The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration.

INTRODUCTION: People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. DISCUSSION: Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. CONCLUSION: Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and programme environment to ensure that all PLHIV and serodiscordant couples have access to FP services, including prevention of unintended pregnancy and safer conception counselling.

Sexual and Gender-Based Violence Attitudes and Experiences among Nine Sub-Saharan African Militaries.

INTRODUCTION: While sexual and gender-based violence (SGBV) is recognized as an important factor driving the HIV epidemic in sub-Saharan Africa, attitudes toward and prevalence of SGBV within sub-Saharan African military populations are unknown. Data on SGBV were collected from military service members of nine sub-Saharan African militaries. Attitudes related to SGBV and characteristics of those who commit and experience SGBV are reported. METHODS: Data for 8815 service members (8165 men and 650 women) aged 18 years or older who voluntarily participated in the Seroprevalence and Behavioral Epidemiology Risk Surveys from 2009 to 2014 were included in this secondary data analysis. Data were collected on demographics, HIV prevalence, SGBV attitudes, and experiences. Descriptive and bivariate statistical analyses were performed. RESULTS: 5% of men and 9% of women reported experiencing SGBV, and 6% of men reported they had ever committed SGBV. Men and women who had experienced SGBV were significantly more likely to agree with negative gender attitudes toward SGBV, and the majority of those who reported experiencing SGBV reported that SGBV was committed by someone outside of the military. CONCLUSION: This is the first study to examine SGBV in sub-Saharan military populations during periods of limited conflict. It provides evidence that SGBV is experienced by both male and female service members at rates not typically found in previous research examining SGBV in other military populations. A better understanding of SGBV in sub-Saharan military service members is necessary to ensure appropriate services and interventions are part of the military infrastructure.

Meeting the family planning needs of women living with HIV in US government global health programs.

The integration of health programs, including HIV and voluntary family planning, is a priority for US government foreign assistance. One critical component of family planning and HIV integration that has significant positive health outcomes is ensuring that all women living with HIV have access to both a full range of contraceptives and safe pregnancy counseling. This article outlines the US government global health strategy to meet the family planning needs of women living with HIV based on three key principles: a focus on reproductive rights through voluntarism and informed choice, quality service provision through evidence-based programming, and development of partnerships.

Dissociative experiences during sexual behavior among a sample of adults living with HIV infection and a history of childhood sexual abuse.

Little attention has been given to the occurrence of dissociative symptoms during sexual behavior in adults who have experienced childhood sexual abuse (CSA). For this study, 57 adults living with HIV infection who had experienced CSA and were entering a treatment study for traumatic stress completed study assessments and clinical interviews, including a 15-item scale of dissociative experiences during sexual behavior. Predictor variables included Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses of posttraumatic stress disorder (PTSD) and dissociative disorders, rape by an intimate partner, duration of CSA, number of perpetrators of CSA, and current sexual satisfaction. A multiple regression analysis was conducted to identify significant associations between predictors and dissociation during sex. Mean differences by clinical diagnosis were also examined. Results indicated that PTSD, dissociative disorders, rape by an intimate partner, duration of CSA, and number of perpetrators of CSA were associated with increased dissociation during sexual behavior. Dissociation during sex likely increases vulnerability to sexual revictimization and risky sexual behavior. Standard behavioral prevention interventions may be ineffective for sexual situations when dissociation occurs, and prevention efforts should be integrated with mental health care for those who have experienced CSA.

The effects of traumatic stressors and HIV-related trauma symptoms on health and health related quality of life.

The study identified relations among traumatic stressors, HIV-related trauma symptoms, comorbid medical conditions, and health related quality of life (HRQL) in individuals with HIV. Participants (N = 118) completed a structured clinical interview on HIV as a traumatic stressor and other severe traumatic stressors and completed the Impact of Event Scale to assess HIV-related trauma symptoms and the Medical Outcomes Study 36-item Short Form (SF-36) to assess HRQL. Medical chart reviews determined comorbid conditions. Path analysis findings indicated participants with prior severe traumatic stressors experienced their HIV diagnosis as traumatic and in turn were more likely to have current HIV-related trauma symptoms which were negatively related to HRQL. HIV as a traumatic stressor was related to coronary artery diseases and HRQL. Traumatic stressors and HIV-related trauma symptoms impact health in individuals with HIV and highlight the need for psychological interventions prior to diagnosis and throughout treatment.

Non-conventional practices and immune functioning among individuals receiving conventional care for HIV.

OBJECTIVE: to examine the relationships among non-conventional practices, adherence and immune functioning in individuals with HIV. METHODS: 92 participants completed an interview on non-conventional practices (complementary and alternative medicines (CAM), psychosocial therapies, and religious practice). They also completed the Psychiatric Symptom Index and the AIDS Clinical Trials Group Adherence Follow-up Questionnaire. Medical chart reviews determined CD4 count and viral load. RESULTS: Hierarchical logistic regressions revealed religious practice was associated with adherence and CAM was associated with viral load. CONCLUSION: Participation in non-conventional practices in HIV populations may lead to positive health and health behaviors. Clinical implications are discussed.

The impact of receiving an HIV diagnosis and cognitive processing on psychological distress and posttraumatic growth.

This study examined human immunodeficiency virus (HIV) as a traumatic stressor, intrusive and deliberate cognitive processing, psychological distress, and posttraumatic growth. One-hundred twelve participants completed interviews on posttraumatic stress disorder (PTSD) Criterion A, Rumination Scale-Revised, Impact of Event Scale, and the Posttraumatic Growth Inventory; relationships were modeled using path analysis. Model 1 attempted to replicate prior empirical research, Model 2 attempted to empirically replicate part of the posttraumatic growth theoretical model, and Model 3 attempted to empirically replicate an integrated model of posttraumatic growth and traumatic stress theories. Model 3 had good fit with study data. Results suggest shared and separate pathways from traumatic stressor to psychological distress and posttraumatic growth, with pathways mediated by cognitive processing. Implications of findings are discussed.