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Biomedical subjects

L Sherr

Publications and source records attributed to L Sherr.

At least 55 records · Page 3Linked to original sources
PubMed1999

HIV testing and prevention issues for women attending termination assessment clinics.

The prevalence of HIV infection in London is nearly threefold in women who seek terminations compared to women who carry to term. Despite the higher prevalence, HIV testing is not systematically offered to women attending termination of pregnancy assessment clinics (TOPCs). The Department of Health has given clear guidance on HIV testing in antenatal clinics and most London antenatal clinics have implemented policies on HIV testing. No similar guidance exists for TOP clinics. This paper describes the results from a study examining HIV testing and prevention issues for women attending five TOPCs in North London. Data on risk disclosure, HIV testing intentions and awareness of HIV infection and testing were analysed for 141 women who completed a self-administered questionnaire. Women who expressed an intention to have an HIV test were more likely to be from ethnic minority origin, to report that their partner intends to have an HIV test and to perceive it as easier to talk to their partner about HIV testing, compared to women who did not report an intention to test for HIV The former group also were more likely to have had a previous HIV test and perceived their personal control for staying HIV negative as greater compared to others. Fifty six (39.8 per cent) women disclosed one or more potential risk factors for HIV Women with risks were more knowledgeable about HIV infection, perceived their personal chances of being HIV positive as greater and experienced greater worry about past risks, compared to women who disclosed no risks. However, women who disclosed risk factors were no more likely to intend to have an HIV test. Knowledge on HIV infection, testing and potential interventions to reduce mother-to-baby transmission was low, with fewer than one in four women being aware that transmission may be reduced by AZT, Caesarean section and bottle feeding. Given the findings about the level of risk disclosed and women's positive attitude towards information on HIV infection and testing, this client group should no longer be overlooked in the planning of future policies on HIV testing for populations at risk.

AIDS Serodiagnosis↗
PubMed1998

Temporal trends in reasons for and result of HIV-testing among women in Rome, Italy.

To describe the trend in the reasons for and result of women's HIV testing, systematic data was gathered for 11,523 consecutive women during pre-and post-test visits at a major counseling and testing (CT) site of Rome, Italy, June 1985-July 1996. The number of tested women and the proportion of female clients attending the CT site significantly increased during the study period (p < 0.001), mostly because of reported sexual risk or when triggered by pregnancy. A significant increasing trend in the proportion of women who had one prior test (30% overall) was observed in all groups, apart from IDU. Newly diagnosed HIV infections were 319 (2.8%). The HIV prevalence was 27% in 1985-1987, when 66.7% of cases were IDUs, and decreased to 1.3% in 1994-1996, when 53.7% of cases were women reporting HIV infected partners. The findings suggest that information on the potential risk of HIV transmission has permeated the female population. The shift of newly diagnosed infections from IDUs towards women reporting sexual exposure, suggests the need for targeting preventive efforts to these population groups. Underlying reasons for multiple testing need further analysis.

AIDS Serodiagnosis↗
PubMed1998

Performance of antenatal HIV screening strategies in the United Kingdom.

BACKGROUND: In 1996 only 13.5% of previously undiagnosed HIV infected women were detected in pregnancy. In this study, all 265 maternity units in the United Kingdom were surveyed to determine the relation between screening strategy, uptake of testing, and detection rate. METHODS: Data on HIV screening strategy and uptake of testing were collected in 1997 by postal questionnaire. The proportion of women with previously undiagnosed HIV infection identified during pregnancy (detection rate) was calculated using data from national obstetric HIV surveillance and unlinked anonymous seroprevalence studies. RESULTS: 239 (90%) units responded; 25 of these (10%) had a universal offer strategy, 89 (37%) a selective offer, and 125 (52%) tested only women who requested it. All selective units offered testing to injecting drug users, but only 26% to women who had lived abroad in high prevalence areas. Uptake was over 10% in only eight units, all with a universal strategy, and in 76% of selective units it was below 0.1%. The detection rate was 14.7% in universal units, 7.8% in selective units, and 7.7% in on request units. In universal units, detection increased by 6.3% (95% confidence interval 3.7% to 8.8%) for every 10% increase in uptake of testing. There was evidence of both selective presentation for testing and avoidance of testing among infected women. CONCLUSIONS: All current antenatal HIV testing strategies fail to identify most infected women. Universal offer strategies achieve a very low uptake and a poor detection rate. Units with selective strategies tend to test only a minority of women at high risk and do not target all the main high risk groups.

Female↗
PubMed1997

Women with HIV disease attending a London clinic.

OBJECTIVE: To examine ethnic, relationship, health, and mental health factors for a cohort of women with HIV infection attending an inner London clinic. DESIGN AND METHODS: Structured schedules were utilised to analyse ethnic group, family, and reproduction issues, mental and physical health for 100 women drawn consecutively from attenders at an inner London HIV clinic RESULTS: 51% of the women were non-ethnic minority groups and 49% were from ethnic groups. HIV testing was often as a result of symptoms or partner illness. One in five had disclosed their status to one person only or no one. Ethnic minority women were more likely to restrict disclosure. Forty seven per cent of the women had 100 children with more children reported in ethnic minority families; 28% of the children had been tested for HIV and five were confirmed HIV positive; 9% of children were born after HIV diagnosis. Nineteen women reported one or more termination of pregnancy, the majority before HIV diagnosis. Three quarters had a partner of whom 56 knew the partner's status. Women with HIV positive partners were more likely to have children. Women kept in ignorance of partner status were more likely to be ethnic minority women. Thirty two per cent had an AIDS diagnosis, diagnosed mostly in the UK. Medical and counselling service uptake was high. Gynaecological problems were common (49% had one or more problem) and 34% had at least one hospital admission. A wide range of counselling issues were recorded, with variations over time. Suicidal issues were relevant for 13% of women (69% ideation, 31% attempts). Significant life events were noted for many women with allied coping demands. CONCLUSIONS: There are a wide range of issues for women with HIV and systematic differences between ethnic and non-ethnic women and those with or without children.

AIDS Serodiagnosis↗
PubMed1997

Repeat HIV testers at a London same-day testing clinic.

OBJECTIVE: To compare the characteristics of repeat HIV testers with first-time testers in a National Health Service HIV testing clinic in London. SUBJECTS AND METHODS: A self-administered questionnaire was distributed to clinic attenders between September 1995 and January 1996. The sample was stratified by gender and sexual orientation. Repeat and first-time testers were compared with respect to recent sexual risk behaviour, reasons for taking the HIV test, condom use, knowledge of sex partner's HIV status, and sociodemographic and psychosocial variables. RESULTS: Of 965 clinic attenders surveyed, 404 (41.9%) reported at least one previous HIV test outside the window period and were classified as repeat testers: homosexual men, 62.5% (178 out of 285); heterosexual men, 35.1% (126 out of 359); heterosexual women, 31.2% (100 out of 321). Among homosexual men, repeat testers were more likely to report the following: two or more partners in the previous 6 months for both unprotected anal sex (25.8 versus 9.3%; P < 0.01) and unprotected oral sex (53.9 versus 37.4%; P < 0.01); ever having had a sexually transmitted disease (STD) other than HIV (49.4 versus 29.0%; P < 0.01); taking the present test "as part of a regular health check' (48.9 versus 28.0%; P < 0.01); and knowing others who had tested for or been infected with HIV. Repeat testing heterosexual men were more likely to report the following: two or more partners in the previous 6 months for unprotected vaginal sex (42.9 versus 30.9%; P < 0.05) and unprotected oral sex (41.3 versus 25.3%; P < 0.01); ever having had an STD other than HIV (31.7 versus 20.6%; P < 0.05); taking the present test "as part of a regular health check' (36.5 versus 26.2%; P < 0.05); and knowing others who had tested for or been infected with HIV. For heterosexual women, repeat testers were more likely to report ever having had an STD other than HIV (25.0 versus 14.5%; P < 0.05), and knowing others who had tested for or been infected with HIV. CONCLUSIONS: Repeat testing was associated with high-risk sexual behaviour, a previous STD, knowledge of others who have tested for or been infected with HIV, and seeking the test as part of a regular health check. Factors contributing to repeat testing are multi-faceted and vary between groups of different sexual orientation. Use of the impact of knowledge of others infected by HIV and the experience of contracting an STD other than HIV may guide the development of HIV counselling interventions aimed at reducing sexual risk behaviour.

Adult↗
PubMed1996

Differences between doctor and patient estimates of outcome in male sub-fertility clinic attenders.

Treatment for male factor sub-fertility is limited, with low increases in pregnancy rate. Couples attending a male sub-fertility clinic are provided with prognostic information and advised about treatment options. This study aimed to examine the influence of clinic attendance on male sub-fertility patients' expectations of their partners becoming pregnant. Data were collected on 103 male sub-fertility clinic attenders before and after clinic consultation. Patients' mood and expectations of their partners achieving a pregnancy were recorded and compared with the consultant's expectations. Before consultation, patients expected that following the clinic visit their chance of pregnancy would be increased. Post-consultation, their perceptions of their chances of pregnancy were often inaccurate and were more influenced by their own expectations than by the consultant's view. There was no overall correlation between anxiety or depression and estimation of achieving a pregnancy. The clinical implications of these findings are discussed.

Adult↗
PubMed1995

Suicide and AIDS: lessons from a case note audit in London.

There is growing evidence that HIV infection and AIDS have an impact on a range of suicidal issues. The literature lacks clarity and the subject is traditionally problematic to research. True prevalence is often difficult to gauge and many researchers focus simply on death by suicide rather than exploring the extreme mental health burden brought about by suicidal thoughts, attempts, completions and bereavement. This study was set up to explore the nature and extent of problems in an unselected cohort of psychology clinic attenders (n = 188) in a London centre comprising 11% females and 89% males. For the cohort 21.4% had a suicide attempt recorded, 1 individual (0.5% of the sample) died by suicide and the level of suicidal ideation (both clear and vague) was noted for 50.5% of the sample. Suicidal issues were noted in 11.9% of referral letters from doctors. HIV seems to add an additional suicidal burden to this group where 43.9% attempted prior to HIV diagnosis, 41.5% after HIV diagnosis and 14.6% had attempts both pre- and post-diagnosis. The most common means involved overdosing. HIV related issues were often involved in triggers as was bereavement. There was a bimodal distribution of suicidal acts according to diagnosis with peaks at or around diagnosis and again at end stage illness. The data are discussed in terms of prevention, intervention and postvention with specific focus on the need to anticipate the mental health needs of people with HIV and AIDS as well as of their carers.

Acquired Immunodeficiency Syndrome↗