《艾滋病毒感染者性与生殖健康管理指南》内容预览

The incidence and prevalence of HIV infections continue to rise in the UK12. Due to theeffectiveness of HIV treatment regimens there are now an increasing number of HIV positiveindividuals, living well, on suppressive antiretroviral treatment3.More attention is thus beinggiven to the wider health needs of People living with HIV/AIDS (PLHA) including a renewedfocus on sexual and reproductive health (SRH) needs.
Men, who have sex with men (MSM)and culturally diverse heterosexual populations fromsub Saharan African, account for large proportions of people living with HIV and accessingtreatment and care services in the UK. It is recognised that any guidance on SRH mustconsider the diversity of needs of those living with HIV despite sometimes there being limitedaccess to the specialised services required.PLHA have the right to protect their own health and to enjoy meaningful sexual relationships,and reproductive health. These rights come with responsibilities however: in particular, toavoid passing infections on to others.
A number of key SRH issues for PLHA have been documented in the literature:There have been several outbreaks of infectious syphilis and gonorrhoea in HIV positiveMSM4 5as well as an outbreak of Lymphogranuloma venereum more recently.6It is welldocumented that HIV progression and transmission is increased and facilitated by STIs.7 8Some groups have questioned whether the availability of HAART has resulted in an increasein unsafe sexual behaviour in some men who have sex with men9.
More positive women are choosing to have children10and an increasing number of coupleswho request fertility investigations and assisted conception. Couples that are either seroconcordant (both HIV positive) or sero discordant clearly require different clinicalmanagement strategiesIn recent years there has been a fall in the prevalence of transmitted drug resistance in theUK from 16% in 2002 to 9% in 200411. This still suggests that there is transmission thatoccurs from individuals taking HIV drug therapy who would therefore know of their infection,there is a need to develop health prevention messages and sexual health services forpositive people. It should be remembered however that most HIV transmission occurs incircumstances when individuals do not know their own status.

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