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      Sociodemographic differences among HIV-positive and HIV-negative recently pregnant women in Mexico City : A case–control study

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          Abstract

          National HIV preventive programs in Mexico focus on high-risk groups that do not consider women, apart from prenatal screening. Nonetheless, the epidemic in women is growing, and there is a need to better understand sociodemographic factors in women living with HIV (WLH). We performed a case–control study in Mexico City, including HIV+ and HIV− women with a recent pregnancy to compare their sociodemographic characteristics and describe the circumstances of diagnosis in HIV+ women, as well as prenatal screening frequency in both groups. Fifty cases and 102 controls were interviewed. HIV+ women were more frequently the only economic support of the family (20% vs 0%, P < .0001). Thirty-eight percent of cases had their first pregnancy at ≤18 years, versus 16% of controls (odds ratio 2.47, 95% confidence interval 1.07–5.72, P = .03); 16% of cases had lived in the street; 6% reported transactional sex, versus none of the controls ( P < .0001). In the multivariate analysis, there was strong evidence of an association between HIV infection and age at the time of the interview, history of sexually transmitted diseases, substance abuse, history of violence, and civil status. Only 6% of controls were tested for HIV during prenatal follow-up. WLH in this study faced important social vulnerability. Targeting women living in these social contexts might increase early diagnosis and could tailor HIV prevention strategies. Prenatal coverage needs to be improved and should represent a national priority.

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          Screening women for intimate partner violence in healthcare settings.

          Intimate partner violence (IPV) damages individuals, their children, communities, and the wider economic and social fabric of society. Some governments and professional organisations recommend screening all women for IPV rather than asking only women with symptoms (case-finding). Here, we examine the evidence for whether screening benefits women and has no deleterious effects.
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            The inevitability of infidelity: sexual reputation, social geographies, and marital HIV risk in rural Mexico.

            Marriage presents the single greatest risk for HIV infection among women in rural Mexico. We drew on 6 months of participant observation, 20 marital case studies, 37 key informant interviews, and archival research to explore the factors that shape HIV risk among married women in one of the country's rural communities. We found that culturally constructed notions of reputation in this community lead to sexual behavior designed to minimize men's social risk (threats to one's social status or relationships), rather than viral risk and that men's desire for companionate intimacy may actually increase women's risk for HIV infection. We also describe the intertwining of reputation-based sexual identities with structurally patterned sexual geographies (i.e. the social spaces that shape sexual behavior). We propose that, because of the structural nature of men's extramarital sexual behavior, intervention development should concentrate on sexual geographies and risky spaces rather than risky behaviors or identities.
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              "It's better for me to drink, at least the stress is going away": perspectives on alcohol use during pregnancy among South African women attending drinking establishments.

              The Western Cape of South Africa has one of the highest rates of fetal alcohol spectrum disorders (FASD) globally. Reducing alcohol use during pregnancy is a pressing public health priority for this region, but insight into the experiences of women who drink during pregnancy is lacking. Convenience sampling in alcohol-serving venues was used to identify women who were currently pregnant (n = 12) or recently post-partum (n = 12) and reported drinking during the pregnancy period. In-depth qualitative interviews were conducted between April and August 2013. Interviews explored drinking narratives, with textual data analyzed for themes related to factors that contributed to drinking during pregnancy. All but one woman reported her pregnancy as unplanned. The majority sustained or increased drinking after pregnancy recognition, with patterns typically including multiple days of binge drinking per week. Analysis of the textual data revealed five primary factors that contributed to drinking during pregnancy: 1) women used alcohol as a strategy to cope with stressors and negative emotions, including those associated with pregnancy; 2) women drank as a way to retain social connection, often during a difficult period of life transition; 3) social norms in women's peer groups supported drinking during pregnancy; 4) women lacked attachment to the pregnancy or were resistant to motherhood; and 5) women were driven physiologically by alcohol addiction. Our data suggest that alcohol-serving settings are important sites to identify and target women at risk of drinking during pregnancy. Intervention approaches to reduce alcohol use during pregnancy should include counseling and contraception to prevent unwanted pregnancies, mental health and coping interventions targeting pregnant women, peer-based interventions to change norms around perinatal drinking, and treatment for alcohol dependence during pregnancy. Our findings suggest that innovative interventions that go beyond the boundaries of the health care system are urgently needed to address FASD in this region.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                July 2017
                07 July 2017
                : 96
                : 27
                : e7305
                Affiliations
                [a ]Departamento de Enfermedades Infecciosas, Instituto Nacional de Cancerología (INCan), Secretaría de Salud (SSA)
                [b ]Medical Director at the Clinica Especializada Condesa and Teresita Cabrera, Gynecology Service
                [c ]Departamento de Enfermedades Infecciosas, Hospital General Manuel Gea Gonzalez, Secretaría de Salud (SSA), Mexico City, Mexico.
                Author notes
                []Correspondence: Alexandra Martin-Onraet, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI, Deleg. Tlalpan, 14080 Ciudad de México, Mexico City, Mexico (e-mail: alexite_maon@ 123456yahoo.com )
                Article
                MD-D-17-00442 07305
                10.1097/MD.0000000000007305
                5502152
                28682879
                6c02051f-6bef-4b64-afc6-974df882a2ab
                Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-nc-sa/4.0

                History
                : 20 January 2017
                : 20 May 2017
                : 26 May 2017
                Categories
                4850
                Research Article
                Observational Study
                Custom metadata
                TRUE

                hiv epidemic in women,hiv in mexico,prenatal hiv screening,vulnerability in women

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