Pregnancies in perinatally HIV-infected young women and implications for care and service programs.

A cohort of individuals with perinatally acquired HIV is maturing into reproductive age. This study describes pregnancy incidence and outcomes among females ages 15-25 with perinatally acquired HIV infection receiving comprehensive family-centered services in New York City. Chart reviews from 1998-2006 indicated 33 pregnancies among 96 young women. Twenty-six percent of the cohort experienced a pregnancy during the study period, with a rate of 125 per 1,000 person years in 2006. The age of first pregnancy ranged from 15-25; 24% were younger than 18. Fourteen pregnancies (42%) were terminated. Nineteen pregnancies resulted in live births, and all infants tested negative for HIV. The success of preventing vertical HIV transmission is attributed to interdisciplinary family-centered services, including reproductive health education, family planning, obstetric-gynecologic services and psychosocial support. Such approach is most likely to be effective at promoting healthy reproductive decisions and reducing morbidity in perinatally infected mothers and their children.

Advances in violence and trauma: toward comprehensive ecological models.

The most important things learned about violence and trauma in the past 20 years are that interpersonal violence is prevalent, with different forms co-occurring, and that victims' reactions are complex. Researchers are called to consider models that include the ecological context within which victims experience violence and trauma to gain a better understanding of the variation seen in psychological outcomes. Multivariate data-analytic techniques such as structural equation modeling and cluster analysis are suggested as promising ways to explore questions framed by comprehensive models. These recommendations are predicted to provide comprehensive and individualized ways to intervene and prevent interpersonal violence.