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By Q. Abbas. Gustavus Adolphus College, Saint Peter, Minnesota.

Individuals with HIV infection often bear the additional stress of the stigma Psychosocial Issues in HIV/AIDS and fear associated with the disease oxytrol 2.5mg mastercard, both of which can lead to rejection and aban- Distress and preoccupation with illness donment by others generic 2.5mg oxytrol with visa. Feelings of depression cheap oxytrol 5mg with mastercard, and imminent death may characterize despair, and hopelessness are common. Coping Individuals may also experience consider- with a diagnosis of HIV and the changes able anger. There may be anger and the disease precipitates can be both phys- resentment toward the society-imposed ically and mentally exhausting (Bower & isolation that hampers HIV-infected indi- Collins, 2000). Individuals with HIV infec- viduals in their efforts to obtain social sup- tion face an even more grim realization port and, at times, even the medical care that, to date, no one with later stages of afforded to individuals with other life- HIV infection has survived. Individuals who Individuals infected with HIV are con- have become infected with HIV through fronted with ongoing stressful situations medical treatment, such as blood transfu- involving noxious symptoms, treatment sions, may experience additional anger at with unpleasant side effects, periods of contracting the disease as “innocent vic- physical disability, potential loss of em- tims. They may find activities or social the individual or individuals from whom interactions at school, work, and social they contracted the disease. The social stigma attached to the viduals’ past behavior or lifestyle, they condition may be particularly overwhelm- may also experience guilt and self-incrim- ing and traumatic if family and friends ination. Individuals ment, and fear of imminent painful death with HIV infection are often left with lit- can lead to self-destructive behaviors, in- tle social support at a time when they cluding attempted suicide. Support groups, although als whose families and friends had not beneficial in many chronic diseases, are been aware of their lifestyle, exposure may even more important for individuals with result in increased anxiety and fear of HIV infection. In other instances, HIV- infected individuals may experience guilt Vocational Issues in HIV/AIDS because of the fear that they have been the source of contagion to others. Maintaining vocational roles despite There may need to be a balance between significant health issues is important in periods of activity and rest to avoid be- meeting individuals’ emotional as well as coming too fatigued. A moderate, regular economic needs (Lynch Fesko, 2001; program of exercise can help individuals McReynolds, 2001). With the advent of with HIV infection maintain optimal new therapies to treat HIV and the asso- emotional as well as physical health. As ciated increase in life expectancy for the condition progresses and stamina some, individuals with HIV may also gain decreases, they may need to modify their a more positive outlook. Individuals in the later stages of functional capacity and longevity, how- HIV infection often need assistance with ever, many individuals living with everyday activities, including at first HIV/AIDS remain unemployed or lose housekeeping chores and later extending their jobs (Glenn, Ford, Moore, & Hollar, to personal care. Barriers to returning to or main- The social effects of HIV infection are as taining employment are numerous and varied as the symptoms associated with require motivation and commitment to the condition. HIV infection is a disease overcome (Maticka-Tyndale, Adam, & that many fear and perceive as shrouded Cohen, 2002). Many social implications of Many psychosocial, financial, medical, HIV infection are related to this fear and and legal factors affect individuals’ abili- misunderstanding. Others avoid indi- or not they should continue to work viduals with HIV infection because they (Nixon & Renwick, 2003). Contextual fac- fear contagion and are not aware of the tors, such as disability and health insur- actual modes of transmission. Such soci- ance or drug plans, often influence etal concepts can result in ostracism and individuals’ decision (Ferrier & Lavis, discrimination against individuals with 2003). The components of a complete most serious impediments to successful blood count include the following: functioning in the workplace are the fear, • Red blood cell count: measurement of discrimination, and prejudice that they the total number of red blood cells in encounter. Many individuals who are HIV a cubic millimeter of blood positive encounter discrimination at work, • White blood cell count: measurement of and as a result they may withdraw from the total number of white blood cells the workplace altogether (Hunt, Jaques, in a cubic millimeter of blood Niles, & Wiezalis, 2003). Individuals with • Differential: measurement of the pro- HIV frequently fear that they will lose portion of each type of white blood their jobs as a result of their diagnosis, re- cell (i.

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The early detection of breast can- Pelvic inflammatory disease (PID) is a general term for inflamma- cer is important because the prognosis worsens as the disease tion of the female reproductive organs within the pelvis discount oxytrol 5 mg. If the mammogram suggests breast cancer purchase oxytrol 5mg free shipping, a through the vagina during coitus oxytrol 2.5 mg line, induced abortion, or childbirth. The surgical treatment for breast cancer is generally cause of the acidity of the vaginal secretions. A simple mastectomy is ever, localized infections and inflammations do occur. These are removal of the entire breast but not the underlying lymph nodes. The symptoms breast, the lymphatic drainage, and perhaps the pectoralis major of vaginitis are a discharge of pus (leukorrhea) and itching (pruri- muscle. The two most common organisms that cause vaginitis are the the pectoralis major muscle is always removed, as well as the pec- protozoan Trichomonas vaginalis and the fungus Candida albicans. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 21 Female Reproductive System 749 (a) (b) FIGURE 21. These contraceptives usually consist of a people, but the popularity of this technique has declined as more synthetic estrogen combined with a synthetic progesterone in successful methods of contraception have been introduced the form of pills that are taken once each day for 3 weeks after (fig. In the rhythm method, an attempt is made to pre- the last day of a menstrual period. This procedure causes an im- dict the day of the woman’s ovulation and restrict coitus to safe mediate increase in blood levels of ovarian steroids (from the times of the cycle that allow no chance for fertilization to occur. As a result of negative feedback inhibition of gonadotrophin temperature or by a change in mucous discharge from the vagina. The entire cycle is like a false This technique has one of the highest failure rates of any of the luteal phase, with high levels of progesterone and estrogen and widely used birth control methods, largely because women’s cy- low levels of gonadotrophins. Because the contraceptive pills contain ovarian steroid More popular methods of birth control include sterilization, hormones, the endometrium proliferates and becomes secretory, oral contraceptives, intrauterine devices (IUDs), and barrier just as it does during a normal cycle. In order to prevent an ab- methods—including condoms for the male and female and di- normal growth of the endometrium, women stop taking the pill aphragms for the female. This causes estrogen and progesterone levels to they vary with respect to safety,side effects,and degree of efficacy. The contraceptive pill is Sterilization techniques include vasectomy for the male and an extremely effective method of birth control, but it does have tubal ligation for the female. In the latter technique (which ac- potentially serious side effects—including an increased incidence counts for over 60% of sterilization procedures performed in the of thromboembolism and cardiovascular disorders. This is analo- pointed out, however, that the mortality risk associated with gous to the procedure performed on the ductus deferentia in a contraceptive pills is still much lower than the risk of death from vasectomy. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 750 Unit 7 Reproduction and Development (a) (b) (c) (d) (e) (f) (g) (h) FIGURE 21. Female Reproductive © The McGraw−Hill Anatomy, Sixth Edition Development System Companies, 2001 Chapter 21 Female Reproductive System 751 Another way in which to deliver hormonal contraceptives signed to resist moisture, the patch releases a week’s worth of es- to a woman’s body is by means of a subdermal implant. They that fits into the uterine cavity where it slowly releases progestin are implanted just under the skin, usually on the upper arm, up to a five-year period. The contraceptive hormone gradually tives have fewer side effects than Depro-Provera, which has been leaches out through the walls of the rods and enters the blood- available since 1992. Intrauterine devices (IUDs) do not prevent ovulation, but instead prevent implantation of the blastocyst in the uterine wall in the event that fertilization occurs. The mechanisms by which their contraceptive effects are produced are not well un- Clinical Case Study Answer derstood but appear to involve their ability to cause inflamma- An ectopic pregnancy is any pregnancy that implants outside the uterine tory reactions in the uterus. Because The events leading up to our patient’s problem are as follows: An oocyte of the potential problems with IUDs, their use has diminished.

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