摘要
Background: Globally, not only are people living longer withthe Human Immunodeficiency Virus (HIV), but there is also a significant increase in older individuals becoming infected.Menopause symptoms affect women’s health status and have been associated with decreased quality of life, impaired work performance, limitations in physical functioningand perceived declines in health status. This study aimed to assess and compare the menopause symptom experience and perceived health status among HIV positive and negative older women in Ibadan Nigeria
Methods: Focus group discussions were conducted among menopausal women attending the ARV and General Outpatient clinics at the University College Hospital Ibadan, Nigeria with the use of a focus group discussion guide. Opinions of discussants on knowledge and experience of menopausal symptoms, perceived health status, perceptions about the menopause and the different coping strategies were explored. Ten focus group discussions were conducted among women aged 40 and 60 years in the two groups, with the average number of discussants in each FGD group being 12.Data were analyzed thematically.
Results: A total of 90 HIV positive and 92 HIV negative women aged between 40 to 60 years were sampled. While all the women were aware of what menopause is, knowledge of the cause of menopause was inadequate in both groups with more HIV positive women opining that sexual promiscuity causes menopause. The majority of the discussants had adequate knowledge of menopausal symptoms with most of them reporting hot flashes and body aches. In both groups, perceptions of women to the menopause include freedom from sexual activity and child birth.More HIV positive women had perceptions of poor health status compared to HIV negative women as the majority of them reported frequent hospital visits.
Conclusions: Menopause symptom experience appears to be similar among HIV positive and negative women, however, women with HIV infection reported perceptions of poor health status. Knowledge of the cause of menopause was inadequate in both groups, hence there’s a need for health education and health promoting interventions that will help these women in coping with the double burden of HIV infection and menopause.
Keywords: Menopause, perceived health status, HIV, older women
Résumé
Contexte: À l’échelle mondiale, non seulement les gens vivent plus longtemps avec le virus de l’immunodéficience humaine (VIH), mais il y a aussi une augmentation significative du nombre de personnes âgées infectées. Les symptômes de la ménopause affectent l’état de santé des femmes et ont été associés à une diminution de la qualité de vie, à une performance au travail altérée, à des limitations du fonctionnement physique et à une dégradation perçue de l’état de santé. Cette étude visait à évaluer et à comparer l’expérience des symptômes de la ménopause et l’état de santé perçu chez les femmes âgées séropositives et négatives à Ibadan au Nigéria.
Méthodes: Des groupes de discussions focus ont été menés parmi les femmes ménopausées fréquentant les cliniques ARV et ambulatoires générales du Collège Hospitalier Universitaire d’Ibadan, au Nigéria, à l’aide d’un guide de groupe de discussion focus. Les opinions des intervenantes sur la connaissance et l’expérience des symptômes de la ménopause, l’état de santé perçu, les perceptions de la ménopause et les différentes stratégies d’adaptation ont été explorées. Dix discussions de groupe de discussion ont été menées parmi des femmes âgées de 40 et 60 ans dans les deux groupes, le nombre moyen de participants dans chaque groupe de discussion étant de 12. Les données ont été analysées thématiquement.
Résultats: Un total de 90 femmes séropositives et 92 séronégatives âgées de 40 à 60 ans ont été échantillonnées. Alors que toutes les femmes savaient ce qu’est la ménopause, la connaissance de la cause de la ménopause était inadéquate dans les deux groupes, avec plus de femmes séropositives étant d’avis que la promiscuité sexuelle entraîne la ménopause. La majorité des participantes avaient une connaissance adéquate des symptômes de la ménopause, la plupart signalant des bouffées de chaleur et des courbatures. Dans les deux groupes, les perceptions des femmes à l’égard de la ménopause incluent l’absence d’activité sexuelle et l’accouchement. Un plus grand nombre de femmes séropositives avaient des perceptions de mauvais état de santé par rapport aux femmes séronégatives, la majorité d’entre elles ayant déclaré de fréquentes visites à l’hôpital.
Conclusions: L’expérience de symptôme de la ménopause semble être similaire chez les femmes séropositives et négatives, cependant, les femmes infectées par le VIH ont signalé des perceptions d’un mauvais état de santé. La connaissance de la cause de la ménopause était insuffisante dans les deux groupes, d’où la nécessité d’une éducation sanitaire et d’interventions de promotion de la santé qui aideront ces femmes à faire face au double fardeau de l’infection à VIH et de la ménopause.
Mots clés: Ménopause, état de santé perçu, VIH, femmes âgées
Correspondence: Dr. Olubukola C. Omobowale, Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan. +2348023416855; mumsyfemo@yahoo.com
参考
North American Menopause Society. Clinical challenges of perimenopause: Consensus opinion of the North American Menopause Society. Menopause. 2000;7:5-13.
National Population Commission. Nigerian population priority tables. Population ditribution by age and sex. [database on the Internet]2010. Available from: http://www.population.gov.ng/factsandfigures.htm. Accessed January 28, 2013.
Palella FJ, Delaney KM and Moorman AC. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. New England Journal of Medicine. 1998;338:853-860.
Hacker MA, Petersen ML, Enriquez M and Bastos FI. Highly active antiretroviral therapy in Brazil: the challenge of universal access in a context of social inequality. Rev Panam Salud Publica. 2004;16:78/83.
National Agency for the Control of AIDS, (NACA), Factsheet 2011: Women, Girls and HIV in Nigeria [database on the Internet]2011 [cited 28 January, 2013].
Blu¨mel JE, Castelo-Branco C, Binfa L, et al. Quality of life after the menopause: a population study. Maturitas 2000;34:17-23.
Conde DM, Pinto-Neto AM, Santos-Sa D, Costa-Paiva L and Martinez EZ. Factors associated with quality of life in a cohort of postmenopausal women. Gynecol Endocrinol 2006;22:441-446.
Beers MH, Fletcher AJ, Jones TV, et al. In The Merck Manual of Medical Information. New Jersey2004. Available from: http://www.merck.com/mmhe/sec22/ch243/ch243a.
Fouzia R Memon, Leon Jonker, Roshan A Qazi Knowledge, attitudes and perceptions towards menopause among highly educated Asian women in their midlife. Post Reproductive Health 2014. 20, (4) 138-14269.
Anolue FC, Dike E, Adogu P and Ebirim C. Women’s experience of menopause in rural communities in Orlu, Eastern Nigeria. International Journal of Gynecology and Obstetrics. 2012;118:31-33.
Morrison LA, Brown DE, Sievert LL, et al. Voices from the Hilo Women’s Health Study: talking story about menopause.Health Care Women Int. 2014 May; 35(5):529-48. doi: 10.1080/07399332.2013.829067. Epub 2013
von Muhlen DG, Kritz- Silverstein D and Barret-Connor E A community-based study of menopause symptoms and estrogen replacement in older women. Maturitas. 1995 22 (2): 71-78
Hvas L. Menopausal women’s positive experience of growing older. Maturitas . 2006; 54 (3) 245-251
Njoku Ola Ama and Enock Ngome. Menopausal Perceptions and Experiences of Older Women from Selected Sites in BotswanaAdvances in Sexual Medicine Vol. 3 No. 3 (2013) , Article ID: 34135 , 13 pagesDOI:10.4236/asm.2013.33009
Loutfy I, Abdel Aziz F, Dabbous NI and Hassan MH Women’s perception and experience of menopause: a community-based study in Alexandria, Egypt. East Mediterr Health J. 2006; 12 Suppl 2:S9-106
Jurgenson JR, Jones EK, Haynes E, Green C and Thompson SC.Exploring Australian Aboriginal women’s experiences of menopause: a descriptive study. BMC Womens Health. 2014 Mar 20; 14(1): 47. doi: 10.1186/1472-6874-14-47.
Fantry LE, Zhan M, Taylor GH, Sill AM and Flaws JA. Age of menopause and menopausal symptoms in HIV-infected women AIDS Patient Care STDS 2005;19:703-711.
Maki PM, Rubin LH, Cohen M, et al. Depressive symptoms are increased in the early perimenopausal stage in ethnically diverse human immunodeficiency virus-infected and human immunodeficiency virus-uninfected women Menopause. 2012 Nov; 19 (11): 121523.10
Martins D, Nelson K, Pan D, Tareen N and Norris K. The effect of gender on age-related blood pressure changes and the prevalence of isolated systolic hypertension among older adults: data from NHANES III.J GendSpecif Med. 2001; 4: 10–13,
Reckelhoff JF and Fortepiani LA. Novel mechanisms responsible for postmenopausal hypertension. Hypertension. 2004; 43: 918–923.
Weiss NS. Relationship of menopause to serum cholesterol and arterial blood pressure: The United States’ Health Examination Survey of adults. Am J Epidemiol. 1972; 96: 237–241.
Staessen J, Bulpitt CJ, Fagard R, Lijnen P and Amery A. The influence of menopause on blood pressure. J Hum Hypertens. 1989; 3: 427–433.
Omobowale O.C and Owoaje E.T. Sociocultural beliefs and sexual activity among postmenopausal women in an urban community in Ibadan, Nigeria. African Journal of Medicine and medical sciences. 2017 Vol. 46 (3) 283-289
Ledésert B, Ringa V and Bréart G. Menopause and perceived health status among the women of the French GAZEL cohort.Maturitas. 1994 Dec;20(2-3):113-20.
Zhu Y, Wu J, Feng X, et al. Patient characteristics and perceived health status of individuals with HIV and tuberculosis coinfection in Guangxi, China. Medicine (Baltimore). 2017 Apr;96(14):6475
Minji Kang, MD and Lori E. Fantry Menopause in HIV-Infected Women Journal of Clinical Outcomes Management. 2016 January;23(1)