced/statistics & numerical data , Decision Making , Brazil , Pregnancy , HIV Infections/psychology , Cross-Over StudiesABSTRACT
Objetivamos compreender os fatores sócio-comportamentais e do Sistema Único de Saúde (SUS) que, na visão de mulheres identificadas como HIV+ por teste rápido no parto, dificultaram ou impediram a adesão ao pré-natal. Foram incluídas 40 mulheres, das quais apenas oito tinham tido seis consultas ou mais. Foi utilizada a abordagem qualitativa, com entrevistas semi-estruturadas. Os dados foram analisados seguindo os preceitos da análise temática. Os resultados foram agrupados em dois blocos: os que dificultaram a adesão ao pré-natal: não aceitação da gestação, falta de apoio familiar, conhecimento prévio da soropositividade, contexto social adverso, experiências negativas de atendimento e práticas e concepções de descrédito em relação ao pré-natal, e os que favoreceram a adesão: apoio familiar, discurso de valorização do cuidado com a saúde, desejo de laqueadura tubária, acolhimento pela equipe de saúde e experiências positivas de assistência. Uma compreensão melhor do contexto sociocultural deveria permitir a construção de estratégias capazes de resgatar essas mulheres para um sistema de saúde mais acolhedor.
This study aimed to elucidate the social and behavioral factors and public health system characteristics that influenced pregnant women's adherence to prenatal care. Forty women diagnosed as HIV-positive by rapid test at delivery were included. Socioeconomic data were collected and a semi-structured interview was conducted. Eight women had > 6 prenatal visits and 12 had no visits. Interviews were submitted to qualitative content analysis. The themes fit into two blocks: those seen as hindering adherence, like unwanted pregnancy, lack of family support, prior knowledge of serological status, adverse social context, negative experiences with prenatal care, and disbelief towards prenatal care, and those facilitating adherence, like family support, valuing healthcare, wanting a tubal ligation, receptiveness by the healthcare team, and positive previous experience with prenatal care. Improving our understanding of the socio-cultural context should help promote strategies to reach such women and include them in better quality care.
Subject(s)
Adult , Female , Humans , Pregnancy , Young Adult , HIV Seropositivity/psychology , Health Services Accessibility/standards , Infectious Disease Transmission, Vertical/prevention & control , Patient Compliance/psychology , Pregnancy Complications, Infectious/psychology , Prenatal Care , Attitude of Health Personnel , Cultural Characteristics , Patient Compliance/statistics & numerical data , Qualitative Research , Social Support , Socioeconomic Factors , Young AdultABSTRACT
Objetivou-se apreender os dilemas e conflitos revelados por mulheres que engravidaram na vigência da infecção pelo HIV/Aids. Estudo qualitativo com oito mulheres atendidas em ambulatório em Fortaleza-CE. Mediante entrevistas observou-se que as mulheres gestam com expectativa do resultado da sorologia do concepto; depois de nascidos vivenciam incertezas e mantêm superproteção da criança. Relatam maneiras inadequadas da comunicação do diagnóstico e pouca orientação para gestar em face do HIV. As mulheres transformam o desejo de ser mãe em realidade. Para elas, lidar com uma criança com possibilidade de contrair infecção pelo HIV é algo além de sua capacidade. Conclui-se ser essencial oferecer suporte emocional e social para essas mulheres independente das fases da vida.
This study aimed to apprehend the dilemmas and conflicts revealed by women infected with HIV/Aids who got pregnant. This qualitative study involved eight women attended at an outpatient clinic in Fortaleza-CE. Through interviews, it was observed that the women go through their pregnancy with expectations about their child's serological status; after birth, they live with uncertainties and overprotect the child. They report on inadequate ways of communicating the diagnosis and lack of advice about pregnancy in cases of HIV. These women transform the desire of motherhood into reality. According to them, dealing with a child with the possibility of catching HIV goes beyond their capacity. In conclusion, it is essential to offer emotional and social support to these women, independently of the phase in life they are in.
La finalidad fue aprehender los dilemas y conflictos revelados por mujeres infectadas por el VIH/Sida que quedaron embarazadas. Estudio cualitativo con ocho mujeres atendidas en ambulatorio en Fortaleza-CE. Mediante entrevistas fue observado que las mujeres gestan con expectativa del resultado de la serología del concepto; después de nacidos viven incertidumbres y mantienen protección exagerada del niño. Relatan maneras inadecuadas de comunicar el diagnóstico y poca orientación para gestar ante el VIH. Las mujeres transforman el deseo de ser madre en realidad. Para ellas, lidiar con un niño con posibilidad de contraer infección por el VIH es algo más allá de su capacidad. Se concluye que es esencial ofrecer soporte emocional y social para esas mujeres independientemente de las fases de la vida.
Subject(s)
Adult , Female , Humans , Middle Aged , Pregnancy , Young Adult , Acquired Immunodeficiency Syndrome/psychology , Mothers/psychology , Pregnancy Complications, Infectious/psychology , HIV Infections/psychology , Young AdultABSTRACT
A SIDA coloca questões sociais, humanitárias e jurídicas cruciais, e ameaça alterar seriamente fundamentos da estrutura social de tolerância e entendimento que sustém a vida das nossas sociedades. A partir de uma contextualização dos aspectos clínicos e epidemiológicos do VIH/SIDA, este artigo de revisão bibliográfica faz uma abordagem da vivência psicológica e das implicações da infecção com o Vírus da Imunodeficiência Humana Adquirida na mulher grávida.
AIDS raises a social issue, humanitarian, legal, and threatens to change the social structure founding of tolerance and understanding, that sustains the life of our societies. From a clinical and epidemiological background of HIV/AIDS, this article of literature review makes an approach about psychological experience and implication of the Human Immunodeficiency Virus infection in pregnant woman.
SIDA plantea cuestiones sociales, humanitarias y jurídicas fundamentales, y amenaza cambiar gravemente motivos de la estructura social de tolerancia y comprensión, que sustenta la vida de nuestra sociedad. Desde una contextualización de los aspectos clínico y epidemiológicos del VIH / SIDA, en este artículo de revisión bibliográfica se hace un enfoque acerca de la v psicológica y la implicación de la infección por el Virus de Inmunodeficiencia Humana Adquirida en la mujer embarazada.
Subject(s)
Female , Humans , Pregnancy , HIV Infections/psychology , Pregnancy Complications, Infectious/psychology , Sex FactorsABSTRACT
Identificar as experiências de gestantes e puérperas portadoras do HIV com a quimioprofilaxia para prevenção da transmissão vertical. Estudo de abordagem qualitativa desenvolvido nos meses de março e abril de 2006 em uma maternidade de referência de Fortaleza-Ceará. Os sujeitos foram gestantes e puérperas HIV positivas em acompanhamento pré-natal e no alojamento conjunto. A coleta de dados deu-se através de entrevista e a análise em três categorias: a revelação do diagnóstico aos familiares, o aconselhamento e a vivência das recomendações para a profilaxia da transmissão vertical. Constatou-se que essas mulheres enfrentaram situações de conflitos e sentimentos negativos diante da vida e a importância do acompanhamento emocional por equipe multiprofissional capacitada, atenta as demandas subjetivas.
Detect the experiences of pregnants and mothers that bear the HIV viruses using quimioprophylaxlis to prevent the upright transmission. A research of qualitative approach developed between march and april of 2006 on main mother-hoods in Fortaleza - Ceará. The persons were pregnants and mothers with positive HIV in the accompaniment and in the accommodations. The colect of informations happened with interviews appointments and analisys in three categories: the revelations of diagnosis to relatives, the advice and how live these persons with the advices to profilaxy of the upright transmission. We can see these women fought against conflicts and negative fellings in their lives and a individualize accompaniment by a capacitate team minimizes the emotional side of the patients.
Identificar las experiencias de las embarazadas y madres recientes portadoras de HIV con la quimioprofilaxia para la prevención de la transmisión vertical. Estudio de abordaje cualitativo desarrollado entre los meses de marzo y abril de año 2006, en maternidad importante de Fortaleza/CE. Las personas fueron embarazadas y madres recientes HIV positivas en acompañamiento prenatal y en alojamiento conjunto. La colecta de datos ocurrió a través de entrevista y análisis en tres categorías: La revelación del diagnóstico a los familiares, el consejo y la vida de las recomendaciones para la profilaxia de las transmisión vertical. Constatase que las mujeres enfrentan situaciones de conflictos y sentimientos negativos delante de la vida y que el acompañamiento individual por una equipo de múltiplos profesionales capacitadas diminuye mucho su estado emocional.
Subject(s)
Adult , Female , Humans , Pregnancy , Young Adult , HIV Infections/psychology , Pregnancy Complications, Infectious/psychology , HIV Infections/prevention & control , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Postpartum Period , Young AdultABSTRACT
OBJECTIVE: To characterize the clinicopathological manifestations and outcomes of a cohort of HIV-infected Jamaican adolescents. METHODS: This is a retrospective cohort study to determine demographic, clinical, immunological characteristics, antiretroviral uptake and mortality in 94 adolescents aged 10-19 years followed in the Kingston Paediatric and Perinatal HIV/AIDS Programme (KPAIDS) between September 2002 and May 2007. Parametric and non-parametric tests are used to compare variables. RESULTS: The median age at initial presentation was 10.0 years (interquartile range (IQR) 7.0-12.0 years), 54.3% (51) were female (p = 0.024), transmission was primarily mother-to-child (70, 73.4%), with 87% (61) of the latter presenting as slow progressors. Sexual transmission accounted for 19.1% and there was significant female predominance (n = 15; p = 0.024). At most recent visit, perinatally infected adolescents were more likely (p < 0.0001) to reside with a non-parent (n = 42) than a biological parent (n = 19) and most had Centers for Disease Control and Prevention (CDC) category C (35/50%) disease, whereas the majority of non-perinatally infected children were classified CDC category A. Mean z scores for height-for-age was -1.47 ± 1.21 (n = 77), weight-for-age -1.06 ± 1.44 (n = 80) and BMI-for-age -0.34 ± 1.21 (n = 76) respectively; females (n = 41) were taller than males (n = 36) at their current height (p = 0.031). Lymphadenopathy (82%), dermatitis (72.0%), hepatomegaly (48%) and parotitis (48%) were the most common clinical manifestations, with significant predilection for lymphadenopathy (p # 0.0001), dermatitis (p = 0.010), splenomegaly (p = 0.008), hepatomegaly (p = 0.001) and parotitis (p = 0.007) among perinatally infected children. Median baseline CD4+ cell count was 256.0/µL (IQR 71.0 - 478.0 cells/µL); median most recent CD4+ cell count was 521/µL (IQR 271.0 - 911.0 cells/µL). Seventy-six per cent (n = 71) were initiated with highly active antiretroviral therapy (HAART) and 62 (87.3%) were currently receiving first-line therapy. Six behaviourally infected females became pregnant, resulting in five live births. There were seven deaths (7.4%). CONCLUSIONS: This study comprehensively characterizes HIV infection among perinatally infected teens with predominantly slow-progressor disease and an increasing population of sexually-infected adolescents. As the cohort transitions to adulthood, adolescent developmental, mental health and life planning issues must be emergently addressed.
OBJETIVO: Caracterizar las manifestaciones clínico-patológicas y la evolución clínica de una cohorte de adolescentes jamaicanos infectados por el VIH. MÉTODOS: El presente es un estudio de cohorte retrospectivo con el fin de determinar las características demográficas, clínicas, inmunológicas, así como el consumo de antiretrovirales y la mortalidad en 94 adolescentes de 10 a 19 años de edad, llevado a cabo como parte del Programa VIH/SIDA perinatal y pediátrico de Kingston (KPAIDS) entre septiembre de 2002 y mayo de 2007. Se usan pruebas paramétricas y no paramétricas para comparar las variables. RESULTADOS: La edad mediana en la presentación inicial fue 10.0 años (rango intercuartil (IQR) 7.0-12.0 años), 54.3% (51) eran hembras (p = 0.024), la transmisión fue fundamentalmente de madre a hijo (70, 73.4%), presentándose el 87% (61) de los últimos como progresores lentos. La transmisión sexual representó el 19.1% y hubo un predominio significativo de las hembras (n = 15; p = 0.024). En la visita más reciente, los adolescentes infectados perinatalmente presentaron una mayor probabilidad (p < 0.0001) de residir con personas distintas de sus padres (n = 42) que con un progenitor biológico (n = 19), y la mayor parte tenía la enfermedad categoría C (35/50%) de acuerdo con los Centros para el Control y la Prevención de las Enfermedades (CCPE), mientras que la mayoría de los niños infectados no perinatalmente fueron clasificados con la categoría A del CCE. Las puntuaciones z medias para altura por edad fue - 1.47 ± 1.21 (n = 77), peso por edad -1.06 ± 1.44 (n = 80), y el IMC por edad -0.34 ± 1.21 (n = 76) respectivamente; las hembras (n = 41) fueron más altas que los varones (n = 36) en altura corriente (p = 0.031). La linfadenopatía (82%), la dermatitis (72.0%), la hepato-megalia (48%) y la parotitis (48%) fueron las manifestaciones clínicas más comunes, con predilección significativa de la linfadenopatía (p # 0.0001), la dermatitis (p = 0.010), la esplenomegalia (p = 0.008), la hepatomegalia (p = 0.001) y la parotitis (p = 0.007) entre los niños perinatalmente infectados. La mediana de la línea de base del conteo celular CD4+ fue 256.0/µL (IQR 71.0 - 478.0 células/µL); la mediana del conteo celular CD4+ más reciente fue 521 /µL (IQR 271.0 - 911.0 células/µL). El setenta y seis por ciento (n = 71) fueron iniciadas con terapia antiretroviral altamente activa (TARAA) y 62 (87.3%) estuvieron corrientemente recibiendo terapia de primera línea. Seis hembras infectadas conductualmente fueron embarazadas, produciéndose como resultado cinco nacimientos. Hubo siete muertes (7.4%). CONCLUSIÓN: Este estudio presenta una caracterización integral de la infección por VIH entre adolescentes infectados perinatalmente predominantemente con la enfermedad de progresores lentos, y una población creciente de adolescentes infectados sexualmente. En la medida en que la cohorte transita a la adultez, el desarrollo del adolescente, la salud mental y los problemas de la planificación de la vida tienen que ser abordados con urgencia.
Subject(s)
Adolescent , Child , Female , Humans , Male , Pregnancy , Young Adult , HIV Infections/pathology , Pregnancy Complications, Infectious/pathology , Sexually Transmitted Diseases, Viral/pathology , Adaptation, Psychological , Anti-HIV Agents/therapeutic use , Cohort Studies , HIV Infections/epidemiology , HIV Infections/psychology , HIV Infections/transmission , Jamaica/epidemiology , Patient Education as Topic , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/psychology , Retrospective Studies , Risk Factors , Sexually Transmitted Diseases, Viral/epidemiology , Sexually Transmitted Diseases, Viral/psychologyABSTRACT
ISSUES: Voluntary counselling and testing (VCT) is a critical issue impacting HIV disease management from a national and global perspective. In Jamaica (population 2.6 million), 2% of women in antenatal clinics are HIV-positive and mother-to-child-transmission (MTCT) accounted for 7% of all reported cases in 2002. Notwithstanding this, VCT was ad hoc and not standardized. In 2003, a structured VCT programme was developed islandwide with over 300 VCT service providers and 16 qualified trainers. DESCRIPTION: We describe the challenges and successes of VCT provided by five trained research nurses in the Perinatal HIV/AIDS Programme in Kingston which services 19 000 pregnant women per year in three major maternity centres and their 42 feeder antenatal clinics. LESSONS LEARNED: The VCT model used was group education, opt-out individual testing, individual post-test counselling for seropositives and informing seronegatives of their negative status. Major challenges encountered included lack of quality control of the counselling process and lost opportunities for un-booked women who presented in labour. However, successes enjoyed included client assessment of risk behaviours with appropriate lifestyle changes, increased uptake of HIV testing and adherence to care for themselves and their infants, as well as reduction in stigma. RECOMMENDATIONS: VCT has proven to be an important intervention that enabled improvement in the awareness, prevention and control of HIV in Jamaican pregnant women. Nurses who are appropriately trained in VCT can play a pivotal role in successful provision of VCT services.
CUESTIONES: El asesoramiento y pruebas voluntarios (APV) constituye una cuestión crítica cuyo impacto sobre el tratamiento de la enfermedad por VIH reviste importancia nacional y global. En Jamaica (con una población de 2.6 millones) 2% de las mujeres en las clínicas de atención prenatal son VIH positivas y la transmisión madre a hijo (TMAH) representa el 7% de todos los casos reportados en 2002. A pesar de ello, el APV fue practicado ad hoc y de manera no estandarizada. En el año 2003, se desarrolló un programa de APV a lo largo de toda la isla, con más de 300 proveedores de servicio y 16 entrenadores calificados. DESCRIPCIÓN: El presente trabajo describe los retos y éxitos del APV ofrecido por cinco enfermeras entrenadas en investigación, en el Programa Perinatal VIH/SIDA en Kingston, el cual ofrece servicios a 19 000 mujeres embarazadas por año en tres centros principales de maternidad y sus 42 clínicas prenatales asociadas. LECCIONES APRENDIDAS: El modelo APV usado fue educación grupal, pruebas individuales con opción a negarse ("opt-out"), aconsejamiento individual posterior a la prueba para seropositivos e información a los seronegativos de su estatus negativo. Los mayores desafíos encontrados incluyeron falta de control de la calidad de los procesos de asesoramiento y pérdida de oportunidades para las mujeres no registradas que se presentaron estando ya de parto. Sin embargo, los éxitos alcanzados incluyeron el asesoramiento de los clientes con respecto a los comportamientos de riesgo con cambios apropiados de estilos de vida, aumento de la toma de pruebas de VIH y la adhesión a encuitar de sí mismos y sus niños, así como la reducción del estigma. RECOMENDACIONES: El APV ha demostrado ser una importante forma de intervención que hace posible mejorar la conciencia, prevención y control del VIH en las mujeres jamaicanas embarazadas. Las enfermeras que están propiamente entrenadas en APV pueden desempeñar un papel cardinal en el ofrecimiento exitoso de servicios de APV.
Subject(s)
Female , Humans , Pregnancy , Young Adult , Directive Counseling , HIV Infections/prevention & control , HIV Infections/psychology , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/psychology , Adaptation, Psychological , HIV Infections/diagnosis , HIV Infections/transmission , Health Behavior , Health Education , Health Knowledge, Attitudes, Practice , Jamaica/epidemiology , Patient Satisfaction , Pregnancy Complications, Infectious/diagnosis , Prenatal Care , Psychotherapy , Surveys and Questionnaires , Risk-Taking , Stress, PsychologicalABSTRACT
BACKGROUND: Approximately 25% of the cumulative AIDS cases in Jamaica involve adolescents and young adults. However, the lives of adolescents living with HIV within Jamaica and the Caribbean have been understudied. OBJECTIVES: (1) To describe the sociodemographic characteristics of HIV+ Jamaican adolescents who have ever been a part of the Kingston Paediatric/Perinatal HIV Programme (KPAIDS) from September 1, 2002 to August 31, 2006 (2). To identify predictors of HIV/AIDS confirmation as well as factors associated or uniquely present in these adolescents by their guardian status. METHODS: Seventy-two HIV+ adolescents, ages 10-19 years, were included. Factors studied included demographics as well as time to and time between HIV and AIDS confirmation. Data were analyzed by bivariate and multivariate statistics. RESULTS: The mean age of the adolescents was 12.6 ± 2.8 years with slightly more males (52.8%) in the programme. There were equal proportions of adolescents living with HIV as with AIDS (43.1%). There were equal proportions who were lost to follow-up or deceased (8.3%). Twenty-two of them lived with parents, 25 with guardians and 18 in residential institutions. The primary mode of transmission was perinatal infection (68.1%), followed by sexual (20.8%), blood transfusion (2.9%) and unknown (8.3%). The mean time from HIV exposure to HIV confirmation and AIDS confirmation in mother-to-child transmission (MTCT) cases were 8.0 ± 2.9 years and 9.6 ± 3.3 years, respectively. In the multivariate analysis model, age and gender were significant in predicting time from HIV exposure to HIV confirmation. CONCLUSION: The majority of HIV-positive adolescents reside with parents and guardians and this might indicate support in spite of stigma and discrimination. However, the mean time to HIV confirmation in MTCT cases is quite long and must be reduced.
ANTECEDENTES: Aproximadamente el 25% de los casos cumulativos de SIDA en Jamaica comprenden adolescentes y adultos jóvenes. Sin embargo, las vidas de los adolescentes que viven con VIH en Jamaica y el Caribe no ha recibido suficiente estudio. OBJETIVOS: (1) Describir las características socio-demográficas de los adolescentes jamaicanos VIH+ que hayan sido alguna vez parte del Programa Pediátrico/Prenatal de Kingston contra el SIDA (KPAIDS) desde septiembre 1 de 2002 a agosto 31 de 2006. (2). Identificar los predictores de la confirmación del VIH/SIDA así como los factores asociados o presentes de forma única en estos adolescentes con respecto a su estatus de tutoría. MÉTODOS: Se incluyeron setenta y dos adolescentes VIH+, con edades de 10 a 19 años. Los factores estudiados comprendieron los datos demográficos así como el tiempo hasta la confirmación de VIH y el SIDA, así como el tiempo entre la confirmación de ambos. Los datos fueron analizados mediante estadísticas divariadas y multivariadas. RESULTADOS: La edad promedio de los adolescentes fue 12.6 ± 2.8 años siendo el número de varones ligeramente mayor (52.8%) en el programa. Las proporciones de adolescentes viviendo con VIH fueron iguales a las de los adolescentes viviendo con SIDA (43.1%). Hubo iguales proporciones perdidas al seguimiento o fallecidas (8.3%). Veintidós de ellos vivían con sus padres, 25 con tutores, y 18 en instituciones residenciales. El modo primario de transmisión fue la infección perinatal (68.1%), seguida por la sexual (20.8%), la transfusión de sangre (2.9%), y otros desconocidos (8.3%). Los tiempos medios desde la exposición al VIH hasta la confirmación de VIH y la confirmación del SIDA en los casos de transmisión madre a hijo (TMAH) fueron 8.0 ± 2.9 años y 9.6 ± 3.3 años, respectivamente. En el modelo de análisis multivariado, la edad y el género fueron significativos a la hora de predecir el tiempo desde la exposición al VIH hasta la confirmación del VIH. CONCLUSIÓN: La mayor parte de los adolescentes VIH positivos residen con sus padres y tutores y esto podría ser un índice de apoyo a pesar del estigma y la discriminación. Sin embargo, el tiempo medio hasta la confirmación del VIH en los casos de TMAH es bien largo y tiene que ser reducido.
Subject(s)
Adolescent , Child , Female , Humans , Male , Pregnancy , Young Adult , HIV Infections/diagnosis , Legal Guardians/psychology , Parents/psychology , Pregnancy Complications, Infectious/diagnosis , HIV Infections/mortality , HIV Infections/psychology , HIV Infections/transmission , Legal Guardians/statistics & numerical data , Multivariate Analysis , Parent-Child Relations , Pregnancy Complications, Infectious/mortality , Pregnancy Complications, Infectious/psychology , Risk Factors , Social Support , Socioeconomic Factors , Survival Analysis , Time FactorsABSTRACT
This article reports the findings of a qualitative research study carried out in Kabarole district, western Uganda. Knowledge of and perceptions about HIV/AIDS and pregnancy and how both relate to one another were elucidated from eight focus-group discussions with 38 female and 32 male secondary students from four different schools. Widespread misinformation and misconceptions about contraceptives still exist as previously found in this area. There was a serious gap in knowledge and understanding of 'dual protection' against sexually transmitted diseases, including HIV/AIDS, and against pregnancy. Fertility was very highly valued, and many girls stated that they would want a child even if they were HIV-positive. Responses of girls showed that they were quite assertive in making decisions to use contraceptives. The reasons for students not being able to understand the interconnectedness of sexually transmitted diseases and pregnancy may lie in the fragmented fashion in which relevant health education is delivered through two separate programmes.
Subject(s)
Adolescent , Condoms/statistics & numerical data , Female , Focus Groups , HIV Infections/psychology , Health Behavior , Health Education/methods , Health Knowledge, Attitudes, Practice , Humans , Male , Pregnancy , Pregnancy Complications, Infectious/psychology , Surveys and Questionnaires , Reproduction , Sex Education , Sexual Behavior , Sexually Transmitted Diseases/psychology , UgandaABSTRACT
A total of 85 HIV seropositive subjects among consecutive new registrants in the STD Department were given health education measures directed to avoiding high risk behaviours and also the events with a high potential for transmission of infection. The emphasis was on the use of condoms, discontinuing promiscuity, abstaining from homosexual acts and avoidance of pregnancy and advice against marriage for those contemplating it. The Health Education Programme was delivered individually to each subject over two or three sessions, each lasting for 30 to 45 min. At the time of follow up (one to 24 months) 42 per cent of subjects had become non-promiscuous. There was a good compliance on advice against marriage and pregnancy. Seven infants born during the follow up period were seronegative. The use of condom was not found to be acceptable. The prostitutes comprised the most resistant group to education. Among the factors that influenced the behaviour change favourably was the absence of earlier STD or a short duration of the current STD. Literacy, marital status, awareness of AIDS did not influence the outcome of education. The study demonstrated the feasibility of health education at individual level in the clinical setting of an STD Department. A longer follow-up may indicate the sustainability of behaviour change in the subjects.