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The Pop Reporter®

Volume 3, Number 33
18 August 2003

"The Pop Reporter" (R) Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs INFO Project When you click on any link below, 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 INFO Project, Johns Hopkins University, or the US Agency for International Development. All links were verified at the date of mailing. 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.

Family Planning/Reproductive Health Research

Availability and Acceptability of IUDs in Guatemala (report)
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The purpose of this study was to identify the reasons for the low use of the IUD in Guatemala and to explore the reasons why other reversible methods are selected more frequently than IUDs. The institutional statistics point toward a lack of contraceptive options available to women, having to choose among only two or three methods. The study shows that there are several demand-side factors that affect the use of the IUD, including lack of knowledge about the method, lack of accessibility, fears, perceived disadvantages, and low quality of services. The main source of fear about the IUD results from the lack of information offered by service providers.

An Assessment of Trends in the Use of the IUD in Ghana (report)
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The aim of this study was to inform the Ghana Health Service, USAID, and other partners on future directions for contraceptive promotion and supply. Researchers used both quantitative and qualitative methods of data collection. Over a 10-year period, knowledge about the IUD was relatively high. However, a very low percentage of women contraceptive users reported ever using the IUD. Similarly, data on current use during the survey period shows stagnation of the IUD compared to other methods. Reasons for discontinuation of use varied by contraceptive method. Overall, side effects were cited as the major reason for discontinuing the IUD compared to other methods.

Will Diaphragms Protect against STIs? (feature article)
The hypothesis that diaphragms might offer women some protection against STIs, including HIV, will soon be tested in several randomized controlled trials. Also to be explored soon is the question of whether diaphragms and microbicides would be more effective in preventing STIs if they were used together.

Dual Protection: Best Approach to Recommend May Vary (feature article)
Continuing research and discussion on the two major strategies for dual protection against both unplanned pregnancy and STIs indicate that each strategy has distinct advantages and disadvantages and that appropriate dual protection messages may differ according to individual situations. Whether a condom-only or dual method approach to dual protection is appropriate and feasible depends on the individuals involved and the settings in which an approach is offered.

Female Condom Reuse Issues Explored (feature article)
For female condom users, use of a new female condom for every act of sexual intercourse is recommended by the World Health Organization (WHO). However, reuse may be acceptable, feasible, and safe in some circumstances, leading WHO to state that "the final decision on whether or not to support reuse of the female condom must ultimately be taken locally." This article explores female condom reuse issues, research, and how the WHO recommendations are implemented at the local level.

Factors Influencing the Use of Contraception in an Urban Slum in Karachi, Pakistan (research article)
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The contraceptive prevalence rate among 502 couples in a predominantly catholic urban slum was 31%. Working women, education, and having more than two sons increased contraceptive use. In addition, the number of daughters was the most significant factor influencing contraception. There did not seem to be any religious objections to the use of contraception, which helped introduce family planning in this community.

Cost-effectiveness of USAID’s Regional Program for Family Planning in West Africa (research article)
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This study assessed the cost-effectiveness of a USAID subregional program in West and Central Africa through an interrupted time-series design spanning the 1990s and compared cost-effectiveness in four similar countries in which mission-based programs continued. Key indicators included costs, contraceptive prevalence rates, and imputed “women-years of protection.” Results indicated that, taking into account all external financing for population and family planning, the USAID West Africa regional approach generated women-years of protection at one-third the cost of the mission-based programs.

Family Planning Impact Evaluation: The Evolution of Techniques (research article)
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This paper is a revised version of one prepared for the seminar on methods for impact evaluation of family planning programs held in Jaco, Costa Rica, May 14-16, 1997. The goal of the seminar was to look at current methodological problems facing careful evaluation of the impact of programs, to examine some of the new methods that have been developed to address persistent issues, and to assess the methodological challenges posed by the expanded goals of many programs following the 1994 Cairo International Conference on Population and Development. This paper served as a background to discussions of current methodologies and issues by tracing the development and nature of methods for assessing impact that started soon after the first programs were initiated in the 1950s. The techniques discussed include standardization and trend analysis, the anaylses of acceptor data, experimental designs, multivariate areal analysis, population-based surveys, and multilevel strategies.

After N-9, What Next? (feature article)
More than 50 agents are being studied for their potential as microbicides that might be used topically as protective barriers against HIV and other STIs. While a microbicide is unlikely to reach the market until after 2010, six microbicide products are expected to enter effectiveness trials in 2003 and 2004.

Contraceptive Activity of a Spermicidal Aryl Phosphate Derivative of Bromo-methoxy Zidovudine (Compound WHI-05) in Rabbits (PubMed abstract)
Investigators studied a highly promising anti-viral and spermicidal agent with clinical potential as a vaginal contraceptive which can prevent the sexual transmission of AIDS.

Seroprevalence and Correlates of Herpes Simplex Virus Type 2 Among Urban Tanzanian Women (research abstract)
A study of women attending primary health care clinics in Tanzania showed a high seroprevalence of HSV-2 (39%). HSV-2 was associated with the presence of a genital ulcer, HIV-1, and demographic and behavioral characteristics.

Equity in Access to Condoms in Urban Zambia (research abstract)
This article examined the degree of equity in access to condoms in urban Zambia. Researchers found that more than 30% of groceries and kiosks (outlets commonly found in low-income residential areas) stocked social marketing condoms and that consumer access to condoms (defined as estimated walking time to a condom source) was greater for poorer compared to wealthier respondents.

Family Planning/Reproductive Health News

Islamic Perspective in Family Planning (feature article)
This article from the Daily Express newspaper in East Malaysia addresses how family planning may be practiced in Islam.

India: HLL Defers Launch of 'Female Condom' (news article)
A public sector company, Hindustan Latex Ltd. (HLL), has deferred the launch of the first 'female condom' in the country, scheduled for this month, to carry out a more extensive consumer survey.

India: Andhra Pradesh's Promiscuity Alarms Health Workers (news article)
Promiscuity among men and women in Andhra Pradesh is the highest in the country, says a new survey that has rung alarm bells among health workers. According to a survey done by ORG-MARG for the National AIDS Control Organisation, 19% of men and 7% of women said they had had sex with non-regular partners in the last year.

Infertility Drug Clinical Trial Design to be Topic of Reproductive Health Committe Meeting (news article)
Clinical trial design for the development of infertility drugs will be discussed at a Sept. 29 meeting of FDA’s Reproductive Health Drugs Advisory Committee.

"No Condom, No Sex" Urges WHO to Asian Sex Workers (news article)
The World Health Organization (WHO) has urged sex workers in Asia to adopt a no condom, no sex policy in a bid to curb the spread of AIDS in the region. WHO said it has embarked on a "100 per cent condom use" campaign in China, Myanmar, Mongolia, Vietnam, Laos and the Philippines after seeing its success in Thailand and Cambodia.

Asia 'Needs Billions of Condoms' (news article)
Asia is facing a huge shortage of condoms, heightening fears over the spread of the HIV/AIDS epidemic, according to the World Health Organization.

Family Planning/Reproductive Health Policy

India's Population Policy Skews Gender Balance (feature article)
The Indian government's aggressive campaign for two-child families and India's obsession with having sons has led to an increasing number of women aborting girls to make sure they have at least one boy, if not two.

Infectious Diseases, Non-Zero-Sum Thinking, and the Developing World (research abstract)
The authors of this article address the relationship between health, poverty, and development in the context of game theory, where the interests of the parties (in this case, rich and poor countries) overlap. They focus on the link between economic inequalities and health outcomes, concentrating on the impact of infectious diseases. Keeping within the context of game theory, they outline the game, the players, and the potential win-win outcomes that may potentially result.

HIV/AIDS Research

Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men (research review)
In this Cochrane Review, the authors found 34 observational studies they could analyze: 16 conducted in the general population and 18 in high-risk populations. Among these studies, they found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. They note that the results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, they point out, observational studies are inherently limited by confounding, which is unlikely to be fully adjusted for.

Cost-effectiveness of Strategies to Reduce Mother-to-child HIV Transmission in Mexico, a Low-prevalence Setting (research abstract)
The authors estimated and compared the cost-effectiveness of five selected interventions to reduce mother-to-child transmission (MTCT) of HIV in Mexico. They propose that minimization of MTCT costs in low-prevalence settings should focus on VCT costs rather than drug costs because even the most cost-effective scenario modelled compared unfavourably with other, highly cost-effective maternal/child interventions that did not reach many Mexicans.

HIV and Islam: Is HIV Prevalence Lower Among Muslims? (research abstract)
This paper tests the hypothesis that Muslims have lower HIV prevalence than non-Muslims. Most studies indicate a negative relationship between HIV prevalence and being Muslim, but some studies on the relationship of risk factors to HIV prevalence produced mixed evidence. Muslims limited sex outside of marriage and alcohol consumption will be pluses. Circumcision may also account for lower HIV prevalence, but Islam's allowance for polygyny and discouragement of condom use would work against reduced sexual transmission of HIV. The hypothesis that Islamic religious affiliation is negatively associated with HIV seropositivity is generally supported.

A Dynamical Model for Stage-Specific HIV Incidences with Application to Sub-Saharan Africa (research abstract)
This paper constructs a compartmental and deterministic model for HIV/AIDS epidemics with three stages of disease progression among infected patients. The model discussed in this paper attempts to generalise the previous dynamical models on the HIV/AIDS epidemic by incorporating the disease stages and can thus be useful in studying the effects of stage-specific interventions on the epidemic.

Antiretroviral Therapy in a Community Clinic - Early Lessons from a Pilot Project (research abstract)
This article reports on operational and clinical problems encountered during the first 6 months of a community-based antiretroviral therapy (ART) program in South Africa. The authors maintain that ART can be successfully implemented within a primary care setting. Drug purchases and staff salaries drive program costing, and the service model they used is capable of managing 250 to 300 patients on chronic ART.

HIV/AIDS News

Indian Village Introduces Mandatory Pre-marriage AIDS Tests to Battle Disease (news article)
A village in the Punjab state has added spark to AIDS awareness drives by prescribing mandatory pre-marriage AIDS tests.

Targeting Populations at Increased Infection Risk (feature article)
Condom promotion remains an important HIV prevention measure. This article looks at intervention programs in various populations at increased risk of HIV infection, including sex workers and men, who often make the final decisions on condom use in sexual relations.

HIV Topical Microbicide Single Large Efficacy Trial Proposed By FDA (news article)
The FDA is proposing a single large efficacy trial for the development of topical microbicides for the reduction of HIV transmission.

Maternal and Child Health Research

Factors Affecting Decisions to Seek Treatment for Sick Children in Kerala (research abstract)
This study in India examined the effects of disease severity and economic status for predicting whether children with acute respiratory infection or diarrhea were taken to medical providers. The gender of the child did not influence whether or not the child was taken for treatment but did influence whether care was sought in the alternative or the allopathic system (boys more often than girls). Of 469 children, 78 (17%) did not receive medical care, 391 (83%) received medical care, 342 (88%) received allopathic medical care, and 48 (12%) received alternative medical care.

Endangering Safe Motherhood in Mozambique: Prenatal Care as Pregnancy Risk (research abstract)
This study examines why Mozambican women with access to prenatal services delay prenatal clinic consultations, limiting opportunity for prevention and treatment. The study found that pregnancy beliefs and prenatal practices reflect women's attempts to influence reproduction under conditions of vulnerability at multiple levels.

The Influence of Mastitis on Antibody Transfer to Infants Through Breast Milk (research abstract)
This article explores how breastfeeding and infant health is affected by mastitis and vaccination programs.

Interpregnancy Interval and Risk of Preterm Birth and Neonatal Death: Retrospective Cohort Study (research abstract)
Related news article: Birth Problems Follow Short-Spaced Pregnancies
Related report: Birth Spacing: Three to Five Saves Lives
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An interval of less than 6 months between pregnancies seems to increase the likelihood of delivering prematurely and the chances that the baby will not survive, according to recent research.

Comparison of Midwifery-led and Consultant-led Maternity Care for Low Risk Deliveries in Nepal (research abstract)
Using a sample of 988 women, researchers compared the efficacy of a midwifery unit with that of a consultant-led maternity unit. They found no significant differences for duration or complications of labor, mode of delivery, birth weight, neonatal Apgar score, or admission to the special care baby unit. They conclude that, after appropriate screening, intrapartum care for low risk deliveries is effectively provided by midwives; and recommend that the midwifery unit model be considered throughout the developing world, particularly as a site for training of skilled attendants.

Maternal and Child Health News

South Africa: Nevirapine Efficacy Underestimated for Protecting Babies From HIV? (news article)
Well thought out procedures to ensure adherence to nevirapine treatment around the time of birth may mean substantial improvements in the protection that nevirapine can provide from mother-to-child HIV transmission. This article discusses a clinical study which recorded a transmission rate of around 3%, compared with the 10% to 15% transmission rate normally seen when nevirapine is used to prevent mother-to-child transmission.

Drug Donation Reduces Mother-Child HIV Transmission (feature article)
The German drug company Boehringer-Ingelheim has been donating its trade-named version of the drug, Viramune, at no cost to mother-to-child HIV prevention programs in developing nations for three years. Forty-four countries are participating with 166,000 mother-child pairs being treated. An HIV positive mother receives a single dose of Viramune during labor and her baby gets one dose within 48 hours of birth. The procedure is said to be affordable and effective.

Group B Strep: The Test Every Pregnant Woman Needs (news article)
Awareness of the importance of testing for Group B streptococcus, or GBS, is growing. GBS can threaten the life of a newborn if it is transmitted from mother to child. A vaginal/rectal swab in late pregnancy can determine its presence. If left untreated, GBS may cause blood infection (sepsis), or meningitis.

Men's Health Research

Human Papillomavirus Infection in Men Who Have Sex with Men Participating in a Dutch Gay-Cohort Study (PubMed abstract)
The authors of the study aim to develop strategies for prevention and early treatment of human papillomavirus (HPV) anal and penile cancer as well as a better understanding of related sexual behavior risk factors. Through a cross-sectional study of 241 HIV-negative and 17 HIV-positive men who have sex with men visiting a sexually transmitted disease clinic, the researchers establish the prevalence of anal and coronal sulcus HPV in a group of men who have sex with men participating in a Dutch gay-cohort study, identifying risk factors associated with HPV infection in this group and investigating the presence of identical HPV types in couples with stable relationships.

Men's Health News

Sexual Dysfunction and Andropause Lead Strong Growth in Men's Health Drugs (news article)
The world market in pharmaceuticals for men's health is poised to grow rapidly in the next 5 years, according to a new market research study released today by Kalorama Information. The two therapeutic areas that are expected to lead the way are sexual dysfunction and male menopause. The other area of significant growth in men's health, according to the research, is in the area of therapy for male hormone deficiency. Although the condition sometimes called male menopause, or andropause, is not fully understood, several companies are gearing up to enter the emerging market.

Device Offers Alternative to Vasectomy (news article)
The article reports that a new birth control device aimed at giving men an alternative to vasectomy promises to be less painful and result in fewer complications, but some urologists are cautious about those claims. The product, VASCLIP, approved by the FDA last year and just now hitting the market, is a plastic clamp the size of a grain of rice that snaps onto each of the two vas deferens tubes in the scrotum and blocks the flow of sperm from the testes, where the sperm is produced. More than 500,000 men in the United States annually undergo vasectomies, making it the third most common form of birth control.

Population Research

South Korea: Syphilis Prevalence has Rapidly Decreased (research abstract)
The study determines the current prevalence of syphilis in the general population of South Korea and its trend over the past 20 years. The researchers screened 15,402 adults, who all were over the age of 20 (6,888 blood donors, 4,951 physical examinees, and 3,563 pregnant women) and the prevalence was compared with the results of previous surveys in similar population groups. The prevalence of syphilis in South Korea was found to be 0.2%, a significant decrease since 1977; however, the prevalence seems to have reached a plateau since 1995.

Exposure to Non-Steroidal Anti-Inflammatory Drugs during Pregnancy and Risk of Miscarriage: Population Based Cohort Study (research abstract)
The authors evaluated whether prenatal use of non-steroidal anti-inflammatory drugs (NSAID) is associated with increased risk of miscarriage in a population based cohort study of 1,055 pregnant women recruited and interviewed immediately after their positive pregnancy test. Median gestational age at entry into the study was 40 days. Of the women interviewed, 53 (5%) reported prenatal NSAID use around conception or during pregnancy. After adjustment for potential confounders, prenatal NSAID use was associated with an 80% increased risk of miscarriage. The association was stronger if the initial NSAID use was around the time of conception or if NSAID use lasted more than a week.

A National Survey of Genitourinary Medicine Clinic Attendees Provides Little Evidence of Sexual Transmission of Hepatitis C Virus Infection (research abstract)
The authors examined the prevalence and genetic diversity of hepatitis C virus in genitourinary medicine clinic attendees to assess the extent of sexual transmission of the virus. A cross sectional, unlinked, anonymous survey in 14 genitourinary medicine clinics situated in England, Wales, and Northern Ireland. The main outcome measures were prevalence of antibodies to hepatitis C virus and identification of hepatitis C virus genotypes. Testing of 17,586 specimens from 1995 showed an adjusted prevalence of anti-HCV in genitourinary medicine clinic attenders of 1.03% overall and 0.65% among those who did not report injecting drug use.

Meta-analysis of Published Studies or Meta-analysis of Individual Data? Caesarean Section in HIV-positive Women as a Study Case (PubMed abstract)
The authors report the results of a meta-analysis of the published studies that shows a statistically significant reduction of perinatal HIV transmission rate with Caesarean section. The results are surprisingly similar to those of the recently published meta-analysis of individual patient data, indicating that, in the absence of significant confounding, the two meta-analytic methods are likely to give consistent results.

Population News

Pakistan: Check on Population Growth a Must: Experts (news article)
Speakers at a seminar on "Role of Population in Poverty Reduction Strategy Papers for Pakistan" agree that existing and future planning for the country's development will have no positive effects until population growth is checked.

Women's Health Research

Sustained High Prevalence of Chlamydia trachomatis Infections in Female Army Recruits (research abstract)
Related research summary: Chlamydia Infection Prevalent Among Female Army Recruits
A study of 23,010 female army recruits demonstrated that a high prevalence of C trachomatis was sustained during 4 years of observation. Year of study, young age, and being from the South were significant predictors of infection.

Just Die Quietly: Domestic Violence and Women’s Vulnerability to HIV in Uganda (report)
Related press release: Uganda: Domestic Violence Worsens AIDS
This report, from Human Rights Watch, documents widespread rape and brutal attacks on women by their husbands in Uganda, where a specific domestic violence law has not been enacted and where spousal rape is not criminalized.

Potential Health and Economic Impact of Adding a Human Papillomavirus Vaccine to Screening Programs (research abstract)
Recently published research suggests that effective vaccines against cervical cancer – associated human papillomavirus (HPV) – may become available within the next decade. Here, the authors examine the potential health and economic effects of an HPV vaccine in a setting of existing screening. They find that vaccination for HPV in combination with screening can be a cost-effective health intervention, but it depends on maintaining effectiveness during the ages of peak oncogenic HPV incidence; therefore, identifying the optimal age for vaccination should be a top research priority.

Do Women Know About What to do With Skipped Pills: Evidence from Rural Bangladesh (research article)
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The study examines knowledge of correct actions to take when women miss a contraceptive pill, or two or three, in rural Bangladesh. The study was based on 1,600 pill users, current or past, who were served by field-workers, predominantly from NGOs. All women were currently married, living in rural areas of Bangladesh, and predominantly Muslim (91.4%). Mean age was 29.3 years. Among the pill users who had some information, only one in ten exactly knew about what to do with two or three skipped pills. Mass media (eg, television and radio) significantly contributed to the correct knowledge about actions with the skipped pills.

Women's Health News

Kenya: Culture Hampering Female Genital Mutilation Eradication (news article)
Culture is the main setback to the ongoing campaign against female genital mutilation in Kisii District, according to the District Children's officer.

Stopping the Unkindest Cut (feature article)
Getting people to question the need for female genital mutilation or even talk openly about the issue has proven one of the biggest challenges for Egyptian lawmakers and women's rights advocates. After the National Council for Childhood and Motherhood released statistics claiming almost 95% of Egypt's girls and women are circumcised, government agencies and NGOs have been working hard to break the silence.

Kenya: 10 Girls Appeal Against FGM (news article)
Ten girls who escaped from their homes in Kerio Valley to avoid forced circumcision have appealed to anti-Female Genital Mutilation organisations to help them continue with their education. The girls, who spoke to the press through a spokesman from the Rimoi Community Development Organisation, said they fear going back home because elders still want them to under-go the rite.

Youth Health Research

Where Does Reproductive Health Fit Into the Lives of Adolescent Males? (research article)
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This study was conducted as part of a larger project designed to expand the capacity of a reproductive health center to involve adolescent males in reproductive health. A total of 32 males (mean age 15.5 years) from two urban highschools in San Francisco participated in six focus group sessions. Participants identified school, family, future career, and sports as their current life priorities; health was not a top concern. Pregnancy and sexually transmitted infections (STIs) were not seen as interrelated health concepts. STIs were considered a health issue, whereas pregnancy was perceived as a negative event that could prevent achievement of specific life goals. At times, notions regarding how a male behaves reflected traditional masculine beliefs: that violence is justified as a way to protect oneself, that having sex is part of a male’s role in a relationship, and that males should handle health issues by themselves. The authors suggest that, to meet the reproductive health needs of adolescent males, program developers should consider how other life priorities and traditional masculine beliefs may serve as barriers to care and how to ensure that services reflect the adolescent male’s perspective.

Sexual Behaviour of Cape Town High-school Students (news article)
In this large sample survey of grade 8 and 11 students at 39 schools in Cape Town, nearly 30% had participated in sexual intercourse. By the age of 14, 23.4% of males and 5.5% of females had participated in sexual intercourse. By age 19 years, these proportions were 71.8% and 58.2%, respectively. At their last coital episode, 65.4% had used contraception, and the most common methods were condoms (67.7%) and injectable steroids (43.2%).

Reproductive Health Behavior among Adolescents and Young Adults in a Semi-urban District in Uganda (research article)
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This article presents findings from a reproductive health study conducted in 1999 among 464 Ugandan 10 to 24 years old. A high percentage (23% males, 29% females) reported to practice non-penetrative sex, such as petting. Masturbation was reportedly practiced by 5% of participants (7% males, 4% females).

Youth Health News

Australia: New Sex Alert for Young People (news article)
Chlamydia is the fastest growing sexually transmitted disease in NSW. Often asymptomatic, about half of NSW's chlamydia cases are diagnosed in people under 29, with 54% being women. Untreated, women can experience chronic infection, pelvic inflammatory disease, ectopic pregnancy and infertility. In men, it can lead to testicular infection and possibly infertility in men.

Special Reports/Profiles/Resources

Establishing Integrated Family Planning/Reproductive Health Preservice and Inservice National ClinicaTraining Systems in Turkey (report)
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This report reviews more than a decade of experience in institutionalizing an integrated training system in Turkey. It focuses on the establishment of an integrated FP/RH preservice clinical training network and the inservice training system in USAID’s target provinces. Relevant achievements are discussed under the key M&E indicators as well as within their relevant components.

The Advance Africa Approach to Best Practices: A Mini-Compendium for Adolescent Reproductive Health Interventions (report)
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This draft report identifies effective approaches to addressing ARH needs based on a review of program efforts undertaken in developing countries, with some reference to developed country programming. Conclusions are based primarily on evaluated projects and, to some extent, on observations by program implementers and assessors. Information gathering and analysis included interviews with more than 70 professionals on a review of a wide array of documents, including published evaluations, program reports, organizational publications, issue reviews, analyses, project descriptions and proposals, presentations, and informal memos.

Strategic Mapping: A Tool for Managers to Revitalize Reproductive Health Programs for Africa (resource material)
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Strategic mapping is a way to design and direct family planning/reproductive health activities, depending upon what is likely to work. Using this approach, program managers and others can reach consensus on program gaps and weaknesses and opportunities.

“My Father Didn’t Think This Way”: Nigerian Boys Contemplate Gender Equality (report)
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This report documents the birth and growth of a Nigerian project called Conscientizing Male Adolescents, whose principal objective is to engage adolescent males in ongoing discussion groups to increase their awareness of gender-based oppression.

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