NANASI 39: June 2005
In this issue of NANASI:
- Relationship between early pregnancy and HIV
- Reproductive Health Advice when one or both partners are HIV positive
Q & A: Pregnant at an early age and HIV/AIDS
QUESTION from health advisor in Siaya District: What is the relationship between being pregnant at an early age and HIV/AIDS?
ANSWER from AfriAfya
Pregnancy is a result of unprotected sex. The risks of unprotected sex include sexually transmitted infections (STIs), infection with HIV, and pregnancy. Unprotected sex at an early age has special considerations. Adolescents are particularly vulnerable because they often do not know how serious the problem of HIV/AIDS is, how it is caused, or what they can do to protect themselves. Many adolescents do not go to school, and do not have access to information about AIDS or to opportunities to develop the life skills that they need to turn this information into action. Often they also do not have access to services that take their specific needs into consideration.
Young people are also influenced by other young people (peer pressure) and made vulnerable by the attitudes and behaviours of the significant adults in their lives, such as parents, teachers and service providers. The wider context in which they live, learn and work, including social values and norms, policies and legislation, and their economic situation are also very important.
Some young people are particularly vulnerable. In countries where the predominant mode of transmission of HIV is by heterosexual sex, girls are often more vulnerable than boys, for both biological and social reasons. A young girl's body faces an increased risk of bruising and tearing of the vagina or injury to the cervix. This increases the risk of contracting STIs, particularly HIV. It is also well understood that girls are more likely than boys to be infected with HIV following the same exposure. Socially, the early onset of sexual activity in the youth is often associated with substance abuse e.g. alcohol, multiple sexual partners and the use of sex for economic and social benefits.
The knowledge of those aged 10 - 24 years on STIs and HIV is low and they often participate in unsafe sex. Sadly, 50 % of all new infections occur amongst those aged 10 - 24 years and 30 % of the world's population living with HIV/AIDS is between 15 - 24 years of age. The vast majority of young people who are HIV positive do not know that they are infected, and few young people who are engaging in sex know the HIV status of their partners. Girls who get pregnant at an early age may be forced to exchange sexual favors for money to fend for themselves and their babies. They are often unable to continue with education, and employment opportunities are few. Given their age, gender and financial needs, they are also often unable to negotiate successfully for safer sex, as they are often desperate.
It is important when dealing with cases of early pregnancy to review knowledge, attitude and practices. Advice on safer sex and the use of contraceptives must go hand-in-hand with reviewing their future plans and economic options. Social structures that can offer support must be explored and reinforced.
REPRODUCTIVE HEALTH ADVICE...when one or both partners is HIV +
A husband and wife can continue sexual relations with one another even if they know that one or both of them is infected with HIV. The couple can take precautions to avoid transmitting HIV to one another, yet still enjoy the sexual fulfillment that is crucial to a good relationship. (In fact, every person participating in a sexual relationship should know his own HIV status and also the HIV status of the partner, whether they are married or not.)
The woman may want a pregnancy, or she may want to avoid a pregnancy. In either case, if she or her partner (or both) are infected with HIV, they must never transmit HIV viruses to the uninfected partner or to a new baby. The chief factor which determines transmission of HIV to a partner or to a baby is the number of HIV viruses in the blood of the infected person (viral load). A high viral load means a greater chance of HIV transmission. A low viral load means less chance of HIV transmission, but there is always some risk.
An asymptomatic woman infected with HIV can carry a pregnancy to term without worsening her HIV condition, although HIV infection of a woman occasionally leads to a low birth weight baby or stillbirth. An HIV-infected pregnant woman should go for ante-natal care like any other pregnant woman, receiving the same examinations and medicines as all others in the clinic. However, she will need instructions about special medicines to take at the time of delivery to prevent transmission of HIV to the baby, and she will need advice on breastfeeding.
A woman taking ARV medicines can conceive and sustain a pregnancy and give birth to a normal baby. Efavirenz (Sustiva, Stocrin) is the only commonly used ARV drug in Kenya that should not be taken by pregnant women, because it could harm the growing foetus.
A woman who wishes to avoid pregnancy should use contraceptives. She should know that some ARV medicines lower the effectiveness of hormonal contraceptives (pills, injections, implants). Copper-containing Intrauterine Contraceptive Devices (IUCDs) can be used by an HIV-infected woman if she has taken ARV drugs for five months or longer and thus has a low viral load. Surgical contraception is best of all. These contraceptives prevent pregnancy, but they do not prevent transmission of HIV. Condoms can prevent both pregnancy and HIV transmission, but condoms sometimes fail.
Advice for couples not desiring pregnancy:
- Always use a condom to avoid transmitting HIV (or different strains of HIV).
- For extra contraception, the woman can use a hormonal contraceptive (pills, injections, or an implant). If the woman is HIV-negative, or if she is HIV+ but appears in good health and is taking ARV drugs, she may use a copper-containing IUCD.
- Consider surgical sterilization for either the man or the woman.
Advice for couples desiring pregnancy:
- If either the woman or the man is sick, medical help should be sought in an HIV clinic to regain a healthy state before trying to become pregnant.
- The HIV + person(s) should take ARV medicines if they are prescribed, in order to reduce the viral load.
- Have unprotected sexual intercourse only during the woman's "fertile period" (the days right in the middle of her menstrual cycle). Use condoms all other times.
NOTE: ANY person who is HIV positive (a man, a woman who is pregnant, or a woman who is not pregnant) should take cotrimoxazole to prevent opportunistic infections.
--Based on a statement of the IPPF International Medical Advisory Panel (IPPF Medical Bulletin, Vol. 39, No. 1, March 2005)
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