Ci Akani

Rate, pattern and barriers of HIV serostatus disclosure in a resource-limited setting in the Niger delta of Nigeria

The disclosure of HIV serostatus is a difficult emotional task creating opportunity for both support and rejection. In this study, we evaluated the rate, patterns and barriers to HIV serostatus disclosure. A pre-tested interviewer-administered questionnaire from 187 HIV infected people residing in a resource-limited setting in the Niger Delta of Nigeria was analysed. Of the 187 HIV seropositive patients studied, 144 (77.0%) had disclosed their HIV-serostatus while 43 (23.0%) had not. Results showed that the patients had disclosed their HIV-serostatus to: parents (22.3%), siblings (9.7%), pastors (27.8%), friends (6.3%), family members (10.4%) and sexual partners (23.6%) (P = 0.004). Females were more likely (59.7%) to disclose their HIV serostatus compared with males (40.3%) (P = 0.003). Mothers were twice as likely (65.6%) to be confided in compared with fathers. Barriers to HIV serostatus disclosure included fear of stigmatization, victimization, fear of confidants spreading the news of their serostatus and fear of accusation of infidelity and abandonment (P = 0.002). Married respondents were more likely to disclose their status. Better-educated respondents with tertiary education were more likely to disclose their HIV-serostatus. Expectation of economic, spiritual, emotional and social support was the major reason for disclosure. The ratio of disclosure to non-disclosure among patients with non-formal education was (2.6:1.0), primary education (2.3:1.0), secondary education (3.3:1.0) and tertiary education (10.0:1.0). Disclosure of HIV serostatus can foster economic social and economic support. There is need for the re-intensification of interventional measure that combines provider, patients and community education particularly in the aspect of anti-stigma campaign, partner notification and skill building to facilitate appropriate HIV serostatus disclosure.

Reproductive health options among HIV-infected persons in the low-income Niger Delta of Nigeria

Background With the advent and widespread use of highly active antiretroviral therapy for the treatment of human immunodeficiency virus (HIV), persons living with HIV/acquired immune deficiency syndrome (AIDS) are living good quality, longer, and healthier lives. Many couples affected by HIV, both serodiscordant and seroconcordant, are beginning to consider options for safer reproduction. The aim of this study was to assess the reproductive health concerns among persons living with HIV/AIDS in the Niger Delta of Nigeria. Methods and results The subjects were aged 18–58 (mean 41.25 ± 11.50) years, with 88 males (45.1%) and 107 females (54.9). Of the 195 subjects studied, 111 (56.9%) indicated a desire to have children. The main reasons for wanting to procreate included ensuring lineage continuity and posterity (52.3%), securing relationships (27.0%), and pressure from relatives to reproduce (20.7%). Single subjects were more inclined to have children (76.3%) compared with married (51.5%), widowed (18.2%), and separated/divorced subjects (11.1%, P = 0.03). Of the 111 subjects who indicated their desire to have children, women were more inclined to have children (64.5%) than men (47.7%). The major concern among the 84 (43.1%) subjects not desiring more children were the fear of infecting a serodiscordant partner and baby (57.1%), fear of dying and leaving behind orphans (28.6%), and fear that they may become too ill and unable to support the child financially (14.3%). Persons with no formal education were more likely to have children irrespective of their positive HIV status (66.7%) than persons educated to tertiary education level (37.0%, P = 0.01). Of 111 subjects who desired to have children, only 58% had attended reproductive health counseling with HIV counselors. Reasons for not seeking advice were anticipated negative reactions and discrimination from counselors. A significant number of subjects were only aware of some of the reproductive health options available to reduce the risk of infecting their partners and/or baby, such as artificial vaginal insemination, intrauterine insemination, cesarean section, avoidance of breast feeding, and offering prenatal pre-exposure prophylaxis to the fetus. They were unaware of other options, such as sperm washing, in vitro fertilization, and intracytoplasmic sperm injection. Of the 43.1% not anticipating more children, 36.9% were anticipating adoption. Conclusion Our study has shown that a significant number of HIV-infected persons in the Niger Delta of Nigeria desire to have children irrespective of their positive serostatus. There is the need to support the sexual and reproductive rights of HIV-infected individuals. Additional training needs to be offered to HIV counselors on evidence-based best and affordable practices regarding reproductive health issues among persons living with HIV. Policies that support availability and accessibility to relevant reproductive and sexual health services, including contraception and procreation, need to be developed. Public enlightenment programs on HIV are needed to reduce the stigmatization that HIV-infected persons face from family members and their communities.

Human immunodeficiency virus prevalence in an unbooked obstetric population in the Niger Delta.

Despite recent advances in the prevention of transmission of human immunodeficiency virus (HIV) infection from mother to child during pregnancy, infants continue to be born and infected with HIV, particularly in Africa. This study was undertaken to determine the seroprevalence of HIV infection among unbooked pregnant women in the Niger Delta of Nigeria. One hundred and eighteen consecutively recruited unbooked subjects presenting to the isolation ward at the University of Port Harcourt Teaching Hospital were screened for HIV. Among the 118 subjects studied, 30 (25.4%) were positive for HIV. HIV-1 was the predominant viral strain. Gestational age of subjects at presentation was 28–40 weeks and mean age was 35.04 ± 8.06 years. The majority of subjects were primigravidas 66 (55.9%), while 52 (44.1%) were multigravidas. The prevalence of HIV was significantly higher among unbooked pregnant women with less formal education: 14 (11.9%) compared with 9 (7.6%), 5 (4.2%), and 2 (1.7%) for those with primary, secondary, and tertiary education, respectively (P = 0.01). Among the occupational groups, the prevalence of HIV was significantly higher among traders 14 (11.9%) than in career women 5 (4.2%, P = 0.04). Multigravid women were more susceptible to HIV infection 17 (14.4%) than primigravid women. Perinatal mortality and emergency cesarean section was high among unbooked pregnant women. The prevalence of HIV observed amongst unbooked antenatal subjects in this study is significantly higher than those of booked patients in previous studies. These findings are very pertinent to health care delivery, because this pool of unbooked patients may not be benefiting from the Prevention of Maternal to Child Transmission program, thus increasing the pediatric HIV burden in our environment.

Reproductive Health Challenges of Living with HIV-Infection in Sub Saharan Africa

The human immunodeficiency Virus (HIV) pandemic is one of the most serious health crisis faced by the world today. An estimated 34 million people were living with HIV/AIDS as at 2010 [1]. A disproportionate burden has been placed on women and children who continue to experience high rates of new infection and HIV-related illness and death. Availability and use of antiretroviral drugs has changed the landscape of HIV/AIDS bringing about a change in the perception of HIV from an incurable deadly disease to a chronic manageable illness. As effective HIV treatments become more widespread, HIV-infected individuals in sub Sa‐ haran Africa are living longer, healthier lives. Many HIV-affected couples (sero-discordant and sero-concordant) are now considering long-term life projects including options for safer reproduction or procreation. There has also been increase in advocacy to expand the capaci‐ ty for the health care system particularly in Africa to provide the sexual and reproductive health services that HIV infected persons in Africa desperately need [2]. This decade has witnessed greater commitment to sexual and reproductive health and HIV linkages particu‐ larly in the developed world. More recent opportunities include policy developments within the Global Fund to Fight AIDS, Tuberculosis and Malaria to accept proposals that form link‐ ages with sexual and reproductive health within the overall frameworks of HIV, tuberculo‐ sis (TB) and malaria. There has also been a renewed commitment by the United States of America to international sexual and reproductive health through support of the United Na‐ tions Population Fund and the repeal of the Mexico City Policy, also known as the “global gag rule”, a United States government policy that hitherto prohibited non-governmental or‐ ganizations from receiving federal funding for performing or promoting abortion services in other countries. A large body of evidence suggests that reproductive technologies can help HIV-affected couples to safely conceive with minimal risk of HIV transmission to their part‐

The Agony of Unsafe Abortion in A Teenager: A Case Report

This report represents a rare case of omental prolapse through posterior vaginal fornix laceration following an induced unsafe abortion. Miss T.R, a 14 year old orphan and junior secondary school 3 student had three different attempts at termination of 15 weeks pregnancy by a medical doctor in a private clinic. Physical examination at presentation in our teaching hospital revealed a very ill teenager, pale, febrile and tachycardic with an irregular fleshy mass protruding from the introitus and arising from a transverse laceration in the posterior vaginal fornix. After appropriate resuscitation, she had an emergency exploratory laparatomy with excision of the omentum , repair of posterior vaginal fornix laceration and manual vacuum aspiration of retained products of conception. The uterus and appendages were intact. The post operative period was uneventful with satisfactory wound healing. She was discharged home by the seventh day on admission after adequate counseling on contraception and referral to the family planning clinic. Key words: Unsafe abortion, Teenager, Omental protrusion, Laparotomy.