eastern european alliance for reproductive choice
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УКРАЇНА. Eastern European Alliance for Reproductive Choice. REPRODUCTIVE CHOICE FOR HIV-INFECTED WOMEN. Prof. POSOKHOVA S.P. UKRAINE. Adults and children estimated to be living with HIV, 200 8. Eastern Europe & Central Asia 1.5 million [1.1 – 1.9 million]. Western & Central Europe - PowerPoint PPT PresentationTRANSCRIPT
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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
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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
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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)
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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
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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.
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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
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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%
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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
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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
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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
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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.
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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
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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
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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.
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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
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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.
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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
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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
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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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Thank you for Thank you for your attention!your attention!