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Barriers to care and reproductive choices in Latin American HIV+ women: a sub-analysis of the ELLA Study
ResumIntroduction: Global prevalence of HIV-1 is estimated at 35 million; 50% of those infected are women. Despite availability of effective antiretroviral therapy (ART), many HIV-positive individuals are not in care; women have greater difficulty accessing HIV care than men. The ELLA study is a cross-sectional, multi-country, non-interventional epidemiological study to investigate the population, disease characteristics, barriers to care, quality of life (QOL) and reproductive choices for women living with HIV. We describe results of women included in ELLA from the Latin American region (LA). Materials and methods: HIV-1-positive females ]18 years were enrolled using a non-random sequential sampling frame in four global geographic regions: Western Europe and Canada, LA, Central/Eastern Europe and Asia. Eligible women completed self-administered Barriers to Access to Care Scale (BACS) and other health status questionnaires. Patients rated each of the 12 BACS items using a four-point Likert scale (10‘‘No problem at all’’ to 40‘‘Major problem’’). Questionnaires with ]6 items completed were included in the analysis, mean score !2.0 was considered a significant barrier to access to care. Results: A total of 519 women participated in ELLA from the LA region (total N01922). For these women, mean age was 42.2 years and 96.7% acquired HIV through sexual contact. A total of 54.4% had been diagnosed with HIV 5 years and 87.3% were currently on ART. Recent CD4 count was !500/mm3 in 48%, and most recent viral load was B50 c/ml in 52.2%. More than 8 years formal education was reported by 69.3%, 45.9% lived with a partner/husband, and 55.3% were employed. Mean overall BACS score was 2.2 across all 12 individual items. Highest barriers to access to care were related to community stigma (mean score 3.1), lack of personal resources (mean score 2.5). Women had an average of 1.9 children (range 0Á12) with 17% indicating a desire to have more children (32% in women B35 years). Birth control strategies were mainly based on female surgery (33.3%), male condom use (68.3%), 19.7% of women reporting abstinence. Conclusions: The majority of HIV' women in LA included in ELLA were receiving ART, approximately half reported to have undetectable viral loads and normal CD4 cell counts. Barriers to access to care remain high, particularly community stigma and personal resources. Special attention on reproductive health counselling, should be considered. (Extraído del documento)
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- Póster presentado en el congreso HIV Drug Therapy 2015 Americas, celebrado en México del 16 al 18 de abril de 2015.