The Pop Reporter®
– Events – Archives – Subscribe – Modify Profile – Headline Sharing Program – The Pop Reporter en Espaņol (Spanish)
Volume 3, Number 27
7 July 2003
GUEST COMMENTARY
Contraception and HIV Acquisition in Rakai, Uganda
by Ronald H. Gray, BSc, MB <rgray@jhsph.edu>
There has been concern that hormonal contraceptives (the pill and injectable), may be associated with increased risk of HIV acquisition in women. This concern arises from epidemiologic studies, mainly conducted among high-risk women, such as commercial sex workers, which did not carefully adjust for sexual risk behaviors. The results of these studies are inconsistent and difficult to interpret. However, if these hormonal methods put women at risk of HIV, it could undermine family planning programs, particularly in sub-Saharan Africa countries most seriously affected by the HIV/AIDS epidemic.
To address this question, researchers in Rakai, Uganda, assessed HIV incidence in women using the pill or Depo-Provera, compared to women using no family modern planning methods.(1) In this population, 18.8% of women reported use a hormonal method, and HIV incidence was 2.3 per 100 women years (wy) among hormonal users, compared with 1.5 per 100 wy in non-hormonal users. This difference was of borderline statistical significance. However, women using hormonal contraception had more high-risk sexual behaviors. For example, they reported more sexual partners and more genital ulceration than women not using hormonal methods. These higher risk behaviors could confound the apparent association between contraception and HIV acquisition, because if hormonal users had more sex partners, they would be more likely to acquire HIV as a result of their behaviors rather than because they were using hormonal contraception. After statistical adjustment for these potential confounders, the investigators found no association between hormonal contraception and HIV. The adjusted relative risks (RR) and 95% confidence intervals (CI) were; for all hormonal methods RR = 0.9 (CI 0.5-1.6), for the pill RR = 1.12 (CI 0.5-2.6) and for injectable RR = 0.8 (CI 0.4-1.7). This finding should reassure women and family planning providers that hormonal contraception does not enhance HIV acquisition, but that risky sexual behaviors do increase HIV risk.
This study also evaluated condom use and found that in 350 women who reported consistent condom use there were no cases of HIV infection, suggesting a high degree of protection. However, among women who reported inconsistent condom use, the HIV incidence was 4.6 per 100 wy, which was significantly higher than among non-condom users (RR = 3.6, CI 2.0-6.2).
This finding is consistent with an earlier Rakai study of both men and women which showed that consistent condom use protected women against HIV, syphilis, Bacterial vaginosis, gonorrhea and chlamydia.(2) However, inconsistent condom use afforded no protection from these infections and was actually associated with an increased risk of gonorrhea and chlamydia. Unfortunately, in this population, most condom use is inconsistent. Programs need to emphasize consistent condom use with all acts of intercourse, and surveys of condom use must assess self-reported consistency.
References
1. Kiddugavu M, Makumbi F, Wawer MJ, Serwadda D, Sewankambo NK, Wabwire-Mangen F, Lutalo T, Meehan M, Xianbin, Gray RH. Hormonal contraceptive use and HIV-1 infection in a population-based cohort in Rakai, Uganda. AIDS. 2003 Jan 24;17(2):233-40.
2. Ahmed S, Lutalo T, Wawer M, Serwadda D, Sewankambo NK, Nalugoda F, Makumbi F, Wabwire-Mangen F, Kiwanuka N, Kigozi G, Kiddugavu M, Gray R. HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS. 2001 Nov 9;15(16):2171-9.
Dr. Gray is Professor, Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
FAMILY PLANNING / REPRODUCTIVE HEALTH LAW AND POLICY
AIDS Relief Showcase of Bush's Africa Tour; Critics Wary of Funding Level, Focus on Abstinence (news article)
As President Bush heads off to Africa today for a five-nation tour of that troubled continent, he will be showcasing his five-year, $15 billion AIDS relief package. AIDS prevention experts are skeptical of the effectiveness of programs that teach "abstinence only" for preventing HIV infection, and they are concerned that such programs in the United States attack condom use.
Peru Moves Away From Birth Control (news article)
Women's advocates say the present government is pushing their conservative Roman Catholic philosophy by promoting motherhood and cutting off free contraceptives and birth-control information to the poor.
Activists Call for Specific Laws against FGM (news article)
Anti-Female Genital Mutilation (FGM) activists from 28 African and Arab countries want their respective governments to come up with a specific legislation prohibiting the practice. In a petition dubbed the Cairo Declaration, the activists want all Governments to adopt an appropriate law which will lead to the prevention and subsequent abandonment of FGM worldwide. The petition was drafted in Cairo during a three-day conference whose theme was "Legal Tools for the Prevention of Female Genital Mutilation".
Infertility Treatment Versus Fertility Control: The Challenges for Developing Countries (press release)
Infertile couples from less developed countries (LDC) face different challenges than couples in developed countries. Infertility carries a particular stigma in the developing world, with many couples facing social ostracization. In addition, the national health policies and government resources of LDCs place a greater emphasis on fertility control, with the result that they do not channel sufficient resources towards infertility issues.
FAMILY PLANNING / REPRODUCTIVE HEALTH RESEARCH
Client and Staff Views on Facilities and Services, Before and After the Convergence of Sexual, Reproductive and Women's Services (research abstract)
The authors evaluated client and staff views on existing facilities and services, before and after the convergence of sexual, reproductive and women's services. They found that the integration of the three services led to a reduction in stigma associated with attending sexual health services. Despite some staff concerns, the number of men attending the services did not decrease. There was increased satisfaction with the new service, especially the quality of facilities.
The 'Frameless' Intrauterine System for Long-term, Reversible Contraception: A Review of 15 Years of Clinical Experience (research abstract)
This paper reviews 15 years of clinical experience in randomized controlled and non-randomized clinical trials. The authors found that the intrauterine system (IUS) had a similar failure rate as the TCu380A intrauterine device (IUD), considered the 'golden standard' IUD, which is attributed to the optimal target delivery of the copper ions in the upper part of the uterine cavity. Its performance is further optimized by the atraumatic design, which reduces partial and total expulsion and minimizes the side-effects and discomforts experienced with conventional 'framed' IUDs. The mini IUS is likely to further reduce the menstrual blood loss due to the very small size. The safety of the anchoring concept is beyond doubt as was demonstrated in all clinical studies covering 15,000 woman-years experience.
A Randomized Clinical Trial of Treatment of Clomiphene Citrate-resistant Anovulation with the Use of Oral Contraceptive Pill Suppression and Repeat Clomiphene Citrate Treatment (research abstract)
The purpose of this study was to evaluate the effectiveness and endocrine response of oral contraceptive ovarian suppression followed by clomiphene citrate in patients who previously were clomiphene citrate resistant. Authors concluded that suppression of the ovary with oral contraceptives results in excellent rates of ovulation and pregnancy in patients who previously were resistant to clomiphene citrate. The decreases in ovarian androgens, luteinizing hormone, and 17beta-estradiol may be responsible for the improved response.
Emergency Contraception: Knowledge, Attitude, and Practices Among Health Care Providers in North India (research abstract)
This study assessed knowledge, attitude, and practice of emergency contraception (EC) in four groups of health care providers (gynecologists, general practitioners, paramedical workers, and medical students) and users in North India. Practically none of the clients were familiar with the concept of EC; and so no further information could be gathered, and this group was excluded from analysis. Many providers (84.8% gynecologists, 41.0% general practitioners, 2.7% paramedical workers, and 64.4% medical students) were vaguely familiar with the concept of EC; very few knew accurately about timing and doses.
A Profile of Contraceptive Non-use in Kuwait: Implications for Health and Health Care (research abstract)
The authors used survey data from a nationally representative random sample of Kuwaiti households, collected in a study conducted in 1999 and containing 1502 currently married women, and analyzed using logistic regression analysis. They found that 19% of women had never used contraception and 50% were not using contraception when interviewed. Among current non-users, 42% did not intend to use contraception, and 31% were unsure about use during the following year. Negative attitudes of the respondents and their husbands were the critical factors in non-use and future intentions for non-use. Never-users were older (average age 37.8 years) and of higher parity (6.2) than other women.
Efficacy, Safety and Cycle Control of Five Oral Contraceptive Regimens Containing Norgestimate and Ethinyl Estradiol (research abstract)
This randomized, multicenter, parallel group study evaluated four new oral contraceptive regimens of norgestimate and ethinyl estradiol relative to Ortho Tri-Cyclen. Among the five regimens compared, ovulation suppression, cycle control and safety were generally comparable.
FAMILY PLANNING / REPRODUCTIVE HEALTH NEWS
Womb Transplant Babies 'Within Three Years' (news article)
The first human babies to be carried to term in transplanted wombs could be born within three years, a leading fertility specialist has predicted. The announcement came after mice born from transplanted wombs were found to be healthy and fertile. If the operation can be perfected for humans, it will potentially offer the chance of a natural pregnancy to thousands of women in the UK alone who are unable to conceive because their wombs have been damaged by disease, have been removed, or are missing due to a defect at birth. Their only ways to have children at present are to adopt or seek a surrogate to carry their child.
Indonesia: Durian-flavoured Condoms Lapped Up (news article)
It started as a joke. Why are there no durian-flavoured condoms when other flavours such as strawberry and banana are available? Some Indonesian activists decided to change that and now they have found a hot new item in their fight against AIDS - durian-flavoured condoms. Since the condoms carrying the distinct scent of the prickly fruit were introduced last month, 150,000 pieces have been sold.
India: Missing Condoms in Orissa Jolt to AIDS Check Plan (news article)
A much publicised attempt of the State AIDS Cell (SAC) and Family Planning Association of India (FPAI) to check AIDS in Orissa, India, is faltering, due to the non-availability of a specific brand of condoms designed to fit into condom-vending machines.
Exposure to Pesticide 'Poses Fertility Risk in Daughters' (news article)
The daughters of women who were exposed to a pesticide in the 1960s may have a decreased chance of conceiving, according to recently published research. DDT has been banned in the US for three decades but continues to be used in some less-developed countries, particularly in areas where it reduces the transmission of malaria by inflicting damage on the mosquito population.
HIV / AIDS RESEARCH
CD4 Cell and CD8 Cell-mediated Resistance to HIV-1 Infection in Exposed Uninfected Intravascular Drug Users in Vietnam (research abstract)
The purpose of the study was to identify mechanisms of resistance to HIV-1 infection in exposed uninfected individuals. The authors examined in-vitro cell susceptibility to HIV-1 infection in highly exposed Vietnamese intravascular drug users (IDU) who, despite a history of more than 10 years of drug use and a high prevalence of other blood-borne viral infections, remain apparently HIV uninfected. Study concluded that reduced PBMC susceptibility to HIV-1 infection was associated with resistance to infection in exposed uninfected IDU. Distinct mechanisms are involved in in-vitro resistance and may contribute to the apparent protection from HIV-1 transmission in this systemically exposed population.
HIV / AIDS NEWS
China, India May Face AIDS Catastrophe: CDC (news article)
China, India and Cambodia could face an AIDS "catastrophe" as HIV spreads deeper into parts of Asia where health controls are weak, according to the US Centers for Disease Control and Prevention.
Kazakhstan: Rights Abuses Fuel HIV Infection Rates (news article)
By global standards, the prevalence of HIV/AIDS remains relatively low in Kazakhstan, but the country is suffering from one of the fastest infection rates in the world. In 2002, the Kazakh government estimated some 25,000 persons were living with HIV/AIDS. Kazakhstan is believed to have more than double the number of persons with HIV/AIDS than the other four Central Asian nations combined.
Information, Services Crucial to Fight Against AIDS, Broader Quest for Good Health, Secretary-General Says in Population Day Message (press release)
The theme of this year's World Population Day, "One billion adolescents: the right to health, information and services", highlights the need to support young people in their efforts to lead safe, rewarding lives and contribute to the well-being of their families and communities. Throughout the world, millions of girls and boys are deprived of an education, harming their individual prospects and those of society at large. In some countries, half of all girls are married before the age of 18, often resulting in early childbearing that poses serious health risks to both mother and child. Experience shows that educated women are more likely to marry later, and have healthy and better-educated children, who will pass on these benefits from one generation to the next. Education and information also influence how many children they will have. If a woman were to wait until age 23, instead of age 18, to have her first child, that alone could reduce the momentum in population growth by over 40%.
African Healers Join the AIDS Fight (news article)
To Western medical workers, traditional African healers - tribal elders who use natural remedies in their medical practice - have become indispensable in the fight against AIDS in Cameroon and around Africa.
The respect these healers garner from their communities makes them a key mouthpiece for passing along accurate information about how the disease is spread. Their holistic approach toward healing has produced results that impress even visiting health workers.
Race is on to Save the First AIDS Vaccine. But Does It Even Work? (news article)
What was billed as the first AIDS vaccine, with potential to end a global disaster that is killing millions every year, has ended with an ignominious whimper, as a Californian biotech company arranges to pull out of Thailand before the final analysis of its clinical trials involving 2,500 Thai volunteers.
MATERNAL AND CHILD HEALTH RESEARCH
Violence Against Women in Mexico: A Study of Abuse Before and During Pregnancy (research article)
The objective of the study was to identify the prevalence and types of violence experienced by pregnant women, the ways victimization changed during pregnancy from the year prior to pregnancy, and factors associated with violence during pregnancy. The authors concluded that violence is common among pregnant women, but pregnancy does not appear to be an initiating factor. Intergenerational violence is highly predictive of violence during pregnancy.
Postnatal Transmission of HIV-1 after a Maternal Short-course Zidovudine Peripartum Regimen in West Africa (research abstract)
The purpose of the study was to assess the postnatal transmission (PT) risk of HIV-1 after a maternal short-course zidovudine regimen in a breastfeeding population. Authors concluded that PT occurred at a similar rate between arms and therefore reduced the long-term overall efficacy of this peripartum zidovudine regimen at age 24 months. The higher risk of PT among women with low CD4 cell count emphasizes the importance of identifying interventions to prevent PT for these women.
MATERNAL AND CHILD HEALTH NEWS
Baby Boys Raise Future Miscarriage Risk (news article)
Mothers whose first child is a boy are then more likely to suffer recurrent miscarriages than those bearing a girl first, suggests a new study. Baby boys are already known to be more taxing for mothers, requiring more energy during gestation and being heavier at birth than girls. But the researchers believe a fundamental immune response from the mother to foreign male antigens or proteins is to blame for the miscarriage link.
MEN'S HEALTH NEWS
Colombian Men Undergo Vasectomies for Land (news article)
According to Colombia's government, every year 250,000 children are born and abandoned by their parents here. Many are left to die. How to help them get out of the vicious circle of entanglement? By giving them land. But not to those that would fill it with children and start the cycle again. Give them land, but on the condition that they don't have more children. While female sterilization campaigns in Latin America have met with outrage in the past, Colombia's vasectomy-for-land scheme is cheered by locals.
Male Infertility Can Be Passed on to Children (news article)
A technique that allows infertile men to have children can transfer the cause of the problem to their children, but it does not generate any new genetic defects.
POPULATION NEWS
Population Trends Will Shape Global Sustainability (news article)
CEOs need to ready their industry for global tectonics - underlying trends that, while gradual and often below the radar screen of business executives, have a significant impact on corporate strategy and managers' ability to implement them over the next two decades. Like the movement of tectonics, these trends will eventually cause major quakes. Those four issues are population growth, aging, immigration and gurbanization.
Population Day Targets Adolescents (news article)
Preparations are under way for the celebration of World Population Day, which is commemorated every July 11. The theme for the day this year is "1 Billion Adolescents: The Right to Health, Information and Services," and coincides with the closing of the South Pacific Games. The United Nations Fund for Population Activities says adolescents account for approximately 20 per cent of the world's population and very few other countries have adequate reproductive health care information and services for adolescents.
WOMEN'S HEALTH RESEARCH
A New Approach for the Detection of Cervical Cancer in Thai Women (research abstract)
The objective of this study was to screen cervical cell samples of Thai women by using the Fourier-transform infrared (FTIR) spectrophotometry technique; the results were compared to the histologic diagnosis (gold standard).FTIR spectrophotometry is a new technology for cervical cancer screening. Instead of detecting the morphological changes as used in Pap smear test, this technique detects, at the molecular level, structural changes of functional groups through the changes of the infrared absorption spectrum. FTIR results versus histology showed sensitivity of 96.3% and specificity of 96.4%. False-negative and false-positive rates were 3.7 and 3.6%, respectively. FTIR showed high sensitivity and yielded a good false-negative rate. Besides the cervical cancer detection, the FTIR spectroscopy technique can also elicit positive results from adenocarcinoma of the endometrium, sarcoma of the uterus, and ovarian malignancies.
WOMEN'S HEALTH NEWS
Study: Lesbians Face Higher Infertility Risk (news article)
A new study has found that polycystic ovarian syndrome, which can cause infertility and is linked to other serious health problems, may be nearly three times more likely in lesbians than heterosexual women.
Tanzania: Anti-mutilation Message Spreads Fast in the North (news article)
The Network Against Female Genital Mutilation in Tanzania builds support but also faces extreme opposition as they spread their anit-FGM message through the country.
YOUTH RESEARCH
Sexual and Demographic Risk Factors for Herpes Simplex Virus Type 2 According to Schooling Level Among Mexican Youths (research abstract)
This cross-sectional population-based study involved students at 92 schools in the state of Morelos, Mexico; 898 students aged 11 to 24 years old were identified. All reported that they had already initiated sexual activity and provided a blood sample to detect the presence of anti-HSV-2 antibodies through the Western blot technique. The prevalence of HSV-2 seropositivity was 5.7% (51/898), and the ratio of females to males was 2:1. The prevalence of consistent condom use overall was 22.6% among the 898 students. The main factors associated with HSV-2 infection were sex (for females the risk was 2.2 times higher than for males; 95% CI, 1.2-3.9); junior high school status (2.5 times higher risk than university students (95% CI, 1.1-6.0); and having had same-sex sexual intercourse (3.5 times higher risk; 95% CI, 1.4-8.9).
Social and Psychological Influences on HIV Preventive Behaviors of Youth in Haiti (research abstract)
This cross-sectional survey included 845 youth, aged 15-19 years, attending 12 primary and/or secondary schools; a subsample of the 491 students who were sexually active comprised the study sample. Only 18% of sexually active adolescents reported always or sometimes using condoms and 27% reported having used a condom the last time they had sex. Over 40% (43%) had had three or more lifetime sex partners. Findings from the multivariate logistic regression analyses indicate that consistent condom use, condom use at last sexual intercourse, and fewer lifetime sexual partners were significantly associated with high levels of self-efficacy to communicate about HIV/AIDS or use a condom.
Sociocultural Contexts of Adolescent Sexual Behavior in Rural Hanover, Jamaica (research abstract)
This study presents findings from focus group discussion (FGD) sessions with 73 out-of-school young adolescents aged 15 to 18 years, recruited primarily from health centers in Hanover, Jamaica. Analyses of transcripts revealed the existence of different sexual scripts for males and females. Whereas females are culturally restrained, abstinence is less desirable for males. Both male and female adolescents expressed the view that the family was an important part of an adolescent's life, and has a strong influence on adolescent sexual behavior. Perception of vulnerability to HIV/AIDS and other sexually transmitted infections, and knowledge of sexual risks among the adolescents was low, and often erroneous.
YOUTH NEWS
Ireland: Booklets on Sex Education Delayed (news article)
The launch of three sex education booklets has been postponed because one of the publications, aimed at boys, did not specify that the age of consent is 17.
Teens are New Focus of Vaccines (news article)
The future of vaccines, infectious disease experts say, is teenagers. Pharmaceutical companies are inventing new vaccines against diseases usually transmitted by sex, drug use, foreign travel or living in dormitories or barracks. Half a dozen are now in the long and tangled medico-regulatory pipeline between the petri dish and the pediatrician's syringe.
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.
_________________________________________________
Tang OS, Tang G, Yip PS, and Li B. Further evaluation on long-term depot-medroxyprogesterone acetate use and bone mineral density: a longitudinal cohort study. Contraception. 2000 Oct;62(4):161-4
Findings in this article have been found relevant to WHO Method: Progestogen-Only Injectables and Condition: Age/Life-stage
Link to CIRE Evidence | Link to POPLINE Record
_________________________________________________Schmidt JE, Hillis SD, Marchbanks PA, Jeng G, and Peterson HB. Requesting information about and obtaining reversal after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Fertility and Sterility. 2000 Nov;74(5):892-8.
Findings in this article have been found relevant to WHO Method: Female Sterilization and Condition: Age/Life-stage
Link to CIRE Evidence | Link to POPLINE Record
_________________________________________________Grabrick DM, Hartmann LC, Cerhan JR, Vierkant RA, Therneau TM, Vachon CM, Olson JE, Couch FJ, Anderson KE, and Pankratz VS. Risk of breast cancer with oral contraceptive use in women with a family history of breast cancer. JAMA. 2000 Oct 11;284(14):1791-8
Findings in this article have been found relevant to WHO Method: Combined OCs and Condition: Family history of breast cancer
Link to CIRE Evidence | Link to POPLINE Record
_________________________________________________Hodoglugil NN, Aslan D, and Bertan M. Intrauterine device use and some issues related to sexually transmitted disease screening and occurrence. Contraception. 2000 Jun;61(6):359-64
Findings in this article have been found relevant to WHO Method: Copper IUD and Condition: Sexually transmitted disease (STDs)
Link to CIRE Evidence | Link to POPLINE Record
_________________________________________________Gillum LA, Mamidipudi SK, and Johnston SC. Ischemic stroke risk with oral contraceptives. A meta-analysis. JAMA. 2000 Jul 5;284(1):72-8
Findings in this article have been found relevant to WHO Method: Combined OCs and Condition: Smoking and Method: Combined OCs and Condition: High blood pressure (Hypertension) and Method: Combined OCs and Condition: Headaches
Link to CIRE Evidence | Link to POPLINE Record
When you click on any link, your Internet browser will access a Web site not connected to "The Pop Reporter.®" Information accessed through these links and contained in this issue of "The Pop Reporter®" does not necessarily state or reflect the views of the Population Information Program, Johns Hopkins University, or the United States Agency for International Development (USAID).
All links were verified at the date of posting. Your computer and/or network configuration regarding Java script, cookies, and other security issues may not allow you to view certain Web sites. Consult your computer technician if you are having problems.
Information & Knowledge for Optimal Health (INFO) Project
111 Market Place Suite 310, Baltimore, MD 21202
Phone: 410-659-6300 Fax: 410-659-6266 Security & Privacy Policy