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The Pop Reporter®

Volume 3, Number 39
29 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!

GUEST EDITORIAL

Cancer Prevention May Be an Additional Benefit of Using Oral Contraceptives

by David B. Thomas, MD, DrPH

dbthomas@fhcrc.org

Oral contraceptives (OCs) have been classified as a Group I carcinogen (evidence sufficient to conclude that the substance is carcinogenic to humans) by the International Agency for Research on Cancer (IARC) (1). This designation is based on strong evidence that OCs can cause liver cancer from multiple epidemiologic studies conducted in countries where incidence rates of liver cancer are low and the hepatitis B virus (HBV), a known cause of this disease, is not endemic. This rare complication of OC use does not develop by enhancing the carcinogenic effect of HBV and has not been observed in developing countries where this virus is endemic and where liver cancer is common (2). OCs have also been conclusively shown to reduce risks of cancers of the endometrium and ovary, by about 50%, in both developed and developing countries (1). The reduction in risk occurs after about 1 year of use for endometrial cancer and after about 3 years of use for ovarian cancer, and lasts at least 20 and 10 years after cessation of use, respectively. The numbers of these two cancers that are prevented are clearly greater than the numbers of liver cancers induced.

A combined statistical analysis of most of the world’s epidemiologic data on breast cancer showed a 16% increase in risk of this disease in users of OCs (3). However, the increase was restricted to current and recent users and may represent stimulation of the growth of pre-existing tumors rather than the development of new tumors that would not otherwise have occurred. This increase in risk was not observed in a recent study (4), in which almost all current and recent users had used low dose preparations (<50 ug ethinyl estradiol), so this possible adverse effect may not occur in users of many currently marketed products. Furthermore, recent users are young women at low underlying risk of breast cancer, so a small actual increase in this risk would not result in the development of many additional cases of breast cancer.

Chronic infection by some types of human papilloma viruses (HPV) is probably a necessary cause of cervical cancer (5). However, most infected persons do not develop cervical cancer, and co-factors are clearly needed for cancer to develop in infected women. Theoretically, OCs could enhance risk of cervical cancer by altering risks of: infection in women exposed to HPV; persistence of infection; pre-invasive disease in chronically infected individuals; or progression of in situ to invasive disease. Different studies are needed to investigate each of these possibilities. OCs do not appear to enhance risk of invasion in women with in situ disease (6). The studies of the possible influence of OCs on the earlier presumed stages in the carcinogenic process conducted to date have been limited by the absence of adequate tests for HPV antibodies that identify persons who have ever been infected and the absence of tests for the presence of the virus that distinguish chronic from transient infections; and the results currently available are inconsistent and inconclusive (1, 7-9). An IARC working group will review the evidence for hormonal factors in relation to cervical cancer in November 2003. If cervical cancer screening services are offered at clinics where OCs are dispensed, risk of invasive cervical cancer can be reduced in users of OCs, regardless of any biological effect OCs may have on the carcinogenic process.

Women may be reassured that their overall risk of cancer is probably not increased, and may actually be reduced, if they use OCs. Fear of cancer should not be a reason to refrain from using OCs.

References:

1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Hormonal Contraception and Post-Menopausal Hormonal Therapy. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. WHO International Agency for Research on Cancer. Vol. 72. 1999, IARC: Lyon, France.

2. The Collaborative MILTS Project Team. Oral contraceptives and liver cancer. Results of the Multicentre International Liver Tumor Study (MILTS). Contraception. 1997;56:275-84.

3. Collaborative Group on Hormonal Factors on Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet. 1996;347:1713-27.

4. Marchbanks PA, et al. Oral contraceptives and the risk of breast cancer. N Engl J Med. 2002;346:2025-32.

5. Munoz N, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003;348:518-27.

6. Thomas DB, et al. Risk factors for progression of squamous cell cervical carcinoma in-situ to invasive cervical cancer: results of a multinational study. Cancer Causes Control. 2002;13:683-90.

7. Moreno V, et al. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet. 2002;359:1085-92.

8. Lacey JV, Jr., et al. Oral contraceptives as risk factors for cervical adenocarcinomas and squamous cell carcinomas. Cancer Epidemiol Biomarkers Prev. 1999;8:1079-85.

9. Smith JS, et al. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet. 2003;361:1159-67.

Dr. Thomas is a Member in the EpidemiologyProgram at the Fred Hutchinson Cancer Research Center, and Professor of Epidemiology at the University of Washington School of Public Health and Community Medicine, Seattle, Washington, USA.

FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

New Survey Findings: The Reproductive Revolution Continues (report)
This report summarizes findings from 120 surveys of women in 71 countries conducted since 1990 as part of the DHS and RHS programs. Sixty of the countries are in the developing world. Eleven others are in Eastern Europe, Central Asia, and the Caucasus. The authors write that birth rates in developing countries have continued to decline since 1990, as people want to have fewer children and contraceptive use increases. Moreover, child survival rates lag far behind international goals for 2000 set a decade earlier. An average of 11 million children under age five died each year in developing countries during the 1990s. In some countries the AIDS epidemic offset improvements in child survival.

The Social Behavior and the Evolution of Sexually Transmitted Diseases (research abstract)
The authors introduce a model for the evolution of sexually transmitted diseases in which the social behavior is incorporated as a determinant factor for the further propagation of the infection.

Correlates of Knowledge of Prevention of Sexually Transmitted Diseases among Primary School Pupils in Tanzania (research abstract)
Using data extracted from the Family Life Education KAP Survey conducted in 1999, researchers attempted to identify factors that determine knowledge on prevention of STDs among primary school pupils in Tanzania. The data used consisted of a sample of 18,564 pupils (about 50% males and 50% females) from all the 20 regions of Tanzania mainland.There were significant differences between boys and girls as regards knowledge of family life education in general. Boys tended to be more knowledgeable than girls about many aspects of family life education. The findings showed that only 40.1% of the respondents were able to identify all three STDs given in the questionnaire, namely gonorrhoea, syphilis, and AIDS. Regarding modes of HIV transmission, only 37.5% had full knowledge, while 48.8% knew condom use and abstinence as methods of STD prevention.

Status and Future Direction of Male Contraceptive Development (research abstract)
This article reviews the present status and future development of a male contraceptive. New and innovative products are expected to come from our knowledge of the unique physiology and genetics of reproduction, as well as by exploiting existing and future genomics, proteomics, and protein network platforms.

Global Sex Survey 2002 (report)
(You need Adobe Acrobat Reader to access this document)
Related news article: Sex, Lies and Bedroom Demons
Almost 50,000 people took part in one of the largest ever Internet surveys. The 2002 Durex Global Sex Survey showed that women are having sex more often than men – 144 times compared with 138 times. But despite their passion for sex, people are still not protecting themselves from STIs and unplanned pregnancy. Almost four in 10 (39%) have had unsafe sex with a new partner in the last 12 months, and 31% would still sleep with someone even if they refused to use a condom. This is despite almost two thirds (65%) believing HIV/AIDS is a serious problem in their country.

Predictors of Consistent Condom Use: A Hierarchical Analysis of Adults from Kenya, Tanzania and Trinidad (research abstract)
In this study, data from 4,293 adults from Kenya, Tanzania, and Trinidad who agreed to participate in the Voluntary Counseling and Testing Efficacy Study were examined employing hierarchical regression modelling. Only 19% reported consistent condom use with their most recent sex partner. Factors associated with consistent condom use were relation to most recent sex partner, gender, study site, perceived difficulty in requesting condom use, and actually making requests for condom use.

Gender, Power and Multi-partner Sex Implications for Dual Method Use in Ghana (report)
(You need Adobe Acrobat Reader to access this document)
This research focuses on men’s and women’s perspectives regarding dual method use, based on focus group discussions with adolescents and young women and men in Dodowa, Ghana. Major findings of the research include the findings that men use condoms for their own protection but not for their partners’ protection; men often refuse to use condoms with regular partners; men do not like women providing condoms in short-term relationships, although they do not mind using them in such relationships; even those men who are determined to use condoms do not use them consistently; introduction of dual methods for dual protection introduces distrust into sexual relationships; men and women lie about their other partners. The authors write that, in HIV prevention and family planning programs that focus on dual protection, public health practitioners should work with the aim of changing gender norms, in addition to providing knowledge and access.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Kenya: Study Challenges Experts to Rethink Main Mode of HIV Spread (news article)
A new study casts doubts on the World Health Organisation and UNAIDS assertion that HIV/AIDS is mostly spread through sexual intercourse. At the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa, the author of the study said that reuse of injections, transfusion of unscreened blood and non-observance of simple internationally accepted practices by health care providers, was contributing highly to new HIV infections in Africa, "even more than unprotected sex".

UK: Attack on Children's Cartoon Sex Guide (news article)
A cartoon booklet showing primary school children how to pleasure themselves sexually was published yesterday by a government-funded charity. The controversial guide includes a cartoon of a girl apparently masturbating in the bath, and says it is "totally normal" to be attracted to people of the same sex.

European Condom Ads Coming to America (news article)
European-style television ads asking parents to urge their teen-age children to use condoms will debut next month with a test run in southern Oregon.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Chinese Researchers to Recommend 2-child Policy (news article)
Ten experts from the Chinese Academy of Social Sciences will recommend that the government revise its birth control policies to allow couples in developed cities such as Beijing and Shanghai to have two children.

Condom Supply to Africa Hit by US Abortion Policy (news article)
The US ban on funds to family planning clinics that offer abortion counselling is adversely affecting the supply of condoms to countries hit by HIV/AIDS, claims a new report from Population Action International. Clinics have had to close in a number of African countries because the family planning organizations running them refuse to sign a declaration that they will not offer abortions or even discuss them.

Ghana: Woman Gets Five-year Jail Term for Performing FGM (news article)
A 50-year-old woman has been sentenced to 5 years' imprisonment for cutting the genital organs of three girls. The woman, a farmer, pleaded guilty to a charge of female circumcision. She is the first person to be convicted of the offence in the Upper West Region since the Criminal Code Amendment Act in 1994 made the practice of FGM a second-degree felony.

Senegal Villages Reject FGM (news article)
More than 250 villages from three rural communities in Senegal have pledged to abandon the practice of female genital mutilation and all other forms of discrimination against women.

Ghana: Expedite Action on Youth Policy - Youth Associations (news article)
A Committee of Youth Associations in the Greater Accra Region has called on the government to expedite action on the drafted youth policy, which it said has laid on the drawing board for far too long.

HIV/AIDS RESEARCH

Social Interactions and HIV/AIDS in Rural Africa (research article)
These 13 papers are the products of a conference on "Research on Demographic Aspects of HIV/AIDS in Rural Africa", held at the University of Pennsylvania, Philadelphia, in October 2002. The aim of the conference was to provide a forum for the presentation of results, to an audience of experts, on a variety of demographic aspects relevant for the study of HIV/AIDS in rural Africa. The aim of the papers in this special volume is to provide these results to a wider audience. Although the topics covered are diverse, ranging from methodological issues in the study of HIV/AIDS such as sample attrition to substantive issues such as fertility, divorce, and women’s autonomy, the papers are united by their use of two similar data sets collected in rural Malawi and Kenya.

Does Violence in the Emotional Relationships Make STD/AIDS Prevention More Difficult? (PubMed abstract)
Researchers focused on a study group of more than 1,000 young people 14 to 22 years old. They anaylzyed variables dealing with aggressiveness, use of drugs, sexual risk behavior, and violence in emotional relationships. The association between the variable "I used a condom the last time I had sex" and the questions that indicated violent or non-violent attitudes in emotional relationships received special attention. Their findings showed that there is an important association between violence in the emotional relationships and the inconsistent use of condoms.

HIV/AIDS NEWS

UN Report Gives World Low Marks on AIDS (news article)
The first report card on the United Nations' 2-year-old commitment to defeat AIDS gives the world's countries generally low marks in their efforts to overcome ignorance about the disease and provide access to prevention and treatment measures. The United Nations estimates that 42 million people are infected with HIV, half of them women, and that the vast majority live in sub-Saharan Africa. Without an expanded response, the United Nations estimates that an additional 45 million people will become infected with the virus by 2010.

Botswana's Women-Led AIDS Success Story (news article)
Wearing a beauty queen's sash, Kgalalelo Ntsepe had her audience at the International Conference on AIDS in Africa in stitches and in an almost non-stop round of clapping when she spoke last week. With five other female ambassadors, Botswana displayed women's leadership when it came to talk about its highly rated approach to dealing with HIV and AIDS.

US-Russian HIV/AIDS Cooperation Initiative (press release)
Dated September 27, this press release provides an overview of how the United States and the Russian Federation are working together to combat the HIV/AIDS threat. The leaders of both countries have agreed to intensify this cooperation to emphasize joint research, program implementation, and public-private cooperation.

South Africa: 'I Don't Know Anyone With HIV' Says Mbeki (news article)
Shock, anger, and a good deal of sarcasm, along with a call for President Thabo Mbeki to apologize, have greeted his insistence in the United States that he does not know anyone who has died of AIDS. Another furious response to the comments from the man who leads South Africa, where nearly 5 million people are infected with HIV and more than 600 people die of AIDS every day, is that his statements are the ultimate confirmation that he is a "dissident".

South Africa Criticized in AIDS Deaths (news article)
Government delay is being blamed for hundreds of thousands of AIDS deaths in South Africa.

Botswana: Stigmatization Accounts for Slow ARV Response (news article)
Stigmatization is in part responsible for the slow response to the anti-retroviral therapy in Botswana. According to the article, stigma and denial have been common responses at all levels of society while HIV has spread over the past years.

Experts Blame Male Ego for AIDS (news article)
Male attitudes towards women and sex have long been acknowledged as one of the biggest sources of Africa's AIDS pandemic, but changing them is a task that would have made Hercules himself throw up his hands in despair. That is the opinion of many experts at the ICASA AIDS conference in Nairobi, where the typical African male was described almost as a walking HIV risk. Their typical thumbnail sketch was of a man ignorant or scornful of safe sex, highly promiscuous, and often forcing his wife or girlfriend into having intercourse.

MATERNAL AND CHILD HEALTH RESEARCH

Maternal Knowledge and Perceptions about the Routine Immunization Programme--A Study in a Semiurban Area in Rajasthan (PubMed abstract)
This paper reports a cross sectional study on immunization coverage in the town of Pilani, India. A total of 166 mothers were interviewed using a pre-tested interview schedule/questionnaire on Knowledge, Attitudes, Perceptions and Expectations (KAPE). The results showed that among the 12-24 month old children, 50% were fully, 31.3% partially, and 18.7% not at all immunized. Though many mothers were aware of the importance of vaccination in general, specific information about the importance of completing the schedule and knowledge about vaccine-preventable diseases other than poliomyelities was very limited. The main reasons for non-immunization were misconceptions/beliefs among the mothers of partially immunized children and lack of information among the not at all immunized group.

Outcome of Delivery and Cause-specific Mortality and Severe Morbidity in Early Infancy: A Kenyan District Hospital Birth Cohort (research abstract)
A total of 2,359 infants eligible for this cohort study were delivered. Of these, 136 (6%) were stillborn and 77 (3.5%) subsequently died. Prematurity (34%), birth asphyxia (27%), and infection (18.5%) were the predominant causes of death in the first 98 days of life, although infection accounted for 36% of all life-threatening illness episodes in the same period. The data suggest that health system constraints are likely to impede programmatic efforts to reduce early infant mortality and morbidity, and that infection prevention measures offer some promise for mortality reduction.

An In-vitro Study of Ginsenoside Rb1-induced Teratogenicity Using a Whole Rat Embryo Culture Model (news article)
Related news article: Ginseng Use During Pregnancy May Hurt Baby
Ginseng, the most commonly used herbal medicine worldwide, contains a chemical, called ginsenoside Rb1, which may harm a growing fetus, new findings suggest. Until further research is available, women should be cautious about using the herb during early pregnancy.

Human Papillomavirus Infection among Indian Mothers and Their Infants (PubMed abstract)
The objective of this study was to determine prevalence of HPV infection among pregnant women and evaluate the extent of perinatal transmission of HPVs to infants. The study included 135 pregnant women and their infants. HPVs detected were genotyped by PCR using type specific primers. HPV DNA was identified in 38 mothers (28.14%, 38/135) and 14 babies (10.37%, 14/135). The prevalence rate of HPV type 16 was highest both in HPV positive maternal (63.15%, 24/38) and baby samples (85.71%, 12/14). At birth, the frequency of HPV transmission from infected mothers to their infants was 18.42% (7/38). The proportion of infants with HPV infection delivered by cesarean section was 78.57% (11/14).

MEN'S HEALTH RESEARCH

The Incidence of Sterilization in the UK (research abstract)
Related news article: UK: Britons Lead the Way for Vasectomies
Using patient files of women aged 20–54 years and men aged 20–64 years, the researchers estimate the incidence rates for tubal occlusion and vasectomy, and examine how these vary with age, geographical area, and time. Figures were examined according to National Health Service Region and population density category of the general practices. The researchers found that the popularity of tubal occlusion appears to be on the decline. The UK is one of very few countries in which sterilization incidence in men is greater than that in women.

MEN'S HEALTH NEWS

UK: One Man in Six 'a Victim of Domestic Violence' (news article)
One in six men will be the victim of domestic violence at some time in his life, the most senior female judge in England and Wales told an audience of law reformers at 10 Downing Street.

US, European Prostate Cancer Deaths Falling (news article)
Fewer men in Europe and the United States are dying of prostate cancer, thanks to earlier diagnosis and hormone treatment, a leading cancer researcher said last week at the ECCO 12 European Cancer Conference. Deaths from the disease fell by one third in men aged 50-74 in the United States between 1990-2000 and by one quarter in males a decade older. A similar trend is apparent in Europe.

Kenya: Male Attitudes Towards Women a Big Source of AIDS Pandemic (news article)
Male attitudes towards women and sex have long been acknowledged as one of the biggest sources of Africa's AIDS pandemic. The article describes a number of programs aimed at addressing underlying causes for changing attitudes.

Kenya: Male Sex Workers Face Silence, Denial And Hostility (news article)
The silence and denial surrounding male sex workers in Africa has left them unable to access services addressing HIV/AIDS and their sexual health needs. According to a study presented last week at the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa, programs targeting men who sell sex in Africa were virtually non-existent. An estimated 532 male sex workers were reported to be working in Mombasa, Kenya, the study found.

POPULATION RESEARCH

Demographic Perspectives on the Future of the Indonesian Family (research abstract)
This paper explores some consequences of rapid changes in contraceptive use, fertility, and mortality in Indonesia. An examination of demographic trends over four decades reveals a behavioural disjuncture, with implications for diagnoses of social problems arising from changing family structures, and for policy prescriptions to overcome these problems.

The End of Population Growth in Asia (research abstract)
This paper presents probabilistic population projections for five regions of Asia (South Asia, Central Asia, China region, Pacific OECD and Pacific Asia) and Asia as a whole.

Below-replacement Fertility in Thailand and Its Policy Implications (research abstract)
The fertility transition in Thailand is reviewed, along with consequences and policy implications of low fertility, with special reference to the family and the elderly population.

POPULATION NEWS

Alarm at Plan to Halve UK Population (news article)
A group of prominent academics is behind controversial proposals to halve the number of people living in the UK over the next century, to help solve the environmental threat posed by the growth in the world's population. The Optimum Population Trust, made up of senior figures from academia, the media and the environmental movement, was criticized last week for suggesting that one method of reducing population levels would be drastically to cut immigration.

President Mubarak Warns Against Population Increase in Egypt (news article)
Egypt's President Mubarak warns against the increasing population growth in Egypt and considers it as the country's main economic problem. In the article, the President describes how standards of education, hospitals or public transport would be affected by the anticipated population increase of over 30 million in the next 30 years.

Pakistan Population Will Swell to 349 million by 2050 (news article)
Pakistan’s population will swell to 349 million by year 2050, making it the fourth most populated country in the world according to the Population Reference Bureau. The Bureau reports that India will become the world’s most populated country with 1,628 million people by 2050, tailed closely by China with 1,394 million. The Bureau’s 2003 world population data sheet puts Pakistan’s existing population at 149 million, the sixth largest in the world. According to the Pakistani government, the country was seventh population-wise globally in 2001 with 142.5 million people.

WOMEN'S HEALTH NEWS

Nigeria: 'On Women's Rights Rests Life' (news article)
The article describes women’s frustrations regarding the scope of reproductive rights. The author suggests that women are beginning to respond to the apparent disconnect between provisions of international policy and otherwise small shifts in socio-cultural stereotypes about gender and the discriminations to which women are subjected.

Are Breast Cancer and IVF Linked? (news article)
The article considers popular debates regarding the link between IVF and breast cancer risk. Depending on the level of risk associated with IVF, many women may consider other pregnancy options.

YOUTH HEALTH RESEARCH

A School-based Randomized Controlled Trial of Peer-led Sex Education in England (research abstract)
This article discusses the design of an ongoing cluster-randomized trial comparing two forms of school-based sex education in terms of educational process and sexual health outcomes.

New Options in Contraception for Teenagers (research abstract)
Adolescents demonstrate some of the highest rates of unintended pregnancy and thus may benefit from considering new contraceptive options that improve compliance. In the paper, the researchers discuss the recent availability of several nondaily contraceptives, which may aid in successful contraceptive use in adolescents.

Does Making Clinic-based Reproductive Health Services More Youth-friendly Increase Service Use by Adolescents? Evidence from Lusaka, Zambia (research abstract)
The investigators report findings from a study evaluating the impact of three youth-friendly service projects in Lusaka, Zambia. Qualitative and quantitative data were collected to measure the degree of "youth-friendliness" clinics and the level of community acceptance of providing reproductive health services to youth. The study finds that although the projects appear to have improved the clinic experience for adolescent clients, the data suggest that community acceptance of reproductive health services for youth may have a larger impact on the health-seeking behaviors of adolescents.

Adolescent and Youth Reproductive Health in Yemen: Status, Issues, Policies, and Programs (report)
(You need Adobe Acrobat Reader to access this document)
This assessment of adolescent reproductive health (ARH) in Yemen is part of a series of assessments in 13 countries in Asia and the Near East. The purpose of the assessment is to highlight the reproductive health status of adolescents in each country. The report begins with social context and gender socialization issues that set girls and boys apart in terms of life expectations, educational attainment, job prospects, labor force participation, reproduction, and duties in the household. The report then outlines laws and policies that pertain to ARH and discusses information and services available, including delivery programs that provide reproductive health information and services to adolescents. The report goes on to identify operational barriers to ARH and ends with recommendations for improving ARH in Yemen.

Domestic Violence Perpetrated against Boys (research abstract)
Urban men were randomly recruited to measure rates of physical violence against boys, identify perpetrators of this violence, and explore potential long-term outcomes. Researchers found that men with histories of child-hood physical abuse (CPA) were more likely to be older, be men of color, be less educated), have not lived with both parents, and have lived with their mother only or father only, compared with men without histories of CPA. For each Conflict Tactics Scale item, mothers were identified as the most common perpetrator, including throw something, hit with something, push/grab/shove, choke/burn/scald, and physically attack. Resulting adult psychological outcomes appeared to be significantly high. Interventions may need to focus on mothers.

What do Salvadoran Teens Think? Determining the Feasibility of Youth-friendly Pharmacies: A Focus Group Report (report)
(You need Adobe Acrobat Reader to access this document)
A study was conducted to inform project program decisions regarding the feasibility of creating a network of youth-friendly pharmacies in San Salvador, El Salvador. The study consisted of 10 focus groups of adolescents aged 15 to 19 from low, middle, and high socioeconomic groups in the greater San Salvador area. The data support implementation of the youth-friendly pharmacies concept. Participants mentioned potential barriers to the success of youth-friendly pharmacies, many of which can be addressed through program design and promotion. Some of the barriers included the negative attitudes toward sex among parents and religious institutions, the "machista" attitudes that influence adolescents to have unprotected sexual intercourse, a lack of trained and sensitive pharmacy personnel, and little communication between parents and teens on the subject of sex.

Adolescent and Youth Reproductive Health in Bangladesh: Status, Issues, Policies, and Programs (report)
(You need Adobe Acrobat Reader to access this document)
This paper on adolescent reproductive health (ARH) status in Bangladesh is part of a series of assessments in 13 countries in Asia and Near East. The purpose of this assessment is to highlight the reproductive health status in each country within the context of the lives of adolescent boys and girls. The paper begins with social issues, the issues that need to be addressed to meet the reproductive health needs of adolescents. It also outlines specific ARH issues, legal and policy issues related to ARH, current in-country programs on ARH, its operational barriers, and concludes with recommendations to improve
the situation in Bangladesh.

Adolescent and Youth Reproductive Health in Cambodia: Status, Issues, Policies, and Programs (report)
(You need Adobe Acrobat Reader to access this document)
This assessment of adolescent and reproductive health (ARH) in Cambodia is part of a series of assessments conducted in 13 countries in Asia and the Near East. The purpose of the assessments is to highlight the reproductive health status of adolescents in each country within the context of the lives of adolescent boys and girls. The report begins with the social context and gender socialization that set girls and boys on separate lifetime paths in terms of life expectations, educational attainment, job prospects, labor force participation, reproduction, and duties in the household. The report also outlines laws and policies that pertain to ARH and discusses information and service delivery programs that provide reproductive health information and services to adolescents. The report identifies operational barriers to ARH and ends with recommendations for action to improve ARH in Cambodia.

YOUTH HEALTH NEWS

Honduras: Religious Groups Learn from Youth AIDS Project (news article)
The project Young People in Action has attracted much positive attention recently from the leaders of religious organizations for its innovative approach to combating the spread of HIV among the adolescent population in Honduras.

Stunting Growth Harms Women's Fertility (news article)
According to the article, girls who are given hormones to prevent them from growing too tall have fertility problems as adults.

Kenya: Students Making Informed Choices (news article)
The rise of HIV/AIDS as well as STDs among university students are addressed in this article. Programs, largely student led, designed to help students make informed choices are taking shape at several Kenyan universities.

SPECIAL REPORTS/PROFILES/RESOURCES

Social Marketing Models for Product-based Reproductive Health Programs: A Comparative Analysis (report)
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Social marketing models for product-based reproductive health programs in developing countries typically have been defined according to the organization that manages them. This paper explores the major differences and similarities between two classic social marketing models: the NGO and manufacturer’s models.

Expanding Contraceptive Choice: Integrating Injectables into NGO Family Planning Services -- A Guide for NGOs (resource material)
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This booklet provides an overview of injectable contraceptives and the major points NGOs should know, including what injectable contraceptives ared and how they work; how NGOs can add this method to the basket of contraceptive choices offered to clients; the effectiveness of injectable contraceptives and appropriate use of injectables; client concerns about injectables; and basic elements of high-quality injectables contraceptive services.

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