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Volume 3, Number 14
7 April 2003
FAMILY PLANNING / REPRODUCTIVE HEALTH RESEARCH
The Female Condom: Attitudes and Experiences Among HIV-positive Heterosexual Women and Men (PubMed abstract)
This study describes attitudes toward and experiences with the female condom of 89 HIV-positive individuals (n = 56 women; n = 33 men) reporting heterosexual behavior. Most respondents (n = 78) had seen or heard of the female condom. However, relatively few (n = 14 women; n = 5 men) had used it at least once. Reactions from both women and men across user groups, regardless of experience with the female condom, centered around aesthetics, difficulties with the male condom, male partner reaction, beliefs about efficacy, and lack of training, indicating the need for comprehensive education efforts targeting both technical use and communication skills-building.
Structural Integrity of the Polyurethane Female Condom after Multiple Cycles of Disinfection, Washing, Drying and Relubrication (research abstract)
This study assessed the effect of the disinfection, washing, drying, and relubrication on the properties of the female condom. Samples from three batches of female condoms were subjected to seven treatment cycles before being tested for structural integrity. Some minor changes in properties were seen but these were not considered important. There was evidence of a small increase in the number of condoms with holes following repeated disinfection and washing cycles, suggesting that excessive or rough handling can damage the condom.
Traditional Healers and the Management of Sexually Transmitted Diseases in Nairobi, Kenya (research abstract)
In-depth interviews were held with 16 healers (seven witchdoctors, five herbalists, and four spiritual healers) in four slum areas in Nairobi, Kenya. All healers believed that STDs are sexually transmitted and recognized the main symptoms. Thirteen healers gave advice on sexual abstinence during treatment, 11 on contact treatment, four on faithfulness and three on condom use. All healers asked patients to return for review and 13 reported referring patients whose conditions persist to public or private health care facilities. Results indicate a role for traditional healers in STD management especially with regards to promotion of condoms and faithfulness.
Progestogen-only Emergency Contraception and Ectopic Pregnancy (editorial)
Reviews and discusses evidence linking POEC contraceptives and ectopic pregnancy.
Infertility in Central Africa (research abstract)
This study determines the prevalence and risk factors of primary and secondary infertility in Cameroon, Chad, Central African Republic, and Gabon. Primary infertility was approximated by the percentage of women childless after at least 5 years of marriage. The percentage with no birth at least 5 years subsequent to a previous birth was considered to have secondary infertility. Primary infertility ranged from 6.9% to 3.1% and secondary infertility for women aged 20 to 44 years ranged from 26.5% to 18.9%. Women married more than once vs. only once and formerly married women vs. women living with their husbands had higher odds of primary and secondary infertility. Also, younger cohorts had relatively higher risks of primary (born after 1970) and secondary infertility (born after 1960) compared with women born before 1960.
Effects of Oral Contraceptive Use on Body Mass Index and Blood Pressure Among Female Villagers in Northeast Thailand (PubMed abstract)
Based on field investigations of 391 married women aged 20 years or over in Northeast Thailand, this study elucidated the effects of oral contraceptive use on body mass index (BMI: kg/m2) and blood pressure, taking into account reproductive histories and socioeconomic conditions. Current contraceptive practices in the studied population included sterilization by operation, oral contraception, and injection. These methods accounted for 43.0%, 12.8% and 8.2% of the population, respectively. Oral contraceptive users had significantly higher BMIs and diastolic blood pressures (p<0.01, ANOVA with age adjustment). Multiple regression analysis also revealed that oral contraceptive use was a weak but significant contributing factor to both high BMI and blood pressure when sociodemographic factors were taken into account and controlled for.
FAMILY PLANNING / REPRODUCTIVE HEALTH NEWS
Computer Could Predict Fertile Days (news article)
A computer could help older women with erratic menstrual cycles predict the days on which they are most likely to fall pregnant.
Slovakia: Plans to Raise Awareness of Family Planning (news article)
DEPUTY Prime Minister Pál Csáky has promised to raise awareness of family planning among Roma communities, and to intensify training of health workers in reproductive health.
Contraception Myths Come Undone (news article)
Professor John Guillebaud, Emeritus Professor of Family Planning and Reproductive Health and Medical Director of the Margaret Pyke Centre, London, was in Mumbai, India recently. He answered several myths that surround contraception.
FAMILY PLANNING / REPRODUCTIVE HEALTH LAW AND POLICY
HIV/AIDS Legislation Advances in US House of Representatives (news article)
The House International Relations Committee approved a $15 billion bill known as the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, acting on what Chairman Henry Hyde called "one of the great moral challenges of our era."
UNFPA Expresses Concern Over Decline in Resources for Population, Reproductive Health (news article)
UNFPA has expressed concern that the world has dropped further behind its Cairo Conference commitment to invest $17 billion a year on population and reproductive health by the year 2000, after preliminary data put the amount provided in 2001 at about $9.4 billion, down from some $11.2 billion in 2000.
Church Schools India HIV Victims (news article)
Two HIV-positive orphan children in India have begun attending a Bible class at the local church after being continually forced out of community schools over the past two years. The two children have become symbols of the social exclusion faced by people who have AIDS or are HIV positive in India.
HIV in Insurgency Forces in Sub-saharan Africa: A Personal View of Policies (research abstract)
This article addresses the special requirements for HIV-prevention programmes by armed forces or insurgency groups in very poor countries that are in active conflict.
HIV / AIDS RESEARCH
Interventions to Modify Sexual Risk Behaviors for Preventing HIV Infection in Men Who Have Sex with Men (Cochrane review)
This paper reviews electronic databases, current journals, manuscript bibliographies, and other published reviews from 1988 to 1997 for studies that examined the effects of behavioral interventions to reduce risk for HIV or STD transmission. Thirtenn eligible studies were identified. Twelve of these (7 trials of small group interventions, 3 community-level interventions, and 2 individual level interventions) reported intervention effects on unprotected sex. A summary measure of intervention effects on reducing unprotected sex was favorable (odds ratio = 0.73) and statistically significant corresponding to a 23% reduction in the proportion of men engaging in unprotected sex.
Let It Be Sexual: How Health Care Transmission of AIDS in Africa was Ignored (research abstract)
The authors examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. According to the authors, evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures.
High Risk Behaviour and Fertility Desires Among Heterosexual HIV-positive Patients with a Serodiscordant Partner: Two Challenging Issues 
(research article)
The article describes a multicentre study to evaluate fertility intentions and condom use among HIV-positive persons in Switzerland. 45% of HIV-positive women and 38% of HIV-positive men expressed the desire for children. Irrespective of this wish, half the study participants felt that health care providers would not sufficiently address their concerns regarding relationship, sexuality, and fertility intentions. In HIV-discordant heterosexual couples, consistent condom use was mentioned by 73% of respondents. Among study participants, no significant relationship between HAART, viral load, and inconsistent condom use was found.
Barriers to HAART Adherence Among Human Immunodeficiency Virus-infected Adolescents (research abstract)
Structured interviews were conducted in 13 US cities to determine the barriers associated with adherence to highly active antiretrovial therapy (HAART). Principal component factor analysis was performed on scores of the 19 barrier variables. Viral load was significantly associated with self-report of adherence to HAART (P = .02). Only 28.3% of adolescents reported taking all of their prescribed antiretroviral medications in the previous month. Factor analysis of the barriers to adherence indicates that the largest proportion of the variance is attributable to medication-related adverse effects and complications in day-to-day routines.
HIV / AIDS NEWS
Philippines Sits on HIV Time Bomb (feature article)
While the government claims the epidemic has passed the Philippines by, the actual magnitude may be much greater, according to a new book.
Spur for Anti-HIV Cream (news article)
The Gates Foundation has pledged US$60 million to help spur the development of a cream women could use to protect themselves from the virus.
HIV in Pregnant Women in UK: Still Failing to Meet Diagnosis Targets (news article)
Latest figures show that during the first six months of 2002, England was still failing to reach government set targets to diagnose 80% of HIV infections in pregnant women prior to delivery.
Southern Africa: New Challenge of HIV/AIDS in Humanitarian Crises (news article)
In a humanitarian emergency, HIV/AIDS prevention and reproductive rights are not likely to be seen as a priority. But Africa's refugees and displaced persons face the prospect of a life of poverty, powerlessness, and social instability: conditions that increase their vulnerability to HIV/AIDS.
India: Condoms in PDS Shops to Prevent AIDS (news article)
As part of the campaign to prevent and control HIV/AIDS, the Tamil Nadu State AIDS Control Society would make arrangements to distribute condoms in all the PDS shops in the state.
MATERNAL AND CHILD HEALTH RESEARCH
Traditional Postpartum Practices Among Thai Women (research abstract)
This descriptive study surveyed 500 Thai women living in Ubon Ratchathani, Thailand, and attending their first postpartum hospital clinic. The majority of Thai women adhered to traditional postpartum practices related to the notion of regaining 'heat', avoiding the wind, and sexual abstinence. Younger, less educated, primiparous women were more likely to report traditional practices. Health professionals need to be aware of clients' culture and consider the extent to which professional care complements the mothers' traditional beliefs.
The Relationship Between Abuse, Sexually Transmitted Diseases, & Group B Streptococcus in Childbearing Women (research abstract)
This paper describes results of a retrospective chart review (n = 205) from two different clinical sites in Washington State, US, using the Childbearing Health Questionnaire to guide data collection. Thirty-eight percent of women (n = 78) reported experiencing physical and/or sexual abuse during their lifetimes and 31% had been diagnosed with an STD. Abuse was significantly related to STDs, and ethnicity emerged as a significant variable for the Hispanic women in this study. Findings indicated that infection with group B Streptococcus was also related to abuse status and to presence of herpes simplex virus-2. Total prevalence of STDs was positively related to abuse.
Domestic Abuse in Pregnancy: Results from a Phone Survey in Northern Israel (research article)
Information regarding demographic data, interaction with the partner, and reporting of physical abuse was collected by means of a standardized questionnaire administered via phone to 270 women seeking gynecologic care at centers in northern Israel. Psychological abuse was found to be the most prevalent (24%), followed by minor and severe physical attack (17% and 8.1%, respectively), and sexual coercion (5.6%). Physical attacks related to pregnancy (directed at the abdomen) occurred in 5.4% of the pregnant women.
Does the Interaction between Maternal Folate Intake and the Methylenetetrahydrofolate Reductase Polymorphisms Affect the Risk of Cleft Lip with or without Cleft Palate? (research abstract)
Related news article: Folate-Rich Diet May Cut Cleft Palate Risk
Women who have certain variations in a folate-processing gene are at greater risk of having a child with a cleft lip or palate, but the risk is increased only if women do not consume enough folic acid in pregnancy.
MATERNAL AND CHILD HEALTH NEWS
Uganda: MP Appeals to Mothers to Attend Antenatal Clinics (news article)
The district woman MP has appealed to pregnant mothers in the area to attend antenatal clinics as a measure to reduce on maternal and infant mortality rate.
UK Doctors Advised on Ethics of Circumcision (news article)
The British Medical Association issued new circumcision guidelines in an effort to help doctors negotiate the ethics of what it calls an increasingly controversial area. The guidance says there is significant disagreement about whether circumcision is beneficial, harmful or neutral when it comes to boys' health, and that parents have the right to make choices about what is in their child's best interest.
MEN'S HEALTH RESEARCH
Rectal Use of Nonoxynol-9 Among Men Who have Sex with Men (research abstract)
The objective of this research was to assess recent rectal use of nonoxynol-9 (N-9), intent to use the product, and factors associated with N-9 use among men who have sex with men (MSM). The study revealed that 61% (349/573) had heard of N-9, of which 55% (192/349) reported hearing in the prior year that N-9 may not be protective against HIV. Many MSM used N-9 during or following public health warnings about the product. Actions (eg, information campaigns, warning labels specific to rectal use) should be considered by communities to reduce rectal use of N-9.
Obesity in Relation to Prostate Cancer Risk: Comparison with a Population having Benign Prostatic Hyperplasia (research abstract)
Related news article: Obese Men Show Increased Risk of Prostate Cancer
Obese men may be more than twice as likely to develop prostate cancer as those who are less overweight, reports this French study. Efforts to tackle obesity would probably also reduce the incidence of prostate cancer, which has steadily increased among men in developed countries.
POPULATION RESEARCH
Tempo-Quantum and Period-Cohort Interplay in Fertility Changes in Europe. Evidence from the Czech Republic, Italy, the Netherlands and Sweden (research article)
Using detailed data on period and cohort fertility in four European countries, this paper discusses various indicators of period fertility, including indicators adjusted for changes in fertility timing. Empirical analysis focuses on the comparison of cohort fertility and corresponding indicators of period fertility; particular attention is paid to the periods of intensive postponement of childbearing. Some period indicators come consistently closer to the completed cohort fertility than the total fertility rates. This pattern of differential period-cohort approximation widely varies by birth order.
Chinese SF-36 Health Survey: Translation, Cultural Adaptation, Validation, and Normalisation (research abstract)
The aim of this study was to develop a self-administered Chinese version of the Short-Form Health Survey (SF-36) for use in health related quality of life measurements in China. Protocols included translation, tests of scaling construction and scoring assumptions, validation, and normalisation. Convergent validity and discriminant validity were satisfactory for all except the social functioning scale. The clustering and ordering of item means was the same as that of the source and other two Chinese versions. This study suggested that the Chinese version of the SF-36 functioned in the general population of Hangzhou, China, quite similarly to the original American population tested.
POPULATION NEWS
Malawian Women 'Too' Fertile (news article)
Malawian women's high fertility rate averaging 6.3 children per woman is among the factors contributing to high population rise despite the government's interventions to balance population growth and available resources.
Southern Africa: Society Reconsiders Polygamy (news article)
Polygamy is an age-old African custom that is being reconsidered throughout the traditional and largely impoverished nations of southern Africa, but current times of poor economies and social uncertainties have kept the practice of multiple-wives a reality for millions of largely rural women. Surveys in Swaziland, where polygamy is legal, have shown that multiple sex partners have increased HIV-infection rates.
Peshawar: Need Urged to Control Population (news article)
Speakers at a seminar in Pakistan urged people to put brakes on the burgeoning population to help check the growth of lethal diseases taking a heavy toll on children because of the lack of resources. Some 50 million children are born every year in Pakistan, of whom 85 die in every 1,000 births before reaching the age of one year, while 116 succumb to death before attaining the age of 5 years.
WOMEN'S HEALTH RESEARCH
Sexual Functioning Among HIV-Infected Women (research abstract)
This descriptive study examined sexual activity, sexual functioning, and safer sex behavior among 101 HIV-seropositive women. Results indicated that (1) the majority of women continue to be sexually active after testing HIV positive, (2) sexual functioning does not change as a result of HIV disease progression, and (3) few women report that HIV itself caused worsening of their sexual functioning.
Attitudes Towards Pelvic Examination and Chaperones: a Questionnaire Survey of Patients and Providers (research abstract)
Most professional organizations recommend the presence of a chaperone for every pelvic examination. In family-planning clinics, usually staffed predominantly by women, the provision of a chaperone for every pelvic examination is a burden to the efficient running of clinics and may not be necessary. Views about pelvic examinations and chaperones were sought from 1000 women attending a family-planning clinic and 98 health-care professionals. The majority of women (59%) do not mind being examined, and most women do not particularly want a chaperone when the examiner is female. One-third of women (34%) actively object to a chaperone. The study recommends that chaperones should be offered to, but not required for, women undergoing pelvic examination. Providers should not be deterred from doing pelvic examinations if they are clinically indicated, in the mistaken belief that women will object.
Cross Sectional Study of Conventional Cervical Smear, Monolayer Cytology, and Human Papillomavirus DNA Testing for Cervical Cancer Screening (research abstract)
Related news article: Smear 'Best Cancer Test'
The traditional smear test is more reliable than a newer screening technique, researchers suggest.
The Effect of a Levonorgestrel-releasing Intrauterine Device in the Treatment of Myoma-related Menorrhagia (research abstract)
In this open observational study conducted in Italy, the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUD) was evaluated in the treatment of myoma-related menorrhagia. The study demonstrated the clinical reduced effectiveness of LNG-IUD in the treatment of myoma-related menorrhagia.
WOMEN'S HEALTH NEWS
FDA Approves Expanded Use of HPV Test (press release)
The Food and Drug Administration approved expanded use of a laboratory test to detect the presence in women of human papillomavirus, one of the most common sexually transmitted infections.
Breast Cancer Drug Could Help 2 Million+ (news article)
The drug tamoxifen could help prevent breast cancer in more than 2 million American women, although not without risk of contracting other health problems.
Study: Pill Use May Raise Cervical Cancer Risk (news article)
Women who take the birth control pill could be increasing their risk of cervical cancer, scientists warned on Friday.
Female Circumsicion: Arrests Rarely Made in US (news article)
The case of an Ethiopian man accused of circumcising his 2-year-old daughter with a pair of scissors is one of a handful of such arrests in the United States. Opponents of female circumcision say the arrest may strike a powerful blow against the centuries-old practice of female circumcision. The procedure is illegal in the United States and has been condemned by the United Nations.
Rights Groups Say Roma Illegally Sterilized (feature article)
Three scrawled crosses on a hospital form ended Zita's dream of a big family. Zita's case is typical of a widespread policy of coercive sterilization of Romany, or Gypsy, women in Slovakia. Many Romany women are extremely vulnerable because they're poorly educated and have no concept of their legal rights.
Bangladesh: Rape, Trafficking (editorial)
The editorial writer points out the deficincies in the Women and Children Repression Act of 2000; rape, domestic abuse, and trafficking in women and children are going on unabated.
Related press release: Bangladesh: Violence Against Women on the Rise
Violence towards women is rising by 14%. Everyday around 10 women are violated and 37 women and children are repressed in various forms, according to a recent study by Bangladesh Mahila Parishad.
YOUTH RESEARCH
HIV Prevention in Latin America: Reaching Youth in Colombia (PubMed abstract)
This paper describes and evaluates a school-based peer education program on HIV primary prevention implemented in urban marginal districts of three cities of Colombia from 1997 to 1999. The intervention targeted adolescents 10 to 19 years of age, and secondary school teachers of 6th to 9th grades. Main strategies used were peer education and classroom sessions conducted by trained teachers. Short-term results suggest that the program had a positive effect on knowledge and attitudes related to HIV/AIDS (the mean knowledge summary indicator among adolescents and secondary school teachers increased 24% and 21%, respectively).
Sexual Health Experiences of Adolescents in Three Ghanaian Towns (research article)
Interviews on sexual health issues were conducted with 704 never-married youth aged 12-24 in three Ghanaian towns. More than half of the respondents had ever had sexual intercourse (52%). Nearly all respondents (99%) knew of condoms, but fewer than half (48%) could identify any of four elements of correct use. Two-thirds of respondents considered it unacceptable for males to carry condoms, and three-quarters considered it unacceptable for females. Twenty-five percent of males and 8% of females reported having had a sexually transmitted infection. One-third of sexually experienced females reported having ever been pregnant; of those, 70% reported having had or having attempted to have an abortion. Both sexes tended to accept violence towards women.
Sexual Initiation Among Adolescent Girls and Boys: Trends and Differentials in Sub-saharan Africa (PubMed abstract)
Data were drawn from Demographic and Health Surveys in 8 countries that had at least 2 surveys conducted, each with distinct questionnaires for women and men of reproductive age regardless of marital status. Multivariate logistic models were used to consider the probability of a young man or woman having first intercourse during adolescence. In some countries, observed declines over time in the proportion of adolescents having had sex were not statistically significant after adjusting for background characteristics. Important gender differentials were also found. While secondary schooling was associated with lower probability of early sex among girls in all countries, the relationship was often in the opposite direction among boys.
YOUTH NEWS
Meanwhile: Young Girls in Africa Cornered by AIDS (news article)
The strikingly higher infection rates among adolescent girls compared to boys in Zambia and many other parts of Africa reveal a disturbing trend: the AIDS epidemic is being fueled by the abuse and subordination of young women.
BOOKS / BOOK REVIEWS
State of the World 2003: Progress Towards a Sustainable Society (book)
Published annually in 28 languages, State of the World is relied upon by national governments, UN agencies, lawmakers, teachers and professionals for its accurate and up-to-the-minute analysis and information. Each year's volume synthesizes developments in the natural and social sciences, in markets and in policy instruments, and describes how they will interact with the ecosystems on which our social fabric depends documenting the challenges and the grounds for hope.
PROFILES / SPECIAL REPORTS / RESOURCES
Participatory Learning and Action: Ethiopia Project Shows How a Participatory Process with Youth can Help Shape National Policy (report)
To begin planning its program, the new Ethiopian Ministry of Youth, Sports, and Culture turned to an approach called participatory learning and action, or PLA. Officials involved young people throughout the country in a learning and planning process for the Ministry. The youth developed a national youth charter and a 3-year action plan to mobilize youth for improved sexual health and HIV/AIDS preventive behavior. Plus, the process led to the creation of a dynamic network of young people committed to the health and future of the country.
CONTINUOUS IDENTIFICATION OF RESEARCH EVIDENCE RELATED TO FAMILY PLANNING GUIDANCE
New evidence has been identified that is directly related to guidance provided in the Medical Eligibility Criteria for Contraceptive Use (MEC) or the Selected Practice Recommendations for Contraceptive Use (SPR). Identification begins with screening of new articles entered into the POPLINE database, with further review for relevance to the WHO guidance. This new evidence will be monitored on an on-going basis by WHO and will be evaluated at future WHO expert meetings to update the MEC and SPR.
_________________________________________________
Barbosa IC, Ladipo OA, de Lourdes M, Nascimento P, and Athayde C. Carbohydrate metabolism in sickle cell patients using a subdermal implant containing nomegestrol acetate (Uniplant). Contraception. 2001;63:263-5
Findings in this article have been found relevant to WHO Method: Levonorgestrel Implants and Condition: Sickle cell disease
Link to CIRE Evidence | Link to POPLINE Record
_________________________________________________Barbosa IC, Ladipo OA, de Lourdes M, Nascimento P, and Athayde C. Carbohydrate metabolism in sickle cell patients using a subdermal implant containing nomegestrol acetate (Uniplant). Contraception. 2001;63:263-5
Findings in this article have been found relevant to WHO Method: Etonorgestrel Implants and Condition: Sickle cell disease
Link to CIRE Evidence | Link to POPLINE Record
_________________________________________________Harrison-Woolrych M, Ashton J, and Coulter D. Insertion of the Multiload Cu375 intrauterine device; experience in over 16,000 New Zealand women. Contraception. 2002 Dec;66(6):387-391
Findings in this article have been found relevant to WHO Method: Copper IUD and Condition: Parity
Link to CIRE Evidence | Link to POPLINE Record
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