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Volume 3, Number 20
19 May 2003
FAMILY PLANNING / REPRODUCTIVE HEALTH RESEARCH
Frustrated Demand for Postpartum Female Sterilization in Brazil (research abstract)
This paper focuses on women's sterilization intentions during pregnancy and their experiences postpartum. In a prospective study of 1612 pregnant women carried out in four Brazilian cities, there was substantial demand for postpartum sterilization in both the private and public sectors among women who wanted no more children. However, public patients were much less likely to be sterilized than private patients. The authors conclude that a new law may not have reduced inequities in access or, paradoxically, the incentive for unnecessary cesarean sections.
Survey of IUD Replacing Status in Sichuan, PR China (research abstract)
Questionnaires were completed and IUDs were inspected through ultrasound among 12,804 subjects of 15 counties who had had an IUD inserted between 1994 and 1998. The insertion rate of the copper-bearing IUD was 42.1%, in a gradually increasing trend. Some factors, such as lower pregnancy rate, lower expulsion rate, and easy removal, etc., contributed to copper-bearing IUD use. On the other hand, other factors like longer contraception period, lower side effects and lower cost contributed to inert IUD use.
Pathways to Evidence-based Reproductive Healthcare in Developing Countries (research abstract)
This study aimed to obtain primary descriptive data about access to and application of reproductive health-related medical knowledge in developing countries. In India and Yemen, 41 doctors working in obstetrics, gynecology, general practice, and family planning services were interviewed. A theory-driven approach was conducted to carry out thematic analysis. The researchers found that doctors felt the need to update their knowledge but this was not always achieved due to time and financial constraints. Alternative knowledge sources were described, including the Internet, scientific meetings, medical family networks, and specialty medical societies, but access to these was limited by the expense of equipment, unfamiliarity with the technology, and restricted advertisement of scientific meetings and conferences. The authors recommend that priorities should be to identify needs specific to different countries and medical settings in the developing world, provide access for all to full text journals, and identify educational activities that fully engage practitioners in the early stages of their careers.
Genital Mycoplasmas in Women Attending a Family Planning Clinic in Guine-Bissau and Their Susceptibility to Antimicrobial Agents (research abstract)
This study determined the prevalence of genital mycoplasmas and their susceptibility to the most common antimicrobial agents used for treating the infection; 94 women attending a family planning clinic in Guine-Bissau were included. Fifty-four women (57.4%) tested positive for Mycoplasma hominis and/or Ureaplasma urealyticum. M. hominis and U. urealyticum separately isolated from infected women yielded frequencies of 31.5% and 27.8%, respectively; the remainder were infected with both species. No strain was found to be resistant to all three commonly employed antibiotics for the management of these infections (erythromycin, tetracycline, and ofloxacin), although multiple resistance to two antibiotics was frequent, especially when both genital mycoplasmas were present. The high prevalence of genital mycoplasmas in women attending a family planning clinic in Guine-Bissau, as demonstrated in this study, appears to be associated with trichomonosis and bacterial vaginosis.
Women's Preferences for Vaginal Antimicrobial Contraceptives: Attitudes of Brazilian Women to the Insertion of Vaginal Products (research abstract)
In many cultures, women do not readily accept touching their genitals or inserting products into their vaginas. Information on this subject was collected during a study involving 635 women in Brazil to determine the preferred attributes of vaginal products. The researchers found that 76% would use an idealized contraceptive method that offered dual protection even though it could only be inserted with a finger, and 96% would use this method if it could only be placed with an applicator. Qualitative analyses of responses to open questions suggest that the majority of Brazilian women studied did not like to touch their vagina with their finger or to insert devices.
Human Herpesvirus 8 Infection within Families in Rural Tanzania (research abstract)
The authors studied the distribution of HHV-8 within families in rural Tanzania to determine routes of spread. The prevalence increased from 3.7% (1/27) among infants to 58.1% (36/62) among children aged 3 to 4 years and 89% (65/73) among adults more than 45 years old. Women with HHV-8 seropositive husbands had a 7-fold risk for infection (odds ratio [OR], 6.9). HHV-8 seropositivity in children was associated with having at least 1 seropositive first-degree relative (OR, 14.7).
FAMILY PLANNING /REPRODUCTIVE HEALTH NEWS
Condom Use Has Hit Plateau in Germany (news article)
A report from Germany's Federal Center for Health Education (BZgA) showed that the proportion of single Germans who use condoms plateaued around 1996. The report revealed that the use of condoms in "risky situations," which had been increasing for several years, was also stable in 2002.
Tajikistan: Family-Planning Initiative Meets with Mixed Response (news article)-
In Soviet times, Tajik women were encouraged to have as many children as possible. Today, however, the government and other organizations are supporting family-planning initiatives focusing on the health of the mother and families' financial well-being.
FAMILY PLANNING /REPRODUCTIVE HEALTH LAW AND POLICY
Senate Passes AIDS Measure for Africa (news article)
The Senate passed a $15 billion bill to stem the spread of AIDS in Africa, with a third of the prevention funds earmarked for programs that stress sexual abstinence. While much of the debate centered on whether to promote abstinence, a novel provision to teach feminism to African men passed without dissent.
Beyond Abstinence (commentary)
The author, from Uganda, argues that the AIDS success story in his country is more complex than has been portrayed in Washington.
Malaysia: Guide to Protect Workers' Health (news article)
The government has launched guidelines to evaluate and monitor potential hazards at the workplace that can lead to reproductive disorders among workers.
African Ambassadors in the United States Support Emergency HIV/AIDS Plan (news article)
The African Ambassadors and the entire African Diplomatic Corps in the United States are united in their efforts to highlight the urgency for action against the impending menace of HIV/AIDS.
HIV/AIDS RESEARCH
Doubting the Existence of AIDS: A Barrier to Voluntary HIV Testing and Counselling in Urban Mali (research abstract)
Qualitative research was carried out in the Malian cities of Sikasso and Bamako with a view to setting up HIV voluntary testing and counselling (VCT) services and a separate program to enable young people to improve their sexual health. The most striking finding was that a large number of respondents said they did not believe in the existence of AIDS. Reasons for disbelief were related to the perceived lack of AIDS cases in China, the inability of the virus to be transmitted by mosquitoes, and confusion about mother-to-child transmission. Highly educated individuals were very skeptical of the existence of the illness, thinking it to be a Western plot to encourage condom use in order to halt the growth of the African population. Respondents thought it likely that this skepticism will limit the use of VCT services. Other reasons for the potential non-use of services included the fact that some people lacked confidence in the competence of the laboratory technicians and were afraid that those testing positive would be highly stigmatized by the community.
HIV and AIDS-related Stigma and Discrimination: A Conceptual Framework and Implications for Action (research abstract)
This paper offers a new framework by which to understand HIV and AIDS-related stigma and its effects and the limitations encountered in individualistic modes of stigma alleviation.
The Impact of Gender and Pregnancy on Antiretroviral Therapy for HIV: Pharmacokinetic and Disease-Related Differences (research article)
This article discusses gender differentials in pharmacokinetics of HAART and changes in drug metabolism in pregnancy.
Randomized, Controlled Evaluation of a Prototype Informed Consent Process for HIV Vaccine Efficacy Trials (research abstract)
A prototype informed consent process was evaluated among 4,892 persons at high risk for HIV infection in the HIV Network for Prevention Trials Vaccine Preparedness Study (VPS). Twenty percent of VPS participants were selected at random to undergo the prototype informed consent process at VPS month 3. Participants' knowledge of 10 key HIV vaccine trial concepts and willingness to participate in HIV vaccine efficacy trials were assessed and compared at baseline and semiannually thereafter for 18 months. Knowledge of HIV vaccine trial concepts was low at baseline. Participation in the prototype process was associated with substantial and sustained increases in knowledge (relative risks for the 10 items, 1.04-2.26), which were of similar magnitude across HIV risk groups, race/ethnicity, and educational levels. It is recommended that the prototype informed consent process be adopted for future HIV vaccine efficacy trials.
Access to HIV Prevention: Closing the Gap 
(report)
Related news article: Report: Billions Needed to Prevent AIDS Now, Study Finds
Only one in five of those most in danger of AIDS infection know anything about how to protect themselves because less than half of what is needed is being spent on prevention, a report issued by the Global HIV Prevention Working Group said.
Related news article: Developing Countries Lead in HIV Prevention Funding
Developed nations, including the United States, donated less money than developing countries for prevention of the AIDS-causing virus worldwide last year. The Global HIV Prevention Working Group estimated that developed governments gave $780 million while developing countries, the world's poorer nations, donated $782 million.
New Strategies for Increasing the Detection of HIV: Analysis of Routine Data (research article)
This article describes a new HIV testing protocol, developed after new recommendations that all people attending genitourinary medicine clinics should be offered an HIV test on their first screening for sexually transmitted infection.
Risk Factors for Pediatric Human Immunodeficiency Virus-Related Malignancy (research abstract)
Forty-three case patients with a new malignancy and 74 control patients without a malignancy were matched based on the duration of their infection. Clinical and laboratory factors assessed as putative risk factors included demographic characteristics, HIV characteristics, prior antiretroviral treatment, and CD4 cell count. Epstein-Barr virus viral load of more than 50 viral genome copies per 105 peripheral blood mononuclear cells was strongly associated with cancer risk but only for children with CD4 cell counts of at least 200/µL (odds ratio [OR], 11.33). Zidovudine antiretroviral therapy did not confer a significant protective effect for either the high (OR, 0.81; 95% CI, 0.22-3.09; P = .77) or the low CD4 cell count groups (OR, 0.27; 95% CI, 0.04-1.46; P = .16). The route of HIV infection was not associated with increased cancer risk.
The Mitochondriotoxic Domain of Vpr Determines HIV-1 Virulence (commentary)
Related research article: Vpr R77Q is Associated with Long-term Nonprogressive HIV Infection and Impaired Induction of Apoptosis
Related news article: Viral Protein Explains Why Some HIV+ Stay Healthy
A group of Canadian and US scientists reported Thursday that people who stay healthy even years after infection with HIV are more likely than other HIV-positive people to be infected with virus that has an alteration in a particular protein. The finding offers another possible explanation why a small number of people with HIV never develop AIDS, and points toward new therapies that might prevent the progression of HIV in other patients, as well.
HIV/AIDS NEWS
As AIDS Ravages Caribbean, Governments Confront Denial (news article)
While the sheer scale of Africa's epidemic has tended to overshadow the problem here, health experts and political leaders warn of the potential for devastation in a region of small, image-conscious countries that depend on a limited pool of labor and resources, as well as tourism. Some 40,000 adults and children in the Caribbean are believed to have died of the disease in 2001 alone, and it is already the leading cause of death among young men.
FDA Panel Backs Bristol-Myers Anti-HIV Drug (news article)
A US advisory panel unanimously backed Bristol-Myers Squibb Co.'s experimental drug Reyataz, the first once-a-day protease inhibitor, for use with other drugs to treat HIV. The Food and Drug Administration will consider the panel's recommendation. The agency usually approves drugs supported by its advisory panels.
Zambia: Kavindele Woos Italian Investors to Start Manufacturing HIV/AIDS Drugs (news article)
Vice President Enoch Kavindele is expected to woo Italian investors in the pharmaceutical industry to start manufacturing HIV/AIDS drugs.
MATERNAL AND CHILD HEALTH RESEARCH
The Risk of Maternal Nutritional Depletion and Poor Outcomes Increases in Early or Closely Spaced Pregnancies (research abstract)
This article discusses the possible repercussions of maternal nutritional deficiencies and the preventive role of supplementation.
Prevalence of Night Blindness Amongst Pregnant Woman of Urban Slum Communities in Delhi: A Pilot Study (letter)
This study was conducted in a hospital amongst pregnant women (PW) of II and III trimester attending an antenatal clinic in New Delhi. Night blindness (NB) was assessed by administering a pre-tested semi-structured questionnaire on the presence of symptoms of NB. From 10% of the randomly selected PW included in the study, the dietary intake for Energy, Protein and Vitamin A was assessed using the 24 hour dietary recall method. Prevalence of NB amongst PW was 4.8%. Nearly 2.7% of PW reported NB also during their previous pregnancy. Results on dietary intake showed that 57% of the PW were consuming less than 50% of Vitamin A as compared to their RDA.
Infant Feeding Practices of HIV-Positive Mothers in India (research abstract)
This study assessed factors that influence the infant feeding decisions of HIV-infected mothers in Pune, India. HIV-positive (HIV+) pregnant women from a government hospital antenatal clinic were interviewed prepartum about infant feeding intention, feeding practice immediately postpartum, and feeding after a minimum of 2 weeks postpartum. The authors found that an equal number of HIV+ women intended to breast-feed (44%) or give "top milk" (44%) (diluted animal milk). Women who chose to top feed were also more likely to disclose their HIV status to family members. The hospital counselor had an important role in assisting women in their intended feeding choice as well as actual practice.
Intimate Partner Violence and Adverse Pregnancy Outcomes: A Population-based Study (research abstract)
The authors measured the prevalence of exposure to intimate partner violence and fear of a partner during pregnancy among 4750 women in Vancouver, British Columbia who gave birth between January 1999 and December 2000 and examined the associations with second- or third-trimester hemorrhage, preterm labor and delivery, intrauterine growth restriction, and perinatal death. There was prevalence rate of 1.2% for exposure to physical violence by an intimate partner in this population. Physical violence was associated with an increased risk of antepartum hemorrhage (adjusted odds ratio [OR]: 3.79), intrauterine growth restriction (OR: 3.06) and perinatal death (OR: 8.06). Fear of a partner in the absence of physical violence was not associated with an elevated risk of adverse pregnancy outcomes.
Prevalence of Breastfeeding in the United States: The 2001 National Immunization Survey (research abstract)
Related news article: US Moms Stop Breastfeeding Too Soon
During the last decade, more and more new mothers in the US have started breastfeeding their babies, but most new moms stop sooner than health experts would like, health officials report.
MATERNAL AND CHILD HEALTH NEWS
Ethiopia: Alone and Ashamed (editorial)
This editorial describes Ethiopia's "Fistula Hospital" and the magnitude of the fistula problem in Africa.
Mercury Baby Fears Eased (news article)
Babies' brain development is unlikely to be impaired by exposure to mercury found in contaminated fish while they are still in the womb, research suggests.
Ghana: Maternal Death Rate Skyrockets in Western Region (news article)
A survey revealed that in the Wassa West district alone, 500 mothers in every 100,000 live births given die because hospitals and clinics lack equipment and medical consumables needed to manage obstetric complications.
MEN'SHEALTH RESEARCH
Shifts in Condom Use Following Microbicide Introduction: Should We Be Concerned? (research abstract)
This study estimated the reduction in condom use that can be tolerated following the introduction of an HIV- and sexually transmitted disease (STD)-efficacious microbicide without increasing an individual's risk of HIV infection, and explored how microbicide use affects HIV risk. The study concluded that there are likely to be many situations in which the benefits of microbicide use outweigh the negative impact of condom migration and where microbicides could substantially reduce HIV-risk.
Does Male Age Affect the Risk of Spontaneous Abortion? An Approach Using Semiparametric Regression (research abstract)
Related news article: Miscarriage More Likely with Older Father: Report
Researchers have long known that older women are more likely to have a miscarriage, and now new research suggests that a man's age may also affect the risk, too. European researchers discovered that 25-year-old women were more than twice as likely to have a miscarriage if their partners were at least 35 at the time of pregnancy than if their partners were younger than 35.
POPULATION RESEARCH
Estimating the Prevalence of Breast Cancer Using a Disease Model: Data Problems and Trends (research abstract)
This study compared the extent to which trends and known quantitative data of disease epidemiology affect model outcome for breast cancer. The authors calculated breast cancer prevalence from Dutch incidence and mortality data and compared this to regionally available prevalence data; they found a large discrepancy between calculated and prevalence data, which could be explained for 60% by the limitations of the prevalence data plus the trend in incidence. The study concluded that IPM models can be useful both for checking data inconsistencies and for supplementing incomplete data, but their results should be interpreted with caution. Unknown data problems and trends may affect the outcome and, in the absence of additional data, expert opinion is the only available judge.
Monitoring Health Inequalities: Life Expectancy and Small Area Deprivation in New Zealand (research abstract)
This paper measures life expectancy by socioeconomic deprivation and ethnicity and describes trends in the deprivation gradient in life expectancy since the mid-1990s in New Zealand.
Infant Mortality Rate as an Indicator of Population Health (research abstract)
This Australian study rebuts the criticism of the use of infant mortality rate (IMR) as a measure of population health for being narrowly based, and the use of more comprehensive measures such as disability adjusted life expectancy (DALE) as alternatives. The authors studied data from 180 countries and found that there was a strong (generally) linear association between DALE and IMR (r=0.91). This led them to conclude that there was little evidence that the use of IMR as a measure of population health has a negative impact on older groups in the population; and that IMR remained an important indicator of health for whole populations, reflecting the intuition that structural factors affecting the health of entire populations have an impact on the mortality rate of infants. For countries with limited resources that require an easily calculated, pithy measure of population health, IMR remains a suitable choice.
POPULATION NEWS
UAE: Population Up 7.6% (news article)
The UAE population surged by 7.6% to nearly 3.75 million at the end of 2002, and males remained the dominant force in the demographic structure, accounting for more than double the number of females, according to official statistics.
Asia Strained by Ageing Population (news article)
One estimate is that by the year 2050, Asia will be home to almost two-thirds of the world's population of people over 60 and many will age in poverty. Due to longer life expectancies and falling birth rates, Asia is rapidly getting older.
Italy May Give Cash in Bid to Boost Birth Rate (news article)
Italy is considering giving couples a bonus of £1,665 for every new child in a bid to boost the falling birth rate.
WOMEN'S HEALTH RESEARCH
Influences of Hormone Replacement Therapy on Postmenopausal Women's Health Perceptions (research abstract)
The objective of this study was to assess the beliefs of climacteric women regarding their health, menopause, and Hormone Replacement Therapy (HRT). Medical students interviewed 500 healthy women about their beliefs and perceptions regarding their quality of life and health risks, as well as their opinions on menopause and HRT. The study concluded that women believe that menopause deteriorates their health. The HRT users perceived themselves to be healthier and to have a smaller risk for cardiovascular disease.
Eligibility and Willingness of Young Icelandic Women to Participate in a HPV Vaccination Trial (research abstract)
The aim of this study was to analyze the eligibility and willingness of 18-23-year-old Icelandic women to participate in a vaccination trial to prevent Human Papilloma Virus (HPV) infection and to assess knowledge of HPV. A questionnaire on demographics, HPV knowledge, sexual behavior, attitude towards HPV vaccination, and other health-related issues was mailed to 300 women aged 18-23 years randomly selected by date of birth from the total population living in the Capital area of Reykjavík. 96% of the respondents reported having had sexual debut; knowledge of HPV infections and associated diseases was limited. Although 60% of the respondents were willing to participate in a HPV vaccination trial, the eligibility rate for the invited women was estimated to be approximately 13%. The study concluded that Icelandic women between 18 and 23 years of age have a sexual behavior profile and lifestyle that may decrease their eligibility in future prophylactic HPV vaccine trials. Improved education about HPV infection and its consequences is needed.
WOMEN'S HEALTH NEWS
What Works, Doesn't Work for Painful Sex Condition (news article)
A survey of more than 2,500 women with a chronic vaginal pain condition called vulvodynia suggests that not all available treatments are equally good at easing symptoms. Asked to indicate which treatments helped, more than half of the survey respondents said their pain was somewhat eased by physical therapy, a special diet that restricts a naturally occurring substance called oxalate, surgery, and antidepressants used to treat pain.
YOUTH RESEARCH
Sexual Function, Sexual Abuse and Sexually Transmitted Diseases in Adolescence (research abstract)
As adolescents attempt to develop intimate sexual relationships, they may be at high risk for health consequences associated with sexual activity, such as pregnancy and sexually transmitted diseases (STDs). Providers, such as physicians, nurse practitioners, physician assistants and nurses, must know current STD diagnosis and treatment recommendations to decrease morbidity caused by these infections. By knowing how to interview, understanding legal issues, and anticipating concerns pertinent to teens, providers have the opportunity to decrease barriers to health care for adolescents.
Unplanned Teenage Pregnancy (research abstract)
This article explores the meaning of a rights-based approach to teenage sexual and reproductive health and examines its implementation in the provision of sexuality, education, and health services.
Preventing Sexual Risk Behaviors and Pregnancy Among Teenagers: Linking Research and Programs (commentary)
This study suggests ways in which research and programs could work in a more integrated and collaborative fashion.
YOUTH NEWS
Wales: Condom Card Seen as Key to Contraception and Better Sexual Health (news article)
As part of National Condom Week, teenagers in some of the most deprived communities were introduced to a "Condom Card" scheme designed to promote the use of contraception.
More than Half of British Teens Prefer One-night Stands (news article)
A new survey has found that above 50 per cent of British teenagers below the age group of 16 have admitted to have gone for one-night stands and one in 10 without any contraception.
PROFILES / SPECIAL REPORTS / RESOURCES
American Cancer Society Guidelines for Breast Cancer Screening: Update 2003 (research abstract)
Related news article: New Breast Cancer Guidelines Downplay Self-exams
Women no longer need to worry about doing a monthly self-exam, but should concentrate on getting professional screening under new US breast cancer screening guidelines issued recently.
Contraceptive Fact Sheets (2003 edition) (resource)
This durable 16-page booklet covers the full range of contraceptive methods, providing information on donor, manufacturer, and brand specifications as well as shelf lives and storage and packaging requirements.
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