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The Pop Reporter®

Volume 3, Number 37
15 September 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. Did you know that "The Pop Reporter" can now be customized? If you haven't done so already, visit the modify profile page at http://prds.infoforhealth.org/modify.php to customize your edition of Pop Reporter. Simply type in the e-mail address at which you receive "The Pop Reporter", leave the password field blank, and log on. You'll be signed on and ready to customize your account!

Family Planning/Reproductive Health Research

Continuous Use of an Oral Contraceptive for Endometriosis-associated Recurrent Dysmenorrhea That Does Not Respond to a Cyclic Pill Regimen (research abstract)
Related news article: Continuous Use of the Pill Curbs Pelvic Pain
The menstrual pain caused by endometriosis can be relieved by taking oral contraceptive pills without the usual monthly interruption, Italian physicians report. In fact, they say, this approach has a lot of benefits for women who have endometriosis, a condition in which the tissue that normally lines the womb and is shed with menstruation, grows beyond the womb and sometimes causes cysts.

Evaluation of Syphilis Reactor Grids: Optimizing Impact (research abstract)
Researchers evaluated the sensitivity and predictive value of five currently used syphilis reactor grids (SRGs). Cases missed by SRGs were predominantly men aged 30 to 50 years and women aged 20 to 40 years. Monitoring the prevalence of syphilis among reactors is critical because in areas with high prevalence, most SRGs miss a substantial number of cases.

The Italian STD 'Hot-Line': Making People Aware (research abstract)
A national telephone hotline was established in Italy in 1997 to deliver information and to allay fears on sexually transmitted diseases. This survey shows the results of the first 3 years of activity.

Using Financing to Motivate a For-profit Health Care Provider to Deliver Family Planning Services: Is It a Cost-effective Intervention? A Study of AAR Health Services in Kenya (research article)
This paper examines the cost effectiveness of using a loan mechanism to motivate a for-profit provider to deliver family planning services. The intervention examined directly resulted in a private provider delivering family planning services; however, it did not create a long-term financial incentive for the private provider to promote the use of family planning. The cost effectiveness of this intervention is analysed using a methodology that captures long-term sustainability of the intervention within a traditional family planning outcome measure, such as couple years protection (CYP), by discounting future expected CYPs. The analysis demonstrates that innovative family planning interventions with private providers should be considered as they can be more cost-effective than traditional programs.

Discontinuation of Contraceptive Use in Ghana (research abstract)
Using data from the Ghana Demographic and Health Survey 1998, this paper analyzed the duration of use of a contraceptive method and the reasons for its non-use given by former users of contraception. The results showed that the duration of use tended to be short, particularly so for the use of condom and withdrawal. Injectable contraceptives and periodic abstinence tended to be used for relatively long periods. After type of method, a woman’s age and residence (urban or rural) were the most significant predictors of duration of use. The reasons for not currently using contraception given by significant numbers of former users of pill and injectable contraceptives should concern service providers and educators.

Update on Contraception: Benefits and Risks of the New Formulations (research article)
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The authors, all from The Cleveland Clinic, review new contraceptive agents, including ultra-lowdose oral contraceptives as well as injectable, vaginal, and patch formulations, with an emphasis on the Yasmin pill (which contains a new progestin), the Lunelle once-a-month injection, the Ortho Evra patch, the NuvaRing vaginal ring, the Mirena intrauterine device, and emergency contraceptive kits.

Family Planning/Reproductive Health News

Zimbabwe: New Family Planning Method Introduced (news article)
The Zimbabwe National Family Planning Council has introduced a new method of family planning. Known as Jadelle, the method replaces Norplant, another family planning method which is no longer being used.

UK: Sexual Health Policies Under Fire (news article)
Despite increasing rates of sexually transmitted diseases, the resources to address sexual health and prevention are lacking, according to the report.

Arabic Language Website Launched on Emergency Contraception (news article)
The Association of Reproductive Health Professionals, Ibis Reproductive Health, and the Office of Population Research at Princeton University announced the creation of an Arabic language website on emergency contraception (EC). The new site provides information about EC and a directory of clinicians willing to provide EC in the US and Canada and a searchable database of contraceptives available worldwide which can be used for EC.

'Living Condom' Could Block HIV (news article)
Genetically-modified vaginal bacteria may be able to serve as a "living condom", secreting proteins that protect women against HIV. The bacteria have already been used to cripple the virus in test tube experiments. Now researchers are verifying whether the unmodified parental strain, a natural component of the vaginal microbial flora, can successfully colonise the vaginal tissues of rhesus macaque monkeys.

Herpes Vaccine Gives Sufferers New Hope (news article)
More than 1 million people in the United States become infected with the virus that causes genital herpes every year. According to this news report, there may be a new vaccine to prevent the disease. The vaccine works by stimulating the body's immune response to the virus.

Family Planning/Reproductive Health Law and Policy

Nigeria: University of Ibadan Introduces Reproductive Rights Into Law Curriculum (news article)
The University of Ibadan, Nigeria, has introduced reproductive rights and maternal health into courses being taught, both at the undergraduate and postgraduate levels. Reproductive topics have been included in major courses like criminal law, family law, tort, labor law, and environmental law. This is Nigeria's first institution of learning to introduce reproductive rights and maternal health to its students' curriculum.

National Responses to HIV/AIDS: A Review of Progress (report)
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This paper reviews the national responses to the AIDS epidemic by examining the progress that governments have made and the constraints they have faced in formulating and implementing policies in three main areas. The paper focuses on policies with respect to: (a) the evolution of government concern; (b) HIV/AIDS prevention; and (c) care, support, and treatment of those infected and affected by HIV/AIDS. The paper also reviews progress with respect to developing multisectoral strategies, establishing HIV/AIDS coordination bodies, and establishing partnerships in the fight against HIV/AIDS.

HIV/AIDS Research

Intrapartum and Neonatal Single-Dose Nevirapine Compared with Zidovudine for Prevention of Mother-to-child Transmission of HIV-1 in Kampala, Uganda: 18-mo Follow-up of the HIVNET 012 Randomized Trial (research abstract)
In 1999, the researchers reported safety and efficacy data for short-course Nevirapine from a Ugandan perinatal HIV-1 prevention trial when 496 babies were followed up to age 14 to 16 weeks. Here, safety and efficacy data are now presented for all babies followed up to 18 months of age. The researchers found that intrapartum/neonatal Nevirapine significantly lowered HIV-1 transmission risk in a breastfeeding population in Uganda compared with a short intrapartum/neonatal Zidovudine regimen. This simple, inexpensive, well-tolerated regimen has the potential to significantly decrease HIV-1 perinatal transmission in less-developed countries.

The Impact of HIV/AIDS on Bahamian Women: A Feminist Perspective (research article)
This article describes the impact of HIV/AIDS on Bahamian women and recommends strategies nurses should implement to enhance the quality of life for these women. Using an eclectic feminist approach, the author conducted a literature review and personal exploration of HIV/AIDS care and support related to women as caregivers, carereceivers, childrearers, and childbearers. Women's oppression in a patriarchal society and HIV/AIDS-associated stigmas have resulted in their decreased quality of life and shortened life span.

Stochastic Simulation of the Impact of Antiretroviral Therapy and HIV Vaccines on HIV Transmission; Rakai, Uganda (research abstract)
Related news article: Drugs Alone Can't Control HIV Epidemic
Related commentary: Contraception and HIV Acquisition in Rakai, Uganda
Data from studies in Uganda to develop a model that would predict the impact of AIDS drugs or an HIV vaccine on the course of the HIV epidemic there show that AIDS drugs alone cannot control the spread of HIV in established epidemics of the infection. Antiretroviral therapy in combination with a low efficacy vaccine could control the epidemic, if behavioral disinhibition is prevented.

Cost Comparison of Three HIV Counseling and Testing Technologies (research abstract)
Related news article: New HIV Test Cheaper, Faster, Efficient
A new test for AIDS which gives results in a half-hour might be faster and cheaper than standard tests taking weeks to deliver results. This one-step test also means clients know their HIV status immediately.

Micronutrients and Human Immunodeficiency Virus Type 1 Disease Progression Among Adults and Children (research abstract)
The results of randomized trials among men and nonpregnant women have confirmed the potential benefits of vitamins B, C, and E supplements on the immune status of human immunodeficiency virus (HIV)-infected individuals. Among pregnant women, vitamin A supplements increase the risk of mother-to-child transmission. Supplementation with vitamins B, C, and E during prenatal and breastfeeding periods should be encouraged, in light of the protective effects on adverse pregnancy and child outcomes.

A Survey of Sexual Risk Behavior for HIV Infection in Nakhonsawan, Thailand, 2001 (research article)
A cross-sectional survey was used to determine the prevalence of sexual risk behaviors for HIV in the general population aged 15-44 years in Nakhonsawan province, Thailand. Most participants were rural, married, and educated at the primary school level. Mean age was 31.5 years; 78% of all participants had ever had sexual intercourse. The prevalence of premarital sex among married participants was 41%. In the previous year, 20% of the participants had had sex with commercial or non-regular partners. Sixty-one percent had used condoms the last time they had sex with a commercial partner, and 46% had used condoms the last time they had sex with non-regular partners. The authors write that the results suggest that Nakhonsawan needs to strengthen implementation of the 100% condom program, address condom use with non-commercial partners, promote awareness of personal risk rather than identification of risk groups, and increase voluntary HIV testing among people who engage in risky behaviors.

HIV/AIDS News

Russia: 250,000 Infected with HIV Virus (news article)
The article explains that the number of Russians diagnosed with HIV has reached 250,000, and about 9,200 infected children have been born to mothers carrying the virus. Last year, 2,700 HIV-infected children were born to mothers who had contracted the virus, and 1,500 more in the first 8 months of 2003.

Botswana: Miss HIV Stigma Free 2003 (news article)
Amidst cultural dance and drama performances, 14 HIV-positive women in Botswana paraded down the runway in a beauty pageant aimed at destroying misconceptions about people living with the disease. This was a beauty contest with a difference - the judges were searching for participants who could be ambassadors of HIV/AIDS, and displayed courage, sacrifice, and patriotism.

AIDS Nightmare Looms in Indonesia's Papua (news article)
According to the article, Papua has one-third of Indonesia's recorded HIV/AIDS cases, yet less than 1% of its population. Health officials fear that 5% of the province could be HIV positive, and warn of an African-style epidemic in an area where hospital facilities are rudimentary at best.

WHO Warns Asia of Wider HIV/AIDS Epidemic (news article)
The World Health Organization warned on Wednesday that an HIV/AIDS epidemic in the Asia-Pacific region could widen because of a rise in sexually transmitted infections, particularly among young adults. High-risk behavior is increasing and there are more sexually transmitted infections, notably in Mongolia, the Philippines, and Pacific island countries, WHO's Western Pacific office said in a statement.

Study Suggests Smallpox Vaccine May Fight AIDS (news article)
The smallpox vaccine may help protect people against the AIDS virus, US researchers said last week. A team at Virginia's George Mason University said they had shown, in lab dishes, that blood cells from people vaccinated against smallpox were four times less likely to become infected by HIV. They are now negotiating with Acambis Plc, which makes vaccines against smallpox and other diseases, to test their idea further. The findings had been submitted to a scientific journal as a first step in the process of peer review.

Cheap Drug Might Prevent HIV Births (news article)
A simple and cheap drug regime could help prevent mothers giving their babies HIV during birth, research by US and Ugandan doctors indicates. It has been shown that infected women who take anti-HIV drugs during labor significantly reduce the chance of passing the virus on to their babies, but the new research found taking a certain drug just once could offer protection.

Maternal and Child Health Research

Measuring and Estimating Maternal Mortality in the Era of HIV/AIDS (report)
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This paper focuses on the challenge of measuring maternal mortality in the context of HIV/AIDS. The first part explores possible biological or behavioral synergies. The remainder focuses on the implications of the presence of HIV/AIDS for the classification, quality, sources, and interpretation of data on maternal mortality. Finally, a brief descriptive profile of global and regional patterns in maternal mortality is given, along with recommendations on priorities for research and development.

Initial and Repeated Screening for Gonorrhea During Pregnancy (research article)
The intent of this study was to determine the value of a late-pregnancy test for gonorrhea after a negative initial test at the beginning of prenatal care. Out of 751 women, 38 (5.1%) had gonorrhea diagnosed at their first testing; 19 women (2.5%) were positive only at their second screening. For one patient, both tests were positive.
Repeating screening for gonorrhea at 34 weeks in a high-prevalence population is warranted.

Longitudinal Evaluation of Parvovirus B19 Infection Among Pregnant Women at Ribeirão Preto, SP, Brazil (research abstract)
Research aimed to evaluate the rate of seropositivity for parvovirus B19 (PB19) among pregnant women in the Hospital of the Medical School of Ribeirão Preto, University of São Paulo, and the rate of seroconversion against this infection during pregnancy. Despite the relatively high rate of seroconversion against PB19 infection during
the pregnancy period, researchers did not observe any symptomatic neonate in this group.

Rapid Point-of-Care Testing for HIV-1 During Labor and Delivery --- Chicago, Illinois, 2002 (research summary)
Related news article: Rapid HIV Test During Labor Gives Accurate Results
Rapid HIV-1 testing performed at the bedside in labor wards by non-laboratory hospital staff gives accurate results much faster than lab testing. This means anti-HIV drugs can be given promptly to the mother and newborn to inhibit transfer of the disease to the baby. The findings in this report indicate that point-of-care rapid testing provided valid HIV test results faster than laboratory testing. The median turnaround time for point-of-care testing was less than one fourth that for laboratory testing.

Domestic Physical Violence and Pregnancy: Results of a Survey in the Postpartum Period (research abstract)
The purpose of this study was to determine the prevalence of domestic physical violence among women who delivered at a tertiary center in the Northeast of Brazil; to study the main risk factors associated with domestic violence; and to determine perinatal outcome. A high prevalence of domestic physical violence (about 13%) was observed. The main risk factors were low educational level and previous familiar history of violence in the women's family, alcohol use by and unemployment of their partners. Neonatal mortality
was increased in victims of violence.

Parsimonious Explanation for Intersecting Perinatal Mortality Curves: Understanding the Effect of Plurality (research abstract)
Birth weight- and gestational age-specific perinatal mortality curves intersect when compared across categories of maternal smoking, plurality, race, and other factors. No simple explanation exists for this paradoxical observation. The proper conceptualization of perinatal risk eliminates the mortality crossover paradox and provides new insights into perinatal health issues.

Effect of Targeted Food Supplementation and Services in the Bangladesh Integrated Nutrition Project on Women and Their Pregnancy Outcomes (research abstract)
Monitoring data from the Bangladesh Integrated Nutrition Project and new data collected for this purpose were analyzed to assess the effects of targeted project services, including supplementation of food, on malnourished pregnant women. The assessment found that, despite lower economic status, the women with low BMI receiving supplementation of food and intensified services were more likely to have adequate pregnancy-related weight gain than the more economically-advantaged women with higher BMI.

Caesarean Section in Malawi: Prospective Study of Early Maternal and Perinatal Mortality (research abstract)
Through a prospective observational study of 8,070 caesarean sections performed between January 1998 and June 2000, the researchers examine potentially modifiable factors that may influence the high maternal and perinatal mortality associated with caesarean section and associated complications.

Maternal and Child Health News

Vietnamese Woman has 1.9 Children on Average (news article)
The average number of children born to a Vietnamese woman fell to 1.9 in 2002 from 2.7 in 1997, according to the Committee for Population, Families and Children. The country's newborn mortality rate was reduced to 18 per thousand in 2002 from 28 per thousand in 1996.

Men's Health Research

Male Condom Use in Tanzania: Results from a National Survey (research abstract)
Data from the 1996 Tanzania Demographic and Health Survey was used to determine factors associated with male condom use in Tanzania. A national representative sample of sexually active men (N= 1898) and women (N=7027) were interviewed. Two hundred and ninety (4.1%) women and 288 (15.2%) men had used condoms during their last sexual encounter. Men aged 20-24 years and women aged 15-19 years reported the highest rate of condom use. In both men and women, condom use increased with increasing level of education, and residents of large urban centers were more likely to have used condoms among both women and men.

Hepatitis A and B Vaccination in a Sexually Transmitted Disease Clinic for Men Who Have Sex With Men (research article)
A study conducted in a sexually transmitted disease clinic serving men who have sex with men found that most clients were eligible for hepatitis A and B vaccines and were willing to accept a first dose of both vaccine series.

Men's Health News

What's Wrong with South African Men? (news article)
The article speculates reasons for increased violence and abuse among South African men. The topics of unsafe sexual practices and sexual violence are discussed.

Population Research

The Problematic Estimation of "Imitation Effects" in Multilevel Models (research article)
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It seems plausible that a person’s demographic behavior may be influenced by that among other people in the community; for example, because of an inclination to imitate. When estimating multilevel models from clustered individual data, some investigators might perhaps feel tempted to try to capture this effect by simply including on the right-hand side the average of the dependent variable, constructed by aggregation within the clusters. However, such modelling must be avoided. According to simulation experiments based on real fertility data from India, the estimated effect of this obviously endogenous variable can be very different from the true effect. Also, the other community effect estimates can be strongly biased. An "imitation effect" can only be estimated under very special assumptions that in practice will be hard to defend.

Adult Mortality in the Developing World: What We Know and How We Know It (research article)
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This paper focuses on the experience of countries for which the data on adult mortality levels appear to be of adequate quality to provide (after adjustment or analysis as necessary) satisfactory estimates for the recent past and, for a subset of cases, of trends over the last three or four decades.

The Impact of HIV/AIDS on Mortality (report)
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The impact of HIV/AIDS on mortality rates worldwide are discussed. Prevalence levels are estimated up to the year 2050. The paper is from a workshop on HIV/AIDS and adult mortality in developing countries, New York, September 8-13, 2003.

Determinants of Adult Mortality in Russia: Estimates from Sibling Data (research abstract)
Researchers modified indirect demographic methods and applied them to a population sample to investigate predictors of mortality in Russia. They estimated the association between personal characteristics and mortality risk for 682 male and 698 female siblings. In both sexes, mortality was strongly associated with smoking and low education. After adjustment for smoking and education, mortality was elevated in men and women who drank alcohol at least once a month. The researchers conclude that the study of siblings appears to be a cost-effective alternative for estimating risk factors for mortality in literate populations.

Population News

Ethiopia: Spiralling Population Growth Contributing to Food Insecurity (news article)
Polygamy is fuelling a population explosion in impoverished southern Ethiopia, which in turn compounds the food crisis, according to the US Famine Early Warning System Network (FEWS). FEWS said the spiralling population was one of a number of underlying causes of the widespread food insecurity in Ethiopia. Each year an estimated 5 million people are in need of food aid regardless of weather conditions in the drought-prone country.

Women's Health Research

Early Onset of Vaginal Douching Is Associated with False Beliefs and High-Risk Behavior (research abstract)
Research aims were to explore associations with early onset of douching. The mean age of the 726 evaluable participants was 27.9 years. Twenty-two percent of participants believed douching "kills germs that cause infections," and 27% agreed that "women believe douching prevents pregnancy." This study indicates that early onset of vaginal douching is associated with false beliefs and sexual debut at younger age.

A Comparative Evaluation of the Papanicolaou Test for the Diagnosis of Trichomoniasis (research abstract)
In a comparative evaluation, the Papanicolaou test had a sensitivity of only 61% and a positive predictive value of 62% for detection of Trichomonas vaginalis, suggesting that this method is not adequate for the diagnosis of trichomoniasis.

Sexual Habits and Human Papillomavirus Infection Among Females in Three New Independent States of the Former Soviet Union (research abstract)
This extensive survey of the sexual habits of 3,175 female patients at different risk for cervical intraepithelial neoplasia, human papillomavirus (HPV), and cervical cancer in three New Independent States of the Former Soviet Union showed that highly significant independent predictors (P < 0.0001) of HPV infection in multivariate analysis were patient category and young age, whereas having zero or one partner during the past 2 years and having a nonsmoking partner were protective factors. Females in this cohort were generally conservative in many of the key characteristics of “high-risk” sexual behavior.

Major Factors that Impact on Women's Health in Tanzania: The Way Forward (research abstract)
This article addresses women's health care in Tanzania through various factors, including maternal mortality, HIV/AIDS, women's workload, number of births per woman, and female genital mutiliation. The authors suggest that, to improve the health of women in Tanzania, health and health-related sectors should cooperate and collaborate in order to empower women in the areas of education, social status, and technology. Policies must also address poverty, nutrition, adolescent health, and violence and sexual abuse.

Sexually Transmitted Infections Among Female Sex Workers in Kupang, Indonesia: Searching for a Screening Algorithm to Detect Cervical Gonococcal and Chlamydial Infections (research abstract)
Researchers aimed to measure the prevalence of STIs among female sex workers in Kupang, West Timor, and to develop screening algorithms to detect cervical infections with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT). The prevalence of N gonorrhoeae infection was 31%, that of C trachomatis infection was 24%, that of Trichomonas vaginalis infection was 5%, and that of syphilis was 13%. No case of HIV infection was detected. Few of the 288 women in this study had symptoms of STI. The only variables significantly associated with NG/CT were the presence of cervical discharge and a high count of polymorphonuclear leukocytes on gram-stained endocervical smear. Algorithms to screen for NG/CT achieved high sensitivity. The high rates of STIs in this population could justify a more aggressive strategy incorporating periodic presumptive treatment to rapidly reduce prevalence.

Women's Health News

Nepal: Chhaupadi System - Age Old Superstition (feature article)
A horror visits thousands of women in western Nepal every month when they are forced to leave in seclusion during menstruation.

Youth Health Research

HIV/AIDS and Child Labour in Zambia: A Rapid Assessment (report)
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Related feature article: Zambia: Poverty Driving Children into Sex Work
Street children and child workers in Zambia are being driven into commercial sex work, exposing them to the risk of HIV/AIDS and STIs, according to a new report. "HIV/AIDS and Child Labour in Zambia: a rapid assessment", released last week by the International Labour Organisation (ILO), found that commercial sex work was common among children between the ages of 14 and 16 years, particularly girls. Boys were also becoming increasingly involved in sex work.

Adolescent Dual Use of Condoms and Hormonal Contraception: Trends and Correlates 1991-2001 (research abstract)
In nationally representative data of high school students, the percentage who used both condoms and hormonal contraceptives during last sexual intercourse increased from 3.2% to 7.2% between 1991 and 2001. Dual use was not associated with reported risk behaviors.

Screening of Volunteer Students in Yaounde (Cameroon, Central Africa) for Chlamydia Trachomatis Infection and Genotyping of Isolated C. Trachomatis Strains (research abstract)
The prevalence of Chlamydia trachomatis infection was 3.78% out of 1,277 volunteer students screened by direct fluorescence assay and Cobas Amplicor PCR. The infection was associated with the nonuse or inconsistent use of condoms in women and a previous sexually transmitted infection in men. The most frequent genotypes determined by sequencing the omp1 genes of 25 clinical isolates were E (44%) and F (20%), and some strains harbored mutations, but E genotype strains did not.

Youth Health News

UK: Pupils Tested for Sex Diseases (news article)
Secondary school pupils are to be screened for sex diseases, in an effort to counter rising rates of infection. The pilot project, in York, comes after known cases of chlamydia, which can lead to infertility in women, rose by 14% last year.

Nepal: Adolescents Under Threat (feature article)
The article describes growing concern about adolescents’ ambivalence towards condom use in Nepal. Despite knowing the importance of using a condom to protect against STDs and HIV, many youth did not use them.

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