In Her Lifetime Female Morbidity and Mortality in Sub-Saharan Africa (1996) / Chapter Skim
Currently Skimming:
11 Sexually Transmitted Diseases and HIV Infection
11 Sexually Transmitted Diseases and HIV Infection
Pages 242-282
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 242... ...
These consequences for individuals, in turn, have serious repercussions for the societies of which they are part. Human immunodeficiency virus (HIV)
|
From page 243... ...
Furthermore, both the anatomy of the female genital tract prone to ascending infections and reproductive events and related medical procedures childbirth, stillbirth, abortion, uterine curettage, and intrauterine device insertion are additional risk factors for STD complications particular to women (Meheus et al., 19903. The main STD complications include pelvic inflammatory disease (PID)
|
From page 244... ...
As many as 10 to 20 percent of women with untreated gonorrhea or chlamydia develop PID (Hook and Handsfield, 1990; Westrom and M5rdh, 1984) , the most common of the complications of sexually transmitted diseases.
|
From page 245... ...
It affects 15 to 18 percent of all women who have had a pelvic inflammatory disease and is often associated with infertility (Westrom, 1980~. In industrialized countries, up to one-third of women who have had a single episode of PID develop recurrent infections because of inadequate treatment, increased vulnerability of damaged tubes, repeated exposure to sex partners who remain untreated, or unaltered risky behaviors (Westrom and Mardh, 1990~.
|
From page 246... ...
, or at or after 20 weeks of gestation (stillbirth) , also appears to be associated with several types of sexually transmitted infections.
|
From page 247... ...
Compared with men, women are less likely to have control over the circumstances of their sexual activity. If they have sex with an infected partner, they are more likely to acquire an STD, including HIV infection; if they have an STD or HIV infection, they are less likely to seek health care; if they seek health care, they are less likely to be treated effectively, are more likely to develop complications, and, finally, frequently pay a heavier social toll for STDs, including HIV and their sequelae.
|
From page 248... ...
For example, in regions where women are circumcised, practice "dry sex," or where STDs are widespread, pain during coitus, irregular vaginal bleeding, or pelvic pain may be considered the norm. Another major reason for gender differentials in seeking care for STDs is the female-specific, stigmatizing character of STDs, including HIV infection.
|
From page 249... ...
STDs and HIV Infection Throughout the Female Life Span The relative contribution of different risk factors for STDs, including HIV infection, varies with age. Increased vulnerability to STDs may be the result of biological or behavioral factors, and these may go in the same or in the opposite direction.
|
From page 250... ...
Behavioral risk factors for congenital infections therefore concern the infant's mother. The consequences of congenital and perinatal infections associated with STDs and HIV infection include, at the extreme, blindness and other physical disabilities, mental retardation, and death.
|
From page 251... ...
Because men tend to have more partners and engage in riskier sexual behavior than women, women's risk for STDs, including HIV infection, is more closely related to their husbands' sexual behavior than their own. Nonsexual transmission of STD pathogens present in the blood such as HIV, treponemes (which cause syphilis)
|
From page 252... ...
First, sexually transmitted diseases including HIV infection are much more prevalent in most developing countries, particularly in Sub-Saharan Africa, than in the majority of industrialized countries. Second, developing countries, again particularly those in Sub-Saharan Africa, have a higher incidence of complications of STDs than industrialized countries experience, and these complications are often more severe.
|
From page 253... ...
The three populations were defined as follows: (1) low-risk populations were women attending antenatal clinic or family planning clinics, or women sampled in community-based studies who are probably fairly representative of the general population; (2)
|
From page 254... ...
254 X EN o ._ Cal > EN o v2 ._ ~ ._ X V _.
|
From page 255... ...
The sexually transmitted diseases are an excellent example: the disease burden derived from STDs is primarily the product of frequent and severe morbidity rather than mortality. Nevertheless, of the six major STD complications, four (ectopic pregnancy, adverse pregnancy outcomes, cervical cancer, and enhanced HIV transmission)
|
From page 256... ...
256 ~ ~ _ ~W _~, s o it: o on ._ Cal o z Cal V: .
|
From page 257... ...
257 :^ s d' Cam Ct o o \ :: o
|
From page 259... ...
Treatment for infertility in Sub-Saharan Africa is very costly and failure rates are high, but what may appear to be an irrational expenditure of scarce resources is, instead, hard evidence of the high nsveholoaica1 and social costs of infertility and, by extension, the diseases that cause it. SOCIETAL DETERMINANTS OF STDS AND HIV INFECTION -- I -- r-J ~ Several societal factors have been postulated as determinants in the transmission of STDs, including HIV infection: population-age composition, sex ratio, urbanization, population mobility, war and social unrest, sexual norms, women's social status, and the availability of health services (Aral, 1990; Brunham and Embree, 1990~.
|
From page 260... ...
As Table 11-5 indicates, STDs and HIV infection can occur at any age, but the importance of both behavioral and biologic risk factors for these diseases ebbs and flows across the life span in ways that have important implications for both research and intervention. Because both of these kinds of factors peak during
|
From page 261... ...
It concerns the translation of knowledge into action and it integrates information from a variety of disciplines: psychology, sociology, anthropology, epidemiology, clinical medicine, microbiology, and administration. Operational questions that are critical for reducing sexually transmitted diseases in women include the following: .
|
From page 262... ...
In the absence of routine screening for women, the only way to identify asymptomatic women with STDs may be through their male sex partners. · How should programs be designed to reach groups at high risk for STDs, including HIV infection, such as prostitutes, their clients, and long-distance truck drivers?
|
From page 263... ...
1989. Sero-erJidemiolo~ic .studv of.several ~~ - - - -r~ sexually transmitted diseases (including HIV infection)
|
From page 264... ...
1990. Sexually transmitted diseases: current and future dimensions of the problem in the Third World.
|
From page 265... ...
Pp. 97-121 in Research Issues in Human Behavior and Sexually Transmitted Diseases in the AIDS Era, J
|
From page 266... ...
Pp. 318-344 in Research Issues in Human Behavior and Sexually Transmitted Diseases in the AIDS Era, J
|
From page 267... ...
1984. Sexually transmitted diseases in pregnant women in Harare, Zimbabwe.
|
From page 268... ...
1984. Sexually transmitted diseases among randomly selected attenders at an antenatal clinic in The Gambia.
|
From page 269... ...
1989. Sexually transmitted diseases among women attending a family planning clinic in Zaria, Nigeria.
|
From page 270... ...
1980a. Sexually transmitted diseases in pregnant women.
|
From page 271... ...
1987. Seroepidemiological study of sexually transmitted diseases and hepatitis B in African promiscuous heterosexuals in relation to HTLVIII infection.
|
From page 272... ...
1992. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases.
|
From page 273... ...
296180 10 1986a AN 234 9 Central African Republic 1980 AN 268 10 Ethiopia 1973-75 PP (asymptomatic) 200209 9 Gabon 1981 AN 530270 6 1988 PP (asymptomatic)
|
From page 274... ...
274 TABLE 11-6 Continued IN HER LIFETIME Country Year Population N Ref. GC CTTV Low-risk population South Africa 1986a AN 23114 1 1986a FP 6214 16 1987 AN 193193 6 1149 1 gg l a AN (white, high SES)
|
From page 275... ...
gonorrhea; CT chlamydia; TV, trichomoniasis; AN antenatal; PP, postpartum; FP. family planning; LAP.
|
From page 276... ...
170 72 8 South Africa 1992a AN (unhooked) 114 172 31 Swaziland 1978 FP52 167 6 6 1978 AN51 167 14 2 1981 a AN90 247 10 33 1986 PP (asymptomatic)
|
From page 277... ...
27457 21 Rwanda 1973 CSW43166 30 1987a CSW33248 58 82 Senegal 1989-92 CSW65370 6 31 1989-92 CSW397227 40 Somalia 1985-86 CSW85117 45 1989 CSW57232 51 1990 CSW1552 69 47 1990a CSW8938 28 Sudan 1987 CSW202163 29 Tanzania 1992a CSW70156 18 16 1991 a CSW106185 27 74 Uganda 1986 Bar girls36112 46 6 Zaire 1989a CSW801150 28 16 7 1990a CSW1,233125 28 16 7 277 NOTE: Non-T, non-treponemal test; Trep, treponemal test; Non-T+Trep, positive non-treponemal test confirmed by treponemal test in most cases; GUD, genital ulcer disease; D/C, discharge; AN. antenatal; PP, postpartum; FP, family planning; CSW~ commercial sex worker; SES, socioeconomic status aNo study date.
|
From page 278... ...
603157 0 1991 AN (St Louis) 418157 0 South Africa 1991 AN (national)
|
From page 279... ...
298 267 7 7 High-risk population Central African Republic 1989 STD (Bangui) 76 95 21.0 Gabon 1988 STD (Southeast)
|
From page 280... ...
280 TABLE 11-8 Continued IN HER FIFETIME Country Year Population Ref. HIV- 1 High-risk population South Africa l99oa STD (Durban)
|
From page 281... ...
NOTE: AN, antenatal; FP, family planning; Vil, village; w/syph, with syphilis; w/out syph, without syphilis; CSW, commercial sex worker.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.