Since the beginning of the US epidemic, more and more women are being afflicted with HIV. Women appear to be more vulnerable to HIV due to the high concentration of the virus in the semen of their male partners (Trzynka and Erlen, 2004, p. 1). It is significant to note that women also tend to suffer most from the disease. An HIV-positive woman not only has to endure the torture of waiting for her death but she also has to suffer damage to her childbearing and nurturing roles. Studies show that women can pass HIV to a child in the womb or at birth. Hence they are rejected by society and often are blamed for the disease.
When women are blamed for HIV, it has been found that they are also exposed to greater levels of abuse within and outside the family context by being deprived of their rights and dignity. They may be assaulted at home or abandoned by their families (Trzynka and Erlen, 2004, p. 5).
HIV women are thus forced to endure extreme discrimination along with heavy domestic responsibilities. They also face barriers in getting care, treatment, and support for HIV or even get tested. Thesis: Women’s unequal social, economic, and legal status is increased by a positive HIV status and in order to ensure that they get proper treatment, nurse providers must take into consideration their physical, psychological, social, and legal problems and make treatment more of a collaborative effort along with the family of the HIV positive woman.
Physical and developmental issues
Women with HIV are often found to have different signs and symptoms of disease than their male counterparts. They are less likely to be afflicted with Kaposi’s sarcoma, hairy leukoplakia, or pneumocycstic carinii pneumonia, but they are likely to suffer from severe gynecologic problems (Trzynka and Erlen, 2004, p. 2). Some of the gynecologic issues that HIV positive women may suffer from are: “mucocutaneous herpes simplex, candida vaginitis, esophageal candiditis, genital warts, toxoplasmosis, lymphadenopathy, extrapulmonary tuberculosis, pelvic inflammatory disease, cervical cancer, and anemia” (Trzynka and Erlen, 2004, p. 2).
The early manifestations of HIV are flu-like symptoms such as general fatigue, fever, and sore throat. However, women who carry a lot of responsibilities at work and home often ignore these symptoms. When treatment is delayed, the disease worsens, the individual’s CD-4 count decreases steadily and as a result the risk of opportunistic infections increases (Abercrombie, 2003, p. 41-54) (cited in Trzynka and Erlen, 2004). Many HIV-positive women are also found to become anemic and as a result, suffer from fatigue and weakness. Studies show that women, particularly if they are African American or Latina, or poor, are less likely to receive highly active antiretroviral therapy (HAART).
Ann B. Williams (2006) in her study has reviewed the gynecologic conditions found among women with HIV. The most prevalent problems are “vulvovaginal candidiasis and cervical dysplasia along with other sexually transmitted diseases, pelvic inflammatory disease, genital ulcer disease, and menstrual abnormalities” (Williams, 2006). Hudson et al (2004) list prevalent symptoms of women with HIV as “depression (83%), muscle aches (84%), weakness (80%), and painful joints (71%)” Hudson et al, 2004, p. 9-23).
Symptoms of greatest intensity were found to be “headaches, rash, insomnia, vaginal itching, and shortness of breath at rest” (Hudson et al, 2004, p. 9-23). The study also held HIV symptoms predicted the way the woman could carry out her roles as mother and wife (Hudson et al, 2004). HIV-positive mothers who were also depressed did not look after their infants well (Cho et al, 2008, p. 58-70).
In their study titled “Correlates of Perceived Health in Women Diagnosed with HIV Disease” (2003), Kirksey et al cite the finding that women with symptomatic HIV disease had to endure psychosocial problems as well. They worried about financial problems, their family, and the extent of their disease. They also had reduced energy to carry out their daily activities and suffered often from pain. The study also found that married women were more susceptible to be affected by psychosocial issues over time (Kirksey et al, 2003, p. 1).
Studies indicate that 1% to 25% of both men and women with HIV suffer from depression and has been often linked to the diagnosis of HIV, feelings of guilt and self-blame for past behaviors, low self-image, and low confidence regarding the future (Trzynka and Erlen, 2004, p. 6). Studies suggest that the extremely high incidence of drug and alcohol abuse found in persons with HIV places this group at an even greater risk for depression
On the developmental side, it is interesting to note that nearly 80% of women currently infected with HIV are of childbearing age. These women are faced with the difficult choice of whether or not to have biological children (McCreary et al, 2003, p. 41). This affects their self-image as a woman.
Community or societal issues
HIV is widely known to spread through heterosexual contact and in a male-dominated society, the woman with HIV suffers a lot of stigma in relationships with others (Sandelowski et al, 2004, p.122-128). Society has an irrational fear of HIV disease and when people know that a particular individual has HIV, they react irrationally, without much compassion or sympathy. And because of this stigma and fear, the disease isolates the person socially and affects all his relationships. Society’s treatment of the disease also has financial consequences they are likely to lose their job and health insurance.
Legal and ethical considerations
Wolf et al in their study titled “Legal Barriers to Implementing Recommendations for Universal, Routine Prenatal HIV Testing” have said that laws often hinder treatment and prevention of HIV in women. It has been found that if women and infants with HIV were given antiretroviral therapy at the right times, HIV transmission from mother to child could be less. This requires that pregnant women must know if they are HIV infected or not. Taking this into consideration, a 1999 Institute of Medicine (IOM) panel recommended that all pregnant women should undergo universal HIV testing (Wolf et al, 2004).
This recommendation was endorsed by The American College of Obstetrics and Gynecology (ACOG), the American Academy of Pediatrics (AAP), and the Centers for Disease Control and Prevention (CDC). However, in order that a woman may be tested prenatally for HIV requires her consent for pretest counseling about HIV. Almost all states have laws that address HIV testing. Rhode Island state law requires pretest counseling to be customized to the client’s requirements and include a personal plan of action to reduce the risk of HIV (Wolf et al, 2004). In New York, the state law requires women to be screened for domestic violence during HIV pre-test counseling.
The majority of states require that there should be informed consent for HIV testing. Maryland and California are the only states to have statutes that offer protection for women undergoing prenatal HIV testing. (Wolf et al, 2004, p. 137). Three of the states allow that the information be passed on to a spouse or sex partner at the discretion of the physician but then, the HIV-positive woman should be informed first. States also have laws that protect patients generally from discrimination based on HIV testing. Several states prohibit denial of care on the basis of HIV test results. Additional protection may be available under general laws, such as the federal Americans with Disabilities Act of 1990 (ADA) and state disability statutes (Wolf et al, 2004, p. 137). The U.S. Supreme Court determined that asymptomatic HIV infection can be considered to be a disability under the ADA. (Wolf et al, 2004).
ADA and state disability laws may not provide adequate protection to HIV women because they do not prohibit actions that cause harm to HIV-infected persons but rather they aim at taking action after an alleged act of discrimination has already occurred. These laws still may not provide sufficient protection for HIV women. Wolf et al recommend that states must provide protection for pregnant women who undergo universal prenatal HIV tests by ensuring there is no denial of care based on the test result, that the results are treated as confidential information, and not used against the woman for legal purposes (Wolf et al, 2004, p. 137).
Nursing care requirement to empower the vulnerable individual and family
The nursing process of assessment, planning, implementation, and evaluation serves can be used as a framework while designing a healthcare plan for HIV women. (Trzynka and Erlen, 2004, p. 7). Basically, the nurse should be respected by the patient and share mutual trust. This requires a conscious commitment from the HIV woman being treated as well as a supportive collaborative relationship with family and care providers. HAART or Highly Active Anti Retroviral Therapy is the best available treatment for HIV. Women have unique barriers in adhering to their treatment schedules. It can cause numerous side effects in women such as “chronic diarrhea, hyperlipidemia, abnormal fat distribution, weight changes, fatigue, anemia, and peripheral neuropathy” (Trzynka and Erlen, 2004, p. 4).
Hence, it is important that women are given details regarding their medicines and their possible side effects. Moreover, it has been found that treatment is most effective when it is offered along with positive social support from others. During the planning phase, the nursing provider must design a realistic plan of care that includes social support, nutrition, and psychiatric assessment. The plan should also consider external issues that the woman may have such as transportation. During the implementation process, the individual must be kept well informed of her treatment module. There must be continuous evaluation during the treatment process keeping in mind that it is important for nurses to have a positive relationship with the patient.
The nurse must be flexible in her approach. In short, Sue Lehman Trzynka and Judith A. Erlen (2004) make the following suggestions for nursing providers: see HIV positive women as valuable human beings; give them good information about the disease and its treatment using HAART; ensure that they receive adequate care including psychotherapy; and help them build supportive. They should also help out with childcare issues or transportation if HIV women face such problems. While nursing may not be able to address all of these issues directly, Trzynka and Erlen (2004) suggest that it is possible for nursing to ensure effective treatment for HIV women by giving them adequate information and ensuring they have support at the community level.
Abercrombie, P.D. (2003). Factors affecting abnormal pap smear follow-up among HIV-infected women. Journal of the Association of Nurses in AIDS Care, Volume 14, Issue 3. p. 41-54.
Cho, June; Davis-Holditch, Diane and Miles, S. Margaret (2008). Effects of Maternal Depressive Symptoms and Infant Gender on the Interactions Between Mothers and Their Medically At-Risk Infants. Journal of Obstetric, Gynecologic and Neonatal Nursing, Volume 37, Issue 1, P. 58-70. Web.
Hudson, Angela; Kirksey, Kenn and Holzemer, William (2004). The Influence of Symptoms on Quality of Life among HIV-Infected Women. Western Journal of Nursing Research, Volume 26, Issue 1, p. 9-23. Web.
Kirksey, M. Kenn; Hamilton, Jane Mary and Holt-Ashley, Mary (2003). Correlates of Perceived Health in Women Diagnosed with HIV Disease: The Internet Journal of Advanced Nursing Practice; Volume 5, Number 2. Web.
McCreary, L. Linda; Ferrer, M. Lilian; Ilagan, R. Perla; Ungerleider, S. Linda (2003). Context-Based Advocacy for HIV-Positive Women Making Reproductive Decisions. Journal of the Association of Nurses in AIDS Care, Volume 14, Issue 1. p. 41-51. Web.
Sandelowski, Margarete; Lambe, Camille; and Barroso, Julie (2004). Stigma in HIV-positive Women. Journal of Nursing Scholarship, Volume 36, Issue 2, P, 122-128. Web.
Trzynka, Lehman Sue and Erlen, A. Judith (2004). HIV disease susceptibility in women and the barriers to adherence. MedSurg Nursing. Web.
Williams, B. Ann (2006). Gynecologic Care for Women With HIV Infection. Journal of Obstetric, Gynecologic and Neonatal Nursing, Volume 32, Issue 1, p. 87-93. Web.
Wolf, E. Leslie; Lo, Bernard; Gostin, O. Lawrence (2004). Legal Barriers to Implementing Recommendations for Universal, Routine Prenatal HIV Testing. Journal of Law, Medicine & Ethics, Volume 32, Issue 1, p. 137+.