The planetary human immunodeficiency virus ( HIV ) pandemic is progressively going a load of the female population. HIV is preponderantly acquired through heterosexual transmittal and in many parts of the universe, HIV prevalence and incidence rates are higher among adult females than work forces ( Daly et al 1994 ) . At the terminal of 2007, an estimated 15.4 million adult females were infected with HIV, most of them being of fertile age ( Heikinheimo and Lahteenmaki 2008 ) . Importantly, immature adult females aged 15-24 have a 4- to 7-fold increased hazard of going infected with HIV, when compared with immature work forces of the same age ( Simon et al. , 2006 ) . The demographics and paths of infection vary harmonizing to the stage of the HIV epidemic ( Beyrer, 2007 ) . Womans with HIV infection may wish to be after gestation to restrict their household or avoid gestation. The pick of contraceptive method in people populating with HIV is constrained by the demand to forestall both sexual transmittal of HIV and unwanted gestations. Correct usage of most user dependant methods requires a basic cognition of reproduction and literacy accomplishments to follow written instructions. Double map preventives that at the same time prevent HIV transmittal every bit good as unwanted gestations might be the most appropriate prophylactic method for adult females populating with HIV and AIDS ( Kakaire et al, 2010 ) .
The human immunodeficiency virus ( HIV ) is a retrovirus belonging to the household of lentiviruses. Retroviruss can utilize their RNA and host Deoxyribonucleic acid to do viral DNA and are known for their long incubation periods. Like other retroviruses, HIV infects the organic structure, has a long incubation period or clinical latency, and finally causes the marks and symptoms of disease. HIV causes terrible harm to the immune system and finally destroys it by utilizing the Deoxyribonucleic acid of CD4+ cells to retroflex itself. In that procedure, the virus finally destroys the CD4+ cells ( Calles et al. 2010 ) . There are two types of human immunodeficiency virus ( HIV-1 and HIV-2 ) , which each evolved from a different simian immunodeficiency virus ( SIV ) . Both viruses emerged in the late twentieth century. In contrast to the SIV 's, which appear non to harm their natural archpriest hosts. HIV infection amendss the immune system, go forthing the organic structure susceptible to infection with a broad scope of bacteriums, viruses, Fungis, and Protozoa ( Calles et al. 2010 ) . Surveies have shown dramatic similarities but besides of import differences between HIV-1 and HIV-2. They have the same manners of transmittal and are associated with the same timeserving infections, but HIV-2appears to come on at a slower rate ( CDC ) .
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HIV-1 is much more prevailing than HIV-2. It is HIV-1 that is mostly responsible for the AIDS pandemic, while HIV-2 is chiefly restricted to West Africa. Now, in each twelvemonth of the early twenty-first century there are about 5 million new HIV infections, and about 3 million deceases from AIDS, which has become the 4th biggest cause of mortality in the universe ( Carter and Saunders 2007 ) . HIV-1 infection is characterized by an insidious impairment of the cellular immune system ( Vergis and Mellors 2000 ) . Both the measure and proportion of plasma CD4+ T-cells lessening steadily over a period of old ages to decennaries, and this progressive loss of CD4+ T-cells is associated with the development of AIDS in septic persons. The grade of immunodeficiency associated with HIV-1 infection, as defined by the oncoming of timeserving diseases, correlatives closely with plasma CD4+ T-cell counts ( Calles et al. 2010 ) .
HIV 's Life Cycle Host cells infected with HIV have a sawed-off life p as a consequence of the virus 's utilizing them as `` mills '' to bring forth multiple transcripts of new HIV. Thus, HIV continuously uses new host cells to retroflex itself. Equally many as 10 million to 10 billion virions ( single viruses ) are produced day-to-day. In the first 24 H after exposure, HIV onslaughts or is captured by dendritic cells in the mucose membranes and tegument. Within 5 yearss after exposure, these septic cells make their manner to the lymph nodes and finally to the peripheral blood, where viral reproduction becomes rapid. CD4+ lymphocytes that are recruited to react to viral antigen migrate to the lymph nodes. These become activated and so proliferate via complex interaction of cytokines released in the microenvironment of the lymph nodes. This sequence of events makes the CD4+ cells more susceptible to HIV infection, and it explains the generalised lymphadenopathy feature of the acute retroviral syndrome seen in grownups and striplings. In contrast, HIV-infected monocytes allow viral reproduction but resist violent death. Therefore, monocytes act as reservoirs of HIV and as effecters of tissue harm in variety meats such as the encephalon ( Calles et al. 2010 ) .
The HIV life rhythm includes six stages harmonizing to Calles et Al. ( 2010 ) binding and entry, rearward written text, integrating, reproduction, budding, and ripening ( Figure 1. Appendix 2. ) . Binding and Entry, the envelope proteins gp120 and gp41 bind to CD4+ cell receptors and co-receptors on the exterior of CD4+ cells and macrophages. The chemokine receptors CCR5 and CXCR4 facilitate viral entry. T-cell tropic viruses require CXCR4 to adhere, and macrotropic strains of the virus require CCR5. R5 is the most common virus transmitted during acute infection, and subsequently during infection X4 is the virus that is most common. The presence of a homozygous inactive mutant of the CCR5 allelomorph has caused opposition to infection by the R5 virus. The connection of the proteins and the receptors and co-receptors fuses the HIV membrane with the CD4+ cell membrane, and the virus enters the CD4+ cell and macrophage. The HIV membrane and the envelope proteins remain outside of the CD4+ cell, whereas the nucleus of the virus enters the CD4+ cell. CD4+ cell enzymes interact with the viral nucleus and excite the release of viral RNA and the viral enzymes rearward RNA polymerase, integrase, and peptidase.
The HIV RNA must be converted to DNA before it can be incorporated into the Deoxyribonucleic acid of the CD4+ cell. This incorporation must happen for the virus to multiply. The transition of HIV RNA to DNA is known as contrary written text and is mediated by the HIV enzyme contrary RNA polymerase. The consequence is the production of a individual strand of Deoxyribonucleic acid from the viral RNA. The individual strand of this new DNA so undergoes reproduction into dual isolated HIV DNA. Once rearward written text has occurred, the viral DNA can come in the karyon of the CD4+ cell. The viral enzyme integrase so inserts the viral DNA into the CD4+ cell 's Deoxyribonucleic acid. This procedure is known as integrating. The CD4+ cell has now been changed into a mill used to bring forth more HIV. The new DNA, which has been formed by the integrating of the viral DNA into the CD4+ cell, causes the production of courier Deoxyribonucleic acid that initiates the synthesis of HIV proteins ( Calles et al. 2010 ) .
The HIV proteins and viral RNA, all the constituents needed to do a new virus, gather at the CD4+ cell membrane to organize new viruses. These new viruses push through the different parts of the cell wall by budding. Many viruses can force through the wall of one CD4+ cell. These new viruses leave the CD4+ cell and contain all the constituents necessary to infect other CD4+ cells. The new virus has all the constituents necessary to infect other CD4+ cells but can non make so until it has matured. During this procedure, the HIV peptidase enzyme cuts the long HIV proteins of the virus into smaller functional units that so reassemble to organize a mature virus. The virus undergone the procedure of ripening and is now ready to infect other cells ( Calles et al. 2010 ) .
Safe and effectual methods of contraceptive method represent a critical constituent of preventative wellness attention cut downing maternal and infant mortality ; particularly in adult females populating in resource-limited scenes ( Zdenek et al. 2010 ) here is broad fluctuation in contraceptive method prevalence worldwide runing from 8 % of adult females aged 15-49 old ages in western Africa up to 78 % in northern Europe. Female sterilization ( 32 % ) , intrauterine devices ( 22 % ) , and the unwritten preventive pill ( 14 % ) history for more than two tierces of all prophylactic pattern worldwide.4 In less developed states 70 % of contraceptive method users rely on female sterilization and intrauterine devices in portion because they are advocated by health care services as a consequence of cost effectivity in footings of gestation bar and service proviso ( UNPD, 2001 ) .
Non-Hormonal Methods of Contraception
A high grade of protection against HIV sexual transmittal is provided by consistent correct rubber usage ( Davis and Weller 1999 ) ; inconsistent or incorrect usage is non protective. Most planetary HIV transmittal occurs because rubbers are non used at all during sexual intercourse ( Steiner and Cates 1999 ) .Condom accidents are reported by 1-12 % of users and the method prophylactic failure rate is at least 12 % ( Trussel et al. 1992 ) . Double protection, the coincident usage of an effectual contraceptive method method with consistent rubber usage, has been advocated to cut down the hazard of unplanned gestation, horizontal transmittal of HIV to a non-infected spouse, transmittal of immune virus to an spouse with HIV infection, and the hazard of acquisition of other STIs including high hazard human papillomavirus ( HPV ) types ( UNDP/UNFPA/WHO 2002 ) .
Male rubbers are the lone means proven to significantly cut down the hazard of HIV transmittal in heterosexual intercourse ( Cates 2005 ) . Harmonizing to a recent Cochrane reappraisal, consistent usage of male rubbers consequences in 80 % decrease in the hazard of HIV transmittal among HIV-serodiscordant twosomes ( Weller and Davis-Beaty, 2002 ) .The female rubber is a polyurethane sheath with two flexible rings at each terminal ; one ring is inserted into the upper vagina and the other covers the introitus. The female rubber is less likely than male rubbers to leak or interrupt during sex, but invasion of the outer pealing into the vagina is reported in 2 % of copulatory episodes. The cumulative chance of vaginal exposure to seeds with female rubber usage has been estimated as 3 % , compared to 11.6 % with the male rubber. The prophylactic failure rate is estimated at 5-21 % over 12 months ( Daly et al. 1994 ) .
Consistent usage of rubber was associated with holding one spouse, greater income, no illicit drug usage and when rubbers were the lone preventive method used ( Wilson et al. 1999 ) .Women who besides use, effectual or long term methods of contraceptive method are less likely to describe consistent rubber usage ( Magalhaes et al. 2002 ) . Condom usage is besides related to whether the adult female has informed her spouse of her position ( DesgreA?es-du-LouE† et al. 2002 ) less consistent usage is reported by concordant twosomes ( Clark et al. 1997 ) , even within discordant partnerships consistent rubber usage is reported by merely about 50 % twosomes ( Allen et al. 2003 ) .Obstacles to greater usage of male rubbers include deficiency of handiness, fright of being perceived as holding multiple spouses and being unfaithful to a regular spouse, resistance on spiritual evidences, and male laterality in determination devising ( UNDP/UNFPA/WHO, 2002 ) . Women populating with HIV infection may experience unable to unwrap their HIV position and negotiate rubber usage with new sexual spouses for fright of forsaking, domestic force, loss of economic support, and societal isolation. The issues around female rubber usage are besides negociating barrier method usage, ( Kalichman et al.2000 ) method acceptableness by users, and higher cost compared with the male rubber. The WHO audience on reuse suggested that female rubbers still run into fabrication quality appraisal specifications after seven rhythms of bleach disinfections, rinsing, drying, and relubrication. This protocol has non been evaluated for safety and efficaciousness in human usage and the WHO does non urge or advance reuse of female rubbers and is presently patronizing research to measure reuse protocols under local conditions ( WHO, 2002 ) .
Furthermore, stop and vimules cover the neck and parts of the vaginal wall, while caps cover merely the neck. Their usage in discordant twosomes is non recommended, as a comparatively big country of vaginal mucous membrane remains exposed, micro injury during interpolation, and the accompaniment usage of nonoxynol-9 spermatocide may do epithelial break and increase viral transmittal hazard to the male spouse ( Carlin and Boag 1995 ) . Nonoxynol-9 ( N-9 ) spermatocide provides no protection against sexually familial infections including HIV ( Wilkinson et al. 2002 ) and frequent usage increases the hazard of HIV acquisition ( Van Damme et Al. 2002 ) . WHO Contraceptive Research and Development ( CONRAD ) proficient audience concluded that N-9 should non be used or promoted for the bar of HIV in adult females at high hazard of infection ( WHO 2001 ) . There are no published surveies on the female-male transmittal hazard with N-9 usage by adult females with HIV infection. It seems advisable for adult females with HIV infection with discordant sexual spouse to avoid N-9 spermicidal entirely or with other prophylactic methods to cut down the possible hazard of HIV sexual transmittal. There is no grounds that rubbers lubricated with N-9 are more effectual in forestalling gestation than rubbers lubricated with silicone. However, where pick is limited it is better to utilize any rubber than no rubber at all. In the hereafter, effectual and acceptable micro biocides may hold a function, supplying HIV positive adult females unable to negociate consistent rubber usage with a discordant spouse with an extra method to cut down sexual transmittal.
HORMONAL METHODS OF CONTRACEPTION
The combined unwritten preventive ( COC ) pill is an effectual user dependent contraceptive method with the non-contraceptive benefits of rhythm control, decrease in hypermenorrhea and dysmenorrhoea. Absorption can be affected by drawn-out intercurrent diarrhea and emesis. The COC is metabolised by the liver and its usage is contraindicated in adult females with unnatural liver map, which may be caused by intoxicant maltreatment, ague or chronic viral hepatitis, and inauspicious events on antiretroviral combinations. These factors are peculiarly relevant when doing contraceptive method picks for HIV positive adult females who are current or old shooting drug users with chronic active hepatitis C infection. Current drug users frequently have a helter-skelter life style that precludes effectual usage of user dependent contraceptive method methods ( Mitchell and Stephens, 2004 ) .
Progestogen ( POP ) merely pills methods may be used by adult females with contraindications to estrogen usage. The POP is an effectual preventive method with right and consistent usage ; ovulation is non inhibited in all users, and inconsistent usage can ensue in gestation. A new progestin merely pill, Cerazette, which contains 75 milligram desogestrel, has late been introduced. In surveies Cerazette inhibited ovulation in97 % of rhythms at 7 and 12 months after induction ; this would propose enhanced efficaciousness in comparing with conventional POPs, though as yet unconfirmed by comparative tests ( Mitchelle and Stephens, 2004 ) .
Under the long playing progestin merely contraceptive method, depot Provera ethanoate ( DMPA ) 150 milligram is given by deep intramuscular injection at 12 hebdomadal intervals and norethisterone oenanthate ( Noristerat ) 200 mg every8 hebdomads. These methods have the advantage of non being intercourse related but require regular entree to wellness attention for repetition injections. Likewise, implants need to be inserted by a trained wellness professional. Implanon is effectual for 3 old ages, and Jadelle for 5 old ages ( non licensed in the United Kingdom ) ; both are extremely effectual, non-user dependant, and reversible methods of progestin merely contraceptive method.
Harmonizing to Mitchell and Stephens ( 2004 ) , factors impacting contraceptive method pick for HIV positive adult females are influence by the state of abode, the handiness of methods, entree to healthcare services, and cost.Religious, cultural, and personal beliefs of the function of adult female in society, acceptableness to spouse, effects on menses. Subsequent is the HIV position of adult female that involves the CD4 count, viral burden and physical well-being. Furthermore HIV serostatus, indefinite spouse concordant and discordant. Then catamenial, sexual, and generative history consist of hypermenorrhea, dysmenorrhoea, past pelvic infection, past ectopic gestation, gestation planning. In add-on the medical history findings like unnatural liver map, past history of venous thromboembolic disease, high blood pressure, lipemia, and current drug maltreatment. Finally the medicines causes such as, enzyme inducers, antibiotics, teratogenic agents.
In the survey of 'contraception among individuals populating HIV with infection go toing an HIV attention and support Centre in Kabale, Uganda ' by Kakaire et Al. ( 2010 ) shows that factors independently associated with prophylactic usage were degree of instruction and whether respondent has changed spouses since HIV diagnosing. Contraception usage and conformity is related to the scope of methods available, patient pick, prevailing wellness and spiritual beliefs, perceptual experiences of method effectivity, and side effects ( for illustration, adult females may hold less tolerance for heavy and drawn-out vaginal hemorrhage than amenorrhea ( Playle 2000 ) . Correct usage of most user dependant methods requires a basic cognition of reproduction and literacy accomplishments to follow written instructions. In Gazmararian et Al, ( 1999 ) many states adult females are unable to do independent determinations about their sexual and generative wellness because of political instability within society, deficiency of economic independency, and predominating cultural or spiritual attitudes to adult females 's rights.
The Government 's 2001 National Strategy for Sexual Health and HIV outlined policies to cut down degrees of insecure sex, new HIV diagnosings, and undiagnosed HIV by 2007, via puting in bar, bettering outreach services, co-ordinating enterprises and widening information runs. A cardinal mark for a 25 % lessening in freshly acquired HIV infections by 2007 was non met ; new diagnosings have increased significantly. The US Department of Health ( 2009 ) argues that other marks were achieved ; HIV proving increased and clinic waiting times declined.
A policy briefing high spots the crisis in presenting just wellness attention for people populating with HIV and AIDS, and the overpowering load it places on adult females and misss. HIV and AIDS have brought an increased demand for community and home-based attention. Due to traditional gender norms and unequal gender dealingss it is the adult females and misss in the communities who are the primary health professionals, whilst perchance being HIV positive, and frequently needing attention themselves.
At this point in the AIDS epidemic, the bar of the heterosexual transmittal of HIV is of paramount importance ( Daly et al. 1994 ) . Women all over the universe are at hazard for HIV, even within matrimonial relationships. Sing that preventive usage is being promoted worldwide, including in countries where HIV incidences increasing, farther cognition sing the consequence of single preventives on HIV transmittal is imperative. Development and proviso of safe, effectual, low-cost and acceptable contraceptive method for adult females at hazard of HIV and those populating with HIV/AIDS is one of the major challenges of generative medical specialty. Currently, consistent usage of male rubbers is the lone proven means to cut down the hazard of HIV transmittal in heterosexual intercourse. All the available reversible prophylactic methods-OCs, prophylactic injections and IUDs-can by and large be used both by adult females at hazard of HIV infection and by HIV-infected adult females. An ideal preventive scheme for adult females at hazard of HIV infection would supply coincident protection against both unintended gestation and HIV acquisition.
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