Current issues in the midwifery management of women living with HIV/AIDS

Changes in the clinical management of women living with human immunodeficie ncy virus (HIV) have occurred as a result of significant gains in the scien tific knowledge of this retrovirus. As the incidence of HIV/AIDS continues to escalate among female adults and adolescents in the United States, all p rimary health care providers must anticipate the likelihood of encountering clients with HIV infection. Midwives must be adequately prepared to meet t he challenges of managing women with HIV in the early stages of the disease . This article presents a comprehensive review of current demographic trend s related to the HIV/AIDS epidemic among U.S. women and a brief overview of the essential immunopathogenesis of HIV. Contemporary issues related to un iversal counseling, updated testing procedures, and reproductive decision-m aking are covered. Initial primary care concerns and the management of newl y infected seropositive women are included, with a focus on gynecologic iss ues. Guidance in the current management of HIV-positive pregnant women is o ffered. Updated antiretroviral prophylaxis recommendations are presented, t o prevent perinatal transmission and to delay maternal immunosuppression wi th subsequent opportunistic infections. The article concludes with implicat ions for health care professionals who provide care for this unique cohort of women. (C) 1998 by the American College of Nurse-Midwives.